Does teaching theory of mind have an effect on the ability to develop conversation in children with autism?

Longitudinal relations between theory of mind and academic achievement among deaf and hard-of-hearing school-aged children

This 2-year longitudinal study investigated the bidirectional relations between the development of theory of mind (ToM) and academic competences in a sample of 270 deaf and hard-of-hearing (DHH) children (Mage at Wave 1 = 7.52 years, SD = 0.99; 58.5% boys and 41.5% girls). Across three waves (10 months apart), children were assessed for their ToM abilities, using the ToM scale and a second-order false belief task, as well as for their language and mathematics skills. Cross-lagged correlational analysis revealed significant bidirectional associations between ToM and academic achievement (language and mathematics). That is, ToM predicted academic achievement with similar strength as ToM development itself was predicted by academic achievement. Our results highlight the bidirectional nature of the association between ToM and academic achievement, and they show that ToM development plays a crucial role in DHH children's school functioning.

Integration and Causality in Enactive Approaches to Psychiatry

In this paper I address what has been called the integration problem in psychiatry. This problem is tied to conceptions of causality and explanatory levels in our understanding of mind. I take an interdisciplinary enactive perspective to develop a 3-fold method for exploring the dynamics of integration, based on a concept of dynamical causation and a non-hierarchical (level-free) notion of gestalt. I also consider Autism Spectrum Disorder (ASD) as a test case.

Facial emotion training as an intervention in autism spectrum disorder: A meta-analysis of randomized controlled trials

A large number of computer-based training programs have been developed as an intervention to help individuals with autism spectrum disorders (ASD) improve their facial emotion recognition ability, as well as social skills. However, it is unclear to what extent these facial emotion training programs can produce beneficial, long-lasting, and generalizable results. Using standard meta-analytic techniques, we investigated the effects of facial emotion training including generalization and maintenance restricted to randomized control trial studies comprising a total of 595 individuals with ASD. Our findings revealed that the intervention resulted in a robust improvement in emotion recognition for individuals receiving training compared with controls. However, while there was also some evidence for generalization of training effects, the small number of studies which conducted follow-ups and assessed social skills reported that improvements were not maintained and there was no evidence for general improvement in social skills. Overall, the analysis revealed a medium effect size in training improvement indicating that facial emotion training may be an effective method for enhancing emotion recognition skills in ASD although more studies are required to assess maintenance of effects and possible general improvements in social skills. LAY SUMMARY: Facial emotion training as an intervention may be a potential way to help improve emotion recognition in autism spectrum disorder (ASD), however robust empirical support for its efficacy has not been sufficiently established. Here, we conducted a meta-analysis of previous studies to summarize the effects of facial emotion training on ASD. Our results show that the training produces a robust improvement in subsequent emotion recognition, while maintenance and generalization effects still need further investigation. To date, no experimentally verified improvements in social skills have been reported.

Pragmatic Language in Children and Adolescents With Autism Spectrum Disorder: Do Theory of Mind and Executive Functions Have a Mediating Role?

Pragmatic language (PL) is defined as the ability to use language effectively in communicative exchanges. Previous findings showed that deficits in PL are a core characteristic of the communicative profile of individuals with autism spectrum disorder (ASD). While different lines of research have revealed a close link between PL and theory of mind (ToM), and between PL and executive functions (EFs), to our knowledge, few studies have explored the relationship between these three domains in children with ASD, and their results have been contradictory. The present study thus aimed to contribute to our understanding of PL in children with ASD and to analyze the underlying mediating role of ToM and EFs. PL is a complex and multifaceted construct. In the present study, we focused on two specific aspects, such as the comprehension of nonliteral language, and the ability to make inferences. After testing 143 participants (73 with ASD), our results confirmed that impairments in PL are a crucial feature of the ASD profile. Children with ASD were also more impaired than their typically developing peers in both ToM and EFs. When the mediating role of ToM and EFs on PL was considered, it emerged that only ToM contributed significantly to the relationship between group and PL. We discussed the potential importance of interventions not focused exclusively on PL, but also involving ToM. LAY SUMMARY: In everyday life, we use pragmatic language to interact successfully with others. Individuals with autism experience significant difficulty in pragmatic language, showing consequent impairments in communication. This study compared the comprehension of nonliteral language, and the ability to make inferences of children with autism and children with typical development, focusing on the role of social and cognitive abilities. Children with autism had difficulties in pragmatic language compared to children with typical development. In addition, the capacity to consider the perspective, intentions and beliefs of other people contributed significantly to the pragmatic language. Autism Res 2021, 14: 932-945. © 2020 International Society for Autism Research and Wiley Periodicals LLC.

Neurobiological mechanisms of social cognition treatment in high-functioning adults with autism spectrum disorder

BACKGROUND

The promise of precision medicine for autism spectrum disorder (ASD) hinges on developing neuroscience-informed individualized interventions. Taking an important step in this direction, we investigated neuroplasticity in response to an ecologically-valid, computer-based social-cognitive training (SCOTT).

METHODS

In an active control group design, 48 adults with ASD were randomly assigned to a 3-month SCOTT or non-social computer training. Participants completed behavioral tasks, a functional and structural magnetic resonance imaging session before and after the training period.

RESULTS

The SCOTT group showed social-cognitive improvements on close and distant generalization tasks. The improvements scaled with reductions in functional activity and increases in cortical thickness in prefrontal regions.

CONCLUSION

In sum, we provide evidence for the sensitivity of neuroscientific methods to reflect training-induced social-cognitive improvements in adults with ASD. These results encourage the use of neuroimaging data to describe and quantify treatment-related changes more broadly.

Systematic Review and Inventory of Theory of Mind Measures for Young Children

Theory of mind (TOM), the ability to infer mental states to self and others, has been a pervasive research theme across many disciplines including developmental, educational, neuro-, and social psychology, social neuroscience and speech therapy. TOM abilities have been consistently linked to markers of social adaptation and have been shown to be affected in a broad range of clinical conditions. Despite the wealth and breadth of research dedicated to TOM, identifying appropriate assessment tools for young children remains challenging. This systematic review presents an inventory of TOM measures for children aged 0-5 years and provides details on their content and characteristics. Electronic databases (1983-2019) and 9 test publisher catalogs were systematically reviewed. In total, 220 measures, identified within 830 studies, were found to assess the understanding of seven categories of mental states and social situations: emotions, desires, intentions, percepts, knowledge, beliefs and mentalistic understanding of non-literal communication, and pertained to 39 types of TOM sub-abilities. Information on the measures' mode of presentation, number of items, scoring options, and target populations were extracted, and psychometric details are listed in summary tables. The results of the systematic review are summarized in a visual framework "Abilities in Theory of Mind Space" (ATOMS) which provides a new taxonomy of TOM sub-domains. This review highlights the remarkable variety of measures that have been created to assess TOM, but also the numerous methodological and psychometric challenges associated with developing and choosing appropriate measures, including issues related to the limited range of sub-abilities targeted, lack of standardization across studies and paucity of psychometric information provided.

Treatment Effects in Social Cognition and Behavior following a Theater-based Intervention for Youth with Autism

This randomized clinical trial ( www.clinicaltrials.gov ID# NCT02276534) examined the impact of a peer-mediated, theater-based social skills intervention, SENSE Theater®, on social cognition and behavior in 77 youth (ages 8-16) with high-functioning autism spectrum disorder. Analysis of Covariance models revealed that post-treatment, the experimental group (n = 44) performed significantly better than the controls (n = 33) on NEPSY theory of mind (verbal) subtest, demonstrated increased neural evidence of memory for faces, and engaged in more cooperative play and verbal interaction with novel peers. The study extends previous findings showing that SENSE Theater® contributes to improvement in social cognition and behavior.

Do Children with Autism Spectrum Disorder Share Fairly and Reciprocally?

This study investigated whether children with autism spectrum disorder (ASD) and typically developing children matched on receptive language share resources fairly and reciprocally. Children completed age-appropriate versions of the Ultimatum and Dictator Games with real stickers and an interactive partner. Both groups offered similar numbers of stickers (preferring equality over self-interest), offered more stickers in the Ultimatum Game, and verbally referenced 'fairness' at similar rates. However, children with ASD were significantly more likely to accept unfair offers and were significantly less likely to reciprocate the puppet's offers. Failure to reciprocate fair sharing may significantly impact on social cohesion and children's ability to build relationships. These important differences may be linked to broader deficits in social-cognitive development and potentially self-other understanding.

Emotion recognition training in autism spectrum disorder: A systematic review of challenges related to generalizability

PURPOSE

To assess the generalizability of findings from randomized controlled trials (RCTs) evaluating emotion recognition (ER) training for children and adolescents with autism spectrum disorder (ASD).

METHODS

We present a systematic review and narrative synthesis of the determinants of external validity in RCTs on ER training. Generalizability of the findings across situations, populations, settings, treatment delivery, and intervention formats was considered.

RESULTS

We identified 13 eligible studies. Participants were predominantly boys with ASD in the normative IQ range (IQ > 70), with an age span from 4 to 18 years across studies. Interventions and outcome measures were highly variable. Several studies indicated that training may improve ER, but it is still largely unknown to what extent training effects are translated to daily social life.

