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

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Title: Steps in Theory-of-Mind Development in Hong Kong Cantonese-Speaking Children with and without Autism
Language: English
Authors: Chi-Hang Cheung, Candice (ORCID 0000-0002-1502-5724), Rong, Yicheng (ORCID 0000-0003-4998-3856), Durrleman, Stephanie (ORCID 0000-0003-1883-5703)
Source: Journal of Cognition and Development. 2022 23(5):732-750.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 19
Publication Date: 2022
Document Type: Journal Articles
Reports - Research
Education Level: Elementary Education
Early Childhood Education
Kindergarten
Primary Education
Descriptors: Theory of Mind, Autism Spectrum Disorders, Young Children, Perspective Taking, Cognitive Development, Cognitive Processes, Foreign Countries, Child Development, Beliefs, Emotional Response, Knowledge Level, Asian Culture, Cultural Influences, Sino Tibetan Languages, Western Civilization, Students with Disabilities, Elementary School Students, Kindergarten
Geographic Terms: Hong Kong
Assessment and Survey Identifiers: Reynell Developmental Language Scales
DOI: 10.1080/15248372.2022.2100397
ISSN: 1524-8372
1532-7647
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
Abstractor: As Provided
Entry Date: 2023
Accession Number: EJ1369609
Database: ERIC
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  Value: <anid>AN0159933724;7m701oct.22;2022Nov01.06:01;v2.2.500</anid> <title id="AN0159933724-1">Steps in Theory-of-Mind Development in Hong Kong Cantonese-Speaking Children with and without Autism </title> <p>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</p> <p>Theory of mind (ToM) refers to the ability to conceptualize and reason about mental states (beliefs, thoughts, feelings, desires, emotions, or intentions) so as to predict or explain behavior (Premack & Woodruff, [<reflink idref="bib55" id="ref1">55</reflink>]; Wellman, [<reflink idref="bib74" id="ref2">74</reflink>], [<reflink idref="bib75" id="ref3">75</reflink>], [<reflink idref="bib76" id="ref4">76</reflink>]). This skill, crucial for successful social interactions (Astington, [<reflink idref="bib4" id="ref5">4</reflink>]; Gweon & Saxe, [<reflink idref="bib29" id="ref6">29</reflink>]; Hughes, Ensor, & Marks, [<reflink idref="bib35" id="ref7">35</reflink>]), develops in stages throughout childhood. The stages of ToM acquisition can be measured via a series of tasks that have been found to form a developmental scale (Wellman & Liu, [<reflink idref="bib71" id="ref8">71</reflink>]), indicating that certain aspects of mind reading are consolidated before others. For instance, reasoning about desires is a milestone that precedes reasoning about beliefs (Bartsch & Wellman, [<reflink idref="bib8" id="ref9">8</reflink>]; Flavell, Flavell, Green, & Moses, [<reflink idref="bib21" id="ref10">21</reflink>]; Gopnik & Slaughter, [<reflink idref="bib26" id="ref11">26</reflink>]; Peterson, Wellman, & Liu, [<reflink idref="bib52" id="ref12">52</reflink>]; Wellman & Liu, [<reflink idref="bib71" id="ref13">71</reflink>]; Wellman & Woolley, [<reflink idref="bib70" id="ref14">70</reflink>]). While certain ToM capacities, such as desire-reasoning and belief-reasoning, seem to obey a universal sequence, others have been reported to vary across populations. In this paper we are concerned with two sources of potential variation in the consolidation of the developmental sequence of ToM skills: cultural and clinical.</p> <hd id="AN0159933724-2">Variation in ToM development: West vs. East</hd> <p>While some studies suggest ToM develops universally across cultures (e.g., Callaghan et al., [<reflink idref="bib14" id="ref15">14</reflink>]; Sabbagh, Xu, Carlson, Moses, & Lee, [<reflink idref="bib60" id="ref16">60</reflink>]), a meta-analysis by Liu, Wellman, Tardif, and Sabbagh ([<reflink idref="bib43" id="ref17">43</reflink>]) revealed cultural variation in the consolidation of ToM concepts. Children growing up in Western cultures, including those of North America, Australia, and Germany, reportedly obey the following order during the acquisition of ToM concepts (Kristen, Thoermer, Hofer, Aschersleben, & Sodian, [<reflink idref="bib38" id="ref18">38</reflink>]; Peterson et al., [<reflink idref="bib52" id="ref19">52</reflink>]; Wellman, Fang, & Peterson, [<reflink idref="bib73" id="ref20">73</reflink>]; Wellman & Liu, [<reflink idref="bib71" id="ref21">71</reflink>]):</p> <p>(<reflink idref="bib1" id="ref22">1</reflink>) people can have <bold>diverse desires</bold> (<bold>DD</bold>), i.e., they may want different things</p> <p>(<reflink idref="bib2" id="ref23">2</reflink>) people can have <bold>diverse beliefs</bold> (<bold>DB</bold>), i.e., they may have different opinions</p> <p>(<reflink idref="bib3" id="ref24">3</reflink>) people's <bold>knowledge</bold> can be limited by not having <bold>access</bold> to certain information (<bold>KA</bold>), i.e., without witnessing an event, they may not know about it</p> <p>(<reflink idref="bib4" id="ref25">4</reflink>) people can hold a <bold>false belief</bold> (<bold>FB</bold>), i.e., what they think is true may not correspond to reality</p> <p>(<reflink idref="bib5" id="ref26">5</reflink>) people can <bold>hide</bold> their <bold>emotions</bold> (<bold>HE</bold>), i.e., the emotion they show may not correspond to what they feel</p> <p>Children from Eastern cultures, however, show a difference in this sequence specifically for DB and KA tasks: Children growing up in mainland China, in Iran, and in Turkey have been found to understand that people differ in their access to knowledge before they grasp that people differ in their beliefs (Selcuk, Brink, Ekerim, & Wellman, [<reflink idref="bib62" id="ref27">62</reflink>]; Shahaeian, Peterson, Slaughter, & Wellman, [<reflink idref="bib63" id="ref28">63</reflink>]; Wellman, Fang, Liu, Zhu, & Liu, [<reflink idref="bib72" id="ref29">72</reflink>]; Wellman et al., [<reflink idref="bib73" id="ref30">73</reflink>]; Zhang, Shao, & Zhang, [<reflink idref="bib81" id="ref31">81</reflink>]). One possible explanation for the cross-cultural difference is that the social experiences of children growing up in Western or Eastern cultures may differentially emphasize notions of knowledge and belief, thus promoting earlier reflection on beliefs in one culture and on knowledge in the other.</p> <p>Specifically, independent, critical thinking and diversity of opinions has been argued to be at the fore in the conversational environment of children in the West, while acquiring knowledge from those in a position of authority, consensual learning, and adherence to the views and traditions of the community is emphasized in the East (Bartsch & Wellman, [<reflink idref="bib8" id="ref32">8</reflink>]; Markus & Kitayama, [<reflink idref="bib46" id="ref33">46</reflink>]; Nisbett, [<reflink idref="bib49" id="ref34">49</reflink>]; Tardif & Wellman, [<reflink idref="bib66" id="ref35">66</reflink>]; Wang et al., [<reflink idref="bib69" id="ref36">69</reflink>]). This emphasis on acquiring knowledge from others allows children growing up in Eastern cultures to develop an acute awareness of the difference between being ignorant and being knowledgeable, and contributes to the acquisition of KA.</p> <p>The current study seeks to extend the investigation of the emergence of the ToM scale to another Eastern society: that of Hong Kong (HK) (Bond & Cheung, [<reflink idref="bib9" id="ref37">9</reflink>]). HK, a special administrative region of China, was a British colony (Tsang, [<reflink idref="bib68" id="ref38">68</reflink>]). Because of the Western influence on the Eastern society, HK is an ideal region for examining the East-West differences in ToM development. Although HK is more "Westernized" than mainland China, it fundamentally remains a collectivist society.