title: Theory of mind predominantly associated with the quality, not quantity, of pretend play in children with autism spectrum disorder.
abstract: This study aimed to clarify the relationships between theory of mind and pretend play in children with autism spectrum disorder, using refined assessments of theory of mind and pretend play while controlling for autistic behaviors and verbal comprehension. A total of 92 children with autism spectrum disorder aged 4-10 years were enrolled. In two visits, the children were assessed with the Theory of Mind Task Battery, the Child-Initiated Pretend Play Assessment, the Childhood Autism Rating Scale, and the Verbal Comprehension Index of the Wechsler Intelligence Scales, respectively, for their theory of mind, pretend play performance, autistic behaviors, and verbal comprehension. The hierarchical regression models showed that in addition to the contributions of the autistic behaviors and verbal comprehension scores, the theory of mind scores positively predicted (p < 0.001) the elaborateness scores of pretend play in the conventional imaginative and symbolic play contexts, respectively, accounting for an additional 8.1 and 18.5% of the variance, but did not predict the scores for number of object substitutions or imitated actions. The findings demonstrate that theory of mind has a predominant role in the quality, not the quantity, of pretend play of children with autism spectrum disorder, when the children's autistic behaviors and verbal comprehension are considered. This study fills a gap in the previous literature and provides information useful for clinicians and researchers on the relationships between theory of mind and pretend play in children with autism spectrum disorder.
authors.affiliation: Department of Psychiatry, Kaohsiung Armed, Forces General Hospital, No. 2, ZhongZheng 1st. Road, Lingya District, Kaohsiung, 802, Taiwan, ROC.
authors.forename: Shu-Kai
authors.initials: SK
authors.lastname: Lin
authors.affiliation: Department of Child and Adolescent Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kaisyuan 2nd. Road, Lingya District, Kaohsiung, 802, Taiwan, ROC.
authors.forename: Ching-Hong
authors.initials: CH
authors.lastname: Tsai
authors.affiliation: Department of Child and Adolescent Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, No. 130, Kaisyuan 2nd. Road, Lingya District, Kaohsiung, 802, Taiwan, ROC.
authors.forename: Hsing-Jung
authors.initials: HJ
authors.lastname: Li
authors.affiliation: Department of Occupational Therapy, College of Medicine, I-Shou University, No.8, Yida Rd., Jiaosu Village, Yanchao District, Kaohsiung, 824, Taiwan, ROC.
authors.forename: Chien-Yu
authors.initials: CY
authors.lastname: Huang
authors.affiliation: Department of Occupational Therapy, College of Medicine, National Cheng Kung University, No. 1, University Road, Tainan, 701, Taiwan, ROC. klchen@mail.ncku.edu.tw.|Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No. 138, ShengLi Road, Tainan, Taiwan, ROC. klchen@mail.ncku.edu.tw.
authors.forename: Kuan-Lin
authors.initials: KL
authors.lastname: Chen
mesh_terms: D000067877:Autism Spectrum Disorder / Q000175:diagnosis* / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007092:Imagination; D008297:Male; D010988:Play and Playthings / Q000523:psychology*; D056345:Theory of Mind / Q000502:physiology*
keywords: Autism spectrum disorder; Pretend play; Theory of mind