Theory of mind, severity of autistic symptoms and parental correlates in children and adolescents with Asperger syndrome

This study addresses the theory of mind (ToM) ability of Asperger's syndrome/high-functioning autism (AS/HFA) children and their parents and the severity of the autistic symptoms. Fifty-three families, each consisting of a mother, father and a child, participated in this study (N=159). The 53 children in the sample included 25 children diagnosed with AS/HFA and 28 typically developing (TD) children. The Social Attribution Task (SAT) and tests assessing autistic symptoms were used. AS/HFA children had lower scores than TD children on three of the SAT indices (Person, ToM Affective, and Salience). Fathers of AS/HFA children did not have lower scores than fathers of TD children on the SAT task, whereas mothers of AS/HFA children had lower scores on the Person index, a pattern similar to seen in their children, suggesting a possible genetic contribution of mothers to ToM deficit in AS/HFA children.     

Reading the mind in the voice: a study with normal adults and adults with Asperger syndrome and high functioning autism

People with high functioning autism (HFA) and Asperger syndrome (AS) have deficits in theory of mind (ToM). Traditional ToM tasks are not sensitive enough to measure ToM deficits in adults, so more subtle ToM tests are needed. One adult level test, the Reading the Mind in the Eyes test has shown that AS and HFA subjects have measurable deficits in the ability to make ToM inferences. Here we introduce a test that extends the above task into the auditory domain and that can be used with adults with IQ Scores in the normal range. We report the use of the test with an adult sample of people with AS/HFA and with two adult control groups. Results suggest that individuals with AS/HFA have difficulty extracting mental state information from vocalizations. These results are consistent with previous results suggesting that people with HFA and AS have difficulties drawing ToM inferences.     

Recognition of ‘Fortune of Others’ Emotions in Asperger Syndrome and High Functioning Autism

'Fortune of others' emotions, such as envy and gloating over the other's misfortune, are complex emotions experienced in situations where events are presumed to be desirable or undesirable for another person. The present paper explores the notion that individuals with AS and HFA are impaired in understanding of envy and gloating. We tested the ability of adults with AS/HFA to understand envy and gloating and compared their performance to that of age-matched healthy controls. The 'fortune of others' emotion task and an additional theory-of-mind (ToM) task were based on a task designed to assess ToM on the basis of eye gaze direction. Individuals with AS and HFA showed no difficulty on basic ToM conditions, but were impaired in their ability to identify envy and gloating. Furthermore, the ability to recognize these emotions was related to scores on a self-rating scale of perspective-taking ability and the ToM task.     

Social attribution in children with high functioning autism and Asperger syndrome: An exploratory study in the Chinese setting

The present study aimed to examine social attribution in children with high-functioning autism (HFA) and Asperger's syndrome (AS). A sample of 20 boys (9 with HFA and 11 with AS) and 20 age-matched controls were recruited for this study. All participated in two tasks measuring social attribution ability, the conventional Social Attribution Task (SAT) and a modified version with animals rather than shapes (mSAT). They also completed a battery of neuropsychological tests. Compared to typically developing controls, children with autism spectrum disorders were impaired on some measures in both SATs. However, group differences in ‘theory-of-mind’ indices were only significant in the mSAT, with the ASD group performing more poorly than controls. In addition, the scores in person index of both versions of the SAT correlated with executive function in children with HFA/AS. The current study found the mSAT paradigm was especially sensitive to ToM difficulties in young Chinese children with HFA/AS. Social attribution in children with HFA/AS, unlike neurotypical children, was related to executive function ability, suggesting these psychological domains are not distinct in children with autism spectrum disorders.     

