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Social Cognition in Adults with Autism Spectrum Conditions: Validation of the Edinburgh Social Cognition Test (ESCoT)
Current tests of social cognition have limited use in clinical settings, do not assess the different aspects of social cognition within the same test and performance on these tests has shown associations with other cognitive abilities such as intelligence. We developed a new test called the Edinburgh Social Cognition Test (ESCoT) to address these limitations. The ESCoT uses animated interactions to assess cognitive and affective ToM and inter- and intra-personal understanding of social norms.
Objectives:
There were three main objectives of this study. First, we sought to investigate convergent validity of the ESCoT against established tests of social cognition. Second, we compared adults with Autism Spectrum Conditions (ASC) and neurotypical controls (NC) on the ESCoT and established tests of social cognition. Finally, we evaluated the psychometric properties of the ESCoT and compared these to traditional social cognition tests by examining the influence of intelligence, ASC traits, empathy and systemizing traits on performance.
Methods:
To support the development of the ESCoT as a clinical tool of social cognition, we derived cut-off scores from a neurotypical population (n=236) and sought to validate the ESCoT in a sample of nineteen adults aged 19-66 (12 males) with a diagnosis of Asperger's Syndrome or High-Functioning Autism according to established DSM-IV. These individuals were recruited from charities and support groups in Edinburgh, UK and from the Cambridge Autism Research Database (CARD), UK. A comparison group of thirty-eight NC (23 males) aged 19-67 years were recruited using online advertisement and through a research volunteer panel in Edinburgh.
The ESCoT was administered alongside established tests; Reading the Mind in the Eyes, Reading the Mind in Films and the Social Norms Questionnaire. Participants also completed the Autism Spectrum Quotient (AQ), the Empathy Quotient (EQ), the Systemizing Quotient (SQ) and the Wechsler Abbreviated Scale of Intelligence.
Results:
Performance on the subtests of the ESCoT and ESCoT total scores correlated with performance on traditional social cognition tests, demonstrating convergent validity. Adults with ASC performed poorer than NC on all measures of social cognition. Unlike the ESCoT, performance on the established tests was predicted by verbal comprehension. A ROC curve analysis demonstrated that the ESCoT was more effective than existing tests at differentiating adults with ASC from NC. Furthermore, a total of 42.11% of ASC adults were impaired on the ESCoT compared to 5.50% of NC adults.
Conclusions:
The results from this study demonstrate that the ESCoT is a valid and sensitive measure of social cognition, it shows better diagnostic accuracy than established tests and it may be a useful test to assess social cognition in clinical settings.