Theory of Mind in ADHD. A Proposal to Improve Working Memory through the Stimulation of the Theory of Mind

Abstract

The aim of this study was to investigate the relationships between Theory of Mind (ToM), Working Memory (WM), and Verbal Comprehension (VC). Performance of these variables was evaluated in 44 elementary students (6–12 years) diagnosed with ADHD. Their performance in all variables was collected through the Neuropsychological Battery (NEPSY-II) and the Wechsler Intelligence Scale for Children IV. The results showed that fifty percent of the participants were below the 25th percentile in ToM and that this low performance was not related to age. In addition, analyses showed statistically significant relationships between WM, VC, and ToM. Analysis of the effect of WM and VC on ToM showed that only WM explained the variance in participant performance in ToM. These results led us to raise the need to include ToM among the skills to be stimulated in programs for the treatment of ADHD, accompanying other skills related to social adaptation that are usually included in such programs. Likewise, considering that ToM implies putting into practice skills such as considering different points of view, attending to relevant aspects of the context, making decisions, inferring mental states, and predicting behaviors, we believe that through the stimulation of ToM, WM would also be stimulated.

Implications of the Online Teaching Model Derived from the COVID-19 Lockdown Situation for Anxiety and Executive Functioning in Spanish Children and Adolescents

“…Few social events have had such an impact on human psychology as the COVID-19 pandemic, especially considering the number of people it has affected and the spheres of life it has influenced [ 2 ]. All of this has caused significant psychological stress in people from different countries [ 3 , 4 ], altering the mental health of adults, children, and adolescents and producing changes in mood, behavior, and daily habits [ 5 , 6 , 7 , 8 , 9 , 10 , 11 ].…”

“…Hence, anxiety states became prevalent during the confinement period among children and adolescents [ 10 , 12 , 13 , 14 , 15 ]. Several studies have shown that anxiety has a negative impact on the academic performance of children and adolescents [ 16 , 17 ] and on their levels of emotional control, which is especially important in situations, such as those experienced during these months due to the pandemic.…”

Teoría de la mente en niños con trastorno por déficit de atención/hiperactividad

“…Thus, the relationship between executive functions and TM in the context of this disorder is hypothesized. In fact, there are several characteristics that corroborate this relationship, such as the fact that both are affected in certain neurodevelopmental disorders, such as ASD; that self-control and the ability to understand 'false-belief ' develop simultaneously; that they share the same neuroanatomical areas, such as the frontal lobe; and yet, the need for behavioural inhibition and working memory to perform TM tasks [12,21,22]. Some studies have shown that children with ADHD have early TM skills preserved, but their deficits in executive functions and their difficulty in establishing social relationships deprive them of developing adequate social cognitive skills, causing deficits in the use of social skills [18,19,23].…”

“…In fact, one study, Mary et al [24], demonstrated that, controlling for inhibition and attention (executive functions), TM results in children with ADHD were similar to children with normal neurodevelopment, which may indicate a unidirectional relationship between executive functions and deficits in TM [24]. This seems to go against some theories that consider the TM deficit as a secondary and consequent symptom of executive system dysregulation [12,25,26]. Supporting this hypothesis, it is known that the administration of psychostimulants causes changes in the activity of affected areas, mainly the increase in activation of the frontal cor-tex, one of the main areas of cognitive control, and, during tasks that require attention, improves performance by normalizing the right caudate nucleus [27,28].…”

“…In children with ADHD, impairment of executive functions has been described [12,13]. The com-mon ground between TM and executive function comes from their shared brain affected areas (frontal lobe), from both influencing the children's neurodevelopment and having an identical starting age and, ultimately, from the fact that TM rely to some extent on behavioural inhibition and working memory (executive functions).…”