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

The Role of Empathy in ADHD Children: Neuropsychological Assessment and Possible Rehabilitation Suggestions-A Narrative Review

Background and Objectives: Theory of mind (ToM) deficits in children with ADHD are closely related to social difficulties and problems in interpersonal interactions. Evidence suggests that these cognitive deficits negatively affect the ability to understand and respond to others' emotions and intentions, thus contributing to social isolation and a lower quality of life. However, the findings across studies vary, indicating that ADHD subtype and comorbidities, such as anxiety and mood disorders, can significantly influence sociocognitive deficits, modulating the extent of social problems. Materials and Methods: This review examines the relationship among ADHD, ToM, and empathy, analyzing studies comparing children with ADHD with peers with typical development or other neurodevelopmental conditions. A search in PubMed, Scopus, and the Cochrane Library prior to January 10, without time restrictions, using "ADHD", "Cognitive Empathy", and "Theory of Mind" identified relevant studies assessing these abilities through neuropsychological tests or questionnaires. Results: Of the initial 243 studies, 23 studies met the inclusion criteria. Children with ADHD exhibited significant impairments in ToM and empathy, affecting social cognition and interpersonal understanding. Various assessment tools revealed difficulties in understanding beliefs, emotions, and intentions, with executive function deficits playing a crucial role in shaping these social challenges. Conclusions: This review highlights the need for targeted therapeutic interventions that not only address cognitive deficits but consider emotional and metacognitive aspects, such as emotion regulation and self-awareness. Future research should focus on integrating executive function training with approaches that develop metacognitive and emotional skills, thus providing more comprehensive support.

Social cognition in autism and ADHD

Social cognition is a crucial capacity for social functioning. The last decades have seen a plethora of social cognition research in neurodevelopmental conditions, foremost autism and, to a lesser extent, ADHD, both characterized by social challenges. Social cognition is a multifaceted construct comprising various overlapping subdomains, such as Theory of Mind/mentalizing, emotion recognition, and social perception. Mechanisms underpinning social cognition are complex, including implicit and explicit, cognitive and affective, and hyper- and hypo-social information processing. This review explores the intricacies of social cognition in the context of autism and ADHD. Research indicates altered performance on social cognition tests in autism, compared to neurotypical groups, with social cognition alterations having a small but robust effect on the defining features of autism. The nature of such alterations in autism appears primarily in relation to implicit processing. ADHD groups show intermediate social cognition performance, appearing to be influenced by executive function difficulties. Social cognition varies with intellectual and verbal abilities and seems to improve with age in autism and ADHD. Social skills interventions in autism, and stimulant medication in ADHD have been shown to improve social cognition test performance, while mentalizing training effects in autism are less conclusive. A limitation of the field is that social cognition constructs and tests are not well delineated. Further, most research has been embedded in a nativist approach rather than a constructivist approach. The former has been questioned for ignoring environmental contributions, especially the dimension of mutual miscommunication between neurodivergent and neurotypical individuals.

Can attention-deficit/hyperactivity disorder be considered a form of cerebellar dysfunction?

Attention-deficit/hyperactivity disorder (ADHD) is a heterogenous disorder, commonly described for presenting difficulties in sustained attention, response inhibition, and organizing goal-oriented behaviors. However, along with its traditionally described executive dysfunction, more than half of the children diagnosed with ADHD have been reported to show difficulties with gross and fine motor skills, albeit motor impairments in ADHD continue to be a neglected area of clinical attention. The rapidly growing field of the clinical cognitive neuroscience of the cerebellum has begun to relate cerebro-cerebellar circuits to neurodevelopmental disorders. While the cerebellum's role in motor function, such as balance, motor coordination, and execution, is well recognized, ongoing research has evidenced its additional and fundamental role in neurocognitive development and executive function, including attention and social cognition, which are all areas of impairment commonly found in ADHD. Interestingly, neuroimaging studies have consistently shown differences in cerebellar volume and functional connectivity between ADHD and typically developing children. Furthermore, methylphenidate is known to act at the cerebellar level, as intrinsic cerebellar dopaminergic systems involved in attention and motor function have been identified. This article reviews some of the main findings linking cerebellar dysfunction to ADHD behavioral symptoms and incorporates the cerebellum as a possible neurological basis and differentiating indicator within the condition. We suggest considering more rigorous assessments in future ADHD studies, including cerebellar-associated skill evaluations to correlate with symptom severity and other detected outcomes, such as executive dysfunction, and study possible associative patterns that may serve as more objective measures for this diagnosis.

Contributions of Attachment and Cognitive Functioning on ADHD Symptoms in Children

ADHD is a neurodevelopmental disorder with multifactorial origins. Several studies have shown that parent-child attachment impacts the expression of ADHD symptoms, while others have highlighted the influence of cognitive impairments on ADHD symptoms. However, few studies have simultaneously examined the respective contributions of child attachment and cognitive functions to ADHD, which is the aim of this study. We included 45 children with ADHD from a university hospital and 44 typically developing children from regular schools. Child attachment was evaluated using a self-report questionnaire, the French Attachment Security Scale (ASS-Fr), and a narrative interview, the Cartes pour l'évaluation de l'Attachement et de la Mentalisation chez l'Enfant (CAME). Cognitive assessment involved both objective and subjective measures. Perceived attachment security to both parents and disorganized attachment were significantly associated with ADHD symptoms, but these relationships were mediated by externalizing symptoms and executive function difficulties. The relationships between attachment and ADHD symptoms are indirect and mediated by the presence of externalizing symptoms and executive function impairments.

Variability of theory of mind versus pragmatic ability in typical and atypical development

INTRODUCTION

Numerous studies have linked deficits in Theory of Mind (ToM) with language problems. We aimed to explore the similarities and differences between children's patterns of performance on a ToM task that requires minimal linguistic skill and a pragmatic inference task that relies on both ToM and language. We assessed variability in pragmatic inference skills and ToM across populations of children (8-14 years) displaying varying cognitive profiles. We further compared the sensitivity of ToM versus pragmatic ability to core language skills, memory and executive functioning (EF).

METHOD

ToM was tested using the Social Attribution Task (SAT-MC-II). Pragmatic ability was assessed in an implicature comprehension task. Receptive vocabulary, grammar comprehension, short-term and working memory (STM and WM) capacity and EF were measured using Hungarian adaptations of standard tasks and tests developed by the authors' lab. In addition to typically developing (TD) children (n = 33), we included children with neurodevelopmental disorders where ToM and/or language abilities are vulnerable: autism spectrum disorder (ASD, n = 26), attention deficit hyperactivity disorder (ADHD, n = 25) and developmental language disorder (DLD, n = 18).

RESULTS

Results revealed a significant but only moderate positive correlation between pragmatic inference and ToM indicating that the two abilities are related but distinct. The ASD group showed impairments in both ToM and pragmatic inference ability but no significant deficit was observed in ADHD or DLD relative to TD children in either skill. However, while SAT-MC-II results were only affected by verbal WM and vocabulary measures, pragmatic performance was associated with STM, verbal WM, EF, grammatical skills and vocabulary.

CONCLUSION

Our findings indicate that disentangling the contributions of different cognitive skills to ToM tasks may help clarify the role of ToM in language skills and identify distinct patterns of ToM and pragmatic skills in developmental disorders.

Research Review: Social cognition and everyday social skills in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analysis of case-control studies

BACKGROUND

Previous studies that have assessed social cognition in Attention-Deficit/Hyperactivity Disorder (ADHD) have produced inconsistent findings. To summarize these data and shed light upon moderators that may explain observed inconsistencies, we conducted a systematic review and meta-analysis exploring social cognition (Theory of Mind (ToM), Empathy, Facial and Non-Facial Emotion Recognition) and Everyday Social Skills in children and adolescents with ADHD.

METHODS

The current meta-analysis involved 142 studies including 652 effect sizes. These studies compared children and adolescents with ADHD (n = 8,300) and with typical development (n = 7,983).

