Are knowledge- and belief-reasoning automatic, and is this the right question?

Phillips et al. conclude that current evidence supports knowledge-, but not belief-reasoning as being automatic. We suggest four reasons why this is an oversimplified answer to a question that might not have a clear-cut answer: (1) knowledge and beliefs can be incompletely equated to perceptual states, (2) sensitivity to mental states does not necessitate representation, (3) automaticity is not a single categorical feature, and (4) how we represent others' minds is dependent on social context.

Measuring visual perspective taking in the brain with avatars and arrows: Which question are we asking?

There is an ongoing debate about the involvement of Theory of Mind (ToM) processes in Visual Perspective Taking (VPT). In an fMRI study (Schurz et al., 2015), we borrowed the positive features from a novel VPT task - which is widely used in behavioral research - to study previously overlooked experimental factors in neuroimaging studies. However, as Catmur et al. (2016) rightly argue in a comment on our work, our data do not speak strongly to questions discussed in the original behavioral studies, in particular the issue of implicit mentalizing. We appreciate the clarification of these interpretational limitations of our study, but would like to point out the differences between questions emerging from behavioral and neuroimaging research on VPT. Different from what Catmur et al. (2016) discuss, our study was not intended as a test of implicit mentalizing. In fact, the terms "automatic" and "implicit mentalizing" were never mentioned in our manuscript. Our study addressed a methodological gap between ToM and VPT research, which we identified in two previous meta-analyses on the topics (Schurz et al., 2013, 2014). With this difference in mind we show that the critical points levelled by Catmur et al. (2016) cease to apply.

The impact of sleep deprivation on visual perspective taking.

Total sleep deprivation (TSD) is known to alter cognitive processes. Surprisingly little attention has been paid to its impact on social cognition. Here, we investigated whether TSD alters levels-1 and -2 visual perspective-taking abilities, i.e. the capacity to infer (a) what can be seen and (b) how it is seen from another person's visual perspective, respectively. Participants completed levels-1 and -2 visual perspective-taking tasks after a night of sleep and after a night of TSD. In these tasks, participants had to take their own (self trials) or someone else's (other trials) visual perspective in trials where both perspectives were either the same (consistent trials) or different (inconsistent trials). An instruction preceding each trial indicated the perspective to take (i.e. the relevant perspective). Results show that TSD globally deteriorates social performance. In the level-1 task, TSD affects the selection of relevant over irrelevant perspectives. In the level-2 task, the effect of TSD cannot be unequivocally explained. This implies that visual perspective taking should be viewed as partially state-dependent, rather than a wholly static trait-like characteristic.

Clarifying the role of theory of mind areas during visual perspective taking: Issues of spontaneity and domain-specificity.

Visual perspective taking is a fundamental feature of the human social brain. Previous research has mainly focused on explicit visual perspective taking and contrasted brain activation for other- versus self-perspective judgements. This produced a conceptual gap to theory of mind studies, where researchers mainly compared activation for taking another's mental perspective to non-mental control conditions. We compared brain activation for visual perspective taking to activation for non-mental control conditions where the avatar was replaced by directional (arrow, lamp) or non-directional (brick-wall) objects. We found domain-specific activation linked to the avatar's visual perspective in right TPJ, ventral mPFC and ventral precuneus. Interestingly, we found that these areas are spontaneously processing information linked to the other's perspective during self-perspective judgements. Based on a review of the visual perspective taking literature, we discuss how these findings can explain some of the inconsistent/negative results found in previous studies comparing other- versus self-perspective judgements.

A Second Look at Automatic Theory of Mind: Reconsidering Kovács, Téglás, and Endress (2010).

In recent work, Kovács, Téglás, and Endress (2010) argued that human adults automatically represented other agents' beliefs even when those beliefs were completely irrelevant to the task being performed. In a series of 13 experiments, we replicated these previous findings but demonstrated that the effects found arose from artifacts in the experimental paradigm. In particular, the critical findings demonstrating automatic belief computation were driven by inconsistencies in the timing of an attention check, and thus do not provide evidence for automatic theory of mind in adults.

Qualitative interview with mothers of moderately or late preterm infants in the UK: where are the care gaps?

