Edinburgh Social Cognition Test (ESCoT): a new test of theory of mind and social norm understanding
Baksh, Rehman Asaad
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Social cognitive abilities are needed to process and understand social information in order to respond appropriately in everyday social interactions. While there are a number of tests that have been developed to measure social cognition in the literature, many have important limitations such as only assessing one ability, performance being predicted by measures of intelligence and exhibiting low ecological validity. To address some of these limitations, I developed a new test called the Edinburgh Social Cognition Test (ESCoT). The ESCoT is an animated test that assesses four domains of social cognition: cognitive Theory of Mind (ToM) (What is X thinking?); affective ToM (How does X feel at the end of the animation?); interpersonal understanding of social norms (Did X behave as other people should behave?); and intrapersonal understanding of social norms (Would you have acted the same as X in the animation?). The aims of this thesis were to examine the validity of the ESCoT as a test of social cognition and to further investigate social cognitive processes in healthy and neurological populations. The ESCoT was firstly administered to a healthy population of older, middle-aged and younger adults to examine the effects of ageing on social abilities. This study found that the ESCoT was sensitive to age; poorer performances on cognitive and affective ToM and also interpersonal but not intrapersonal understanding of social norms were predicted by older age. Furthermore unlike traditional tests used in the study, performance was not predicted by measures of intelligence. Instead, the sex of participants and autistic-like traits, in addition to age were found to be important for performance. The ESCoT was then validated in a sample of adults with Autism Spectrum Disorder (ASD), and performance was compared to performance on established social cognition tests. Convergent validity was demonstrated in the study and the ESCoT was sensitive to social cognitive difficulties found in ASD. This study also showed that the ESCoT was more effective than existing tests at differentiating ASD adults and neurotypical controls. The interplay of social anxiety and empathy on ESCoT performance in addition to further exploring sex and autistic-like traits were then examined in a younger adult population. Social anxiety and empathy were not significant predictors of performance on the ESCoT. Similar to the results of the ageing study, this study found that women were better than men on affective ToM. However, unlike the ageing study, better cognitive ToM performance was predicted by older age. Better performance on interpersonal understanding of social norms and ESCoT total scores were predicted by more years of education. The subsequent chapter then examined the clinical efficacy of the ESCoT in a patient population (Alzheimer's disease, behavioural-variant Frontotemporal dementia and amnestic mild cognitive impairment). Here performance on the ESCoT was compared between the patients and neurotypical controls. It was found that patients performed poorer than neurotypical controls on ESCoT total scores, affective ToM, inter-and intrapersonal understanding of social norms. The final chapter returned to healthy ageing to more closely investigate the consequences of healthy ageing on social cognitive processes, by examining the positivity bias (preference for positive over negative stimuli) found in older adults using an attention paradigm. There was no evidence of the positivity bias in older, middle-aged and younger adults in regards to reaction time or accuracy. However, older and middle-aged adults differed in accuracy across stimuli type compared to younger adults. This thesis offers novel insights into the social cognitive abilities of various populations. The ESCoT presents a new, informative and validated test of social cognition for researchers and clinicians to use, which has many advantages over established tests of social cognition.