Different mediators of applied theory-of-mind competence in children with autism spectrum disorder

Background: Children with autistic spectrum disorder (ASD) with mild and moderate symptom levels have significant differences in applied theory of mind (ToM) competence. However, their mediators of applied ToM competence have not been documented. Aims: This study aimed to identify the mediators of applied ToM competence in these two clinically distinct groups. Methods: A total of 163 children with ASD aged 3–12 years old (88 and 75 children respectively in the mild and moderate groups) and their caregivers participated in this study. Data of children's verbal comprehension, explicit ToM knowledge and applied ToM competence were collected and then analyzed using mediation analysis. Results: The results of mediation analysis showed that verbal comprehension (95% confidence interval [CI] of indirect effect: 0.02 − 0.19) and explicit ToM knowledge (95% CI of indirect effect: 0.01 − 0.07) were the mediators of applied ToM competence in children with mild and those with moderate symptoms, respectively. Conclusions and Implications: Our findings demonstrate that the mediators of applied ToM competence differ by symptom level in children with ASD. Applied ToM competence and the mediators should be assessed for designing tailored and effective intervention plans for these children according to their symptom level.