Meta-analysis of social cognition in attention-deficit/hyperactivity disorder (ADHD): comparison with healthy controls and autistic spectrum disorder

Variability of theory of mind versus pragmatic ability in typical and atypical development

INTRODUCTION

Numerous studies have linked deficits in Theory of Mind (ToM) with language problems. We aimed to explore the similarities and differences between children's patterns of performance on a ToM task that requires minimal linguistic skill and a pragmatic inference task that relies on both ToM and language. We assessed variability in pragmatic inference skills and ToM across populations of children (8-14 years) displaying varying cognitive profiles. We further compared the sensitivity of ToM versus pragmatic ability to core language skills, memory and executive functioning (EF).

METHOD

ToM was tested using the Social Attribution Task (SAT-MC-II). Pragmatic ability was assessed in an implicature comprehension task. Receptive vocabulary, grammar comprehension, short-term and working memory (STM and WM) capacity and EF were measured using Hungarian adaptations of standard tasks and tests developed by the authors' lab. In addition to typically developing (TD) children (n = 33), we included children with neurodevelopmental disorders where ToM and/or language abilities are vulnerable: autism spectrum disorder (ASD, n = 26), attention deficit hyperactivity disorder (ADHD, n = 25) and developmental language disorder (DLD, n = 18).

RESULTS

Results revealed a significant but only moderate positive correlation between pragmatic inference and ToM indicating that the two abilities are related but distinct. The ASD group showed impairments in both ToM and pragmatic inference ability but no significant deficit was observed in ADHD or DLD relative to TD children in either skill. However, while SAT-MC-II results were only affected by verbal WM and vocabulary measures, pragmatic performance was associated with STM, verbal WM, EF, grammatical skills and vocabulary.

CONCLUSION

Our findings indicate that disentangling the contributions of different cognitive skills to ToM tasks may help clarify the role of ToM in language skills and identify distinct patterns of ToM and pragmatic skills in developmental disorders.

Research Review: Social cognition and everyday social skills in children and adolescents with attention-deficit/hyperactivity disorder: a meta-analysis of case-control studies

BACKGROUND

Previous studies that have assessed social cognition in Attention-Deficit/Hyperactivity Disorder (ADHD) have produced inconsistent findings. To summarize these data and shed light upon moderators that may explain observed inconsistencies, we conducted a systematic review and meta-analysis exploring social cognition (Theory of Mind (ToM), Empathy, Facial and Non-Facial Emotion Recognition) and Everyday Social Skills in children and adolescents with ADHD.

METHODS

The current meta-analysis involved 142 studies including 652 effect sizes. These studies compared children and adolescents with ADHD (n = 8,300) and with typical development (n = 7,983).

RESULTS

Participants with ADHD exhibited moderate to very large deficits in ToM (SMD = 0.84, 95% CI = 0.68-0.99), Facial Emotion Recognition (SMD = 0.63, 95% CI = 0.46-0.81), and Everyday Social Skills (SMD = 1.23, 95% CI = 1.08-1.37). The magnitude of these impairments was similar when considering effect sizes adjusted for some covariates and the methodological quality of the studies. Few studies have investigated Empathy and Non-Facial Emotion Recognition, which precludes definitive conclusions.

CONCLUSIONS

Children and adolescents with ADHD experience robust impairments in ToM, Facial Emotion Recognition and Everyday Social Skills. Future studies should explore whether these deficits are a consequence of difficulties in other areas of cognition (e.g., executive functioning). We have made all our raw data open access to facilitate the use of the present work by the community (e.g., clinicians looking for tools, assessing social impairments, or researchers designing new studies).

Theory of mind in epilepsy

Epilepsy is characterized by recurrent, chronic, and unprovoked seizures. Epilepsy has a significant negative impact on a patient's quality of life even if seizures are well controlled. In addition to the distress caused by seizures, patients with epilepsy (PwE) may suffer from cognitive impairment with serious social consequences such as poor interpersonal relationships, loss of employment, and reduced social networks. Pathological changes and functional connectivity abnormalities observed in PwE can disrupt the neural network responsible for the theory of mind. Theory of mind is the ability to attribute mental states to other people (intentions, beliefs, and emotions). It is a complex aspect of social cognition and includes cognitive and affective constructs. In recent years, numerous studies have assessed the relationship between social cognition, including the theory of mind, in PwE, and suggested impairment in this domain. Interventions targeting the theory of mind can be potentially helpful in improving the quality of life of PwE.

Autistic Adults Avoid Unpredictability in Decision-Making

Decision-making under unpredictable conditions can cause discomfort in autistic persons due to their preference for predictability. Decision-making impairments might furthermore be associated with a dysregulation of sex and stress hormones. This prospective, cross-sectional study investigated decision-making in 32 autistic participants (AP, 14 female) and 31 non-autistic participants (NAP, 20 female) aged 18-64 years. The Iowa Gambling Task (IGT) and the Cambridge Risk Task (CRT) were used to assess decision-making under ambiguity and under risk with known outcome probabilities, respectively. Cortisol, estradiol, and testosterone serum levels were related to decision-making performance. Groups did not differ in overall IGT and CRT performance, but compared with NAP, AP preferred less profitable card decks with predictable outcomes while avoiding those with unpredictable outcomes. AP required more time to reach decisions compared to NAP. Additionally, AP without comorbid depression performed significantly worse than NAP in the IGT. Estradiol and cortisol concentrations were significant predictors of CRT scores in NAP, but not in AP. The study results imply that AP are 'risk-averse' in decision-making under ambiguity as they avoided choice options with unpredictable losses in comparison to NAP. Our findings highlight the intolerance for uncertainty, particularly in ambiguous situations. Thus, we recommend being as transparent and precise as possible when interacting with autistic individuals. Future research should explore decision-making in social situations among individuals with ASD, factoring in person-dependent variables such as depression.

Validity of the Systemizer Profile Questionnaire: A New Tool to Identify Cognitive, Mentalizing, Sensory, Social, and Systemizing Abilities in Adults with Autism-Spectrum-Disorders With and Without Comorbid ADHD

PURPOSE

Systemizer Profile Questionnaire (SPQ), which has not been used before, investigates difficulties in mentalisation, sensory- and/or social sensitivity and social cognition (MSSSC) in subjects with Autism-Spectrum-Disorders (ASD) with and without Attention-Deficit-Hyperactivity-Disorder (ADHD). The aim of this study was to evaluate the reliability and validity of the SPQ domains, and to assess the predictive validity of the SPQ against the Ritvo Autism Asperger Diagnostic Scale (RAADS).

METHODS

Three-hundred-fifty-four study subjects with ICD-10 verified ASD confirmed by RAADS and 354 controls matched on age group and gender were recruited and evaluated systematically with SPQ, standardized questions about demographic and clinical data. Hypothesized SPQ subscales formed from 85 items were evaluated using confirmatory factor analysis (CFA). Resulting revised sub-scales were confirmed using item response theory (IRT) and the predictive validity of the SPQ scores was evaluated using RAADS scores above 64 as the standard.

RESULTS

Twenty-two of the original 85 items were removed, resulting in an instrument with 63 items across nine psychometrically valid domains. These domains had high sensitivity (range: 0.64 to 0.84), and high specificity (range: 0.73 to 0.90). Positive predictive values (range: 0.76 to 0.89) and negative predictive values (range: 0.69 to 0.90) were also high. For the total SPQ score the sensitivity was 0.95, the specificity was 0.87, the positive predictive value was 0.88 and the negative predictive value was 0.95.

