Theory of Mind Training in Children with Autism: A Randomized Controlled Trial Effects and Moderators of a Short Theory of Mind Intervention for Children with Autism Spectrum Disorder: A Randomized Controlled Trial Developing the Frith‐Happé animations: A quick and objective test of Theory of Mind for adults with autism Theory of Mind in first-episode schizophrenia patients: Correlations with cognition and personality traits Thought-Bubbles Help Children with Autism Acquire an Alternative to a Theory of Mind Systemizing empathy: teaching adults with Asperger syndrome or high-functioning autism to recognize complex emotions using interactive multimedia. Time-Based and Event-Based Prospective Memory in Autism Spectrum Disorder: The Roles of Executive Function and Theory of Mind, and Time-Estimation Evaluation of a New Computer Intervention to Teach People with Autism or Asperger Syndrome to Recognize and Predict Emotions in Others Teaching emotion recognition skills to young children with autism: a randomised controlled trial of an emotion training programme. Mindfulness-based therapy in adults with an autism spectrum disorder: a randomized controlled trial. Cluster Randomized Trial of the Classroom SCERTS Intervention for Elementary Students with Autism Spectrum Disorder Improvement in Social Competence Using a Randomized Trial of a Theatre Intervention for Children with Autism Spectrum Disorder Randomized comparative trial of a social cognitive skills group for children with autism spectrum disorder. Anatomical differences in the mirror neuron system and social cognition network in autism. Impact of Cognitive Behavioral Therapy on Observed Autism Symptom Severity During School Recess: A Preliminary Randomized, Controlled Trial A Randomised Controlled Trial of an Information Communication Technology Delivered Intervention for Children with Autism Spectrum Disorder Living in Regional Australia A Chinese Mind-Body Exercise Improves Self-Control of Children with Autism: A Randomized Controlled Trial
Many children with Autism Spectrum Disorders ( ASD ) participate in social skills or Theory of Mind ( ToM ) treatments . However , few studies have shown evidence for their effectiveness . The current study used a r and omized controlled design to test the effectiveness of a 16-week ToM treatment in 8–13 year old children with ASD and normal IQs ( n = 40 ) . The results showed that , compared to controls , the treated children with ASD improved in their conceptual ToM skills , but their elementary underst and ing , self reported empathic skills or parent reported social behaviour did not improve . Despite the effects on conceptual underst and ing , the current study does not indicate strong evidence for the effectiveness of a ToM treatment on the daily life mindreading skills Limited perspective taking or “ Theory of Mind ” ( ToM ) abilities are a core deficit of autism , and many interventions are aim ed to improve ToM abilities . In this study , we investigated the effectiveness of a ToM treatment for children with autism spectrum disorders ( ASD ) and , for the first time , the moderating roles of social interaction style ( SIS ) and disruptive behavior ( DB ) , to determine which children are most likely to respond to this intervention . The trial protocol is registered at www.trialregister.nl , trial number 2327 and published before the data collection was finished ( www.trialsjournal.com ) . Children with autism aged 7–12 years ( n = 97 ) were r and omized over a waitlist control or a treatment condition . Outcome measures included ToM and emotion underst and ing , parent and teacher question naires on children 's social skills , ToM‐related social behavior , and autistic traits . Six‐month follow‐up parent reported data were collected for the treatment group . The treatment had a positive effect on ToM underst and ing , parent‐reported ToM behavior , and autistic traits , but not on parent or teacher‐reported social behavior . Passive SIS was associated with diminished treatment effects on autistic traits , but DB was unrelated to outcomes . The ToM intervention  improved conceptual social underst and ing and ToM‐related behavior of children with ASD . However , broader application of learned skills to other domains of functioning was limited . Individual differences with regard to treatment response are discussed . Autism Res 2015 , 8 : 738–748 . © 2015 International Society for Autism Research , Wiley Periodicals , It is now widely accepted that individuals with autism have a Theory of Mind ( ToM ) or mentalizing deficit . This has traditionally been assessed with false‐belief tasks and , more recently , with silent geometric animations , an on‐line ToM task . In adults with milder forms of autism st and ard false‐belief tests , originally devised for children , often prove insensitive , while the Frith‐Happé animations have had rather better success at capturing the on‐line ToM deficit in this population . However , analysis of participants ' verbal descriptions of these animations , which span scenarios from “ R and om ” to “ Goal ‐Directed ” and “ ToM , ” is time consuming and subjective . In this study , we developed and established the feasibility of an objective method of response through a series of multiple‐choice questions .  