Hot and Cool Executive Function and its Relation to Theory of Mind in Children with and without Autism Spectrum Disorder

Previous research has clearly demonstrated that autism spectrum disorder (ASD) involves deficits in multiple neuropsychological functions, such as executive function (EF) and theory of mind (ToM). A conceptual distinction is commonly made between cool and hot EF. In ASD, continued attention has been paid to the cool areas of executive dysfunction. Cool EF has been strongly related to ToM, but research has not taken into account the association between hot EF and ToM in ASD. The present study investigated the associations between hot and cool EF and ToM in 56 school-aged children with ASD and 69 controls on tasks tapping cool EF (i.e., working memory, inhibition, planning), hot EF (i.e., affective decision making, delay discounting), and ToM (i.e., mental state/emotion recognition and false belief). Significant group differences in each EF measure support an executive dysfunction in both domains in ASD. Strong associations between delay discounting and ToM mental state/emotion recognition were found, suggesting that hot EF makes a unique contribution to ToM above and beyond cool EF in typical development and ASD. This study improves understanding of the profile of higher-order cognitive deficits in children with ASD, which may inform diagnosis and intervention.     

Putting theory of mind in its place: psychological explanations of the socio-emotional-communicative impairments in autistic spectrum disorder

In this review, the history of the theory of mind (ToM) theory of autistic spectrum disorder (ASD) is outlined (in which ToM is indexed by success on false belief tasks), and the explanatory power and psychological causes of impaired ToM in ASD are critically discussed. It is concluded that impaired ToM by itself has only limited explanatory power, but that explorations of the psychological precursors of impaired ToM have been fruitful in increasing understanding of mindreading impairments in ASD (where 'mindreading' refers those abilities that underlie triadic interaction as well as ToM). It is argued that early explanations of impaired mindreading are untenable for various reasons, but that impairments of dyadic interaction in ASD that could lead to impaired ability to represent others' mental states may be the critical psychological cause, or causes, of impaired ToM. The complexity of causal routes to impaired ToM is emphasized.     

Neural bases of Theory of Mind in children with autism spectrum disorders and children with conduct problems and callous‐unemotional traits

Individuals with autism spectrum disorders (ASD) have difficulty understanding other minds (Theory of Mind; ToM), with atypical processing evident at both behavioural and neural levels. Individuals with conduct problems and high levels of callous‐unemotional (CU) traits (CP/HCU) exhibit reduced responsiveness to others' emotions and difficulties interacting with others, but nonetheless perform normally in experimental tests of ToM. The present study aimed to examine the neural underpinnings of ToM in children (aged 10–16) with ASD (N = 16), CP/HCU (N = 16) and typically developing (TD) controls (N = 16) using a non‐verbal cartoon vignette task. Whilst individuals with ASD were predicted to show reduced fMRI responses across regions involved in ToM processing, CP/HCU individuals were predicted to show no differences compared with TD controls. The analyses indicated that neural responses did not differ between TD and CP/HCU groups during ToM. TD and CP/HCU children exhibited significantly greater medial prefrontal cortex responses during ToM than did the ASD group. Within the ASD group, responses in medial prefrontal cortex and right temporoparietal junction (TPJ) correlated with symptom severity as measured by the Autism Diagnostic Observation Schedule (ADOS). Findings suggest that although both ASD and CP/HCU are characterized by social difficulties, only children with ASD display atypical neural processing associated with ToM.     

Executive and attentional contributions to Theory of Mind deficit in attention deficit/hyperactivity disorder (ADHD)

