Exploring the Role of Theory of Mind in Moral Judgment: The Case of Children with Autism Spectrum Disorder

Abstract

This paper adds to the growing research on moral judgment (MJ) by considering whether theory of mind (ToM) might foster children’s autonomous MJ achievement. A group of 30 children with autism spectrum disorder (ASD) was compared in MJ and ToM with 30 typically developing (TD) children. Participants were tested for MJ with a classical Piaget’s task and for ToM with a second order False Belief task. In the moral task, children were told two versions of a story: in one version the protagonist acted according to a moral intention but the action resulted in a harmful consequence; in the other version the protagonist acted according to an immoral intention, but the action resulted in a harmless consequence. Children were asked which of the two protagonists was the “naughtier.” In line with previous studies, the results indicated that, while the majority of TD participants succeeded in the second order False Belief task, only few individuals with ASD showed intact perspective taking abilities. The analysis of the MJ in relation to ToM showed that children with ASD lacking ToM abilities judged guilty the protagonists of the two versions of the story in the moral task because both of them violated a moral rule or because they considered the consequences of the actions, ignoring any psychological information. These results indicate a heteronomous morality in individuals with ASD, based on the respect of learned moral rules and outcomes rather than others’ subjective states.

Full text

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ORIGINAL RESEARCH
published: 18 April 2016
doi: 10.3389/fpsyg.2016.00523
Edited by:
Antonella Marchetti,
Università Cattolica del Sacro Cuore,
Italy
Reviewed by:
Adam Goodie,
University of Georgia, USA
Ankita Sharma,
Indian Institute of Technology
Jodhpur, India
*Correspondence:
Roberta Fadda
robfadda@unica.it
Specialty section:
This article was submitted to
Cognitive Science,
a section of the journal
Frontiers in Psychology
Received: 22 January 2016
Accepted: 29 March 2016
Published: 18 April 2016
Citation:
Fadda R, Parisi M, Ferretti L, Saba G,
Foscoliano M, Salvago A
and Doneddu G (2016) Exploring
the Role of Theory of Mind in Moral
Judgment: The Case of Children with
Autism Spectrum Disorder.
Front. Psychol. 7:523.
doi: 10.3389/fpsyg.2016.00523
Exploring the Role of Theory of Mind
in Moral Judgment: The Case of
Children with Autism Spectrum
Disorder
Roberta Fadda1*, Marinella Parisi1, Luca Ferretti2, Gessica Saba2, Maria Foscoliano3,
Azzurra Salvago2and Giuseppe Doneddu2
1Department of Pedagogy, Psychology, Philosophy, University of Cagliari, Cagliari, Italy, 2Center for Pervasive
Developmental Disorders, Azienda Ospedaliera Brotzu, Cagliari, Italy, 3Studio Kaleidos, Cagliari, Italy
This paper adds to the growing research on moral judgment (MJ) by considering whether
theory of mind (ToM) might foster children’s autonomous MJ achievement. A group of
30 children with autism spectrum disorder (ASD) was compared in MJ and ToM with
30 typically developing (TD) children. Participants were tested for MJ with a classical
Piaget’s task and for ToM with a second order False Belief task. In the moral task,
children were told two versions of a story: in one version the protagonist acted according
to a moral intention but the action resulted in a harmful consequence; in the other version
the protagonist acted according to an immoral intention, but the action resulted in a
harmless consequence. Children were asked which of the two protagonists was the
“naughtier.” In line with previous studies, the results indicated that, while the majority of
TD participants succeeded in the second order False Belief task, only few individuals
with ASD showed intact perspective taking abilities. The analysis of the MJ in relation to
ToM showed that children with ASD lacking ToM abilities judged guilty the protagonists
of the two versions of the story in the moral task because both of them violated a
moral rule or because they considered the consequences of the actions, ignoring any
psychological information. These results indicate a heteronomous morality in individuals
with ASD, based on the respect of learned moral rules and outcomes rather than others’
subjective states.