Sixteen adults with autism and 15 typically developing adults took part , matched for age and intelligence . The adults with autism were less accurate as a group at categorizing the Frith‐Happé animations by the presence or absence of mental and physical interactions . Furthermore , they were less able to select the correct emotions that are typically attributed to the triangles in the mental state animations . This new objective method for assessing the underst and ing of the animations succeeded in being as sensitive as the original subjective method in detecting the mentalizing difficulties in autism , as well as being quicker and easier to administer and analyze . Autism Res 2011 , 4 : 149–154 . © 2011 , International Society for Autism Research , Wiley Periodicals , INTRODUCTION There is substantial evidence for Theory of Mind ( ToM ) deficits in patients with schizophrenia . Many psychotic symptoms may best be understood in light of an impaired capacity to infer one 's own and other persons ' mental states and to relate those to executing behavior . The aim of our study was to investigate ToM abilities in first-episode schizophrenia patients and to analyze them in relation to neuropsychological and psychopathological functioning . MATERIAL S AND METHODS A modified Moving Shapes paradigm was used to assess ToM abilities in 23 first-episode patients with schizophrenia and 23 matched healthy controls . Participants had to describe animated triangles which moved ( 1 ) r and omly , ( 2 ) goal -directed , or ( 3 ) in complex , socially interactive ways ( ToM video sequences ) . Neuropsychological functioning , psychopathology , autistic and alexithymic features as well as empathetic abilities were correlated with ToM performance . RESULTS Compared to healthy controls , first-episode schizophrenia patients gave more incorrect descriptions and used less ToM-related vocabulary when responding to socially complex ToM video sequences . No group differences were revealed for videos with r and om movements . ToM abilities correlated significantly with positive symptoms , reasoning , verbal memory performance and verbal IQ , but not with empathetic abilities or autistic and alexithymic features . When controlling for reasoning , verbal memory performance and verbal IQ , the correctness of video descriptions was still significantly worse in schizophrenia patients . DISCUSSION The results of our study in first-episode schizophrenia patients underline recent findings on ToM deficits in the early course of schizophrenia . Only a moderate influence of neurocognitive deficits on ToM performance was observed . Impairment in ToM abilities seems to be predominantly independent of clinical state , alexithymia and empathy Children with autism have specific difficulties underst and ing complex mental states like thought , belief , and false belief and their effects on behaviour . Such children benefit from focused teaching , where beliefs are likened to photographs-in-the-head . Here two studies , one with seven participants and one with 10 , tested a picture- in-the-head strategy for dealing with thoughts and behaviour by teaching children with autism  about cartoon thought-bubbles as a device for representing such mental states . This prosthetic device led children with autism to pass not only false belief tests , but also related theory of mind tests . These results confirm earlier findings of the efficacy of picture-in-the-head teaching about mental states , but go further in showing that thought-bubble training more easily extends to children ’s underst and ing of thoughts ( not just behaviour ) and to enhanced performance on several transfer tasks . Thought-bubbles provide a theoretically interesting as well as an especially easy and effective teaching technique This study evaluated Mind Reading , an interactive systematic guide to emotions , for its effectiveness in teaching adults with Asperger syndrome ( AS ) and high-functioning autism ( HFA ) to recognize complex emotions in faces and voices . Experiment 1 tested a group of adults diagnosed with AS/HFA ( n = 19 ) who used the software at home for 10 - 15 weeks . Participants were tested on recognition of faces and voices at three different levels of generalization . A matched control group of adults with AS/HFA ( n = 22 ) were assessed without any intervention . In addition , a third group of general population controls ( n = 24 ) was tested . Experiment 2 repeated the design of Experiment 1 with a group of adults with AS/HFA who used the software at home and met in a group with a tutor on a weekly basis . They were matched to a control group of adults with AS/HFA attending social skills training and to a