[<reflink idref="bib1" id="ref39">1</reflink>] If children from HK show the KA > DB developmental progression like their peers from other Eastern countries, and in contrast to Western children, who reportedly show a DB > KA sequence, this would underscore the importance of such a collectivist environmental influence on the development of these initial ToM steps.</p> <hd id="AN0159933724-3">Variation in ToM development: TD vs. ASD</hd> <p>Differences in the development of mentalizing abilities have also been noted between TD children and children diagnosed as having autism spectrum disorder (ASD),[<reflink idref="bib2" id="ref40">2</reflink>] a neurodevelopmental condition associated with ToM difficulties (Baron-Cohen, [<reflink idref="bib7" id="ref41">7</reflink>]; Baron-Cohen, Leslie, & Frith, [<reflink idref="bib6" id="ref42">6</reflink>]; Girli, [<reflink idref="bib24" id="ref43">24</reflink>]; Peterson, Garnett, Kelly, & Attwood, [<reflink idref="bib53" id="ref44">53</reflink>]; Roeyers & Demurie, [<reflink idref="bib58" id="ref45">58</reflink>]; Yirmiya, Erel, Shaked, & Solomonica-Levi, [<reflink idref="bib80" id="ref46">80</reflink>]; but see Gernsbacher & Yergeau, [<reflink idref="bib23" id="ref47">23</reflink>]). Some authors observe that ToM skills in autistic children respect the same developmental sequence found in TD children, only emerging more slowly, thus supporting a "delayed development model" (Hoogenhout & Malcolm-Smith, [<reflink idref="bib34" id="ref48">34</reflink>]). However, other authors report differences in the order of acquiring mental state attribution in ASD, which may moreover plateau before attaining TD levels, in line with a "different development model" (Peterson et al., [<reflink idref="bib52" id="ref49">52</reflink>]; Peterson, Wellman, & Slaughter, [<reflink idref="bib54" id="ref50">54</reflink>]; Zhang et al., [<reflink idref="bib81" id="ref51">81</reflink>]). Thus, whether ToM in ASD is delayed or different is still a matter of debate (Hoogenhout & Malcolm-Smith, [<reflink idref="bib34" id="ref52">34</reflink>]).</p> <p>Two studies have addressed the developmental sequence of Wellman and Liu's ([<reflink idref="bib71" id="ref53">71</reflink>]) ToM scale in different regions and among TD and autistic children: Zhang et al.'s ([<reflink idref="bib81" id="ref54">81</reflink>]) study focused on mainland Chinese children, and Peterson and colleagues' work ([<reflink idref="bib52" id="ref55">52</reflink>], [<reflink idref="bib54" id="ref56">54</reflink>]) focused on Australian children. Discrepancies in the ToM scale in autistic children have been observed on both easier tasks, situated at the beginning of the scale, as well as more complex ones, situated closer to the upper end. Starting with the easier tasks, mainland Chinese autistic children show the DB > KA progression, in contrast to their mainland Chinese TD peers, who, as mentioned above, adhere to the KA > DB order (Zhang et al., [<reflink idref="bib81" id="ref57">81</reflink>]). However, Australian autistic children behave like their TD peers by respecting the DB > KA order (Peterson et al., [<reflink idref="bib52" id="ref58">52</reflink>], [<reflink idref="bib54" id="ref59">54</reflink>]). All autistic children studied to date, cross-culturally, understand diversity of beliefs before understanding that perceptual access leads to knowledge.</p> <p>Concerning the harder tasks on the ToM scale, Australian autistic children show the HE > FB order, which is the opposite of their TD peers who follow an FB > HE progression (Peterson et al., [<reflink idref="bib52" id="ref60">52</reflink>], [<reflink idref="bib54" id="ref61">54</reflink>]). Mainland Chinese autistic children and their Chinese TD peers show the developmental sequence FB > HE (Zhang et al., [<reflink idref="bib81" id="ref62">81</reflink>]), like the Australian TD children. Therefore, only autistic children from Australia reportedly differ from their TD peers in the order of acquiring these more complex mind-reading notions.</p> <p>The potential source of these various findings regarding ToM development in ASD remains unclear. It has been proposed that in Eastern societies, the parents of children on the spectrum may form a micro-culture (Zhang et al., [<reflink idref="bib81" id="ref63">81</reflink>]): Faced with the specific communicative challenges of their children, they would more emphatically promote the children's expression of their personal desires than the acquisition of skills and knowledge, which is opposite to the pedagogical approach generally applied at the macro-cultural level of collectivist societies. As a result, mainland Chinese autistic children would gain practice in consolidating the concept of DB before that of KA, in contrast to their TD peers. In this respect, autistic children from the East would have experiences similar to those of children growing up in individualistic communities; thus, the DB > KA sequence would be shared by all of these populations, with only TD children from the East showing KA > DB.</p> <p>Regarding the harder tasks on the scale, recall that the HE > FB discrepancy was only observed in autistic children from Australia – not in mainland China, where autistic and TD children behaved similarly. Thus, the idea of a micro-culture associated with ASD parenting across cultures is not easily tenable in this case, as it would remain to be explained why this would not hold for Chinese parents of autistic children. Peterson and colleagues ([<reflink idref="bib54" id="ref64">54</reflink>]) have suggested that because autistic children are often exposed to contexts where they are excluded or made fun of (Attwood, [<reflink idref="bib5" id="ref65">5</reflink>]), they would gain practice with having to conceal their emotions earlier than their TD peers (Peterson et al., [<reflink idref="bib54" id="ref66">54</reflink>]). However, this view would lead us to expect HE > FB order in autistic children from Eastern cultures as well, since they are also victims of bullying (Chou et al., [<reflink idref="bib17" id="ref67">17</reflink>]); but as noted, this is not what Zhang et al. ([<reflink idref="bib81" id="ref68">81</reflink>]) observed. The current study seeks to better elucidate the potential discrepancy and/or delay associated with ToM development in ASD, extending the empirical coverage to children on the spectrum growing up in HK.</p> <hd id="AN0159933724-4">The current study</hd> <p>The current study thus aimed to shed light on the two potential sources of variation in ToM development discussed above, namely clinical and cultural, by addressing the following two questions:</p> <p>First, does the ToM development in HK autistic children speaking Cantonese pattern like that observed for Mandarin-speaking autistic children in mainland China? If so, both "delayed" and "different" development models could exist in the course of ToM development in HK autistic children. Specifically, we expect that autistic children will show significantly lower performance than TD children in the five ToM tasks, but that autistic children's ToM skills will be affected by their verbal mental age along the lines of that attested in TD children. Put differently, all children who are older in verbal mental age (be they autistic or TD) will perform better on ToM tasks than those who are younger in verbal mental age. In addition to observing difficulties in autistic children compared to TD children on the ToM tasks, we also expect that the developmental sequence of the five ToM skills in autistic children will differ from their TD peers.