Objective:

To summarize evidence and propose a broader conceptual framework for understanding mentalization in autism, emphasizing a shift from a deficit-based perspective.

Approach:

• Conceptual Framework: Mentalization is framed as a multidimensional, relational, and developmental process rather than solely a Theory of Mind (ToM) deficit.
• Focus on Caregiver Interactions: Emphasis on child-caregiver meaning-making processes to clarify assessment and intervention targets.

Key Findings:

• Other-related mentalizing may present greater difficulties than self-related mentalizing, requiring further investigation.
• Caregiver mentalization, particularly parental reflective functioning, significantly influences how children's behavior is interpreted and their emotional outcomes.
• Preliminary intervention studies suggest that mentalization-based approaches can enhance parental reflective functioning and may improve children's emotional outcomes.

Interpretation:

A relational-developmental framework for mentalization may lead to more precise assessments and targeted interventions in autism.

Limitations:

• The hypothesis regarding other-related mentalizing requires further replication.
• Ambiguity in the definition of mentalization complicates both research and clinical practice.

Conclusion:

A multidimensional and relational understanding of mentalization can enhance the understanding of social functioning and psychopathological vulnerability in autism.