||Development, validation and applicability of newly developed Brief School-aged Theory of Mind Assessment (BSc-ToMA)
||Department of Occupational Therapy
theory of mind
心智理論(theory of mind)是指瞭解個體自己或他人的心理狀態的能力，心理狀態包含信念、想法、意圖、感覺或情緒。對學齡孩童而言，良好的心智理論能力有助於與他人的溝通及互動，並影響社交表現與同儕關係，因此瞭解學齡孩童的心智理論蔚為重要。根據神經影像學證據，評估心智理論應考量發展性元素(developmental components)與多面向架構(multidimensional constructs)二大觀點。然而，目前的學齡孩童的心智理論評估工具未在多面向架構（認知與情感二層面）下同時考量學齡孩童各個重要的發展元素。此外，亦有三項限制：評估工具的語言能力需求可能會干擾心智理論能力的評估結果、紙筆測驗效率較低，且對孩童的吸引力較低，以及使用古典測驗理論(classical test theory)作為工具心理計量特性的發展與檢驗方式。因此，為克服目前學齡孩童心智理論評估工具的限制，本研究採用學齡孩童重要的發展性元素及多面向架構發展「心智理論評估工具-學齡簡版」(Brief School-aged children of Theory of Mind Assessment, BSc-ToMA)，並使用現代測驗理論中的羅序分析(Rasch)檢驗使用於學齡孩童的心理計量特性。發展BSc-ToMA包含三階段：項目設計、項目修正及圖畫設計，皆經由熟悉心智理論與孩童發展的5位職能治療師確認內容是否合適，因此具備了內容效度。接著，共召募204位正常發展的學齡孩童（110位男生），平均年齡9歲1個月（標準差=20.98），進行心理計量特性的檢驗。研究結果顯示BSc-ToMA符合二向度的模型（認知與情感），二向度分別有中度的一致性 (個案分離指數=0.663, 0.508)。除了失禮情境(faux pas)不符合模型（偏離反應均方=1.36），所有題目皆吻合二向度的模型（訊息加權均方=0.94–1.19，偏離反應均方=0.73–1.21），且不因性別而有試題差異(p>0.05)。此外，奇怪故事測驗(Strange Stories Task)、魏式兒童智力測驗(Wechsler Intelligence Scale for Children-IV)的語文理解指數、文蘭適應行為量表(Vineland Adaptive Behavior Scale)的溝通與社會化領域分數都顯著預測BSc-ToMA分數，因此BSc-ToMA具備良好建構效度。BSc-ToMA有良好的再測信度，施測於22位孩童，其前後測分數具有0.88的相關程度。關於適用性，透過電腦化呈現與作答方式以及連續圖畫的故事情境，超過半數學齡孩童表示喜愛此評估工具(56%)，多數在回答過程中沒有出現理解困難(70.2%)與其他阻礙(83.3%)影響作答。因此本研究所發展之BSc-ToMA符合心智理論發展性元素及多面向架構兩大觀點並具備良好心理計量特性及適用性，適合作為評估學齡孩童心智理論的工具，有助於實際應用於臨床及研究中，協助專業人員掌握心智理論的發展與缺損，而能進一步給予相對應的介入。
Theory of mind (ToM) is the ability to comprehend the mental states of self and others. For school-aged children, ToM significantly influences their social communication and interaction, and even their social competence and peer relationships. Therefore, it is crucial to understand the ToM of school-aged children. ToM has been confirmed to have developmental components and a multidimensional construct. However, no measure simultaneously considers the different developmental components in both the cognitive and the affective dimensions. In addition, interference of verbal ability, low efficiency, low attractiveness to children, and inherent problems of the adopted psychometric method (i.e., classical test theory) have been identified as limitations of the current measures for school-aged children. Therefore, this study had two purposes: to develop the BSc-ToMA to overcome the above the limitations, and then to examine the psychometric properties and applicability of the BSc-ToMA, including the content validity, construct validity, internal consistency and test–retest reliability. The BSc-ToMA was developed in three steps, namely, item design, item revision, and picture story design, and all components were revised and confirmed by 5 occupational therapists who were familiar with ToM. The BSc-ToMA was developed according to the multidimensional construct of ToM and includes important developmental components for school-aged children. For the psychometric evaluation, a total of 204 school-aged children with typical development (boys = 110) were assessed with the BSc-ToMA, Strange Stories Task (SST), Verbal Comprehension Index of the Wechsler Intelligence Scale for Children-IV (VCI, WISC-IV), and Vineland Adaptive Behavior Scale (VABS) respectively for ToM, verbal ability, and adaptive behaviors. For the test–retest reliability, 22 children were assessed with the BSc-ToMA again after 3 to 7 weeks. The results of the multidimensional random coefficients multinomial logit model showed that the BSc-ToMA fitted the two-dimensional model (cognitive and affective dimensions), and that both dimensions had moderate internal consistency (person separation reliability = 0.663 and 0.508). Every item fitted the two-dimensional model (infit MNSQ = 0.94–1.19, outfit MNSQ = 0.73–1.21), except the item of faux pas (outfit MNSQ = 1.36). No items had differential functioning between genders (p > 0.05). Moreover, the BSc-ToMA also has good convergent validity with the VCI, the SST and the socialization and communication domains of the VABS (p < 0.001). In addition, the BSc-ToMA has good test–retest reliability, shown by the relation of 0.88 between the scores of the BSc-ToMA in the first and second assessment. The results of applicability also showed that the BSc-ToMA has high comprehensibility and likability as well as low difficulty for school-aged children. In conclusion, the newly-developed BSc-ToMA includes the identified multidimensional construct of ToM and covers the entire spectrum of the ToM capacity of school-aged children. Featuring picture stories, forced-choice questions and a computer-based format, the BSc-ToMA assesses ToM accurately without the inference of verbal ability and motivates children’s engagement in the assessment. The BSc-ToMA has been shown to be able to assess school-aged children’s ToM capability precisely, validly, and applicably. The BSc-ToMA can help clinicians and researchers to identify the ToM development or deficit of school-aged children and then to target interventions efficiently to address ToM deficit.
Table of contents VI
List of Tables IX
List of Figures XI
Chapter 1 Introduction 1
Chapter 2 Literature review 4
2.1 Theory of mind 4
2.1.1 Definition and Importance 4
2.1.2 Child development of theory of mind 4
2.1.3 Multidimensional theory of mind 8
2.2 Measures of theory of mind for school-aged children 9
2.2.1 Developmental components 13
2.2.2 Dimensions 14
2.2.3 Demand on verbal ability 15
2.2.4 Materials 22
2.2.5 Psychometric methods 23
2.3 Limitations of the theory of mind measures on school-aged children 25
2.4 Purposes 26
Chapter 3 Method 27
3.1 Development of the Brief School-aged children Theory of Mind Assessment (BSc-ToMA) 27
3.1.1 Design of the Brief School-aged children Theory of Mind Assessment 27
3.1.2 Procedures 35
3.2 Psychometric evaluation of the Brief School-aged children Theory of Mind Assessment 37
3.2.1 Participants 37
3.2.2 Measures 37
3.2.3 Procedures 41
3.2.4 Data analysis 42
Chapter 4 Results 46
4.1 Descriptive statistics 46
4.2 Validity 49
4.2.1 Content validity 49
4.2.2 Construct validity 49
4.3 Reliability 56
4.3.1 Internal consistency 56
4.3.2 Test–retest reliability 56
4.4 Applicability 57
Chapter 5 Discussion 60
5.1 The development of the Brief School-aged children Theory of Mind Assessment 61
5.1.1 The multidimensional model of the Brief School-aged children Theory of Mind Assessment 61
5.1.2 The developmental components of the Brief School-aged children Theory of Mind Assessment 61
5.2 Examination of the construct validity of the Brief School-aged children Theory of Mind Assessment 70
5.2.1 The model decision and model–data fit 70
5.2.2 Item difficulty 72
5.2.3 Convergent and divergent validity 75
5.3 Examination of the reliability of the Brief School-aged children Theory of Mind Assessment 76
5.3.1 Internal consistency 76
5.3.2 Test–retest reliability 76
5.4 The applicability of the Brief School-aged children Theory of Mind Assessment 77
5.4.1 Comprehensibility 77
5.4.2 Likability 78
5.4.3 Difficulty 79
5.5 Limitations and future studies 80
5.6 Implications 81
5.7 Conclusion 82
Abu-Akel, A., & Shamay-Tsoory, S. (2011). Neuroanatomical and neurochemical bases of theory of mind. Neuropsychologia, 49(11), 2971-2984.
