Theory Of Mind Impairment Research Articles

Does ChatGPT have a typical or atypical theory of mind?

In recent years, the capabilities of Large Language Models (LLMs), such as ChatGPT, to imitate human behavioral patterns have been attracting growing interest from experimental psychology. Although ChatGPT can successfully generate accurate theoretical and inferential information in several fields, its ability to exhibit a Theory of Mind (ToM) is a topic of debate and interest in literature. Impairments in ToM are considered responsible for social difficulties in many clinical conditions, such as Autism Spectrum Disorder (ASD). Some studies showed that ChatGPT can successfully pass classical ToM tasks, however, the response style used by LLMs to solve advanced ToM tasks, comparing their abilities with those of typical development (TD) individuals and clinical populations, has not been explored. In this preliminary study, we administered the Advanced ToM Test and the Emotion Attribution Task to ChatGPT 3.5 and ChatGPT-4 and compared their responses with those of an ASD and TD group. Our results showed that the two LLMs had higher accuracy in understanding mental states, although ChatGPT-3.5 failed with more complex mental states. In understanding emotional states, ChatGPT-3.5 performed significantly worse than TDs but did not differ from ASDs, showing difficulty with negative emotions. ChatGPT-4 achieved higher accuracy, but difficulties with recognizing sadness and anger persisted. The style adopted by both LLMs appeared verbose, and repetitive, tending to violate Grice's maxims. This conversational style seems similar to that adopted by high-functioning ASDs. Clinical implications and potential applications are discussed.

Variability of theory of mind versus pragmatic ability in typical and atypical development

IntroductionNumerous studies have linked deficits in Theory of Mind (ToM) with language problems. We aimed to explore the similarities and differences between children's patterns of performance on a ToM task that requires minimal linguistic skill and a pragmatic inference task that relies on both ToM and language. We assessed variability in pragmatic inference skills and ToM across populations of children (8–14 years) displaying varying cognitive profiles. We further compared the sensitivity of ToM versus pragmatic ability to core language skills, memory and executive functioning (EF). MethodToM was tested using the Social Attribution Task (SAT-MC-II). Pragmatic ability was assessed in an implicature comprehension task. Receptive vocabulary, grammar comprehension, short-term and working memory (STM and WM) capacity and EF were measured using Hungarian adaptations of standard tasks and tests developed by the authors’ lab. In addition to typically developing (TD) children (n = 33), we included children with neurodevelopmental disorders where ToM and/or language abilities are vulnerable: autism spectrum disorder (ASD, n = 26), attention deficit hyperactivity disorder (ADHD, n = 25) and developmental language disorder (DLD, n = 18). ResultsResults revealed a significant but only moderate positive correlation between pragmatic inference and ToM indicating that the two abilities are related but distinct. The ASD group showed impairments in both ToM and pragmatic inference ability but no significant deficit was observed in ADHD or DLD relative to TD children in either skill. However, while SAT-MC-II results were only affected by verbal WM and vocabulary measures, pragmatic performance was associated with STM, verbal WM, EF, grammatical skills and vocabulary. ConclusionOur findings indicate that disentangling the contributions of different cognitive skills to ToM tasks may help clarify the role of ToM in language skills and identify distinct patterns of ToM and pragmatic skills in developmental disorders.

Motor, cognitive, and socio-cognitive mechanisms explaining social skills in autism and typical development.

Challenges in social functioning are considered a core criterion for diagnosing autism. Although motor skills, executive functioning (EF), and theory of mind (ToM) abilities independently affect social challenges and are interconnected, these abilities' shared contribution to the explanation of social functioning in autism remains under-investigated. To address this disparity, we examined the motor, EF, and ToM abilities of 148 autistic and non-autistic youth (ages 6-16 years), evaluating these variables' impact on social ability and their interconnections. Our mediation model exploring the contribution of motor, EF, and ToM skills explained 85% of the variance in social functioning (Social Responsiveness Scale-SRS-2). Analysis yielded a direct path from study group to SRS-2-social (typically developing-TD > autistic) and two main parallel indirect joint paths: (a) Group ➔ motor ➔ EF ➔ SRS-2-social; and (b) Group ➔ motor ➔ ToM ➔ SRS-2-social. In two secondary indirect paths, autistic children showed lower motor skills, which in turn explained their higher EF and/or ToM impairment, which in turn explained their higher social skills impairment. Put differently, our results suggest that better EF and TOM proficiency may compensate for poorer motor skills. Findings also indicated that the collective impact of motor, EF, and ToM skills on social functioning, along with the mediating role played by EF and ToM on the social-motor linkage, may contribute to understanding individual differences in the social functioning of autistic children. These conclusions call for the inclusion of motor, EF, and ToM activities into daily practices to facilitate social functioning.