RESULTS

Participants with ADHD exhibited moderate to very large deficits in ToM (SMD = 0.84, 95% CI = 0.68-0.99), Facial Emotion Recognition (SMD = 0.63, 95% CI = 0.46-0.81), and Everyday Social Skills (SMD = 1.23, 95% CI = 1.08-1.37). The magnitude of these impairments was similar when considering effect sizes adjusted for some covariates and the methodological quality of the studies. Few studies have investigated Empathy and Non-Facial Emotion Recognition, which precludes definitive conclusions.

CONCLUSIONS

Children and adolescents with ADHD experience robust impairments in ToM, Facial Emotion Recognition and Everyday Social Skills. Future studies should explore whether these deficits are a consequence of difficulties in other areas of cognition (e.g., executive functioning). We have made all our raw data open access to facilitate the use of the present work by the community (e.g., clinicians looking for tools, assessing social impairments, or researchers designing new studies).

Neural bases of social deficits in ADHD: A systematic review. Does the Theory of Mind matter?

INTRODUCTION

The Attention Deficit Hyperactivity Disorder (ADHD) causes serious interpersonal problems from childhood to adulthood, one of them being problematic social functioning. This phenomenon in ADHD should be associated with impairments in the Theory of Mind (ToM). Therefore, understanding the neural correlates of the ToM could be crucial for helping individuals with ADHD with their social functioning. Thus, we aimed to review published literature concerning neuroanatomical and functional correlates of ToM deficits in children and adolescents with ADHD.

METHODS

We reviewed studies published between 1970 and 2023. In accordance with PRISMA guidelines, after data from three databases were collected, two authors (LN and PM) independently screened all relevant records (n=638) and consequently, both authors did the data extraction. The quality of the included studies (n=5) was measured by a modified version of The Newcastle-Ottawa Scale and by measures specific for our study. This systematic review was registered on PROSPERO (CRD42020139847).

RESULTS

Results indicated that impairments in performing of the ToM tasks were negatively associated with the grey matter volume in the bilateral amygdala and hippocampus in both, ADHD and control group. In EEG studies, a significantly greater electrophysiological activity during ToM tasks was observed in the, frontal, temporal, parietal and occipital lobes in participants with ADHD as compared to healthy subjects.

CONCLUSION

More research is needed to explore the ToM deficits in children with ADHD. Future research might focus on the neural circuits associated with attention and inhibition, which deficits seems to contribute to the ToM deficits in children and adolescents with ADHD.

Children's color trails test: Greek normative data and clinical validity in children with traumatic brain injury and attention deficit - Hyperactivity disorder

The Children's Color Trail Test (CCTT) is considered a culture fair equivalent of the Trail Making Test for the assessment of cognitive flexibility in pediatric populations, while others emphasize its additional validity as a measure of attention, perceptual tracking, processing speed, susceptibility to interference and inhibition. The need for standardized neuropsychological tests in Greece, especially for the pediatric population is significant. In the present study, considering the relatively good psychometric properties of the CCTT and its wide cross-cultural application, we decided that such a tool would be useful to Greek clinicians and researchers, and therefore developed norms for the Greek child and adolescent population. Additionally, we examined the clinical validity of the test, administering it to two groups of patients (children with Traumatic Brain Injury and Attention Deficit - Hyperactivity Disorder). We administered the test to 417 native healthy Greek children 6-15 years, recruited primarily from Southwestern Greece from several public schools. Linear regression analysis revealed a significant influence of age on completion time in both parts of the CCTT, whereas sex did not influence time to completion. Older children consistently completed the test faster than younger children, whereas girls and boys performed similarly on both conditions. In addition, CCTT differentiated the performance of children who have had a TBI and those diagnosed with ADHD from the performances of their typically developing peers. This study provides much needed performance and clinical utility data for the pediatric population in Greece on a promising neuropsychological tool for use in clinical and research settings.

Theory of Mind: A Brief Review of Candidate Genes

Deficits in theory of mind (ToM), known as the ability to understand the other's mind, have been associated with several psychopathological outcomes. The present systematic review aims to summarize the results of genetic studies that investigated gene polymorphisms associated with mentalization performance tasks in children and adults. The systematic review was carried out following PRISMA guidelines, and the literature search was conducted in PubMed and EBSCOhost using the following keywords: 'theory of mind, mentalizing, mindreading' and 'gene, genetic basis'. Nineteen studies met the eligibility criteria for inclusion. Most of the literature focused on the role of DRD4, DAT1, OXTR, OXT, COMT, ZNF804A, AVP, AVPR, SCL6A4, EFHC2, MAO-A, and the family of GTF2I genes in influencing ToM. However, controversial results emerged in sustaining the link between specific genetic polymorphisms and mentalization abilities in children and adults. Available data show heterogeneous outcomes, with studies reporting an association between the same family genes in subjects of the same age and other studies reporting no correlation. This does not allow us to draw any solid conclusions but paves the way for exploring genes involved in ToM tasks.

Measuring mindreading in preschoolers: The perspective battery (PERBAT)

OBJECTIVE

The capacity to take another person's visual perspective is pivotal for solving mindreading tests, such as Theory of Mind (ToM) tasks, but most of them heavily rely on domain-general abilities (e.g., language, executive functions). Here we present a novel battery of visual perspective-taking tests for child neuropsychological assessment, the Perspective Battery (PERBAT), which poses a limited load on domain-general abilities.

METHODS

The battery includes four tests: i) Block Building; ii) Hide and Seek; iii) Deceptive Figures; iv) Double-Sided Shelf. We administered the PERBAT to 126 typically developing preschoolers (65 males; 3-6-year-old); the participants also performed classical tests of social cognition, language, and nonverbal abstract reasoning.

RESULTS

The scores of all the PERBAT tests were significantly and positively related with age and scores of the classical social cognition tests, but not with scores of the language and nonverbal abstract reasoning tests.

CONCLUSIONS

The PERBAT could represent a useful neuropsychological tool providing a comprehensive assessment of visual perspective-taking skills in preschool children. Future investigation is needed to examine the validity of the PERBAT with neurotypical samples across countries, race, ethnicity, and language as well as with clinical populations. Longitudinal studies are also encouraged to examine whether early visual perspective-taking weaknesses are associated with later development of mindreading skills.

Common and distinct cortical thickness alterations in youth with autism spectrum disorder and attention-deficit/hyperactivity disorder

BACKGROUND

Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with overlapping behavioral features and genetic etiology. While brain cortical thickness (CTh) alterations have been reported in ASD and ADHD separately, the degree to which ASD and ADHD are associated with common and distinct patterns of CTh changes is unclear.

METHODS

We searched PubMed, Web of Science, Embase, and Science Direct from inception to 8 December 2023 and included studies of cortical thickness comparing youth (age less than 18) with ASD or ADHD with typically developing controls (TDC). We conducted a comparative meta-analysis of vertex-based studies to identify common and distinct CTh alterations in ASD and ADHD.

RESULTS

Twelve ASD datasets involving 458 individuals with ASD and 10 ADHD datasets involving 383 individuals with ADHD were included in the analysis. Compared to TDC, ASD showed increased CTh in bilateral superior frontal gyrus, left middle temporal gyrus, and right superior parietal lobule (SPL) and decreased CTh in right temporoparietal junction (TPJ). ADHD showed decreased CTh in bilateral precentral gyri, right postcentral gyrus, and right TPJ relative to TDC. Conjunction analysis showed both disorders shared reduced TPJ CTh located in default mode network (DMN). Comparative analyses indicated ASD had greater CTh in right SPL and TPJ located in dorsal attention network and thinner CTh in right TPJ located in ventral attention network than ADHD.

CONCLUSIONS

These results suggest shared thinner TPJ located in DMN is an overlapping neurobiological feature of ASD and ADHD. This alteration together with SPL alterations might be related to altered biological motion processing in ASD, while abnormalities in sensorimotor systems may contribute to behavioral control problems in ADHD. The disorder-specific thinner TPJ located in disparate attention networks provides novel insight into distinct symptoms of attentional deficits associated with the two neurodevelopmental disorders.

