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Original article
Theory of mind in neurodevelopmental disorders: beyond autistic spectrum disorder
Teoría de la Mente en trastornos del neurodesarrollo: más allá del trastorno del espectro autista
A. Pérez-Vigila,
Corresponding author
aperezv@clinic.cat

Corresponding author.
, D. Ilzarbea, B. Garcia-Delgara, A. Morera,b, M. Pomaresa,b,c,d, O. Puiga,d, S. Lera-Miguela, M. Rosaa,c, M. Romeroa, R. Calvo Escalonaa,b,c,d, L. Lázaroa,b,c,d
a Departamento de Psiquiatría Infantil y Juvenil, Instituto de Neurociencias, Hospital Clínic de Barcelona, Barcelona, Spain
b Departamento de Medicina, Universidad de Barcelona, Barcelona, Spain
c Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
d Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Theory of mind as evaluated with the Eyes Task&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; autistic spectrum disorder&#59; OCD&#58; childhood-onset obsessive-compulsive disorder&#59; TS&#58; Tourette syndrome&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#42;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05 for the intergroup comparison&#44; before Bonferroni correction&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05 for the intergroup comparison&#44; after Bonferroni correction&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Social cognition is a construct encompassing a range of cognitive processes by which we store&#44; process&#44; and use information about other people&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It includes multiple subdomains&#44; such as the interpretation of social cues&#44; emotional recognition&#44; empathy&#44; and theory of mind &#40;ToM&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> ToM&#44; defined as the ability to infer the feelings and emotions of other people&#44; is a prerequisite for successful social interaction&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The complexity of this cognitive function constitutes a challenge for its conceptual delimitation&#44; which involves different levels and types of information processing&#44; with more cognitive &#40;inferring the motivations and beliefs of others&#41; and more affective aspects &#40;inferring the feelings and emotions of others&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Furthermore&#44; there is evidence of an association between ToM and other neurocognitive functions&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Multiple tasks have been developed to assess ToM&#44; such as false belief tasks&#44; which explore the ability to differentiate between one&#8217;s own knowledge about one&#8217;s surroundings from what another person may believe about them&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> These tasks are divided into 2 levels of difficulty&#58; first-order &#40;e&#46;g&#46;&#44; what is this person thinking&#63;&#41;&#44; and second-order &#40;e&#46;g&#46;&#44; what do you think that another person thinks about what the first person thought&#63;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Some are designed for pre-school children&#44;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> and assess first- and second-order false beliefs&#44; but do not discriminate more complex ToM skills acquired at the age of 6&#8211;8 years in neurotypical individuals&#46; To evaluate ToM after this ceiling effect occurs&#44; so-called advanced ToM tasks have been developed that examine an individual&#8217;s capacity to generate attributions based on a social interaction in which they must correctly infer the mental or emotional state of a character shown interacting with others&#46; Examples include the Happ&#233;&#8217;s<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Strange Stories task&#44; which evaluates the attribution of intentions to others&#44; such as sarcasm or white lies&#44; or the test developed by Baron-Cohen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> examining the ability to detect social faux pas&#46; Another advanced theory of mind test&#44; the &#8220;Reading the Mind in the Eyes&#8221; task &#40;Eyes Task for short&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> differs from the previous tests in that subjects are only provided information from the eye area&#46; In this case&#44; attributions refer not only to emotions or mental status&#44; but also to intentions&#44; such as &#8220;wanting to play&#46;&#8221; Finally&#44; more complex ToM tasks address the ability to attribute beliefs&#44; desires&#44; and intentions&#44; as well as the child&#8217;s ability to understand pragmatic language&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">ToM dysfunction is considered a key symptom in autistic spectrum disorders &#40;ASD&#41;&#44; both in adult and in paediatric populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8&#44;11&#44;12</span></a> However&#44; while less attention has been placed on ToM in other disorders&#44; this dysfunction is not specific to ASD&#44; and is also reported in other neurodevelopmental disorders&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> Specifically&#44; childhood-onset obsessive compulsive disorder &#40;OCD&#41; and Tourette syndrome &#40;TS&#41; are neurodevelopmental disorders that&#44; like ASD&#44; can be severe and present in some patients with social difficulties&#44; emotional outbursts&#44; and such motor signs as repetitive movements&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;16</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">OCD is characterised by the presence of persistent undesired obsessions that cause elevated anxiety or ritualistic behaviours&#44; or repetitive mental acts that are performed to alleviate the anxiety caused by the obsessions&#46; A recent systematic review&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> including 10 articles on ToM in adult patients with OCD&#44; reported that the majority of studies did not find statistically significant differences in ToM task performance between patients and controls&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18&#8211;20</span></a> However&#44; some studies did find evidence of ToM deficits in these patients&#44; particularly in second-order false belief tasks&#44;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a> although the available evidence does not clearly show whether said deficits are related to the neurocognitive alterations that are also observed in some of these