Skip to main content
NCBI home page
Wiley Open Access Collection logoLink to Wiley Open Access Collection
. 2026 Apr 19;65(4):1075–1093. doi: 10.1111/bjc.70054

Developmental trajectories of social responsiveness and theory of mind in adolescent offspring at familial high‐risk of schizophrenia or bipolar disorder and population‐based controls—The Danish High Risk and Resilience Study, VIA 15

Lotte Veddum 1,2,✉, Andreas Færgemand Laursen 1,2, Anette Faurskov Bundgaard 1,2, Nicoline Hemager 3,4,5, Maja Gregersen 3,4, Mette Falkenberg Krantz 3,4,6, Anja Vaskinn 7,8, Jens Richardt Møllegaard Jepsen 3,4,9, Anne Søndergaard 3,4, Sinnika Birkehøj Rohd 3,4,6, Martin Wilms 3,4,6, Marta Schiavon 3,4,6, Doris Helena Bjarnadóttir Streymá 4,5,6, Anne Amalie Elgaard Thorup 3,4,6, Merete Nordentoft 4,6, Ole Mors 1,2, Aja Neergaard Greve 1,2
PMCID: PMC13655951  PMID: 42003073

Abstract

Objectives

We aimed to investigate the developmental trajectories of social responsiveness and theory of mind (ToM) from childhood to adolescence in offspring at familial high risk of schizophrenia (FHR‐SZ) or bipolar disorder (FHR‐BP) and population‐based controls (PBC).

Design

The Danish High Risk and Resilience Study is a longitudinal cohort study investigating offspring at FHR‐SZ (n = 202) or FHR‐BP (n = 120) and PBC (n = 200), assessed at age 7, 11 and 15.

Methods

Social responsiveness was measured with The Social Responsiveness Scale, Second Edition, completed by a teacher and the primary caregiver, and ToM was assessed using the Animated Triangles Task. Developmental differences and cross‐sectional between‐group differences were ascertained with multi‐level mixed effects linear regression models.

Results

We found non‐significantly different development of social responsiveness and ToM across groups. At age 15, offspring at FHR‐SZ displayed social responsiveness impairments compared with PBC, both according to teachers and primary caregivers. Offspring at FHR‐BP only displayed social responsiveness impairments compared with PBC according to the primary caregivers. Significantly more offspring at FHR‐SZ displayed clinically significant impairments in social responsiveness compared with PBC. We found no significant between‐group difference in ToM at age 15.

Conclusions

Especially offspring at FHR‐SZ, but also offspring at FHR‐BP, show developmental deficits in social responsiveness and normal ToM development from childhood to adolescence, indicating that social responsiveness impairments may constitute a vulnerability marker. Additional studies are needed to validate our findings and to investigate the long‐term impact of social responsiveness impairments in offspring at FHR‐SZ or FHR‐BP.

Keywords: development, mentalizing, psychosis, social cognition, vulnerability markers

Practitioner points.

  • Social responsiveness impairments may be a potential vulnerability marker in young offspring at familial high risk of schizophrenia or bipolar disorder.

  • More offspring at familial high risk of schizophrenia display social responsiveness impairments at a clinically significant level, suggesting that these offspring may constitute a particularly vulnerable subgroup.

  • Intact ToM abilities and normal ToM development in offspring at familial high‐risk of schizophrenia or bipolar disorder may serve as a protective factor. However, task‐related properties should be taken into consideration.

  • Our findings are important to clinical practice working with families affected by parental schizophrenia or bipolar disorder and may serve the potential to improve detection of particularly vulnerable children. Importantly, future studies should investigate the long‐term impact of our findings.

INTRODUCTION

Social impairments are well‐established in schizophrenia and bipolar disorder and have consistently been identified across the different phases of illness, including the premorbid and prodromal phases (Gillissie et al., 2022; Healey et al., 2016; Lee et al., 2015; Samamé, 2013; Velthorst et al., 2017). Interestingly, a large population‐based and prospective study identified social impairments many years before illness onset in schizophrenia, with a progression of the severity of impairments the closer to hospitalization (Velthorst et al., 2016). Importantly, social cognitive impairments have been found to be predictive of functional outcomes and symptom severity in schizophrenia (Fett et al., 2011; Halverson et al., 2019; Lemmers‐Jansen et al., 2023). Offspring of parents with schizophrenia or bipolar disorder have an elevated risk of developing a mental disorder (Rasic et al., 2013; Uher et al., 2023), thereby representing a valuable study group in investigations of potential vulnerability markers. However, developmental and prospective studies of social impairments in children and adolescents at familial high‐risk are lacking.

Social responsiveness is defined as the ability to understand and engage in social interactions with others, that is involving processing social information, comprehending the message being conveyed, and responding appropriately in interpersonal interactions (Constantino et al., 2000). Social responsiveness has not been given much attention in research on schizophrenia and bipolar disorder, but impairments have been found in adults with either disorder (Matsuo et al., 2015), in adolescents at clinical high risk of developing psychosis (Jalbrzikowski et al., 2013), and in offspring of parents with bipolar disorder (Whitney et al., 2013). Similarly, a previously published study of the current cohort showed that offspring at familial high‐risk of schizophrenia (FHR‐SZ) or bipolar disorder (FHR‐BP) display stable impairments in social responsiveness from age 7 to 11, with a similar developmental pattern relative to population‐based controls (PBC). Furthermore, a significantly larger proportion of offspring at FHR‐SZ displayed clinically significant social responsiveness impairments than PBC at age 11 (Christiani et al., 2019; Veddum et al., 2022).

Theory of mind (ToM) refers to the ability to infer and predict other people's behaviour, intentions, thoughts, beliefs, plans, and desires with an awareness that these may differ from one's own (Frith & Frith, 2011; Green et al., 2008). ToM is a highly developmental construct involving a progression of insights that unfold and change throughout the different phases of childhood and adolescence (Weimer et al., 2021; Wellman, 2018). ToM impairments have consistently been identified in schizophrenia and bipolar disorder (Bora et al., 2016; Gillissie et al., 2022; Savla et al., 2013; Sprong et al., 2007), but the literature agrees that the ToM impairments associated with schizophrenia are more severe than those observed in bipolar disorder (Bora & Pantelis, 2016; Lewandowski et al., 2024; van Neerven et al., 2021). Moreover, ToM impairments are also evident in first‐degree relatives of individuals with schizophrenia or bipolar disorder, yet their ToM impairments are not as severe as those in patients (Bora & Pantelis, 2013; Bora & Özerdem, 2017; Tucci et al., 2023). Importantly, the existing studies included in meta‐analyses of first‐degree relatives primarily rely on adult samples, thereby lacking the developmental aspect of ToM. Only very few studies have investigated ToM during childhood or adolescence in offspring of parents with schizophrenia or bipolar disorder, with evidence of ToM deficits in children of parents with schizophrenia, but not in children of parents with bipolar disorder (Maróthi & Kéri, 2014; Whitney et al., 2013). Previously published results from the current cohort suggest that offspring at FHR‐SZ or FHR‐BP display similar development and intact ToM abilities compared with PBC from age 7 to 11 (Christiani et al., 2019; Veddum et al., 2022). Importantly though, adolescence has been pointed out as a highly essential and sensitive period for social cognitive development (Blakemore, 2008; Burnett et al., 2011), and a critical time for increase in vulnerability to severe mental illness given significant changes in neurodevelopment and other important domains, including social factors (Mennigen & Bearden, 2020; Patel et al., 2021; Rowland & Marwaha, 2018). Nevertheless, to the best of our knowledge, no other study has examined the development of social responsiveness or ToM into adolescence in a familial high‐risk cohort.

Building upon existing work from the current cohort (Christiani et al., 2019; Veddum et al., 2022), the primary aim of this study was to compare the developmental trajectories of social responsiveness and ToM from age 7 to 11 to 15 in offspring at FHR‐SZ or FHR‐BP and PBC, thereby adding another follow‐up assessment. Additionally, we aimed to examine group differences between offspring at FHR‐SZ or FHR‐BP and PBC at age 15, including a comparison of the proportion of offspring with clinically significant social responsiveness impairments in the three groups. We hypothesized that offspring at FHR‐SZ or FHR‐BP would display similar developmental trajectories (i.e. same slope, but different point estimates) from age 7 to 11 to 15, thereby exhibiting social responsiveness impairments at age 15 compared with PBC, thus with more pronounced impairments in FHR‐SZ than in FHR‐BP. Moreover, we expected that a significantly larger proportion of children at FHR‐SZ would display social responsiveness impairments at a clinically significant level compared with PBC at age 15. We further hypothesized that offspring at FHR‐SZ or FHR‐BP would display ToM impairments at age 15, thereby showing a different developmental trajectory (i.e. different slope and point estimates) in ToM from age 7 to 11 to 15 than PBC.

MATERIALS AND METHODS

This study is part of The Danish High Risk and Resilience Study (the VIA study), a longitudinal and prospective familial high‐risk study investigating offspring of parents with schizophrenia, bipolar disorder, or neither of these two mental disorders (i.e. PBC) from early childhood into adulthood. The included families were identified through The Danish Civil Registration System (Pedersen et al., 2006) in combination with The Danish Psychiatric Central Research Register (Mors et al., 2011). Data collection for the third wave of assessment (the VIA 15 study) took place from June 1st, 2021 to May 31st, 2024. Prior to participation, the participants received thorough oral and written information about the study, and before enrolment, oral consent was obtained from the offspring, and written consent was obtained from the legal guardians. Formal approval of the VIA 15 study was obtained from The National Committee on Health and Research Ethics and The Danish Data Protection Agency.

