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OJHAS Vol. 22, Issue 2: April-June 2023

Original Article
A Scoping Review of Research on Attributes of Social Cognition Impairment among Children with Disruptive Behaviours

Lakshmi Saranya MT, PhD scholar, Amrita Institute of Medical Sciences, Kochi,
Jayakumar, Professor and HoD, Dept of Pediatrics, Amrita Institute of Medical Sciences, Kochi,
Gitanjali Natarajan, Professor and HOD, Dept of Clinical Psychology, Amrita Institute of Medical Sciences, Kochi,
Monsy Edward, Professor and HoD, Dept of Clinical Psychology, Jubilee Mission Medical College, Thrissur,
Shaju, Psychiatrist, International Modern Hospital, Dubai
Elsa Ashish, Assistant Professor and HoD, Dept of Humanities and Social Sciences, MAHE, Dubai.

Address for Correspondence
Lakshmi Saranya MT,
Clinical Psychologist,
PhD Scholar, Amrita Institute of Medical Sciences,
Kochi, India.


Lakshmi SMT, Jayakumar, Natarajan G, Edward M, Shaju, Ashish E. A Scoping Review of Research on Attributes of Social Cognition Impairment among Children with Disruptive Behaviours. Online J Health Allied Scs. 2023;22(2):2. Available at URL:

Submitted: May 16, 2023; Accepted: July 4, 2023; Published: July 15, 2023


Abstract: Background: Children's social cognition, an ability to understand and infer the thoughts and feelings of others influences how they develop a unique view of the world. Higher social cognitive capacities are associated with better prosocial skills whereas difficulties in understanding and thinking about others’ mental states can lead to disruptive social functioning and increase the risk of major mental health problems. Impairment in the development of social cognition is considered to be the most important reason behind a child’s disruptive behaviour. Therefore, this paper aimed to understand different factors involved with disrupted social cognition which results in disruptive behaviour in children. Methods: The review was done by systematically using the keywords such as social cognition AND disruptive children OR anger children OR externalizing disorders OR conduct disorder and the timeline selected was from 2008 to 2023. Articles published on PubMed and Google Scholar were included in the study. The PRISMA was followed for reporting the systematic review. Results: The contribution of biological factors involving the role of callous-unemotional trait, disturbed neuropsychological processes, imbalance in the behavioural regulation system, hostile parenting, poor attachment patterns and poor environmental factors were considered as major causes of anger among children. Conclusions: The paper concludes that, although considerable progress has been made in understanding this topic, there is a need to further refine our conceptualisation of the problem to develop an effective treatment plan for dealing with children with disruptive behaviour.
Key Words: Biological, Psychological, Social cognition, Disruptive behaviour


Children's social cognition, an ability to understand and infer the thoughts and feelings of others influences how they develop a unique view of the world [1]. Higher social cognitive capacities are associated with better prosocial skills whereas difficulties in understanding and thinking about others’ mental states can lead to disruptive social functioning and increase the risk of major mental health problems [2]. Examining developmental factors that impact young children's disruptive behaviour, we must understand that both social and cognitive domains play an important role in children who are suffering from disruptive problems.

Disruptive behaviour has been recognized as one of the most common and persistent forms of childhood maladjustment, and predictive of a range of negative adolescent and adult outcomes including continuing aggression, failure in school and work settings, substance abuse, and late-onset psychopathology [3]. Disruptive behaviours refer to childhood problems defined by a broad array of disruptive antisocial behaviours [4]. Defining characteristics of disruptive behaviour include being aggressive, defiant, and antisocial behaviours tantrums, oppositionality and restless, impulsive behaviours which violate the rights of others or even criminality. Several clinically recognized disorders such as attention-deficit/ hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD) also involve disruptive behaviours [4]. The behaviours characteristic of these disorders is prevalent and serious childhood problems [4]. Recent studies suggest that the prevalence of disruptive behaviours is on the rise [5, 6]. Children who are with externalizing behaviour tend to have low social thinking. Social thinking or social cognition refers to how people think about themselves and others in the social world. The social cognition construct provides a broad theoretical perspective that focuses on how people process information within social contexts. It includes person perception, causal attributions concerning self and others, and bringing social judgments to decision-making, among other elements. Major difficulties with social cognition limit their functioning. Deficits in social cognition lead to behavioural disorders, poor academic performance, inappropriate interpersonal relationships, educational and cognitive impairments, isolation, and psychological issues [7]. Indian Statistics report revealed that 73% of conduct disorders have their onset during middle childhood. Among the Indian studies, Deivasigamani has reported the prevalence of CD to be 11.13%. Considering the significance of this problem and the severe consequences it has in a growing child’s life we need to understand the different ways to resolve and prevent a child from growing into a psychopath.

