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Assessment of Social Cognition and Theory of Mind: Initial Validation of the

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 Original Paper
Eur Neurol 2015;74:288–295
DOI: 10.1159/000442412
Assessment of Social Cognition and
Theory of Mind: Initial Validation of
the Geneva Social Cognition Scale
Marie-Dominique Martory a Alan John Pegna a, b Laurent Sheybani c
Mélanie Métral a Françoise Bernasconi Pertusio a Jean-Marie Annoni d
a
Neuropsychology Unit and Laboratory of Experimental Neuropsychology, Department of Neurology, Geneva
University Hospital, b Faculty of Psychology and Educational Science and c Department of Neuroscience, University
Medical Center (CMU), University of Geneva, Geneva, and d Neurology Unit, Department of Medicine, Faculty of
Sciences, University and Hospital of Fribourg, Fribourg, Switzerland
Key Words
Clinical scale · Neuropsychological evaluation · Brain
damage · Social emotions · False beliefs · Inferences ·
Absurdity judgement · Executive planning
Abstract
Background: Social cognition is widely studied in neurolo-
gy. At present, such evaluations are designed for research or
for specific diseases and simple general clinical tools are
lacking. We propose a clinical evaluation tool for social cog-
nition, the Geneva Social Cognition Scale (GeSoCS). Meth-
ods: The GeSoCS is a 100-point scale composed of 6 subtests
(theory of mind stories, recognition of social emotions, false
beliefs, inferences, absurdity judgement and planning abili-
ties) chosen from different validated tests of social and cog-
nitive evaluation. Eighty-four patients with neurological dis-
orders and 52 controls participated in the study. Evaluation
duration lasted 20–60 min. Results: Mean scores were 92.6 ±
4.5 for controls and 76.5 ± 15.3 for patients and differentiate
patients and controls in all subtests. With a cut-off score of
84, the scale had a sensitivity of 62% and a specificity of 94%.
In our stroke subgroup, right CVAs failed in cartoons, infer-
ences, ‘mind in the eyes’, and in the temporal rule task while
© 2015 S. Karger AG, Basel
0014–3022/15/0746–0288$39.50/0
E-Mail karger@karger.com
www.karger.com/ene
Received: June 23, 2015
Accepted: November 11, 2015
Published online: December 12, 2015
left CVAs were impaired in verbal/discourse tasks (social cog-
nition, inferences, absurd stories, and cartoons. Conclu-
sions: The GeSoCS is a medium duration assessment tool
that appears to detect and characterize significant social im-
pairment in neurological patients. © 2015 S. Karger AG, Basel
Introduction
The last decade saw the development of social neuro-
science, which integrated social psychology, cognitive
neuropsychology and neurosciences and raised the ques-
tion of whether social cognition exists as a specific do-
main (for review see Ward [1]). Social cognition refers to
the abilities and processes allowing people to interact and
to understand the behaviour of others. Among these dif-
ferent processes, the capacity to attribute mental states
such as feelings and beliefs and then to predict behaviour
is called theory of mind (ToM) and plays a determining
role in social adaptation. ToM was first studied in pri-
mates [2], and subsequently in developmental psycholo-
gy [3]. Its first clinical application involved autistic per-
sons [4]. Social cognition has also been addressed exten-
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Dr. Marie-Dominique Martory
Bibliotheque Cantonale
Neuropsychology Unit, Department of Neurology
Geneva University Hospital
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4, Gabrielle-Perret-Gentil, 1205 Geneva (Switzerland)
E-Mail mdmartory @ bluewin.ch
sively using brain imaging techniques. Along these lines, Table 1. Demographic characteristics of control and patient groups
fMRI studies, for example, have shown that the temporal
lobe, the temporal-parietal-junction, the medial prefron- Control group Patient group
(n = 52) (n = 84)
tal cortex and the posterior cingulate cortex are specifi-
