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Meta-Analysis
. 2014 Mar 21;2014(3):CD008785.
doi: 10.1002/14651858.CD008785.pub2.

Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD)

Sue Fletcher-Watson  1 , Fiona McConnell, Eirini Manola, Helen McConachie
Affiliations
Meta-Analysis

Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD)

Sue Fletcher-Watson et al. Cochrane Database Syst Rev. .

Abstract

Background: The 'Theory of Mind' (ToM) model suggests that people with autism spectrum disorder (ASD) have a profound difficulty understanding the minds of other people - their emotions, feelings, beliefs, and thoughts. As an explanation for some of the characteristic social and communication behaviours of people with ASD, this model has had a significant influence on research and practice. It implies that successful interventions to teach ToM could, in turn, have far-reaching effects on behaviours and outcome.

Objectives: To review the efficacy of interventions based on the ToM model for individuals with ASD.

Search methods: In August 2013 we searched CENTRAL, Ovid MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Social Services Abstracts, AutismData, and two trials registers. We also searched the reference lists of relevant papers, contacted authors who work in this field, and handsearched a number of journals.

Selection criteria: Review studies were selected on the basis that they reported on an applicable intervention (linked to ToM in one of four clearly-defined ways), presented new randomised controlled trial data, and participants had a confirmed diagnosis of an autism spectrum disorder. Studies were selected by two review authors independently and a third author arbitrated when necessary.

Data collection and analysis: Risk of bias was evaluated and data were extracted by two review authors independently; a third author arbitrated when necessary. Most studies were not eligible for meta-analysis, the principal reason being mis-matching methodologies and outcome measures. Three small meta-analyses were carried out.

Main results: Twenty-two randomised trials were included in the review (N = 695). Studies were highly variable in their country of origin, sample size, participant age, intervention delivery type, and outcome measures. Risk of bias was variable across categories. There were very few studies for which there was adequate blinding of participants and personnel, and some were also judged at high risk of bias in blinding of outcome assessors. There was also evidence of some bias in sequence generation and allocation concealment. Not all studies reported data that fell within the pre-defined primary outcome categories for the review, instead many studies reported measures which were intervention-specific (e.g. emotion recognition). The wide range of measures used within each outcome category and the mixed results from these measures introduced further complexity when interpreting results.Studies were grouped into four main categories according to intervention target/primary outcome measure. These were: emotion recognition studies, joint attention and social communication studies, imitation studies, and studies teaching ToM itself. Within the first two of these categories, a sub-set of studies were deemed suitable for meta-analysis for a limited number of key outcomes.There was very low quality evidence of a positive effect on measures of communication based on individual results from three studies. There was low quality evidence from 11 studies reporting mixed results of interventions on measures of social interaction, very low quality evidence from four studies reporting mixed results on measures of general communication, and very low quality evidence from four studies reporting mixed results on measures of ToM ability. The meta-analysis results we were able to generate showed that interventions targeting emotion recognition across age groups and working with people within the average range of intellectual ability had a positive effect on the target skill, measured by a test using photographs of faces (mean increase of 0.75 points, 95% confidence interval (CI) 0.22 to 1.29 points, Z = 2.75, P < 0.006, four studies, N = 105). Therapist-led joint attention interventions can promote production of more joint attention behaviours within adult-child interaction (mean increase of 0.55 points, 95% CI 0.11 to 0.99 points, Z = 2.45, P value = 0.01, two studies, N = 88). Further analysis undermines this conclusion somewhat by demonstrating that there was no clear evidence that intervention can have an effect on joint attention initiations as measured using a standardised assessment tool (mean increase of 0.23 points, 95% CI -0.48 to 0.94 points, Z = 0.63, P value = 0.53, three studies, N = 92). No adverse effects were apparent.

Authors' conclusions: While there is some evidence that ToM, or a precursor skill, can be taught to people with ASD, there is little evidence of maintenance of that skill, generalisation to other settings, or developmental effects on related skills. Furthermore, inconsistency in findings and measurement means that evidence has been graded of 'very low' or 'low' quality and we cannot be confident that suggestions of positive effects will be sustained as high-quality evidence accumulates. Further longitudinal designs and larger samples are needed to help elucidate both the efficacy of ToM-linked interventions and the explanatory value of the ToM model itself. It is possible that the continuing refinement of the ToM model will lead to better interventions which have a greater impact on development than those investigated to date.

PubMed Disclaimer

Conflict of interest statement

A £1000 grant was provided by the charity Research Autism, to pay for some research assistance.

Sue Fletcher‐Watson and Helen McConachie ‐ both of these authors have been involved in the development of a therapeutic iPad app for preschoolers with autism, targeting skills relevant to the current review. An RCT of this app was completed and was due to be published after this review. This study may have been deemed eligible for inclusion in a future version of this review. The app was available on the commercial market and the authors could have received royalties from sales of the app if these exceeded a certain threshold. As of 2019, however, the app is no longer available and the authors did not receive any royalties from the app. The funding arbiter has determined that this is not compliant with the Cochrane Commercial Sponsorship policy. As a result, future updates will be conducted by a new team that will have two thirds of authors ‐ including both the first and last authors ‐ free of conflicts.

Fiona McConnell ‐ none known.

Eirini Manola ‐ none known.

