Prior Knowledge, Episodic Control and Theory of Mind in Autism: Toward an Integrative Account of Social Cognition

Empowering Young People with Special Educational Needs to Recognize and Report Child Sexual Exploitation and Abuse: A Mixed-Methods Review

Young people with special educational needs (SEN), such as intellectual disability and/or autism, are particularly vulnerable to child sexual exploitation and abuse (CSEA). This mixed-methods systematic literature review consolidates findings in respect to how young people with SEN are currently being taught about CSEA in the UK, incorporating empirical and practice-based findings to counteract publication bias. Key databases were searched, and relevant organizations were contacted regarding studies published between 2015 and 2022 (inclusive). Thirteen articles met the inclusion criteria. Of these, 10 adopted a qualitative methodology, and three a mixed-methods approach. The thematic synthesis of the qualitative studies identified the following themes: (a) beliefs and stereotypes about CSEA, vulnerability. and risk have led to young people with SEN being misinformed and misunderstood, and (b) anxiety about the topic of sex and abuse creates polarized views regarding CSEA education in adult guardians of young people with SEN. Themes are discussed in the context of societal biases in respect to vulnerability and risk, and these biases are considered to have a negative effect on how young people with SEN are supported. The findings of this review encourage providers of CSEA awareness education to be mindful of not endorsing harmful stereotypes, and to involve parent-carers as much as possible. This review additionally encourages services and organizations to increase focus on practitioner reflexivity and regular training to counteract potential biases in respect to gender, vulnerability, and risk.

Theory of Mind and Social Informant Discrepancy in Autism

When autistic youth are asked to assess their own social skills, they frequently rate themselves more favorably than their parents rate them. The magnitude of this informant discrepancy has been shown to relate to key clinical outcomes such as treatment response. It has been proposed that this discrepancy arises from difficulties with Theory of Mind. Participants were 167 youth 11 to 17 years old; 72% male, and their parents. Youth completed self-report measures of social skills and social cognitive tasks, while their parents completed questionnaires regarding social skills. A repeated-measures ANOVA indicated both non-autistic and autistic youth rated themselves more favorably than their parents rated them across all measures. Zero-order correlations revealed that raw differences between parent- and participant-report were negatively correlated with scores on parent-reported Theory of Mind measures. However, polynomial analysis did not indicate interaction effects between parent- and participant-report on any of the measures used. Polynomial regression revealed that increases in parent-reported social skill predicted larger increases in parent-report Theory of Mind at low levels of parent-reported social skill compared to high levels of parent-reported social skill. Participant-report social skills predicted performance on a behavioral Theory of Mind test in a curvilinear fashion, such that the relationship was positive at low levels of participant-reported social skills, but negative at high levels. This study replicates the finding that raw difference score analyses may result in illusory effects that are not supported when using more contemporary analysis methods, and that more complex and subtle relationships between social insight and perspective-taking exist within autistic youth.

Default mode network connectivity and social dysfunction in children with Attention Deficit/Hyperactivity Disorder

Objective

Attention Deficit/Hyperactivity Disorder (ADHD) negatively affects social functioning; however, its neurological underpinnings remain unclear. Altered Default Mode Network (DMN) connectivity may contribute to social dysfunction in ADHD. We investigated whether DMN's dynamic functional connectivity (dFC) alterations were associated with social dysfunction in individuals with ADHD.

Methods

Resting-state fMRI was used to examine DMN subsystems (dorsal medial prefrontal cortex (dMPFC), medial temporal lobe (MTL)) and the midline core in 40 male ADHD patients (7-10 years) and 45 healthy controls (HCs). Connectivity correlations with symptoms and demographic data were assessed. Group-based analyses compared rsFC between groups with two-sample t-tests and post-hoc analyses.

Results

Social dysfunction in ADHD patients was related to reduced DMN connectivity, specifically in the MTL subsystem and the midline core. ADHD patients showed decreased dFC between parahippocampal cortex (PHC) and left superior frontal gyrus, and between ventral medial prefrontal cortex (vMPFC) and right middle frontal gyrus compared to HCs (MTL subsystem). Additionally, decreased dFC between posterior cingulate cortex (PCC), anterior medial prefrontal cortex (aMPFC), and right angular gyrus (midline core) was observed in ADHD patients relative to HCs. No abnormal connectivity was found within the dMPFC.

Conclusion

Preliminary findings suggest that DMN connectional abnormalities may contribute to social dysfunction in ADHD, providing insights into the disorder's neurobiology and pathophysiology.

