Theory of Mind and Executive Function Underlie Childhood Psychotic Symptoms

• In Event: Poster Session 13
  In Poster Session: PS 13 Topic - Developmental Psychopathology

Abstract

Psychotic symptoms, including disorganized thinking, delusions, hallucinations, plus grossly disorganized psychomotor behavior (American Psychiatric Association, 2013), are not only reported by psychosis patients (e.g., those with schizophrenia) but are also common in the general population. Even in children, psychotic symptoms frequently occur, with a median prevalence of 17% in middle childhood (Kelleher et al., 2012). Such early symptoms might foreshadow later adverse outcomes, such as a risk for full-blown psychotic disorders, social functioning deficits, and lower quality of life (e.g., Trotta et al., 2020).

Less studied are early childhood risk factors that underlie psychotic symptoms, yet some research suggests two potential mechanisms, Theory of Mind (ToM) and executive function (EF). ToM refers to abilities to understand others’ mental states, which fundamentally influence children’s social lives; EF refers to general control mechanisms, which modulate conscious, goal-directed behaviors. Accumulated evidence has shown both ToM and EF deficits in adults experiencing psychotic symptoms (e.g., Bora and Pantelis, 2013; Sitskoorn et al., 2004).

While previous studies with adult psychotics provide clues, possible developmental links between ToM/EF and psychotic symptoms remain unknown in young children. Our primary aim was to longitudinally examine whether early childhood ToM and EF (specifically, poorer ToM and EF) are indeed risk factors for middle childhood psychotic symptoms. A secondary aim was to examine the developmental pathway between ToM and EF, which needs further longitudinal exploration (e.g., Devine and Hughes, 2014), but is also required to set the stage for our primary analyses integrating ToM, EF, and psychotic symptomology in childhood.

To address these research aims, we longitudinally assessed 214 children’s ToM and EF skills at age 3 and then again at age 6 by using false-belief tasks (Bartsch and Wellman, 1989) and EF batteries (Kochanska et al., 1996, 1997). Their mothers rated children’s psychotic symptoms at age 6 and then again at age 10 by using, focally, the Thought Problems, but also the Withdrawn/Depressed, and the Attention Problems subscales in the Child Behavior Checklist (CBCL 6-18; Achenbach & Rescorla, 2001).

We found that ToM at 3-years predicted EF at age 6, but EF at 3-years did not predict 6-year-old ToM. Based on this underlying ToM-EF trajectory, our main results showed that poorer ToM skills at 6-years predicted more severe development of Thought Problems between ages 6 and 10. Moreover, poorer EF skills at 6-years predicted more Attention Problems at 10-years. These findings, as summarized in Figure 1, provide evidence that poorer ToM and EF are indeed early risk factors of childhood psychotic symptoms, but in contrasting fashions: ToM underlies psychotic thought problems, one of the core problems in psychosis; EF underlies attention problems, such as difficulties in staying focused.

In sum, our longitudinal study demonstrates the developmental links between ToM, EF, and psychotic symptoms. This demonstration has theoretical implications for developmental-psychopathology accounts, specifically about social-cognitive factors in childhood psychosis. Relatedly, it has potential practical implications for early childhood screening and intervention efforts.

Authors

• Chi-Lin Yu, University of Michigan - Ann Arbor
  Presenting Author

• Sujin Lee, University of Michigan - Ann Arbor
  Non-Presenting Author

• Henry M. Wellman, University of Michigan
  Non-Presenting Author

• Sheryl L Olson, University of Michigan - Ann Arbor
  Non-Presenting Author