Altschuler, M., Sideridis, G., Kala, S., Warshawsky, M., Gilbert, R., Carroll, D., Burger-Caplan, R., Faja, S. (2018). Measuring Individual Differences in Cognitive, Affective, and Spontaneous Theory of Mind Among School-Aged Children with Autism Spectrum Disorder. Journal of Autism and Developmental Disorders, 48(11), 3945-3957.
Arslan, B., Taatgen, N. A., & Verbrugge, R. (2017). Five-Year-Olds' Systematic Errors in Second-Order False Belief Tasks Are Due to First-Order Theory of Mind Strategy Selection: A Computational Modeling Study. Frontiers in Psychology, 8, 275.
Astington, J. W., & Jenkins, J. M. (1999). A longitudinal study of the relation between language and theory-of-mind development. Developmental Psychology, 35(5), 1311.
Banerjee, R., Watling, D., & Caputi, M. (2011a). Peer relations and the understanding of faux pas: longitudinal evidence for bidirectional associations. Child Development, 82(6), 1887-1905.
Banerjee, R., Watling, D., & Caputi, M. (2011b). Peer Relations and the Understanding of Faux Pas: Longitudinal Evidence for Bidirectional Associations. Child Development, 82(6), 1887-1905.
Baron-Cohen, S. (2000). Theory of mind and autism: A review. International Review of Mental Retardation, 23, 169-184.
Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child have a “theory of mind”? Cognition, 21(1), 37-46.
Baron-Cohen, S., O'riordan, M., Stone, V., Jones, R., & Plaisted, K. (1999). Recognition of faux pas by normally developing children and children with Asperger syndrome or high-functioning autism. Journal of Autism and Developmental disorders, 29(5), 407-418.
Beaumont, R. B., & Sofronoff, K. (2008). A new computerised advanced theory of mind measure for children with Asperger syndrome: the ATOMIC. Journal of Autism and Developmental Disorders, 38(2), 249-260.
Broomfield, K. A., Robinson, E. J., & Robinson, W. P. (2002). Children's understanding about white lies. British Journal of Developmental Psychology, 20(1), 47-65.
Burnel, M., Perrone-Bertolotti, M., Reboul, A., Baciu, M., & Durrleman, S. (2018). Reducing the language content in ToM tests: A developmental scale. Developmental Psychology, 54(2), 293-307.
Cameron, C. A., Lau, C., Fu, G., & Lee, K. (2012). Development of children's moral evaluations of modesty and self-promotion in diverse cultural settings. Journal of Moral Education, 41(1), 61-78.
Cheung, H., Siu, T. S., & Chen, L. (2015). The roles of liar intention, lie content, and theory of mind in children's evaluation of lies. Journal of Experimental Child Psychology, 132, 1-13.
Clemmensen, L., Bartels-Velthuis, A. A., Jespersen, R. a. F., Os, J. v., Blijd-Hoogewys, E. M. A., Ankerstrøm, L., Væver, M., Daniel, P. F., Drukker, M., Jeppesen, P., Jepsen, J. R. M. (2016). A Psychometric Evaluation of the Danish Version of the Theory of Mind Storybook for 8-14 Year-Old Children. Frontiers in psychology, 7, 330.
Devine, R. T., & Hughes, C. (2013). Silent films and strange stories: theory of mind, gender, and social experiences in middle childhood. Child Development, 84(3), 989-1003.
