Mind Deficits Research Articles

Narrative Review: The Intersection of Genetic Predisposition for Autism Spectrum Disorder and Nurture Factors in the Development of Borderline Personality Disorder

Purpose: This narrative review explores the significant overlaps between Borderline Personality Disorder (BPD) and Autism Spectrum Disorder (ASD), focusing on shared symptoms and genetic underpinnings. The purpose was to investigate neurodivergent traits in BPD similar to autism and examine how genetic predisposition for ASD can increase BPD risk when faced with adverse childhood experiences. Despite different DSM-5 classifications, both disorders share traits like emotional dysregulation, interpersonal difficulties, and cognitive distortions. Genetic markers, including variations in BDNF, COMT, and CNTNAP2 genes, suggest a shared biological vulnerability. The review posits that a family history of ASD may increase BPD likelihood during adolescence, especially when encountering adverse childhood experiences (ACEs). This interplay between genetic predisposition and environmental stressors highlights the need for improved BPD diagnostic criteria and tailored interventions. Methodology: A comprehensive literature search was conducted using databases such as PubMed, Semantic Scholar, and Google Scholar. Key search terms included "Autism Spectrum Disorder," "Borderline Personality Disorder," "Genetic Overlap," and "Theory of Mind." The review focused on peer-reviewed studies from the last decade, with some foundational papers included for historical context. Findings: The review uncovered notable overlaps between ASD and BPD in genetics, neurocognition, and symptomatology. Shared genetic factors include variations in the BDNF, COMT, SHANK3, and CNTNAP2 genes. Neurocognitive similarities were evident in impairments like social cognition, emotional regulation, and facial expression processing. Overlapping symptoms such as emotional dysregulation, Theory of Mind deficits, and executive dysfunction emphasize the neurodivergent nature of BPD. Importantly, the review suggests that a family history of ASD, combined with exposure to adverse childhood experiences (ACEs), may increase the risk of developing BPD during adolescence. Unique Contribution to Theory, Practice and Policy: This review reimagines BPD within a neurodivergent framework, similar to ASD, focusing on its neurobiological foundations. It supports an integrated theoretical model highlighting the neurodivergent traits of BPD which are similar to those of ASD. In clinical practice, the review emphasizes the importance of recognizing overlaps during assessment to improve diagnostic accuracy and inform tailored interventions. It advocates for incorporating neurodiversity-affirming practices into BPD treatment, inspired by approaches used in ASD care. The findings encourage deeper study of the shared genetic and neurodevelopmental aspects of BPD, potentially leading to improved treatment and diagnostic models.

Cross-neurotype communication from an autistic point of view: Insights on autistic Theory of Mind from a focus group study.

The conceptualisation of autism as a disorder where Theory of Mind (ToM) and pragmatics are fundamentally impaired has prompted a wealth of research on autistic deficits, most of which is characterised by two main assumptions: first, that autistic people would display said deficits, if present, with any conversation partner and in any situation; second, that neurotypical people do not present these deficits, regardless of the conversation partner. However, this is not necessarily reflected in autistic accounts of the way they experience social cognition and pragmatics. The present paper aims to investigate the autistic experience of communication with both autistic and neurotypical people, with a particular focus on their perception of the ability of autistic and neurotypical people to understand their communicative intentions. Participants, 23 adult Italian autistic people without intellectual disability or language disorders, were recruited online. Two virtual focus groups of 2 hours each were conducted, transcribed and analysed through thematic analysis with a descriptive phenomenological approach by two independent researchers. Six themes were developed from the analysis, the most relevant being Autistic-Autistic communication and Autistic ToM. The results, in line with the Double Empathy theory, suggest there seem to be important differences between neurotypical and autistic people's ToM. These appear to make it easier for autistic people to communicate with one another, as well as to create difficulties for neurotypical people to understand autistic people, not just the other way around. These results seem to confirm that challenges in cross-neurotype communication are better interpreted as mutual miscomprehension and reciprocal differences in ToM rather than deficits on the autistic part. This calls for a reframing of ToM and/or the need for autistic ToM as a construct, of which neurotypical people seem to be lacking. Moreover, these insights should be taken into account for speech and language therapy and clinical practice in general, advocating for a neurodiversity-informed view of co-constructed communication as well as for a broader societal change in which therapists can play a crucial role, through participatory approaches or raising awareness in their daily practice. What is already known on the subject Autism is conceived as characterised by social cognition and communication difficulties, often linked to Theory of Mind (ToM) deficits. However, recent research suggested variations in ToM abilities within the autistic population and proposed alternative theories like the Double Empathy theory. Nevertheless, only a few studies examined how autistic individuals perceive communication across neurotypes. What this study adds Autistic individuals seem to find it easier to communicate with other autistic people, and they identify specific characteristics of neurotypical communication that hinder successful communication. Moreover, neurotypical people are perceived as having difficulties in autistic ToM, which seems to emerge as a relevant and needed construct in light of the Double Empathy problem. What are the clinical implications of this work? These findings can inform speech and language therapy and clinical practice about the potential gains of raising awareness on the Double Empathy problem and the higher communication ease inside the autistic community, alongside individualised support. Participatory approaches and closer collaboration with the autistic community also seem to be crucial for therapists to help improve communication experiences for autistic individuals.

