Journal of Neuropsychiatry Disorders & Therapy

Volume 1 | Issue 1

Research Article Open Access

Theory of Mind Understanding and Socioeconomic Status

Nazila Shojaeian 1, *, Marjorie P Daniel2

1
Blanquerna - Ramon Llull University, Spain
2
Nova Southeastern University, Florida, Untied States

*
Corresponding Author: Nazila Shojaeian, Blanquerna - Ramon Llull University, Spain, E-mail: [email protected]

Citation: Nazila Shojaeian, Marjorie P Daniel (2024) Theory of Mind Understanding and Socioeconomic Status, J Neuropsychia-
try Disord Ther 1(1): 101

Received Date: December 08, 2023 Accepted Date: February 08, 2024 Published Date: February 12, 2024

Abstract

The participants underwent assessments across all Theory of Mind (ToM) tasks. All individuals were native speakers, com-
prising 74 from Iran and 66 from Sweden, aged 6-12, and included those with autism spectrum disorder, Down syndrome,
and typical development. We conclude that children’s behavior serves as a scale for social and thought problem assessments,
evaluated based on teachers' and parents’ scores. These scales exhibited a robust correlation with ToM results as perceived
by teachers but diverged significantly from parents' perspectives. While exploring the relationship between family socioeco-
nomic status and children’s ToM understanding, we were unable to establish a clear link in any of our cases. The current
findings underscore that the impact of culture is partially evident in the specific tasks developed by children during child-
hood. However, this cultural influence did not extend to the entire ToM construct. In essence, our results indicate that while
the effect of culture is partially confirmed in certain tasks developed by children in their formative years, it is not uniformly
present across the entirety of the ToM constructs within these groups.

Keywords: Autism Spectrum Disorder; Down Syndrome; Intelligence Quotient; Theory Of Mind; Socioeconomic Status;
ASEBA

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Introduction

According to Dunn et al. 1991 [1], the social world plays a mediating role in crucial conceptual advancements evident in social cog-
nition tasks. Individuals with autism spectrum disorder (ASD) often encounter challenges in social communication and interac-
tions [2]. Consequently, children with ASD may find it difficult to express themselves socially and communicate effectively with
strangers, thereby affecting their overall social and communication skills. To test their theory, Perner, Frith, & Leslie et al. [3] de-
signed dolls, and the experiment was subsequently replicated by real individuals who enacted scenarios involving these dolls [3].

One interesting observation in cultural studies of the Theory of Mind (ToM) is that a child may outperform peers from different
cultural backgrounds in a specific ToM task. A variety of approaches have been used to study the development of Theory of Mind
among children with disabilities considering its importance in the development of daily living skills. In fact, researchers have em-
ployed diverse methodologies to examine the evolution of Theory of Mind in children with disabilities, recognizing its significance
in shaping daily life that documents is mentioned in one study of Peterson, Slaughter et al. [4]

Method
Participants

The initial sample consisted of 155 children: 86 from Iran and 69 from Sweden. After excluding 140 schoolchildren from Tehran
and Karaj, Iran, the study focused on 74 children (43 boys and 31 girls), including 24 with autism spectrum disorder (ASD), 24
with Down syndrome (DS), and 26 with typical development (TD). Additionally, 66 children (33 boys and 33 girls) aged 6-12,
with similar characteristics were included, comprising 26 with ASD, 18 with DS, and 22 with TD. Sampling was conducted across
23 different locations in Tehran, including clinics, centers, and elementary schools, with and without special needs. In Sweden, chil-
dren with typical development (TD), Down syndrome (DS), and autism spectrum disorder (ASD) are selected from regular
schools in Stockholm and Göteborg. Children with Down syndrome were recruited from Särskolan schools, which were designed
for typically developing students.

Procedures

To gather medical, behavioral, and psychological information about the children in our clinical sample, we used a comprehensive
approach. Parents were requested to complete a Child Behavior Checklist (CBCL) questionnaire that offered insights into their
children’s behavior. Simultaneously, the teachers provided corresponding information by filling out the Teacher Report Form (TR-
F), detailing the child's behavior in the school environment. As a native speaker of Persian (Farsi), the author administered all
tasks to Iranian individuals in a language familiar to them. Swedish children in similar circumstances underwent testing either at
their schools or homes facilitated by a native Swedish research assistant. The testing process involved individual sessions, conduct-
ed either by the author or in collaboration with a local researcher, in a quiet room within the school or clinic setting.

Tasks and Instruments

Cognitive Measure: Raven's Progressive Matrices (RPMs)

John C. Raven in 2002 [5] developed Raven’s Progressive Matrices (RPMs), originally introduced by Raven in 1936 [6]. Coloured
Progressive Matrices (CPM) and Standard Progressive Matrices (SPM) were employed for both typical and clinical groups, with
SPM specifically used for children typically aged 12 years. Identical versions of Raven's Progressive Matrices were used to establish
IQ ranges for both Iranian and Swedish children.

