Ventromedial prefrontal cortex damage does not impair the development and use of common ground in social interaction: implications for cognitive theory of mind.

During conversation, interactants draw on their shared communicative context and history ("common ground") to help decide what to say next, tailoring utterances based on their knowledge of what the listener knows. The use of common ground draws on an understanding of the thoughts and feelings of others to create and update a model of what is known by the other person, employing cognitive processes such as theory of mind. We tested the hypothesis that the ventromedial prefrontal cortex (vmPFC), a neural region involved in processing and interpreting social and emotional information, would be critical for the development and use of common ground. We studied seven patients with bilateral vmPFC damage and seven age-, sex-, and education-matched healthy comparison participants, each interacting with a familiar partner. Across 24 trials, participants verbally directed their partners how to arrange a set of 12 abstract tangram cards. Our hypothesis was not supported: the vmPFC and healthy comparison groups showed similar development and use of common ground, evident in reduction in time and words used to describe the cards, similar increases in the use of definite references (e.g., the horse), and comparable use of verbal play (playful language) in their interactions. These results argue against the idea that the vmPFC is critical for the development and use of common ground in social interaction. We propose that a cognitive and neuroanatomical bifurcation in theory of mind processes may explain this outcome. The vmPFC may be important for affective theory of mind (the ability to understand another's feelings); however, the development and use of common ground in social interaction may place higher demands on the ability to understand another's knowledge, or cognitive theory of mind, which may not require the vmPFC.