Figures

1
1
Study flow diagram
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
4
4
Forest plot of comparison: 1 test, outcome: 1.3 Joint attention initiations in standardised assessment.
5
5
Forest plot of comparison: 1 test, outcome: 1.2 Emotion recognition from face photographs, TAU control.
6
6
Forest plot of comparison: 1 test, outcome: 1.1 Joint engagement in mother‐child interaction.
1.1
1.1. Analysis
Comparison 1 Treatment effects in meta‐analysis, Outcome 1 Joint engagement in mother‐child interaction.
1.2
1.2. Analysis
Comparison 1 Treatment effects in meta‐analysis, Outcome 2 Emotion recognition from face photographs, TAU control.
1.3
1.3. Analysis
Comparison 1 Treatment effects in meta‐analysis, Outcome 3 Joint attention initiations in standardised assessment.
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References

References to studies included in this review

Baghdadli 2013 {published data only}
    1. Baghdadli A, Brisot J, Henry V, Michelon C, Soussana M, Rattaz C, et al. Social skills improvement in children with high‐functioning autism: a pilot randomized controlled trial. European Child & Adolescent Psychiatry 2013;22(7):433‐42. - PubMed
Begeer 2011 {published data only}
    1. Begeer S, Gevers C, Clifford P, Verhoeve M, Kat K, Hoddenbach E, et al. Theory of mind training in children with autism: a randomized controlled trial. Journal of Autism and Developmental Disorders 2011;41(8):997‐1006. - PMC - PubMed
Bolte 2002 {published data only}
    1. Bolte S, Feineis‐Matthews S, Leber S, Dierks T, Hubl D, Poutska F. The development and evaluation of a computer‐based program to test and teach the recognition of facial affect. International Journal of Circumpolar Health 2002;61 Suppl 2:61‐8. - PubMed
    1. Bolte S, Hubl D, Feineis‐Matthews S, Prvulovia D, Dierks T, Poutska F. Facial affect recognition training in autism: can we animate the fusiform gyrus?. Behavioural Neuroscience 2006;120(1):211‐6. - PubMed
Fisher 2005 {published data only}
    1. Fisher N, Happe F. A training study of theory of mind and executive function in children with autistic spectrum disorders. Journal of Autism and Developmental Disorders 2005;35(6):757‐71. - PubMed
Golan 2006 {published data only}
    1. Golan O, Baron‐Cohen S. Systemizing empathy: teaching adults with Asperger syndrome or high‐functioning autism to recognize complex emotions using interactive multimedia. Development and Psychopathology 2006;18(2):591‐617. - PubMed
Golan 2010 {published data only}
    1. Golan O, Ashwin E, Granader Y, McClintock S, Day K, Leggett V, et al. Enhancing emotion recognition in children with autism spectrum conditions: an intervention using animated vehicles with real emotional faces. Journal of Autism and Developmental Disorders 2010;40(3):269‐79. - PubMed
Goods 2013 {published data only}
    1. Goods KS, Ishijim E, Chang Y‐C, Kasari C. Preschool based JASPER intervention in minimally verbal children with autism: pilot RCT. Journal of Autism and Developmental Disorders 2013;43(5):1050‐6. - PMC - PubMed
Hadwin 1996 {published data only}
    1. Hadwin J, Baron‐Cohen S, Howlin P, Hill K. Can we teach children with autism to understand emotions, belief or pretence?. Development and Psychopathology 1996;8(2):345‐65.
    1. Hadwin J, Baron‐Cohen S, Howlin P, Hill K. Does teaching theory of mind have an effect on the ability to develop conversation in children with autism?. Journal of Autism and Developmental Disorders 1997;27(5):519‐37. - PubMed
Hopkins 2011 {published data only}
    1. Hopkins IM, Gower MW, Perez TA, Smith DS, Amthor FR, Wimsatt FC, et al. Avatar assistant: improving social skills in students with an ASD through a computer‐based intervention. Journal of Autism and Developmental Disorders 2011;41(11):1543‐55. - PubMed
Ingersoll 2012 {published and unpublished data}
    1. Ingersoll B. Brief report: effect of a focused imitation intervention of social functioning in children with autism. Journal of Autism and Developmental Disorders 2012;42(8):1768‐73. - PMC - PubMed
    1. Ingersoll B. Brief report: pilot randomized controlled trial of reciprocal imitation training for teaching elicited and spontaneous imitation to children with autism. Journal of Autism and Developmental Disorders 2010;40(9):1154‐60. [PUBMED: 20155309] - PMC - PubMed
