The effect of theory of mind skills on sluggi̇sh cognitive tempo in children with adhd: A comparative analysis with healthy controls

Aim and hypothesis: Disruptive and aggressive behaviors in children with Attention Deficit Hyperactivity Disorder (ADHD) may lead to social problems which cause considerable impairment in psychosocial functioning. Unlike ADHD, social problems in Sluggish Cognitive Tempo (SCT) are characterized with social withdrawal and peer isolation. Theory of Mind (ToM) skills are predictive for an efficient socialization, and the children with ADHD have lesser scores in ToM Scales. To our knowledge, there is no study examining the relationship between SCT and ToM in children with ADHD. Because of the fact that SCT has a distinct relationship with social problems, in this study, we aimed to compare children with ADHD and healthy controls (HC), with regard to relationship between SCT and ToM skills. Our primary hypothesis was that lower ToM skills had a negative effect on SCT. Method: The sample included 50 children with ADHD and 40 HC, aged between 8 and 14. All participants were assessed with K-SADS-PL and DSM-V, and those with psychotropic drug use history or comorbid psychiatric disorder were excluded. The parents completed Turgay Disruptive Behavior Rating Scale for Parents (T-DSM-IV), Barkley Child Attention Scale (BCAS) and Child Behavior Checklist (CBCL). The teachers filled out T-DSM-IV-teacher form, BCAS and Teacher Report Form (TRF). The children were administered ToM Tasks (first and second order false belief tasks, Reading Mind in the Eyes (RMET), Unexpected Outcomes and Comprehension Tests) by the clinician. Results: ADHD group showed worse performance in all ToM tests than HC. In regression analysis, false belief tasks and RMET significantly predicted the outcome between children with ADHD and HC. ADHD-Inattention was significantly associated with social problems, while hyperactivity significantly predicted social problems and externalization. SCT symptoms were related to social withdrawal/depression. Comprehension test was negatively associated with inattention, whereas unexpected outcomes test was positively related to SCT. Inattention, paternal age and unexpected outcomes test significantly predicted parent-reported SCT. Additionally; hyperactivity, SCT and second order false belief tasks significantly predicted parent-reported social problems wheras inattention and first order false belief tasks predicted teacher-reported social problems. Conclusion: Our findings demonstrated that ADHD-Inattention symptoms were negatively associated with ToM test scores, while unexpected outcomes test was positively related to SCT. The different presentations of social problems in ADHD and SCT might be related to different relations of ToM. Further studies with larger samples are required to evaluate the combined effects of ToM, SCT, and executive functions in children with ADHD. Keywords: attention deficit hyperactivity disorder, sluggish cognitive tempo, social problems, theory of mind