Cognitive and affective theory of mind in young and elderly patients with multiple sclerosis.

Theory of mind (ToM) deficits have been reported in persons with multiple sclerosis (pwMS). However, most studies have used pictures or written scenarios as stimuli without distinguishing between cognitive and affective ToM, and no studies have investigated older pwMS. We recruited 13 young healthy controls (HC), 14 young pwMS, 14 elderly HC and 15 elderly pwMS. ToM was measured using an adaptation of the Conversations and Insinuations task (Ouellet etal., J. Int. Neuropsychol. Soc., 16, 2010, 287). In this ecological video-based task, participants watch four 2-minute videos of social interactions, which are interrupted by multiple choice questions about either the emotional state (affective ToM) or the intention (cognitive ToM) of the characters. They also underwent a short neuropsychological battery including cognitive, executive and social cognition tasks and questionnaires. We observed a significant interaction between the ToM conditions and the groups regarding ToM performance. Elderly pwMS scored significantly lower than elderly HC and young pwMS in cognitive ToM, but not in affective ToM. They also showed the largest discrepancy between their cognitive and affective ToM. Young pwMS showed relatively preserved ToM in both conditions. Both cognitive and affective ToM correlated with global cognition and executive abilities, but not with social cognitive measures (emotion recognition, real-life empathy). This study suggests that decline in cognitive ToM might be accentuated by advancing age in pwMS. These impairments are most likely underlied by cognitive and executive difficulties, but not by core social cognitive impairments. Future studies should investigate the real-life impacts of ToM impairments in pwMS.

Theory of mind abilities during the course of bipolar disorder: A longitudinal study using mixed models

Theory of mind (ToM) deficits, difficulties in recognizing the intentions, propensities, and beliefs of others have been shown in individuals with bipolar disorder in several studies; however, it is not yet elucidated how ToM abilities changes over the course of bipolar disorder and is related to illness symptoms. This is one of the first longitudinal studies to compare the ToM abilities of euthymic bipolar individuals and healthy controls over a four and a half years period. ToM abilities were measured using the Reading the Mind in the Eyes Test (RMET). A total of 91 euthymic bipolar individuals and 91 healthy controls were included in the analyses. Linear mixed models were used to compare ToM abilities of bipolar individuals and healthy controls. It was found that bipolar individuals scored lower on average on the RMET than healthy controls and that these RMET scores were stable over four and a half years. The results of this study suggest that ToM deficits are a stable (possibly endophenotypic) trait of bipolar disorder. This understanding can contribute to better identification, assessment, and treatment strategies for individuals with bipolar disorder, ultimately improving their overall care and outcome.

Correction to: to the Roots of Theory of Mind Deficits in Autism Spectrum Disorder: A Narrative Review

Correction to: to the Roots of Theory of Mind Deficits in Autism Spectrum Disorder: A Narrative Review

Topical Review: Getting into the head of youth with chronic pain: how theory of mind deficits may relate to the development and maintenance of pediatric pain.