Keywords: school children, moral judgment, theory of mind, autism spectrum disorder, moral education
INTRODUCTION
The psychological roots of morality have been one of the major focuses of attention of philosophy
for centuries. More recently, experimental psychologists empirically investigated moral reasoning
in children and adults in the attempt to appreciate the impact of this process on individuals’ social
lives.
Piaget (1932) studied the psychological origins of moral judgment in children by using moral
dilemmas, in which answers varied along one cognitive dimension (intention) and one contextual
dimension (consequence). Piaget (1932) demonstrated that children up to the age of six use
consequences rather than intentions to judge culpability in such dilemmas, so they consider
the obedience to the moral rule more important than intentions. Piaget called this phase the
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“heteronomous stage,” in which children consider moral rules
as unchangeable and requiring strict obedience. Later in their
development, at the end of the school years, children view rules
as flexible and related to social principles that vary according
to people’s intentions. Piaget named this stage the “autonomous
stage,” in which moral transgressions are judged considering the
intentions behind the actions (Piaget, 1932).
Subsequent research on children confirmed the role of
perspective taking in moral reasoning. The majority of children
tend to consider intentional behaviors “wrong” compared to
the accidental ones (Nunez and Harris, 1998). The relationship
can also run from moral judgment to theory of mind (ToM),
so that preschool children judge the intentionality underlying
an action depending on the moral valence of the action itself
(Leslie et al., 2006a;Pellizzoni et al., 2010). Adults usually rely on
mentalistic motivations to define moral judgements about agents’
behaviors. While unintentional behaviors are usually explained
merely in terms of mechanical causal factors, intentional
actions are interpreted by considering agents’ knowledge that
a behavior might cause negative effects on others (Knobe,
2005).
A number of research on TD adults and children indicated the
role of perspective taking in moral reasoning. However, as long as
perspective taking precedes the development of moral judgment
(MJ) in childhood, it is difficult to identify the actual weight of
ToM on morality.
Recently, studies of morality in individuals with autism
spectrum disorder (ASD) provided important insights into the
role of ToM abilities in MJ. Given the mentalizing impairments
that characterize individuals with ASD (Baron-Cohen et al., 1985;
Baron-Cohen, 1989;Hill and Frith, 2003), it might be predicted
that MJ would be impaired in these individuals. Surprisingly,
the majority of previous studies showed that individuals with
ASD are sensitive to moral transgressions, despite a lack of ToM
abilities.
Blair (1996) investigated the ability of children with ASD
to distinguish between moral and conventional transgressions.
While moral transgressions determine a consequence for
the rights and welfare of others, conventional transgressions
determine a consequence for the social order. Thus, it is the
responsivity to the distress of a victim that is crucial to distinguish
moral from conventional transgressions (Smetana et al., 2008).
Blair (1996) investigated the responses to the moral/conventional
distinction of two groups of children with ASD: one group
lacking the ability to mentalize and the other group showing
the capacity to mentalize. Typically developing children and
moderate learning difficulty children were evaluated as control
groups. The results indicate that all the groups made the
moral/conventional distinction. Thus, ToM abilities were not
crucial for basic MJ.
Leslie et al. (2006b) investigated whether children with ASD
make basic MJ in comparison to TD controls in two experiments.
In the first experiment, children were tested for very basic MJ
about prosocial (“good”) and antisocial (“bad”) acts (Killen,
1991). Participants with ASD were also tested on two standard
false belief tasks (Baron-Cohen et al., 1985;Perner et al., 1989).
The first experiment indicated that the ASD group, despite a
lower ToM performance compared to controls, made simple
bi-valued MJs as TD children. The second experiment replicated
and extended Blair’s study by introducing a new control task:
the “cry baby” story. In this story, the action of the protagonist
determined neither a moral nor a conventional transgression.