Studies show that the development of social cognition has a high variability concerning individual characteristics of the child, parent interaction, culture, and environmental factors [8, 9]. Children with externalizing disorders lack social cognition [8,9]. Therefore, it is important to identify individual and family characteristics that differentiate children who show persistent problems from those who follow typical or changeable pathways.

The present study aims to explore the attributes of impairment in social cognition among children with disruptive behaviours and understand the gaps and lacunae in areas of existing literature related to this topic, this scoping review was thought to be necessary.

Materials and Methods

In order to understand the current status of research being conducted in this area, a scoping review of articles on social cognition among disruptive children was done. This was done by systematically using the keywords such as social cognition AND disruptive children OR anger children OR externalizing disorders OR conduct disorder and the timeline selected was from 2008 to 2023. Articles published on PubMed and Google Scholar were included in the study. The PRISMA was followed for reporting the systematic review (Figure 1).

Inclusion and Exclusion criteria: Original articles published in indexed journals were included. The systematic review, meta-analysis, general discussions based on secondary data and qualitative studies were excluded. Studies in English were considered. Parent responses about their children were included but teachers’ responses were excluded. Studies on adolescent age groups, orphans, and shelter/foster care homes were excluded. Most studies in this field have been conducted with pubescent youths and adults, which is why it seems important to study pre-pubescent populations in order to explore the developmental origins of aggression. Studies on children with comorbid conditions like intellectual disability, genetic anomalies, autism spectrum disordered, neurological problems, depression and anxiety were not considered. Intervention studies were excluded.

Data collection and Analysis

The various research mentioned in this review were explored using scoping review guide by Arksey and O’Malley five stage methodological framework. At the inception phase, the finalization of the research question was done based on articles related to social cognition published in index journals. In the second step, a comprehensive search strategy was developed for 2 electronic citation databases, Pubmed, and Google scholar using the keywords and Boolean operators to obtain the maximum number of articles from 2008 and onwards with the assumption that these databases index the journals of good quality. In the third step, as per the eligibility, systematic review, meta-analysis, general discussions based on secondary data and qualitative studies were excluded. Further, in fourth step, characteristics such as year of publication, objectives, type and setting, sample size, study participants, and key findings in the study were reviewed. Finally, in the fifth step, all articles were summarized, and frequency analysis was done. This scoping review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Scoping Reviews (PRISMA-ScR) as shown in the Figure 1.

Ethical Clearance

Ethical clearance was taken from the Institutional Ethics Committee for further proceedings.

Figure 1: Preferred Reporting Items for Systematic reviews and Meta Analysis (PRISMA) for scoping reviews flow diagram of the search and study selection process

Table 1: Results of the Review


Sample size & Characteristics

Tools used

Study variable

Key Outcomes

Role of traits

Kolko & Pardini (2010) [10]

n=177 children

Age 6 -11years

Antisocial Processes Screening Device, Global Assessment of Functioning, CBCL

Role of callous unemotional trait in children with conduct issues

Callous unemotional trait is related to the empathy deficit and therefore seen in children with conduct issues

Ezpeleta, Granero , de la Osa & Domènech . (2015) [11]

n =622 children

Age 3 -5 years

Inventory of Callous-Unemotional Traits, Children’s Aggression Scale, Social Communication Disorders Checklist, CBCL

