False Belief Stories Research Articles

How does teaching experience impact brain processes underlying the theory of mind? Study on primary school educators

ABSTRACT Despite its importance for daily social interactions, few studies have explored interindividual differences in the Theory of Mind (ToM) abilities of healthy adults. We used Children’s False-Attribution (CFA), Children’s False-Beliefs (CFB), and Belief-Desire Reasoning tasks, along with fMRI-based assessments, in a comparative analysis of ToM among primary school teachers (PST; n = 27), skilled in social interactions with children, and matched controls (MC; n = 24), who lacked such experience. PST demonstrated slower reaction times than MC in Adult and Child false-belief stories of CFB. However, no other behavioral differences between the groups and between-group differences were observed at the brain level. Both groups presented similar valence ratings for stories in the CFA. Notably, fMRI analysis revealed a group-by-condition interaction effect in the right lateral orbitofrontal cortex (OFC). In PSTs, OFC activation decreased during negative false-attribution stories regarding children compared to stories related to adults, whereas MC demonstrated an opposite activation pattern. Between-group differences in right lateral OFC activity possibly signify a neural efficiency effect secondary to frequent social interactions of PSTs, unlike the MCs, with children in the working environment. These results underscore the significance of everyday social experiences in the functional plasticity of ToM networks.

Cognitive and Affective Theory of Mind in Female Patients With Borderline Personality Disorder

Empirical studies have identified deficits in cognitive and affective theory of mind (ToM) in patients with borderline personality disorder (BPD), but results remain heterogeneous and not much is known about the role of childhood trauma. The current study assessed cognitive and affective ToM in 80 patients with BPD and 41 healthy controls in a false-belief cartoon task. Childhood trauma was measured with the Childhood Trauma Questionnaire (CTQ). Patients with BPD responded slower in all experimental conditions in false-belief situations, but not when false beliefs were resolved; made more errors in the cognitive ToM condition; and reported worse affective states more often in and after false-belief situations. No significant correlations between ToM and childhood trauma could be found. The current study revealed deficits in cognitive and affective ToM in patients with BPD that may be related to a more negative affective state raised by the false-belief stories.

Group and sex differences in social cognition in bipolar disorder, schizophrenia/schizoaffective disorder and healthy people

BackgroundImpairment of social cognition is documented in bipolar disorder (BD) and schizophrenia/schizoaffective disorder (SCH). In healthy individuals, women perform better than men in some of its sub-domains. However, in BD and SCH the results are mixed. Our aim was to compare emotion recognition, affective Theory of Mind (ToM) and first- and second-order cognitive ToM in BD, SCH and healthy subjects, and to investigate sex-related differences. Methods120 patients (BD = 60, SCH = 60) and 40 healthy subjects were recruited. Emotion recognition was assessed by the Pictures of Facial Affect (POFA) test, affective ToM by the Reading the Mind in the Eyes Test (RMET) and cognitive ToM by several false-belief stories. Group and sex differences were analyzed using parametric (POFA, RMET) and non-parametric (false-belief stories) tests. The impact of age, intelligence quotient (IQ) and clinical variables on patient performance was examined using a series of linear/logistic regressions. ResultsBoth groups of patients performed worse than healthy subjects on POFA, RMET and second-order false-belief (p < 0.001), but no differences were found between them. Instead, their deficits were related to older age and/or lower IQ (p < 0.01). Subthreshold depression was associated with a 6-fold increased risk of first-order false-belief failure (p < 0.001). Sex differences were only found in healthy subjects, with women outperforming men on POFA and RMET (p ≤ 0.012), but not on first/second-order false-belief. LimitationsThe cross-sectional design does not allow for causal inferences. ConclusionBD and SCH patients had deficits in emotion recognition, affective ToM, and second-order cognitive ToM, but their performance was comparable to each other, highlighting that the differences between them may be subtler than previously thought. First-order cognitive ToM remained intact, but subthreshold depression altered their normal functioning. Our results suggest that the advantage of healthy women in the emotional and affective aspects of social cognition would not be maintained in BD and SCH.

Cognitive and Affective Theory of Mind in Female Patients With Borderline Personality Disorder.