Participants

The cohort originally comprised 522 offspring (FHR‐SZ, n = 202; FHR‐BP, n = 120; PBC, n = 200) assessed for the first time at age 7 (the VIA 7 study) (Thorup et al., 2015). The PBC were matched to offspring at FHR‐SZ based on sex, age, and municipality. Offspring at FHR‐BP were not matched, but were comparable to the two other groups in terms of sex and age. The second wave of assessment was conducted at age 11 (FHR‐SZ, n = 179; FHR‐BP, n = 105; PBC, n = 181) (the VIA 11 study) (Thorup et al., 2018), and the third wave of assessment was conducted at age 15 (FHR‐SZ, n = 158; FHR‐BP, n = 100; PBC, n = 169) (the VIA 15 study) (Thorup et al., 2022), corresponding to an overall retention rate of 81.8% from baseline to second follow‐up. Participants who did not participate in the second wave of assessment were invited to participate again in the third wave of assessment, unless they specifically stated that they did not wish to be contacted again.

Descriptive and clinical measures

Current level of global functioning was assessed with the Children's Global Assessment Scale (CGAS) (Shaffer et al., 1983), where a higher score (ranging from zero to 100) reflects a higher level of global functioning.

Social responsiveness

Social responsiveness was assessed using the Social Responsiveness Scale, Second Edition (SRS‐2), a rating scale originally designed to observe the presence and severity of social impairments associated with autism spectrum disorders (Constantino & Gruber, 2012). The scale has been widely administered in various populations, as it is also considered useful when characterizing the behaviour of individuals whose social deficits are less severe than those observed in autism, but who may still need support (Constantino, 2011; Constantino & Gruber, 2012). Thereby, SRS‐2 ratings can be interpreted as reflecting overall impairment in social responsiveness, rather than solely as a measure of severity of core symptoms related to autism (Hus et al., 2013). The 65 items in the SRS‐2 questionnaire are answered on a four‐point Likert scale and are based on the individual's behaviour over the past 6 months. At age 7, the SRS‐2 School‐Age Form was completed by a teacher, and at age 11 and 15, it was completed both by a teacher and the primary caregiver. The primary caregiver was defined as the adult who knew the offspring the best and preferably had to live with the offspring. Thereby, the primary caregiver could both be the affected parent with schizophrenia or bipolar disorder and the co‐parent. SRS‐2 provides a global score (ranging from 0–195), with higher scores reflecting greater severity of impairment. The scale can be divided into two highly correlated and validated subscales compatible with DSM‐5 criteria for autism—namely the Social Communication and Interaction (SCI) subscale (based on 53 items) and the Restricted Interests and Repetitive Behavior (RIRB) subscale (based on 12 items), where the latter reflects highly autistic traits (Constantino & Gruber, 2012; Frazier et al., 2014). Congruent with our previously published study (Veddum et al., 2022) and based on recommendations in the SRS‐2 manual (Constantino & Gruber, 2012), we further established a clinically significant level at a global score ≥70.

Theory of mind

ToM was assessed with The Animated Triangles Task, which consists of short animations featuring two triangles moving around on a computer screen either in an intentional (ToM conditions) or arbitrary manner (random conditions) (Abell et al., 2000; Castelli et al., 2000). After each animation, participants are asked to give a free description. The descriptions were recorded, transcribed, and rated according to the published set of scoring criteria regarding intentionality and appropriateness (Abell et al., 2000; Castelli et al., 2000). Intentionality refers to the degree of mental state attribution and ranges from 0 to 5, with a score of 4 or 5 indicating ToM. Appropriateness refers to how well the intended script is captured and ranges from 0 to 3, where 3 reflects an accurate description. Afterwards, these ratings were summarized to calculate the total scores (ToM intentionality, ToM appropriateness, random intentionality, and random appropriateness). In the VIA 15 study, the ratings were performed by a trained psychology student under close and continuous supervision by the first author. Calculations of inter‐rater reliability between the first author and the student showed good agreement (random intentionality, ICC = .88, 95% CI = .79–.93; random appropriateness, ICC = .83, 95% CI = .72–.90; ToM intentionality, ICC = .85; 95% CI = .75–.91; ToM appropriateness, ICC = .84, 95% CI = .73–.91). See supplementary for a detailed description of the rating process, including intra‐class correlation analyses of inter‐rater agreements for each animation (Table S1). The exact results from the intra‐class correlations from the previous waves of assessment can be obtained in previous publications (Christiani et al., 2019; Veddum et al., 2022), but we note here that they showed good to excellent agreement.

Statistical analyses

One‐way ANOVA (continuous variables) or chi‐square tests (categorical variables) were applied in analyses of descriptive and clinical characteristics, followed by pairwise comparisons in case of a significant main effect of group. As advised in the manual, missing items on SRS‐2 were assigned with the particular item's median score in the SRS‐2 manual (n = 2) (Constantino & Gruber, 2012). Dropout analyses investigating differences in social responsiveness and ToM between offspring participating both at age 7 (or age 11 for SRS‐2 primary caregiver ratings) and 15 and offspring only participating at age 7 (or age 11 for SRS‐2 primary caregiver ratings) were conducted using t‐tests. Multi‐level mixed effects linear regression models were conducted to examine both developmental differences from age 7 to 11 to 15 and cross‐sectional between‐group differences at age 15 on the outcome variables from the Animated Triangles Task (ToM intentionality, ToM appropriateness, random intentionality, and random appropriateness) and SRS‐2 (global score, SCI subscale score, and RIRB subscale score). Time (defined as first, second, and third assessment), group (defined as FHR‐SZ, FHR‐BP, or PBC), and time × group interaction were included as fixed factors, and id‐level was included as a random factor in all models. Missing data for included participants on a specific time point was handled in the analyses by the maximum likelihood method, where the observed data is used to estimate the missing data (Grund et al., 2019). Associations between teachers and primary caregiver ratings on SRS‐2 at age 15 were ascertained using linear regression analyses with teacher ratings as the dependent variable and primary caregiver ratings as the independent variable. Similarly, associations between social responsiveness and ToM at age 15 and analyses of whether ToM at age 7 or 11 predicted social responsiveness at age 15 were conducted using linear regression analyses with ToM (i.e. ToM intentionality, ToM appropriateness, random intentionality, random appropriateness) as the independent variable and social responsiveness (i.e. the SRS‐2 global score, SCI subscale score, RIRB subscale score) as the dependent variable. Using multiple linear regression analyses, we examined the interaction effect of FHR status on all associations. In the event of a non‐significant interaction, the interaction term was removed, and the models were subsequently adjusted for FHR status. In the event of a significant interaction, we conducted separate linear regression analyses for each FHR group. In all regression models, cluster robust variance estimation was applied to account for clustering at family level. Between‐group differences in the proportion of adolescent offspring rated at a clinically significant level by a teacher or the primary caregiver were ascertained with chi‐square tests. Differences in ToM between adolescent offspring with or without clinically significant social responsiveness impairments were examined with t‐tests. Effect sizes were calculated using Cohen's d (Cohen, 1988). Alpha level was set to .05 for all analyses, and the false discovery rate in the multiple comparisons were calculated for each analysis model according to the Benjamini‐Hochberg procedure with the q‐value set to .05 (Benjamini & Hochberg, 1995). All analyses were conducted using Stata IC software, version 18.0 (StataCorp., 2023).

RESULTS

Sample characteristics

A total of 424 adolescents participated in this study at age 15 (FHR‐SZ, n = 154; FHR‐BP, n = 99; PBC, n = 166), including 12 sibling pairs (FHR‐SZ, n = 12; FHR‐BP, n = 8; PBC, n = 4). The three groups did not differ regarding sex or age. Adolescent offspring at FHR‐SZ or FHR‐BP had a significantly lower level of global functioning compared with PBC, and offspring at FHR‐SZ had a significantly lower level of global functioning than FHR‐BP. Across the three groups, an equal proportion of the primary caregivers who completed SRS‐2 at age 15 were the affected parent with schizophrenia or bipolar disorder or the sex‐matched PBC parent (Table 1, see also Figure S1 for a flowchart of number of participants on each measure at each wave of assessment and Table S2 for demographic and clinical characteristics of offspring participating at age 7 and 11).

TABLE 1.

Demographic and clinical characteristics of the 15‐year‐old offspring at familial high‐risk of schizophrenia or bipolar disorder and population‐based controls.

FHR‐SZ FHR‐BP PBC p‐Value Pairwise comparisons
FHR‐SZ vs. PBC FHR‐BP vs. PBC FHR‐SZ vs. FHR‐BP
p‐Value
Adolescent offspring, N a 154 99 166
Female, N (%) 76 (49.35) 45 (45.45) 79 (47.59) .832 — — —
Age at inclusion, mean (SD) 15.96 (.34) 15.98 (.40) 15.90 (.40) .149 — — —
Level of functioning, mean (SD) b 65.41 (16.60) 70.48 (15.97) 76.78 (13.39) <.001 <.001 <.001 .018
Primary caregiver is index, N (%) c 68 (32.23) 47 (22.27) 96 (45.50) .088 — — —
Open in a new tab

Note: p‐value, significance level p < .05.