Devine, R. T., & Hughes, C. (2016). Measuring theory of mind across middle childhood: Reliability and validity of the Silent Films and Strange Stories tasks. Journal of Experimental Child Psychology, 149, 23-40.
Dvash, J., & Shamay-Tsoory, S. G. (2014). Theory of Mind and Empathy as Multidimensional Constructs. Topics in Language Disorders, 34(4), 282-295.
Fan, X. (1998). Item response theory and classical test theory: An empirical comparison of their item/person statistics. Educational and Psychological Measurement, 58(3), 357-381.
Filippova, E., & Astington, J. W. (2008). Further development in social reasoning revealed in discourse irony understanding. Child Development, 79(1), 126-138.
Happé, F. G. (1994). An advanced test of theory of mind: Understanding of story characters' thoughts and feelings by able autistic, mentally handicapped, and normal children and adults. Journal of Autism and Developmental Disorders, 24(2), 129-154.
Hayward, E. O., & Homer, B. D. (2017). Reliability and validity of advanced theory-of-mind measures in middle childhood and adolescence. British Journal of Developmental Psychology, 35(3), 454-462.
Hughes, C., & Leekam, S. (2004). What are the links between theory of mind and social relations? Review, reflections and new directions for studies of typical and atypical development. Social Development, 13(4), 590-619.
Kipps, C. M., & Hodges, J. R. (2006). Theory of mind in frontotemporal dementia. Social Neuroscience, 1(3-4), 235-244.
Koo, T. K., & Li, M. Y. (2016). A Guideline of Selecting and Reporting Intraclass Correlation Coefficients for Reliability Research. Journal of Chiropractic Medicine, 15(2), 155-163.
Lonigro, A., Laghi, F., Baiocco, R., & Baumgartner, E. (2013). Mind Reading Skills and Empathy: Evidence for Nice and Nasty ToM Behaviours in School-Aged Children. Journal of Child and Family Studies, 23(3), 581-590.
Miller, C. A. (2006). Developmental relationships between language and Theory of mind. American Jounal of Speech-language Pathology, 15, 142-154.
Mundy, P., Block, J., Delgado, C., Pomares, Y., Hecke, A. V. V., & Parlade, M. V. (2007). Individual Differences and the Development of Joint Attention in Infancy. Child Development, 78(3), 938-954.
Nettle, D., & Liddle, B. (2006). Higher-order theory of mind and social competence in school-age children. Journal of Cultural and Evolutionary Psychology, 4(3), 231-244.
Nilsson, K. K., & de Lopez, K. J. (2016). Theory of Mind in Children With Specific Language Impairment: A Systematic Review and Meta-Analysis. Child Development, 87(1), 143-153.
O’Hare, A. E., Bremner, L., Nash, M., Happé, F., & Pettigrew, L. M. (2009). A Clinical Assessment Tool for Advanced Theory of Mind Performance in 5 to 12 Year Olds. Journal of Autism and Developmental Disorders, 39(6), 916-928.
Perner, J., & Wimmer, H. (1985). “John thinks that Mary thinks that…” attribution of second-order beliefs by 5-to 10-year-old children. Journal of Experimental Child Psychology, 39(3), 437-471.
Peterson, C., Slaughter, V., Moore, C., & Wellman, H. M. (2016). Peer social skills and theory of mind in children with autism, deafness, or typical development. Developmental Psychology, 52(1), 46-57.
Peterson, C. C., Slaughter, V., & Wellman, H. M. (2018). Nimble negotiators: How theory of mind (ToM) interconnects with persuasion skills in children with and without ToM delay. Developmental Psychology, 54(3), 494-509.
Peterson, C. C., & Wellman, H. M. (2019). Longitudinal Theory of Mind (ToM) Development From Preschool to Adolescence With and Without ToM Delay. Child Development, 90(6), 1917-1934.
