COGNITIVE AND AFFECTIVE THEORY OF MIND IN CHILDREN AND YOUNG ADOLESCENTS

Transcription

1 COGNITIVE AND AFFECTIVE THEORY OF MIND IN CHILDREN AND YOUNG ADOLESCENTS A Thesis Submitted to the Committee on Graduate Studies in Partial Fulfillment of the Requirements for the Degree of Master of Science in the Faculty of Arts and Science TRENT UNIVERSITY Peterborough, Ontario, Canada (c) Copyright by Ashley Toohey 2015 Psychology M. Sc. Graduate Program September 2015

2 ii Abstract Cognitive and Affective Theory of Mind in Children and Young Adolescents Ashley Toohey Recently, a distinction has been made between cognitive theory of mind, the ability to make inferences about other's beliefs and thoughts, and affective theory of mind, the ability to make inferences about other's emotional states. The purpose of this study is to determine if the distinction between cognitive and affective theory of mind is developmentally appropriate and whether the relation between language and theory of mind is maintained when cognitive and affective theory of mind are examined separately. The sample consisted of 20 children aged 6 to 9 years, and 27 children aged 11 to 15 years. Results showed that the older group outperformed the younger group on both cognitive and affective theory of mind, and that different aspects of language were related to each type of theory of mind. This suggests the distinction between cognitive and affective theory of mind may in fact be valid in this age range. Keywords: Cognitive Theory of Mind, Affective Theory of Mind, Development, Language

3 iii Acknowledgements I would like to sincerely thank Dr. Nancie Im-Bolter for supervising and mentoring me for the past four years. Her passion for the research she does sparked my initial interest in this field and without her unwavering patience, guidance, and faith in me as an academic, I am certain I would not have accomplished this piece of work. Dr. Im-Bolter s commitment to the highest standards and unwavering work ethic are inspiring. I feel very fortunate to have had the opportunity to work with someone for whom I have a great deal of respect and admiration. I would also like to thank Dr. Brenda Smith-Chant and Dr. Hugo Lehmann for taking time out of their busy schedules to serve as my committee members. Their invaluable feedback has helped elevate the quality of this transcript. I would like to thank Keely Owens-Jaffray for her help and support throughout this process, for answering my endless questions, and encouraging me to stay on task. I would also like to thank the children and parents who were involved in this study. Without their participation, this thesis would not have been possible. To Trent University, as well as the Social Sciences and Humanities Research Council of Canada, thank you for funding this research project. Finally, I would like to thank my friends and family. In particular, I would like to thank my parents for providing me with constant support and encouragement, and for letting me use them as sounding boards when I needed to think out loud.

4 iv Contents Abstract ii Acknowledgements iii List of Figures v List of Tables vi Overview 1 Theory of Mind 2 Theory of Mind and Language 8 Cognitive Versus Affective Theory of Mind 14 Present Study 21 Hypotheses 21 Methods 22 Participants 22 Procedure 22 Measures 22 Socioeconomic Status 22 Nonverbal Intelligence 23 Language Skills 23 Cognitive Theory of Mind 23 Affective Theory of Mind 23 Results 26 Data Screening 26 Sample Characteristics 27 Group Differences in Type of Theory of Mind 28 Relations Between Higher Order Theory of Mind and Language 29 Predicting Performance on Theory of Mind 30 Higher Order Cognitive Theory of Mind 30 First Order Affective Theory of Mind 31 Higher Order Affective Theory of Mind 31 Discussion 31 Cognitive and Affective Theory of Mind in Children and Young Adolescents 32 Cognitive and Affective Theory of Mind and Language 35 References 38 Appendix A- Parent Questionnaire 51 Appendix B- Happe Strange Stories Vignettes and Questions 52 Appendix C- Real and Deceptive Emotion Vignettes and Questions 54

5 v List of Figures Figure 1-Facial Array for Real and Deceptive Emotion Task 25 Figure 2-Performance on Theory of Mind Type by Age Group Controlling For Task Comprehension 29

6 vi List of Tables Table 1-Group Differences in Background Characteristics, IQ, and Language 27 Table 2-Adjusted Means and Standard Deviations of Group Performance on Theory of Mind Tasks 28 Table 3-Correlations for Age, Language, and Theory of Mind 30 Table 4-Hierarchical Multiple Regression Analyses Predicting Theory of Mind from Age, Semantic Language Competence, and Syntactic Language Competence 31

7 1 Cognitive and affective theory of mind in children and young adolescents Overview Theory of mind refers to children s developing concepts of the mental activity of others such as beliefs and thoughts (Bjorklund, 2005) and implies the possession of a causalexplanatory framework to account for the actions of others (Miller, 2006). Theory of mind is typically first seen in children at 3 or 4 years of age (Astington & Jenkins, 1999; Bosacki, 2000; Miller, 2006; Miller, 2009) and continues to develop and increase in complexity throughout later childhood and adolescence (Bosacki, 2000; Miller, 2006). Studies indicate a significant relationship between language and theory of mind such that lower performance on one is linked with lower performance on the other (Astington & Jenkins, 1999; Milligan, Astington & Dack, 2007). This suggests that lower language competence could negatively impact the development of theory of mind and research with children with autism, specific language impairment, and hearing impairment supports this idea (e.g., Gillot, Furniss & Walter, 2004; Happé, 1995; Jackson, 2001; Schick, de Villiers, de Villiers & Hoffmeister, 2007). Recently, a distinction has been made between cognitive theory of mind, the ability to make inferences about other's beliefs and thoughts, and affective theory of mind, the ability to make inferences about other's emotional states (e.g., Kalbe et al., 2010). The majority of research to date however, has focused on adult samples. As such, it is not known whether this distinction applies to children nor whether the well-established relation between theory of mind and language holds when examining cognitive and affective theory of mind separately. The purpose of the current study is to determine if cognitive and affective theory of mind are distinct in children and young adolescents and whether the relation between language and theory of mind is maintained when cognitive and affective theory of mind are examined separately.