Role of callous unemotional trait and ODD

High callous unemotional trait was associated with high anger, externalizing symptoms of ODD

Zumbach, Rademacher & Koglin (2021) [12]

n =371 children, Mean Age=4.7years

Inventory of Callous-


Association between Callous unemotional traits and aggressive behavior

Callous unemotional traits is associated with aggressive behaviors in children


Ziv & Arbel (2020) [13]


(Mean Age = 5.72 years)

and their mothers

-Parenting Styles and Dimensions Questionnaire,

-Child–parent relationship scale

Parenting styles and mother’s attachment with child in social information processing of the child

Hostile mother results in hostile child. (Authoritarian parenting style )

Chen, Zhou, Eisenberg, Valiente, & Wang (2011) [14]

n=425children Age 7.7-11.6 years & their parents


Expressiveness in the Family Questionnaire, Parenting Styles and Dimensions scale

Role of parent expression & parenting on child’s externalizing behavior

Parental negative dominant expressivity positively predicted Chinese children's externalizing problems

Guajardo, Snyder, & Petersen (2009)[15]

n = 47 children Age 3-5years & their parents

The Parenting Scale (Arnold et al., 1993)

CBCL (Achenbach, 1991, Parent Stress Index

Parenting and social cognition

Ineffective parenting lead to misbehavior and inadequate emotional understanding in children

Bornstein , Putnick, & Suwalsky (2018)[16]


children below 10 years, & their mothers

Self-Perceptions of the Parental Role,

Parent Attributions Questionnaire, Preschool Behavior Questionnaire

Parental cognition and child’s cognition

Better supportive parenting resulted in low externalizing behavior in children

Stoltz, Londen , Dekovic, Prinzie, Castro, Lochman (2013)[17]

n =206 children

Mean Age =10.5 years and their parents

Parent version of the Teacher Rating of Aggression

Alabama Parenting Questionnaire Parenting Stress Index

Parenting and social cognition on children’s aggressive behavior

Negative parenting was related to less positive self-perception, and resulted in aggressive tendencies


Licata, Kristen, & Sodian (2016)[18]

n =56 children

Age 4years

The EAS, Children’s Behavior Questionnaire

Maternal Mind mindedness and child’s social cognition

Emotional availability leads to proper development of social cognition and emotional understanding

Ziv & Arbel (2020)[13]


152 girls, 149 boys, Mean Age =5.72 years

Parenting Styles and Dimensions Questionnaire ,

Social Information Processing Questionnaire

Role of parenting and mother- child interaction

Maladaptive mother- child relations results in incompetent social cognition and social maladjustments in children

Bizzi, Ensink, Borelli, Mora, & Cavanna (2019)[19]

n = 131 children, Mean Age =11.2years

Child attachment interview, child reflective functioning scale


Attachment and mentalizing in children with disruptive behavior disorders

Insecure, disorganized attachment leads to disruptive behaviour disorder among children

Molina & Musich (2016) [20]

n =102 children

Age 7 -13 years

Children’s Perception of Parent–Child Relation Scale, SNAP

Child’s perception of parental attachment and ADHD

Controlling and high autonomy in parents resulted in externalizing symptoms in children


Schultz, Ambike, Logie, Bohner & Stapleton (2010)[21]


early childhood

Schultz Test of Emotion Processing - Preliminary Version (STEP-P).