CONCLUSION

SPQ domains are valid descriptions/profiles of MSSSC given that ASD is confirmed by RAADS, though irrelevant if not, as SPQ is not a diagnostic instrument.

Comparing pragmatic abilities across multiple languages in adults with ADHD: Insights from a self-report questionnaire

Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with pragmatic language impairments in children, but less is known about the communicative abilities of adults with ADHD, especially when using a second or third language. In this study, we developed a questionnaire to collect self-report measures of a set of pragmatic skills in a person's first, second and third language, comparing adults with and without an ADHD diagnosis. One hundred seventy-nine multilingual adults with (N = 91) and without ADHD (N = 88) completed the survey. As predicted, adults with ADHD reported more pragmatic difficulties than the control group. More specifically, people with ADHD showed pronounced impairments in regulating their behaviour in spoken interactions in the form of excessive talking, frequently interrupting others, and speaking without thinking first. Notably, these types of hyperactive and impulsive behaviours were significantly reduced when people with ADHD communicated in a second or third language. For pragmatic difficulties related to inattention such as concentrating on a conversation, both groups tended to be more inattentive in their third language compared to their first and second language. The understanding of non-literal language was only affected by ADHD in the first language and was generally more taxing in a language with lower proficiency levels. Our study contributes to a more nuanced understanding of how ADHD affects different kinds of communicative abilities in multilingual adults. It also has implications for clinical practice, highlighting the importance of assessing symptoms of inattention, hyperactivity, and impulsivity in a person's dominant language.

Visual perspective taking neural processing in forensic cases with high density EEG

This EEG study aims at dissecting the differences in the activation of neural generators between borderline personality disorder patients with court-ordered measures (BDL-COM) and healthy controls in visual perspective taking. We focused on the distinction between mentalizing (Avatar) and non-mentalizing (Arrow) stimuli as well as self versus other-perspective in the dot perspective task (dPT) in a sample of 15 BDL-COM cases and 54 controls, all of male gender. BDL-COM patients showed a late and diffuse right hemisphere involvement of neural generators contrasting with the occipitofrontal topography observed in controls. For Avatars only and compared to controls, the adoption of Self perspective involved a lower EEG activity in the left inferior frontal, right middle temporal cortex and insula in BDL-COM patients prior to 80 ms post-stimulus. When taking the Other-perspective, BDL-COM patients also showed a lower activation of superior frontal, right inferior temporal and fusiform cortex within the same time frame. The beta oscillation power was significantly lower in BDL-COM patients than controls between 400 and 1300 ms post stimulus in the Avatar-Other condition. These results indicate that BDL-COM patients display both altered topography of EEG activation patterns and reduced abilities to mobilize beta oscillations during the treatment of mentalistic stimuli in dPT.

Identifying Autistic-Like Symptoms in Children with ADHD: A Comparative Study Using ADOS-2

Purpose

Recent literature has focused attention on the presence of autistic-like symptoms in children with Attention Deficit/Hyperactivity Disorder (ADHD), who often exhibit social difficulties, posing challenges for a distinct clinical diagnosis. The current study aimed to identify the specific pattern of autistic symptoms in subjects with ADHD or Autistic Spectrum Disorder (ASD), examining similarities or differences at both the domain and individual item levels.

Patients and Methods

In this study, we enrolled 43 school-age children divided into the following: the ADHD group (n=25) consisted of children initially referred for ASD symptoms but subsequently clinically diagnosed with ADHD, and the ASD group consisted of 18 children with ASD. We used the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2), to examine relative differences in the presence of symptoms such as deficits in communication and social interaction, and restricted and repetitive behaviors in these two groups. Comparison between groups was conducted to explore differences in IQ, age, ADOS-2 domains, and externalizing and internalizing problems among the groups.

Results

We found significant differences between the groups when comparing summary scores of ADOS-2 domains (Social Affect, Restricted and Repetitive Behavior, and Total Score). Interestingly, at the individual item level, the ADHD group exhibited a similar level of atypical behaviors compared to the ASD group in two items related to the social-communication area: "Pointing" and "Gestures". Additionally, the frequencies of "Stereotyped/idiosyncratic words or phrases", "Mannerisms", and "Repetitive interests and behaviors" also showed similarities between groups.

Conclusion

These findings indicate the importance of exploring and developing potential transdiagnostic domains that could be targeted for treatments specifically designed for children with ADHD.

Atypical local and global biological motion perception in children with attention deficit hyperactivity disorder

Perceiving biological motion (BM) is crucial for human survival and social interaction. Many studies have reported impaired BM perception in autism spectrum disorder, which is characterised by deficits in social interaction. Children with attention deficit hyperactivity disorder (ADHD) often exhibit similar difficulties in social interaction. However, few studies have investigated BM perception in children with ADHD. Here, we compared differences in the ability to process local kinematic and global configurational cues, two fundamental abilities of BM perception, between typically developing and ADHD children. We further investigated the relationship between BM perception and social interaction skills measured using the Social Responsiveness Scale and examined the contributions of latent factors (e.g. sex, age, attention, and intelligence) to BM perception. The results revealed that children with ADHD exhibited atypical BM perception. Local and global BM processing showed distinct features. Local BM processing ability was related to social interaction skills, whereas global BM processing ability significantly improved with age. Critically, general BM perception (i.e. both local and global BM processing) may be affected by sustained attentional ability in children with ADHD. This relationship was primarily mediated by reasoning intelligence. These findings elucidate atypical BM perception in ADHD and the latent factors related to BM perception. Moreover, this study provides new evidence that BM perception is a hallmark of social cognition and advances our understanding of the potential roles of local and global processing in BM perception and social cognitive disorders.

The reverse congruency effect elicited by eye-gaze as a function of attention-deficit/hyperactivity disorder symptoms

Individuals diagnosed with attention deficit/hyperactivity disorder (ADHD) have been found to have impairments in multiple aspects of social cognition, thus including the attentional processing of socially relevant stimuli such as eye-gaze. However, to date, it remains unclear whether only the social-specific but not the domain-general directional components, elicited by eye-gaze are affected by ADHD symptomatology. To address this issue, the present study aimed to investigate the impact of ADHD-like traits on the social-specific attentional processing of eye-gaze. To this purpose, we conducted an online experiment with a sample of 140 healthy undergraduate participants who completed two self-reported questionnaires designed to assess ADHD-like traits, and a social variant of an interference spatial task known to effectively isolate the social-specific component of eye-gaze. To make our research plan transparent, our hypotheses, together with the plans of analyses, were registered before data exploration. Results showed that while the social-specific component of eye-gaze was evident in the sample, no significant correlation was found between this component and the measured ADHD-like traits. These results appear to contradict the intuition that the attentional processing of the social-specific components of eye-gaze may be impaired by ADHD symptomatology. However, further research involving children and clinical populations is needed in order to clarify this matter.