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.

Predictors of clinical insight in first-episode psychosis: Different patterns in men and women

BackgroundWe aimed to explore gender-related differences in the associations of insight impairment with clinical symptoms, metacognition, and social cognition in psychosis. MethodsRegression analysis of several clinical insight dimensions was conducted on the data from 116 men and 56 women with first-episode psychosis. Various clinical symptoms and measures of metacognition and social cognition were entered as predictors. ResultsIn both men and women, delusions emerged as a strong predictor of all insight dimensions, and verbal hallucinations as a strong predictor of symptom relabelling. In men, certain negative symptoms as well as self-certainty, lack of self-reflectiveness, impaired theory of mind, attributional biases, and a jumping-to-conclusions bias were additional predictors of poor insight, while good insight was associated with depression, anxiety, avolition, blunted affect, and impaired emotional recognition. In women, poor insight was associated with a self-serving/externalising bias, impaired emotional recognition, and attention disorders. ConclusionsPoor insight in first-episode psychosis is strongly linked to deficits in metacognition and social cognition, with marked differences between men and women with respect to the specific skills involved in the impairment. Meanwhile, good insight is linked to a variety of affective manifestations in men. These findings suggest new avenues for more targeted cognitive interventions to improve clinical insight in psychosis.

Research Review: Social cognition and everyday social skills in children and adolescents with attention-deficit/hyperactivity disorder: ameta-analysis of case-control studies.

Previous studies that have assessed social cognition in Attention-Deficit/Hyperactivity Disorder (ADHD) have produced inconsistent findings. To summarize these data and shed light upon moderators that may explain observed inconsistencies, we conducted a systematic review and meta-analysis exploring social cognition (Theory of Mind (ToM), Empathy, Facial and Non-Facial Emotion Recognition) and Everyday Social Skills in children and adolescents with ADHD. The current meta-analysis involved 142 studies including 652 effect sizes. These studies compared children and adolescents with ADHD (n = 8,300) and with typical development (n = 7,983). Participants with ADHD exhibited moderate to very large deficits in ToM (SMD = 0.84, 95% CI = 0.68-0.99), Facial Emotion Recognition (SMD = 0.63, 95% CI = 0.46-0.81), and Everyday Social Skills (SMD = 1.23, 95% CI = 1.08-1.37). The magnitude of these impairments was similar when considering effect sizes adjusted for some covariates and the methodological quality of the studies. Few studies have investigated Empathy and Non-Facial Emotion Recognition, which precludes definitive conclusions. Children and adolescents with ADHD experience robust impairments in ToM, Facial Emotion Recognition and Everyday Social Skills. Future studies should explore whether these deficits are a consequence of difficulties in other areas of cognition (e.g., executive functioning). We have made all our raw data open access to facilitate the use of the present work by the community (e.g., clinicians looking for tools, assessing social impairments, or researchers designing new studies).

Multidimensional assessment of social cognition using non-immersive virtual reality in dementia with Lewy bodies and Alzheimer’s disease: an exploratory study

