Is social cognitive training efficient in autism? A pilot single-case study using the RC2S+ program

BackgroundProblems in social functioning (e.g., unemployment, social isolation), are common in people with a psychotic disorder. Social cognition is a treatment target to improve social functioning, as it is a proximal predictor of social functioning. Social Cognition Training (SCT) improves social cognition, but may not generalize (enduringly) to social functioning, perhaps due to insufficient opportunity to practice in daily-life social situations. Using virtual reality (VR) for SCT could address this problem, as VR is customizable, accessible, and interactive. We will test the effect of a VR SCT, ‘DiSCoVR’, on social cognition and social functioning in a randomized controlled trial (RCT).MethodsIn total 100 people with a psychotic disorder and deficits in social cognition will be recruited for this multicenter randomized controlled trial (RCT). Participants will be randomized to VR SCT (DiSCoVR) or VR relaxation training (VRelax; active control). DiSCoVR is a 16-session individual SCT, consisting of three modules: 1) emotion perception (recognizing facial emotions in a virtual shopping street); 2) social perception and theory of mind (observing social interactions between virtual characters and assessing their behavior, emotions and thoughts); and 3) application of higher-order social cognition in social interaction (role-playing personalized situations in VR). People receiving VRelax complete sixteen individual sessions, in which they receive psycho-education about stress, identify personal stressors, learn relaxation techniques, and explore relaxing immersive virtual environments.Assessments will be performed at baseline, post-treatment, and 3-month follow-up. Primary outcomes are emotion perception (Ekman 60 Faces), social perception and theory of mind (The Awareness of Social Inference Test). Secondary outcomes include social functioning (Personal and Social Performance Scale), experiences and social interactions in daily life (experience sampling of emotions, social participation and subjective experience of social situations), psychiatric symptoms (e.g., depression, perceived stress, anxiety, positive and negative symptoms) and self-esteem.DiscussionTo our knowledge, this will be the first RCT testing the efficacy of VR SCT. It will also investigate generalization to daily life social situations, the durability of treatment effects, and moderators and mediators of treatment success.Trial registrationOn December 5, 2017, this trial was registered prospectively in the Dutch Trial Register as NTR6863.

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are neurodevelopmental disorders characterized by social impairments. The first objective of this study was to analyze social cognition deficits of children with ADHD, high-functioning ASD (HFASD), and typical development (TD) in their performance on explicit and applied measures of theory of mind (ToM). The second objective was to investigate the relationships between executive functions and social cognition in HFASD and ADHD. One hundred and twenty-six 7- to 11-year old children, 52 with HFASD, 35 with ADHD, and 39 with TD, performed the NEPSY-II social perception subtests. Parents estimated their children's ToM skills using the Theory of Mind Inventory (ToMI). Teacher-reported data from the Behavior Rating Inventory of Executive Function (BRIEF) were also obtained. The HFASD and ADHD groups showed worse performance on the verbal ToM task than the TD group, and only the performance of the HFASD group was significantly lower than the TD group on the contextual ToM task. Parents also estimated that the HFASD group had more difficulties on the applied ToM than the ADHD and TD groups. Furthermore, there is a different executive function-theory of mind link in the HFASD and ADHD groups: behavioral regulation processes such as inhibition and emotional control are more associated with social cognition in children with ADHD, whereas metacognitive processes such as initiation and planning have a strong association with social cognition in children with HFASD. These findings have implications for understanding social perception deficits in neurodevelopmental disorders, highlighting the need for early intervention.

In schizophrenic disorders, impairments in social functioning, neurocognition, and theory of mind (ToM) are frequently reported but little is known about the relationships between them. The aim of this study is twofold: (a) to compare neurocognition, social-functioning, and ToM in patients and controls and (b) to investigate whether impairments in these domains are related to psychiatric symptoms. Participants were 16 outpatients with schizophrenic disorders (DSM-IV), and 16 healthy controls. We administered neuropsychological tests, ToM, social functioning, and psychopathology measures. Patients and controls differed on most neurocognitive variables (memory, attention, executive functions). We also found significant differences in 1 ToM factor and 2 social measures. The latter were the only 2 related to manic-hostility and negative symptoms subscores of Brief Psychiatric Rating Scale. Our findings suggest that there is no direct relation between neurocognitive impairments and social dysfunctions.