In the absence of a Swedish standardization version, British norms were applied in Sweden [7]. Indeed, it is important to highlight

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that the distinct linguistic and cultural contexts between Britain and Sweden could impact the validity and applicability of the as-
sessment. Language variations may introduce biases, affecting how individuals comprehend and respond to the test items. Conse-
quently, caution should be exercised in generalizing findings and interpreting scores. In addition, it is worth noting that the Raven
test had been standardized with Iranian individuals in previous studies [8].

Sally and Anne Task; this classic task evaluates an individual's social cognitive ability within the first order of Theory of Mind
(ToM) [9].

Smarties Tube Task; this task involves a tube containing smarties instead of a pen. The child demonstrates and reseals the box to re-
veal its contents [10].

Representational Change Test (Picture Task); in this task children initially view animal pictures in various colors. Subsequently,
the examiner disclosed that the animals were concealed except for one body part. With the exception of the final picture and some
false belief questions, these are the same objects that the children encountered earlier [11].

The New Theory of Mind (ToM) Test which introduce by, Muris et al., (1999) [12]. For the current study, we utilized the formatt-
ed version by Karen L. Anderson (2013), comprising 20 items for ToM 1 (scored from 0 to 20), 13 items for ToM 2 (scored from 0
to 13), and 5 items for ToM 3 (scored from 0 to 5).

BEHAVIOR: The TRF and CBCL Behavior Scales 6/18 [13]: The Achenbach System of Empirically Based Assessment (ASEBA)
employs rating forms to evaluate competencies and problems in an individual's behavior from various sources. Our references
were parents or parent surrogates using the Child Behavior Checklist (CBCL 6/18), and teachers or school personnel using the
Teacher Report Form (TRF 6/18) [13]. Each item was rated on a three-point Likert scale regarding its applicability to the child: 0 =
not true, 1 = somewhat or sometimes true, 2 = very true or often true, or within the past six months for the CBCL and more than
two months for the TRF [13]. The questionnaires were completed by parents in both countries in their respective languages, with
the Iranian versions documented in earlier studies [15,16 ], and the Swedish versions [14,17].

MEASURE OF SOCIOECONOMIC STATUS: The Hollingshead four-factor index of socioeconomic status (SES) is a survey de-
signed to assess family socioeconomic status [18]. This measure incorporates social status determined by parents’ educational lev-
el, profession, and occupational status, which are code-rated on predetermined scales. The education code was scored on a 7-point
scale, and the occupational code was scored on a 9-point scale. These codes were then multiplied by specific values (profession and
occupation level 5 + education 3 = divided by 2 if there were two parents).

Data Analysis

Statistical analyses were conducted using SPSS version 25 (IBM Corporation, 2013). Descriptive statistics were employed to ex-
amine the participants' sociodemographic characteristics and variables. Furthermore, analysis of variance (ANOVA) was utilized
to explore group differences in Theory of Mind (ToM) tasks, providing mean and standard deviation values for quantitative vari-
ables, and frequency and prevalence for categorical variables. The rates of the measures were evaluated through ANOVA, and
post-hoc comparisons were carried out using Bonferroni tests. Additionally, one-way ANOVA was applied to assess the associa-
tion between variables. The relationship between ASEBA internalization and externalization indicators and socioeconomic status
was determined using analysis of variance and correlation coefficients. The significance level was set at .05.

Results

Based on evaluations from both parents and teachers, the Achenbach System of Empirically Based Assessment (ASEBA) was used
to assess internalizing and externalizing disorders. Our findings demonstrated a robust correlation between our thought and social

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problem scales and Theory of Mind (ToM) scores. Notably, there were significant differences in Teacher Report Form (TRF)
scores for social problems, thought problems, internalizing, and externalizing, providing additional support for the majority of the
tests. Conversely, there was no significant difference in any variable among individuals who completed the Child Behavior Check-
list (CBCL) questionnaire. For more information, see table 1.
Table1: Statistical Analyses of Correct and Incorrect Answers on ToM Tasks in Terms of TRF

T Score (TS) Response X (SD) T/F Sig

S_A_R TS Social Problems No Answer 65.00 (7.216) 1.818 .071

Answer 61.24 (10.631)
TS Thought Problems No Answer 65.47 (8.370) 2.651 .010
Answer 60.30 (12.189)

S_A_C TS Social Problems No Answer 63.71 (11.479) 1.835 .069

Answer 60.52(8.243)
TS Thought Problems No Answer 62.40 (13.182) .899 .37
Answer 60.58 (9.866)

S_A_M TS Social Problems No Answer 65.60(7.577) 2.805 .006

Answer 60.46(10.675)
TS Thought Problems No Answer 66.10 (10.603) 3.233 .002
Answer 59.32 (11.481)

Repr_ Q TS Social Problems No Answer 64.72(7.854) 2.490 .014

Answer 60.33(10.589)
TS Thought Problems No Answer 65.68(10.393) 3.652 <.001
Answer 58.45(11.162)

Repr_RD TS Social Problems No Answer 64.41 (8.021) 1.734 .085

Answer 61.02 (13.353)
TS Thought Problems No Answer 64.76 (14.468) 2.256 .026
Answer 59.72 (9.879)

