Reliability of Theory of Mind Tasks in Schizophrenia, ASD, and Nonclinical Populations: A Systematic Review and Reliability Generalization Meta-analysis.

Though theory of mind (ToM) is an important area of study for different disciplines, however, the psychometric evaluations of ToM tasks have yielded inconsistent results across studies and populations, raising the concerns about the accuracy, consistency, and generalizability of these tasks. This systematic review and meta-analysis examined the psychometric reliability of 27 distinct ToM tasks across 90 studies involving 2771 schizophrenia (SZ), 690 autism spectrum disorder (ASD), and 15,599 nonclinical populations (NC). Findings revealed that while all ToM tasks exhibited satisfactory internal consistency in ASD and SZ, about half of them were not satisfactory in NC, including the commonly used Reading the Mind in the Eye Test and Hinting Task. Other than that, Reading the Mind in the Eye Test showed acceptable reliability across populations, whereas Hinting Task had poor test-retest reliability. Notably, only Faux Pas Test and Movie for the Assessment of Social Cognition had satisfactory reliability across populations albeit limited numbers of studies. However, only ten studies examined the psychometric properties of ToM tasks in ASD adults, warranting additional evaluations. The study offered practical implications for selecting ToM tasks in research and clinical settings, and underscored the importance of having a robust psychometric reliability in ToM tasks across populations.

Mentalistic attention orienting triggered by android eyes.

The eyes play a special role in human communications. Previous psychological studies have reported reflexive attention orienting in response to another individual's eyes during live interactions. Although robots are expected to collaborate with humans in various social situations, it remains unclear whether robot eyes have the potential to trigger attention orienting similarly to human eyes, specifically based on mental attribution. We investigated this issue in a series of experiments using a live gaze-cueing paradigm with an android. In Experiment 1, the non-predictive cue was the eyes and head of an android placed in front of human participants. Light-emitting diodes in the periphery served as target signals. The reaction times (RTs) required to localize the valid cued targets were faster than those for invalid cued targets for both types of cues. In Experiment 2, the gaze direction of the android eyes changed before the peripheral target lights appeared with or without barriers that made the targets non-visible, such that the android did not attend to them. The RTs were faster for validly cued targets only when there were no barriers. In Experiment 3, the targets were changed from lights to sounds, which the android could attend to even in the presence of barriers. The RTs to the target sounds were faster with valid cues, irrespective of the presence of barriers. These results suggest that android eyes may automatically induce attention orienting in humans based on mental state attribution.

Mapping the mentalizing brain: An ALE meta-analysis to differentiate the representation of social scenes and ages on theory of mind.

Theory of mind (ToM) involves understanding others' mental states and relies on brain regions like the temporoparietal junction (TPJ) and medial prefrontal cortex (mPFC). This meta-analytic review categorizes ToM studies into six sub-components across three pairs: (1) Theory of collective mind (ToCM) and individualized theory of mind (iToM), (2) Social intention ToM and private intention ToM, and (3) ToM in adults and ToM in children. We conducted coordinate-based activation likelihood estimation (ALE) analyses and meta-analytic connectivity modeling (MACM) for each sub-component. We found that the ToM components utilized in social or group situations were associated with both the dorsomedial PFC (dmPFC) and right superior temporal sulcus (STS), whereas the ToM components focused on personal concentration were associated with both the lateral PFC and the left STS. The coactivation patterns for the group and age sub-component pairs showed significant spatial overlap with the language networks. These findings indicate that ToM is a multidimensional construct that is related to distinct functional networks for processing each of the ToM sub-components.

Research on pragmatic impairment in autistic children during the past two decades (2001-2022): hot spots and frontiers-based on CiteSpace bibliometric analysis.

Pragmatic impairment has become a critical aspect of language development in autistic children and has gained significant academic attention over the past two decades. This study leverages bibliometric methods to conduct an exhaustive analysis of literature derived from Web of Science database. Utilizing CiteSpace software, we construct a knowledge map to dissect the academic hotspots in research related to pragmatic impairment in autistic children. This enables us to delineate the evolutionary trajectory of this research domain, analyze the prevailing research dimensions, and anticipate potential future dimensions. Our findings indicate that research hotspots in this field over the past two decades predominantly concentrate on assessing and diagnosing pragmatic impairment in autistic children, intervention strategies, and theory of mind. The research scope on pragmatic impairment in autistic children has progressively broadened and deepened. Research has evolved from initial descriptions and interpretations of autism to exploring the theory of mind in high-functioning, school-aged children. The current emphasis is on examining the specific skills that these children possess.