Theory of mind (ToM) is the ability to understand the thoughts, feelings, and mental states of others and is critical for effective social and psychological functioning. ToM deficits have been associated with various psychological disorders and identified in adult pain populations. For youth with chronic pain, ToM deficits may underlie the biological, psychological, and social factors that contribute to their experience of pain, but this remains poorly understood. This topical review explored the extant literature in the areas of ToM and chronic pain, particularly for pediatric populations, with respect to biological, psychological, and social elements of the biopsychosocial model of pain. ToM deficits may be present alongside previously identified biological, psychological, and social correlates of pediatric pain, as a vulnerability, mechanism, and/or consequence. Biologically, ToM deficits may relate to cortisol abnormalities and neurobiological substrates of pain processing. Psychologically, ToM deficits may stem from pain-focused cognitions, thus impacting relationships and fueling impairment. Socially, chronic pain may preclude normative development of ToM abilities through social withdrawal, thereby exacerbating the experience of pain. Taken together, ToM deficits may be associated with increased risk for the development and/or maintenance of pediatric chronic pain, and pediatric chronic pain may similarly confer risk for ToM deficits. Future research should investigate the nature of ToM abilities in youth with chronic pain to test these hypotheses and ultimately inform ToM-focused and pain-based interventions, as this ability has been demonstrated to be modifiable.

The Relationship Between Brain-Behavior Systems, Dark Personality Traits, Alexithymia, and Theory of Mind Deficits in Sexual Offenders

The aim of the current research is to examine the relationship between brain-behavior systems, dark personality dimensions, and Alexithymia with theory of mind deficits in sexual offenders. For this purpose, 80 inmates from the central prison of Bojnurd were selected using purposive sampling. The variables were measured using the Gray-Wilson Personality Questionnaire (GWPQ), the Dirty Dozen scale of dark personality traits, the 20-item Toronto Alexithymia Scale (TAS-20), and the Reading the Mind in the Eyes Test (RMET). Data were analyzed using Pearson correlation coefficients and multiple regression analysis. The results showed a significant positive correlation between the fight system and theory of mind deficits; and significant negative correlations between the flight and freeze systems, all aspects of dark personality dimensions, difficulty in identifying and describing feelings, and overall Alexithymia with theory of mind deficits. The regression analysis findings suggest that the fight/flight/freeze systems, dark personality traits, and Alexithymia play predictive roles in mind-reading abilities.

Cognitive Theory of Mind Deficit Associated with Executive Dysfunction in Cervical Dystonia

Introduction. Cervical dystonia (CD) is viewed as a circumscribed movement disorder. However, beyond motor symptoms, it can imply subtle cognitive change, among others with respect to theory of mind (ToM) capacities. Here, affective and cognitive ToM performances and potential relations to other mental functions were investigated to refine the concept of social cognitive dysfunction in CD. Methods. 20 persons with CD were clinically assessed, together with 20 healthy controls engaged in overview cognitive testing, executive function (EF) tasks, and the Faux Pas Recognition Test (FPRT) as well as the Reading the Mind in the Eyes Tests (RMET) addressing cognitive and affective ToM functions, respectively. Results. Persons with CD showed lower cognitive, but not affective ToM performance than controls. Further, they had abnormally low word production in verbal fluency (VF) tasks, imposing high EF demands. Generally, ToM performance correlated with VF and, further, with the decreased quality of life score in persons with CD. Conclusion. Cognitive ToM deficits seem to occur in the context of executive dysfunction in CD. They belong to an underrecognized spectrum of nonmotor symptoms of likely clinical relevance.

Theory of mind deficits in language delayed deaf subjects?

Recent studies claim to show that language delayed deaf subjects typically display longlingering deficits in Theory of Mind (ToM) development, despite suffering no known deficits in other cognitive domains. These claims are supported by experimental evidence indicating that such subjects fare poorly on False Belief (FB) tasks. This paper turns a critical eye on these claims. In particular, I argue that the reported results raise important questions about the status of FB tasks as evidence, and about how such evidence should be weighted against naturalistic observations of subjects engaged in everyday activities requiring complex social coordination. I conclude that these studies give us no decisive reason to believe that language delayed deaf subjects suffer distinctively and symptomatically in the domain of social cognition. To the contrary, the attribution of significant socio-cognitive impairment is potentially stigmatizing and may not help us understand the unique challenges these subjects face or suggest remedial strategies to aid them in overcoming these challenges.

