Copyright Blackwell Munksgaard 2003

Acta Psychiatr Scand 2003: 108: 110117

Printed in UK. All rights reserved

ACTA PSYCHIATRICA
SCANDINAVICA
ISSN 0001-690X

Alterations in theory of mind in patients with

schizophrenia and non-psychotic relatives
Janssen I, Krabbendam L, Jolles J, van Os J. Alterations in theory of
mind in patients with schizophrenia and non-psychotic relatives.
Acta Psychiatr Scand 2003: 108: 110117. Blackwell Munksgaard 2003.
Objective: It has been proposed that alterations in theory of mind
underlie specic symptoms of psychosis. The present study examined
whether alterations in theory of mind reect a trait that can be detected
in non-psychotic relatives of patients with schizophrenia.
Method: Participants were 43 patients with schizophrenia or
schizoaective disorder, 41 rst-degree non-psychotic relatives and 43
controls from the general population. Theory of mind was assessed
using a hinting task and a false-belief task.
Results: There was a signicant association between schizophrenia
risk and failure on the hinting task (OR linear trend 2.01, 95% CI:
1.223.31), with relatives having intermediate values between patients
and controls. Adjustment for IQ and neuropsychological factors
reduced the association by small amounts. The association between
schizophrenia risk and failure on the false-belief tasks was not
signicant.
Conclusion: Changes in theory of mind are associated with
schizophrenia liability. General cognitive ability and neuropsychological measures seem to mediate only part of this association.

Introduction

The ability to infer the mental states (beliefs,

thoughts and intentions) of others in order to
predict and explain their behaviour has been
conceptualized as a mentalizing ability or theory
of mind (1, 2). Frith (3) has proposed that
alterations in theory of mind underlie specic
symptoms of psychosis, notably delusions of persecution, delusions of reference, delusions of misidentication, third-person auditory hallucinations,
some aspects of thought disorder, and negative
symptoms. According to Frith, theory of mind
skills in people with these experiences develop
normally, but are impaired during an acute psychotic episode. Subsequent studies by Frith and coworkers have indeed found that patients with
persecutory delusions, thought disorder, or negative symptoms had diculties performing a hinting
task and a false-belief task, two tasks that are
sensitive to alterations in theory of mind, whereas
patients who were symptom-free at the time of
testing, performed normally (4, 5). These observations suggest that mentalizing ability is a state
110

I. Janssen1, L. Krabbendam1,
J. Jolles1, Jim van Os1,2
1
Department of Psychiatry and Neuropsychology, azM/
Mondriaan/Riagg/RIBW/Vijverdal Academic Centre,
EURON, Maastricht University, Maastricht, The
Netherlands and 2Division of Psychological Medicine,
Institute of Psychiatry, De Crespigny Park, Denmark Hill,
London, UK

Key words: cognition disorders; neuropsychology;

schizophrenia; family; risk factors
Prof. J. van Os, Department of Psychiatry and Neuropsychology, Maastricht University, PO Box 616 (DRT 10),
6200 MD Maastricht, The Netherlands
E-mail: j.vanos@sp.unimaas.nl
Accepted for publication January 21, 2003

rather than a trait variable. However, others found

that the siblings of individuals with a diagnosis of
schizophrenia performed signicantly worser than
the control participants on theory of mind tests (6).
These authors suggested that alterations in theory
of mind in people with psychosis represent at least
in part a trait rather than a state factor. However,
their sample was very small and statistical resolution limited.
One way to explain ndings of alterations in
theory of mind in patients and their healthy
relatives is to assume that alterations in theory of
mind are at least in part secondary to neuropsychological decits. Schizophrenia is associated with
neuropsychological decits (712), and similar,
although reduced, neuropsychological decits
have also been noted in relatives of patients with
schizophrenia (1318). The relatives may be at risk
for later development of schizophrenia or have an
undiagnosed (but genetically related) schizophrenia
spectrum personality disorder. Therefore, as a
group, non-schizophrenic relatives will appear
less impaired than those with schizophrenia, but
possibly more impaired than unrelated controls

