The ToM test-R: Assessment of 'Theory of Mind' in children diagnosed with PDD, ADHD and social phobia

The concept 'theory-of-mind' (ToM) is originally defined by Premack and
Woodruff (1978) as the ability to ascribe thoughts, feelings, ideas, and
intentions to others and to employ this ability to anticipate the behaviour of
others. The acquisition of this ability is supposed to be a prerequisite for
the development of social competence in children. ToM abilities develop along 3
stages: (a) precursors of ToM (e.g., emotion recognition), (b) a first
manifestation of ToM (e.g., false belief), and (c) more mature ToM aspects
(e.g., second order beliefs). The ToM test (Steerneman, Meesters & Muris, 2000)
is an instrument intended to assess the aforementioned ToM abilities. By means
of an interview consisting of read aloud stories and drawings information on
social understanding and social sensitivity of children aged 5 to 12 years is
obtained. The ToM test is useful in the study of childrens' social and
cognitive development, in particular of those children who exhibit deficits in
social and interactive abilities (for example children with PDD, ADHD and
anxiety disorders). In addition, the test can be used in training programmes
that are focused on the remediation of deficits in social and cognitive
development. The ToM test yields a profile of strengths and difficulties of an
individual child, which may be helpful for the implementation of intervention
programmes as well as evaluations of effect.
Past experiences with the ToM test have revealed some bottlenecks. First,
normative data were found to be inadequate due to small normative samples.
Second, practical use has shown some problems regarding the interpretation of
certain stimuli, resulting from ambiguous drawings.
Therefore, a revised version of the ToM test, the ToM test-R , has been
developed.

The research question targets the validation and examination of norm scores of
the ToM test-R test in the mental disorders PDD, ADHD, and social phobia in
children of different ages. It will be investigated:

(1) Whether or not differences in *theory of mind* abilities in children with
PDD, ADHD or social phobia exist when tested with the ToM-R test.

(2) How *theory of mind* develops in these disorders, referring to differences
and deficits at different ages when compared to the other disorders.

More specifically and based on results coming from research on the original ToM
test it is hypothesized that:

(1) a positive correlation between age and *theory of mind* scores in all three
groups will be found;

(2) PDD children will receive lower *theory of mind* scores and will
demonstrate especially problems on items concerning *false belief* tasks, when
compared to children with social phobia or ADHD;

(3) no difference in performance between children with social phobia and ADHD
will be discovered.

In all, 180 children will participate in the present study, with 60 children in
each diagnostic category. The sub-samples will be divided into four age
categories (5-6 years; 7-8 years; 9-10 years; 11-12 years), each age group
consisting of at least 15 subjects.
In total the study consists of two separate sessions with an interval of one
week between the sessions in order to overcome carry-over effects.
Additionally, sessions will be counterbalanced among subjects. One session will
consist of *theory of mind* abilities measured by the ToM test-R, the other one
will assess the same constructs as the ones being included in the ToM test-R by
using well validated assessment tools.

Study participation bears no risk at all for subjects. No disadvantages for the
subjects are expected by the used measurements. Children usually like these
kind of tasks because they give them a lot freedom for own interpretations and
all the attention will be drawn to their stories. Furthermore, no intervention
will be used. More and deeper insight in emotional processes in children who
meet the full or some criteria of the mental disorders in question, can build
the basis for more focused and specific treatment interventions in the future.