Neural responses to affective and cognitive theory of mind in children and adolescents with autism spectrum disorder

Abstract

Objectives: Children and adolescents with Autism Spectrum Disorder (ASD) are characterized by the impairment of Theory of Mind (ToM) abilities. Recent evidence suggested that two aspects of ToM (cognitive ToM vs Affective ToM) is differentially impaired in individuals with ASD. In this study, we aimed to examine the neural correlates of cognitive and affective ToM processes in children and adolescents with ASD compared to typically developing controls (TDC). Methods: 12 children and adolescents with a diagnosis of Autism Spectrum disorder (11 males, mean age 12.4) and age, IQ matched 12 healthy control subjects (12 males, mean age 11.7) participated in functional MRI study. The ToM task involved the attribution of cognitive and affective mental states to a cartoon character based on verbal and eye-gaze cues. The difference in brain activation between ASD and TDC subjects was examined contrasting affective and cognitive ToM conditions.Results: In cognitive ToM tasks, ASD subjects recruited a region within the anterior prefrontal cortex (medial prefrontal cortex, anterior cingulate cortex: mPFC/ACC) and superior temporal gyrus to a greater extent than TDC. In affective ToM tasks, they showed more activation in insula, middle frontal gyrus and precentral gyrus. Exploratory correlational analysis revealed that inverse relationship between autistic symptoms of social impairment and fMRI functional response for cognitive ToM task, and this result suggests that greater activation of the mPFC/ACC regions was associated with less symptom severity in ASD patients.Conclusions: The present study demonstrated the neural bases of cognitive and affective ToM in ASD patients. From a clinical perspective, this data suggested that the recruitment of additional prefrontal resources can compensate for the successful performance in the ToM task at behavioral level in children and adolescents with ASD. This kind of research can be applied to the tailored implementation of treatment intervention for children and adolescents with ASD in the direction of strengthening the prefrontal function in the implementation of social skill training program for ASD patients.