ADHD and Theory of Mind in School-Age Children: Exploring the Cognitive Nature of Social Interactions in Children with ADHD

Children with Attention Deficit Hyperactivity Disorder (ADHD) experience significant difficulties with social skills (Barkley, 2006; DuPaul & Stoner, 2003; Stormont, 2001). The inhibitory deficit associated with ADHD is typically identified as the cause of these impaired social skills (Barkley, 2006). Additionally, some researchers have suggested that theory of mind (ToM), which is the ability to attribute mental states to oneself and to others, may be involved, but the research on ToM deficits in children with ADHD is limited and the findings are mixed. A key methodological issue in this literature is the use of traditional but problematic measures of advanced ToM. These measures either fail to find developmental changes or do not measure adaptive reasoning, which is more representative of how individuals behave in real social interactions (Hayward, Homer, & Sprung, 2016). The present investigation used a different tool called Flexibility and Automaticity of Social Cognition (FASC), a new measure of advanced ToM (Hayward et al., 2016), as well as the Strange Stories (SS) task to analyze the relation between ToM, ADHD, and social difficulties in children. Results indicated that children with ADHD did not differ in performance from controls on the SS task, or on the FASC dimensions of total responses (TRs), total mental state terms (MSTs), and First Common Response (FASC-FCR). Participants in the ADHD group did demonstrated impairment relative to controls in the number of mental state justifications (MSJs) provided in the FASC. There was also a significant negative correlation between ADHD symptom count and FASC-FCR. Finally, the number of FASC-FCRs significantly correlated with social skills domains on the C3-PRS and the BASC-2-PRS. The current findings suggest that social skills deficits in children with ADHD can partially be explained by difficulties with some aspects of ToM