The role of cognitive estimation in understanding the mental states of others

Previous studies have emphasized the critical role of the prefrontal cortex in cognitive estimation and theory of mind, however, none of them has questioned the possible role of cognitive estimation processes in understanding the mental states of others. In this study, we compared 30 patients with focal prefrontal cortex damage and 30 control subjects matched by gender, age, and education level on their performances on a cognitive estimation task and two tasks assessing theory of mind: the "Faux-Pas" task and the Reading the Mind in the Eyes task. The results showed that patients were significantly impaired compared with control subjects on both abilities of cognitive estimation and theory of mind. Moreover, regression analyses showed that performance on theory of mind was predicted by the scores on cognitive estimation. Finally, using voxel-based lesion analysis, we identified a partially common bilaterally distributed prefrontal network involved in both these domains centred within the ventral and dorsomedial areas with extension to the dorsolateral prefrontal cortex.

Sex differences in autistic adults: A preliminary study showing differences in mentalizing, but not in narrative coherence

Studying autism might be a complex endeavor due to its clinical heterogeneity. Little is currently known about potential sex differences in autistic adults, especially regarding mentalizing and narrative coherence. In this study, male and female participants told a personal story about one of their most positive and most negative life events and performed two mentalizing tasks. One of these mentalizing tasks was a recently developed Picture and Verbal Sequencing task that has shown cerebellar recruitment, and which requires mentalizing in a sequential context (i.e., participants chronologically ordered scenarios that required true and false belief mentalizing). Our preliminary comparison shows that males were faster and more accurate on the Picture Sequencing task compared to female participants when ordering sequences involving false beliefs, but not true beliefs. No sex differences were found for the other mentalizing and narrative tasks. These results highlight the importance of looking at sex differences in autistic adults and provide a possible explanation for sex-related differences in daily life mentalizing functions, which suggest a need for more sensitive diagnosis and tailored support.

Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction

BYLEMANS, T., et al. Mentalizing and narrative coherence in autistic adults: Cerebellar sequencing and prediction. NEUROSCI BIOBEHAV REV, 2022. - This review focuses on autistic adults and serves 4 purposes: (1) providing an overview of their difficulties regarding mentalizing (understanding others' mental states) and narrative coherence (structured storytelling), (2) highlighting the relations between both skills by examining behavioral observations and shared neural substrates, (3) providing an integrated perspective regarding novel diagnostic tools and support services, and (4) raising awareness of adult autism. We suggest that mentalizing and narrative coherence are related at the behavioral level and neural level. In addition to the traditional mentalizing network, the cerebellum probably serves as an important hub in shared cerebral networks implicated in mentalizing and narrative coherence. Future autism research and support services should tackle new questions within a framework of social cerebellar (dys)functioning.

A narrative sequencing and mentalizing training for adults with autism: A pilot study

Adults diagnosed with autism experience difficulties with understanding the mental states of others, or themselves (mentalizing) and with adequately sequencing personal stories (narrative coherence). Given that the posterior cerebellum is implicated in both skills, as well as in the etiology of autism, we developed a narrative sequencing and mentalizing training for autistic adults. Participants with an official autism diagnosis were randomly assigned to a Training group (n = 17) or a waiting-list Control group (n = 15). The Training group took part in six weekly sessions in groups of three participants lasting each about 60 min. During training, participants had to (re)tell stories from the perspective of the original storyteller and answer questions that required mentalizing. We found significant improvements in mentalizing about others’ beliefs and in narrative coherence for the Training group compared to the Control group immediately after the training compared to before the training. Almost all participants from the Training group expressed beneficial effects of the training on their mood and half of the participants reported positive effects on their self-confidence in social situations. All participants recommended the current training to others. Results are discussed in light of cerebellar theories on sequencing of social actions during mentalizing. Further improvements to the program are suggested. Our results highlight the potential clinical utility of adopting a neuroscience-informed approach to developing novel therapeutic interventions for autistic populations.

Measuring cognitive and affective Theory of Mind with the Italian Yoni task: normative data and short versions

Theory of Mind (ToM), a high-order human social cognition skill, is relevant for mental health and wellbeing and frequently impaired in many clinical conditions. To detect ToM difficulties, validated and standardized measures need to be adopted in clinical practice. The Yoni task provides a comprehensive evaluation of first-order, second-order, affective and cognitive mentalistic inferences. However, the Yoni task remains a time-demanding tool without normative data. To fill this gap, we explored the convergent and discriminant validity, the inter-item reliability and provided normative data of the Italian version of the Yoni task (98 items), and developed two short versions (48 and 36 items). For the validation, internal consistency and convergent/discriminant validity have been considered. Then, the effects of demographical variables on 98 item Yoni were explored, and normative data were provided. Our data demonstrated high reliability and a good convergent validity in all the Yoni versions. Then, two composite scores were proposed to obtain: 1) a global ToM level and 2) the balance between affective and cognitive ToM components, whose alteration represents a signature of several clinical conditions. The future standardization of the short versions of Yoni will allow a comprehensive and quick examination of ToM abilities, suitable for both research and clinical settings.