However, the action caused a distress of a baby. Thus, if
the participants would simply react to the distress of another
person, then they will judge the “cry baby” story as a moral
transgression. The same participants with ASD tested in the
first experiment were considered (with and without ToM). The
results of the second experiment supported the findings of Blair
(1996): children with ASD who failed standard false belief tasks
distinguished between moral and conventional transgressions.
Moreover, both TD and ASD children distinguished between the
distress of a “cry baby” and the distress of a victim in a moral
transgression. Taken together the results of the two experiments
suggest that children with ASD who fail standard false belief tasks
may present a basic moral sense.
Lecciso et al. (2008) analyzed the value of the intention
behind moral actions and its link with mentalising abilities in
high-functioning children with ASD and in normally developing
children. The results indicated that, although children with ASD
showed difficulties in both first-order and second-order false
belief tasks, their ability to make moral judgements was not
impaired.
Recently, Kretschmer et al. (2014) investigate relations
between moral reasoning, executive functioning and ToM in
children with ASD compared to TD children. A dilemma was
presented to participants and they had to judge if the protagonist’s
behavior was correct or not. In addition, participants completed
two ToM tasks, a working memory and an inhibition test. The
results indicated that children with ASD did not differ from TD
children in cognitive and affective aspects of moral reasoning,
ToM and executive functioning. However, there was a correlation
between moral reasoning and inhibitory control and between
ToM abilities and inhibition. Thus, these results showed that
ToM is not a prerequisite for MJ but that inhibitory control might
play a mediating role between ToM and MJ in children with ASD.
These studies on MJ in ASD has focused on the ability to
distinguish between intentional moral and conventional harms
(Blair, 1996). They also focused on the MJ of intentional negative
acts as good or bad (Leslie et al., 2006b;Lecciso et al., 2008;
Kretschmer et al., 2014). Both kinds of studies found that ASD
and TD individuals possess the same basic understanding of
moral right and wrong: they can distinguish morally acceptable
from morally unacceptable acts.
Other studies applied more complex moral reasoning
paradigms, which varied the intentionality of immoral acts
requiring participants to involve ToM abilities to make MJ.
Grant et al. (2005) investigated whether children with ASD are
able to weight up both the motive and outcome of behavior for
judgments of culpability, compared with a group of children with
moderate learning difficulties and a group of TD children in MJ.
Participants were presented with pairs of stories in which motive
and outcomes were combined into three conditions: (A) different
motives (ill/good), same outcome; (B) same motives (good),
different outcomes (damage to a person/damage to a property);
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(C) different motives (ill/good) and different outcomes (damage
to a person/damage to a property). Participants were asked to
judge which protagonist was the naughtier and to justify verbally
this judgement. Justifications were analyzed to assess whether
correct culpability judgements derived from appropriate, adult-
like reasoning, or whether correct judgements did not involve
an appreciation of intentions. Results showed that children with
ASD were as likely as controls to judge ill intentions more
culpability than good ones regardless the outcomes. They judge
injury to persons as more culpable than damage to property.
Thus, participants with ASD were able to evaluate intentions
and outcomes in making MJ. However, no measures of ToM
abilities were considered in this study. Moreover, differently from
controls, the majority of the justifications given by the children
with ASD were reiterations of the story rather than explanations
of their judgements.
Moran et al. (2011) tested whether ASD adults would consider
both the intentions and the outcomes of a person’s actions when
expressing MJ, in comparison to TD controls. Participants read
vignettes in which protagonists produced either a negative or
a neutral outcome based on the belief that they were causing
the negative outcome (negative belief) or the neutral outcome
(neutral belief). The MJs required both processing beliefs and
intentions and processing outcomes. Participants in both groups
were also tested for ToM abilities. The results indicated that
there were no differences between participants with ASD and
TD controls in ToM abilities. However, adults with ASD showed
an over-reliance on the action’s negative outcome and an under-
reliance on information about a person’s innocent intention
compared to controls. These findings indicate that individuals
with ASD don’t integrate mental state information into MJs.