patients&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;23</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">TS is characterised by tics&#44; repetitive movements&#44; and vocalisations provoked by a sensory-cognitive premonitory urge&#46; There is considerable evidence that patients with TS may have poorer ToM skills than healthy controls in the adult population&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;27</span></a> A study using a self-reported questionnaire to compare 95 patients with TS against 60 healthy controls of both sexes concluded that the TS groups presented differences in interpersonal reactivity with respect to controls&#44; characterised by a reduced tendency to understand the perspectives of others and marked distress in response to intense emotional situations in others&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> Another study&#44; including 18 adult patients diagnosed with TS and 10 healthy controls&#44;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> reported that patients were less accurate than controls in interpreting sarcasm and metaphor in various ToM tasks&#46; Neuroimaging studies have also identified differences in brain activity in somatosensory areas associated with the mirror neuron system during the performance of ToM tasks in patients with TS &#40;e&#46;g&#46;&#44; at the temporoparietal junction&#44; posterior cingulate&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> Patients with TS show greater activity than healthy controls in the lateral orbitofrontal cortex&#44; posterior cingulate&#44; right temporoparietal junction&#44; and right amygdala&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">One of the main issues with the current scientific evidence on ToM difficulties in OCD and TS&#44; unlike in other neurodevelopmental disorders&#44; is the limited literature on adult populations and near-complete lack of research on paediatric populations&#46; To our knowledge&#44; only one study has compared different neurodevelopmental disorders&#44; studying 4 patient groups&#58; 35 with ASD&#44; 33 with severe mood dysregulation&#44; 32 with childhood-onset OCD&#44; and 20 with TS&#59; no control group was included&#46; Patients were studied with the 65-item Social Responsiveness Scale&#44; which dimensionally evaluates 5 domains of social reciprocity&#46;<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28&#44;29</span></a> Social reciprocity includes the following components&#58; social communication &#40;interaction&#41;&#44; understanding of how to react in social situations &#40;social awareness&#41;&#44; the desire to interact with other people &#40;social motivation&#41;&#44; the ability to attribute a perspective to other people &#40;social cognition&#41;&#44; and proper management of atypical behaviours in social situations&#46; No significant difference was observed between the OCD and TS groups in social cognition and communication scores&#46; The ASD group showed the greatest deficits&#44; followed by the severe mood dysregulation group&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">These neurodevelopmental disorders share certain neuroanatomical&#44; cognitive&#44; and behavioural characteristics that may explain the similarities between the ToM dysfunctions observed in the adult population&#46; In the light of the fact that satisfactory interpersonal relationships constitute a protective factor for mental health&#44; and are associated with an adequate capacity to perceive and interpret human behaviour&#44; these deficits must be analysed in paediatric populations with specific&#44; sensitive advanced ToM tasks&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Objective</span><p id="par0035" class="elsevierStylePara elsevierViewall">The primary objective of this study is to compare advanced ToM in groups of children and adolescents diagnosed with OCD&#44; TS&#44; and ASD&#44; and in a group of healthy controls&#46; The secondary objective is to examine how ToM is influenced by clinical characteristics and other aspects of neurocognitive function&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Patients and methods</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients</span><p id="par0040" class="elsevierStylePara elsevierViewall">We gathered a sample of boys aged 11&#8211;17 years from the outpatient clinic of the paediatric psychiatry department of Hospital Cl&#237;nic &#40;Barcelona&#44; Spain&#41;&#44; with a main diagnosis of OCD &#40;n&#8239;&#61;&#8239;19&#41; or TS &#40;n&#8239;&#61;&#8239;14&#41;&#44; established according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders&#44; Fifth Edition &#40;DSM-5&#41;&#46; &#8220;Main diagnosis&#8221; refers to the diagnosis for which the patient and their family were consulting the department and which caused the greatest interference in their functioning &#40;although comorbidities could also be diagnosed during follow-up&#41;&#46; In addition to these samples&#44; we used data gathered from participants in another study&#44; from the same outpatient clinic&#44;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> with the permission of the authors of that study&#46; The sample from this second study included boys with a main diagnosis of ASD &#40;n&#8239;&#61;&#8239;29&#41; and a control group of healthy boys &#40;n&#8239;&#61;&#8239;25&#41;&#46; To enable age matching of samples&#44; we only included 18 of the patients with ASD and 20 controls&#46; The sample was restricted to male patients due to the low prevalence of ASD diagnoses in girls in our setting&#46; The final sample included 19 patients with OCD&#44; 14 with TS&#44; 18 with ASD&#44; and 20 healthy controls&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Procedure</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study was approved by the Hospital Cl&#237;nic ethics committee&#44; and the parents or guardians of all patients gave written informed consent prior to assessment&#46; All patient data were anonymised in compliance with Spanish data protection legislation&#46; The test battery applied has an approximate duration of 3&#46;5&#8239;hours&#44; and includes the Kaufman Brief Intelligence Test &#40;KBIT&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a> a series of clinical questionnaires administered to parents&#47;guardians &#40;Autism Spectrum Screening Questionnaire &#91;ASSQ&#93;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#41; and patients &#40;Children&#8217;s Yale-Brown Obsessive