Affect Recognition, Theory of Mind, and Empathy in Preschool Children with Externalizing Behavior Problems—A Group Comparison and Developmental Psychological Consideration

Preschool mental disorders are often associated with significant interpersonal problems, related to impaired affect recognition, theory of mind (ToM), and empathy. To date, these skills have not been studied together in preschoolers with externalizing behavior problems (EBPs). The aim of the present study was to investigate whether and to what extent preschool children with EBPs show impairments in affect recognition, ToM, and empathy. Preschoolers with EBPs, defined by current psychiatric treatment and T-scores ≥ 60 on the externalizing problem scale of the Child Behavior Checklist (CBCL/1½-5 or 6-18R) were compared to non-clinical controls (HCs), defined by no past and no current psychiatric treatment and T-scores < 60 on all CBCL broad-band scales. Groups were compared on affect recognition (NEuroPSYchological Assessment-II), affective ToM (Test of Emotion Comprehension), cognitive ToM (Extended Theory-of-Mind Scale), parent-reported emotional contagion, attention to others’ feelings, and prosocial action (Empathy Questionnaire), IQ and language (Wechsler Preschool and Primary Scale of Intelligence-III Matrices, Active and Passive Vocabulary test), controlling for age, sex, and language abilities. Compared to 28 HCs, 22 preschoolers with EBPs (total sample mean(age) = 5.5 years +/− 0.8 years, range= 4.2–6.9 years, males 66%) had significantly greater impairments in cognitive ToM (p = 0.0012, η(2) = 0.266), attention to others’ feelings (p = 0.0049, η(2) = 0.222), and prosocial action (p = 0.0070, η(2) = 0.210), each representing strong effect sizes. EBPs were significantly related to cognitive domains, like prosocial action (r = −0.501), cognitive ToM (r = −0.425), and attention to others’ feelings (r = −0.332), but not to affective domains of social cognition. Social cognitive development may be impaired as early as preschool age and should be promoted before the child starts school.