Theory of Mind and Executive Functions in Children With Attention Deficit Hyperactivity Disorder and Specific Learning Disorder

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

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

Understanding social cognition in children with cerebral palsy: exploring the relationship with executive functions and the intervention outcomes in a randomized controlled trial

Children with Cerebral Palsy (CP) experience Social Cognition (SC) difficulties, which could be related to executive functioning. While motor interventions are common, there is limited knowledge about the impact of cognitive interventions on SC in this population. This study examined the relationship between SC and Executive Function (EF) skills and the effectiveness of an EF intervention that included some SC tasks for improving SC in children with CP. SC and EF domains were assessed in 60 participants with CP (30 females; 8-12 years). The relationship between SC and EF baseline scores was analyzed by bivariate correlations and contingency tables. Participants were matched by age, sex, motor ability, and intelligence quotient and randomized into intervention or control groups. The intervention group underwent a 12-week home-based computerized EF intervention. Analysis of covariance was used to examine differences in SC components between groups at post-intervention and 9 months after. Significant positive correlations were found between the SC and EF scores. The frequencies of impaired and average scores in SC were distributed similarly to the impaired and average scores in EFs. The intervention group showed significant improvements in Affect Recognition performance post-intervention, which were maintained at the follow-up assessment, with a moderate effect size. Long-term improvements in Theory of Mind were observed 9 months after.

CONCLUSIONS

This study highlights the association between SC and EFs. A home-based computerized cognitive intervention program improves SC in children with CP. Including SC tasks in EF interventions may lead to positive short- and long-term effects for children with CP.

CLINICAL TRIAL REGISTRATION

NCT04025749 retrospectively registered on 19 July 2019.

WHAT IS KNOWN

• Executive functions and social cognition are associated with social and community participation in people with cerebral palsy. • A home-based computerized cognitive intervention can improve the executive functioning of children with cerebral palsy.

WHAT IS NEW

• Social cognition performance is related to core and higher-order executive functions. • A home-based computerized executive function intervention, including social cognition tasks, has positive short- and long-term effects on social cognition skills in children with cerebral palsy.

Hot and cool executive function and theory of mind in children with and without specific learning disorders

Executive function (EF) in specific learning disorders (SLD) has been investigated using mainly cool EF tasks, whilst less is known about hot EF and theory of mind (ToM) in this population. The aim of this study was to examine group differences in hot and cool EF and ToM in school-aged children with SLD relative to typically developing peers. It also attempted to investigate whether EF measures are significant predictors of ToM in SLD and typical development. Cross-sectional data were collected from 135 school-aged children with and without SLD (8-10 years old), tested on measures of cool & hot EF and ToM. Significant group differences were observed in EFs inhibition (p= .04), working memory (p= .04) and delay of gratification (p < .001), as well as ToM mental state/emotion recognition (p = .019). Inhibition and planning contributed to 22% of the explained variance of ToM mental state/emotion recognition, but not false belief overall. Results suggest that cool EF may be a crucial predictor of ToM in children with and without SLD. Finally, stepwise logistic regression analysis identified specific hot EF and ToM measures contributing to group differentiation, specifically delay of gratification (odds ratio=.995, 95% CI [.993-.998]) and mental state/emotion recognition (odds ratio= .89, 95% CI [.796-.995]). This study contributes to our understanding of cognitive deficits and socio-cognitive impairment in children with SLD, which hold promise for informing interventions aimed at addressing these cognitive challenges.

Searching the underlying mechanisms of specific learning disorder: An emotion recognition and social cognition aspect for Turkish clinical youth population

This study aimed to investigate impairments in social cognition in youth with specific learning disorder (SLD) through a cross sectional study. Eighty six adolescents which include of 43 SLD and 43 typically developing (TD) children completed a battery of tests to analyze social cognition, emotional process and clinical psychopathological profile. SLD group performed significantly worse than healthy controls in facial ER total accuracy score (Cohen d = .77) and Stroop interference (Cohen d = .92). In individual emotion analyses, patients with SLD have a very high deficiency in recognition of angry faces (Cohen d = .89). Between-group difference was also significant for Stroop congruent and facilitation scores (Cohen d = .99). The Specific Learning Disorder Symptom Check List-Parent Form scores were significant -and only- predictor of the model which for total accuracy score of facial recognition. The results of this study supported an impairment in emotion recognition and executive functions in adolescents with SLD but causality seems still unclear.