Quantitative Expression of Latent Disease Factors in Individuals Associated with Psychopathology Dimensions and Treatment Response

Psychiatric comorbidity is common in symptom-based diagnoses like autism spectrum disorder (ASD), attention/deficit hyper-activity disorder (ADHD), and obsessive-compulsive disorder (OCD). However, these co-occurring symptoms mediated by shared and/or distinct neural mechanisms are difficult to profile at the individual level. Capitalizing on unsupervised machine learning with a hierarchical Bayesian framework, we derived latent disease factors from resting-state functional connectivity data in a hybrid cohort of ASD and ADHD and delineated individual associations with dimensional symptoms based on canonical correlation analysis. Models based on the same factors generalized to previously unseen individuals in a subclinical cohort and one local OCD database with a subset of patients undergoing neurosurgical intervention. Four factors, identified as variably co-expressed in each patient, were significantly correlated with distinct symptom domains (r = -0.26-0.53, P < 0.05): behavioral regulation (Factor-1), communication (Factor-2), anxiety (Factor-3), adaptive behaviors (Factor-4). Moreover, we demonstrated Factor-1 expressed in patients with OCD and Factor-3 expressed in participants with anxiety, at the degree to which factor expression was significantly predictive of individual symptom scores (r = 0.18-0.5, P < 0.01). Importantly, peri-intervention changes in Factor-1 of OCD were associated with variable treatment outcomes (r = 0.39, P < 0.05). Our results indicate that these data-derived latent disease factors quantify individual factor expression to inform dimensional symptom and treatment outcomes across cohorts, which may promote quantitative psychiatric diagnosis and personalized intervention.

Theory of Mind: A Brief Review of Candidate Genes

Deficits in theory of mind (ToM), known as the ability to understand the other's mind, have been associated with several psychopathological outcomes. The present systematic review aims to summarize the results of genetic studies that investigated gene polymorphisms associated with mentalization performance tasks in children and adults. The systematic review was carried out following PRISMA guidelines, and the literature search was conducted in PubMed and EBSCOhost using the following keywords: 'theory of mind, mentalizing, mindreading' and 'gene, genetic basis'. Nineteen studies met the eligibility criteria for inclusion. Most of the literature focused on the role of DRD4, DAT1, OXTR, OXT, COMT, ZNF804A, AVP, AVPR, SCL6A4, EFHC2, MAO-A, and the family of GTF2I genes in influencing ToM. However, controversial results emerged in sustaining the link between specific genetic polymorphisms and mentalization abilities in children and adults. Available data show heterogeneous outcomes, with studies reporting an association between the same family genes in subjects of the same age and other studies reporting no correlation. This does not allow us to draw any solid conclusions but paves the way for exploring genes involved in ToM tasks.

Social Functioning in Children and Adolescents with ADHD and Autism Spectrum Disorder: A Cross-Disorder Comparison

OBJECTIVE

Social functioning can be defined according to three main components: social perception, social performance, and social knowledge. Although they are important in daily life relationships and in children's adaptation, these components have never been tested together in children and adolescents with Attention Deficit/Hyperactivity Disorder (ADHD) or with Autism Spectrum Disorder (ASD) using lab-based tasks. The present study used a cross-disorder approach to compare the performance of children with ADHD and ASD and non-diagnosed (ND) peers utilizing a task that involves these three fundamental social functioning components.

METHODS

Two hundred and twenty-five Italian children (86% boys) aged between 8 and 16 (66 with a clinical diagnosis of ADHD; 51 with a clinical diagnosis of ASD, level 1; 108 ND children) were enrolled. The three groups were matched for age, gender, and IQ. Social functioning was assessed using a lab-based task, including videos of problematic interactions among peers, created ad hoc for the study, and a semi-structured interview based on the Social Information Processing model.

RESULTS

Data were analyzed using one-way ANOVAs and multinomial mixed effects models. Our findings suggested that both groups with ADHD and ASD presented social functioning difficulties in comparison to ND children. However, a different pattern of performance emerged. Children with ADHD showed higher difficulties in social performance than those with ASD, whereas autistic children revealed more difficulties in social perception and in some aspects of social knowledge.

CONCLUSIONS

Our findings have important clinical implications for assessment, intervention, and differential diagnosis, and should encourage clinicians to investigate different aspects of social functioning and identify specific strengths and weaknesses in each social profile.

Facial expression recognition ability and its neuropsychological mechanisms in children with attention deficit and hyperactive disorder

Attention deficit and hyperactive disorder (ADHD) is a chronic neurodevelopmental disorder characterized by inattention, hyperactivity-impulsivity, and working memory deficits. Social dysfunction is one of the major challenges faced by children with ADHD. It has been found that children with ADHD can't perform as well as typically developing children on facial expression recognition (FER) tasks. Generally, children with ADHD have some difficulties in FER, while some studies suggest that they have no significant differences in accuracy of specific emotion recognition compared with typically developing children. The neuropsychological mechanisms underlying these difficulties are as follows. First, neuroanatomically. Compared to typically developing children, children with ADHD show smaller gray matter volume and surface area in the amygdala and medial prefrontal cortex regions, as well as reduced density and volume of axons/cells in certain frontal white matter fiber tracts. Second, neurophysiologically. Children with ADHD exhibit increased slow-wave activity in their electroencephalogram, and event-related potential studies reveal abnormalities in emotional regulation and responses to angry faces when facing facial stimuli. Third, psychologically. Psychosocial stressors may influence FER abilities in children with ADHD, and sleep deprivation in ADHD children may significantly increase their recognition threshold for negative expressions such as sadness and anger. This article reviews research progress over the past three years on FER abilities of children with ADHD, analyzing the FER deficit in children with ADHD from three dimensions: neuroanatomy, neurophysiology and psychology, aiming to provide new perspectives for further research and clinical treatment of ADHD.

Social competence in autism: A structural equation modeling approach

Autistic individuals present with difficulties in social competence (e.g., navigating social interactions and fostering relationships). Clinical interventions widely target social cognition and social behavior, but there is inconsistent understanding of the underlying components of social competence. The present study used structural equation modeling to examine social cognition and social behavior and explore the relationship between these latent constructs. Autistic youth (ages 10-17; n = 219) and their caregivers participated in this study. Constructs of social cognition and social behavior were captured using caregiver-report and self-report rating scales, as well as observational measures and direct clinical assessments (e.g., NEPSY-II). Measurement models of social cognition and social behavior demonstrated adequate to good fit. Correlational models demonstrated adequate to poor fit, indicating latent constructs of social cognition and social behavior are not closely related in autistic youth. Exploratory examination of a subsample of male youth (n = 157) evidenced improved model fit of social behavior, specifically. Findings tease apart social cognition and social behavior as cohesive and separable constructs; results do not support a structural relationship between social cognition and social behavior. Noted treatment implications include consideration of how targeting social cognition and social behavior together or separately may support autistic youth's progress toward reaching their identified therapeutic goals and supporting their self-directed social development.

Unpacking the overlap between Autism and ADHD in adults: A multi-method approach

The overlap between Autism and Attention-Deficit Hyperactivity Disorder (ADHD) is widely observed in clinical settings, with growing interest in their co-occurrence in neurodiversity research. Until relatively recently, however, concurrent diagnoses of Autism and ADHD were not possible. This has limited the scope for large-scale research on their cross-condition associations, further stymied by a dearth of open science practices in the neurodiversity field. Additionally, almost all previous research linking Autism and ADHD has focused on children and adolescents, despite them being lifelong conditions. Tackling these limitations in previous research, 5504 adults - including a nationally representative sample of the UK (Study 1; n = 504) and a large pre-registered study (Study 2; n = 5000) - completed well-established self-report measures of Autism and ADHD traits. A series of network analyses unpacked the associations between Autism and ADHD at the individual trait level. Low inter-item connectivity was consistently found between conditions, supporting the distinction between Autism and ADHD as separable constructs. Subjective social enjoyment and hyperactivity-impulsivity traits were most condition-specific to Autism and ADHD, respectively. Traits related to attention control showed the greatest Bridge Expected Influence across conditions, revealing a potential transdiagnostic process underlying the overlap between Autism and ADHD. To investigate this further at the cognitive level, participants completed a large, well-powered, and pre-registered study measuring the relative contributions of Autism and ADHD traits to attention control (Study 3; n = 500). We detected age- and sex-related effects, however, attention control did not account for the covariance between Autism and ADHD traits. We situate our findings and discuss future directions in the cognitive science of Autism, ADHD, and neurodiversity, noting how our open datasets may be used in future research.

