Cognitive contributions to theory of mind ability in children with a traumatic head injury

The objective of the current study is to examine the contribution of intellectual abilities, executive functions (EF), and facial emotion recognition to difficulties in Theory of Mind (ToM) abilities in children with a traumatic head injury. Israeli children with a traumatic head injury were compared with their non-injured counterparts. Each group included 18 children (12 males) ages 7–13. Measurements included reading the mind in the eyes, facial emotion recognition, reasoning the other’s characteristics based on motive and outcome, Raven’s Coloured Progressive Matrices, similarities and digit span (Wechsler Intelligence Scale for Children – Revised 95 subscales), verbal fluency, and the Behaviour Rating Inventory of Executive Functions. Non-injured children performed significantly better on ToM, abstract reasoning, and EF measures compared with children with a traumatic head injury. However, differences in ToM abilities between the groups were no longer significant after controlling for abstract reasoning, working memory, verbal fluency, or facial emotion recognition. Impaired ToM recognition and reasoning abilities after a head injury may result from other cognitive impairments. In children with mild and moderate head injury, poorer performance on ToM tasks may reflect poorer abstract reasoning, a general tendency to concretize stimuli, working memory and verbal fluency deficits, and difficulties in facial emotion recognition, rather than deficits in the ability to understand the other’s thoughts and emotions. ToM impairments may be secondary to a range of cognitive deficits in determining social outcomes in this population.     

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.     

Social Cognition in Multiple Sclerosis: a Meta-Analysis

Multiple sclerosis (MS) is associated with cognitive decline and impairment in social functioning. Accumulating evidence suggests that patients with MS are impaired in social cognition, including theory of mind (ToM) and emotion recognition. In this meta-analysis of 24 studies, facial emotion recognition and ToM performances of 989 patients with MS and 836 healthy controls were compared. MS was associated with significant impairments with medium effect sizes in ToM (d?=?0.57) and facial emotion recognition (d?=?0.61). Among individual emotions recognition of fear and anger were particularly impaired. The severity of social cognitive deficits was significantly associated with non-social cognitive impairment. These deficits in social cognition may underpin difficulties in social functioning in MS. However, there is a need for further studies investigating the longitudinal evolution of social cognitive deficits and their neural correlates in MS.     

Cumulative risk disparities in children's neurocognitive functioning: a developmental cascade model

The current longitudinal study examined the role of cumulative social risk on children's theory of mind (ToM) and executive functioning (EF) across early development. Further, we also tested a cascade model of development in which children's social cognition at 18 months was hypothesized to predict ToM and EF at age 4.5 through intermediary language skills at age 3. We then examined whether this developmental mechanism varied as a function of social risk status. Participants were 501 children recruited when they were newborns, at which point eight psychosocial risk factors were assessed and combined into a metric of cumulative social disadvantage. Families were followed up at 18 months, at which point four social‐cognitive skills were assessed using developmentally sensitive tasks: joint attention, empathy, cooperation, and self‐recognition. Language was measured at age 3 using a standardized measure of receptive vocabulary. At age 3 and 4.5, EF and ToM were measured using previously validated tasks. Results showed that there were notable cumulative risk disparities in overall neurocognitive skill development, and these effects became more differentiated over time. Support was also found for a developmental mechanism wherein the effect of social cognition at 18 months on ToM and EF in the preschool period operated specifically through children's receptive language ability at age 3. This pathway functioned similarly for children with both low‐ and high‐risk backgrounds. These results extend previous findings by documenting the role of cumulative social disadvantage on children's neurocognition and the pathways that link key neurocognitive abilities across early development.     

Social cognition and social functioning in patients with amnestic mild cognitive impairment or Alzheimer’s dementia

The aim of the present study was to examine social cognition and social functioning in a group of amnestic mild cognitive impairment (aMCI) and Alzheimer’s dementia (AD) patients. Thirty one people with aMCI, 29 individuals with AD, and 45 healthy older adults participated in the study. Facial expressions of happiness, anger, fear, disgust, and surprise presented in different intensities had to be labelled. Mentalizing was assessed using first-order belief theory of mind (ToM) stories and everyday social functioning by the Inventory of Interpersonal Situations (IIS), completed by an informant. aMCI patients were impaired in recognizing the emotions anger, disgust, and fear, while AD patients were impaired in recognizing the emotions anger, disgust, and surprise. More importantly, no significant differences between aMCI and AD patients were found on overall emotion recognition. Both the aMCI and AD patients were impaired on the ToM task, but no differences between the aMCI and AD patients were found. On everyday social functioning, only the AD patients showed impairments. No associations between the IIS and ToM were found, but the IIS and emotion perception were significantly correlated. Regression analysis taking all potentially confounding variables into account showed that only mood, but not the social-cognitive task performance or any other cognitive variable, predicted social functioning. aMCI and AD patients demonstrated impairments in mentalizing and facial emotion perception, and showed decrements in everyday social functioning. Informing caregivers about these deficits may help them to understand deficits in social cognition that may be present already in the MCI stage of Alzheimer’s disease.     

