Executive and attentional contributions to Theory of Mind deficit in attention deficit/hyperactivity disorder (ADHD)

Abstract

Attention deficit/hyperactivity disorder (ADHD) in children has been associated with attentional and executive problems, but also with socioemotional difficulties possibly associated with deficits in Theory of Mind (ToM). Socioemotional problems in ADHD are associated with more negative prognoses, notably interpersonal, educational problems, and an increased risk of developing other psychiatric disorders that emphasize the need to clarify the nature of their ToM deficits. In this study, we hypothesized that ToM dysfunction in children with ADHD is largely attributable to their attentional and/or executive deficits. Thirty-one children with ADHD (8-12 years, IQ > 85) and 31 typically developing (TD) children were assessed using executive functions (inhibition, planning, and flexibility) and attentional tasks, as well as two advanced ToM tasks (Reading the Mind in the Eyes and Faux Pas) involving different levels of executive control. Children with ADHD performed more poorly than TD children in attentional, executive function, and ToM tasks. Linear regression analyses conducted in the ADHD group indicated that inhibition scores predicted performance on the "Faux Pas" task the best, while attention scores were the best for predicting performance on the Reading the Mind in the Eyes task. When controlled for inhibition and attentional variables, ToM performance in children with ADHD was actually similar to TD children. Contrarily, controlling for ToM scores did not normalize performance for inhibition and attentional tasks in children with ADHD. This unidirectional relationship suggests that deficits in the EF and attentional domains are responsible for ToM deficits in ADHD, which therefore may contribute to their socioemotional difficulties.

Cognitive Improvement of Attention and Inhibition in the Late Afternoon in Children With Attention-Deficit Hyperactivity Disorder (ADHD) Treated With Osmotic-Release Oral System Methylphenidate

“…For instance, another study of our laboratory found higher interference in children with ADHD compared to typically developing children with the same counting Stroop task. 67 Finally, we cannot discard a possible placebo effect on Stroop interference that has already been described in previous studies. 68 ADHD features severity was similar between placebo and osmotic-release oral system methylphenidate groups and is, thus, not responsible for the observed differences between groups.…”

Theory of Mind in Depressive Disorders: A Review of the Literature

“…Only a small number of the discussed studies tried to control social-cognitive ability for non-social-cognitive ability [35,43,48,58,75]. However, as neurocognitive deficits contribute to ToM impairment in other psychiatric disorders [84,85], it is probable that they would also be partly responsible for ToM deficits observed in depression. Another confounding factor may be the possible effect of medication on social cognition.…”

Social Cognition in Children with High-Functioning Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. Associations with Executive Functions

“…In other words, ToM itself remains intact, but there is a failure to express this ability (Papadopoulos et al, 2005; Sodian and Hulsken, 2005). Supporting this view, Mary et al (2016) hypothesize that ToM dysfunctions in children with ADHD could be due to attentional or executive deficits. They found that children with ADHD performed worse than neurotypical children on all the EF tests (inhibition, planning, attention) and two higher-order ToM tasks.…”