A Brain-Inspired Theory of Mind Spiking Neural Network for Reducing Safety Risks of Other Agents

Artificial Intelligence (AI) systems are increasingly applied to complex tasks that involve interaction with multiple agents. Such interaction-based systems can lead to safety risks. Due to limited perception and prior knowledge, agents acting in the real world may unconsciously hold false beliefs and strategies about their environment, leading to safety risks in their future decisions. For humans, we can usually rely on the high-level theory of mind (ToM) capability to perceive the mental states of others, identify risk-inducing errors, and offer our timely help to keep others away from dangerous situations. Inspired by the biological information processing mechanism of ToM, we propose a brain-inspired theory of mind spiking neural network (ToM-SNN) model to enable agents to perceive such risk-inducing errors inside others' mental states and make decisions to help others when necessary. The ToM-SNN model incorporates the multiple brain areas coordination mechanisms and biologically realistic spiking neural networks (SNNs) trained with Reward-modulated Spike-Timing-Dependent Plasticity (R-STDP). To verify the effectiveness of the ToM-SNN model, we conducted various experiments in the gridworld environments with random agents' starting positions and random blocking walls. Experimental results demonstrate that the agent with the ToM-SNN model selects rescue behavior to help others avoid safety risks based on self-experience and prior knowledge. To the best of our knowledge, this study provides a new perspective to explore how agents help others avoid potential risks based on bio-inspired ToM mechanisms and may contribute more inspiration toward better research on safety risks.

Emotion Recognition and Context in Adolescents with Autism Spectrum Disorder

Emotion recognition research in autism has provided conflicting results and has ignored the role of context. We examined if autistic adolescents use context to identify displayed and felt emotion. Twenty adolescents with autism and 20 age-matched neurotypical adolescents identified emotions from a standardised set of images. The groups also viewed videos scenes with actors displaying a feigned emotion masking their true feelings. Participants identified the displayed and felt emotions. Both groups identified emotions from static images equally well. In the video condition, the autism group was unable to distinguish between the displayed and felt emotions. Emotion research is often divorced from context. Our findings suggest that autistic individuals have difficulty integrating contextual cues when processing emotions.

The Impact of Social Cognition on the Real-Life of People with Epilepsy

Background. Previous research has demonstrated the impairment of social cognition (SC) in people with epilepsy. It is associated with worse social functioning and quality of life; however, the influence on real-life outcomes is unknown. The purpose of this study was to investigate how SC is associated with epilepsy variables and real-life outcomes (education, employment and relationships) among patients with epilepsy (PWE). Methods. Eighty-one PWE completed tasks of theory of mind (ToM) (faux pas recognition (FPRT) and Happé Strange Stories test (HST)) and emotion recognition (ER) (Reading of the Mind in the Eyes (RMET)). Variables reflecting their education, employment and relationship status were treated as endpoints in search of association with SC. Data from a matched group (n = 30) of healthy controls (HCs) were used for comparison of ToM abilities. Results. ToM scores were lower among PWE as compared to HCs (U = 1816.0, p < 0.0001 (HST), U = 1564.5, p = 0.020 (FPRT)). All SC tests were associated with the level of education (OR = 1.22, 95% confidence interval (CI) = 1.09 to 1.36 (RMET), OR = 1.20, 95% CI = 1.02 to 1.40 (HST), OR = 0.93, 95% CI = 0.87 to 1.00 (FPRT)). The results of ToM and ER testing were not associated with employment (χ² = 33.423, p < 0.0001) if adjusted for the level of education (B = 0.804, OR = 2.23 (95% CI = 1.33 to 3.76), p = 0.002). SC abilities did not differ between PWE who were single and those in a relationship (U = 858.5, p = 0.541 (HST)), t= −1.236, p = 0.220 (RMET), U = 909.5, p = 0.271 (FPRT)). Conclusion. Better social cognition skills are linked to a higher level of education among PWE. SC probably has less influence on professional achievements and interpersonal relationships.