Attention deficit/hyperactivity disorder (ADHD) in children has been associated with attentional and executive problems, but also with socioemotional difficulties possibly associated with deficits in Theory of Mind (ToM). Socioemotional problems in ADHD are associated with more negative prognoses, notably interpersonal, educational problems, and an increased risk of developing other psychiatric disorders that emphasize the need to clarify the nature of their ToM deficits. In this study, we hypothesized that ToM dysfunction in children with ADHD is largely attributable to their attentional and/or executive deficits. Thirty-one children with ADHD (8–12 years, IQ > 85) and 31 typically developing (TD) children were assessed using executive functions (inhibition, planning, and flexibility) and attentional tasks, as well as two advanced ToM tasks (Reading the Mind in the Eyes and Faux Pas) involving different levels of executive control. Children with ADHD performed more poorly than TD children in attentional, executive function, and ToM tasks. Linear regression analyses conducted in the ADHD group indicated that inhibition scores predicted performance on the “Faux Pas” task the best, while attention scores were the best for predicting performance on the Reading the Mind in the Eyes task. When controlled for inhibition and attentional variables, ToM performance in children with ADHD was actually similar to TD children. Contrarily, controlling for ToM scores did not normalize performance for inhibition and attentional tasks in children with ADHD. This unidirectional relationship suggests that deficits in the EF and attentional domains are responsible for ToM deficits in ADHD, which therefore may contribute to their socioemotional difficulties.     

Behind the wheels with autism and ADHD: Brain networks involved in driving hazard detection

Driving is a cognitively challenging task, and many individuals with autism spectrum disorder (ASD) or with attention-deficit/hyperactivity disorder (ADHD) struggle to drive safely and effectively. Previous evidence suggests that core neuropsychological deficits in executive functioning (EF) and theory of mind (ToM) may impact driving in ASD and ADHD. This functional magnetic resonance imaging (fMRI) study compares the brain mechanisms underlying ToM and EF during a hazard perception driving task. Forty-six licensed drivers (14 ASD, 17 ADHD, 15 typically developing (TD)), ages 16–27 years, viewed a driving scenario in the MRI scanner and were instructed to respond to driving hazards that were either “social” (contained a human component such as a pedestrian) or “nonsocial” (physical objects such as a barrel). All groups of participants recruited regions part of the “social brain” (anterior insula, angular gyrus, right middle occipital gyrus, right cuneus/precuneus, and right inferior frontal gyrus) when processing social hazards, and regions associated with motor planning and object recognition (postcentral gyrus, precentral gyrus, and supplementary motor area) when processing nonsocial hazards. While there were no group differences in brain activation during the driving task, years licensed was predictive of greater prefrontal and temporal activation to social hazards in all participants. Findings of the current study suggest that high-functioning ASD and ADHD licensed drivers may be utilizing similar cognitive resources as TD controls for decisions related to driving-related hazard detection.     

Attributing social and physical meaning to ambiguous visual displays in individuals with higher-functioning autism spectrum disorders

The weak central coherence (WCC) account of autism characterizes the learning style of individuals with this condition as favoring localized and fragmented (to the detriment of global and integrative) processing of information. This pattern of learning is thought to lead to deficits in aspects of perception (e.g., face processing), cognition, and communication (e.g., focus on disjointed details rather than "gist" or context), ultimately leading to social impairments. This study was carried out to examine whether WCC applies to social and to non-social aspects of learning alike, or, alternatively, some areas of learning (e.g., physical reasoning) are spared in autism. classic social animation as quantified in the Social Attribution Task (SAT) () and a novel animation involving physical reasoning (the Physical Attribution Task; PAT) were used to test the domain specificity of the WCC hypothesis. A pilot study involving a reference group of typically developing young adults and a group of individuals with higher-functioning autism spectrum disorders (ASDs) revealed gender differences in the reference group in regards to performance on the PAT (males outperformed females). In a follow-up case-control comparison involving only males where the ASD group was matched on age and IQ to a typically developing (TD) group of children, adolescents, and adults, the ASD group showed lower SAT scores and comparable PAT scores relative to the TD group. The interaction of diagnostic group by task was highly significant, with little overlap between the groups in the distributions of SAT minus PAT scores. These results indicated preserved integrative skills in the area of physical attribution in the ASD group, thus failing to support the WCC account as a domain-independent (or more general) model of learning in autism, while highlighting the centrality of the social deficits in the characterization of learning style in the autism spectrum disorders.     