Mental playmates: Siblings,executive functioning and theory of mind

This study assessed the theory of mind (ToM) and executive functioning (EF) abilities of 124 typically developing preschool children aged 3 to 5 years in relation to whether or not they had a child‐aged sibling (i.e. a child aged 1 to 12 years) at home with whom to play and converse. On a ToM battery that included tests of false belief, appearance‐reality (AR) and pretend representation, children who had at least 1 child‐aged sibling scored significantly higher than both only children and those whose only siblings were infants or adults. The numbers of child‐aged siblings in preschoolers' families positively predicted their scores on both a ToM battery (4 tasks) and an EF battery (2 tasks), and these associations remained significant with language ability partialled out. Results of a hierarchical multiple regression analysis revealed that independent contributions to individual differences in ToM were made by language ability, EF skill and having a child‐aged sibling. However, even though some conditions for mediation were met, there was no statistically reliable evidence that EF skills mediated the advantage of presence of child‐aged siblings for ToM performance. While consistent with the theory that distinctively childish interaction among siblings accelerates the growth of both ToM and EF capacities, alternative evidence and alternative theoretical interpretations for the findings were also considered.     

Executive function and theory of mind: Predictive relations from ages 2 to 4

Despite robust associations between children's theory of mind (ToM) and executive function (EF) skills, longitudinal studies examining this association remain scarce. In a socially diverse sample of 122 children (seen at ages 2, 3, and 4), this study examined (a) developmental stability of associations between ToM, EF, verbal ability, and social disadvantage; (b) continuity and change in ToM and EF; and (c) predictive relations between ToM and EF. Verbal ability and social disadvantage independently predicted changes in EF (but not ToM). Task scores improved with age and showed stable individual differences. The authors examined predictive relations between ToM and EF using partial correlations (controlling for age and verbal ability) and hierarchical regressions (that also controlled for social disadvantage and initial ToM and EF). The findings provide only partial support for the view that ToM is a prerequisite for EF but stronger support for the proposal that EF facilitates children's performance on ToM tasks.     

Common mechanisms of executive attention underlie executive function and effortful control in children

Executive Function (EF) and Effortful Control (EC) have traditionally been viewed as distinct constructs related to cognition and temperament during development. More recently, EF and EC have been implicated in top‐down self‐regulation ‐ the goal‐directed control of cognition, emotion, and behavior. We propose that executive attention, a limited‐capacity attentional resource subserving goal‐directed cognition and behavior, is the common cognitive mechanism underlying the self‐regulatory capacities captured by EF and EC. We addressed three related questions: (a) Do behavioral ratings of EF and EC represent the same self‐regulation construct? (b) Is this self‐regulation construct explained by a common executive attention factor as measured by performance on cognitive tasks? and (c) Does the executive attention factor explain additional variance in attention deficit hyperactivity disorder (ADHD) problems to behavioral ratings of self‐regulation? Measures of performance on complex span, general intelligence, and response inhibition tasks were obtained from 136 preadolescent children (M = 11 years, 10 months, SD = 8 months), along with self‐ and parent‐reported EC, and parent‐reported EF, and ADHD problems. Results from structural equation modeling demonstrated that behavioral ratings of EF and EC measured the same self‐regulation construct. Cognitive tasks measured a common executive attention factor that significantly explained 30% of the variance in behavioral ratings of self‐regulation. Executive attention failed to significantly explain additional variance in ADHD problems beyond that explained by behavioral ratings of self‐regulation. These findings raise questions about the utility of task‐based cognitive measures in research and clinical assessment of self‐regulation and psychopathology in developmental samples.     

Executive Functions and Theory-of-Mind Among Deaf Children: Different Routes to Understanding Other Minds?

The aim of the present study was to investigate the role of executive functions (EF) in theory-of-mind (ToM) performance in deaf children and adolescents. Four groups of deaf children aged 7–16 years, with different language backgrounds at home and at school, that is, bilingually instructed native signers, oralist-instructed native signers, and two groups of bilingually instructed late signers from Sweden and Estonia, respectively, were given eight ToM and four EF measures. The bilingually instructed native signers performed at a significantly higher level on the ToM measures than the other groups of deaf children. On the EF measures, there were no significant differences found between any of the groups, with one exception—the Swedish bilingual late signers had a significantly shorter average reaction time on the go-no-go inhibition task than the oralist native signers and the Estonian bilingual late signers. However, the Swedish children's better EF performance was not mirrored in better performance on ToM tasks. Our results indicate that despite all deaf children's good general cognitive abilities, there were still differences in their performance on ToM tasks that need to be explained in other terms. Thus, whatever the cause of late signers' difficulties with ToM, poor EF-skills seem to be of minor importance.     

