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Abstract

Background & Aims

Mental state verbs (MSVs) describe people's internal states and processes. Reports on the use of MSVs in school-age children with autism spectrum disorder (ASD) are contradictory, and little is known about the developmental trajectories of these verbs in this population during early childhood. In contrast, among young, typically developing (TD) children, research has shown that the use of desire, perception, and physiological verbs precedes the use of cognitive and emotion verbs. This study aimed to describe the development of MSV use among autistic children as compared to TD children and investigate the variables that influence this development.

Methods

A total of 118 children participated in the study (59 autistic and 59 TD children), aged 3–10 years. Parents of all children completed an MSV questionnaire indicating whether their child produced the MSVs included in it. Additionally, two variables influencing MSV use were examined: sentence repetition for estimating syntax and measures of theory of mind (TOM) ability, which included three tasks: diverse desires and first- and second-order false belief.

Results

According to the parental questionnaire, cognitive and emotion verbs have a more protracted developmental trajectory in both autistic and TD children than other MSV categories (desire, perception, and physiological verbs), and they are more challenging for autistic children than for TD children. Cognitive and emotion verbs are also less common in preschoolers’ speech than in that of school-aged children. In addition, language abilities, TOM, and group (autistic vs. TD) explained the variance in the development of cognitive and emotion verb use beyond age.

Conclusions and Implications

These findings demonstrate the development of MSVs from all five semantic categories from the age of three years to the age of ten in autistic children. In addition, our results indicate a specific linguistic difference between autistic and TD children in the development of cognitive and emotion verbs, as was found in the MSV parental questionnaire. The study also highlights the role of syntax, TOM, and autism in relation to the development of these verbs, supporting the notion of complex developmental conditions associated with MSV development and, thus, the need to evaluate them in autistic children.

Keywords

Mental state verbs autism parental questionnaire

Introduction

Mental language addresses the mental states of oneself and others and is crucial for understanding and expressing people's mental processes in everyday life and during social interactions. Mental State Verbs (MSVs) are part of the mental language, related to the cognitive ability of Theory of Mind (TOM), and linguistically based on the intersection of semantic and syntactic abilities (Smolík & Chromá, 2022). As such, MSVs allow the opportunity to investigate and understand the delicate connections between cognitive and linguistic domains and their development in typically developing (TD) children and those diagnosed with autism spectrum disorder (ASD). The current study explored the development of MSV use among autistic children throughout childhood and the cognitive and linguistic variables related to this development.

In the language domain, MSVs are related to semantic and syntactic abilities. Semantically, for a word to be part of the mental lexicon, its lexical meaning must focus on internal processes or states (e.g., ‘remember’, ‘guess’, ‘hard’). The internal state must be a psychological state (e.g., ‘happy’), not a physical one (e.g., ‘smile’), and refer to temporary states or experiences (e.g., ‘sad,’ ‘think’), not a permanent condition (e.g., ‘smart’) (Hall & Nagy, 1986). The mental lexicon contains terms from various lexical categories (e.g., verbs and adjectives), of which MSVs, the focus of the current study, are the largest. Bretherton and Beeghly (1982) divided the mental lexicon into six semantic categories of words: cognitive (e.g., ‘know’, ‘remember’); emotion and affective (e.g., ‘hope’, ‘sad’, ‘afraid’, ‘love’); perceptual (e.g., ‘see’, ‘hear’, ‘feel’, ‘hurt’); desire and ability (e.g., ‘want’); physiological (e.g., ‘hungry’, ‘thirsty’); and moral judgment and obligation (e.g., ‘must’, ‘may’, ‘have to’). This division is the basis for the semantic categories of MSVs used in the current study. According to the contextual views of semantic development, the meaning of MSVs develops through communicative exchanges, beginning with prelinguistic experiences and progressing to verbal communication (Montgomery, 2002). With development, children begin to understand the contrast and relations between MSVs from the same category and create semantic distinctions between them. This process is influenced by the child's growing awareness of the variety of MSV conversational purposes, such as regulating an interaction (e.g., ‘Do you know where that goes?’) or calling for attention (e.g., ‘Do you know…?’). According to this view, the mental referential use of MSVs becomes conceptually meaningful in line with their pragmatic and conversational purposes (Montgomery, 2002).

Pragmatically, research has shown that MSVs serve different kinds of speech acts and are often used for indirect ones (e.g., “I want you to tell me the time”- indirect request, “I think it is 5 P.M.”- indirect assertions), leaving the literal content of the MSV a minor role in understanding the meaning of the sentence. In addition, there is a connection between the verb's category, and the frequent speech act it is used for; desire verbs are usually used for indirect requests, while cognitive verbs are used for indirect assertions (Hacquard & Lidz, 2019, 2022). The development of MSVs is described as learning to use a word rather than connecting a label to a referent (Montgomery, 2002).

Syntactically, MSVs tend to appear and strongly correlate with the structure of sentential complements (e.g., “I know that she loves candy”) (Nixon, 2005; Papafragou et al., 2007), a structure that is difficult for autistic children (Eigsti et al., 2007; Tager-Flusberg & Joseph, 2003). For example, Eigsti et al. (2007) investigated the morphosyntactic characteristics of 5-year-old autistic children compared with 3-year-old TD children. They found that the autistic group used less complex syntax in a discourse task after controlling for lexical knowledge, nonverbal IQ, and overall talkativeness. The syntactic structure of sentential complements has a semantic meaning and is an essential clue for acquiring the meaning of MSVs (Papafragou et al., 2007; Tager-Flusberg, 2000); thus, these two language domains cannot be completely separated from each other. Specifically, the sentential complement structure (e.g., “The boy thinks that the apple is red”) implies a thematic relation between an animate entity (the boy) and an intention (thinking) (Papafragou et al., 2007), which is an essential clue for acquiring the meaning of MSVs (Durrleman & Franck, 2015; Papafragou et al., 2007; Tager-Flusberg, 2000).