Theory of mind in patients and their relatives

(19). It has been suggested that there may be at
least three domains of neuropsychological decits
in the non-psychotic relatives of patients that are
stable over time: auditory attention, verbal
memory and executive functioning (16, 20). In
children, theory of mind skills have been associated
with executive functions in particular (2124).
Some authors have argued that the cognitive
changes in schizophrenia are part of a generalized
decline (25), but there is evidence that alterations
in theory of mind in schizophrenia cannot be
explained by the eect of IQ decline alone (26, 27).
In the current study therefore, we wished to
examine whether alterations in theory of mind
reect a trait that can be detected in the relatives of
patients with schizophrenia, independent of general IQ and neuropsychological functions such as
executive functions, memory, verbal uency, speed
and attention.

Material and methods

Subjects

The sample has been described in previous publications (17, 28). Initial selection criteria for all
cases were a lifetime history of a period of
psychosis (at least 2 weeks) in clear consciousness,
according to the research diagnostic criteria (RDC)
(29), or being a rst-degree relative of a patient
meeting this criterion. All patients were in remission or in partial remission, dened as not in need
of hospital admission or intensive case management. Inclusion criteria for all participants were:
between the ages of 1855 years, suciently uent
in Dutch, and normal results for physical examination. Written informed consent, conforming
to the local ethical committee guidelines, was
obtained from all participants.
Patients were recruited from the catchment area
Community Mental Health Centre and the outpatient clinic of the catchment area psychiatric
hospital. Relatives (free of a lifetime history of
psychosis) were sampled through participating
patients or through associations for relatives of
patients with psychotic illness. Control subjects
were recruited from the general population through
a random mailing procedure in the local area. None
of the controls reported a history of psychosis in a
rst-degree relative, and no control used psychotropic medication. The present study included 43
patients with psychosis, 41 non-psychotic rstdegree relatives, and 43 healthy controls with
completed measures on social cognition, derived
from a larger sample of 50 patients, 51 relatives and
50 controls. The study population originated from

57 families with at least one patient with psychosis.

Of the healthy relatives, there were six mothers, ve
fathers, 20 sisters, nine brothers and one son. Of the
57 families, 35 families contributed one case or one
relative, 20 contributed at least one case and one
relative, one contributed two and one contributed
three relatives. Patients, relatives and controls were
interviewed with the expanded version of the Brief
Psychiatric Rating Scale (BPRS) (30), the Positive
and Negative Syndromes Scale (PANSS) (31), the
Peters et al. Delusions Inventory (PDI an instrument to measure delusional ideation in non-clinical
populations) (32), and case note and other historical
material were additionally screened for symptoms
listed in the Operational Criteria Checklist for
Psychotic Disorder (OCCPI) (33). Where necessary,
additional information was derived from interviews
with the responsible medical ocer. Based on the
combined information, the computerized program
OPCRIT (33) yielded RDC diagnoses. There were
34 patients (79%) with a diagnosis of schizophrenia,
and nine patients with a diagnosis of schizoaective
disorder (21%). In addition, ve relatives were
diagnosed with major depression. The patients were
frequency-matched with the control subjects on age,
sex and educational level (eight-point scale; primary
school to university degree) (34). The mean total
score of the patient group on the BPRS was 39.0
(SD 10.1) and on the PDI the mean score was
19.3 (SD 7.3). There were no signicant dierences between relatives and controls in mean BPRS
score and PDI score (Table 1). The mean age of rst
psychotic symptoms was 22.0 years (SD 6.0,
range 1441 years); 41 (95.3%) patients were
using antipsychotic medication, three (7.0%)
patients were also using lithium, 14 (32.6%) were
also using benzodiazepines, eight (18.6%) were also
using antidepressants and ve (11.6%) were also
using anticholinergic medication. Of the relatives,
three (7.3%) were using benzodiazepines, and one
of them was also using antidepressants. Current use
of illicit drugs was assessed using section I of the
Composite International Diagnostic Interview
(CIDI; version 1.1) (35). Four patients used marihuana and one used cocaine on a weekly basis. Two
relatives reported weekly use of marihuana.
Theory of mind tasks

