The Relationship Between Theory of Mind and Executive Function in a Sample of Children from Mainland China

To explore the relationship between theory of mind (ToM) and executive function (EF) in a sample of individuals from mainland China, 20 children with autism spectrum disorders (ASD), 26 children with Attention Deficit Hyperactivity Disorder (ADHD), and 30 normal control subjects were compared on two batteries of ToM tasks and EF tasks. Children with ASD had a significant theory of mind impairment relative to the other controls, while non-verbal IQ removed group differences in executive function. ToM was significantly correlated with inhibitory control. Performance on inhibitory control tasks, however, did not affect performance on ToM tasks.     

The language cognition interface in ASD: Complement sentences and false belief reasoning

Theory of Mind (ToM) deficits are often attested in Autism Spectrum Disorders (ASD). Previous work on ASD has identified links between ToM abilities and knowledge of sentential complements, with the hypothesis that this component of language provides a tool for individuals with ASD to figure out solutions to ToM tasks. However studies on ASD are yet to show if the impact of complementation on ToM performance carries over to instances where ToM is assessed nonverbally. As such, the links identified between ToM tasks and complementation tasks may stem from linguistic difficulties that impact scores across the measures used, rather than from the role played by sentential complements in mental representation. This study is the first to evaluate associations between complements and nonverbal ToM in children with ASD compared to typically developing children of similar nonverbal intellectual ability and general language level. Correlations controlling for nonverbal abilities were found between complements and non-verbal ToM success in the ASD group only. Furthermore, regression analyses showed that competence with complement sentences of verbs of communication explained 30% of the variance in their performance at non-verbal ToM. These findings provide new evidence in favour of the view that sentential complements play a role in ToM reasoning in ASD.     

Emotion-recognition and theory of mind in high-functioning children with ASD: Relationships with attachment security and executive functioning

This study explored the relationships that attachment security and executive functioning (EF) (working memory and inhibition) had with emotion-recognition and theory of mind (ToM) in children with high-functioning Autism Spectrum Disorder (ASD) aged between 6 and 12 years (n = 26), while controlling for cognitive ability. Group differences in attachment security were also explored in this group, compared to a typically-developing group (n = 27) matched on age and cognitive ability. Attachment security was not found to be significantly different between groups, however studies employing larger sample sizes are needed to further clarify this finding. Cognitive processes and attachment insecurity appear to relate to performance on structured behavioural measures of emotion-recognition and ToM differentially in children with high-functioning ASD and typically-developing children. Implications for the mechanisms underlying socio-emotional processes in childhood are discussed.     

Simple Mindreading Abilities Predict Complex Theory of Mind: Developmental Delay in Autism Spectrum Disorders

Theory of mind (ToM) is impaired in individuals with autism spectrum disorders (ASD). The aims of this study were to: (i) examine the developmental trajectories of ToM abilities in two different mentalizing tasks in children with ASD compared to TD children; and (ii) to assess if a ToM simple test known as eyes-test could predict performance on the more advanced ToM task, i.e. comic strip test. Based on a sample of 37 children with ASD and 55 TD children, our results revealed slower development at varying rates in all ToM measures in children with ASD, with delayed onset compared to TD children. These results could stimulate new treatments for social abilities, which would lessen the social deficit in ASD.     

Neural correlates of executive function in autistic spectrum disorders.

BACKGROUND: Some clinical characteristics of high-functioning individuals with autistic spectrum disorder (ASD) such as repetitive stereotyped behaviors, perseveration, and obsessionality have been related to executive function (EF) deficits, more specifically to deficits in inhibitory control and set shifting and mediating frontostriatal neural pathways. However, to date, no functional imaging study on ASD has investigated inhibition and cognitive flexibility and no one has related EF brain activation to brain structure. METHODS: We compared brain activation (using functional magnetic resonance imaging) in 10 normal intelligence adults with ASD and 12 healthy control subjects during three different EF tasks: 1) motor-inhibition (GO/NO-GO); 2) cognitive interference-inhibition (spatial STROOP); and 3) set shifting (SWITCH). Using voxel-based morphometry, we investigated if cortical areas which were functionally different in people with ASD were also anatomically abnormal. RESULTS: Compared with control subjects, ASD individuals showed significantly increased brain activation in 1) left inferior and orbital frontal gyrus (motor-inhibition); 2) left insula (interference-inhibition); and 3) parietal lobes (set shifting). Moreover, in individuals with ASD, increased frontal gray matter density and increased functional activation shared the same anatomical location. CONCLUSIONS: Our findings suggest an association between successful completion of EF tasks and increased brain activation in people with ASD, which partially may be explained by differences in brain anatomy.     

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.     