Abbreviations: FHR‐BP, Familial high‐risk of bipolar disorder; FHR‐SZ, familial high‐risk of schizophrenia; PBC, population‐based controls.

a

Includes adolescent offspring with data on the Social Responsiveness Scale, Second Edition, or the Animated Triangles Task at age 15.

b

Assessed with the Children's Global Assessment Scale (CGAS), ranging from zero to 100, where higher scores reflect a higher level of general functioning. CGAS scores in this sample range from 33–96 (FHR‐SZ, n = 152; FHR‐BP, n = 98; PBC, n = 163).

c

The index parent is defined as the affected parent with schizophrenia or bipolar disorder or the sex‐matched PBC parent.

Dropout analyses

Dropout analyses revealed that offspring only participating at age 7 had significantly poorer performance on random intentionality (p = .049) and random appropriateness (p = .039) compared with those participating both at age 7 and 15. No significant differences were found on ToM intentionality (p = .767) and ToM appropriateness (p = .659) or the SRS‐2 teacher ratings (global score, p = .174; SCI subscale score, p = .131; RIRB subscale score, p = .555) (Table S3). According to the primary caregivers, offspring only participating at age 11 were rated poorer on the RIRB subscale score (p = .045), but not on the SRS‐2 global score (p = .080) or the SCI subscale score (p = .146), than those participating both at age 11 and 15 (Table S4).

Developmental trajectories of social responsiveness and theory of mind

We observed no time by group interactions on the SRS‐2 teacher ratings or the primary caregiver ratings (Table 2 and Figure 1). Likewise, we found no time by group interactions on any of the ToM outcomes (Table 2 and Figure 2). We observed a main effect of time in the analyses of the SRS‐2 teacher ratings from age 7 to 15 on the global score and the SCI subscale score, but not on the RIRB subscale score. From age 11 to 15, we found a main effect of time on the SCI subscale score, but not on the global score or the RIRB subscale score. Similarly, in the analyses of the SRS‐2 primary caregiver ratings, we found a main effect of time from age 11 to 15 on the SCI subscale score, but not on the global score or the RIRB subscale score. We observed a main effect of time in all analyses of ToM, both from age 7 to 15 and from age 11 to 15 (Table 2).

TABLE 2.

Development from age 7 to 11 to 15 and between‐group differences at age 15 on social responsiveness and theory of mind for offspring at familial high risk of schizophrenia or bipolar disorder and population‐based controls.

FHR‐SZ FHR‐BP PBC Main effect of time, age 7–15 Main effect of time, age 11–15 Main effect of group Pairwise comparisons Time × group interaction
FHR‐SZ vs. PBC FHR‐BP vs. PBC FHR‐SZ vs. FHR‐BP
Mean (95% CI) p‐Value (contrast) p‐Value (contrast) p‐Value p‐Value (d) p‐Value
SRS‐2 teacher ratings
Global score 42.17 (36.68–47.66) 35.32 (28.98–41.67) 27.86 (24.03–31.70) .017 (4.19) .113 (2.50) <.001 <.001 (.57) .048 (.29) .110 (.28) .952
Social Communication and Interaction (SCI) 37.27 (32.67–41.87) 32.17 (26.67–37.67) 25.42 (22.13–28.72) .004 (4.24) .021 (3.09) <.001 <.001 (.56) .039 (.31) .164 (.25) .988
Restricted Interests and Repetitive Behavior (RIRB) 4.86 (3.86–5.86) 3.09 (2.11–4.07) 2.42 (1.77–3.08) .754 (.10) .041 (−.62) <.001 <.001 (.54) .267 (.15) .013 (.39) .445
SRS‐2 primary caregiver ratings
Global score 38.11 (33.60–42.62) 29.17 (24.31–34.04) 23.01 (20.52–25.50) – .164 (1.29) <.001 <.001 (.65) .027 (.33) .008 (.30) .133
Social Communication and Interaction (SCI) 33.14 (29.49–36.79) 25.63 (21.60–29.66) 20.86 (18.72–23.00) – .022 (1.73) <.001 <.001 (.64) .040 (.31) .007 (.31) .207
Restricted Interests and Repetitive Behaviour (RIRB) 4.95 (4.00–5.91) 3.44 (2.48–4.40) 2.14 (1.67–2.60) – .047 (−.44) <.001 <.001 (.61) .016 (.40) .029 (.24) .082
The Animated Triangles Task
ToM intentionality 15.56 (14.97–16.14) 15.38 (14.80–15.96) 15.99 (15.58–16.39) <.001 (3.90) <.001 (1.28) .194 – – – .284
ToM appropriateness 7.64 (7.29–7.99) 7.62 (7.24–7.99) 7.88 (7.59–8.17) <.001 (2.90) <.001 (.83) .445 – – – .596
Random intentionality 2.61 (2.28–2.98) 2.46 (2.01–2.91) 2.31 (2.03–2.59) <.001 (2.70) <.001 (−.92) .379 – – – .975
Random appropriateness 9.61 (9.34–9.88) 9.60 (9.26–9.94) 9.88 (9.64–10.13) <.001 (2.73) <.001 (1.21) .235 – – – .784
Open in a new tab

Note: Between‐group differences at age 7 and 11 have already been presented elsewhere (Christiani et al., 2019; Veddum et al., 2022), but are also available in supplementary material (Tables S4 and S5). p‐Value, significance level p < .026 for SRS‐2 teacher ratings, p < .036 for SRS‐2 primary caregiver ratings, p < .028 for The Animated Triangles Task after correction according to the Benjamini‐Hochberg procedure.

Abbreviations: CI, Confidence Intervals; d, Cohens d; FHR‐BP, Familial high‐risk of bipolar disorder; FHR‐SZ, Familial high‐risk of schizophrenia; PBC, Population‐based controls; SRS‐2, Social Responsiveness Scale, Second Edition; ToM, Theory of mind.

FIGURE 1.

FIGURE 1

Open in a new tab

Development of social responsiveness in offspring at familial high‐risk of schizophrenia or bipolar disorder and population‐based controls from age 7 to 11 to 15 (according to teachers) and from age 11 to 15 (according to primary caregivers). FHR‐BP, familial high‐risk of bipolar disorder; FHR‐SZ¸ familial high‐risk of schizophrenia; PBC, Population‐based controls; RIRB, Restricted Interests and Repetitive Behaviour; SCI, Social Communication and Interaction; SRS‐2, The Social Responsiveness Scale, Second Edition.

FIGURE 2.

FIGURE 2

Open in a new tab

Development of theory of mind in offspring at familial high‐risk of schizophrenia or bipolar disorder and population‐based controls from age 7 to 11 to 15. ToM was assessed with The Animated Triangles Task. For the ToM intentionality, ToM appropriateness, and random appropriateness score a higher score indicates better performance, whereas for the random intentionality score a lower score indicates better performance. FHR‐BP, familial high‐risk of bipolar disorder; FHR‐SZ, familial high‐risk of schizophrenia; PBC, population‐based controls; ToM, Theory of mind.

Between‐group differences in social responsiveness and theory of mind at age 15

We observed a main effect of group in all analyses of social responsiveness. At age 15, offspring at FHR‐SZ had significantly poorer social responsiveness compared with PBC, with medium effect sizes, both according to teachers and primary caregivers. According to primary caregivers, offspring at FHR‐BP had significantly poorer scores on the SRS‐2 global score and the RIRB subscale score compared with PBC, with medium effect sizes, but not on the SCI subscale score. According to teachers, social responsiveness did not differ significantly between offspring at FHR‐BP and PBC. According to primary caregivers, offspring at FHR‐SZ also had significantly poorer social responsiveness than offspring at FHR‐BP, with small effect sizes. According to teachers, offspring at FHR‐SZ had a significantly higher score on the RIRB subscale than offspring at FHR‐BP, but not on the global score or the SCI subscale score (Table 2). Notably though, we identified significant and moderate to strong associations between teacher and primary caregiver ratings on SRS‐2 at age 15 across groups (Table S7). We found no main effect of group on any of the ToM outcomes at age 15 (Table 2). Between‐group differences in social responsiveness and ToM at age 7 and 11 have already been presented elsewhere (Christiani et al., 2019; Veddum et al., 2022), but are also available in Tables S5 and S6.

We found no significant associations between teacher ratings of social responsiveness and ToM at age 15 (Table S8). Similarly, we found no significant associations between primary caregiver ratings of social responsiveness and ToM in offspring at FHR‐BP and PBC at age 15. For offspring at FHR‐SZ, we observed significant associations between primary caregiver ratings of social responsiveness (both the global score and the two subscale scores) and ToM intentionality and ToM appropriateness (p ≤ .004), but not between primary caregiver ratings of social responsiveness and random intentionality or random appropriateness (Table S9). For teacher ratings, we found that ToM intentionality at age 7 significantly predicted the RIRB subscale score at age 15, but only in PBC. For primary caregiver ratings, we observed that ToM appropriateness at age 7 significantly predicted the RIRB subscale score at age 15, but only in PBC. No other significant results were observed in any of the three FHR groups when we examined whether ToM at age 7 or 11 predicted social responsiveness at age 15 (Tables S10–S13).