“Hunting with a knife and … fork”: Examining central coherence in autism,attention deficit/hyperactivity disorder,and typical development with a linguistic task

A local processing bias, referred to as “weak central coherence,” has been postulated to underlie key aspects of autism spectrum disorder (ASD). Little research has examined whether individual differences in this cognitive style can be found in typical development, independent of intelligence, and how local processing relates to executive control. We present a brief and easy-to-administer test of coherence requiring global sentence completions. We report results from three studies assessing (a) 176 typically developing (TD) 8- to 25-year-olds, (b) individuals with ASD and matched controls, and (c) matched groups with ASD or attention deficit/hyperactivity disorder (ADHD). The results suggest that the Sentence Completion Task can reveal individual differences in cognitive style unrelated to IQ in typical development, that most (but not all) people with ASD show weak coherence on this task, and that performance is not related to inhibitory control. The Sentence Completion Task was found to be a useful test instrument, capable of tapping local processing bias in a range of populations.     

Executive function deficits in autism spectrum disorders and attention-deficit/hyperactivity disorder: examining profiles across domains and ages

Deficits in 'executive function' (EF) are characteristic of several clinical disorders, most notably Autism Spectrum Disorders (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD). In this study, age- and IQ-matched groups with ASD, ADHD, or typical development (TD) were compared on a battery of EF tasks tapping three core domains: response selection/inhibition, flexibility, and planning/working memory. Relations between EF, age and everyday difficulties (rated by parents and teachers) were also examined. Both clinical groups showed significant EF impairments compared with TD peers. The ADHD group showed greater inhibitory problems on a Go-no-Go task, while the ASD group was significantly worse on response selection/monitoring in a cognitive estimates task. Age-related improvements were clearer in ASD and TD than in ADHD. At older (but not younger) ages, the ASD group outperformed the ADHD group, performing as well as the TD group on many EF measures. EF scores were related to specific aspects of communicative and social adaptation, and negatively correlated with hyperactivity in ASD and TD. Within the present groups, the overall findings suggested less severe and persistent EF deficits in ASD (including Asperger Syndrome) than in ADHD.     

Aging of theory of mind: The influence of educational level and cognitive processing

Previous studies of theory of mind (ToM) in old age have provided mixed results. We predicted that educational level and cognitive processing are two factors influencing the pattern of the aging of ToM. To test this hypothesis, a younger group who received higher education (mean age 20.46 years), an older group with an education level equal to that of the young group (mean age 76.29 years), and an older group with less education (mean age 73.52 years) were recruited. ToM tasks included the following tests: the second‐order false‐belief task, the faux‐pas task, the eyes test, and tests of fundamental aspects of cognitive function that included two background tests (memory span and processing speed) and three subcomponents of executive function (inhibition, updating, and shifting). We found that the younger group and the older group with equally high education outperformed the older group with less education in false‐belief and faux‐pas tasks. However, there was no significant difference between the two former groups. The three groups of participants performed equivalently in the eyes test as well as in control tasks (false‐belief control question, faux‐pas control question, faux‐pas control story, and Eyes Test control task). The younger group outperformed the other two groups in the cognitive processing tasks. Mediation analyses showed that difficulties in inhibition, memory span, and processing speed mediated the age differences in false‐belief reasoning. Also, the variables of inhibition, updating, memory span, and processing speed mediated age‐related variance in faux‐pas. Discussion focused on the links between ToM aging, educational level, and cognitive processing.     

Autism: beyond “theory of mind”

The theory of mind account of autism has been remarkably successful in making specific predictions about the impairments in socialization, imagination and communication shown by people with autism. It cannot, however, explain either the non-triad features of autism, or earlier experimental findings of abnormal assets and deficits on non-social tasks. These unexplained aspects of autism, and the existence of autistic individuals who consistently pass false belief tasks, suggest that it may be necessary to postulate an additional cognitive abnormality. One possible abnormality - weak central coherence - is discussed, and preliminary evidence for this theory is presented.     