Zalla et al. (2011) investigated the ability of adults with ASD
to distinguish moral, conventional and disgust transgressions
using a set of six transgression scenarios. Each transgression
was followed by questions about permissibility, seriousness,
authority contingency, and justification. The results showed
that individuals with ASD were able to distinguish between
moral and conventional norms. However, they failed to
distinguish moral and disgust transgressions and were unable to
provide appropriate moral justifications. Moreover, they judged
conventional transgressions and disgust transgressions to be
more serious compared to TD controls. The seriousness rating
correlated with their ToM impairment. The authors concluded
that individuals with ASD might be responsive to rule violations,
even though they fail to use relevant information about the agent’s
intentions in moral reasoning.
Shulman et al. (2012) compared moral and social reasoning
in individuals with and without ASD. Familiar schoolyard
transgressions were shown to participants and a yes/no question
examining the acceptability of the portrayed behaviors was
asked to them. They also had to judge the appropriateness
of the behavior and explain their judgments concerning
acceptability. The judgments were categorized into different
categories, corresponding to the Kohlberg’s developmental
model of morality. For example, concern over the damage
resulting from the specific transgression corresponded to
the first stage of pre-conventional level and justifications
based on an awareness of general principles prohibiting the
depicted behaviors corresponded to the second stage of pre-
conventional morality. The results indicated both groups made
the moral/social distinction. Participants with TD were more
flexible than participants with ASD, providing more examples
of behaviors that might be considered as transgressions in one
context but not in another one. Moreover, participants with
ASD considered more often than TD participants the expected
damage which would result from the transgressions and they
cited more often a specific simple rule prohibiting such behavior
(e.g., “that’s bad,” “you can’t do that”). These results seem to
indicate that participants with ASD are at a pre-conventional
level of moral development, in which intentions are not yet
included in their moral reasoning. However, the authors did
not consider differences in ToM abilities between ASD and TD
participants. Differences in MJ between groups were explained
considering that individuals with ASD focus on the details. Thus,
it becomes difficult for them to discern the relevant features (e.g.,
the intentions) as different and as more important than irrelevant
ones (Happé and Frith, 2006).
In summary, previous studies showed that individuals with
ASD are able to perform at the same level as TD individuals
in basic moral reasoning despite a lack of ToM (Blair, 1996;
Leslie et al., 2006b;Lecciso et al., 2008;Kretschmer et al., 2014).
Basic moral reasoning tests, which presented participants with a
yes/no question to examine the acceptability of an action, have
in common that they do not require individuals to explain moral
decisions, but only to distinguish whether an action is ‘good’ or
‘bad.’ This might explain the similar performance of individuals
with and without ASD.
Other studies revealed differences in moral reasoning between
individuals with TD and individuals with ASD when more
complex moral reasoning paradigms were applied that put
higher demands on reasoning (Grant et al., 2005;Moran et al.,
2011;Zalla et al., 2011;Shulman et al., 2012). Specifically,
while TD individuals integrate intentions into their justification
of moral reasoning, individuals with ASD seems to employ
a compensatory strategy, in which the rigid application of
a learned moral rule might supply for ToM deficits in this
population.
The results of the empirical studies described so far are
consistent with the recent philosophical conceptualization of
morality in individuals with ASD. Kennet (2002) described
individuals with ASD as lacking the ability to self-develop
moral rules or to apply them into new situations. According to
Kennet’s view, since individuals with ASD have ToM deficits,
they fail to represent other people’s thoughts in a particular
situation, which is crucial to elaborate a moral judgement.
However, individuals with ASD develop moral judgements by
other means, like for example by reasoning on explicit rules
taught by others and/or by inferring the social norms from
past experiences (Kennet, 2002). Krahn and Fenton (2009)
recently supported such a view of morality in ASD: individuals
with ASD are viewed as not morally autonomous because they
lack a sense of intersubjectivity – the ability to understand
moral behavior from the viewpoint of an agent involved in an
action.