8 2 Theory of Mind Theory of mind refers to our ability to explain and predict what people do based on what we think about their wants, desires, hopes, goals, ideas, knowledge, and opinions as well as how we believe these mental processes are related (Bjorklund, 2005). Theory of mind is often referred to as mentalizing or mind reading as it involves using mental state understanding of another individual in order to predict and explain their behaviour. For example, you see someone slip on a wet floor and fall. You may think that this person is physically hurt and would therefore be upset or sad. You might also think that person s pride might be wounded and that they might look around to see if anyone saw them fall. You may hypothesize that the person would get up and brush themselves off and/or check to see if they or their wardrobe sustained any injuries or damage. The ideas we generate about another person s beliefs, emotions, and behaviours are a result of our ability to develop a theory of that person s mental state. Research demonstrates that at around 4 years of age, children understand that people s actions are based on their thoughts, ideas, and beliefs of the world (Bosacki, 2000). At this point in their development, children begin to understand that different people will have different interpretations of the same situation depending on their perspective and that not everyone likes and wants the same things (Miller, 2006). In this case, children show an ability to understand that others have thoughts, ideas, and beliefs that are different from theirs. This understanding of others thoughts and beliefs is referred to as first-order theory of mind (e.g., John thinks that the chocolate is in the cupboard ). There are three classic tasks used to tap first-order theory of mind: unexpected location, deceptive contents, and appearance-reality. These tasks are also referred to as false belief tasks as they involve the child s ability to understand that people will act in accordance with their

9 3 beliefs about reality even if those beliefs are false (Miller, 2004). A typical unexpected location task involves presenting a child with a scenario in which a character (Maxi) puts chocolate (or some other object) in a particular location (e.g., a green cupboard in the kitchen) (Wimmer & Perner, 1983). After Maxi leaves the room, another character (Maxi s mother in this case) transfers the chocolate to a different, unexpected, location (a blue cupboard). The child is then asked where Maxi will look for his chocolate when he comes back to the kitchen. A child who has first-order theory of mind will answer the green cupboard because this is where Maxi last saw the chocolate. A child without first-order theory of mind would reply the blue cupboard because they fail to understand that Maxi s knowledge is not only different from reality (i.e., where the chocolate actually is), but also different from the child s. Maxi did not see his mother move the chocolate even though the child did. As a result, Maxi has a false belief regarding the location of the chocolate. A child who successfully completes this false belief task and who has first-order theory of mind would recognize that Maxi has a false belief, which affects Maxi s behaviour (i.e., where Maxi would look for the chocolate). A typical deceptive contents task involves showing a child a box that clearly indicates the contents (e.g., Smarties box) (Perner, Leekman & Wimmer, 1987). Without being shown the contents of the box, the child is asked what they think is in the box. The child answers "Smarties". The child is then shown that the box actually contains pencil crayons and is asked what another child would think was in the box. A child who has first-order theory of mind will answer "Smarties" because this is what the box appears to contain. A child without first-order theory of mind would reply "pencil crayons" because they fail to understand that the other child's knowledge is different from reality (i.e., what the box really contains). The other child was not shown the contents of the Smarties box, and as a result, has a false belief regarding its contents.

10 4 A typical appearance-reality task involves showing a child an object that appears to be something it is not (Flavell, Flavell & Green, 1983). For example, a child would be shown an object that looks like a rock, but is really a sponge, and asked what the object looks like. The child would answer "a rock". The child would then be given the object to manipulate and asked whether the object is really a rock or a sponge. A child is said to understand the appearancereality distinction if they respond a sponge when asked what the object really is, and a rock when asked what the object looks like. The child who lacks theory of mind does not understand that what the object appears to be and what the object is in reality are two different things. Theory of mind continues to develop beyond early childhood (Bosacki, 2000; Miller, 2006) although research in this development period is sparse. Research has demonstrated that children are able to start representing what is referred to as second- or higher order theory of mind (i.e., John thinks that Jane thinks that the man is in the park ) between the ages of 5 and 9 (Astington, Pelletier & Homer, 2002; Filippova & Astington, 2008; Perner & Wimmer, 1985; Sullivan, Zaitchik & Tager-Flusberg, 1994). Whereas first-order theory of mind refers to beliefs one has of another person s mental state (i.e., John thinks that the sky is green ), second-order theory of mind refers to beliefs one has about what another thinks of yet another s mental state. Mastery of second-order theory of mind tasks requires realizations regarding mental states beyond those necessary for success on tasks that measure first-order theory of mind (Miller, 2009). As such, second-order theory of mind is acquired only after mastery of first-order theory of mind, which acts as a building block upon which second-order theory of mind is built. A classic second-order theory of mind task is the Second Order Location Change Task, also referred to as the Ice Cream Van Task (Perner & Wimmer, 1985). This task involves the following scenario, which is either acted out with figures and objects or illustrated with pictures.

