Understanding theory of mind in school age: Insights from cochlear implant users and typically developing peers

ABSTRACTBackground: This study focused on the linguistic consequences of damage to Theory of Mind (TOM) in patients after Traumatic Brain Injury (TBI). It was designed to extend a previous study that tested the consequences of TOM impairment (aTOMia) on referring abilities in right-hemisphere damaged patients.Aims: To explore whether aTOMia in patients with TBI affects their use and comprehension of various referring expressions (definite and indefinite noun phrases, proper names and pronouns).Methods and Procedures: We identified individuals with TOM impairment (aTOMia) in a group of 15 TBI patients using a battery of six types of TOM task. We then tested two groups of TBI patients: participants with aTOMia and participants without aTOMia, compared to a control group of non brain-damaged participants. Four TOM-related language tasks assessed their ability to vary the use of referring expressions according to the knowledge of the discourse partners.Outcomes and Results: Five of the participants showed TOM impairment (aTOMia), whereas ten showed intact-TOM ability. The two groups did not differ according to most neuropsychological measures, or on grammatical performance. On the TOM-related language tasks the participants with aTOMia performed consistently worse than the participants with TBI and intact-TOM, and the control group.Conclusions: Individuals after TBI do not form a homogenous group regarding their TOM abilities. Some patients show TOM-related language impairment, and should be considered for language evaluation and treatment focusing on aspects of language that depend on TOM ability.

Association between executive functions and theory of mind in children: Empirical evidence and theoretical implications. Previous studies have found that executive functioning (EF) is related to theory of mind (ToM). However, the directionality and strength of this link remain a topic of debate in the current literature. The aim of this paper was to analyze the study perspectives and empirical evidence on the directionality and strength of the co-development of EF and ToM in children. The literature search was performed in Web of Science. Sci2 Tool and Gephi were used for the analysis. Cluster analysis showed three study perspectives focused on the relationship between EF performance and ToM in children with attention deficit hyperactivity disorder (ADHD) (1), autism spectrum disorder (ASD) (2) and typical development (TD) (3). We found a consistent pattern of association between EF and ToM in children with ASD, ADHD, and TD. Longitudinal findings showed that the association between early EF and late ToM, including false belief comprehension, is stronger than the inverse association and tends to consolidate with age, indicating an EF→ToM, but not ToM→EF directionality, and is not better explained by the effect of executive demands posed in ToM tasks. Taken together, the evidence supports the “emergence” and “enrichment” theoretical accounts in considering that EFs in early child neurodevelopment are ontogenetically implicated in the acquisition, consolidation, and change of psychological state comprehension abilities in others

The development of episodic memory, its relation to theory of mind (ToM), executive functions (e.g., cognitive inhibition), and to suggestibility was studied. Children (n= 115) between 3 and 6 years of age saw two versions of a video film and were tested for their memory of critical elements of the videos. Results indicated similar developmental trends for all memory measures, ToM, and inhibition, but ToM and inhibition were not associated with any memory measures. Correlations involving source memory was found in relation to specific questions, whereas inhibition and ToM were significantly correlated to resistance to suggestions. A regression analysis showed that age was the main contributor to resistance to suggestions, to correct source monitoring, and to correct responses to specific questions. Inhibition was also a significant main predictor of resistance to suggestive questions, whereas the relative contribution of ToM was wiped out when an extended model was tested.

The development of executive function (EF) in autism spectrum disorder (ASD) has been investigated using only "cool"-cognitive EF tasks while there is limited knowledge regarding the development of "hot"-affective EF. Although cool EF development and its links to theory of mind (ToM) have been widely examined, understanding of the influence of hot EF to ToM mechanisms is minimal. The present study introduced a longitudinal design to examine the developmental changes in cool and hot EF of children with ASD (n = 45) and matched (to age and IQ) controls (n = 37) as well as the impact of EF on ToM development over a school year. For children with ASD, although selective cool (working memory and inhibition) and hot (affective decision making) EF domains presented age-related improvements, they never reached the performance level of the control group. Early cool working memory predicted later ToM in both groups but early hot delay discounting predicted later ToM only in the ASD group. No evidence was found for the reverse pattern (early ToM predicting later EF). These findings suggest that improvements in some EF aspects are evident in school age in ASD and highlight the crucial role that both cool and hot EF play in ToM development.

