Tompkins Connie A, Scharp Victoria L, Fassbinder Wiltrud, Meigh Kimberly M, Armstrong Elizabeth M
University of Pittsburgh, Pittsburgh, PA, USA.
Aphasiology. 2008 Jan 1;22(1):42-61. doi: 10.1080/02687030600830999.
Difficulties in social cognition and interaction can characterise adults with unilateral right hemisphere brain damage (RHD). Some pertinent evidence involves their apparently poor reasoning from a "Theory of Mind" perspective, which requires a capacity to attribute thoughts, beliefs, and intentions in order to understand other people's behaviour. Theory of Mind is typically assessed with tasks that induce conflicting mental representations. Prior research with a commonly used text task reported that adults with RHD were less accurate in drawing causal inferences about mental states than at making non-mental-state causal inferences from control texts. However, the Theory of Mind and control texts differed in the number and nature of competing discourse entity representations. This stimulus discrepancy, together with the explicit measure of causal inferencing, likely put the adults with RHD at a disadvantage on the Theory of Mind texts. AIMS: This study revisited the question of Theory of Mind deficit in adults with RHD. The aforementioned Theory of Mind texts were used but new control texts were written to address stimulus discrepancies, and causal inferencing was assessed relatively implicitly. Adults with RHD were hypothesised not to display a Theory of Mind deficit under these conditions. METHODS #ENTITYSTARTX00026; PROCEDURES: The participants were 22 adults with unilateral RHD from cerebrovascular accident, and 38 adults without brain damage. Participants listened to spoken texts that targeted either mental-state or non-mental-state causal inferences. Each text was followed by spoken True/False probe sentences, to gauge target inference comprehension. Both accuracy and RT data were recorded. Data were analysed with mixed, two-way Analyses of Variance (Group by Text Type). OUTCOMES #ENTITYSTARTX00026; RESULTS: There was a main effect of Text Type in both accuracy and RT analyses, with a performance advantage for the Theory of Mind/mental-state inference stimuli. The control group was faster at responding, and primed more for the target inferences, than the RHD group. The overall advantage for Theory of Mind texts was traceable to one highly conventional inference: someone tells a white lie to be polite. Particularly poor performance in mental-state causal inferencing was not related to neglect or lesion site for the group with RHD. CONCLUSIONS: With appropriate stimulus controls and a relatively implicit measure of causal inferencing, this study found no "Theory of Mind" deficit for adults with RHD. The utility of the "Theory of Mind" construct is questioned. A better understanding of the social communication difficulties of adults with RHD will enhance clinical management in the future.
社交认知与互动方面的困难是单侧右半球脑损伤（RHD）成年患者的特征。一些相关证据表明，从“心理理论”角度来看，他们的推理能力明显较差，而“心理理论”需要具备将思想、信念和意图归因于他人的能力，以便理解他人的行为。心理理论通常通过引发相互冲突的心理表征的任务来评估。先前使用常用文本任务的研究报告称，与从对照文本中进行非心理状态因果推理相比，患有RHD的成年人在对心理状态进行因果推理时准确性较低。然而，心理理论文本和对照文本在相互竞争的话语实体表征的数量和性质上存在差异。这种刺激差异，再加上因果推理的明确测量方法，可能使患有RHD的成年人在心理理论文本上处于劣势。
本研究重新探讨了患有RHD的成年人是否存在心理理论缺陷的问题。使用了上述心理理论文本，但编写了新的对照文本以解决刺激差异问题，并相对隐含地评估因果推理。假设在这些条件下，患有RHD的成年人不会表现出心理理论缺陷。
参与者包括22名因脑血管意外导致单侧RHD的成年人和38名无脑部损伤的成年人。参与者听取针对心理状态或非心理状态因果推理的口语文本。每个文本之后是口头的对错探测句，以评估对目标推理的理解。记录准确性和反应时间（RT）数据。使用混合的双向方差分析（组别×文本类型）对数据进行分析。
在准确性和反应时间分析中，文本类型均有主效应，心理理论/心理状态推理刺激的表现更具优势。与RHD组相比，对照组的反应更快，对目标推理的启动更强。心理理论文本的总体优势可追溯到一个高度常规的推理：有人出于礼貌撒了个善意的谎言。患有RHD的组在心理状态因果推理方面表现特别差，这与忽视或损伤部位无关。
通过适当的刺激控制和相对隐含的因果推理测量方法，本研究发现患有RHD的成年人不存在“心理理论”缺陷。对“心理理论”概念的实用性提出了质疑。更好地理解患有RHD的成年人的社交沟通困难将有助于未来的临床管理。
