Steps in Theory-of-Mind Development in Hong Kong Cantonese-Speaking Children with and without Autism

ABSTRACT

It has been debated whether the progressive emergence of theory of mind (ToM) in autistic children is compatible with a ”delayed” or ”different” development model, and whether and how the sequential consolidation of ToM concepts is subject to cross-cultural variations in autistic and typically developing (TD) children. To study these questions, we examined ToM development in autistic children and TD children in Hong Kong (HK). Using an established five-step ToM scale, we measured five ToM abilities in 37 autistic children (M =  6.41 years) and 142 TD children (M =  5.81 years); the two samples were equivalent on verbal mental age. We found that the development of ToM abilities was delayed in autistic children relative to TD children. Moreover, the developmental sequence of ToM of autistic children also differed from that of TD children. Specifically, the sequence observed in autistic children was knowledge access (KA) > diverse desires (DD) > diverse beliefs (DB) > false belief (FB) > hidden emotion (HE), while TD children acquired DD before KA. Additionally, both autistic and TD children in HK mastered KA before DB like their peers from other Eastern countries, but in contrast to Western children who reportedly develop DB earlier than KA. This suggests that HK children are strongly influenced by Eastern culture despite growing up in an East-meets-West society

Acknowledgement

We thank all participating children and their parents for their cooperation. We are grateful to LoveXpress Foundation Limited and Speech Therapy Unit at the Hong Kong Polytechnic University for recruitment of the participants. We would also like to thank Sally Chan, Cynthia Chow, Janice Chu, and Caroline Wong for their help in preparing the materials for this study. We are greatly indebted to the anonymous reviewers for the valuable comments and suggestions on an earlier version of this paper. Special thanks go to Hazel Chan, Sally Chan, Rhea Chim, Hiu Wan Chong, Cynthia Chow, Janice Chu, Vivian Fung, Janice Ho, Winnie Ho, Isaac Kan, Gary Lau, Kelly Lau, Sean Lee, Wendy Leung, Mandee Lung, Caroline Wong, Peter Yeung, and To Ze-To for their help with data collection.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/15248372.2022.2100397

Notes

¹ See e.g., https://www.hofstede-insights.com/product/compare-countries/

² This work takes into the account the opinions of individuals who have received a diagnosis of autism regarding the terms used to refer to them, and more specifically the preference of most autistic adults in the UK and Australia for identity-first (autistic person) over person-first language (person with autism) language (Bury, Jellett, Spoor, & Hedley, 2020; Kenny et al., 2016). Moreover, it seems that the use of person-first language currently prevalent in scientific discourse may exacerbate the stigma associated with autism (e.g., Gernsbacher, 2017). The current manuscript thus consistently applies identity-first language (see also Botha 2021; Bottema-Beutel, Kapp, Lester, Sasson, & Hand, 2021).

³ An exclusionary criterion of the current study was having comorbid attention deficit hyperactivity disorder because our tasks were administered in one session of approximately two hours, and it would have been difficult for children with attention deficit hyperactivity disorder to complete all tasks in the allotted amount of time.

⁴ 11.76% participants in the autistic group and 18.44% participants in the TD were attending private kindergarten/primary school.

⁵ The participants’ kindergartens and primary schools are distributed in the three areas of HK: Kowloon, New Territories, and HK Island. The proportions of the three areas where autistic children went to school were 58.82%, 29.41%, and 11.76%, and the proportions in TD group were 58.82%, 31.91%, and 17.73%.

Additional information

Funding

This work was supported by Departmental General Research Fund from the Hong Kong Polytechnic University [4-ZZJR] and General Research Fund from the Research Grants Council of the University Grants Committee of Hong Kong [15608318] awarded to Candice Chi-Hang Cheung.