Promoting theory of mind during middle childhood: A training program

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Highlights

  • Conversation was effective in promoting ToM during middle childhood.

  • The positive effect of the ToM training was independent of executive functions.

  • The positive effect of the ToM intervention was stable over two months.

Abstract

Evidence that conversations about the mind foster improvements in theory of mind (ToM) is growing, but their efficacy in typically developing school-aged children has yet to be demonstrated. To address this gap, we designed a conversation-based training program for 9- and 10-year-olds and measured its effectiveness by pre- and post-test comparisons of performance on age-appropriate ToM tasks for two groups (matched at pre-test for gender, age, socioeconomic background, verbal ability, reading comprehension, executive functions, and ToM) who were assigned to either the intervention condition (n = 45) or an active control condition (n = 46). The intervention group showed significantly greater gains in ToM than the control group; this contrast was stable over 2 months, and (in a subsample) the improvement in ToM was independent of any changes in executive functions. Implications for the role of conversations about the mind in children’s mental state reasoning are discussed.

Introduction

Children’s theory of mind (ToM) represents one of the liveliest areas of study in developmental psychology. After 30 years of research in this field, there is some consensus about key milestones of normative ToM development, particularly during the preschool years (Wellman, Cross, & Watson, 2001). Recent years have also seen mounting evidence that ToM continues to develop during and even beyond the school years (Miller, 2012), extending into adolescence and adulthood (Apperly, 2011, Devine and Hughes, 2013).

During the school years, children become increasingly sophisticated in applying their ToM skills to make sense of complex social situations. Despite being able to pass second-order false belief tasks (involving mistaken beliefs about beliefs), 9-year-olds are still only beginning to effectively use their ToM skills to explain behavior (Banerjee, Watling, & Caputi, 2011). Recent studies have shown that, with increasing age, children became better at reasoning about beliefs and perspectives and in applying these skills in a variety of contexts/scenarios. For example, they become able to accurately judge one person’s beliefs about the intentions of others (Miller, 2009, Pillow, 1991) and use a higher frequency of mental state terms to describe social behavior (Meins, Fernyhough, Johnson, & Lidstone, 2006). Between 9 and 11 years of age, children become more sophisticated in interpreting ironic utterances (Filippova & Astington, 2008), and understanding faux pas (Baron-Cohen, O’Riordan, Stone, Jones, & Plaisted, 1999). Crucially, a recent study of 230 children between 8 and 13 years of age showed age-related improvement in two ToM tasks: the well-established text-based Strange Stories task (White, Hill, Happé, & Frith, 2009) and a novel paradigm involving brief clips from a classic silent film (Devine & Hughes, 2013). This result is important because it suggests that children’s ability to use their understanding of mental states continues to improve beyond the preschool years.

Despite these promising studies, we still know very little about what drives development in ToM beyond early childhood. The current article addresses the hypothesis that conversations about mental states have a crucial role in the development of relatively advanced ToM skills.

Several strands of evidence, including cross-cultural studies (Hughes et al., 2014, Lecce and Hughes, 2010) and observational studies (see Hughes, 2011), indicate that variation in social experiences contributes to individual differences in ToM. Interestingly, empirical results from twin studies suggest that as children increase in age, the social environment becomes important in explaining individual differences in ToM (Hughes and Cutting, 1999, Hughes et al., 2005, Ronald et al., 2006). Notably, a large-scale study of 5-year-old twins showed common influences of shared environment on individual differences in children’s understanding of false beliefs and verbal ability, indicating that variation in linguistic environments (i.e., family talk) may contribute to variation in children’s ToM (Hughes et al., 2005).

Numerous authors have highlighted participation in conversations about mental states as an important influence on children’s development of ToM. According to this conversational approach, exposure to conversations that are rich in reference to (and explanation of) mental states such as desires, emotions, and beliefs facilitates children’s understanding of others’ minds (Dunn and Brophy, 2005, Nelson, 2005, Turnbull and Carpendale, 1999). Indeed, some existing theoretical models present mental state conversations as the key learning context within which ToM progress can be made. For example, Nelson (2007) proposed that conversations make children enter into the “community of minds,” allowing them to reflect on their social experiences and improve their awareness that people can have different mental states that relate to the same situation. From this perspective, conversations constitute a privileged context for helping children to reflect on the differences between others’ and their own states of mind. In turn, the need to coordinate others’ points of view with their own experience gives birth to a gradually constructed understanding of the mind (Harris, 1999).