Kaale 2012 {published data only}
    1. Kaale A, Smith L, Sponheim E. A randomized controlled trial of preschool‐based joint attention intervention for children with autism. Journal of Child Psychology and Psychiatry 2012;53(1):97‐105. - PubMed
Kasari 2006 {published data only}
    1. Arora T. Perseveration in young children with autism and the association with joint attention [PhD Thesis]. University of California, 2008.
    1. Gulsrud AC, Kasari C, Freeman S, Paparella T. Brief report: children with autism's response to novel stimuli while participating in interventions targeting joint attention or symbolic play skills. Autism 2007;11(6):535‐46. - PubMed
    1. Kasari C, Freeman S, Paparella T. Joint attention and symbolic play in young children with autism: a randomized controlled intervention study. Journal of Child Psychology and Psychiatry 2006;47(6):611‐20. - PubMed
    1. Kasari C, Gulsrud A, Freeman S, Paparella T, Hellemann G. Longitudinal follow up of children with autism receiving targeted interventions on joint attention and play. Journal of the American Academy of Child and Adolescent Psychiatry 2012;51(5):487‐95. - PMC - PubMed
    1. Kasari C, Paparella T, Freeman S, Jahromi LB. Language outcome in autism: a randomised comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology 2008;76(1):125‐37. - PubMed
Kasari 2010 {published data only}
    1. Kasari C, Gulsrud A, Wong C, Kwon S, Locke J. Randomized controlled caregiver mediated joint engagement intervention for toddlers with autism. Journal of Autism and Developmental Disorders 2010;40(9):1045‐56. - PMC - PubMed
Kim 2009 {published data only}
    1. Kim J, Wigram T, Gold C. Emotional, motivational and interpersonal responsiveness of children with autism in improvisational music therapy. Autism 2009;13(4):389‐409. - PubMed
    1. Kim J, Wigram T, Gold C. The effects of improvisational music therapy on joint attention behaviours in autistic children: a randomized controlled study. Journal of Autism and Developmental Disorders 2008;38(9):1758‐66. - PubMed
Landa 2011 {published data only}
    1. Landa RJ, Holman KC, O'Neill AH, Stuart EA. Intervention targeting development of socially synchronous engagement in toddlers with autism spectrum disorder: a randomized controlled trial. Journal of Child Psychiatry and Psychology 2011;52(1):13‐21. - PMC - PubMed
Ryan 2010 {published and unpublished data}
    1. Ryan C, Charragain CN. Teaching emotions recognition skills to children with autism. Journal of Autism and Developmental Disorders 2010;40(12):1505‐11. - PubMed
Schertz 2013 {published data only}
    1. Schertz HH, Odom SL, Baggett KM, Sideris JH. Effects of joint attention mediated learning for toddlers with autism spectrum disorders: an ititial randomized controlled study. Early Childhood Research Quarterly 2013;28(2):249‐58.
Solomon 2004 {published data only}
    1. Solomon M, Goodlin‐Jones BL, Anders TF. A social adjustment enhancement intervention for high functioning autism, Asperger's syndrome and pervasive developmental disorder NOS. Journal of Autism and Developmental Disorders 2004;34(6):649‐68. - PubMed
Williams 2012 {published data only}
    1. Williams BT, Gray KM, Tonge BJ. Teaching emotion recognition skills to young children with autism: a randomized controlled trial of an emotion training programme. Journal of Child Psychology and Psychiatry 2012;53(12):1268‐76. - PubMed
Wong 2010 {published data only}
    1. Wong VCN, Kwan QK. Ramdomized controlled trial for early intervention for autism: a pilot study of the Autism 1‐2‐3 Project. Journal of Autism and Developmental Disorders 2010;40(6):677‐88. - PubMed
Wong 2013 {published data only}
    1. Wong CS. A play and joint attention intervention for teachers of young children with autism: a randomized controlled pilot study. Autism 2013;17:340‐57. - PubMed
Young 2012 {published data only}
    1. Young RL, Posselt M. Using The Transporters DVD as a learning tool for children with autism spectrum disorders. Journal of Autism and Developmental Disorders 2012;42(6):984‐91. - PubMed