Benefits of social cognitive skills training within routine community mental health services: Evidence from a non-randomized parallel controlled study.

Social communication in autism spectrum disorder not improved by Theory of Mind interventions.

The cerebellum is recognized as an affect and cognition modulator, besides the traditional role of movement coordinator [1]. Bidirectional connections exist between the cerebellum and cortical structures involved in the regulation of different cognitive and emotional processes [1–3]. Stoodley and Schmahmann [3] supported a functional dichotomy of the cerebellum: the anterior portion would control the sensory-motor system, while the posterior portion would control the cognitive–affective functions. Schmahmann and Sherman [4] defined the ‘‘cerebellar cognitive affective syndrome’’ (CCAS) as a pattern of deficits in language, visuospatial abilities, executive functioning and affective regulation. The affective component includes changes in personality, lack of inhibitory regulation, inappropriate behaviour, altered mood regulation, blunting of affect, obsessive–compulsive tendencies, and psychotic thinking [4]. These symptoms may be secondary to an impairment of social cognition, the capacity to construct mental representations of social relations and to flexibly use them in the social environment. Social cognition comprehends theory of mind (ToM), one’s perspective taking, empathy, the appreciation of behavior appropriateness, and the understanding of conventional and moral rules, resulting an important prerequisite to successful behavior [5]. ToM, the reading of others’ mental states (beliefs, intentions, desires), allows distinguishing mental states that have a basis in reality from lies, metaphors, persuasion, or delusion [6]. Indeed, in psychiatric patients, some psycho-behavioural symptoms were related to ToM deficit [6]. Functional imaging and clinico-pathological studies indicated that a widely distributed neuronal system underlies ToM, especially the anterior paracingulate cortex, superior temporal sulci, temporal poles, and the dorsolateral and ventromedial prefrontal cortex [7–11]. A study of autism and abnormalities of the cerebellar hemispheres, vermis, and lobules, suggested an involvement of the cerebellum [12]. The cerebellum is linked, through different neural pathways, to the associative and paralimbic cortex that are linked to the regulation of the emotions and social behaviour [4]. Research on connectivity also evidenced that bi-directional pathways link the left lateral cerebellum and the right posterior superior temporal sulcus, supporting a role for the cerebellum in a wide range of social cognitive functions [13]. Few clinical studies addressed the relationship between the cerebellum and ToM, reporting conflicting results: ToM impairment in the absence of emotion attribution and appreciation of social situation deficits in patients with cerebellar siderosis or atrophy [12, 14, 15] or normal ToM functions in patients with cerebellar stroke [16]. Given the differences in the patient samples and ToM tasks, these results are scarcely comparable, preventing general conclusions. Within this research framework, it is interesting to evaluate the case of a right-handed, 65-year-old patient with 8-year education, who was admitted to hospital due to progressive gait and limb ataxia and dysarthria. Neurologic symptoms began at age 63, with progressive walking A. Parente, V. Manfredi, and A. Tarallo have contributed equally to this work.

P03-228 - Brain activity during social cognition tasks in individuals with schizophrenia, their unaffected siblings, and healthy controls

Functional outcome and social cognition in bipolar disorder: Is there a connection?

Dysfunction of social-cognitive abilities is one of the hallmark features of schizophrenia and is associated with neurocognition and social functioning. The Green and Nuechterlein model proposed that social cognition mediates the relationship between neurocognition and functional outcome. We tested this hypothesis in schizophrenia patients in the everyday clinical setting. Social cognition, executive function and social functioning were assessed in a group of 43 patients with schizophrenia or schizoaffective disorder using a range of measures. Theory of mind was associated with executive functions and social functioning. Results of our mediation analysis suggested that the relationship between executive functions and social functioning was mediated by theory of mind. No relationships between emotion recognition and the domains of social functioning were found. In line with prior research, zero-order associations were found between theory of mind and social functioning. Theory of mind was a mediator of the relationships between neurocognition and social functioning. Our results suggest that theory of mind should be a potential target of interventions to improve social functioning.

Alcohol use disorder and emotional processing patterns: Insights from a systematic review.