TRIAL REGISTRATION

PROSPERO CRD42022370620. Registered on November 9, 2022.

Far Transfer Effects of Trainings on Executive Functions in Neurodevelopmental Disorders: A Systematic Review and Metanalysis

Executive Functions are a set of interrelated, top-down processes essential for adaptive goal-directed behaviour, frequently impaired across different neurodevelopmental disorders with variable degrees of severity. Many executive-function-training studies in children with neurodevelopmental disorders have focused on near effects, investigating post-treatment improvements on directly trained processes, while enhancements of skills not directly trained, defined as far effects, are less considered, albeit these could be extremely relevant for reducing the negative impact of a disorder's core symptomatology. This systematic review and metanalysis aims to investigate the far effect outcomes after EF training in children with different types of neurodevelopmental disorders. 17 studies met the inclusion criteria for the systematic review, while 15 studies were selected in the metanalysis. An overall statistically significant effect size was found in the majority of far effect outcome measures considered in the studies. In particular, trainings on executive functions determine significant far effects on daily life functioning (0.46, 95% CI: [0.05-0.87]) and clinical symptoms (0.33, 95% CI: [0.15-0.51]). Despite a high variability of the results, intensity, frequency and the laboratory/life contexts dimension seem to be the most influential variables in determining far effects. This systematic review and metanalysis highlights the need to measure far effects of executive function training in neurodevelopmental disorders, selecting treatments not only on directly targeted processes, but also according to far impacts on the functional weakness of the disorder.

Difficulties in social cognitive functioning among pediatric patients with muscular dystrophies

Introduction

Pediatric muscular dystrophies (MDs) are a heterogeneous group of rare neuromuscular diseases characterized by progressive muscle degeneration. A neuropsychosocial approach is crucial for these patients due to associated cognitive, behavioral, and psychiatric comorbidities; however, the social cognitive domain has not been adequately addressed.

Methods

This study aimed to analyze on social cognition performance in a pediatric MD patient cohort. This cross-sectional study included 32 pediatric patients with MD and 32 matched-healthy controls. The Social Perception Domain of the NEPSY-II, the Reading the Mind in the Eyes Test-Child and Happé's Strange Stories Test were administered. General intelligence and behavioral and emotional symptoms were controlled for to eliminate covariables' possible influence. The assessments were performed remotely.

Results

Children with MDs performed significantly worse on most of the social cognition tasks. The differences found between the groups could be explained by the level of general intelligence for some aspects more related to theory of mind (ToM) (TM NEPSY-II: F = 1.703, p = .197; Verbal task: F = 2.411, p = .125; RMET-C: F = 2.899, p = .094), but not for emotion recognition. Furthermore, these differences were also independent of behavioral and emotional symptoms.

Discussion

In conclusion, social cognition is apparently impaired in pediatric patients with MD, both for emotion recognition and ToM. Screening assessment in social cognition should be considered to promote early interventions aimed at improving these patient's quality of life.

How the Spreading and Intensity of Interictal Epileptic Activity Are Associated with Visuo-Spatial Skills in Children with Self-Limited Focal Epilepsy with Centro-Temporal Spikes

This paper investigates brain-behaviour associations between interictal epileptic discharges and cognitive performance in a population of children with self-limited focal epilepsy with centro-temporal spikes (SeLECTS). Sixteen patients with SeLECTS underwent an extensive neuropsychological assessment, including verbal short-term and episodic memory, non-verbal short-term memory, attentional abilities and executive function. Two quantitative EEG indices were analysed, i.e., the Spike Wave Index (SWI) and the Spike Wave Frequency (SWF), and one qualitative EEG index, i.e., the EEG score, was used to evaluate the spreading of focal SW to other parts of the brain. We investigated associations between EEG indices and neuropsychological performance with non-parametric Spearman correlation analyses, including correction for multiple comparisons. The results showed a significant negative correlation between (i) the awake EEG score and the Block Tapping Test, a visuo-spatial short-term memory task, and (ii) the sleep SWI and the Tower of London, a visuo-spatial planning task (pcorr < 0.05). These findings suggest that, in addition to the usual quantitative EEG indices, the EEG analysis should include the qualitative EEG score evaluating the spreading of focal SW to other parts of the brain and that neuropsychological assessment should include visuo-spatial skills.

Cognitive predictors of Social processing in congenital atypical development

According to current accounts of social cognition, the emergence of verbal and non-verbal components of social perception might rely on the acquisition of different cognitive abilities. These components might be differently sensitive to the pattern of neuropsychological impairments in congenital neurodevelopmental disorders. Here, we explored the association between social and non-social cognitive domains by administering subtests of the NEPSY-II battery to 92 patients with Intellectual and Developmental Disability (IDD). Regardless the level of intellectual functioning and presence of congenital brain malformations, results revealed that visuospatial skills predicted emotion recognition and verbal component of Theory of Mind, whereas imitation predicted the non-verbal one. Future interventions might focus on spatial and sensorimotor abilities to boost the development of social cognition in IDD.

Mentalizing in Adolescents and Young Adults with Attention Deficit Hyperactivity Disorder: Associations with Age and Attention Problems

INTRODUCTION

Growing, albeit heterogenous evidence questions whether attention deficit/hyperactivity disorder (ADHD) is associated with socio-cognitive impairments, especially beyond childhood. This study focuses on mentalizing - the socio-cognitive ability to attribute and reason in terms of mental states. We aimed to characterize mentalizing performance in terms of correct scores and types of errors in adolescents and young adults with ADHD.

METHODS

Forty-nine adolescents and adults with ADHD and 49 healthy controls matched for age and gender completed a computerized naturalistic mentalizing task, the Movie for Assessment of Social Cognition (MASC). Repeated measures analyses of variance examined the effects of age group and ADHD diagnosis on MASC performance. Additionally, associations between mentalizing scores, the severity of attention problems, and the presence of comorbidity were explored in the ADHD group.

RESULTS

Results showed an increased prevalence of hypomentalizing errors in adolescents with ADHD. Lower mentalizing scores in adolescents with ADHD were correlated with indices of inattentiveness, impulsivity, and vigilance problems. Hypomentalizing errors in adolescents showed to be particularly associated with inattentiveness, after controlling for age and comorbidity. In contrast, adults with ADHD performed similarly to controls and their scores on the mentalizing task were not correlated to attention problems.

CONCLUSION

These findings highlight potential developmental differences in mentalizing abilities in ADHD youths and their association with attentional impairments.

Social Cognition and Prosocial Behavior in Children with Attention Deficit Hyperactivity Disorder: A Systematic Review

The purpose of this research is to analyze the empirical evidence on the relationship between social cognition and prosocial behavior in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). A systematic review was carried out following the PRISMA guidelines of empirical studies found in PubMed and Scopus databases, including a total of 51 research studies. The results indicate that children and adolescents with ADHD have deficits in social cognition and prosocial behavior. For children with ADHD, their deficits in social cognition highlight their difficulty in the process of theory of mind, emotional self-regulation, emotion recognition and empathy, affecting prosocial behavior, evidencing difficulty in personal relationships, and the creation of emotional bonds with their peers.

The association between autistic traits and serum testosterone, oxytocin, and androstenedione levels in prepubertal male drug naive children with attention-deficit/hyperactivity disorder

BACKGROUND

Children with attention-deficit/hyperactivity disorder (ADHD) might have similar problems as in autism spectrum disorder (ASD) and show impairment in social behaviour. Also, there is a relationship between social relationship skills and ToM (theory of mind) skills of children with ADHD. Besides, ASD is associated with prenatal exposure to high levels of androgens, and oxytocin plays a role in the modulation of emotions, coping with stress, and social behaviour like ASD. In this study, the relationship between autistic traits and serum oxytocin, testosterone, and androstenedione levels in prepubertal male drug naive children with ADHD has been investigated.