</p> <p>Second, does the ToM development in HK autistic and TD children show cross-cultural variation as compared to their peers from Western cultures? If so, we should again find the TD children adhering to the KA > DB order that is prevalent in collectivist societies, in contrast to the DB > KA order observed in their peers from Western, individualist cultures. The autistic group, potentially forming a micro-individualistic-culture, may behave like their Western TD peers as well as the autistic children growing up in mainland China, thus revealing a progression from DB to KA.</p> <p>To address the first question, we investigated the development of a five-step ToM scale (Wellman & Liu, [<reflink idref="bib71" id="ref69">71</reflink>]) in HK autistic children compared to their TD peers. To address the second question, we compared the results of this study with previous results from mainland China (Zhang et al., [<reflink idref="bib81" id="ref70">81</reflink>]) and Australia (Peterson et al., [<reflink idref="bib52" id="ref71">52</reflink>]), both for autistic and TD children.</p> <hd id="AN0159933724-5">Method</hd> <p></p> <hd id="AN0159933724-6">Participants</hd> <p>Thirty-seven autistic children (<emph>M</emph> = 6.41 years, SD = 1.78) and 142 TD children (<emph>M</emph> = 5.81 years, SD = 1.85) participated in the study. All children were students in mainstream kindergartens and primary schools in HK, and they were monolingual speakers of Cantonese. Exclusion criteria for the TD children were diagnosis or suspicion of a language or mental health disorder or a learning disability. Autistic children were recruited through the Speech Therapy Unit at the Hong Kong Polytechnic University and the LoveXpress Foundation Limited, a nonprofit charitable organization. To participate in this study, all autistic children had to have received an official clinical diagnosis of ASD by a pediatrician or a clinical psycholinguist in a government setting, either in child assessment centers or in public hospitals using the criteria in the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, [<reflink idref="bib2" id="ref72">2</reflink>]) and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, [<reflink idref="bib3" id="ref73">3</reflink>]). All clinical records were inspected, and children whose records lacked detailed information about the official source of diagnosis or who had a diagnosed psychiatric illness or a comorbid condition (e.g., attention deficit hyperactivity disorder[<reflink idref="bib3" id="ref74">3</reflink>]) were excluded.</p> <p>To ensure the children could fully understand the instructions of tasks, only those who scored above −1.25 SD on standardized language tests (described below) were included. A −1.25 SD cutoff was chosen because speech-language pathologists in HK use this level to identify a child as having a language impairment.</p> <p>Ethical approval for the study was obtained from the Human Subjects Ethics Subcommittee at the Hong Kong Polytechnic University, and all participants' parents/guardians read and signed a written informed consent form prior to the commencement of the investigation.</p> <hd id="AN0159933724-7">Tasks and procedures</hd> <p>The present study involved three tasks: the five-step ToM scale, the receptive subtest of the Reynell Developmental Language Scale or the Test of HK Cantonese Grammar, and the Primary Test of Nonverbal Intelligence. Participants were tested individually. Each task was administered in Cantonese, and the task administration order was randomized. All participants were tested in quiet rooms at the Hong Kong Polytechnic University.</p> <hd id="AN0159933724-8">ToM scale</hd> <p>The five-step ToM scale developed by Wellman and Liu ([<reflink idref="bib71" id="ref75">71</reflink>]) was used to examine participants' ToM development. This scale includes five tasks assessing children's understanding of diverse desires (DD), diverse beliefs (DB), knowledge access (KA), false belief (FB), and hidden emotion (HE). Zhang and colleagues ([<reflink idref="bib81" id="ref76">81</reflink>]) translated the initial scale from English into Chinese for their study of autistic and TD children growing up in mainland China, showing that the translated version is suitable for autistic children. Therefore, the five-step ToM scale implemented in the present study was modeled closely on the Chinese version, and its back-translation (see online supplementary material) was checked by native speakers to ensure similarity with both the versions of Zhang et al. ([<reflink idref="bib81" id="ref77">81</reflink>]) and Peterson et al. ([<reflink idref="bib52" id="ref78">52</reflink>]).</p> <p>All tasks were presented with the aid of full-color pictures and/or puppets. As in Zhang and colleagues' ([<reflink idref="bib81" id="ref79">81</reflink>]) study, DD and DB tasks involved one test question, and KA, FB, and HE tasks involved both test and control questions. For the former two tasks, participants who gave correct responses to test questions were considered to pass; for the latter three tasks, participants who gave correct responses to both test and control questions were considered to pass.</p> <hd id="AN0159933724-9">Language ability</hd> <p>To assess the participants' language ability, we administered the receptive subtest of the Reynell Developmental Language Scale (Reynell & Huntley, [<reflink idref="bib57" id="ref80">57</reflink>]) for children below 5 years of age, and the Test of HK Cantonese Grammar, a subtest of the HK Cantonese Oral Language Assessment Scale (T'sou et al.'s, [<reflink idref="bib64" id="ref81">64</reflink>]), for children 5 years of age or above.</p> <p>The Reynell Developmental Language Scale was first developed to measure English-speaking children's language abilities and later was adapted for HK Cantonese-speaking children (HK Society for Child Health and Development, [<reflink idref="bib32" id="ref82">32</reflink>]). Test norms were based on results from 1,081 HK children between 1 and 7 years of age (see Klee, Wong, Stokes, Fletcher, & Leonard, [<reflink idref="bib37" id="ref83">37</reflink>] for a review). The receptive subtest of the Reynell Developmental Language Scale includes 67 increasingly complex items. This subtest examines children's vocabulary knowledge, syntactic ability, and semantic skill, including comprehension of single words, understanding of role assignment, interpretation of spatial relations between objects, and inferencing. A participant's score is the sum of correct responses, one point for each; the maximum score is 67.</p> <p>The HK Cantonese Oral Language Assessment Scale was originally designed for HK preschool and primary school children. Test norms were based on results from 1,120 HK children aged between 4 years 10 months and 12 years 1 months (Klee et al., [<reflink idref="bib37" id="ref84">37</reflink>]). The Test of HK Cantonese Grammar is a subtest developed to measure receptive and expressive knowledge of Cantonese grammar. In the test, participants were asked to identify pictures matching the sentences they hear and answer questions that examine specific grammatical morphemes. The test also assessed participants' ability to judge the grammaticality of complex sentences and to produce complex sentences themselves. The maximum score on this subtest is 83.