general population control group ( n = 13 for all three groups ) . In both experiments the intervention group improved significantly more than the control group on close , but not distant , generalization tasks . Verbal IQ had significant effects in Experiment 2 . Using Mind Reading for a relatively short period of time allows users to learn to recognize a variety of complex emotions and mental states . However , additional methods are required to enhance generalization Prospect i ve memory ( remembering to carry out an action in the future ) has been studied relatively little in ASD . We explored time-based ( carry out an action at a pre-specified time ) and event-based ( carry out an action upon the occurrence of a pre-specified event )  prospect i ve memory , as well as possible cognitive correlates , among 21 intellectually high-functioning children with ASD , and 21 age- and IQ-matched neurotypical comparison children . We found impaired time-based , but undiminished event-based , prospect i ve memory among children with ASD . In the ASD group , time-based prospect i ve memory performance was associated significantly with diminished theory of mind , but not with diminished cognitive flexibility . There was no evidence that time-estimation ability contributed to time-based prospect i ve memory impairment in ASD This r and omized controlled trial looked at the effect of a new computer program design ed to teach people with autistic spectrum disorders to better recognize and predict emotional responses in others . Two groups of 11 children ( age 12 - 18 ) with autism or Asperger syndrome at two special schools participated :  one group used the computer program for 10 half-hour sessions over 2 weeks . Within-program data showed a significant reduction in errors made from first to last use . Students were assessed pre- and post-intervention using facial expression photographs , cartoons depicting emotion-laden situations , and non-literal stories . Scores were not related to age or verbal ability . The experimental group made gains relative to the control group on all three measures . Gains correlated significantly with the number of times the computer program was used and results suggest positive effects . Further research could assess whether these gains generalized into real life or improved performance on theory of mind measures BACKGROUND Children with autism have difficulties in emotion recognition and a number of interventions have been design ed to target these problems . However , few emotion training interventions have been trialled with young children with autism and co-morbid ID . This study aim ed to evaluate the efficacy of an emotion training programme for a group of young children with autism with a range of intellectual ability . METHODS Participants were 55 children with autistic disorder , aged 4 - 7 years ( FSIQ 42 - 107 ) . Children were r and omly assigned to an intervention ( n = 28 ) or control group ( n = 27 ) . Participants in the intervention group watched a DVD design ed to teach emotion recognition skills to children with autism  ( the Transporters ) , whereas the control group watched a DVD of Thomas the Tank Engine . Participants were assessed on their ability to complete basic emotion recognition tasks , mindreading and theory of mind ( TOM ) tasks before and after the 4-week intervention period , and at 3-month follow-up . RESULTS Analyses controlled for the effect of chronological age , verbal intelligence , gender and DVD viewing time on outcomes . Children in the intervention group showed improved performance in the recognition of anger compared with the control group , with few improvements maintained at 3-month follow-up . There was no generalisation of skills to TOM or social skills . CONCLUSIONS The Transporters programme showed limited efficacy in teaching basic emotion recognition skills to young children with autism with a lower range of cognitive ability . Improvements were limited to the recognition of expressions of anger , with poor maintenance of these skills at follow-up . These findings provide limited support for the efficacy of the Transporters programme for young children with autism of a lower cognitive range Research shows that depression and anxiety disorders are the most common psychiatric concern in autism spectrum disorders ( ASD ) . Mindfulness-based therapy ( MBT ) has been found effective in reducing anxiety and depression symptoms , however research in autism is limited . Therefore , we examined the effects of a modified MBT protocol ( MBT-AS ) in high-functioning adults with ASD . 