METHOD

Eighty-three prepubertal children, who were diagnosed with ADHD between the ages of 6-10 years old, are included in the study. For the study, intelligence levels were evaluated by using WISC-4, and autistic traits were measured by using both social responsiveness scale and theory of mind tests. In addition, serum oxytocin, testosterone, and androstenedione levels were measured by using ELISA.

RESULTS

It has been found that serum testosterone levels of patients with lower autistic traits are significantly lower than those with moderate and severe autistic traits, while the serum oxytocin levels are significantly higher. Also, patients with severe autistic traits have had significantly higher serum androstenedione levels than those with lower and moderate autistic traits.

CONCLUSION

This study suggests that patients who have higher autistic traits have elevated testosterone and androstenedione levels and lower serum oxytocin levels. Further studies are needed to clarify this relationship.

Faux-Pas Recognition Test: A Turkish adaptation study and a proposal of a standardized short version

Faux Pas Recognition Test (FPRT) is one of the most commonly used tools to assess the theory of mind (ToM) and a valid and reliable screening of this social cognitive function in both clinical and research settings is essential. We aimed to evaluate the psychometric properties of the FPRT on a healthy Turkish sample and to develop a shorter form with adequate psychometric properties to provide an easier application for the tester by shortening the test's duration of administration. Four hundred sixteen healthy individuals completed the Turkish version of the FPRT. Addenbrooke's Cognitive Evaluation-Revised form (ACE-R) was given to the participants who were over 60 years of age in order to eliminate the adverse effects of a potential cognitive decline on FPRT performance. Effects of psychological symptoms on FPRT performance were controlled with Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Both the original and short versions of the test showed good psychometric properties: for the original version internal consistency reliability was 0.94 for faux-pas (FP) stories and 0.92 for control stories; for the short version it was 0.92 for FP stories and was 0.93 for control stories. For the original version of the FPRT; inter-rater reliability was 0.88 for FP stories and was 0.96 for control stories. Split-half reliability was 0.78 for FP stories and was 0.85 for control stories. Gender and age comparisons were carried out. Results revealed that women had significantly higher total scores than men in three measures of FPRT.

The profile of pragmatic language impairments in children with ADHD: A systematic review

This systematic review synthesizes the empirical literature examining pragmatic language in children diagnosed with attention-deficit/hyperactivity disorder (ADHD). Using a taxonomy of pragmatic language, we compared the pragmatic language profiles of children with ADHD to those of typically developing (TD) children and children with autism. Three databases were searched up to October 2019: PsychInfo; PubMed; and CSA Linguistics and Language Behavior Abstracts. We included 34 studies reporting on 2,845 children (ADHD = 1,407; TD = 1,058; autism = 380). Quality and risk of bias assessments included sample size and representativeness; measure reliability and validity; and missing data management. Children with ADHD were found to have higher rates of pragmatic difficulties than their TD peers. Specific difficulties were identified with inappropriate initiation, presupposition, social discourse, and narrative coherence. Children with ADHD appear to differ from those with autism in the degree of their pragmatic language impairments. General language skills contribute to, but do not explain, pragmatic difficulties in samples of children with ADHD. Though the extant evidence is limited, a preliminary profile of the pragmatic language impairments in children with ADHD is indicated. This supports a call for evidence-based interventions that include pragmatic language skills training.

Reading mind from the eyes in individuals with attention deficit-hyperactivity disorder (ADHD): A meta-analysis

OBJECTIVES

Individuals with ADHD struggle with social impairments. The present study aimed to find out the inconsistent results of theory of mind skill in individuals with ADHD.

METHODS

The current meta-analysis reviewed 17 empirical studies that compared theory of mind in individuals with and without ADHD based on reading mind from the eyes test (RMET).

RESULTS

Finding from 1620 participants with ADHD and 1249 healthy controls showed a significant impairment in theory of mind in individuals with ADHD (Hedges' g = 0.66). Moderator analyses indicated that the impaired theory of mind was not affected by age and gender.

CONCLUSION

These findings describe impaired theory of mind in individuals with ADHD and provide an insight to pay attention to theory of mind in respective clinical assessments and treatments.

Callous-Unemotional Traits and Face-Emotion Recognition as Mediators in Conduct Problems of Children With ADHD

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk for conduct problems (CP), as well as with callous-unemotional traits (CUt) and lower accuracy in face emotional recognition (FER). It is unclear, however, whether CUt and low accuracy in FER contribute to the risk for CP in ADHD. The present study investigated the possibility of such contribution.

METHODS

This pilot study's participants included 31 children aged 7-17 years, diagnosed with ADHD, and treated in a psychiatric outpatient clinic. The parents rated their children on the ADHD Rating Scale, Inventory of Callous-Unemotional Traits, and the Child Behavior Checklist-Conduct Problems scale. Participants completed the Hebrew version of the children's Reading the Mind in the Eyes Test (cRMET)-a Theory of Mind measure. A bootstrapped multiple mediator model was used, adjusting for age and gender.

RESULTS

ADHD symptoms were associated with CP. This association was not mediated by CUt or cRMET. CUt was associated with CP independent of ADHD symptom severity.

CONCLUSIONS

ADHD symptoms and CUt both should be considered when assessing risk for CP and devising a treatment plan, in children with ADHD. Current results did not confirm the hypothesis that cRMET and CUt mediate between ADHD symptoms and CP. More studies employing larger samples, longitudinal design, and other emotion recognition measures are needed.

Cognitive, perceptual, and motor profiles of school-aged children with developmental coordination disorder

Developmental coordination disorder (DCD) is a heterogeneous condition. Besides motor impairments, children with DCD often exhibit poor visual perceptual skills and executive functions. This study aimed to characterize the motor, perceptual, and cognitive profiles of children with DCD at the group level and in terms of subtypes. A total of 50 children with DCD and 31 typically developing (TD) peers (7–11 years old) underwent a comprehensive neuropsychological (15 tests) and motor (three subscales of the Movement Assessment Battery for Children-2) assessment. The percentage of children with DCD showing impairments in each measurement was first described. Hierarchical agglomerative and K-means iterative partitioning clustering analyses were then performed to distinguish the subtypes present among the complete sample of children (DCD and TD) in a data-driven way. Moderate to large percentages of children with DCD showed impaired executive functions (92%) and praxis (meaningless gestures and postures, 68%), as well as attentional (52%), visual perceptual (46%), and visuomotor (36%) skills. Clustering analyses identified five subtypes, four of them mainly consisting of children with DCD and one of TD children. These subtypes were characterized by: (i) generalized impairments (8 children with DCD), (ii) impaired manual dexterity, poor balance (static/dynamic), planning, and alertness (15 DCD and 1 TD child), (iii) impaired manual dexterity, cognitive inhibition, and poor visual perception (11 children with DCD), (iv) impaired manual dexterity and cognitive inhibition (15 DCD and 5 TD children), and (v) no impairment (25 TD and 1 child with DCD). Besides subtle differences, the motor and praxis measures did not enable to discriminate between the four subtypes of children with DCD. The subtypes were, however, characterized by distinct perceptual or cognitive impairments. These results highlight the importance of assessing exhaustively the perceptual and cognitive skills of children with DCD.

Social Thinking Metacognitive Strategies to Support Self-Determined Social Goals in Autistic Youth

On any given day, the social mind is taxed with attending to and making sense of a myriad of social events. The social mind is at work when trying to imagine the experiences of others and their inner mental worlds, and is equally active when people seek to approach, connect with, and sometimes avoid one another. Ultimately, the social mind is responsible for thinking about (social) thinking, or social metacognition. Social metacognitive teaching strategies can be helpful for supporting social learners as they observe social landscapes, interpret what is observed to problem solve, or decide whether and how to produce social responses. This article describes how social metacognitive strategies from the Social Thinking Methodology have been used to support the self-determined social goals of two autistic students. Visual frameworks and their underlying theories are provided as evidence-aligned tools for supporting clinical journeys.