The Influence of Temperament, Theory of Mind, Inhibitory Control, and Prosocial Behavior on Child Anxiety Symptoms in the First Five Years of Life.

Anxiety disorders are among the most prevalent of all mental health disorders, often originating in early childhood and extending into later childhood, adolescence, and adulthood. Determining salient risk factors that precede their development is important for prevention and intervention efforts. Towards this end, we examined the role of temperament, theory of mind, inhibitory control, and prosocial behavior on child anxiety symptoms in the first 5 years of life. A community sample of children and their parents (N = 399) enrolled in a longitudinal study of emotion processing were assessed when the children were infants and at ages 2 years, 3 years, and 5 years. Linear mixed models and linear regression models revealed that greater anxiety at 5 years was associated with greater negative affectivity and behavioral inhibition, lower effortful control, lower theory of mind scores on the "desires" domain, and higher scores on the "intentions" domain (assessed from infancy to 3 years of age). These characteristics may be useful to assess in clinical settings to evaluate a patient's risk for developing anxiety. They may also be useful in developing interventions targeting specific vulnerabilities.

Morally-Relevant Theory of Mind is Related to Viewing Gender Inequalities as Unacceptable.

Previous research has shown that morally-relevant theory of mind enables children to avoid blaming a peer for an accidental transgression. The current study investigated whether this form of theory of mind helps children recognize that gender inequalities are unfair and create negative emotional experiences. Further, the study examined this ability across three perspectives (for themselves, for those who have been advantaged by inequality, and for those who have been disadvantaged by inequality). Participants were 141 children (M Age = 6.67 years, 49% female, 32% ethnic/racial minority) recruited from the mid-Atlantic region of the U.S. Experience with the negative consequences of gender bias and more advanced mental state understanding was associated with more negative evaluations of gender inequalities and more neutral attributions of others' emotions. These findings shed light on the role of different forms of mental state understanding in children's evaluations of inequalities based on gender.

The Effect of Social Information Processing, Self-Regulation and Metacognition on Theory of Mind: Path Analysis.

OBJECTIVES: The main purpose of the current study was to examine the effects of social information processing, self-regulation, and metacognition variables on ToM using path analysis. METHODS: For this purpose, path analysis was conducted for the model established according to the relationships between the variables. Theory of mind task battery (ToMTB), Metacognitive Knowledge Interview (McKI), Schultz Test of Emotion Processing-Preliminary Version (STEP-P), and self-regulation scale were administered to 310 children aged 3-5 years. RESULTS: The results show that social information processing (except STEP-P.P.B, one of the sub-dimensions of the STEP-P scale) has a significant effect on ToM through metacognition and self-regulation. CONCLUSIONS: In this context, it can be said that social information processing, metacognition, and self-regulation are effective in the development of ToM.

Training individuals with schizophrenia to gain volitional control of the theory of mind network with real-time fMRI: A pilot study.

Individuals diagnosed with schizophrenia spectrum disorders (SSDs) often demonstrate alterations in the Theory of Mind Network (ToM-N). Here, in this proof-of-concept, single-arm pilot study, we investigate whether participants with an SSD (N = 7) were able to learn to volitionally control regions of the ToM-N (dorso/middle/ventromedial prefrontal cortex [D/M/VMPFC], left temporoparietal junction [LTPJ], precuneus [PC], right superior temporal sulcus [RSTS], and right temporoparietal junction [RTPJ]) using real-time fMRI neurofeedback (rtfMRI-NF). Region-of-interest analyses demonstrate that after neurofeedback training, participants were able to gain volitional control in the following ToM-N brain regions during the transfer task, where no active feedback was given: right temporoparietal junction, precuneus, and dorso/ventromedial prefrontal cortex (neurofeedback effect Fs > 6.17, ps < .05). These findings suggest that trained volitional control over the ToM-N is tentatively feasible with rtfMRI neurofeedback in SSD, although findings need to be replicated with more robust designs that include a control group and larger samples.

