Raisa ZH
Karuppali S
Bhat JS
Bajaj G
metalinguistics
Thinking about what he thinks of what I think: Assessing higher theory of mind abilities in Indian bilingual children between 3.0 and 8.11 years of age
Zeba Hussain Raisa, Sudhin Karuppali, Jayashree Sunil Bhat, Gagan Bajaj
Department of Audiology and Speech Language Pathology, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Mangalore, Karnataka, India
Date of Web Publication 11-Mar-2019
Context: The competence in theory of mind (ToM) abilities occurs in parallel with the development of language. To gain a deeper discernment about its proficiency, tasks tapping on higher-order ToM abilities have been implemented.
Aims: This study aims to explore the development of higher-order ToM abilities in bilingual Indian children between 3.0 and 8.11 years of age, to achieve an insight into the influence of language on ToM abilities.
Settings and Design: The current study followed a cross-sectional design along with an employment of a random convenient sampling procedure. The study was conducted in regular English medium schools with each participant individually being assessed.
Materials and Methods: The study was done on 60 Kannada-English bilingual children, with each participant being assessed using two sets of stories (English and Kannada) that were constructed based on two different central themes which were verbally narrated. The stimulus of each set consisted of questions tapping on three levels (first-second-third orders) of ToM abilities.
Statistical Analysis: Descriptive statistics determined the mean and standard deviation of the total ToM scores (in both languages). Wilcoxon Signed-Rank and Mann–Whitney U-tests were done to determine the level of significance across and between the age groups (in both languages), respectively.
Results: The results revealed a significant difference across the age groups. In addition, a significant difference between the responses in English and Kannada were obtained.
Conclusions: The development of metalinguistic abilities is influenced by socioenvironmental factors as well as the language maturity of the child.
Keywords: Bilingual, development, higher-order, metalinguistics, theory of mind
Raisa ZH, Karuppali S, Bhat JS, Bajaj G. Thinking about what he thinks of what I think: Assessing higher theory of mind abilities in Indian bilingual children between 3.0 and 8.11 years of age. Indian J Psychiatry 2019;61:167-76
Raisa ZH, Karuppali S, Bhat JS, Bajaj G. Thinking about what he thinks of what I think: Assessing higher theory of mind abilities in Indian bilingual children between 3.0 and 8.11 years of age. Indian J Psychiatry [serial online] 2019 [cited 2021 Jan 21];61:167-76. Available from: https://www.indianjpsychiatry.org/text.asp?2019/61/2/167/253817
Metalinguistic or higher-linguistic abilities refer to those skills that go beyond basic vocabulary, word form, and grammar skills, which are critical to academic and social success.[1] Once the basic forms of language are learned, children transition toward higher-linguistic skills that involve thinking about and manipulating the structural features of spoken language.[2] To facilitate these metalinguistic abilities, certain cognitive processes particularly attention, memory, and organization are required.[3] Hence, there is an intricate relationship that exists between cognition and language as these individual cognitive processes are internalized and therefore silent, while language allows for this knowledge and information to be shared. This interaction between language and cognition has been generally reflected through communicative skills that one possesses. In order to engage in effective communication, it is essential that an individual understands the mental states such as beliefs, desires, and knowledge, so as to explain and predict the behavior of another person. These mental states of people which are developed during the preoperational stage[4] are showcased through conversations that happen in social contexts. The portrayal of such skills involving the understanding of the mental states of the communication partner/s is termed as "theory of mind (ToM)". On this account, Rejón Altable et al.[5] suggested ToM as the skill to take on another individual's perspective as well as to attribute mental states of others. Although the specific mechanism of ToM is not thoroughly understood, it requires a fairly sophisticated inferential capacity[6] that aids in filling the gaps between what is meant and what is said.[7] This comprises making the distinction between the real world and mental representations of the world.
