Poor Theory Of Mind Research Articles

Attachment and thought problems in an adolescent inpatient sample: The mediational role of theory of mind

BackgroundPrevious research has documented increased incidence of insecure attachment and theory of mind (ToM) deficits in individuals experiencing psychotic disorders. ToM has been theorized as a possible mediator of the relation between attachment and psychosis (Korver-Nieberg et al., 2014). The current study sought to extend this area of research to adolescents for the first time by examining adolescent-parent attachment and ToM in inpatient adolescents. MethodsParticipants were 362 inpatient adolescents and their parents; participants completed the Child Attachment Interview, Movie for the Assessment of Social Cognition, Youth Self Report, and Child Behavior Checklist. ResultsBivariate correlations indicated that attachment coherence (a marker of security) was significantly and positively correlated with ToM abilities, and that low attachment coherence and poor ToM performance were each associated with increased youth- and parent-reported thought problems. Mediational models indicated that ToM mediated the relation between insecure attachment and thought problems according to both parent- and self-report. ConclusionsThe results of the current study provide support for a model in which impairments in ToM contribute to the frequently documented association between insecure attachment and emerging psychotic symptoms. Theoretical and clinical implications of these results are discussed, including the potential support for ToM-based interventions for early psychotic symptoms.

Problems with Object Permanence: Rethinking Traditional Beliefs Associated with Poor Theory of Mind in Autism

Poor Theory of Mind (ToM) (or difficulties imputing mental states to self and others) [1], (See also [2-5]) is often blamed for certain responses and behaviour in autism. However, the Theory of Mind Task Battery requires an understanding of language, the use of cognitive skills, as well as the child’s motivation and attention to complete. All of these factors are either weak or under-developed in individuals with autism suggesting that this is not the best means to measure one’s understanding that other people have their own thoughts, plans, beliefs, or point of view. Behaviours like strong defiance, insistence on sameness, fear associated with sudden change and severe anxiety may be related to difficulties seeing beyond the ‘now’ [6]. This paper suggests that some of the stress and anxiety in the autism population may actually be due to delayed object permanence (OP) (knowing something may still exist even if it is out of sight), which can appear as poor ToM. This delay in establishing OP is governed by single focused attention. For more information on this concept see: Lawson, W. (2011) The passionate mind, JKP:London. Although ToM and OP are defined differently, this paper aims to show the relationship between them and how one concept can influence the other using examples in everyday life to illustrate how poor OP is associated with single focused attention, which detracts from the bigger picture.

A Cultural Conundrum

Theory of mind (ToM) is the child’s representational understanding of mental states (e.g., true and false beliefs) and how these influence people’s overt behavior. Past research in numerous Western and a few non-Western cultures has suggested that children throughout the world master a key milestone in ToM development, false-belief understanding, by age 5 to 6 years. However, before drawing theoretical conclusions about such apparent cross-cultural synchrony in timing, investigation of a broader range of non-Western cultures is crucial. We selected the Philippines because there has been no known previous study of ToM development in this population. A sample of 78 Filipino children aged 3 through 6 years took three standard false-belief tests and a measure of language ability in their mother tongue. The results revealed strikingly poor ToM performance. Only 12% of the full sample ( Mage = 4.95 years) passed any false-belief test at all, and only 15% of those older than 5 years ( Mage = 5.54 years; n = 39) displayed ToM by passing two out of three tests. ToM was unrelated to parents’ educational background, family size, and child language ability. Nor could methodological factors (e.g., type of false-belief test used) readily explain Filipino children’s exceptionally slow false-belief mastery. Further study is clearly needed to confirm and extend these intriguing results. Based on past evidence from other cultures, possible influences of parental conversation and socialization styles warrant further exploration in the Filipino context.

Aggression, Sibling Antagonism, and Theory of Mind During the First Year of Siblinghood: A Developmental Cascade Model.

A developmental cascade model was tested to examine longitudinal associations among firstborn children's aggression, theory of mind (ToM), and antagonism toward their younger sibling during the 1st year of siblinghood. Aggression and ToM were assessed before the birth of a sibling and 4 and 12months after the birth, and antagonism was examined at 4 and 12months in a sample of 208 firstborn children (initial Mage =30months, 56% girls) from primarily European American, middle-class families. Firstborns' aggression consistently predicted high sibling antagonism both directly and through poorer ToM. Results highlight the importance of examining longitudinal influences across behavioral, social-cognitive, and relational factors that are closely intertwined even from the early years of life.

