Theory of mind and pragmatic understanding following right hemisphere damage

It has been maintained that 3-year-olds' difficulties in correctly predicting the undesired outcome of false beliefs reflects difficulties in interpreting the implications of conversations rather than a conceptual limitation in their theory of mind. As the right hemisphere has been seen to be responsible for the interpretation of the pragmatic aspects of communication, right-hemisphere-damaged (RHD) and left-hemisphere-damaged (LHD) adult patients in our study were compared on their ability to correctly draw inferences in false belief tasks. The RHD but not the LHD patients were found to have difficulties similar to those of young children in understanding the conversational implications test questions. Most reported that a central story character would look for a pet in the place where it was really located instead of where the character believed it was located. However, when then asked in a control question where the pet really was, the RHD patients often switched their answer to the test question and referred to the believed location. Removal of the need to infer the questioner's meaning enabled both RHD and LHD subjects to make correct false belief predictions. The results are discussed in terms of the effects of brain damage on spatial memory and the pragmatic demands of theory of mind tasks.