Original Paper

Folia Phoniatr Logop 2014;66:1824

DOI: 10.1159/000363697

Published online: November 14, 2014

Reading the Mind in the Eyes Test (Childrens

Version): A Comparison Study between Children
with Typical Development, Children with
High-Functioning Autism and Typically
Developed Adults
IoannisVogindroukas Evripidis-NikolaosChelas NikolaosE.Petridis

Key Words
Reading the Mind in the Eyes Test Children Autism,
high-functioning Typical development

ed in the Greek language, confirm findings of other studies

in the literature conducted with the RMET in the English language.
2014 S. Karger AG, Basel

Abstract
Background/Aims: One of psychologys challenges is to develop and evaluate sensitive tests in the area of social cognition. Yet, there are few available scales that can measure
mild deficits in social understanding, especially for typically
developing (TD) populations. The Reading the Mind in the
Eyes Test (childrens version) was translated and adapted for
use in the Greek language [RMET-G (child)]. The aim of this
study was to examine in the Greek language the qualitative
and quantitative differences between TD youngsters and
those with high-functioning autism (HFA), as well as the difference between TD children and TD adults. Methods: An
interview-based psychometric study was conducted. Participants completed the RMET-G (child), constituting 3 groups:
TD children older than 8 years, children with HFA and TD
adults. Results: 103 participants completed the study. The
results demonstrated that TD adults scored slightly higher
than TD children, and children with HFA scored lower than
their TD peers. Children with HFA, however, were able to recognize many of the pictures shown in the test. Conclusion:
The results of this study, which were the first to be conduct-

Among humans, understanding other peoples feelings

and intentions takes place during daily interactions and
exchanges. The framework of evolutionary psychology
states that the human mind should be considered in terms
of its evolved adaptedness to the environment [1]. Awareness of the emotional state of interaction partners proffers
considerable advantage for the social perceiver [2]. The
ability to predict, understand and explain the behavior of
other humans plays a crucial role in successfully adapting
to ones complex social environment [3, 4]. This ability is
often termed theory of mind (ToM). ToM is the capacity
humans have to understand mental states such as beliefs,
feelings, desires, hopes and intentions. ToM is the ability
to attribute these mental states not only to oneself but also
to others. ToM helps us understand that others can have
different beliefs or desires from our own, and it plays a role
in facilitating the ability to predict and explain the behavior of others [5, 6]. There is a significant body of evidence
that indicates that the majority of children with autism
have impairments in developing ToM [5, 7], and over the

2014 S. Karger AG, Basel

10217762/14/06620018$39.50/0
E-Mail karger@karger.com
www.karger.com/fpl

Ioannis Vogindroukas, PhD

Medicopedagogical Center of Northern Greece
Psychiatric Hospital of Thessaloniki
Giannitson 52, GR54627 Thessaloniki (Greece)
E-Mail ioannisvogindroukas@gmail.com

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Medicopedagogical Center of Northern Greece, Psychiatric Hospital of Thessaloniki, Thessaloniki, Greece

