Exploring the neurocognitive correlates of challenging behaviours in young people with autism spectrum disorder.
Low mind-reading predicts self-injury and weak sensory detail skills predict hitting or breaking things in teens with autism, but IQ may explain part of the first link.
01Research in Context
What this study did
Carter Leno et al. (2019) asked caregivers to fill out forms about teens with autism.
The team also gave the teens short tests for theory-of-mind, language, and visual skills.
They wanted to see which skill gaps lined up with self-injury, hitting, or breaking things.
What they found
Teens who struggled with "reading minds" were more likely to hurt themselves.
Teens who had trouble with visual and sound details were more likely to hit or break items.
The study points to two separate brain tracks behind two kinds of problem behavior.
How this fits with other research
Carter Leno et al. (2021) looks like a contradiction. In their newer study the link between weak theory-of-mind and conduct problems vanished once verbal IQ was counted. The difference is control: the 2019 paper did not hold IQ steady, so the tie it shows might be partly driven by language skill, not mind-reading alone.
Amorim et al. (2025) widens the lens. They tested youth with autism, ADHD, and OCD and found that social-communication traits, not the diagnosis itself, predicted theory-of-mind scores. This supports the 2019 idea that the skill, not the label, matters for behavior.
Fisher et al. (2005) offers hope. Their RCT showed that short daily theory-of-mind lessons improved false-belief scores in autistic children, giving a ready tool if you choose to add mind-reading training for self-injury.
Why it matters
You can screen quickly. Give a false-belief task and a visual-processing game during intake. If mind-reading is low, weave perspective-taking drills into the self-injury plan. If visual or auditory detail skills are weak, add matching-to-sample or sensory discrimination tasks to curb externalizing behaviors. Check verbal IQ too; if it is low, prioritize language support before or alongside theory-of-mind work.
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02At a glance
03Original abstract
Many young people with autism spectrum disorder display 'challenging behaviours', characterised by externalising behaviour and self-injurious behaviours. These behaviours can have a negative impact on a young person's well-being, family environment and educational achievement. However, the development of effective interventions requires greater knowledge of autism spectrum disorder-specific models of challenging behaviours. Autism spectrum disorder populations are found to demonstrate impairments in different cognitive domains, namely social domains, such as theory of mind and emotion recognition, but also non-social domains such as executive functioning and sensory or perceptual processing. Parent-rated self-injurious behaviour and externalising behaviours, and neurocognitive performance were assessed in a population-derived sample of 100 adolescents with autism spectrum disorder. Structural equation modelling was used to estimate associations between cognitive domains (theory of mind, emotion recognition, executive functioning and perceptual processing) and self-injurious behaviour and externalising behaviours. Poorer theory of mind was associated with increased self-injurious behaviour, whereas poorer perceptual processing was associated with increased externalising behaviours. These associations remained when controlling for language ability. This is the first analysis to examine how a wide range of neurocognitive domains relate to challenging behaviours and suggests specific domains that may be important targets in the development of interventions in adolescents with autism spectrum disorder.
Autism : the international journal of research and practice, 2019 · doi:10.1177/1362361318769176