Repr_FB TS Social Problems No Answer 63.43(10.665) 2.616 .010

Answer 58.72(7.219)
TS Thought Problems No Answer 62.06 (12.252) 1.506 .134
Answer 58.88 (9.147)

Smart_ N TS Social Problems No Answer 65.14 (7.185) 1.514 .133

Answer 61.57 (10.359)
TS Thought Problems No Answer 65.90 (10.931) 2.035 .044
Answer 60.42 (11.426)

Smart_ F TS Social Problems No Answer 66.16(7.297) 4.511 <.001

Answer 59.14(10.689)

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TS Thought Problems No Answer 64.02 (9.191) 2.534 .012

Answer 59.25(12.601)

Smart _RQ TS Social Problems No Answer 64.95 (12.999) 2.082 .039

Answer 61.01 (8.337)
TS Thought Problems No Answer 65.05 (14.058) 2.439 .016
Answer 59.78 (9.988)

The use of ToM tasks aimed to gauge the impact of a country, revealing a relationship specific to certain tasks rather than ToM as
a whole. Specifically, the Sally and Anne tasks, including S_A_R (2 (1) = 1.550; P =.213), S_A_M (2 (1) = 1.512; P =.219), and
S_A_C (2 (1) = .125; P =.724), did not exhibit a significant relationship with the country.

Furthermore, significant differences were observed between the Smart_FT and Smart_RQ subscales ((1) = 7.553 and 27.296, re-
spectively). Smart_N scores consistently yielded positive results ((1) = .906; P =.341). Regarding false beliefs and representational
change (Repr_FB), no significant relationship with the country was found ((1) = .034; P =.853). However, both the Representation-
al Change-Question (Repr_Q) scores ((1) = 7.038; P =.008) and the Representational Change-Reality (Repr_RD) scores ((1) =
23.993; P < .001) exhibited significant relationships with countries. Several orders of the New Theory of Mind task did not show
any significant relationship with the NTT_1 (T = .296; p = .441), NTT_2 (T = .996, p = .743), and NTT_3 subscales (T = 2.325; p =
.508). For further details, refer to Table 2.
Table 2: Statistical Analyses of Correct and Incorrect Answers on new ToM task in Terms of First and Second Orders

Country X and (SD) (T) Sig.

NTT_1 Iran (68) 10.43 (4.198) -.296 .441

Sweden (63) 10.65 (4.473)

NTT_2 Iran (68) 4.24 (2.666) -.996 .743

Sweden (63) 4.70 (2.650)

Note. NTT1-2 (New ToM test _second-third)

Table 3: Frequencies and percentages of Correct and Incorrect Answers on new ToM task in Terms of Tired Order

Country Total
Iran Sweden
NTT_3 0 Number 47 36 83
% NTT_3 56.6% 43.4% 100.0%
% Country 68.1% 57.1% 62.9%
% Total 35.6% 27.3% 62.9%
1 Number 11 16 27
% NTT_3 40.7% 59.3% 100.0%
% Country 15.9% 25.4% 20.5%
% Total 8.3% 12,1% 20.5%
2 Number 8 7 15
% NTT_3 53.3% 46.7% 100.0%
% Country 11.6% 11.1% 11.4%

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% Total 6.1% 5.3% 11.4%

3 Number 3 4 7
% NTT_3 42.9% 57.1% 100.0%
% Country 4.3% 6.3% 5.3%
% Total 2.3% 3.0% 5.3%
Total Number 69 63 132
% NTT_3 52.3% 47.7% 100.0%
% Country 100.0% 100.0% 100.0%
% Total 52.3% 47,7% 100.0%

Note. NTT_3 (New ToM test- third order).

Despite observing elevated levels of occupation and education within families, our expectations of socioeconomic status (SES)
proving indicative of superior performance in Theory of Mind (ToM) tests did not materialize.

Discussion

It has been established that the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF) serve as valuable behavioral
measurements for assessing thought and social problems. While significant differences were identified between the subjects, no
such distinctions were noted from the parental perspective, where no significant variations were observed. Consequently, children
with higher scores demonstrated poorer performance in Theory of Mind (ToM) tasks, indicating a robust correlation between th-
ese scales and ToM results. Teachers, in attributing their perceptions, consider daily social situations within the school context,
even if these challenges may be less noticeable on a broader scale. The weaker implementation of ToM skills was associated with
higher thought and social scores in teacher reports.

Cultural influences were found to affect specific ToM tasks rather than the entire ToM construct. Notably, several tasks exhibited a
significant relationship between countries and our predictions, including the Smarties false belief question and representational
change/Smarties reality question. Several cross-cultural studies have linked evidence of cognitive precursors and an understanding
of false beliefs in the accurate implementation of tasks [19,20,21,22].

Contrary to early studies that utilized socioeconomic status (SES) to assess children's ToM development, our findings suggest that
the socioeconomic status of children does not exhibit a significant association with ToM scores [1,23]. Despite previous attempts
to establish a link between family SES and ToM development, no clear correlation has emerged [1,23,24].

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