Theory of mind was assessed by two tasks, a

so-called rst order false-belief task and a hinting
task, translated into Dutch from Corcoran et al.
and Frith (4, 5). The false-belief task consisted of
two stories that were read aloud to the subjects (see
Appendix 1). After the story was read out, two
questions were asked. The rst question could only
111

Janssen et al.
Table 1. Summary statistics of participant characteristics
Controls (1) (n 43)
Mean
Age
Sex (M/F)
Educational level
IQ
BPRS
PDI
Neuropsychological tests
AVLT total words
SCWT Card 1 (sec)
SCWT interference
CST number (sec)
CST interference
Digit Span backward
Verbal fluency

SD (range)

34.9
22/21
4.3
113.2
25.3
4.4

8.8 (2150)
1.7
11.8
1.5
3.7

(18)
(89139)
(2430)
(015)

54.7
40.1
72.2
15.8
39.7
7.4
25.1

7.1
5.7
24.0
3.1
29.4
1.9
6.0

(3566)
(31.662.0)
(28.4130.9)
(10.625.4)
()8.8100)
(312)
(1039)

Relatives (2) (n 41)

Mean

Patients (3) (n 43)

SD (range)

Mean

38.0
16/25
4.1
116.5
28.6
5.3

11.7 (1955)
1.7
12.5
5.3
6.6

(17)
(86135)
(2451)
(037)

50.0
43.9
72.7
17.5
52.0
6.4
25.0

9.2
8.7
19.6
4.1
32.9
1.9
6.1

(2968)
(32.669.0)
(30.3119.0)
(11.226.9)
()0.4146.5)
(211)
(1644)

SD (range)

32.1
24/19
3.9
104.6
39.0
19.3

7.6 (2048)
1.4
13.3
10.1
7.3

(16)
(75132)
(2473)
(534)

48.4
46.9
84.2
19.1
55.4
6.0
21.2

8.2
9.3
31.9
6.1
38.9
1.7
6.4

(2964)
(34.788.4)
(25.6168.4)
(11.540.3)
()21.1158.4)
(311)
(937)

F (df 2,124)

Scheff=

4.0
2.51*
0.8
10.1
48.8
81.2

0.020
0.285
0.432
0.000
0.000
0.000

3<2

6.9
7.7
2.94
5.6
2.5
6.3
5.50

0.001
0.001
0.057
0.005
0.0851
0.002
0.005

3 < 1,2
3 > 1,2
3 > 1,2
2,3 < 1
3>1
3>1
3<1
3 < 2,1

* Chi-square test. AVLT, Auditory Verbal Learning Task; SCWT, Stroop Color-Word Test; CST, Concept Shifting Test.

be answered with knowledge of the mental state of

one of the characters (theory of mind question) and
reected that characters false belief about the
situation. As a measure of comprehension, subjects
were asked a second question about the reality of
the situation (reality question). This question could
be answered correctly without the use of mentalizing abilities. The second question also served as a
measure of how well the subject had remembered
the story. If the subject gave the wrong answer to
the reality question then the answer to the theory
of mind question for that story was ignored in
order to ensure that the measure reected a decit
in mentalizing rather than mnemonic or comprehension ability.
The hinting task was devised to test the ability of
subjects to infer the real intentions behind indirect
speech utterances. The original task comprised 10
short passages presenting an interaction between
two characters, four of which were used in the
present study (see Appendix 1). All passages ended
with one of the characters dropping an obvious
hint. The subject was then asked what the character really meant when he/she said this. An appropriate response given at this stage was given a score
of two and the next story was read out. If the
subjects failed to give the correct response, an even
more obvious hint was added to the story. The
subject was then asked what the character wants
the other one to do. If a correct response was given
at this stage, the subject was given a score of one. If
the subject failed again to give a correct response, a
score of zero was given for that item.