References to studies excluded from this review

Adams 2012 {published data only}
    1. Adams C, Lockton E, Freed J, Gaile J, Earl G, McBean K, et al. The Social Communication Intervention Project: a randomized controlled trial of the effectiveness of speech and language therapy for school‐age children who have pragmatic and social communication problems with or without autism spectrum disorder. International Journal of Language & Communication Disorders 2012;47(3):233‐44. - PubMed
Aldred 2004 {published data only}
    1. Aldred C, Green J, Adams C. A new social communication intervention for children with autism: a pilot randomised controlled treatment study suggesting effectiveness. Journal of Child Psychology and Psychiatry 2004;45(8):1420‐30. [DOI: 10.1111/j.1469-7610.2004] - DOI - PubMed
Beaumont 2008 {published data only}
    1. Beaumont R, Sofronoff K. A multi‐component social skills intervention for children with Asperger syndrome: the Junior Detective Training Program. Journal of Child Psychology and Psychiatry 2008;49(7):743‐53. - PubMed
Cardon 2011 {published data only}
    1. Cardon TA, Wilcox MJ. Promoting imitation in young children with autism: a comparison of reciprocal imitation training and video modelling. Journal of Autism and Developmental Disorders 2011;41(5):654‐66. - PubMed
Carter 2011 {published data only}
    1. Carter AS, Messinger DS, Stone WL, Celimli S, Nahmias AS, Yoder P. A randomized controlled trial of Hanen's 'More Than Words' in toddlers with early autism symptoms. Journal of Child Psychology and Psychiatry 2011;52(7):741‐52. - PMC - PubMed
Casenhiser 2011 {published data only}
    1. Casenhiser DM, Shanker SG, Steiben J. Learning through interaction in children with autism: preliminary data from a social‐communication‐based intervention. Autism 2011;17(2):220‐41. [DOI: 10.1177/1362361311422052] - DOI - PubMed
Castorina 2011 {published data only}
    1. Castorina LL, Negri LM. The inclusion of siblings in social skills training groups for boys with Asperger syndrome. Journal of Autism and Developmental Disorders 2011;41(1):73‐81. - PubMed
Charman 2007 {published data only}
    1. Charman T, Hudry K. Interventions targeting joint attention and symbolic play can improve aspects of these skills in young children with autism. Evidence‐Based Mental Health 2007;10(1):12‐21. - PubMed
Corbett 2011 {published data only}
    1. Corbett B, Gunther J, Comins D, Price J, Ryan N, Simon D, et al. Brief report: theatre as therapy for children with autism spectrum disorder. Journal of Autism and Developmental Disorders 2011;41(4):505‐11. - PMC - PubMed
Dawson 2010 {published data only}
    1. Dawson G, Rogers S, Munson J, Smith M, Winter J, Greenson J, et al. Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics 2010;125(1):e17‐23. - PMC - PubMed
DeRosier 2011 {published data only}
    1. DeRosier M, Swick D, Davis N, McMillen J, Matthews R. The efficacy of a social skills group intervention for improving social behaviors in children with high functioning autism spectrum disorders. Journal of Autism and Developmental Disorders 2011;41(8):1033‐43. - PubMed
Drew 2002 {published data only}
    1. Drew A, Baird G, Baron‐Cohen S, Cox A, Slonims V, Wheelwright S, et al. A pilot randomised control trial of a parent training intervention for pre‐school children with autism: preliminary findings and methodological challenges. European Child & Adolescent Psychiatry 2002;11(6):266‐72. - PubMed
Estes 2011 {published data only}
    1. Estes A, Rivera V, Bryan M, Cali P, Dawson G. Discrepancies between academic achievement and intellectual ability in higher‐functioning school‐aged children with autism spectrum disorder. Journal of Autism and Developmental Disorders 2011;41(8):1044‐52. - PubMed
Field 2001 {published data only}
    1. Field T, Field T, Sanders C, Nadel J. Children with autism display more social behaviours after repeated imitation sessions. Autism 2001;5(3):317‐23. - PubMed
Frankel 2010a {published data only}
    1. Frankel F, Myatt R, Sugar C, Whitham C, Gorospe CM, Laugeson E. A randomized controlled study of parent‐assisted children's friendship training with children having autism spectrum disorders. Journal of Autism and Developmental Disorders 2010;40(7):827‐42. - PMC - PubMed
Frankel 2010b {published data only}
    1. Frankel F, Myatt R, Sugar C, Whitham C, Gorospe CM, Laugeson E. Erratum: a randomized controlled study of parent‐assisted children's friendship training with children having autism spectrum disorders. Journal of Autism and Developmental Disorders 2010;40(7):843. - PMC - PubMed
Gantman 2012 {published data only}
    1. Gantman A, Kapp S, Orenski K, Laugeson E. Social skills training for young adults with high‐functioning autism spectrum disorders: a randomized controlled pilot study. Journal of Autism and Developmental Disorders 2012;42(6):1094‐103. - PubMed
Gattino 2011 {published data only}
    1. Gattino GS, Dos Santos Riesgo R, Longo D, Leite JCL, Faccini LS. Effects of relational music therapy on communication of children with autism: a randomised controlled study. Nordic Journal of Music Therapy 2011;20(2):142‐54.
Geretsegger 2012 {published data only}
    1. Geretsegger M, Holck U, Gold C. Randomised controlled trial of improvisational music therapy's effectiveness for children with autism spectrum disorders (TIME‐A): study protocol. BMC Pediatrics 2012;12(1):2. - PMC - PubMed
Girolametto 1988 {published data only}
    1. Girolametto LE. Improving the social‐conversational skills of developmentally disabled children: an intervention study. Journal of Speech and Hearing Disorders 1988;53(2):156‐67. - PubMed
Green 2010 {published data only}
    1. Green J, Charman T, McConachie H, Aldred C, Slonims V, Howlin P, et al. Parent‐mediated communication‐focused treatment in children with autism (PACT): a randomised controlled trial. Lancet 2010;375(9732):2152‐60. - PMC - PubMed
Hanley‐Hochdorfer 2010 {published data only}