Compulsive Scale &#91;CY-BOCS&#93;&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> Yale Global Tic Severity Scale &#91;YGTSS&#93;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#41;&#44; and advanced ToM tasks &#40;the Stories from Everyday Life task &#91;SEL&#93;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> and the Eyes Task<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#41;&#46; The 2 ToM tasks evaluate patients&#8217; capacity to correctly infer a mental state based on a social interaction &#40;SEL&#41; or an image of the eye area &#40;Eyes Task&#41;&#46; All participants were evaluated by experienced specialists in paediatric clinical psychology or psychiatry from Hospital Cl&#237;nic&#44; with specific training in the administration of the SEL&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> In all cases&#44; audio recordings were made during the SEL task&#44; then anonymised for review and scoring by other members of the research team&#46; To rule out psychopathology in members of the control group&#44; we conducted a standardised&#44; semi-structured interview with participants and their parents&#44; applying the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> an instrument used to diagnose psychiatric disorders in children and adolescents according to the criteria of the DSM-IV-TR&#46; Clinical instruments were administered by 2 different research teams&#44; at different times&#44; although all professionals participated in a joint training session on the administration of the SEL&#46; Furthermore&#44; some instruments&#44; such as the YGTSS&#44; were included later&#44; and therefore were not applied to the ASD group&#46; In all groups&#44; we excluded individuals with an intelligence quotient &#40;IQ&#41; below 70 or diagnosed with a psychotic disorder&#44; substance use disorder&#44; or disabling neurological disease&#46; We also excluded patients with comorbid diagnoses of ASD plus OCD or ASD plus TS&#44; according to data from their clinical records&#46; Members of the research team who validated the Spanish-language version of the SEL<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> administered the Autism Diagnostic Interview Revised<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> to the main caregivers of patients in the ASD group to confirm the diagnosis&#46; Comorbidity data for the OCD&#44; TS&#44; and ASD groups were provided by their regular physicians &#40;psychiatrists or clinical psychologists&#41; via clinical records&#44; as screening for all mental disorders is performed during the first consultations&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Assessment instruments applied to parents</span><p id="par0050" class="elsevierStylePara elsevierViewall">Autistic Spectrum Screening Questionnaire<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#58;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The ASSQ is a screening instrument for the detection of high-functioning autistic spectrum disorders in individuals aged 7&#8211;17 years&#44; for administration to parents&#46; Data are presented as direct scores&#46; A score of 22 based on information from parents indicates a need for more specific assessment of the children&#46; In this study&#44; the ASSQ was used to evaluate the severity of ASD symptoms in all participants&#44; although only patients in the ASD group met criteria for this diagnosis&#46; The administration time of the instrument is &#8804;&#8201;10&#8239;minutes&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Assessment instruments applied to participants</span><p id="par0060" class="elsevierStylePara elsevierViewall">Children&#8217;s Yale-Brown Obsessive-Compulsive Scale<a class="elsevierStyleCrossRefs" href="#bib0165"><span class="elsevierStyleSup">33&#44;37</span></a>&#58;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The CY-BOCS is the gold standard instrument for assessing the severity of OCD in children&#46; It is a semi-structured clinical scale comprising 10 items &#40;5 on obsessions and 5 on compulsion&#47;rituals&#41; that evaluate time&#44; interference&#44; distress&#44; resistance&#44; and control of symptoms&#46; The maximum score for each item is 4 points &#40;maximum total score of 40&#41;&#46; Severity of OCD is classified as subclinical &#40;&#8804;&#8201;10 points&#41;&#44; mild &#40;11&#8211;16&#41;&#44; moderate &#40;17&#8211;24&#41;&#44; severe &#40;25&#8211;32&#41;&#44; or extreme &#40;33&#8211;40&#41;&#46; The validation study in a Spanish population found a Cronbach alpha of 0&#46;87&#46; Administration time ranges from 45 to 60&#8239;minutes&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Yale Global Tic Severity Scale<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#44;38</span></a>&#58;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The YGTSS is the gold standard instrument for assessing the severity of TS&#46; This semi-structured clinical scale begins with a semi-systematic inventory of tic symptoms&#44; which the clinician marks as being present or absent over the past week and at the worst ever moment of the disease&#46; Current motor and verbal tics are evaluated separately according to number&#44; frequency&#44; intensity&#44; complexity&#44; and interference&#44; on a 6-point ordinal scale &#40;0&#58; absent&#59; 1&#8722;5&#58; level of severity&#41;&#44; yielding 3 scores&#58; total motor tic score&#44; total verbal tic score&#44; and total tic score &#40;sum of the previous 2 scores&#44; with a maximum of 50&#41;&#46; Finally&#44; the scale provides a global severity score &#40;0&#8211;100&#41;&#44; which is the sum of the total tic score &#40;0&#8211;50&#41; and the overall impairment rating &#40;0&#8211;50&#41;&#46; Severity is classified as subclinical &#40;&#8804; 10 points&#41;&#44; mild &#40;11&#8211;20&#41;&#44; marked &#40;21&#8211;40&#41;&#44; or severe &#40;&#62; 40&#41;&#46; The validation study in a Spanish population found a Cronbach alpha of 0&#46;99 for both dimensions &#40;motor tics and phonic tics&#41;&#46; Administration time ranges from 45 to 60&#8239;minutes&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Kaufman Brief Intelligence Test<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#58;</p><p id="par0085" class="elsevierStylePara elsevierViewall">The KBIT is a measure of verbal and non-verbal intelligence in children&#44; adolescents&#44; and adults&#46; It includes 2 subtests&#44; vocabulary and matrices&#46; The vocabulary subtest comprises 