cally involved in ToM [5–7]. Age, mean (SD) 42.2 (16.4) 53.3 (15.5)
In the field of clinical neuroscience, investigations of Gender
brain-injured patients with acute or neurodegenerative Male 20 49
Female 32 35
disease have also revealed different types of impairments Handedness
in social cognition and the understanding of people’s be- Right 51 71
haviour [8]. Indeed, ToM constitutes a complex domain Left 1 13
that involves numerous cognitive processes, including Level of education, years
executive functions [9, 10] and, in certain conditions, <12 1 11
>12 51 73
normal language development [11].
Thus, the evaluation of social cognition and ToM in
adults relies on a wide range of tasks of varying complex-
ity. The most common involves false beliefs and can be
used with young children. In particular, first-order beliefs Table 2. Patient group aetiologies
necessitate understanding another person’s mental state, Patient Stroke Trauma Tumor Dementia Encephalopathy
while second-order beliefs, which are more complex, pre- group (n = 31) (n = 17) (n = 7) (n = 17) (n = 11)
dict what a person thinks about a third person’s feelings (n = 84)
[3, 4]. More complex tasks used to assess the mental state
Age,
of others require that participants identify a person’s emo- mean
tional state on the basis of the expression in their eyes (the (SD) 58 (12.8) 41 (13) 51 (14) 66.4 (8.8) 44.8 (16.6)
‘mind in the eyes’ test) [12, 13], detect a social ‘faux pas’ Gender
Male 15 13 4 11 7
[14], or understand mental inferences or indirect speech Female 16 4 3 6 4
as in metaphors and jokes. Children are able to resolve Handedness
these tasks at different ages (age 4 for the first order false Right 28 14 6 14 8
belief and 9 or 11 for the faux pas). In brain-damaged pa- Left 3 3 1 3 3
tients, a number of authors have proposed that patients
with brain injuries would process simple false beliefs sto-
ries correctly but would fail in more complex tasks [14].
Despite the great number of studies in social neurosci- neurological patients rather than a short screening tool.
ence investigating patients with acute acquired or neuro- Deficits identified with this tool would then allow subse-
degenerative brain damage, research in the field has not quent detailed examination using the existing tests.
yet provided tests that are broad enough for use in the
clinic and have focused either on specific pathologies,
such as multiple sclerosis [15] or neurodegenerative
Method
groups (for review see Henry et al. [16]), or alternately,
have addressed specifics such as false beliefs [17], or faux Participants
pas recognition [14]. Additional global testing, as de- All subjects gave written informed consent for their participa-
scribed earlier, is often too long for clinical practice. To tion in accordance with the Declaration of Helsinki. The study was
our knowledge, there is yet no general test that allows approved by the local Ethics Committee, (Commission d’Ethique
de la Recherche Clinique, Geneva University Hospital, Switzerland;
neuropsychologists to assess ToM and social cognition CER 10-073).
function more globally in everyday clinical practice. The population was composed of 52 healthy French-speaking,
The aim of this study is thus to offer a short assessment volunteers, with no known neurological or psychiatric disorders.
tool that is easy to use in everyday neuropsychological Demographic data are summarized in table 1.
practice, which has been developed from existing tests de- Eighty-four brain-damaged French-speaking patients were ex-
amined consecutively during their hospitalization in the neuro-
scribed in the literature such as the mind in the eyes test logical clinic. The patient population presented various aetiologies
or false beliefs. This scale was intended as a clinical tool (stroke, epilepsy, trauma, tumour, dementia; table 2). Participants
for potential impairment in social cognition found in with CVA were assessed in the post-acute stage (about 10 days to
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GeSoCS as a ToM Clinical Tool Eur Neurol 2015;74:288–295 289