ABSTRACT Introduction Few studies have focused on social cognition in dementia with Lewy bodies (DLB), even though some brain structures being well known as underlying social cognitive processes are directly impacted in this disease. Furthermore, social cognition processes have been mostly studied independently using evaluations with poor ecological validity. We aimed at studying the ability of a new naturalistic and multidimensional social cognition task to reveal impairments in DLB patients. We chose to compare the profile of these patients with that of Alzheimer’s disease (AD) patients, for which social cognition is better preserved. Method Fifteen patients (DLB: n = 7; AD: n = 8) and 28 healthy controls underwent the REALSoCog task. They encountered several social situations (e.g. control versus transgressions) in a non-immersive virtual city environment allowing the assessment of moral cognition, cognitive and affective theory of mind (ToM), emotional empathy and behavioral intentions. Results The main results showed (i) a lower ability to detect transgressions in DLB patients, particularly conventional ones, whereas moral cognition seemed better preserved in AD patients; (ii) a cognitive ToM impairment in both DLB and AD patients, while affective ToM is impaired only in DLB patients; (iii) a decreased emotional empathy specifically observed in DLB patients; (iv) more inappropriate behavioral intentions, mainly in DLB patients, but also in some AD patients. Conclusions This study suggests the feasibility and potential interest of the REALSoCog task in revealing social cognition deficits, particularly for DLB patients by showing different social patterns as compared to AD patients. These results offer interesting clinical perspectives to develop more naturalistic tasks in such populations and for clinical differential diagnosis. Limitations and future perspectives are discussed.

A patient`s trajectory with autism spectrum disorder leading to forensic psychiatric institutionalisation

IntroductionAutism-spectrum-disorder (ASD) is a heterogenous neurodevelopmental condition with a wide range of symptoms. Typical deficits, such as impairment in social communication and interactions, can lead to violent behaviours. However, ASD is often underdiagnosed and little is known about patients with ASD in forensic institutions.ObjectivesTo highlight the diagnostic challenges and offending behaviour of people with ASD in the context of the criminal justice system (CJS) through a case report.MethodsThe case report is based on exploration, third party anamnesis, medical documentations and court filesResults A 25-year-old man was placed in detention in 2021 after having committed a dangerous threat to unknown persons and was considered not guilty by reason of insanity. Since early childhood the patient presented with extreme mood swings and impulsive-aggressive outbursts that led to criminal mischief later on. During elementary school he developed concentration problems as well as specific learning deficits. Due to his deviant social behaviour, he was rejected from his peer group. Over the course of the years, he showed no significant responses to different psychopharmacological treatment approaches. His social anxiety grew and ultimately, he started experimenting with various drugs and drinking excessive amounts of alcohol, which induced multiple psychotic episodes. Due to the psychotic exacerbations, he was repeatedly admitted to psychiatric units for acute treatment, however the autistic disorder remained untreated. At the time of the crime an independent psychiatric assessor diagnosed schizophrenia simplex and multiple drug abuse. The patient had been in psychiatric treatment since the age of 5 and received multiple diagnoses such as combined personality disorder, different subtypes of schizophrenia, ADHD, Tourette syndrome, depressive disorder and ASD at the age of 14. Nevertheless, prior to his detention he had never received a complex therapy focusing on his ASD. According to the verdict he was admitted to a medium secure forensic ward in Lower Austria, where he was treated with antipsychotic and anxiolytic medication. Furthermore, he participated in the day-structuring treatment program ensuring routine.Conclusions Neurodevelopmental disorders such as ASD often impose a diagnostic challenge, particularly without intellectual disability. This can lead to under- and misdiagnosis, inadequate treatment or even criminal behaviour. Impaired theory of mind, poor emotional regulation and problems with moral reasoning should be recognized and treated specifically early on to prevent further damage to both the individual and society.Disclosure of InterestNone Declared

Decreased oxytocin levels related to social cognition impairment in borderline personality disorder.

Dysfunctions in the oxytocin system have been reported in patients with borderline personality disorder (BPD). Deficits could be related to interpersonal hypersensitivity, which has been previously associated with failures in social cognition (SC) in this disorder, especially in Theory of Mind (ToM) skills. The aim of this work is to study the links between the oxytocin system and SC impairments in patients with BPD. Plasma oxytocin levels (OXT) and protein expression of oxytocin receptors in blood mononuclear cells (OXTR) were examined in 33 patients with a diagnosis of BPD (age: M 28.85, DT = 8.83). Social cognition was assessed using the Movie for the Assessment of Social Cognition (MASC). Statistical associations between biochemical factors and different response errors in MASC were analyzed through generalized linear regression controlling for relevant clinical factors. Generalized linear regression showed a significant relationship between lower OXTR and overmentalization in BPD patients (OR = 0.90). This work supports the relationship between alterations in the oxytocin system and ToM impairments observed in BPD patients, enhancing the search for endophenotypes related to the phenotypic features of the disorder to improve current clinical knowledge and address more specific therapeutic targets.