Criminal behaviors: A theory of mind problem?

Theory of mind (ToM) has been addressed in relation to functional alterations of certain brain regions and their connections. The objective is to evaluate ToM in imprisoned criminal offenders and to analyze their relationship with the functions linked to the prefrontal cortex according to their expression in neuropsychological tests. The sample was composed of 52 subjects. 27 committed instrumental homicides and 25 crimes of sale and/or possession of narcotics. A control group was taken, 19 healthy subjects at liberty. The Faux-Pas (FP) and the Reading the Mind in the Eyes tests were used. A neuropsychological battery of executive functions and functions related to the frontal lobes and Hare's Psychopathy Checklist-Revised (PCL-R) was also applied. The criminal groups have comparable performances in all measures. The control group (in freedom) showed higher performance, with statistical significance, in the Faux-Pas test. Moderate negative correlations were found between the FP and the PCL-R. A distinction between affective and cognitive ToM could be affirmed, with people deprived of liberty presenting deficient functioning in the cognitive ToM test. This difference in performance could be linked to the disruptive event with the social norm and not so much with the violent homicide act itself.

Theory of mind in neurodevelopmental disorders: beyond autistic spectrum disorder

INTRODUCTION

Theory of mind (ToM) is the human ability to perceive, interpret, and attribute the mental states of other people, and the alteration of this cognitive function is a core symptom of autistic spectrum disorder (ASD). In such other neurodevelopmental disorders as childhood-onset obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) that can present with cognitive dysfunctions, ToM has been less extensively studied, especially in the young population. The aim of the study was to compare advanced ToM between groups of young people diagnosed with OCD, TS, or ASD and a control group.

METHODS

Clinical interviews were conducted with male patients aged between 11 and 17 years with a main diagnosis of OCD (n = 19), TS (n = 14), or ASD (n = 18), and a control group (n = 20). We administered instruments for estimating intelligence quotient and severity of psychiatric symptoms, and tasks to evaluate ToM (the "Stories from everyday life" task and the "Reading the mind in the eyes" test).

RESULTS

Young people with TS and with ASD present similar difficulties in solving advanced ToM tasks, whereas patients with childhood-onset OCD present similar results to controls.

CONCLUSIONS

ToM is altered in other neurodevelopmental disorders beyond ASD, such as TS.

Far Transfer Effects of Trainings on Executive Functions in Neurodevelopmental Disorders: A Systematic Review and Metanalysis

Executive Functions are a set of interrelated, top-down processes essential for adaptive goal-directed behaviour, frequently impaired across different neurodevelopmental disorders with variable degrees of severity. Many executive-function-training studies in children with neurodevelopmental disorders have focused on near effects, investigating post-treatment improvements on directly trained processes, while enhancements of skills not directly trained, defined as far effects, are less considered, albeit these could be extremely relevant for reducing the negative impact of a disorder's core symptomatology. This systematic review and metanalysis aims to investigate the far effect outcomes after EF training in children with different types of neurodevelopmental disorders. 17 studies met the inclusion criteria for the systematic review, while 15 studies were selected in the metanalysis. An overall statistically significant effect size was found in the majority of far effect outcome measures considered in the studies. In particular, trainings on executive functions determine significant far effects on daily life functioning (0.46, 95% CI: [0.05-0.87]) and clinical symptoms (0.33, 95% CI: [0.15-0.51]). Despite a high variability of the results, intensity, frequency and the laboratory/life contexts dimension seem to be the most influential variables in determining far effects. This systematic review and metanalysis highlights the need to measure far effects of executive function training in neurodevelopmental disorders, selecting treatments not only on directly targeted processes, but also according to far impacts on the functional weakness of the disorder.

Effectiveness of an online dialectical behavior therapy skills training in adults with attention-deficit/hyperactivity disorder: A randomized controlled trial

OBJECTIVE

The current study aims to examine the efficacy of an add-on dialectical behavior therapy skills training (DBT-ST) on adult attention-deficit/hyperactivity disorder (ADHD). The DBT-ST was applied online under the pandemic conditions that occurred after the study had started.

METHODS

The current randomized controlled trial consists of an intervention group to whom the DBT-ST was applied in online setting and a waitlist control group who received treatment as usual (TAU). Data were collected pre-, post-, and mid-treatment. ADHD symptoms (with the sub-dimensions of inattention and hyperactivity), impulsivity, mindfulness, difficulty with emotion regulation, interpersonal effectiveness, distress tolerance, life satisfaction, functionality in daily life, and general psychological symptom levels were measured with self-report scales. The data were analyzed using mixed-design ANOVA.

RESULTS

The global ADHD, inattention, and hyperactivity symptoms of the DBT-ST group significantly decreased more than those in the TAU control group. The DBT-ST group also showed a significant decrease regarding difficulty with emotion regulation and increases in life satisfaction and functionality, though the group × time effect was not significant.

CONCLUSION

DBT-ST was found effective against the participants' ADHD symptoms. The treatment was additionally found to improve their emotion regulation and quality of life. Further investigation is needed to investigate DBT-ST in an online setting.

An assessment of dynamic facial emotion recognition and theory of mind in children with ADHD: An eye-tracking study

Deficits in social cognition in attention deficit hyperactivity disorder (ADHD) have been associated with difficulties in functioning. Since recognizing emotional facial expressions is essential for developing the perceptual components of the theory of mind (ToM), it is important to assess this relationship in children with ADHD. This study therefore compared the recognition of emotional stimuli and gaze patterns between children with ADHD and healthy children using eye-tracking with dynamic facial images. It also examined the relationship between facial emotion recognition accuracy, gaze patterns, ToM scores, and ADHD symptoms. Children with ADHD aged 8-13 (n = 47) and a control group (n = 38) completed a facial emotion recognition test, ToM tests, and the Conners' Parent Rating Scale. Participants' gaze patterns in response to dynamic facial emotion expressions were recorded using eye-tracking technology. Children with ADHD exhibited significantly lower accuracy in the recognition of the facial expressions of disgust and anger. The percentage fixation in the eye region was also significantly lower for happy, angry, sad, disgusted, and neutral emotions in the children with ADHD compared to the control group. No relationship was determined between the percentage of fixations on facial areas of interests and ADHD symptoms or ToM tests. This study provides evidence that children with ADHD experience deficits in visual attention to emotional cues. In addition, it suggests that facial emotion recognition deficits in children with ADHD represent a separate domain of social cognition that develops independently of ToM skills and core symptoms. Understanding and treating the social difficulties of individuals with ADHD may help improve their social functioning.

Perceptual Observer Modeling Reveals Likely Mechanisms of Face Expression Recognition Deficits in Depression

BACKGROUND

Deficits in face emotion recognition are well documented in depression, but the underlying mechanisms are poorly understood. Psychophysical observer models provide a way to precisely characterize such mechanisms. Using model-based analyses, we tested 2 hypotheses about how depression may reduce sensitivity to detect face emotion: 1) via a change in selectivity for visual information diagnostic of emotion or 2) via a change in signal-to-noise ratio in the system performing emotion detection.

