TASIT The Awareness of Social Inference Test

1. TASITThe Awareness of Social Inference Test Available from ASSBI Resources: www.assbi.com.au

2. Why TASIT Was Developed • Social skills deficits are common in many clinical groups, e.g. autism, traumatic brain injury, learning disabilities • Social skills comprise • Expression (behaviour) • Perception and social cognition • There are few tools available that measure social cognition

3. What Is Social Cognition? • Social cognition is the ability to read social cues in order to make judgements about the thoughts, attitudes, intentions and emotions of others and the meaning of their behaviour • Social cognition requires the ability to understand and integrate: • Facial expression and tone of voice • Gesture and “body language” • Contextual information • Knowledge of the world

4. Why Does Social Cognition Matter? • Verbal messages alone are insufficient to convey meaning • A single utterance e.g. “Thankyou!” may be meant • Sincerely to end an encounter • As a request for further assistance • As a sarcastic insult • Nonverbal cues determine this meaning • Failure to read these = Failure of communication

5. The Awareness of Social Inference Test (TASIT) • Part 1: Emotion Evaluation Test (28 items) • Part 2: Social Inference – Minimal (15 items) • Sarcasm vs sincere • Part 3: Social Inference – Enriched (16 items) • Sarcasm vs lies • Alternate forms for re-testing • Normed on 424 (Part 1) 342 (Part 2) and 408 (Part 3) adults and 464 adolescents

6. Part 1: Emotion Evaluation Test (EET) 28 videos 4 each of Happy Sad Angry Fearful Disgusted Surprised Neutral Actors schooled in method acting. Vignettes encompass Face Voice Gesture Partner cues

7. Part 1: Emotion Evaluation Test (EET) • Neutral scripts • Cues include • Facial expression • Tone of voice • Gesture • Non-verbal cues from other person in the scene • Participants select the emotion label that matches the expression

8. Part 2: Social Inference Minimal (SI-M) 15 vignettes Sincere Sarcastic Paradoxical • Watch the vignette and answer yes/no questions about the speakers’ • Feelings • Thoughts • Intentions • Meaning

9. Part 2: Social Inference Minimal (SI-M) Neutral scripts are enacted by professional actors to represent • Sincere exchanges (5 examples) • Sarcastic exchanges (5 examples) • Paradoxical sarcasm, i.e. the content does not make sense unless interpreted as sarcasm (5 examples)

10. PART 2: SI-M Example of neutral script enacted as either sincere or sarcastic Ruth:Great movie, wasn’t it? Michael:Oh yeah, great. Ruth:I thought it was terrific I was on the edge of my seat. Michael:Oh me too, on the edge of my seat. Ruth:Weren’t you surprised by the ending? Michael: Oh yeah, the ending was a huge surprise.

11. Part 2: SI-M Example of a paradoxical script • Gary: Are you sure you’ve got your passport? • Keith:(sarcastically) Oh, yes, I tore it up and threw it away. • Gary: Good, that’s OK then. These are nonsensical unless it is recognised that one speakers is sarcastic

12. Part 3: Social Inference Enriched (SI-E) 16 vignettes Sarcastic Lies • Enriched vignettes have additional • prologues • visual edits • that provide information on true state of affairs

13. PART 3: Social Inference – Enriched (SI-E) • SI-E assesses the ability to use contextual knowledge, i.e. visual and verbal information to derive meaning • SI-E comprises 16 videoed vignettes of everyday exchanges • In each of these there is a literally untrue comment.

14. PART 3: SI-E Literally untrue scripts These comments: e.g. • “Yes Cal has finished his dinner!” (when he has not) • “No of course you don’t look fat” (when he does) are enacted in one of two ways: • As sarcasm meant to amplify the truth • As a lie meant to conceal or minimise the truth

15. PART 3: SI-E Contextual cues SI-E provides two sources of non-verbal cues to determine meaning • Paralinguistic features (like Part 2) • Contextual cues - Visual edit indicating the true state of affairs e.g. a view of Cal’s still full dinner plate - Prologue that reveals the speaker’s true thoughts e.g. Ruth confiding to a third person that Garry has put on weight

16. Comprehension questions for Parts 2 and 3 In both SI-M and SI-E each vignette is followed by 4 Yes/No questions INTEND Is Tanya trying to hide the fact that Cal hasn’t eaten his dinner? MEAN Is she trying to say Cal obeyed his father? THINK Does his father think Cal ate all his dinner? FEEL Is Tanya openly annoyed?

