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Journal of Autism and Developmental Disorders

, Volume 49, Issue 8, pp 3376–3386 | Cite as

Theory of Mind (ToM) Performance in High Functioning Autism (HFA) and Schizotypal–Schizoid Personality Disorders (SSPD) Patients

  • Tereza-Maria Booules-KatriEmail author
  • Carla Pedreño
  • Jose-Blás Navarro
  • Montserrat Pamias
  • Jordi E. Obiols
Original Paper

Abstract

The similarities between high functioning autism (HFA) and schizotypal–schizoid personality disorder (SSPD) in terms of social cognition and interpersonal deficits may lead to confusion in symptom interpretation, and consequently result in misdiagnosis. Thus, this study aims to investigate differences in mentalizing with particular interest on the socio-cognitive and socio-affective dimensions. Three Advanced Theory of Mind (ToM) tests were applied in 35 patients with HFA, 30 patients with SSPD and 36 healthy controls. Individuals with HFA showed greater impairment and no dissociation between affective and cognitive ToM components. Conversely, SSPD individuals displayed less difficulties but greater impairments on the cognitive component. Beyond the replicability of ToM impairment in HFA individuals, our findings suggest more impaired cognitive ToM in SSPD participants which further support the sequence of mentalizing development build upon different chronological stages.

Keywords

Social cognition High functioning autism Schizotypal–schizoid personality disorder Advanced theory of mind Cognitive Affective 

Notes

Acknowledgments

This research was supported by Grant from Fondo Investigación Sanitaria (FIS PI081217). We express our sincere thanks to the participants and their families. We also gratefully acknowledge to a large number of professionals for their help with recruiting and testing the sample. All authors read and approved the final manuscript. This research constituted part of a master’s dissertation in the University of Autόnoma de Barcelona, it is based on an earlier study of Pedreno et al. (2017) entitled as “Exploring the Components of Advanced Theory of Mind in Autism Spectrum Disorder.”