Role of gender in emotional processing of a provoking situation

Girls were more socially competent than boys

Guajardo, Snyder, & Petersen (2009)[15]

n = 47 children Age 3-5years & their parents

The Parenting Scale (Arnold et al., 1993)

CBCL (Achenbach, 1991, Parent Stress Index

Parenting and social cognition among boys and girls

In boys, there is an inverse relationship between externalizing behaviour and theory of mind understanding

Salimi, Karimi-Shahanjarini, Rezapur-Shahkolai, Hamzeh, Roshanaei & Babamiri(2019) [22]

n=900, mean age 11years

Researcher developed social cognition and aggression questionnaire

Predicting variable for anger among elementary schools children

Boys tend to have more physical aggression than girls

Executive functions

Miranda, Berenguer, Rosello, Baixauli , Colomer (2017)[23]

n =126

Age 7-11year

A Developmental Neuropsychological Assessment Battery, Theory of Mind Inventory,

analyze social cognition deficits of children with ADHD

Children with ADHD, compared to normal, showed impairments on all the social cognition

Behavior Rating Inventory of Executive Function

O’Toole , Monks , Tsermentseli (2017)[24]

106 children Age 46- and 80-months


relations of EF and ToM to aggression,

cool and hot EF and ToM jointly predicted physical, but not relational,

aggression. In particular, poor cool inhibition

Al-Yagon, Forte, Avrahami

(2020) [25]

100, Mean Age 11.4years,

Parenting Dimensions Inventory CBCL

Role of executive functions on ADHD

High deficit in executive functions in children with ADHD

Environmental factors

Guajardo, Snyder, & Suwalsky (2009)[15]

n = 47 children Age 3-5years

The Parenting Scale (Arnold et al., 1993)

CBCL (Achenbach, 1991, Parent Stress Index

Parenting, parenting stress and social cognition among children

Parenting stress predicts the social cognition among children. Also results in externalizing problems in children

Hughes, , Aldercotte & Foley (2017)[26]

n =116 children

Age 6 years

Alabama Parenting Questionnaire Peer Relationships Questionnaire e Family Affluence Scale

Maternal Mind-Mindedness and risk for Disruptive Behavior in Pre-Adolescents in family adversities

Maternal Mind-Mindedness Provides a Buffer for Pre-Adolescents at Risk for Disruptive Behavior in case of family adversities

Price, Chiapa, & Walsh (2013)[27]

n =177 children, Mean Age =5.43 years

CBCL, Post Visit Inventory

Social & home environment in predicting externalizing behaviour

Family environment with physical abused children resulted in externalizing behavior

Renouf , Brendgen , Séguin , Vitaro, Dionne , Boivin (2010)[28]

n=574 children

Age 5years

Peer victimization and reactive aggression

High peer victimization resulted in high reactive aggression

Silver, Measelle, Armstrong, & Essex (2010)[29]

n= 241 children

Mean Age=4,5 years

Preschool Behavior


Block Child-rearing Practices Report

Child Adaptive Behavior Inventory

Teacher and peer victimization

Children who were victims of teacher and peer victimization developed with externalizing problems

Veiga, Neto, & Rieffe (2016)[30]

N=78 children Age 55months-77months

Free play - connections with emotional and social functioning

Free play and children’s theory of mind are negatively related to externalizing behaviors.


This review was done on the articles published from 2008 onwards till 2023 (15 years period). The reason for defining this timeline was to understand how much was done so far in this area. The information extracted from the articles included the author, year of study, sample size, the age range of the sample, tools used in the study, variables considered in the study and key findings. Data extraction was done by the authors independently, and discrepancies were sorted out through mutual discussion and consensus. A detailed list of all the studies included in the present study is given in Table 1. Studies in English were considered. A systematic review, meta-analysis and qualitative studies were excluded. Parent responses about their children were included but teacher’s responses were excluded. Studies on adolescent age groups, orphans, and shelter/foster care homes were excluded. Studies on children with comorbid conditions like intellectual disability, genetic anomalies, autism spectrum disordered, neurological problems, depression and anxiety were not considered. Intervention studies were excluded.

A total of 19360 articles were found on the PubMed database and 18100 articles were found on Google Scholar relevant for this scoping review. Both databases were compared, and 423 articles were selected after removing the duplicates. A total of 423 articles were screened and 391 were removed from the selection criteria based on eligibility. Out of 32 full-text articles reviewed, 11 were removed because of other comorbid conditions present in children. The present study included 21 articles for review.