</p> <p>Both standardized language tests yielded a participant's verbal mental age based on the raw score of the test and the participant's chronological age.</p> <hd id="AN0159933724-10">Nonverbal intelligence</hd> <p>The Primary Test of Nonverbal Intelligence (Ehrler & McGhee, [<reflink idref="bib20" id="ref85">20</reflink>]) was used to assess participants' nonverbal intelligence. This test is designed for evaluating nonverbal intelligence in children aged between 3 years and 9 years 11 months from diverse language backgrounds (Ehrler & McGhee, [<reflink idref="bib20" id="ref86">20</reflink>]). The test has been previously used to examine Chinese-speaking children's nonverbal intelligence (e.g., Hao et al., [<reflink idref="bib30" id="ref87">30</reflink>]; Liu et al., [<reflink idref="bib44" id="ref88">44</reflink>]). We administered the test following the Chinese test directions provided in the manual. In this test, participants were asked to choose from a series of pictures the one that does not belong with the others. There are 75 items in total, which become increasingly difficult. Easier items assess visual and spatial perception, while more difficult ones assess analogical thinking, categorical formulation, and sequential reasoning. The starting item varies in different age groups: Item 1 for children aged below 5 years, Item 15 for children aged between 5 years and 6 years 11 months, and Item 30 for children aged 7 years or above. The test ended once the participant missed five out of seven consecutive items.</p> <hd id="AN0159933724-11">Results</hd> <p></p> <hd id="AN0159933724-12">Autistic and TD sample characteristics</hd> <p>Table 1 shows the descriptive characteristics (means and standard deviations) of the two groups of children. The autistic children were significantly older than TD children (Mann-Whitney <emph>U</emph> = 2074.50, <emph>p</emph> =.049). However since we excluded children who scored below 1.25 standard deviations on the standardized language measures, the autistic and TD groups were, on average, equivalent on verbal mental age (Mann-Whitney <emph>U</emph> = 2534.00, <emph>p</emph> =.738). Additionally, the autistic and TD groups were equivalent on nonverbal intelligence (<emph>U</emph> = 2530.00, <emph>p</emph> =.730).</p> <p>Table 1. Descriptive characteristics of autistic and TD Children.</p> <p> <ephtml> <table><thead><tr><td /><td>Autistic group</td><td>TD group</td></tr></thead><tbody><tr><td>Number of participants</td><td>37</td><td>142</td></tr><tr><td>Chronological age (<italic>SD</italic>) in months</td><td>76.89 (21.39)</td><td>69.68 (22.20)</td></tr><tr><td>Chronological age range in months</td><td>42–118</td><td>38–113</td></tr><tr><td>Verbal mental age (<italic>SD</italic>) in months</td><td>93.38 (32.13)</td><td>93.49 (36.35)</td></tr><tr><td>Verbal metal age range in months</td><td>40–144</td><td>38–144</td></tr><tr><td>Nonverbal intelligence (<italic>SD</italic>)</td><td>115.49 (17.62)</td><td>116.29 (16.26)</td></tr></tbody></table> </ephtml> </p> <p>Finally, Fisher's Exact Tests showed that autistic and TD children were comparable in the percent attending private kindergarten/primary school[<reflink idref="bib4" id="ref89">4</reflink>] (<emph>p</emph> =.453) as well as regarding the areas[<reflink idref="bib5" id="ref90">5</reflink>] where they went to school (<emph>p</emph> =.637).</p> <hd id="AN0159933724-13">Group comparison</hd> <p>We examined the performance of autistic and TD children on the five ToM tasks. Table 2 shows the proportions of children passing each task in the two groups. A Pearson's chi-square test showed that the percentage of autistic children passing each of the five tasks did not differ significantly from the percentage of TD children passing each of the tasks (all <emph>p</emph>s >.05), suggesting that the autistic participants performed as well on the ToM tasks as their significantly younger TD peers.</p> <p>Table 2. Performance of autistic and TD children on the five ToM tasks.</p> <p> <ephtml> <table><thead><tr><td /><td>Autistic group</td><td>TD group</td></tr></thead><tbody><tr><td>Diverse desires</td><td>86.49%</td><td>93.76%</td></tr><tr><td>Diverse beliefs</td><td>67.57%</td><td>69.01%</td></tr><tr><td>Knowledge access</td><td>91.89%</td><td>85.92%</td></tr><tr><td>False belief</td><td>59.46%</td><td>61.27%</td></tr><tr><td>Hidden emotion</td><td>18.92%</td><td>29.58%</td></tr></tbody></table> </ephtml> </p> <p>An ordinal regression model was conducted using the rms package (Harrell, [<reflink idref="bib31" id="ref91">31</reflink>]) to examine whether the autistic group differed from the TD group in their performance on the five ToM tasks after controlling for chronological age. The dependent variable of the model was the total score on the five ToM tasks. The result showed a significant difference between the two groups of children in terms of their performance in the ToM tasks (<emph>Z</emph> = 2.67, <emph>p</emph> =.007, <emph>SE</emph> =.35). Specifically, the autistic group scored significantly lower than the TD group on the ToM tasks after the effect of chronological age was controlled for.</p> <p>Two linear regressions were conducted to examine the influence of verbal mental age on ToM development in the two groups of children. In both regressions, the total score on the five ToM tasks was the dependent variable, and verbal mental age was the independent variable. The regression analyses showed that in both groups, verbal mental age significantly predicted their total scores on the five ToM tasks. For the autistic group, <emph>R<sups>2</sups></emph> =.24, <emph>B</emph> =.23, and <emph>F</emph> (<reflink idref="bib1" id="ref92">1</reflink>, 35) = 11.19 (<emph>p</emph> =.002); for the TD group, <emph>R<sups>2</sups></emph> =.48, <emph>B</emph> =.31, and <emph>F</emph> (<reflink idref="bib1" id="ref93">1</reflink>, 140) = 131.58 (<emph>p</emph> <.001). Figure 1 illustrates the developmental trajectories of ToM abilities in the two groups of children, and the slopes indicate the developmental rates. Welch's <emph>t</emph>-test revealed no significant difference between the slopes of the two regression equations (<emph>p</emph> =.286). The combination of the results of the ordinal regression analysis and the two linear regression analyses suggested that although autistic children scored lower on the five ToM tasks relative to TD children, the developmental rates of ToM skills in the two groups were not significantly different when verbal mental age was the predictor.</p> <p>Graph: Figure 1. Developmental trajectories of ToM in autistic and TD children.</p> <hd id="AN0159933724-14">Developmental sequence of ToM skills</hd> <p></p> <hd id="AN0159933724-15">Guttman scale analyses</hd> <p>The developmental sequences of ToM skills in the two groups were examined using Guttman scale analyses. Guttman scale analyses assess how well an observed order of item difficulty matches the theoretical prediction of a perfectly ordered scale (Green, [<reflink idref="bib27" id="ref94">27</reflink>]). In a perfectly ordered scale, any participant who passes a more difficult item will have passed all the easier ones in the scale, and none of the participants who passes a more difficult item will have failed in any of the easier ones. Table 3 shows the number of autistic and TD children whose pass (indicated by "+") and fail (indicated by "–") responses conformed to the Guttman scale patterns and other patterns, along with the coefficient of reproducibility and the index of consistency.</p> <p>Table 3. Guttman scale patterns in autistic and TD children.