Theory of mind deficits in Parkinson's disease are not modulated by dopaminergic medication.

Patients with Parkinson's disease (PD) exhibit deficits in social cognition, particularly with respect to Theory of Mind (ToM) capacities. It is unclear whether they are associated with PD-related dopamine deficiency and modulated by levodopa replacement therapy. A total of 15 persons with PD and 13 healthy controls (HC) participated in the study. They performed different neuropsychological tasks, including the Faux Pas Recognition Test (FPRT), assessing different dimensions of cognitive ToM (e.g., detection, inappropriateness, intentions), and the Reading the Mind in the Eyes Test (RMET) as an index of affective ToM. Persons with PD were tested twice, once under their regular treatment and another time after at least 18 h of levodopa withdrawal (MED-ON and MED-OFF, respectively). On either occasion, serum drug levels and motor symptom severity [Unified Parkinson's Disease Rating Scale (UPDRS)] were measured. MED-ON and MED-OFF conditions in patients with PD were confirmed by higher serum drug levels in the former than in the latter state and a corresponding amelioration of the motor deficit. In so doing, no performance difference in any ToM-related task was identified as a function of the levodopa therapy. Generally, patients performed worse than controls in both affective and cognitive ToM tests. Patients with PD have deficits in cognitive and affective ToM. Dopamine replacement, effective for improving the motor condition, does not appear to counteract these dysfunctions.

The other side of the social interaction: Theory of mind impairments in people with schizophrenia are linked to other people's difficulties in understanding them.

People with schizophrenia (SZ) often present with theory of mind (ToM) deficits and with speech production deficits. While a link has been established between ToM abilities and symptoms of thought disorder, much less is known about other aspects of speech production in SZ. This is a case-control study in which 25 stable outpatients with recent-onset SZ (27.1years, 22 men) and 22 matched healthy controls (25.6years, 16 men) performed a collaborative, verbal production task with a real interaction partner. Blind raters scored how easy participants made it to understand them (Facility ratings), how interesting they were to listen to (Interest ratings) and how expressive they were (Expressivity ratings). ToM was assessed with the Combined Stories Test and Sarfati's cartoon task. Symptoms were assessed with the PANSS five-factor version. Compared to healthy controls, SZ received significantly lower ratings for all three aspects of their verbal productions (Facility, Interest and Expressivity), despite the raters being blind to group membership. Interestingly, the Facility ratings were linked to ToM performance in the SZ group, which suggest that SZ participants who have difficulties understanding others (ToM deficits) also make it harder for others to understand them. Other notable findings include a strong link between the Expressivity ratings and the Interest ratings for both groups, and significant correlations between the Facility ratings and Cognitive/Disorganisation symptoms, and between the Expressivity ratings and both Negative and Depression/Anxiety symptoms in SZ. Studying speech production during real, collaborative social interactions could help move beyond the individual approach to SZ deficits, making it possible to involve the interaction partners to promote more efficient communication for people with schizophrenia.

Beyond the simplicity of theory of mind deficit in multiple sclerosis: from kinetic perception to socio-emotional abstraction and mentalizing.

Theory of Mind (ToM) processing in Multiple Sclerosis (MS) is still poorly understood due to the difficulty of most tasks in qualifying the mentalizing deficit net of cognitive load. In this study, we administered the New False Belief Animation Task (NFBAT) to 50 MS and 33 healthy controls (HC) to investigate spontaneous mentalizing in ToM and goal-directed interactions. The global cognitive level was assessed by the Montreal Cognitive Assessment (MoCA). NFBAT appropriateness and intentionality scores were computed to investigate the ToM accuracy and intentionality attribution difficulties. NFBAT answers were qualitatively analyzed and categorized into kinetically and socially coherent/not coherent responses to test a low-level perceptual deficit. The main result showed dysfunctional mentalizing reasoning in MS compared to HC in the NFBAT Intentionality score in ToM conditions (p=0.028, d=0.501), while the two groups were equally proficient in mentalization accuracy. The Intentionality underperformance in MS was related to social low-level perceptual processing (β =0.06, p<0.001) and visuospatial functions (β =0.05, p =0.002). A predictive role of memory and executive functions on NFBAT Intentionality scores was not observed. These results strengthen the hypothesis that ToM in MS is likely related to low-level social processing.