Studies which analyzed children who were brought up by parents, belonging to early childhood were considered for the present review. The study considered elementary and preadolescent age as the theory of mind or social thinking develops between the age of 3 to 4 [11].

The results of the present review are discussed in six categories based on causal factors or attributes that are responsible for children with disruptive behaviours. These are the role of traits, parenting, attachment, the role of gender, neuropsychological factors (executive functions) and environmental factors. In the studies included in the review, equal participation percentages of males and females were observed.

Role of Traits

The genes contribute to a child’s behaviour. The role of a child’s genetic composition or traits, play a significant role in contributing to a child’s disruptive behavior. In the present review, three studies have been included which emphasize the role of genetics and trait, leading to the child’s poor social regulation and externalizing behaviours. Callous Unemotional (CU) traits characterize a particular interpersonal and affective style distinguished by a lack of empathy, remorse, lack of guilt and constricted feeling. The three reviewed studies [10, 11, 12] found that children higher on CU appear to be at increased risk of experiencing disruptions in parent‐child attachment relations. Higher CU trait was associated with high anger, withdrawal and externalizing symptoms. The presence of CU traits will alter the appropriate development of the child which affects his social cues and increases likelihood of disruptive behavior.


Parenting styles contribute to the impairment in social cognition and the development of disruptive behaviour among children. Parenting is expressed in cognitions and practices followed by a child. Parents’ cognitions – their parenting knowledge, satisfaction, and attributions influence the growing child. The quality of the child’s early family relationships is critical to our understanding of why some young children with challenging temperaments show persistent disruptive behaviour whereas others do not. Toddlers and preschoolers who manifest high levels of early disruptive behaviour have been found to experience lower levels of warm, and responsive parenting than others [9]. Studies have revealed that authoritarian parenting styles contribute to a child’s incompetent response. In the present review, two studies have found that authoritarian parenting styles contribute to a child’s externalizing behaviour. One of these studies was to understand the role of culture in understanding parenting style and behavioural problems among children. The study concluded that the authoritarian parenting style contributed to a child’s behaviour problems both in Western and Asian cultures [13]. Negative parenting or negative parental emotion toward the children is another contributory factor to a child’s externalizing problems. In the present review, three studies have emphasized that parental negative dominant expressivity positively predicted children's externalizing problems. Inconsistent or harsh discipline leads to a child developing externalizing or aggressive behaviour. Across countries, child inhibitory control and maternal hostility made significant independent contributions to early externalizing problems, and leading to disruptive behaviours in young children [14, 31]


Parent–child attachment plays a significant role in a child who grows with adequate self-regulation and proper social cognition. The disruptive pattern in the parent-child relation results in a child having disruptive behaviours[18]. In the present review, three studies have highlighted the role of secure attachments with the mother as very important in a growing child. One study revealed that high parental control and extreme autonomy predicted externalizing symptoms in children with ADHD [20]. The results showed that low maternal attachment style contributed to the psychopathology of children. Mothers who tend to attribute more hostile intents to unknown others also tend to view their relationships with their children as more conflictual than mothers who did not have the same tendency. In turn, their children are less competent in social skills. Maternal mind-mindedness was considered an important component which brings the emotional connection between child and mother, which affects the social cognition of the child. School-aged children with disruptive behaviours have higher rates of insecure and disorganized attachment with their mothers (8,15,18,19)


Boys’ theory of mind performance related positively to the severity of parental discipline, while girls’ performance related positively to general parental warmth. In the present review, [15,21] studies highlighted that girls use their understanding of the mind to foster relationships with an emphasis on emotional support, empathy, and cooperation, while boys use their knowledge in less prosocial ways, leading to reasons for severely aggressive reactions. In boys, there is an inverse relationship between externalizing behaviour and theory of mind [22]. One of the studies revealed that boys enter into more physical aggression and girls enter into relational aggression [21]

Executive functioning

Differences in executive functions like -attention and inhibitory control develop rapidly during the toddler and preschool years and are thought to underlie the establishment of children’s behavioural adjustment. The role of the brain and its function also contribute to a child’s social information processing or social cognition. In the present review, three studies have emphasized the role of executive functions in children with disruptive behaviours. The involvement of inhibitory control in different executive function components (e.g., affect regulation and motivation) affects a wide range of behaviours linked to social information processing. The executive functioning deficit has been observed in children with externalizing problems [23,24,25]. One study done specifically on ADHD children revealed that children with externalizing problems have impairment in all social cognition measures- in areas of inhibition, shifting, emotional control and behavioural regulation [25].

