2026

Neural and behavioural correlates of theory of mind reasoning in five-year-old children born preterm

Background information

When we talk about the long-term impacts of being born prematurely, much of the conversation focuses on physical milestones, motor skills, and academic performance. But what about social abilities— specifically our “Theory of Mind”, our ability to reason about other people’s thoughts and feelings? 

Past research has sometimes found children and adults born preterm to have more difficulties with social relationships or to have fewer social relationships. Interestingly, though, the quality of those close relationships appears to be just as high among preemies as among people born at term.

Research question

To better understand observed differences in social behaviours, our team at the University of Edinburgh set out to study brain activity during social reasoning alongside social reasoning behavioural performance in 5-year-old children who are part of the Theirworld Edinburgh Birth Cohort (TEBC). The TEBC is comprised of children born very preterm (between 24 and 32 weeks' gestational age) and term-born peers.

Findings

First, we measured children’s social reasoning using a task that involved answering questions about the thoughts and feelings of story characters. Like some prior research, we found that some children born preterm scored lower on this task than term-born children. Importantly, children who scored lower on this task were those who also scored lower on an assessment of language skills. 

Second, we measured responses in brain regions that support social reasoning to a short movie while children underwent functional magnetic resonance imaging (fMRI). Interestingly, while social brain responses among children born preterm showed more heterogeneity (i.e., responses among preterm-born children were less similar than among term-born children) and responses to one social scene differed across preterm- and term-born children, we did not find evidence to suggest delayed development in social brain regions among children born preterm. Preterm-born children’s social brain responses to the movie resembled those of their term-born peers. 

Conclusion

Overall, these results suggest that early social reasoning and brain development is similar across preterm- and term-born five-year-old children.  One question for future research to explore further is whether differences in social reasoning and behaviours primarily reflect differences in language development, rather than social understanding per se. This is an avenue of research our team will pursue – in hopes of informing efforts to support preemies as they grow into school and beyond.