Eye-tracking reveals a slowdown of social context processing during intention attribution in patients with schizophrenia.

Schizophrenia is associated with poor theory of mind (ToM), particularly in the attribution of intentions to others. It is also associated with abnormal gaze behaviours and contextual processing. This study investigated to what extent impaired ToM in patients with schizophrenia is related to abnormal processing of social context. We evaluated ToM using a nonverbal intention attribution task based on comic strips depicting social/nonsocial and contextual/noncontextual events while eye movements were recorded. Eye-tracking was used to assess processing time dedicated to visual cues contained in regions of interest identified in a pilot study. We measured cognitive contextual control on a separate task. We tested 29 patients with schizophrenia and 29 controls. Compared with controls, patients were slower in intention attribution but not in physical reasoning. They looked longer than controls at contextual cues displayed in the first 2 context pictures of the comic strips, and this difference was greater for intention attribution than for physical reasoning. We found no group difference in time spent looking at noncontextual cues. Patients' impairment in contextual control did not explain their increased reaction time and gaze duration on contextual cues during intention attribution. Difficulty may not have been equivalent between intention attribution and physical reasoning conditions. Overall, schizophrenia was characterized by a delay in intention attribution related to a slowdown of social context processing that was not explained by worse executive contextual control.

Implicit and explicit processing of emotional facial expressions in Parkinson’s disease

ObjectiveBesides motor problems, Parkinson’s disease (PD) is associated with detrimental emotional and cognitive functioning. Deficient explicit emotional processing has been observed, whilst patients also show impaired Theory of Mind (ToM) abilities. However, it is unclear whether this PD patients’ ToM deficit is based on an inability to infer otherś emotional states or whether it is due to explicit emotional processing deficits. We investigated implicit and explicit emotional processing in PD with an affective priming paradigm in which we used pictures of human eyes for emotional primes and a lexical decision task (LDT) with emotional connoted words for target stimuli. MethodSixteen PD patients and sixteen matched healthy controls performed a LTD combined with an emotional priming paradigm providing emotional information through the facial eye region to assess implicit emotional processing. Second, participants explicitly evaluated the emotional status of eyes and words used in the implicit task. ResultsCompared to controls implicit emotional processing abilities were generally preserved in PD with, however, considerable alterations for happiness and disgust processing. Furthermore, we observed a general impairment of patients for explicit evaluation of emotional stimuli, which was augmented for the rating of facial expressions. ConclusionsThis is the first study reporting results for affective priming with facial eye expressions in PD patients. Our findings indicate largely preserved implicit emotional processing, with a specific altered processing of disgust and happiness. Explicit emotional processing was considerably impaired for semantic and especially for facial stimulus material. Poor ToM abilities in PD patients might be based on deficient explicit emotional processing, with preserved ability to implicitly infer other people’s feelings.

INTERACTIVE LINKS BETWEEN RELATIONAL AGGRESSION, THEORY OF MIND, AND MORAL DISENGAGEMENT AMONG EARLY ADOLESCENTS

The aim of this study was to investigate possible interactive links between theory of mind (ToM), moral disengagement and relational aggression, using a moderated mediation analysis, with gender as a moderator, in a sample of 120 Greek preadolescents. Results indicated that relational aggression was significantly positively associated with moral disengagement and negatively with ToM. Moderated mediation analyses indicated that boys with deficient ToM were more likely to morally disengage from their actions which in turn resulted in relational aggression, while poor ToM was directly linked to relational aggression only for preadolescent girls. Moral disengagement had a direct effect on relational aggression only for boys, while ToM was found to partially mediate the relationship between moral disengagement and relational aggression only for girls. The results emphasize that the co‐morbid effects of socio‐cognitive factors should be taken into consideration when relational aggression is explored.

Clinical assessment of social cognitive function in neurological disorders.

Social cognition broadly refers to the processing of social information in the brain that underlies abilities such as the detection of others' emotions and responding appropriately to these emotions. Social cognitive skills are critical for successful communication and, consequently, mental health and wellbeing. Disturbances of social cognition are early and salient features of many neuropsychiatric, neurodevelopmental and neurodegenerative disorders, and often occur after acute brain injury. Its assessment in the clinic is, therefore, of paramount importance. Indeed, the most recent edition of the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM-5) introduced social cognition as one of six core components of neurocognitive function, alongside memory and executive control. Failures of social cognition most often present as poor theory of mind, reduced affective empathy, impaired social perception or abnormal social behaviour. Standard neuropsychological assessments lack the precision and sensitivity needed to adequately inform treatment of these failures. In this Review, we present appropriate methods of assessment for each of the four domains, using an example disorder to illustrate the value of these approaches. We discuss the clinical applications of testing for social cognitive function, and finally suggest a five-step algorithm for the evaluation and treatment of impairments, providing quantitative evidence to guide the selection of social cognitive measures in clinical practice.