The link between impaired theory of mind and executive function in children with cerebral palsy

The aim of the study was to explore the relationship between theory of mind (ToM) deficits and executive function (EF) impairments in children with cerebral palsy (CP), 42 CP with children and 42 typically developing (TD) children, acting as controls, were assessed on the tasks of ToM (false belief and faux pas) and EF (inhibition, updating and shifting). Results showed that CP children had deficits both in ToM and EF tasks. The correlation analyses showed that two EF components (inhibition and updating) were strongly related to false belief and faux pas in both two groups. We also found correlation between shifting and false belief and faux pas. However, this correlation was only found in TD children and not in children with CP. These findings suggest that children with CP lag behind TD children in both ToM and EF. Further, the results reveal, interestingly, that ToM deficits in CP children might be related to their inhibition and updating impairments, but not to shifting impairments.     

Theory of mind deficits in patients with acquired brain injury: A quantitative review

Impaired theory of mind (ToM) reasoning is considered an underlying cause of social cognition deficits in patients with acquired brain injury (ABI). However, the literature does not agree on the severity of ToM impairment in this clinical population, nor does it coincide on the proper tools for its assessment. In this paper, we use a meta-analytic approach to review 26 studies which compare the performance of ABI patients and healthy controls in four widely-used ToM tasks: first-order belief task, second order belief task, understanding indirect speech (IS) and social faux pas. Overall, patients show moderate to severe ToM impairment. The latter appears in faux pas (effect size = 0.70) and understanding IS tasks (ES = 0.87), while moderate impairment can be seen in second-order (ES = 0.60) and first-order belief tasks (ES = 0.52). The severity of ToM impairment was influenced by ratio of patients with frontal lobe lesion, ratio of patients with right hemisphere injury, type of belief task, and heterogeneity of the sample's etiology. Our results provide important quantitative evidence on the severity of ToM deficits in the ABI population, while identifying variables that influence these deficits. Implications for basic and clinical neuropsychology are discussed.     

Exploring theory of mind after severe traumatic brain injury

Previous studies have reported a dissociation between social behavioral impairments after severe traumatic brain injury (TBI) and relatively preserved performances in traditional tasks that investigate cognitive abilities. Theory of mind (ToM) refers to the ability to make inferences about other's mental states and use them to understand and predict others' behavior. We tested a group of 15 patients with severe TBI and 15 matched controls on a series of four verbal and non-verbal ToM tasks: the faux pas test, the first-order and second-order false belief task, the character intention task and the Reading the Mind in the Eyes Test. Participants with severe TBI were also compared to controls on non-ToM inference tasks of indirect speech act from the Montreal Evaluation of Communication (M.E.C.) Protocol and empathy (Davis Interpersonal Reactivity Index - I.R.I.) and tests for executive functions. Subjects with TBI performed worse than control subjects on all ToM tasks, except the first-order false belief task. The findings converge with previous evidence for ToM deficit in TBI and dissociation between ToM and executive functions. We show that ToM deficit is probably distinct from other aspects of social cognition like empathy and pragmatic communication skills.     

Faux Pas Detection and Intentional Action in Asperger Syndrome. A Replication on a French Sample

In the present study, we investigated mindreading abilities in a group of adults with Asperger Syndrome (AS) by using the faux pas task, an advanced test of theory of mind (Baron-Cohen et al. (1999). Journal of Autism and Developmental Disorders, 29, 407–418). The faux pas is a particular case of a non-intentional action reflecting an involuntary socially inappropriate behavior. Here, individuals with AS over-detected faux pas stories, failed to provide correct justifications of the speaker’s behavior and were unaware of the mistaken belief and of the resulting emotional impact, whereas they appeared to be responsive to social rule violations. We hypothesized that because of an impaired theory-of-mind, individuals with AS may develop compensatory cognitive strategies based on overlearned abstract knowledge about normative rules.     

Impaired "affective theory of mind" is associated with right ventromedial prefrontal damage.