Author Contributions

TBK conceived of the study, participated in its design and performed the measurement, interpretation of the data and drafted the manuscript. CP conceived of the study, participated in its design and acquisition of data. JBN participated in the design, performed the statistical analysis and interpretation of the data. MP conceived of the study, participated in its design and critical revision of the manuscript. JEO conceived of the study, participated in its design and coordination and critical revision of the manuscript.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. American Psychiatric Association. (2002). DSM-IV-TR: Manual diagnóstico y estadístico de los trastornos mentales. Barcelona: Masson.Google Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric.Google Scholar
  3. Ashwin, C., Wheelwright, S., & Baron-Cohen, S. (2006). Finding a face in the crowd: Testing the anger superiority effect in autism. Brain and Cognition, 61, 78–95.Google Scholar
  4. 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(1), 89–126.Google Scholar
  5. Bakhshi, K., & Chance, S. A. (2015). The neuropathology of schizophrenia: A selective review of past studies and emerging themes in brain structure and cytoarchitecture. Neuroscience, 303, 82–102.Google Scholar
  6. Barahona-Correa, B. (2017). The high-functioning group: High-functioning autism and asperger syndrome in adults. In Correa B. Barahona & R. J. van der Gaag (Eds.), Autism Spectrum Disorders in Adults (pp. 129–178). Cham: Springer.Google Scholar
  7. Baron-Cohen, S. (1989). The autistic child’s theory of mind: A case of specific developmental delay. Journal of Child Psychology and Psychiatry, 30, 285–297.Google Scholar
  8. Baron-Cohen, S. (1995). Mind blindness: An essay on autism and theory of mind. Cambridge: MIT Press.Google Scholar
  9. Baron-Cohen, S., Jolliffe, T., Mortimore, C., & Roberts, 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
  10. Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a theory of mind? Cognition, 21, 37–46.Google Scholar
  11. Bastiaansen, J. A., Meffert, H., Hein, S., Huizinga, P., Ketelaars, C., Pijnenborg, M., et al. (2011). Diagnosing autism spectrum disorders in adults: The use of Autism Diagnostic Observation Schedule (ADOS)” module 4. Journal of Autism and Developmental Disorders, 41, 1256–1266.Google Scholar
  12. Bliksted, V., Ubukata, S., & Koelkebeck, K. (2016). Discriminating autism spectrum disorders from schizophrenia by investigation of mental state attribution on an on-line mentalizing task: A review and meta-analysis. Schizophrenia Research, 171, 16–26.Google Scholar
  13. Bölte, S., & Poustka, F. (2003). The recognition of facial affect in autistic and schizophrenic subjects and their first-degree relatives. Psychological Medicine, 33(5), 907–915.Google Scholar
  14. Bora, E., & Pantelis, C. (2013). Theory of mind impairments in first-episode psychosis, individuals at ultra-high risk for psychosis and in first-degree relatives of schizophrenia: Systematic review and meta-analysis. Schizophrenia Research, 144, 31–36.Google Scholar
  15. Bottiroli, S., Cavallini, E., Ceccato, I., Vecchi, T., & Lecce, S. (2016). Theory of Mind in aging: Comparing cognitive and affective components in the faux pas test. Archives of Gerontology and Geriatrics, 62, 152–162.Google Scholar
  16. Brien, O. M., Weaver, M. J., Nelson, A. J., Calkins, D. S., Leerkes, M. E., & Marcovitch, S. (2011). Longitudinal associations between children’s understanding of emotions and Theory of Mind. Cognition and Emotion, 25(6), 1074–1086.Google Scholar
  17. Cantio, C., Richardt, J., Jepsen, M., Madsen, G. F., Bilenberg, N., & White, S. J. (2016). Exploring ‘the autisms’ at a cognitive level. International Society for Autism Research, Wiley Periodicals, 9(12), 1328–1339.Google Scholar
  18. Chung, Y. S., Barch, D., & Strube, M. (2014). A meta-analysis of mentalizing impairments in adults with schizophrenia and autism spectrum disorder. Schizophrenia Bulletin, 40(3), 602–616.Google Scholar
