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