Clinically significant social responsiveness impairments

At age 15, 27 offspring were rated at a clinically significant level on SRS‐2 according to their teacher (FHR‐SZ, n = 17; FHR‐BP, n = 4, PBC, n = 6) or primary caregiver (FHR‐SZ, n = 19, FHR‐BP, n = 5, PBC, n = 3). Significantly more offspring at FHR‐SZ had clinically significant social responsiveness impairments compared with PBC, both according to teachers and primary caregivers (Figure 3 and Table S14). Additionally, offspring with clinically significant social responsiveness impairments at age 15 displayed poorer performance on ToM appropriateness (n = 31, mean = 6.67, 95% CI: 6.28–7.66) compared with offspring without clinically significant impairments (n = 199, mean = 7.96, 95% CI: 7.71–8.22, p = .005, d = .54). No significant differences were found on ToM intentionality, random intentionality, or random appropriateness between offspring with and without clinically significant social responsiveness impairments at age 15.

FIGURE 3.

FIGURE 3

Open in a new tab

Proportion of offspring at familial high risk of schizophrenia or bipolar disorder and population‐based controls with clinically significant social responsiveness impairments at age 15. p‐Value = significance level p < .025 after correction according to the Benjamini‐Hochberg procedure. 95% confidence intervals: Teacher ratings (FHR‐SZ, 11.41–28.51; FHR‐BP, 2.019–18.21; PBC, 2.15–12.13), Primary caregiver ratings (FHR‐SZ, 8.02–19.57; FHR‐BP, 1.79–12.22; PBC, .38–5.25). FHR‐SZ, familial high‐risk of schizophrenia; FHR‐BP, familial high‐risk of bipolar disorder; PBC, population‐based controls; SRS‐2, The Social Responsiveness Scale, Second Edition.

DISCUSSION

In this longitudinal familial high‐risk study, we found similar development of social responsiveness and ToM from age 7 to 11 to 15 in offspring at FHR‐SZ or FHR‐BP and PBC. More specifically, offspring at FHR‐SZ or FHR‐BP display stable impairments in social responsiveness and intact ToM by age 15 compared with PBC. Moreover, a larger proportion of adolescent offspring at FHR‐SZ display social responsiveness impairments at a clinically significant level than PBC at age 15.

Our results regarding social responsiveness are in line with our hypotheses as well as a previous publication within the same cohort where similar development of social responsiveness and ToM from age 7 to 11 were found across the three groups (Veddum et al., 2022). Additionally, the observed group differences between offspring at FHR‐SZ or FHR‐BP and PBC corresponds to existing studies of adolescents at clinical high‐risk of developing psychosis (Jalbrzikowski et al., 2013), and offspring of parents with bipolar disorder (Whitney et al., 2013). Notably though, results based on data from the same cohort have continuously revealed that offspring at FHR‐BP only exhibit social responsiveness impairments according to primary caregivers, but not according to teachers, whereas offspring at FHR‐SZ exhibit impairments according to both teachers and primary caregivers (Christiani et al., 2019; Veddum et al., 2022). However, at age 11, a significantly larger proportion of offspring at FHR‐BP also displayed social responsiveness impairments at a clinically significant level, which was not the case in the current study at age 15. Additionally, the effect sizes are generally larger in comparisons between offspring at FHR‐SZ and PBC than between FHR‐BP and PBC, indicating more severe social responsiveness impairments in offspring at FHR‐SZ. Thereby, early detection and support for this particular high‐risk group may be crucial in prevention of adverse outcomes. For example, results from a previous study imply that social cognitive training improves social functioning and social cognitive abilities in young individuals at clinical high‐risk of psychosis (Friedman‐Yakoobian et al., 2020). Similarly, integrated psychological interventions, including social skills training, have been found to prevent or delay progression into psychosis in young individuals with prodromal psychotic symptoms (Bechdolf et al., 2012; Nordentoft et al., 2006; van der Gaag et al., 2013). Besides that social impairments are well known to be closely related to schizophrenia and may constitute a vulnerability marker (Healey et al., 2016; Lee et al., 2015; Velthorst et al., 2017), possible explanations of our findings also include that young offspring at FHR‐SZ are more likely to grow up in an inadequate home environment (Krantz et al., 2021) and display more psychopathology and psychotic experiences (Gregersen et al., 2022; Rasic et al., 2013; Uher et al., 2023), which may impact the development of their social abilities. Also, existing stigma towards individuals with schizophrenia may further lead to secondary stigma towards the offspring (Valery & Prouteau, 2020), which could potentially affect the teacher ratings. Already planned studies within the current cohort will hopefully help elucidate the potential influence of the identified social responsiveness impairments on the development of psychopathology, including subclinical psychotic symptoms. Furthermore, future studies should aim at investigating the potential impact of environmental factors such as family distress and secondary stigma on social development in offspring at FHR‐SZ or FHR‐BP.

The primary caregivers within the three groups generally reported the adolescent offspring's social responsiveness to be better than the teachers did, indicating some degree of disagreement, a finding we previously published in Veddum et al. (2022). However, we found significant and moderate to strong associations between teacher and primary caregiver ratings at age 15, which corresponds to results from previous studies of the general population and children with autism (Azad et al., 2016; Constantino & Todd, 2003). Nevertheless, the fact that teachers generally report poorer social responsiveness than primary caregivers may relate to adolescents behaving differently depending on the social and environmental context and the fact that some social behaviours are more prevalent and more or less appropriate in certain social situations (Jepsen et al., 2012; Kanne et al., 2009). Moreover, it is likely that teachers and primary caregivers perceive social difficulties differently. Importantly, the primary caregiver could both be the affected parent with schizophrenia or bipolar disorder and the co‐parent. In the current sample, 32% (n = 68) of the primary caregivers were diagnosed with schizophrenia and 22% (n = 47) were diagnosed with bipolar disorder. We have previously shown that parents with schizophrenia or bipolar disorder and co‐parents to parents with schizophrenia display social responsiveness impairments compared with PBC parents (Veddum, Gregersen, et al., 2023), which may affect their ability to evaluate and recognize impairments in their offspring. Additionally, it was found that parents and their children's social responsiveness abilities were positively and significantly associated (Veddum, Gregersen, et al., 2023), which corresponds to findings from another study of the same cohort revealing moderate to high heritability estimates for social responsiveness (Veddum, Greve, et al., 2023). Importantly, besides the genetic liability, offspring at familial high‐risk of schizophrenia or bipolar disorder are more likely to grow up in an inadequate home environment (Krantz et al., 2021), experience more childhood trauma (Brandt et al., 2022) as well as a higher level of parental expressed emotion (Rohd et al., 2025). Future studies are warranted in order to determine the possible effect of such environmental factors on the social responsiveness impairments observed in offspring at FHR‐SZ or FHR‐BP.

Contrary to our expectations, offspring at FHR‐SZ or FHR‐BP display intact ToM at age 15 and normal ToM development from childhood to adolescence relative to PBC. Previously, we speculated that ToM deficits associated with schizophrenia and bipolar disorder may first emerge later during development, especially given the important developmental characteristics of adolescence (Blakemore, 2008; Burnett et al., 2011; Patel et al., 2021; Rowland & Marwaha, 2018). However, our results revealed a significant improvement in ToM from childhood to adolescence, but also that the offspring have now reached a developmental stage close to that of healthy adults (Castelli et al., 2000, 2002). This suggests preserved ToM abilities in adolescents at FHR‐SZ or FHR‐BP, which may even serve as a protective factor. However, our results contradict existing meta‐analytic evidence of ToM impairments in adult first‐degree relatives of individuals with schizophrenia or bipolar disorder (Bora & Pantelis, 2013; Bora & Özerdem, 2017; Tucci et al., 2023), and a previous study of offspring of mothers with schizophrenia (Maróthi & Kéri, 2014). Importantly though, task‐related properties should be taken into consideration in the interpretation of our results. Although the Animated Triangles Task is considered a reliable tool for assessing ToM (Moessnang et al., 2020; Schurz et al., 2014), it has recently been suggested that it is not able to detect subtle deficits, which is what we would expect to find in our study (Wilson, 2021). For example, results from a psychometric investigation did not identify the expected differences in ToM between adolescents from the general population with and without autism (Andersen et al., 2022). Similarly, although most previous studies using the same or similar ToM tasks entailing animated shapes have found ToM deficits in individuals with schizophrenia (Blakemore et al., 2003; Bliksted et al., 2019; Martinez et al., 2019; Pedersen et al., 2012), one study did not detect any differences between adolescent patients with early psychosis and controls (Fett et al., 2015). Taken together, this emphasizes that future studies should aim at investigating ToM in young offspring at familial high‐risk by applying other and more age‐appropriate ToM tasks. It is also possible that our results are influenced by dropout as offspring participating only at age 7 had poorer scores on random intentionality and random appropriateness compared with offspring participating both at age 7 and 15. Interestingly, poorer performance on the random animations indicates a tendency towards hyper‐mentalizing (i.e. over‐interpretation of social cues), which has been suggested to play an important role in risk trajectories of developing psychosis (Clemmensen et al., 2014, 2016).

The results from supplementary analyses regarding that primary caregiver ratings of social responsiveness and ToM are significantly associated in offspring at FHR‐SZ at age 15 correspond to existing literature suggesting that ToM is a predictor of functional outcomes in schizophrenia (Fett et al., 2011; Halverson et al., 2019; Lemmers‐Jansen et al., 2023). Surprisingly though, our supplementary analyses of whether ToM at age 7 or 11 predict social responsiveness at age 15 only showed that ToM at age 7 predicts the RIRB subscale score in PBC at age 15, which thus corresponds to a recent study of children with autism (Mao et al., 2023).

