Altered social cognition in Tourette syndrome: nature and implications

Behavioural, cognitive and neuroanatomical characteristics of Tourette syndrome (TS) encourage the investigation of social cognitive abilities, which are critical for successful social interaction. This exhaustive review covers studies which have addressed a range of abilities in TS including the understanding of nonliteral language, socially inappropriate exchanges, facial expressions and specific aspects of theory of mind. While the changes in social cognition in TS appear subtle, suitably sensitive measures such as the faux pas task highlight alterations in TS on tasks which involve combinations of emotional information, conflicting perspectives and decision making. Importantly, the differences on social cognitive tasks in TS do not generally reflect a failure to attribute mental states, but rather reflect unconventional responses to social information. Studies have yet to investigate social cognition in children with TS, or evaluate the contribution of common co-morbid disorders. Interpretation of the basis for task deficits is also complex, and research using carefully matched tasks is needed. Nevertheless, it is becoming evident that some aspects of social reasoning involved in decision making are altered in uncomplicated TS, and further investigation in this area may shed light on the mechanisms involved in some of the more socially disabling symptoms associated with this condition.