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Hot and Cool Executive Function Have Different Mediating Effects on Theory of Mind in High‐Functioning Children with Autism Spectrum Disorder
Children with autism spectrum disorder (ASD) often show difficulties in executive function (EF) and theory of mind (ToM). The relationship between EF and ToM has been greatly debated due to their developmental coexistence. Previous studies have mainly focused on the association between the cognitive aspect of EF (i.e., cool EF) and ToM in children with ASD, so understanding of the influence of the affective aspect of EF (i.e., hot EF) on ToM is limited, not to mention the separate influences of cool and hot EF on ToM. Separating EF into cool and hot aspects to understand the linkage between EF and ToM could extend current understanding of the cognitive difficulties of children with ASD and be useful in assessment and intervention in clinical practice.
Objectives:
This study examined the mediating effects of cool and hot EF on ToM to elaborate the link between EF and ToM in high‐functioning children with ASD.
Methods:
Children with high‐functioning ASD aged from 4 to 12 years old were recruited from hospitals, clinics, and developmental centers in Taiwan between January 2015 and June 2018. Children’s ToM, cool EF, and hot EF were respectively measured with the Theory of Mind Task Battery, computerized Dimensional Change Card Sort (DCCS) task, and Children’s Gambling Task. The DCCS generates four cool EF variables. Mediation analysis was applied to assess whether cool/hot EF mediated the effect of hot/cool EF on ToM. A complete mediator would have an insignificant direct effect (X→Y) and a significant indirect effect (X→M→Y); a partial mediator would have both a significant direct effect and an indirect effect.
Results:
A total of 118 high‐functioning children with ASD (104 boys) participated in this study. On average, they had severe ASD symptoms and average verbal comprehension respectively, as determined by the Social Responsiveness Scale, Second Edition (mean = 78.9, SD = 10.2) and the Verbal Comprehension Index (mean = 106.9, SD = 16.4). The mediation analysis showed that cool EF was a complete mediator of the effect of hot EF on ToM (indirect effect: 0.01 [95%CI: 0.00−0.04] and direct effect: 0.05 [95%CI: -0.00−0.11]), whereas hot EF was a partial mediator of the effect of cool EF on ToM (indirect effect: 0.99 [95%CI: 0.05−2.55] and direct effect: 4.87 [95%CI: 0.48−9.26]).
Conclusions:
Both cool and hot EF were correlated with ToM in high‐functioning children with ASD. Interestingly, the influence of hot EF on ToM could occur simply through cool EF, while the influence of cool EF on ToM could happen partially through hot EF. Our findings highlight the necessity of considering the distinction of hot and cool EF in clinical assessment and intervention for children with high‐functioning ASD.