2 parts&#44; expressive vocabulary &#40;including 45 elements&#41; and definitions &#40;37 elements&#41;&#46; In the matrices subtest&#44; all elements &#40;48&#41; are made up of drawings and abstract figures&#44; reducing potential cultural influences&#46; Results are presented as standardised scores with a mean of 100 and standard deviation of 15&#46; The test takes 15-30&#8239;minutes to administer&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">ToM task&#58; Kaland&#8217;s Stories from Everyday Life<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;30</span></a>&#58;</p><p id="par0095" class="elsevierStylePara elsevierViewall">This task comprises a battery of 13 stories&#44; and seeks to assess subjects&#8217; capacity to make inferences about the mental&#44; cognitive&#44; and emotional state of characters in 13 interpersonal situations from everyday life&#46; We used the abbreviated 7-item version &#40;SEL-7&#41; of the adapted&#44; validated Spanish-language version<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> of the original instrument&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> Stories are always presented in such a way that the first part describes a given situation to examine the subject&#8217;s ability to understand concrete facts &#40;physical inferences&#41;&#44; and the final part presents information on the mental state to be evaluated &#40;mental inferences&#41;&#46; The 7 phenomena evaluated are lies&#44; white lies&#44; figures of speech&#44; misunderstandings&#44; persuasion&#44; contrary emotions&#44; and empathy&#46; The task yields 2&#8239;final scores&#44; one for physical inferences and one for mental inferences&#59; each score ranges from 0 to 14 points&#46; Administering the test is a complex process&#59; details are given in the Supplementary Material&#46; The validation study in a Spanish population found a Cronbach alpha of 0&#46;78 for physical inferences and 0&#46;74 for mental inferences&#46; Administration time ranges from 45 to 60&#8239;minutes&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">ToM task&#58; Eyes Task<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#58;</p><p id="par0105" class="elsevierStylePara elsevierViewall">This task evaluates the ability to recognise the cognitive and emotional mental state of a person by reading the expression of their eyes&#46; The children&#8217;s version includes 28 black-and-white photographs of the upper part of the face &#40;eyes and eyebrows&#41; of individuals of both sexes&#46; The subject must select from a list of 4 words the one that best reflects the emotional state of the person in the image&#46; It assesses advanced ToM by providing the subject only with information on the eye area&#44; requiring attributions including both emotional and mental states and intentions&#44; such as &#8220;wanting to play&#44;&#8221; &#8220;thoughtful&#44;&#8221; or &#8220;satisfied&#46;&#8221; As a control task&#44; to rule out face processing disorders&#44; the subject is asked to identify the sex of the person in the photograph&#46; Administration time is &#8804;&#8201;15&#8239;minutes&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Statistical analysis</span><p id="par0110" class="elsevierStylePara elsevierViewall">Statistical analysis was performed using the Stata statistics software&#44; version 13&#46; The nonparametric Kruskal-Wallis test was used for intergroup comparisons of quantitative variables&#46; Given the potential influence of level of neurodevelopment and IQ on performance in ToM tests&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> a second analysis used a linear regression model including verbal IQ&#44; non-verbal IQ&#44; and age as covariates&#44; with the final model including only those variables showing a significant effect &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05&#41;&#46; Post hoc comparisons between groups were analysed with the Dunn test for multiple comparisons&#44; and are presented without adjustment and after application of the Bonferroni correction&#46; We calculated Pearson correlation coefficients between the ToM task and clinical and neurocognitive variables &#40;age&#44; verbal IQ&#44; non-verbal IQ&#44; CY-BOCS&#44; YGTSS&#44; ASSQ&#44; number of comorbidities&#41;&#44; with the threshold for significance set at &#46;007 &#40;&#46;05&#47;7&#41;&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Descriptive statistics</span><p id="par0115" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> displays descriptive statistics from the sample&#46; Mean age was lower in the TS group&#44; although no statistically significant differences were observed between the 4 groups&#46; Total and verbal IQ did show significant differences between groups&#44; with the control group scoring better than the patient groups&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Symptom severity</span><p id="par0120" class="elsevierStylePara elsevierViewall">As shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#44; the group scoring highest in the ASSQ was the ASD group&#44; followed by the TS group&#59; the OCD group scored higher in the CY-BOCS than the TS and ASD groups&#59; and the TS group scored higher than the OCD group in the YGTSS&#46; Both the TS and the ASD group presented more comorbidities than the OCD group &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239; &#46;05 and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;008&#44; respectively&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the comorbidities identified in the 3 patient groups as percentages&#59; the most frequent were attention-deficit&#47;hyperactivity disorder &#40;ADHD&#41; and anxiety disorders&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Theory of mind as evaluated with the Stories from Everyday Life test &#40;abbreviated 7-story version&#41;</span><p id="par0125" class="elsevierStylePara elsevierViewall">In the SEL&#44; the ASD group scored lowest both for physical and for mental inferences &#40;although no significant difference was observed with the TS group for median mental inference score&#41;&#44; followed by the OCD group and control group&#46; No significant differences between groups were observed for response times or the number of prompt questions&#46; Significant differences in physical inference scores were observed between the ASD and the control group&#44; between the ASD and the OCD group&#44; between the TS and the control group&#44; and between the TS and the