Brief Report: Episodic Foresight in Autism Spectrum Disorder

Episodic foresight (EpF) or, the ability to imagine the future and use such imagination to guide our actions, is an important aspect of cognition that has not yet been explored in children with autism spectrum disorder (ASD). This is despite its proposed links with theory of mind (ToM) and executive function (EF), two areas found to be impaired in ASD. Twenty-five children with ASD (M = 5 years, 10 months; 22 male) and 25 mental-age-matched typically developing children (M = 4 years, 10 months; 22 male) completed a series of EpF, ToM, and EF tasks. Significant group differences were detected on several EpF tasks suggesting that children with ASD show impairments in thinking about their future selves.     

Real World Executive Control Impairments in Preschoolers with Autism Spectrum Disorders

This study examined executive control (EC) in preschoolers with and without autism spectrum disorders (ASD) using the Behavior Rating Inventory of Executive Functions-Preschool Version (BRIEF-P). ASD participants were a clinically referred sample of preschoolers; the typically developing control group was selected from the BRIEF-P standardization sample. The ASD group was rated significantly worse on all BRIEF-P scores, and these impairments did not correlate with ASD symptoms. These findings document impairments in real world EC in preschoolers with ASD, and have implications for assessing preschoolers suspected of having an ASD. Furthermore, the findings also converge with BRIEF studies of school-aged children with ASD.     

Theory of Mind and social reserve: Alternative hypothesis of progressive Theory of Mind decay during different stages of Alzheimer’s disease

Although Theory of Mind (ToM) is thought to be impaired in Alzheimer’s disease (AD), it remains unclear whether this impairment is linked to the level of task complexity, the heterogeneity of the studied patients, or the implication of executive dysfunctions. To elucidate this point, 42 AD patients, divided into two subgroups [moderate AD (mAD) patients (n = 19) and early AD (eAD) patients (n = 23)], and 23 matched healthy older subjects (HO) were enrolled. All participants were given (1) a false-belief task (cognitive ToM), (2) a revised version of the “Reading the Mind in the Eyes” test (affective ToM), and (3) a composite task designed to assess ToM abilities with minimal cognitive demands. Participants were also given executive tasks assessing inhibition, shifting, and updating processes. We observed a significant impairment of cognitive and composite ToM abilities in eAD patients compared with mAD patients. There was no impairment of affective ToM. Stepwise regression revealed that measures of global efficiency and executive functions (EFs) were the best predictors of progressive decay of ToM scores. These results indicate that cognitive aspects of ToM are more sensitive to AD progression than affective tasks. They also show that ToM abilities are more affected by dementia severity than by task complexity. One explanation of our results is the presence of compensatory mechanisms (social reserve) in AD.     

Measuring Theory of Mind in Adults with Autism Spectrum Disorder

Deficits in Theory of Mind (ToM)—the ability to interpret others’ beliefs, intentions and emotions—undermine the ability of individuals with Autism Spectrum Disorder (ASD) to interact in socially normative ways. This study provides psychometric data for the Adult-Theory of Mind (A-ToM) measure using video-scenarios based in part on Happé’s (Instructions for theory of mind story task, 1999) Strange Stories test. The final items discriminated IQ-matched adults with ASD from controls on the social but not the physical items. Additional validity data included a two-component principal components solution, correlations with existing ToM scales, and the absence of correlations with self-report measures of empathy and social anxiety (not requiring inferences about the intent of others). The expected group differences in ToM were accompanied by marked variability in the ASD sample.     

Patterns of Nonverbal Cognitive Functioning in Young Children with Autism Spectrum Disorders

Previous research demonstrates an uneven pattern of cognitive abilities in children with autism spectrum disorders (ASDs). This study examined whether this uneven pattern exists within the nonverbal domain in young children. We hypothesized relative strengths in perceptual abilities and weaknesses in nonverbal conceptual abilities in preschoolers with ASDs compared to groups with non-autism developmental delays and typical development. Profiles were examined using the Leiter International Performance Scale-Revised. The ASD group displayed clear relative strengths in visuospatial disembedding and detail-focused processing, with relative weaknesses in abstraction and concept formation. This contrasted with patterns of roughly equivalent abilities in both comparison groups. These findings have implications for subsequent development and may represent key features of the cognitive profile of autism.     