CONCLUSION

The generalizability of findings from currently available RCTs remains unclear. This underscores the importance of involving children with ASD and their caregivers in informed treatment decisions.

How Teaching Perspective Taking to Individuals with Autism Spectrum Disorders Affects Social Skills: Findings from Research and Suggestions for Practitioners

Behavior-analytic practitioners working with individuals with autism spectrum disorders (ASDs) may be approached to incorporate perspective taking into a client's programming. Teaching perspective taking to individuals with ASDs has received attention in both the developmental psychology and, more recently, the behavior-analytic literature. The results of our review of the current evidence suggest that although perspective-taking repertoires believed to be related to social skills can be taught (false belief task performance, deictic frames), only directly teaching the social skills of interest (or applied perspective-taking skills) results in improvements in socially important behavior. The aim of this article is to provide practitioners with the current state of research on how teaching perspective taking affects social skills and to provide suggestions on how these findings might be incorporated into their practice.

Effects of theory of mind performance training on reducing bullying involvement in children and adolescents with high-functioning autism spectrum disorder

Bullying involvement is prevalent among children and adolescents with autism spectrum disorder (ASD). This study examined the effects of theory of mind performance training (ToMPT) on reducing bullying involvement in children and adolescents with high-functioning ASD. Children and adolescents with high-functioning ASD completed ToMPT (n = 26) and social skills training (SST; n = 23) programs. Participants in both groups and their mothers rated the pretraining and posttraining bullying involvement of participants on the Chinese version of the School Bullying Experience Questionnaire. The paired t test was used to evaluate changes in bullying victimization and perpetration between the pretraining and posttraining assessments. Furthermore, the linear mixed-effect model was used to examine the difference in the training effect between the ToMPT and SST groups. The paired t test indicated that in the ToMPT group, the severities of both self-reported (p = .039) and mother-reported (p = .003) bullying victimization significantly decreased from the pretraining to posttraining assessments, whereas in the SST group, only self-reported bullying victimization significantly decreased (p = .027). The linear mixed-effect model indicated that compared with the SST program, the ToMPT program significantly reduced the severity of mother-reported bullying victimization (p = .041). The present study supports the effects of ToMPT on reducing mother-reported bullying victimization in children and adolescents with high-functioning ASD.

Mine is better than yours: Investigating the ownership effect in children with autism spectrum disorder and typically developing children

Ownership has a unique and privileged influence on human psychology. Typically developing (TD) children judge their objects to be more desirable and valuable than similar objects belonging to others. This 'ownership effect' is due to processing one's property in relation to 'the self'. Here we explore whether children with autism spectrum disorder (ASD) - a population with impaired self-understanding - prefer and over-value property due to ownership. In Experiment 1, we discovered that children with ASD did not favour a randomly endowed toy and frequently traded for a different object. By contrast, TD children showed a clear preference for their randomly endowed toy and traded infrequently. Both populations also demonstrated highly-accurate tracking of owner-object relationships. Experiment 2 showed that both TD children and children with ASD over-value their toys if they are self-selected and different from other-owned toys. Unlike TD children, children with ASD did not over-value their toys in comparison to non-owned identical copies. This finding was replicated in Experiment 3, which also established that mere ownership elicited over-valuation of randomly endowed property in TD children. However, children with ASD did not consistently regard their randomly endowed toys as the most valuable, and evaluated property irrespective of ownership. Our findings show that mere ownership increases preferences and valuations for self-owned property in TD children, but not children with ASD. We propose that deficits in self-understanding may diminish ownership effects in ASD, eliciting a more economically-rational strategy that prioritises material qualities (e.g. what a toy is) rather than whom it belongs to.

Examining the Effectiveness of Naturalistic Social Skills Training in Developing Social Skills and Theory of Mind in Preschoolers with ASD

We compared the effectiveness of two programs for developing social skills, ‘Play Time/Social Time’ (PT/ST) and ‘I Can Problem Solve’ (ICPS), in improving the social skills and theory of mind (ToM) of preschoolers with ASD. The experiment took place in a classroom setting. Fifty-two children attended and data were analyzed with latent growth curve models. Comparison with a control group indicated that both programs were effective in developing social skills. The PT/ST program was more effective than ICPS in developing interaction skills; both programs improved children’s ability to cope with difficult social situations. The ICPS program was marginally effective in developing ToM when compared with PT/ST and control condition. These results are relevant to children with ASD and their teachers.

Inhibitory control and lexical alignment in children with an autism spectrum disorder

BACKGROUND

Two experiments investigated the contribution of conflict inhibition to pragmatic deficits in children with autism spectrum disorder (ASD). Typical adults' tendency to reuse interlocutors' referential choices (lexical alignment) implicates communicative perspective-taking, which is regulated by conflict inhibition. We examined whether children with ASD spontaneously lexically aligned, and whether conflict inhibition mediated alignment.

METHODS

Children with ASD and chronological- and verbal-age-matched typically developing controls played a picture-naming game. We manipulated whether the experimenter used a preferred or dispreferred name for each picture, and examined whether children subsequently used the same name.

RESULTS

Children with ASD spontaneously lexically aligned, to the same extent as typically developing controls. Alignment was unrelated to conflict inhibition in both groups.

CONCLUSIONS

Children with ASD's referential communication is robust to impairments in conflict inhibition under some circumstances. Their pragmatic deficits may be mitigated in a highly structured interaction.

Signaling of noncomprehension in communication breakdowns in fragile X syndrome, Down syndrome, and autism spectrum disorder

The ability to indicate a failure to understand a message is a critical pragmatic (social) language skill for managing communication breakdowns and supporting successful communicative exchanges. The current study examined the ability to signal noncomprehension across different types of confusing message conditions in children and adolescents with fragile X syndrome (FXS), Down syndrome (DS), autism spectrum disorder (ASD), and typical development (TD). Controlling for nonverbal mental age and receptive vocabulary skills, youth with comorbid FXS and ASD and those with DS were less likely than TD controls to signal noncomprehension of confusing messages. Youth with FXS without ASD and those with idiopathic ASD did not differ from controls. No sex differences were detected in any group. Findings contribute to current knowledge of pragmatic profiles in different forms of genetically-based neurodevelopmental disorders associated with intellectual disability, and the role of sex in the expression of such profiles.

LEARNING OUTCOMES

Upon completion of this article, readers will have learned about: (1) the social-communicative profiles of youth with FXS, DS, and ASD, (2) the importance of signaling noncomprehension in response to a confusing message, and (3) the similarities and differences in noncomprehension signaling in youth with FXS (with and without ASD), DS, idiopathic ASD, and TD.

Conversational Abilities Among Children with Autism and Children with Developmental Delays

While it is widely recognized that autism undercuts conversational ability, there has been little systematic examination of the involvement of children with autism in informal conversational interaction. This study compares the behaviour of 15 children with autism and 15 children with developmental delays matched on language ability within the context of a semi-structured conversation. Children with autism more often failed to respond to questions and comments, less often offered new, relevant contributions, and produced fewer narratives of personal experience. In contrast to prior research findings, groups did not differ with respect to use of gesture: several children with autism enhanced their communication through dramatization and pointing. Discussion focuses on the nature of pragmatic impairment in autism; factors underlying the development of conversational ability, including theory of mind; and practices that may promote communicative competence.

Do children with autism acknowledge the influence of mood on behaviour?

We tested whether children with and without high-functioning autism spectrum disorders (HFASD) differ in their understanding of the influence of mood states on behaviour. A total of 122 children with HFASD or typical development were asked to predict and explain the behaviour of story characters during hypothetical social interactions. HFASD and typically developing children predicted at equal rates that mood states likely result in similar valenced behaviour. `Explicit' descriptions were used to explain predictions more often by children with HFASD than by typically developing children. However, `implicit' and `irrelevant' descriptions elicited fewer mood references among HFASD children. Furthermore, they less often referred to the uncertainty of the influence of mood on behaviour, and less often used mood-related explanations, in particular when they had to rely on implicit information. This may indicate a rote- rather than self-generated understanding of emotions in children with HFASD.

Improvement in Social Competence Using a Randomized Trial of a Theatre Intervention for Children with Autism Spectrum Disorder

The efficacy of a peer-mediated, theatre-based intervention on social competence in participants with autism spectrum disorder (ASD) was tested. Thirty 8-to-14 year-olds with ASD were randomly assigned to the treatment (n = 17) or a wait-list control (n = 13) group. Immediately after treatment, group effects were seen on social ability, (d = .77), communication symptoms (d = -.86), group play with toys in the company of peers (d = .77), immediate memory of faces as measured by neuropsychological (d = .75) and ERP methods (d = .93), delayed memory for faces (d = .98), and theory of mind (d = .99). At the 2 month follow-up period, group effects were detected on communication symptoms (d = .82). The results of this pilot clinical trial provide initial support for the efficacy of the theatre-based intervention.

Noticing the unusual: a self-prompt strategy for adults with autism

Purpose

– There is a substantial lack of research focusing on how to support the social understanding of high-functioning adults with autism (HFA). The perspectives of three adults with HFA were used to develop and implement self-prompt systems to increase knowledge and awareness of social situations. The paper aims to discuss these issues.

Design/methodology/approach

– Semi-structured interviews and diaries were used to support individuals to reflect on video-based and real-life social situations, within a qualitative participatory case study design. Qualitative data were analyzed thematically.