Methods

used for the diagnosis of autism from the public diagnostic center
were: (1) evaluation by a child psychiatrist based on the diagnostic
criteria of DSM-IV-TR [13], (2) the Childhood Asperger Syndrome
Test [14] and (3) the Greek version of the Wechsler Intelligence
Scale for Children III [15] performed by a psychologist. Two groups
of children were excluded from participation in the study, i.e. children diagnosed with HFA who did not have an IQ score within
normal limits and TD children who were unable to provide a completed consent form and proof of no developmental delays.
Procedure and Measures
Ethical approval was obtained from the Organization for Social
Protection and School Education from the City Council of Ioannina. Moreover, all speech and language therapists who examined
the participants in the private sector had ethical approval from the
Pan-Hellenic Association of Logopedists. The participants were
interviewed in a quiet room in their home, in their school environment or at the speech-language therapy clinic. Subjects in all 3
groups were tested using the RMET-G (child).
The RMET (child) [12] is a test where the participant is presented with a series of 28 photographs of the eye region of the face of
different people. Afterwards, participants were asked to use only the
visual information to choose a word that best described what the
man or woman was feeling or thinking based on the visual information from the photograph. For each item of the test, a photograph is
framed with 4 words that describe the possible mental state or feeling of the person shown in the photograph. Three of these words
were foils, only one was the target word that correctly identified the
mental state of the person in the photo. The test was scored by totaling the number of items correctly answered by the participant.
The RMET (child) [12] was downloaded via the Autism Research Centre website [16], translated and cross-culturally adapted
for use in the Greek language. First, all target and foil words were
translated by a certified translator into Greek in order for the foil
words to have the same emotional valence as the target word. The
words were then piloted on a group of 8 judges (4 male, 4 female).
All judges were TD adults. The pilot process was carried out as in
the study of Baron-Cohen et al. [10]. The criterion for adaptation
of the translated words was that at least 5 out of 8 judges agreed
that the target word best described the persons mental state, and
that no more than 2 judges selected any single foil word for the
same test item. In the RMET-G (child), all items met the above
criterion, which indicated that the translation was adequate for
Greek children and adults to comprehend.
Psychometric Evaluation and Data Analysis
Descriptive statistics were used to summarize participant characteristics and performance on the measure used. Standard psychometric methods were used to evaluate the internal consistency
and validity of the RMET-G (child).

Design and Participants

An interview-based psychometric study was implemented. All
researchers were speech and language therapists who were experienced in working with children with HFA and TD adults. Participants were TD children, children with HFA and TD adults. All
participants were recruited to participate in this study by speech
and language therapists working for the national health system or
in private practice in 3 different cities in Greece. The inclusion criteria were: (1) children with HFA who had an intelligence quotient
(IQ) score within normal limits and had been diagnosed at a public
diagnostic center in Greece; (2) parents as well as teachers of the
TD children both had to sign a consent form saying the children
had no signs of developmental delay; (3) all children were at least 8
years old; (4) adults participating in the study were not mental
health professionals. The evaluation tests and diagnostic criteria

Participants
A total of 103 participants met the eligibility criteria
and agreed to take part in the study. Table1 presents the
participant characteristics. The sample consisted of 3

Reading the Mind in the Eyes Test in

Greek for Children

Folia Phoniatr Logop 2014;66:1824

DOI: 10.1159/000363697

Results

19

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past 20 years, child development of ToM skills has been

extensively studied [8]. Such a deficit may play a substantial role in the development of social, communicative and
imaginative abilities, and an impairment in ToM can reveal itself in early childhood, as early as age 1 [9].
Several studies that have been conducted use a variety
of tests to evaluate how people use (or do not use) ToM.
There are few tests, however, that can measure if a typically developing (TD) child or adult may have a mild deficit in social understanding [10]. Moreover, failure to find
group differences in the studies with adults and children
may reflect the limits of many ToM measures [11]. The
development of an advanced ToM task has attempted to
overcome this problem [9, 10]. This test, named Reading
the Mind in the Eyes Test (RMET) (childrens version)
[12], requires participants to look at the eye region of a
photograph of a person, and then attribute a mental state
or feeling expressed by the photographed persons eyes.
This task is considered to be an advanced ToM test because participants in the study are required to take the
perspective of the person shown in each task and attribute
a relevant mental state to the persons eye expression [11].
This current study aims to present and evaluate the
outcomes and the answers that TD children, children
with high-functioning autism (HFA) and TD adults gave
in the Greek language version of the RMET [RMET-G
(child)]. Furthermore, the results of this current study are
used to make an effort to fill the gap regarding statistical
analyses on results of the RMET-G (child) acquired from
children and adults. Finally, this current study is one of
the first efforts to adapt the RMET to a different language
(Greek) and to evaluate the use of the Greek language version RMET-G (child) as a clinical outcome measure for
deficits of ToM in children.

