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Assessing Theory of Mind in Children: A Tablet-Based Adaptation of a Classic Picture Sequencing Task

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Abstract

Correctly assessing children’s theory of mind (TOM) is essential to clinical practice. Yet, most tasks heavily rely on language, which is an obstacle for several populations. Langdon and Coltheart’s (Cognition 71(1):43–71, 1999) Picture Sequencing Task (PST), developed for research purposes, avoids this limitation through a minimally-verbal procedure. We thus developed a tablet adaptation of this task for individual application, engaging children’s motivation and allowing response times collection. To assess this tablet-PST, we first tested a large sample of neurotypical children (6–11 years-old, N = 248), whose results confirmed the task’s structural and content validity, and permitted the construction of three standardized clinical indices. In a second experiment, we applied those to previously diagnosed autistic children (N = 23), who were expected to show atypical TOM performance. Children’s outcomes were consistent with what was hypothesized and confirmed the task’s external validity and moderate clinical sensitivity. The tablet-PST thus appears as a suitable tool, providing detailed profiles to inform clinical decisions.

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Data Availability

Data and analytic code to reproduce the analyses are available upon request to the corresponding author.

Notes

  1. Following Botha et al. ([67]), we use identity-first language to refer to autistic individuals, which is considered less offending and stigmatizing than person-first language (“person with autism”) by the autistic community (e.g., [68]). Note, too, that the adjective “autistic” refers here to the whole autistic spectrum.

  2. Interestingly, response times measures were included in Langdon & Coltheart’s ([34]) original study but were later abandoned, after failing to reveal group difference between high vs. low schizotypal healthy adults. Given that response times have been shown to reveal meaningful effects in autism, we decided to include them on the tablet-PST.

  3. To make sure that grouping together the two control conditions did not hide important effects, we also ran the analyses contrasting TOM, mechanical and social scripts, and report the results in supplementary materials.

  4. In line with Experiment 1, perfect responses (score = 6) were not distributed equally across item types: they represented 39% of responses to TOM items and 70% of the responses to non-TOM items.

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Acknowledgements

We are to thank all the children who participated to this study, as well as Beynes school (Egletons, France) and Saint-Sacrement school (Lyon, France) which welcomed us despite a COVID context, Caroline Morellet and Isabelle Petit who helped with data collection in Experiment 1, and to Marie-Maude Geoffray as well as to the teams of the Vinatier who helped with the recruitment of the clinical group of Experiment 2. This project was funded by the hospital Le Vinatier and the French Ministry of Health (PHRIP-2018-266).

Funding

This work was supported by funds granted to the first author by the Centre Hospitalier Le Vinatier and the French Ministry of Health (PHRIP-2018-266).

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Authors and Affiliations

  1. Le Vinatier Psychiatrie Universitaire, Lyon Métropole, France

    Nicolas Petit & Matias Baltazar

  2. Centre de Recherche en Neurosciences de Lyon (CRNL), Lyon, France

    Nicolas Petit & Jérôme Prado

  3. Laboratoire de Linguistique Formelle (LLF), Paris, France

    Ira Noveck

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Contributions

NP performed conceptualization, funding acquisition, methodology, investigation, analysis, and wrote the original draft. IN performed supervision and writing—review and editing. MB performed writing—review and editing. JP provided resources and performed supervision, writing—review and editing.

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Correspondence to Nicolas Petit.

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The authors have no competing interests, or other interests that might be perceived to influence the results and/or discussion reported in this paper.

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All participants of these experiments provided informed consent to participate, as well as their parents. This study was run in accordance with the Declaration of Helsinki and received approval from the local IRB (Comité de Protection des Personnes Sud-Est I, ID RCB 2019-A01721-56).

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Appendix

Appendix

Clinical Vignettes

In order to illustrate how the tablet-PST can be used to provide clinical information, richer than a simple standardized score on a classical task, we extracted three prototypical profiles from our sample.

Participant 1 is a 6-years; 7-months-old boy. His autism diagnosis was confirmed by a positive SCQ and a positive ADOS-2. His level of intelligence functioning was also assessed and is strictly normal. In the tablet-PST, he obtained a GSA of 2.8/6, placing him only at the 1st percentile, given his age and SES. This score indicates that the task itself is not suitable to assess this specific child’s skills. Indeed, the ability of that child to sequence pictures is compromised, maybe due to his young age, to behavioral difficulties and/or to difficulties in sequencing events and representing time which can be observed in certain individuals with autism [66]. If theory of mind must be assessed, it should be done otherwise.

Participant 7 presents a different profile. She is a 7-years; 6-months-old girl, whose autism diagnosis was confirmed by a positive SCQ and a positive ADI-R. Her level of intelligence functioning had not been formally tested, but no difficulties were suspected by the clinicians who follow her, and her language skills were in the normal to normal-superior range. In the tablet-PST, she got a 4.9/6 GSA (71st percentile) but scored 1.5/6 on average on TOM items (3rd percentile). Contrary to participant 1, participant 7 is thus very able to sequence pictures in general, with a GSA that is even in the normal-superior range. However, specific difficulties arise as soon as TOM is involved, where she scores much lower than expected, given her age and her good sequencing abilities. This is indicative of specific difficulties in theory of mind. No particularity was observed in her response times: she answered TOM items in 29 seconds on average, contra 23 seconds for the control items, which places her at percentile 26.

Finally, participant 6 is a 7-years; 6-months-old boy, whose diagnosis was confirmed by a positive ADOS-2 and a positive SCQ. His intelligence was assessed as normal, as well as his language skills. He performed very well with the tablet-PST control items, with a GSA of 5.6/6 (85th percentile), and even better on TOM items with a mean accuracy of 6/6 (94th percentile). This child has no problem in sequencing pictures in general and, given his age and his good GSA, he performs even significantly better than expected with TOM items. However, he took 44 seconds on average to answer items involving false beliefs, contra only 18 seconds on control items: this difference, given his good accuracy, places him only at the 1st percentile. This indicated that participant 6’s good accuracy on TOM items is obtained with unusual effort, in terms of response times, that is specific to items where TOM is involved. This might reflect atypical processing strategies such as compensatory mechanisms specifically associated with mentalizing.

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Petit, N., Noveck, I., Baltazar, M. et al. Assessing Theory of Mind in Children: A Tablet-Based Adaptation of a Classic Picture Sequencing Task. Child Psychiatry Hum Dev (2024). https://doi.org/10.1007/s10578-023-01648-0

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