Pragmatic Language in Children and Adolescents With Autism Spectrum Disorder: Do Theory of Mind and Executive Functions Have a Mediating Role?
For autistic clients with pragmatic language goals, prioritize explicit theory-of-mind lessons; executive-function training won't close the gap.
01Research in Context
What this study did
Cardillo et al. (2021) compared kids with autism to same-age peers without autism. They gave everyone tests of pragmatic language, theory of mind, and executive function.
The team used numbers to see which skill, ToM or EF, carried the autism-pragmatics link. This design is called mediation.
What they found
Children with autism scored lower on everyday language use, like taking turns or staying on topic. Only theory-of-mind gaps explained these language problems; executive-function scores did not.
In short, weak mind-reading skill, not weak planning or memory, drives pragmatic language trouble in autism.
How this fits with other research
Berenguer et al. (2018) saw the same pattern: ToM, not EF, stood between autism and social-language issues. The two studies are conceptual replications, boosting confidence.
Kouklari et al. (2018) looked almost identical on paper, yet they found EF predicted ToM but NOT social verbal communication. The twist is outcome choice: they tested short conversation samples, while Ramona used broad pragmatic checklists. Method difference, not true conflict.
Rong (2024) extended the idea to Mandarin demonstratives and still saw ToM plus working memory matter. The mechanism travels across languages and tasks.
Why it matters
If pragmatic errors show up on your caseload, probe false-belief and perspective-taking first. Add quick ToM drills—'What does he think?'—before you spend hours on EF games like card sorting. The evidence says mind-reading work will give you the biggest language payoff.
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Start each session with a 5-minute false-belief role-play, then practice the same perspective in real peer chat.
02At a glance
03Original abstract
Pragmatic language (PL) is defined as the ability to use language effectively in communicative exchanges. Previous findings showed that deficits in PL are a core characteristic of the communicative profile of individuals with autism spectrum disorder (ASD). While different lines of research have revealed a close link between PL and theory of mind (ToM), and between PL and executive functions (EFs), to our knowledge, few studies have explored the relationship between these three domains in children with ASD, and their results have been contradictory. The present study thus aimed to contribute to our understanding of PL in children with ASD and to analyze the underlying mediating role of ToM and EFs. PL is a complex and multifaceted construct. In the present study, we focused on two specific aspects, such as the comprehension of nonliteral language, and the ability to make inferences. After testing 143 participants (73 with ASD), our results confirmed that impairments in PL are a crucial feature of the ASD profile. Children with ASD were also more impaired than their typically developing peers in both ToM and EFs. When the mediating role of ToM and EFs on PL was considered, it emerged that only ToM contributed significantly to the relationship between group and PL. We discussed the potential importance of interventions not focused exclusively on PL, but also involving ToM. LAY SUMMARY: In everyday life, we use pragmatic language to interact successfully with others. Individuals with autism experience significant difficulty in pragmatic language, showing consequent impairments in communication. This study compared the comprehension of nonliteral language, and the ability to make inferences of children with autism and children with typical development, focusing on the role of social and cognitive abilities. Children with autism had difficulties in pragmatic language compared to children with typical development. In addition, the capacity to consider the perspective, intentions and beliefs of other people contributed significantly to the pragmatic language. Autism Res 2021, 14: 932-945. © 2020 International Society for Autism Research and Wiley Periodicals LLC.
Autism research : official journal of the International Society for Autism Research, 2021 · doi:10.1002/aur.2423