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The relationship of theory of mind and executive functions to symptom type and severity in children with autism

Published online by Cambridge University Press:  13 April 2004

ROBERT M. JOSEPH  and
HELEN TAGER–FLUSBERG
ROBERT M. JOSEPH
Affiliation:
Boston University School of Medicine
HELEN TAGER–FLUSBERG
Affiliation:
Boston University School of Medicine
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Abstract

Although neurocognitive impairments in theory of mind and in executive functions have both been hypothesized to play a causal role in autism, there has been little research investigating the explanatory power of these impairments with regard to autistic symptomatology. The present study examined the degree to which individual differences in theory of mind and executive functions could explain variations in the severity of autism symptoms. Participants included 31 verbal, school-aged children with autism who were administered a battery of tests assessing the understanding of mental states (knowledge and false belief) and executive control skills (working memory, combined working memory and inhibitory control, and planning) and who were behaviorally evaluated for autism severity in the three core symptom domains. Whereas theory of mind and executive control abilities explained the significant variance beyond that accounted for by language level in communication symptoms, neither explained the significant variance in reciprocal social interaction or repetitive behaviors symptoms. These findings are discussed in terms of a proposed distinction between higher level, cognitive–linguistic aspects of theory of mind and related executive control skills, and more fundamental social–perceptual processes involved in the apprehension of mental state information conveyed through eyes, faces, and voices, which may be more closely linked to autistic deficits in social reciprocity.This research was supported by grants from the National Institute on Child Health and Human Development (RO3 HD37898) to Robert Joseph and from the National Institute on Deafness and Other Communication Disorders (PO1 DC03610) to Helen Tager–Flusberg. In addition, this study was conducted as part of the NICHD/NIDCD Collaborative Programs of Excellence in Autism. We thank the following individuals for their assistance in collecting and preparing the data reported in this article: Susan Bacalman, Laura Becker, June Chu, Susan Folstein, Anne Gavin, Margaret Kjelgaard, Lauren McGrath, Echo Meyer, and Shelly Steele. We are especially grateful to the children and families who generously participated in this study.

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Type
Research Article
Information
Development and Psychopathology , Volume 16 , Issue 1 , March 2004 , pp. 137 - 155
Copyright
© 2004 Cambridge University Press

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References

REFERENCES

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, 4th ed.). Washington, DC: Author.
Astington, J. W., & Gopnik, A. (1991). Theoretical explanations of children's understanding of the mind. British Journal of Developmental Psychology 9, 7–31.Google Scholar
Bailey, A., Phillips, W., & Rutter, M. (1996). Autism: Towards an integration of clinical, genetic, neuropsychological, and neurobiological perspectives. Journal of Child Psychology and Psychiatry 37, 89–126.Google Scholar
Baron–Cohen, S. (1988). Social and pragmatic deficits in autism: Cognitive or affective? Journal of Autism and Developmental Disorders 18, 379–402.Google Scholar
Baron–Cohen, S. (2000). Theory of mind and autism: A fifteen year review. In S. Baron–Cohen, H. Tager–Flusberg, & D. J. Cohen (Eds.), Understanding other minds: Perspectives from developmental cognitive neuroscience (pp. 3–20). Oxford: Oxford University Press.
Baron–Cohen, S., Joliffe, T., Mortimore, C., & Robertson, M. (1997). Another advanced test of theory of mind: Evidence from very high functioning adults with autism or Asperger syndrome. Journal of Child Psychology and Psychiatry 38, 813–822.Google Scholar
Baron–Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition 21, 37–46.Google Scholar
Baron–Cohen, S., Tager–Flusberg, H., & Cohen, D. J. (Eds.). (2000). Understanding other minds: Perspectives from developmental cognitive neuroscience. Oxford: Oxford University Press.