MSVs are naturally related to TOM, which is the cognitive ability to understand the internal states and processes of oneself and others (Astington & Jenkins, 1999; Premack & Woodruff, 1978). One type of connection is that MSVs are a common way to assess TOM. One can learn about the speaker's TOM abilities by analyzing children's language of internal states and processes, of which MSVs are a part (Wellman, 2018). Additionally, experimental tasks assessing TOM and MSV abilities (production and understanding) revealed correlations between them. These findings were found in different age ranges and for both TD (Grazzani & Ornaghi, 2012; Li & Leung, 2020; Siller et al., 2014) and autistic children (Capps et al., 2000; Siller et al., 2014; Tager-Flusberg & Sullivan, 1995). Another type of connection is shown by the link between training MSV use and improving TOM abilities (Bianco et al., 2016).

Development of the Use of MSVs in TD and Autistic Children

The first MSVs reported in children's language are those of desire and ability, and they are typically observed in children's speech during the second year of life. The first and most frequent desire verb is ‘want’ (Bartsch & Wellman, 1995; Pascual et al., 2008; Shatz et al., 1983).

Children's ability to use mental state terms develops significantly during the third year of life. Bretherton and Beeghly (1982) found mental terms from all six semantic categories (see above sections) in the speech of 28-month-old TD children, based on their mothers’ reports. The most common categories were desire and ability, perceptions, and physiological terms, followed by emotion and judgment and moral obligation terms. Cognitive terms were the least common. Similar findings were noted in the vocabulary of 24- and 30-month-old German-speaking children (Kristen et al., 2012). First, MSVs describe the child's own mental state, and shortly after that, children begin to refer to other people's mental states (e.g., use for self: ‘I am mad’; use for others: ‘Mommy's mad at you’) (Bartsch & Wellman, 1995; Bretherton & Beeghly, 1982).

Children begin to use cognitive verbs during the third year of life, and their frequency and variety of use increase with age (Pascual et al., 2008). Around the age of six to seven years, studies investigating cognitive verb development show significant development in the use of these verbs. One common explanation for this development is exposure to written language when entering school (Antonietti et al., 2006; Egoz-Libshtain, 2009). For example, Antonietti et al. (2006) found that the use of metacognitive verbs (e.g., ‘learn’ and ‘understand’) in a metacognitive vocabulary task improved significantly from ages 4 to 6 and from 6 to 8, particularly those related to school activities. Their explanation for the improvement in the use of cognitive verbs was linked to literacy. It seems that the formal language of schooling encourages cognitive language. Building on these studies, the current study examined the development of MSVs in preschool and school-age children as part of an investigation of age-related development.

In Hebrew (the language tested in the current study), children use MSVs as early as two years of age and follow the same developmental pattern described in other languages (discourse data: Egoz-Libshtain, 2009; parental questionnaire: Eilon & Novogrodsky, 2024). These findings align with those of English-speaking children (Bartsch & Wellman, 1995), Spanish-speaking children (Pascual et al., 2008), and Chinese-speaking children (Tardif & Wellman, 2000), suggesting a universal pattern of MSV development in production.

Another important variable that needs to be examined when exploring young children's language is sex. Studies have shown that girls tend to score higher than boys at a young age in language tasks, including MSV production (Bornstein et al., 2004; Eilon & Novogrodsky, 2024; Eriksson et al., 2012). For example, Bornstein et al. (2004) found that girls have an advantage in various language measures compared to boys between the ages of 1;8–6;0, but not at younger or older ages. Specifically, Eilon and Novogrodsky (2024) showed that TD girls tend to use more MSVs than TD boys during the early years of development, and this gap closes at approximately seven years of age. Note that although exploring sex differences was not part of the current study's aims, sex was included as a variable in the models to ensure that the difference in the number of boys and girls between groups did not influence the difference in MSV use.

When investigating the development of MSV use among autistic children, the findings varied. One of the first studies by Baron-Cohen et al. (1986) showed that autistic children (ages 6–16;9 years) scored lower than TD children (matched on verbal age) in understanding stories that required mental comprehension (e.g., a story about a girl putting down a teddy to peak flowers, then a boy takes the teddy away and the girl sees that the teddy is gone). In contrast, this difference was not found in stories that required mechanical understanding (e.g., a story about a child rolling a ball into the sea) or behavioral understanding (e.g., a story about a child taking ice cream from another child). In this study, the comprehension of the stories was measured by (a) the correct sequencing of the stories’ pictures and (b) the type of terms used when telling the story (mental state terms in mental stories, causal terms in mechanical stories, and descriptive terms in behavioral stories). The study found that when telling mental stories, autistic children used fewer mental state terms than TD children (Baron-Cohen et al., 1986).