Investigating the relationship of theory of mind and empathy with neuroimaging, neuropsychological, and neuropsychiatric data in persons with multiple sclerosis

ABSTRACT Theory of Mind (ToM) is understanding others’ minds. Empathy is an insight into emotions and feelings of others. Persons with multiple sclerosis (pwMS) may experience impairment in ToM and empathy. To investigate ToM, empathy, and their relationship with neuroimaging, neuropsychological, and neuropsychiatric data. 41 pwMS and 41 HC were assessed using RMET for ToM, EQ, BICAMS, HADS. Cortical and subcortical gray matter volumes were calculated with Freesurfer from 3T MRI scans. pwMS showed lower EQ scores (44.82 ± 11.9 vs 51.29 ± 9.18, p = 0.02) and worse RMET performance (22.37 ± 4.09 vs 24,47 ± 2.93, p = 0.011). Anxiety and depression were higher in pwMS. EQ correlated with subcortical (amygdala) and cortical (anterior cingulate) volumes. RMET correlated with cortical volumes (posterior cingulate, lingual). In regression analysis, amygdala volume was the single predictor of empathy performance (p = 0.041). There were no significant correlations between social cognitive tests and general cognition. A weak negative correlation was found between EQ and the level of anxiety (r = -0.342, p = 0.038) The present study indicates that pwMS have impairment on ToM and empathy. The performance of ToM and empathy in MS is linked to the volumes of critical brain areas involved in social cognition.

Theory of Mind impairment in childhood narcolepsy type 1: a case-control study.

Narcolepsy type 1 is a central disorder of hypersomnolence characterized by excessive daytime sleepiness, cataplexy and other rapid eye movement sleep-related manifestations. Neurophysiological studies suggest that narcolepsy type 1 patients may experience impairment in emotional processing due to structural and functional changes in limbic structures and associated areas. However, the only study exploring narcolepsy behavioural responses found no impairment in the ability to recognize emotions, possibly due to compensatory mechanisms. The present study was designed to fill this gap in the literature by investigating the behavioural impairment related to emotional processing focusing on an advanced socio-cognitive skill, namely Theory of Mind, in paediatric narcolepsy type 1 patients. Twenty-two narcolepsy type 1 children and adolescents (six female; age range: 8.0-13.5) and 22 healthy controls matched for age and sex (six female; age range: 8.9-13.0) underwent a neuropsychological evaluation to assess socio-economic status, verbal abilities, working memory, social anxiety and Theory of Mind via a verbal task (i.e. Strange Stories task) and a visual task (i.e. Silent Films). Narcolepsy type 1 patients were also evaluated for disease severity. Patients exhibited impairment in Theory of Mind skills, as assessed both through both verbal (controls median = 8; patients median = 5; P = 0.009) and visual tasks (controls median = 8; patients median = 6; P = 0.003), compared to healthy controls. Correlation analyses showed that verbal and visual Theory of Mind was negatively related to narcolepsy severity (ρ = -0.45, P = 0.035 and ρ = -0.52, P = 0.012), and daytime sleepiness (ρ = -0.48, P = 0.025 and ρ = -0.45, P = 0.038). Our study shows a selective impairment in the Theory of Mind domain in children and adolescents with narcolepsy type 1. In addition, our results highlight a link between symptom severity and Theory of Mind, suggesting that lower Theory of Mind levels are associated with higher symptom severity. Further, longitudinal studies are needed to disentangle the direction of this relation and to disambiguate if narcolepsy severity impaired children's Theory of Mind or if Theory of Mind skills modulate the severity of narcolepsy symptoms by providing a greater ability to avoid cataplexy.

