Assessment of Theory of Mind for People with Schizophrenia Questionnaire (AToMS)

Abstract

The Assessment of Theory of Mind for People with Schizophrenia (AToMS; Yeh et al., 2023) is a tool designed to measure the theory of mind (ToM; Baron-Cohen, 1995) abilities specifically in individuals diagnosed with schizophrenia. The development of the AToMS was informed by comprehensive review findings (Yeh et al., 2021) and established ToM theories (Abu-Akel & Shamay-Tsoory, 2011; Hutchins, Prelock, & Bonazinga, 2012; Baron-Cohen, 1995). This instrument comprises 16 items that evaluate 8 distinct ToM concepts across cognitive and affective dimensions. Rooted in the neurobiological model of ToM, the AToMS is structured to assess two primary ToM dimensions: cognitive ToM, which pertains to inferring thoughts, and affective ToM, which involves inferring feelings. The eight concepts included are categorized into basic and advanced ToM, based on three levels of complexity and ontogenetic ToM theories. These concepts are: first-order false belief, first-order deception, second-order false belief, appearance and reality, banter, hinting, social cues, and faux pas. The AToMS has demonstrated adequate content validity. Its psychometric properties, including test reliability (internal consistency, test-retest reliability, inter-rater reliability) and validity (convergent and divergent), have been rigorously tested and reported in individuals with schizophrenia.

Keywords

Affective, Cognitive, Divergent Validity, Inferring Feelings, Inferring Thoughts, Schizophrenia, Theory of Mind, Neuropsychological Assessment

Authors

Yeh, Ya‑Chin; Hung, Chi‑Fa; Lin, Chung‑Ying; Wu, Yuh‑Yih; Kuo, Chun‑Hong; Potenza, Marc N.; Cheng, Chun‑Hua; Chen, Kuan‑Lin

Purpose

The AToMS aims to measure the theory of mind (ToM) abilities in individuals diagnosed with schizophrenia.

Validity

Content Validity: The AToMS demonstrated adequate content validity, with Aiken’s content validity index ranging from 0.80 to 0.93. The overall Content Validity Index was 0.91.

Convergent Validity: Convergent validity was supported by a moderate correlation between the AToMS and the Social Skills Performance Assessment (SSPA; Patterson et al., 2001) (r = 0.577; p < 0.001).

Divergent Validity: Divergent validity was supported by a low correlation between the AToMS and the 30-second Chair Stand Test (30 CST; Jones, Rikli, & Beam, 1999) (r = 0.184; p = 0.081).

Reliability

Internal Consistency: The Cronbach’s alpha for the AToMS was 0.850, indicating good internal consistency.

Test-Retest Reliability: The Intraclass Correlation Coefficient (ICC) for the overall scale items was 0.901 (95% confidence interval (CI) = 0.35–0.97). For both the cognitive and affective items, the ICC was 0.900 (95% CI = 0.57–0.97; 0.50–0.97), under the condition that the subsample maintained stable psychotic symptoms between the two assessment periods (p = 0.22 with respect to psychotic symptoms).

Inter-Rater Reliability: The inter-rater reliability among five raters was excellent, demonstrated by a high ICC value of 0.997 (95% CI = 0.994–0.999).

Factor Analysis

No data is Available.

Instrument: Assessment of Theory of Mind for People with Schizophrenia (AToMS)

Test Type: Original Inventory/Questionnaire.

Format: Each control question is scored 1 point if answered correctly. Each Theory of Mind (ToM) question is scored 1 point if answered correctly. Subscale scores range from 0 to 8 (8 items, each scored 0 or 1). The total AToMS score ranges from 0 to 16. Higher total scores indicate better ToM performance.

Language Available: Chinese, Mandarin.

Population Group: Human (Male and Female).

Age Group: Adulthood (18 years and older), including Young Adulthood (18-29 years), Thirties (30-39 years), and Middle Age (40-64 years).

Population Details:

• Location: Taiwan.

• Respondents: Patients with Schizophrenia.

Test Methodology: The AToMS utilized various test methodologies for its validation, including Test Validity, Construct Validity, Content Validity, Convergent Validity, Discriminant Validity, Test Reliability, Internal Consistency, Interrater Reliability, and Test-Retest Reliability.

Keywords

Affective, Cognitive, Divergent Validity, Inferring Feelings, Inferring Thoughts, Schizophrenia, Theory of Mind, Neuropsychological Assessment.

Authors

• Yeh, Ya‑Chin:

  • Affiliation: Shu-Zen Junior College of Medicine and Management Department of Occupational Therapy

  • Email: [email protected]

• Hung, Chi‑Fa:

  • Affiliation: National Sun Yat-sen University, College of Medicine School of Medicine

  • Email: [email protected]

• Lin, Chung‑Ying:

  • Affiliation: National Cheng Kung University College of Medicine, Institute of Allied Health Sciences

  • Email: [email protected]

  • Correspondence Address: National Cheng Kung University, College of Medicine, Institute of Allied Health Sciences, Tainan, Taiwan, Province of China, 701401

• Wu, Yuh‑Yih:

  • Affiliation: National Kaohsiung Normal University Department of Special Education

  • Email: [email protected]

• Kuo, Chun‑Hong:

  • Affiliation: Kaohsiung Municipal Nan-Zih Special School Department of Academic Office

  • Email: [email protected]

• Potenza, Marc N.:

  • Affiliation: Yale School of Medicine Department of Psychiatry

  • Email: [email protected]

• Cheng, Chun‑Hua:

  • Affiliation: Kaohsiung Municipal Kai-Syuan Psychiatric Hospital Department of Occupational Therapy

  • Email: [email protected]

• Chen, Kuan‑Lin:

  • ORCID Identifier: 0000-0001-9996-814X

  • Affiliation: National Cheng Kung University College of Medicine, Institute of Allied Health Sciences

  • Email: [email protected]

Permissions & Fee and Test Year

Permissions: Contact Corresponding Author for permissions.
Fee: No fee is required for the use of the AToMS.
Test Year: 2023.

References

Yeh, Y.-C., Hung, C.-F., Lin, C.-Y., Wu, Y.-Y., Kuo, C.-H., Potenza, M. N., Cheng, C.-H., & Chen, K.-L. (2023). The animated assessment of theory of mind for people with schizophrenia (AToMS): Development and psychometric evaluation. European Archives of Psychiatry and Clinical Neuroscience, 273(3), 663–677. doi:10.1007/s00406-022-01498-2

Items of the Assessment of Theory of Mind for People with Schizophrenia (AToMS)

The AToMS is a 16-item measure designed to assess Theory of Mind (ToM) in individuals with schizophrenia. These items measure 8 ToM concepts, which are categorized into cognitive and affective dimensions. The eight concepts, classified based on three levels of complexity and ontogenetic ToM theories, include:

• First-order false belief

• First-order deception

• Second-order false belief

• Appearance and reality

• Banter

• Hinting

• Social cues

• Faux pas

The AToMS features two main subscales: Cognitive ToM and Affective ToM. Cognitive ToM focuses on inferring thoughts, while Affective ToM focuses on inferring feelings. No individual test items are available in the provided text.