The development of ToM is a long process with the advancement in the understanding of mental states being initiated at infancy and lasting throughout adolescence,[8],[9],[10] adulthood,[9],[10],[11] and older adults.[12] The foundation of ToM is based on various aspects of reasoning about others that includes social awareness, joint attention, and anticipation of other people's behavior that matures as age advances. Onishi and Baillargeon[13] suggested children to acquire ToM skills as early as 15 months during the preoperational stage, establishing its foundation by the age of 2½ years. By the age of 3 years, toddlers are able to reveal desires, wants and drive behavior to that of reality.[14] Banerjee[15] suggested that these children are able to understand certain aspects of emotional displays, and are able to correctly identify when it would and would not be appropriate to express certain emotions in response to the situation. Children aged 4 years and above have evident improvement in the ToM skills in the form of increased ability in perspective taking, recursive awareness, understanding the implications of others, and appearance-reality differences.[16] The showcased skills of children after the age of 5–6 years are solidified and less fragile, which could be due to the enhancement in language skills and social experience.[17] More adult like abilities to introspect develops at a later age of 5.6–8.6 years.[18] Higher-order false-belief tasks were found to be understood between the ages of 6 and 8 years,[19] which may be influenced by the complexity of the story.[20] Schultz and Cloghesy[21] showed 7–9-year-old children to show an increase in recursive awareness abilities, utilizing strategies to manipulate competitive social exchanges.
Higher-order ToM processes such as social reasoning and reasoning about ambiguity can influence conceptual development.[22] Such skills can influence the moral reasoning abilities, which is a socio-cognitive skill essential for the social functioning of children.[23] Tasks incorporating mental physical distinctions were utilized to assess ToM skills as they involved one character having a mental experience, while a second character was indulged in a physical experience. Wellman and Estes[24] found typically developing 3–4-year-old children to make judgments implying that there was a firm grasp that existed on their ability to distinguish between mental and physical events and entities. In an attempt to study the ToM skills, Flavell et al.[18] incorporated tasks to distinguish between appearance and reality, and found 4-year-old children to be able to make a distinction between the two. On similar lines, Pratt and Bryant[25] reported the "seeing-leads-to knowing phenomena" to emerge in 3-year-old typically developing children. While Apperly and Butterfill[26] reasoned that the ability to use first-order ToM tasks develops by the age of 3–4 years; Baron-Cohen et al.[27] found typically developing 4-year-old to recognize what goes on in mind and what does not. Subsequent to this, studies reported that typically developing 3-year-old were able to judge when the speaker was joking or pretending.[28] 4–6-year-old children were able to comprehend different emotional causation thus implying its relevance in using such tasks to assess this metalinguistic ability.[29] Since 5-year-old children were able to reach the maximum score in a ToM task,[26] research has extended to develop more demanding tasks by tapping onto higher orders of ToM levels (third order: Interpreting about a belief about a belief about a belief and so on up to the eighth order).[28] These higher-order ToM skills were assessed through tasks that involved hearing or reading multi-character stories and deriving what one character thought to believe about another character's belief. While 6-year-old children were able to perform well in second-order ToM tasks,[30],[31] Happé[32] found 8-year-old to have advanced mindreading skills involving irony and sarcasm. The performance rate of adults was efficient till the fourth-order though the error rate increased drastically above this point.[33] Further studies were done pertaining to the assessment of higher-order ToM skills incorporating deception,[34] and facial expression recognition.[35]
Language is involved in a host of control mechanisms that have executive function that is linked to the development of ToM.[36] Spelke[37] proclaimed language as an universal medium through which the outputs of the distinct modules in the mind could be combined and integrated. Language assists as a representational re-description of knowledge which aids in the development of ToM abilities.[38] Considerable language ability was a pre-requisite to participate in any standard ToM task.[39] Both language and ToM development undergo a drastic developmental change during the first 5 years of age.[40] With the development of language skills, children are able to take part in conversations, and it is this experience that allows them to acquire concepts of mental states, and to master the syntax for representing them. Although Abry and Laboissiere[41] suggested ToM capacities to be linked to language abilities, Tomasello[42] claimed language to have a limited role in ToM development. Deficits in language skills and/or ToM abilities in children with developmental disorders have highlighted this relationship. Thus, language abilities have been incorporated in assessing higher-order ToM abilities,[43],[44] which led to the construction of various developmentally appropriate tests[45] to gain a deeper understanding into the mechanism of this ability. Although Hughes and Leekam[46] reported the semantic language to play an influential role on ToM abilities, Gleitman[47] suggested that it was a combination of the roles that semantic, pragmatics, and grammatical systems of language that influenced ToM development. Studies did indicate semantics, syntax, vocabulary, and memory components to play an integral role in building ToM.[44],[48]
The simultaneous acquisition of two languages during early childhood years has become increasingly common, enhancing ToM abilities.[49] Bilingualism studies have revealed that multilingual children have better metalinguistic abilities when compared to monolinguals.[50] Bialystok[51] found greater metalinguistic ability in bilingual children than their monolingual peers. Farhadian et al.[52] concluded that the number of languages the child is exposed to can be an influencing factor for the development of ToM abilities during the early years of life. Better conflict inhibition and effective working memory capacities were found to be present in bilingual preschool children compared to monolinguals using false-belief tasks. Studies pertaining to the development of ToM have largely been studied in the western population, and adopting the results of the same may have drastic limitations when considered to be used in a multilingual population like India. Although research on bilingualism and ToM are at the forefront, none have attempted to study the developmental pattern of the higher orders of ToM in bilingual Indian children. In addition, it would be interesting to examine the influence of language on these higher-order ToM skills. Therefore, the aim of the present study was to explore the development of higher-order ToM abilities in bilingual Indian children between 3 and 8 years of age.