Psychometric Properties
A psychometric evaluation of participants scores was
performed to identify statistical differences between the
two different diagnostic groups (children with HFA and
TD children). The Mann-Whitney test was used to identify if there was any difference in the mean scores between
the two diagnostic groups. Results showed that mean
scores are significantly different (p < 0.005) for 5 items
(concern, serious, thinking about something sad, sure
and nervous). The same psychometric test (Mann-Whitney) was also used to evaluate the significance of score
differences between sexes (feminine vs. masculine). Results of the Mann-Whitney test showed that 3 items
(friendly, made up her mind and thinking about something) were significantly different (p < 0.005).
The participants were also divided into 3 different age
groups to determine if age plays a substantial role in the
way participants interpret mental states from eye expres20

Folia Phoniatr Logop 2014;66:1824

DOI: 10.1159/000363697

Table 1. Participant characteristics (n = 103)

Gender
Male
Female
Diagnosis
TD children
Children with HFA
TD adults
Mean age SD, years
TD adults
Children with HFA
TD children
Mean IQ SD
Children with HFA

65 (63.2%)
38 (36.8%)
53 (51.5%)
27 (26.2%)
23 (22.3%)
38.2 9.03
10.06 1.7
9.84 1.13
93.6 7.7

sions. These groups were: (1) 810 years old, (2) 1013
years old and (3) 1362 years old. Because there were
more than 2 age groups, the nonparametric Kruskal-Wallis test was used. Results indicated significant differences
for 8 items (concern, thinking about something, serious,
made up her mind, thinking about something sad, unhappy, sure about something and worried). In terms of
psychometric evaluation, results revealed that the variable
of age had the most statistically significant items compared to variables of diagnosis (HFA and TD children)
and sex (masculine and feminine). Table 3 presents the
statistically significant differences for these 3 variables.
Mental States and Feelings
More in-depth qualitative analysis was conducted by
grouping emotions described in the test into 4 groups and
comparing the mean scores based on this grouping. Emotions were first divided into feelings and mental states and
were then further separated according to their levels of
positivity. The following groups were created: (a) positive
feelings (hoping, happy), (b) negative feelings (sadness,
concern, not pleased, worried, nervous), (c) positive mental states (kind, friendly, interested, remembering, thinking about something, sure about something) and (d) negative mental states (serious, misbelief, made up her mind, a
bit worried, thinking about something sad, not believing).
Table4 presents the participants mean scores based on the
grouping of the emotions. Results indicate that adults
scored higher (mean = 16.6) in identifying negative feelings and lower in identifying positive mental states
(mean = 12.9). Children with HFA scored higher in identifying the negative mental states and negative feelings
(mean = 7.2 and 7.1) and lower in identifying positive feelings (mean = 4.75). TD children also scored higher in identifying the negative mental states and negative feelings
Vogindroukas/Chelas/Petridis

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groups. Group 1 comprised 23 TD adults (10 females, 13

males) with a mean age of 38.2 years (SD = 9.03). Group
2 comprised 27 children with HFA (2 females, 25 males)
with a mean age of 10.06 years (SD = 1.7). Group 3 consisted of 53 TD children (26 females, 27 males) with a
mean age of 9.84 years (SD = 1.13). Both groups of children had a similar mean age of approximately 10 years.
All participants in group 2 were formally assessed regarding the IQ with the Greek version of the Wechsler Intelligence Scale III. Children with HFA had a mean IQ score
of 93.6 (SD = 7.7). All participants completed the test
without asking for help with any of the questions or asking for clarification of the meaning of the words used to
describe the persons feelings or mental states.
Table 2 shows the scores of the participants in the
RMET-G (child). Correct answers of TD adults had a
mean score of 17.3 out of 28 (SD = 2.5), with 100% of the
participants responding correctly to question 20, which
shows a man who feels not pleased. Question 1 had the
smallest number of correct responses (17.3%), which had
a photograph of a woman with the target word kind. TD
children had a mean score of 16.4 out of 28 (SD = 3.01)
with question 18 having the greatest proportion of correct
responses, which had the target mental state of thinking
about something sad (96.2%). Question 1 had the lowest
percentage of correct responses for the target word kind
(5.66%). Children with HFA had a mean score of 13.6 out
of 28 questions correct (SD = 3.9) with question 20 not
pleased having the most correct responses (85.7%), and
the lowest number of correct responses for question 1 for
a woman who is kind (18.5%).