The findings from the current study should be interpreted in the light of some limitations. As already discussed, offspring lost to dropout performed worse on the random animations at age 7, which may have influenced our opportunity to detect group differences in ToM at age 15. Moreover, the psychometric properties of the applied ToM measure may have an impact on the validity of our findings. Nevertheless, this task allowed for developmental investigation as the same version can be applied longitudinally from childhood to adolescence and adulthood (Wilson, 2021). However, important strengths of our study include the large sample size, high retention rates, and application of the same measurements across assessments, which strengthen the reliability of our results. Additionally, the inclusion of same‐aged offspring at FHR‐SZ or FHR‐BP and a matched PBC group ensures that our results are unlikely to be influenced by age‐related differences.

CONCLUSION

Conclusively, we identified similar developmental trajectories in social responsiveness and ToM in offspring at FHR‐SZ or FHR‐BP and PBC from age 7 to 11 to age 15. We found stable impairments in social responsiveness throughout development in offspring at FHR‐SZ or FHR‐BP, indicating that social responsiveness impairments may be a potential vulnerability marker. Additionally, a significantly larger proportion of adolescent offspring at FHR‐SZ displayed social responsiveness impairments at a clinically significant level relative to PBC, suggesting that these offspring may constitute a particularly vulnerable subgroup. This knowledge is important in order to improve early detection of particularly vulnerable children and can potentially guide development of preventative interventions. Further, our findings suggest normal ToM development in both FHR groups, although we acknowledge that future studies using well‐validated and age‐appropriate ToM tasks efficient in detecting subtle deficits are needed to clarify the developmental trajectories of ToM in offspring at familial high‐risk of schizophrenia or bipolar disorder. To the best of our knowledge, we are the first to assess developmental trajectories of social abilities in a cohort comprising same‐aged offspring at FHR‐SZ or FHR‐BP and PBC. Therefore, additional studies are required in order to validate our findings. Moreover, future studies should aim at investigating the long‐term impact of the identified social responsiveness impairments in offspring at FHR‐SZ or FHR‐BP.

AUTHOR CONTRIBUTIONS

Lotte Veddum: Conceptualization; writing – original draft; methodology; visualization; formal analysis. Andreas Færgemand Laursen: Investigation; writing – review and editing. Anette Faurskov Bundgaard: Investigation; writing – review and editing. Nicoline Hemager: Funding acquisition; writing – review and editing; project administration. Maja Gregersen: Writing – review and editing. Mette Falkenberg Krantz: Writing – review and editing. Anja Vaskinn: Writing – review and editing. Jens Richardt Møllegaard Jepsen: Writing – review and editing. Anne Søndergaard: Writing – review and editing. Sinnika Birkehøj Rohd: Investigation; writing – review and editing. Martin Wilms: Writing – review and editing. Marta Schiavon: Investigation; writing – review and editing. Doris Helena Bjarnadóttir Streymá: Investigation; writing – review and editing. Anne Amalie Elgaard Thorup: Funding acquisition; project administration; writing – review and editing. Merete Nordentoft: Funding acquisition; writing – review and editing; project administration. Ole Mors: Funding acquisition; writing – review and editing; project administration. Aja Neergaard Greve: Conceptualization; funding acquisition; writing – review and editing; project administration; supervision.

CONFLICT OF INTEREST STATEMENT

All contributing authors declare that they have no conflicts of interest to disclose.

ETHICS STATEMENT

Prior to participation, the participants received thorough oral and written information about the study, and before enrolment, oral consent was obtained from the offspring, and written consent was obtained from the legal guardians. Formal approval of the VIA 15 study was obtained from The National Committee on Health and Research Ethics (ref. H‐20067908) and The Danish Data Protection Agency (ref. P‐2019‐273).

Supporting information

Table S1

BJC-65-1075-s001.docx (122.3KB, docx)

ACKNOWLEDGEMENTS

The authors would like to express their gratitude to all the families participating in The Danish High Risk and Resilience Study—VIA; to M. Birk, N. L. Steffensen, C. S. Nielsen, S. B. Christensen, M. Nymand and M. Enevoldsen for contributing to the data collection in the VIA 15 study, to K. K. Roager for transcription and rating of data from The Animated Triangles Task from the VIA 15 study; and to A. H. Callesen for statistic support. The VIA 7 study was supported by The Lundbeck Foundation (ref. R102‐A9118); The TRYG Foundation, The Capital Region of Denmark, The Mental Health Services in the Capital Region of Denmark; Aarhus University Hospital—Psychiatry, Central Denmark Region. The VIA 11 study was supported by The Lundbeck Foundation (ref. R155‐2014‐1724); The Innovation Fund Denmark (ref. 6152‐00002B); The Beatrice Surovell Haskell Fund for Child Mental Health Research of Copenhagen, Denmark (ref. 11531); The Independent Research Fund Denmark (ref. 9039‐00220B); The Capital Region of Denmark, The Mental Health Services in the Capital Region of Denmark; Aarhus University Hospital—Psychiatry, Central Denmark Region. The VIA 15 study was supported by the Lundbeck Foundation, Denmark (ref. R277‐2018‐594); The Novo Nordic Foundation, Denmark (ref. NNF20OC0060468); Mental Health Services in the Capital Region of Denmark; and the Central Region of Denmark. The study sponsors solely provided financial support and had no additional involvement in the study design, data collection, or preparation of this manuscript.

DATA AVAILABILITY STATEMENT

The participants included in this study did not give consent for their data to be shared publicly. Therefore, and due to the sensitive nature of the research and the General Data Protection Regulation policy, the data are not publicly available. Data sharing may be possible upon request to the corresponding author.

