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Neural Correlates of Theory of Mind in Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and the Comorbid Condition

Research output: Contribution to journalArticle

Original languageEnglish
JournalFrontiers in Psychiatry
Publication statusSubmitted - 20 Mar 2020

King's Authors


Theory of mind (ToM) or mentalizing difficulties are reported in attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), but the mechanism underpinning these apparently shared deficits is relatively unknown. Eighty-three young adult males, 19 with ASD alone, 21 with ADHD alone, 18 with dual diagnosis of ASD and ADHD and 25 typically developing (TD) controls completed the functional magnetic resonance imaging version of the Frith-Happé animated-triangle ToM task. We compared brain activation during ToM with two non-ToM conditions, random and goal directed motions, using whole-brain, region-of-interest and functional connectivity (FC) analyses. Despite comparable ToM ability across groups, adults with ASD and ASD+ADHD, when compared to ADHD, had increased activation during ToM relative to non-ToM condition in right temporo-parietal cortex, a key region for ToM. The FC analysis showed that all three clinical groups relative to TD controls shared a lack of increase in FC between right angular gyrus and bilateral posterior temporo-parietal junction during ToM trials, relative to the non-ToM conditions. In contrast to TD controls, who showed increased FC with ToM, the ASD groups, with and without ADHD, lacked the positive coupling between right inferior frontal and posterior cingulate cortices while the ADHD groups, with and without ASD, showed decreased FC between medial prefrontal and left temporo-parietal cortices. The findings show that during ToM, the presence of atypically enhanced activation in a key social brain region was related specifically to ASD and not ADHD, although FC was characterized by a combination of shared, as well as ASD-differentiating and ADHD-differentiating abnormalities.

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