Executive neurocognitive functioning and neurobehavioral systems indicators in borderline personality disorder: a preliminary study

It is argued that borderline personality disorder (BPD) represents the interaction of underlying neurobehavioral systems that are reflected principally in the phenotypic constructs of positive emotion, negative emotion, and nonaffective constraint (Depue & Lenzenweger, 2001). This preliminary and exploratory study sought to examine predictions made from the Depue-Lenzenweger model with respect to controlled (effortful) information processing in BPD. It was hypothesized that (a) BPD subjects may display deficits on tasks that require controlled information processing (sustained attention, spatial working memory, and executive functioning), (b) they may reveal elevated negative emotion as well as decreased positive emotion and nonaffective constraint, and (c) nonaffective constraint should be substantially inversely associated with accurate performance on controlled information processing tasks. The results of this study, which examined 24 BPD diagnosed individuals and 68 normal adults, found support for each of these predictions in relation to performance on the Wisconsin Card Sorting Test. The implications of these results for further experimental psychopathology investigations of BPD as well as further refinement of theoretical models of the disorder are discussed.     

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.     

Recognition of facial affect in Borderline Personality Disorder

Patients with Borderline Personality Disorder (BPD) have been described as emotionally hyperresponsive, especially to anger and fear in social contexts. The aim was to investigate whether BPD patients are more sensitive but less accurate in terms of basic emotion recognition, and show a bias towards perceiving anger and fear when evaluating ambiguous facial expressions. Twenty-five women with BPD were compared with healthy controls on two different facial emotion recognition tasks. The first task allowed the assessment of the subjective detection threshold as well as the number of evaluation errors on six basic emotions. The second task assessed a response bias to blends of basic emotions. BPD patients showed no general deficit on the affect recognition task, but did show enhanced learning over the course of the experiment. For ambiguous emotional stimuli, we found a bias towards the perception of anger in the BPD patients but not towards fear. BPD patients are accurate in perceiving facial emotions, and are probably more sensitive to familiar facial expressions. They show a bias towards perceiving anger, when socio-affective cues are ambiguous. Interpersonal training should focus on the differentiation of ambiguous emotion in order to reduce a biased appraisal of others.     

孤独症个体的公平决策：心理理论和自我/他人情绪识别的作用

研究通过最后通牒任务,考查孤独症儿童在公平任务中的决策,以及心理理论和识别自我/他人情绪对决策的影响。29名孤独症儿童和三组对照组儿童参加实验结果发现,孤独症儿童在任务中面对不同分配比例的接受率（2:8、3:7）与对照组之间存在显著差异。心理理论能力和自我情绪识别都与决策存在相关：当处于不公平的情况下（1:9、2:8、3:7）,通过心理理论任务的孤独症儿童才会拒绝接受不公平分配,儿童也会感觉到不高兴并且做出拒绝的决定。     

Theory of Mind in Patients with Epilepsy: a Systematic Review and Meta-analysis

The ability to understand our own thoughts, intentions, beliefs and emotions and those of others (Theory of Mind; ToM) is a high-order social cognitive skill that is vital for social interaction and which has been found to be impaired in patients with epilepsy. Studies examining ToM in patients with epilepsy, however, have yielded inconsistent findings. The main aim of this study is to determine whether the magnitude of ToM deficits varies as a function of the site of epilepsy focus and/or the type of ToM task used. Electronic databases searches included Psychinfo, Medline/PubMed and EMBASE. Studies were included if they examined a group of patients with epilepsy and a group of healthy controls, reported original research, were published in the English language in peer reviewed journals, and used one of five empirically validated measures of ToM: False Belief, Reading the Mind in the Eyes Task (RMET), Faux-pas, Strange Stories, Cartoon ToM vignettes. Twelve studies were identified, ten included adults and two included children with epilepsy. Findings revealed marked ToM deficits in adults with focal seizures emanating from core brain regions underpinning ToM: temporal and frontal lobes (frontal lobe epilepsy, FLE; temporal lobe epilepsy, TLE), but not in adults with focal seizures outside the temporal and frontal lobes (extra-TLE/FLE). ToM deficits were also observed in children with generalised seizures (idiopathic generalised epilepsy, IGE). ToM deficits were documented across ToM tasks. In conclusion, ToM deficits represent a robust finding in adults with frontal and temporal epilepsy, but are also found in children with generalised seizures. Further research into ToM is needed, especially in children with epilepsy as early ToM may have cumulative, negative effects on development of social skills that continues into adulthood.     