OCD group &#40;&#967;<span class="elsevierStyleSup">2</span>&#8239;&#61;&#8239;9&#46;8&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;02&#59; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Significant differences in mental inference scores were observed between the ASD and the control group&#44; between the ASD and the OCD group&#44; between the TS and the control group&#44; and between the TS and the OCD group &#40;&#967;<span class="elsevierStyleSup">2</span>&#8239;&#61;&#8239;15&#46;29&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;002&#59; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; After application of the Bonferroni correction&#44; the only significant differences were between the control and ASD groups&#44; for mental and physical inferences &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#8804;&#8239; &#46;03&#41; and between the control group and the TS group&#44; for mental inferences &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;002&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0130" class="elsevierStylePara elsevierViewall">After age and verbal IQ were added as covariates &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#8804;&#8239;&#46;003&#41; in the analysis of physical inferences&#44; the differences between the OCD and ASD groups remained significant &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;004&#41;&#44; whereas significance was lost for the difference between controls and patients with ASD &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#62;&#8239;&#46;01&#41;&#46; In the analysis of mental inferences&#44; after inclusion of verbal IQ as a covariate &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;015&#41;&#44; only the differences between controls and the ASD group remained significant &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;017&#41;&#44; with the differences between controls and patients with TS and between the OCD and ASD groups losing significance &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;69 and <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;84&#44; respectively&#41;&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Results of the analysis with the complete version of the test &#40;13 stories&#41; are included in the Supplementary Material&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Theory of mind as evaluated with the Eyes Task</span><p id="par0140" class="elsevierStylePara elsevierViewall">The TS group scored the lowest in the Eyes Task&#44; followed by the ASD&#44; OCD&#44; and control groups&#46; Statistical analysis revealed significant differences between the control and the ASD group&#44; between the control and the TS group&#44; and between the OCD and the TS group &#40;&#967;<span class="elsevierStyleSup">2</span>&#8239;&#61;&#8239;10&#46;16&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;017&#59; <a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Only the differences between controls and patients with TS survived the Bonferroni correction &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;009&#41;&#44; with the difference between the OCD and TS groups showing a trend towards significance &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;05&#41;&#46; None of the covariates added to the model had a significant effect on the dependent variable &#40;<span class="elsevierStyleItalic">P</span>&#8239;&#8805;&#8239;&#46;13&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Correlations between theory of mind and clinical or cognitive variables</span><p id="par0145" class="elsevierStylePara elsevierViewall">SEL-7 scores showed a positive correlation with verbal IQ &#40;r&#8239;&#61;&#8239;0&#46;34&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;005&#41; and a negative correlation with ASSQ &#40;r &#61; &#8211;0&#46;33&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;005&#41; and number of comorbidities &#40;r&#8239;&#61;&#8239;&#8211;0&#46;34&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;005&#41; in the entire sample&#59; thus&#44; SEL-7 scores were lower in patients with higher scores for ASD symptoms and higher numbers of comorbidities &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Eyes Task scores were negatively correlated with number of comorbidities&#44; in the entire sample &#40;r&#8239;&#61;&#8239;&#8211;0&#46;36&#59; <span class="elsevierStyleItalic">P</span>&#8239;&#61;&#8239;&#46;004&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Discussion</span><p id="par0150" class="elsevierStylePara elsevierViewall">The primary objective of this study was to compare advanced ToM in groups of children and adolescents diagnosed with OCD&#44; TS&#44; and ASD&#44; and in healthy controls&#44; using 2 different tests&#46; Our main findings show that patients with TS have difficulty solving advanced ToM tasks as assessed with the SEL-7&#44; performing similarly to patients with ASD&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> On the other hand&#44; patients with childhood-onset OCD performed similarly to healthy controls&#46; In the second ToM task&#44; the Eyes Task&#44; a surprising result was the greater difference observed between controls and patients with TS than between controls and patients with ASD&#46; This may be explained by the impulsive behaviour of patients with TS<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> and their difficulty inhibiting responses&#44;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> which may lead them to give a less reflexive response than participants from the other groups&#46; A systematic review including evidence on ToM and from neuroimaging studies suggests that among executive functions&#44; inhibition is necessary but not sufficient for ToM processing&#44; as several brain regions seem to contribute to mentalising&#44; in addition to the regions supporting inhibitory control&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> One possible reason for these results is that patients with ASD were better trained in emotional recognition than those in the TS group&#46; This may have been the case in our sample&#44; as training in ToM tasks &#40;e&#46;g&#46;&#44; emotional recognition&#41; is commonly used in the therapeutic management of patients with ASD at our department&#44; whereas patients with TS do not receive specific training in these skills&#46; Another explanation may be unconventional responses mediated by emotional dysregulation in patients with TS&#44; rather than