False belief tasks, such as the Sally-Anne test and the Maxi task, are widely used to assess children's understanding that others can hold beliefs different from reality.1 In these tasks, children observe a scenario where a character's belief becomes false due to an unseen change in the environment. Children are then asked to predict the character's behavior based on their false belief. Success in these tasks indicates a developed theory of mind, typically emerging around age four.23

However, some researchers argue that children with autism spectrum disorder (ASD) may fail these tasks due to language difficulties, attention, memory, and inhibition deficits, rather than a lack of theory of mind.45 Additionally, the social and communicative behaviors of individuals with ASD during these tests may not be adequately captured or interpreted within the traditional testing framework.5

The Reading the Mind in the Eyes Test (RMET) is a widely used measure of theory of mind that assesses the ability to recognize and understand another person's mental state by viewing photographs of the eye region.12 Participants choose which word best describes what the person in the picture is thinking or feeling. The test has been used extensively to measure cognitive empathy in adults, including those with ASD.2

A 2022 study of over 300,000 people across 57 countries found that females, on average, score higher than males on the RMET.3 This sex difference was observed across all ages and most countries, suggesting that females may have an advantage in cognitive empathy. However, individual performance can vary widely, and the causes of this sex difference are likely due to a combination of biological and social factors.3

A systematic review of 220 theory of mind measures for children aged 0-5 years highlighted the diversity of assessments available, covering various mental states and social situations.1 The review also identified methodological and psychometric challenges in developing and choosing appropriate measures, such as the limited range of sub-abilities targeted, lack of standardization across studies, and paucity of psychometric information provided.1 Ongoing development and refinement of theory of mind assessments are crucial for advancing our understanding of social cognition across the lifespan.2

Some researchers argue that traditional theory of mind tests, such as false belief tasks, may not accurately capture the abilities of individuals with autism spectrum disorder (ASD).1 Children with ASD may fail these tasks due to language difficulties, attention deficits, or alternative interpretations of the test scenarios, rather than a lack of theory of mind.23 Moreover, the social and communicative behaviors of individuals with ASD during these tests may not be adequately captured or interpreted within the traditional testing framework.4 Ongoing refinements in theory of mind assessments, such as the 2021 update to the Reading the Mind in the Eyes Test5 and comprehensive reviews of available measures6, are crucial for advancing our understanding of social cognition across diverse populations.