Relaciones de igualdad y buen trato

Several factors that potentially contribute specifically to interpersonal problem­ solving will be discussed below. One o f these has been derived from work with people with autism and other pervasive developmental disorders. It has been postulated that the key deficit in autism is an inability to appreciate other peoples’ mental states, known as ‘theory of m ind’ (e.g. Baron-Cohen, Leslie and Frith, 1985), and that intact theory o f mind ability may be dependent on the frontal lobes. Functional imaging studies have provided evidence to support this (e.g. Baron- Cohen, Ring, Moriarty, Schmitz, Costa & Ell, 1994; Fletcher, Happé, Frith, Baker, Dolan, Frackowiak & Frith, 1995; Goel, Grafman, Sadato & Hallett, 1995; Baron- Cohen, Ring, Wheelwright, Bullmore, Brammer, Simmons & Williams, 1999). However, there is ongoing debate about which specific areas o f the frontal lobes are involved, as the findings have varied across these different studies. Most o f the measures that have been used to assess theory o f mind ability in autism, such as the classic first order false belief tasks (Wimmer & Pemer, 1983), have been designed for use with young children. More recently, there have been moves to create tests that are appropriate for older children and adolescents with high-functioning autism or Aspergers’ Syndrome. For example. Happé (1994) developed a set o f stories assessing ability to understand aspects o f theory o f mind such as sarcasm, pretence and humour. She found that these stories were sensitive to deficits shown by high- functioning autistic participants, who were able to pass standard first-order false- belief tasks.

Social comprehension performance o f patients with acquired brain lesions has also been examined using tasks looking at aspects o f pragmatic language. These have commonly found impairments in patients with right-sided lesions (e.g. Brownell, Simpson, Bihrle, Potter & Gardner, 1990; Winner, Brownell, Happé, Blum & Pincus, 1998; Happé, Brownell & Winner, 1999). However, these studies did not consider the anterior-posterior dimension, and McDonald (1993) has argued that this might distort the findings, and that what appear to be right-sided deficits may be accounted for by frontal lobe involvement. This corresponds with work by other authors, who have reported impairments on similar measures in patients with frontal lobe lesions (Stone, Baron-Cohen & Knight, 1992; Shammi & Stuss, 1999), and in patients with head injury, which is often linked with frontal lobe involvement (McDonald & Pearce, 1996; Bara, Tirassa & Zettin, 1997). Studies using focal lesion groups have found mixed findings. A recent study using inference and deception tasks found that participants with right-sided and bilateral frontal lesions showed greater impairments than those with left-sided frontal lesions, participants with non-frontal lesions and a healthy control group (Stuss, Gallup & Alexander, 2001). By contrast, Channon and Crawford (2000) developed a story comprehension measure based on the Happé stories, but designed for use with adults. They found that participants with left-sided anterior lesions were impaired on these stories relative to right-sided anterior participants, patients with posterior lesions, and a matched healthy control group. The left anterior group also showed poorer performance than the other groups on a battery o f abstract standardised executive tests, and there were correlations between many o f these measures and story comprehension performance. The discussion concluded that the most parsimonious explanation for the deficits seen on the theory-of-mind-type measure was that they were due to executive dysfunction rather than a specific deficit in social reasoning. This was strengthened by the observation that the greatest source o f impairment for the left anterior participants was a failure to make non-literal inferences. This explanation o f the impairments shown is consistent with the viewpoint that there is no fundamental difference in the processes used in interpersonal versus non-interpersonal reasoning. However, this could not be determined beyond doubt, as there was no matched non-interpersonal control for

the story comprehension measure. In addition, other work examining the relationship between theory o f mind and executive function in patients with focal frontal lesions has concluded that the evidence suggests that they are independent processes (Rowe, Bullock, Polkey & Morris, 2001; Bach, Happé, Fleminger & Powell, 2000). The most likely explanation o f these different findings is that difficulties on theory o f mind tasks may occur for more than one reason, such that some patients perform poorly because o f a selective deficit, while others have disruption to relevant executive sub-processes.

Some studies have attempted to address the question o f whether theory o f mind ability is independent of other, non-interpersonal processes by comparing performance with that on matched non-interpersonal control items. In her original study. Happé (1994) presented 24 ‘Strange Stories’ and 6 ‘Physical’ stories that were intended to function as controls as they did not involve inferences about mental states. However, the physical stories were easier to answer than the mental state stories, as the requisite information could be directly quoted from the text, and she concluded herself that they could not be considered to be a valid control. Later studies using the Strange Stories developed new control items. For example, Fletcher et al (1995) endeavoured to create stories that involved inferences, but not consideration o f other people’s mental states. In a pilot study o f 60 healthy control participants, they found that the mean scores of these two sets o f stories did not differ, and thus concluded that they were matched for difficulty. The measures were tested on healthy volunteers in a functional imaging study, and it was found that the same areas were activated on each, but with additional activation o f the left medial frontal gyrus and posterior cingulate cortex during the theory o f mind items. This supports the hypothesis that theory o f mind is a separate ability, with a specified brain region, and is consistent with the concept that there may be aspects of interpersonal problem-solving that are distinctly different from non-interpersonal problem-solving.

The frontal lobes have been implicated in deficits in empathy (e.g. Grattan, Bloomer, Archambault and Eslinger, 1994, Eslinger, 1998), and a functional imaging study has also linked empathy with areas o f prefrontal cortex (Farrow,

Zheng, Wilkinson, Spence, Deakin, Tarrer et al, 2001). Performance on standardised measures o f empathy has been related to performance on measures o f ‘cognitive flexibility’ such as the Wisconsin Card Sorting Test (Grattan & Eslinger, 1989), and it is hypothesised that both processes involve the ability to consider alternative viewpoints. In addition, frontal lobe lesions have been linked with difficulties in interpreting nonverbal emotional cues such as face perception or voice intonation (Homak, Rolls & Wade, 1996).

Blair and Cipolotti (2000) reported on a patient who showed ‘acquired sociopathy’, in that his behaviour was so socially inappropriate following his brain injury that he resembled patients diagnosed with Antisocial Personality Disorder. EVR, and other patients with ventrolateral damage, have also been described in this way. Unlike EVR, he did not show impairment on the gambling tasks, indicating that he had no difficulties with reward and punishment learning. However, he was impaired in his ability to recognise emotional facial expressions, and appeared to have difficulty understanding when people would be afraid, angry or embarrassed. He was also impaired in identifying social transgressions. This was in the context o f intact theory o f mind, and ability to make moral judgements. This indicates that different types o f social cognition may be dissociable. The evidence indicated that a straightforward explanation in terms o f general abstraction or inhibitory deficits did not fit with the evidence. The authors suggested that right orbitofrontal cortex is involved with understanding and interpreting other people’s anger, and that this system is dismpted in JS, although they note that he also had damage to the amygdala, which is known to be involved in processing emotions, particularly related to fear (Young, Hellawell, Van De Wal & Johnson, 1996; Adolphs, Tranel, Hamann, Young, Calder, Phelps et al, 1999).

Therefore, several potential factors that appear to be particularly relevant for interpersonal but not non-interpersonal situations are associated with frontal lobe lesions. However, it is also plausible that executive processes play an important role in interpersonal problem-solving. More work is needed to investigate the relative patterns o f performance on equivalent measures involving interpersonal versus non-interpersonal problems.