Empirical studies have identified deficits in cognitive and affective theory of mind (ToM) in patients with borderline personality disorder (BPD), but results remain heterogeneous and not much is known about the role of childhood trauma. The current study assessed cognitive and affective ToM in 80 patients with BPD and 41 healthy controls in a false-belief cartoon task. Childhood trauma was measured with the Childhood Trauma Questionnaire (CTQ). Patients with BPD responded slower in all experimental conditions in false-belief situations, but not when false beliefs were resolved; made more errors in the cognitive ToM condition; and reported worse affective states more often in and after false-belief situations. No significant correlations between ToM and childhood trauma could be found. The current study revealed deficits in cognitive and affective ToM in patients with BPD that may be related to a more negative affective state raised by the false-belief stories.

2.5-year-olds succeed in identity and location elicited-response false-belief tasks with adequate response practice

Researchers have argued that traditional elicited-response false-belief tasks involve considerable processing demands and hence underestimate children’s false-belief understanding. Consistent with this claim, Setoh et al. (2016) recently found that when processing demands were sufficiently reduced, children could succeed in an elicited-response task as early as 2.5 years of age. Here we examined whether 2.5-year-olds could also succeed in a low-demand elicited-response task involving false beliefs about identity, which have been argued to provide a critical test of whether children truly represent beliefs, while also clarifying how the practice trials in Setoh et al.’s task facilitated children’s elicited-response performance. 2.5-year-olds were tested in a version of Setoh et al.’s elicited-response task in which they heard a location or identity false-belief story. We varied whether the practice trials had the same type of wh-question as the test trial. Children who heard the same type of wh-question on all trials succeeded regardless of which story they heard (location or identity) and performance did not differ across belief type. This replicates Setoh et al.’s positive results and demonstrates that when processing demands are sufficiently reduced, children can succeed in elicited-response tasks involving false beliefs about object location or identity. This suggests that children are capable of attributing genuine false beliefs prior to 4 years of age. However, children performed at chance if the practice trials involved a different type of wh-question than the test trials, suggesting that at this age practice with the wh-question used in the test trial is essential to children’s success.

The role of the cerebellum in reconstructing social action sequences: a pilot study.

Recent research has revealed that the cerebellum plays a critical role in social reasoning and in particular in understanding false beliefs and making trait attributions. One hypothesis is that the cerebellum is responsible for the understanding of sequences of motions and actions, which may be a prerequisite for social understanding. To investigate the role of action sequencing in mentalizing, we tested patients with generalized cerebellar degenerative lesions on tests of social understanding and compared their performance with matched healthy volunteers. The tests involved understanding violations of social norms making trait and causal attributions on the basis of short behavioral sentences and generating the correct chronological order of social actions depicted in cartoons (picture sequencing task). Cerebellar patients showed clear deficits only on the picture sequencing task when generating the correct order of cartoons depicting false belief stories and showed at or close to normal performance for mechanical stories and overlearned social scripts. In addition, they performed marginally worse on trait attributions inferred from verbal behavioral descriptions. We conclude that inferring the mental state of others through understanding the correct sequences of their actions requires the support of the cerebellum.

Localizing Pain Matrix and Theory of Mind networks with both verbal and non-verbal stimuli

Functional localizer tasks allow researchers to identify brain regions in each individual's brain, using a combination of anatomical and functional constraints. In this study, we compare three social cognitive localizer tasks, designed to efficiently identify regions in the “Pain Matrix,” recruited in response to a person's physical pain, and the “Theory of Mind network,” recruited in response to a person's mental states (i.e. beliefs and emotions). Participants performed three tasks: first, the verbal false-belief stories task; second, a verbal task including stories describing physical pain versus emotional suffering; and third, passively viewing a non-verbal animated movie, which included segments depicting physical pain and beliefs and emotions. All three localizers were efficient in identifying replicable, stable networks in individual subjects. The consistency across tasks makes all three tasks viable localizers. Nevertheless, there were small reliable differences in the location of the regions and the pattern of activity within regions, hinting at more specific representations. The new localizers go beyond those currently available: first, they simultaneously identify two functional networks with no additional scan time, and second, the non-verbal task extends the populations in whom functional localizers can be applied. These localizers will be made publicly available.