Baron–Cohen, S., Wheelwright, S., Hill, J., Raste, Y., & Plumb, I. (2001). The “Reading the Mind in the Eyes” Test revised version: A study with normal adults, and adults with Asperger syndrome or high-functioning autism. Journal of Child Psychology and Psychiatry 42, 241–251.Google Scholar
Bennetto, L., Pennington, B., & Rogers, S. (1996). Intact and impaired memory functions in autism. Child Development 67, 1816–1835.Google Scholar
Bowler, D. M. (1992). “Theory of mind” in Asperger's syndrome. Journal of Child Psychology and Psychiatry 33, 877–893.Google Scholar
Bruning, J. L., & Kintz, B. L. (1987). Computational handbook of statistics. Glenview, IL: Scott, Foresman, & Company.
Capps, L., Kehres, J., & Sigman, M. (1998). Conversational abilities among children with autism and children with developmental delays. Autism 2, 325–344.Google Scholar
Carlson, S., & Moses, L. J. (2001). Individual differences in inhibitory control and children's theory of mind. Child Development 72, 1032–1053.Google Scholar
Damasio, A. R., & Maurer, R. G. (1978). A neurological model for childhood autism. Archives of Neurology 35, 777–786.Google Scholar
Dawson, G., Meltzoff, A. N., Osterling, J., & Rinaldi, J. (1998). Neuropsychological correlates of early symptoms of autism. Child Development 69, 1276–1285.Google Scholar
Dawson, G., Munson, J., Estes, A., Osterling, J., McPartland, J., Toth, K., Carver, L., & Abbott, R. (2002). Neurocognitive function and joint attention ability in young children with autism spectrum disorder versus developmental delay. Child Development 73, 345–358.Google Scholar
Dennis, M. (1991). Frontal lobe function in childhood and adolescence: A heuristic for assessing attention regulation, executive control, and the intentional states important for social discourse. Developmental Neuropsychology 7, 327–358.Google Scholar
Diamond, A., Prevor, M. B., Callender, G., & Druin, D. P. (1997). Prefrontal cortex cognitive deficits in children treated early and continuously for PKU. Monographs of the Society for Research in Child Development 62.Google Scholar
Dunn, L. M., & Dunn, L. M. (1997). Peabody Picture Vocabulary Test (3rd ed.). Circle Pines, MN: American Guidance Service.
Elliott, C. D. (1990). Differential ability scales: Introductory and technical handbook. New York: The Psychological Corporation.
Fombonne, E., Siddons, F., Achard, S., Frith, U., & Happe, F. (1994). Adaptive behavior and theory of mind. European Child and Adolescent Psychiatry 3, 176–186.Google Scholar
Frith, U., Happé, F., & Siddons, F. (1994). Autism and theory of mind in everyday life. Social Development 3, 108–124.Google Scholar
Frith, U., Morton, J., & Leslie, A. M. (1991). The cognitive basis of a biological disorder: Autism. Trends in Neuroscience 14, 433–438.Google Scholar
Gerstadt, C., Hong, Y., & Diamond, A. (1994). The relationship between cognition and action: Performance of 3–7 year old children on a Stroop-like day–night test. Cognition 53, 129–153.Google Scholar
Gopnik, A., & Astington, J. W. (1988). Children's understanding of representational change and its relation to the understanding of false belief and the appearance–reality distinction. Child Development 59, 26–37.Google Scholar
Griffith, E. M., Pennington, B. F., Wehner, E. A., & Rogers, S. (1999). Executive functions in young children with autism. Child Development 70, 817–832.Google Scholar
Hadwin, J., Baron–Cohen, S., Howlin, P., & Hill, K. (1997). Does teaching theory of mind have an effect on the ability to develop conversation in children with autism? Journal of Autism and Developmental Disorders 27, 519–537.Google Scholar
Happé, F. (1994). Autism: An introduction to psychological theory. London: University College London Press.
Happé, F. (1995). The role of age and verbal ability in the theory of mind task performance of subjects with autism. Child Development 66, 843–855.Google Scholar
Hobson, R. P. (1989). Beyond cognition: A theory of autism. In G. Dawson (Ed.), Autism (pp. 22–48). New York: Guilford Press.