The participants included in this study were typically developing children between 3 and 8 years of age. A cross-sectional design along with a random convenient sampling procedure was employed to assess the language abilities across different age groups. The study was conducted in Mangalore, Karnataka, India, between December 2015 and January 2017. Ethical approval was received from the Institutional Ethical Board before the commencement of the study.
The participants were selected based on selection criteria. The inclusion criteria included typically developing children attending regular English medium schools and those fitting the age criteria. Participants having Kannada (an official language in the Southern state of India) as their L1 and English as their L2 were included in the study.
The exclusion criteria included children with a history of speech, language, cognitive, and hearing deficits, as well as any transfer from more than one school or shift in the medium of instruction or any academic failures. The selected participants were divided into six groups with each group consisting of 10 participants each. The sample size was calculated using the formula n = zα2 σ2/d2 [zα= 0.84, σ = 1.82, d = 7.45]. [Table 1] shows the distribution of participants based on groups, classes and age range for the current study.
Table 1: Distribution of participants across age and class
The present study was carried out in three phases. Phase 1 focused on the preparation of the stimuli for assessing higher-order ToM abilities; phase 2 included the data collection and scoring the responses; and phase 3 comprised the statistical analysis of the obtained data.
The procedure and method that was used in the study was at par with the method followed in the study done by Liddle and Nettle.[53] Two sets of stimuli were prepared-English story (Set 1) and Kannada story (Set 2) [Appendix]. Each constructed story though different in theme, aimed to evaluate the higher-order ToM abilities in children between 3.0 and 8.11 years of age. The central theme of the Kannada story was a "school cricket team," while the English story was a "birthday party." The story themes were selected based on their familiarity and exposure to children. Each story was constructed to follow the story grammar (characters, settings, initiating event, internal response, internal plan, attempt, outcome, and reactions) as suggested by Schneider et al.[54] Two types of questions (memory and ToM) were framed per story. The memory questions were formulated to ensure the child's comprehension of the story; while the ToM questions were formulated to tap upon the three levels (first, second, and third order) of ToM abilities. Each ToM level consisted of two questions each addressing higher-order ToM skills. Level 1 questions were classic inferences about belief; whereas level 2 corresponded to second-order ToM ability (inferences about someone's belief about another's belief). Level 3 involved one further level of embedding. Each memory and ToM question was designed to generate a single permissible response (one word). A total of three memory questions and six ToM questions were framed per story.
A scoring system was formulated for the ToM questions for each story, with every correct answer being assigned a score of 1. Each ToM level could attain a score of 2, hence a maximum score of 6 could be attained by any participant. Scoring was not assigned to the memory questions as it was designed only to evaluate the participant's comprehension of the story. A participant could not go ahead to the second-order ToM level if he/she attained a score of 0 in the preceding level. Instead, even if the participant could attain a score of 1, testing would continue to the following level. Therefore, a total score of 2 would indicate that the participant is functioning at a first-order ToM level; while a total score of 4 would imply that the participant was able to reach up to the second-order ToM level; and a total score of 6 would indicate that the participant was at the third-order ToM level.
The content validation of the prepared stimuli was performed by 5 experienced bilingual (Kannada and English language) speech-language pathologists on the two formulated stories, 6 memory and 12 ToM questions, their respective permissible responses, and the scoring system. The stories were validated based on the presence of story grammar components as well as the vocabulary and morphosyntactic structure used in the stories. The memory/ToM questions, permissible responses, and the scoring system were validated based on its appropriateness to assess ToM abilities. After incorporating the necessary suggestions by the experts, each story was verbally produced by a female speaker in a quiet room and was digitally recorded using Sony ICD-UX533F/SCE 4GB voice recorder.