Stability and change in the interpretation of facial emotions in fetal alcohol spectrum disorders from childhood to adolescence

BACKGROUND

The ability to identify and interpret facial emotions plays a critical role in effective social functioning, which may be impaired in individuals with fetal alcohol spectrum disorders (FASD). We previously reported deficits in children with fetal alcohol syndrome (FAS) and partial FAS (PFAS) on the "Reading the Mind in the Eyes" (RME) test, which assesses the interpretation of facial emotion. This follow-up study in adolescents was designed to determine whether this impairment persists or represents a developmental delay; to classify the RME stimuli by valence (positive, negative, or neutral) and determine whether RME deficits differ by affective valence; and to explore how components of executive function mediate these associations.

METHODS

The RME stimuli were rated and grouped according to valence. Sixty-two participants who had been administered the RME in late childhood (mean ± SD = 11.0 ± 0.4 years) were re-administered this test during adolescence (17.2 ± 0.6 years). Overall and valence-specific RME accuracy was examined in relation to prenatal alcohol exposure (PAE) and FASD diagnosis.

RESULTS

Children with FAS (n = 8) and PFAS (n = 15) performed more poorly on the RME than non-syndromal heavily exposed (HE; n = 19) and control individuals (n = 20). By adolescence, the PFAS group performed similarly to HE and controls, whereas the FAS group continued to perform more poorly. No deficits were seen for positively valenced items in any of the groups. For negative and neutral items, in late childhood individuals with FAS and PFAS performed more poorly than HE and controls, but by adolescence only the FAS group continued to perform more poorly. Test-retest reliability was moderate across the two ages. At both timepoints, the effects in the FAS group were partially mediated by Verbal Fluency but not by other aspects of executive function.

CONCLUSIONS

Individuals with full FAS have greater difficulty interpreting facial emotions than those with non-syndromal HE and healthy controls in both childhood and adolescence. By contrast, RME deficits in individuals with PFAS in childhood represent developmental delay.

Dysfunctional temporal stages of eye-gaze perception in adults with ADHD: a high-density EEG study

ADHD has been associated with social cognitive impairments across the lifespan, but no studies have specifically addressed the presence of abnormalities in eye-gaze processing in the adult brain. This study investigated the neural basis of eye-gaze perception in adults with ADHD using event-related potentials (ERP). Twenty-three ADHD and 23 controls performed a delayed face-matching task with neutral faces that had either direct or averted gaze. ERPs were classified using microstate analyses. ADHD and controls displayed similar P100 and N170 microstates. ADHD was associated with cluster abnormalities in the attention-sensitive P200 to direct gaze, and in the N250 related to facial recognition. For direct gaze, source localization revealed reduced activity in ADHD for the P200 in the left/midline cerebellum, as well as in a cingulate-occipital network at the N250. These results suggest brain impairments involving eye-gaze decoding in adults with ADHD, suggestive of neural signatures associated with this disorder in adulthood.

Attentive-executive functioning and compensatory strategies in adult ADHD: A retrospective case series study

Background

Adults with ADHD exhibit a neuropsychological profile that may present deficits in many cognitive domains, particularly attention and executive functions (EFs). However, some authors do not consider executive disfunction as an important part of the clinical profile of the syndrome; this could be related to the use of inappropriate neuropsychological tests, probably not adapted and not sufficiently ecological. Moreover, new data are required on specific correlation of attentive-executive symptoms with socio-demographic factors. Therefore, the aim of this study is to analyze the neuropsychological performance of a group of adults with ADHD, also evaluating the influence of gender, age and education level.

Methods

We retrospectively collected health-related personal data of 40 adult ADHD patients, clinically diagnosed and evaluated via a battery of 4 neuropsychological tests and 1 self-administered questionnaire. Gender, age and years of education differences were assessed.

Results

Attention and EFs deficits have been highlighted mainly on the d2-R and 5-point neuropsychological tests, which therefore seem to be more sensitive in measuring the attention-executive dysfunction in an adult ADHD population, than TAP Go/No-go and ROCFT. ADHD patients also manifested subjective behavioral impulsivity disorders on BIS-11. There were no statistically significant gender differences in cognitive performance. On the contrary, younger patients performed worse on subscales TAP Go/No-go errors and 5-points number of drawings, while participants with a higher education level performed better on subscales d2-R speed of execution and d2-R errors. This supports a reduction in the number of errors and the execution time as a function of older age and a higher level of education. Finally, patients with higher education also self-reported greater impulsivity in planning.

Conclusion

Our preliminary findings suggest that adult ADHD is not a lifelong stable disorder, but it may change over time. Moreover, attention-executive deficits may be influenced and partially counterbalanced by experience (i.e., advancing age) and a higher level of education. This could underlie the development of specific psycho-behavioral and cognitive compensatory strategies. The use of self-administered questionnaires is therefore recommended to highlight attentional and executive difficulties that may not result in neuropsychological tests.

Unimpaired social cognition in adult patients with ADHD: brain volumetric and behavioral results

The present study aimed to investigate whether adult patients with attention deficit hyperactivity disorder (ADHD) show deficits in social cognition and to identify the structural neural correlates of social cognitive skills in ADHD. Twenty-six adult patients with ADHD and 26 matched healthy control participants performed the Movie for the Assessment of Social Cognition and underwent a structural magnetic resonance imaging scan. We compared theory of mind (ToM) performance between ADHD patients and healthy controls. Using voxel-based morphometry, we further compared gray matter volumes in regions that are critical for social cognition between the two groups and examined whether ToM performance was correlated with brain morphometry measures. We did not observe any between-group differences in ToM abilities or regional gray matter volumes. Across both groups, performance on affective aspects of ToM correlated positively with gray matter volumes in the medial part of the superior frontal gyri, which is typically involved in social cognition. This study is the first to relate brain structure to social cognitive abilities in adult patients with ADHD. Although our sample was small and heterogeneous, with half of the patients showing mild-to-moderate psychiatric comorbidities, our results may encourage longitudinal studies that relate social cognitive development in childhood and adolescence to brain maturation of ADHD patients.

The relationship between theory of mind and sluggish cognitive tempo in school-age children with attention deficit and hyperactivity disorder

Sluggish cognitive tempo (SCT) is considered as a cognitive-emotional style. Theory of mind (ToM) skills form the basis of human cognition and social behavior. The aim of this study is to contribute to SCT literature by examining the relationship between SCT and cognitive and affective ToM in school-age children with attention deficit and hyperactivity disorder (ADHD). Fifty school-age children with ADHD (43 boys and seven girls) and 40 typically developing children (34 boys and six girls) were assessed using Parent-rated Barkley Child Attention Scale and Child Behavior Checklist/6-18, cognitive (first- and second-order ToM) and affective ToM (Reading Mind in the Eyes Test and Unexpected Outcomes Test (UOT)) tests. Multiple linear regression analysis was performed to determine the variables that may predict SCT levels in children with ADHD. Attention deficit and hyperactivity disorder-inattention (Exp(B) = .334, p = .027), internalization (Exp(B) = .305, p = .006), and UOT scores (Exp(B) = .933, p = .015) significantly predicted SCT severity in children with ADHD. SCT severity was significantly associated with impaired cognitive ToM skills as measured by second-order ToM (Exp(B) = 1.933, p = .045). Our findings may indicate that affective ToM developing with age, and impaired cognitive ToM skills are associated with increasing SCT severity.

Divergent mentalization types in adolescent borderline personality disorder and attention deficit/hyperactivity disorder

BACKGROUND

Attention deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have several similarities and it is difficult to distinguish these disorders in adolescents. We aimed to identify the unique correlates of mentalization abilities that may distinguish these two disorders, and to investigate the mentalization abilities of adolescents with ADHD, BPD and ADHD + BPD in an inpatient sample to determine the effect of co-morbidity on mentalization abilities.

METHODS

We have explored the relationship between Child Eye Test (CET) scores, Movie for the Assessment of Social Cognition (MASC) subscales, and ADHD and BPD symptoms in adolescent inpatients. In addition, we compared ADHD, BPD and ADHD + BPD groups in terms of their mentalization abilities.