  19. Claridge, G. (1997). Schizotypy: Implications for illness and health. New York: Oxford University Press.Google Scholar
  20. Cochrane, M., Petch, I., & Pickering, A. D. (2012). Aspects of cognitive functioning in schizotypy and schizophrenia: Evidence for a continuum model. Psychiatry Research, 196, 230–234.Google Scholar
  21. Debbane, Μ., Benmiloud, J., Salaminios, G., Solida-Tozzi, A., Armando, M., Fonagy, P., et al. (2016). Mentalization-based treatment in clinical high-risk for psychosis: A rationale and clinical illustration. Journal of Contemporary Psychotherapy, 46(4), 217–225.Google Scholar
  22. Dennis, M., Simic, N., Bigler, E. D., Abildskov, T., Agostino, A., Taylor, H. G., et al. (2013). Cognitive, affective, and conative theory of mind (ToM) in children with traumatic brain injury. Developmental Cognitive Neuroscience, 5, 25–39.Google Scholar
  23. Dinsdale, L. N., Hurd, L. P., Wakabayashi, A., Elliot, M., & Crespi, J. B. (2013). How are autism and schizotypy related? Evidence from a non-clinical population. PLoS ONE, 8(5), 63316.Google Scholar
  24. Dziobek, I., Rogers, K., Fleck, S., Bahnemann, M., Heekeren, H. R., Wolf, O. T., et al. (2008). Dissociation of cognitive and emotional empathy in adults with Asperger syndrome using the Multifaceted Empathy Test (MET). Journal of Autism and Developmental Disorders, 38, 464–473.Google Scholar
  25. Enticott, P. G., Kennedy, H. A., Johnston, P. J., Rinehart, N. J., Tonge, B. J., Taffe, J. R., et al. (2014). Emotion recognition of static and dynamic faces in autism spectrum disorder. Cognition and Emotion, 28(6), 1110–1118.Google Scholar
  26. Fernyhough, C., Jones, S. R., Whittle, C., Waterhouse, J., & Bentall, R. P. (2008). Theory of mind, schizotypy, and persecutory ideation in young adults. Cognitive Neuropsychiatry, 13, 233–249.Google Scholar
  27. First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B., & Benjamin, L. S. (1997). Structured clinical interview for DSM-IV axis II personality disorders (SCID-II). Washington: American Psychiatric Association.Google Scholar
  28. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (2002). Structured clinical interview for DSM-IV-TR axis I disorders. Research version, patient edition. (SCID-I/P). New York: New York State Psychiatric Institute.Google Scholar
  29. Ford, T. C., & Crewther, D. P. (2014). Factor analysis demonstrates a common schizoidal phenotype within autistic and schizotypal tendency: Implications for neuroscientific studies. Frontiers in Psychiatry, 5, 117.Google Scholar
  30. Grossman, J. B., Klin, A., Carter, A. S., & Volkmar, F. R. (2000). Verbal bias in recognition of facial emotions in children with Asperger syndrome. Journal of Child Psychology and Psychiatry, 41, 369–379.Google Scholar
  31. Happé, F. (1994). An advanced test of theory of mind: Understanding of story characters thoughts and feelings by able autistic, mentally handicapped and normal children and adults. Journal of Autism and Developmental Disorders, 24, 129–154.Google Scholar
  32. Happe, 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
  33. Heavey, L., Phillips, W., Baron-Cohen, S., & Rutter, M. (2000). The awkward moments test: A naturalistic measure of social understanding in autism. Journal of Autism and Developmental Disorders, 30(3), 225–236.Google Scholar
  34. Ho, K. K., Lui, S. S., Hung, K. S., Wang, Y., Li, Z., Cheung, E. F., et al. (2015). Theory of mind impairments in patients with first-episode schizophrenia and their unaffected siblings. Schizophrenia Research, 166(1), 1–8.Google Scholar
  35. Hurst, R. M., Nelson-Gray, R. O., Mitchell, J. T., & Kwapil, T. R. (2007). The relationship of Asperger’s characteristics and schizotypal personality traits in a nonclinical adult sample. Journal of Autism and Developmental Disorders, 37, 1711–1720.Google Scholar