11 5 In the scenario three main characters, John, Mary, and the ice cream man, are at a park. John wants to buy an ice cream but he does not have enough money. The ice cream man tells John he will be in the park all day so John goes home to get some money. The ice cream man then changes his mind and tells Mary he is going to go to the church. Mary decides to go to John s house to tell John that the ice cream man has gone to the church. Unknown to Mary, John sees the ice cream man and the ice cream man tells John he is going to the church to sell ice cream. When Mary arrives at John s house she is told that John has gone out to buy an ice cream. Children are then asked a question that taps second order theory of mind, Where does Mary think that John has gone to buy an ice cream?. The correct answer is, the park because Mary does not know that John has seen the ice cream man. Using this task, Perner and Wimmer (1985) demonstrated that by roughly 7 years of age, children are able to represent second-order beliefs. As such, they can determine that Mary thinks John went to the park. Subsequent studies of second-order theory of mind have adapted Perner and Wimmer's (1985) Ice Cream Van task due to the memory demands and artificial nature of the story. In an effort to ensure that children s performance on second-order false-belief tasks was not due to the information processing and linguistic demands of these tasks, researchers have made modifications to the methodology such as adding probe questions (to ensure comprehension of the story), feedback, and memory aids (e.g., Remember, Mary does not know that the ice-cream man told John where he was going ) to the story or using fewer characters and settings. These studies showed that children as young as 5 years of age were able to correctly attribute second order false beliefs (e.g. Banerjee, 2002; Bennett & Matthew, 2000; Lockl & Schneider, 2007; Naito & Seki, 2009; Silliman, Diehl, Hnath-Chisolm, Zenko, & Friedman, 2003; Sullivan et al., 1994); however, these studies are not without their drawbacks. Although one of the main

12 6 reasons for the modifications was to ensure that younger children did not fail second-order theory of mind tasks due to memory or linguistic demands, there is little investigation focusing on the actual association between language competence and second-order theory of mind. This is curious when we consider that Lockl and Schneider (2007) found that language competence at three years of age predicted performance on second-order theory of mind tasks two years later. Another problem with much of the research investigating second-order of theory of mind is the reliance on artificial scenarios that depend on second order change of location (e.g., ice cream moving from one location to another unexpected one). To remedy this problem, other studies examining second-order or higher order theory of mind have used tasks such as the Happé Strange Stories (Happé, 1994), Real and Deceptive Emotion Task (Dennis, Barnes, Wilkinson & Humphreys, 1998), Social Faux Pas (Baron-Cohen, O'Riordan, Stone, Jones & Plaisted, 1999) and Awkward Moments (Heavey, Phillips, Baron- Cohen & Rutter, 2000), which utilize more natural scenarios and contexts. The Happé Strange Stories consist of short stories with situations that are more likely to be encountered by children in their everyday lives. In this task, children are presented with a series of vignettes in which a character says something that is not literally true for a variety of different reasons including that it is a joke, a sarcastic remark, or a white lie. For example, two characters see a lady come out of the hairdresser's with a funny haircut. One of them says to the other "It looks like she got in a fight with a lawnmower." The child is asked if what the character said is true and then why the character said this. Children s responses are scored on their ability to explain the character s true intentions. Answers that reflect higher order theory of mind would refer to the character s thoughts, beliefs, and intentions in order to explain the reasoning behind the character s behaviour. Studies investigating higher order theory of mind using the Happé Strange Stories

13 7 have demonstrated that this task is sensitive to the developmental nature of higher order theory of mind with older children outperforming younger children (e.g. Adrian, Clemente & Villanueva, 2007; Brent, Rios, Happé & Charman, 2004; O'Hare, Bremner, Nash, Happé & Pettigrew, 2009). In addition, research using the Happé Strange Stories task with adults between the ages of 50 and 90 have not shown ceiling effects (Charlton, Barrick, Markus & Morris, 2009), thereby highlighting that this task is appropriate to use with a wide age range of participants, including older children and adolescents. A task similar to the Happé Strange Stories is the Real and Deceptive Emotion Task (Dennis et al., 1998). This task was adapted from Harris, Donnelly, Guz, and Pitt-Watson (1986), which was designed to examine the appearance-reality distinction with respect to emotions. In the Real and Deceptive Emotion Test, the child is presented with a series of vignettes in which the main character (Terry) feels a certain emotion but outwardly displays a different emotion due to the situation Terry is in. For example, the child (a girl) is told that Terry sees someone wearing funny clothes, but that the person would be angry if Terry laughed at them. So in this situation Terry hides how she feels. The child is asked to indicate the emotion Terry feels inside and why Terry feels that way. The child is then asked to indicate the emotion Terry would show on her face and why Terry would do that. In this example, Terry would be happy inside because she found the clothing quite funny but Terry would show a neutral expression on her face because she thinks the person wearing the funny clothes would get angry if Terry laughed. Dennis et al. (1998) used this task to examine theory of mind in children with and without brain injury who were between the ages of 6 and 15 years. Regardless of brain injury status, there was a significant effect of age for questions that asked Terry's reason for concealing her emotions. Further, children in both groups who were older than 10 years had less