    1. Hanley‐Hochdorfer K, Bray MA, Kehle TJ, Elinoff MJ. Social stories to increase verbal initiation in children with autism and Asperger's disorder. School Psychology Review 2010;39(3):484‐92.
Heimann 2006 {published data only}
    1. Heimann M, Laberg KE, Nordoen B. Imitative interaction increases social interest and elicited imitation in non‐verbal children with autism. Infant and Child Development 2006;15(3):297‐309.
Hillier 2012 {published data only}
    1. Hillier A, Greher G, Poto N, Dougherty M. Positive outcomes following participation in a music intervention for adolescents and young adults on the autism spectrum. Psychology of Music 2012;40(2):201‐15.
Howlin 1997 {published data only}
    1. Howlin P. When is a significant change not significant?. Journal of Autism and Developmental Disorders 1997;27(3):347‐8. - PubMed
Howlin 2007 {published data only}
    1. Howlin P, Gordon RK, Pasco G, Wade A, Charman T. The effectiveness of Picture Exchange Communication System (PECS) training for teachers of children with autism: a pragmatic, group randomised controlled trial. Journal of Child Psychology and Psychiatry 2007;48(5):473‐81. - PubMed
Jocelyn 1998 {published data only}
    1. Jocelyn LJ, Casiro OG, Beattie D, Bow J, Kneisz J. Treatment of children with autism: a randomized controlled trial to evaluate a caregiver‐based intervention program in community day‐care centers. Journal of Developmental and Behavioural Pediatrics 1998;19(5):326‐34. - PubMed
Jones 2010 {published data only}
    1. Jones K, Howley M. An investigation into an interaction programme for children on the autism spectrum: outcomes for children, perceptions of schools and a model for training. Journal of Research in Special Educational Needs 2010;10(2):115‐23.
Kasari 2012a {published data only}
    1. Kasari C, Rotheram‐Fuller E, Locke J, Gulsrud A. Making the connection: randomised controlled trial of social skills at school for children with autism spectrum disorders. Journal of Child Psychology and Psychiatry 2012;53(4):431‐9. - PMC - PubMed
Kern 2011 {published data only}
    1. Kern JK, Fletcher CL, Garver CR, Mehta JA, Grannemann BD, Knox KR, et al. Prospective trial of equine‐assisted activities in autism spectrum disorder. Alternative Therapies in Health and Medicine 2011;17(3):14‐20. - PubMed
Koenig 2010 {published data only}
    1. Koenig K, White SW, Pachler M, Lau M, Lewis M, Klin A, et al. Promoting social skill development in children with pervasive developmental disorders: a feasibility and efficacy study. Journal of Autism and Developmental Disorders 2010;40(10):1209‐18. - PubMed
Lang 2010 {published data only}
    1. Lang R. The Autism 1‐2‐3 Project, a short‐duration and low‐intensity intervention that targets basic social and communication skills and parent involvement, shows promise and is worthy of future research. Evidence‐Based Communication Assessment and Intervention 2010;4(4):196‐9.
Laugeson 2012 {published data only}
    1. Laugeson E, Frankel F, Gantman A, Dillon AR, Mogil C. Evidence‐based social skills training for adolescents with autism spectrum disorders: The UCLA PEERS Program. Journal of Autism and Developmental Disorders 2012;42(6):1025‐36. - PubMed
Lawton 2012 {published data only}
    1. Lawton K, Kasari C. Teacher‐implemented joint attention intervention: pilot randomised controlled study for preschoolers with autism. Journal of Consulting and Clinical Psychology 2012;80(4):687‐95. - PubMed
LeGoff 2004 {published data only}
    1. LeGoff DB. Use of LEGO as a therapeutic medium for improving social competence. Journal of Autism and Developmental Disorders 2004;34(5):557‐71. - PubMed
Lerner 2012 {published data only}
    1. Lerner MD, Mikami AY. A preliminary randomized controlled trial of two social skills interventions for youth with high‐functioning autism spectrum disorders. Focus on Autism and Other Developmental Disabilities 2012;27:147‐57.
Lopata 2010 {published data only}
    1. Lopata C, Thomeer ML, Volker MA, Toomey JA, Nida RE, Lee GK, et al. RCT of a manualized social treatment for high‐functioning autism spectrum disorders. Journal of Autism and Developmental Disorders 2010;40(11):1297‐310. - PubMed
Mahoney 2005 {published data only}
    1. Mahoney G, Perales F. Relationship‐focused early intervention with children with pervasive developmental disorders and other disabilities: a comparative study. Developmental and Behavioural Pediatrics 2005;26(2):77‐85. - PubMed
McConachie 2004 {published data only}
    1. McConachie H. Commentary on: joint attention and symbolic play in young children with autism: a randomized controlled intervention study. Child: Care, Health and Development 2006;32(6):752.
McGregor 1998 {published data only}
    1. McGregor E, Whiten A, Blackburn P. Teaching theory of mind by highlighting intention and illustrating thoughts: a comparison of their effectiveness with 3‐year‐olds and autistic individuals. British Journal of Developmental Psychology 1998;16(3):281‐300.
Minshew 2010 {published data only}
    1. Minshew N, Eack S. Cognitive enhancement therapy for adults with autism spectrum disorders. NIH Clinical Trials Register. [NCT00902798]
Morgan 2010 {published data only}
    1. Morgan L, Newton L, McCormick J. Comparing parent‐implemented interventions for toddlers with autism spectrum disorders. NIH Clinical Trials Register. [NCT00760812]
Nefdt 2010 {published data only}
    1. Nefdt, N, Koegel R, Singer G, Gerber M. The use of a self‐directed learning program to provide introductory training in pivotal response treatment to parents of children with autism. Journal of Positive Behaviour Interventions 2010;12(1):23‐32.
Oosterling 2010 {published data only}
    1. Oosterling I, Visser J, Swinkels S, Rommelse N, Donders R, Woundenberg T, et al. Randomised controlled trial of the focus parent training for toddlers with autism: 1‐year outcome. Journal of Autism and Developmental Disorders 2010;40(12):1447‐58. - PMC - PubMed
Ozonoff 1995 {published data only}
    1. Ozonoff S, Miller JN. Teaching theory of mind: a new approach to social skills training for individuals with autism. Journal of Autism and Developmental Disorders 1995;25(4):415‐33. - PubMed