  36. Hynes, C. A., Baird, A. A., & Grafton, S. T. (2006). Differential role of the orbital frontal lobe in emotional versus cognitive perspective-taking. Neuropychologia, 44, 374–483.Google Scholar
  37. Jahshan, C., & Sergi, M. (2007). Theory of mind, neurocognition, and functional status in schizotypy. Schizophrenia Research, 89, 278–286.Google Scholar
  38. Kaland, N., Callesen, K., Møller-Nielsen, A., Mortensen, E. L., & Smith, L. (2008). Performance of children and adolescents with Asperger syndrome or high-functioning autism on advanced theory of mind tasks. Journal of Autism and Developmental Disorders, 38, 1112–1123.Google Scholar
  39. Kaland, N., Møller-Nielsen, A., Callesen, K., Mortensen, E. L., Gottlieb, D., & Smith, L. (2002). An ‘advanced’ test of theory of mind: Evidence from children and adolescents with Asperger syndrome. Journal of Child Psychology and Psychiatry, 43, 517–528.Google Scholar
  40. Kästner, A., Begemann, M., Michel, T. M., Everts, S., Stepniak, B., Bach, C., et al. (2015). Autism beyond diagnostic categories: Characterization of autistic phenotypes in schizophrenia. BMC Psychiatry, 15, 115.Google Scholar
  41. Kelley, K., & Preacher, K. J. (2012). On effect size. Psychological Methods, 17, 137–152.  https://doi.org/10.1037/a0028086.Google Scholar
  42. Kettle, J. W., O’Brien-Simpson, L., & Allen, N. B. (2008). Impaired theory of mind in first-episode schizophrenia: Comparison with community, university and depressed controls. Schizophrenia Research, 99(1–3), 96–102.Google Scholar
  43. King, B. H., & Lord, C. (2011). Is schizophrenia on the autism spectrum? Brain Research, 1380, 34–41.Google Scholar
  44. Klin, A. (2000). Attributing social meaning to ambiguous visual stimuli in higher functioning autism and Asperger syndrome: The social attribution task. Journal of Child Psychology and Psychiatry, 41, 831–846.Google Scholar
  45. Kocsis-Bogár, K., Kotulla, S., Maier, S., Voracek, M., & Hennig-Fast, K. (2017). Cognitive correlates of different mentalizing abilities in individuals with high and low trait schizotypy: Findings from an extreme-group. Frontiers in Psychology, 8, 922.Google Scholar
  46. Koelkebeck, K., Pedersen, A., Suslow, T., Kueppers, K. A., Arolt, V., & Ohrmann, P. (2010). Theory of Mind in first-episode schizophrenia patients: Correlations with cognition and personality traits. Schizophrenia Research, 119(1–3), 115–123.Google Scholar
  47. Larson, F. V., Wagner, A. P., Jones, P. B., Tantam, D., Lai, M. C., Baron-Cohen, S., et al. (2017). Psychosis in autism: Comparison of the features of both conditions in a dually affected cohort. British Journal of Psychiatry, 210(4), 269–275.Google Scholar
  48. Le Couteur, A., Lord, C., & Rutter, M. (2003). Autism diagnostic interview-revised. Los Angeles, CA: Western Psychological Services.Google Scholar
  49. Li, X., Branch, C. A., & DeLisi, L. E. (2009). Language pathway abnormalities in schizophrenia: A review of fMRI and other imaging studies. Current Opinion in Psychiatry, 22, 131–139.Google Scholar
  50. Lockwood, P. L., Bird, G., Bridge, M., & Viding, E. (2013). Dissecting empathy: High levels of psychopathic and autistic traits are characterized by difficulties in different social information processing domains. Frontiers in Human Neuroscience, 7, 760.Google Scholar
  51. Lord, C., Rutter, M., DiLavore, P. C., & Risi, S. (1999). Autism diagnostic observation schedule. Los Angeles: Western Psychological Services.Google Scholar
  52. Lord, C., Rutter, M., & Le Couteur, 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, 659–685.Google Scholar
  53. Lugnegård, T., Hallerbäck, U. M., Hjärthag, F., & Gillberg, C. (2013). Social cognition impairments in Asperger syndrome and schizophrenia. Schizophrenia Research, 143(2–3), 277–284.Google Scholar
  54. Lugnegårda, T., Hallerback, M., & Christopher Gillberg, C. (2012). Personality disorders and autism spectrum disorders: What are the connections? Comprehensive Psychiatry, 53(4), 333–340.Google Scholar
