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.     

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.     

Theory of mind and its relationship with executive functions and emotion recognition in borderline personality disorder

Impaired social cognition has been claimed to be a mechanism underlying the development and maintenance of borderline personality disorder (BPD). One important aspect of social cognition is the theory of mind (ToM), a complex skill that seems to be influenced by more basic processes, such as executive functions (EF) and emotion recognition. Previous ToM studies in BPD have yielded inconsistent results. This study assessed the performance of BPD adults on ToM, emotion recognition, and EF tasks. We also examined whether EF and emotion recognition could predict the performance on ToM tasks. We evaluated 15 adults with BPD and 15 matched healthy controls using different tasks of EF, emotion recognition, and ToM. The results showed that BPD adults exhibited deficits in the three domains, which seem to be task‐dependent. Furthermore, we found that EF and emotion recognition predicted the performance on ToM. Our results suggest that tasks that involve real‐life social scenarios and contextual cues are more sensitive to detect ToM and emotion recognition deficits in BPD individuals. Our findings also indicate that (a) ToM variability in BPD is partially explained by individual differences on EF and emotion recognition; and (b) ToM deficits of BPD patients are partially explained by the capacity to integrate cues from face, prosody, gesture, and social context to identify the emotions and others' beliefs.     

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.     

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.     

On the relation between theory of mind and executive functioning: A developmental cognitive neuroscience perspective

Theory of mind (ToM) and executive functioning (EF) show marked interrelatedness across childhood, and developmental psychologists have long been interested in understanding the nature of this association. The present review addresses this issue from a cognitive neuroscience perspective by exploring three hypotheses regarding their functional overlap: (1) ToM relies on EF (EF→ToM); (2) EF relies on ToM (ToM→EF); and (3) ToM and EF are mutually related, owing to shared neural structures or networks (ToM?EF). Drawing on evidence from normative brain development, neurodevelopmental and neurodegenerative diseases, patient lesion studies, and brain-imaging studies, we suggest that only a strict version of the ToM?EF proposal of complete neural overlap can be confidently ruled out on the basis of existing evidence. The balance of evidence suggests that separable neurobiological mechanisms likely underlie ToM and EF, with shared mechanisms for domain-general processing that support both abilities. We highlight how future studies may empirically substantiate the nature of the ToM–EF relationship using various biobehavioral approaches.     

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.     

幼儿执行功能的发展对心理理论发展的影响*

采用追踪研究设计,探讨儿童3至5岁成长过程中,执行功能与心理理论发展间的预测关系。以155名3岁、4岁儿童为被试,采用经典实验任务对儿童的执行功能和心理理论进行间隔1年的追踪测查,并运用分层回归分析检验了二者间的预测关系。结果发现：儿童执行功能、心理理论在3至5岁期间均有显著的发展,且在此期间执行功能、心理理论的个体差异相对稳定;儿童在3岁、4岁时执行功能与心理理论呈显著正相关,但在5岁时二者间相关不显著;儿童3岁时的执行功能能够显著预测3至4岁期间心理理论的发展,而4岁时的执行功能不能预测4至5岁期间心理理论的发展;3至5岁期间,心理理论对执行功能发展始终不具有预测作用。     

Knowing minds, controlling actions: the developmental relations between theory of mind and executive function from 2 to 4 years of age

This longitudinal study examined the concurrent and predictive relations between executive function (EF) and theory of mind (ToM) in 82 preschoolers who were assessed when they were 2, 3, and 4 years old. The results showed that the concurrent relation between EF and ToM, after controlling for age, verbal ability, and sex, was significant at 3 and 4 years of age but not at 2 years of age. Hierarchical regression analyses showed that EF at age 2 significantly predicted ToM at age 3 and that EF at age 3 significantly predicted ToM at age 4, over and above the effects of age, verbal ability, and prior performance on ToM tasks. However, ToM at ages 2 and 3 did not explain a significant amount of variance in EF at age 4. Bootstrap procedures revealed that verbal ability at age 3 fully mediated the relation between ToM at age 2 and EF at age 4.     

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.     