Pajareya 2011 {published data only}
    1. Pajareya K, Nopmaneejumruslers K. A pilot randomised controlled trial of DIR/Floortime parent training intervention for pre‐school children with autistic spectrum disorders. Autism 2011;15(2):1‐15. - PubMed
Quirmbach 2009 {published data only}
    1. Quirmbach LM, Lincoln AJ, Feinberg‐Gizzo MJ, Ingersoll BR, Andrews SM. Social stories: mechanisms of effectiveness in increasing game play skills in children diagnosed with autism spectrum disorder using a pretest posttest repeated measures randomized control group design. Journal of Autism and Developmental Disorders 2009;39(2):299‐321. - PubMed
Roberts 2011 {published data only}
    1. Roberts J, Williams K, Carter M, Evans D, Parmenter T, Silove N, et al. A randomised controlled trial of two early intervention programs for young children with autism: centre‐based with parent program and home‐based. Research in Autism Spectrum Disorders 2011;5(4):1553‐66.
Rodgers 2012 {unpublished data only}
    1. Rodgers JD. Efficacy of a Social Intervention on Facial Encoding in Children with High‐Functioning Autism Spectrum Disorders [PhD thesis]. Buffalo, New York: University at Buffalo, The State University of New York, 2012.
Rogers 2010 {published data only}
    1. Rogers L, Hemmeter ML, Wolery M. Using a constant time delay procedure to teach foundational swimming skills to children with autism. Topics in Early Childhood Special Education 2010;30(2):102‐11.
Schertz 2007 {published data only}
    1. Schertz HM, Odom SL. Promoting joint attention in toddlers with autism: a parent‐mediated developmental model. Journal of Autism and Developmental Disorders 2007;37(8):1562‐75. - PubMed
Schmidt 2012 {published data only}
    1. Schmidt C, Stichter JP. The use of peer‐mediated interventions to promote the generalization of social competence for adolescents with high‐functioning autism and Asperger's syndrome. Exceptionality 2012;20(2):94‐113.
Silver 2001 {published data only}
    1. Silver M, Oakes P. Evaluation of a new computer intervention to teach people with autism of Asperger syndrome to recognise and predict emotions in others. Autism 2001;5(3):299‐316. - PubMed
Smith 2000 {published data only}
    1. Smith T, Buch GA, Gamby TE. Parent‐directed, intensive early intervention for children with pervasive developmental disorder. Research in Developmental Disbailities 2000;21(4):297‐309. - PubMed
Smith 2004 {published data only}
    1. Smith T, Groen AD, Wynn JW. Randomized trial of intensive early intervention for children with pervasive developmental disorder. In: Feldman MA editor(s). Early Intervention: The Essential Readings. Blackwell, 2004:153‐81.
Stichter 2001 {published data only}
    1. Stichter JP. Functional analysis: the use of analogues in applied settings. Focus on Autism and Other Developmental Disabilities 2001;16(4):232‐9.
Strain 2011 {published data only}
    1. Strain PS, Bovey EH. Randomized, controlled trial of the LEAP model of early intervention for young children with autism spectrum disorders. Topics in Early Childhood Special Education 2011;31(3):133‐54.
Swettenham 1996 {published data only}
    1. Swettenham J. Can children with autism be taught to understand false belief using computers?. Journal of Child Psychology and Psychiatry 1996;37(2):157‐65. - PubMed
Tanaka 2010 {published data only}
    1. Tanaka JW, Wolf JM, Klaiman C, Koenig K, Cockburn J, Herlihy L, et al. Using computerized games to teach face recognition skills to children with autism spectrum disorder: the Let's Face It! program. Journal of Child Psycholgy and Psychiatry 2010;51(8):944‐52. - PubMed
Temple 2007 {published data only}
    1. Temple K. A randomized comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Child: Care, Health and Development 2007;33(3):348‐9.
Thomeer 2012 {published data only}
    1. Thomeer ML, Lopata C, Volker MA, Toomey JA, Lee GK, Smerback AM, et al. Randomized clinical trial replication of a psychosocial treatment for children with high‐functioning autism spectrum disorders. Psychology in the Schools 2012;49(10):942‐54.
Turner‐Brown 2008 {published data only}
    1. Turner‐Brown LM, Perry TD, Dichter G, Bodfish J, Penn DL. Brief report: feasibility of social cognition and interaction training for adults with high‐functioning autism. Journal of Autism and Developmental Disorders 2008;38(9):1777‐84. - PMC - PubMed
Wellman 2002 {published data only}
    1. Wellman HM, Baron‐Cohen S, Caswell R, Gomez JC, Swettenham J, Toye E, et al. Thought‐bubbles help children with autism acquire an alternative to a theory of mind. Autism 2002;6(4):343‐63. - PubMed
Whalen 2003 {published data only}
    1. Whalen C, Schreibman L. Joint attention training for children with autism using behavior modification procedures. Journal of Child Psychology and Psychiatry 2003;44(3):456‐68. - PubMed
White 2010 {published data only}
    1. White SW, Koenig K, Scahill L. Group social skills instruction for adolescents with high‐functioning autism spectrum disorders. Focus on Autism and Other Developmental Disabilities 2010;25(4):209‐19.
Wood 2009 {published data only}
    1. Wood JJ, Drahota A, Sze K, Dyke M, Decker K, Fujii C, et al. Brief report: effects of cognitive behavioral therapy on parent‐reported autism symptoms in school‐age children with high‐functioning autism. Journal of Autism and Developmental Disorders 2009;39(11):1608‐12. - PMC - PubMed
Yoder 2006 {published data only}
    1. Yoder P, Stone W. A randomised comparison of the effect of two prelinguistic communication interventions on the acquisition of spoken communication in preschoolers with ASD. Journal of Speech, Language and Hearing Research 2006;49(4):698‐711. - PubMed
Yoder 2006b {published data only}
    1. Yoder P, Stone WL. Randomised comparison of two communication interventions for preschoolers with autism spectrum disorders. Journal of Consulting and Clinical Psychology 2006;74(3):426‐35. - PubMed