Cortico-limbic disruption, material-specificity, and deficits in cognitive-affective theory of mind.

The Theory of Mind deficit due to cognitive-affective disintegration is a poorly understood cognitive consequence of cortical and subcortical disruption in right temporal lobe epilepsy. Following Marr's trilevel approach, we used the material-specific processing model to understand the Theory of Mind deficit in drug-resistant epilepsy (N = 30). We examined pre- and post-surgery changes in first-order (somatic-affective, non-verbal component) and second-order Theory of Mind (cognitive-verbal component) in three groups formed using: (i) seizure side (right versus left), (ii) right temporal epilepsy (right temporal lobe epilepsy versus non-right temporal lobe epilepsy), and (iii) right temporal lobe epilepsy with amygdalohippocampectomy (right temporal lobe epilepsy versus left temporal lobe epilepsy amygdalohippocampectomy versus non-amygdalohippocampectomy). We observed a marked deficit in the first-order Theory of Mind in the right temporal lobe amygdalohippocampectomy group; we mapped this deficit to decline in the non-verbal component of Theory of Mind (somatic-affective component). Preliminary results support using a material-specific processing model to understand the Theory of Mind deficits in right temporal lobe epilepsy amygdalohippocampectomy. Malleability of verbal processing in presence of deterioration of non-verbal processing might have clinical relevance for post-surgery recovery in right temporal lobe epilepsy amygdalohippocampectomy. Documenting the material-specific nature of deficits (verbal versus non-verbal) in non-western, linguistically, and socioeconomically diverse country enables us to understand the problem of heterogeneity in post-surgery cognitive consequences in the right amygdalohippocampectomy.

Associations between theory of mind and clinical symptoms in recent onset schizophrenia spectrum disorders.

People with schizophrenia often present with Theory of mind (ToM) deficits, and the link between these deficits and clinical symptoms remains to be refined, for instance through the use of more recent assessment methods. The objective of this study was to examine the associations between a psychometrically sound ToM task and the clinical symptoms of schizophrenia as measured with the five dimensions of the Positive and Negative Syndrome Scale (PANSS) namely positive, negative, cognitive/disorganization, depression/anxiety and excitability/hostility, while controlling for non-social cognitive abilities. Seventy participants with recent-onset schizophrenia spectrum disorders (SSD) were assessed for ToM using the Combined stories task (COST) and for clinical symptoms using the PANSS. The results revealed significant correlations between ToM and the positive (r = -0.292, p = 0.015) and cognitive/disorganization (r = -0.480, p < 0.001) dimensions when controlling for non-social cognitive abilities. In contrast, the negative symptoms dimension was only significantly correlated with ToM when non-social cognitive abilities were not controlled for (r = -0.278, p = 0.020). Very few prior studies used the five-dimensions of the PANSS to examine the link with ToM and this study is the first to rely on the COST, which includes a non-social control condition. This study highlights the importance of taking non-social cognitive abilities into account when considering the relationship between ToM and symptoms.

Transdiagnostic overlap in brain correlates of affective and cognitive theory of mind deficits.

