Theory of Mind Predicts Social Interaction in Children with Autism Spectrum Disorder: A Two-Year Follow-Up Study.

This two-year follow-up study examined the predictive relationships of theory of mind (ToM) to social interaction by reciprocal social behaviors (RSBs) and social functioning (SF) in 106 children with ASD. The results of the path analysis showed that the earlier ToM predicted children's current component RSBs (B = 3.53, SE = 1.86, p = 0.039) and the current SF (B = 1.79-1.87, SE = 0.03-0.34, p < 0.001). The aloof and passive social interaction styles predicted fewer turn-taking of RSBs (B = - 48.77 to - 111.17, p < 0.001) and fewer components of RSBs (B = - 36.30 to - 81.41, p < 0.001). This finding provides empirical evidence that ToM predicts social interaction in children with ASD.

Different mediators of applied theory-of-mind competence in children with autism spectrum disorder.

BACKGROUND: Children with autistic spectrum disorder (ASD) with mild and moderate symptom levels have significant differences in applied theory of mind (ToM) competence. However, their mediators of applied ToM competence have not been documented. AIMS: This study aimed to identify the mediators of applied ToM competence in these two clinically distinct groups. METHODS: A total of 163 children with ASD aged 3-12 years old (88 and 75 children respectively in the mild and moderate groups) and their caregivers participated in this study. Data of children's verbal comprehension, explicit ToM knowledge and applied ToM competence were collected and then analyzed using mediation analysis. RESULTS: The results of mediation analysis showed that verbal comprehension (95% confidence interval [CI] of indirect effect: 0.02 - 0.19) and explicit ToM knowledge (95% CI of indirect effect: 0.01 - 0.07) were the mediators of applied ToM competence in children with mild and those with moderate symptoms, respectively. CONCLUSIONS AND IMPLICATIONS: Our findings demonstrate that the mediators of applied ToM competence differ by symptom level in children with ASD. Applied ToM competence and the mediators should be assessed for designing tailored and effective intervention plans for these children according to their symptom level.

Factorial validity of the Theory of Mind Inventory-2 in children with autism spectrum disorder.

The Theory of Mind Inventory-2 appears to be a promising measure assessing children's theory of mind. However, a lack of evidence on its factorial structure interferes with score interpretation. To examine whether the currently-available structures of the Theory of Mind Inventory-2 are robust and replicable, confirmatory factor analysis was conducted in 242 children with autism spectrum disorder aged 3-12 years. Two possible structures were examined: the development-based structure, which reflects children's developmental stages of theory of mind (early, basic, and advanced), and the content-based structure, which represents children's social-related functions (emotion recognition, mental state term comprehension, and pragmatics). Four fit indices were adopted simultaneously to examine the model fit of both structures. We found that the development-based structure had a better model fit and was further modified. After modification, the development-based structure showed an improved model fit, but it was not completely acceptable in all fit indices. These findings suggest that the scores of the Theory of Mind Inventory-2 are more appropriate for reflecting children's developmental stages of theory of mind than the social-related functions in children with autism spectrum disorder. However, the domain scores should be cautiously interpreted because the model fits were not completely acceptable. For further revisions, ambiguous terms (e.g., "want" and "need") and confusing concepts assessed by the items (e.g., "recognize" and "understand") could be specified for a better representation of children's developmental stages of theory of mind. Moreover, further validations are needed. LAY SUMMARY: In children with autism spectrum disorder, the scores of the Theory of Mind Inventory-2 are more appropriate for indicating the developmental stages of theory of mind (early, basic, and advanced) than for indicating the social-related functions (emotion recognition, mental state term comprehension, and pragmatics). However, since the factorial validity was not completely acceptable, the domain scores should be interpreted cautiously. Moreover, further revisions and validations are warranted.

Cool Executive Function and Verbal Comprehension Mediate the Relation of Hot Executive Function and Theory of Mind in Children with Autism Spectrum Disorder.