Emotion recognition and theory of mind are related to gray matter volume of the prefrontal cortex in schizophrenia

Investigations of social cognition in schizophrenia have demonstrated consistent impairments compared to healthy controls. Functional imaging studies in schizophrenia patients and healthy controls have revealed that social cognitive processing depends critically on the amygdala and the prefrontal cortex (PFC). However, the relationship between social cognition and structural brain abnormalities in these regions in schizophrenia patients is less well understood. Measures of facial emotion recognition and theory of mind (ToM), two key social cognitive abilities, as well as face perception and IQ, were assessed in 166 patients with schizophrenia and 134 healthy controls. MRI brain scans were acquired. Automated parcellation of the brain to determine gray matter volume of the amygdala and the superior, middle, inferior and orbital PFC was performed. Between-group analyses showed poorer recognition of angry faces and ToM performance, and decreased amygdala and PFC gray matter volumes in schizophrenia patients as compared to healthy controls. Moreover, in schizophrenia patients, recognition of angry faces was associated with inferior PFC gray matter volume, particularly the pars triangularis (p=0.006), with poor performance being related to reduced pars triangularis gray matter volume. In addition, ToM ability was related to PFC gray matter volume, particularly middle PFC (p=0.001), in that poor ToM skills in schizophrenia patients were associated with reduced middle PFC gray matter volume. In conclusion, reduced PFC, but not amygdala, gray matter volume is associated with social cognitive deficits in schizophrenia.

Disentangling principle C: A contribution from individuals with brain damage

We suggest a disentangling approach according to which the use of referring expressions obeys two types of guidelines. Deviance in repeating referential expressions (R-expressions) can result from two possible sources: one is the violation of the syntactic principle C, ruling out configurations in which c-command holds between the two identical R-expressions; the other is a Go-Lighter (GL) economy principle, applying in discourse and arguably based on shared knowledge and theory of mind (TOM), operative also in environments in which c-command does not hold. To examine this disentangling approach, we tested 36 brain-damaged patients: 20 who had aTOMia, a deficit in TOM, and 16 brain-damaged patients with good TOM, and 29 healthy control participants. Experiment 1 tested the comprehension of principles A and B using a sentence-picture-matching task. Experiment 2 tested principles C and GL using a sentence-choice task. Experiment 3 tested sentence interpretation according to principles C and GL using sentence-picture matching. In line with the disentangling approach, the individuals with poor TOM (and good syntax) failed to rule out and interpret repeating expressions that rely solely on the Go-Lighter principle, but succeeded in judging and interpreting sentences in which the repetition is ruled out by the syntactic principle C.

Theory-of-mind use in remitted schizophrenia patients: The role of inhibition and perspective-switching

In social interaction, Theory of Mind (ToM) enables us to construct representations of others' mental states, and to use those representations flexibly to explain or predict others' behavior. Although previous literature has documented that schizophrenia is associated with poor ToM ability, little is known about the cognitive mechanisms underlying their difficulty in ToM use. This study developed a new methodology to test whether the difficulty in false-belief-use might be related to deficits in perspective-switching or impaired inhibitory control among 23 remitted schizophrenia patients and 18 normal controls. Patients showed a significantly greater error rate in a perspective-switching condition than a perspective-repeating position in a false-belief-use task, whereas normal controls did not show a difference between the two conditions. In addition, a larger main effect of inhibition was found in remitted schizophrenia patients than normal controls in both a false-belief-use task and control task. Thus, remitted schizophrenia patients’ impairment in ToM use might be accounted for, at least partially, by deficits in perspective-switching and impaired inhibitory control.

Judging Strangers' Trustworthiness is Associated with Theory of Mind Skills.

