Externalizing Behaviors: Relations to Pragmatic Language and Theory of Mind in Children with Autism Spectrum Disorder

This study examined the association between pragmatic language and theory of mind (ToM) in relation to children's externalizing behaviors. Participants included 27 typically developing children and 11 children with autism spectrum disorder (ASD) between the ages of 4:0 and 6:11 years (M age = 63.47 months, SD = 11.14 months). Participating children were 71% Caucasian, 3% African American, 5% Asian American, and 21% were multiethnic. The sample of typically developing children was 63% male, and the sample of children with ASD was 81% male. Parent and teacher reports were used to evaluate children's externalizing behaviors and parent reports were used to determine pragmatic language abilities. A battery of three ToM tasks was administered to children to assess ToM. Conditional indirect effects models were tested whereby the relation between pragmatic language and externalizing behaviors was mediated by ToM, and the strength of this mediation was contingent on children's developmental status (ASD or typically developing). With developmental status moderating both the alpha and beta pathways of the mediation, the model was non-significant. However, when developmental status was set as the moderator for just the beta pathway, the model was significant. Findings indicated that pragmatic language predicted externalizing behavior indirectly through ToM only for children in the ASD group, 95% CI [-.030, -.002]. For children in this group, a negative association between ToM and externalizing behaviors was found, such that as ToM abilities increased, externalizing behaviors decreased. This mediation was not found for typically developing children, 95% CI [-.001, .01]. For this group, pragmatic language remained a significant predictor of ToM, but ToM appeared unrelated to externalizing behaviors. Analyses of the direct effects of developmental status indicated that developmental status predicted parent report of externalizing behaviors, beta = .40, t = 2.80, p = .008, and pragmatic language, beta = -.40, t = -2.75, p = .009. Children with ASD exhibited higher rates of externalizing behaviors as rated by their parents and also had lower pragmatic language abilities overall. Results provide support for clinical interventions which target pragmatic language and ToM abilities in young children with ASD and co-occurring behavioral problems.