REFERENCES

  1. Abell, F. , Happé, F. , & Frith, U. (2000). Do triangles play tricks? Attribution of mental states to animated shapes in normal and abnormal development. Cognitive Development, 15(1), 1–16. 10.1016/S0885-2014(00)00014-9 [DOI] [Google Scholar]
  2. Andersen, N. K. , Rimvall, M. K. , Jeppesen, P. , Bentz, M. , Jepsen, J. R. M. , Clemmensen, L. , Jacobsen, R. K. , & Olsen, E. M. (2022). A psychometric investigation of the multiple‐choice version of animated triangles task to measure theory of mind in adolescence. PLoS One, 17(3), e0264319. 10.1371/journal.pone.0264319 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Azad, G. , Reisinger, E. , Xie, M. , & Mandell, D. S. (2016). Parent and teacher concordance on the social responsiveness scale for children with autism. School Mental Health, 8(3), 368–376. 10.1007/s12310-015-9168-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bechdolf, A. , Wagner, M. , Ruhrmann, S. , Harrigan, S. , Putzfeld, V. , Pukrop, R. , Brockhaus‐Dumke, A. , Berning, J. , Janssen, B. , Decker, P. , Bottlender, R. , Maurer, K. , Möller, H. J. , Gaebel, W. , Häfner, H. , Maier, W. , & Klosterkötter, J. (2012). Preventing progression to first‐episode psychosis in early initial prodromal states. British Journal of Psychiatry, 200(1), 22–29. 10.1192/bjp.bp.109.066357 [DOI] [PubMed] [Google Scholar]
  5. Benjamini, Y. , & Hochberg, Y. (1995). Controlling the false discovery rate ‐ A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, Series B (Statistical Methodology), 57, 289–300. 10.2307/2346101 [DOI] [Google Scholar]
  6. Blakemore, S. J. , Sarfati, Y. , Bazin, N. , & Decety, J. (2003). The detection of intentional contingencies in simple animations in patients with delusions of persecution. Psychological Medicine, 33(8), 1433–1441. 10.1017/s0033291703008341 [DOI] [PubMed] [Google Scholar]
  7. Blakemore, S.‐J. (2008). The social brain in adolescence. Nature Reviews Neuroscience, 9(4), 267–277. 10.1038/nrn2353 [DOI] [PubMed] [Google Scholar]
  8. Bliksted, V. , Frith, C. , Videbech, P. , Fagerlund, B. , Emborg, C. , Simonsen, A. , Roepstorff, A. , & Campbell‐Meiklejohn, D. (2019). Hyper‐ and hypomentalizing in patients with first‐episode schizophrenia: fMRI and behavioral studies. Schizophrenia Bulletin, 45(2), 377–385. 10.1093/schbul/sby027 [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bora, E. , Bartholomeusz, C. , & Pantelis, C. (2016). Meta‐analysis of theory of mind (ToM) impairment in bipolar disorder. Psychological Medicine, 46(2), 253–264. 10.1017/S0033291715001993 [DOI] [PubMed] [Google Scholar]
  10. Bora, E. , & Özerdem, A. (2017). Social cognition in first‐degree relatives of patients with bipolar disorder: A meta‐analysis. European Neuropsychopharmacology, 27(4), 293–300. 10.1016/j.euroneuro.2017.02.009 [DOI] [PubMed] [Google Scholar]
  11. Bora, E. , & Pantelis, C. (2013). Theory of mind impairments in first‐episode psychosis, individuals at ultra‐high risk for psychosis and in first‐degree relatives of schizophrenia: Systematic review and meta‐analysis. Schizophrenia Research, 144(1), 31–36. 10.1016/j.schres.2012.12.013 [DOI] [PubMed] [Google Scholar]
  12. Bora, E. , & Pantelis, C. (2016). Social cognition in schizophrenia in comparison to bipolar disorder: A meta‐analysis. Schizophrenia Research, 175(1–3), 72–78. 10.1016/j.schres.2016.04.018 [DOI] [PubMed] [Google Scholar]
  13. Brandt, J. M. , Hemager, N. , Gregersen, M. , Søndergaard, A. , Falkenberg Krantz, M. , Ohland, J. , Wilms, M. , Birkehøj Rohd, S. , Hjorthøj, C. , Veddum, L. , Bruun Knudsen, C. , Krogh Andreassen, A. , Greve, A. , Spang, K. S. , Christiani, C. A. , Ellersgaard, D. , Klee Burton, B. , Gantriis, D. L. , Bliksted, V. , … Elgaard Thorup, A. A. (2022). Childhood trauma in children at familial high risk of schizophrenia or bipolar disorder: A longitudinal study. The Danish High Risk and Resilience Study – VIA 7 and VIA 11. British Journal of Clinical Psychology, 61(4), 875–894. 10.1111/bjc.12364 [DOI] [PubMed] [Google Scholar]
  14. Burnett, S. , Sebastian, C. , Cohen, K. K. , & Blakemore, S. (2011). The social brain in adolescence: Evidence from functional magnetic resonance imaging and behavioural studies. Neuroscience and Biobehavioral Reviews, 35(8), 1654–1664. 10.1016/j.neubiorev.2010.10.011 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Castelli, F. , Frith, C. , Happé, F. , & Frith, U. (2002). Autism, Asperger syndrome and brain mechanisms for the attribution of mental states to animated shapes. Brain: A Journal of Neurology, 125(Pt 8), 1839–1849. 10.1093/brain/awf189 [DOI] [PubMed] [Google Scholar]
  16. Castelli, F. , Happé, F. , Frith, C. , & Frith, U. (2000). Movement and mind: A functional imaging study of perception and interpretation of complex intentional movement patterns. Neuroimage, 12(3), 314–325. 10.1006/nimg.2000.0612 [DOI] [PubMed] [Google Scholar]
  17. Christiani, C. J. , Jepsen, J. R. M. , Thorup, A. , Hemager, N. , Ellersgaard, D. , Spang, K. S. , Burton, B. K. , Gregersen, M. , Søndergaard, A. , Greve, A. N. , Gantriis, D. L. , Poulsen, G. , Uddin, M. J. , Seidman, L. J. , Mors, O. , Plessen, K. J. , & Nordentoft, M. (2019). Social cognition, language, and social behavior in 7‐year‐old children at familial high‐risk of developing schizophrenia or bipolar disorder: The Danish high risk and resilience study VIA 7—A population‐based cohort study. Schizophrenia Bulletin, 45(6), 1218–1230. 10.1093/schbul/sbz001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Clemmensen, L. , van Os, J. , Drukker, M. , Munkholm, A. , Rimvall, M. K. , Væver, M. , Rask, C. U. , Bartels‐Velthuis, A. A. , Skovgaard, A. M. , & Jeppesen, P. (2016). Psychotic experiences and hyper‐theory‐of‐mind in preadolescence—A birth cohort study. Psychological Medicine, 46(1), 87–101. 10.1017/S0033291715001567 [DOI] [PubMed] [Google Scholar]
  19. Clemmensen, L. , van Os, J. , Skovgaard, A. M. , Væver, M. , Blijd‐Hoogewys, E. M. A. , Bartels‐Velthuis, A. A. , & Jeppesen, P. (2014). Hyper‐theory‐of‐mind in children with psychotic experiences. PLoS One, 9(11), 10. 10.1371/journal.pone.0113082 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Routledge Academic. [Google Scholar]
  21. Constantino, J. N. (2011). The quantitative nature of autistic social impairment. Pediatric Research, 69(5 Pt 2), 55R–62R. 10.1203/PDR.0b013e318212ec6e [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Constantino, J. N. , & Gruber, C. P. (2012). Social responsiveness scale–second edition (SRS‐2). Western Psychological Services. [Google Scholar]
  23. Constantino, J. N. , Przybeck, T. , Friesen, D. , & Todd, R. D. (2000). Reciprocal social behavior in children with and without pervasive developmental disorders. Journal of Developmental and Behavioral Pediatrics, 21(1), 2–11. 10.1097/00004703-200002000-00002 [DOI] [PubMed] [Google Scholar]
  24. Constantino, J. N. , & Todd, R. D. (2003). Autistic traits in the general population: A twin study. Archives of General Psychiatry, 60(5), 524–530. 10.1001/archpsyc.60.5.524 [DOI] [PubMed] [Google Scholar]
  25. Fett, A.‐K. J. , González Berdugo, C. I. , Hanssen, E. , Lemmers‐Jansen, I. , Shergill, S. S. , & Krabbendam, L. (2015). I spy with my little eye – The detection of intentional contingency in early psychosis. Cognitive Neuropsychiatry, 20(6), 473–481. 10.1080/13546805.2015.1088824 [DOI] [PubMed] [Google Scholar]
  26. Fett, A.‐K. J. , Viechtbauer, W. , Dominguez, M.‐d.‐G. , Penn, D. L. , van Os, J. , & Krabbendam, L. (2011). The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: A meta‐analysis. Neuroscience and Biobehavioral Reviews, 35(3), 573–588. 10.1016/j.neubiorev.2010.07.001 [DOI] [PubMed] [Google Scholar]
  27. Frazier, T. W. , Ratliff, K. R. , Gruber, C. , Zhang, Y. , Law, P. A. , & Constantino, J. N. (2014). Confirmatory factor analytic structure and measurement invariance of quantitative autistic traits measured by the social responsiveness scale‐2. Autism, 18(1), 31–44. 10.1177/1362361313500382 [DOI] [PubMed] [Google Scholar]
  28. Friedman‐Yakoobian, M. S. , Parrish, E. M. , Eack, S. M. , & Keshavan, M. S. (2020). Neurocognitive and social cognitive training for youth at clinical high risk (CHR) for psychosis: A randomized controlled feasibility trial. Schizophrenia Research, 243, 302–306. 10.1016/j.schres.2020.09.005 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Frith, C. D. , & Frith, U. (2011). Mechanisms of social cognition. Annual Review of Psychology, 63(1), 287–313. 10.1146/annurev-psych-120710-100449 [DOI] [PubMed] [Google Scholar]
  30. Gillissie, E. S. , Lui, L. M. W. , Ceban, F. , Miskowiak, K. , Gok, S. , Cao, B. , Teopiz, K. M. , Ho, R. , Lee, Y. , Rosenblat, J. D. , & McIntyre, R. S. (2022). Deficits of social cognition in bipolar disorder: Systematic review and meta‐analysis. Bipolar Disorders, 24(2), 137–148. 10.1111/bdi.13163 [DOI] [PubMed] [Google Scholar]