Trusting people requires evaluating them to assess their trustworthiness. Evaluating a stranger’s intentions is likely to be one method of assessing trustworthiness. The present study tested the hypothesis that judgments of trustworthiness are associated with mind reading skills, also called theory of mind (ToM). We tested a group of healthy participants and a group of patients with paranoid schizophrenia. Both groups made ToM judgments and judged the trustworthiness of strangers. Participants were also assessed for their disposition to trust as well as levels of paranoid belief. As anticipated, healthy participants had a normal ToM scores and patients with paranoid schizophrenia had poor ToM scores. In paranoid patients, better ability to read others’ minds was associated with judging others as more trustworthy, while the reverse was found in the healthy participants (better mind reading was associated with judging others as less trustworthy), suggesting a non-linear relationship between trust in others and being able to read their intentions.

Might we be Calling Problems Seen in Autism Spectrum Conditions: ‘Poor Theory of Mind,’ when Actually they are Related to Non-Generalised ‘Object Permanence’?

Autism spectrum conditions (ASC) and the delayed development of object permanence is often not questioned, and is rarely understood. The following paper attempts to explore this idea and suggests reasons for why such development is delayed and the possibility that certain difficult behaviours seen in children with ASC are less likely to be connected to having poor theory of mind and more connected to lacking generalized concepts of object permanence.

Impaired performance on advanced Theory of Mind tasks in children with epilepsy is related to poor communication and increased attention problems

Children with epilepsy (CWE) have social difficulties that can persist into adulthood, and this could be related to problems with understanding others' thoughts, feelings, and intentions. This study assessed children's ability to interpret and reason on mental and emotional states (Theory of Mind) and examined the relationships between task scores and reports of communication and behavior. Performance of 56 CWE (8–16years of age) with below average IQ (n=17) or an average IQ (n=39) was compared with that of 62 healthy controls with an average IQ (6–16years of age) on cognition, language, and two advanced Theory of Mind (ToM) tasks that required children to attribute mental or emotional states to eye regions and to reason on internal mental states in order to explain behavior. The CWE-below average group were significantly poorer in both ToM tasks compared with controls. The CWE — average group showed a significantly poorer ability to reason on mental states in order to explain behavior, a difference that remained after accounting for lower IQ and language deficits. Poor ToM skills were related to increased communication and attention problems in both CWE groups. There is a risk for atypical social understanding in CWE, even for children with average cognitive function.

Is the Theory of Mind deficit observed in visual paradigms in schizophrenia explained by an impaired attention toward gaze orientation?

Schizophrenia is associated with poor Theory of Mind (ToM), particularly in goal and belief attribution to others. It is also associated with abnormal gaze behaviors toward others: individuals with schizophrenia usually look less to others' face and gaze, which are crucial epistemic cues that contribute to correct mental states inferences. This study tests the hypothesis that impaired ToM in schizophrenia might be related to a deficit in visual attention toward gaze orientation.We adapted a previous non-verbal ToM paradigm consisting of animated cartoons allowing the assessment of goal and belief attribution. In the true and false belief conditions, an object was displaced while an agent was either looking at it or away, respectively. Eye movements were recorded to quantify visual attention to gaze orientation (proportion of time participants spent looking at the head of the agent while the target object changed locations).29 patients with schizophrenia and 29 matched controls were tested. Compared to controls, patients looked significantly less at the agent's head and had lower performance in belief and goal attribution. Performance in belief and goal attribution significantly increased with the head looking percentage. When the head looking percentage was entered as a covariate, the group effect on belief and goal attribution performance was not significant anymore.Patients' deficit on this visual ToM paradigm is thus entirely explained by a decreased visual attention toward gaze.

Adaptive Associations between Social Cognition and Emotion Regulation are Absent in Schizophrenia and Bipolar Disorder