RESULTS

Correct MASC scores were negatively associated with both ADHD and BPD symptoms in girls, and negatively associated with ADHD symptoms in boys. In addition, hypermentalization scores were associated with BPD symptoms in girls, and hypomentalization and no mentalization scores were associated with ADHD symptoms in girls. CET scores were negatively associated with ADHD symptoms in girls, but no relations with BPD were found. Group comparisons revealed no significant difference among groups.

LIMITATIONS

We included only inpatient sample without considering their medication condition, we did not compare the mentalization scores of the patient groups with healthy controls and we used self-report measures for several assessments.

CONCLUSION

Mentalization patterns in ADHD and BPD are distinct. ADHD may be related to hypomentalization, instead, BPD may be related to hypermentalization.

Deficits in Working Memory and Theory of Mind May Underlie Difficulties in Social Perception of Children with ADHD

Children with attention deficit hyperactivity disorder (ADHD) are prone to peer rejection and disliking due to difficulties in social perception and interaction. To address social perception impairments in ADHD, we examined children with ADHD in a noisy biological motion (BM) direction discrimination paradigm in association with sociocognitive factors including emotion regulation, theory of mind (TOM), and working memory compared to healthy controls. Our results showed that children with ADHD were poorer in discriminating BM direction in noisy environments (F (1, 36) = 4.655, p=0.038). Moreover, a significant correlation was found between working memory and TOM with BM discrimination in an ADHD group (r = 0.442, p=0.01, and r = 0.403, p=0.05, respectively). Our findings could suggest that social perception in noisy scenarios may be affected by memory and social cognitive abilities of children with ADHD.

The association between symptom severity and theory of mind impairment in children with attention deficit/hyperactivity disorder

The aim was to investigate the correlation between ADHD symptom severity and impairments in "theory of mind" (ToM) and empathy, and the improvement in these functions following the administration of methylphenidate (MPH). Fifty children aged 6-12 years with ADHD participated in the study. Symptom severity was assessed using the Swanson, Nolan and Pelham Questionnaire-IV (SNAP-IV). ToM performance was assessed using the "ToM test" and the "Faux-Pas Recognition Test". A significant negative correlation was found between the SNAP-IV Conners index, the oppositional and deportment subscales, and ToM test scores. MPH administration improved ToM scores in a magnitude that was negatively correlated with baseline performance. Additionally, Children with more severe behavioral problems showed greater improvement in ToM following administration of MPH. We conclude that severity of ADHD symptoms, most notably behavioral symptoms, is correlated with deficits in ToM. Administration of MPH improves ToM performance, with the greatest improvement occurring in children with more severe behavioral symptoms.

Language Can Obscure as Well as Facilitate Apparent-Theory of Mind Performance: Part 2-The Case of Dyslexia in Adulthood

Many studies imply causal links between linguistic competencies and Theory of Mind (ToM). But despite Dyslexia being a prime example of linguistic deficits, studies on whether it is related to ToM have been relatively unforthcoming. In the first of 2 studies (N = 89), independently-diagnosed dyslexic adults and non-dyslexic adults were presented with false-belief vignettes via computer, answering 4 types of question (Factual, Inference, 1st-order ToM & 2nd-order ToM). Dyslexia related to lower false-belief scores. Study 2 (N = 93) replicated this result with a non-computer-based variant on the false-belief task. We considered the possibility that the apparent-issue with ToM is caused by processing demands more associated to domains of cognition such as language, than to ToM itself. Addressing this possibility, study 2 additionally utilised the ToM30Q questionnaire, designed largely to circumvent issues related to language and memory. Principal-Components analysis extracted 4 factors, 2 capturing perceptual/representational ToM, and the other 2 capturing affective components related to ToM. The ToM30Q was validated via its associations to a published measure of empathy, replication of the female gender advantage over males, and for one factor from the ToM30Q there was a correlation with an existing published index of ToM. However, when we considered the performance of dyslexic and non-dyslexic participants using the ToM30Q, we found absolutely no difference between them. The contrasting findings from our 2 studies here, arguably offer the first experimental evidence with adults, that there is in fact no ToM deficit in dyslexia. Additionally, this finding raises the possibility that some other groups considered in some sense atypical, failed ToM tasks, not because they actually have a ToM deficit at all, but rather because they are asked to reveal their ToM competence through cognitive domains, such as language and memory.

What's the Link Between Theory of Mind and Other Cognitive Abilities - A Co-twin Control Design of Neurodevelopmental Disorders

Theory of mind (ToM), or the ability to attribute mental states to oneself and others, is a core element of social cognition (SC). Even though its importance for social functioning in general, and neurodevelopmental disorders (NDDs), in particular, is well established, the links between ToM and other cognitive functions are not. Especially the familial underpinnings of such links remain unclear. Using a co-twin control design, we examined N = 311 twins (mean age M = 17.19 years, 47% females) diagnosed with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), other NDDs, or typically developing individuals. We used the Reading the Mind in the Eyes Test to operationalize ToM, the Fragmented Pictures Test for central coherence (CC), the Tower Test for executive functioning (EF), and the general ability index in the Wechsler Intelligence Scales for IQ. In the linear regressions, weak CC and a lower IQ were associated with a reduced ToM ability across pairs. Female sex and higher age were robustly associated with increased ToM ability, whereas EF was not associated with ToM. In the within-pair analyses, where unmeasured familial confounders are implicitly adjusted, the associations between ToM and other cognitive functions, were attenuated and the association with CC was non-significant. The result suggests that familial factors shared by the twins, such as genetic and shared environment, influence the association between CC, IQ, and ToM. Future studies need to include a larger sample of monozygotic twins, who are genetically identical, in order to draw more firm conclusions regarding the influence of familial factors, and to differentiate between shared environmental and genetic effects on the associations between cognitive functions.

Attentional networks, vigilance, and distraction as a function of attention-deficit/hyperactivity disorder symptoms in an adult community sample

Attentional difficulties are a core axis in attention-deficit/hyperactivity disorder (ADHD). However, establishing a consistent and detailed pattern of these neurocognitive alterations has not been an easy endeavour. Based on a dimensional approach to ADHD, the present study aims at comprehensively characterizing three key attentional domains: the three attentional networks (alerting, orienting, and executive attention), two components of vigilance (executive and arousal vigilance), and distraction. To do so, we modified a single, fine-grained task (the ANTI-Vea) by adding irrelevant distractors. One hundred and twenty undergraduates completed three self-reports of ADHD symptoms in childhood and adulthood and performed the ANTI-Vea. Despite the low reliability of some ANTI-Vea indexes, the task worked successfully. While ADHD symptoms in childhood were related to alerting network and arousal vigilance, symptoms in adulthood were linked to executive vigilance. No association between ADHD symptom severity and executive attention and distraction was found. In general, our hypotheses about the relationships between ADHD symptoms and attentional processes were partially supported. We discuss our findings according to ADHD theories and attention measurement.

Children's Pronoun Interpretation Problems Are Related to Theory of Mind and Inhibition, But Not Working Memory

In several languages, including English and Dutch, children’s acquisition of the interpretation of object pronouns (e.g., him) is delayed compared to that of reflexives (e.g., himself). Various syntactic and pragmatic explanations have been proposed to account for this delay in children’s acquisition of pronoun interpretation. This study aims to provide more insight into this delay by investigating potential cognitive mechanisms underlying this delay. Dutch-speaking children between 6 and 12 years old with autism spectrum disorder (ASD; n = 47), attention-deficit/hyperactivity disorder (ADHD; n = 36) or typical development (TD; n = 38) were tested on their interpretation and production of object pronouns and reflexives and on theory of mind, working memory, and response inhibition. It was found that all three groups of children had difficulty with pronoun interpretation and that their performance on pronoun interpretation was associated with theory of mind and inhibition. These findings support an explanation of object pronoun interpretation in terms of perspective taking, according to which listeners need to consider the speaker’s perspective in order to block coreference between the object pronoun and the subject of the same sentence. Unlike what is predicted by alternative theoretical accounts, performance on pronoun interpretation was not associated with working memory, and the children made virtually no errors in their production of object pronouns. As the difficulties with pronoun interpretation were similar for children with ASD, children with ADHD and typically developing children, this suggests that certain types of perspective taking are unaffected in children with ASD and ADHD.

