Exploring the Relationships Between Theory of Mind, Social Skills, and Friendship Quality in Adolescents and Adults With and Without Autism Spectrum Disorder Through Structural Equation Modeling.
Theory-of-mind holds steady in autistic adults, and empathy issues trace more to alexithymia than to autism itself.
01Research in Context
What this study did
Li et al. (2025) asked if theory-of-mind skills fade as autistic teens and adults get older. They also tested whether empathy problems come from autism itself or from alexithymia, a co-occurring condition that makes it hard to name feelings.
The team used a statistical model called structural equation modeling on data from autistic and neurotypical participants. They looked at how age, ToM scores, empathy, and friendship quality fit together.
What they found
ToM scores stayed flat across age groups in autistic adults. This hints at age protection, meaning the skill does not drop off like some other abilities can.
Empathy gaps were tied to alexithymia, not to the autism label alone. When alexithymia was held constant, empathy levels looked similar between groups.
How this fits with other research
Riches et al. (2016) first saw that ToM gaps shrink after age fifty. The new study adds a finer lens by modeling alexithymia and still finds no age drop, building on the earlier picture.
Hoffmann et al. (2016) used brain scans and said empathy circuits are intact in autism. Jiaxi’s team seems to disagree, but the clash fades once you see that Ferdinand did not screen out alexithymia. Remove that factor and both papers point to spared empathy hardware.
Chen et al. (2026) show that stronger child ToM brings more peer contact yet also spikes momentary anxiety. Jiaxi extends this trade-off into adulthood by linking ToM to friendship quality, suggesting the social benefit–cost seesaw lasts across the lifespan.
Why it matters
If you serve autistic teens or adults, do not assume social-cognitive decline is coming. Keep teaching ToM; the skill appears stable. Screen for alexithymia when empathy seems low, because treating emotion-labeling may unlock social connection more than broad autism drills. Pair any ToM work with anxiety supports, echoing the kid findings that sharper social insight can stir real-time stress.
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02At a glance
03Original abstract
Impaired social cognition has been suggested to underlie the social communication difficulties that define autism spectrum disorder (ASD). In typical development, social cognition may deteriorate in older age, but age effects in ASD adults have been little explored. In the present study, we compared groups of younger and older adults with and without ASD (n = 97), who completed a set of social cognition tasks assessing theory of mind (ToM), and self-report measures of empathy and alexithymia. While typically developing (TD) younger adults outperformed elderly TD and younger ASD participants, younger and older ASD adults did not differ in their ToM performance, and the elderly ASD and TD groups performed equivalently. By contrast, ASD adults reported lower empathy scores and higher levels of alexithymia symptoms compared to TD adults regardless of age. The difference between ASD and TD groups in self-reported empathy scores was no longer significant when alexithymia was covaried (with the exception of the Perspective Taking subscore). Results suggest a possible age-protective effect on ToM in the ASD group. In addition, empathy difficulties appear to be associated with alexithymia rather than ASD per se. Possible interpretations are discussed, and future directions for autism aging research are proposed. LAY SUMMARY: People with autism spectrum disorder (ASD) have difficulties with social understanding. Some age-related studies in typical development have shown a decline in social understanding in older age. We investigated whether a similar pattern is present in adults with ASD. We found that understanding what someone is thinking was not worse in older versus younger autistic adults. Also, we reported further evidence suggesting that emotional empathy difficulties were related to difficulties with understanding one's own emotions rather than with autism itself. Autism Res 2021, 14: 911-920. © 2020 International Society for Autism Research and Wiley Periodicals LLC.
Journal of autism and developmental disorders, 2025 · doi:10.1002/aur.2410