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DOI: 10.1159/000442412
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3 weeks after their stroke and after stabilization for other aetiolo-
gies). All patients’ diagnoses were based on a clinical evaluation, a
laboratory evaluation including an MRI, and a formal neuropsy-
chological assessment. Exclusion criteria included a history of pri-
or psychiatric disorders, delirium, global aphasia and severe de-
mentia (≥CDR3).
Subsequent statistical inquiries as to the effects of levels of edu-
cation on our tests showed that this factor did not influence the
results. The different levels were therefore merged.
Assessment of ToM and Social Cognition
The test was developed internally on the basis of the literature
reported above and spanned aspects most frequently explored in
social cognition. Each of them was evaluated through specific tasks
as described in the literature and combined in order to form a scale
with a total score of 100 points (online suppl. appendix, see www.
karger.com/doi/10.1159/000442412).
Tasks 1, 2, 3 and 4 were specific to social cognition and com-
prehension of inferences. For each of them, the patients were asked
to read a story and to answer specific questions involving ToM, but
also to respond to simple control questions in order to test linguis-
tic comprehension. The lengths of the stories were similar. In ad-
dition, precautions were taken to ensure that the questions and the
syntactic structures of the sentences were equivalent and simple
enough to be understood by most patients.
Task 1 was composed of 5 written ToM and social cognition
stories: one ‘faux pas’ situation, one ‘normal’ situation (‘Helen’ and
‘Jim’ stories [14]), one ToM story (‘burglar’ story [18]), and one
in-house ToM story involving a self-perspective1.
Task 2 involved 10 items chosen from the ‘reading the mind in
the eyes’ test [12, 13]. The original test is composed of 36 pairs of
eyes each evoking an emotion. The subject has to choose between
4 written propositions the one that best describes the emotion. The
items selected (1-4-5-8-14-16-18-30-33-35) were retained as being
the most easily identifiable on the basis of a pilot experiment with
25 participants.
Task 3 was made up of 5 ToM picture stories [19] representing
first- and second-order false beliefs (e.g. A man is sitting on a
bench with his dog beside him and he is preparing to eat a sand-
wich; while he is throwing the paper packaging, a bird steals the
sandwich; on seeing the sandwich missing, the man scolds the
dog. Question: why does the man scold his dog?) and one story
not requiring inference (A boy sits on his sofa when he hears the
doorbell ring. He thinks that it is the mailman but he smiles when
he sees that it is his friend. Question: Why does the boy seem
happy?).
Task 4 was composed of 5 stories that the patient had to read
before answering questions about possible or impossible infer-
ences [20, 21] e.g. ‘The more Willy loses at the casino, the more
affectionate he is with his wife; apparently, he was not very lucky
in his game this evening’. Control question without inference:
Did Willy win a lot at the casino this evening? (response: no).
Question with impossible inference to make: Is Willy’s wife rich?
(response: we cannot know). Question with an inference to make:
1
  In a fMRI study with healthy subjects, Vogeley et al. [2001], found differ-
ent patterns of brain activation, as the subjects took the first or third person
perspective and Gambini, Barbieri, Scarone [2004], supported this idea in a
study involving schizophrenic subjects.
290 Eur Neurol 2015;74:288–295
DOI: 10.1159/000442412
Is Willy rather affectionate with his wife this evening? (response:
yes).
Tasks 5 and 6 are beyond ToM strictly speaking but are used to
determine clinically a general executive impairment, which can be
associated (although not necessarily) with deficits in social cogni-
tion [9].
Task 5 required that patients correctly detect an absurdity in
4  stories and accept a control story (e.g. ‘The management of a
railroad company noticed that in train accidents, injuries were for
more serious in the tail wagons. Consequently, it was decided to
remove the last wagon of each train. What do you think of that?’).
This test was retained as it constituted an interesting match with
the social cognition stories that also required a ‘meta’ representa-
tion, albeit without the social component (adapted from Binet and
Simon [22]).
Task 6 was not directly related to social cognition, but was pre-
sented as a general measure of executive function. It is a French
adaptation of the Counter test [23] and consists in determining the
rules underlying the temporal appearance of colour counters (e.g.
black-white-white, black-white-white…). This test was chosen for
its ease of use and its good prediction of mental flexibility in fron-
tal impairment [24].
Every verbal or picture task contained control questions
measuring literal comprehension but excluding ToM or social
aspect. The control questions were not scored but were includ-
ed to ensure correct linguistic comprehension. The item ‘Jim’
that constituted a full question in the test was an exception. The
duration of the whole test ranged from about 40 min in a
healthy subject to between 60 and 70 min in the brain-damaged
patients. In this latter group, participants could re-read the sto-
ries or obtain repetitions of the questions. Patients and control
subjects were examined by clinically qualified neuropsycholo-
gists.
Procedure
The Geneva Social Cognition Scale (GeSoCS) was tested in ad-
dition to the patients’ standard neuropsychological examination,
which will not be detailed in this study. In controls, no additional
evaluation was performed, as participants were considered to be
cognitively normal. However, a semi-structured interview was car-
ried out to confirm the absence of any indicators of cognitive im-
pairment, either anamnestically or behaviourally. The subjects
were individually tested in a single session of about 40–60 min. The
sessions took place at the University Hospital of Geneva, in the
Neuropsychology Unit.
During the test, they were asked to answer the questions freely
and no solutions were proposed. If necessary, the question was re-
peated. For each item, full points were given when the answer was
complete and correct. Half points were given if the answer was in-
complete, or if the answer was correct but not the explanation.
Statistical Analysis
The results of the whole group are described first, followed by
that of the patients and controls (global scores, then subtests).
Significant differences and interactions between the controls and
the patients were calculated using an analysis of variance
(ANOVA; statistical analyses were performed using Statistica
12  software). For the smaller and more heterogeneous groups
(TBI, dementia), additional testing was carried out using non-
parametrical tests.
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 Social Mind in Absurd Temporal
cognition the eyes Cartoons Inferences stories rules Total
0.80