Children with ASD Show Impaired Item-Space Recollection, But Preserved Item-Color Recollection

Although individuals with autism spectrum disorder (ASD) have been often shown to display similar memory performance on semantic memory tasks compared to typically developing (TD) children, there is ongoing debate about whether and how their ability to remember specific past events (i.e., episodic memory) is impaired. We assessed a sample of 62 children with ASD and 72 TD children, ranging in age between 8 and 12 years on 2 memory tasks. Participants encoded a series of images and their association with either where they appeared on the screen (item-space association task) or with the color of an image's border (item-color association task). Children with ASD showed worse memory in the item-space association task compared to their TD peers, but comparable memory for the item-color association task. These differences persisted when age, intellectual quotient, and general item recognition memory were accounted for statistically. We interpret these results in light of evidence for specific deficits along the dorsal stream affecting processing of spatiotemporal information in ASD. Autism Res 2020, 13: 1985-1997. © 2020 International Society for Autism Research and Wiley Periodicals LLC LAY SUMMARY: Episodic memory requires the ability to bind contextual details (such as color, location, etc.) to an item or event in order to remember the past with specific detail. Here, we compared children with autism spectrum disorder (ASD) and typically developing (TD) children on tasks examining episodic memory. Children with ASD recalled more poorly previously seen items and their associated space-related details, but they performed comparably to TD children on color details. We discuss the possible mechanisms that contribute to worse spatial processing/recall in ASD.

Interactive Psychometrics for Autism With the Human Dynamic Clamp: Interpersonal Synchrony From Sensorimotor to Sociocognitive Domains

The human dynamic clamp (HDC) is a human-machine interface designed on the basis of coordination dynamics for studying realistic social interaction under controlled and reproducible conditions. Here, we propose to probe the validity of the HDC as a psychometric instrument for quantifying social abilities in children with autism spectrum disorder (ASD) and neurotypical development. To study interpersonal synchrony with the HDC, we derived five standardized scores following a gradient from sensorimotor and motor to higher sociocognitive skills in a sample of 155 individuals (113 participants with ASD, 42 typically developing participants; aged 5 to 25 years; IQ > 70). Regression analyses were performed using normative modeling on global scores according to four subconditions (HDC behavior "cooperative/competitive," human task "in-phase/anti-phase," diagnosis, and age at inclusion). Children with ASD had lower scores than controls for motor skills. HDC motor coordination scores were the best candidates for stratification and diagnostic biomarkers according to exploratory analyses of hierarchical clustering and multivariate classification. Independently of phenotype, sociocognitive skills increased with developmental age while being affected by the ongoing task and HDC behavior. Weaker performance in ASD for motor skills suggests the convergent validity of the HDC for evaluating social interaction. Results provided additional evidence of a relationship between sensorimotor and sociocognitive skills. HDC may also be used as a marker of maturation of sociocognitive skills during real-time social interaction. Through its standardized and objective evaluation, the HDC not only represents a valid paradigm for the study of interpersonal synchrony but also offers a promising, clinically relevant psychometric instrument for the evaluation and stratification of sociomotor dysfunctions.

What Do You Have in Mind? Measures to Assess Mental State Reasoning in Neuropsychiatric Populations

Social interaction is closely associated with both functional capacity and well-being. Previous research has not only revealed evidence of social dysfunction in individuals with a wide range of psychiatric and neurological disorders but also generated an abundance of potential measures for assessing social cognition. This review explores the most popular measures used within neuropsychiatric populations to investigate the ability to recognize or reason about the mental states of others. Measures are also critically analyzed in terms of strengths and limitations to aid task selection in future clinical studies. The most frequently applied assessment tools use verbal, visual or audiovisual forms of presentation and assess recognition of mental states from facial features, self-rated empathy, the understanding of other's cognitive mental states such as beliefs and intentions, or the ability to combine knowledge of other's thoughts and emotions in order to understand subtle communications or socially inappropriate behavior. Key weaknesses of previous research include limited investigation of relationships with clinical symptoms, and underutilization of measures of everyday social functioning that offer a useful counterpart to traditional "lab" tasks. Future studies should aim to carefully select measures not only based on the range of skills to be assessed but also taking into account potential difficulties with interpretation and the need to gain insight into the application of social cognitive skills as well as ability per se. Some of the best measures include those with well-matched control trials (e.g., Yoni Task) or those that restrict the influence of verbal deficits (e.g., intentions comic strip task), elicit spontaneous mentalizing (e.g., Animations Task), and possess greater ecological validity (e.g., Movie for the Assessment of Social Cognition). Social cognitive research within psychiatric populations will be further enhanced through the development of more closely matched control tasks, and the exploration of relationships between task performance, medication, strategy use, and broader emotional and motor functions.