The neurobiological map of theory of mind and pragmatic communication in autism

ABSTRACT Children with autism often have difficulty with Theory of Mind (ToM), the ability to infer mental states, and pragmatic skills, the contextual use of language. Neuroimaging research suggests ToM and pragmatic skills overlap, as the ability to understand another's mental state is a prerequisite to interpersonal communication. To our knowledge, no study in the last decade has examined this overlap further. To assess the emerging consensus across neuroimaging studies of ToM and pragmatic skills in autism, we used coordinate-based activation likelihood estimation (ALE) analysis of 35 functional magnetic resonance imaging (MRI) studies (13 pragmatic skills, 22 ToM), resulting in a meta-analysis of 1,295 participants (647 autistic, 648 non-autistic) aged 7 to 49 years. Group difference analysis revealed decreased left inferior frontal gyrus (LIFG) activation in autistic participants during pragmatic skills tasks. For ToM tasks, we found reduced anterior cingulate cortex (ACC), medial prefrontal cortex (MPFC), and temporoparietal junction (TPJ) activation in autistic participants. Collectively, both ToM and pragmatic tasks showed activation in IFG and superior temporal gyrus (STG) and a reduction in left hemispheric activation in autistic participants. Overall, the findings underscore the cognitive and neural processing similarities between ToM and pragmatic skills, and their underlying neurobiological differences in autism.KEYWORDS: Autism spectrum disorderneuroimagingtheory of mindpragmatic language Disclosure statementNo potential conflict of interest was reported by the authors.Authors' contributionsLD was involved in the conceptualization of the study, data analyses, and in writing the manuscriptAW was involved in data analyses and in writing the manuscriptKEM was involved in the conceptualization of the study, data analyses, and in writing the manuscriptRKK was involved in the conceptualization of the study, data analyses, and in writing the manuscriptAdditional informationFundingThis study was supported by the National Institute of Deafness and other Communicative Disorders (NIDCD)#5R01DC016303