14 8 difficulty identifying deceptive emotions (i.e., the emotion shown on the face) (Dennis et al., 1998). These findings highlight that younger children have more difficulty understanding that the way someone else feels inside may not be the same as how they choose to show on the outside. More recently, Dennis, Lockyer, and Lazenby (2000) found that children with autism had difficulty identifying the emotion felt, the emotion displayed, and the reason for the use of deceptive emotional expression compared to the children without autism. It has been established in the literature that children with autism show poor theory of mind skills (e.g., Baron-Cohen, Leslie & Frith, 1985; Happé, 1994; Leslie & Frith, 1988; Perner, Frith, Leslie & Leekam, 1989; Yirmiya, Solominica-Levi & Shulman, 1996). Given this well-established finding, we would expect that children with autism would have more difficulty with the Real and Deceptive Emotion task, which proposes to tap theory of mind, than their typically developing peers. It has been well established in the literature that children with autism have language deficits (e.g., Baltaxe, 1977; Frith, 1989; Lord, 1985; Paul, 1985; Tager-Flusberg, 1989). These difficulties in communicative language have been proposed to explain the poor performance children with autism tend to exhibit on theory of mind tasks (e.g.; Capps, Kehres & Sigman, 1998; Hale & Tager-Flusberg, 2005; Paul, 1987). This relation between language and theory of mind has been an area of intense focus in theory of mind literature. Theory of Mind and Language There is now a well established relation between theory of mind and language (e.g. Astington & Jenkins, 1999; Bosacki, 2000; Hughes & Dunn, 1998; Miller, 2004; Milligan et al., 2007). In addition, longitudinal research has shown that earlier performance on measures of language predicts later performance on false-belief tasks in 3 and 4 years olds (Astington &

15 9 Jenkins, 1999; Slade & Ruffman, 2005) and that earlier false belief task performance in 3 and 4 year olds predicts later performance on language measures (Slade & Ruffman, 2005). Although Astington and Jenkins (1999) found that early theory of mind performance was not predictive of later language skills, Slade and Ruffman (2005) found that in addition to early language skills predicting later performance on theory of mind, early theory of mind performance did in fact predict later language skills once the wide range of possible scores on the language measures and the narrow range of possible scores on the theory of mind tasks was taken into account. These results point to the relation between theory of mind and language being positive and reciprocal in nature, at least in preschool children. The relation between theory of mind and language makes sense intuitively when we consider that throughout the first few years, the development of theory of mind and language are interwoven in complex ways (Miller, 2006). Infants demonstrate an appreciation of others intentions within the context of communicative interactions or during interactions where there is shared attention on an object or an act. For example, when someone reaches out to pick up an infant, that infant will in turn reach out to that person (Miller, 2006). This joint attention, the coordination of attention between another, the self, and an external object or event, is seen as a precursor to language skills (Tomasello, 1995). In a longitudinal study, Charman et al. (2001) measured what is referred to as joint attention at 20 months and found that it significantly predicted theory of mind at 44 months. Further, in a more recent study, Kristen, Sodian, Theormer and Perst (2011) found that comprehension of referential pointing, or pointing that has the specific intent of referring to something, at 9 months was predictive of mental state language use at 24 and 36 months. These findings highlight that communicative acts in infancy, which reflect early language competence, may predict theory of mind. Taken together, these findings

16 10 highlight the complex interplay between language and mental state understanding early on in theory of mind development. In preschool children, two components of language have been found to correlate with theory of mind -- semantics and syntax. Semantics refers to our knowledge of word meaning and word properties (Hughes & Dunn, 1998). This knowledge of word meaning includes our understanding of associations between the words themselves and what they represent (e.g., things, concepts, actions, etc.). As a result, semantic language can be used to make unobservable beliefs and intentions, as well as their relationship to behaviour, explicit by providing verbal labels to represent mental states (Zadeh, Im-Bolter & Cohen, 2007). These verbal labels serve to make unobservable beliefs, motives, and intentions observable or visible. Theory of mind is dependent on the semantic understanding of mental state language, such as think, know, and believe, in order to consider why a person behaves in a particular way (i.e., developing a theory of another s mental intentions). Young children hear and begin to take part in conversations in which people explain and make predictions about the behaviours of others using mental state language involving desires and beliefs (Miller, 2006). Ruffman, Slade and Crowe (2002) found that mental state utterances of children between the ages of 2 and 5 years involving desires and beliefs predicted later performance on theory of mind tasks. Toddlers begin to use mental state terms such as think and know, as well as emotion words such as happy and sad as they are exposed to them and begin to associate meaning with them through their semantic understanding of these and other such terms (Miller, 2006). Moore, Pure and Furrow (1990) found that, in 4 to 6 year olds, understanding mental state language such as think and know was related to falsebelief understanding. In a longitudinal study, Ruffman, Slade, Rowlandson, Rumsey and Garnham (2003) found that, starting at 3 years of age, semantic language performance uniquely

17 11 predicted variance in later false belief understanding over a 2.5 year period. Given the inseparable relationship between understanding mental states and mental state language, it is not surprising that research shows a significant relation between semantic language ability and children s performance on tasks that tap false belief understanding (Doherty, 2001; Garnham, Brooks, Garnham, & Ostenfeld, 2000; Moore et al., 1990; Ruffman et al., 2003). Without words and the meanings assigned to them, mental states would remain unobservable. Syntactic ability, which is the understanding of the rules that dictate how sentences are formed, has also been found to correlate with theory of mind (Astington & Jenkins, 1999; Rakhlin et al., 2011; Ruffman et al., 2003). Astington and Jenkins (1999) point out that mental state awareness requires mental representations of complex language constructions consisting of a sentence with a subordinate clause embedded in it. For example, in the sentence, Mary thinks the earth is flat., the subordinate clause, the earth is flat, acts as the grammatical object of the verb thinks in the sentence. Such a clause is referred to as an object complement. Object complements play a key role in mental state understanding because they allow the reporting of false beliefs, that is, the whole sentence may be true even though the subordinate clause is false (Astington & Jenkins, 1999). Therefore, one could honestly say, Mary thinks the earth is flat even though in reality, the earth is not flat. Object complements allow us to express our understanding of other s beliefs, desires, thoughts, and feelings (i.e., theory of mind). The importance of object complements for theory of mind has been demonstrated in a number of different studies with children with typical and atypical development. In a one year longitudinal study with 3 to 5 year olds, de Villiers and Pyers (2002) found that mastery of object complements was predictive of successful false belief performance. Schick et al. (2007) found that understanding object complements was a significant and independent predictor of success on