Findings

– Participants developed and used a self-prompt system to support their social understanding in a range of situations. “Noticing the unusual” in social situations, consideration of the potential impact of others’ behavior on them personally, and guessing the intention of others were identified as useful strategies. Basing social judgments on the facial expressions of others was not useful.

Research limitations/implications

– This was a small-scale study with only three high-functioning participants and so the research needs to be extended to a wider group.

Practical implications

– There is considerable potential for this approach to be used with adults accessing support services because the strategies identified can be easily applied and personalized.

Social implications

– Independent, unplanned use of the self-prompt strategy enabled participants to reduce dependence on others in social situations through supporting their independent thinking and actions.

Originality/value

– This study moves away from a deficit-focussed model of intervention to one that seeks to uncover strengths in order to empower individuals to use their existing knowledge.

Approximating implicit and explicit mentalizing with two naturalistic video-based tasks in typical development and autism spectrum disorder

Individuals with autism spectrum disorder (ASD) have been proposed to show greater impairments in implicit than explicit mentalizing. To test this proposition, we developed two comparable naturalistic tasks for a performance-based approximation of implicit and explicit mentalizing in 28 individuals with ASD and 23 matched typically developed (TD) participants. Although both tasks were sensitive to the social impairments of individuals with ASD, implicit mentalizing was not more dysfunctional than explicit mentalizing. In TD participants, performance on the tasks did not correlate with each other, whereas in individuals with ASD they were highly correlated. These findings suggest that implicit and explicit mentalizing processes are separable in typical development. In contrast, in individuals with ASD implicit and explicit mentalizing processes are similarly impaired and closely linked suggesting a lack of developmental specification of these processes in ASD.

A Blueprint for Social Cognitive Development

The field of social cognitive development (SCD) has historically failed to emerge as a dominant approach in developmental psychology. We take this opportunity to articulate the assumptions, goals, and contributions of SCD with the aim of invigorating research from this perspective. We begin by describing the current landscape of social and cognitive development, suggesting what they have and have not given us. We then outline major goals of the social cognitive developmental approach and walk through examples of successful SCD research. Finally, we examine the unique potential of the social cognitive approach to cross-fertilize social and cognitive development (as well as related fields such as social psychology and neuroscience) and to answer new questions about development.

Interventions based on the Theory of Mind cognitive model for autism spectrum disorder (ASD)

BACKGROUND

The 'Theory of Mind' (ToM) model suggests that people with autism spectrum disorder (ASD) have a profound difficulty understanding the minds of other people - their emotions, feelings, beliefs, and thoughts. As an explanation for some of the characteristic social and communication behaviours of people with ASD, this model has had a significant influence on research and practice. It implies that successful interventions to teach ToM could, in turn, have far-reaching effects on behaviours and outcome.

OBJECTIVES

To review the efficacy of interventions based on the ToM model for individuals with ASD.

SEARCH METHODS

In August 2013 we searched CENTRAL, Ovid MEDLINE, Embase, CINAHL, PsycINFO, ERIC, Social Services Abstracts, AutismData, and two trials registers. We also searched the reference lists of relevant papers, contacted authors who work in this field, and handsearched a number of journals.

SELECTION CRITERIA

Review studies were selected on the basis that they reported on an applicable intervention (linked to ToM in one of four clearly-defined ways), presented new randomised controlled trial data, and participants had a confirmed diagnosis of an autism spectrum disorder. Studies were selected by two review authors independently and a third author arbitrated when necessary.

DATA COLLECTION AND ANALYSIS

Risk of bias was evaluated and data were extracted by two review authors independently; a third author arbitrated when necessary. Most studies were not eligible for meta-analysis, the principal reason being mis-matching methodologies and outcome measures. Three small meta-analyses were carried out.