Other studies focusing on the narrative abilities of school-age autistic children reported inconsistent results. Some studies have shown that autistic children use fewer cognitive terms (Brown et al., 2012; Rumpf et al., 2012), emotion terms (Brown et al., 2012; Siller et al., 2014), and perception terms (Brown et al., 2012) than TD children. In contrast, other studies have failed to find differences in the number of MSVs used in a narrative task between autistic children and TD group (Capps et al., 2000; Engberg-Pedersen & Christensen, 2017; Losh & Capps, 2003; Tager-Flusberg, 1995; Tager-Flusberg & Sullivan, 1995). There are three types of explanations for the lack of difference in the use of MSVs in the narrative task: first, the autistic and control groups were both unlikely to use cognitive verbs in their stories; hence, the results represent a floor effect (Tager-Flusberg, 1995); second, similar verbal abilities between the autistic and control groups (Tager-Flusberg & Sullivan, 1995); third, merging the different categorical terms, which masks the differences between the groups. For example, Capps et al. (2000) and Losh and Capps (2003) counted revealed terms (e.g., ‘smile’) in addition to MSVs (e.g., ‘happy’) in their sample, a method that might have blurred the difference between the groups.

In summary, TD children follow a developmental trajectory when acquiring MSVs use. When exploring MSV use in autistic children, findings in school-age children are contradictory, and less is known about the developmental trajectory of the use of different semantic categories in this population, specifically in preschool-age children, and the variables that influence this development.

Aims of the Study

This study addresses two main research questions that, together, aim to provide a comprehensive understanding of MSV development in autistic children. First, how does the use of MSVs from five semantic categories develop in autistic children compared to TD children? We hypothesize that MSV use will increase with age in both groups, that autistic children will produce fewer MSVs than TD children, particularly cognitive (Brown et al., 2012; Rumpf et al., 2012) and emotion (Brown et al., 2012; Siller et al., 2014) verbs, and that differences between groups will be evident in both preschool- and school-age children, with sex examined as a control variable given its influence on language development, including in MSVs.

Building on this developmental perspective, the second research question asks: How do linguistic and cognitive factors, beyond age, contribute to children's MSV use in the categories that differ between groups, as reflected in the parental questionnaire? We predict that language ability, TOM, and group (autistic vs. TD) will each explain unique variance in MSV development.

Methods

Participants

A total of 118 children aged 3;00–10;07 years participated in the study: 59 autistic children and 59 TD children. This broad age range was selected to explore the development of MSVs during childhood. Figure 1 presents the distribution of autistic and TD children by age. In both groups, children were recruited from the public education system and through word of mouth. Based on the years of primary caregivers’ education, most children were from families with a mid-to-high socioeconomic status (see Table 1). Note that data on the primary caregivers’ years of education were missing for 17 children (five from the autistic group and 12 from the TD group).

Figure 1.

Distribution of Children by Age in the TD and Autistic Groups.

Table 1.

Participant Characteristics.

Groups			Autistic Group (n = 59)	TD Group (n = 59)	t-test
Sex (boys/girls)			45/14	28/31
Age (Months)		Mean (SD)	77.8 (23.9)	80.2 (24.8)	0.54
Age (Months)		Range	36–127	36–127
Schooling		Preschool	28	24
Schooling		School-age	31	35
Socioeconomic status*		Academic	41	42
		Vocational	9	3
		High school	4	2
Non-verbal IQ (score range 0–36)		Mean (SD)	17.5 (9.1)	20.6 (8.7)	1.87
Non-verbal IQ (score range 0–36)		Range	6–35	6–35
LITMUS Hebrew SRep (Score range 0–28)		Mean (SD)	18.6 (9.7)	24.5 (4.4)	4.17***
LITMUS Hebrew SRep (Score range 0–28)		Range	0–28	5–28
TOM	Diverse desires	Mean (SD)	0.65 (0.48)	0.90 (0.30)
	First-order FB	Mean (SD)	0.37 (0.49)	0.73 (0.45)
	Second-order FB	Mean (SD)	0.29 (0.46)	0.66 (0.48)

Note: *** p ≤ .001; *Socioeconomic status was reported based on the primary caregiver's years of education; Non-verbal IQ = Raven's Colored Progressive Matrices (Raven et al., 1998); LITMUS Hebrew SRep = LITMUS Hebrew sentence repetition (Armon-Lotem & Meir, 2016); Diverse desires (Repacholi & Gopnik, 1997); FB = false belief; First- and second-order false belief tasks (Wimmer & Perner, 1983).

Autistic Group

All autistic children had been diagnosed with ASD prior to the study through the public health system, according to the criteria of the DSM-IV or DSM-V (American Psychiatric Association, 1994, 2013). The diagnosis was reconfirmed for 47 children as part of this study or based on previous diagnostic reports using the Autism Diagnostic Observation Schedule (ADOS) (Lord et al., 2000). Autistic children learned at mainstream schools (n = 16) and kindergartens (n = 5), special classes for autistic children within mainstream schools (n = 14), and special education kindergartens for autistic children (n = 23) (the type of education system was not available for one child). Based on parents’ and speech therapists’ reports, all children were verbal and met the criteria for stage 4 in language level (Tager-Flusberg et al., 2009), meaning they used sentences in interactions. Ten autistic children were from bilingual homes, with Hebrew as their dominant language: they spoke Hebrew in their educational system for 5–9 h daily and at home with some family members. As shown in the results section, we compared the MSV scores of autistic and TD children with and without the subgroup of bilingual children, and the effect of group was significant in both comparisons.

TD Group

All 59 TD children were monolingual Hebrew speakers from mainstream schools and kindergartens. Six additional children were tested for this group but were excluded from the data because of concerns about their language development: three because of parental concern, as reported in the demographic questionnaire, and three outliers whose scores on the language task (LITMUS Sentence-Repetition task (SRep), see Materials section below) were more than 1.5 interquartile ranges below the first quartile.