episodic memory, verbal uency, speed and executive functions. As a measure of attentional span,
the number of sequences recalled correctly on the
Digit Span backwards was used (36). Episodic
memory was assessed by the Auditory Verbal
Learning Task (AVLT) (37, 38). Animal naming
was used as a measure of verbal uency (38). As
measures of speed of information processing we
used the reading task of the Stroop Color-Word
Test (SCWT Card 1) (39) and the number tracking
task of the Concept Shifting Test (CST) (40) which
is a modied version of the Trailmaking Test (41).
The Stroop Color-Word Test involves three cards
displaying a hundred stimuli each: color names,
colored patches, and color names printed in
incongruously colored ink. To assess executive
functions, we used the interference score of the
SCWT, and the interference score of the CST
(which is comparable with Trailmaking B). Stroop
interference was expressed as the percentage of
extra time needed for Card III, relative to the
average of the rst and second card. Similarly,
the interference score of the CST was expressed as
the percentage of extra time needed for the
number/letter tracking, relative to the average of
the number and letter version. To obtain a measure
of general intelligence, we used the shortened form
of a widely used Dutch Intelligence Test, the
Groningen Intelligence Test (GIT) (42). This test
yields results that are comparable with those of the
Wechsler Adult Intelligence Scale-Revised (36).
Three subtests have proven to yield a good
approximation of fullscale IQ (42).

Neuropsychological assessment

Statistical analyses

The neuropsychological assessment was directed at

the following cognitive domains: attentional span,

Statistical analyses were performed using STATA,

version 7.0 (43).

112

Theory of mind in patients and their relatives

Continuous outcome variables measuring theory
of mind were generated for the false-belief tasks
and the hinting task separately. Because these
variables were extremely skewed because of the
fact that the great majority of participants performed well on the tasks, the variables were
dichotomized (score 0 or 1), a score of 0 indicating
that the subject did not make any error on the task,
a score of 1 indicating that the subject made at
least one error. A three-level group variable was
constructed reecting risk for schizophrenia
with controls (coded 0) at the baseline, relatives
(coded 1) in the middle, and patients (coded 2) in
the highest category. Logistic regression was used
to assess and adjust the association between theory
of mind and schizophrenia risk, expressed as the
logistic regression odds ratio. The following a priori
selected confounders of the association between
theory of mind and schizophrenia risk were included in the logistic regression model: age, sex, level
of education (low, medium, high) and IQ. In
addition, we assessed the eect of controlling for
neuropsychological functions (executive functions,
memory, verbal uency, speed and attention) with
higher scores of these variables indicating poorer
performance. In order to examine the eect of
current level of symptoms on the association
between schizophrenia risk and theory of mind,
the analyses were adjusted for total score on the
BPRS and for the score reecting the positive
psychotic symptoms. Because alterations in theory
of mind in relatives may be mediated by schizotypal features, additional analyses were performed
in which the association between theory of mind
and schizophrenia risk were adjusted for PDI
score.
Results

The mean age of the sample was 35.3 years

(SD 9.8). As a group, the patients were somewhat younger than the relatives (see Table 1). The
three groups were well matched in terms of level of
education. The patient group had a signicantly
lower IQ compared with the relatives and the
controls (see Table 1). One-way analyses of variance indicated signicant dierences between the
groups on the total score of the AVLT, SCWT
Card 1, CST number tracking, the Digit Span
backward and verbal uency (see Table 1). Some
participants could not be assessed with the falsebelief task, because the task was not available at
the time of testing. For the false-belief task, data
were available for 34 patients (47% male), 31
relatives (42% male) and 42 controls (50% male).
For these groups, mean age of the patients was