MAIN RESULTS

Twenty-two randomised trials were included in the review (N = 695). Studies were highly variable in their country of origin, sample size, participant age, intervention delivery type, and outcome measures. Risk of bias was variable across categories. There were very few studies for which there was adequate blinding of participants and personnel, and some were also judged at high risk of bias in blinding of outcome assessors. There was also evidence of some bias in sequence generation and allocation concealment. Not all studies reported data that fell within the pre-defined primary outcome categories for the review, instead many studies reported measures which were intervention-specific (e.g. emotion recognition). The wide range of measures used within each outcome category and the mixed results from these measures introduced further complexity when interpreting results.Studies were grouped into four main categories according to intervention target/primary outcome measure. These were: emotion recognition studies, joint attention and social communication studies, imitation studies, and studies teaching ToM itself. Within the first two of these categories, a sub-set of studies were deemed suitable for meta-analysis for a limited number of key outcomes.There was very low quality evidence of a positive effect on measures of communication based on individual results from three studies. There was low quality evidence from 11 studies reporting mixed results of interventions on measures of social interaction, very low quality evidence from four studies reporting mixed results on measures of general communication, and very low quality evidence from four studies reporting mixed results on measures of ToM ability.  The meta-analysis results we were able to generate showed that interventions targeting emotion recognition across age groups and working with people within the average range of intellectual ability had a positive effect on the target skill, measured by a test using photographs of faces (mean increase of 0.75 points, 95% confidence interval (CI) 0.22 to 1.29 points, Z = 2.75, P < 0.006, four studies, N = 105). Therapist-led joint attention interventions can promote production of more joint attention behaviours within adult-child interaction (mean increase of 0.55 points, 95% CI 0.11 to 0.99 points, Z = 2.45, P value = 0.01, two studies, N = 88). Further analysis undermines this conclusion somewhat by demonstrating that there was no clear evidence that intervention can have an effect on joint attention initiations as measured using a standardised assessment tool (mean increase of 0.23 points, 95% CI -0.48 to 0.94 points, Z = 0.63, P value = 0.53, three studies, N = 92). No adverse effects were apparent.

AUTHORS' CONCLUSIONS

While there is some evidence that ToM, or a precursor skill, can be taught to people with ASD, there is little evidence of maintenance of that skill, generalisation to other settings, or developmental effects on related skills. Furthermore, inconsistency in findings and measurement means that evidence has been graded of 'very low' or 'low' quality and we cannot be confident that suggestions of positive effects will be sustained as high-quality evidence accumulates. Further longitudinal designs and larger samples are needed to help elucidate both the efficacy of ToM-linked interventions and the explanatory value of the ToM model itself. It is possible that the continuing refinement of the ToM model will lead to better interventions which have a greater impact on development than those investigated to date.

Psychometric properties of the Emotion Understanding Assessment with Spanish- and English-speaking preschoolers attending Head Start

The Emotion Understanding Assessment (EUA) is based on a theoretical model of recognizing emotion expressions and reasoning about situation-based, desire-based, and belief-based emotions. While research has noted that emotion understanding predicts current and future social and academic functioning, little is known about the psychometric properties of the EUA. This research sought to test the EUA factor structure and measurement invariance across gender, across language (English and Spanish speakers), and over time (24 weeks) in 281 preschoolers attending Head Start. Results indicated that a two-factor model of emotion expression recognition and emotional perspective taking of the EUA fit the data for the total sample, for each group (gender and language), and at each time point. Furthermore, configural and scalar invariance of the EUA was demonstrated across gender, language, and time. These results offer support that the EUA is assessing emotion expression recognition and emotional perspective taking constructs equivalently in boy, girls, Spanish and English speakers, and over time. Examination of latent means across groups and time indicate no differences in emotion understanding based on gender or language or over the 24-week time frame in this sample of preschoolers attending Head Start.

Intensive exposure to narrative in story books as a possibly effective treatment of social perspective-taking in schoolchildren with autism

One of the major characteristics of autism is impairment of communication and socialization. While such impairment per se has been well documented, research into effective interventions for children with this developmental disorder is still limited. Here we present preliminary evidence for the possibility of improvement of the capability of social perspective-taking in schoolchildren with autism by having intensive experience with narrative, in which they were exposed to narrative in story books read by their parents over a consecutive 5- to 6-day-period. When their capability was evaluated on the basis of a conventional role-taking task, the mean score tended to increase after the exposure as compared to before the exposure, whereas such a change was not recorded in children who did not experience such exposure. These effects were confirmed when the children were retested 4 months later. Although preliminary, the current study represents a step toward the development of more effective social perspective-taking interventions for children with autism.

Measuring reciprocity in high functioning children and adolescents with autism spectrum disorders

Few instruments have been developed that measure impairments in reciprocity, a defining feature of autism. We introduce a new test assessing the quality of reciprocal behaviour: the interactive drawing test (IDT). Children and adolescents (n = 49) with and without high functioning autism spectrum disorders (HFASD) were invited to collaborate with an experimenter in making a joint drawing. Within both groups the performance on collaborative reciprocity improved with age. However, compared to the control group, HFASD participants showed less collaborative and more basic reciprocal behaviour and preferred to draw their own objects. They were less tolerant of the experimenter's input as well. Performance on the IDT was independent of estimated verbal IQ. Reciprocal behaviour in self-initiated objects corresponded with more parental reported autistic traits, while reciprocal behaviour in other-initiated objects corresponded with less autistic traits. The findings of this study suggest that IDT is a promising instrument to assess reciprocity.