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Thus, nowadays philosophers converge in the hypothesis
that individuals with ASD should not be considered fully
mature moral agents (autonomous) because of their significant
social impairment. On the contrary, these individuals express
heteronomous MJ based on overlearned abstract knowledge
about normative rules (Kennet, 2002;Krahn and Fenton, 2009;
Damm, 2010). For the best of our knowledge, this hypothesis
of a heteronomous morality in individuals with ASD has never
been empirically tested using a developmental model of morality.
This model might be helpful to conceptualize MJ in ASD as
developmentally immature, rather than merely atypical, whit
important implication for interventions.
The only study so far, for the best of our knowledge, that
tried to explain morality in individuals with ASD according to a
developmental model of morality is Shulman et al. (2012), which
indicated that children with ASD tend to express judgments
at a pre-conventional stage of Kohlberg’s moral development
model. However, this study explained these results in terms of
attention to details rather than in terms of ToM abilities, which
were not evaluated in the participants. This study left open the
question of whether ToM abilities might play a crucial role in the
development of a mature level of morality in ASD.
The present study tested the hypothesis of an heteronomous
morality in individuals with ASD, in the light of the Piagetian
model of moral development in children. Even though Piagetian
framework of moral development has been challenged in the
last decades, Piaget’s dilemmas might offer an ideal context
to verify the hypothesis of a heteronomous MJ in children
with ASD, because the answers could vary along intention,
transgressions of a moral rule and consequences. To achieve this
aim, we investigated ToM and MJ in children with ASD and in
typically developing children. We predicted that, if individuals
with ASD are heteronomous agents, they will consider more the
consequences of the actions or the violations of the moral rule
when solving Piaget’s dilemmas rather than the others’ intentions.
MATERIALS AND METHODS
Participants
Two groups participated in the study. The first group included
30 TD school children (all males; average chronological
age =10 years and 6 months; SD =1.687). The TD participants
were recruited at school and they were interviewed during
the school hours. The second group included 30 participants
with ASD (all males; average chronological age =11 years and
8 months; SD =3.808; average IQ =87.57; SD =17.344).
The participants with ASD were diagnosed by expert clinicians
using the DSM-IV criteria and Autism Diagnostic Observation
Scale (ADOS) scores (Lord et al., 1999). The participants in
both groups were all males, considering the higher prevalence
of ASD in this gender. Only the IQ scores of the clinical
groups were known, but since the TD group consisted of a
random group of typically developing children, who were average
performing students in mainstream education, the mean IQ of
the control group can be considered to be in the normal range.
Official authorizations to carry out the research were provided
by the school director and the teachers of the classes involved.
Informed written consent was obtained from the parents of each
participant. The research was conducted in the absence of any
commercial or financial relationship that could be construed
as a potential conflict of interest. The study was approved by
the local ethics committee and carried out in accordance with
the Society for Research in Child Development’s (SRCD) Ethical
Standards for Research with Children, the Italian Psychological
Association’s Ethical Standards for Research with Humans, and
the World Medical Association’s Helsinki Declaration, as revised
in October 2008.
Materials
The participants were tested for mentalizing abilities with a
second-order FB task (Perner and Wimmer, 1985) and for moral
judgment with a classic Piagetian dilemma. The two tasks were
presented in a written form. The FB task included also colored
pictures, representing the most salient parts of the story.
Procedure
Participants were tested individually in a quiet room of the school
during a school day. For the FB and the moral judgment tasks,
the participants were instructed to read the stories carefully
and to imagine each hypothetical situation. The experimenter
was available for explanation and support. The order of task
presentation was counterbalanced between subjects.