32.9 (SD 8.0), mean age of the relatives was 40.2

(SD 11.3) and mean age of the controls was 34.8
(SD 8.9). Other participant characteristics as well
as neuropsychological test results were comparable
with the characteristics of the whole sample. The
number of people that failed on the hinting task
was: 20 in the patient group (46.5%), 10 in the
relatives (24.4%) and eight in the control group
(18.6%). Six (17.7%) patients failed on the rstorder false-belief task, ve (16.1%) relatives and
three (7.1%) controls. Regardless of the eect of
diagnostic group, a positive but statistically imprecise association was found between performance
on the false-belief task and the hinting task
(OR 1.43, 95% CI 0.454.56).
There was a signicant association between
schizophrenia risk (the three-level variable with
controls coded 0, relatives coded 1 and schizophrenia coded 2) and failure on the hinting task
(OR linear trend 2.01, 95% CI: 1.223.31)
(Table 2). Compared with controls, the chance of
failing the hinting tasks was highest for the patient
group (OR 3.80, 95% CI: 1.4410.04), whereas
relatives had an intermediate chance of failing
(OR 1.41, 95% CI: 0.513.90), indicating a
doseresponse relationship. Associations between
failure on the false-belief task and schizophrenia
risk were equally large but not statistically signicant (OR linear trend 1.61, 95% CI: 0.85
3.04).
Adjusting the association between schizophrenia
risk and performance on the hinting task for age, sex
and educational level reduced the excess risk by only
2% (OR 1.99, 95% CI: 1.183.35), and additional adjustment for IQ reduced the association by
around 6% (OR 1.95, 95% CI: 1.133.35
(Table 2). Adjustment for the neuropsychological
factors on top of age, sex and educational level
reduced the association by <30%. Adjustment for
total score on the BPRS did not change the pattern
of results (see Table 2), nor did adjustment for the
score reecting the items on positive psychotic
symptoms (OR linear trend 2.30, 95% CI: 1.26
4.20). Likewise, after adjustment for the total score
on the PDI, the association between failure on the
hinting task and schizophrenia risk remained signicant (OR linear trend 4.03, 95% CI: 1.848.83).
Discussion

The results show that there was a signicant dose

response relationship in the association between
schizophrenia risk and errors on the hinting task,
patients having the highest risk, and rst-degree
relatives having intermediate values. Controlling
for age, sex and educational level did not reduce
113

Janssen et al.
Table 2. Associations between performance on hinting tasks and schizophrenia risk, adjusted for symptoms and neuropsychological variables

OR unadjusted
OR*
OR* + BPRS
OR* + IQ
OR* + AVLT
OR* + Stroop Card 1
OR* + Stroop interference
OR* + CST number
OR* + CST interference
OR* + Digit Span
OR* + Verbal fluency

OR (relatives
vs. controls)

95% CI

OR (patients
vs. controls)

95% CI

OR (linear trend)

95% CI

1.41
1.29
1.22
1.29
1.21
1.14
1.27
1.31
1.25
1.35
1.35

0.513.90
0.443.80
0.393.76
0.423.98
0.403.68
0.383.45
0.423.82
0.443.88
0.433.70
0.454.11
0.444.12

0.507
0.644
0.735
0.658
0.733
0.816
0.670
0.630
0.681
0.596
0.594

3.80
3.77
4.51
3.78
3.47
2.92
3.27
3.96
3.63
4.20
3.14

1.4410.04
1.3810.30
1.2516.20
1.3210.78
1.1810.23
0.988.70
1.228.77
1.3211.86
1.3010.15
1.3113.42
1.128.76

0.007
0.010
0.021
0.013
0.024
0.054
0.18
0.014
0.014
0.015
0.029

2.01
1.99
2.07
1.95
1.92
1.74
1.84
2.01
1.95
2.09
1.79

1.223.31
1.183.35
1.054.09
1.133.35
1.103.35
1.003.05
1.113.05
1.143.57
1.143.33
1.153.81
1.063.02

0.006
0.010
0.036
0.016
0.021
0.052
0.019
0.016
0.014
0.016
0.031

* OR adjusted for age, sex and level of education.