INTRODUCTION: Preterm birth (<37 gestational weeks) accounts for an increasing proportion of global births each year, with moderately or late preterm birth (MLPT) (32+0/7-36+6/7 gestational weeks) comprising over 80% of all preterm births. Despite the frequency, MLPT births represent only a small fraction of prematurity research, with research exploring the parental experiences of having a child born MLPT particularly neglected. It is vital this perspective is considered to provide appropriate grounding for future research and service provision. METHODS: Six mothers from the UK of infants (aged between 18 and 36 months) born MLPT were invited to take part in a semistructured qualitative interview study. Reflexive thematic analysis was employed to explore the data and codes were then conceptualised through a process of inductive reasoning to identify patterns of meaning. RESULTS: Five themes are presented that are conceptualised from the data: (1) the moderate or later preterm 'label-does it matter?, (2) vulnerability within a new role, (3) coming home and wanting to start 'normal' life, (4) comparisons to provide a reference to experiences and (5) experience of professionals throughout the pregnancy, newborn and early years journey. CONCLUSIONS: Findings offer in-depth evidence surrounding mothers' experiences of healthcare throughout pregnancy and immediately after birth, perceptions of the 'preterm' label and thoughts on how mothers reflect on their experiences. Future research should show an awareness of the broader family context when interpreting findings and providing suggestions for future research avenues or service provision.

Three key questions to move towards a theoretical framework of visuospatial perspective taking.

What would a theory of visuospatial perspective taking (VSPT) look like? Here, ten researchers in the field, many with different theoretical viewpoints and empirical approaches, present their consensus on the three big questions we need to answer in order to bring this theory (or these theories) closer.

Exploring an objective measure of overactivity in children with rare genetic syndromes.

BACKGROUND: Overactivity is prevalent in several rare genetic neurodevelopmental syndromes, including Smith-Magenis syndrome, Angelman syndrome, and tuberous sclerosis complex, although has been predominantly assessed using questionnaire techniques. Threats to the precision and validity of questionnaire data may undermine existing insights into this behaviour. Previous research indicates objective measures, namely actigraphy, can effectively differentiate non-overactive children from those with attention-deficit hyperactivity disorder. This study is the first to examine the sensitivity of actigraphy to overactivity across rare genetic syndromes associated with intellectual disability, through comparisons with typically-developing peers and questionnaire overactivity estimates. METHODS: A secondary analysis of actigraphy data and overactivity estimates from The Activity Questionnaire (TAQ) was conducted for children aged 4-15 years with Smith-Magenis syndrome (N=20), Angelman syndrome (N=26), tuberous sclerosis complex (N=16), and typically-developing children (N=61). Actigraphy data were summarized using the M10 non-parametric circadian rhythm variable, and 24-hour activity profiles were modelled via functional linear modelling. Associations between actigraphy data and TAQ overactivity estimates were explored. Differences in actigraphy-defined activity were also examined between syndrome and typically-developing groups, and between children with high and low TAQ overactivity scores within syndromes. RESULTS: M10 and TAQ overactivity scores were strongly positively correlated for children with Angelman syndrome and Smith-Magenis syndrome. M10 did not substantially differ between the syndrome and typically-developing groups. Higher early morning activity and lower evening activity was observed across all syndrome groups relative to typically-developing peers. High and low TAQ group comparisons revealed syndrome-specific profiles of overactivity, persisting throughout the day in Angelman syndrome, occurring during the early morning and early afternoon in Smith-Magenis syndrome, and manifesting briefly in the evening in tuberous sclerosis complex. DISCUSSION: These findings provide some support for the sensitivity of actigraphy to overactivity in children with rare genetic syndromes, and offer syndrome-specific temporal descriptions of overactivity. The findings advance existing descriptions of overactivity, provided by questionnaire techniques, in children with rare genetic syndromes and have implications for the measurement of overactivity. Future studies should examine the impact of syndrome-related characteristics on actigraphy-defined activity and overactivity estimates from actigraphy and questionnaire techniques.

Changes in parental sleep from pregnancy to postpartum: A meta-analytic review of actigraphy studies.