The neural bases of empathic accuracy

Theories of empathy suggest that an accurate understanding of another's emotions should depend on affective, motor, and/or higher cognitive brain regions, but until recently no experimental method has been available to directly test these possibilities. Here, we present a functional imaging paradigm that allowed us to address this issue. We found that empathically accurate, as compared with inaccurate, judgments depended on (i) structures within the human mirror neuron system thought to be involved in shared sensorimotor representations, and (ii) regions implicated in mental state attribution, the superior temporal sulcus and medial prefrontal cortex. These data demonstrate that activity in these 2 sets of brain regions tracks with the accuracy of attributions made about another's internal emotional state. Taken together, these results provide both an experimental approach and theoretical insights for studying empathy and its dysfunction.

The need for a cognitive neuroscience of naturalistic social cognition

Understanding the minds of others is one of the great challenges humans face. Accordingly, much work in cognitive neuroscience has explored the brain systems engaged when perceivers share and make inferences about the internal states of social targets. These studies, however, typically use divergent and highly simplified stimuli and methods and as a consequence have produced largely non-overlapping sets of results and artificially constrained theories about the processes involved in perceivers' abilities to understand targets. Here we suggest that these difficulties may stem from two main sources: the lack of meaningful behavioral data about the brain bases of perceivers' accuracy in inferring target states and qualitative differences between the social stimuli used in neuroimaging paradigms and the social information perceivers encounter in the real world. We advocate more focus on studies of naturalistic social cognition, which could overcome these limitations and complement current approaches, and discuss work in our laboratory that has demonstrated the feasibility and utility of such a focus. Finally, we discuss the relevance of naturalistic social cognition to diagnosing and treating autism spectrum disorder. Overall, using naturalistic paradigms in neuroimaging will be critical to modeling the way the brain actually understands other minds.

A multi-component social skills intervention for children with Asperger syndrome: the Junior Detective Training Program

BACKGROUND

The study aimed to investigate the effectiveness of a new multi-component social skills intervention for children with Asperger syndrome (AS): The Junior Detective Training Program. This 7-week program included a computer game, small group sessions, parent training sessions and teacher handouts.

METHOD

Forty-nine children with AS were recruited to participate and randomly assigned to intervention (n = 26) or wait-list control (n = 23) conditions.

RESULTS

Relative to children in the wait-list group, program participants showed greater improvements in social skills over the course of the intervention, as indicated by parent-report measures. Teacher-report data also confirmed that children receiving the intervention made significant improvements in social functioning from pre- to post-treatment. Treatment group participants were better able to suggest appropriate emotion-management strategies for story characters at post-intervention than at pre-intervention, whereas control participants were not. However, there was no difference in the improvements made by children in the intervention and control conditions on facial expression and body-posture recognition measures. Follow-up data suggested that treatment gains were maintained by children at 5-months post-intervention.

CONCLUSIONS

The Junior Detective Training Program appeared to be effective in enhancing the social skills and emotional understanding of children with AS. Limitations and suggestions for future research are discussed.

Brief report: feasibility of social cognition and interaction training for adults with high functioning autism

The goal of this study was to evaluate the feasibility and utility of a group-based cognitive behavioral intervention to improve social-cognitive functioning in adults with high-functioning autism (HFA). We modified the treatment manual of a previously validated intervention, Social Cognition and Interaction Training (SCIT), for optimal use with HFA adults (SCIT-A). We then conducted a pilot study to compare SCIT-A (n = 6) to treatment as usual (TAU) (n = 5) for adults with HFA. Feasibility was supported; attendance was high (92%) and satisfaction reports were primarily positive. Participants in SCIT-A showed significant improvement in theory-of-mind skills and trend level improvements in social communication skills; TAU participants did not show these improvements. Findings indicate SCIT-A shows promise as an intervention for adults with HFA.

Brief report: a scale for rating conversational impairment in autism spectrum disorder

There are few well-standardized measures of conversational breakdown in Autism Spectrum Disorders (ASD). The study's objective was to develop a scale for measuring pragmatic impairments in conversations of individuals with ASD. We analyzed 46 semi-structured conversations of children and adolescents with high-functioning ASD using a functional linguistic paradigm. Five constructs were developed that assessed difficulties related to the pragmatics of conversation: atypical intonation; semantic drift; terseness; pedantic speech; perseveration. The scale shows good inter-rater reliability and variation in the scales is not simply a reflection of IQ or language competence. This tool represents a way of characterizing language use in ASD and is an initial step towards developing a tool to evaluate change in degree of social impairments in conversation.

Discourse skills of boys with fragile X syndrome in comparison to boys with Down syndrome

PURPOSE

This study compared the conversational discourse skills of boys who have fragile X syndrome with and without autism spectrum disorder (ASD) with those of boys with Down syndrome and boys who are typically developing.