As shown in Table 1, the two groups did not differ significantly in chronological age (see also Figure 1) or in nonverbal cognitive abilities. However, they differed in their morpho-syntax abilities according to the Hebrew-SRep task (Marinis & Armon-Lotem, 2015) and TOM abilities (see Materials section). In both tasks, the TD group scored higher than the autistic group did. Therefore, the scores of these two tests were further included as variables in the statistical model explaining the MSV scores. Two children did not participate in the nonverbal cognitive abilities task (one from each group); nine children did not participate in the SRep task (one from the TD group and eight from the autistic group); and three children from the autistic group did not participate in the TOM task.

Materials

The Hebrew MSV questionnaire was developed by Eilon and Novogrodsky (2024) to estimate the diversity of MSVs in a child's lexicon. It includes 80 verbs from five semantic categories of MSVs: desire and ability (5 verbs), emotions (28 verbs), cognitive (33 verbs), perception (8 verbs), and physiological (6 verbs), and 10 physical verbs as control¹. Following previous studies that used parental questionnaires to estimate language use (see Kristen et al., 2014 for MSV questionnaire and Braginsky et al., 2019 for parental report on word learning in ten different languages), parents were instructed to indicate whether their child produced each verb, regardless of how they pronounced it, or the morphological template used by the child. The score in each MSV category was calculated based on the percentage of verbs marked in that category.

The sentence repetition task used was the Hebrew LITMUS sentence repetition task (SRep-30; Marinis & Armon-Lotem, 2015). This task enables a measure of structural language beyond vocabulary, as demonstrated in previous studies of autistic children (e.g., Manenti et al., 2023; Meir & Novogrodsky, 2020). From the SRep-30, we excluded six question sentences that are difficult for autistic children due to pragmatic difficulties (Manenti et al., 2023). We replaced them with four complement clause sentences (e.g., “The principal said that the teacher is late”), which are related to the acquisition of MSVs (de Villiers & Pyers, 2002; Durrleman & Franck, 2015). These four sentences were added from the extended Hebrew LITMUS Sentence-Repetition task (SRep-56) (Meir et al., 2016). The final task included 28 sentences. To elicit repetitions of the target sentences, the child was shown a figure of a bear on a tablet computer screen and instructed to help the bear find the treasure. To accomplish this, the children were asked to repeat the sentences they heard accurately, and each sentence moved the bear one step forward. The first author recorded, transcribed, and coded all the sentences. Each sentence was coded as correct if the child repeated the syntactic structure correctly, with all its obligatory parts. Lexical, morphological, and phonological exchanges were not counted as mistakes. A student who was part of the research team recoded 20% (672) of the sentences to evaluate inter-rater reliability. The agreement rate between the two coders was 97%, and disagreements were resolved through discussion.

The theory of mind (TOM) tasks included three tasks evaluating TOM abilities. The first task was the diverse desires task, which estimates the child's understanding that different people have different desires (Repacholi & Gopnik, 1997; Wellman & Liu, 2004). In this task, the child was told that the girl on the screen was hungry and could eat only one thing: a carrot or a cookie. The child was then asked what they preferred to eat and was told that the girl preferred the opposite food. The child was then asked which food the girl would choose and why. If the child answered that the girl would choose to eat the food she preferred and explained it correctly, he scored one point.

The second and third tasks were computerized versions of the first- and second-order False Belief tasks, which explored understanding, thoughts, and beliefs (Wimmer & Perner, 1983; Baron-Cohen et al., 1985). The False Belief tasks were adapted to Hebrew by Meir and Novogrodsky (2019). In each task, the child was shown a short video describing a false belief event (one first-order and one second-order). At the end of each video, the child was asked two questions. The first was a TOM question to estimate the understanding of the beliefs of the character in the story (e.g., ‘Where will Shira look for the cookie?’ for the first-order task and ‘Where does Maya think Jonatan will look for the ball?’ for the second-order false belief tasks). The second question was to explain the first answer (e.g., ‘Why will Shira look for the cookie there?’ for the first-order task, and ‘Why does Maya think so?’ for the second-order false belief task). The answers were transcribed by the first author and students who worked on the research project and coded by the first author. In the False Belief tasks, one point was given only if the child answered both questions correctly. If children answered only one question correctly, they received zero points.

Each task was scored separately, resulting in three binary scores representing different TOM abilities.

A demographic questionnaire included 15 questions about background information, such as the age at which motor and language milestones were achieved, signs of atypical language development, and information about the language spoken at home.

Procedure

The study was approved by the University of Haifa Ethics Committee (protocol number 271/21), and all parents provided written informed consent to participate in the study. The children were tested in a quiet room in their homes by the first author and research assistants. The researcher explained the purpose of the study to the children at a level that matched their age and understanding. The TOM and SRep tasks were part of a larger battery of tasks designed to estimate MSV acquisition, and the complete battery was conducted in a single meeting.

At the end of the meeting with the child, two questionnaires were sent to the parents via Google Forms: the demographic questionnaire, followed by the Hebrew MSV questionnaire, and the parents were asked to complete both. For the autistic children who were tested with the ADOS, another meeting was scheduled, and the first author conducted the ADOS. Note that four parents did not respond to the parental questionnaire (two from each group).

Statistical Analysis

To address the first research question on the development of MSV use in autistic and TD children, we examined the effects of age, group, MSV category, and sex (as a control variable) on questionnaire scores using general linear regression models. The random structure was determined via backward stepwise elimination with the Buildmer function in R (Buildmer v. 1.3; Voeten, 2019; R Version 3.6.1; R Core Team, 2019), retaining all theoretically relevant fixed effects (using the “include” subcommand). Bonferroni corrections were applied for multiple comparisons. Categories that differed between groups were further explored by dividing participants into preschool and school-age groups and calculating the mean score of these categories, followed by a 2 × 2 ANOVA with group and age group as between-subject factors.