Direct evidence for the role of mental state talk in school-aged children’s ToM skills comes from three separate sources. First, extending early demonstrations of delayed ToM success among deaf children born to hearing parents (DoH) but not deaf children born to deaf parents (DoD) (e.g., Peterson and Siegal, 1995, Peterson and Slaughter, 2006), two studies showed that the richness of conversational experience at school predicts variation in ToM success within DoD children (Meristo et al., 2007, Tomasuolo et al., 2013). Second, longitudinal studies of typically developing children have shown that early variation in mothers’ mental state talk predict individual differences in children’s ToM both in preschool (Ensor and Hughes, 2008, Ruffman et al., 2002) and during middle childhood (Ensor, Devine, Marks, & Hughes, 2014). Finally, recent training studies with young children suggest a causal influence of children’s participation in mental state conversations on ToM development. In two separate studies, Ornaghi and colleagues reported that preschoolers and Year 1 children who had opportunities to take part in conversations about mental states showed better ToM than children who did not (Ornaghi et al., 2011, Ornaghi et al., 2014). Within the same conversational paradigm, Ziv, Smadja, and Aram (2013) showed that promoting sociocognitive themes within conversations between parents and children during shared reading led to enhancements in children’s mental state understanding. Together, these studies suggest that young children’s participation in conversations about mental states brings about fundamental changes in their capacity to reason in psychological terms (de Rosnay & Hughes, 2006). What is lacking, however, is direct experimental evidence for a similar influence of mental state conversations on ToM development during middle childhood, which is known to be significantly associated with real-world indicators of social success (e.g., Banerjee et al., 2011, Caputi et al., 2012). Addressing this gap was a key goal for the current study. Specifically, we designed an intervention to demonstrate specific causal relations between mental states conversations and the development of ToM understanding in 9- and 10-year-olds.

Before entering into the details of the training program literature, it should be stressed that middle childhood is also characterized by growth in executive functions (see Davidson et al., 2006, Huizinga et al., 2006), which are known to be crucial for ToM abilities (Carlson and Moses, 2001, Hughes, 1998b). Therefore, it is possible that executive function skills might also underpin the continued growth in ToM use during the school years. This acknowledgment of a possible link between ToM and executive functions during middle childhood raises two important issues in relation to any ToM training study. First, given that executive functions promote learning across a number of domains (e.g., Blair and Razza, 2007, Bull and Scerif, 2001, Espy et al., 2004), individual differences in executive functions prior to training might predict the extent to which children’s ToM improves during the training. By this account, we should expect significant associations between individual differences in executive functioning at pre-test and children’s gains in ToM as a result of the training.

Alternatively, it might be that ToM training is effective not because it directly causes improvement in ToM but rather because it enhances children’s executive functions. If this is the case, we should find significant associations between gains in executive functions and gains in ToM scores. The current study was designed to help us address these possibilities as well as the more fundamental hypothesis that a conversation-based training program would improve ToM during middle childhood.

Existing studies with typically developing children have shown that training ToM can be successful during the preschool years (Kloo & Perner, 2008). In two early studies on this topic, Slaughter and Gopnik (1996) and Appleton and Reddy (1996) showed that 3- and 4-year-olds involved in conversations about beliefs, desires, and perceptions improved their false belief understanding more than children in the control group. Two subsequent studies by Hale and Tager-Flusberg (2003) and Lohmann and Tomasello (2003) highlighted the importance of using sentential complement constructions (i.e., sentences that take a full clause as their object complement, e.g., “Peter thinks that the candy is in the cupboard”) to improve 3- to 5-year-olds’ false belief understanding. Importantly, other studies have confirmed the importance of giving detailed feedback and explanations to children on why their answers to ToM questions were right or wrong during verbal interactions (Clements et al., 2000, Melot and Angeard, 2003).