</p> <p> <ephtml> <table><thead><tr><td /><td /><td>Pattern 1</td><td>Pattern 2</td><td>Pattern 3</td><td>Pattern 4</td><td>Pattern 5</td><td>Pattern 6</td><td>Other patterns</td><td>N</td><td>CR</td><td>IC</td></tr></thead><tbody><tr><td>Autistic group</td><td>HE</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>+</td><td /><td /><td /><td /></tr><tr><td>FB</td><td>–</td><td>–</td><td>–</td><td>–</td><td>+</td><td>+</td><td /><td /><td /><td /></tr><tr><td>DB</td><td>–</td><td>–</td><td>–</td><td>+</td><td>+</td><td>+</td><td /><td /><td /><td /></tr><tr><td>DD</td><td>–</td><td>–</td><td>+</td><td>+</td><td>+</td><td>+</td><td /><td /><td /><td /></tr><tr><td>KA</td><td>–</td><td>+</td><td>+</td><td>+</td><td>+</td><td>+</td><td /><td /><td /><td /></tr><tr><td /><td>1</td><td>2</td><td>1</td><td>8</td><td>9</td><td>6</td><td>10</td><td>37</td><td>.95</td><td>.39</td></tr><tr><td>TD group</td><td>HE</td><td>–</td><td>–</td><td>–</td><td>–</td><td>–</td><td>+</td><td /><td /><td /><td /></tr><tr><td>FB</td><td>–</td><td>–</td><td>–</td><td>–</td><td>+</td><td>+</td><td /><td /><td /><td /></tr><tr><td>DB</td><td>–</td><td>–</td><td>–</td><td>+</td><td>+</td><td>+</td><td /><td /><td /><td /></tr><tr><td>KA</td><td>–</td><td>–</td><td>+</td><td>+</td><td>+</td><td>+</td><td /><td /><td /><td /></tr><tr><td>DD</td><td>–</td><td>+</td><td>+</td><td>+</td><td>+</td><td>+</td><td /><td /><td /><td /></tr><tr><td /><td>4</td><td>11</td><td>9</td><td>23</td><td>29</td><td>36</td><td>30</td><td>142</td><td>.96</td><td>.52</td></tr></tbody></table> </ephtml> </p> <p>1 Note: HE = hidden emotion; FB = false belief; DB = diverse beliefs; KA = knowledge access; DD = diverse desires; CR = coefficient of reproducibility; IC = index of consistency.</p> <p>For the TD children, 112 out of the 142 participants (79%) fit the Guttman scale pattern: DD > KA > DB > FB > HE. The coefficient of reproducibility was.96 (values greater than.90 indicate scalable items; Green, [<reflink idref="bib27" id="ref95">27</reflink>]). The index of consistency, which assessed whether the coefficient of reproducibility was greater than what could be expected by chance alone, was.52 (values greater than.5 are considered significant; Green, [<reflink idref="bib27" id="ref96">27</reflink>]). These results suggest that the developmental sequence DD > KA > DB > FB > HE was highly reproducible and consistent among the TD children.</p> <p>However, autistic children displayed a clearly different pattern from TD children. Specifically, 27 out of the 37 autistic participants (73%) fit the Guttman scale pattern: KA > DD > DB > FB > HE, which differed from that of the TD children with respect to the order of DD and KA (i.e., DD > KA). The coefficient of reproducibility was.95, and the index of consistency was.39. These results indicate that the developmental sequence KA > DD > DB > FB > HE was reproducible but not consistent among the autistic children. To confirm whether the autistic children followed the developmental sequence KA > DD > DB > FB > HE, Rasch analyses (Rasch, [<reflink idref="bib56" id="ref97">56</reflink>]) were conducted.</p> <hd id="AN0159933724-16">Rasch analyses</hd> <p>Rasch model fit statistics evaluates the notion that an individual with a given ability level will likely respond correctly to less difficult items and will likely respond incorrectly to more difficult items (Rasch, [<reflink idref="bib56" id="ref98">56</reflink>]; Wright & Masters, [<reflink idref="bib79" id="ref99">79</reflink>]; Wright & Stone, [<reflink idref="bib78" id="ref100">78</reflink>]). Two types of fit statistics are estimated for each individual and each item, namely infit and outfit. Infit is more sensitive to unexpected probabilities of response near the item or individual's measurement level, whereas outfit is more sensitive to unexpected probabilities of response far from the item or individual's measurement level (Linacre & Wright, [<reflink idref="bib41" id="ref101">41</reflink>]; Wright & Masters, [<reflink idref="bib79" id="ref102">79</reflink>]). Standardized infit and outfit statistics for individual items have an expected value of 0, and values greater than 2.0 indicate greater unpredictable variation than expected. Negative values suggest that the scale is more deterministic than expected because Rasch models are probabilistic. Therefore, negative values are acceptable for our comparison with the Guttman scale because they indicate overfit (Bond & Fox, [<reflink idref="bib10" id="ref103">10</reflink>]). If the standardized fit statistics for individual items is greater than 2.0, we consider it as indicating misfit (Wright & Masters, [<reflink idref="bib79" id="ref104">79</reflink>]).</p> <p>Data for the five ToM tasks for the TD and autistic children were analyzed with Rasch models using the WINSTEPS computer program (Linacre, [<reflink idref="bib42" id="ref105">42</reflink>]; Linacre & Wright, [<reflink idref="bib41" id="ref106">41</reflink>]). For comparison with Australian (Peterson et al., [<reflink idref="bib52" id="ref107">52</reflink>]) and mainland Chinese TD and autistic children (Zhang et al., [<reflink idref="bib81" id="ref108">81</reflink>]), we followed these studies to use DD as the anchor task, and hence DD had an item difficulty measurement score of.00 on the linear scale. Table 4 shows ordered solutions from the least difficult (i.e., lowest measurement score) to the most difficult (i.e., highest measurement score) for the two groups of children. The order of item difficulty is the same in the Rasch models as in the Guttman scales for both groups of children. In other words, the results confirm that the TD children followed the sequence DD > KA > DB > FB > HE, while autistic children showed a key reverse for DD and KA (i.e., KA > DD).</p> <p>Table 4. Rasch analysis results for autistic and TD children.</p> <p> <ephtml> <table><thead><tr><td>Autistic group</td><td>TD group</td></tr><tr><td /><td>Measure</td><td>Model S.E.</td><td>Standardized infit</td><td>Standardized outfit</td><td /><td>Measure</td><td>Model S.E.</td><td>Standardized infit</td><td>Standardized outfit</td></tr></thead><tbody><tr><td>HE</td><td>7.63</td><td>1.01</td><td>.18</td><td>−.17</td><td>HE</td><td>8.72</td><td>.44</td><td>.13</td><td>.17</td></tr><tr><td>FB</td><td>2.75</td><td>.47</td><td>1.23</td><td>.75</td><td>FB</td><td>4.85</td><td>.26</td><td>−.47</td><td>−.56</td></tr><tr><td>DB</td><td>2.07</td><td>.48</td><td>−.43</td><td>−.63</td><td>DB</td><td>4.11</td><td>.26</td><td>−.01</td><td>−.13</td></tr><tr><td>DD</td><td>.00</td><td>.65</td><td>−.32</td><td>−.17</td><td>KA</td><td>1.92</td><td>.36</td><td>−.65</td><td>−.28</td></tr><tr><td>KA</td><td>−1.05</td><td>.83</td><td>.24</td><td>−.12</td><td>DD</td><td>.00</td><td>.51</td><td>.86</td><td>.71</td></tr><tr><td><italic>M</italic></td><td /><td /><td>.2</td><td>−.1</td><td><italic>M</italic></td><td /><td /><td>0</td><td>0</td></tr><tr><td><italic>SD</italic></td><td /><td /><td>.6</td><td>.4</td><td><italic>SD</italic></td><td /><td /><td>.5</td><td>.4</td></tr></tbody></table> </ephtml> </p> <p>2 Note: S.E. = standard errors; HE = hidden emotion; FB = false belief; DB = diverse beliefs; DD = diverse desires; KA = knowledge access.