Hobson, R. P. (1991). Against the theory of “Theory of Mind”. British Journal of Developmental Psychology 9, 33–51.Google Scholar
Hughes, C. (1996). Control of action and thought: Normal development and dysfunction in autism: A research note. Journal of Child Psychology and Psychiatry 37, 229–236.Google Scholar
Hughes, C. (1998a). Executive function in preschoolers: Links with theory of mind and verbal ability. British Journal of Developmental Psychology 16, 233–253.Google Scholar
Hughes, C. (1998b). Finding your marbles: Does preschoolers' strategic behavior predict later understanding of the mind? Developmental Psychology 34, 1326–1339.Google Scholar
Hughes, C. (2001). Executive dysfunction in autism: Its nature and implications for the everyday problems experienced by individuals with autism. In J. Burack, T. Charman, N. Yirmiya, & P. Zelazo (Eds.), The development of autism: Perspectives from theory and research (pp. 255–275). Mahwah, NJ: Erlbaum.
Hughes, C., Adlam, A., Happe, F., Jackson, J., Taylor, A., & Caspi, A. (2000). Good test–retest reliability for standard and advance false-belief tasks across a wide range of abilities. Journal of Child Psychology and Psychiatry 41, 483–490.Google Scholar
Hughes, C., & Russell, J. (1993). Autistic children's difficulty with mental disengagement from an object: Its implications for theories of autism. Developmental Psychology 29, 498–510.Google Scholar
Hughes, C., Russell, J., & Robbins, T. W. (1994). Evidence for executive dysfunction in autism. Neuropsychologia 32, 477–492.Google Scholar
Isaacs, E. B., & Vargha–Khadem, F. (1989). Differential course of development of spatial and verbal memory span: A normative study. British Journal of Developmental Psychology 7, 377–380.Google Scholar
Joseph, R. M. (1999). Neuropsychological frameworks for understanding autism. International Review of Psychiatry 11, 309–325.Google Scholar
Kleinman, J., Marciano, P., & Ault, R. (2001). Advanced theory of mind in high-functioning adults with autism. Journal of Autism and Developmental Disorders 31, 29–36.Google Scholar
Klin, A. (2000). Attributing social meaning to ambiguous social stimuli in higher-functioning autism and Asperger syndrome: The social attribution task. Journal of Child Psychology and Psychiatry 41, 831–846.Google Scholar
Klin, A., Jones, W., Schultz, R., Volkmar, F., & Cohen, D. J. (2002a). Defining and quantifying the social phenotype in autism. American Journal of Psychiatry 159, 895–908.Google Scholar
Klin, A., Jones, W., Schultz, R., Volkmar, F., & Cohen, D. J. (2002b). Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism. Archives of General Psychiatry 59, 809–816.Google Scholar
Klin, A., Schultz, R., & Cohen, D. J. (2000). Theory of mind in action: Developmental perspectives on social neuroscience. In S. Baron–Cohen, H. Tager–Flusberg, & D. J. Cohen (Eds.), Understanding other minds: Perspectives from developmental cognitive neuroscience (2nd ed., pp. 357–388). Oxford: Oxford University Press.
Korkman, M., Kirk, U., & Kemp, S. (1998). NEPSY: A developmental neuropsychological assessment. San Antonio, TX: Psychological Corporation.
Liss, M., Fein, D., Allen, D., Dunn, M., Feinstein, C., Morris, R., Waterhouse, L., & Rapin, I. (2001). Executive functioning in high-functioning children with autism. Journal of Child Psychology and Psychiatry 42, 261–270.Google Scholar
Lord, C. (1990). A cognitive–behavioral model for the treatment of social–communicative deficits in adolescents with autism. In R. McMahon & R. D. Peters (Eds.), Behavior disorders of adolescence: Research, intervention, and policy in clinical and school settings (pp. 155–174). New York: Plenum Press.
Lord, C., & Paul, R. (1997). Language and communication in autism. In D. Cohen & F. Volkmar (Eds.), Handbook of autism and pervasive developmental disorders (2nd ed., pp. 195–225). New York: Wiley.