Caudate and cerebellar involvement in altered P2 and P3 components of GO/NoGO evoked potentials in children with attention-deficit/hyperactivity disorder

Previous studies showed reduced activity of the anterior cingulate cortex (ACC) and supplementary motor area during inhibition in children with attention-deficit/hyperactivity disorder (ADHD). This study aimed to investigate deep brain generators underlying alterations of evoked potential components triggered by visual GO/NoGO tasks in children with ADHD compared with typically developing children (TDC). Standardized weighted low-resolution electromagnetic tomography (swLORETA) source analysis showed that lower GO-P3 component in children with ADHD was explained not only by a reduced contribution of the frontal areas but also by a stronger contribution of the anterior part of the caudate nucleus in these children compared with TDC. While the reduction of the NoGO-P3 component in children with ADHD was essentially explained by a reduced contribution of the dorsal ACC, the higher NoGO-P2 amplitude in these children was concomitant to the reduced contribution of the dorsolateral prefrontal cortex, the insula, and the cerebellum. These data corroborate previous findings showed by fMRI studies and offered insight relative to the precise time-related contribution of the caudate nucleus and the cerebellum during the automatic feature of inhibition processes in children with ADHD. These results were discussed regarding the involvement of the fronto-basal ganglia and fronto-cerebellum networks in inhibition and attention alterations in ADHD.

Social Cognition in Children With ADHD

Objective: Despite evidence of social skill deficits in children with ADHD, there is no consensus regarding a social cognitive profile and whether these skills predict behavior. Therefore, a comprehensive battery was used to investigate the relationship between social cognition and behavioral functioning. Method: Children ages 7 to 13 with ADHD (n = 25) and controls (n = 25) completed tests assessing social cognitive domains (affect recognition and theory of mind [ToM]). Parents completed measures of social cognition (pragmatic language ability and empathy), behavioral symptoms, and adaptive functioning. Results: Children with ADHD performed significantly worse on measures of cognitive ToM and affect recognition and received lower ratings of pragmatic language and cognitive empathy than typically developing peers. These domains, particularly pragmatic language, predicted parent ratings of problematic and adaptive behaviors. Conclusion: Results establish a relationship between specific social cognitive abilities and daily functioning, which has implications for treatment.

The Relationship between the Theory of Mind Skills and Disorder Severity among Adolescents with ADHD

Objective

This study aimed to examine the sub-dimensions of the theory of mind (ToM) and to investigate the relationship between ToM skills and disorder severity by comparing adolescents with attention-deficit hyperactive disorder (ADHD) with healthy individuals.

Methods

The study included 42 adolescents with ADHD and education- and age-matched 41 healthy volunteers. The Smarties test, ice cream truck test, faux pas recognition test, and eyes test were applied to all participants. Turgay Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-IV)-Based Child and Adolescent Disruptive Behavioral Disorders Screening and Rating Scale (T-DSM-IV-S) was applied to the group with ADHD to measure the disorder severity.

Results

The group with ADHD was seen to have ToM skills impairment. There was a statistically significant difference between the groups in terms of the ice cream truck test, faux pas recognition test, and eyes test. A significant correlation was observed between the T-DSM-IV-S results and the eyes test results of the patients.

Conclusion

This study has shown that advanced ToM skills can be impaired in adolescents with ADHD and that impairment in skills is associated with disorder severity.

A Further Look at Reading the Mind in the Eyes-Child Version: Association With Fluid Intelligence, Receptive Language, and Intergenerational Transmission in Typically Developing School-Aged Children

A number of tasks have been developed to measure the affective theory of mind (ToM), nevertheless, recent studies found that different affective ToM tasks do not correlate with each other, suggesting that further studies on affective ToM and its measurement are needed. More in-depth knowledge of the tools that are available to assess affective ToM is needed to decide which should be used in research and in clinical practice, and how to interpret results. The current study focuses on the Reading the Mind in the Eyes Test (RMET) primarily to investigate in a sample of 112 children the currently unexplored relationships in middle childhood between performance on the RMET and fluid intelligence. Relationships with receptive vocabulary, age, and sex were also investigated. Moreover, because studying the family's influence on children mentalization could have important implications in developing prevention and treatment interventions, this study offers a novel contribution to the field by exploring the family's influence on children's RMET performance. Although significant positive correlations were found among RMET-C performance, fluid intelligence, and receptive language, regression analysis revealed that fluid intelligence was the only predictor. No family influence was found on children's RMET performance. On the whole, results from the current study offer some support to the hypothesis that RMET-C is not a “pure” ToM task, specifically the effect of fluid intelligence on RMET performance should be taken into account when RMET is used both in research and in the clinical setting.

Theory of Mind in ADHD. A Proposal to Improve Working Memory through the Stimulation of the Theory of Mind

The aim of this study was to investigate the relationships between Theory of Mind (ToM), Working Memory (WM), and Verbal Comprehension (VC). Performance of these variables was evaluated in 44 elementary students (6-12 years) diagnosed with ADHD. Their performance in all variables was collected through the Neuropsychological Battery (NEPSY-II) and the Wechsler Intelligence Scale for Children IV. The results showed that fifty percent of the participants were below the 25th percentile in ToM and that this low performance was not related to age. In addition, analyses showed statistically significant relationships between WM, VC, and ToM. Analysis of the effect of WM and VC on ToM showed that only WM explained the variance in participant performance in ToM. These results led us to raise the need to include ToM among the skills to be stimulated in programs for the treatment of ADHD, accompanying other skills related to social adaptation that are usually included in such programs. Likewise, considering that ToM implies putting into practice skills such as considering different points of view, attending to relevant aspects of the context, making decisions, inferring mental states, and predicting behaviors, we believe that through the stimulation of ToM, WM would also be stimulated.

Neural Correlates of Theory of Mind in Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and the Comorbid Condition

Theory of mind (ToM) or mentalizing difficulties is reported in attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), but the mechanism underpinning these apparently shared deficits is relatively unknown. Eighty-three young adult males, 19 with ASD alone, 21 with ADHD alone, 18 with dual diagnosis of ASD and ADHD, and 25 typically developing (TD) controls completed the functional magnetic resonance imaging version of the Frith-Happé animated-triangle ToM task. We compared neural function during ToM with two non-ToM conditions, random and goal directed motions, using whole-brain and region-of-interest analysis of brain activation and functional connectivity analyses. The groups showed comparable ToM task performance. All three clinical groups lacked local connectivity increase shown by TD controls during ToM in the right temporoparietal cortex, a key mentalizing region, with a differentially increased activation pattern in both ASD and comorbid groups relative to ADHD. Both ASD groups also showed reduced connectivity between right inferior lateral prefrontal and posterior cingulate cortices that could reflect an atypical information transmission to the mentalizing network. In contrast, with mentalizing both ADHD groups showed decreasing connectivity between the medial prefrontal and left temporoparietal cortices when compared to TD controls. Therefore, despite the complex pattern of atypical brain function underpinning ToM across the three disorders, some neurofunctional abnormalities during ToM are associated with ASD and appeared differentiable from those associated with ADHD, with the comorbid group displaying combined abnormalities found in each condition.

Aberrant posterior superior temporal sulcus functional connectivity and executive dysfunction in adolescents with internet gaming disorder

BACKGROUND AND AIMS

The clinical significance of Internet gaming disorder (IGD) is spreading worldwide, but its underlying neural mechanism still remains unclear. Moreover, the prevalence of IGD seems to be the highest in adolescents whose brains are in development. This study investigated the functional connectivity between large-scale intrinsic networks including default mode network, executive control network, and salience network. We hypothesized that adolescents with IGD would demonstrate different functional connectivity patterns among large-scale intrinsic networks, implying neurodevelopmental alterations, which might be associated with executive dysfunction.

