Does Theory of Mind Training Enhance Empathy in Autism?

Autistic and schizotypal traits exhibit similarities in their impact on mentalization and adult attachment impairments: a cross-sectional study

BACKGROUND

Deficits in mentalizing and attachment occur in the autism and schizophrenia spectrum, and their extended traits in the general population. Parental attachment and the broader social environment highly influence the development of mentalizing. Given the similarities in the symptomatology and neurodevelopmental correlates of autism spectrum disorder (ASD) and schizophrenia (SCH), it is crucial to identify their overlaps and differences to support screening, differential diagnosis, and intervention.

METHODS

This cross-sectional study utilized questionnaire data from 2203 adults (65.1% female, mean age[SD] = 37.98[9.66]), including participants diagnosed with ASD, SCH, and those exhibiting subclinical traits to investigate the associations between mentalizing, attachment, and perceived social support during adolescence across the autistic and schizotypy spectrum.

RESULTS

It was revealed that both autistic and schizotypal traits have comparable effects on insecure adult attachment, primarily through challenges in mentalizing. The impact of mentalizing deficits on adult attachment slightly varies between autistic and schizotypal traits. Conversely, perceived social support during adolescence relates to improved mentalizing and secure adult attachment as a protective factor during development.

CONCLUSIONS

These outcomes highlight the significance of supportive therapeutic relationships and community care while suggesting directions for further research and collaborative treatments addressing ASD and SCH, considering the differential impact of mentalizing on adult attachment.

No Sex-based Differences in Self-reported Empathy between Patients with Schizophrenia and Control Subjects

BACKGROUND

Schizophrenia, one of the most disabling disorders worldwide, is characterized by impaired empathy, which appears to be more common in women.

METHODS

This study aimed to compare empathy levels between control subjects and patients with schizophrenia by sex. We compared sixty-two patients with schizophrenia and 166 control subjects. All participants completed the Empathy Quotient (EQ) questionnaire. A multivariate analysis of variance model was performed with the EQ as the outcome criterion, and group and sex as fixed factors to test for interaction effects.

RESULTS

Overall, patients obtained lower scores in the cognitive, emotional reactivity and social skills domains of empathy (p < 0.001). No differences between men and women were found and no interaction effect was identified between sex and group (schizophrenia vs. control) (p > 0.05).

CONCLUSION

This study adds to the evidence on differences in social cognition between people with and without a mental illness such as schizophrenia. It also identifies the absence of sex differences between men and women, observed in both the group of patients and control subjects, which warrants further exploration.

The Moderating Effect of Sex on Autistic Trait Emotional Intelligence, Alexithymia, and Empathy

Autism spectrum disorder (ASD) is associated with differences in social communication, and these differences are related to trait emotional intelligence (TEI), alexithymia, and empathy. Autism is known to present differently in males and females, but research on sex differences in TEI, alexithymia, and empathy is largely relegated to non-autistic people. Therefore, the current research sought to explore individual relationships between autistic characteristics and TEI, alexithymia, and empathy, as well as the possible influence of sex in these relationships. In the current study, autistic and non-autistic adults reported on their autistic characteristics, TEI, alexithymia, and empathy. Based on previous research, it was hypothesized that more autistic characteristics would be associated with less TEI, more alexithymia, and less empathy, and that these relationships would be more prominent amongst males. More autistic characteristics were associated with greater challenges across the three areas of interest. However, only the relationship between TEI and autistic characteristics was moderated by sex, such that males demonstrated higher support needs related to TEI than females. Results from this analysis indicate that adults with more autistic characteristics, regardless of diagnostic status, demonstrate differences in TEI, alexithymia, and empathy. The current analysis may offer additional context to the evolving understanding of empathy and autism by suggesting that TEI and alexithymia could account for differences in empathy. Moreover, sex seems to play a role in the relationship between autistic characteristics and TEI such that differences are especially prominent for males.