METHODS

Sixty adults, one half meeting criteria for major depressive disorder and the other half healthy control participants, identified sadness and happiness in noisy face stimuli, and their responses were used to estimate templates encoding the visual information used for emotion identification. We analyzed these templates using traditional and model-based analyses; in the latter, the match between templates and stimuli, representing sensory evidence for the information encoded in the template, was compared against behavioral data.

RESULTS

Estimated happiness templates produced sensory evidence that was less strongly correlated with response times in participants with depression than in control participants, suggesting that depression was associated with a reduced signal-to-noise ratio in the detection of happiness. The opposite results were found for the detection of sadness. We found little evidence that depression was accompanied by changes in selectivity (i.e., information used to detect emotion), but depression was associated with a stronger influence of face identity on selectivity.

CONCLUSIONS

Depression is more strongly associated with changes in signal-to-noise ratio during emotion recognition, suggesting that deficits in emotion detection are driven primarily by deprecated signal quality rather than suboptimal sampling of information used to detect emotion.

Vocal emotion recognition in attention-deficit hyperactivity disorder: a meta-analysis

There is debate within the literature as to whether emotion dysregulation (ED) in Attention-Deficit Hyperactivity Disorder (ADHD) reflects deviant attentional mechanisms or atypical perceptual emotion processing. Previous reviews have reliably examined the nature of facial, but not vocal, emotion recognition accuracy in ADHD. The present meta-analysis quantified vocal emotion recognition (VER) accuracy scores in ADHD and controls using robust variance estimation, gathered from 21 published and unpublished papers. Additional moderator analyses were carried out to determine whether the nature of VER accuracy in ADHD varied depending on emotion type. Findings revealed a medium effect size for the presence of VER deficits in ADHD, and moderator analyses showed VER accuracy in ADHD did not differ due to emotion type. These results support the theories which implicate the role of attentional mechanisms in driving VER deficits in ADHD. However, there is insufficient data within the behavioural VER literature to support the presence of emotion processing atypicalities in ADHD. Future neuro-imaging research could explore the interaction between attention and emotion processing in ADHD, taking into consideration ADHD subtypes and comorbidities.

Lowered social motivation is associated with adolescent attention deficit hyperactivity disorder and social anxiety symptoms

BACKGROUND

Difficulties in social skills are highly prevalent in children and adolescents with attention deficit hyperactivity disorder (ADHD), however, the reasons for these social difficulties are poorly understood. This study aimed to understand social motivation in children (aged 5-8) and adolescents (aged 13-17) with and without ADHD, and the relationship between social anxiety and social motivation in youth with ADHD.

METHOD

204 parents of children and adolescents with and without ADHD completed online questionnaires on social motivation, social anxiety, and ADHD symptoms.

RESULTS

Adolescents with ADHD had significantly lower social motivation than typically developing adolescents, and children with ADHD. Higher social anxiety significantly predicted lowered social motivation in participants with ADHD.

CONCLUSIONS

These findings indicate a unique pattern of social motivation in ADHD, specifically a reduction during adolescence, reflecting social intervention inefficacy. Additionally, these findings establish a link between social motivation and social anxiety, suggesting that they may act as barriers to social intervention.

Cerebral response to emotional working memory based on vocal cues: an fNIRS study

Introduction

Humans mainly utilize visual and auditory information as a cue to infer others' emotions. Previous neuroimaging studies have shown the neural basis of memory processing based on facial expression, but few studies have examined it based on vocal cues. Thus, we aimed to investigate brain regions associated with emotional judgment based on vocal cues using an N-back task paradigm.

Methods

Thirty participants performed N-back tasks requiring them to judge emotion or gender from voices that contained both emotion and gender information. During these tasks, cerebral hemodynamic response was measured using functional near-infrared spectroscopy (fNIRS).

Results

The results revealed that during the Emotion 2-back task there was significant activation in the frontal area, including the right precentral and inferior frontal gyri, possibly reflecting the function of an attentional network with auditory top-down processing. In addition, there was significant activation in the ventrolateral prefrontal cortex, which is known to be a major part of the working memory center.

Discussion

These results suggest that, compared to judging the gender of voice stimuli, when judging emotional information, attention is directed more deeply and demands for higher-order cognition, including working memory, are greater. We have revealed for the first time the specific neural basis for emotional judgments based on vocal cues compared to that for gender judgments based on vocal cues.

Reduced gaze-cueing effect with neutral and emotional faces in adults with attention deficit/hyperactivity disorder

This study examined whether gaze shift of neutral and emotional faces triggers reflexive attention orienting in 45 adults with attention deficit/hyperactivity disorder (ADHD) and 45 age-, sex-, and intelligence quotient-matched typically developing (TD) adults. The cues changed from neutral to anger, fearful, or happy expressions under the emotional face condition. Participants were asked to detect a target that appeared to the left or right of the cue stimuli, as rapidly and accurately as possible. The results revealed a gaze-cueing effect, where the reaction time to the target was shorter under the "gaze-at-target" condition than under the "non-gaze-at-target" condition in both groups. Facial expressions did not modulate the gaze-cueing effect in either group. However, the magnitude of the gaze-cueing effect was smaller in the ADHD group than in the TD group. Contrary to our expectations, a larger gaze-cueing effect was observed in individuals with ADHD who exhibited more severe inattention. Our results suggest that adults with ADHD ineffectively orient their attention toward another's gaze. Moreover, difficulty with sustained and selective attention may be associated with a larger influence of gaze direction; this difficulty may play a role in social interaction problems.

Computerized Cognitive Test Batteries for Children and Adolescents-A Scoping Review of Tools For Lab- and Web-Based Settings From 2000 to 2021

OBJECTIVE

Cognitive functioning is essential to well-being. Since cognitive difficulties are common in many disorders, their early identification is critical, notably during childhood and adolescence. This scoping review aims to provide a comprehensive literature overview of computerized cognitive test batteries (CCTB) that have been developed and used in children and adolescents over the past 22 years and to evaluate their psychometric properties.

METHOD

Among 3192 records identified from three databases (PubMed, PsycNET, and Web of Science) between 2000 and 2021, 564 peer-reviewed articles conducted in children and adolescents aged 3 to 18 years met inclusion criteria. Twenty main CCTBs were identified and further reviewed following PRISMA guidelines. Relevant study details (sample information, topic, location, setting, norms, and psychometrics) were extracted, as well as administration and instrument characteristics for the main CCTBs.

RESULTS

Findings suggest that CCTB use varies according to age, location, and topic, with eight tools accounting for 85% of studies, and the Cambridge Neuropsychological Test Automated Battery (CANTAB) being most frequently used. Few instruments were applied in web-based settings or include social cognition tasks. Only 13% of studies reported psychometric properties.

CONCLUSIONS

Over the past two decades, a high number of computerized cognitive batteries have been developed. Among these, more validation studies are needed, particularly across diverse cultural contexts. This review offers a comprehensive synthesis of CCTBs to aid both researchers and clinicians to conduct cognitive assessments in children in either a lab- or web-based setting.

