Presentation on Social Cognition in Pediatric-Onset MS.

1. Social Cognition in
Pediatric-Onset MS
Leigh Charvet, Rebecca Cleary, Katherine Vazquez,
Livana Koznesoff, Kate Bartolotta, Jeremy
Benhamroum & Lauren Krupp for the
U.S. Network of Pediatric MS Centers
Lourie Center for Pediatric MS, Stony Brook Medicine
Supported by the National MS Society (grant numbers PP2106, 10020073405); NIH (grant
number R01NS071463); The Lourie Foundation, Inc.

2. Social cognition
• Cognitive processes that guide social
interaction
• Theory of mind (ToM) is core construct
– infer another’s mental state, making attributions to
their knowledge, beliefs, and emotions
– affective and cognitive

3. Social cognitive deficits
• Characterize autism spectrum disorders, frontal lobe
injury, schizophrenia
• More recent studies have found often subtle deficits
in a wide range of neurodegenerative conditions

4. Social cognition in
adults with MS
• Deficits found in:
– Accurate attribution of the mental state of others
– Accurate recognition of emotions, intentions
• Cognitively intact participants
• Independent from
– disease duration
– level of neurologic impairment (EDSS)
– fatigue and depressed mood

5. Pilot study objective
• To determine whether pediatric-onset MS is
associated with impaired social cognition
• Pediatric-onset (less than 18 years):
– Youngest MS subpopulation
– Approximately one-third with cognitive
impairment
• Social cognition especially critical for this age
group

6. Participants
• Pediatric-onset MS participants under the age
of 21 years
– No other primary neurologic, psychiatric or
medical condition
– Steroid-free for 30 days or more and
neurologically stable
• Healthy controls participants
– Recruited from community

7. Measures
• Symbol Digit Modalities Test (SDMT)
• ToM
– False Beliefs Task
– Reading the Mind in the Eyes Test
– Faux Pas Test
• Parent behavior inventory
– Empathizing/Systematizing (EQ-SQ)

8. False Beliefs Task
Story narrative with cartoon illustration
• First Order: What does character know or believe?
• Second Order: What does one character know or believe about another?
Bake Sale, Hollebranse 2007, Perner & Wimmer, 1985

9. Reading the Mind in the Eyes Test
Baron-Cohen et al., 2001

10. Faux Pas Test
• Narrative vignettes in which a character inadvertently hurts or
offends another
Example: James bought Richard a toy airplane for his birthday. A few
months later, they were playing with it, and James accidentally dropped it.
“Don’t worry” said Richard, “I never liked it anyway. Someone gave it to
me for my birthday”.
– Detection:
• Did someone say something they shouldn’t have?
– Comprehension:
• What did James give Richard for his birthday?
– False Belief:
• Did Richard remember James had given him the toy airplane for his birthday?
Baron-Cohen et al., 2001

11. Empathizing/Systemizing (EQ-SQ) Inventory
• Empathizing Quotient: Interest in the thoughts and
feelings of others with appropriate responses
• “My child would not cry or get upset if a character in a film died.”
• “My child is quick to notice when people are joking.”
• Systemizing Quotient: Interest in aspects of the world
where rules are applied, e.g., mechanical and natural
systems
• “My child is interested in the different members of a specific animal category (e.g. dinosaurs,
insects, etc).”
• My child enjoys arranging things precisely (e.g. flowers, books, music collections
• Baron-Cohen et al., 2005

12. Sample characteristics
MS (n=28)
mean (±sd) or
%(n)
Control (n=32)
mean (±sd) or
%(n)
p
Age 16.29 (±3.12)
Range: 8 to 20
15.69 (±2.94)
Range: 8 to 19
0.45
Female 68(19) 72(23) 0.78
Caucasian 52(14) 81(26) 0.02
Hispanic 50(14) 28(9) 0.11
Maternal
Education
5.48 (±1.89) 7.07 (±1.24) 0.001
WASI FSIQ 103.29 (±12.67) 108.06 (±13.82) 0.21

13. Clinical characteristics of MS participants
EDSS at testing Median: 1.0 0.0 to 4.0
Disease duration Mean: 33.86
(±30.11) months
1 – 97 months
Total Relapses 2.46 ± 2.44 0 – 9 relapses
Relapse Rate 0.90 ± 0.91 per
year
0 – 3.50 per year

14. Performances on ToM tasks
Measure MS n=28
mean (±sd)
Control n=32
mean (±sd)
p
Eyes Test 19.73 (±3.19) 21.75 (±2.49) 0.008
Faux Pas Test Total 8.68 (±0.91) 9.24 (±0.69) 0.009
False Beliefs Task * 2.57 (±0.81) 2.88 (±0.34) 0.06
*MS n=21

15. Item sub-analyses
• Faux Pas Test:
– MS participants’ performed lower on the false
beliefs component
• Identification of faux pas p=0.19
• Story comprehension p=0.25
• False beliefs p=0.008
• False Beliefs task:
– MS group made more errors for both first and
second order items
– Approached significance for more errors on second
order item (p=0.08)

16. ToM and relation to
demographic factors
• MS group more racially diverse with lower
maternal educational attainment
• Controlling for these and other factors (age,
estimated IQ, gender, or ethnicity) did not alter
pattern of results

17. ToM and relation to MS
clinical features
• Total ToM performance
– Total number of relapses (r=-0.39, ns)
– Disease duration (r=-0.27, ns)
– EDSS (r=-0.17, ns)
– Relapse rate (r=0.13, ns)

18. Relation to information processing
speed (SDMT)
• SDMT z-scores
MS= - 0.26 (±1.74) vs. HCs= 0.44 (±1.19), p=0.08
• SDMT impairment
– 10 (38%) in MS vs. 2 (6%) in HC group
• SDMT with ToM total score, r=0.35, p=0.01
• Controlling for SDMT, MS participants’ToM
performance remained lower than controls
(p=0.05)

19. EQ-SQ Inventory
• MS n=18 vs. HC n=16
• Mean EQ: 40.28 ±5.94 vs. 40.69 ±8.51 (ns)
• Mean SQ= 23.94 ± 8.29 vs. 23.69 ± 5.77 (ns)
• Not related to ToM performance (in either
group)

20. Summary
• Relative to healthy controls, pediatric-onset MS participants
performed worse on study ToM measures
– Poorer facial recognition of affective state
– Poorer ability to identify beliefs and knowledge of others
• Not explained by demographic factors
• Not clearly linked with disease activity
• Lower SDMT performance was predictive of ToM, but did not
fully account for the MS group’s deficit
• The EQ-SQ inventory did not distinguish the two groups

21. Limitations
• Cross-sectional pilot study
• Only preliminary measures of ToM
• Additional measures of cognitive functioning
needed
– Executive functioning
• Real-world measures of actual social
functioning

22. Conclusions
• ToM deficits may occur in pediatric-onset MS
• Consistent with findings in adult MS samples
• Deficits are subtle and clinical significance is
unclear
• May underlie functional difficulties that would
otherwise go undetected
• Youngest may be most vulnerable to long-term
consequences of even subtle deficits