**1. Introduction**

262 Novel Aspects on Epilepsy

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There is a paucity of research which has investigated social cognition in epilepsy, this is surprising given the abundance of evidence that exists in relation to the difficulties that people with epilepsy (PWE) have in relation to social functioning (McCagh et al., 2009).

The study of social cognition in epilepsy will lead to a greater understanding of the social cognitive deficits of the epileptic condition. This may in turn lead to more effective psychological interventions to enable the smoother functioning of people with epilepsy in society.

The aim of this chapter is to provide a detailed critical review of research which has investigated socio-cognitive functioning in people with epilepsy to date. Throughout the chapter, the impact of epilepsy related variables in relation to socio-cognitive processing will be considered.

The final part of the chapter will explore why people with epilepsy may have social cognitive deficits and will go on to summarise limitations in past research. The author will conclude by providing the rationale and aims of their current research in this area and suggestions for future work.

#### **Abbreviations**


Social Cognition in Epilepsy 265

Researchers have used a variety of assessment techniques to tap into ToM functioning. The most common measures and those which are most relevant to the studies which will be

The most established and validated measure of ToM has utilised the concept of false belief. Dennett (1978) argued that the best evidence for an understanding of other people's minds is the ability to attribute a "false belief" to another person. Detection of false belief requires that you can appreciate that another person has misconceived an event as a result of incorrect reasoning. Many subsequent empirical tests of ToM are based on this criterion and assessment of false belief is regarded as the 'litmus test' of ToM functioning. This method is widely used and validated because it establishes whether an individual can attribute beliefs to others that may differ from their own. As Astington (2001) highlights, false belief is 'an

Typically false belief has been assessed at first order and second order levels of intentionality. Appreciation of first order false belief usually develops by the age of four and by the age of seven, children should be able to pass second order false belief tasks (Perner & Wimmer, 1985; Wellman et al., 2001; Wimmer & Perner, 1983). Often such tests are developed within the context of ToM stories, which are often accompanied by story boards to aid the participant in following the story. First order stories involve a character having a false belief about the state of the world. The tasks require the individual to understand that another person may not have access to information about the world which they themselves have and as a consequence that the other person's viewpoint is mistaken. Typically first order stories involve a protagonist leaving an object in one location and then leaving a room upon which the object is moved to a new location. Demonstration of intact first order false belief would involve the participant appreciating that the protagonist will look for the object in the old location on re entering the room. To master first order false belief the participant must appreciate that reality and another person's perception of reality can be different. Second order stories are more complex and involve one character having a false belief about the belief of another character in a story. The age of developing false belief skills has been shown to be the same across cultures and continents (Avis & Harris, 1991; Wellman et al., 2001; Wellman & Lagattuta, 2000). Generally adults score at ceiling on both first and second order false belief tasks (Stone et al., 1998a) so designing tests which tap in to ToM in adults

Deception has also been used as another way of testing mentalising ability. As Baron-Cohen (2000) proposes, deception is important in understanding another's mind as it involves trying to make a person believe something that is untrue. It involves being aware that beliefs can be manipulated and people will base these beliefs on knowledge derived from what

More advanced tests of ToM involve being able to appreciate non–literal language or figurative speech. An appreciation of the pragmatics of language is needed to understand such things as sarcasm, irony, humour, metaphor and hinting and consequently paradigms using these concepts have been applied to assess ToM performance. By reference to contextual information, the listener must go beyond the literal meaning of the words that are used and

A number of paradigms have been used in studies to assess these higher order ToM abilities. These include: appreciation of irony (Shamay-Tsoory et al., 2003; Shamay-Tsoory et al., 2005a), sarcasm (Shamay-Tsoory et al., 2002; Shamay-Tsoory et al.,2005 a; Shamay-

comprehend the intentions of the speaker and the meaning they are trying to convey.

**2.2 Assessment of theory of mind** 

can be challenging.

they have heard or observed.

discussed in this chapter will be outlined.

unequivocal marker of mentalistic understanding' (p.685).