OBJECTIVE: To examine the hypothesis that patients with ventromedial (VM) frontal lesions are impaired in the affective rather than cognitive facets of theory of mind (ToM). BACKGROUND: Prefrontal brain damage may result in impaired social behavior, especially when the damage involves the orbitofrontal/VM prefrontal cortex (PFC). It has been previously suggested that deficits in ToM may account for such aberrant behavior. However, inconsistent results have been reported, and different regions within the frontal cortex have been associated with ToM impairment. METHOD: The performance of 26 patients with localized lesions in the PFC was compared with responses of 13 patients with posterior lesions and 13 normal control subjects. Three ToM tasks differing in the level of emotional processing involved were used: second-order false belief task, understanding ironic utterances, and identifying social faux pas. RESULTS AND CONCLUSIONS: The results indicated that patients with VM (but not dorsolateral) prefrontal lesions were significantly impaired in irony and faux pas but not in second-order false belief as compared with patients with posterior lesions and normal control subjects. Lesions in the right VM area were associated with the most severe ToM deficit. These results are discussed in terms of the cognitive and affective facets of "mind-reading" processes mediated by the VM cortex.     

Use of Context in Pragmatic Language Comprehension by Children with Asperger Syndrome or High-Functioning Autism

Utilizing relevance theory, this study investigated the ability of children with Asperger syndrome (AS) and high-functioning autism (HFA) to use context when answering questions and when giving explanations for their correct answers. Three groups participated in this study: younger AS/HFA group (age 7–9, n = 16), older AS/HFA group (age 10–12, n = 23) and a normally functioning control group (age 7–9, n = 23). The results indicated that the younger AS/HFA group did less well when answering contextually demanding questions compared to the control group, and the performance of the older AS/HFA group fell in between the younger AS/HFA group and the control group. Both AS/HFA groups had difficulties explaining their correct answers, suggesting that they are not always aware of how they have derived answers from the context.     

Social cognition in frontal lobe epilepsy

This study investigated the social cognitive functioning of patients with frontal lobe epilepsy (FLE), using a range of procedures that have shown impairments in patients following focal prefrontal brain lesions. Fourteen participants with FLE were compared with 14 healthy controls on story tests of theory of mind (ToM), faux pas appreciation, mental and physical state cartoon humor appreciation, facial emotional recognition, and the ability to perceive eye gaze expression. They were not impaired on story tests of ToM and showed only a trend toward impairment on a test of faux pas appreciation. They were impaired on humor appreciation, with both mental and physical state cartoons, and on their recognition of facial emotion and perception of eye gaze expression. Hence the patients with FLE exhibited impairments on tests of social cognition following a distinct pattern, with relatively preserved ToM, but impaired humor appreciation and ability to detect emotional expression.     

Theory of mind in frontal and temporal lobe epilepsy: cognitive and neural aspects

Purpose: Theory of mind (ToM) is an important prerequisite to social behavior. This study evaluated ToM in patients with temporal (TLE) or frontal lobe epilepsy (FLE) aiming to determine the cognitive aspects, severity, and pathophysiologic mechanisms of ToM impairment in focal epilepsy. Methods: One hundred thirty‐eight patients with TLE (n = 109) or FLE (n = 29) and 69 healthy subjects underwent the Faux Pas task (FPT), which evaluates the recognition and comprehension of others’ mental states, and neuropsychological tests for other cognitive functions. Key Findings: Factor analysis of all test scores yielded two ToM factors (Recognizing faux pas, FP; Excluding nonexistent FP) distinct from the Control, Language, Matching, and Praxis factors. With respect to healthy subjects, both TLE and FLE patients showed correct exclusion of nonexistent FPs but significantly lower recognition and comprehension of real FPs. FLE patients were also impaired with respect to TLE patients. In the whole patient group, schooling and group membership predicted ToM impairment. In FLE patients, the comprehension of mental states was predicted by disease duration, whereas TLE patients’ comprehension of affects and intentions was associated with early age of seizure onset and medial temporal lobe sclerosis (MTLS). Significance: Focal epilepsy impairs advanced ToM abilities. FLE may affect online performances owing to long‐lasting dysfunctions of the prefrontal areas. MTLS may provoke selective ToM deficits due to medial temporal damage, prefrontal dysfunctions, or early interference with cognitive development. Future studies are needed to determine the implications of ToM impairment on behavior and quality of life.     