  55. Mason, O., Linney, Y., & Claridge, G. (2005). Short scales for measuring schizotypy. Schizophrenia Research, 78, 293–296.Google Scholar
  56. McCleery, A., Divilbiss, M., St-Hilaire, A., Aakre, J. M., Seghers, J. P., Bell, E. K., et al. (2012). Predicting social functioning in schizotypy: An investigation of the relative contributions of theory of mind and mood. Journal of Nervous and Mental Disease, 200(2), 147–152.Google Scholar
  57. Medina-Pradas, C., Navarro, J. B., Álvarez-Moya, E. M., Grau, A., & Obiols, J. E. (2012). Emotional theory of mind in eating disorders. International Journal of Clinical and Health Psychology, 12(2), 189–202.Google Scholar
  58. Mitelman, S. A., Bralet, M. C., Haznedar, M. M., Hollander, E., Shihabuddin, L., Hazlett, E. A., et al. (2016). Diametrical relationship between gray and white matter volumes in autism spectrum disorder and schizophrenia. Brain Imaging and Behaviour, 11(6), 1823–1835.Google Scholar
  59. Montag, C., Neuhaus, K., Lehmann, A., Krüger, K., Dziobek, I., Heekeren, H. R., et al. (2012). Subtle deficits of cognitive theory of mind in unaffected first-degree relatives of schizophrenia patients. European Archives of Psychiatry and Clinical Neuroscience, 262(3), 217–226.Google Scholar
  60. Mouridsen, S. E., Rich, B., Isager, T., & Nedergaard, J. N. (2008). Psychiatric disorders in individuals diagnosed with infantile autism as children: A case control study. Journal of Psychiatric Practice, 14(1), 5–12.Google Scholar
  61. Nelson, M. T., Seal, M. L., Pantelis, C., & Phillips, L. J. (2013). Evidence of a dimensional relationship between schizotypy and schizophrenia: A systematic review. Neuroscience and Biobehavioral Reviews, 37(3), 317–327.Google Scholar
  62. Okruszek, L., Piejka, A., Szczepocka, E., Wysokiński, A., & Pluta, A. (2017). Affective and cognitive verbal theory of mind in schizophrenia: Results from a novel paradigm. Journal of the International Neuropsychological Society, 23, 1–5.Google Scholar
  63. Ozguven, D. H., Oner, O., Baskak, B., Oktem, F., Olmez, S., & Munir, K. (2010). Theory of mind in schizophrenia and Asperger’s syndrome: Relationship with negative symptoms. US National Library of Medicine National Institutes of Health, 20(1), 5–13.Google Scholar
  64. Pedreno, C., Pousa, E., Navarro, J. B., Pamlas, M., & Obiols, J. E. (2017). Exploring the components of advanced theory of mind in autism spectrum disorder. Journal of Autism and Developmental Disorders, 47(8), 2401–2409.Google Scholar
  65. Rogers, K., Dziobek, I., Hassenstab, J., Wolf, O. T., & Convit, A. (2007). Who cares? Revisiting empathy in Asperger syndrome. Journal of Autism and Developmental Disorders, 37, 709–715.Google Scholar
  66. Salvador, M.J., Silver, S., & Mahoor, M.J (2015). An emotion recognition comparative study of autistic and typically-developing children using the zeno robot. Proceedings - IEEE International Conference on Robotics and Automation, 6128-6133. Google Scholar
  67. Sasson, N. J., Pinkham, A. E., Carpenter, K. L., & Belger, A. (2011). The benefit of directly comparing autism and schizophrenia for revealing mechanisms of social cognitive impairment. Journal of Neurodevelopmental Disorders, 3(2), 87–100.Google Scholar
  68. Shamay-Tsoory, S. G., Shur, S., Barcai-Goodman, L., Medlovich, S., Harari, H., & Levkovitz, Y. (2007). Dissociation of cognitive from affective components of theory of mind in schizophrenia. Psychiatry Research, 149(1–3), 11–23.Google Scholar
  69. Shamay-Tsoory, S. G., Tomer, R., Yaniv, S., & Aharon-Peretz, J. (2002). Empathy deficits in Asperger syndrome: A cognitive profile. Neurocase, 8, 245–252.Google Scholar
  70. Sheitman, B. B., Kraus, J. E., Bodfish, J. W., & Carmel, H. (2004). Are the negative symptoms of schizophrenia consistent with an autistic spectrum illness? Schizophrenia Research, 69, 119–120.Google Scholar