  31. Green, M. F. , Penn, D. L. , Bentall, R. , Carpenter, W. T. , Gaebel, W. , Gur, R. C. , Kring, A. M. , Park, S. , Silverstein, S. M. , & Heinssen, R. (2008). Social cognition in schizophrenia: An NIMH workshop on definitions, assessment, and research opportunities. Schizophrenia Bulletin, 34(6), 1211–1220. 10.1093/schbul/sbm145 [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Gregersen, M. , Møllegaard Jepsen, J. R. , Rohd, S. B. , Søndergaard, A. , Brandt, J. M. , Ellersgaard, D. , Hjorthøj, C. , Ohland, J. , Krantz, M. F. , Wilms, M. , Andreassen, A. K. , Veddum, L. , Knudsen, C. B. , Greve, A. N. , Bliksted, V. , Mors, O. , Clemmensen, L. , Nordentoft, M. , Hemager, N. , & Elgaard Thorup, A. A. (2022). Developmental pathways and clinical outcomes of early childhood psychotic experiences in preadolescent children at familial high risk of schizophrenia or bipolar disorder: A prospective, longitudinal cohort study ‐ the Danish high risk and resilience study, VIA 11. The American Journal of Psychiatry, 179(9), 628–639. 10.1176/appi.ajp.21101076 [DOI] [PubMed] [Google Scholar]
  33. Grund, S. , Lüdtke, O. , & Robitzsch, A. (2019). Missing data in multilevel research. In The handbook of multilevel theory, measurement, and analysis (pp. 365–386). American Psychological Association. 10.1037/0000115-017 [DOI] [Google Scholar]
  34. Halverson, T. F. , Orleans‐Pobee, M. , Merritt, C. , Sheeran, P. , Fett, A.‐K. , & Penn, D. L. (2019). Pathways to functional outcomes in schizophrenia spectrum disorders: Meta‐analysis of social cognitive and neurocognitive predictors. Neuroscience & Biobehavioral Reviews, 105, 212–219. 10.1016/j.neubiorev.2019.07.020 [DOI] [PubMed] [Google Scholar]
  35. Healey, K. M. , Bartholomeusz, C. F. , & Penn, D. L. (2016). Deficits in social cognition in first episode psychosis: A review of the literature. Clinical Psychology Review, 50, 108–137. 10.1016/j.cpr.2016.10.001 [DOI] [PubMed] [Google Scholar]
  36. Hus, V. , Bishop, S. , Gotham, K. , Huerta, M. , & Lord, C. (2013). Factors influencing scores on the social responsiveness scale. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 54(2), 216–224. 10.1111/j.1469-7610.2012.02589.x [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Jalbrzikowski, M. , Krasileva, K. E. , Marvin, S. , Zinberg, J. , Andaya, A. , Bachman, P. , Cannon, T. D. , & Bearden, C. E. (2013). Reciprocal social behavior in youths with psychotic illness and those at clinical high risk. Development and Psychopathology, 25(4 Pt 1), 1187–1197. 10.1017/S095457941300045X [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Jepsen, M. I. , Gray, K. M. , & Taffe, J. R. (2012). Agreement in multi‐informant assessment of behaviour and emotional problems and social functioning in adolescents with autistic and Asperger's disorder. Research in Autism Spectrum Disorders, 6(3), 1091–1098. 10.1016/j.rasd.2012.02.008 [DOI] [Google Scholar]
  39. Kanne, S. M. , Abbacchi, A. M. , & Constantino, J. N. (2009). Multi‐informant ratings of psychiatric symptom severity in children with autism spectrum disorders: The importance of environmental context. Journal of Autism and Developmental Disorders, 39(6), 856–864. 10.1007/s10803-009-0694-7 [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Krantz, M. F. , Hjorthøj, C. , Brandt, J. M. , Prøsch, Å. K. , Rohd, S. B. , Wilms, M. , Veddum, L. , Steffensen, N. L. , Knudsen, C. B. , Andreasen, A. K. , Stadsgaard, H. , Hemager, N. , Burton, B. K. , Gregersen, M. , Søndergaard, A. , Greve, A. , Gantriis, D. L. , Melau, M. , Ohland, J. , … Nordentoft, M. (2021). Home environment of 11‐year‐old children born to parents with schizophrenia or bipolar disorder – A controlled, 4‐year follow‐up study: The Danish High Risk and Resilience Study – VIA 11. Psychological Medicine, 53, 1–11. 10.1017/S0033291721004487 [DOI] [PubMed] [Google Scholar]
  41. Lee, T. Y. , Hong, S. B. , Shin, N. Y. , & Kwon, J. S. (2015). Social cognitive functioning in prodromal psychosis: A meta‐analysis. Schizophrenia Research, 164(1–3), 28–34. 10.1016/j.schres.2015.02.008 [DOI] [PubMed] [Google Scholar]
  42. Lemmers‐Jansen, I. , Velthorst, E. , & Fett, A. K. (2023). The social cognitive and neural mechanisms that underlie social functioning in individuals with schizophrenia – A review. Translational Psychiatry, 13(1), 327. 10.1038/s41398-023-02593-1 [DOI] [PMC free article] [PubMed] [Google Scholar]
  43. Lewandowski, K. E. , Pinkham, A. E. , & Van Rheenen, T. E. (2024). Social cognition across the schizophrenia–bipolar disorder spectrum. Nature Reviews Psychology, 3(2), 91–107. 10.1038/s44159-023-00269-7 [DOI] [Google Scholar]
  44. Mao, S.‐Y. , Chiu, H. M. , Yu, Y.‐T. , & Chen, K.‐L. (2023). The associations of theory of mind with both general and theory‐of‐mind‐related social interaction in children with autism spectrum disorder. Research in Autism Spectrum Disorders, 102, 102107. 10.1016/j.rasd.2023.102107 [DOI] [Google Scholar]
  45. Maróthi, R. , & Kéri, S. (2014). Intuitive physics and intuitive psychology (“theory of mind”) in offspring of mothers with psychoses. PeerJ, 2, e330. 10.7717/peerj.330 [DOI] [PMC free article] [PubMed] [Google Scholar]
  46. Martinez, G. , Mosconi, E. , Daban‐Huard, C. , Parellada, M. , Fananas, L. , Gaillard, R. , Fatjo‐Vilas, M. , Krebs, M.‐O. , & Amado, I. (2019). “A circle and a triangle dancing together”: Alteration of social cognition in schizophrenia compared to autism spectrum disorders. Schizophrenia Research, 210, 94–100. 10.1016/j.schres.2019.05.043 [DOI] [PubMed] [Google Scholar]
  47. Matsuo, J. , Kamio, Y. , Takahashi, H. , Ota, M. , Teraishi, T. , Hori, H. , Nagashima, A. , Takei, R. , Higuchi, T. , Motohashi, N. , & Kunugi, H. (2015). Autistic‐like traits in adult patients with mood disorders and schizophrenia. PLoS One, 10(4), e0122711. 10.1371/journal.pone.0122711 [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Mennigen, E. , & Bearden, C. E. (2020). Psychosis risk and development: What do we know from population‐based studies? Biological Psychiatry, 88(4), 315–325. 10.1016/j.biopsych.2019.12.014 [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Moessnang, C. , Baumeister, S. , Tillmann, J. , Goyard, D. , Charman, T. , Ambrosino, S. , Baron‐Cohen, S. , Beckmann, C. , Bölte, S. , Bours, C. , Crawley, D. , Dell'Acqua, F. , Durston, S. , Ecker, C. , Frouin, V. , Hayward, H. , Holt, R. , Johnson, M. , Jones, E. , … EU‐AIMS LEAP Group . (2020). Social brain activation during mentalizing in a large autism cohort: The Longitudinal European Autism Project. Molecular Autism, 11(1), 17. 10.1186/s13229-020-0317-x [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Mors, O. , Perto, G. P. , & Mortensen, P. B. (2011). The Danish Psychiatric Central Research Register. Scandinavian Journal of Public Health, 39(7 Suppl), 54–57. 10.1177/1403494810395825 [DOI] [PubMed] [Google Scholar]
  51. Nordentoft, M. , Thorup, A. , Petersen, L. , Ohlenschlaeger, J. , Melau, M. , Christensen, T. , Krarup, G. , Jørgensen, P. , & Jeppesen, P. (2006). Transition rates from schizotypal disorder to psychotic disorder for first‐contact patients included in the OPUS trial. A randomized clinical trial of integrated treatment and standard treatment. Schizophrenia Research, 83(1), 29–40. 10.1016/j.schres.2006.01.002 [DOI] [PubMed] [Google Scholar]
  52. Patel, P. K. , Leathem, L. D. , Currin, D. L. , & Karlsgodt, K. H. (2021). Adolescent neurodevelopment and vulnerability to psychosis. Biological Psychiatry, 89(2), 184–193. 10.1016/j.biopsych.2020.06.028 [DOI] [PMC free article] [PubMed] [Google Scholar]
  53. Pedersen, A. , Koelkebeck, K. , Brandt, M. , Wee, M. , Kueppers, K. A. , Kugel, H. , Kohl, W. , Bauer, J. , & Ohrmann, P. (2012). Theory of mind in patients with schizophrenia: Is mentalizing delayed? Schizophrenia Research, 137(1), 224–229. 10.1016/j.schres.2012.02.022 [DOI] [PubMed] [Google Scholar]
  54. Pedersen, C. B. , Gøtzsche, H. , Møller, J. O. , & Mortensen, P. B. (2006). The Danish Civil Registration System. A cohort of eight million persons. Danish Medical Bulletin, 53(4), 441–449. [PubMed] [Google Scholar]
  55. Rasic, D. , Hajek, T. , Alda, M. , & Uher, R. (2013). Risk of mental illness in offspring of parents with schizophrenia, bipolar disorder, and major depressive disorder: A meta‐analysis of family high‐risk studies. Schizophrenia Bulletin, 40(1), 28–38. 10.1093/schbul/sbt114 [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Rohd, S. B. , Hemager, N. , Gregersen, M. , Brandt, J. M. , Søndergaard, A. , Krantz, M. F. , Ohland, J. , Hjorthøj, C. , Veddum, L. , Andreassen, A. K. , Knudsen, C. B. , Greve, A. , Mors, O. , Nordentoft, M. , & Thorup, A. A. E. (2025). Expressed emotion of caregivers to children at familial high risk of schizophrenia or bipolar disorder: The Danish High Risk and Resilience Study – VIA 11. British Journal of Psychology, 116(3), 702–718. 10.1111/bjop.12788 [DOI] [PubMed] [Google Scholar]