To address the second research question on the contribution of language ability, TOM, and group beyond age on the mean score of the MSV categories that differed between groups in the parental questionnaire, a block regression analysis was conducted. Age was entered in the first block, language ability ( SRep task) in the second block, TOM tasks in the third block, and group (autistic vs. TD) in the fourth block. In the third block of TOM tasks, the three TOM scores (one for each task) were entered in a stepwise fashion.

Results

The first aim of this study was to investigate the development of MSV use across five semantic categories through age, as reflected in the parental questionnaire, in autistic children compared to TD children, and in a cross-sectional design. In addition, we aimed to explore how language (as measured by the syntax score in the SRep task), TOM (as reflected in the scores of the three TOM tasks), and group (autistic vs. TD) explained the variance in MSV use of the categories that differed between groups, as indicated by the parental questionnaire, beyond the influence of age.

MSV Development in Autistic and TD Children

The scores for MSV production, as reported in the parental questionnaire for each group, are presented in Table 2, categorized into five semantic categories (in percentage and raw data). When examining the development of this production in both groups, the best statistical model to describe the results included the variables of age, group, and category, as well as all two- and three-way interactions. Sex was also included as a variable in this statistical analysis to ensure that the difference in the proportions of boys and girls between the groups did not influence the results. However, the findings showed that it was not part of the model that best described the results (F = 0.1, p = .752) and was thus excluded from further analysis. Linear regression analyses using the selected variables revealed main effects of age (F = 9.67, p < .0001), group (F = 1.66, p < 0.001), and category (F = 33.23, p < .0001). Additionally, significant interactions were found between age and group (F = 4.55, p = .03), age and category (F = 13.37, p < .0001), group and category (F = 9.67, p < .0001), and age, group, and category (F = 3.57, p = .007). These results suggest that the scores of the MSV categories were affected differently by age and group (see Table 2 and Figures 2 and 3).

Figure 2.

MSV Questionnaire Scores of the TD Group in the Five Semantic Categories. Note That the Prediction in the Figure Exceeds 100% and is for Illustration Purposes Only.

Figure 3.

MSV Questionnaire Scores of the Autistic Group in the Five Semantic Categories. Note That the Prediction in the Figure Exceeds 100% and is for Illustration Purposes Only.

Table 2.

Percentage and Raw Scores (in Parentheses) of MSV Used by Categories as Reported in the Parental Questionnaire for the TD and Autistic Groups.

Category (Total Number of Verbs)		Cognitive Verbs (33)	Emotion Verbs (28)	Desire Verbs (5)	Perception Verbs (8)	Physiological Verbs (6)	Physical Verbs (10)
TD group	Mean	91 (30)	87 (24)	100 (5)	94 (7)	99 (6)	99.6 (9.9)
TD group	SD	14.3 (4.7)	14.9 (4.2)	0 (0)	11.8 (0.9)	4.3 (0.3)	2.6 (0.3)
Autistic group	Mean	70.5 (23.3)	69 (19.3)	94 (4.7)	91 (7.3)	94.7 (5.7)	96.5 (9.6)
Autistic group	SD	25.6 (8.4)	23.9 (6.7)	13.6 (0.7)	12.4 (1)	11.8 (0.7)	72 (0.7)

As shown in Figure 2 (TD group) and 3 (autistic group), the questionnaire scores increased with age; however, the slopes differed between categories and groups.

The differences between the slopes were examined using pairwise comparisons for each group separately and corrected using the Bonferroni correction for multiple comparisons. The results revealed differences between the cognitive and emotion categories and the other three categories of MSVs in the autistic group and the desire and physiological categories in the TD group. Cognitive and emotion verbs were less varied than the other categories through age in both groups. No differences were found between cognitive and emotion MSVs (see Table 3). In the autistic group, the desire, perception, and physiological categories did not differ significantly from one another (Table 3 and Figure 3). In contrast, in the TD group, the perception category differed only from the desire category, showing a more varied use of desire verbs than perception verbs. However, the desire and physiological categories did not differ from each other (Table 3 and Figure 2).

Table 3.

Comparison of Category Slopes Within the Autistic and TD Groups.

Compared Categories	Autistic Group	TD Group
Cognitive – emotion	t = 0.43	t = 0.18
Cognitive – desire	t = 7.98***	t = 5.00***
Cognitive – perception	t = 6.56***	t = 2.09
Cognitive – physiological	t = 7.88***	t = 4.36***
Emotion – desire	t = 7.55***	t = 5.19***
Emotion – perception	t = 6.13***	t = 2.27
Emotion – physiological	t = 7.45***	t = 4.54***
Desire – perception	t = 1.42	t = 2.91*
Desire – physiological	t = 0.10	t = 0.65
Perception – physiological	t = 1.32	t = 2.27

Note: * = p ≤ .05; ** = p ≤ .01; *** = p ≤ .001, the p values presented are the adjusted p-values, after Bonferroni correction for multiple comparisons.

In addition, differences between groups were found solely in the cognitive and emotion categories and not in the desire, perception, and physiological categories (Table 4). This result indicates a specific difference between TD and autistic children, showing that autistic children used fewer cognitive and emotion verbs than TD children. Note that this gap decreases with age (see Figures 2 and 3).

Table 4.

Comparison Between the TD and Autistic Groups on the MSV Questionnaire Score by Category.