Although our own efforts focused on using conversations to stimulate progress in more advanced aspects of ToM reasoning, the studies cited above provide important insights into the principles of effective ToM training. Therefore, in designing our intervention, we focused on mental state terms within sentential complement constructions and made frequent use of feedback and explanation within group conversation. We chose to use group conversations about mental states because there is strong agreement in the literature that the frequency, quality, and content of conversations about the mind predict later ToM skills (Appleton and Reddy, 1996, Ensor and Hughes, 2008, Ornaghi et al., 2011, Peterson and Slaughter, 2003). Notably, the emphasis in the conversations was on elaborating on children’s comments, explaining the reasons why their answers were right or wrong, and highlighting the existence of different points of view on the same event.

We designed two types of activity to prompt conversations about mental states: one centered on short stories/vignettes and the other focused on the meaning of mental state verbs. Although the comprehension of mental state verbs is a key correlate of ToM (Grazzani & Ornaghi, 2012), stories offer a good opportunity to reflect, as a “social apprentice,” on the range of complex mental state dynamics relevant to everyday social contexts (Dyer et al., 2000, Lecce et al., 2010). Our training program also built on research regarding key developmental changes in ToM skills during middle childhood and highlighted the dynamic nature of mental states. Being able to recognize that mental states are not static but rather change over time is one of the core acquisitions within ToM (Flavell, 1993, Gopnik and Astington, 1988).

Given that the maintenance of a training effect is crucial in the evaluation of the intervention itself, it is surprising that this issue has rarely been addressed in previous studies. Indeed, most published research studies have measured children’s ToM skills within 1 week of the intervention (Clements et al., 2000, Hale and Tager-Flusberg, 2003, Lohmann and Tomasello, 2003, Melot and Angeard, 2003, Slaughter and Gopnik, 1996), precluding any examination of whether any detected effects endured beyond training. In one notable exception, Appleton and Reddy (1996) completed both an immediate post-test and a follow-up session 2 to 3 weeks after the training program, showing that at follow-up children in the training group outperformed those in the control group on all of the tasks. This finding indicates that the effects of conversation-based intervention may remain stable for some weeks after the end of the intervention. However, even 3 weeks represents a relatively short period of time to establish the efficacy of an intervention. Thus, as well as testing children’s ToM 2 weeks after the end of the training in our studies, we also conducted a 2-month follow-up to test the enduring effects of the intervention program.

This study had three main aims. The first goal was to test the efficacy of our ToM intervention and provide experimental evidence for the role of conversations about mental states in the development of ToM skills during middle childhood. The second goal was to test the stability of the training effect by retesting children’s ToM 2 months after the end of the training program. The third goal was to control for possible variations in executive functions when evaluating the impact of the training conversations about mental states. In addressing these issues, we also controlled for individual differences on a wide variety of potential confounding variables that are known to be associated with ToM: children’s family background (Cutting & Dunn, 1999), verbal ability (Milligan, Astington, & Dack, 2007), and reading comprehension (Lecce & Hughes, 2014).

Section snippets

Participants

We recruited a sample of 91 children from two primary schools in the area surrounding Milan in northern Italy. Participants had a mean age of 9 years 7 months (SD = 4.03 months) and were randomly assigned to either the ToM condition (30 boys and 15 girls) or the control condition (24 boys and 22 girls). A total of seven classes took part in the current study. Children within the same classroom were assigned to different conditions. All of the children were fluent Italian speakers. Criteria for

Results

Preliminary analysis showed no effects of gender. Thus, given that we had no a priori hypothesis, gender was excluded from the main analysis reported below. Table 1 shows descriptive statistics for all variables in the analysis.

t-Tests showed no significant differences between the experimental and control groups on any of the pre-test control measures, all ps > .17. Importantly, the two groups also had a similar level of ToM ability at pre-test, t(89) = 0.33, p = .744, 95% confidence interval (CI)

Discussion

This study evaluated the effects of a ToM training program based on conversations about mental states in typically developing school-aged children. Compared with the control group (matched for gender, family socioeconomic status, age, verbal ability, reading comprehension, planning, and working memory and pre-test ToM performance), children in the experimental group performed significantly better on the ToM task at post-test and follow-up and made greater gains in ToM from pre-test to post-test

Acknowledgments

We thank the children who took part in this study, their parents, and school staff members for their interest in and support of this project. We also thank Marta Nola for her support and contribution to the study.

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