Social Understanding and Self-Control: A Link Left Untested

What the research found

A theory of mind task battery asks a child to attend to nine short stories, arranged in ascending order of difficulty, and to answer fifteen questions about them. The earliest items ask which face shows which feeling. The last require second-order false belief, meaning what one character wrongly believes about what a second character believes. Answering demands that the child follow the story and keep two versions of events apart while reporting only one.

That battery was one of two social measures used by Jeetinder Singh, Priti Arun and Manoj Kumar Bajaj in a cross-sectional study published in 2021 in the Indian Journal of Psychological Medicine. Recruitment ran through the psychiatry department at Government Medical College and Hospital in Chandigarh. Twenty children had ADHD, twenty had a specific learning disorder, and twenty were typically developing siblings or peers, all aged 7 to 15 and all with measured intelligence in the average band of 90 to 110.

The second social measure was the Theory of Mind Inventory, 42 statements about a child’s everyday conduct rated by a parent. There the ADHD group scored below controls on every subscale and on the overall mean, each at a P value of 0.001 or below. Children with a specific learning disorder did not differ from controls on the inventory at any level.

On the tasks the children answered themselves, the separation was narrower. Two of the reported tasks distinguished the groups: a line of sight task, which tests the understanding that people see different things from different positions, and a task on emotions produced by belief rather than by events. The ADHD group differed from controls on these at P below 0.001 and P of 0.03, and the learning disorder group differed from controls on the same two.

Executive function was assessed with the Wisconsin Card Sorting Test, a card sort in which the rule changes without warning, and with the Stroop test of response inhibition. Children with ADHD needed more trials than controls, a mean of 123 against 89.45, and completed fewer sorting categories, 4.20 against 5.8.

The two sets of results were compared group by group and never against each other. No analysis asked whether the theory of mind differences survived once set-shifting and inhibition were accounted for, and none adjusted for intelligence, which was higher in the control group at 109.35 against 100.85. The authors state that the degree to which one predicts the other cannot yet be established. What the study establishes is a group comparison and nothing closer: the group with the lowest social scores was also the group with the weakest set-shifting and inhibition.

What it means for you and your child

A low score on a theory of mind measure records how a child performed on nine vignettes on one afternoon, or how a parent rated 42 statements about the child’s behaviour at home. It describes an outcome, and the reasons behind that outcome are precisely what this design left open. The authors’ own account allows that inhibition, working memory or general intellectual ability may each be involved in how executive function and theory of mind relate.

The learning disorder group complicates any single explanation. Their set-shifting and inhibition were also poorer than controls, significantly so on the number of trials, on perseverative responses and on failure to maintain a rule, and their parents nevertheless rated their everyday social understanding no differently from the parents of typically developing children. Weak executive function by itself did not produce a low parent rating.

The moment a teacher observes usually occurs in a corridor or a group task, under time pressure and among competing demands, which are the conditions under which set-shifting and inhibition are most taxed. The study did not test whether the same child would read the situation accurately with that pressure removed, which remains the more useful question for the adults who see the child daily.

The evidence is thin in the ordinary ways. There were twenty children to a group, all drawn from one hospital, and the controls were often siblings of the children being studied. Fourteen of the twenty children with ADHD were taking methylphenidate or atomoxetine, stopped one day before testing, and executive function was assessed with two instruments rather than a full battery. What that design yields is an association and nothing stronger.

A school meeting goes further when the discussion moves from what the child understands to what the situation required of them. Whether the difficulty appears as readily in a quiet conversation with one adult as it does in the corridor at changeover is something a teacher can answer and a score cannot. So is whether the child, asked calmly afterwards, can explain what the other person was thinking.

Sixty children in one Indian city can show that the two difficulties travel together. Which one moves first is a question the next study has to be built to ask.