  57. Rowland, T. A. , & Marwaha, S. (2018). Epidemiology and risk factors for bipolar disorder. Therapeutic Advances in Psychopharmacology, 8(9), 251–269. 10.1177/2045125318769235 [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. Samamé, C. (2013). Social cognition throughout the three phases of bipolar disorder: A state‐of‐the‐art overview. Psychiatry Research, 210(3), 1275–1286. 10.1016/j.psychres.2013.08.012 [DOI] [PubMed] [Google Scholar]
  59. Savla, G. N. , Vella, L. , Armstrong, C. C. , Penn, D. L. , & Twamley, E. W. (2013). Deficits in domains of social cognition in schizophrenia: A meta‐analysis of the empirical evidence. Schizophrenia Bulletin, 39(5), 979–992. 10.1093/schbul/sbs080 [DOI] [PMC free article] [PubMed] [Google Scholar]
  60. Schurz, M. , Radua, J. , Aichhorn, M. , Richlan, F. , & Perner, J. (2014). Fractionating theory of mind: A meta‐analysis of functional brain imaging studies. Neuroscience & Biobehavioral Reviews, 42, 9–34. 10.1016/j.neubiorev.2014.01.009 [DOI] [PubMed] [Google Scholar]
  61. Shaffer, D. , Gould, M. S. , Brasic, J. , Ambrosini, P. , Fisher, P. , Bird, H. , & Aluwahlia, S. (1983). A Children's Global Assessment Scale (CGAS). Archives of General Psychiatry, 40(11), 1228–1231. 10.1001/archpsyc.1983.01790100074010 [DOI] [PubMed] [Google Scholar]
  62. Sprong, M. , Schothorst, P. , Vos, E. , Hox, J. , & Van Engeland, H. (2007). Theory of mind in schizophrenia: Meta‐analysis. British Journal of Psychiatry, 191(1), 5. 10.1192/bjp.bp.107.035899 [DOI] [PubMed] [Google Scholar]
  63. StataCorp . (2023). Stata statistical software: Release 18. StataCorp LLC. [Google Scholar]
  64. Thorup, A. A. E. , Hemager, N. , Bliksted, V. F. , Greve, A. N. , Ohland, J. , Wilms, M. , Rohd, S. B. , Birk, M. , Bundgaard, A. F. , Laursen, A. F. , Jefsen, O. H. , Steffensen, N. L. , Andreassen, A. K. , Veddum, L. , Knudsen, C. B. , Enevoldsen, M. , Nymand, M. , Brandt, J. M. , Søndergaard, A. , … Nordentoft, M. (2022). The Danish high‐risk and resilience study—VIA 15 – A study protocol for the third clinical assessment of a cohort of 522 children born to parents diagnosed with schizophrenia or bipolar disorder and population‐based controls [study protocol]. Frontiers in Psychiatry, 13, 809807. 10.3389/fpsyt.2022.809807 [DOI] [PMC free article] [PubMed] [Google Scholar]
  65. Thorup, A. A. E. , Hemager, N. , Søndergaard, A. , Gregersen, M. , Prøsch, Å. K. , Krantz, M. F. , Brandt, J. M. , Carmichael, L. , Melau, M. , Ellersgaard, D. V. , Burton, B. K. , Greve, A. N. , Uddin, M. J. , Ohland, J. , Nejad, A. B. , Johnsen, L. K. , Ver Loren van Themaat, A. H. , Andreassen, A. K. , Vedum, L. , … Nordentoft, M. (2018). The Danish High Risk and Resilience Study—VIA 11: Study protocol for the first follow‐up of the VIA 7 cohort −522 children born to parents with schizophrenia spectrum disorders or bipolar disorder and controls being re‐examined for the first time at age 11. Frontiers in Psychiatry, 9, 661. 10.3389/fpsyt.2018.00661 [DOI] [PMC free article] [PubMed] [Google Scholar]
  66. Thorup, A. A. E. , Jepsen, J. R. , Ellersgaard, D. V. , Burton, B. K. , Christiani, C. J. , Hemager, N. , Skjærbæk, M. , Ranning, A. , Spang, K. S. , Gantriis, D. L. , Greve, A. N. , Zahle, K. K. , Mors, O. , Plessen, K. J. , & Nordentoft, M. (2015). The Danish high risk and resilience study‐‐VIA 7 – A cohort study of 520 7‐year‐old children born of parents diagnosed with either schizophrenia, bipolar disorder or neither of these two mental disorders. BMC Psychiatry, 15(1), 233. 10.1186/s12888-015-0616-5 [DOI] [PMC free article] [PubMed] [Google Scholar]
  67. Tucci, A. A. , Schroeder, A. , Noël, C. , Shvetz, C. , Yee, J. , Howard, A. L. , Keshavan, M. S. , & Guimond, S. (2023). Social cognition in youth with a first‐degree relative with schizophrenia: A systematic scoping review. Psychiatry Research, 323, 115173. 10.1016/j.psychres.2023.115173 [DOI] [PubMed] [Google Scholar]
  68. Uher, R. , Pavlova, B. , Radua, J. , Provenzani, U. , Najafi, S. , Fortea, L. , Ortuño, M. , Nazarova, A. , Perroud, N. , Palaniyappan, L. , Domschke, K. , Cortese, S. , Arnold, P. D. , Austin, J. C. , Vanyukov, M. M. , Weissman, M. M. , Young, A. H. , Hillegers, M. H. J. , Danese, A. , … Fusar‐Poli, P. (2023). Transdiagnostic risk of mental disorders in offspring of affected parents: A meta‐analysis of family high‐risk and registry studies. World Psychiatry, 22(3), 433–448. 10.1002/wps.21147 [DOI] [PMC free article] [PubMed] [Google Scholar]
  69. Valery, K.‐M. , & Prouteau, A. (2020). Schizophrenia stigma in mental health professionals and associated factors: A systematic review. Psychiatry Research, 290, 113068. 10.1016/j.psychres.2020.113068 [DOI] [PubMed] [Google Scholar]
  70. van der Gaag, M. , Smit, F. , Bechdolf, A. , French, P. , Linszen, D. H. , Yung, A. R. , McGorry, P. , & Cuijpers, P. (2013). Preventing a first episode of psychosis: Meta‐analysis of randomized controlled prevention trials of 12month and longer‐term follow‐ups. Schizophrenia Research, 149(1), 56–62. 10.1016/j.schres.2013.07.004 [DOI] [PubMed] [Google Scholar]
  71. van Neerven, T. , Bos, D. J. , & van Haren, N. E. M. (2021). Deficiencies in theory of mind in patients with schizophrenia, bipolar disorder, and major depressive disorder: A systematic review of secondary literature. Neuroscience & Biobehavioral Reviews, 120, 249–261. 10.1016/j.neubiorev.2020.11.011 [DOI] [PubMed] [Google Scholar]
  72. Veddum, L. , Gregersen, M. , Andreassen, A. K. , Knudsen, C. B. , Brandt, J. M. , Krantz, M. F. , Søndergaard, A. , Burton, B. K. , Jepsen, J. R. M. , Hemager, N. , Thorup, A. A. E. , Nordentoft, M. , Mors, O. , Bliksted, V. , & Greve, A. N. (2023). Social responsiveness in families with parental schizophrenia or bipolar disorder – The Danish high risk and resilience study. Psychiatry Research, 323, 115140. 10.1016/j.psychres.2023.115140 [DOI] [PubMed] [Google Scholar]
  73. Veddum, L. , Greve, A. N. , Andreassen, A. K. , Knudsen, C. B. , Brandt, J. M. , Gregersen, M. , Krantz, M. F. , Søndergaard, A. , Ohland, J. , Burton, B. K. , Jepsen, J. R. M. , Hemager, N. , Thorup, A. A. E. , Nordentoft, M. , Mors, O. , & Bliksted, V. (2022). Development of social responsiveness and theory of mind in children of parents with schizophrenia or bipolar disorder. Schizophrenia Research: Cognition, 28, 100242. 10.1016/j.scog.2022.100242 [DOI] [PMC free article] [PubMed] [Google Scholar]
  74. Veddum, L. , Greve, A. N. , Gregersen, M. , Andreassen, A. K. , Knudsen, C. B. , Brandt, J. M. , Krantz, M. F. , Søndergaard, A. , Burton, B. K. , Jepsen, J. R. M. , Hemager, N. , Werge, T. , Thorup, A. A. E. , Nordentoft, M. , Mors, O. , & Nudel, R. (2023). A study of the genetic architecture of social responsiveness in families with parental schizophrenia or bipolar disorder and population‐based controls. Psychiatry Research, 326, 115280. 10.1016/j.psychres.2023.115280 [DOI] [PubMed] [Google Scholar]
  75. Velthorst, E. , Fett, A. J. , Reichenberg, A. , Perlman, G. , van Os, J. , Bromet, E. J. , & Kotov, R. (2017). The 20‐year longitudinal trajectories of social functioning in individuals with psychotic disorders. American Journal of Psychiatry, 174(11), 1075–1085. 10.1176/appi.ajp.2016.15111419 [DOI] [PMC free article] [PubMed] [Google Scholar]
  76. Velthorst, E. , Reichenberg, A. , Kapra, O. , Goldberg, S. , Fromer, M. , Fruchter, E. , Ginat, K. , de Haan, L. , Davidson, M. , & Weiser, M. (2016). Developmental trajectories of impaired community functioning in schizophrenia. JAMA Psychiatry, 73(1), 48–55. 10.1001/jamapsychiatry.2015.2253 [DOI] [PubMed] [Google Scholar]
  77. Weimer, A. A. , Warnell, K. R. , Ettekal, I. , Cartwright, K. B. , Guajardo, N. R. , & Liew, J. (2021). Correlates and antecedents of theory of mind development during middle childhood and adolescence: An integrated model. Developmental Review, 59, 100945. 10.1016/j.dr.2020.100945 [DOI] [Google Scholar]
  78. Wellman, H. M. (2018). Theory of mind: The state of the art. European Journal of Developmental Psychology, 15(6), 728–755. 10.1080/17405629.2018.1435413 [DOI] [Google Scholar]
  79. Whitney, J. , Howe, M. , Shoemaker, V. , Li, S. , Sanders, E. M. , Dijamco, C. , Acquaye, T. , Phillips, J. , Singh, M. , & Chang, K. (2013). Socio‐emotional processing and functioning of youth at high risk for bipolar disorder. Journal of Affective Disorders, 148(1), 112–117. 10.1016/j.jad.2012.08.016 [DOI] [PMC free article] [PubMed] [Google Scholar]
  80. Wilson, A. (2021). Do animated triangles reveal a marked difficulty among autistic people with reading minds? Autism, 25, 136236132198915. 10.1177/1362361321989152 [DOI] [PMC free article] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Table S1

BJC-65-1075-s001.docx (122.3KB, docx)

Data Availability Statement

The participants included in this study did not give consent for their data to be shared publicly. Therefore, and due to the sensitive nature of the research and the General Data Protection Regulation policy, the data are not publicly available. Data sharing may be possible upon request to the corresponding author.

Articles from The British Journal of Clinical Psychology are provided here courtesy of Wiley

RESOURCES