References to studies awaiting assessment

Baghdadli 2010 {published data only}
    1. Baghdadli A, Bristo‐Dubois J, Picot M, Michelon C. Comparison of the effect of two prosocial interventions about the evolution of recognition of facial expression abilities and social cognition of children with an Asperger syndrome or high functioning autism [Comparaison de l’effet de deux interventions prosociales sur l’évolution descapacités d’identification des expressions faciales et du raisonnement social d’enfants avec un syndrome d’Asperger ou autisme de haut niveau]. Neuropsychiatrie de l'Enfance et de l'Adolescence 2010;58(8):456‐62.

Additional references

APA 1994
    1. APA. Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association, 1994.
APA 2013
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders ‐ V. Washington, DC: APA, 2013.
Arora 2008
    1. Arora T. Perseveration in Young Children with Autism and the Association with Joint Attention [PhD thesis]. University of California, 2008.
Astington 2011
    1. Astington JW, Gopnik A. Theoretical explanations of children's understanding of the mind. British Journal of Developmental Psychology 2011;9(1):7‐31.
Atladottir 2007
    1. Atladottir HO, Parner ET, Schendel D, Dalsgaard S, Thomsen PH, Thorsen P. Time trends in reported diagnoses of childhood neuropsychiatric disorders. Archives of Pediatrics & Adolescent Medicine 2007;161(2):193‐8. - PubMed
Baird 2006
    1. Baird G, Simonoff E, Pickles A, Chandler S, Loucas T, Meldrum D, et al. Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet 2006;368(9531):210‐5. - PubMed
Baron‐Cohen 1985
    1. Baron‐Cohen S, Leslie AM, Frith U. Does the autistic child have a "theory of mind"?. Cognition 1985;21(1):37‐46. - PubMed
Baron‐Cohen 1995
    1. Baron‐Cohen S. Mindblindness. London, UK: MIT Press, 1995.
Baron‐Cohen 2000
    1. Baron‐Cohen S. Theory of mind and autism: a fifteen year review. In: Baron‐Cohen S, Tager‐Flusberg H, Cohen DJ editor(s). Understanding Other Minds: Perspectives from Developmental Cognitive Neuroscience. Oxford: Oxford University Press, 2000:3‐20.
Baron‐Cohen 2010
    1. Baron‐Cohen S. The empathizing‐systematizing (E‐S) theory of autism. In: Goswami U editor(s). The Wiley‐Blackwell Handbook of Childhood Cognitive Development. 2nd Edition. Oxford, UK: Wiley‐Blackwell, 2010.
Bloom 2000
    1. Bloom P, German TP. Two reasons to abandon the false belief task as a test of theory of mind. Cognition 2000;77(1):B25‐31. - PubMed
Bowler 1992
    1. Bowler DM. "Theory of mind" in Asperger's syndrome. Journal of Child Psychology and Psychiatry 1992;35(5):877‐93. - PubMed
Bowler 1997
    1. Bowler DM. Reaction times to mental state and non‐mental state questions in false belief tasks by high‐functioning individuals with autism. European Child and Adolescent Psychiatry 1997;6(3):160‐5. - PubMed
Carruthers 1996
    1. Carruthers P, Smith PK. Theories of Theories of Mind. Cambridge, UK: Cambridge University Press, 1996.
Charman 2000
    1. Charman T, Baron‐Cohen S, Swettenham J, Baird G, Cox A, Drew A. Testing joint attention, imitation, and play as infancy precursors to language and theory of mind. Cognitive Development 2000;15(4):481‐98.
Croen 2002
    1. Croen LA, Grether JK, Hoogstrate J, Selvin S. The changing prevalence of autism in California. Journal of Autism and Developmental Disorders 2002;32(3):207‐15. - PubMed
Elsabbagh 2012
    1. Elsabbagh M, Divan G, Koh Y‐J, Kim YS, Kauchali S, Marcin C, et al. Global prevalence of autism and other pervasive developmental disorders. Autism Research 2012;5(3):160‐79. - PMC - PubMed
Fombonne 2001
    1. Fombonne E, Simmons H, Ford T, Meltzer H, Goodman R. Prevalence of pervasive developmental disorders in the British nationwide survey of child mental health. Journal of the American Academy of Child and Adolescent Psychiatry 2001;40(7):827‐9. - PubMed
Frith 1994
    1. Frith U, Happe F, Siddons F. Autism and theory of mind in everyday life. Social Development 1994;3(2):108‐24.
Garfield 2001
    1. Garfield JL, Peterson CC, Perry T. Social cognition, language acquisition and the development of theory of mind. Mind and Language 2001;16(5):494‐541.
Gulsrud 2007
    1. Gulsrud A, Kasari C, Freeman S, Paparella T. Brief report: children with autism's response to novel stimuli while participating in interventions targeting joint attention or symbolic play skills. Autism 2007;11(6):535‐46. - PubMed
Hadwin 1997
    1. Hadwin J, Baron‐Cohen S, Howlin P, Hill K. Does teaching theory of mind have an effect on the ability to develop conversation in children with autism?. Journal of Autism and Developmental Disorders 1997;27(5):519‐37. - PubMed
Happe 1994
    1. Happe F. Wechsler IQ profile and theory of mind in autism: a research note. Journal of Child Psychology and Psychiatry 1994;35(8):1461‐71. - PubMed
Happe 1995
    1. Happe F. The role of age and verbal ability in the theory of mind task performance of subjects with autism. Child Development 1995;66(3):843‐55. - PubMed
Happe 2006
    1. Happe F, Frith U. The weak coherence account: detail‐focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders 2006;36(1):5‐25. - PubMed
Hartley 2009
    1. Hartley SL, Sikora DM. Sex differences in autism spectrum disorder: an examination of developmental functioning, autistic symptoms, and coexisting behavior problems in toddlers. Journal of Autism and Developmental Disorders 2009;39(12):1715‐22. - PMC - PubMed
Higgins 2008
    1. Higgins JPT. Cochrane Handbook for Systematic Reviews of Interventions. Chichester: John Wiley & Sons, 2008.
Hobson 1991
    1. Hobson RP. Against the theory of 'Theory of mind'. British Journal of Developmental Psychology 1991;9(1):33‐51.
Ingersoll 2010
    1. Ingersoll B. Brief report: pilot randomized controlled trial of reciprocal imitation training for teaching elicited and spontaneous imitation to children with autism. Journal of Autism and Developmental Disorders 2010;40(9):1154‐60. [PUBMED: 20155309] - PMC - PubMed
Joseph 2004
    1. Joseph RM, Tager‐Flusberg H. The relationship of theory of mind and executive functions to symptom type and severity in children with autism. Development and Psychopathology 2004;16(1):137‐55. - PMC - PubMed
