Processing False Beliefs in Preschool Children and Adults: Developing a Set of Custom Tasks to Test the Theory of Mind in Neuroimaging and Behavioral Research

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.

Unveiling the neural dynamics of the theory of mind: a fMRI study on belief processing phases

Theory of mind (ToM), the ability to interpret others' behaviors in terms of mental states, has been extensively studied through the False-Belief Task (FBT). However, limited research exists regarding the distinction between different phases of FBT, suggesting that they are subserved by separate neural mechanisms. Further inquiry into this matter seems crucial for deepening our knowledge of the neurocognitive basis of mental-state processing. Therefore, we employed functional Magnetic Resonance Imaging (fMRI) to examine neural responses and functional connectivity within the core network for ToM across phases of the FBT, which was administered to 61 healthy adults during scanning. The region-of-interest analysis revealed heightened responses of the temporoparietal junction (TPJ) during and increased activation of medial prefrontal cortex (mPFC) during the outcome phase. Negative connectivity between these regions was observed during belief-formation. Unlike the TPJ, mPFC responded similarly to conditions that require belief reasoning and to control conditions that do not entail tracking mental states. Our results indicate a functional dissociation within the core network for ToM. While the TPJ is possibly engaged in coding beliefs, the mPFC shows no such specificity. These findings advance our understanding of the unique roles of the TPJ and mPFC in mental-state processing.

Executive functions and theory of mind development in preschoolers: Insights from NIRS data

Numerous studies have highlighted the importance of executive functions (EFs) in the development of Theory of Mind (ToM) in preschoolers. However, research focusing on young children at the neural level has been limited. This study examined the relationship between EFs and ToM in twenty-nine healthy Japanese preschoolers aged 5-7 years, focusing on neural responses during EF and ToM tasks using near-infrared spectroscopy (NIRS) to monitor prefrontal cortex (PFC) activity. The study utilized EF tasks and the Sally-Anne scenario to assess false- and true-belief understanding, aiming to provide a comprehensive analysis of ToM capabilities. Results indicated that despite advanced EF capabilities and a ceiling effect across all EF tasks, there were no significant correlations between EF performance or verbal ability and ToM task performance. NIRS data revealed no PFC activation during the Stroop task. However, activation was observed in the left and right lateral PFC in the control false belief condition, the left lateral PFC in the false belief condition, and across all PFC regions in the true belief condition during ToM tasks. Significant relationships were found between behavioral performance in ToM tasks and neural activity in key brain regions. The study also identified a complex relationship between false and true belief reasoning, suggesting a nuanced developmental trajectory for ToM. These findings underscore the crucial role of early childhood in the development of ToM and the complex interplay between cognitive functions and neural efficiency in understanding others' mental states.

How does teaching experience impact brain processes underlying the theory of mind? Study on primary school educators

Despite its importance for daily social interactions, few studies have explored interindividual differences in the Theory of Mind (ToM) abilities of healthy adults. We used Children's False-Attribution (CFA), Children's False-Beliefs (CFB), and Belief-Desire Reasoning tasks, along with fMRI-based assessments, in a comparative analysis of ToM among primary school teachers (PST; n = 27), skilled in social interactions with children, and matched controls (MC; n = 24), who lacked such experience. PST demonstrated slower reaction times than MC in Adult and Child false-belief stories of CFB. However, no other behavioral differences between the groups and between-group differences were observed at the brain level. Both groups presented similar valence ratings for stories in the CFA. Notably, fMRI analysis revealed a group-by-condition interaction effect in the right lateral orbitofrontal cortex (OFC). In PSTs, OFC activation decreased during negative false-attribution stories regarding children compared to stories related to adults, whereas MC demonstrated an opposite activation pattern. Between-group differences in right lateral OFC activity possibly signify a neural efficiency effect secondary to frequent social interactions of PSTs, unlike the MCs, with children in the working environment. These results underscore the significance of everyday social experiences in the functional plasticity of ToM networks.

The Neural Bases of Language Processing During Social and Non-Social Contexts: A fNIRS Study of Autistic and Neurotypical Preschool-Aged Children

Background

Little is known about how the brains of autistic children process language during real-world "social contexts," despite the fact that challenges with language, communication, and social interaction are core features of Autism Spectrum Disorder (ASD).