difficulty attributing mental states&#46;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">Our results are consistent with those reported in studies of adult populations with TS&#44; which have shown that these patients have difficulties taking the perspective of others&#44;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> as well as alterations in emotional aspects of advanced ToM&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p><p id="par0160" class="elsevierStylePara elsevierViewall">Our secondary objective was to examine how ToM is influenced by clinical characteristics and other aspects of neurocognitive function&#46; The results show that comorbidities can also affect performance&#44; particularly in the TS group&#44; as shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> &#40;57&#37; presented ADHD&#59; 14&#37; OCD&#44; and 7&#37; emotional&#44; behavioural&#44; and learning disorders&#41;&#46; To our knowledge&#44; no previous study of paediatric populations has addressed the effect of comorbidities in ToM task performance in patients with childhood-onset OCD or TS&#44; although one study reported that anxiety influences ToM in patients with ASD&#44;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> and a recent meta-analysis concluded that adolescent and pre-adolescent patients with ASD tend to present high levels of social anxiety symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">45</span></a> TS also shows a high level of comorbidity with anxiety disorders&#44;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">46</span></a> and some patients may have presented symptoms of anxiety&#44; but without sufficient interference for this diagnosis to be established&#46; Furthermore&#44; we did not evaluate comorbidities on a systematic&#44; prospective basis&#59; rather&#44; these data were collected from the clinical records of each participant&#59; therefore&#44; some comorbidities may not have been identified&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The main limitation of this study is the small sample size&#44; which reduces its statistical power&#46; Furthermore&#44; given its cross-sectional design and the correlations observed between ToM task performance and other variables that may be considered intermediaries of neurodevelopment &#40;e&#46;g&#46;&#44; verbal IQ and age&#41;&#44; the results presented must be interpreted with caution&#46; While this effect was not observed with the SEL-7&#44; scores on the complete version &#40;13 stories&#41; were positively correlated with age &#40;Supplementary Material&#41;&#46; Studies suggest that age influences cerebral responses during the performance of ToM tasks in younger subjects&#44; particularly in tests of emotion attribution&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">47</span></a> The exact mechanism underlying this association is poorly understood&#44; although it may reflect several processes that are not mutually exclusive&#44; such as synaptic pruning&#44;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">48</span></a> greater automatism in certain processes due to age&#44;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">49</span></a> or increased neuronal efficiency due to practice&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">50</span></a> Another limitation is that ToM tasks were administered by 2 different research teams&#44; at different times&#44; although all professionals participated in a joint training session on the administration of the SEL&#46; While patients with comorbid ASD were excluded from the OCD and TS groups&#44; we did not rule out patients with OCD or TS as a comorbidity&#44; which should also be taken into account in future studies&#46; We also did not include questionnaires to screen for ADHD or assess symptom severity&#59; therefore&#44; ADHD symptoms may have acted as a confounder&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">51</span></a> Finally&#44; we did not administer a complete neuropsychological battery beyond estimating IQ &#40;e&#46;g&#46;&#44; executive dysfunction&#41;&#44; despite the evidence on the relationship between these 2 areas of cognition&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> Furthermore&#44; IQ was estimated using a screening tool&#44; rather than the Wechsler Intelligence Scale for Children-V&#44; which would have helped to better characterise the potential mediating role of IQ in the interpretation of ToM tasks&#46; Another important consideration is that all participants were boys&#59; therefore&#44; our results do not present a sex bias&#44; although they cannot be extrapolated to female patients&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">In the light of all of the above&#44; future studies should focus on administering ToM tasks to female patients with TS&#44; OCD&#44; or ASD&#44; and seek to replicate the results of the present study in larger patient samples&#46; It would also be valuable to use a semi-structured interview to identify all comorbidities&#46; The most relevant clinical implication of our results is that at least some patients with TS may benefit from training in ToM skills as part of their therapeutic management&#44; as is currently the case for paediatric patients with ASD&#46; Future research could also use neuroimaging studies and neuropsychological tests in addition to these clinical assessments of advanced ToM&#44; before and after application of specific treatments to improve ToM skills&#44; in order to identify neuroanatomical changes or associations with other neurocognitive deficits&#46; Finally&#44; future studies might include a group of patients with ADHD and evaluate the influence of multicomorbidity in neurodevelopmental disorders&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Based on our results&#44; we may conclude that patients with TS and ASD have greater difficulty in ToM tasks&#44; compared to patients with childhood-onset OCD and healthy controls&#46; Our findings also reflect the complex interaction and the reciprocal influence between different areas of cognition and neurodevelopmental disorders&#46; Thus&#44; ToM alterations are not an exclusive feature of ASD&#59; rather&#44; they constitute a marker of neurodevelopmental alterations as in other mental disorders with onset in childhood&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Funding</span><p id="par0180" class="elsevierStylePara elsevierViewall">A&#46; P&#233;rez-Vigil received a grant from the <span class="elsevierStyleGrantSponsor" id="gs0005">Alicia Koplowitz Foundation</span> during the development of this study&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicts of interest</span><p id="par0185" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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    "fechaRecibido" => "2020-11-16"