Hippocampal volume mediates the relationship of parental rejection in childhood with social cognition in healthy adults

Childhood abuse reduces hippocampal and amygdala volumes and impairs social cognition, including the ability to recognize facial expressions. However, these associations have been studied primarily in individuals with a history of severe abuse and psychiatric symptoms; researchers have not determined whether these associations can also be observed in healthy adults. In the present study, we analyzed data from 400 healthy adults (208 men and 192 women) at Tamagawa University. Parental rejection reflecting childhood abuse was assessed using the short form of Egna Minnen Beträffande Uppfostran, while social cognition was assessed using the "Fake Smile Detection Task." Hippocampal and amygdala volumes were extracted from T1-weighted magnetic resonance imaging data using FreeSurfer. We found that greater parental rejection resulted in smaller hippocampal and amygdala volumes and poorer performance in the Fake Smile Detection Task. Structural equation modeling analysis supported the model that hippocampal volume mediates maternal rejection effect on performance on the Fake Smile Detection Task, with involvement of the amygdala. These findings are in line with the structural and functional connectivity found between the hippocampus and amygdala and their joint involvement in social cognition. Therefore, parental rejection may affect hippocampal and amygdala volumes and social cognitive function even in symptom-free adults.

Social Cognition and Functioning in Patients With Social Anxiety Disorder and/or Attention-Deficit/Hyperactivity Disorder

ABSTRACT

In recent years, social cognition and one of its dimensions, the theory of mind, have been more commonly investigated in patients with social anxiety disorder (SAD) and attention-deficit/hyperactivity disorder (ADHD). In this study, SAD, ADHD, comorbid SAD-ADHD, and healthy control (HC) groups, each consisting of 30 participants, were included and compared in terms of social cognition and functionality. Mean global functioning assessment scores were found to be significantly higher in the HC group compared with the other three groups and in the ADHD group compared with the SAD and SAD-ADHD groups. Mean Dokuz Eylül Theory of Mind Index total scores were found to be significantly higher in the HC group compared with the other three groups and in the SAD and SAD-ADHD groups compared with the ADHD group. These findings suggest that SAD patients with or without ADHD show better social cognition but worse functioning compared with pure ADHD patients.

Deep phenotyping of socio-emotional skills in children with typical development, neurodevelopmental disorders, and mental health conditions: Evidence from the PEERS

OBJECTIVE

Socio-emotional skills, including social competence and social cognition, form the basis for robust relationships and wellbeing. Despite their importance, these skills are poorly defined and measured, particularly in children with developmental vulnerabilities. As a consequence, targets for effective management and treatment remain unclear. We aimed to i) phenotype social competence and social cognition in typically developing children (TDC) and in children with neurodevelopmental or mental health disorders (clinical groups) and ii) establish the relationships between these child-direct measures and parent ratings of social competence and behavior.

METHOD

Using a multi-site, cross-sectional study design, we recruited 513 TDC and 136 children with neurodevelopmental (autism spectrum disorder [ASD], attention deficit hyperactivity disorder [ADHD]) or mental health (Anxiety Disorder [ANX]) diagnoses (age range 5-15 years). We administered the Paediatric Evaluation of Emotions, Relationships and Socialisation (PEERS) to children, and parents completed standardised questionnaires rating children's socio-emotional function.

RESULTS

Standardised parent questionnaires revealed a global pattern of everyday socio-emotional impairment that was common to all clinical groups, while PEERS identified disorder-specific socio-cognitive profiles for children with ASD, ADHD and ANX. Compared to TDCs, children with ASD demonstrated global socio-cognitive impairment. Children with ADHD were impulsive, demonstrating difficulties managing speed accuracy trade-offs. Children with ANX exhibited slowed social decision-making, but otherwise intact skills.

CONCLUSIONS

Standardized parent questionnaires of child socio-emotional function reveal differences between children with typical and atypical development, but do not yield disorder-specific, socio-emotional profiles. In contrast, findings from the PEERS objective assessment suggest that that ASD, ADHD and ANX are associated with distinct socio-cognitive phenotypes, to more accurately guide and target management and treatment of impaired social competence.

Probing the overarching continuum theory: data-driven phenotypic clustering of children with ASD or ADHD

The clinical validity of the distinction between ADHD and ASD is a longstanding discussion. Recent advances in the realm of data-driven analytic techniques now enable us to formally investigate theories aiming to explain the frequent co-occurrence of these neurodevelopmental conditions. In this study, we probe different theoretical positions by means of a pre-registered integrative approach of novel classification, subgrouping, and taxometric techniques in a representative sample (N = 434), and replicate the results in an independent sample (N = 219) of children (ADHD, ASD, and typically developing) aged 7-14 years. First, Random Forest Classification could predict diagnostic groups based on questionnaire data with limited accuracy-suggesting some remaining overlap in behavioral symptoms between them. Second, community detection identified four distinct groups, but none of them showed a symptom profile clearly related to either ADHD or ASD in neither the original sample nor the replication sample. Third, taxometric analyses showed evidence for a categorical distinction between ASD and typically developing children, a dimensional characterization of the difference between ADHD and typically developing children, and mixed results for the distinction between the diagnostic groups. We present a novel framework of cutting-edge statistical techniques which represent recent advances in both the models and the data used for research in psychiatric nosology. Our results suggest that ASD and ADHD cannot be unambiguously characterized as either two separate clinical entities or opposite ends of a spectrum, and highlight the need to study ADHD and ASD traits in tandem.

Self- and proxy-reported impaired social interaction in young adults with simple congenital heart defects

Background

Simple Congenital Heart Defects such as septal defects constitute a large proportion of Congenital Heart Defects. New research has demonstrated more co-morbidities than previously thought. In particular, co-morbidities involving neurocognitive, psychiatric, and social difficulties have been described. Neurocognitive and psychiatric morbidities affect social interaction. Social interaction is important in everyday social life (education, work life, family life). In this study, we investigated social interaction through self- and proxy-answered Social Responsiveness Scale 2 (SRS-2) in young adults with simple Congenital Heart Defects and compared their social interaction profile to healthy matched controls.

Methods

We included a total of 80 patients with either atrial or ventricular septal defect (age 26.6 years) and 38 heart-healthy, age, sex, and ISCED educational matched controls (age: 25.3 years). A close relative proxy from each participant took part in the study as well. All participants answered the Social Responsiveness Scale 2 (SRS-2) (n = 225). Our primary and secondary outcomes were the SRS-2 Total score and the SRS-2 sub-scores.

Results

In the Congenital Heart Defects group, 31.3% had a Total score above 60 compared to 7.9% in the control group (p = 0.005, RR = 3.96). The participants with a septal defect had a higher Total score (52.5 vs. 45.5, p = 0.004), a higher Social Cognition sub-score (55.0 vs. 47.0, p = 0.0004), and a higher Social Motivation sub-score (50.0 vs. 45.0, p = 0.003) than the heart-healthy participants. We found no difference between the two groups regarding the sub-scores of Social Awareness and Social Communication. A multiple linear regression model showed that the variable that explained most of the variation in Total Score was having a previously diagnosed psychiatric disorder.

Conclusion

We found that young adults with atrial or ventricular septal defects have a fourfold increased risk of social interaction difficulties compared to heart-healthy peers. They have a social interaction profile, with difficulties in social cognition and social motivation, and preserved social awareness and social communication. Psychiatric morbidity explained most of the variation in social interaction problems. As social difficulties and psychiatric morbidities are intertwined, social interaction difficulties could be an indication of already underlying psychiatric morbidities or a risk factor for future psychiatric morbidity.