Processing Demands Impact 3-Year-Olds' Performance in a Spontaneous-Response Task: New Evidence for the Processing-Load Account of Early False-Belief Understanding.

Prior to age four, children succeed in non-elicited-response false-belief tasks but fail elicited-response false-belief tasks. To explain this discrepancy, the processing-load account argues that the capacity to represent beliefs emerges in infancy, as indicated by early success on non-elicited-response tasks, but that children’s ability to demonstrate this capacity depends on the processing demands of the task and children’s processing skills. When processing demands exceed young children’s processing abilities, such as in standard elicited-response tasks, children fail despite their capacity to represent beliefs. Support for this account comes from recent evidence that reducing processing demands improves young children’s performance: when demands are sufficiently reduced, 2.5-year-olds succeed in elicited-response tasks. Here we sought complementary evidence for the processing-load account by examining whether increasing processing demands impeded children’s performance in a non-elicited-response task. 3-year-olds were tested in a preferential-looking task in which they heard a change-of-location false-belief story accompanied by a picture book; across children, we manipulated the amount of linguistic ambiguity in the story. The final page of the book showed two images: one that was consistent with the main character’s false belief and one that was consistent with reality. When the story was relatively unambiguous, children looked reliably longer at the false-belief-consistent image, successfully demonstrating their false-belief understanding. When the story was ambiguous, however, this undermined children’s performance: looking times to the belief-consistent image were correlated with verbal ability, and only children with verbal skills in the upper quartile of the sample demonstrated a significant preference for the belief-consistent image. These results support the processing-load account by demonstrating that regardless of whether a task involves an elicited response, children’s performance depends on the processing demands of the task and their processing skills. These findings also have implications for alternative, deflationary accounts of early false-belief understanding.

Low Self-Awareness of Individuals With Severe Traumatic Brain Injury Can Lead to Reduced Ability to Take Another Person's Perspective

Aims of this study were (i) to verify whether a deficit or a lack of self-awareness can lead to difficulties in assuming another person's perspective after a severe traumatic brain injury (TBI); (ii) to verify whether perspective-taking deficits emerge more from performance-based tasks than self-reports; and (iii) to evaluate the possible relationships between perspective-taking difficulties and some clinical, neuropsychological, neuropsychiatric, and neuroimaging variables. The Interpersonal Reactivity Index, Empathy Quotient, first-order false-belief, and faux pas written stories were administered to 28 patients with severe TBI and 28 healthy controls. The Awareness Questionnaire was also administered to TBI patients and their caregivers. Patients were split into 2 groups (impaired self-awareness vs adequate self-awareness) on the basis of the discrepancy Awareness Questionnaire score. Both TBI groups obtained lower scores than healthy controls on the Fantasy subscale of the Interpersonal Reactivity Index, the reality question of the false-belief stories, and the memory questions of the faux pas test. Only impaired self-awareness patients tended to obtain lower scores in first-order false-belief detection. Impaired self-awareness patients also performed significantly worse than both healthy controls and adequate self-awareness patients on the faux pas tasks. The analysis suggests a causal relationship between low self-awareness and perspective-taking difficulties in this population of patients.

The predator-avoidance effect: an evolved constraint on emerging theory of mind

The present research examined whether children's ability to impute false belief is overridden or impaired by content that activates an early-developing, prepotent motivational system: predator avoidance. In three studies, children aged 3 to 8years completed variants of a false-belief test, including analogous predator-avoidance and playmate-avoidances scenarios, in which passing the test meant having the focal character get caught by the pursuer. The proportion of correct answers in the playmate-avoidance scenario was reliably greater than in the predator-avoidance scenario, though this effect largely dissipated by 7 to 8years of age. Enhanced predatory stimuli significantly increased the frequency of false-belief errors in the predator-avoidance scenario (Study 3). Analysis of children's justifications revealed that predator-avoidance false-belief errors were overwhelming motivated by a desire for the prey to avoid the predator (Study 2). The predator-avoidance effect was not an artifact of children generally performing better in playmate than predator–prey scenarios (Studies 1 and 3), the predator-avoidance scenario simply evoking strong emotions (Study 3), or differences between children in their knowledge of predator–prey relationships (Study 1) or executive-function abilities (Study 2). Findings support the hypothesis that activation of the predator-avoidance system generates prepotent response patterns that impair or override full consideration of the mental states of the prey characters in false-belief stories.