0.40

–0.40

Controls
Patients
Fig. 1. Comparison of mean z-scores of –0.80
controls and patients for all the tasks.

Results Table 3. Results: mean scores and SD for controls and patients for
all tasks
Descriptive statistics for the controls and the patients
Tasks Controls (n = 52), Patients (n = 84),
are provided in table  3. The controls obtained a total mean (SD) mean (SD)
mean score of 92.6/100 (SD 4.5); for each test, the result
was close to the maximum score with a standard devia- Social cognition 19.36 (1.20) 16.02 (4.08)
tion equal to 1, with the exception of the ‘mind in the eyes’ Mind in the eyes 15.09 (2.28) 12.11 (3.81)
test, (mean 15/20, SD 2.3). There was no significant dif- ToM cartoons 19.55 (0.79) 17.22 (3.5)
Inferences 19.17 (1.49) 15.83 (4.4)
ference due to gender (women 92.4, men 93). The pa- Absurd stories 9.65 (0.94) 7.78 (2.32)
tients obtained a total mean score lower than the controls Temporal rules 9.76 (0.85) 7.54 (3.42)
(76.51) with a large dispersal (SD 15.32) and performanc- Total 92.61 (4.51) 76.51 (15.32)
es for each test were lower than the controls.
For every task, the performance of the patients and the
controls were expressed as z-scores of the mean total
group’s performances (patients + controls; fig. 1). The ANOVA confirmed that the difference was sig-
An ANOVA comparing the 2 groups’ z-scores revealed nificant (F(15, 395)  = 4.4,651, p  < 0.05). However, when
a significant difference in performance between the con- considering the side of the lesion, a post hoc Fisher test
trols and the patients (F(1, 134) = 55.035, p < 0.00001), and showed different patterns of impairment in the case of
a post hoc test showed that the patients were impaired right CVA, left CVA or bilateral CVA.
compared to the healthy subjects in all tasks. Right CVAs did not differ from the controls in the first
We now considered the mean z-score for the CVA pop- task of social cognition and were quite correct in ‘faux pas’
ulation compared to the mean z-score of the control group. stories, which required criticism (p = 0.06), but they failed
in cartoons, in inferences and in tasks in which they had to
Comparison of z-Scores: CVA Patients vs. Controls guess a feeling, such as the ‘mind in the eyes’ test (p < 0.05),
The 31 patients with CVA demonstrated approxi- or an intention, such as in the temporal rule task (p < 0.05).
mately the same pattern as the entire patient group with Left CVAs were impaired in all verbal tasks, social cog-
altered performances compared to the controls as shown nition tasks (p < 0.05), inferences (p < 0.05), absurd sto-
in figure 2. ries, and also in cartoons (p < 0.05). Conversely, they have
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GeSoCS as a ToM Clinical Tool Eur Neurol 2015;74:288–295 291

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DOI: 10.1159/000442412
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 Controls ight C A eft C A ilateral C A
. 0

0.80

0.40

–0.40
Social cognition
Mind in the eyes
–0.80
Cartoons
Inferences
– . 0 Absurd stories
Temporal rules
Fig. 2. Comparison of mean z-scores of
right CVA, left CVA, bilateral CVA and – . 0
controls for all the tasks.