Resting-state EEG microstates predict mentalizing ability as assessed by the Reading the Mind in the Eyes test.

Microstates analysis of electroencephalography (EEG) has gained increasing attention among researchers and clinicians as a valid tool for investigating temporal dynamics of large-scale brain networks with a millisecond time resolution. Although microstates analysis has been widely applied to elucidate the neurophysiological basis of various cognitive functions in both clinical and non-clinical samples, its application in relation to socio-affective processing has been relatively under-researched. Therefore, the main aim of the current study was to investigate the relationship between EEG microstates and mentalizing (i.e., the ability to understand the mental states of others). Eighty-two participants (thirty-six men; mean age: 24.28 ± 7.35 years; mean years of education: 15.82 ± 1.77) underwent a resting-state EEG recording and performed the Reading the Mind in the Eyes Test (RMET). The parameters of the microstates were then calculated using Cartool v. 4.09 software. Our results showed that the occurrence of microstate map C was independently and positively associated with the RMET total score and contributed to the prediction of mentalizing performance, even when controlling for potential confounding variables (i.e., age, sex, education level, tobacco and alcohol use). Since microstate C is involved in self-related processes, our findings may reflect the link between self-awareness of one's own thoughts/feelings and the enhanced ability to recognize the mental states of others at the neurophysiological level. This finding extends the functions traditionally attributed to microstate C, i.e. mind-wandering, self-related thoughts, prosociality, and emotional and interoceptive processing, to include mentalizing ability.

On the Relationship Between Alexithymia and Social Cognition: A Systematic Review.

Objective: This systematic review summarises the studies that have investigated the relationship between dimensions of social cognition (i.e., Theory of Mind - ToM, emotion recognition, and empathy) and alexithymia in the general adult non-clinical population. Method: PubMed, PsycINFO, and Scopus databases were screened, using the following strings: ("alexithymi*") AND ("theory of mind" OR "ToM"); ("alexithymi*") AND ("empath*"); ("alexithymi*") AND ("emotion recognition"); ("alexithymi*") AND ("social cognition"). Results: A total of 117 studies met the inclusion criteria and were included in this review. The total number of participants included in the reviewed studies was 40,231. Mixed results were found for alexithymia and ToM, while the relationship between emotion recognition or empathy and alexithymia was more homogeneous. Alexithymia was found to be significantly associated with both a reduced ability to recognise emotions and empathy. Conclusions: These results support the existence of significant relationships between alexithymia and altered social cognitive abilities. Future research is needed to confirm the present findings and further elucidate the complex relationship between these processes. Suggestions are made on how to overcome some of the theoretical and methodological problems in the literature.

Social cognition and healthy aging: Cross-sectional associations of emotion perception, theory of mind, and emotional empathy.

OBJECTIVE: Older adults are identified to have reduced social cognitive performance compared to younger adults. However, few studies have examined age-associations throughout later life to determine whether these reductions continue with advancing age. METHOD: This study assesses cross-sectional associations of emotion perception, cognitive and affective theory of mind (ToM), and emotional empathy in a healthy sample of 157 adults aged 50-89 years (M = 65.31, SD = 9.00, 68% female sex). Emotion perception, cognitive ToM, and affective ToM were measured using The Awareness of Social Inference Test Short Form (TASIT-S), while affective ToM was also measured using Reading the Mind in the Eyes Revised (RME-R). Emotional empathy was measured using the Empathy Quotient. RESULTS: Multiple regression analyses, adjusting for multiple comparisons, revealed a moderate negative association between age and emotion perception for all emotions combined, as well as for sad and revolted expressions, but not happy, neutral, anxious, or angry expressions. Age had a negative, moderate association with first-order cognitive, second-order cognitive, and affective ToM measured using TASIT-S, but not RME-R. Age was not significantly associated with emotional empathy. CONCLUSIONS: This study contributes to the limited understanding of age-related associations of social cognitive performance throughout later life. This knowledge can inform future research examining the clinical utility of including social cognitive measures in neuropsychological screening and diagnostic tools for later-life neurological disorders.

Differential Social Cognitive Performance in Older Adults With Mild Cognitive Impairment and Dementia.