Picture sequencing task performance indicates theory of mind deficit in bipolar disorder

BackgroundThis paper reports the performance of DSM-IV-TR diagnosed bipolar disorder (BD) patients on a well-recognised measure of theory of mind (ToM) that commonly elicits group-related differences in schizophrenia research. MethodsForty-nine BD patients and 49 age and gender matched controls completed Langdon and Coltheart (1999)Picture Sequencing Task. ResultsRelative to controls, patients with BD performed significantly worse on the ToM relevant false-belief stories of the picture sequencing task, but not on the control stories requiring social script knowledge, executive control or an understanding of causal connexions. There were no differences in the ToM performance of symptomatic versus euthymic patients or those categorised as having BD I or BD II. LimitationsAs sub group sizes were small, data suggesting a trait-like deficit in ToM should be interpreted with caution. ConclusionsThe results support previous evidence of ToM impairment in BD and indicate a potential endophenotypic overlap in the phenomenology of both schizophrenia and BD.

Cognitive and affective Theory of Mind in mild to moderate Alzheimer's disease

Theory of Mind (ToM) allows one's own and others' cognitive and emotional mental states to be inferred. Although many patients with Alzheimer's disease (AD) display impaired social functioning as their disease progresses, very few studies have investigated ToM in AD. Those that have done so suggest that patients' ToM deficits are the consequence of other cognitive impairments. The aim of this study was thus to investigate changes in both the cognitive and the affective dimensions of ToM in AD, using tasks designed to circumvent the patients' comprehension difficulties. Sixteen mild to moderate AD patients and 15 healthy controls matched on age, sex and education level underwent cognitive (preference judgment and first- and second-order false belief) and affective (Reading the Mind in the Eyes) ToM assessments. Comprehension of false belief stories was verified and an additional neuropsychological examination was undergone. We observed impaired performances by AD patients on all the ToM tasks. While working memory and executive functioning impairments contributed to the deterioration in the more complex aspects of cognitive ToM abilities as highlighted by a correlation analysis, we failed to observe any comprehension difficulties in patients who performed poorly on simple cognitive ToM tasks, which suggests that AD truly affects cognitive ToM.

Social-Cognitive Deficits in Normal Aging

A sizeable number of studies have implicated the default network (e.g., medial prefrontal and parietal cortices) in tasks that require participants to infer the mental states of others (i.e., to mentalize). Parallel research has demonstrated that default network function declines over the lifespan, suggesting that older adults may show impairments in social-cognitive tasks that require mentalizing. Older and younger human adults were scanned using functional magnetic resonance imaging while performing three different social-cognitive tasks. Across three mentalizing paradigms, younger and older adults viewed animated shapes in brief social vignettes, stories about a person's moral actions, and false belief stories. Consistent with predictions, older adults responded less accurately to stories about others' false beliefs and made less use of actors' intentions to judge the moral permissibility of behavior. These impairments in performance during social-cognitive tasks were accompanied by age-related decreases across all three paradigms in the BOLD response of a single brain region, the dorsomedial prefrontal cortex. These findings suggest specific task-independent age-related deficits in mentalizing that are localizable to changes in circumscribed subregions of the default network.

False-belief understanding in 2.5-year-olds: evidence from two novel verbal spontaneous-response tasks.

Recent research indicates that toddlers and infants succeed at various non-verbal spontaneous-response false-belief tasks; here we asked whether toddlers would also succeed at verbal spontaneous-response false-belief tasks that imposed significant linguistic demands. We tested 2.5-year-olds using two novel tasks: a preferential-looking task in which children listened to a false-belief story while looking at a picture book (with matching and non-matching pictures), and a violation-of-expectation task in which children watched an adult 'Subject' answer (correctly or incorrectly) a standard false-belief question. Positive results were obtained with both tasks, despite their linguistic demands. These results (1) support the distinction between spontaneous- and elicited-response tasks by showing that toddlers succeed at verbal false-belief tasks that do not require them to answer direct questions about agents' false beliefs, (2) reinforce claims of robust continuity in early false-belief understanding as assessed by spontaneous-response tasks, and (3) provide researchers with new experimental tasks for exploring early false-belief understanding in neurotypical and autistic populations.