shown significant difficulties in the ‘mind in the eyes’ task Table 4. Cut-off for each subtest and the total test
(p = 0.07).
Finally, bilateral CVAs were significantly impaired Tasks Controls, Cut-off (rounded
mean (SD) to nearest unit)
(p < 0.05) in all 6 tasks.
Social cognition 19.36 (1.20) 17
Determining Pathological Function: The Cut-Off Score Mind in the eyes 15.09 (2.28) 11
Based on these data, we attempted to determine a cut- ToM cartoons 19.55 (0.79) 18
Inferences 19.17 (1.49) 16
off score for clinical use. The values for each test are given Absurd stories 9.65 (0.94) 8
in table 4 using a cut-off score of minus 2 SDs. Temporal rules 9.76 (0.85) 8
Using these values, 52 patients fell below the cut-off Total 92.61 (4.51) 84
(84) and 32 remained above; among the 31 CVA patients,
19 were below the cut off (9/15 left, 5/8 right and 5/7 bi-
lateral CVA); 3 healthy subjects fell below the cut-off and
49 were above. The cut-off of 84 allowed to significantly rological patients in a daily clinical practice. This screening
differentiate between controls and patients (χ2(1) = 42.02; test was constructed with items taken from existing tasks
p  < 0.0001). Sensitivity was at 61.9% and specificity at previously described in the literature for evaluating the
94.23%. An analysis computing the receiver operating ToM. These tasks were subsequently adapted and grouped
curve (ROC) with these cut-off scores showed an esti- in order to form a scale graded from 0 to 100. To the best of
mated area of 0.78 under the curve. Thus, the probability our knowledge, it is the first global tool adapted for every-
of correctly classifying a neurological patient as patho- day clinical work as most of the studies on clinical patients
logical on the basis of our test is 78% (fig. 3). until now have used extensive batteries. From a clinical per-
spective, GeSoCS appears to conform to the criteria for a
consistent scale. First, the GeSoCS uses multiple aspects of
Discussion validated tests for assessment of ToM, a ‘complex, multi-
faceted cognitive ability’ [25]. On average, GeSoCS lasts
In order to provide a simple tool for evaluating social 40–60 min. Generally, this duration is easily tolerated by
cognition, we designed the GeSoCS, which allows rapid neurological patients, although one cannot exclude poten-
and easy assessment of social cognition in hospitalized neu- tial attentional deficits during evaluation.
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292 Eur Neurol 2015;74:288–295 Martory/Pegna/Sheybani/Métral/

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DOI: 10.1159/000442412 Bernasconi Pertusio/Annoni