18 12 theory of mind tasks in a group of deaf and hearing children aged 3 to 8 years. Miller (2004) found that children with specific language impairment had difficulty with object complements compared to their typically developing peers. Further, for both groups, performance on object complement tasks was highly and positively correlated with performance on false belief tasks (Miller, 2004). Given the central role that both semantic knowledge and object complements play in our understanding of others mental states or intentions it is not surprising that researchers have become interested in whether semantic or syntactic language plays a more important role in theory of mind. Work by Astington and Jenkins (1999) suggests that syntactic language may be more critical for theory of mind than semantics, at least in preschoolers. Astington and Jenkins (1999) used scores on semantic and syntactic language tests taken at time 1 in their longitudinal study to predict theory of mind at time 2. Results of their hierarchical analyses revealed that, after controlling for age and semantic language competence, syntactic language significantly predicted later performance on measures of theory of mind (Astington & Jenkins, 1999). However, semantic language did not significantly predict theory of mind after age and syntactic language were accounted for suggesting syntactic language played a unique role in theory of mind. More recently, Ruffman, et al. (2003) have argued that Astington and Jenkins's (1999) findings are misleading because a number of the items used to assess syntax relied on background semantic knowledge. In an effort to determine the extent to which semantic and syntactic language uniquely accounted for higher order false belief understanding, Ruffman et al. (2003) conducted a longitudinal study over 2.5 years. Results from their two studies were mixed. In their first study, Ruffman et al. (2003) found that semantics and structural language (a composite of syntax and semantics scores) predicted false belief at later times, but syntax alone did not. However, as

19 13 a result of their second study Ruffman et al. (2003) found that object complements (syntactic language) predicted unique variance in all the theory of mind tasks even after accounting for age and other language variables whereas semantic language was a unique predictor in one of the theory of mind tasks only. Taken together, the literature highlights that some aspects of syntactic language may be a better predictor of theory of mind than semantic language; however, more research is required in order to determine whether syntactic or semantic language plays a more critical role in theory of mind. Much less is known about the relation between higher order theory of mind and language. The few studies that have been conducted suggest that language continues to play an important role in theory of mind as children move into middle childhood (e.g., Andres-Roqueta, Adrian, Clemente & Katsos, 2013; Bosacki, 2000; Gillot et al., 2004; Grazzani & Ornaghi, 2012; Miller, 2001; Rakhlin, et al., 2011). However, findings are mixed as to whether semantic, syntactic, or general language ability plays a more important role in theory of mind during this developmental period. Bosacki (2000) found that in a group of children ages 10 to 13 years, general language was positively correlated with theory of mind. If language is important for theory of mind then children with deficits in language should demonstrate deficits in their performance on theory of mind tasks. Gillot et al. (2004) compared theory of mind in children with specific language impairment, with autism, and with typical development between 8 and 12 years of age. Using the Happe Strange Stories task, Gillot et al. (2004) found that typically developing children provided more correct mental state answers than the children with specific language impairment and with autism. A more recent study by Andres-Roqueta et al. (2013) investigated the role of language on performance on two false belief tasks in a group of 3 to 7 year olds. They found that children with specific language impairment performed similarly to the language matched

20 14 controls but more poorly than age matched control group on both false belief tasks. Further, grammar (syntactic language) was found to be the best predictor of theory of mind performance (Andres-Roqueta et al., 2013). Given the importance of understanding object complements for first order theory of mind, it stands to reason that a firm grasp of complex syntax would be especially important for higher-order theory of mind. In order for a child to explain what they think another person thinks of another person s thoughts, the child needs to be able to understand and construct syntactically complex sentences containing multiple embedded object complements. Results from Rakhlin et al. (2012) support the continued importance of syntax for theory of mind performance. Researchers found that in a group of 6 to 12 year olds, scores on language measures were positively related to scores on a false belief task after controlling for IQ and short-term memory. Specifically, children who failed the false belief task had significantly lower scores for syntactic complexity on narratives they created than children who passed the false belief task. Further, use of mental state language (semantic language) was not related to performance on the false belief task. Although these findings highlight that language and theory of mind continue to be associated in middle childhood, they do not provide clear insight into the relative importance of semantic versus syntactic language. Cognitive versus Affective Theory of Mind Although theory of mind has been an intense focus of research for several decades now, the vast majority of studies have concentrated on what are referred to as cognitive mental states (i.e., thoughts, beliefs, and intentions). Recent research with adults suggests that mental state understanding can be differentiated into cognitive and affective components (e.g., Duval et al., 2011; Duval et al., 2012; Genizi et al., 2012; Gupta, Tranel & Duff, 2012; Kalbe et al., 2010;