Schizophrenia (SZ) and bipolar disorder (BD) are associated with impairments in facial emotion perception and Theory of Mind (ToM). These social cognitive skills deficits may be related to a reduced capacity to effectively regulate one’s own emotions according to the social context. We therefore set out to examine the relationship between social cognitive abilities and the use of cognitive strategies for regulating negative emotion in SZ and BD. Participants were 56 SZ, 33 BD, and 58 healthy controls (HC) who completed the Ekman 60-faces test of facial emotion recognition; a sub-set of these participants also completed The Awareness of Social Inference Test (TASIT) and the Cognitive Emotion Regulation Questionnaire (CERQ). SZ participants demonstrated impairments in emotion perception on both the Ekman and the TASIT Emotion Evaluation tests relative to BD and HC. While both SZ and BD patients showed ToM deficits (i.e., perception of sarcasm and lie) compared to HC, SZ patients demonstrated significantly greater ToM impairment compared to BD. There were also distinct patterns of cognitive strategies used to regulate emotion in both patient groups: those with SZ were more likely to engage in catastrophizing and rumination, while BD subjects were more likely to blame themselves and were less likely to engage in positive reappraisal, relative to HC. In addition, those with SZ were more likely to blame others compared to BD. Associations between social cognition and affect regulation were revealed for HC only: TASIT performance was negatively associated with more frequent use of rumination, catastrophizing, and blaming others, such that more frequent use of maladaptive cognitive emotion regulation strategies was associated with poor social cognitive performance. These associations were not present in either patient group. However, both SZ and BD patients demonstrated poor ToM performance and aberrant use of emotion regulation strategies consistent with previous studies. SZ also showed basic emotion recognition deficits relative to BD and HC. That there were no associations between social cognition and the capacity to self-regulate negative emotion in SZ and BD (in the context of poor social cognition and maladaptive regulatory strategies) suggests that dysfunction in fronto-limbic brain networks may underpin both social cognitive deficits and the use of maladaptive cognitive strategies in these disorders, albeit by potentially different routes.

Delusional Misidentification Syndromes in Obsessive–Compulsive Disorder

Delusional misidentification syndromes (DMS) have been rarely reported in patients with conditions other than schizophrenia-related disorders, diffuse brain disease (dementia) and focal neurological illness. In this report, we describe DMS (i.e. Capgras and Fregoli syndromes) in two patients with severe and treatment resistant obsessive-compulsive disorder (OCD), one with paranoid personality disorder (PPD) and the other with a pervasive developmental disorder (PDD) not otherwise specified. While our findings highlight an interesting phenomenon (the occurrence of DMS in OCD), it is presently unclear whether this association is rare or underreported. Misidentification syndromes might be the ultimate result of a combination of obsessive fears and preexisting cognitive bias/deficits, such as mistrustfulness (in PPD) or poor theory of mind (in PDD).

Children's memory distortions following social contact with a co-witness: Disentangling social and cognitive mechanisms

This study examined whether recalling an event with a co-witness influences children's recall. Individual 3–5-year-olds (n = 48) watched a film with a co-witness. Unbeknown to participants, the co-witness was watching an alternative version of the film. Afterwards both the co-witness and the participant answered questions about the film together (public recall), and the degree to which children conformed to the co-witness's alternative version of events was measured. Subsequently participants were questioned again individually (private recall). Children also completed false belief and inhibitory control tasks. By separating errors made in public and private, the results indicated that both social conformity (32% of errors) and memory distortion (68% of errors) played a role in co-witness influence. Inhibitory control predicted the likelihood of retracting errors in private, but only for children who failed (r=.66) rather than passed false belief tasks (r=−.10). The results suggest that children with a theory of mind conform in the company of the co-witness to avoid social embarrassment, while those a poor theory of mind conform on the basis of an inability to inhibit the co-witness's response. The findings contribute to our understanding of the motivations responsible for co-witness conformity across early childhood.

Autobiographical memory and mentalizing impairment in personality disorders and schizophrenia: clinical and research implications.

OPINION article Front. Psychol., 26 November 2012Sec. Cognition Volume 3 - 2012 | https://doi.org/10.3389/fpsyg.2012.00529

A prospective longitudinal study of children’s theory of mind and adolescent involvement in bullying

Theory of mind (ToM) allows the understanding and prediction of other people's behaviours based on their mental states (e.g. beliefs). It is important for healthy social relationships and thus may contribute towards children's involvement in bullying. The present study investigated whether children involved in bullying during early adolescence had poor ToM in childhood. Participants were members of the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally representative sample of 2,232 children and their families. We visited families when children were 5, 7, 10 and 12 years. ToM was assessed when the children were 5 years using eight standardized tasks. Identification of those children who were involved in bullying as victims, bullies and bully-victims using mothers', teachers' and children's reports was carried out when they were 12 years' old. Poor ToM predicted becoming a victim (effect size, d = 0.26), bully (d = 0.25) or bully-victim (d = 0.44) in early adolescence. These associations remained for victims and bully-victims when child-specific (e.g. IQ) and family factors (e.g. child maltreatment) were controlled for. Emotional and behavioural problems during middle childhood did not modify the association between poor ToM and adolescent bullying experiences. Identifying and supporting children with poor ToM early in life could help reduce their vulnerability for involvement in bullying and thus limit its adverse effects on mental health.