Impaired executive function (EF), verbal comprehension, and theory of mind (ToM) may contribute to social difficulties in children with autism spectrum disorder (ASD). The linkage between cool (cognitive) EF and ToM has been widely investigated, but the relations between hot (affective) EF and ToM remain largely unknown. The roles of cool EF and verbal comprehension have not been previously explored together to address hot EF-ToM relations. This study applied mediation analysis to investigate the mediating effects of cool EF and verbal comprehension to further elaborate the link between hot EF and ToM in children with ASD and average intellectual abilities. A total of 97 children with ASD aged from 6 to 12 years participated in this study. Children's cool EF, hot EF, and verbal comprehension were, respectively, measured with the computerized Dimensional Change Card Sort task, Children's Gambling Task, and the verbal comprehension index of the Wechsler Intelligence Scale for Children-fourth edition. Children's ToM was assessed with the Theory of Mind Task Battery. Partial correlation coefficients indicated that hot EF was significantly related with ToM with age controlled for. The results of the mediation analysis showed that cool EF and verbal comprehension mediated the linkage between hot EF and ToM. These findings highlight not only the connections between hot EF and ToM but also the importance of cool EF and verbal comprehension on hot EF-ToM relations in clinical assessments and interventions for school-aged children with ASD and average intellectual abilities. LAY SUMMARY: Relatively few studies have investigated the hot (affective) executive function (EF)-theory of mind (ToM) relations in children with autism spectrum disorder (ASD). This study discovered that hot EF was significantly related to ToM, while cool (cognitive) EF and verbal comprehension mediated the relationship between hot EF and ToM. Therefore, the influence of cool EF and verbal comprehension on hot EF-ToM relations should be considered in studies involving children with ASD. Autism Res 2021, 14: 921-931. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

The symptoms of autism including social communication deficits and repetitive and restricted behaviors are associated with different emotional and behavioral problems.

The aim of the study was to investigate the associations between symptoms of autism and emotional and behavioral problems in children with autism spectrum disorder from both caregivers' and clinicians' perspectives. Three main findings were found in our study. First, the association patterns were similar in the preschool and school-aged children. Second, different association patterns were found from caregivers' and professionals' perspectives. From the professionals' perspective, only repetitive behaviors were associated with behavioral problems, while from the caregivers' perspective, all symptoms of autism were associated with emotional and behavioral problems. Third, different types of symptoms of autism were associated with different types of emotional and behavioral problems. For example, from the professionals' perspective, restricted and repetitive behaviors were only associated with hyperactivity and inattention. From the caregivers' perspective, social emotion was associated with emotional symptoms, and other symptoms of autism were associated with hyperactivity and inattention, as well as with peer problems. The results of our study provided deeper understanding of the relationships between symptoms of autism and emotional and behavioral problems, and the findings could serve as a reference for intervention planning when clinicians approach children with autism spectrum disorder.

Identifying the Cognitive Correlates of Reciprocity in Children with Autism Spectrum Disorder.

This study examined the cognitive correlates of reciprocity in children with autism spectrum disorder (ASD). A total of 59 children with ASD were assessed with the Interactive Drawing Task, Theory of Mind Task Battery, Children's Card Change Sort Task, and Children's Gambling Task respectively for their reciprocity, theory of mind, cool executive function (EF), and hot EF. The correlational findings revealed that cool EF (r = .482 and - .501, p < .01) and hot EF (r = .396, p < .05) were significantly correlated with children's total reciprocity. The regression models also showed that cool and hot EF abilities were significant predictors. Conclusively, cool and hot EF abilities are the correlates of reciprocity rather than of ToM in children with ASD.

Utilization and medical costs of outpatient rehabilitation among children with autism spectrum conditions in Taiwan.

BACKGROUND: We examined the utilization of rehabilitation resources among children with autism spectrum condition (ASC), a neurodevelopmental condition, in Taiwan. METHODS: We derived from the National Health Insurance Research Database of Taiwan data pertaining to 3- to 12-year-old children for the period 2008-2010. Based on diagnoses executed in accordance with the International Classification of Diseases, Ninth Revision, Clinical Modification, we classified these data into the ASC and non-ASC groups and analyzed them through multiple linear regression model, negative binomial model, independent sample t testing, and χ2 testing. RESULTS: Compared with the non-ASC group, the ASC group exhibited higher utilization of rehabilitation resources. Because hospitals are constrained by overall expenditure limits, expenditure on rehabilitation resources has plateaued, preventing any increase in the utilization of rehabilitation resources. In our ASC group, preschool-aged children significantly outnumbered (p < 0.001) school-aged children. When stratified by the hospital level, district hospitals reported the highest utilization (p < 0.001). When stratified by region, the highest utilization was in Taipei, whereas the lowest was in the East region (p < 0.001). The total annual cost, average frequency of visits, utilization of rehabilitation resources, and average cost were all affected by such elements as patient demographics, hospital type and location (p < 0.001). CONCLUSIONS: For improving treatment outcomes among children with ASC and decreasing treatment expenditure, policies that promote the timely ASC detection and treatment should be implemented.

Association Between Executing Theory of Mind in a Limited Experimental Context and Executing It in Daily Contexts in Children With Autism Spectrum Disorder: A Cross-Sectional Study.