OBJECTIVE: To study general and subdomain performance in measures of social cognition in individuals with mild cognitive impairment (MCI), and dementia, and to explore associations between social cognitive and neuropsychological subdomains. DESIGN: Cross-sectional study of participants from the Sydney Memory and Ageing Study (MAS). SETTING: Current data was collected in 2016-2018. PARTICIPANTS: Community-dwelling older adults (n=321) aged 80 years and above, with no history of neurological or psychiatric conditions. Participants had dementia, MCI, or no cognitive impairment (NCI). MEASURES: Social cognition was indexed using the Reading the Mind in the Eyes Test (RMET), the Interpersonal Reactivity Index - Perspective Taking (IRI-PT) and Empathic Concern (IRI-EC) subscales, and the Emotion Recognition Task (ERT). These subdomain scores were used to make a composite social cognition score. Apathy was measured via the Apathy Evaluation Scale (AES). Neurocognitive function was indexed using the Addenbrooke Cognitive Examination v3 (ACE-3). RESULTS: Dementia was associated with poorer overall social cognitive composite performance. MCI and dementia participants performed poorer on RMET and recognition of anger, disgust and happiness on ERT. RMET and ERT disgust remained significant after controlling for relevant covariates. Dementia participants performed poorer than MCI and NCI on the IRI-PT, IRI-EC, and AES. AES remained significant after regression. RMET was correlated with ACE-3 Fluency and/or Language in all study groups. CONCLUSIONS: MCI is associated with poorer scores in specific social cognitive assessments. Dementia is somewhat associated with poorer scores in informant-rated social cognition scales, though this is no longer significant after accounting for apathy.

Executive functions and theory of mind associations in middle childhood: Does social interaction act as a mediator?

This study explored the interplay of executive functions (EFs), social interactions, and theory of mind (ToM) in middle childhood. The first aim was to examine how specific EFs-shifting, inhibition, and working memory (WM)-predict social-perceptual and social-cognitive ToM. The second aim was to explore the potential mediating role of social interactions in the EF-ToM relationship. A total of 98 children aged 8 to 11 years completed three computerized EF tasks (task switching, flanker, and running span) and two ToM tasks (Strange Stories and Reading the Mind in the Eyes). The quality and quantity of social interactions were self-reported by using questionnaires. First, multiple regression analyses with age-adjusted scores examined how specific EFs predict ToM scores. The regression model was significant for social-cognitive ToM, but not for social-perceptual ToM. WM accuracy was the only significant, positive predictor for performance on the Strange Stories task. Second, mediation analyses assessed whether social interactions mediate this EF-ToM relationship. There were no significant mediation effects of the quality and quantity of social interactions on the relationship between WM and social-cognitive ToM. In conclusion, EFs play a significant role in explaining social-cognitive ToM variability in middle childhood. WM is relevant for understanding others' mental states, in contrast to shifting and inhibition that lacked predictive value. The results also suggest different cognitive processes associated with social-perceptual versus social-cognitive ToM in this developmental stage.

Group Coordination Catalyzes Individual and Cultural Intelligence.

A large program of research has aimed to ground large-scale cultural phenomena in processes taking place within individual minds. For example, investigating whether individual agents equipped with the right social learning strategies can enable cumulative cultural evolution given long enough time horizons. However, this approach often omits the critical group-level processes that mediate between individual agents and multi-generational societies. Here, we argue that interacting groups are a necessary and explanatory level of analysis, linking individual and collective intelligence through two characteristic feedback loops. In the first loop, more sophisticated individual-level social learning mechanisms based on Theory of Mind facilitate group-level complementarity, allowing distributed knowledge to be compositionally recombined in groups; these group-level innovations, in turn, ease the cognitive load on individuals. In the second loop, societal-level processes of cumulative culture provide groups with new cognitive technologies, including shared language and conceptual abstractions, which set in motion new group-level processes to further coordinate, recombine, and innovate. Taken together, these cycles establish group-level interaction as a dual engine of intelligence, catalyzing both individual cognition and cumulative culture.

Linking the inner and outer mental representations of the body to social cognition skills: A systematic review and meta-analysis.

