The relationship between theory of mind and perceptions of sexual consent in high-functioning autism

Background: Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by differences in social communication, interaction, and cognitive flexibility. These differences may affect how individuals interpret and convey intentions, boundaries, and consent, particularly in romantic and sexual contexts [1]. Contemporary frameworks emphasize affirmative sexual consent, defined as a voluntary, explicit, ongoing, and mutually communicated agreement, rather than the absence of refusal. Understanding and communicating consent requires complex social-cognitive processes, including Theory of Mind (ToM)—the ability to infer others’ mental states and intentions. However, how these processes function in individuals with ASD and how they relate to sexual consent perception remain insufficiently investigated. This study aimed to compare perceptions of sexual consent in adults with high-functioning autism (HFA) and neurotypical controls, and to examine the relationship between these perceptions and ToM abilities.

Methods: A total of 65 adults participated in the study, including 34 individuals diagnosed with HFA and 31 neurotypical controls. Participants completed the Autism Spectrum Questionnaire (ASQ) [2], the Dokuz Eylül Theory of Mind Scale (DEZİKÖ) [3], the Affirmative Sexual Consent Situational Knowledge Scale (ASCSKS) [4], and Sexual Consent Vignettes [5]. The ASCSKS is a structured self-report instrument assessing knowledge and interpretation of affirmative consent principles across interpersonal situations, focusing on recognition of explicit, voluntary, and ongoing agreement. Sexual Consent Vignettes consist of standardized hypothetical scenarios depicting sexual interactions, in which participants evaluate whether valid consent is present. Particular emphasis was placed on non-response situations, defined as contexts in which an individual does not explicitly communicate “yes” or “no,” requiring interpretation of ambiguous or absent verbal cues.

Statistical analyses were conducted using SPSS 22.0. Continuous variables were summarized with means and standard deviations, and categorical variables with frequencies and percentages. Group comparisons were performed using independent samples t-tests or Mann–Whitney U tests depending on normality, while categorical variables were analyzed using chi-square or Fisher’s exact tests. Associations between variables were examined using Pearson or Spearman correlation analyses, with significance set at p < .05 .

Results: No significant difference was found between groups in ASCSKS scores, suggesting comparable levels of conceptual knowledge of affirmative consent. However, DEZİKÖ scores were positively correlated with accurate recognition of sexual consent in both vignette-based scenarios and the ASCSKS. Individuals with higher ToM performance—particularly in tasks involving metaphor, irony, and empathy—demonstrated more accurate evaluations of consent. Educational level also influenced responses: participants with lower educational attainment (high school level) were more likely to interpret non-response scenarios as indicating consent.

Conclusions: Although individuals with HFA may possess adequate explicit knowledge of affirmative consent, the application of this knowledge in socially complex and ambiguous situations appears to depend on ToM abilities. Difficulties in interpreting implicit cues, especially in non-response contexts, may increase the risk of misjudging consent. These findings highlight the importance of incorporating social-cognitive components, including ToM-informed training, into sexuality education for individuals with ASD. Structured, explicit, and practice-based educational interventions may help bridge the gap between knowledge and real-life application, supporting safer and more mutually respectful relationships.

References

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