ObjectiveIt was proposed that the ability to recognize facial emotions is closely related to complex neurocognitive processes and/or skills related to theory of mind (ToM). This study examines whether ToM skills mediate the relationship between higher neurocognitive functions, such as reasoning ability, and facial emotion recognition.MethodsA total of 200 healthy subjects (101 males, 99 females) were recruited. Facial emotion recognition was measured through the use of 64 facial emotional stimuli that were selected from photographs from the Korean Facial Expressions of Emotion (KOFEE). Participants were requested to complete the Theory of Mind Picture Stories task and Standard Progressive Matrices (SPM).ResultsMultiple regression analysis showed that the SPM score (t=3.19, p=0.002, β=0.22) and the overall ToM score (t=2.56, p=0.011, β=0.18) were primarily associated with a total hit rate (%) of the emotion recognition task. Hierarchical regression analysis through a three-step mediation model showed that ToM may partially mediate the relationship between SPM and performance on facial emotion recognition.ConclusionThese findings imply that higher neurocognitive functioning, inclusive of reasoning, may not only directly contribute towards facial emotion recognition but also influence ToM, which in turn, influences facial emotion recognition. These findings are particularly true for healthy young people.

The comprehension of ironic criticisms and ironic compliments in individuals with Down syndrome: Adding another piece to the puzzle

An endophenotype for attention deficit/hyperactivity disorder (AD/HD) is executive functioning. In the autism and developmental literature executive dysfunctions has also been linked to theory of mind (ToM) and pragmatic language use. The central question of this review is whether deficits in ToM and pragmatic language use are common in AD/HD. AD/HD seems to be associated with pragmatic deficits, but not with ToM deficits. In this review we address how this pattern of findings might facilitate the understanding of the commonalities and differences between executive functioning, ToM, and pragmatic abilities. Based on the reviewed studies we conclude that ToM is not likely to be a potential endophenotype for AD/HD, while it is too early to draw such a conclusion for pragmatic language use.

ObjectiveThis study investigated Theory of Mind (ToM) abilities as measured by a hinting task and the Reading the Mind in the Eyes Test (RMET) in individuals diagnosed with post-traumatic strees disorder (PTSD) in relation to different types of childhood trauma and compared to a healthy control group.MethodRMET, a Clinician Administered PTSD Scale (CAPS), a Beck Depression Inventory (BDI), a Childhood Trauma Questionnaire (CTQ), a hinting task, and a socio-demographic questionnaire were administered to PTSD (n=30) patients and healthy controls (n=30).ResultsThere was a significant difference in ToM performance between healthy participants and the PTSD group (p<0.001). A significant correlation was found between trauma types and ToM performance (p<0.01). The diagnosis of PTSD and the severity of PTSD symptoms showed significant correlations with ToM performance (p<0.01). In comparison with the healthy control group, the PTSD group demonstrated lower performance on both ToM tasks. Regardless of the PTSD diagnosis, those people who had a history of childhood trauma had slowed reaction times in response to photographs representing emotionally salient mental states and demonstrated difficulties in the identification of irony/hints in the context of the administered assessment task.ConclusionThe findings of the present study suggest that a diagnosis of PTSD and a history of different types of trauma have an effect on ToM performance. PTSD seems to lead to deterioration in ToM capacities. This may mean that the experience of childhood adversity may lead to long-lasting damage to social cognition. The current study is helpful in that it contributes to a better understanding of the pathogenesis of PTSD; moreover, it will be beneficial in the development of new treatment options. Our research findings suggest that we must concentrate not only on traumatic events during the treatment process of PTSD follow-up and treatment; we must also target deficiencies in cognitive and emotional capabilities.