METHODS

This study included 17 male adolescents with Internet gaming disorder, and 18 age-matched male adolescents as healthy controls. Functional connectivity was examined using seed-to-voxel analysis and seed-to-seed analysis, with the nodes of large-scale intrinsic networks used as region of interests. Group independent component analysis was performed to investigate spatially independent network.

RESULTS

We identified aberrant functional connectivity of salience network and default mode network with the left posterior superior temporal sulcus (pSTS) in adolescents with IGD. Furthermore, functional connectivity between salience network and pSTS correlated with proneness to Internet addiction and self-reported cognitive problems. Independent component analysis revealed that pSTS was involved in social brain network.

DISCUSSION AND CONCLUSIONS

The results imply that aberrant functional connectivity of social brain network with default mode network and salience network was identified in IGD that may be associated with executive dysfunction. Our results suggest that inordinate social stimuli during excessive online gaming leads to altered connections among large-scale networks during neurodevelopment of adolescents.

Associations between theory of mind and conduct problems in autistic and nonautistic youth

Many autistic young people exhibit co-occurring behavior difficulties, characterized by conduct problems and oppositional behavior. However, the causes of these co-occurring difficulties are not well understood. Impairments in theory of mind (ToM) are often reported in autistic individuals and have been linked to conduct problems in nonautistic individuals. Whether an association between ToM ability and conduct problems exists in autistic populations, whether this association is similar between individuals who are autistic versus nonautistic, and whether these associations are specific to conduct problems (as opposed to other domains of psychopathology) remains unclear. ToM ability was assessed using the Frith-Happé Triangles task in a pooled sample of autistic (N = 128; mean age 14.78 years) and nonautistic youth (N = 50; mean age 15.48 years), along with parent-rated psychiatric symptoms of conduct problems, hyperactivity/inattention and emotional problems. Analyses tested ToM ability between autistic versus nonautistic participants, and compared associations between ToM performance and conduct problems between the two groups. Where no significant group differences in associations were found, the pooled association between ToM and conduct problems was estimated in the combined sample. Results showed no evidence of moderation in associations by diagnostic status, and an association between poorer ToM ability and higher levels of conduct problems, hyperactivity/inattention and emotional problems across the total sample. However, these associations became nonsignificant when adjusting for verbal IQ. Results provide support for theoretical models of co-occurring psychopathology in autistic populations, and suggest targets for intervention for conduct problems in autistic youth. LAY SUMMARY: Many young people with autism spectrum disorder show co-occurring behavior problems, but the causes of these are not well understood. This paper found an association between difficulties recognizing what others think and intend (so-called "theory of mind") in a simple animated task, and emotional and behavioral problems in autistic and nonautistic young people. However, a substantial part of this association was explained by individual differences in verbal ability. These findings may have implications for intervention efforts to improve young people's mental health.

Exploring mentalization, trust, communication quality, and alienation in adolescents

INTRODUCTION

A growing body of evidence has demonstrated the importance of mentalization for adolescents' psychosocial functioning; however, further research is needed to understand links between mentalization and other socio-cognitive factors. The aim of this quantitative, cross-sectional study was to investigate the relationship between a teen's capacity to mentalize and three attachment-related factors: parent-teen trust, parent-teen communication, and parent-teen alienation.

METHODS

In an online survey, 82 (mainly) Australian adolescents (57 female; 23 male; 2 non-binary; mean age 17.09 years) completed: i) The Children's Eyes Test, which measured mentalization; and ii) The Inventory of Parent and Peer Attachment-45, which measured trust, communication quality, and alienation.

RESULTS

In teens' relationships with both mothers and fathers, trust and communication quality were significantly positively correlated (p = .001) when controlling for age and gender. Both were significantly negatively correlated with alienation (p = .001) with control variables included. Capacity to mentalize did not correlate with trust, communication quality, or alienation in relationships with either mothers or fathers (p ≤ .05).

CONCLUSIONS

Possible reasons are proposed for why no relationship was found between mentalization and trust, communication quality, or alienation. Implications for future research are discussed.

Spontaneous theory of mind in adults with attention-deficit/hyperactivity disorder

Spontaneous theory of mind (ToM) is an unconscious and automatic understanding of others' mental states. Recently, individuals with attention-deficit hyperactivity disorder (ADHD) have been shown to have social and communication difficulties, and ToM in ADHD has come under scrutiny. Although some studies have employed explicit ToM tasks to this end with contradictory results, none, to our knowledge, has investigated spontaneous ToM in individuals with ADHD. Therefore, we performed this study to examine implicit mentalizing in adults with ADHD using the anticipatory-looking paradigm designed by Senju et al. (2009) with a sample of 24 adults with ADHD and 18 neurotypical adults. The total fixation times to three areas of interest, i.e., the actor and the false-belief congruent and incongruent sides of the scene were measured. We found that neither group showed looking bias toward either the false-belief congruent or incongruent side. We interpret that this similar gaze pattern and the absence of looking bias to the false-belief incongruent side in both groups is indicative of intact implicit ToM in adults with ADHD. Adults with ADHD looked significantly less at the actor than did neurotypical individuals, possibly due to inattention and further experimental modifications should be considered.

Executive function deficits contribute to poor theory of mind abilities in adults with ADHD

Introduction: Studies exploring the theory of mind (ToM) in adults with Attention/Deficit Hyperactivity Disorder (ADHD), have tended to result in mixed findings. The contribution of neuropsychologic functions to ToM has not been investigated yet in adults with ADHD. The aim of this study was to investigate ToM abilities and the role of attention and executive functions in ToM of adults with ADHD.Methods: This study was conducted in Bakirkoy Training and Research Hospital. Forty adults with ADHD and 40 healthy controls were administered a sociodemographic data form, and scales. Both groups were also assessed by Reading Mind From the Eyes Test (RMET), Trail Making Test (TMT) Part A-B and Continuous Performance Test (CPT).Results: ToM was significantly impaired in adults with ADHD relative to controls (23.50 ± 3.44 and 26.25 ± 1.67, t(77) = 4.543, p = 0.003). Adults with ADHD performed worse on TMT Part B (76.02 ± 51.47 and 46.39 ± 18.33 seconds, t(78) = -3.429, p < 0.001), and CPT than the controls (46.20 ± 8.09 and 52.00 ± 3.56, t(78) = 4.145, p < 0.001). A significant regression equation was found: F (1,38) = 6.494, β = -0.382, p < 0.05 with an R² of 0.146.Conclusion: Our findings suggest that adults with ADHD demonstrated social cognition difficulties and executive function deficits contributed to poor ToM abilities in ADHD.

Poor performance of the 'child Reading the Mind in the Eyes Test' correlates with poorer social-emotional functioning in children with attention-deficit/hyperactivity disorder

The performance of the 'child Reading the Mind in the Eyes Test' (cRMET), a measure of Theory of Mind (ToM), was assessed in children with attention-deficit/hyperactivity disorder (ADHD) with relation to social-emotional functioning and ADHD severity. The impact of a single dose of methylphenidate on cRMET performance was evaluated. A group of 25 children aged 7-17 years diagnosed with ADHD were assessed at baseline by cRMET, the Strengths and Difficulties Questionnaire (SDQ) and the ADHD-rating scale. cRMET assessment was repeated after administration of a single dose of methylphenidate. Significant correlation was found between the age of the participant and baseline cRMET levels (r = 0.56; P = 0.0037). Significant correlation was found between poorer cRMET performance and worse socioemotional functioning, as reflected by higher baseline SDQ scores (r = -0.39, P = 0.048). No significant correlations were found at baseline between cRMET scores and ADHD severity. No significant improvement in cRMET was detected following administration of a single methylphenidate dose. Poor baseline ToM functioning is associated with lower social-emotional functioning. The ToM functioning improves with age in children with ADHD, but is not affected by a single methylphenidate administration.