IMPORTANCE: Theory of mind (ToM) can be divided into two constructs: capacity and performance. Although severity of autism traits and verbal comprehension have been identified as being associated with ToM capacity, no study has yet verified their role in predicting the ToM performance of children with autism spectrum disorder (ASD). OBJECTIVE: To examine the differences and associations between ToM capacity and ToM performance and to verify the role of autism traits and verbal comprehension in predicting ToM performance in children with ASD. DESIGN: Cross-sectional study. SETTING: Pediatric rehabilitation hospitals and clinics. PARTICIPANTS: One hundred four children with ASD who met the inclusion criteria. OUTCOMES AND MEASURES: We examined ToM capacity and ToM performance with the Theory of Mind Task Battery (ToMTB) and the Theory of Mind Inventory-2-Chinese version (ToMI-2-C). Severity of autism traits and verbal comprehension were assessed with the Social Responsiveness Scale, Second Edition (SRS-2), and the Verbal Comprehension Index (VCI) of either the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition or the Wechsler Intelligence Scale for Children-Fourth Edition. We conducted correlation and hierarchical regression analyses. RESULTS: Scores on the ToMI-2-C were significantly correlated with those on the ToMTB, SRS-2, and VCI (rs = .613, -.344, and .566, respectively; p < .01). CONCLUSIONS AND RELEVANCE: ToM capacity is significantly correlated with ToM performance. Both severity of autism traits and verbal comprehension played an important role in predicting ToM performance of children with ASD after controlling for ToM capacity. WHAT THIS ARTICLE ADDS: ToM capacity, severity of autism traits, and verbal comprehension were all significant predictors of ToM performance. Improving ToM capacity, severity of autism traits, and verbal comprehension of children with ASD would be beneficial to their ToM performance.

Credibility Judgment Predictors for Child Sexual Abuse Reports in Forensic Psychiatric Evaluations.

OBJECTIVE: We intended to analyze the credibility judgment in written forensic psychiatric reports of child sexual abuse registered in Southern Taiwan. METHODS: Ninety-six cases of child sexual abuse between August 2010 and October 2017 encountered in two hospitals were analyzed. The. RESULTS: in these reports were categorized into credible and non-credible. We identified the factors that distinguished between the two groups in bivariate analyses using chi-square test. A binary logistic regression analysis was performed to determine whether the factors that significantly correlated in the bivariate analyses were independent predictors of credible judgments. RESULTS: Among 96 cases, 70 (73%) were judged as credible. Consistent testimonies of children (odds ratio=40.82) and multiple abuse events (odds ratio=6.05) were positive variables independently related to the sexual abuse allegations judged as credible. CONCLUSION: The number of allegations judged as credible in this study was slightly higher than that reported in other studies. Our findings about predictors for credible cases are not in line with those reported previously. Due to the differences in resources of the cases and backgrounds of the evaluators among multiple studies, direct comparisons with previous studies must be treated with caution.

A comparison of hospital and community stay in patients who underwent compulsory admission before and after the 2007 Amendment to the Mental Health Act in Taiwan.

OBJECTIVE: The main purpose of this study was to assess the empirical findings of compulsory admission for psychiatric disorders before and after the 2007 amendment to the Mental Health Act in Taiwan. METHODS: A matched case-control study design was applied. Participants were selected using the National Health Insurance Research Database (NHIRD) in Taiwan. The control and case data were collected in 2006 and 2011, and the number of compulsory admission cases was recorded with a case-control ratio of 1:4, along with information on age (±3 years) and gender. In 2006, the number of patients recruited was 9265, including 1853 compulsorily admitted patients and 7412 voluntarily admitted patients. In 2011, the number of patients recruited was 4505, including 901 compulsorily admitted patients and 3604 voluntarily admitted patients. RESULTS: The data collected for the patients who underwent compulsory admission before and after the amended Mental Health Act included gender, diagnosis, Charlson Comorbidity Index Score (CCIS), length of stay in an acute hospital ward (days), hospital accreditation level, ownership, teaching hospital status, psychiatrist gender and age, and hospital location. Although the number of compulsory admission cases (1853 vs. 901) markedly decreased and the length of stay in an acute hospital ward (30.7 ±â€¯25.0 days vs. 39.0 ±â€¯22.6 days) increased from 2006 to 2011, the readmission rate was reduced from 52.6% in 2006 to 42.5% in 2011. CONCLUSIONS: The average lengths of hospital stay and community survival time were greater for compulsorily admitted patients than those for voluntarily admitted patients. This result might be attributed to a number of changes implemented since the 2007 amendment of the Mental Health Act, including a strict review process for compulsory admissions and a new discharge planning process, which require further research for approval.

Outpatient rehabilitation resources and medical expenditure in children with attention-deficit hyperactivity disorder in Taiwan.

