Autism and intention attribution test: a non-verbal evaluation with comic strips

Ilenia Le Donne; Margherita Attanasio; Antony Bologna; Roberto Vagnetti; Francesco Masedu; Marco Valenti; Monica Mazza

doi:10.1186/s12991-023-00461-2

Autism and intention attribution test: a non-verbal evaluation with comic strips

Ann Gen Psychiatry. 2023 Aug 12;22(1):29. doi: 10.1186/s12991-023-00461-2.

Authors

Ilenia Le Donne^#¹, Margherita Attanasio^#², Antony Bologna², Roberto Vagnetti², Francesco Masedu², Marco Valenti^{2

3}, Monica Mazza²

Affiliations

¹ Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, Località Coppito, 67100, L'Aquila, Italy. ilenia.ledonne@graduate.univaq.it.
² Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Via Vetoio, Località Coppito, 67100, L'Aquila, Italy.
³ Regional Reference Centre for Autism of the Abruzzo Region, Local Health Unit ASL 1, 67100, L'Aquila, Italy.

^# Contributed equally.

Abstract

Background: Despite autism spectrum disorder (ASD) and mentalization being two words often associated in the literature, the assessment of this ability in individuals with ASD in the clinical setting is still limited. Indeed, there are no standardized Theory of Mind (ToM) tests that are adaptable to different cognitive profiles, such as individuals with language poverty, and intellectual or memory impairments. This study proposes a non-verbal test (Intentions Attribution-Comic Strip Test; IA-CST) to evaluate the ability to infer the intentions of others, a basic component of ToM, in the clinical setting.

Method: In Study 1, the test was administered to 261 healthy individuals and we performed structural validation using Exploratory Graph Analysis. In Study 2, the final version of the test was administered to 32 individuals with ASD to assess the known group validity of the measure by comparing their scores with a sample of IQ-matched controls. Moreover, we performed logistic regression and ROC curve to preliminarily assess the diagnostic performance of the IA-CST.

Results: The IA-CST resulted in a 3-dimension measure with good structural stability. Group comparison indicated that the ASD group shows significantly lower performance in intention attribution but not in inferring causal consequences. The test demonstrated known group validity and that, preliminarily, it is suitable for implementation within the clinical practice.

Conclusions: The results support the IA-CST as a valid non-verbal task for evaluating intentions attribution in the clinical setting. Difficulties in ToM are early and relevant in ASD, so assessing these aspects is valuable for structuring individualized and evidence-based interventions.

Keywords: Autism spectrum disorders; Clinical utility; Intention attribution; Psychometric proprieties; Theory of Mind.