42 participants were r and omized into a 9-week MBT-AS training or a wait-list control group . Results showed a significant reduction in depression , anxiety and rumination in the intervention group , as opposed to the control group . Furthermore , positive affect increased in the intervention group , but not in the control group . Concluding , the present study is the first controlled trial to demonstrate that adults with ASD can benefit from MBT-AS Objective : This cluster r and omized trial ( CRT ) evaluated the efficacy of the Classroom Social , Communication , Emotional Regulation , and Transactional Support ( SCERTS ) Intervention ( CSI ) compared with usual school-based education with autism training modules ( ATM ) . Method : Sixty schools with 197 students with autism spectrum disorder ( ASD ) in 129 classrooms were r and omly assigned to CSI or ATM .  Mean student age was 6.79 years ( SD 1.05 ) and 81.2 % were male . CSI teachers were trained on the model and provided coaching throughout the school year to assist with implementation . A CRT , with students nested within general and special education classrooms nested within schools , was used to evaluate student outcomes . Results : The CSI group showed significantly better outcomes than the ATM group on observed measures of classroom active engagement with respect to social interaction . The CSI group also had significantly better outcomes on measures of adaptive communication , social skills , and executive functioning with Cohen ’s d effect sizes ranging from 0.31 to 0.45 . Conclusion : These findings support the preliminary efficacy of CSI , a classroom-based , teacher-implemented intervention for improving active engagement , adaptive communication , social skills , executive functioning , and problem behavior within a heterogeneous sample of students with ASD . This makes a significant contribution to the literature by demonstrating efficacy of a classroom-based teacher-implemented intervention with a heterogeneous group of students with ASD using both observed and reported measures The efficacy of a peer-mediated , theatre-based intervention on social competence  in participants with autism spectrum disorder ( ASD ) was tested . Thirty 8-to-14 year-olds with ASD were r and omly assigned to the treatment ( n = 17 ) or a wait-list control ( n = 13 ) group . Immediately after treatment , group effects were seen on social ability , ( d = .77 ) , communication symptoms ( d = −.86 ) , group play with toys in the company of peers ( d = .77 ) , immediate memory of faces as measured by neuropsychological ( d = .75 ) and ERP methods ( d = .93 ) , delayed memory for faces ( d = .98 ) , and theory of mind ( d = .99 ) . At the 2 month follow-up period , group effects were detected on communication symptoms ( d = .82 ) . The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention OBJECTIVE This study evaluated the efficacy of a targeted social skills training group in school-aged children with autism spectrum disorder ( ASD ) . The intervention , Seaver-NETT ( Nonverbal communication , Emotion recognition , and Theory of mind Training ) , is a 12-session cognitive-behavioral intervention ( CBI ) for verbal , school-aged children targeting ASD-specific social behavioral impairments . METHOD Sixty-nine children with ASD , 8 to 11 years of age , with verbal IQs greater than 70 , participated in a r and omized comparative trial to examine the efficacy of NETT relative to a facilitated play group . Treatment outcomes included caregiver reports of social behavior and neuropsychological assessment s of social cognition conducted by blinded raters . Outcomes were collected at baseline , endpoint , and 3 months posttreatment . RESULTS Significant improvements were found on social behavior outcomes such as nonverbal communication , empathic responding , and social relations in the NETT condition relative to the active control at endpoint . Verbal IQ moderated the interaction effect on social behavior , with higher verbal IQ associated with improvements in the CBI condition . No significant improvements were found on social cognitive outcomes . No significant group differences were found at 3-month follow-up conducted with approximately half the sample ( n = 34 ) . CONCLUSION These data indicate that targeted CBI social skills groups such as NETT improve social communication deficits in verbal , school-aged children with ASD . The moderating effects of high verbal IQ suggest a need to consider participant and treatment characteristics associated with outcomes in future studies . Clinical trial registration information-Neural and Behavioral Outcomes of Social Skills Groups in Children With Autism Spectrum Disorder ; https:// clinical trials.gov ; NCT01190917 Autism spectrum disorder ( ASD ) is a neurodevelopmental disorder associated with impaired social and emotional skills , the anatomical substrate of which is still unknown . In this study , we compared a group of 14 high-functioning ASD adults with a group of controls matched for sex , age , intelligence quotient , and h and edness . We used an automated technique of analysis that accurately measures the thickness of the cerebral cortex and generates cross-subject statistics in a coordinate system based on cortical anatomy . We found local decreases of gray matter in the ASD group in areas belonging to the mirror neuron system ( MNS ) , argued