The data collection was carried out in a quiet room within the school premises, with each participant individually being assessed. Each participant was seated opposite to the examiner and was presented with the digitally recorded stories via a standard Lenovo L420 laptop using a circumaural Philips SHP2500/97 headphone. Set 1 was presented first; wherein each participant was instructed to carefully listen to the Kannada story. Subsequent to this, the examiner verbally presented the memory questions followed by the ToM questions depending on the participant's comprehension of the story. At any instance, if the participant was unable to accurately respond to one or more of the memory questions, the story was presented again followed by the memory questions. If the participant continued to find it difficult to comprehend the story, the testing was terminated, and the participant was excluded from the study. Subsequent to the presentation and response analysis of the ToM questions of the Kannada story, the English story was administered with the similar presentation and scoring guidelines.
This phase included the analysis of the obtained total ToM scores of each participant of the six groups for both Kannada and English (languages) stories. Descriptive statistics using SPSS software (version 17.0) was done to obtain the mean and standard deviation (SD) of the total ToM scores of each participant of each group for both the languages. Test of normality was done using Kolmogorov–Smirnov and Shapiro–Wilk test indicating that the data were not normally distributed. Nonparametric tests such as Kruskal–Wallis test was done to determine the level of significance across the age groups. Wilcoxon Signed-Rank test was done to establish the level of significance between the languages across and within each age group. Mann–Whitney U-tests were done to determine the level of significance between the age groups for each of the languages.
The results of the descriptive statistics revealed an overall steady increase in the total ToM scores indicating an increase in the higher-order ToM performance across the six groups for English. Group I attained the lowest mean (SD) of 0.0 with a subsequent increase of 1.50 ± 1.08, 2.50 ± 1.27, 2.80 ± 1.61, 4.30 ± 1.25, and 4.60 ± 1.26 across Group II, III, IV, V, and VI, respectively. When considering the responses obtained by the six groups for Kannada, a similar developmental pattern was observed. Group I attained the lowest mean (SD) of 0.0 with a subsequent increase of 1.30 ± 0.67, 1.40 ± 0.96, 1.60 ± 1.07, and 2.80 ± 1.13 across Group II, III, IV, and V, respectively. However, unlike the highest response obtained by Group VI for English language, a mean score of 2.40 ± 1.71 was obtained by this group for the Kannada language, which was comparatively lower than Group V. The below figure show the obtained total ToM scores of all six groups for the Kannada and English stories.
The results of the Kruskal–Wallis test which was done to determine the level of significance across the age groups revealed a main significant effect for the total ToM scores across the age groups (H(5) =63.511, P = 0.000). Wilcoxon Signed-Rank test which was done to study the level of significance between languages across the age groups indicated a main significant effect (Z = 4.360, P < 0.001) in the total ToM scores. The level of significance between Kannada and English within each group is mentioned in [Table 2].
Table 2: The Z and P values of the theory of mind scores across the age groups for both languages
[Table 3] illustrates the results of Mann–Whitney U-tests which were done to determine the level of significance of the total ToM scores between the age groups for each of the languages.
Table 3: The Z and P values of the total theory of mind scores between the age groups for English and Kannada
The objective of the present study was to explore the developmental pattern of higher-order ToM abilities in children between 3 and 8.11 years of age in Kannada and English languages. The results have been discussed on the basis of the developmental pattern of higher-order ToM abilities in the children, and the influence of language on their ToM performance. The 3-year-old attained the lowest score as they were unable to respond to the memory questions which was a pre-requisite for the presentation of the ToM questions. However, the 4-year-old responded to the memory questions indicating that they had comprehended the presented stories (English and Kannada). The performance of the participants of this group in English and Kannada was limited to that of the first-order ToM level, attaining a mean score of >1.0 and <2.0. This emergence of comprehension of first-order ToM questions can be attributed to the ability to comprehend the underlying instructions, with an enhanced understanding of the narrative samples.[55] This finding is in line with the study done by de Villiers and de Villiers[56] who suggested that the mastery in the comprehension and production of complement structures of 4-year-old does predict the success rates of their false-belief performance. Furthermore, it was also revealed that children by the age of 4 years have adequate skills to comprehend that things can be conceived to be different,[16] and are therefore able to perform well on false belief tasks, and distinguish between appearance and reality.[18] In addition to the attainment of higher mean scores by the 5- and 6-year-old in English compared to the preceding group, these two groups were able to respond to questions pertaining to second-order ToM, attaining a mean score of >2.0 and <3.0. However, they were unable to attain a score of 4 which indicated a full-fledged second-order ToM level of functioning. This ability of the 5- and 6-year-old, to progress onto the subsequent higher-order questions can be attributed to their ability to extract the underlying information that was embedded through multiple characters in the narrative samples owing to immature mental state skills. Arslan, Taatgen, and Verbrugge[57] predicted children's failures in the performance of ToM tasks are due to their lack of experience, and with exposure to second-order false belief reasoning, they tend to revise their incorrect first-order reasoning strategy toward a more correct form of second-order reasoning strategy.