Second-Order False-Belief Attribution Task
In the second-order FB attribution task (Perner and Wimmer,
1985), the children were told a story in which two characters,
A and B, saw an ice-cream van in the park. Later, each was
independently told that the ice-cream van had moved from
the park to the church, but they did not know that the other
one had also been informed. The participants were asked
where A thought B would go to buy ice cream. To respond
correctly, the children must employ recursive thinking about
mental states, by predicting one person’s thoughts about another’s
thoughts. Specifically, the participants should take into account
A’s ignorance of B’s knowledge of the true location of the ice-
cream van. The second-order FB question was administered only
if the child passed a memory question and a reality question.
The belief question was scored in a pass or fail manner (Baron-
Cohen, 1989). Specifically, the answer was considered correct if
the child considers the false belief in order to predict the behavior
of the protagonist. On the other side, the answer was considered
incorrect if the child considers the real facts to predicts the
behavior of the protagonist.
Moral Judgment Task
Moral judgment was assessed by telling children the following
stories, in which two protagonists used the scissors without the
supervision of an adult (transgression):
(a) Margherita wants to play with the scissors when her mum
is gone. As soon as she plays with the scissors she cut a little
hole in her dress.
(b) Lucia wants to please her mother with a little present. She
decides to cut some flowers from a colored paper sheet and
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give them to her mum. While she’s doing her job, she cut a
big hole in her dress.
In the first version of the story, the character intentionally
acted unfairly but she caused an insubstantial material damage.
In the other version, the character acted fairly but she caused
a considerable material damage. The participants were asked to
decide which of the two protagonists was naughtier and why.
An experimenter, which was blind to the group from which
the responses were drawn, judged the participants’ answers. The
responses were coded as follows: intention – the child refers to the
intention of the protagonist (e.g., “Margherita was the naughtier
because she used the scissors just for fun); transgression of a
moral rule (moral rules)- the child considers both protagonist
as equally nasty (e.g., “Both children were naughty because
they used the scissors without the supervision of an adult);
consequence – the child refers to the consequence of the action
(e.g., “Lucia was the naughtier because she made a bigger hole
in her dress compared to Margherita”). While the answers using
the intentions indicate the autonomous stage, the other two
categories indicate an heteronomous stage.
Design and Analysis
A series of non-parametric analysis were applied to compared
ASD children and TD children in MJ and ToM. Chi-square
was used to compare group differences in ToM and MJ in
the general sample. Moreover, chi-square was used to compare
group differences in MJ in two subgroups of participants,
with and without ToM abilities. Finally, Fisher’s exact test was
applied to compared the frequency of participants that expressed
heteronomous vs. autonomous MJ in the participants with and
without ToM abilities.
RESULTS
The results indicated that, while half of the TD participants
succeeded in the second-order FB task (50%), only a few
children with ASD (5%) showed intact perspective-taking
abilities (χ2=7.5; df =1; p=0.006).
As shown in Figure 1, children with ASD judged the
culpability on an action mainly in terms of consequences (23%)
and transgression of a moral rule (17%). Only a few of the
children with ASD referred to the intentions (10%). On the
opposite, TD children mainly referred to the intentions (30%)
and only a few of them considered the consequences (10%)
and the transgression of a moral rule in their judgment (10%).
The differences between group were statistically significant
(χ2=10.200; df =2; p=0.006).
Then, we considered the MJ in children with TD and ASD
divided into two subgroups of participants, with and without
ToM abilities. In the subgroup of participants that failed the
False-Belief Task (Figure 2), the results indicated that, even
though the differences between groups are not statistically
significant (χ2=4.627; df =2; p=0.099), there is a tendency in
TD children to consider the intentions of the participants (18%).
On the opposite, children with ASD tend to consider mainly
the consequences (28%) or the transgression of the moral rules
(25%).
In order to identify the heteronomous participants, we
collapsed in a unique group the participants that considered
the consequences and the transgression of the moral rules
in the MJ and we compared them to the autonomous
participants, who considered the intentions (Table 1). The
results indicated that there is a tendency in children with ASD
lacking ToM to be mainly heteronomous agents, while TD
children tend to be mainly autonomous agents (Fisher’s exact test
p=0.06).