Category	Estimate (diff)	Autistic Slope	TD Slope	SE	DF	T	Adjusted p-value
Physiological	0.08837	0.13307	0.0447	0.1001	439	0.88	1.000
Cognitive	0.3247	0.6701	0.3454	0.1001	439	3.24	.0063
Emotion	0.2826	0.6406	0.358	0.1001	439	2.82	.0249
Desire	0.1263	0.0000	0.1263	0.1001	439	1.26	1.000
Perception	0.02175	0.22285	0.2011	0.1001	439	0.22	1.000

We further expanded the investigation of the development of cognitive and emotion verbs with age, comparing categories that differed between groups and did not differ from each other, in preschool and school-age children from the two groups². As no difference was found between the cognitive and emotion categories within each group, we calculated an average score for the two categories for each participant and the mean per group, which was used as the dependent variable in the following analysis. The scores for each age group are presented in Table 5.

Table 5.

Mean and SD of the Joined Score of the Production of Cognitive and Emotion Verbs in the Parental Questionnaire by Preschoolers and School-Age Children in the two Groups.

	Autistic Group		TD Group
	Preschool	School-Age	Preschool	School-Age
Mean	55.1	78.5	74.6	93.8
SD.	20.4	26.8	28.3	8.2

A two-way ANOVA model was used to explore the effects of group (autistic vs. TD) and age group (preschool vs. school-age) on the joint scores for cognitive and emotion verbs. The results showed a main effect of group for this joint score (F = 32.744, p < .001), such that TD children scored significantly higher than autistic children did. In addition, a main effect of age group was found for the joint score (F = 41.537, p < .001), indicating that school-age children scored significantly higher than preschoolers did. The interaction between group and age group was also significant for the joint score (F = 6.65, p = .011). As shown in Figure 4, the results indicate that in both groups, school-age children scored higher than preschool children, and TD children scored higher than autistic children in both age groups. However, the gap between preschool and school-age children in the autistic group was larger than in the TD group.

Figure 4.

Mean Joint Scores and SD of the Cognitive and Emotion Categories by Group (ASD vs. TD) and Age Group (Preschool vs. School-age).

Predictors for MSV Use

Next, we continued to focus on the categories that differed between groups (the joint score of cognitive and emotion verbs) and examined the variables that predicted the explained variance in this score. The results indicated that the variables of SRep score, first-order false belief score and group contributed significantly to the explained variance beyond the influence of age, and that, overall, the model explained 61% of the observed variance in the joint cognitive and emotion score. As expected, age had the greatest contribution to the explained variance in the joint score (R² = .305), followed by the SRep score (R² = .237), first-order false belief (R² = .044), and group (R² = .023) (see Table 6). Although a small percentage of the observed variance was explained by first-order false belief and group, its significance beyond the variables of age and language was meaningful. These results indicate that, in addition to age, the variables of language, TOM, and group explain MSV use as reported by the parental questionnaire.

Table 6.

Explained Variance in MSV Questionnaire Scores of Cognitive and Emotion Verbs by Age, SRep, First-Order False Belief and Group.

	R² Change	F Change	df	p
Age	0.305	45.201	1,103	<.001
SRep	0.237	52.850	1,102	<.001
First-order false belief	0.044	10.644	1,101	.002
Group	0.023	5.902	1,100	.017

Note that diverse desires and second-order false belief tasks did not significantly predict the variance in the model (t = .698, p = .487; t = 1.593, p = .114, respectively). Further examination of these variables revealed that there was a small variance in the diverse desires task due to the fact that the vast majority of children (91/118) succeeded in the task. Regarding the second-order false belief task, the small unique variance in the scores of the task was due to the fact that the vast majority of children who succeeded in this task (51/55) also succeeded in the first-order false belief task.

In summary, for both groups and all semantic categories, the diversity of MSV use, as reflected in the parental questionnaire, increased with age. However, the growth slopes of the categories exhibited a different pattern within each group. Specifically, in the autistic group, the slopes differed between the cognitive and emotion categories and the other three categories. In the TD group, a difference was observed between the slopes of the cognitive and emotion categories and the physiological and desire categories and between the perception category and the desire category. Finally, there was a significant difference in slope between the groups solely in the cognitive and emotion categories. These results suggest that autistic children use fewer varied cognitive and emotion verbs at younger ages and that it takes them more time to acquire these MSVs than it does for TD children. When focusing on the cognitive and emotion MSVs, which differ between the groups, a significant difference was found between preschoolers and school-age children, indicating that the development of these verbs progresses with age in both groups. In addition, an interaction was found between group (autistic vs. TD) and age-group (preschool vs. school-age), indicating that developmental progress with age differed between groups.

Regarding the second aim of the study, language, TOM, and autism explained the variance in the participants’ scores beyond the effect of age. Note that the variance explained by TOM and autism was small but significant, and it was beyond the effect of age and language.

Discussion

The first aim of this study was to describe the development of different semantic categories of MSVs among autistic children compared to TD children through childhood using a cross-sectional design and a parental questionnaire. Our findings, in line with previous research on TD children (Bartsch & Wellman, 1995; Eilon & Novogrodsky, 2024; Pascual et al., 2008; Tardif & Wellman, 2000), showed that the diversity of MSV use in each category increased with age in both TD and autistic children. The novelty of the findings lies in their demonstration of an increase in the diversity of MSV use across all five semantic categories in autistic children aged 3–10 years, particularly in the diversity of cognitive and emotion verbs from preschool to school-age. To our knowledge, no study has investigated the development of MSVs in autistic children in this age range. These results suggest that autistic children, regardless of their difficulties in acquiring mental language (here, specifically MSVs), show increased development during childhood. Note that all autistic children in the current study were fully verbal and participated in intervention programs, two characteristics that might affect the group results. Another explanation for this development is the exposure to written language upon entering school (Antonietti et al., 2006; Egoz-Libshtain, 2009). However, more research is required on the relationship between literacy exposure and MSVs acquisition to support this explanation.