Sleep changes in new parents are widely observed but there is no extant meta-analysis of changes to sleep parameters in this group. We completed a meta-analysis of changes in actigraphy-measured parent sleep between pregnancy and the end of the first year of a child's life. A search of six databases was completed. Following review using predetermined inclusion and exclusion criteria, 16 papers were left for review. Data were extracted, analysed and each paper was reviewed for methodological quality. Where possible, subgroup analysis was completed based on time since birth and location of the study, and meta-regression of parent age. Parents' total sleep time and sleep efficiency were shown to decrease following the birth of a child, with wake after sleep onset increasing. This change was most notably observed in the first four weeks after birth. Up to 16 weeks post-birth, differences were still apparent, but sleep parameters were beginning to return to pre-birth levels. New parents experience a significant change in multiple sleep parameters following the birth of a child. Future data collection, using best practice actigraphy measurement, reporting a broader range of variables and including fathers, as well as mothers, is warranted.

Personality traits as risk factors for relapse or recurrence in major depression: a systematic review.

Background: Major depressive disorder (MDD) is highly recurrent. Identifying risk factors for relapse in depression is essential to improve prevention plans and therapeutic outcomes. Personality traits and personality disorders are widely considered to impact outcomes in MDD. We aimed to evaluate the role of personality aspects in the risk of relapse and recurrence in MDD. Method: A PROSPERO-registered systematic review was conducted using Medline, Embase, PsycINFO, Web of Science and CINAHL as data sources, together with hand searching of four journals over the five years till 2022. There was independent abstract selection, quality assessment and data extraction from each study. Results: Twenty two studies me t eligibility criteria involving 12,393 participants. Neurotic personality features are significantly associated with the risk of relapse and recurrence of depression, though the data is not uniform. There is some, though limited, evidence that borderline, obsessive-compulsive and dependent personality traits or disorders increase the risk for relapse in depression. Limitations: The small number, in addition to the methodological heterogeneity of the included studies, did not allow further analysis, such as meta-analysis. Conclusion: People with high neuroticism and dependent personality traits, borderline personality disorder or obsessive-compulsive personality disorder, compared to those without, may be at a higher risk of experiencing relapse or recurrence of MDD. Specific and targeted interventions may potentially reduce relapse and recurrence rates in these groups and could improve outcomes. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=235919, identifier: CRD42021235919.

The neural and cognitive time course of theory of mind.

Neuroimaging and neuropsychological studies implicate both frontal and temporoparietal cortices when humans reason about the mental states of others. Here, we report an event-related potentials study of the time course of one such "theory of mind" ability: visual perspective taking. The findings suggest that posterior cortex, perhaps the temporoparietal cortex, calculates and represents the perspective of self versus other, and then, later, the right frontal cortex resolves conflict between perspectives during response selection.

Egocentrism and automatic perspective taking in children and adults.

Children (aged 6-10) and adults (total N = 136) completed a novel visual perspective-taking task that allowed quantitative comparisons across age groups. All age groups found it harder to judge the other person's perspective when it differed from their own. This egocentric interference did not decrease with age, even though, overall, performance improved. In addition, it was more difficult to judge one's own perspective when it differed from that of the other person, suggesting that the other's perspective was processed even though it interfered with self-perspective judgments. In a logically equivalent, nonsocial task, the same degree of interference was not observed. These findings are discussed in relation to recent findings suggesting precocious theory-of-mind abilities in infancy.

Direct and indirect measures of Level-2 perspective-taking in children and adults.

Studies with infants show divergence between performance on theory of mind tasks depending on whether direct or indirect measures are used. It has been suggested that direct measures assess a flexible but cognitively demanding ability to reason about the minds of others, whereas indirect measures assess distinct processes which afford more efficient but less flexible theory of mind abilities (Apperly & Butterfill, 2009). This leads to the prediction that performance on indirect measures should be subject to signature limits. The current study tested whether the Level-1/Level-2 distinction might constitute one such limit. The study adapted a task that has shown evidence of Level-1 perspective-taking on both direct and indirect measures (Samson, Apperly, Braithwaite, Andrews, & Bodley-Scott, 2010). The aim was to test Level-2 perspective-taking in a sample of 6- to 11-year-olds (N = 80) and adults (N = 20). Participants were able to make Level-2 judgements on the direct measure. In contrast with the findings from Level-1 perspective-taking, there was no evidence of automatic processing of Level-2 perspectives on the indirect measure. This finding is consistent with the view that theory of mind abilities assessed by indirect measures are subject to signature limits. The Level-1/Level-2 distinction, suitably refined, marks one way in which efficient but inflexible theory of mind abilities are limited.