Theory of mind in mild cognitive impairment and Parkinson’s disease: The role of memory impairment

BackgroundSocial cognition is impaired in Parkinson’s disease (PD). Whether social cognitive impairment (iSC) is a by-product of the underlying cognitive deficits in PD or a process independent of cognitive status is unknown. To this end, the present study was designed to investigate the weight of specific cognitive deficits in social cognition, considering different mild cognitive impairment subtypes of PD (PD-MCI).MethodsFifty-eight PD patients underwent a neuropsychological battery assessing executive functions, memory, language, and visuospatial domains, together with social cognitive tests focused on theory of mind (ToM). Patients were divided into subgroups according to their clinical cognitive status: amnestic PD-MCI (PD-aMCI, n = 18), non-amnestic PD-MCI (PD-naMCI, n = 16), and cognitively unimpaired (PD-CU, n = 24). Composite scores for cognitive and social domains were computed to perform mediation analyses.ResultsMemory and language impairments mediated the effect of executive functioning in social cognitive deficits in PD patients. Dividing by MCI subgroups, iSC occurred more frequently in PD-aMCI (77.8%) than in PD-naMCI (18.8%) and PD-CU (8.3%). Moreover, PD-aMCI performed worse than PD-CU in all social cognitive measures, whereas PD-naMCI performed worse than PD-CU in only one subtype of the affective and cognitive ToM tests.ConclusionsOur findings suggest that ToM impairment in PD can be explained by memory dysfunction that mediates executive control. ToM downsides in the amnesic forms of PD-MCI may suggest that subtle changes in social cognition could partly explain future transitions into dementia. Hence, the evaluation of social cognition in PD is critical to characterize a possible behavioral marker of cognitive decline.

Affective theory of mind in people with mild and moderate Alzheimer's disease.

This study compared the affective theory of mind (ToM) of people with mild and moderate Alzheimer's disease (AD) and healthy older adults and also investigated the relationship between affective ToM and cognitive and clinical functioning in AD people. This cross-sectional study included 156 older adults with AD and 40 healthy older adults. We used an experimental task involving reasoning processes in different contextual situations. The affective ToM was impaired in AD groups compared with healthy group, with moderate AD group showing lower performance than mild AD group. The affective ToM task of mild AD group was significantly correlated with the Mini-Mental State Examination (MMSE) and education years. Linear regression showed only education years as a predictor of ToM task performance. The neuropsychiatric symptoms and functionality were not correlated with the affective ToM. Our findings demonstrated that people with mild and moderate AD presented impairments in affective ToM that can be explained by the difficulties to infer emotion from reasoning processes. In addition, the education years variable proved to be an affective ToM performance's predictor for the mild AD group, but not for the moderate AD group, indicating that ToM abilities are affected differently in different stages of AD. Neuropsychiatric symptoms and functionality seem to have no influence on affective ToM impairments in people with AD.

Characteristics of theory of mind impairment and its relationship with clinical symptoms and neurocognition in patients with schizophrenia

BackgroundSchizophrenia (SCZ) is a mental disorder that can cause severe disability, including impairment of social cognition, which is considered a core feature of SCZ, and the Theory of Mind (ToM) is a core component of social cognition. Although many studies have confirmed the presence of ToM impairment in patients with SCZ, its characteristics in terms of different orders (first-order and second-order) and components remain unclear, and no studies have investigated the independent correlations between such impairment and clinical symptoms. Therefore, this study aimed to identify the characteristics of ToM impairment in patients with SCZ.MethodsThis study included 30 patients with SCZ and 30 healthy controls who were matched for age, sex, and level of education. The clinical symptoms of the patients with SCZ were evaluated using the Positive and Negative Symptom Scale (PANSS), and the neurocognitive ability of the subjects was evaluated using the Trail Making Test, Symbol Coding Test, and Digit Span Test. The degree of ToM impairment of the subjects at different stages (first- and second-order) and for individual components was evaluated using the Yoni task. Latent profile analysis and network analysis were conducted to identify and analyze the potential ToM performance types, and independent correlations were assessed between ToM impairment and clinical symptoms.ResultsThe patients with SCZ exhibited significant first-order and second-order impairment (P < 0.05), and the second-order affective ToM component was mainly reflected by complex affective states (P = 0.003). The latent profile analysis revealed that ToM impairments in patients with SCZ could be classified into groups with complete, second-order, and comprehensive defects, whereas it was impossible to classify patients according to differences in the cognitive and affective ToM components. The Network analysis demonstrated that the cognitive component of ToM was associated with positive symptoms, whereas the affective ToM component was associated with negative symptoms.ConclusionPatients with SCZ exhibited differences in order levels and ToM impairments, as well as different defect types. In addition, cognitive and affective ToM components may be related to different psychotic symptoms; therefore, understanding these differences could promote the rehabilitation of patients with SCZ.