21 15 Shamay-Tsoory et al., 2007; Shamay-Tsoory, Hagai, Aharon-Peretz & Levkovitz, 2010). It should be noted that research has found support for there being two distinct types of empathy, cognitive and emotional. Further, findings highlight that the terms affective theory of mind and cognitive empathy, may essentially be used interchangeably. As the focus of this paper is on theory of mind, we will be using the terms cognitive and affective theory of mind. Investigations of affective mental states (i.e., emotional) in children are limited. In fact, much of the research to date on this cognitive/affective distinction has focused on adult samples and individuals with neurologically-based difficulties. Studies with adults have used brain imaging techniques in order to determine the specific neural substrates involved in these two aspects of mental state understanding and to show that the brain areas associated with them are distinct (e.g., Gupta et al., 2012; Kalbe, et al., 2010; Sebastian et al., 2012; Shamay-Tsoory et al., 2010). Generally, these studies show differences in brain area activation while participants completed cognitive versus affective theory of mind tasks (e.g., Gupta et al., 2012; Kalbe, et al., 2010; Sebastian et al., 2012; Shamay-Tsoory et al., 2010). A recent meta-analysis found that brain regions linked with the main substructure related to cognitive theory of mind have little or no direct connections with areas of the brain involved in emotion processing, whereas those linked to the main substructure related to affective theory of mind are responsible for the representation and regulation of emotion information (Abu-Akel & Shamay-Tsoory, 2011). Further, research with individuals who have damage to the substructure related to affective theory of mind, but not to the substructure related to cognitive theory of mind, show impairments in affective, but not cognitive theory of mind (e.g., Gupta et al., 2012; Shamay-Tsoory et al., 2007). Evidence from these neural imaging studies has been used to form the basis for the

22 16 distinction between cognitive and affective theory of mind. In these studies the Yoni task (Shamay-Tsoory et al., 2007), or the very similar Tom's Taste task (Duval et al., 2011), is often used to assess cognitive and affective theory of mind (e.g., Duval et al., 2011; Duval et al., 2012; Genizi et al., 2012; Kalbe et al., 2010; Shamay-Tsoory et al., 2007; Shamay-Tsoory et al., 2010). In the Yoni task, participants are presented with a cartoon outline drawing of a face, Yoni, in the center of the computer screen and four coloured thought bubbles surrounding him. Participants examine Yoni s facial expression and/or eye gaze direction to answer a question regarding Yoni s thoughts or emotions, which are posed near the top of the screen. There are three conditions in this task; cognitive, affective, and physical. The cognitive and affective conditions contain first-order and higher order theory of mind questions. A first-order question asks what Yoni is thinking (cognitive) or feeling (affective). In each case the direction of Yoni s eye gaze to one of the four thought bubbles indicates what he thinks or feels. An example of a first-order cognitive item would be an image of Yoni, with a neutral facial expression, and his eyes looking at one of the four thought bubbles around his head. The question on the screen would be, Yoni is thinking of apples. The correct answer would be to select the image (apples) that Yoni s eye gaze is directed to. An example of a first-order affective item would be an image of Yoni, with a smile on his face, and his eyes looking at one of the four thought bubbles around his head. The question would be, Yoni loves dogs and the correct answer would be to select the image (dogs) that Yoni s eye gaze is directed to. Higher order cognitive items incorporate questions that ask what Yoni is thinking about what another individual thinks (e.g., Yoni is thinking of the fruit that John wants ), but similar to the first-order cognitive the correct answer is indicated by the direction of Yoni s eye gaze. Higher order affective items depict Yoni looking forward but with different emotional

23 17 expressions on his face. In each item, Yoni is surrounded by four thought bubbles, one of which contain a facial expression that matches the expression on his face and the participant is asked to match the facial expressions (e.g., "Yoni identifies with John ). Using this task, researchers have found differences in brain activation during the cognitive and affective subtests, which has been taken as confirmation that theory of mind is made up of both cognitive and affective components that are functionally different from one another. Once differences in neural activation were found in healthy adults, researchers started investigating differences in performance on cognitive and affective theory of mind in atypical samples. This was done not only to determine which groups of individuals outperformed others on cognitive and/or affective tasks, but also in an effort to more precisely isolate the parts of the brain involved in each domain. One of the major limitations of the Yoni, and also Tom's Taste, task is that it may not be measuring theory of mind. In three of the four tasks, there is a clear visual cue as to which answer is correct because of Yoni's changing eye direction. This means that participants can get the question correct by simply selecting the image that matches the direction of Yoni s eye gaze. It is questionable that correctly identifying gaze direction taps cognitive or affective theory of mind. Instead, the questions may be measuring the participants inferential thinking and problem solving skills as opposed to their ability to understand and predict another s mental activity. Further, the higher order affective component of this task does not really seem to get at understanding another s affective mental state but rather, one s ability to recognize and match emotional expressions. Moreover, despite the well established relation between theory of mind and language, none of the studies using the Yoni or Tom s Taste task have examined whether cognitive and affective theory of mind are related to language skill. Although the Yoni task is commonly used to examine cognitive and affective theory of

24 18 mind in adults, there are a number of other tasks that have also been used. Affective theory of mind is often assessed in older adolescent and adult samples using the Reading the Mind in the Eyes test (e.g., Baron-Cohen et al., 1999; Baron-Cohen, Wheelwright, Hill, Raste & Plumb, 2001; De Ferrari et al., 2015), which features facial expressions of complex emotions (e.g., scheming, guilty, threatening, etc.). In the Reading the Mind in the Eyes test, participants are shown a series of photographs of facial expressions that depict various emotions but are of the eye region only. Participants are then asked to select one of the four emotion words they think the person in the photograph is thinking or feeling. Although this task is often used to assess affective theory of mind, Baron-Cohen et al. (2001) concede that it does not, in fact, fully tap affective theory of mind. That is, the task measures attribution or identification of emotional mental states (e.g., compassion), but it does not require the individual to infer the reason for or intention behind the emotional mental state (e.g., compassion for another's loss of a loved one). In order to remedy this problem, others have used story based tasks to tap affective theory of mind. These tasks require participants to correctly identify the emotion an individual is feeling based on a short story they heard or read (e.g., Altmann, Bohm, Lubrich, Menninghaus & Jacobs, 2012; Lecce, Demicheli, Zocchi & Palladino, 2015; Lecce, Zocchi, Pagnin, Palladino & Taumoepeau, 2010; Santangelo et al., 2012). However, these tasks fail to explore the intention behind the emotional mental state. As such, they fail to fully tap into affective theory of mind. Recently, an expanded version of the Real and Deceptive Emotion Test has been used to assess affective theory of mind in children with traumatic brain injury (Dennis et al., 2013). Dennis et al. (2013) point out that affective theory of mind involves communicating and understanding the affective states of others based on what we believe they feel and think. As such, they argue that selecting an emotional expression that we believe matches the inner (or