17. Normative data for TASIT Gender is represented roughly equally across samples. Those with very low education (<9 years) represented a very small proportion (6% or less), those with medium levels (i.e. 10-12 years) represented 36-54% and those with high education (13 years or more) represented 41-61%

18. TASIT Validity • Initial studies were completed with people with traumatic brain injury • For example, McDonald & Flanagan examined 32 adults with severe TBI compared to 32 normal demographically matched controls

19. Part 1: EET: McDonald and Flanagan, Neuropsychology, 2004

20. PART 2: SI-M: Sincere vs Sarcastic Exchanges McDonald and Flanagan, Neuropsychology, 2004

21. Part 2 SI-M Responses to the 4 questions McDonald and Flanagan, Neuropsychology, 2004

22. PART 3 SI-E: Sarcasm Versus Lies McDonald and Flanagan, Neuropsychology, 2004

23. There are now many studies of TASIT with (adult) clinical populations  = Impairment found  = no impairment

24. TASIT Validity continued • Reliability(32-38 adults with TBI) • Test-retest reliability: 0.74 to 0.88. • Alternate forms reliability: 0.62 to 0.83. • Validity(up to 116 people with TBI) • Expect TASIT • to be associated with • face perception  • information processing speed  • working memory  • Socially relevant new learning/executive tasks  • Experimental social cognition tasks  • to not be associated with • Non-social learning/executive tasks X McDonald, Bornhofen, Shum, Long, Saunders & Neulinger (2006)

25. TASIT Validity continued • Predictive validity • TASIT predicts • social interaction skills (McDonald et al, 2003) • Reduced communicative competence on relative report (Watts & Douglas, 2006) • Differential validity • Different brain lesions affect prosody, facial recognition etc. • Differences in recognition of dynamic and static visual displays as well as voice only (McDonald & Saunders, 2005). • General patterns across studies suggest that people with clinical disorders • can understand sincere exchanges normally • have difficulty with emotion perception and understanding sarcasm and lies

26. TASIT in Adolescents • Normative data • 665 school students across Sydney 13-15 y.o. • 97 of these did not speak English at home • Girls out-performed boys on all parts • Adolescent scores lower than adults but not hugely (6-11% drop) • Lack of English reduced scores further 6-13% • Chronological age – few systematic effects • Adolescents with TBI • 16 adolescents with mod-severe TBI compared to matched controls (13-19 y.o.) • Adolescents with TBI worse on Part 2 • TASIT correlated with • Relative and self-reported communication difficulties • IQ, face recognition, injury severity

27. TASIT versus other tests of social cognition • There are a number of other measures of social cognition available in the literature. Few have established norms • In the field of schizophrenia an expert panel was established to determine which tests it would recommend • TASIT received the second (of 21) most recommendations (59 experts) (Pinkham et al, 2014) and was rated overall 3 (of 19) measures for • Reliability (3 of 19) • Distribution (7 of 19) • Tolerance for repeated measures (5 of 19) • Convergent/Discriminant validity (7 of 19) • Criterion validity (9 of 19) • Practicality (12 of 19) • Tolerability (5 of 19) • Further testing of TASIT for re-testing (Pinkham 2016) suggested that TASIT had 2 drawbacks • Form B has less well established psychometrics for repeated testing • TASIT is lengthy to administer

28. TASIT-Short (TASIT-S) TASIT-Short was developed to provide a shortened version of TASIT, based on Form A

29. TASIT-S • Correlates highly with original TASIT • Retains the three subtests • Takes about 20 minutes • Differentiates • adults with TBI and those without • Adults with FTD from AD Honan, C., et al (2016) The Clinical Neuropsychologist, Kumfor et al, (2017) Cortex

30. Normative data Australian speakers USA speakers

31. Australian vs USA Speakers

32. McDonald, Honan, Allen et al, TCN, 2017

33. McDonald, Honan, Allen et al, TCN, 2017

34. McDonald, Honan, Allen et al, TCN, 2017

35. TASIT-S • Sensitive to clinical disorders of social cognition • Relatively insensitive to • Education: • Part 1: r=.14 • Part 2: r = .11 • (English) cultural background • 36-44% adolescents NESB • Gender • Young and middle aged adults tend to perform better than adolescents and older adults Conclusions

36. Uses of TASIT • TASIT appears to be sensitive to a range of deficits in social perception • It can be used to assess social perception • It can also be used to treat such deficits

37. Treatment Applications • Common scripts on Form A and B of TASIT denote contrasting meanings • sad versus angry, etc • sarcastic versus sincere • lie versus sarcastic • These can be used to help clients appreciate the importance of contextual cues

38. Treatment Applications • The audio channel can be muted or the visual channel obscured to assist clients concentrate on information from one channel alone

39. Contact Details For purchasing: • ASSBI Resources

40. Contact Details For information regarding research • Prof Skye McDonald • School of Psychology, • University of New South Wales • Sydney 2052, • NSW, AUSTRALIA • Phone: +61 (2) 93853029 • Fax: +61 (2) 93853641 • Email: s.mcdonald@unsw.edu.au