P01-215 - Is theory of mind impairment a trait-marker in bipolar disorder?

ObjectivesPrevious studies have provided evidence for Theory of Mind (ToM) impairment in bipolar disorder (BD). The aim of the study was to determine whether ToM impairment can be considered as a trait- marker or a state characteristic of BD.MethodsToM was assessed in 29 patients with bipolar-I during an episode and in remission as well as in 29 pair-matched for age, gender and education level healthy controls. Three different ToM tests were used (multilevel assessment): First Order False Belief Stories, Hinting Test, Faux Pas Recognition Test. Attention, memory, verbal learning ability, visuospatial ability, executive functions were also assessed using WAIS – Vocabulary, Block design, and Digit span, Stroop Test, Rey Auditory Verbal Learning Test, Trail Making Test, Wisconsin Card Sorting Test. Paired t-test was used to compare patients’ neuropsychological performance in episode and euthimic states and one-way ANOVA with post hoc Bonferroni corrections for the between groups comparisons.ResultsPatients showed significant impairments on ToM tasks in the acute phase compared to the control group. ToM deficits did not persist beyond mood episode, except patients’ poor performance on Faux Pas. Dysfunction in verbal learning, working memory, visospatial ability was found during both the acute and the euthymic phases in relation to the comparison group. Poorer performance in attention, immediate verbal memory and executive function tasks was observed only in the acute phase of the illness.ConclusionsImpairments in social cognition might reflect underlying general cognitive deficits and residual symptoms rather than representing a specific trait-marker in BD.

Theory of mind tasks and executive functions: A systematic review of group studies in neurology

A growing number of studies have been addressing the relationship between theory of mind (TOM) and executive functions (EF) in patients with acquired neurological pathology. In order to provide a global overview on the main findings, we conducted a systematic review on group studies where we aimed to (1) evaluate the patterns of impaired and preserved abilities of both TOM and EF in groups of patients with acquired neurological pathology and (2) investigate the existence of particular relations between different EF domains and TOM tasks. The search was conducted in Pubmed/Medline. A total of 24 articles met the inclusion criteria. We considered for analysis classical clinically accepted TOM tasks (first- and second-order false belief stories, the Faux Pas test, Happe's stories, the Mind in the Eyes task, and Cartoon's tasks) and EF domains (updating, shifting, inhibition, and access). The review suggests that (1) EF and TOM appear tightly associated. However, the few dissociations observed suggest they cannot be reduced to a single function; (2) no executive subprocess could be specifically associated with TOM performances; (3) the first-order false belief task and the Happe's story task seem to be less sensitive to neurological pathologies and less associated to EF. Even though the analysis of the reviewed studies demonstrates a close relationship between TOM and EF in patients with acquired neurological pathology, the nature of this relationship must be further investigated. Studies investigating ecological consequences of TOM and EF deficits, and intervention researches may bring further contributions to this question.

False Belief vs. False Photographs: A Test of Theory of Mind or Working Memory?

Theory of mind (ToM), the ability to reason about other people’s thoughts and beliefs, has been traditionally studied in behavioral and neuroimaging experiments by comparing performance in “false belief” and “false photograph” (control) stories. However, some evidence suggests that these stories are not matched in difficulty, complicating the interpretation of results. Here, we more fully evaluated the relative difficulty of comprehending these stories and drawing inferences from them. Subjects read false belief and false photograph stories followed by comprehension questions that probed true (“reality” questions) or false beliefs (“representation” questions) appropriate to the stories. Stories and comprehension questions were read and answered, respectively, more slowly in the false photograph than false belief conditions, indicating their greater difficulty. Interestingly, accuracy on representation questions for false photograph stories was significantly lower than for all other conditions and correlated positively with participants’ working memory span scores. These results suggest that drawing representational inferences from false photo stories is particularly difficult and places heavy demands on working memory. Extensive naturalistic practice with ToM reasoning may enable a more flexible and efficient mental representation of false belief stories, resulting in lower memory load requirements. An important implication of these results is that the differential modulation of right temporal–parietal junction (RTPJ) during ToM and “false photo” control conditions may reflect the documented negative correlation of RTPJ activity with working memory load rather than a specialized involvement in ToM processes.