Further exploration of the differences between the semantic categories of MSVs within each group highlights the challenge of developing diverse cognitive and emotion MSVs compared to desire, physiological, and perception MSVs. The findings indicate the existence of two different developmental trajectories within MSVs (see Figures 2 and 3 and Table 3) and support previous studies’ findings about the prolonged development of the use of emotion and cognitive verbs in TD children (Bartsch & Wellman, 1995; Egoz-Libshtain, 2009; Eilon & Novogrodsky, 2024; Pascual et al., 2008).

When focusing on between-group differences, cognitive and emotion verbs were the only categories in which autistic children used fewer verbs than TD children (Table 4). This was observed in both preschool and school-age children. These findings are in line with previous studies, which have shown that autistic children aged 6–14 years use fewer cognitive terms (Brown et al., 2012; Rumpf et al., 2012) and emotion terms (Brown et al., 2012; Siller et al., 2014) when telling narratives. Our findings indicate that the gap between autistic and TD children occurs at younger ages, is specific to these two categories, and extends beyond narrative tasks (e.g., Brown et al., 2012). The findings add to those of Jimenez et al. (2021), who found that young autistic children (ages 12–84 months) are delayed in learning highly social verbs (e.g., ‘smile’, ‘hug’) as compared to late talkers and TD children. The results indicate that cognitive and emotion verbs are particularly challenging for both autistic and TD children compared to other MSV categories, as well as for autistic children in relation to their TD peers.

In contrast to previous studies on TD children (Bornstein et al., 2004; Eilon & Novogrodsky, 2024; Eriksson et al., 2012), and contrary to our prediction, sex was not found to influence children's MSV production in the current study. It is possible that the small ratio of girls in the autistic group, which represents the population, affected these results. In addition, there is some evidence that autistic females may show different language profiles from males (Lockwood Estrin et al., 2021; Kauschke et al., 2016), but it is unclear how this difference affects MSVs. Thus, further research on the differences between the acquisition of MSVs in autistic boys and girls is required.

The second research aim was to examine the factors influencing the variance in scores for cognitive and emotion verbs, as presented in the parental questionnaire. Specifically, we examined the effects of language, TOM, and group on the variance of MSV scores beyond the effect of age, which was confirmed in the first research question. As predicted, age explained the most significant part of the variance (30.5%), which aligned with the broad age range (3–10 years). In addition, syntactic language abilities, first-order false belief (representing TOM abilities), and the participants’ diagnosis (autistic vs. TD) explained additional significant parts of the variance in MSV scores (23.7%, 4.4%, and 2.3%, respectively). Note that the effects of first-order false belief and diagnosis were minor, but they are shown beyond the effects of age and syntax. It is agreed that autistic children as a group have difficulties in syntax and false belief tasks but 2% of the variance is explained by the diagnosis of autism beyond the difficulties in syntax and TOM. These findings highlight the complex relationship between MSVs and language (specifically, syntax) as well as cognitive abilities (specifically, TOM). Below, we discuss variables of syntax, TOM, and diagnosis.

From a syntactic perspective, it is suggested that MSVs tend to appear in a syntactic structure of clausal complement sentences (Papafragou et al., 2007). Studies investigating the acquisition of MSVs in TD children found that the structure of clausal complement is usually present in children's language before they start using MSVs to describe internal conditions (e.g., ‘I tried to eat it all’) (Shatz et al., 1983), indicating the important influence this syntactic structure has on MSV development. Cross-linguistically, desire and cognitive verbs take different types of complements when appearing in the structure of sentential complements: cognitive verbs take complements with syntactic features of declarative main clauses, while desire verbs take other clauses that are acquired at a young age. The specific linguistic features that distinguish declarative main clauses from other clauses vary across languages (Hacquard & Lidz, 2022). For example, the finite tense is one of the main characteristics of declarative clauses in English. This increased syntactic complexity might explain the delay in the use of cognitive verbs by both TD and autistic groups. But note that in Hebrew, MSVs from all categories take various sentential complements and noun phrases (Egoz-Libshtain, 2009). In addition, performing complex syntax tends to be challenging for autistic children (Tager-Flusberg & Joseph, 2003), which may explain the differences between the groups in the current study. Syntactic abilities explaind 24% of the variance beyond age, supporting the importances of language in the acquisition of MSVs for both TD and autistic children.

Cognitively, the connection between MSVs and TOM abilities is well established and supported by correlations between the use (Siller et al., 2014; Tager-Flusberg & Sullivan, 1995) and comprehension (De Mulder, 2015; Li & Leung, 2020) of MSVs and TOM ability, as demonstrated in false belief tasks. In the current research, aligned with these previous studies, first-order false belief was found to be the sole significant TOM ability predicting cognitive and emotional variance. Furthermore, the two trajectories of MSV development found in this study and described above are aligned with the division by Tsimpli et al. (2016) of related TOM terms (cognitive and emotion verbs) versus non-related TOM terms (perception and physiological verbs). Note that TOM explained only 4.4% of the variance, but it was beyond age and language (syntax).