Theory of Mind: A Brief Review of Candidate Genes

Deficits in theory of mind (ToM), known as the ability to understand the other's mind, have been associated with several psychopathological outcomes. The present systematic review aims to summarize the results of genetic studies that investigated gene polymorphisms associated with mentalization performance tasks in children and adults. The systematic review was carried out following PRISMA guidelines, and the literature search was conducted in PubMed and EBSCOhost using the following keywords: 'theory of mind, mentalizing, mindreading' and 'gene, genetic basis'. Nineteen studies met the eligibility criteria for inclusion. Most of the literature focused on the role of DRD4, DAT1, OXTR, OXT, COMT, ZNF804A, AVP, AVPR, SCL6A4, EFHC2, MAO-A, and the family of GTF2I genes in influencing ToM. However, controversial results emerged in sustaining the link between specific genetic polymorphisms and mentalization abilities in children and adults. Available data show heterogeneous outcomes, with studies reporting an association between the same family genes in subjects of the same age and other studies reporting no correlation. This does not allow us to draw any solid conclusions but paves the way for exploring genes involved in ToM tasks.

Let's face it! The role of social anxiety and executive functions in recognizing others' emotions from faces: Evidence from autism and specific learning disorders

Youth with different developmental disorders might experience challenges when dealing with facial emotion recognition (FER). By comparing FER and related emotional and cognitive factors across developmental disorders, researchers can gain a better understanding of challenges and strengths associated with each condition. The aim of the present study was to investigate how social anxiety and executive functioning might underlie FER in youth with and without autism spectrum disorders (ASD) and specific learning disorders (SLD). The study involved 263 children and adolescents between 8 and 16 years old divided into three groups matched for age, sex, and IQ: 60 (52 M) with ASD without intellectual disability, 63 (44 M) with SLD, and 140 (105 M) non-diagnosed. Participants completed an FER test, three executive functions' tasks (inhibition, updating, and set-shifting), and parents filled in a questionnaire reporting their children's social anxiety. Our results suggest that better FER was consistent with higher social anxiety and better updating skills in ASD, while with lower social anxiety in SLD. Clinical practice should focus on coping strategies in autistic youth who could feel anxiety when facing social cues, and on self-efficacy and social worries in SLD. Executive functioning should also be addressed to support social learning in autism.

Irony Understanding in Children With Attention-Deficit/Hyperactivity Disorder: A Comparative Analysis

INTRODUCTION

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that can significantly impact a child's daily life and academic performance. Some studies have noted challenges in social cognition among children with ADHD, specifically in aspects like emotion perception and processing, empathy, Theory of Mind, and pragmatics. One of the lesser-explored aspects of ADHD is its potential impact on higher-level language skills, such as irony understanding. Our goal in this study was to compare irony comprehension in two groups: schoolchildren with normal development and schoolchildren with ADHD.

METHODS

We performed a comparative cross-sectional study on a total of 35 children aged between 6 and 12 years: 17 with ADHD and 18 not neurodevelopmentally impaired. Irony comprehension was evaluated using an assessment method validated for the Portuguese population: Turtle on the Island - Battery of Assessment of Executive Functions in Children (TI-BAFEC). We also applied the EACE (Emotional Awareness and Coping in Children) scale. It is the Portuguese adaptation of the Assessment of Children's Emotion Skills and assesses children's emotional knowledge.

RESULTS

We obtained two comparable groups concerning sociodemographic data. The analysis of the data, using the Mann-Whitney U Test, showed that in all parameters, the control group consistently exhibited superior performance compared to the ADHD group. However, only TI-BAFEC (p = 0.005) and emotional behavior (p = 0.007) showed a significant statistical variance between the two groups.