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Lenventhal, B. L., DiLavore, P. S., Pickles, A., & Rutter, M. (2000). The Autism Diagnostic Observation Schedule—Generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders 30, 205–223.Google Scholar
Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism Diagnostic Observation Schedule—WPS (ADOS-WPS). Los Angeles: Western Psychological Services.
Lord, C., Rutter, M., & LeCouteur, A. (1994). Autism Diagnostic Interview—Revised: A revised version of a diagnostic interview for caregivers of individuals with possible pervasive developmental disorders. Journal of Autism and Developmental Disorders 24, 659–668.Google Scholar
McEvoy, R. E., Rogers, S. J., & Pennington, B. F. (1993). Executive function and social communication deficits in young autistic children. Journal of Child Psychology and Psychiatry 34, 563–578.Google Scholar
Moses, L. J. (2001). Executive accounts of theory-of-mind development. Child Development 72, 688–690.Google Scholar
Ozonoff, S. (1997). Components of executive function in autism and other disorders. In J. Russell (Ed.), Autism as an executive disorder (pp. 179–211). Oxford: Oxford University Press.
Ozonoff, S., & Jensen, J. (1999). Brief report: Specific executive function profiles in three neurodevelopmental disorders. Journal of Autism and Developmental Disorders 29, 171–177.Google Scholar
Ozonoff, S., & McEvoy, R. E (1994). A longitudinal study of executive function and theory of mind development in autism. Development and Psychopathology 6, 415–431.Google Scholar
Ozonoff, S., & Miller, J. N. (1995). Teaching theory of mind: A new approach to social skills training for individuals with autism. Journal of Autism and Developmental Disorders 25, 415–433.Google Scholar
Ozonoff, S., Pennington, B. F., & Rogers, S. J. (1991). Executive function deficits in high-functioning autistic individuals: Relationship to theory of mind. Journal of Child Psychology and Psychiatry 32, 1081–1105.Google Scholar
Ozonoff, S., & Strayer, D. L. (1997). Inhibitory function in nonretarded children with autism. Journal of Autism and Developmental Disorders 27, 59–77.Google Scholar
Ozonoff, S., & Strayer, D. L. (2001). Further evidence of intact working memory in autism. Journal of Autism and Developmental Disorders 31, 257–263.Google Scholar
Ozonoff, S., Strayer, D. L., McMahon, W. M., & Filloux, F. (1994). Executive function abilities in autism and Tourette syndrome: An information processing approach. Journal of Child Psychology and Psychiatry 35, 1015–1032.Google Scholar
Pennington, B. F., Rogers, S. J., Bennetto, L., Griffith, E. M., Reed, D. T., & Shyu, V. (1997). Validity tests of the executive dysfunction hypothesis of autism. In J. Russell (Ed.), Autism as an executive disorder (pp. 143–178). Oxford: Oxford University Press.
Perner, J. (1991). Understanding the representational mind. Cambridge, MA: MIT Press.
Perner, J., Leekam, S., & Wimmer, H. (1987). Three-year-olds' difficulty with false belief: The case for a conceptual deficit. British Journal of Developmental Psychology 5, 125–137.Google Scholar
Pillow, B. (1989). Early understanding of perception as a source of knowledge. Journal of Experimental Child Psychology 47, 116–129.Google Scholar
Pratt, C., & Bryant, P. (1990). Young children understand that looking leads to knowing (so long as they are looking into a single barrel). Child Development 61, 973–982.Google Scholar
Robbins, T. W. (1996). Dissociating executive functions of the prefrontal cortex. Philosophical Transactions of the Royal Society of London: Series B 351, 1463–1471.Google Scholar
Roberts, R. J., & Pennington, B. F. (1996). An interactive framework for examining prefrontal cognitive processes. Developmental Neuropsychology 12, 105–126.Google Scholar
Ruffman, T. (2000). Nonverbal theory of mind: Is it important, is it implicit, is it simulation, is it relevant to autism? In J. W. Astington (Ed.), Minds in the making: Essays in honor of David R. Olson (pp. 250–266). Malden, MA: Blackwell.