Table 2. RMET-G (child) scores (n = 103)

Participants

Mean SD

Score range Highest scored answer

Lowest scored answer

TD adults
Children with HFA
TD children

17.3 2.5
13.6 3.9
16.4 3.01

11 21
7 20
10 24

Kind
Kind
Kind

(mean = 19.4 and 16.3), but the lowest mean score was observed identifying positive mental states (mean = 13.3).

Man not pleased

Man not pleased
Thinking about something sad

Table 3. Psychometric evaluation of the RMET-G (child) (n = 103)

Psychometric test

Reading the Mind in the Eyes Test in

Greek for Children

Mann-Whitney

Kruskal-Wallis

Diagnostic groups Concern

(TD vs. HFA
Serious
Thinking about
children)
something sad
Sure
Nervous
Sex groups
(male vs. female)

Friendly
Made up her mind
Thinking about
something
Concern
Thinking about
something
Serious
Made up her mind
Thinking about
something sad
Unhappy
Sure about something
Worried

Age groups
(8 10, 10 13,
13 62 years)

The table presents the statistically significant items in terms of

each different factor.

Table 4. Mean scores based on feelings and mental status grouping

Variable

TD
children

Children
with HFA

TD
adults

Positive feelings
Negative feelings
Positive mental states
Negative mental states

13.7
16.3
13.3
19.4

4.75
7.1
6.2
7.2

13.5
16.6
12.9
15.5

that logistic regression take the natural logarithm of the

odds of the dependent variable being a case to create a
continuous criterion as a transformed version of the deFolia Phoniatr Logop 2014;66:1824
DOI: 10.1159/000363697

21

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Validity and Determining Factors of the Introduced

Test
In order to assess the internal consistency of the translated test, Cronbachs alpha measure was computed. This
described the extent to which all items in a test measure
the same concept [17], and in this study it showed the degree to which participants correctly perceived and understood the true meaning of items in the RMET-G (child).
Cronbachs alpha values range from 0 and 1, and most
psychometric tests primarily have values fall between 0.75
and 0.83 [18]. The validity of the introduced modified test
was evaluated using an initial sample of 25 examinees
(pretest) and resulted in a Cronbachs alpha value of
0.687, which is considered acceptable. This value indicates that the test in general can be acknowledged as successfully translated (fig.1), because the overall mean correct response was over 55% (horizontal line) and over
90% for some questions. More specifically, figure 1 presents all the test items (x-axis) regarding the percent of
correct responses for every test question (y-axis).
The authors were interested in investigating the underlying variables that aided participants to respond correctly. Since responses were recorded using a binary system (i.e. 0 for incorrect responses and 1 for correct responses), the logit model was useful for analyzing the
underlying variables that influenced the participants responses [19]. Logit binary choice models demonstrate the
probability that an event is happening, and that the event
is related to some external (independent) variables. It is
used extensively in many disciplines, including the medical and social science fields. Like other forms of regression analysis, logistic regression makes use of one or more
predictor variables that may be either continuous or categorical data. Unlike ordinary linear regression, however,
logistic regression is used for predicting binary outcomes
for the dependent variable (treating the dependent variable as the outcome of a Bernoulli trial) rather than continuous outcomes. Given this difference, it is necessary

Proportion of correct responses

0.8

0.6

0.4

0.2

X1

X4

X7

X10 X13 X16 X19 X22 X25 X28

Test item

Fig. 1. Bar graph of correct answers for each question in the RMET.

pendent variable. Thus, the logit transformation is referred to as a linking function in logistic regression, although the dependent variable in logistic regression is binomial. The logit is the continuous criterion upon which
linear regression is conducted [20]. Mathematical formulation of these models is given as follows:
exp xb

