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The animated assessment of theory of mind for people with schizophrenia (AToMS): development and psychometric evaluation

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Abstract

Theory of mind (ToM) deficits in people with schizophrenia have been reported and associated with impaired social interactions. Thus, ToM deficits may negatively impact social functioning and warrant consideration in treatment development. However, extant ToM measures may place excessive cognitive demands on people with schizophrenia. Therefore, the study aimed to develop a comprehensible Assessment of ToM for people with Schizophrenia (AToMS) and evaluate its psychometric properties. The AToMs was developed in 5 stages, including item formation, expert review, content validity evaluation, animation production, and cognitive interviews of 25 people with schizophrenia. The psychometric properties of the 16-item AToMS (including reliability and validity) were then tested on 59 people with schizophrenia. The newly developed animated AToMS assesses 8 ToM concepts in the cognitive and affective dimensions while placing minimal neurocognitive demands on people with schizophrenia. The AToMS presented satisfactory psychometric properties, with adequate content validity (content validity index = 0.91); mostly moderate item difficulty (item difficulty index = 0.339–0.966); good discrimination (coefficients = 0.379–0.786), internal consistency (Cronbach’s α = 0.850), and reliability (intraclass correlation coefficient = 0.901 for test–retest, 0.997 for inter-rater); and satisfactory convergent and divergent validity. The AToMS is reliable and valid for evaluating ToM characteristics in people with schizophrenia. Future studies are warranted to examine the AToMS in other populations (e.g., people with affective disorders) to cross-validate and extend its utility and psychometric evidence.

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Acknowledgements

We are grateful to the patients who participated. We sincerely thank Chwen-Yng Su for her recommendations on statistical analysis and the adopted neurocognitive measures in this study, Shih-Chieh Lee for his assistance in instrument development, and the occupational therapists and nursing staff of Kaohsiung Municipal Kai-Syuan Psychiatric Hospital for patient recruitment.

Funding

This work was supported by the Ministry of Science and Technology (MOST 109–2628-B-006–023 and MOST 110–2628-B-006–031).

Author information

Authors and Affiliations

  1. Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, Kaohsiung, 821004, Taiwan

    Ya-Chin Yeh

  2. School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, 804201, Taiwan

    Chi-Fa Hung

  3. Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 833401, Taiwan

    Chi-Fa Hung

  4. College of Humanities and Social Sciences, National Pingtung University of Science and Technology, 912301, Pingtung, Taiwan

    Chi-Fa Hung

  5. Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, 701401, Taiwan

    Chung-Ying Lin & Kuan-Lin Chen

  6. Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, 701401, Taiwan

    Chung-Ying Lin & Kuan-Lin Chen

  7. Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, 701401, Taiwan

    Chung-Ying Lin

  8. Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 701401, Taiwan

    Chung-Ying Lin

  9. Department of Special Education, National Kaohsiung Normal University, Kaohsiung, 802561, Taiwan

    Yuh-Yih Wu

  10. Department of Academic Office, Kaohsiung Municipal Nan-Zih Special School, Kaohsiung, 811214, Taiwan

    Chun-Hong Kuo

  11. Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA

    Marc N. Potenza

  12. Connecticut Mental Health Center, New Haven, CT, USA

    Marc N. Potenza

  13. Connecticut Council on Problem Gambling, Wethersfield, CT, USA

    Marc N. Potenza

  14. Child Study Center, Yale School of Medicine, New Haven, CT, USA

    Marc N. Potenza

  15. Department of Neuroscience, Yale University, New Haven, CT, USA

    Marc N. Potenza

  16. Wu Tsai Institute, Yale University, New Haven, CT, USA

    Marc N. Potenza

  17. Department of Occupational Therapy, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, 802211, Taiwan

    Chun-Hua Cheng

  18. Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, 701401, Taiwan

    Kuan-Lin Chen

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  1. Ya-Chin Yeh
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Contributions

Conceptualization: Y-CY, C-YL, Y-YW and K-LC; methodology, Y-CY, C-FH, C-YL, Y-YW and K-LC; validation: Y-CY, C-FH, C-Y.L, Y-YW, M-NP and K-LC; formal analysis and investigation: Y-CY, C-YL, Y-YW, C-HC, C-HK and K-LC; writing—original draft preparation: Y-CY, C-YL and K-LC; writing—review and editing: Y-CY, C-FH, C-YL, M-NP and K-LC; resources: C-FH, Y-YW, C-HC and C-HK; supervision: C-FH, C-YL, Y-YW and K-LC All authors contributed to and approved the final draft of the manuscript.

Corresponding authors

Correspondence to Chung-Ying Lin or Kuan-Lin Chen.

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Conflict of interest

The authors declare no conflicts of interest.

Ethical approval

The investigations were approved by the Institutional Review Board of Kaohsiung Municipal Kai-Syuan Psychiatric Hospital (Approval number 1090360).

Consent to participate

All participants provided written informed consent prior to participation, in accordance with the Helsinki Declaration of 1975, as revised in 2008.

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Yeh, YC., Hung, CF., Lin, CY. et al. The animated assessment of theory of mind for people with schizophrenia (AToMS): development and psychometric evaluation. Eur Arch Psychiatry Clin Neurosci 273, 663–677 (2023). https://doi.org/10.1007/s00406-022-01498-2

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