Development and Psychometric Evaluation of the Chinese Version of the Theory of Mind Inventory-2 (ToMI-2) in Children with Autism Spectrum Disorder

Abstract

Theory of Mind (ToM) is a social cognitive ability to understand the mental states of oneself and others including beliefs desires intentions and thoughts that can be used to interpret and predict others’ behavior The core symptoms of children with autism spectrum disorder (ASD) are impairments in social communication and social interaction which have been found to be related to specific deficits in theory of mind Many assessments have been developed to measure ToM However three issues remain to be discussed about current pediatric assessments as follows: (1) Some tasks such as the Sally & Anne and Smarties tests only assess a single concept of ToM and thus do not cover the whole spectrum of ToM; (2) many measures are limited to children without cognitive or language impairments; and (3) children’s capacity of ToM assessed within a standard laboratory environment may not represent children’s performance of ToM in daily contexts The Theory of Mind Inventory-2 (ToMI-2) developed by Hutchins et al in 2014 may overcome the above-mentioned limitations The ToMI-2 (1) contains concepts covering the whole spectrum of ToM comprehensively; (2) is independent of a child’s cognitive or language ability because it is completed by the child’s caregiver and (3) focuses on performance in the child’s actual daily life instead of in a laboratory context However the ToMI-2 cannot be applied to children in Taiwan because of cultural differences To measure the ToM of Taiwanese children the development of a Chinese version of the ToMI-2 (ToMI-2-C) is warranted Therefore this study had two purposes: (1) to develop the ToMI-2-C; and (2) to evaluate the psychometric properties of the ToMI-2-C This study included two parts: development and psychometric evaluation First the ToMI-2-C was developed in five steps: (1) forward translation from English to Chinese (2) back-translation from Chinese to English (3) synthesis of the original version and back-translation (4) expert validation and content validity and (5) a pilot study with the caregivers Second to the examine the psychometric properties the ToMI-2-C Theory of Mind Task Battery (ToMTB) Childhood Autism Rating Scale (CARS) Social Responsiveness Scale-second edition-school age form (SRS-2) Vineland Adaptive Behavior Scale (VABS) and the verbal comprehension index (VCI) of the Wechsler Intelligence Scale for Children-IV or the Wechsler Preschool and Primary Scale of Intelligence-IV were used for measuring ToM performance ToM capacity symptom severity social interaction and verbal comprehension ability Cronbach’s ? intra-class correlation coefficients (ICC) Pearson’s correlation coefficients (r) and independent t-tests were respectively used to examine the internal consistency test-retest reliability content validity convergent validity and discriminative validity of the ToMI-2-C The ToMI-2-C was developed with culturally-adapted content to fit the Taiwanese cultural context The modifications included changes in content based on cultural differences the modification of characters or sentence patterns and the addition of examples to items Through the standard translation process the culturally-fit ToMI-2-C was established The content validity was also established based on expert consultation In the cognitive debriefing of the pilot study the ToMI-2-C was modified to be understandable based on feedback from the target population A total of 166 children with ASD (mean=83 45 months SD=27 85 months) and 54 children with typical development (mean= 63 07 months SD=12 19 months) of 3 to 12 years of age were recruited in this study The ToMI-2-C was found to have good psychometric properties in children with ASD in Taiwan The results of Cronbach’s ? of the ToMI-2- C showed high internal consistency (Cronbach’s ?=0 965) For the test-retest reliability 30 children in the ASD group completed the test and retest assessments of the ToMI-2-C with a 2-week interval The test-retest reliability of the ToMI-2-C total score was appropriate (ICC=0 88) The results of convergent validity of the ToMI-2-C showed that the scores of the ToMI-2-C had significantly moderate correlation with the scores of the ToMTB (r=0 475 p

Date of Award	2017 Feb 15
Original language	English
Supervisor	Kuan-Lin Chen (Supervisor)