Theory of mind deficits in children with congenital heart disease

The cognitive and academic challenges faced by children with congenital heart disease (CHD) as they grow older have been extensively researched. Fewer studies have focused on characterizing the nature and severity of the psychosocial challenges, despite their potential importance for the children’s quality of life. I recently speculated that deficits in social cognition and, in particular, theory of mind are among the morbidities of children with CHD. This speculation was based primarily on the moderately severe and persistent pragmatic language deficits (e.g. storytelling, pretend play) of a group of children with d-transposition of the great arteries (d-TGA). Such deficits, which are usually discussed in the context of autism spectrum disorders, impair a child’s ability to process social information and to read other people and discern their inner states, threatening success in establishing and sustaining social relationships. Calderon et al. provide the first direct evidence to support aspects of this conjecture, showing that children with d-TGA were less accurate than typically developing children in analysing false belief stories, suggesting a reduced capacity to put themselves ‘in the shoes’ of story characters in order to predict their behavior. This study is an important initial step in evaluating the broad domain of social cognition in children with CHD. It is a multifaceted concept, providing many avenues for future research. Do children with CHD have greater difficulty than their typically developing peers in discerning internal states on the basis of facial expression, nonverbal cues, or paralinguistic cues such as prosody? Do they have greater difficulty understanding jokes, sarcasm, irony, and other messages in which the literal interpretation conflcts with the intended interpretation? Do they have difficulty identifying and communicating their own emotions, as well as those of other people (i.e. alexithymia)? In terms of prevention and remediation, it will be important in future research to address several potential explanations for an increased risk of social cognition deficits in children with CHD. First, the embryological event that resulted in CHD might also affect the brain structures or circuits responsible for the processing of social and affective information. Children with CHD have concomitant brain abnormalities, particularly disorders of white matter, even before undergoing reparative interventions. It is noteworthy that other groups of children with such disorders (e.g. extremely low birthweight or preterm children) also tend to exhibit behaviors associated with autism spectrum disorders. Second, the social cognition deficits might be the result of interventions undertaken to correct or palliate CHD. This possibility seems unlikely, however, as such interventions tend to explain little of the variability in the cognitive outcomes of children with CHD. Third, the social cognition deficits might be secondary to the neuropsychological deficits associated with CHD. Among the areas in which deficits are commonly reported are visualspatial skills, attention, and executive function. Indeed, in the Calderon et al. study, children who performed poorly on the false belief stories also showed executive function deficits, specifically in self-regulation and inhibiting interference. Such co-occurrence in a cross-sectional study does not necessarily indicate mediation, but it is consistent with this hypothesis. Social cognition deficits are frequently observed in children with other neurodevelopmental disorders. For example, on a group basis, children with specific learning disabilities, traumatic brain injuries, and attention-deficit–hyperactivity dis-

Theory of mind, language and the temporoparietal junction mystery

Brain imaging of adults during false-belief story tasks consistently shows activation of the temporoparietal junction in English-speaking Americans and German-speaking Europeans. Kobayashi et al. find this observation in adult English speakers but not in English-speaking children or in English-Japanese bilingual persons. This finding suggests a cultural or linguistic influence on location of brain function and argues against maturation of innately specified neural substrates. It is reminiscent of effects of linguistic development, bilingualism and cultural differences on theory of mind development.

Narrative dependency and the false belief task in autism

Several studies have used a cognitive approach to teaching people with autism to pass false belief tasks with a broader aim of developing theory of mind abilities. However, these tasks have certain executive features that may influence performance on the tasks and the potential for generalization. The study examines the influence of narrative support and language level on the ability of children with autism to pass tests of false belief and control tasks of “false photo”. Thirty-four children with ASD, with a range of age and ability, were shown six video-recorded false belief stories and six matched false photo stories, half narrated and half not. Results showed that the children performed similarly on the tasks overall in narrated and unnarrated conditions. However, the narrative support aided responses to the control questions, highlighting the executive load in these tasks. Results showed a significant effect of verbal age on the children's performance on both sets of tasks.