There is considerable evidence that the development of jointattention and pretend play skills are impaired in children withautism. Some accounts of autistic psychopathology give a crucial roleto early impairments in joint attention and suggest that these lead toimpoverished development of the representational abilities thatunderlie the later emerging impairments in pretend play and theory ofmind. Other accounts of impairments in joint attention and pretendplay see them merely as symptoms of a more basic underlying cognitivedeficit, in attention or executive function. This review examines theevidence for the possible relationships that may exist between jointattention and pretend play and the later development of a theory ofmind. It also suggests directions for future work to clarify therelationship between the two skills and to identify the nature of theunderlying primary deficit in autism.