Affect Recognition, Theory of Mind, and Empathy in Preschool Children with Externalizing Behavior Problems-A Group Comparison and Developmental Psychological Consideration

Preschool mental disorders are often associated with significant interpersonal problems, related to impaired affect recognition, theory of mind (ToM), and empathy. To date, these skills have not been studied together in preschoolers with externalizing behavior problems (EBPs). The aim of the present study was to investigate whether and to what extent preschool children with EBPs show impairments in affect recognition, ToM, and empathy. Preschoolers with EBPs, defined by current psychiatric treatment and T-scores ≥ 60 on the externalizing problem scale of the Child Behavior Checklist (CBCL/1½-5 or 6-18R) were compared to non-clinical controls (HCs), defined by no past and no current psychiatric treatment and T-scores < 60 on all CBCL broad-band scales. Groups were compared on affect recognition (NEuroPSYchological Assessment-II), affective ToM (Test of Emotion Comprehension), cognitive ToM (Extended Theory-of-Mind Scale), parent-reported emotional contagion, attention to others' feelings, and prosocial action (Empathy Questionnaire), IQ and language (Wechsler Preschool and Primary Scale of Intelligence-III Matrices, Active and Passive Vocabulary test), controlling for age, sex, and language abilities. Compared to 28 HCs, 22 preschoolers with EBPs (total sample meanage = 5.5 years +/- 0.8 years, range= 4.2-6.9 years, males 66%) had significantly greater impairments in cognitive ToM (p = 0.0012, η2 = 0.266), attention to others' feelings (p = 0.0049, η2 = 0.222), and prosocial action (p = 0.0070, η2 = 0.210), each representing strong effect sizes. EBPs were significantly related to cognitive domains, like prosocial action (r = -0.501), cognitive ToM (r = -0.425), and attention to others' feelings (r = -0.332), but not to affective domains of social cognition. Social cognitive development may be impaired as early as preschool age and should be promoted before the child starts school.

Mentalizing in Adolescents and Young Adults with Attention Deficit Hyperactivity Disorder: Associations with Age and Attention Problems

INTRODUCTION

Growing, albeit heterogenous evidence questions whether attention deficit/hyperactivity disorder (ADHD) is associated with socio-cognitive impairments, especially beyond childhood. This study focuses on mentalizing - the socio-cognitive ability to attribute and reason in terms of mental states. We aimed to characterize mentalizing performance in terms of correct scores and types of errors in adolescents and young adults with ADHD.

METHODS

Forty-nine adolescents and adults with ADHD and 49 healthy controls matched for age and gender completed a computerized naturalistic mentalizing task, the Movie for Assessment of Social Cognition (MASC). Repeated measures analyses of variance examined the effects of age group and ADHD diagnosis on MASC performance. Additionally, associations between mentalizing scores, the severity of attention problems, and the presence of comorbidity were explored in the ADHD group.

RESULTS

Results showed an increased prevalence of hypomentalizing errors in adolescents with ADHD. Lower mentalizing scores in adolescents with ADHD were correlated with indices of inattentiveness, impulsivity, and vigilance problems. Hypomentalizing errors in adolescents showed to be particularly associated with inattentiveness, after controlling for age and comorbidity. In contrast, adults with ADHD performed similarly to controls and their scores on the mentalizing task were not correlated to attention problems.

CONCLUSION

These findings highlight potential developmental differences in mentalizing abilities in ADHD youths and their association with attentional impairments.

Beyond simultaneity: Temporal interdependence of behavior is key to affiliative effects of interpersonal synchrony in children

Interpersonal synchrony (IPS) is the temporal coordination of behavior during social interactions. IPS acts as a social cue signifying affiliation both when children witness IPS between others and when they experience it themselves. However, it is unclear which temporal qualities of IPS produce these effects and why. We hypothesized that both the simultaneity and temporal regularity of partners' actions would influence affiliation judgments and that subjective perceptions of IPS ("togetherness") would play a role in mediating these relations. In two online tasks, children aged 4 to 11 years listened to a pair of children tapping (witnessed IPS; n = 68) or themselves tapped with another child (experienced IPS; n = 63). Tapping partners were presented as real, but the sounds attributed to them were computer generated so that their temporal relations could be experimentally manipulated. The simultaneity and regularity of their tapping was systematically manipulated across trials. For witnessed IPS, both the simultaneity and regularity of partners' tapping significantly positively affected the perceived degree of affiliation between them. These effects were mediated by the perceived togetherness of the tapping. No affiliative effects of IPS were found in the experienced IPS condition. Our findings suggest that both the simultaneity and regularity of partners' actions influence children's affiliation judgments when witnessing IPS via elicited perceptions of togetherness. We conclude that temporal interdependence-which includes but is not limited to simultaneity of action-is responsible for inducing perceptions of affiliation during witnessed IPS.

Transcranial direct current stimulation alters the process of reward processing in children with ADHD: Evidence from cognitive modeling

BACKGROUND

The ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) are the neural underpinnings of reward processing, which is impaired in individuals with attention deficit hyperactivity disorder (ADHD). In the present study, we aimed to explore the impact of the vmPFC and the dlPFC regulation on reward processing.

METHODS

Twenty-six children with ADHD performed the balloon analogue risk-taking task (BART) and chocolate delay discounting task (CDDT) during five different sessions of transcranial direct current stimulation (tDCS), separated by a one-week interval: anodal left dlPFC/cathodal right vmPFC, the reversed electrode positioning, anodal left dlPFC stimulation with extracranial return electrode, anodal right vmPFC stimulation with extracranial return electrodes, and sham stimulation. Four-parameter and constant-sensitivity models were used to model the data.

RESULTS

In the BART, anodal dlPFC/cathodal vmPFC stimulation facilitated conservative decision making, anodal tDCS over dlPFC with extracranial return electrode increased positive beliefs about the explosion of a balloon, and anodal vmPFC/cathodal dlPFC stimulation reduced ongoing learning in the process of decision making. In the CDDT, anodal vmPFC stimulation with extracranial return electrode decreased impatience in the process of the task.

CONCLUSION

These results suggest a role of the left dlPFC and right vmPFC in the outcome of decision making and the process of risky decision making and delay discounting.

Seeing in my way or your way: impact of intelligence, attention, and empathy on brain reactivity

Previous studies showed that neurotypical adults are able to engage in unconscious analyses of others' mental states in the context of automatic perspective taking and experience systematic difficulties when judging the conflicts between their own (Self) and another's (Other) perspective. Several functional MRI (fMRI) studies reported widespread activation of mentalizing, salience, and executive networks when adopting the Other compared to Self perspective. This study aims to explore whether cognitive and emotional parameters impact on brain reactivity in dot perspective task (dPT). We provide here an fMRI analysis based on individual z-scores in eighty-two healthy adults who underwent the Samson's dPT after detailed assessment of fluid intelligence, attention, levels of alexithymia and social cognition abilities. Univariate regression models were used to explore the association between brain activation patterns and psychological variables. There was a strong positive association between Wechsler Adult Intelligence Scale (WAIS) and fMRI z-scores in Self perspective. When the Other perspective is taken, Continuous Performance Test (CPT)-II parameters were negatively associated with fMRI z-scores. Individuals with higher Toronto Alexithymia scale (TAS) score and lower scores in mini-Social cognition and Emotional Assessment (SEA) displayed significantly higher egocentric interference-related fMRI z-scores. Our data demonstrate that brain activation when focusing on our own perspective depends on the levels of fluid intelligence. Decreased attentional recruitment and decreased inhibitory control affects the brain efforts to adopt the Other perspective. Egocentric interference-associated brain fMRI activation was less marked in cases with better empathy abilities but the opposite was true for persons who experience increased difficulties in the recognition of emotions.