Environmental factors

The environmental factors are mainly referred to any other factors which caused impairment in social cognition. Children who are exposed to maltreatment at young ages are more likely to have impaired socio-emotional skills and empathy. In the review, two studies have found that a high level of adversity in the family leads to poor social cognition and further contributed to aggressive behaviours among children [15, 27]. Relative to non-maltreated children, the family environments of physically abused children were characterized by higher levels of negative social interactions. Also, in comparison to non-maltreated children, the home environments of children who experienced neglect were characterized as less organized and clean [27]. Two studies revealed that high peer victimization resulted in highly reactive aggressive behaviour among children [28, 29]. The absence of free play is another causal factor that contributes to impaired social cognition. Lack of free play usually results in disruptive tendencies, among children. One study has highlighted the role of free play in building an adequate level of social understanding among children [30].

The review has given a composite view of the attributes or causal factors which contribute to the impairment of social cognition among disruptive children. Though the scarcity in the number of studies limits the generalizability of the review results, it serves to provide a reliable overview of the subject with the existing evidence. When one plans for a treatment or intervention for children with disruptive behaviours, the role of social cognition and its enhancement should be considered as an inevitable area of work for improvement as it is one of the major deficits in these children. Considering the increasing prevalence of anger among children, it is essential to examine the different factors that influence a child’s disruptive behaviour. To our knowledge, this is the first attempt at reviewing the multicomponent which are responsible for causing disruptive behaviour among children.

The 21 reviewed studies included approximately 5693 children below 12 years. Methodological quality varied, but every study had its limitations. Each study has looked into one particular factor which is responsible for poor social cognition among children with disruptive or externalizing behaviours. However, we should understand that not every factor is responsive to cause impairment in social cognition among children with disruptive behaviour, but one should consider these entire components while treating a child with disruptive behaviours.


In conclusion, the aim of the present review was to synthesize up-to-date evidence about understanding the multicomponent responsible for causing aggression among children as it is getting alarmingly prevalent. Understanding the social cognitive theory as the framework for the prediction of aggression behaviours in children and adolescents can be used in designing and implementing educational interventions in the management of aggression in children and adolescents. Earlier specific social adjustment difficulties are detected in younger children, there is a scope for planning effective treatment or intervention to cure this at the early stage of life. Accordingly, we can plan early intervention programs aiming to reduce children’s problem behaviour and increase their prosocial behaviours as early as possible. Our findings could make an important contribution to such programs because this review identifies different paths by which early maladjusted behaviours develop in a child. In particular, the findings that social maladjustments are associated with biased and incompetent social cognition should be highlighted in that respect.

Limitations of the study

The main limitation of the present review is the lack of an adequate number of studies available in the published literature on the subject. We might have missed articles indexed on other databases.

Future research, implications and recommendations

Future research must focus on considering an intervention which looks into the different factors which are responsible for anger in children, by using social cognition and parent-mediated intervention. Knowledge about risk factors for understanding externalizing behaviour in children displaying symptoms of behavioural disorders can result in more adequate preventive indicated interventions. The findings from this study indicate that externalizing behaviour problems apparent in early elementary school are associated with experiences occurring prior to and concurrent with the transition into elementary school. An important direction for future research will be to determine which all contextual factors contribute to the onset of externalizing problems and which factors contribute to their maintenance. This type of research will have important implications for the prevention and treatment of externalizing behaviour problems. Aggression in children and adolescents can be prevented and reduced through designing and implementing educational interventions based on these factors.

Conflict of Interest: None declared


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