Exploring the Processes Involved in Seeking Help from a General Practitioner for Young People Who Have Been at Risk of Suicide.

General practitioners (GPs) play a key role in the early identification and management of suicide risk in young people. However, little is known about the processes involved in how, when and why a young person decides to seek help from their GP. Eight young people, aged 17-23, took part in semi-structured interviews exploring their experiences of help seeking when feeling suicidal. Data were analysed using framework analysis. The analysis identified three main themes and seven subthemes. The main themes explored were: understanding when to seek help from a GP, barriers and facilitating factors at the GP consultation, and help seeking as a non-linear and dynamic process. The processes involved in how, when and why young people seek help from a GP when feeling suicidal were found to be dynamic and to fluctuate over time. Help seeking was initially related to how young people were able to understand and articulate their distress, the availability of informal support networks, and their perception of the GP as a source of help. During a GP consultation, help seeking was influenced by how safe and supported the young people felt. Perceived GP training, communication and validation of young people's concerns were important factors to help facilitate this process. Subsequent help seeking was influenced by prior experience of GP consultations and the availability of alternative support.

The prevalence and profile of autism in individuals born preterm: a systematic review and meta-analysis.

INTRODUCTION: Preterm birth (<37 weeks) adversely affects development in behavioural, cognitive and mental health domains. Heightened rates of autism are identified in preterm populations, indicating that prematurity may confer an increased likelihood of adverse neurodevelopmental outcomes. The present meta-analysis aims to synthesise existing literature and calculate pooled prevalence estimates for rates of autism characteristics in preterm populations. METHODS: Search terms were generated from inspection of relevant high-impact papers and a recent meta-analysis. Five databases were searched from database creation until December 2020 with PRISMA guidelines followed throughout. RESULTS: 10,900 papers were retrieved, with 52 papers included in the final analyses, further classified by assessment method (screening tools N=30, diagnostic assessment N=29). Pooled prevalence estimates for autism in preterm samples was 20% when using screening tools and 6% when using diagnostic assessments. The odds of an autism diagnosis were 3.3 times higher in individuals born preterm than in the general population. CONCLUSIONS: The pooled prevalence estimate of autism characteristics in individuals born preterm is considerably higher than in the general population. Findings highlight the clinical need to provide further monitoring and support for individuals born preterm.

Anxiety and intellectual functioning in autistic children: A systematic review and meta-analysis.

LAY ABSTRACT: Autistic children often experience higher levels of anxiety than their peers. It can be difficult to diagnose and treat anxiety disorders in autistic children, in part because of the high degree of variability in their underlying abilities and presentations. Some evidence suggests that autistic children with higher intelligence (as measured by intelligence quotient) experience higher levels of anxiety than autistic children with lower intelligence. However, the evidence is inconsistent, with other papers not finding a difference or finding higher levels of anxiety in autistic children with lower intelligence. In this article, we review existing literature to see whether autistic children with higher intelligence quotients have higher anxiety than autistic children with lower intelligence quotients. A systematic search of the literature was conducted which identified 49 papers on the topic. The methods of all the papers were reviewed using an objective quality assessment framework. When combining the data statistically, there was evidence that autistic children with higher intelligence quotients are more anxious than autistic children with lower intelligence quotients. The quality review raised common weaknesses across studies. Most importantly, few studies used measures of anxiety that have been shown to be valid for children with very low intelligence quotients. Similarly, many studies used measures of anxiety that have not been shown to be valid for autistic children. These factors are important because autistic children and those with low intelligence quotient may experience or understand anxiety differently. Future research should use fully validated measures to test whether high intelligence quotient is associated with high levels of anxiety in autistic children.

Sleep in children with Smith-Magenis syndrome: a case-control actigraphy study.