P y  1

,
1  exp xb

where P (y = 1) is the probability that the binary variable

receives a value of 1 (success), x is a vector of covariates
and b represents the parameters to be estimated using the
maximum likelihood method. In the present work, these
covariates are age, sex and group of participants. Positive
values of estimated parameters depict a potential increase
in the covariates of the model, which would increase the
probability of a successful response. However, negative
parameters of the logit model show that a potential increase in one of the covariates would decrease the probability of a successful response occurring.
Table 5 not only shows which factors influence the
probability of a participant providing a correct response
in the test but also provides information about the magnitude to which a covariate influences responses. In the majority of the cases, the sex of the participant appeared to
increase the probability that a participant correctly identified the target word of the photograph. Women answered
more items correctly than men. When the estimated pa22

Folia Phoniatr Logop 2014;66:1824

DOI: 10.1159/000363697

rameter value is negative, this indicates that sex of the participant does not improve the ability to find the correct
answer. The age of the participant also influenced the
probability of participants responding correctly, as it was
a statistically significant covariate in 18 out of 28 variables.
Children, both children with HFA and TD, correctly identified the emotions in pictures more frequently than
adults. The diagnosis of participants positively affected
approximately half of the variables examined in the study.
TD participants (children or adults) had more success in
identifying the correct response for the pictures, while
children with HFA scored better in fewer cases. In 5 out
of 28 variables, none of the 3 covariates used above had an
effect. This may indicate that there are other factors affecting these 5 variables or that there is no statistical difference
between the levels of these categorical variables.

Discussion

This study investigated the performance of 3 different

groups (TD children, children with HFA and TD adults)
in the Greek version of the RMET (child), which is an advanced ToM test [12]. The RMET-G (child) has been
translated and adapted to the Greek language using the
study of Baron-Cohen et al. [10]. The criteria for adaptation were met, and all the participants understood the
words describing the feelings/mental states and completed the test without asking any questions about the target
or foil words. More specifically, adults and TD children
had a similar mean score (17.3 and 16.4, respectively) and
children with HFA had a mean score of 13.6. It is also important to note that the score range for the test was proportional to each group and its mean score. Adults scores
range between 11 and 21 correct answers, children with
HFA scored between 7 and 20 correct and TD children
scored between 10 and 24 correct answers. The higher
scores for TD children showed us that children can understand the emotions better than adults which may be
attributed to TD children not trying to analyze the eye
region shown as adults might do because they have more
life experience in similar situations. Considering the validity of the RMET-G (child), Cronbachs alpha 0.687 is
generally considered as acceptable. Combination of the
above criteria gives us the ability to generalize the suitability of using the RMET-G (child) for the Greek population with HFA. Moreover, results between groups of
TD children and children with HFA support this outcome because there were many significant differences between these two groups.
Vogindroukas/Chelas/Petridis

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1.0

Table 5. Estimated coefficients of the logit model

Dependent
variable

Covariates
sex

age
children

diagnosis

males

females

adults

TD

HFA

X1
X2
X3
X4
X5
X6
X7

2.19***
0.84***
1.73***
1.38***
n.s.
n.s.
n.s.

1.82***
1.56**
n.s.
1.63***
n.s.
n.s.
n.s.

2.19***
1.01***
1.23***
1.38***
n.s.
n.s.
n.s.

1.56**
0.95**
n.s.
1.89***
n.s.
n.s.
n.s.

2.28***
0.96***
1.09***
1.77***
n.s.
n.s.
0.77***

1.48***
1.04*
1.25**
0.86*
n.s.
n.s.
n.s.

X8
X9
X10
X11
X12
X13
X14

n.s.
0.61*
0.92***
n.s.
1.49***
0.69***
n.s.

n.s.
n.s.
1.19***
n.s.
1.32***
1.06***
n.s.

n.s.
0.45*
1.09***
n.s.
1.46***
0.85***
n.s.

n.s.
n.s.
n.s.
n.s.
1.28*
n.s.
n.s.

n.s.
n.s.
1.02***
n.s.
2.01***
0.71***
n.s.

n.s.
1.04*
1.05*
0.54*
n.s.
1.25***
n.s.