This study analyzed the effectiveness of an integrative cognitive remediation program (REHACOP) in improving neurocognition, social cognition, creativity, functional outcome, and clinical symptoms in patients with schizophrenia. In addition, possible mediators predicting improvement in functional outcomes were explored. The program combined cognitive remediation with social cognitive training and social and functional skill training over 20 weeks. The sample included 94 patients, 47 in the REHACOP group and 47 in the active control group (occupational activities). Significant differences were found between the two groups in change scores of processing speed, working memory, verbal memory (VM), inhibition, theory of mind, emotion processing (EP), figural creative strengths, functional competence, disorganization, excitement, and primary negative symptoms. A mediational analysis revealed that changes in VM, inhibition, and EP partially explained the effect of cognitive remediation on functional competence improvement. This study provides initial evidence of the effect of integrative cognitive remediation on primary negative symptoms and creativity.

Neuropsychological correlates of cognitive, emotional-affective and auto-activation apathy in Alzheimer's disease

Weak theory of mind (ToM) ability is a core deficit in children with autism. A growing body of work has found that there is a close relation between complement syntax and ToM in autistic children. However, researchers have not yet investigated whether other linguistic components may explain the difficulties in ToM reasoning in autistic children. To determine whether verb factuality (i.e., mental and action verbs) is related to ToM ability, as measured by a false belief understanding (FBU) task after controlling the effect of complement syntax for Mandarin-speaking autistic children. Participants were verbal autistic children, aged 4-7 years. Their IQ performance (verbal, performance and total IQ) and the comprehension of complement syntax were evaluated. A total of 38 children scoring over 9 points in complement syntax test and 90 points in the verbal IQ test were selected to complete verb factuality and FBU task. The χ2 tests and correlation analyses were carried out on two relations: (1) ToM ability and understanding of verb factuality; and (2) ToM ability and comprehension of complement syntax. A total of 11 autistic children completed the action verb factuality task, while 14 completed the mental verb factuality task and 13 completed both tasks. Participants performed well on the verb factuality task, and their ToM performance appeared to be related to their linguistic ability, regardless of the type of verb (i.e., action or mental verb). However, complement syntax scores did not significantly predict the success of the FBU task for the autistic children. The results of this study link weaker ToM ability with the understanding of verb factuality among autistic children aged 4-7 and provide new evidence for the view that the development of language facilitates improvement of ToM skills. The findings shed new light on how language affects or determines social interactions. What is already known on the subject ToM ability is crucial for social interaction. It has been claimed that mental verb factuality (e.g., think, had thought) may play a role in the development of ToM reasoning in typically developing children, but whether there is a link between the mastery of verb factuality and ToM skills in autistic children is still unclear. What this study adds to existing knowledge Correlational analysis revealed links between verbal ToM measured by unexpected location task and factuality test of mental verbs as well as action verbs. More importantly, this study confirmed the extra role of verb factuality in explaining ToM ability after excluding the influence of the complement syntax. What are the potential or actual clinical implications of this work? This study suggests that the factuality of verbs could serve as a tool for autistic children to infer the mental states of others. Thus, training on this linguistic structure could be taken into consideration when improving the social skills of autistic children.

Déficit de cognición social en el trastorno bipolar: relevancia y estrategias de rehabilitación

Previous studies indicate that theory of mind (ToM) skills are affected in bipolar disorder (BD). However, findings on the relationship between ToM and social functioning remain inconsistent. This study included forty-one remitted patients with BD and forty-one age and gender-matched healthy controls. In this cross-sectional study, participants completed the Reading the Mind in the Eyes Test (RMET) to assess ToM, the Functioning Assessment Short Test (FAST) to measure social functioning, the Brief Irritability Test (BiTe) for irritability, the Acceptance and Action Questionnaire-II (AAQ-2) for psychological flexibility, and the Valued Living Questionnaire (VLQ) to assess valued living. Hierarchical linear regression and correlation analyses were conducted to determine explanatory variables of social functioning and the role of irritability, psychological flexibility, and valued living. Patients with BD demonstrated lower ToM abilities, psychological flexibility, valued living scores, and higher irritability levels compared to controls. Social functioning was also impaired in the BD group. In healthy controls, ToM performance was associated with social functioning. Psychological flexibility and valued living were correlated with social functioning, indicating that these factors may play a prominent role in functional impairment in BD. While ToM deficits were associated with social functioning in healthy individuals, this relationship was not evident in remitted patients with BD. This suggests other factors, beyond ToM, contribute to social functioning deficits in BD. Further research is needed to clarify these complex relationships.