An interesting interpretation of embodiment highlights the critical role of mental body representations (BR), including motor, somatosensory, and interoceptive formats, for social cognition. However, the nature of this relationship is still debated at the empirical level, with various studies arriving at different conclusions. Here, we present a systematic review and meta-analysis aimed to summarize data from 3466 participants in 21 studies to provide a more comprehensive understanding of the relationship between inner and outer BR and social cognition. We focused on two core social cognition aspects: empathy and Theory of Mind (ToM). Concerning the inner BR, our meta-analytic findings reveal a significant correlation between specific interoceptive dimensions (i.e., interoceptive sensibility and accuracy) and social cognition, which was stronger for empathy than ToM. Conversely, although further research is needed, functional BR that mainly involve the outer body processing (i.e., nonaction-oriented BR) may show positive links with ToM. These findings point to specific interactions between BR and social cognition skills, supporting multi-faceted and embodied social cognition models. However, we also identified critical knowledge gaps and highlighted the need for further investigation to deepen our theoretical understanding of these relationships and their implications for clinical practice.

Mindsets over matter: priming theory of mind improves older adults' mental state attributions about naturalistic social interactions.

OBJECTIVES: Aging is associated with declines in theory of mind - the ability to infer the mental states of others. We examined whether priming theory of mind mindsets actively (Study 1) and passively (Study 2) improved older adults' performance. METHOD: Across two studies, participants completed a novel question-and-answer theory of mind task using the television show Nathan for You® in a mindset or no mindset condition. In Study 1, participants (N = 324, 18-84 years) completed a similar task related to a different show prior to the Nathan for You task (active mindset). In Study 2, young (N = 235; MAge = 20.47) and older (N = 193, MAge = 74.48) adults made continuous ratings of awkwardness of different episodes of Nathan for You before completing the question-and-answer task (passive mindset). We also measured executive function and episodic memory. In both studies, the same tasks were performed in reverse order for the control conditions (no mindset). RESULTS: Mindsets were associated with small-to-medium increases in theory of mind performance. Cognitive ability did not explain these improvements. CONCLUSION: These findings suggest that theory of mind performance can be improved through motivation (e.g. mindsets); cognitive function (e.g. ability) does not moderate this relationship.

Characterization of the temporal stability of ToM and pain functional brain networks carry distinct developmental signatures during naturalistic viewing.

A temporally stable functional brain network pattern among coordinated brain regions is fundamental to stimulus selectivity and functional specificity during the critical period of brain development. Brain networks that are recruited in time to process internal states of others' bodies (like hunger and pain) versus internal mental states (like beliefs, desires, and emotions) of others' minds allow us to ask whether a quantitative characterization of the stability of these networks carries meaning during early development and constrain cognition in a specific way. Previous research provides critical insight into the early development of the theory-of-mind (ToM) network and its segregation from the Pain network throughout normal development using functional connectivity. However, a quantitative characterization of the temporal stability of ToM networks from early childhood to adulthood remains unexplored. In this work, reusing a large sample of children (n = 122, 3-12 years) and adults (n = 33) dataset that is available on the OpenfMRI database under the accession number ds000228, we addressed this question based on their fMRI data during a short and engaging naturalistic movie-watching task. The movie highlights the characters' bodily sensations (often pain) and mental states (beliefs, desires, emotions), and is a feasible experiment for young children. Our results tracked the change in temporal stability using an unsupervised characterization of ToM and Pain networks DFC patterns using Angular and Mahalanobis distances between dominant dynamic functional connectivity subspaces. Our findings reveal that both ToM and Pain networks exhibit lower temporal stability as early as 3-years and gradually stabilize by 5-years, which continues till adolescence and late adulthood (often sharing similarity with adult DFC stability patterns). Furthermore, we find that the temporal stability of ToM brain networks is associated with the performance of participants in the false belief task to access mentalization at an early age. Interestingly, higher temporal stability is associated with the pass group, and similarly, moderate and low temporal stability are associated with the inconsistent group and the fail group. Our findings open an avenue for applying the temporal stability of large-scale functional brain networks during cortical development to act as a biomarker for multiple developmental disorders concerning impairment and discontinuity in the neural basis of social cognition.

Social cognition, psychosocial development and well-being in galactosemia.