X15
X16
X17
X18
X19
X20
X21

n.s.
0.92***
1.09***
1.28***
0.62*
2.39***
0.69*

n.s.
1.06***
0.95***
3.02***
n.s.
3.02***
n.s.

n.s.
0.96***
1.09***
1.64***
0.51*
2.34***
n.s.

n.s.
1.04*
n.s.
2.35***
1.04*
n.s.
1.28*

n.s.
1.40***
0.96***
2.89***
0.60*
3.19***
0.77*

0.48*
n.s.
1.25**
n.s.
n.s.
1.75**
n.s.

X22
X23
X24
X25
X26
X27
X28

n.s.
1.73***
n.s.
0.54*
n.s.
n.s.
0.62*

n.s.
1.82***
n.s.
n.s.
n.s.
n.s.
n.s.

1.28*
1.64***
n.s.
0.56*
n.s.
n.s.
0.67*

n.s.
2.35**
n.s.
n.s.
n.s.
n.s.
n.s.

n.s.
2.45***
n.s.
n.s.
n.s.
n.s.
n.s.

n.s.
n.s.
n.s.
n.s.
1.25**
n.s.
1.25**

Beyond the quantitative differences, the qualitative

ones are also important to consider in a study that has
participants with HFA. Results supported that Greek
children with HFA present statistically significant differences in comparison with TD children and adults. However, these differences were found in only 5 of the test
items, which indicates that participants with HFA are
able to recognize many of the pictures from the RMET-G
(child). This finding demonstrated that children with
HFA have the ability to recognize feelings outside of a
communication context, but the inability to use this
knowledge in their everyday social interactions can be attributed to the difficulty in interpreting information pro-

vided from the communication context [21]. These differences between the groups confirmed that the RMET-G
(child) is an advanced ToM scale that is able to detect
mild deficits in social understanding. Moreover, data in
the Greek language indicated that both age and diagnosis
play a substantial role in the overall score of the participant. In 18 out of 28 variables, age was a statistically significant covariate and more than half of the variables had
a positive correlation to that participants diagnosis. Other collateral variables, such as positive/negative mental
states and feelings, revealed more qualitative differences
between participants. The test item with the highest number of correct responses was a negative feeling for both

Reading the Mind in the Eyes Test in

Greek for Children

Folia Phoniatr Logop 2014;66:1824

DOI: 10.1159/000363697

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n.s. = Not significant. * p < 0.05, ** p < 0.01, *** p < 0.001.

TD adults and children with HFA, and a negative mental

state for TD children. In general, all the participants recognized more negative feelings than positive ones based
on the eyes of the person in the photograph which could
be attributed to people requiring the whole facial expression, and not just the eyes, to recognize positive feelings
and mental states. Another factor that had been analyzed
for its effects on correct responses was the sex of the participant. There were statistical differences between the
sexes for 3 of the test items, although in general, female
participants scored better than males. These findings support the statement of Baron-Cohen et al. [12] that females
have a social brain while men have a technical brain.
In general, results from this study for the Greek language support the findings of previous research [12].
Data revealed statistically significant differences between
participant groups, which also occurred in the original
studies. However, there are no other data to compare with
the data in this study because there is currently no other
published research using the RMET (child) translated
into other languages.
As is common with new measures, further testing is
needed with the RMET-G (child), with a focus on measuring its responsiveness to change and its use as a clinical

outcome measure. So far the RMET-G (child) has been

used in research, and future studies should evaluate its appropriateness and usefulness as outcome measures in people with HFA undergoing educational or therapeutic programs. Lastly, future studies should include larger samples
of participants of different ages and who speak different
languages in order to make comparisons between HFA
and TD groups using the RMET (child). This would enable a better understanding of the impact of social deficits
in HFA, as opposed to the general impact of a lack of ToM.

Conclusion

The RMET-G (child) has good validity to be used as a

measure of social understanding in the Greek language for
people with HFA. The main advantages of the RMET-G
are that it was adapted well into the Greek language and
that the participants understood all target and foil words.
People with or without HFA are able to complete the
RMET-G (child) in an interview format. Its use can inform
the clinicians about the social understanding deficits in
their clients and can allow for many qualitative outcomes.

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