It has been suggested that children worldwide follow a common pattern when acquiring MSVs. First, they use desire terms and then refer to knowledge and thoughts (cognitive verbs) (Tardif & Wellman, 2000). The current results support this hypothesis, showing that autistic children also show this pattern of acquisition. This universal process of acquisition might reflect the developmental process of TOM, where infants first understand that people are intentional agents driven by desires and goals that underlie their actions and behaviors (Meltzoff, 1995; Wellman, 2018), and later learn that different people have various beliefs and that their beliefs can differ from reality (e.g., false beliefs) (Wellman & Liu, 2004). The parallel development of TOM and the use of desire verbs before cognitive verbs support the connection between these two abilities. In this manner, our findings from both Hebrew-speaking autistic and TD children agree with those from other languages, such as English (Bartsch & Wellman, 1995; Shatz et al., 1983), Spanish (Pascual et al., 2008), Italian, German, and French (Kristen et al., 2014), and Cantonese and Mandarin (Tardif & Wellman, 2000). This connection between MSVs and TOM can be explained by the conceptual growth hypothesis, which argues that the delay in acquiring cognitive verbs is due to the difficulty in understanding the conceptual meaning (i.e., the mental state) that they represent. This theory connects the conceptual development of understanding mental states of self and others (TOM) with the acquisition of the semantic meaning of mental verbs (Papafragou et al., 2007). Autistic children are known to differ from TD children in TOM ability (Baron-Cohen et al., 1985), and this difference may explain the differences between groups in the emotion and cognitive verbs found in this study (in addition to the syntactic explanation). Another complementary approach, the information growth hypothesis, claims that MSVs are acquired late due to a lack of obvious and stable observational correlates, meaning that mental states are not directly observable when they occur (Papafragou et al., 2007). This theory explains the long trajectory of acquisition in both groups.

The complex relationship between MSVs, TOM, and syntax development was studied by Durrleman and Franck (2015). In their study they found that the connection between the performance on verbal false belief tasks and sentential complement tasks depended on the type of verbs used in the sentence. Specifically, the relationship between the verbal false belief task and complement sentences was found when the sentence contained a cognitive verb (e.g., ‘think’) or a communicative verb (e.g., ‘say’), but not when it contained a perceptual verb (e.g., ‘see’). Based on these studies, and in conjunction with the results of the current study, a complex relationship appears to exist between MSVs, syntax, and TOM understanding, which may explain the protracted developmental process of these verbs. This finding warrants further studies to understand the characteristics of these relationships and the overlap between them, as well as how they are reflected in autistic children.

Finally, beyond age, syntax, and TOM, the diagnosis of ASD also explained an additional unique variance in the MSV scores (small but significant). This finding suggests that there are characteristics of autism beyond language and TOM abilities that are related to the development of MSV use. The characteristics of these difficulties remain an open question for future studies.

The implications of the lack of MSV use are broad and affect different areas of the lives of autistic children. Childhood verb diversity, specifically among autistic children, was found to be the best linguistic predictor of adult language and communication outcomes (LeGrand et al., 2021). The authors suggested that these outcomes occurred because verbs have semantic and syntactic roles, such that evaluating verb use can be described as a measure of both semantic and syntactic skills. In addition, since verbs are more abstract than nouns in most cases (Gentner, 1978), having a more extensive verb lexicon may indicate a better understanding of the abstract relationships among objects and ideas in the world (LeGrand et al., 2021). The development of MSVs is correlated with various social and communicational abilities, including components of pretend play (e.g., object substitution, imaginary play, and role assignment; Nielsen & Dissanayake, 2000) and prosocial behavior, as observed in observational reports (Carr et al., 2018). Together, these findings emphasize the importance of MSV development in autistic children.

The current study has some limitations. First, the study's design was cross-sectional; therefore, longitudinal data are required to further support developmental trajectories. More data are needed on the syntactic structures of MSVs in Hebrew to better understand the relationship between MSV development and syntax. Additionally, data on the literacy levels of the participants were not available and are necessary for further exploration of the effects of schooling and literacy exposure on MSV development. Finally, the current research did not explore the comprehension of MSVs, which would complete the full picture of MSV development (see Eilon & Novogrodsky, 2025). These issues await future research.

In summary, the diversity of MSV production increases with age in autistic children. Cognitive and emotion verbs pose greater challenges for acquisition among both TD and autistic children, and autistic children have more difficulties in these categories in preschool and school-age. Syntactic abilities, TOM abilities, and autism diagnosis explained unique parts of the variance in the performance of cognitive and emotion verbs. Overall, the findings highlight the particular challenges that cognitive and emotion verbs pose for children in general, and more significantly for autistic children.

Footnotes

Acknowledgments

We express our heartfelt gratitude to the parents and children for their voluntary participation in this study and their willingness to help this study exist. We also wish to extend ourappreciation to the research assistants who helped with the data collection and analysis.

ORCID iDs

Inbal Eilon

Rama Novogrodsky

Ethical Consideration

This study was approved by the Ethics Committee University of Haifa (Ethics Code: 271/21) on June 03, 2021. All participants provided written informed consent prior to enrolment in the study.

Consent for Publication

Not applicable

Author Contributions

The authors declare equal contributions.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and publication of this article: This work was supported by the National Institute for Psychobiology in Israel- Founded by The Charles E. Smith Family. [grant number 16-2021-2022].

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability

All materials, data and statistics are available in

Notes

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The Development of Mental State Verb Use Among Autistic Children

Abstract

Background & Aims

Methods

Results

Conclusions and Implications

Keywords

Introduction

Development of the Use of MSVs in TD and Autistic Children

Aims of the Study

Methods

Participants

Autistic Group

TD Group

Materials

Procedure

Statistical Analysis

Results

MSV Development in Autistic and TD Children

Predictors for MSV Use

Discussion

Footnotes

Acknowledgments

ORCID iDs

Ethical Consideration

Consent for Publication

Author Contributions

Funding

Declaration of Conflicting Interests

Data Availability

Notes

References