to be the basis of empathic behavior . Cortical thinning of the MNS was correlated with ASD symptom severity . Cortical thinning was also observed in areas involved in emotion recognition and social cognition . These findings suggest that the social and emotional deficits characteristic of autism may reflect abnormal thinning of the MNS and the broader network of cortical areas subserving social cognition This study compared cognitive behavioral therapy ( CBT ) and treatment-as-usual ( TAU ) in terms of effects on observed social communication-related autism symptom severity during unstructured play time at school for children with autism spectrum disorders ( ASD ) . Thirteen children with ASD ( 7–11 years old ) were r and omly assigned to 32 sessions of CBT or community-based psychosocial treatment ( TAU ) for 16 weeks . The CBT program is based on the memory retrieval competition model and emphasizes the development of perspective-taking through guided behavioral experimentation supplemented with reflective Socratic discussion and supported by parent training and school consultation to promote generalization of social communication and emotion regulation skills . Trained observers blind to treatment condition observed each child during recess on two separate days at baseline and again at posttreatment , using a structured behavioral observation system that generates frequency scores for observed social communication-related autism symptoms .  CBT outperformed TAU at posttreatment on the frequency of self-isolation , the proportion of time spent with peers , the frequency of positive or appropriate interaction with peers , and the frequency of positive or appropriate peer responses to the target child ( d effect size range 1.34–1.62 ) . On average , children in CBT were engaged in positive or appropriate social interaction with peers in 68.6 % of observed intervals at posttreatment , compared to 25 % of intervals for children in TAU . Further investigation of this intervention modality with larger sample s and follow-up assessment s is warranted This exploratory r and omised controlled trial tested the effectiveness of a tablet-based information communication technology early intervention application to augment existing therapy with the aim of improving visual motor , imitation , language and social skills in young children with ASD who reside in regional areas . Fifty-nine participants were recruited and r and omised to either a therapy-as-usual group or intervention group . With the exception of the expressive language subscale on the Mullen Scales of Early Learning , no significant between-group differences were recorded for visual motor , imitation , receptive language and social skills of participants between baseline and post-intervention . When all participants were pooled and measured over time , improvements were shown in receptive and pragmatic language and social skills ; these gains were maintained , thus suggesting skill acquisition Self-control problems commonly manifest as temper outbursts and repetitive/rigid/impulsive behaviors , in children with autism spectrum disorders ( ASD ) , which often contributes to learning difficulties and caregiver burden . The present study aims to compare the effect of a traditional Chinese Chan-based mind-body exercise , Nei Yang Gong , with that of the conventional Progressive Muscle Relaxation ( PMR ) technique in enhancing the self-control of children with ASD . Forty-six age- and IQ-matched ASD children were r and omly assigned to receive group training in Nei Yang Gong ( experimental group ) or PMR ( control group ) twice per week for four weeks . The participants ’ self-control was measured by three neuropsychological tests and parental rating on st and ardized question naires  , and the underlying neural mechanism was assessed by the participants ’ brain EEG activity during an inhibitory-control task before and after intervention . The results show that the experimental group demonstrated significantly greater improvement in self-control than the control group , which concurs with the parental reports of reduced autistic symptoms and increased control of temper and behaviors . In addition , the experimental group showed enhanced EEG activity in the anterior cingulate cortex , a region that mediates self-control , whereas the PMR group did not . The present findings support the potential application of Chinese Chan-based mind-body exercises as a form of neuropsychological rehabilitation for patients with self-control problems . Chinese Clinical Trial Registry ; Registration No. : ChiCTR-TRC-12002561 ; URL : www.chictr.org
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 setting s , or developmental effects on related skills .
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
BACKGROUND The ' Theory of Mind ' ( ToM ) model suggests that people with autism spectrum disorder ( ASD ) have a profound difficulty underst and ing 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 .