Evidence for theory of mind deficits in euthymic patients with bipolar disorder

OBJECTIVE: i) To investigate the subtle ToM (theory of mind) deficits in euthymic patients with bipolar disorder. ii) To investigate the impact of non-ToM cognitive deficits on ToM abilities. METHOD: Forty-three euthymic patients with bipolar disorder and 30 healthy control subjects were involved in this study. ToM was assessed by the Eyes test and the Hinting task. Both groups were also evaluated with a comprehensive neuropsychological battery including tasks for basic emotion and face recognition. RESULTS: The patient group was impaired on both of the ToM tasks. The patient group also showed impairment in many cognitive tasks including tasks related to sustained attention. CONCLUSION: Even euthymic patients with bipolar disorder may be impaired in advanced ToM tasks. Executive dysfunction and some other cognitives deficits such as basic emotion recognition may be at least partly responsible for this result.     

Advantages of the multiple case series approach to the study of cognitive deficits in autism spectrum disorder

In the neuropsychological case series approach, tasks are administered that tap different cognitive domains, and differences within rather than across individuals are the basis for theorising; each individual is effectively their own control. This approach is a mainstay of cognitive neuropsychology, and is particularly suited to the study of populations with heterogeneous deficits. However it has very rarely been applied to the study of cognitive differences in autism spectrum disorder (ASD). Here, we investigate whether this approach can yield information beyond that given by the typical group study method, when applied to an ASD population. Twenty-one high-functioning adult ASD participants and 22 IQ, age, and gender-matched control participants were administered a large battery of neuropsychological tests that would represent a typical neuropsychological assessment for neurological patients in the United Kingdom. The data were analysed using both group and single-case study methods. The group analysis revealed a limited number of deficits, principally on tests with a large executive function component, with no impairment in more routine abilities such as basic attending, language and perception. Single-case study analysis proved more fruitful revealing evidence of considerable variation in abilities both between and within ASD participants. Both sub-normal and supra-normal performance were observed, with the most defining feature of the ASD group being this variability. We conclude that the use of group-level analysis alone in the study of cognitive deficits in ASD risks missing cognitive characteristics that may be vitally important both theoretically and clinically, and even may be misleading because of averaging artifact.     

Executive functioning in children with ASD + ADHD and ASD + ID: A systematic review

Executive functions (EF) are skills that impact an individual’s ability to flexibly and efficiently problem solve and react to their environment. Children with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD), commonly experience EF deficits. However, it is unclear how a co-occurring diagnosis of attention-deficit/hyperactivity disorder (ADHD) or intellectual disability (ID) impact EF in children with ASD. This study systematically reviewed 26 studies – within 24 journal articles – that examined EF among children with ASD + ADHD and ASD + ID. Results revealed many non-congruent findings regarding EF in children with ASD + ADHD and ASD + ID, including differences across performance-based and indirect measures of EF. Children with ASD + ADHD exhibited unique flexibility and shifting, inhibition, and attention deficits. Among children with ASD + ID, planning and organizing, flexibility and shifting, attention, behavior regulation, and global EF skills significantly differed from comparison groups. Notably, these findings were dependent on assessment type used (performance-based versus indirect). Furthermore, analyses of mean Z-scores suggest that children with ASD + ADHD and ASD + ID exhibited more severe EF impairments than children with ASD. These results may be used to inform assessment practices for differentiating and determining co-occurring diagnoses. Understanding unique EF deficits may also inform the development of targeted treatment and interventions.     

Inhibitory Control in Children with Autism Spectrum Disorder

Impairments in executive abilities such as cognitive flexibility have been identified in individuals with autism spectrum disorder (ASD). It remains unclear, however, whether such individuals also experience impairments in another executive ability: inhibitory control. In the present study, we administered three inhibitory tasks to 18 children with ASD, 23 siblings of children with ASD, and 25 typically developing children. After controlling for individual differences in age, overall IQ, and processing speed, children with ASD demonstrated impaired performance on two of the three inhibitory tasks. Results suggest that children with ASD experience circumscribed deficits in some but not all aspects of inhibitory control. More generally, the findings underscore the importance of using multiple measures to assess a putative single cognitive ability.     

Social cognition and Reading comprehension in children and adolescents with autism spectrum disorders or typical development

BackgroundMany individuals with autism spectrum disorders (ASD) exhibit social cognitive impairments in the development of theory of mind (ToM), or the ability to attribute mental states to oneself and others. ToM has been shown to relate to reading comprehension for children and adolescents with typical development (TD) and with ASD. This study examined the relation between reading comprehension, word recognition, oral language, and ToM for higher-functioning children and adolescents with ASD (HFASD) as compared to those with TD.Method70 children with HFASD and 40 children with TD, aged 9–17 years, participated in the study. In order to describe the HFASD as compared to the TD sample, a series of ANOVAs and ANCOVAs were conducted. Multiple regression analyses were conducted with reading comprehension as the outcome variable. Separate regression models (TD & HFASD) were run with IQ, word recognition, oral language, and two ToM measures (Happé’s Strange Stories and the Silent Films Task) as predictors.ResultsThe TD group performed better than the HFASD group on all standardized and experimental measures. Regression analyses revealed that after controlling for IQ, word recognition, and oral language, both ToM measures predicted unique variance in reading comprehension in the HFASD, but not the TD, sample. Furthermore, the TD and HFASD groups displayed different patterns of significant predictors of reading comprehension.ConclusionsThis study suggests that in addition to oral language and higher-order linguistic comprehension, social cognition is an important factor to consider when designing reading interventions for students with ASD.     