The increase in risk with one unit change in schizophrenia risk.

the association. Adjusting for IQ and neuropsychological factors reduced the association by small
amounts. Failure on the false-belief task was also
positively associated with schizophrenia risk, but
not signicantly so.
The current eect sizes may even underestimate
the true extent of the changes in theory of mind in
patients and relatives, because the groups were
matched on educational level with the control
group. As the onset of schizophrenia may interfere
with an educational career, individuals fall short of
their educational potential, so that adjusting for
educational level may lead to an underestimation
of the size of the group dierences. A modest
version of the matching fallacy eect has been
reported in non-psychotic relatives (44).
In the present study, many patients performed
well on the rst-order false-belief task, which
suggests that this task was less sensitive in detecting
theory of mind impairments in schizophrenia. In
the study by Frith and Corcoran (5), performance
was impaired on both rst and second-order falsebelief task but other studies have indicated that
alterations in theory of mind in schizophrenia are
more pronounced on second-order tasks, in which
a character has a false belief about the belief of
another character (27). Second-order tasks involve
more sophisticated theory of mind skills than those
of rst order. It is thus possible that signicant
decits on false-belief tasks would have been
apparent in the current study, if we had used a
second-order task. Yet, because of the higher
information processing demands posed by this
type of false-belief tasks, performance will be
partly determined by general cognitive abilities.
Indeed, in the study by Doody et al. (45) learningdisabled individuals performed worse than normal
controls on a second-order task, indicating that IQ
does inuence performance. The individuals with
114

schizophrenia nonetheless performed markedly

worse compared with the mild learning disabilities
group and with the aective disorder group,
suggesting a degree of specicity of poor theory
of mind performance to schizophrenia that cannot
be explained by the eect of IQ alone.
A limitation of the current investigation is that
we used verbal theory of mind tasks only.
Although severe decits of verbal comprehension
would have limited performance on each of the
cognitive tests, as they all depend on the correct
understanding of verbal instructions, comprehension skills may be particularly relevant for tasks
that consists of short stories. Yet, other studies
have found that theory of mind decits in
patients with schizophrenia are independent of
the pictorial or verbal form of the mode of
answering (46, 47), which argues against the
possibility that our ndings can be ascribed to
the verbal nature of the tasks that we used. The
results of Sarfati et al. (46, 47) suggested that
tasks testing the theory of mind with and without
verbal material result in comparable conclusions.
Dierences between both conditions, if present,
were slight and consistently pointed to better
performance in the verbal than in the pictorial
condition. This argues against the possibility that
our ndings can be ascribed to the verbal nature
of the tasks that we used.
Previous studies have suggested that theory of
mind decit is a state-dependent decit that uctuates with symptoms (4, 5, 47). However, the
present ndings concur with data presented by
Wykes et al. (6) that non-psychotic relatives of
patients with schizophrenia show subtle changes of
theory of mind, suggesting that the theory of mind
decit is at least in part trait-related. In line with
this, alterations in theory of mind in patients and
relatives were apparently not mediated by the

Theory of mind in patients and their relatives

presence of symptoms or schizotypal features. The
fact that the association between schizophrenia
liability and alterations in theory of mind was
independent of (subclinical) psychopathology gives
further support to the notion that changes in
theory of mind can be considered trait markers for
schizophrenia or endophenotypes (48). Yet, all
individuals with schizophrenia who participated in
the current study were in remission or partial
remission with a low level of symptoms. It is
possible that impairments in theory of mind
become more severe with increasing levels of
symptoms. Indeed, a recent study showed that
decits of theory of mind that were present during
the acute phase had disappeared during recovery
(49). Together with the present ndings, this may
imply that subtle decits of theory of mind that are
part of the vulnerability for the disorder become
more severe with increasing levels of symptoms.
This would mean that alterations in theory of mind
can be considered a mediating vulnerability indicator (50).
Group (controls, relatives and patients) was used
as a linear variable of continuous schizophrenia
liability. By doing so, it was assumed that the
dierence between 0 (controls) and 1 (relatives) is
the same as the dierence between 1 and 2 (cases).
While there is no formal way of assessing whether
this assumption is correct, testing linear hypotheses
of schizophrenia risk using relatives of patients has
nevertheless been proven a useful and statistically
powerful way to identify traits that may be markers
of familial risk (20, 51, 52). The ndings are
consistent with the hypothesis that alterations in
theory of mind in schizophrenia reect, at least in
part, factors associated with the disorders genetic
basis or shared environmental eects. Although the
number of schizophrenia genes is unknown, most
researchers agree that it is the sum of a number of
genes and environmental factors that lead to the
disorder (53, 54). If this is true, then it is likely that
there is a graded disposition to the disorder, such
that the probability of developing schizophrenia,
or showing related neuropsychological impairments, increases as the degree of predisposition
increases (55). As rst-degree relatives of patients
with schizophrenia presumably carry a greater
genetic risk for the disorder than the general
population, our nding of alterations in theory in
mind in relatives is consistent with the multifactorial model.
General cognitive ability and neuropsychological measures of memory, attention, verbal uency
and executive functions seemed to mediate only
part of the association between theory of mind and
schizophrenia risk. The nding that theory of mind

