Theory of Mind and Pretend Play in Children with Specific Language Impairment

The ability to represent the mental states of others (i.e., Theory of Mind, ToM) is vital for social interaction. There is limited information on ToM knowledge in children with specific language impairment (SLI). These children have deficient language abilities that cannot be explained by hearing, cognitive, or neurological problems. Furthermore, children with SLI experience difficulty in initiating and maintaining social pretend play. Language, pretend play, and ToM typically develop in concert, which may indicate that they share an underlying capacity for representation. Given that language is deficient in children with SLI, these children may have problems with ToM, which might be related to their social behaviors during pretend play. This study was the first to investigate the association between ToM and pretend play in children with and without SLI. Twenty-two children with SLI and 22 with typical development (TD), between 48-71 months of age, participated in this study. Children engaged in a variety of ToM tasks and participated in two pretend play assessments: a standardized pretend play assessment and a role play activity. Children with SLI scored significantly lower on ToM tasks and engaged less often in some sophisticated forms of pretend play than their age-matched peers with TD. After controlling for language and SES, there were no significant associations between ToM and pretend play in children with and without SLI. When language groups were analyzed individually, different patterns of associations emerged for children with and without SLI. ToM was positively associated with pretend play in children with TD but negatively associated in children with SLI. Moreover, inconsistent patterns of associations were observed for some children with SLI (i.e., poor ToM understanding but sophisticated pretend play or vice versa). This study demonstrated that children with SLI may also have concomitant problems in ToM and pretend play, which may have implications for clinical assessment and intervention. The study contributes to the literature by investigating the link between ToM and different forms of sophisticated pretend play in children with and without SLI. Given the different patterns of partial correlations, future investigation of the relationship between ToM and pretend play relationship is warranted.Ph