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Color version available online
Total
00
80
0 eas. However, this disorder can evolve favourably in the
Sensiti ity
40
0 posed of tests that are described and validated in the lit-
0
0 0 40 0 80 00
00 – Specificity
Fig. 3. ROC with an estimated area of 0.78 under the curve.
This scale was administered by experienced neuropsy-
chologists to 136 volunteers: 52 healthy subjects and
84 patients who were either hospitalized in the post-acute
stage or stabilized. The results showed that patients per-
formed significantly more poorly than healthy controls
on average (p  < 0.05). In our sample, patients differed
from controls not only in the global score but also in all
subtests. This ability to differentiate between both groups,
despite the patients’ heterogeneous results (SD 15.368 in
the patients’ group vs. 4.5 in the controls), offers a satisfy-
ing perspective in the use of this tool.
The CVA patients, who constituted the main group,
performed in a significantly worse manner in all events.
Interestingly, the results differed according to the lateral-
ization of the lesion: left CVAs were significantly different
from the controls in all the tests (p < 0.05) except the ‘mind
in the eyes’ test. Some of these left CVA patients suffered
from aphasia and, although it has been shown that ToM
abilities are not fundamentally impaired in this population
[26], it is possible that language difficulties and deficient
working memory may play a part in these results, and also
in ToM picture tasks where all the answers require a verbal
argumentation. Nevertheless, this group was not signifi-
cantly different from the controls in the interpretation of
the ‘mind in the eyes’ test (p > 0.5). The right CVAs showed
a different pattern with respect to the controls and to the
left CVAs: they failed in the ‘mind in the eyes’ test, in tem-
poral rule tasks (which nevertheless do not require an elab-
GeSoCS as a ToM Clinical Tool
orated verbal response) and ToM pictures (cartoons) but
performed correctly in the cognition scale. The bilateral
strokes, as expected, had more difficulty in all tasks.
As regards CVA, the recent data in the literature show
that social cognition is affected during the acute phase,
particularly if the lesion involves anatomical regions such
as the parieto-temporal junction and fronto-parietal ar-
same way as other cognitive functions [27].
Interest and Limitations of Current Study
The GeSoCS scale has the advantage of being com-
erature as being sensitive to social cognition and ToM.
Instructions and scoring methods are simple to use for
neuropsychologists and behavioural neurologists. Its du-
ration and the absence of heavy equipment allow it to be
used quite easily with any patient suspected of presenting
disorders of social cognition.
In our study, the number of healthy controls was
slightly limited, but their scores were high and homoge-
neous, and most tests have already been reported exten-
sively in the literature and their use has been confirmed.
Their average age was younger (11 years) than the average
age of the patients. This difference might have influenced
our findings. However, a recent study that considers the
effect of aging on mind-reading abilities in healthy people
has suggested the absence of any difference between
younger and older subjects [28]. The test cannot be un-
derstood as a screening, but must be considered as a more
descriptive test. It took often between 30 min and 1 h, and
had to be done in a different session than the usual neu-
ropsychological evaluation. Such durations have also
been used in other populations with clinically oriented
test (see social cognition impairments in relation to gen-
eral cognitive deficits, injury severity, and prefrontal le-
sions in traumatic brain injury patients [29] or in fronto-
temporal dementia [30]). So it must be considered a clin-
ical test with a capacity of describing the type of deficit in
clinical cognition in neurological patients. Our experi-
ence suggests that patients easily support this non-chal-
lenging evaluation, except strongly demented patients
and severe aphasia.
Our data showed a good specificity of 94% for a cut-off
of 84, making the GeSoCS a highly efficient method for
detecting deficits of social cognition. The sensitivity of
61% is of course a limitation in our study and the GeSoCS
cannot be considered an interesting screening tool for
neurological disorders. It has, however, a strong clinical
interest because it can detect, among the neurological pa-
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Eur Neurol 2015;74:288–295 293
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DOI: 10.1159/000442412
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tients those who have effectively a deficit in social cogni-
tion. As mentioned, the high specificity allows predicting
that impaired results at the GeSoCS in neurological pa-
tients are indeed related to the disease and less probably
to non-neurological effects and are a sign of an acquired
deficit in social cognition. In order to confirm the eco-
logical validity of the GeSoCs, we made a post hoc corre-
lation between the GeSoCS scores and scores obtained at
the dysexecutive questionnaire (DEX) [31], a standard-
ized 20 items rating scale used for quantifying behav-
ioural disturbances commonly associated with executive
impairment. In an unselected subgroup of 28 patients, a
close relative completed the DEX questionnaire. In this
subgroup, there was a correlation between total GeSoCS
score and DEX score (CC = –0.450, p = 0.02).
Another limitation of this study is the fact that various
aetiologies were included, some of which contained
smaller samples of patients, with the exception of the
CVA group. Aetiologies therefore could not be investi-
gated systematically and only the effect of the side of the
lesion was taken into account because of the absence of
prior known behavioural deficits. The aim was actually to
test different neurological populations to show that dif-
ferent pathologies could be detected as causing ToM and
social cognition deficits. However, in the second part of
the results, we analysed separately dementia, stroke pa-
tients and the other aetiologies, in order to show that all
pathologies may have social cognition impairment, but
the pattern varies with the aetiologies. GeSoCS sub scores
seemed also sensitive to the side of the lesions as described
in our stroke subgroup: right CVAs failed in cartoons,
inferences, ‘mind in the eyes’, and in the temporal rule
task while left CVAs were impaired in verbal/discourse
tasks (social cognition, inferences, absurd stories, and
cartoons). Furthermore, we did not attempt any qualita-
tive analysis of the answers or the different questions for
social cognition (ToM, point of view, faux pas) and did
not establish correlations between the GeSoCS and neu-
ropsychological (e.g. executive functions and language)
or ecological measures. Finally, the test was intended to
be as short as possible and thus, the test samples used may
not have had the same diagnostic value as the test as a
whole, e.g. the ‘reading the mind in the eyes’ test consists
of 36 items, but only 10 were selected for our task.
More elaborate studies on the different patient groups
should be considered and, in particular, their correlation
with other ecological measures, including questionnaires
and behavioural scales, could be examined in more detail.
Nevertheless, the data obtained from the current-screen-
ing test for disorders of social cognition and ToM provide
a useful bedside assessment tool that should allow the cli-
nician to determine the presence of ToM deficits in brain-
damaged patients.
Acknowledgements
We thank S. Baron Cohen, A. Duchêne May-Carle, M. Monfort
and I. Monfort, Ortho Editions for allowing us to use parts of their
tests to devise our scale and the neuropsychologists who adminis-
trated the GeSoCS.
Disclosure Statement
The authors declare no conflict of interest.

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