25 19 real) emotions of others is a form of affective theory of mind. The focus of Dennis et al. s study was to examine group differences on affective theory of mind in children who had suffered traumatic brain injury and those who had orthopedic injuries. Though they did find group differences, Dennis et al. also found that regardless of injury type, all children performed better on the Feel Inside questions than they did on the Look on Face questions. Although the Real and Deceptive Emotion Test is not considered to be a typical higher-order affective theory of mind task, it does tap higher-order mental state understanding because it requires the child consider how they think someone else would act based on what that individual thinks about yet another individual s motives, emotions, or beliefs. In the Real and Deceptive Emotion Test, the child must understand that an individual might display emotions that are not always congruous to how she actually feels because she is considering another person s feelings. This understanding requires a complex level of mental state understanding. This idea is supported by Harwood and Farrar (2006), who found that the ability to understand false beliefs is related to the ability to understand conflicting emotions. Unlike the Reading the Mind in the Eyes task, the Real and Deceptive Emotion Test requires the inference of emotional states in addition to identification of internal emotions and display of external emotions. Further, identification of emotions is based on a vignette rather than matching direction of eye gaze, and as a result, there is no possibility of physically cuing the participant to the correct response like in the Yoni task. For these reasons, the Real and Deceptive Emotion Test addresses the main limitations of the two tasks most commonly used to assess affective theory of mind. Although studies examining cognitive and affective theory of mind focus on adult samples, research with adolescents can provide clues regarding the potential distinction between, and development of, these two aspects of theory of mind. Sebastian et al. (2012) investigated the

26 20 neural correlates of cognitive and affective theory of mind in adolescents and adults. No group differences were found for the cognitive theory of mind measure. However, results indicated that adolescents made significantly more errors on items measuring affective theory of mind than the adult sample. In addition, Sebastian et al. observed more activation in the brain area associated with affective theory of mind in their adolescent sample than in their adult sample when responding to affective theory of mind items. Sebastian et al. suggested that these findings suggest that there may be developmental changes that occur in affective theory of mind throughout adolescence. This idea is further supported by results of Vetter, Altgassen, Phillips, Mahy, and Kliehel (2013) in a study of 12 to 22 year olds that found 35% of variance in their affective theory of mind task was explained by age. These findings suggest that affective theory of mind may continue to develop into late adolescence or early adulthood. There appear to be only two studies that have included measures of cognitive and affective theory of mind in children with typical development. However, the focus of these studies was not on the distinction between, or development of, cognitive and affective theory of mind, but rather their association with reading metaknowledge (e.g., Lecce, et al., 2010) or declarative metamemory (e.g., Lecce et al., 2015). Lecce et al. (2010) found that, after controlling for verbal ability, there was a significant correlation between early cognitive, but not affective, theory of mind and later reading metaknowledge (strategies and purpose). Lecce et al. (2015) found that, after controlling for verbal and nonverbal ability and working memory, cognitive rather than affective theory of mind was related to declarative metamemory, or people s knowledge about the functioning of their own memory. These results suggest that cognitive and affective theory of mind may be distinct in children but do not add to our understanding of the developmental nature of cognitive and affective theory of mind. In

27 21 addition, little is known about the relations between language and cognitive and affective theory of mind since Lecce et al. (2010) and Lecce et al. (2015) used language as a control variable only rather than in relation to type of theory of mind. Present Study The purpose of the current study was twofold. The first was to address a gap in the literature with respect to whether the distinction between cognitive and affective theory of mind holds in children and young adolescents ages 6 to 15. The second was to address a gap in the literature with respect to the relation between language and both cognitive and affective theory of mind. Hypotheses 1) Given the developmental nature of theory of mind in general, it was predicted that the older group would outperform the younger group on both cognitive and affective theory of mind. 2) Based on findings that indicate affective theory of mind continues to develop in late adolescence and early adulthood, it was expected that older children would perform similarly on tasks measuring cognitive and affective theory of mind whereas younger children would score higher on a task measuring cognitive theory of mind compared to affective theory of mind. 3) Given the established relation between language and theory of mind, it was predicted that language would be significantly associated to both cognitive and affective theory of mind. Further, based on findings that syntactic language plays a more important role for theory of mind than semantic language, it was predicted that syntactic language would be a better predictor of both cognitive and affective theory of mind than semantic language.