</p> <hd id="AN0159933724-17">Comparisons among present results and results of previous studies</hd> <p>We compared the results of the current study with previous results from mainland China (Zhang et al., [<reflink idref="bib81" id="ref109">81</reflink>]) and Australia (Peterson et al., [<reflink idref="bib52" id="ref110">52</reflink>]). As shown in Table 5, the autistic group in the present study demonstrated a different developmental sequence of ToM skills from that of autistic children in mainland China and that of autistic children in Australia. Specifically, HK autistic children showed the order KA > DD > DB, but those in mainland China and Australia showed the order DD > DB > KA. There is however variation between beliefs and knowledge between East and West, such that the HK TD sample patterned with those from mainland China, namely KA > DB, which is distinct from TD children from Australia, for whom the sequence DB > KA holds.</p> <p>Table 5. Comparison of the ToM developmental sequences found in the present study and in the studies of Zhang et al. ([<reflink idref="bib81" id="ref111">81</reflink>]) and Peterson et al. ([<reflink idref="bib52" id="ref112">52</reflink>]).</p> <p> <ephtml> <table><thead><tr><td>Autistic group</td><td>TD group</td></tr><tr><td>Hong Kong(n = 37;M = 6.41)</td><td>Mainland China(n = 34;M = 6.15)</td><td>Australia(n = 36;M = 9.32)</td><td>Hong Kong(n = 142;M = 5.81)</td><td>Mainland China(n = 76;M = 5.10)</td><td>Australia(n = 62;M = 4.50)</td></tr><tr><td>Order</td><td>Measure</td><td>Order</td><td>Measure</td><td>Order</td><td>Measure</td><td>Order</td><td>Measure</td><td>Order</td><td>Measure</td><td>Order</td><td>Measure</td></tr></thead><tbody><tr><td>HE</td><td>7.63</td><td>HE</td><td>8.16</td><td>FB</td><td>3.28</td><td>HE</td><td>8.72</td><td>HE</td><td>8.10</td><td>HE</td><td>6.99</td></tr><tr><td>FB</td><td>2.75</td><td>FB</td><td>6.18</td><td>HE</td><td>2.08</td><td>FB</td><td>4.85</td><td>FB</td><td>4.80</td><td>FB</td><td>5.72</td></tr><tr><td>DB</td><td>2.07</td><td>KA</td><td>5.44</td><td>KA</td><td>1.15</td><td>DB</td><td>4.11</td><td>DB</td><td>2.77</td><td>KA</td><td>1.95</td></tr><tr><td>DD</td><td>.00</td><td>DB</td><td>3.72</td><td>DB</td><td>.00</td><td>KA</td><td>1.92</td><td>KA</td><td>.88</td><td>DB</td><td>1.59</td></tr><tr><td>KA</td><td>−1.05</td><td>DD</td><td>.00</td><td>DD</td><td>.00</td><td>DD</td><td>.00</td><td>DD</td><td>.00</td><td>DD</td><td>.00</td></tr></tbody></table> </ephtml> </p> <p>3 Note: n = sample size; M = mean age; HE = hidden emotion; FB = false belief; DB = diverse beliefs; DD = diverse desires; KA = knowledge access.</p> <p>For autistic children, the order of FB and HE development in HK children is the same as that of children in mainland China (i.e., FB > HE) but the reverse of that of children in Australia (HE > FB). TD children from HK, mainland China, and Australia patterned the same for these harder tasks (i.e., FB > HE). In sum, only in Australian autistic children does HE emerge before FB; thus, these children seem to be the exception to all other reports of ToM development, for both different cultures and different cognitive profiles. However, the larger variation among the three autistic groups relative to TD groups (TD children from the three regions patterned the same for the harder tasks on the scale) should be interpreted with caution as the sample sizes for the autistic groups across the three studies are relatively small.</p> <hd id="AN0159933724-18">Discussion</hd> <p>The first aim of the current study was to examine whether the ToM development of HK Cantonese-speaking autistic children would follow a delayed or different development model, or both. The second aim was to examine whether the developmental sequences of ToM skills in HK Cantonese-speaking autistic and TD children show cross-cultural variation compared to their peers growing up in Western cultures.</p> <hd id="AN0159933724-19">ToM development of HK autistic and TD children</hd> <p>Regarding our first aim, we found that after we controlled for the effect of chronological age, autistic children in the current study had significantly lower ToM skills compared to TD children whose verbal mental age was equivalent. When verbal mental age was taken as the predictor, the two groups demonstrated similar developmental rates of ToM skills. These results support the view that the ToM development is delayed in autistic children in HK. In addition, autistic children showed the developmental sequence KA > DD > DB > FB > HE, in contrast to their TD peers, whose developmental sequence was DD > KA > DB > FB > HE. This finding, together with the finding of HK autistic children's significantly lower ToM skills, supports the different development account. Our findings are thus consistent with those of Zhang et al.'s ([<reflink idref="bib81" id="ref113">81</reflink>]) study, which revealed that both delayed and different development models could exist in mainland Chinese autistic children.</p> <p>Delving deeper into the divergence between our TD and autistic groups, the developmental sequence of ToM skills in HK TD and autistic children differed with respect to KA and DD. More specifically, our autistic participants were found to understand that not seeing leads to not knowing before they grasped the concept that people can have different desires. We speculatively attributed these participants' early mastery of KA to their access to formal education and to their parents' emphasis on the importance of acquiring knowledge. As Kuntoro and colleagues ([<reflink idref="bib39" id="ref114">39</reflink>]) report, formal educational experiences are conducive to children's development of KA. Kuntoro et al. ([<reflink idref="bib39" id="ref115">39</reflink>]) revealed that Indonesian pemulung (trash picker) children, who lacked exposure to formal education, had difficulties with the KA task. In the current study, all autistic participants were attending mainstream schools, as were their TD counterparts, and we speculate that formal education in daily school settings facilitates grasping the process of knowledge acquisition and lays the foundation for KA understanding. Additionally, HK parents of autistic children enrolled in mainstream schools have been reported to adopt various methods to improve their children's academic performance, including hiring private tutors, arranging extra lessons, etc. (Pearson et al., [<reflink idref="bib51" id="ref116">51</reflink>]; Wong, Pearson, Ip, & Lo, [<reflink idref="bib77" id="ref117">77</reflink>]). Therefore, these autistic children in HK may have had more exposure to a wide range of formal and informal educational settings where they were instructed to pay attention in order to acquire knowledge. This plausibly enabled them to better understand the basics of knowledge access and thus helped them develop KA quickly. Nonetheless, these claims should be treated with some caution since the extra-educational experiences of the autistic children were not measured.