CONCLUSION

This article shows that children with ADHD encounter challenges in grasping irony. However, the underlying cognitive processes contributing to these difficulties warrant further investigation.

Differential Effects of Disruptive Mood Dysregulation Disorder Comorbidity in Attention Deficit Hyperactivity Disorder on Social Cognition and Empathy

OBJECTIVE

This study aimed to investigate social cognition and empathy properties in children among Disruptive Mood Dysregulation Disorder (DMDD) + Attention and Hyperactivity Disorder(ADHD); ADHD and healthy controls from Türkiye.

METHODS

Twenty-two children with DMDD were compared to matched 30 children with ADHD and 60 healthy controls. We administered Affective Reactivity Index (ARI), KaSi Empathy Scale, Kiddie-SADS, and Reading Mind in the Eyes Test (RMET) to evaluate Theory of Mind skills to all study participants.

RESULTS

DMDD + ADHD group had lower performance in ToM skills and empathy than in two groups. The ARI scores were found to be statistically significantly higher in the DMDD group than in two groups. It was also found that ARI, empathy, and ToM scores were significantly related in children with DMDD + ADHD.

CONCLUSION

These results might be important to understand the difficulties in social functioning and interpersonal relationship in children with DMDD and ADHD. Children with DMDD may attend specific therapeutic programs which include specific techniques in social cognition, emotion regulation, and irritability.

Social Cognition and Prosocial Behavior in Children with Attention Deficit Hyperactivity Disorder: A Systematic Review

The purpose of this research is to analyze the empirical evidence on the relationship between social cognition and prosocial behavior in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). A systematic review was carried out following the PRISMA guidelines of empirical studies found in PubMed and Scopus databases, including a total of 51 research studies. The results indicate that children and adolescents with ADHD have deficits in social cognition and prosocial behavior. For children with ADHD, their deficits in social cognition highlight their difficulty in the process of theory of mind, emotional self-regulation, emotion recognition and empathy, affecting prosocial behavior, evidencing difficulty in personal relationships, and the creation of emotional bonds with their peers.

[Disorders of social cognition in children]

The article presents an overview of scientific publications devoted to the study of social cognition as a separate cognitive function and its role in the formation of normal mental development. Modern ideas about the « theory of mind « and its neurobiological foundations are considered. The results of studies of social competence in children with autism, specific language impairment, attention deficit hyperactivity disorder and specific learning disorder are presented. The main neurocognitive deficits observed in violation of social cognition in children and the possibility of their pharmacological correction are considered.

Individual responsiveness to a school-based karate intervention: An ancillary analysis of a randomized controlled trial

INTRODUCTION

School-based sport interventions have shown beneficial effects on psychosocial functioning and academic performance in children. However, the inter-individual variability in response to these types of interventions remains unclear. We aimed to determine which children benefit most from a school-based sport intervention.

METHODS

This is an ancillary analysis of a randomized controlled trial assessing the effects of a 1-year school-based karate intervention (versus "traditional" physical education lessons) in children (7-8 years) from twenty schools across five European countries. Outcomes included psychosocial functioning (Strengths and Difficulties Questionnaire [SDQ] for parents) and academic performance (grade point average). Only participants of the intervention group were included in the present ancillary analysis, and were categorized as responders or non-responders for the analyzed outcomes attending to whether improvements surpassed a minimal clinically important difference.

RESULTS

About 388 children (187 girls) from the intervention group completed the study, of which 17% and 46% were considered responders for SDQ and academic performance, respectively. Responders for the SDQ presented higher SDQ scores (i.e., higher psychosocial difficulties) at baseline than non-responders (p < 0.001). Responders for academic performance were mostly males (p = 0.017), with an older age (p = 0.030), and with worse academic performance (p < 0.001) at baseline compared with non-responders, and tended to present higher SDQ scores (p = 0.055). Responders for one outcome obtained greater benefits from the intervention on the other outcome (e.g., responders for SDQ improved academic performance [p < 0.001] compared with non-responders).

CONCLUSIONS

A school-based sport intervention (karate) seems particularly effective for children with psychosocial difficulties and low academic performance.