Validation of a child-friendly version of the monetary incentive delay task

The monetary incentive delay (MID) task (Knutson, 2000) is an imaging paradigm used to measure neural activity of incentive receipt anticipation. The task reliably elicits striatal activation and is commonly used with both adult and adolescent populations, but is not designed for use with children. In the current article, we present data on the newly designed ‘piñata task’ a child-friendly analog of the MID task. We demonstrate the task can be used successfully in children to study the neural correlates of anticipatory incentive processing. Results from a behavioral study and a neuroimaging study are reported. In Study #1, a sample of 8- to 14-year-old children demonstrates expected behavioral effects: subjects responded most quickly and most accurately on trials with greater potential rewards; older children displayed faster reaction times than younger. In Study #2, 8- to 12-year-old children showed neural activation patterns consistent with those seen in adults in the MID task: activation was modulated by cue incentive value in reward-processing regions, including the striatum, thalamus, mesial prefrontal cortex and insula. Study results suggest that the piñata task is a valid analog of the MID task, and can be used to assess neural correlates of reward processing in children as young as 8–9 years of age.     

Asperger's syndrome and autism: neurocognitive aspects

The objectives of this study were to see: (1) whether children with Asperger's Syndrome (AS) have similar neurocognitive deficits compared to nonretarded, or high-functioning autistic (HFA) children; and (2) whether the essential cognitive deficit among these children is in language or abstract problem solving. Subjects with AS, HFA, and a control group of socially impaired child psychiatric outpatient controls (OPC) were compared on a battery of neuropsychological tests. The results indicated that the AS and HFA groups differed little but that large differences from the OPC were observed on all tests. When the AS and HFA with FSIQ above 85 were compared to the OPC, outstanding deficits on motor coordination, language comprehension, and facial recognition were observed. Finally, some evidence is presented to suggest that the pattern of deficits of AS and HFA subjects varied by developmental level. The implications of these results for a neurological theory of autism are discussed.     

Sleep Patterns in School-age Children with Asperger Syndrome or High-functioning Autism: A Follow-up Study

The course of sleep patterns over 2–3 years was compared between 16 school-age children with Asperger syndrome (AS) or high-functioning autism (HFA) and 16 age- and gender-matched typically developing children, using 1-week actigraphy at baseline and follow-up. At baseline (mean age 11.1 years), children with AS/HFA had longer sleep latency and lower sleep efficiency during school days, but earlier sleep start and sleep end during weekends. At follow-up (mean age 13.7 years), children with AS/HFA had longer night wakings and lower sleep efficiency during weekends than the controls. The overall change of sleep patterns, however, is similar in children with AS/HFA and typically developing controls over a 2 to 3-year period. There is one change in affiliation since the time of the study, namely, Hiie Allik has defended her thesis, and obtained a doctoral degree at the Karolinska Institutet, Stockholm, Sweden. Dr. Allik conducted this study in partial fulfilment of the requirements for a doctoral degree at the Karolinska Institutet, Stockholm, Sweden.     

Social Anxiety in High-functioning Children and Adolescents with Autism and Asperger Syndrome

We examined social anxiety and internalizing symptoms using the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Social Anxiety Scale for Children -Revised (SASC-R), and the Child Behavior Checklist (CBCL) in a sample of fifty-four high-functioning subjects with autism or Asperger syndrome (HFA/AS) (M = 11.2 ± 1.7 years) and 305 community subjects (M = 12.2 ± 2.2 years). Children and adolescents completed the SPAI-C and SASC-R, and their parents completed the CBCL Internalizing scale. Adolescents with HFA/AS scored higher than the community sample on all measures. Behavioural avoidance and evaluative social anxiety increased by age within the HFA/AS group, whereas behavioural avoidance decreased by age in control participants. Data support that HFA/AS in adolescents may be associated with clinically relevant social anxiety symptoms.     