Russell, J. (1997). How executive disorders can bring about an inadequate “theory of mind.” In J. Russell (Ed.), Autism as an executive disorder (pp. 256–304). Oxford: Oxford University Press.
Russell, J., Jarrold, C., & Henry, L. (1996). Working memory in children with autism and with moderate learning difficulties. Journal of Child Psychology and Psychiatry 37, 673–686.Google Scholar
Russell, J., Jarrold, C., & Hood, B. (1999). Two intact executive capacities in children with autism: Implications for the core executive dysfunctions in the disorder. Journal of Autism and Developmental Disorders 29, 103–112.Google Scholar
Russell, J., Mauthner, N., Sharpe, S., & Tidswell, T. (1991). The “windows task” as a measure of strategic deception in preschoolers and autistic subjects. British Journal of Developmental Psychology 9, 331–349.Google Scholar
Shallice, T. (1982). Specific impairments of planning. Philosophical Transactions of the Royal Society of London, Series B, 298, 199–209.Google Scholar
Tager–Flusberg, H. (1999). A psychological approach to understanding the social and language impairments in autism. International Review of Psychiatry 11, 325–334.Google Scholar
Tager–Flusberg, H. (2000). Understanding the language and communicative impairments in autism. In L. M. Glidden (Ed.), Autism (pp. 185–205). San Diego, CA: Academic Press.
Tager–Flusberg, H. (2001). A re-examination of the theory of mind hypothesis of autism. In J. Burack, T. Charman, N. Yirmiya, & P. Zelazo (Eds.), The development of autism: Perspectives from theory and research (pp. 173–193). Mahwah, NJ: Erlbaum.
Tager–Flusberg, H., & Anderson, M. (1991). The development of contingent discourse ability in autistic children. Journal of Child Psychology and Psychiatry 32, 1123–1134.Google Scholar
Tager–Flusberg, H., & Sullivan, K. (1994). Predicting and explaining behavior: A comparison of autistic, mentally retarded and normal children. Journal of Child Psychology and Psychiatry 35, 1059–1075.Google Scholar
Tager–Flusberg, H., & Sullivan, K. (1995). Attributing mental states to story characters: A comparison of narratives produced by autistic and mentally retarded individuals. Applied Psycholinguistics 16, 241–256.Google Scholar
Tager–Flusberg, H., & Sullivan, K. (2000). A componential view of theory of mind: Evidence from Williams syndrome. Cognition 76, 59–89.Google Scholar
Tanguay, P., Robertson, J., & Derrick, A. (1998). A dimensional classification of autism spectrum disorder by social communication domains. Journal of the American Academy of Child and Adolescent Psychiatry 37, 271–277.Google Scholar
Travis, L., Sigman, M., & Ruskin, E. (2001). Links between social understanding and social behavior in verbal able children with autism. Journal of Autism and Developmental Disorders 31, 119–130.Google Scholar
Turner, M. (1997). Towards an executive dysfunction account of repetitive behavior in autism. In J. Russell (Ed.), Autism as an executive disorder (pp. 57–100). Oxford: Oxford University Press.
Turner, M. (1999). Generating novel ideas: Fluency performance in high-functioning and learning disabled individuals with autism. Journal of Child Psychology and Psychiatry 40, 189–201.Google Scholar
Wellman, H. M. (1990). The child's theory of mind. Cambridge, MA: Bradford Books/MIT Press.
Williams, K. T. (1997). Expressive Vocabulary Test. Circle Pines, MN: American Guidance Service.
Wimmer, H., & Perner, J. (1983). Beliefs about beliefs: Representation and constraining function of wrong beliefs in children's understanding of deception. Cognition 13, 103–128.Google Scholar
World Health Organization. (1993). International classification of diseases (10th ed.). Geneva: Author.
Yirmiya, N., Erel, O., Shaked, M., & Solomonica–Levi, D. (1998). Meta-analyses comparing theory of mind abilities of individuals with autism, individuals with mental retardation, and normally developing individuals. Psychological Bulletin 124, 283–307.Google Scholar