Social cognitive symptoms characterize multiple neurological disorders, including brain tumours and neurodegeneration. Recently, Campanella and colleagues1 investigated deficits in cognitive and affective theory of mind (TOM) in 105 tumour patients using a non-verbal task of 18 stimuli that required patients to select one out of three possible endings of a cartoon story, i.e. the Story-based Empathy Task (SET).2 The SET includes three conditions [Causal Inference (CI), Intention Attribution (IA) and Emotion Attribution (EA)], reflecting the type of inference the items tap into: inference of physical properties, intentions, or characters’ emotional state, respectively. The behavioural results of Campanella’s study revealed specific EA deficits in patients with temporal lobe tumours. Furthermore, the authors used parcel-based lesion-symptom mapping (PLSM) and reported an association between a right anterior temporal cluster and EA performance. Right amygdalar lesions showed a stronger association with EA than with IA. The association between EA deficits and amygdalar volume has also been also reported in behavioural variant frontotemporal dementia (bvFTD),3 a neurodegenerative disorder, characterized by deficits in social cognition, including cognitive and affective TOM. Consistent with the findings of Campanella, we also observed an association between performance on the EA condition and grey matter volume of the right temporal lobe and amygdala3 (Fig. 1). As documented by Campanella and colleagues, such common neural correlates of EA performance largely overlap with a ‘reasoning about emotions’ network derived from a recent meta-analysis of functional brain imaging studies in healthy participants.4 These combined findings converge in supporting a critical role of the right amygdala and temporal lobe in emotion attribution.

The complexity of theory of mind deficit in schizophrenia: A cross-sectional analysis of baseline data from a longitudinal schizophrenia study

A large number of trials have supported the functional significance of Theory of Mind (ToM) impairment in schizophrenia. However, the nature and the extent of the impairment are still unclear. Reviews on the topic suggest that, in many cases, studies use only one tool to assess the levels of difficulty in the field, limiting the validity of the measurement to one aspect of ToM. On the other hand, the divergence of the used assessment tools makes it hard to compare the result of these studies. Thus, we decided to use additional assessment tools to evaluate the extent of ToM in order to describe several aspects of the phenomenon.A hierarchical cluster analysis of variables was used on a sample of 68 participants with schizophrenia or schizoaffective disorder, to determine the similarity between variances of the assessed ToM subcomponents. Further cross-sectional correlational analysis was then performed to investigate the association between the identified clusters and other used measures (e.g.: neurocognition).The statistical analysis supported a five-cluster model. Identified clusters illustrate the difference between Hypo and HyperToM as well as the degree of ToM task complexity, allowing for a more accurate description of the nature of ToM deficit in schizophrenia.

Indirect effects of theory of mind on alcohol use and problems in underage drinkers: The role of peer pressure to drink

ObjectivePrior studies demonstrate a link between socio-cognitive deficits and alcohol problems in adolescents and young adults. Researchers have proposed that young people with such deficits may misperceive and over-value peers' attitudes about drinking and consider drinking a way to be accepted by their peer group. We test this hypothesis by investigating whether theory of mind (ToM) deficits in underage (18–20-year-old) drinkers are associated with binge drinking and alcohol problems, and whether these ToM deficits have an indirect effect on alcohol outcomes through perceived peer pressure to drink (i.e., high conformity motives and low perceived ability to refuse alcohol during social pressure). MethodParticipants (N = 472; 91 % female; 71 % White; Mage = 19.28 ± 0.77) were recruited from TurkPrime and completed measures assessing ToM, conformity motives, self-efficacy to resist peer pressure to drink, alcohol problems, and binge drinking. Bivariate correlations were run to examine associations between study variables. Indirect effect models were run in SPSS, using the PROCESS add-on, to assess the indirect effects of ToM on alcohol outcomes through conformity motives and self-efficacy to refuse peer pressure to drink. ResultsToM had indirect effects on binge drinking and alcohol problems through conformity motives (but not self-efficacy to resist peer pressure to drink). Lower ToM was associated with higher conformity motives, which were then associated with more frequent binge drinking and greater alcohol problems. ConclusionsThese findings highlight the role of social cognition in young adult alcohol misuse and suggest more work is needed to understand the potential influence of peer pressure in this association.

The animated assessment of theory of mind for people with schizophrenia (AToMS): development and psychometric evaluation.