    "fechaAceptado" => "2021-04-06"
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            2 => "Tourette syndrome"
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            0 => "Teor&#237;a de la mente"
            1 => "Cognici&#243;n social"
            2 => "S&#237;ndrome de tourette"
            3 => "Trastorno obsesivo-compulsivo"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Theory of mind &#40;ToM&#41; is the human ability to perceive&#44; interpret&#44; and attribute the mental states of other people&#44; and the alteration of this cognitive function is a core symptom of autistic spectrum disorder &#40;ASD&#41;&#46; In such other neurodevelopmental disorders as childhood-onset obsessive-compulsive disorder &#40;OCD&#41; and Tourette syndrome &#40;TS&#41; that can present with cognitive dysfunctions&#44; ToM has been less extensively studied&#44; especially in the young population&#46; The aim of the study was to compare advanced ToM between groups of young people diagnosed with OCD&#44; TS&#44; or ASD and a control group&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Clinical interviews were conducted with male patients aged between 11 and 17 years with a main diagnosis of OCD &#40;n&#8239;&#61;&#8239;19&#41;&#44; TS &#40;n&#8239;&#61;&#8239;14&#41;&#44; or ASD &#40;n&#8239;&#61;&#8239;18&#41;&#44; and a control group &#40;n&#8239;&#61;&#8239;20&#41;&#46; We administered instruments for estimating intelligence quotient and severity of psychiatric symptoms&#44; and tasks to evaluate ToM &#40;the &#34;Stories from everyday life&#34; task and the &#34;Reading the mind in the eyes&#8221; test&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Young people with TS and with ASD present similar difficulties in solving advanced ToM tasks&#44; whereas patients with childhood-onset OCD present similar results to controls&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">ToM is altered in other neurodevelopmental disorders beyond ASD&#44; such as TS&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">La Teor&#237;a de la Mente &#40;ToM&#41; es la capacidad humana de percibir&#44; interpretar y atribuir los estados mentales de las otras personas y la alteraci&#243;n de esta funci&#243;n cognitiva es un s&#237;ntoma nuclear del Trastorno del Espectro Autista &#40;TEA&#41;&#46; Hay otros trastornos del neurodesarrollo como el Trastorno Obsesivo-Compulsivo de inicio en la infancia &#40;TOC&#41; y el S&#237;ndrome de Tourette &#40;ST&#41;&#44; que pueden presentarse con disfunciones cognitivas&#44; y en los que la ToM ha sido menos estudiada&#44; especialmente en poblaci&#243;n juvenil&#46; El objetivo de este estudio fue comparar la ToM avanzada entre grupos de j&#243;venes con diagn&#243;stico de TOC&#44; ST o TEA y un grupo de controles sanos&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Se entrevistaron cl&#237;nicamente a varones de entre 11 y 17 a&#241;os con diagn&#243;stico principal de TOC &#40;n&#8239;&#61;&#8239;19&#41;&#44; ST &#40;n&#8239;&#61;&#8239;14&#41;&#44; TEA &#40;n&#8239;&#61;&#8239;18&#41;&#44; y un grupo control de sujetos sanos &#40;n&#8239;&#61;&#8239;20&#41;&#46; Se les administraron instrumentos de estimaci&#243;n de cociente intelectual&#44; severidad de los s&#237;ntomas psiqui&#225;tricos&#44; y las pruebas para evaluar la ToM&#58; la tarea <span class="elsevierStyleItalic">Historias de la Vida Cotidiana</span> y el <span class="elsevierStyleItalic">Test de la Mirada</span>&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Los j&#243;venes con ST presentan dificultades similares para resolver tareas de ToM avanzada al nivel de los pacientes con TEA&#44; a diferencia de los pacientes con TOC de inicio en la infancia que presentan resultados similares a los controles sanos&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">La ToM est&#225; alterada en otros trastornos del neurodesarrollo m&#225;s all&#225; del TEA&#44; como en el ST&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
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    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0195" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0095"
          ]
        ]
      ]
    ]
    "multimedia" => array:7 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
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        "detalles" => array:1 [
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            "identificador" => "at0005"
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            "rol" => "short"
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        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Theory of mind as evaluated with the Stories from Everyday Life task&#46; &#40;A&#41; Physical inferences&#46; &#40;B&#41; Mental inferences&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; autistic spectrum disorder&#59; OCD&#58; childhood-onset obsessive-compulsive disorder&#59; SEL&#58; Stories from Everyday Life task&#59; TS&#58; Tourette syndrome&#46;</p> <p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#42;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05 for the intergroup comparison&#44; before Bonferroni correction&#46;</p> <p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05 for the intergroup comparison&#44; after Bonferroni correction&#46;</p> <p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;&#42;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05 for the intergroup comparison&#44; after Bonferroni correction and inclusion of the covariate verbal intelligence quotient&#46;</p> <p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;&#42;&#42;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05 for the intergroup comparison&#44; after Bonferroni correction and inclusion of the covariates verbal intelligence quotient and age&#46;</p>"
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        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "imagen" => "gr2.jpeg"
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        "detalles" => array:1 [