Social Competence Intervention for Elementary Students with Aspergers Syndrome and High Functioning Autism

Despite frequent reports of academic success, individuals with high functioning autism or Aspergers Syndrome (HFA/AS) often manifest deficits in social abilities. These deficits can lead to daily difficulties, and negative long-term outcomes. Deficits in social competency are evident in this population from an early age, as children with HFA/AS present unique challenges relating to peers, interpreting complex contextual cues, and transitioning across settings. A paucity of social interventions exist that target elementary-age children with HFA/AS and their combination of core social competence deficit areas: theory of mind (ToM), emotional recognition, and executive functioning. The current study expanded on the Social Competence Intervention (for adolescents; SCI-A), as detailed in Stichter et al. (J Autism Dev Disorders 40:1067–1079, 2010), by adjusting the curriculum to meet the needs of an elementary population. Results indicate significant improvements on direct assessments measuring theory of mind and problem solving, and parent perceptions of overall social abilities and executive functioning for 20 students, aged 6-10, with HFA/AS. The elementary SCI program appears promising, however, additional replications are necessary including expansion to school settings.     

Facial emotion recognition and visual search strategies of children with high functioning autism and Asperger syndrome

Adults with high functioning autism (HFA) and Asperger syndrome (AS) are often less able to identify facially expressed emotions than their matched controls. However, results regarding emotion recognition abilities in children with HFA/AS remain equivocal. Emotion recognition ability and visual search strategies of 26 children with HFA/AS and matched controls were compared. An eye tracker measured the number of fixations and fixation durations as participants were shown 12 pairs of slides, displaying photos of faces expressing anger, happiness or surprise. The first slide of each pair showed a face broken up into puzzle pieces. The eyes in half of the puzzle piece slides were bisected, while those in the remaining half were whole. Participants then identified which of three alternative faces was expressing the same emotion shown in the preceding puzzle piece slide. No differences between the participant groups were found for either emotion recognition ability or number of fixations. Both groups fixated more often on the eyes and performed better when the eyes were whole, suggesting that both children with HFA/AS and controls consider the eyes to be the most important source of information during emotion recognition. Fixation durations were longer in the group with HFA/AS, which indicates that while children with HFA/AS may be able to accurately recognise emotions, they find the task more demanding.     

Asperger’s syndrome and high-functioning autism: language, motor and cognitive profiles

The objective of this study is to compare the cognitive profile, the motor and language functioning and the psychosocial adaptation of children with Asperger syndrome (AS) and with high-functioning autism (HFA). Subjects were recruited through the department Autism and Developmental Disorders of the Heckscher-Klinikum. To be included in the study, the full-scale-IQ had to be at least 80. Subjects with AS had to have a normal early language development and subjects with HFA a clear delay in language development, as reported by their parents. The sample consisted of 57 children with Asperger syndrome and 55 children with high-functioning autism. The mean age of the children was 10 years. All subjects were examined with a standardised test battery. Children with AS had a higher full-scale-IQ than children with HFA. This was due to a higher verbal-IQ. There were no significant differences in the performance-IQ. At a mean age of 10 years, subjects with AS had better language skills than subjects with HFA, but at least 30% showed clear receptive language problems. Motor problems were present in about 50% of the children with AS and HFA. The level of psychosocial adaptation was clearly reduced, but was comparable for the two groups. The differences in verbal-IQ and language skills between the two groups could be explained through the definition of the syndromes. The presence of language problems in the subjects with AS at age 10, the comparable degree of motor impairment and level of psychosocial adaptation question the validity of the distinction between AS and HFA within the category of pervasive developmental disorders.     

An Examination of Handedness and Footedness in Children with High Functioning Autism and Asperger Syndrome

Motor control deficits have been documented in children with high functioning autism and Asperger syndrome (HFA/AS), but the extent to which these disorders affect the children's footedness must be delineated. Twelve typically developing (TD) children and 12 children with HFA/AS, ages 6-9?years, were recruited. Motor control skills were assessed through a variety of footedness tasks to determine location and nature of impairment, regarding motor dominance. Overall, greater inconsistencies in dominance arose in children with HFA/AS, through disparities in measures of preference. Results will have broader implications for understanding motor impairments in children with HFA/AS as determined by comparing performance on footedness tasks, as well as for the design of interventions to account for these deficits.