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.     

Theory of mind in spina bifida: Relationship with intellectual and executive functioning

This article investigates emotion recognition ability, a central aspect of Theory of Mind (ToM), in a group of individuals with spina bifida myelomeningocele (SBM) experiencing executive function deficits, and examine associations between emotion recognition, and intellectual and executive functioning. A total of 38 adult subjects with SBM were included in this study, participating in a randomized controlled trial evaluating the effects of a cognitive rehabilitation intervention for executive dysfunction. Reading the Mind in the Eyes Test (RMET) was used as a measure of emotion recognition, and neuropsychological tests and questionnaires were utilized as executive function measures. One third of the participants performed poorer on the emotion recognition task compared to normative data. Emotion recognition may represent an area being affected in adults with SBM, and it is related to verbal IQ. Findings also suggest that executive functions and emotion recognition ability in adults with SBM are independent.     

Increasing the salience of fluency cues does not reduce the recognition memory impairment in Alzheimer's disease!

In Alzheimer's disease (AD), it is now well established that recollection is impaired from the beginning of the disease, whereas findings are less clear concerning familiarity. One of the most important mechanisms underlying familiarity is the sense of familiarity driven by processing fluency. In this study, we attempted to attenuate recognition memory deficits in AD by maximizing the salience of fluency cues in two conditions of a recognition memory task. In one condition, targets and foils have been created from the same pool of letters (Overlap condition). In a second condition, targets and foils have been derived from two separate pools of letters (No‐Overlap condition), promoting the use of letter‐driven visual and phonetic fluency. Targets and foils were low‐frequency words. The memory tasks were performed by 15 patients with AD and 16 healthy controls. Both groups improved their memory performance in the No‐Overlap condition compared to the Overlap condition. Patients with AD were able to use fluency cues during recognition memory as older adults did, but this did not allow to compensate for dysfunction of recognition memory processes.     

Studying social cognition in patients with schizophrenia and patients with frontotemporal dementia: theory of mind and the perception of sarcasm

We investigated social cognition and theory of mind in patients with schizophrenia and in patients with frontotemporal dementia in order to elucidate the cognitive mechanisms involved in the breakdown of these skills in psychiatric and neurological patients. Our tasks included videotaped scenarios of social interactions depicting sincere, sarcastic and paradoxical remarks, as well as lies. We found impaired performance of the schizophrenia group on all theory of mind conditions despite their intact understanding of sincere statements. In contrast, the FTD group performed poorly only when they had to rely on paralinguistic cues indicating sarcasm or lies, and not on paradoxical remarks or sarcasm when given additional verbal cues. Our findings suggest that, while current deficits in social and interpersonal functioning in patients with FTD may reflect a decrement in previously acquired skills, similar deficits in patients with schizophrenia may reflect an altogether inadequately learned process.     

Fonctions exécutives et théorie de l’esprit chez le jeune enfant : une relation réciproque ?

The aim of this study was to assess the specific relation between 18-month-olds’ performance on tasks measuring language skills, executive function (EF) and theory of mind (ToM). The ToM tasks included measures of intention and false-belief understanding whereas working memory and inhibitory control were assessed with three EF tasks. Expressive vocabulary was assessed with the MacArthur Communicative Development Inventory. The main findings showed that both aspects of ToM are strongly linked at this age to inhibitory control, but not to working memory abilities. Language skills were not associated with either ToM or EF abilities. With regard to inter-tasks coherence within EF and ToM, we replicated previous findings with no consistency across EF tasks but an association between false-belief and intention understanding. Overall, these findings provide evidence for a link between executive function and theory of mind at the youngest age ever tested. They also challenge the view that EF is not required to succeed on the false-belief task based on spontaneous responses.     

Theory of Mind and Executive Functions in Young Bilingual Children

Few studies have explored the relationship between theory of mind (ToM), executive function (EF), and bilingualism at the same time. In this study 14 young bilingual children were compared with monolingual children on a test battery composed of 5 ToM tests, 5 EF tests, and 1 test of general language ability. The result showed that despite significantly lower verbal ability, the bilingual children outperformed the monolingual ones on tests of EF. There were no differences in ToM performance. The authors argue that there is a strong relationship between bilingualism and EF, but, contrary to results from earlier studies, they could not find any relationship between bilingualism and ToM. EF did not predict ToM performance. Lack of a significant relationship could be due to the children's young age and consequently their low scores on the ToM tasks.