Do Theory of Mind and Executive Function Deficits Underlie the Adverse Outcomes Associated with Profound Early Deprivation?: Findings from the English and Romanian Adoptees Study

Theory of Mind (ToM) and Executive Function (EF) have been associated with autism and with attention-deficit hyperactivity disorder (ADHD), and hence might play a role in similar syndromes found following profound early institutional deprivation. In order to examine this possibility the current study included a group of 165 Romanian adoptees, of whom 144 were adopted into the UK from deprived institutional settings before 43months of age, and a group of 52 within-UK adoptees, all adopted before 6months of age. Both groups were assessed at 6 and 11years. The Strange Stories task was used to assess ToM and the Stroop task was used to assess EF, both at age 11. The Romanian adoptees displayed deficits in both ToM and EF compared with the within-UK adoptee group. The degree of deficit was greater for children who had experienced more than 6months of institutional deprivation. Deficits in both domains (ToM and EF) were associated with each of the three apparently deprivation-specific problems, namely quasi-autism, disinhibited attachment and inattention/overactivity. Statistical analyses indicated a mediating role for both ToM and EF with respect to quasi-autism; possibly a partial mediating role for EF with respect to inattention/overactivity; and probably no mediating role for either ToM or EF in the case of disinhibited attachment. In conclusion, there is evidence for a possible mediating role for ToM and EF in the development of some apparently deprivation-specific difficulties in institution-reared Romanian adoptees, but neither accounts for the overall pattern of deprivation-related difficulties.     

The More the Merrier? Sibling Composition and Early Manifestations of Theory of Mind in Toddlers

Sibling relationships are argued to offer a rich social context for the development of young children’s theory of mind (ToM). There is evidence that the presence of siblings, particularly older siblings, may promote preschoolers’ ToM, but it has not been investigated among toddlers. This study evaluated differences in early manifestations of ToM between toddlers in different sibling compositions: 1) without a sibling, 2) with younger siblings only, and 3) with older siblings only. The sample included 227 toddlers who completed 2 tasks assessing their understanding of discrepant desires and visual perspectives. Results indicated that only children and those who had older siblings did not differ from each other on either task. However, on both tasks, toddlers with younger siblings performed significantly more poorly compared with those with older siblings. Moreover, children with younger siblings demonstrated poorer visual-perspective understanding compared with only children. It may be critical to take siblings’ birth order into account when investigating their respective effects on each other’s ToM, especially in toddlerhood.     

Pregnancy hypertension and the risk for neuropsychological difficulties across early development: A brief report

Despite documented effects on fetal brain development, little is currently known about the relationship between maternal pregnancy hypertension and child neuropsychological outcomes. This brief report examined the association between maternal hypertension during pregnancy and children’s social cognition and executive functioning when children were 18 months, 3 years, and 4.5 years. A community sample of 501 families (23 hypertensive mothers; 478 nonhypertensive) was recruited when children were newborns. Social cognition (including theory of mind [ToM]) and executive functioning (EF) were measured using a battery of age-appropriate standardized and/or observational tasks. Information on pregnancy and prenatal factors were measured via maternal report when children were newborns. After controlling for prenatal and demographic covariates, the presence of hypertension difficulties during pregnancy was associated with all measures of social cognition, ToM, and EF. A secondary analysis comparing the hypertension group (n = 23) to a nonhypertensive matched control group (n = 23) supported the effect of pregnancy hypertension on children’s social-cognitive and EF development. Future studies using obstetrical records are encouraged based on these preliminary findings.     

“热”执行对注意缺陷多动障碍和阅读障碍儿童言语工作记忆的影响

ADHD儿童在与背外侧前额叶(DLPFC)相关的"冷"执行功能上的缺陷已大量证实,但在与眼眶和中前额叶皮层(OMPFC)相关的"热"执行功能上,ADHD儿童是否存在缺陷则未可知。与儿童赌博任务实验范式(该任务中"热"启动对"冷"执行起到抑制作用)不同,本研究考察趣味言语N-back任务是否对ADHD和阅读障碍儿童的成绩有促进作用。枯燥N-back任务考察的是言语工作记忆的纯认知特征,而趣味任务则卷入了"热"执行对"冷"执行的影响。结果表明,在枯燥任务上,ADHD和阅读障碍儿童的成绩均明显低于正常儿童,二者之间差异不显著,在趣味任务成绩上,ADHD儿童与正常儿童的成绩没有显著差异,而阅读障碍儿童成绩落后于正常控制组和ADHD组,在成绩变化的趋势上,ADHD儿童在趣味任务上成绩明显提高,而阅读障碍儿童则无明显改善。结果说明ADHD和阅读障碍儿童的言语工作记忆均存在明显的缺陷,但是机制不同,"热"执行对提高ADHD的言语工作记忆有明显的促进作用,ADHD的"冷"执行缺陷能够通过"热"执行的调节得到改善。     

