Assessing Social Cognition in Neurological and Psychiatric Patients: A Psychometric Meta-analysis

Social cognition impairments have received growing attention in both neuroscientific research and clinical practice, largely due to their high prevalence in neurological and psychiatric populations. However, selecting an appropriate and sensitive assessment tool remains challenging in both fields due to the limited availability of comprehensive psychometric data across conditions. Suboptimal test selection may significantly influence research outcomes and diagnostic accuracy. To address this, this meta-analysis synthesizes the literature on the validation of social attribution tasks, including theory of mind (ToM) and emotion recognition measures, across a broad range of clinical conditions. We extracted psychometric data (i.e. known-group, content and convergent validity, sensitivity/specificity, test-retest reliability, interrater reliability, internal consistency) from validation studies published until May 2024. Pooled effect sizes, confidence intervals, and heterogeneity indices were estimated within a random-effect model. In addition, we synthesized all available psychometric criteria for each test. We also examined ecological validity, which is particularly relevant for social cognition. Of 1055 articles, 55 studies reporting psychometric data from 3'845 patients and 3'807 control subjects were included in the present paper. Known-group validity was assessed via pooled effect sizes derived from 46 studies with control groups, with robust outcomes for schizophrenia and ASD (ToM tests only), but considerable heterogeneity and inconsistencies for other populations. Several tasks and batteries emerged as particularly well validated for specific conditions. Our findings underscore the importance and possibility of selecting valid social attribution tests for a given population of interest. This article provides useful information to facilitate this selection process, including a review of ecological validity. Additional research is needed to promote the validation and use of social cognition assessments.