STUDY OBJECTIVES: The objectives of the study were (1) to compare both actigraphy and questionnaire-assessed sleep quality and timing in children with Smith-Magenis syndrome (SMS) to a chronologically age-matched typically developing (TD) group and (2) to explore associations between age, nocturnal and diurnal sleep quality, and daytime behavior. METHODS: Seven nights of actigraphy data were collected from 20 children with SMS (mean age 8.70; SD 2.70) and 20 TD children. Daily parent/teacher ratings of behavior and sleepiness were obtained. Mixed linear modeling was used to explore associations between total sleep time and daytime naps and behavior. RESULTS: Sleep in children with SMS was characterized by shorter total sleep time (TST), extended night waking, shorter sleep onset, more daytime naps, and earlier morning waking compared to the TD group. Considerable inter-daily and inter-individual variability in sleep quality was found in the SMS group, so caution in generalizing results is required. An expected inverse association between age and TST was found in the TD group, but no significant association was found for the SMS group. No between-group differences in sleep hygiene practices were identified. A bidirectional negative association between TST and nap duration was found for the SMS group. In the SMS group, increased afternoon sleepiness was associated with increased irritability (p = .007) and overactivity (p = .005). CONCLUSION: These findings evidence poor sleep quality in SMS and the need to implement evidence-based interventions in this population.

Multi-Method Assessment of Sleep in Children With Angelman Syndrome: A Case-Controlled Study.

Objectives: To assess sleep quality and timing in children with Angelman syndrome (AS) with sleep problems using questionnaires and actigraphy and contrast sleep parameters to those of typically developing (TD) children matched for age and sex. Methods: Week-long actigraphy assessments were undertaken with children with AS (n = 20) with parent-reported sleep difficulties and compared with age and sex matched TD controls. The presence of severe sleep problems was assessed using the modified Simonds and Parraga sleep questionnaire. Sleep hygiene was measured using the Family Inventory of Sleep Habits. Results: Actigraphy and parent-completed sleep diary data indicated that children with AS had significantly earlier bedtimes (p = .003, Cohen d = .47) and poorer sleep efficiency (78%, p = .04, d = .33) than TD children (84%). No significant differences in total sleep time, sleep onset latency or wake after sleep onset were found between the two groups. The expected relationship between later bedtimes and increasing age found for the TD group (p < .001, ß.78) was not evidenced for the AS group (p = .09, ß.39). Considerable inter-individual and night to night variation in actigraphy assessed total sleep time and wake after sleep onset was found for children with AS compared to TD children. Parent report indicated that a greater proportion of children with AS had severe night waking problems compared to TD children (81 versus 5%). No significant differences in sleep hygiene and excessive daytime sleepiness were found between the two groups (p > .05). Conclusions: This study reports the largest objective dataset of sleep quality parameters in children with AS. Sleep quality in this group was characterised by poor efficiency and significant intra- and inter-individual variability that warrants further investigation. This variability should inform assessment and intervention for sleep in children with AS, as averages of total sleep, even across a 7 day period may not capture the difficulties with night waking highlighted by parental questionnaire report.

Sleep duration and sleep quality in people with and without intellectual disability: A meta-analysis.

This study provides the first meta-analysis of the purported differences in sleep time and sleep quality between people with and without intellectual disabilities. Twenty-one papers were identified that compared sleep time and/or sleep quality in people with and without intellectual disabilities. The meta-analysis of sleep time revealed that people with an intellectual disability slept for 18 min less, on average, than people without an intellectual disability. This significant difference was limited to those studies that tested groups of people with an identified genetic syndrome or developmental disorder. The analysis of sleep quality also concluded that people with intellectual disabilities experienced poorer sleep: In 93% of comparisons between groups, sleep was found to be of poorer quality in the group of people with intellectual disabilities. There were no differences found between studies that measured sleep objectively and those that used diary or questionnaire measures. Notably, most samples were drawn from populations of people with specified genetic syndromes or developmental disorders, rather than intellectual disability of heterogeneous origin. Similarly, most studies investigated sleep in children, although there was no evidence that the differences between the groups reduced during adulthood. Most studies used highly-regarded objective measures of sleep, such as polysomnography or actigraphy, although methodological flaws were evident in the identification of samples and the measurement of intellectual disability.