Theory of Mind Deficit is Associated with Pretend Play Performance, but not Playfulness, in Children with Autism Spectrum Disorder.

Only 20 children were studied, so the associations may be unstable and the regression models had limited statistical power. The sample was limited to verbal, relatively high-functioning children with ASD, so findings do not apply to lower-functioning or nonverbal children. The theory of mind test required spoken responses, and the authors say expressive verbal ability could not be separated from theory of mind scores. The study measured associations at one time point and did not test an intervention, so it cannot show that improving theory of mind improves play. No typically developing comparison group was included, so the play scores are interpreted only within this ASD sample.

Do not read this as proof that improving theory of mind will improve playfulness. The study had only 20 verbal children with ASD, and theory of mind did not predict intrinsic motivation or freedom to suspend reality.