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

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