Does Theory of Mind Training Enhance Empathy in Autism?
Annaleena Holopainen, Daniëlle M J de Veld, Elske Hoddenbach and 1 others
PMID 30074122WHAT IT FOUND
Children with autism who completed eight weeks of Theory of Mind training showed a small but significant improvement in how they reacted to an adult’s emotions during unscripted interactions.
The control group showed no change. This suggests gains can transfer to real-life social moments.
Key findings
01The intervention group showed a significant increase in observed empathic responsiveness from baseline to post-test, while the waitlist control group did not.
02There was no significant difference between the intervention and control groups in empathic responsiveness when comparing scores at the post-test assessment alone.
03The effect of the training on empathic responsiveness was significant but small, and the result did not remain significant when participants with missing data were excluded from the analysis.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The sample excluded children with lower verbal IQ, limiting generalizability to non-verbal or lower-functioning children with autism. The intervention group had a lower baseline score than the control group, which may have influenced the observed improvement. The result was not significant when participants with missing data were excluded, suggesting the finding is sensitive to how missing data is handled. The study used a waitlist control, which does not account for the effects of group interaction or attention alone. The measure of empathic responsiveness did not correlate with parent-reported measures, raising questions about its clinical validity or what it specifically captures. The sample was heavily male and included a large proportion of children diagnosed with PDD-NOS rather than classic autism.
Declared interests
The study was funded by ZonMw. No other conflicts of interest were declared.
The easy way to misread this
Do not interpret the significant within-group improvement in the intervention arm as proof that the training is superior to no treatment at the end of the study. The direct comparison between the intervention and control groups at post-test was not statistically significant, and the overall effect size was small.