Maternal Executive Functioning and Scaffolding in Families of Children with and without Parent-Reported ADHD

Parental scaffolding robustly predicts child developmental outcomes, including improved self-regulation and peer relationships and fewer externalizing behaviors. However, few studies have examined parental characteristics associated with a parent’s ability to scaffold. Executive functioning (EF) may be an important individual difference factor associated with maternal scaffolding that has yet to be examined empirically. Scaffolding may be particularly important for children with attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior disorder (DBD) symptoms due to their core difficulties with inattention, disorganization, EF, and self-regulation, their need for greater parental structure, and higher-than-average rates of parental EF deficits. Yet, little research has examined child ADHD in relation to parental scaffolding. This cross-sectional study examined: (1) the association between maternal EF (as measured by the Hotel Test, Barkley’s Deficits in Executive Functioning Scale, and Digit Span) and observed scaffolding, (2) the association between parent-reported child ADHD/DBD symptoms and scaffolding, and (3) the interaction between child ADHD/DBD symptoms and maternal EF in predicting scaffolding. In a sample of 84 mothers and their 5–10 year-old biological children (62% male) with and without parent-reported ADHD, we found that maternal EF, as measured by Digit Span and the Hotel Test, predicted observed maternal scaffolding. However, child ADHD/DBD symptoms did not significantly predict maternal scaffolding controlling for child age, maternal education, and maternal EF, nor did the interaction of maternal EF and parent-reported child ADHD/DBD symptoms. Working memory and task shifting may be key components of parental EF that could be targeted in interventions to improve parental scaffolding.     

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.     

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.     

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.     

4岁儿童对他人记忆的评判与错误信念理解的关系

从观点采择的角度考察儿童对他人记忆的评判及其与错误信念理解的关系。与他人分享记忆时,个体需要同时处理自我与他人对过去的表征和看法;而要顺利完成错误信念任务,个体需要同时加工自我的真实信念与他人的错误信念。因此个体对他人记忆的评判能力可能会与其对错误信念的理解相关。40名4岁儿童完成一系列错误信念任务和评判他人记忆是否正确任务,情境包括视觉、意图解释和情绪解释。结果表明,控制年龄、语言和记忆能力等因素后,被试评判他人记忆的成绩仍然可以预测其对错误信念的理解。这些结果为幼儿在回忆叙述中谈及他人越多,其心理理论越好提供了进一步的证据和可能的解释     

Does interference between self and other perspectives in theory of mind tasks reflect a common underlying process? Evidence from individual differences in theory of mind and inhibitory control

Theory of mind (ToM), the ability to understand that other agents have different beliefs, desires, and knowledge than oneself, has been extensively researched. Theory of mind tasks involve participants dealing with interference between their self-perspective and another agent’s perspective, and this interference has been related to executive function, particularly to inhibitory control. This study assessed whether there are individual differences in self–other interference, and whether these effects are due to individual differences in executive function. A total of 142 participants completed two ToM (the director task and a Level 1 visual perspective-taking task), which both involve self–other interference, and a battery of inhibitory control tasks. The relationships between the tasks were examined using path analysis. Results showed that the self–other interference effects of the two ToM tasks were dissociable, with individual differences in performance on the ToM tasks being unrelated and performance in each predicted by different inhibitory control tasks. We suggest that self–other differences are part of the nature of ToM tasks, but self–other interference is not a unitary construct. Instead, self–other differences result in interference effects in various ways and at different stages of processing, and these effects may not be a major limiting step for adults’ performance on typical ToM tasks. Further work is needed to assess other factors that may limit adults’ ToM performance and hence explain individual differences in social ability.