decit is independent from executive functions is

not in line with some previous studies. For
example, executive functions were related to
theory of mind abilities in both healthy and hardto-manage children (23, 56) and in children with
autism (21). It has even been argued that executive
functions and theory of mind are cognitively
dependent skills. Particularly, it has been suggested
that executive functions allow for the development
of theory of mind and that executive decits result
in a secondary decit in the ability to exert control
over ones own mental states (24, 56, 57). However,
this has been questioned by the publication of
several case reports of double dissociations
between both functions (58, 59). Executive functions comprise several cognitive skills. Specic
skills, such as the ability to draw inferences from
narratives are most likely involved in theory of
mind (60).
According to our ndings, susceptibility to
interference, a dierent aspect of executive functions, seems to be of minor importance to theory of
mind.
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Appendix 1
First-order false-belief tasks used in the study (5)

John has ve cigarettes left in his packet. He puts

his packet on the table and goes out of the room.
Meanwhile, Janet comes in and takes one of Johns
cigarettes and leaves the room without John
knowing.
Theory of mind question: When John comes back
for his cigarettes, how many cigarettes does he
think he has left?
Reality question: How many cigarettes are really
left in Johns packet?
Mary has a box of chocolates which she puts in
her top drawer for safe keeping. A few minutes

later Burglar Bill comes in and asks Mary, Where are

your chocolates, in the top or the bottom drawer?
Mary doesnt want Bill to nd her chocolates.
Theory of mind question: In which drawer does
Mary say her chocolates are, the bottom or the
top? Why?
Reality question: Where are the chocolates really?
The four hinting tasks used in the study (4)

Melissa goes to the bathroom for a shower. Anne

has just had a bath. Melissa notices the bath is
dirty. She calls upstairs to Anne, Couldnt you nd
the Ajax, Anne?
Question: What does Melissa really mean when she
says this?
(If subject fails to respond or gives wrong answer:)
Add: Melissa goes on to say, You are very lazy
sometimes, Anne!
Question: What does Melissa want Anne to do?
Gordon goes to the supermarket with his mom.
They arrive at the sweet aisle. Gordon says, Cor!
Those treacle toees look delicious!
Question: What does Gordon really mean when she
says this?
(If subject fails to respond or gives wrong answer:)
Add: Gordon goes on to say, Im hungry mum!
Question: What does Gordon want his mum to do?
Rebeccas birthday is approaching. She says to
her dad, I love animals, especially dogs!
Question: What does Rebecca really mean when
she says this?
(If subject fails to respond or gives wrong answer:)
Add: Rebecca goes on to say, Will the pet shop be
open on my birthday, dad?
Question: What does Rebecca want her dad to do?
Jessica and Max are playing with a train set.
Jessica has the blue train and Max the red one.
Jessica says to Max, I dont like this train.
Question: What does Jessica really mean when she
says this?
(If subject fails to respond or gives wrong answer:)
Add: Jessica goes on to say, Red is my favourite
colour.
Question: What does Jessica want Max to do?

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