</p> <hd id="AN0159933724-20">Cultural influence on ToM development</hd> <p>Turning to our second aim, our study revealed that the ToM development of HK Cantonese-speaking TD children differed from that of their TD peers from Australia. Specifically, KA was easier than DB (i.e., KA > DB) for TD children from HK and mainland China, while the reverse held for TD children from Australia (DB > KA). The DB > KA pattern has also been observed in TD children from other Western countries, such as North America and Germany (Kristen et al., [<reflink idref="bib38" id="ref118">38</reflink>]; Wellman et al., [<reflink idref="bib73" id="ref119">73</reflink>]; Wellman & Liu, [<reflink idref="bib71" id="ref120">71</reflink>]). The HK TD children's developmental sequence patterned instead with that of their Mandarin-speaking peers in mainland China. Although HK is more "Westernized" than mainland China, both HK and mainland China are characterized as collectivist societies (Chiu & Kosinski, [<reflink idref="bib16" id="ref121">16</reflink>]; Greenfield, Keller, Fuligni, & Maynard, [<reflink idref="bib28" id="ref122">28</reflink>]; Hofstede, [<reflink idref="bib33" id="ref123">33</reflink>]; Tang & Kirkbride, [<reflink idref="bib65" id="ref124">65</reflink>]). Parents in collectivist cultures discourage children's expression of independent opinions (Chen, Dong, & Zhou, [<reflink idref="bib15" id="ref125">15</reflink>]) and instead emphasize the acquisition of well-established knowledge (Greenfield et al., [<reflink idref="bib28" id="ref126">28</reflink>]; Nisbett, [<reflink idref="bib50" id="ref127">50</reflink>]; Wellman et al., [<reflink idref="bib72" id="ref128">72</reflink>]), which allows their children to develop an acute awareness of the difference between being ignorant and being knowledgeable. This could explain the early mastery of KA by TD children in HK and mainland China. In contrast, parents in individualistic cultures value children's self-confident assertion of divergent opinions (Goodnow & Collins, [<reflink idref="bib25" id="ref129">25</reflink>]; Triandis, McCusker, & Hui, [<reflink idref="bib67" id="ref130">67</reflink>]). With an individualistic cultural background, Australian TD children and those from North America and Germany are more likely to quickly understand that people can have different beliefs. Therefore, they tend to master DB earlier than children from collectivist cultures.</p> <p>Concerning cross-cultural comparisons within autistic groups, unlike previous findings in mainland China and Australia, KA was the easiest task for HK autistic children. Australian autistic children performed better on DB than KA. As with the differences found in TD children, the difference between autistic children in HK and Australia might be explained by the contrast between individualistic and collectivist cultures. However, the difference between autistic children in HK and mainland China deserves more attention. Growing up in homogeneous collectivist cultures, autistic children in HK mastered KA first, while their peers in mainland China developed DD and DB ahead of KA, like those in Western, individualistic cultures.</p> <p>Zhang and colleagues ([<reflink idref="bib81" id="ref131">81</reflink>]) attribute the pattern in mainland Chinese autistic children to a micro-individualistic-culture formed within the special community of autistic children and their parents. Parents with autistic children in mainland China tend to devote more effort to promoting their children's interpersonal communication skills. They were reported to send the children to training centers in the belief that these centers would promote the children's communication and social interaction skills (Lin, Qin, & Zhang, [<reflink idref="bib40" id="ref132">40</reflink>]). This extra "training" on social communication abilities could be the reason that autistic children in mainland China acquired the concept that people can have diverse desires or beliefs earlier. Such a micro-individualistic-culture was not found in the HK ASD community. However, there might be another possible micro-culture contributing to HK autistic children's early mastery of KA. As mentioned, HK autistic children's parents would employ various methods to advance the children's academic competence and knowledge acquisition (Pearson et al., [<reflink idref="bib51" id="ref133">51</reflink>]; Wong et al., [<reflink idref="bib77" id="ref134">77</reflink>]). This would help to consolidate understanding of how people acquire knowledge, promoting the development of KA in HK autistic children.</p> <hd id="AN0159933724-21">Limitations and future directions</hd> <p>This study presents several limitations that deserve attention. First, in light of the relatively small sample size of the autistic group in the current work, the variation observed in ToM development among autistic children from different regions (HK, Australia, and mainland China) must be interpreted with caution. Second, the discussion of how collectivist/individualistic cultures and formal/informal education could be shaping our findings remains speculative until more precise data on the language environments of the participants and their extra-educational experiences can be included. Indeed, ToM development has been shown to be impacted by a variety of factors, such as participants' language status as monolingual or bilingual and their actual linguistic experiences, the number of their siblings as well as their socio-economic situations (SES).</p> <p>While here we focused solely on monolingual children in HK, which allowed us to compare our study with previous studies of monolingual children from mainland China (Zhang et al., [<reflink idref="bib81" id="ref135">81</reflink>]) and Australia (Peterson et al., [<reflink idref="bib52" id="ref136">52</reflink>]), the current findings do not necessarily extend to bilinguals in HK. As being bilingual has been found to play a role in ToM skills (see Schroeder, [<reflink idref="bib61" id="ref137">61</reflink>]), future studies with autistic and TD participants speaking two or more languages would make it possible to more comprehensively understand ToM development in HK children. Pursuing the relevance of linguistic experiences to ToM, children exposed to specific linguistic cues such as evidential markers (Aksu‐Koç, Ögel‐Balaban, & Alp, [<reflink idref="bib1" id="ref138">1</reflink>]; Lucas, Lewis, Pala, Wong, & Berridge, [<reflink idref="bib45" id="ref139">45</reflink>]) have been found to master ToM skills earlier compared to those acquiring languages without such cues. Cross-linguistic differences such as these should then be taken into consideration in future ToM investigations, so as to better grasp the nature of cross-cultural differences arising in ToM development.</p> <p>In addition, the actual discourse of caregivers and the number of siblings may also influence the trajectory of mentalizing. For example, mothers' increased use of mental state terms has been found to be predictive of children's later ToM achievements (Ruffman, Slade, & Crowe, [<reflink idref="bib59" id="ref140">59</reflink>]). Moreover, children with siblings versus without tend to be better at understanding others' minds (McAlister & Peterson, [<reflink idref="bib47" id="ref141">47</reflink>], [<reflink idref="bib48" id="ref142">48</reflink>]). Finally, the background information on the participants' kindergartens and primary schools collected here could only serve as a rudimentary indication of SES, while SES may play a role in ToM (Cutting & Dunn, [<reflink idref="bib18" id="ref143">18</reflink>]; Dunn, Brown, Slomkowski, Tesla, & Youngblade, [<reflink idref="bib19" id="ref144">19</reflink>]). Given this, a specific measure of SES would be an important addition to future work exploring variation in ToM development in autism.</p> <hd id="AN0159933724-22">Acknowledgement</hd> <p>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.</p> <hd id="AN0159933724-23">Disclosure statement</hd> <p>No potential conflict of interest was reported by the author(s).</p> <hd id="AN0159933724-24">Supplementary material</hd> <p>Supplemental data for this article can be accessed online at https://doi.org/10.1080/15248372.2022.2100397</p> <ref id="AN0159933724-25"> <title> Footnotes </title> <blist> <bibl id="bib1" idref="ref22" type="bt">1</bibl> <bibtext> See e.g., https://<ulink href="http://www.hofstede-insights.com/product/compare-countries/">www.hofstede-insights.com/product/compare-countries/</ulink></bibtext> </blist> <blist> <bibl id="bib2" idref="ref23" type="bt">2</bibl> <bibtext> 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, [13]; Kenny et al., [36]). 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, [22]). The current manuscript thus consistently applies identity-first language (see also Botha [11]; Bottema-Beutel, Kapp, Lester, Sasson, & Hand, [12]).</bibtext> </blist> <blist> <bibl id="bib3" idref="ref24" type="bt">3</bibl> <bibtext> 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.</bibtext> </blist> <blist> <bibl id="bib4" idref="ref5" type="bt">4</bibl> <bibtext> 11.76% participants in the autistic group and 18.44% participants in the TD were attending private kindergarten/primary school.</bibtext> </blist> <blist> <bibl id="bib5" idref="ref26" type="bt">5</bibl> <bibtext> The participants' kindergartens and primary schools are distributed in the three areas of HK: Kowloon, New Territories, and HK Island. 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Items – Name: Title