Exploring Pragmatic Deficits in Relation to Theory of Mind and Executive Functions: Evidence from Individuals with Right Hemisphere Stroke.

Research investigating pragmatic deficits in individuals with right hemisphere damage focuses on identifying the potential mechanisms responsible for the nature of these impairments. Nonetheless, the presumed shared cognitive mechanisms that could account for these deficits have not yet been established through data-based evidence from lesion studies. This study aimed to examine the co-occurrence of pragmatic language deficits, Theory of Mind impairments, and executive functions while also exploring their associations with brain lesion sites. Twenty-five patients suffering from unilateral right hemisphere stroke and thirty-seven healthy participants were recruited for this study. The two groups were tested in pragmatics, Theory of Mind, and executive function tasks. Structural imaging data were also obtained for the identification of the lesion sites. The findings of this study suggest a potential convergence among the three aforementioned cognitive mechanisms. Moreover, we postulate a hypothesis for a neural circuitry for communication impairments observed in individuals with right hemisphere damage.

Exploring Cognitive-Pragmatic Heterogeneity Following Acquired Brain Injury: A Cluster Analysis of Hint Comprehension.

Difficulties understanding nonliteral language (especially hints) are frequently reported following acquired brain injury (ABI). Several cognitive mechanisms, such as context processing, executive functions, and theory of mind (ToM), may underlie these disorders. However, their role remains controversial, mainly because of the characteristic heterogeneity of this population. Therefore, our study aimed to identify cognitive-pragmatic profiles in individuals with ABI. A new task of hint comprehension, manipulating executive demand, markers of hints, and ToM and neuropsychological tests were administered to 33 participants with frontal ABI and 33 control participants. Cluster analysis, a method sensitive to profile heterogeneity, was applied and coupled with error analysis. We highlighted two cognitive-pragmatic profiles. One subgroup of participants with ABI exhibited contextual insensitivity, leading them to infer the utterance meaning based on linguistic decoding alone-literal meaning. This difficulty in understanding hints was associated with deficits in working memory, inhibition, and ToM. The second subgroup of participants with ABI showed difficulty with literal statements, associated with impaired inhibition and ToM. In addition, the two subgroups differed only on the ToM task. This result suggests that various types of ToM deficit (misunderstanding vs. incorrect attribution of mental states) could contribute to the variability of the pragmatic profiles observed (difficulties in interpreting hints vs. literal statements). The experimental design adopted in this study provides valuable insight into the explanatory hypotheses of nonliteral language comprehension disorders and has important clinical implications. https://doi.org/10.23641/asha.24069516.

Characterization of theory of mind performance in patients with myotonic dystrophy type 1

IntroductionMyotonic dystrophy type 1 (DM1) is associated with motor dysfunction as well as psychological and cognitive impairments, including altered social cognition. Theory of mind (ToM) impairments have been reported in this disease but their nature and their cognitive/cerebral correlates have yet to be determined. MethodsFifty DM1 patients and 50 healthy controls were assessed using the Movie for the Assessment of Social Cognition, which quantifies impairments in affective and cognitive components of ToM through the depiction of everyday situations. We also measured the study participants' cognitive, behavioral and social abilities, quality of life, and brain MRI characteristics. ResultsDM1 patients presented a significant impairment in ToM performance compared to controls (p < .001). The patients' errors were related to hypomentalizations (p < .001 vs controls) but not to hypermentalizations (p = .95). The affective component was affected (p < .001 vs controls) but not the cognitive component (p = .09). The ToM impairment was associated with demographic variables (older age and a lower educational level), genetic findings (a larger CTG triplets repeat expansion) and cognitive scores (slower information processing speed). Associations were also found with brain MRI variables (lower white matter and supratentorial volumes) but not with behavioral or social variables. DiscussionDM1 patients display a ToM impairment, characterized by predominant hypomentalizations concerning the affective component. This impairment might result from structural brain abnormalities observed in DM1.