  71. Singer, T. (2006). The neuronal basis and ontogeny of empathy and mind reading: Review of literature and implications for future research. Neuroscience and Biobehavioral Reviews, 30(6), 855–863.Google Scholar
  72. Spek, A. Α., Scholte, E. Μ., & Van Berckelaer-Onnes, I. Α. (2010). Theory of mind in adults with HFA and Asperger syndrome. Journal of Autism and Developmental Disorders, 40(3), 280–289.Google Scholar
  73. Stanford, D. A., Messinger, J., Malaspina, D., & Corcoran, M. C. (2011). Theory of mind in patients at clinical high risk for psychosis. Schizophrenia Research, 131(1–3), 11–17.Google Scholar
  74. Stefanatos, G. A., & Baron, I. S. (2011). The ontogenesis of language impairment in autism: A neuropsychological perspective. Neuropsycholοgy Review, 21, 252–270.Google Scholar
  75. Steffen, M., Meyhöfer, I., Fassbender, K., Ulrich Ettinger, U., & Kambeitz, J. (2018). Association of schizotypy with dimensions of cognitive control: A meta-analysis. Schizophrenia Bulletin, 44(2), 512–524.Google Scholar
  76. Stephane, M., Kuskowski, M., & Gundel, J. (2014). Abnormal dynamics of language in schizophrenia. Psychiatry Researsch, 216, 320–324.Google Scholar
  77. Stone, V. E., Baron-Cohen, S., & Knight, R. T. (1998). Frontal lobe contributions to theory of mind. Journal of Cognitive Neuroscience, 10, 640–656.Google Scholar
  78. Tager-Flusberg, H., Paul, R., & Lord, C. E. (2005). Language and communication in autism. In F. Volkmar, R. Paul, A. Klin, & D. J. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Diagnosis, development, neurobiology, and behavior (3rd ed., pp. 335–364). New York: Wiley.Google Scholar
  79. Tin, L. N. W., Lui, S. S. Y., Ho, K. K. Y., Hung, K. S. Y., Wang, Y., Yeung, H. K. H., et al. (2017). High-functioning autism patients share similar but more severe impairments in verbal theory of mind than schizophrenia patients. Psychological Medicine, 48(8), 1264–1273.Google Scholar
  80. Van Os, J., & Kapur, S. (2009). Schizophrenia. Lancet (London, England), 374(9690), 635–645.Google Scholar
  81. Walter, E. E., Fernandez, F., Snelling, M., & Barkus, E. (2016). Genetic consideration of schizotypal traits: A review. Frontiers in Psychology, 7, 1769.Google Scholar
  82. Wechsler, D. (1999). Escala de Inteligencia Wechsler para Adultos (WAIS-III). Madrid: TEA Ediciones, S.A.Google Scholar
  83. Wechsler, D. (2005). Escala de Inteligencia Wechsler para niños (WISC-IV). Madrid: TEA Ediciones, S.A.Google Scholar
  84. Wellman, H. M., Cross, D., & Watson, J. (2001). Meta-analysis of theory-of-mind development: The truth about false belief. Child Development, 72(3), 655–684.Google Scholar
  85. Wond, N., Beidel, D. C., Sarver, D. E., & Sims, V. (2012). Facial emotion recognition in children with high functioning autism and children with social phobia. Child Psychiatry and Human Development, 43(5), 775–794.Google Scholar
  86. Zalla, T., Sav, A., Stopin, A., Leboyer, M., & Ahade, S. (2008). Faux pas detection and intentional action in Asperger syndrome. A replication on a French sample. Journal of Autism and Developmental Disorders, 39(2), 373–382.Google Scholar
  87. Ziv, I., Leiser, D., & Levine, J. (2011). Social cognition in schizophrenia: Cognitive and affective factors. Cognitive Neuropsychiatry, 16(1), 71–91.Google Scholar

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Authors and Affiliations

  • Tereza-Maria Booules-Katri
    • 1
    Email author
  • Carla Pedreño
    • 1
  • Jose-Blás Navarro
    • 2
  • Montserrat Pamias
    • 3
  • Jordi E. Obiols
    • 1
  1. 1.Department of Clinical and Health Psychology, Psychopathology and Neuropsychology Research UnitUniversitát Autónoma de BarcelonaBarcelonaSpain
  2. 2.Department of Psychobiology and Methodology of Health SciencesUniversitát Autónoma de BarcelonaBarcelonaSpain
  3. 3.Department of Mental HealthCorporacio Sanitaria Parc Tauli de SabadellBellaterraSpain

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