Inhibition, flexibility, working memory and planning in autism spectrum disorders with and without comorbid ADHD-symptoms

Background

Recent studies have not paid a great deal of attention to comorbid attention-deficit/hyperactivity disorder (ADHD) symptoms in autistic children even though it is well known that almost half of children with autism spectrum disorder (ASD) suffer from hyperactivity, inattention and impulsivity. The goal of this study was to evaluate and compare executive functioning (EF) profiles in children with ADHD and in children with ASD with and without comorbid ADHD.

Methods

Children aged 6 to 18 years old with ADHD (n = 20) or ASD (High-Functioning autism or Asperger syndrome) with (n = 20) and without (n = 20) comorbid ADHD and a typically developing group (n = 20) were compared on a battery of EF tasks comprising inhibition, flexibility, working memory and planning tasks. A MANOVA, effect sizes as well as correlations between ADHD-symptomatology and EF performance were calculated. Age- and IQ-corrected z scores were used.

Results

There was a significant effect for the factor group (F = 1.55; dF = 42; p = .02). Post-hoc analysis revealed significant differences between the ADHD and the TD group on the inhibition task for false alarms (p = .01) and between the ADHD group, the ASD+ group (p = .03), the ASD- group (p = .02) and the TD group (p = .01) for omissions. Effect sizes showed clear deficits of ADHD children in inhibition and working memory tasks. Participants with ASD were impaired in planning and flexibility abilities. The ASD+ group showed compared to the ASD- group more problems in inhibitory performance but not in the working memory task.

Conclusion

Our findings replicate previous results reporting impairment of ADHD children in inhibition and working memory tasks and of ASD children in planning and flexibility abilities. The ASD + group showed similarities to the ADHD group with regard to inhibitory but not to working memory deficits. Nevertheless the heterogeneity of these and previous results shows that EF assessment is not useful for differential diagnosis between ADHD and ASD. It might be useful for evaluating strengths and weaknesses in individual children.     

Early Word Reading of Preschoolers with ASD,Both With and Without Hyperlexia,Compared to Typically Developing Preschoolers

A portion of children with Autism Spectrum Disorder (ASD) exhibit a strength in early word reading referred to as hyperlexia (HPL), yet it remains unclear what mechanisms underlie this strength. Typically developing children (TD) acquire phonological awareness, alphabet knowledge and language skills as precursors to word reading. We compared these skills across English-speaking preschoolers with ASD, both with and without hyperlexia, and TD preschoolers. Findings indicated that the group with both ASD and HPL (ASD?+?HPL) exhibited advanced word reading and letter naming skills as compared to the other two groups, but did not demonstrate commensurate phonological awareness, letter-sound correspondence, or language skills. Findings support an alternative, non-phonological approach to early word reading in preschoolers with ASD and hyperlexia.

     

Assessing effortful control in typical and atypical development: Are questionnaires and neuropsychological measures interchangeable? A latent-variable analysis

ObjectiveEffortful control (EC), the self-regulation component of temperament, is traditionally measured using questionnaires. Through the years, several neuropsychological measures originating from the cognitive psychology and the executive function (EF) literature have been introduced in the domain of temperament research to tap EC. Although this is not particularly surprising, given the conceptual overlap between EC and EF, it remains unclear whether EC questionnaires and neuropsychological EF tasks can really be used interchangeably when measuring EC. The current study addressed two important aspects in evaluating the interchangeability of both types of measures, that is: (a) do they measure the same construct? and (b) do they give the same results when comparing clinical populations?MethodThree EC questionnaires, two inhibitory control tasks, and two attentional control tasks were administered in 148 typically developing children, 30 children with attention-deficit/hyperactivity disorder (ADHD), and 31 children with autism spectrum disorder (ASD). All children were between 10 and 15 years of age and had a full scale IQ of 80 or higher.ResultsConfirmatory factor analyses revealed that the questionnaires and EF tasks do not capture the same underlying latent variable(s). Groups could not be differentiated from each other based on their performance on EF tasks, whereas significant group differences were found for all EC-reports.ConclusionsOverall, our findings show more differences than commonalities between the EC questionnaires and EF tasks and, consequently, suggest that both types of measures should not be used interchangeably.