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.

Affect Recognition, Theory of Mind, and Empathy in Preschool Children with Externalizing Behavior Problems-A Group Comparison and Developmental Psychological Consideration.

Preschool mental disorders are often associated with significant interpersonal problems, related to impaired affect recognition, theory of mind (ToM), and empathy. To date, these skills have not been studied together in preschoolers with externalizing behavior problems (EBPs). The aim of the present study was to investigate whether and to what extent preschool children with EBPs show impairments in affect recognition, ToM, and empathy. Preschoolers with EBPs, defined by current psychiatric treatment and T-scores ≥ 60 on the externalizing problem scale of the Child Behavior Checklist (CBCL/1½-5 or 6-18R) were compared to non-clinical controls (HCs), defined by no past and no current psychiatric treatment and T-scores < 60 on all CBCL broad-band scales. Groups were compared on affect recognition (NEuroPSYchological Assessment-II), affective ToM (Test of Emotion Comprehension), cognitive ToM (Extended Theory-of-Mind Scale), parent-reported emotional contagion, attention to others' feelings, and prosocial action (Empathy Questionnaire), IQ and language (Wechsler Preschool and Primary Scale of Intelligence-III Matrices, Active and Passive Vocabulary test), controlling for age, sex, and language abilities. Compared to 28 HCs, 22 preschoolers with EBPs (total sample meanage = 5.5 years +/- 0.8 years, range= 4.2-6.9 years, males 66%) had significantly greater impairments in cognitive ToM (p = 0.0012, η2 = 0.266), attention to others' feelings (p = 0.0049, η2 = 0.222), and prosocial action (p = 0.0070, η2 = 0.210), each representing strong effect sizes. EBPs were significantly related to cognitive domains, like prosocial action (r = -0.501), cognitive ToM (r = -0.425), and attention to others' feelings (r = -0.332), but not to affective domains of social cognition. Social cognitive development may be impaired as early as preschool age and should be promoted before the child starts school.

Autism and Employment Challenges: The Double Empathy Problem and Perceptions of an Autistic Employee in the Workplace.

High unemployment rates are found among autistic adults. Difficulties with social functioning in non-autistic workplaces can be significant barriers to employment success. Autistic social functioning challenges in non-autistic spaces have traditionally been attributed to assumed impairments in Theory of Mind (ToM). Alternatively, the Double Empathy Problem (DEP) posits that autistic social challenges arise not from assumed impairments within the autistic person but instead from mutual misunderstandings in the autistic/non-autistic social interaction. The purpose of this study was to compare the ToM impairments explanation of autistic social functioning with the DEP, within the context of autistic employee social functioning in a non-autistic workplace. This study compared autistic and non-autistic participants' ability to accurately interpret the behaviors of an autistic employee at work. A sample of 254 participants (173 non-autistic and 81 autistic) read a vignette about a hypothetical autistic employee having difficulty coping in the workplace. Participants answered open-ended questions regarding their interpretation of the employee's behavior and emotional state. A significantly greater proportion of autistic participants (50.7%) accurately interpreted the behavior of the employee compared with non-autistic participants (31.2%) (χ 2 = 8.65, p = 0.003). Autistic participants with the highest behavior interpretation scores had significantly higher mean self-reported autism traits scores (M = 26.8) compared with autistic participants who scored lowest on behavior interpretation (M = 19.3, p < 0.001). The opposite relationship was found for non-autistic participants. Results from this study contribute to evidence supporting the DEP, shifting the paradigm of autistic social functioning away from a deficit model and toward addressing mutual misunderstandings in the autistic/non-autistic social interaction. The pattern of findings between neurotype groups by behavior interpretation abilities on an autism traits measure points to mutual misunderstandings as a clash of neurologically different social cultures. Addressing the DEP in the workplace would contribute to removing barriers to successful employment for autistic adults.