Interpreting the results of explicit and applied theory of mind collectively in autistic children: A solution from Rasch analysis

LAY ABSTRACT

Theory of mind is an ability to infer others' mental states, which is a foundation for generating appropriate social responses. Theory of mind can be conceptually divided into two related but distinguishable constructs: explicit theory of mind (conceptual knowledge/information about others' mental states) and applied theory of mind (the ability to use theory of mind skills in real-life contexts). Although these two theory of mind scores can be described by the percentages of children in the early, basic, and advanced developmental stages, the resulting information may not be sufficient to determine the corresponding relationships between these two theory of mind constructs or identify children with mismatched theory of mind abilities (e.g. children who have difficulty in effectively applying their theory of mind knowledge in real-life contexts). To resolve these limitations, methods for simultaneously interpreting the relationships between the two theory of mind scores are proposed. Based on the findings, each applied theory of mind score can reflect multiple scores of explicit theory of mind. In particular, the results do not take measurement error into consideration, which would make them more ambiguous. Therefore, the scores of applied theory of mind should be interpreted carefully, given that children who have the same applied theory of mind score may actually have high or low explicit theory of mind. Regarding the method for joint interpretation, cutoff scores were selected to identify children who have mismatched theory of mind abilities (high explicit theory of mind with low applied theory of mind or low explicit theory of mind with high applied theory of mind) and determine the priority for interventions.

Remediation of theory of mind in children with autism spectrum disorders: Effectiveness and transferability of training effects to behavioral symptoms

BACKGROUND

Children with autism spectrum disorders (ASD) struggle with impaired theory of mind. We aimed to evaluate the effect of remediation of theory of mind on theory of mind, face perception, and behavioral symptoms in children with ASD.

METHODS

Thirty children with ASD were randomly assigned to two equal groups of theory of mind training and active control group. Attentive remediation of theory of mind (ARTOM) and story-telling sessions were used for intervention in the groups. Theory of mind and facial emotion recognition tests as well as Gilliam autism rating scale (GARS) were used for assessment in three baseline, post-intervention, and follow-up sessions. Repeated measures ANOVAs were used for analysis.

RESULTS

The results showed improvement in facial emotion recognition and theory of mind in intervention group. The behavioral symptoms, measured by GARS, were ameliorated in the intervention group. The training effects lasted until follow-up session.

CONCLUSIONS

The results suggest remediation of basic components of theory of mind, without direct intervention on theory of mind, improves theory of mind skill. The results also suggest that the remediation of basic components of theory of mind improves social and communicational performance and ameliorates stereotypes symptoms in children with ASD.

Language skills and interpersonal trust in adolescents with and without mental illness

PURPOSE

The primary aim was to compare adolescents with mental illness and non-clinical adolescents on vocabulary, social problem-solving, trust in parents, attachment and mentalisation. A secondary aim was to investigate whether adolescents' language skills were associated with trust in parents.

METHOD

Seventy-eight adolescents (16-18 years) participated in this cross-sectional quantitative study: a clinical sample (n = 28, M = 16.7 years, 19F) recruited from a mental health service and a non-clinical sample (n = 50, M = 17.0 years, 28F). Standardised language measures and self-report measures of trust in parents; communication quality; attachment; and mentalisation were used. Primary and secondary aims were addressed through independent samples t-tests and Pearson's correlation analyses, respectively.

RESULT

Adolescents experiencing mental illness reported significantly poorer vocabulary, less trust in mother/father, greater attachment anxiety/avoidance, and poorer reflective functioning, than non-clinical adolescents. Expressive vocabulary of clinical (but not non-clinical) adolescents significantly negatively correlated with trust in mother (but not father).

CONCLUSION

Results highlight a role for speech-language pathologists (SLPs) in supporting communication needs of adolescents with mental illness. SLPs should consider trust by: i) understanding adolescents with mental illness may have difficulty trusting them potentially impacting therapeutic engagement; and ii) delivering services in ways that might build trust, such as involving adolescents in treatment planning.