Peterson, C. C., Wellman, H. M., & Slaughter, V. (2012). The mind behind the message: advancing theory-of-mind scales for typically developing children, and those with deafness, autism, or Asperger syndrome. Child Development, 83(2), 469-485.
Pratt, C., & Bryant, P. (1990). Young children understand that looking leads to knowing (so long as they are looking into a single barrel). Child Development, 61(4), 973-982.
Premack, D., & Woodruff, G. (1978). Does the chimpanzee have a theory of mind? Behavioral and Brain Sciences, 1(04), 515.
Prieto, L., Alonso, J., & Lamarca, R. (2003). Classical test theory versus Rasch analysis for quality of life questionnaire reduction. Health and Quality of Life Outcomes, 1(27).
Rasch, G. (1960). Studies in mathematical psychology: I. Probabilistic models for some intelligence and attainment tests. Oxford, England: Nielsen & Lydiche.
Shamay-Tsoory, S. G., & Aharon-Peretz, J. (2007). Dissociable prefrontal networks for cognitive and affective theory of mind: a lesion study. Neuropsychologia, 45(13), 3054-3067.
Shamay-Tsoory, S. G., Harari, H., Aharon-Peretz, J., & Levkovit, Y. (2010). The role of the orbitofrontal cortex in affective theory of mind deficits in criminal offenders with psychopathic tendencies. Cortex, 46(5), 668-677.
Shamay-Tsoory, S. G., Tibi-Elhanany, Y., & Aharon-Peretz, J. (2006). The ventromedial prefrontal cortex is involved in understanding affective but not cognitive theory of mind stories. Social Neuroscience, 1(3-4), 149-166.
Shih, C.-L., Chen, C.-H., Sheu, C.-F., Lang, H.-C., & Hsieh, C.-L. (2013). Validating and improving the reliability of the EORTC qlq-c30 using a multidimensional Rasch model. Value in Health, 16(5), 848-854.
Talwar, V., Gordon, H. M., & Lee, K. (2007). Lying in the elementary school years: Verbal deception and its relation to second-order belief understanding. Developmental Psychology, 43(3), 804.
Talwar, V., & Lee, K. (2002). Development of lying to conceal a transgression: Children’s control of expressive behaviour during verbal deception. International Journal of Behavioral Development, 26(5), 436-444.
Talwar, V., & Lee, K. (2008). Social and cognitive correlates of children’s lying behavior. Child Development, 79(4), 866-881.
Talwar, V., Zwaigenbaum, L., Goulden, K. J., Manji, S., Loomes, C., & Rasmussen, C. (2012). Lie-Telling Behavior in Children With Autism and Its Relation to False-Belief Understanding. Focus on Autism and Other Developmental Disabilities, 27(2), 122-129.
Wang, W.-C., Shih, C.-L., & Sun, G.-W. (2012). The DIF-Free-Then-DIF Strategy for the Assessment of Differential Item Functioning. Educational and Psychological Measurement, 72(4), 687-708.
Wang, W.-C., Yao, G., Tsai, Y.-J., Wang, J.-D., & Hsieh, C.-L. (2006). Validating, improving reliability, and estimating correlation of the four subscales in the WHOQOL-BREF using multidimensional Rasch analysis. Quality of Life Research, 15(4), 607-620.
Wellman, H. M., Cross, D., & Watson, J. (2001). Meta‐analysis of theory‐of‐mind development: the truth about false belief. Child Development, 72(3), 655-684.
Wellman, H. M., & Liu, D. (2004). Scaling of theory‐of‐mind tasks. Child Development, 75(2), 523-541.
Westby, C., & Robinson, L. (2014). A Developmental Perspective for Promoting Theory of Mind. Topics in Language Disorders, 34(4), 362-382.
White, S., Hill, E., Happé, F., & Frith, U. (2009). Revisiting the strange stories: revealing mentalizing impairments in autism. Child Development, 80(4), 1097-1117.
Xu, F., Bao, X., Fu, G., & Talwar, V. (2010). Lying and Truth-Telling in Children: From Concept to Action. Child Development, 81(2), 581-596.