Links between theory of mind and executive function in young children with autism: clues to developmental primacy

There has been much theoretical discussion of a functional link between theory of mind (ToM) and executive function (EF) in autism. This study sought to establish the relationship between ToM and EF in young children with autism (M = 5 years, 6 months) and to examine issues of developmental primacy. Thirty children with autism and 40 typically developing children, matched on age and ability, were assessed on a battery of tasks measuring ToM (1st- and 2nd-order false belief) and components of EF (planning, set shifting, inhibition). A significant correlation emerged between ToM and EF variables in the autism group, independent of age and ability, while ToM and higher order planning ability remained significantly related in the comparison group. Examination of the pattern of ToM-EF impairments in the autism group revealed dissociations in 1 direction only: impaired ToM with intact EF. These findings support the view that EF may be 1 important factor in the advancement of ToM understanding in autism. The theoretical implications of these findings are discussed.     

Representing intentions in self and other: studies of autism and typical development

Two experiments were conducted to explore the extent to which individuals with Autism Spectrum Disorder (ASD), as well as young typically developing (TD) children, are explicitly aware of their own and others’ intentions. In Experiment 1, participants with ASD were significantly less likely than age‐ and ability‐matched comparison participants to correctly recognize their own knee‐jerk reflex movements as unintentional. Performance on this knee‐jerk task was associated with performance on measures of false belief understanding, independent of age and verbal ability, in both participants with ASD and TD children. In Experiment 2, participants with ASD were significantly less able than comparison participants to correctly recognize their own or another person’s mistaken actions as unintended, in a ‘Transparent Intentions’ task ( Russell & Hill, 2001 ; Russell, Hill & Franco, 2001 ). Performance on aspects of the Transparent Intentions task was associated with performance on measures of false belief understanding, independent of age and verbal ability, in both participants with ASD and TD children. This study suggests that individuals with ASD have a diminished awareness of their own and others’ intentions and that this diminution is associated with other impairments in theory of mind.     

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

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

The accidental transgressor: morally-relevant theory of mind

To test young children’s false belief theory of mind in a morally relevant context, two experiments were conducted. In Experiment 1, children (N = 162) at 3.5, 5.5, and 7.5 years of age were administered three tasks: prototypic moral transgression task, false belief theory of mind task (ToM), and an “accidental transgressor” task, which measured a morally-relevant false belief theory of mind (MoToM). Children who did not pass false belief ToM were more likely to attribute negative intentions to an accidental transgressor than children who passed false belief ToM, and to use moral reasons when blaming the accidental transgressor. In Experiment 2, children (N = 46) who did not pass false belief ToM viewed it as more acceptable to punish the accidental transgressor than did participants who passed false belief ToM. Findings are discussed in light of research on the emergence of moral judgment and theory of mind.     

Executive functions in children with Autism Spectrum Disorders

Executive dysfunction is a characteristic impairment of individuals with Autism Spectrum Disorders (ASD). However whether such deficits are related to autism per se, or to associated intellectual disability is unclear. This paper examines executive functions in a group of children with ASD (N = 54, all IQ?70) in relation to a typically developing control group individually matched on the basis of age, gender, IQ and vocabulary. Significant impairments in the inhibition of prepotent responses (Stroop, Junior Hayling Test) and planning (Tower of London) were reported for children with ASD, with preserved performance for mental flexibility (Wisconsin Card Sorting Task) and generativity (Verbal Fluency). Atypical age-related patterns of performance were reported on tasks tapping response inhibition and self-monitoring for children with ASD compared to controls. The disparity between these and previous research findings are discussed. A multidimensional notion of executive functions is proposed, with difficulties in planning, the inhibition of prepotent responses and self-monitoring reflecting characteristic features of ASD that are independent of IQ and verbal ability, and relatively stable across the childhood years.     