Training College Students with Hearing Loss in Theory of Mind

This paper explored training methods to improve the Theory of Mind levels of Chinese college students with hearing loss and investigated the transfer effect of training. Ninety Chinese college students with hearing loss were randomly divided into two groups: the ToM training group and the physical-conversation training group. The ToM training group received ToM training, and the physical-conversation training group as the control group received physical-conversation training. All the participants attended four separate 60-min lectures. The ToM Story Task and the False Belief Task were used to assess the training's effect, and the ToM animation task was adopted to investigate the transfer effect. Before training, the level of ToM of the two participant groups was similar. After training, the ToM level of Chinese college students with hearing loss who participated in ToM training was significantly higher than the students who underwent physical-conversation training. Moreover, the findings revealed that ToM training has long-term transfer effects. This study thus showed that ToM training can effectively improve the ToM level of Chinese college students with hearing loss.

Early Neuro-Psychomotor Therapy Intervention for Theory of Mind and Emotion Recognition in Neurodevelopmental Disorders: A Pilot Study

The aim of the present study is to explore the effect of early neuro-psychomotor therapy to improve theory of mind skills and emotion recognition in children with neurodevelopmental disorders. A pilot study was set up, consisting of in-group training activities based on the neuro-psychomotor approach. Children were evaluated using Neuropsychological Assessment for Child (Nepsy-II), Test of Emotion Comprehension (TEC), and Social Communication Questionnaire (SCQ). For data analysis, one-sample Wilcoxon signed rank test was used with a significance of p < 0.05. Two children with a developmental language disorder and four children with autism spectrum disorders participated in a 3-month training program. Our findings revealed significant improvement in emotion recognition, as measured with Nepsy-II (p = 0.04), while no statistical improvement was found for theory of mind. Despite the limited sample, early neuro-psychomotor therapy improves emotion recognition skills in children with neurodevelopmental disorders. However, considering the explorative nature of the study, findings should be interpreted with caution.

Feeling for the Other With Ease: Prospective Actors Show High Levels of Emotion Recognition and Report Above Average Empathic Concern, but Do Not Experience Strong Distress

Differences in empathic abilities between acting, dance, and psychology students were explored, in addition to the appropriateness of existing empathy measures in the context of these cohorts. Students (N = 176) across Higher Education Institutions in the United Kingdom and Europe were included in the online survey analysis, consisting of the Reading the Mind in the Eyes (RME) test, the Interpersonal Reactivity Index (IRI), the Empathy Quotient (EQ), and the E-drawing test (EDT), each measuring particular facets of empathy. Based on existing evidence and our understanding of the discipline practices, we predicted that acting students would perform the best at identifying people’s emotional expressions but might lack other cognitive or affective empathy skills, particularly those related to emotional reactions. This cohort thus provides an opportunity to evaluate different empathy measures. While actors showed significantly higher RME scores than dancers, the difference between actors and psychologists was marginal. Moreover, actors’ scores did not differ significantly on other empathy measures, such as their concern for others’ emotional wellbeing or fantasy, both measured by IRI subscales. Psychology students scored highest in the IRI perspective taking subscale and the data supported anecdotal evidence that psychologists were more concerned for others’ emotional wellbeing than dancers or actors. Dancers seemed the least concerned with others’ perspectives and emotional states, which we explained through a somatosensory ‘inward’ focus required by their art form. Nevertheless, compared to the general population, our groups reported higher empathic abilities on all IRI subscales except for personal distress. Altogether, our study shows that the RME, the IRI, and the EDT vary in their susceptibility to different facets of empathic abilities in acting, dance, and psychology students whereas the EQ does not. Emotions can be expressed and perceived through language, facial expressions, or behavior. As many empathy tests focus on one type of signal they might miss other strategies. Where empathy tests are applied to individuals that have a predominance to read or respond to others in a particular way, as we showed through these three disciplines, they might not capture these empathic strategies. We thus propose that empathy tests must evolve by means of integrating varied forms of communication.

