Theory of mind deficit and its relationship with executive functions in adults with attention-deficit/hyperactivity disorder: A comparative study

INTRODUCTION: While the ability to understand others' mental states (Theory of Mind, ToM) is fundamental for social interactions, its relationship with executive functions (EF) in adults with attention-deficit/hyperactivity disorder (ADHD) remains under-explored. This study investigated ToM abilities and three core EFs (working memory, response inhibition, and planning) in adults with ADHD compared to a healthy control group. METHODS: Thirty adults with ADHD were matched with thirty controls on age, gender, IQ, and education. ToM was assessed using the Strange Stories Test. EFs were evaluated using four subtests from the Cambridge Neuropsychological Test Automated Battery (CANTAB): Spatial Span (SSP) for short-term memory, Spatial Working Memory (SWM) for working memory, Stockings of Cambridge (SOC) for planning, and Stop Signal Task (SST) for response inhibition. Mann-Whitney U tests compared groups, and Spearman's rho examined ToM-EF relationships. RESULTS: Individuals with ADHD showed significantly poorer performance on the Strange Stories Test and all CANTAB subtests compared to controls. Within the ADHD group, most EF components showed no significant correlation with ToM scores. CONCLUSIONS: These findings confirm deficits in both ToM and EFs in adults with ADHD. The lack of strong correlations suggests that ToM difficulties may represent a distinct cognitive domain, independent of core EF impairments.