28 22 Method Participants Participants included two groups of children representing a younger group (middle childhood) and an older group (early to mid adolescence). The younger group of children were aged 6 to 9 years (n = 20; m Age = 7.73; SD = 1.44) and included 9 males and 11 females. The age range for this group was based on research suggesting children aged 5 years are able to pass second order theory of mind tasks (Astington et al., 2002; Fillipova & Astington, 2008; Perner & Wimmer, 1985; Sullivan et al., 1994). The older sample of children was aged 11 to 15 years (n = 27; m Age = 12.88; SD =.96) and included 7 males and 20 females. Children were recruited via the use of advertisement and flyers in community centers, libraries, day care centers and other childoriented organizations, as well as online through social media. The first language for all participants was English; six of the participants were bilingual, three in the younger sample and three in the older sample. Procedure All children were seen for one session of roughly 90 to 120 minutes, with breaks provided as necessary. Parent consent and child assent was given prior to beginning the session. Parents were asked to complete a brief background questionnaire that included questions regarding general medical history (e.g., hearing and vision problems), general school performance (e.g., repeated any grades, learning difficulties), and parent occupation. Measures Socioeconomic Status (SES). Mother s and father s occupation were coded using the Blishen scale (Blishen, Carroll & Moore, 1987), which provides a score for socioeconomic status that takes into account both occupation and education. Scores on the Blishen scale range from

29 (newspaper carriers and vendors) to (dentists, physicians, surgeons). Nonverbal Intelligence. The Matrix Analogies subtest from the Wechsler Abbreviated Scale of Intelligence (WASI, Wechsler, 1999) was used to estimate nonverbal IQ. Language Skills. The receptive and expressive aspects of semantic language were measured using the Peabody Picture Vocabulary Test-Fourth Edition (PPVT-4: Dunn & Dunn, 2007) and the Expressive Vocabulary Test-Second Edition (EVT-2: Williams, 2007), respectively. The Test for Reception of Grammar-Second Edition (TROG-2: Bishop, 2003) and the Formulated Sentences subscale of the Clinical Evaluation of Language Fundamentals-Fourth Edition (CELF-4: Semel, Wiig & Secord, 2003) were used to assess the receptive and expressive aspects of syntactic language, respectively. Cognitive Theory of Mind. Higher order cognitive theory of mind was assessed using the Happé Strange Stories task (Happé, 1994). In this task, children are read eight short stories about hypothetical characters, which were also provided in written form in order to reduce memory demand. All stories depicted situations in which one character says something that is not literally true. For example: Daniel and Ian see Mrs Thompson coming out of the hairdresser s one day. She looks a bit funny because the hairdresser cut her hair much too short. Daniel says to Ian, She must have been in a fight with a lawnmower! For each story children were asked if what the character said was true ("Is it true what Daniel says?") as a comprehension check and why the character said what they did ("Why does he say this?") to assess higher order cognitive theory of mind. For all comprehension questions children s responses received a score of 0 for incorrect responses and 1 for correct responses. For the explanation questions ( Why did he/she say

30 24 that? ), children s responses received a score of 0 for incorrect response (e.g., Maybe she used a lawn mower to cut her hair ), 1 for correct responses that were based on physical actions (i.e., contained no mental state terms, e.g., It looks like short grass cut by a lawnmower ), 2 for correct responses that reflected an understanding of protagonist s mental state (i.e., contained mental state terms, e.g., He wanted to be funny ), or 2.5 for correct responses that reflected an understanding of the protagonist s mental state and alluded to consideration of the other character s mental state (e.g., Because he found it funny and thought that his friend would find it funny as well ). Proportion scores for comprehension questions were calculated out of a total possible 8 points. A total proportion score for responses to higher order cognitive theory of mind questions was also calculated for each participant out of a total possible 20. Inter-rater reliability of at least 0.74 was achieved on a sample not included in the current study before scoring of the current study data was completed. Kappa coefficients (all p <.005 or less) were calculated for all stories and ranged from κ =.74 to κ = Affective Theory of Mind. Higher order affective theory of mind was assessed using the Real and Deceptive Emotion task (Dennis et al., 1998). In this task, children were read 10 short vignettes about a hypothetical character, Terry, which were also provided in written form to reduce memory demands. All vignettes depicted situations that involve a mismatch between Terry s feelings and facial expressions and instructions stress that Terry is trying to hide the way he/she feels. Items were balanced so half the vignettes have a positive valence (i.e., Terry is trying to hide positive feelings) and half have a negative valence (i.e., Terry is trying to hide negative feelings). For example: A big boy runs past Terry. Suddenly the boy slips and falls over. The boy would be angry with Terry if he knew that Terry thought this was funny. Terry tries to hide how (s)he

31 25 feels. Prior to asking children the critical questions that tap higher order theory of mind, two questions were asked that assessed the child s comprehension of the story. The first asked about the situation that provoked the felt emotion ( What happened to the big boy? ) and the second asked about the reason why the real emotion should be hidden ( What will he do if Terry shows how he/she feels? ). Children were then presented with a gender neutral face array showing five facial expressions (from left to right depicting very happy, a bit happy, not happy/not sad/just OK, a bit sad, and very sad; see Figure 1) and asked to point to the facial expression that matched how Terry would look or feel ( How did Terry really feel when the boy fell over? ; How did Terry try to look on his/her face when the boy fell over? ). After each facial expression question, children were asked why Terry would look or feel that way ( Why did Terry feel like that? ; Why did Terry look like that? ). Figure 1. Facial Array for Real and Deceptive Emotion Task For all comprehension and facial array questions, children s responses received a score of 0 for incorrect responses and 1 for correct responses. The why feel inside questions ( Why did Terry feel like that? ) were scored on a 2-point scale: 0 for an incorrect response, 1 for correct responses that were based on physical actions (i.e., contained no mental state terms, e.g., Because the boy fell ), or 2 for correct responses that reflected an understanding of Terry s mental state (i.e., contained mental state terms, e.g., Because he thought it was funny that the