Qualitative Differences in Attribution of Mental States to Other People in Autism and Schizophrenia: What are the Tools for Differential Diagnosis?
Monica Mazza, Maria Chiara Pino, Roberto Keller and 6 others
PMID 33909212WHAT IT FOUND
Adults with autism understood story meanings but gave physical or literal explanations for characters' actions.
Adults with psychosis often failed to understand the stories or attributed hostile intentions to neutral characters. These distinct reasoning styles may help differentiate the two conditions.
Key findings
01Participants with autism spectrum disorder understood the stories but showed a 'pure mentalising difficulty', failing to identify the protagonist's intention.
02Participants with schizophrenia spectrum disorders had greater difficulty understanding the social scenarios and frequently failed the comprehension questions.
03When interpreting pretend stories, individuals with autism tended to use mentalistic reasoning, while those with psychosis were significantly more likely to respond incorrectly by attributing bad intentions.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
The typically developing control group made unexpected errors on some stories, which the authors suggest may be due to low motivation or a superficial approach to the test. The study did not assess language and emotional vocabulary skills, which are known to influence Theory of Mind performance. Comorbid conditions like catatonia, which can overlap with autism and psychosis, were not considered in the analysis. The participants were all native Italian speakers with average or above-average intelligence, so findings may not apply to those with intellectual disability or different linguistic backgrounds.
Declared interests
The study was funded by the Università degli Studi dell’Aquila. No other conflicts of interest were declared.
The easy way to misread this
Do not use these specific story tasks as a standalone diagnostic tool. The study was cross-sectional and did not validate the test against a gold-standard clinical diagnosis in a real-world setting. Furthermore, the control group's poor performance on some items suggests the test may be sensitive to participant engagement, which is difficult to control in clinical populations.