Kanner 1943
    1. Kanner L. Autistic disturbances of affective contact. Nervous Child 1943;2:217‐50. - PubMed
Kasari 2008
    1. Kasari C, Paparella T, Freeman S, Jahromi LB. Language outcome in autism: randomized comparison of joint attention and play interventions. Journal of Consulting and Clinical Psychology 2008;76(1):125‐37. - PubMed
Kasari 2012b
    1. Kasari C, Gulsrud A, Freeman S, Paparella T, Helleman G. Longitudinal follow up of children with autism receiving targeted interventions on joint attention and play. Journal of the American Academy of Child and Adolescent Psychiatry 2012;51(5):487‐95. - PMC - PubMed
Kim 2008
    1. Kim J, Wigram T, Gold C. The effects of improvisational music therapy on joint attention behaviours in autistic children: a randomized controlled study. Journal of Autism and Developmental Disorders 2008;38(9):1758‐66. - PubMed
Klin 2005
    1. Klin A. Clinical evaluation in autism spectrum disorders: psychological assessment within a trans‐disciplinary framework. Handbook of Autism and Pervasive Developmental Disorders. Wiley, 2005.
Kogan 2009
    1. Kogan MD, Blumberg SJ, Schieve LA, Boyle CA, Perrin JM, Ghandour RM, et al. Prevalence of parent‐reported diagnosis of autism spectrum disorder among children in the US, 2007. Pediatrics 2009;124(5):1395‐403. - PubMed
Lefebvre 2008
    1. Lefebvre C, Manheimer E, Glaville J. Chapter 6: Searching for studies. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. Chicester: John Wiley & Sons, 2008.
Lord 1994
    1. Lord C, Rutter M, Couteur A. Autism diagnostic interview‐revised: a revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders 1994;24(5):659‐85. - PubMed
Lord 2000
    1. Lord C, Risi S, Lambracht L, Cook EH, Leventhal BL, DiLavore PC, et al. The Autism Diagnostic Observation Schedule ‐ Generic: a standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders 2000;30(3):205‐23. - PubMed
Melzoff 1993
    1. Melzoff AM, Gopnik A. The role of imitation in understanding persons and developing a theory of mind. In: Baron‐Cohen S, Tager‐Flusberg H, Cohen DJ editor(s). Understanding Other Minds: Perspectives from Autism. 1st Edition. Oxford, UK: Oxford University Press, 1993.
Mottron 2006
    1. Mottron L, Dawson M, Soulieres I, Hubert B, Burack J. Enhanced perceptual functioning in autism: an update and eight principles of autistic perception. Journal of Autism and Developmental Disorders 2006;36(1):27‐43. - PubMed
Mundy 1994
    1. Mundy P, Sigman M, Kasari C. Joint attention, developmental level and symptom presentation in autism. Development and Psychopathology 1994;6(3):389‐401.
Nassar 2009
    1. Nassar N, Dixon G, Bourke J, Bower C, Glasson E, Klerk N, et al. Autism spectrum disorders in young children: effect of changes in diagnostic practices. International Journal of Epidemiology 2009;38(5):1245‐54. - PubMed
Ozonoff 1991a
    1. Ozonoff S, Pennington B, Rogers SJ. Executive function deficits in high‐functioning autistic individuals: relationship to theory of mind. Journal of Child Psychology and Psychiatry 1991;32(7):1081‐105. - PubMed
Ozonoff 1991b
    1. Ozonoff S, Rogers SJ, Pennington B. Asperger's syndrome: evidence of an empirical distinction from high‐functioning autism. Journal of Child Psychology and Psychiatry 1991;32(7):1107‐22. - PubMed
Parsons 1999
    1. Parsons S, Mitchell P. What children with autism understand about thoughts and thought bubbles. Autism 1999;3(1):17‐38.
Ponnet 2004
    1. Ponnet KS, Roeyers H, Buysse A, Clercq A, Heyden E. Advanced mind reading in adults with Asperger syndrome. Autism 2004;8(3):249‐66. - PubMed
Premack 1978
    1. Premack D, Woodruff G. Does the chimpanzee have a theory of mind?. Behavioural and Brain Sciences 1978;1(4):515‐26.
Ruffman 2001
    1. Ruffman T, Garnham W, Rideout P. Social understanding in autism: eye gaze as a measure of core insights. Journal of Child Psychology and Psychiatry 2001;42(8):1083‐94. - PubMed
Rutter 2003
    1. Rutter M, Bailey A, Berument SK, Lord C, Pickles A. Social Communication Questionnaire. Los Angeles, USA: Western Psychological Services, 2003.
Rutter 2005
    1. Rutter M. Aetiology of autism: findings and questions. Journal of Intellectual Disability Research 2005;49(Pt 4):231‐8. - PubMed
Schopler 1986
    1. Schopler E, Reichler RJ, Renner BR. The Childhood Autism Rating Scale (CARS): For Diagnostic Screening and Classification of Autism. New York, USA: Irvington, 1986.
Swettenham 2000
    1. Swettenham J. Teaching theory of mind to individuals with autism. In: Baron‐Cohen S, Tager‐Flusberg H, Cohen DJ editor(s). Understanding Other Minds: Perspectives from Developmental Cognitive Neuroscience. Oxford: Oxford University Press, 2000:442‐58.
Tager‐Flusberg 2000
    1. Tager‐Flusberg H. Language and understanding minds: connections in autism. In: Baron‐Cohen S, Tager‐Flusberg H, Cohen DJ editor(s). Understanding Other Minds: Perspectives from Developmental Cognitive Neuroscience. 2nd Edition. Oxford, UK: Oxford University Press, 2000:124‐49.
Wellman 2000
    1. Wellman HM, Lagattuta KH. Developing understandings of mind. In: Baron‐Cohen S, Tager‐Flusberg H, Cohen DJ editor(s). Understanding Other Minds: Perspectives from Developmental Cognitive Neuroscience. 2nd Edition. Oxford, UK: Oxford University Press, 2000:21‐49.
Wellman 2001
    1. Wellman HM, Cross D, Watson J. Meta‐analysis of theory of mind development: the truth about false belief. Child Development 2001;72(3):655‐84. - PubMed
Williams 2006
    1. Williams JG, Higgins JPT, Brayne CEG. Systematic review of prevalence studies of autism spectrum disorders. Archives of Disease in Childhood 2006;91(1):8‐15. - PMC - PubMed
Yeargin‐Allsopp 2003
    1. Yeargin‐Allsopp M, Rice C, Karapurkar T, Doernberg N, Boyle C, Murphy C. Prevalence of autism in a US metropolitan area. JAMA 2003;289(1):49‐55. - PubMed

References to other published versions of this review

Fletcher‐Watson 2010
    1. Fletcher‐Watson S, McConachie H. Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD). Cochrane Database of Systematic Reviews 2010, Issue 10. [DOI: 10.1002/14651858.CD008785] - DOI - PMC - PubMed

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