Amorim Kaela, Vandewouw Marlee M, Huynh Nhu, de Villa Kathrina, Safati Celine, Almonte Aurora, Nicolson Rob, Kelley Elizabeth, Crosbie Jennifer, Brian Jessica, Anagnostou Evdokia, Taylor Margot J, Sato Julie
Diagnostic & Interventional Radiology, The Hospital for Sick Children, Toronto, Canada.
Program in Neurosciences & Mental Health, The Hospital for Sick Children, Toronto, Canada.
Mol Autism. 2025 Jul 20;16(1):37. doi: 10.1186/s13229-025-00671-3.
Theory of mind (ToM) is fundamental for social interactions, allowing individuals to appreciate that others have their own mental states. Children and youth with neurodevelopmental conditions (e.g., autism, attention-deficit hyperactivity disorder (ADHD), and obsessive-compulsive disorder (OCD)) often show differences in ToM abilities compared to their neurotypical (NT) peers. Given the phenotypic heterogeneity and overlap associated with these conditions, this motivates a transdiagnostic investigation of ToM across neurodevelopmental conditions.
Five hundred and fifty-five participants (5-22 years; 193 ADHD, 189 autism, 33 OCD, and 140 NT) were recruited via the Province of Ontario Neurodevelopmental Disorders network. To measure ToM, participants completed the Social Attribution Task (SAT), where participants attribute social stories to videos of moving shapes. The Animation Index (ability to attribute social stories to the videos) and Pertinence Index (how pertinent the attributions are) were calculated from the descriptions. Three analyses were performed: (1) a case-control analysis, comparing the SAT indices amongst the diagnostic groups, (2) a univariate dimensional analysis, examining associations with phenotypic variables (e.g., full-scale IQ, verbal IQ, and social communication difficulties), (3) and a multivariate analysis (partial least squares) that identifies a latent space that describes the associations between the SAT and phenotypic measures.
There were no between-group differences in the Animation Index, but the Pertinence Index was significantly lower in autism compared to the other diagnostic categories. Phenotypic variables (full-scale IQ, verbal IQ, and social communication difficulties) were found to be significantly associated with SAT performance across groups, and explained more variance than the diagnostic categories. In the multivariate analysis, the phenotypic variables contributed more strongly to the identified latent component compared to the diagnostic categories.
The verbal requirement of the SAT limited the inclusion of non-verbal participants, while the overall cognitive demand limited the participation of those with lower IQs. Additionally, our OCD group was significantly smaller than the other groups, which may have limited our ability to detect OCD-specific effects.
In a large sample, we found that transdiagnostic measures, such as IQ and social communication difficulties, are related to SAT abilities across neurodivergent and neurotypical children and youth and better describe differences in SAT performance compared to the individual diagnostic categories. Although poorer performance on ToM tasks has been classically associated with autism, this study highlights that transdiagnostic, phenotypic variables are a stronger predictor of SAT performance than diagnostic group.
心理理论（ToM）是社交互动的基础，使个体能够认识到他人有自己的心理状态。患有神经发育障碍（如自闭症、注意力缺陷多动障碍（ADHD）和强迫症（OCD））的儿童和青少年与神经典型（NT）同龄人相比，在心理理论能力方面往往存在差异。鉴于这些疾病存在表型异质性和重叠性，这促使对跨神经发育障碍的心理理论进行跨诊断研究。
通过安大略省神经发育障碍网络招募了555名参与者（5 - 22岁；193名ADHD患者、189名自闭症患者、33名OCD患者和140名NT）。为了测量心理理论，参与者完成了社会归因任务（SAT），即参与者将社会故事归因于移动形状的视频。根据描述计算动画指数（将社会故事归因于视频的能力）和相关性指数（归因的相关程度）。进行了三项分析：（1）病例对照分析，比较诊断组之间的SAT指数；（2）单变量维度分析，研究与表型变量（如全量表智商、言语智商和社会沟通困难）的关联；（3）多变量分析（偏最小二乘法），确定一个潜在空间，描述SAT与表型测量之间的关联。
动画指数在组间没有差异，但与其他诊断类别相比，自闭症患者的相关性指数显著更低。发现表型变量（全量表智商、言语智商和社会沟通困难）与各组的SAT表现显著相关，并且比诊断类别解释了更多的方差。在多变量分析中，与诊断类别相比，表型变量对确定的潜在成分的贡献更强。
SAT的语言要求限制了非语言参与者的纳入，而总体认知需求限制了低智商者的参与。此外，我们的OCD组明显小于其他组，这可能限制了我们检测OCD特定效应的能力。
在一个大样本中，我们发现跨诊断测量，如智商和社会沟通困难，与神经发育异常和神经典型的儿童及青少年的SAT能力相关，并且与个体诊断类别相比，能更好地描述SAT表现的差异。尽管心理理论任务表现较差传统上与自闭症相关，但本研究强调，跨诊断的表型变量比诊断组更能预测SAT表现。