  Label: Title
  Group: Ti
  Data: Steps in Theory-of-Mind Development in Hong Kong Cantonese-Speaking Children with and without Autism
– Name: Language
  Label: Language
  Group: Lang
  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22Chi-Hang+Cheung%2C+Candice%22">Chi-Hang Cheung, Candice</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0002-1502-5724">0000-0002-1502-5724</externalLink>)<br /><searchLink fieldCode="AR" term="%22Rong%2C+Yicheng%22">Rong, Yicheng</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-4998-3856">0000-0003-4998-3856</externalLink>)<br /><searchLink fieldCode="AR" term="%22Durrleman%2C+Stephanie%22">Durrleman, Stephanie</searchLink> (ORCID <externalLink term="http://orcid.org/0000-0003-1883-5703">0000-0003-1883-5703</externalLink>)
– Name: TitleSource
  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Cognition+and+Development%22"><i>Journal of Cognition and Development</i></searchLink>. 2022 23(5):732-750.
– Name: Avail
  Label: Availability
  Group: Avail
  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
– Name: PeerReviewed
  Label: Peer Reviewed
  Group: SrcInfo
  Data: Y
– Name: Pages
  Label: Page Count
  Group: Src
  Data: 19
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2022
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
– Name: Audience
  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Elementary+Education%22">Elementary Education</searchLink><br /><searchLink fieldCode="EL" term="%22Early+Childhood+Education%22">Early Childhood Education</searchLink><br /><searchLink fieldCode="EL" term="%22Kindergarten%22">Kindergarten</searchLink><br /><searchLink fieldCode="EL" term="%22Primary+Education%22">Primary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Theory+of+Mind%22">Theory of Mind</searchLink><br /><searchLink fieldCode="DE" term="%22Autism+Spectrum+Disorders%22">Autism Spectrum Disorders</searchLink><br /><searchLink fieldCode="DE" term="%22Young+Children%22">Young Children</searchLink><br /><searchLink fieldCode="DE" term="%22Perspective+Taking%22">Perspective Taking</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+Development%22">Cognitive Development</searchLink><br /><searchLink fieldCode="DE" term="%22Cognitive+Processes%22">Cognitive Processes</searchLink><br /><searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Child+Development%22">Child Development</searchLink><br /><searchLink fieldCode="DE" term="%22Beliefs%22">Beliefs</searchLink><br /><searchLink fieldCode="DE" term="%22Emotional+Response%22">Emotional Response</searchLink><br /><searchLink fieldCode="DE" term="%22Knowledge+Level%22">Knowledge Level</searchLink><br /><searchLink fieldCode="DE" term="%22Asian+Culture%22">Asian Culture</searchLink><br /><searchLink fieldCode="DE" term="%22Cultural+Influences%22">Cultural Influences</searchLink><br /><searchLink fieldCode="DE" term="%22Sino+Tibetan+Languages%22">Sino Tibetan Languages</searchLink><br /><searchLink fieldCode="DE" term="%22Western+Civilization%22">Western Civilization</searchLink><br /><searchLink fieldCode="DE" term="%22Students+with+Disabilities%22">Students with Disabilities</searchLink><br /><searchLink fieldCode="DE" term="%22Elementary+School+Students%22">Elementary School Students</searchLink><br /><searchLink fieldCode="DE" term="%22Kindergarten%22">Kindergarten</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Hong+Kong%22">Hong Kong</searchLink>
– Name: SubjectThesaurus
  Label: Assessment and Survey Identifiers
  Group: Su
  Data: <searchLink fieldCode="SU" term="%22Reynell+Developmental+Language+Scales%22">Reynell Developmental Language Scales</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/15248372.2022.2100397
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1524-8372<br />1532-7647
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: 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
– Name: AbstractInfo
  Label: Abstractor
  Group: Ab
  Data: As Provided
– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2023
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1369609
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1369609
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      – Type: doi
        Value: 10.1080/15248372.2022.2100397
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 19
        StartPage: 732
    Subjects:
      – SubjectFull: Theory of Mind
        Type: general
      – SubjectFull: Autism Spectrum Disorders
        Type: general
      – SubjectFull: Young Children
        Type: general
      – SubjectFull: Perspective Taking
        Type: general
      – SubjectFull: Cognitive Development
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      – SubjectFull: Cognitive Processes
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      – SubjectFull: Foreign Countries
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      – SubjectFull: Child Development
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      – SubjectFull: Beliefs
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      – SubjectFull: Emotional Response
        Type: general
      – SubjectFull: Knowledge Level
        Type: general
      – SubjectFull: Asian Culture
        Type: general
      – SubjectFull: Cultural Influences
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      – SubjectFull: Sino Tibetan Languages
        Type: general
      – SubjectFull: Western Civilization
        Type: general
      – SubjectFull: Students with Disabilities
        Type: general
      – SubjectFull: Elementary School Students
        Type: general
      – SubjectFull: Kindergarten
        Type: general
      – SubjectFull: Hong Kong
        Type: general
      – SubjectFull: Reynell Developmental Language Scales
        Type: general
    Titles:
      – TitleFull: Steps in Theory-of-Mind Development in Hong Kong Cantonese-Speaking Children with and without Autism
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            NameFull: Chi-Hang Cheung, Candice
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            NameFull: Rong, Yicheng
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            NameFull: Durrleman, Stephanie
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            – D: 01
              M: 01
              Type: published
              Y: 2022
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            – Type: issn-print
              Value: 1524-8372
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              Value: 1532-7647
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            – TitleFull: Journal of Cognition and Development
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