Bibby and McDonald[58] proposed that children between 3 and 5 years of age are on the track of beginning to understand others' false beliefs, appearance-reality differences, and their own previous false-beliefs, giving them a better understanding into another individual's perspective. Sullivan et al.[20] also advocated that for complex stories, 6-year-old are equipped with the ability to keep a track of a great deal of information to accurately represent the various beliefs of characters. The 7- and 8-year-old in the present study attained higher mean scores (>4.0 and <5.0) in English in the third-order ToM level. However, only two 7-year-old and three 8-year-old achieved the maximum target score of 6.0, indicating that with an increase in the number of samples, a higher mean score could have been obtained. Furthermore, with an increase in age, the performance on third-order ToM tasks could be subjected to progress. This improvement in the performance of higher-order ToM skills with the advancement in age can also be attributed to the Piagetian Model[4] which claims that children within this age range, experience a transition from the preoperational stage to the concrete-operational stage. These higher-order ToM tasks are cognitively demanding in nature,[59] consenting children to think about the world using objective rules of language, freeing them from the misconceptions of intuitive thought. Schick et al.[48] also conveyed that the complement syntax along with concepts about mental states and varied perspectives did help shape the base for ToM abilities. This indicated that syntactic advancement due to formal education and language abilities can also be attributed to the improvement in higher-order ToM abilities.
Apart from the performance of the 3-year-old in Kannada which was similar to its English counterpart, the 4-, 5-, and 6-year-old attained mean scores which were within a score of 2.0 indicating that the performance of the three groups was within the first-order ToM level. However, the responses obtained by the 7 and 8-year-old did progress into the second-order ToM level attaining a score >2.0 and <3.0. These findings can be accredited to the two narrative samples (English and Kannada) which were presented a few minutes apart which might have led to language differentiating skills thus influencing their performance on higher-order ToM skills. Paradis and Nicoladis's[60] study is in harmony with the present findings suggesting that the language performance of children can be influenced by the language dominance and the child's sensitivity to the sociolinguistic context. The poor ToM scores obtained by the 3-year-old could indicate the stimuli to be either difficult to comprehend, participants having under-developed prelinguistic skills, or due to an initial entry into the nursery (pre-kindergarten) wherein formal based education had not been initiated. The Piagetian model did propose children to possess logical skills that are limited to their own personal experience, which could explain the lowest mean scores obtained by the 3 years old. As a consequence of being unable to use more objective forms of logic, the child tends to become egocentric, which can result in an inability to understand another individual's perspective.
Although a main significant difference (P < 0.05) was obtained across the age groups, Mann–Whitney U tests did not reveal a significant difference (P > 0.05) between the 5- and 6-year-old, and 7- and 8-year-old in English. Similarly, a poor significant effect (P > 0.05) was obtained in Kannada between all subsequent groups, except for the 3- and 4-year-old (P < 0.05). The main significant difference across the age groups can be attributed to an increase in lexical diversity and maturing mental state beliefs. According to Pons et al.,[17] various skills such as perspective taking, recursive awareness, appearance-reality distinction, and tactile deception serve facilitates ToM development. The significant difference (P < 0.05) obtained between the 3- and 4-year-old was predictable, as the former group had attained a score of 0 while the latter group exhibited a mean score of 1.5 in English and 1.3 in Kannada. The significant difference observed between the 4- and 5-year-old can be attributed to the children being introduced to formal schooling which begins after 4 years of age, which may serve as a precursor toward the development of ToM skills. This was in line with the study done by Slaughter, Dennis, and Pritchard[61] who found peer acceptance of preschool children was correlated to their social preference and their ToM development. A significant difference (P < 0.05) was evident between the 6- and 7-year-old in English, indicating that children have better language structures as a result of formal educational training in English, and improved cognitive influences with age, which is reflected in their native language. The Piagetian model proposes children between 6 and 7 years of age to exhibit rapid escalation in the linguistic skills, marked by flourishing abilities of mental representations, along with symbol to object associations and increased memory power. These functions act as an important indicator of ToM abilities, requiring an understanding of the speaker's intent.[62]