BACKGROUND: Classic galactosemia is a rare inherited metabolic disease with long-term complications, particularly in the psychosocial domain. Patients report a lower quality of social life, difficulties in interactions and social relationships, and a lower mental health. We hypothesised that social cognition deficits could partially explain this psychological symptomatology. Eleven adults with galactosemia and 31 control adults participated in the study. We measured social cognition skills in cognitive and affective theory of Mind, and in basic and complex emotion recognition. We explored psychosocial development and mental well-being. RESULTS: We found significant deficits on all 4 social cognition measures. Compared to controls, participants with galactosemia were impaired in the 2nd-order cognitive theory of mind, in affective theory of mind, and in basic and complex emotion recognition. Participants with galactosemia had a significant delay in their psychosexual development, but we found no delay in social development and no significant decrease in mental health. CONCLUSION: Social cognition processes seem impaired among our participants with galactosemia. We discuss the future path research may follow. More research is needed to replicate and strengthen these results and establish the links between psychosocial complications and deficits in social cognition.

THE THEORY OF MIND AND PSYCHOTIC SYMPTOMS PHENOMENOLOGY IN SUBSTANCE-INDUCED PSYCHOTIC DISORDER AND SCHIZOPHRENIA. / MADDEYE BAGLI PSIKOTIK BOZUKLUK VE SIZOFRENIDE PSIKOTIK BELIRTI FENOMENOLOJISI VE ZIHIN KURAMI.

OBJECTIVE: The study aimed to determine clinical indicators that could be used to differentiate between patients diagnosed with substance-induced psychotic disorder (SIPD) and patients diagnosed with schizophrenia by comparing their psychotic symptoms and theory of mind (ToM). METHODS: The study included 43 male patients diagnosed with schizophrenia according to DSM-5 criteria and 43 male patients diagnosed with SIPD. The patients were administered the Sociodemographic and Clinical Data Form, Scale for the Assessment of Positive Symptoms (SAPS), Scale for the Assessment of Negative Symptoms (SANS), Psychotic Symptom Evaluation Scale (PSYRATS), and Reading the Mind in the Eyes Test (RMET). RESULTS: In patients diagnosed with schizophrenia, the scores on SAPS subscales for structural thought disorder and bizarre behavior, as well as SANS total scores, were significantly higher compared to patients diagnosed with SIPD (z=2.679, p=0.007; z=2.984, p=0.003; z=6.916, p<0.001). The scores for recognizing negative and neutral expressions on the RMET were significantly higher in patients with SIPD than in patients with schizophrenia (z=3.540; p<0.001; z=4.404, p<0.001). It was found that as the scores on the SANS total and Affect Blunting or Flattening subscale, as well as the scores on the SAPS Bizarre Behavior subscale decrease, the probability of having SIPD increases. CONCLUSION: In patients diagnosed with SIPD, there are fewer disorganized and negative symptoms compared to patients diagnosed with schizophrenia. Patients with SIPD can recognize negative and neutral expressions better than patients with schizophrenia. When making a differential diagnosis between SIPD and schizophrenia, as blunting in affect, total negative symptoms, and severity of bizarre behavior decrease, the probability of being diagnosed with SIPD increases relative to the probability of being diagnosed with schizophrenia.

Validation of behavioral measures of social cognition in individuals diagnosed with schizophrenia.

Schizophrenia, a complex neuropsychiatric disorder, manifests severe impairments in social cognition, notably in Theory of Mind (ToM), empathy, and emotion recognition, which significantly influence social competence and overall functioning. These aspects are crucial for prognosis in individuals diagnosed with schizophrenia (SZ). This study validates a comics strip paradigm for ToM and empathy assessment, the Montreal Affective Voices (MAV) for measuring emotion recognition, and a Go-NoGo task for inhibition control estimation in individuals diagnosed with SZ, comparing their performance with healthy controls. SZ participants exhibited diminished abilities in the comics strip task, especially in ToM and empathy conditions, alongside challenges in identifying emotions from vocal cues in MAV. They responded slower and tended to be less accurate in the Go-NoGo task. The validated behavioral battery addresses the limitations of previous measures and emerges as a promising tool for future investigations into the neural systems underlying social cognition in schizophrenia. Such insights can lead to the development of long-needed treatment for negative symptoms and social dysfunctions in schizophrenia.