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.