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        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Theory of mind as evaluated with the Eyes Task&#46;</p> <p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; autistic spectrum disorder&#59; OCD&#58; childhood-onset obsessive-compulsive disorder&#59; TS&#58; Tourette syndrome&#46;</p> <p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#42;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05 for the intergroup comparison&#44; before Bonferroni correction&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;<span class="elsevierStyleItalic">P</span>&#8239;&#60;&#8239;&#46;05 for the intergroup comparison&#44; after Bonferroni correction&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "fig0015"
        "etiqueta" => "Figure 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 2288
            "Ancho" => 3049
            "Tamanyo" => 353899
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        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Correlations of theory of mind task performance with clinical and neurocognitive variables and with number of psychiatric comorbidities<span class="elsevierStyleSup">a</span>&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; autistic spectrum disorder&#59; OCD&#58; childhood-onset obsessive-compulsive disorder&#59; SEL&#58; Stories from Everyday Life task&#59; TS&#58; Tourette syndrome&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleSup">a</span>Pearson correlation coefficients&#46;</p>"
        ]
      ]
      3 => array:8 [
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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            "identificador" => "at0020"
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          "leyenda" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; autistic spectrum disorder&#59; IQ&#58; intelligence quotient&#59; OCD&#58; childhood-onset obsessive-compulsive disorder&#59; TS&#58; Tourette syndrome&#46; C &#62; &#40;TS&#44; OCD&#44; ASD&#41;&#58; controls showed significantly higher total IQ than all other groups&#46; C &#62; &#40;TS&#44; OCD&#41;&#58; controls showed significantly higher verbal IQ than the TS and OCD groups&#46;</p>"
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                  <table border="0" frame="\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OCD &#40;n&#8239;&#61;&#8239;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TS &#40;n&#8239;&#61;&#8239;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ASD &#40;n&#8239;&#61;&#8239;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controls &#40;n&#8239;&#61;&#8239;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Differences between groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;083&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total IQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">100&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">109&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C &#62; &#40;TS&#44; OCD&#44; ASD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Verbal IQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">98&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">108&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C &#62; &#40;TS&#44; OCD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Non-verbal IQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">105&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">103&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">101&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">111&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#46;062&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Descriptive statistics&#58; age and estimated intelligence quotient&#46;</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">ASD&#58; autistic spectrum disorder&#59; ASSQ&#58; Autism Spectrum Screening Questionnaire&#59; CY-BOCS&#58; Children&#8217;s Yale-Brown Obsessive-Compulsive Scale&#59; OCD&#58; childhood-onset obsessive-compulsive disorder&#59; TS&#58; Tourette syndrome&#59; YGTSS&#58; Yale Global Tic Severity Scale&#46;</p><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">ASD&#8239;&#62;&#8239;TS&#44; OCD&#8239;&#62;&#8239;C&#58; patients with ASD scored significantly higher than the other 3 groups&#44; and the TS and ASD groups scored significantly higher than the control group&#46; OCD&#8239;&#62;&#8239;TS&#8239;&#62;&#8239;ASD&#58; patients with OCD scored significantly higher than the TS group&#44; and the TS group scored significantly higher than the ASD group&#46; TS&#8239;&#62;&#8239;OCD&#58; the TS group scored significantly higher than the OCD group&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OCD &#40;n&#8239;&#61;&#8239;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TS &#40;n&#8239;&#61;&#8239;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ASD &#40;n&#8239;&#61;&#8239;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Controls &#40;n&#8239;&#61;&#8239;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Differences between groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ASSQ&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ASD&#8239;&#62;&#8239;TS&#44; OCD&#8239;&#62;&#8239;C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CY-BOCS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">OCD&#8239;&#62;&#8239;TS&#8239;&#62;&#8239;ASD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">YGTSS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">19&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TS&#8239;&#62;&#8239;OCD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">OCD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">TS &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ASD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ADHD &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Anxiety &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Emotional disorders &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Behavioural disorders &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Learning disorders &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">OCD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">TS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">57&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">ASD&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">44&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 21735808
Original language: English
DOI:10.1016/j.nrleng.2024.01.005
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