Thinking outside the executive functions box: Theory of mind and pragmatic abilities in attention deficit/hyperactivity disorder

Abstract

An endophenotype for attention deficit/hyperactivity disorder (AD/HD) is executive functioning. In the autism and developmental literature executive dysfunctions has also been linked to theory of mind (ToM) and pragmatic language use. The central question of this review is whether deficits in ToM and pragmatic language use are common in AD/HD. AD/HD seems to be associated with pragmatic deficits, but not with ToM deficits. In this review we address how this pattern of findings might facilitate the understanding of the commonalities and differences between executive functioning, ToM, and pragmatic abilities. Based on the reviewed studies we conclude that ToM is not likely to be a potential endophenotype for AD/HD, while it is too early to draw such a conclusion for pragmatic language use.

Keywords:

• Autism
• AD/HD
• Executive functioning
• Pragmatic abilities
• Theory of Mind

We want to thank the organizers of the ToM meeting “Theory of Mind: Module or Emergent property” (March 2007, Wageningen, The Netherlands) for the initiative for this special issue on ToM. Moreover, we thank Sander Begeer and two anonymous reviewers for their comments on an earlier version of this article.

Notes

¹We use the term autism to refer to autism spectrum disorders including autism, Asperger syndrome, and pervasive developmental disorders not otherwise specified (PPD-NOS).

²We calculated the pooled effect size by incorporating the number of participants for each of the effect sizes following the method described in the review paper of Willcutt and colleagues (2005). For the ToM studies this pooled effect size could not be calculated as most studies did not report all the necessary details (mean and standard deviation and number of participants per group). However, for the pragmatic language use studies, even though the studies sometimes differed in the reported dependent measures, the pooled effect size could be calculated. The pooled effect size (Cohen's d) for the pragmatic language measures is 0.14, which is small (N _AD/HD = 266 and N _controls = 281).