Theory of mind (ToM) deficits in people with schizophrenia have been reported and associated with impaired social interactions. Thus, ToM deficits may negatively impact social functioning and warrant consideration in treatment development. However, extant ToM measures may place excessive cognitive demands on people with schizophrenia. Therefore, the study aimed to develop a comprehensible Assessment of ToM for people with Schizophrenia (AToMS) and evaluate its psychometric properties. The AToMs was developed in 5 stages, including item formation, expert review, content validity evaluation, animation production, and cognitive interviews of 25 people with schizophrenia. The psychometric properties of the 16-item AToMS (including reliability and validity) were then tested on 59 people with schizophrenia. The newly developed animated AToMS assesses 8 ToM concepts in the cognitive and affective dimensions while placing minimal neurocognitive demands on people with schizophrenia. The AToMS presented satisfactory psychometric properties, with adequate content validity (content validity index = 0.91); mostly moderate item difficulty (item difficulty index = 0.339-0.966); good discrimination (coefficients = 0.379-0.786), internal consistency (Cronbach's α = 0.850), and reliability (intraclass correlation coefficient = 0.901 for test-retest, 0.997 for inter-rater); and satisfactory convergent and divergent validity. The AToMS is reliable and valid for evaluating ToM characteristics in people with schizophrenia. Future studies are warranted to examine the AToMS in other populations (e.g., people with affective disorders) to cross-validate and extend its utility and psychometric evidence.

Virtual reality-based theory of mind intervention in schizophrenia: Preliminary efficacy results

BackgroundIn recent years, a growing body of literature has supported the core nature and functional significance of Theory of Mind (ToM) deficit in schizophrenia. These findings have made ToM impairment a promising treatment target. However, despite the encouraging results, its complexity makes it difficult to develop new interventions and even to understand the exact nature and scope of the deficit. Yet, further investigation has suggested that using modern technology and multilevel assessment may help solve the problem. MethodsVirtual Reality-based Theory of Mind Intervention (VR-ToMIS) is a recently developed structured method using the combination of cognitive and behavioral therapeutic techniques and the advantages of Virtual Reality (VR) technology. A controlled study with a three-month follow-up was conducted with 42 patients (suffering from schizophrenia or schizo-affective disorder) randomly assigned to either an experimental (VR-ToMIS) or control group (passive-VR). Repeated two-way factorial analysis of covariance was used to evaluate the effects of VR-ToMIS on symptoms, neuro- and social cognition, pragmatic skills, and quality of life when the effect of IQ was controlled. ResultsPatients participating in VR-ToMIS showed significant improvements in all types of ToM tasks (except for hyper-ToM task, based on the results of Cartoon test, Faux pas test and and Baron-Cohen Minds in the Eyes Test) compared to the control group with moderate to large effect sizes. In the case of negative and cognitive symptoms, significant between-group differences were also supported. Improvement was moderated by IQ in the case of higher-order ToM, manner, and relevance implicatures. Results were proved to be sustainable three months after the treatment. ConclusionAlthough the presented results are considered preliminary, they support the potential of the integration of modern technology and traditional methods for future interventions.

Aberrant Emotional Prosody Circuitry Predicts Social Communication Impairments in Children With Autism

BackgroundEmotional prosody provides acoustical cues that reflect a communication partner’s emotional state and is crucial for successful social interactions. Many children with autism have deficits in recognizing emotions from voices; however, the neural basis for these impairments is unknown. We examined brain circuit features underlying emotional prosody processing deficits and their relationship to clinical symptoms of autism. MethodsWe used an event-related functional magnetic resonance imaging task to measure neural activity and connectivity during processing of sad and happy emotional prosody and neutral speech in 22 children with autism and 21 matched control children (7–12 years old). We employed functional connectivity analyses to test competing theoretical accounts that attribute emotional prosody impairments to either sensory processing deficits in auditory cortex or theory of mind deficits instantiated in the temporoparietal junction (TPJ). ResultsChildren with autism showed specific behavioral impairments for recognizing emotions from voices. They also showed aberrant functional connectivity between voice-sensitive auditory cortex and the bilateral TPJ during emotional prosody processing. Neural activity in the bilateral TPJ during processing of both sad and happy emotional prosody stimuli was associated with social communication impairments in children with autism. In contrast, activity and decoding of emotional prosody in auditory cortex was comparable between autism and control groups and did not predict social communication impairments. ConclusionsOur findings support a social-cognitive deficit model of autism by identifying a role for TPJ dysfunction during emotional prosody processing. Our study underscores the importance of tuning in to vocal-emotional cues for building social connections in children with autism.