When we considered the participants that passed the ToM
task (Figure 3), TD children mainly considered the intentions
(55%). Only few children with ASD passed this task and they
were distributed between those that considered the intentions
(10%) and those that considered the consequences (15%). The
differences between groups are statistically significant (χ2=6.97;
df =2; p=0.031).
FIGURE 1 | Percentage of participants with autism spectrum disorder (ASD) and with typical development (TD) who expressed a judgment of
consequence (conseq), transgression of a moral rule (moral rules) and intention (intent) in the Piaget’s moral judgment (MJ) task.
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FIGURE 2 | Percentages of participants with typical development that failed the theory of mind task (TD ToM−) and percentages of participants with
autism spectrum disorder that failed the theory of mind task (ASD ToM−) which expressed a MJ according to the intention (intent), the transgression
of the moral rule (moral rules) and the consequences (conseq) of the protagonists.
As shown in Table 2, the results indicated that, even though
the differences between groups are not statistically significant
(Fisher’s exact test p=0.2898), there is a tendency in TD children
to be mainly autonomous agents.
DISCUSSION AND CONCLUSION
In line with previous studies, our results indicated that children
with ASD develop a MJ, despite their deficit in ToM. However,
children with ASD who lacked ToM abilities showed more
negative MJ concerning actions that broke the rules of morally
appropriate behavior or regarding damaging outcomes. Reduced
ToM abilities in children with ASD seem to enhance their
likelihood to conform rigidly to a social norm or to consider the
outcomes of an action, which is typical of a heteronomous stage
of moral development in the Piagetian model. Thus, the results
of our study confirm our hypothesis of a heteronomous morality
in individuals with ASD. Our results are also consistent with a
recent philosophical conceptualization of morality in individuals
with ASD. As described in the introduction, philosophers
nowadays agree that individuals with ASD should not be
considered fully mature moral agents due to their social deficits
(Kennet, 2002;Krahn and Fenton, 2009;Damm, 2010). These
results indicate, as Kohlberg (1971) already said in his studies,
TABLE 1 | Frequencies of participants with autism spectrum disorder that
failed the theory of mind task (ASD ToM−) and typical development that
failed the theory of mind task (TD ToM−) that showed heteronomous or
autonomous MJ.
Heteronomous Autonomous
TD ToM −
(n=15)
8 7
ASD ToM −
(n=25)
21 4
that philosophy and psychology can significantly enrich each
other in achieving new knowledge in the field of morality.
A possible explanation for these results might be that
individuals with ASD reach the heteronomous stage of moral
development thanks to their experiences, which promotes the
learning of moral rules developed by other people, but fail to
advance to the autonomous stage due to their ToM deficits.
Similar to the morally heteronomous TD children, children with
ASD seem to have an immature sense of morality, so they
view moral rules as unchangeable and requiring strict obedience.
According to the Piaget’s model of moral development, the
developmental transition from a heteronomous morality to an
autonomous one might be promoted by the metarepresentational
ability to consider others’ viewpoints (Piaget, 1932). Thus,
the results of the present study emphasize the importance
of evaluating ToM in children with ASD, indicating that
interventions aimed at improving children’s MJ need to take
theory-of-mind abilities into consideration as a possible pivotal
ability. It might be of interest to investigate the possible effect
of ToM training on moral reasoning in children with ASD in a
future intervention study.
A possible alternative explanation for our results might be that
executive functions (EFs) also play a key role in moral judgement,
considering the atypical inflexibility in morality expressed by
individuals with ASD. Indeed, EFs have been shown to be
impaired in young individuals with ASD and ToM deficits but
not in the TD control group in whom the two abilities were
found to be independent (Ozonoff et al., 1991). Moreover, a
recent study found a correlation between moral reasoning and
inhibitory control in school children with ASD (Kretschmer
et al., 2014). Thus, in future studies, it might be of interest
to investigate whether possible prefrontal impairments in ASD,
which are capable of causing dysfunctions in a wide variety of
neuropsychological domains, such as ToM and EF, might also
account for rigid moral judgements in ASD.
