Characterising the relationship between theory of mind and anxiety in children with Autism Spectrum Disorder and typically developing children

Background: Social communication impairments associated with Autism Spectrum Disorder (ASD) is a multi-faceted phenomenon that encapsulates a broad range of skills with Theory of Mind (ToM) as a key component. Early Theory of Mind (ToM) skills, such as joint attention, typically develop during infancy and provide a foundation for the co-emergence of affect regulation via social referencing. Children with Autism Spectrum Disorder (ASD) demonstrate delays and impairments in the development of ToM, and up to 40% of children with ASD also experience co-occurring symptoms of anxiety and poor affect regulation. Method: Using parent report, this cross-sectional study aimed to characterise the relationship between ToM competency and anxiety, and explore how specific ToM deficits may confer vulnerability to anxiety in children (4–8 years old) with ASD. Results: Early ToM skills, such as joint attention and social referencing, mediated the relationship between broader social communication impairments and anxiety symptom severity in children with ASD. Conclusions: Increasing competency of early ToM skills might provide additional therapeutic benefits for clinical interventions targeting anxiety in children with ASD.