Neural Responses of Benefiting From the Prosocial Exchange: The Effect of Helping Behavior

Prosocial behavior is critical for the natural development of an individual as well as for promoting social relationships. Although this complex behavior results from gratuitous acts occurring between an agent and a recipient and a wealth of literature on prosocial behavior has investigated these actions, little is known about the effects on the recipient and the neurobiology underlying them. In this study, we used functional magnetic resonance imaging to identify neural correlates of receiving prosocial behavior in the context of real-world experiences, with different types of action provided by the agent, including practical help and effort appreciation. Practical help was associated with increased activation in a network of regions spanning across bilateral superior temporal sulcus, temporoparietal junction, temporal pole, and medial prefrontal cortex. Effort appreciation was associated with activation and increased task-modulated connectivity of the occipital cortex. Prosocial-dependent brain responses were associated with positive affect. Our results support the role of the theory of mind network and the visual cortices in mediating the positive effects of receiving gratuitous help. Moreover, they indicate that specific types of prosocial behavior are mediated by distinct brain networks, which further demonstrates the uniqueness of the psychological processes underlying prosocial actions.

Association of Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder Traits with Depression and Empathy Among Medical Students

PURPOSE

This study aimed to investigate the associations of the traits of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) with depression and empathy among medical students.

PATIENTS AND METHODS

A cross-sectional survey was conducted with 202 fifth-year students at a Japanese medical school for 10 months during their clinical clerkship. The survey included sociodemographic questions and validated tools to measure depressive symptoms (Hospital Anxiety and Depression Scale [HADS]), medical students' empathy for patients (Jefferson Scale of Empathy-Student version [JSE]), ADHD traits (ADHD Self-Report Scale Screener [ASRS Screener]), and ASD traits (Autism-Spectrum Quotient Japanese version-21 [AQ-J-21]).

RESULTS

A total of 151 students (response rate: 74.7%) participated in the survey. Of these, 41 (27.2%) reported a total score of ≥ 20 on the HADS and were categorized as depressed. Depressed students reported significantly lower and higher rates of having a part-time job and a history of enrolment in other faculties, respectively, than non-depressed students. According to the cutoff criteria of the ASRS Screener and AQ-J-21, 31 (20.5%) and 42 (27.8%) students reported ADHD and ASD traits, respectively. Multivariate regression analysis, controlling for age and sex, reported that higher age, ASRS Screener scores, and AQ-J-21 scores were significant predictors of higher HADS total scores. Additionally, higher AQ-J-21 scores significantly predicted lower JSE scores.

CONCLUSION

The degree of ADHD and ASD traits was significantly associated with depression. Moreover, the degree of ASD traits was significantly associated with lower empathy for their patients. It is important to consider that about 20-30% of medical students have these neurodevelopmental traits and to develop intervention strategies for improving depression and empathy.

Machine Learning for Differential Diagnosis Between Clinical Conditions With Social Difficulty: Autism Spectrum Disorder, Early Psychosis, and Social Anxiety Disorder

Differential diagnosis in adult cohorts with social difficulty is confounded by comorbid mental health conditions, common etiologies, and shared phenotypes. Identifying shared and discriminating profiles can facilitate intervention and remediation strategies. The objective of the study was to identify salient features of a composite test battery of cognitive and mood measures using a machine learning paradigm in clinical cohorts with social interaction difficulties. We recruited clinical participants who met standardized diagnostic criteria for autism spectrum disorder (ASD: n = 62), early psychosis (EP: n = 48), or social anxiety disorder (SAD: N = 83) and compared them with a neurotypical comparison group (TYP: N = 43). Using five machine-learning algorithms and repeated cross-validation, we trained and tested classification models using measures of cognitive and executive function, lower- and higher-order social cognition and mood severity. Performance metrics were the area under the curve (AUC) and Brier Scores. Sixteen features successfully differentiated between the groups. The control versus social impairment cohorts (ASD, EP, SAD) were differentiated by social cognition, visuospatial memory and mood measures. Importantly, a distinct profile cluster drawn from social cognition, visual learning, executive function and mood, distinguished the neurodevelopmental cohort (EP and ASD) from the SAD group. The mean AUC range was between 0.891 and 0.916 for social impairment versus control cohorts and, 0.729 to 0.781 for SAD vs neurodevelopmental cohorts. This is the first study that compares an extensive battery of neuropsychological and self-report measures using a machine learning protocol in clinical and neurodevelopmental cohorts characterized by social impairment. Findings are relevant for diagnostic, intervention and remediation strategies for these groups.