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

Abstract

The Assessment of Theory of Mind for People with Schizophrenia (AToMS), developed by Yeh et al. in 2023, is a specialized psychometric instrument designed to measure Theory of Mind (ToM) abilities specifically in individuals diagnosed with schizophrenia. The scale’s construction is grounded in established ToM theories and a comprehensive review of existing literature, adopting a neurobiological model of social cognition.

The AToMS comprises 16 items that evaluate 8 distinct ToM concepts, which are categorized across two major dimensions: Cognitive ToM, focusing on the ability to infer thoughts, and Affective ToM, focusing on the ability to infer feelings. The instrument has demonstrated strong psychometric properties, including adequate content validity, good internal consistency, and excellent inter-rater and test-retest reliability, making it a reliable tool for neuropsychological assessment in this clinical population.

Keywords

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

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 primary purpose of the Assessment of Theory of Mind for People with Schizophrenia (AToMS) is to rigorously measure Theory of Mind (ToM) abilities specifically within individuals diagnosed with schizophrenia. This instrument was developed to overcome limitations in existing ToM measures when applied to this clinical population.

The scale aims to provide clinicians and researchers with a standardized, reliable, and valid tool to quantify specific social cognitive deficits, which are often implicated in the functional impairment associated with schizophrenia.

Construct

The AToMS is fundamentally rooted in the psychological construct of Theory of Mind (ToM), which is the essential ability to attribute mental states—such as beliefs, intentions, desires, and emotions—to oneself and others. Deficits in this area are a core feature of social dysfunction in schizophrenia.

The scale adopts a neurobiological model of ToM and structures the assessment across two primary, interlinked dimensions:

• Cognitive ToM: Pertains to the ability to infer thoughts, beliefs, and intentions (e.g., understanding a false belief or deception).
• Affective ToM: Focuses on the ability to infer and understand feelings, emotional states, and empathy.

The eight concepts assessed are further categorized into basic and advanced ToM, reflecting increasing levels of complexity based on ontogenetic ToM theories.

Validity

The AToMS underwent rigorous validation procedures, yielding strong evidence across multiple types of validity.

Content Validity: Content validity was established as adequate, with Aiken’s content validity index ranging favorably from 0.80 to 0.93. The calculation resulted in an overall Content Validity Index of 0.91, confirming that the items comprehensively cover the domain of ToM relevant to schizophrenia.

Convergent Validity: Convergent validity was supported by a moderate positive correlation (r = 0.577; p < 0.001) between the AToMS total score and the Social Skills Performance Assessment (SSPA; Patterson et al., 2001). This finding indicates that the AToMS measures a construct closely related to general social functioning, as theoretically expected.

Divergent Validity: Evidence for Divergent Validity was demonstrated by a low correlation (r = 0.184; p = 0.081) between the AToMS and the 30-second Chair Stand Test (30 CST; Jones, Rikli, & Beam, 1999). This low correlation confirms that the AToMS is distinct from measures of physical capability, establishing the uniqueness of its measured construct.

Reliability

The reliability of the AToMS was extensively assessed across several domains, demonstrating high consistency and stability.

Internal Consistency: The scale exhibited good internal consistency, indicated by a Cronbach’s alpha value of 0.850. This suggests that the 16 items reliably measure the underlying construct of Theory of Mind.

Test-Retest Reliability: The stability of the measure over time was high, with the Intraclass Correlation Coefficient (ICC) for the overall scale items reported at 0.901 (95% confidence interval (CI) = 0.35–0.97). For both the cognitive and affective items specifically, the ICC was 0.900. This stability was achieved under the condition that the subsample of patients with schizophrenia maintained stable psychotic symptoms between the two assessment periods.

Inter-Rater Reliability: The agreement among five independent raters was found to be excellent, evidenced by a very high ICC value of 0.997 (95% CI = 0.994–0.999), confirming that scoring is objective and consistent across different administrators.

Factor Analysis

Specific data regarding the factor structure or results of exploratory or confirmatory factor analysis for the AToMS are currently unavailable in the provided source documentation.

Instrument

Test Type: Original Inventory/Questionnaire.

Format: The instrument consists of 16 items, organized around 8 core ToM concepts. Scoring is binary (0 or 1 point) for both control questions and ToM questions. Subscale scores range from 0 to 8, while the total AToMS score ranges from 0 to 16. Higher total scores indicate superior Theory of Mind performance.

Language Available: Chinese, Mandarin.

Population Group: Human (Male and Female).

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

Population Details:

• Location: Taiwan.

• Respondents: Patients diagnosed with Schizophrenia.

Test Methodology: The validation employed comprehensive methodologies, including Test Validity, Construct Validity, Content Validity, Convergent Validity, Discriminant Validity, Test Reliability, Internal Consistency, Interrater Reliability, and Test-Retest Reliability.

Keywords

Affective ToM, Psychometric properties, Cognitive ToM, False Belief, Social Cognition, Neuropsychological Assessment, Schizophrenia, Social Skills Performance Assessment.

Authors

Author ORCID Identifier: Chen, Kuan‑Lin: 0000-0001-9996-814X.

Affiliation Email addresses:

• Yeh, Ya‑Chin: [email protected]
• Hung, Chi‑Fa: [email protected]
• Lin, Chung‑Ying: [email protected]
• Wu, Yuh‑Yih: [email protected]
• Kuo, Chun‑Hong: [email protected]
• Potenza, Marc N.: [email protected]
• Cheng, Chun‑Hua: [email protected]
• Chen, Kuan‑Lin: [email protected]

Correspondence Address: Lin, Chung‑Ying: National Cheng Kung University, College of Medicine, Institute of Allied Health Sciences, Tainan, Taiwan, Province of China, 701401.

Permissions & Fee and Test Year

Permissions: Interested users must contact the Corresponding Author for permissions regarding the use of the AToMS.

Fee: No fee is required for the use of this instrument.

Test Year: 2023.

Reference’s

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 Questionnaire (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.