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder in children. This study investigated the use of rehabilitation treatment in Taiwan. We selected children aged 3-12 years from the National Health Insurance Research Database from 2008 to 2012 and included them in the analysis. The children who received a diagnosis according to the International Classification of Diseases, Ninth Revision, Clinical Modification were divided into two groups: ADHD and non-ADHD. We used the chi-squared test, independent sample t test, and multiple regression analysis to conduct the analysis. The utilisation of rehabilitation resources was higher in the ADHD group than in the non-ADHD group. The number of school-aged children with ADHD was higher than the number of preschool-aged children (p < 0.001). The highest utilisation of rehabilitation resources was observed in clinics (p < 0.001). In terms of region, Taipei exhibited the highest utilisation of rehabilitation resources, and the East exhibited the lowest resource utilisation (p < 0.001). Prediction of the use of rehabilitation resources, average cost, average frequency of visits, and total annual cost was affected by factors such as the average frequency of rehabilitation use, demographic characteristics, and the hospital characteristics and location (p < 0.001). The number of children with ADHD and rehabilitation use are increasing yearly; however, limitations in payment restrict the growth of rehabilitation resource use in hospitals. Supplementation of rehabilitation resources at clinics accounts for more than 60%, however, the total annual cost is less than what is observed for hospitals (p < 0.001). Policies should be established to aid in the early detection and treatment of children with ADHD to improve treatment outcomes and reduce the family burden and treatment expenditure in the future.

Theory of mind predominantly associated with the quality, not quantity, of pretend play in children with autism spectrum disorder.

This study aimed to clarify the relationships between theory of mind and pretend play in children with autism spectrum disorder, using refined assessments of theory of mind and pretend play while controlling for autistic behaviors and verbal comprehension. A total of 92 children with autism spectrum disorder aged 4-10 years were enrolled. In two visits, the children were assessed with the Theory of Mind Task Battery, the Child-Initiated Pretend Play Assessment, the Childhood Autism Rating Scale, and the Verbal Comprehension Index of the Wechsler Intelligence Scales, respectively, for their theory of mind, pretend play performance, autistic behaviors, and verbal comprehension. The hierarchical regression models showed that in addition to the contributions of the autistic behaviors and verbal comprehension scores, the theory of mind scores positively predicted (p < 0.001) the elaborateness scores of pretend play in the conventional imaginative and symbolic play contexts, respectively, accounting for an additional 8.1 and 18.5% of the variance, but did not predict the scores for number of object substitutions or imitated actions. The findings demonstrate that theory of mind has a predominant role in the quality, not the quantity, of pretend play of children with autism spectrum disorder, when the children's autistic behaviors and verbal comprehension are considered. This study fills a gap in the previous literature and provides information useful for clinicians and researchers on the relationships between theory of mind and pretend play in children with autism spectrum disorder.

Children's disclosure of sexual abuse during early forensic psychiatric evaluation in Southern Taiwan.

BACKGROUND/PURPOSE: Many surveys of child sexual abuse (CSA) in Western countries focus on the victims' disclosures and their associated factors during forensic interviews, but similar data in Asian countries is scarce. We explored the disclosure rate of CSA allegations during forensic interviews in South Taiwan and the factors predicting such disclosure. We compared our findings with those of previous studies. METHODS: Data were collected from written forensic psychiatric reports of CSA victims who underwent early forensic psychiatric evaluation at two hospitals in Kaohsiung City from 2010 to 2015. All cases were divided into categories of full or nonfull disclosures. We identified the variables that distinguished between the two groups in bivariate analyses using the independent t test and the Chi-square test. Binary logistic regression analysis was done to determine whether those significant correlates in the bivariate analyses were independent predictors of full disclosure. RESULTS: Among the 55 cases, 32 (58%) were full disclosures. Older age at first interview (odds ratio=1.39), no diagnosis of mental retardation (odds ratio=0.04), and experiencing sexual abuse more than once (odds ratio=5.90) were positive factors independently related to the full disclosure of CSA allegations. CONCLUSION: The rate of disclosure under the program was comparable to that of prior studies. This may suggest a role for early forensic psychiatric evaluation of children to promote disclosure of CSA allegations. We hope the findings may serve as a basis for future studies of CSA disclosure and associated factors in Taiwanese society.

The 1999 Ji-Ji (Taiwan) earthquake as a trigger for acute myocardial infarction.

The authors evaluated the effect of stress due to the Ji-Ji, Taiwan, earthquake, which occurred at 1:47 a.m. on September 21, 1999, on the onset of acute myocardial infarction in six counties near the earthquake epicenter. The rate of hospitalization due to acute myocardial infarction increased during the 6 weeks after the earthquake, and a significantly higher number of patients were hospitalized with acute myocardial infarction during that period, compared with the same 6-week period in the previous year (99 and 65 patients, respectively). The findings suggest that extreme emotional stress due to the natural disaster, superimposed on the stress of awakening, increased the incidence of acute myocardial infarction in this population.