Journal of the International Neuropsychological Society

Research Articles

Theory of Mind in Children with Traumatic Brain Injury

Maureen Dennisa1a2 c1, Nevena Simica1a3, H. Gerry Taylora4, Erin D. Biglera5a6, Kenneth Rubina7, Kathryn Vannattaa8a9, Cynthia A. Gerhardta8a9, Terry Stancina4a10, Caroline Roncadina11 and Keith Owen Yeatesa8a9

a1 Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Ontario

a2 Department of Surgery, University of Toronto, Toronto, Ontario

a3 Department of Psychology, University of Toronto, Toronto, Ontario

a4 Department of Pediatrics, Case Western Reserve University, Rainbow Babies & Children's Hospital, University Hospitals Case Medical Center, Cleveland, Ohio

a5 Department of Psychology, Brigham Young University, Provo, Utah

a6 Department of Psychiatry, University of Utah, Salt Lake City, Utah

a7 Department of Psychology, University of Maryland, College Park, Maryland

a8 Department of Pediatrics, The Ohio State University, Columbus, Ohio

a9 Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio

a10 Department of Psychiatry, MetroHealth Medical Center, Cleveland, Ohio

a11 Psychology Department, Peel Children's Centre, Mississauga, Ontario


Theory of mind (ToM) involves thinking about mental states and intentions to understand what other people know and to predict how they will act. We studied ToM in children with traumatic brain injury (TBI) and age- and gender-matched children with orthopedic injuries (OI), using a new three-frame Jack and Jill cartoon task that measures intentional thinking separate from contingent task demands. In the key ToM trials, which required intentional thinking, Jack switched a black ball from one hat to another of a different color, but Jill did not witness the switch; in the otherwise identical non-ToM trials, the switch was witnessed. Overall accuracy was higher in children with OI than in those with TBI. Children with severe TBI showed a larger decline in accuracy on ToM trials, suggesting a specific deficit in ToM among children with severe TBI. Accuracy was significantly higher on trials following errors than on trials following correct responses, suggesting that all groups monitored performance and responded to errors with increased vigilance. TBI is associated with poorer intentional processing in school-age children and adolescents relative to peers with OI; furthermore, children with TBI are challenged specifically by intentional demands, especially when their injury is severe. (JINS, 2012, 19, 1–9)

(Received February 03 2012)

(Revised May 03 2012)

(Accepted May 03 2012)


c1 Correspondence and reprint requests to: Maureen Dennis, Department of Psychology, The Hospital for Sick Children, 555 University Avenue, Toronto, ON. Canada, M5G 1X8. E-mail: