Psychological Medicine

Original Articles

Theory of mind and social inference in children and adolescents with bipolar disorder

L. S. Schenkela1 c1, M. Marlow-O'Connora1, M. Mossa1, J. A. Sweeneya1 and M. N. Pavuluria1

a1 Center for Cognitive Medicine and the Institute for Juvenile Research, Department of Psychiatry, University of Illinois at Chicago, USA


Background Deficits in theory of mind (ToM), or the ability to infer what another person is thinking or feeling, have been reported in manic and euthymic adults with bipolar disorder. To date, there have been no investigations of ToM in pediatric bipolar disorder (PBD). The aim of the current study was to investigate this ability in PBD patients and healthy controls.

Method PBD patients (n=26) and intellectually and demographically similar healthy comparison subjects (n=20) were administered two ToM tasks. In the Affective Story Task, subjects were read positive-, negative- and neutral-valenced stories, and were assessed on their ability to recognize that a misleading series of events could lead one character to develop a false belief about another character. On the Hinting Task, subjects were required to infer the real intentions behind subtle hints.

Results The PBD group performed significantly more poorly than controls on the Hinting Task and the positive and negative conditions of the Affective Story Task. In the PBD group only, younger age, earlier illness onset and manic symptoms were associated with poorer ToM performance.

Conclusions Consistent with past findings in adult bipolar disorder (BD), PBD youth performed more poorly than controls on ToM tasks. Data suggest that ToM ability may be more impaired in affectively charged contexts. Additionally, an earlier onset of illness among PBD youth may interfere with the development of social-cognitive skills. ToM disturbances may be a useful treatment target in PBD, with the aim of facilitating more accurate assessment of social cues and better interpersonal functioning.

(Received April 06 2007)

(Revised October 31 2007)

(Accepted November 03 2007)

(Online publication January 14 2008)


c1 Address for correspondence: Dr L. S. Schenkel, Rochester Institute of Technology, 92 Lomb Memorial Drive, Rochester, NY, 14623, USA. (Email: