Does Hot Executive Function Predict Theory of Mind in Children with Autism Spectrum Disorder?

Background:  Previous research has clearly demonstrated that Autism Spectrum Disorder (ASD) involves deficits in multiple neuropsychological functions, such as executive functioning and theory of mind. A conceptual distinction is commonly made between cool (cognitive) and hot (affective) Executive Function (EF). In ASD, continued attention has been paid to the cool areas of executive dysfunction. Cool EF has been strongly related to Theory of Mind (ToM) but research has not taken into account the association between hot EF and ToM in ASD.

Objectives: The current study aimed to investigate group differences in hot and cool EF in school-aged children with ASD relative to typically developing peers by employing a more extensive battery of both cool and hot EF tasks in comparison to previous studies. The second aim was to explore the association between hot and cool EF and ToM abilities in school-aged children with ASD. Traditionally, research on the EF-ToM relationship has mainly employed cool EF tasks. The distinction between cool and hot EF proposes that ToM may be more strongly related to hot EF than cool EF. We thus attempted to specifically examine whether ToM performance could be predicted by hot EF performance after controlling for potential co-variates and cool EF.

Methods: Sixty children with an official diagnosis of ASD (55 males) (M=9.98 years, SD=1.9) and sixty nine (69) controls (M=9.64 years, SD=1.58) (60 males) aged 7-12 years old matched for mental and chronological age completed tasks tapping cool EF (i.e. working memory, inhibition, planning), hot EF (i.e. affective decision making, delay discounting), and ToM (i.e. emotion understanding and false/no false belief).

Results:  Significant group differences in each EF measure supported a global executive dysfunction in ASD. Correlational analysis showed several significant associations between EF and ToM measures. Specifically, ToM false/no false belief performance was significantly correlated to Go/No-Go and Tower of London scores, whereas performance on the Eyes Test was related to all EF measures, both cool and hot. Regression analysis revealed that the ASD group demonstrated deficits in emotional understanding relative to controls that were predicted by hot EF delay discounting, over and above cool EF and control variables.

Conclusions: Our findings replicated the well-established relationship between cool EF and ToM but also demonstrated a predictive relationship between hot EF and ToM emotion understanding, prompting questions of how these seemingly distinct constructs are related. This study improves understanding of the profile of higher-order cognitive deficits in children with ASD, which may inform diagnosis and intervention.