Social Cognition, Mental Health, and Quality of Life in Autism Spectrum Disorder in Children and Adolescents: A Narrative Review

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition involving persistent differences in social communication, restricted interests, and repetitive behaviors. Social cognition–the ability to understand others’ thoughts, emotions, and intentions–is central to mental health and quality of life (QoL), particularly during childhood and adolescence. This narrative review followed PRISMA guidelines and examined studies published from 2000 to 2025 across PubMed, Scopus, Web of Science, and ScienceDirect, focusing on participants under 18 years or studies reporting child/adolescent data separately. Thirty studies met the revised inclusion criteria and were thematically analyzed using Theory of Mind, Social Cognitive Theory, Learning Theory, mentalization-based models, and neurodiversity perspectives. Findings indicate difficulties in emotion recognition, perspective-taking, and ToM among autistic children and adolescents, with associations with anxiety, depression, and reduced adaptive functioning varying by age, language, and cognitive/support-needs profiles. ToM-based, social-cognitive, mindfulness, parent-mediated, and technology-assisted interventions showed positive but heterogeneous outcomes. Direct comparisons with Applied Behavior Analysis remain limited. Future research should prioritize age-, IQ/support-needs-, and language-stratified outcomes to support individualized, neurodiversity-informed practice.