Executive functions in children with Autism Spectrum Disorders

Executive dysfunction is a characteristic impairment of individuals with Autism Spectrum Disorders (ASD). However whether such deficits are related to autism per se, or to associated intellectual disability is unclear. This paper examines executive functions in a group of children with ASD (N = 54, all IQ⩾70) in relation to a typically developing control group individually matched on the basis of age, gender, IQ and vocabulary. Significant impairments in the inhibition of prepotent responses (Stroop, Junior Hayling Test) and planning (Tower of London) were reported for children with ASD, with preserved performance for mental flexibility (Wisconsin Card Sorting Task) and generativity (Verbal Fluency). Atypical age-related patterns of performance were reported on tasks tapping response inhibition and self-monitoring for children with ASD compared to controls. The disparity between these and previous research findings are discussed. A multidimensional notion of executive functions is proposed, with difficulties in planning, the inhibition of prepotent responses and self-monitoring reflecting characteristic features of ASD that are independent of IQ and verbal ability, and relatively stable across the childhood years.     

Reliability and generalizability of an acted-out false belief task in 3-year-olds

The current study tested the reliability and generalizability of a narrative act-out false belief task held to reveal Theory of Mind (ToM) competence at 3 years of age, before children pass verbal standard false belief tasks (the “Duplo task”; Rubio-Fernández & Geurts, 2013, Psychological Science). We conducted the task across two labs with methodologically improved matched control conditions. Further, we administered an analogue intensionality version to assess the scope of ToM competence in the Duplo task. 72 3-year-olds participated in a Duplo change-of-location task, a Duplo intensionality task, and half of them in a matched verbal standard change-of-location task, receiving either false belief or matched true belief scenarios. Children performed at chance in the false belief Duplo location change and intensionality tasks as well as in the standard false belief task. There were no differences to the standard task, and performance correlated across all three false belief tasks, revealing a rather unified competence and no task advantage. In the true belief conditions of both Duplo tasks, children performed at ceiling and significantly different from the false belief conditions, while they were at chance in the true belief condition of the standard task. The latter indicates that a pragmatic advantage of the Duplo task compared to the standard task holds only for the true belief scenarios. Our study shows that the Duplo task measures the same ToM competence as the standard task and rejects a notion of earlier false belief understanding on the group level in 3-year-old children.     

Unfamiliar face recognition in children with autistic spectrum disorders

We investigated unfamiliar face recognition in low‐functioning children with autistic spectrum disorders (ASD) using a ‘part‐of‐face’ method. This method has not previously been used for unfamiliar faces with this population. The ‘part‐of‐face’ procedure provides measures of both face recognition accuracy and of processing style. We compared the performance of the children with ASD with three control groups: children with developmental delay (DD), typically developing (TD) children matched for verbal cognitive ability and TD children matched for chronological age (CA). Compared to the DD group, the ASD group showed similar processing in recognition accuracy and processing style. Compared to the TD children, the ASD group did not show the same level of accuracy as controls of the same CA, instead showing similar performance to younger TD children. However, as both children with ASD and DD showed the same performance, no ASD‐specific deficit was found. Copyright © 2009 John Wiley & Sons, Ltd.     

Lifespan aging and belief reasoning: Influences of executive function and social cue decoding

Older adults often perform poorly on Theory of Mind (ToM) tests that require understanding of others’ beliefs and intentions. The course and specificity of age changes in belief reasoning across the adult lifespan is unclear, as is the cause of the age effects. Cognitive and neuropsychological models predict that two types of processing might influence age differences in belief reasoning: executive functioning and social cue detection. In the current study we assessed 129 adults aged between 18 and 86 on novel measures of ToM (video clips and verbal vignettes), which manipulated whether true or false belief reasoning was required. On both video and verbal tasks, older adults (aged 65–88) had specific impairments in false belief reasoning, but showed no such problem in performing true belief tasks. Middle-aged adults (aged 40–64) generally performed as well as the younger adults (aged 18–39). Difficulties in updating information in working memory (but not inhibitory problems) partially mediated the age differences in false belief reasoning. Also, the ability to decode biological motion, indexing social cue detection, partially mediated age-related variance in the ability to interpret false beliefs. These results indicate that age differences in decoding social cues and updating information in memory may be important influences on the specific problems encountered when reasoning about false beliefs in old age.