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Fadda et al. Moral Judgment in Autism Spectrum Disorder
FIGURE 3 | Percentages of participants with typical development that succeeded in the theory of mind task (TD ToM+) and percentages of
participants with autism spectrum disorder that succeeded in the theory of mind task (ASD ToM+) which expressed a MJ according to the intention
(intent), the transgression of the moral rule (moral rules) and the consequences (conseq) of the protagonists.
TABLE 2 | Frequencies of participants with autism spectrum disorder that
succeeded in the theory of mind task (ASD ToM+) and with typical
development that succeeded in the theory of mind task (TD ToM+) that
showed heteronomous or autonomous MJ.
Heteronomous Autonomous
TD ToM +
(n=15)
4 11
ASD ToM +
(n=5)
3 2
This study has some limitations that need to be acknowledged.
First, participants were asked to read the second order false belief
vignette, which is a rather complex story, so that participants may
fail this task just by a lack of motivation or basic understanding.
However, as we explained in the procedure, the second-order FB
question was administered only if the child passed a memory
question and a reality question. These questions allowed to
control for possible intervening effects of a lack of motivation
or basic understanding in the participants performance (Perner
and Wimmer, 1985). Moreover, we decided to test ToM abilities
with the “ice-cream van story” rather than a different version
of the test, the so-called ‘birthday puppy story’ (Sullivan et al.,
1994), for several reasons. The “birthday puppy story” has
been shown to elicit better performance in TD children, thanks
to a simplified procedure (Hayashi, 2007) and an additional
question about the content of the belief (Miller, 2012). However,
its wording is more complex than “the ice-cream van” story,
and it includes deception, whose beneficial effects on second-
order false belief understanding are still controversial (Miller,
2012). Given that individuals with ASD are known to have
difficulties with deception (Russell et al., 1991) and with the
understanding of language (Volkmar et al., 2005), we decided to
administer the Perner and Wimmer’s task to reduce the possible
effect of language and deception. Moreover, considering that
individuals with ASD respond most favorably to information
that is presented visually (see for example Ganz, 2007), we
presented the FB task with colored vignettes representing the
most salient parts of the story, to aid participants’ understanding
and motivation.
A second limitation of our study might be that we used only
one task to assess perspective taking. Since the use of only one
task has been identified as a methodological limit in previous
studies on ToM (see for example, Valle et al., 2015), it might
be of interest to use in a future study more different tasks to
assess perspective taking, to better define participants mentalistic
abilities. Moreover, we used laboratory tasks, which seem to
enhance the abilities of children with ASD to reason about social
contents (see for example, Sally and Hill, 2006). Thus, it would
be interesting in the future to further investigate ToM and MJ in
more ecological settings, such as daily life situations.
CONCLUSION
The results from the present study lead to the need of important
intervention strategies which might help individuals with ASD
understand and reason about social interactions in an effective
way. Rather than simply teach the “immorality” of an action,
new programs should teach the mentalistic principles upon which
moral rules are based, and stress the psychological motives of the
behavior. It might be of interest, in a future study, to investigate
the effect of a training in ToM abilities on autonomous MJ in
individuals with Autism Spectrum Disorder.
AUTHOR CONTRIBUTIONS
RF contributed to the conception and design of this work.
She collected, analyzed and interpreted the data. She wrote
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Fadda et al. Moral Judgment in Autism Spectrum Disorder
the manuscript. MP made the conception and design of
this work. She contributed to the analysis and interpretation
of the results. LF, GS, MF, and AS contributed to data
collection, to the analysis and interpretation of the results. GD
contributed to the conception and design of this work and
to the interpretation of the data. All the authors reviewed
the final version of the manuscript and approved it for
publication.
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Conflict of Interest Statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
Copyright © 2016 Fadda, Parisi, Ferretti, Saba, Foscoliano, Salvago and Doneddu.
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