METHOD

Participants were boys who have fragile X syndrome with (n = 26) and without (n = 28) ASD, boys with Down syndrome (n = 29), and boys who are typically developing (n = 22). Turns during an examiner-child interaction consisting of structured and semistructured activities were coded for the boys' ability to maintain a topic of conversation and the frequency of perseveration.

RESULTS

The results revealed that boys who had both fragile X and ASD produced significantly more noncontingent discourse than did boys who had only fragile X, boys with Down syndrome, or typically developing boys. This finding was observed regardless of whether the topic was maintained or changed and whether the turn type was a response or initiation. Regardless of autism status, boys with fragile X used more perseveration than did boys in the other groups.

CONCLUSION

These findings suggest that some aspects of the conversational discourse difficulties attributed to fragile X syndrome may be a function of the high rate of comorbidity between fragile X and autism, whereas some difficulties may be characteristic of fragile X syndrome.

Is Theory of Mind Understanding Impaired in Males with Fragile X Syndrome?

Males with fragile X syndrome (FXS) have difficulties with social interaction and many show autistic features. This study examined whether the social deficits characteristic of FXS are associated with theory of mind difficulties. Two groups of boys with FXS participated: a group with few autistic features and a group with many autistic features. An intellectual disability control group also participated. In addition to using standard theory of mind tasks, new techniques were used that were able to separate out the various processing demands of the task (e.g., memory, inhibitory control). Overall, the findings indicate that both groups of boys with FXS have difficulty with theory of mind tasks compared to an intellectual disability control group. However, both groups with FXS also performed worse on comparison trials that required working memory but not theory of mind. Theory of mind difficulties are likely to be an important aspect of the FXS clinical profile, but are most likely the result from a more basic difficulty with working memory.

A training study of theory of mind and executive function in children with autistic spectrum disorders

This study investigated the relationship between theory of mind and executive functioning in children with autistic spectrum disorders through a training study. Ten children were trained on theory of mind, whilst ten were trained in executive function. Seven children were assigned to a control group, receiving no intervention. Training programmes were administered individually, lasting for 25 minutes per day for 5-10 days. Children were tested before training, after training and at a two-month follow-up. Significant improvements were seen in performance on theory of mind tasks in both trained groups, whilst the control group showed no improvement. No improvement on the executive function tasks was seen in any of the groups. The implications of these findings are discussed.

Modifying the affective behavior of preschoolers with autism using in-vivo or video modeling and reinforcement contingencies

The purpose of this study was to modify the affective behavior of three preschoolers with autism in home settings and in the context of play activities, and to compare the effects of video modeling to the effects of in-vivo modeling in teaching these children contextually appropriate affective responses. A multiple-baseline design across subjects, with a return to baseline condition, was used to assess the effects of treatment that consisted of reinforcement, video modeling, in-vivo modeling, and prompting. During training trials, reinforcement in the form of verbal praise and tokens was delivered contingent upon appropriate affective responding. Error correction procedures differed for each treatment condition. In the in-vivo modeling condition, the therapist used modeling and verbal prompting. In the video modeling condition, video segments of a peer modeling the correct response and verbal prompting by the therapist were used as corrective procedures. Participants received treatment in three categories of affective behavior--sympathy, appreciation, and disapproval--and were presented with a total of 140 different scenarios. The study demonstrated that both treatments--video modeling and in-vivo modeling--systematically increased appropriate affective responding in all response categories for the three participants. Additionally, treatment effects generalized across responses to untrained scenarios, the child's mother, new therapists, and time.

Elaboration of a rehabilitation method based on a pathogenetic hypothesis of “theory of mind” impairment in schizophrenia

"Theory of mind" skills have repeatedly been shown to be impaired in schizophrenic patients. The purpose of this paper is to develop a therapeutic intervention targeting schizophrenic patients' abilities to attribute mental states to others. This preliminary study tried to test the hypothesis that this kind of intervention should improve patients' communication abilities; we also wondered if this would have a positive impact on their more general psychopathology. Eight chronic schizophrenic patients were asked to analyse video scenes (showing interactions between two or more persons), with particular attention being paid to the characters' mental states. Their clinical assessments (general clinical symptoms, communication, and the ability to attribute intentions to others, rated before and after two training sessions, over a one-week period) were compared with those of a control group of six chronic schizophrenic patients. The results support our hypothesis of a possible improvement of patients' communication disorders and an improvement of their abilities to attribute intentions to others. The more general psychopathology ratings, however, remained unchanged. Although these results need further development and confirmation, they suggest a possible promising approach for psychosocial rehabilitation therapies based on "theory of mind" skills.