Children make choices between generosity and greed every day. Often they must also choose between confession or denial of antisocial acts like greed, thereby displaying either honesty or hypocrisy. Such choices pose cognitive challenges that, in theory, might reflect children's developing social-cognitions and affect their daily social lives and developmental opportunities. Individual differences in altruism and hypocrisy were examined in relation to theory of mind (ToM) in 102 school-age children (44 autistic; 58 typically developing) using ecologically valid altruism and hypocrisy tests where generosity had lasting real-life costs and hypocrisy was self-serving. Selfless altruism was abundant for autistic and nonautistic children alike and was significantly predicted by ToM over and above other predictors like age, gender, and language. More nonautistic (74%) than autistic children (41%) displayed hypocrisy, although individual ToM differences among ASD children were not significantly correlated with it. Findings extend to new instances (altruism and hypocrisy) evidence of ToM's importance for everyday social behaviors that impact upon peer relations while also extending past evidence that: (a) unexpected sociomoral strengths can coexist with ToM delays, (b) attention to individual differences is crucial, and (c) autistic children's capacity to develop sociomoral reasoning should not be underestimated. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social impairment in Autism Spectrum Disorder (ASD) has been linked to Theory of Mind (ToM) deficits. However, little research has investigated the relationship between ToM and moral decision-making in children with ASD. This study compared moral decision-making and ToM between aggregate-matched ASD and neurotypical boys (n = 38 per group; aged 6-12). In a third-party resource allocation task manipulating recipient merit, wealth, and health, neurotypical children allocated significantly more resources to the morally deserving recipient, suggesting equitable allocation. A comparatively larger portion of the ASD group allocated equally. ToM emerged as a predictor of moral decision-making. We suggest that ToM (cognitive empathy) deficits may underly atypical moral decision-making in ASD by limiting the integration of empathic arousal (affective empathy) with moral information.

Improving our understanding of contribution of environmental factors to Theory of Mind (ToM) and Emotion Regulation (ER) competences in children with intellectual disabilities (IDs) is crucial to helping them to boost their emotional and social abilities. Parental emotion-related socialization behaviors (ERSBs) have been shown to be favorable factors for the development of these competences in preschoolers. However, few studies have investigated links between mothers’ and fathers’ ERSBs and socio-emotional abilities in children with IDs. The goal of this study is to explore the share of the variance in ToM and ER abilities explained by individual characteristic and each parent’s reactions to the emotions of their children with IDs and emotion-related conversation. Twenty-seven mothers, 16 fathers, and their children with IDs participated. Direct and indirect measures of children’s ToM were used. Questionnaires about children’s ER competences and parents’ ERSBs were completed by parents. The results demonstrated that, at preschool developmental age, parents’ ERSBs had an impact on affective and cognitive ToM as well as on ER, depending on the parent’s gender, on children’s chronological and developmental age, and on the nature of ERSBs, namely reactions or conversations.

Reading the mind in the face and voice in parents of children with Autism Spectrum Disorders

Adolescents with developmental language disorders (DLDs) and adolescents who are deaf or hard of hearing (D/HH) are at greater risk of social emotional problems. These problems may not only be attributed to communication and language problems but, at least in part, to Theory of Mind (ToM) deficits as well. In this mini review, an overview is provided of studies on social emotional functioning and ToM performance in adolescents with DLD and D/HH adolescents. A possible interplay between social emotional functioning and Theory of Mind is discussed. There is empirical evidence for social emotional problems and ToM problems in both adolescents with DLD and D/HH. We hypothesized that language deficits as seen in adolescents with DLD and impoverished exposure to language and communication, as seen in adolescents who are D/HH can explain differences in social emotional functioning and ToM performance. The present mini review provides a possible framework for the relation between ToM and social emotional functioning in adolescents with communication and language problems, which is mediated by their limited linguistic ability or restricted language exposure and gives suggestions for future research.

The development of irony comprehension

Developmental executive function (EF) theories have proposed distinct domains of EF (cool and hot) but the EF development in autism spectrum disorder (ASD) has been assessed mainly with cool EF measures. Little is known regarding the development of hot EF in ASD. EF is suggested to strongly associate to theory of mind (ToM) in typical development but the correlation between hot EF and ToM is understudied in ASD. The current study was aimed at investigating the cross-sectional developmental changes of cool and hot EF in middle childhood and adolescence and their association to ToM in ASD. Eighty-two children and adolescents (7–16 years) were assessed with measures of cool EF (inhibition, working memory, planning, and cognitive flexibility), hot EF (affective decision-making and delay discounting), and ToM (2nd-order false belief and ignorance; mental state/emotion recognition). Our results showed that the trajectories of all cool EF presented linear age-related improvements in ASD. In terms of hot EF, trajectories demonstrated non-linear functions of age for affective decision-making and delay discounting. Both EF domains were found to associate with ToM over and above age, while hot EF associated with ToM over and above cool EF as well. The investigation of the developmental trajectories of cool and hot EF may help define potential cognitive phenotypes across age within ASD.