41. References • Blake, M.L (2009) Inferencing processes after right hemisphere brain damage: Maintenance of inferences. Journal of Speech, Language, and Hearing Research. Vol 52(2) 359-372 • Dewar, B-K, Gracey, F. (2007) "Am not was": Cognitive-behavioral therapy for adjustment and identity change following herpes simplex encephalitis.Neuropsychological Rehabilitation. Vol 17(4-5), Aug 2007, 602-620. • Fournier, N.M., Calverley, K.L., Wagner, J.P., Poock, J.L., & Crossley, M. (2008). Impaired social cognition 30 years after hemispherectomy for intractable epilepsy: The importance of the right hemisphere in complex social functioning. Epilepsy & Behavior, 12, 460-471. • Honan, C. A., McDonald, S., Sufani, C., Hine, D. W., & Kumfor, F. (2016). The awareness of social inference test: development of a shortened version for use in adults with acquired brain injury. Clinical Neuropsychologist, 30 (2) 243-264. doi:10.1080/13854046.2015.1136691 • Jahshan, C.S. & Sergi, M.J. (2007) Theory of mind, neurocognition, and functional status in schizotypy.Schizophrenia Research. Vol 89(1-3) 278-286. • Kern, R. S.; Green, M. F.; Fiske, A. P.; Kee, K. S.; Lee, J.; Sergi, M. J.; Horan, W. P.; Subotnik, K. L.; Sugar, C. A.; Nuechterlein, K. H. (2009) Theory of mind deficits for processing counterfactual information in persons with chronic schizophrenia.Psychological Medicine. Vol 39(4) 645-654 • Kipps, C.M., Nestor, P.J., Acosta-Cabronero, J., Arnold, R., & Hodges, J.R. (2009). Understanding social dysfunction in the behavioural variant of frontotemporal dementia:the role of emotion and sarcasm processing. Brain. 132, 592-603

42. References continued • Knox, L. & Douglas, J. (2009) Long–term ability to interpret facial expression after traumatic brain injury and its relation to social integration.Brain and Cognition. Vol 69(2), 442-449 • Kosmidis, M.H., Eleni, A., P., B.V., Maria, G., & Panayiotis, I. (2008). Studying social cognition in patients with schizophrenia and patients with frontotemporal dementia: Theory of mind and the perception of sarcasm. Behavioural Neurology, 19(Print), 65-69. • Kumfor, F., Honan, C.,McDonald, S., Hazelton, J., Hodges, JR., & Piguet, O. (2017) Assessing the social brain in dementia: Applying TASIT-S Cortex, 93,166-177 • Mathersul, D., McDonald, S. & Rushby, J.A. (2013) Understanding advanced theory of mind in high-functioning adults with autism spectrum disorders. Journal of Clinical and Experimental Neuropsychology, 35 (6), 655-668. DOI: 10.1080/13803395.2013.809700 • McDonald, S., Flanagan, S., Rollins, J. & Kinch, J. (2003) TASIT: A New Clinical Tool for Assessing Social Perception after traumatic brain injury Journal of Head Trauma Rehabilitation, 18, 219-238. • McDonald, S., & Flanagan, S. (2004) Social perception deficits after Traumatic Brain Injury: The interaction between emotion recognition, mentalising ability and social communication. Neuropsychology18, 572-579. • McDonald, S., Flanagan, Martin, I. & Saunders, C. (2004) The ecological validity of TASIT: A test of social perception, Neuropsychological Rehabilitation, 14, 205-302. • McDonald, S.,  Honan, C.,  Allen, S.K., El-Helou, R., Kelly, M., Kumfor, F., Piguet, O., Hazelton, J.L., Padgett, C., Keage, H.A. Normal adult and adolescent performance on TASIT-S, a short version of The Assessment of Social Inference Test The Clinical Neuropsychologist, 32 (4) 700-719. doi: 10.1080/13854046.2017.1400106

43. References continued • McDonald, S., Saunders, C. (2005) Differential impairment in recognition of emotion from still, dynamic and multi-modal displays in people with severe TBI. Journal of the International Neuropsychological Society, 11, 392-399. • McDonald, S., Bornhofen, C., Shum, D., Long, E.Saunders, C., Neulinger, K. (2006) Reliability and validity of ‘The Awareness of Social Inference Test’ (TASIT): A clinical test of social perception. Disability and Rehabilitation, 28, 1529-1542. • McDonald, S., Fisher, A., Togher, L., Tate, R., Rushby, J., English, T., Kelly, M., Mathersul, D., Foriech, F. & Francis, H.(2015) Adolescent performance on The Awareness of Social Inference Test: TASIT. Brain Impairment 16 (1) 3-18 doi:10.1017/BrImp.2015.7 • Pinkham, A. E., Penn, D. L., Green, M. F., & Harvey, P. D. (2016). Social cognition psychometric evaluation: Results of the initial psychometric study. Schizophrenia Bulletin, 42(2), 494-504 • Pinkham, A. E., Penn, D. L., Green, M. F., & Harvey, P. D. (2016). Social cognition psychometric evaluation: Results of the initial psychometric study. Schizophrenia Bulletin, 42(2), 494-504 • Rankin, K., Salazar, A., Goorno-Tempini, M.L., Sollberger, M., Wilson, S.M., Pavlic, D., Stanley, C.M., Glenn, S., Weiner, M.W., Miller, B.L. (2009) Detecting sarcasm from paralinguistic cues: Anatomic and cognitive correlates in neurodegenerative disease. Neuroiamge, 47, 2005-2015. • Sparks, A., McDonald, S., Lino, B., O’Donnell, M., Green, M.J. (2010) Social cognition, empathy and functional outcome in schizophrenia. Schizophrenia Research,122, 172-178