As earlier mentioned, the poor level of significance received between the subsequent groups in Kannada and English does indicate the performance of these groups to be indistinguishable. The descriptive statistics did reveal higher mean scores with every succeeding group for English and Kannada, except for the 8-year-old who performed comparatively poorer than the 7-year-old in Kannada. The poor significance observed between the selective groups can be accounted for the gradual and subtle metalinguistic changes that are evident, sometimes only when considering the groups to be widely spread (e.g., 4 vs. 6 vs. 8 year-old). This was further supported by other studies.[58],[63] Although the developmental pattern of the ToM mean scores of English and Kannada across the age groups did reveal a similar gradual and steady increasing trend, the English set comparatively attained higher mean scores than Kannada set for each age group. A main significant difference (P < 0.05) obtained between the English and Kannada language, indicated the ToM skills in both languages to follow a different acquisition rate. Except for the 8 year-old who exhibited a lower ToM mean score compared to its preceding group, all other groups did exhibit an increasing trend in English and Kannada. The participants in the present study were recruited from English medium schools wherein which they would have begun using and being exposed to English in a formal manner especially from the age of 5 years. Folstein and Rosen-Sheidley[64] suggested ToM skills be influenced primarily by the language and social experience, along with engaging in general conversations and having good social interaction skills.[65]
The performance of the higher-order ToM abilities in Kannada that led to a varied trajectory pattern could be attributed to the acculturation theory proposed by Ellis.[66] This theory which accounts for second language acquisition development in natural settings does highlight adaptation to a new culture. According to this hypothesis, the greater the contact with L2 speakers and their culture, the more the acquisition of the second language occurs, leading to a reduced accessibility to the native language considering its loss at societal or cultural levels. Although these individuals may retain receptive (understanding) skills in the language, they tend to use the majority language which appears to be more accessible to them to speak with their peers and siblings and in responding to their parents. In the present study, a significant effect (P < 0.05) was observed between English (majority language) and Kannada (minority language) using the Wilcoxon Signed-Rank Test, indicating a difference in the performance of both languages across all age groups, except for the 3 and 4 years old. Due to constant exposure of English, school going children within this age range experience a transition wherein their mother tongue (majority language) which was initially their L1, becomes the L2 (minority language), while English would eventually become their L1. Locke, Ginsborg, and Peers[67] supported that the child's poor language performance upon entry into preschool was not due to their poor cognitive abilities, but instead could be attributed to an enhancement in their nonverbal skills that they used more frequently than their language skills. The authors also pointed out that teaching the children received did not offer them enough exposure or opportunity to use spoken language, bringing about the poor performance in the ToM tasks. The findings of the influence of languages (L1 and L2) are at par with other studies,[68],[69],[70] wherein the researchers had noted bilinguals to exhibit a loss or incomplete acquisition of their heritage language under conditions of exposure and use of the majority language. The foundation that is built by teachers by consciously introducing and using language that focuses on thinking and other mental states paves the way toward a sturdy ToM foundation. Any deficits to the components of language could compromise the efficiency of ToM skills as language serves as a universal medium that allows for the representation of thoughts and perspectives.[37]
The present study gives a preview into the developmental trend of higher-order ToM abilities in typically developing bilingual children. The findings of this study pave the way toward the importance of assessing the ToM issues faced by bilingual children (English and Kannada) with autism spectrum disorders, who struggle to complete tasks that incorporate false belief concepts.[71],[72] The present study also has its implications towards assessing young children with a history of abuse,[73],[74] as well as child sexual offenders[75] who have found it challenging to pass false belief tasks, which can be attributed to their difficulty in comprehending other's emotions and facial expressions which are constituents of ToM abilities. Understanding the development of ToM skills may provide an insight into the emotional processing abilities of typically developing children, as both these skills are found to be essential to interpret social cues, predict behaviors and increase social communication.[76] As the present study included a small sample size, future research may be directed to overcome this issue as well as address higher-order ToM skills in typically developing children and children with socio-pragmatic issues.
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Dr. Sudhin Karuppali
Department of Audiology and Speech Language Pathology, Manipal Academy of Higher Education, Kasturba Medical College, Light House Hill Road, Mangalore, Karnataka
DOI: 10.4103/psychiatry.IndianJPsychiatry_115_18