Theory of Mind and Mental Health in Middle Childhood and Adolescence: Evidence for general and specific associations.

• In Event: Theory of Mind and Mental Health in Childhood and Adolescence: Towards a transdiagnostic approach.

Abstract

The ability to understand the minds of others, called ‘theory of mind’ (ToM), is a promising neurocognitive phenotype for understanding why children with mental health problems and neurodiversity characteristics experience adverse social outcomes in middle childhood and early adolescence (Erskine et al., 2015). Case-control studies show that difficulties with ToM crosscut a wide range of mental health conditions and neurodiversity characteristics (Cotter et al., 2018). Unlike case-control studies, a dimensional approach uses latent variable models to isolate distinct dimensions of mental health (e.g., internalizing, externalizing) and neurodiversity (e.g., autism traits, inattentiveness/hyperactivity) from a more general vulnerability to experience emotional and behavioral problems (called ‘p’ or general psychopathology) (Caspi et al., 2014). To date, most studies focused on ToM and mental health among children and adolescents have been limited to specific aspects of mental health and neurodiversity such that it is unclear whether difficulties understanding others’ minds are linked with a tendency to experience diffuse emotional and behavioral problems (‘p’) or more specific dimensions of mental health or neurodiversity.

The current study had two aims:
1. To examine whether ToM difficulties in middle childhood and early adolescence are transdiagnostic (cross-cutting traditional categories of mental health and neurodiversity) or are limited to specific dimensions of mental health and neurodiversity.
2. To test whether ToM accounts for links between mental health and neurodiversity characteristics and children’s social adjustment at school.

A socially mixed (24% in receipt of free school meals) and ethnically diverse sample (52% White, 32% Asian, 8% Black, 6% Mixed race/ethnicity) of 1020 children (Mage = 10.36, SDage = 1.27, Range: 8 – 13 years, 55% girls) from the United Kingdom participated in whole-class testing. Children completed measures of ToM (Devine et al., 2016), executive function (Obradovic et al., 2018) and verbal ability (Rust, 2008). Teachers reported on mental health and neurodiversity characteristics using the Child Behavior Checklist (Achenbach & Rescorla, 2007) and Childhood Autism Syndrome Test (Ronald et al., 2008). Social adjustment at school was measured using a peer nomination task (Cillessen & Marks, 2017), peer assessment of social reputation (Masten et al., 1985) and teacher-rated social competence (Peterson et al., 2007).

Three key results emerged. First, a bifactor model provided a good fit to the mental health and neurodiversity data, whereby traits/symptoms were explained by both a general ‘p’ factor (capturing diffuse emotional and behavioral problems) and four dimensions of mental health and neurodiversity (i.e., internalizing, externalizing, autism traits, inattentiveness/hyperactivity). Second, controlling for demographic characteristics, verbal ability, and executive function, ToM was negatively associated with diffuse emotional and behavioural problems (p) over associations with neurodiversity characteristics (i.e., autism traits and inattentiveness/hyperactivity) (Figure 1A). Third, ToM partially accounted for links between mental health and teacher-rated social competence, Est. = -.025, SE = .01, p = .008, and peer-rated social reputation, Est. = -.028, SE = .01, p = .005 (Figure 1B). Rather than being confined to specific conditions or neurodiversity characteristics, ToM difficulties may be transdiagnostic and contribute to adverse social outcomes in middle childhood and adolescence.

Authors

• Rory T. Devine, University of Birmingham
  Presenting Author

• Imogen Grumley-Traynor, University of Birmingham

• Venelin Kovatchev, University of Birmingham