Methods

We investigated the neural bases of language processing during social and non-social contexts in a sample of N=20 autistic and N=20 neurotypical (NT) preschool-aged children, 3 to 6 years old. Functional near-infrared spectroscopy (fNIRS) was used to measure children's brain response to "live language" spoken by a live experimenter during an in-person social context (i.e., book reading), and "recorded language" played via an audio recording during a non-social context (i.e., screen time). We examined within-group and between-group differences in the strength and localization of brain response to live language and recorded language, as well as correlations between children's brain response and language skills measured by the Preschool Language Scales.

Results

In the NT group, brain response to live language was greater than brain response to recorded language in the right temporal parietal junction (TPJ). In the ASD group, the strength of brain response did not differ between conditions. The ASD group showed greater brain response to recorded language than the NT group in the right inferior and middle frontal gyrus (IMFG). Across groups, children's language skills were negatively associated with brain response to recorded language in the right IMFG, suggesting that processing recorded language required more cognitive effort for children with lower language skills. Children's language skills were also positively associated with the difference in brain response between conditions in the right TPJ, demonstrating that children who showed a greater difference in brain response to live language versus recorded language had higher language skills.

Limitations

Findings should be considered preliminary until they are replicated in a larger sample.

Conclusions

Findings suggest that the brains of NT children, but not autistic children, process language differently during social and non-social contexts. Individual differences in how the brain processes language during social and non-social contexts may help to explain why language skills are so variable across children with and without autism.

Theory of Mind and Parental Mental-State Talk in Children with CIs

Previous studies have suggested that parents may support the development of theory of mind (ToM) in their child by talking about mental states (mental state talk; MST). However, MST has not been sufficiently explored in deaf children with cochlear implants (CIs). This study investigated ToM and availability of parental MST in deaf children with CIs (n = 39, Mage = 62.92, SD = 15.23) in comparison with their peers with typical hearing (TH; n = 52, Mage = 52.48, SD = 1.07). MST was measured during shared storybook reading. Parents' narratives were coded for cognitive, emotional, literal, and non-mental references. ToM was measured with a parental questionnaire. Children with CIs had lower ToM scores than their peers with TH, and their parents used more literal references during shared storybook reading. There were no significant differences in the frequencies of cognitive and emotional references between groups. Parental emotional references contributed positively to children's ToM scores when controlling for the child's age and receptive grammar only in the CI group. These results indicated some distinctive features in parents of deaf children with CIs' MST and highlighted the role of MST in the development of ToM abilities in this group.

Relational vs representational social cognitive processing: a coordinate-based meta-analysis of neuroimaging data

The neurocognitive bases of social cognition have been framed in terms of representing others' actions through the mirror system and their mental states via the mentalizing network. Alongside representing another person's actions or mental states, however, social cognitive processing is also shaped by their (mis)match with one's own corresponding states. Here, we addressed the distinction between representing others' states through the action observation or mentalizing networks (i.e. representational processing) and detecting the extent to which such states align with one's own ones (i.e. relational processing, mediated by social conflict). We took a meta-analytic approach to unveil the neural bases of both relational and representational processing by focusing on previously reported brain activations from functional magnetic resonance imaging studies using false-belief and action observation tasks. Our findings suggest that relational processing for belief and action states involves, respectively, the left and right temporo-parietal junction, likely contributing to self-other differentiation. Moreover, distinct sectors of the posterior fronto-medial cortex support social conflict processing for belief and action, possibly through the inhibition of conflictual representations. These data might pave the way for further studies addressing social conflict as an important component of normal and pathological processing, and inform the design of rehabilitative treatments for social deficits.

False Belief Understanding in Deaf Children With Cochlear Implants

Theory of mind (ToM) is crucial for social interactions. Previous research has indicated that deaf and hard-of-hearing children born into hearing families (DoH) are at risk of delayed ToM development. However, it is unclear whether this is the case for DoH children who receive cochlear implants (CIs) before and around the second year of life. The present study aimed to investigate false belief understanding (FBU) in DoH children with CIs. The relationships between false belief task (FBT) performance, sentence comprehension, age at implantation, duration of CI use, and Speech Recognition Threshold were explored. A total of 94 children with typical levels of hearing (TH) and 45 DoH children (age range: 3-8), who received their first CI between 6 and 27 months of age, were tested on the FBT and a sentence comprehension test. Results showed that 4- and 5-year-old children with CIs performed significantly worse than their peers with TH on the FBT; 6- to 8-year-old children with CIs performed similarly to age-matched children with TH. Age at implantation and duration of CI use were correlated with sentence comprehension but not with the FBT. The results indicated that FBU was delayed until the age of 6 years in most of children with CIs.