Psychopathic Traits and Theory of Mind Task Performance: A Systematic Review and Meta-analysis

This meta-analysis aims to examine the relationship between psychopathic traits and theory of mind (ToM), which is classically and broadly defined as competency in representing and attributing mental states such as emotions, intentions, and beliefs to others. Our search strategy gathered 142 effect sizes, from 42 studies, with a total sample size of 7463 participants. Random effects models were used to analyze the data. Our findings suggested that psychopathic traits are associated with impaired ToM task performance. This relationship was not moderated by age, population, psychopathy measurement (self-report versus clinical checklist) or conceptualization, or ToM task type (cognitive versus affective). The effect also remained significant after excluding tasks that did not require the participant to 1) mentalize or 2) differentiate self and other perspectives. However, interpersonal/affective traits were associated with a more pronounced impairment in ToM task performance compared to lifestyle/antisocial traits. Future research should investigate the effects of distinct psychopathy facets that will allow for a more precise understanding of the social-cognitive bases of relevant clinical presentations in psychopathy.

Social Cognition and Prosocial Behavior in Children with Attention Deficit Hyperactivity Disorder: A Systematic Review

The purpose of this research is to analyze the empirical evidence on the relationship between social cognition and prosocial behavior in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). A systematic review was carried out following the PRISMA guidelines of empirical studies found in PubMed and Scopus databases, including a total of 51 research studies. The results indicate that children and adolescents with ADHD have deficits in social cognition and prosocial behavior. For children with ADHD, their deficits in social cognition highlight their difficulty in the process of theory of mind, emotional self-regulation, emotion recognition and empathy, affecting prosocial behavior, evidencing difficulty in personal relationships, and the creation of emotional bonds with their peers.

Social perception in children and adolescents with ADHD: The role of higher-order cognitive skills

Despite children with ADHD frequently experiencing difficulties in social perception, the mechanisms underlying this impairment have been poorly explored. In this study, we examined social perception in children with ADHD, comparing them with typically-developing (TD) children on semi-naturalistic tasks, and considering the effect of nonverbal signal recognition. Our aim was to ascertain whether the two groups' social perception related to different types of stimulus (video, audio or combined/multimodal). The role of three higher-order cognitive skills (theory of mind, attention and pragmatic language) was also investigated. Thirty-six children with ADHD, and 36 TD controls were tested. Social perception was significantly associated with participants' ability to recognize nonverbal signals, and with the stimulus presentation modality. Children with ADHD only performed less well than TD children with combined stimuli. As concerns the higher-order cognitive skills, theory of mind had a significant role in both groups, but only with the video and combined stimuli, while attention explained most of the variance in social perception for all types of stimulus. Better pragmatic language skills were only associated with a better social perception in TD children, whatever the type of stimulus presented. Semi-naturalistic tasks should be included when assessing social perception in ADHD, and both theory of mind and attention should be the object of efforts to enhance social perception in the ADHD population.

Face processing in young adults with autism and ADHD: An event related potentials study

Background

Atypicalities in perception and interpretation of faces and emotional facial expressions have been reported in both autism and attention-deficit/hyperactivity disorder (ADHD) during childhood and adulthood. Investigation of face processing during young adulthood (18 to 25 years), a transition period to full-fledged adulthood, could provide important information on the adult outcomes of autism and ADHD.

Methods

In this study, we investigated event-related potentials (ERPs) related to visual face processing in autism, ADHD, and co-occurring autism and ADHD in a large sample of young adults (N = 566). The groups were based on the Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2) and the Autism Diagnostic Observation Schedule-2 (ADOS-2). We analyzed ERPs from two passive viewing tasks previously used in childhood investigations: (1) upright and inverted faces with direct or averted gaze; (2) faces expressing different emotions.

Results

Across both tasks, we consistently found lower amplitude and longer latency of N170 in participants with autism compared to those without. Longer P1 latencies and smaller P3 amplitudes in response to emotional expressions and longer P3 latencies for upright faces were also characteristic to the autistic group. Those with ADHD had longer N170 latencies, specific to the face-gaze task. Individuals with both autism and ADHD showed additional alterations in gaze modulation and a lack of the face inversion effect indexed by a delayed N170.

Conclusion

Alterations in N170 for autistic young adults is largely consistent with studies on autistic adults, and some studies in autistic children. These findings suggest that there are identifiable and measurable socio-functional atypicalities in young adults with autism.

Executive Functions Contribute to the Differences Between ADHD and Sluggish Cognitive Tempo (SCT) in Adults

OBJECTIVES

This paper analyses the relationship between sociodemographic variables, executive dysfunctions, Sluggish Cognitive Tempo (SCT) and the mainly dimensions of ADHD: hyperactivity-impulsivity (ADHD-H/I) and inattention (ADHD-IN) in Brazilian adults.

METHOD

A cross-sectional, exploratory, and comparative design was used. A total of 446 participants (295 women) aging from 18 to 63 years old (M = 3,499 years, SD = 10.7) were recruited on the internet. Correlations, t independent tests and regressions were conducted.

RESULTS

Higher scores in ADHD dimensions were associated to more executive functioning problems and time perception distortions in comparison to those participants without significant ADHD symptoms. However, ADHD-IN dimension as well as SCT were higher associated with these dysfunctions than ADHD-H/I. The regression results showed that ADHD-IN was more related to Self-Management to time while ADHD-H/I to Self-Restraint and SCT to Self-Organization/Problem Solving.

CONCLUSION

This paper contributed to the distinction between SCT and ADHD in adults in important psychological dimensions.

Tackling emotional processing in adults with attention deficit hyperactivity disorder and attention deficit hyperactivity disorder + autism spectrum disorder using emotional and action verbal fluency tasks

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are two neurodevelopmental conditions with neuropsychological, social, emotional, and psychopathological similarities. Both are characterized by executive dysfunction, emotion dysregulation (ED), and psychiatric comorbidities. By focusing on emotions and embodied cognition, this study aims to improve the understanding of overlapping symptoms between ADHD and ASD through the use of verbal fluency tasks.

Methods

Fifty-two adults with ADHD, 13 adults with ADHD + ASD and 24 neurotypical (NT) participants were recruited in this study. A neuropsychological evaluation, including different verbal fluency conditions (e.g. emotional and action), was proposed. Subjects also completed several self-report questionnaires, such as scales measuring symptoms of ED.

Results

Compared to NT controls, adults with ADHD + ASD produced fewer anger-related emotions. Symptoms of emotion dysregulation were associated with an increased number of actions verbs and emotions produced in ADHD.

Discussion

The association between affective language of adults with ADHD and symptoms of emotion dysregulation may reflect their social maladjustment. Moreover, the addition of ADHD + ASD conditions may reflect more severe affective dysfunction.

Catecholaminergic and cholinergic neuromodulation in autism spectrum disorder: A comparison to attention-deficit hyperactivity disorder

Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by social impairments and restricted, repetitive behaviors. Treatment of ASD is notoriously difficult and might benefit from identification of underlying mechanisms that overlap with those disturbed in other developmental disorders, for which treatment options are more obvious. One example of the latter is attention-deficit hyperactivity disorder (ADHD), given the efficacy of especially stimulants in treatment of ADHD. Deficiencies in catecholaminergic systems [dopamine (DA), norepinephrine (NE)] in ADHD are obvious targets for stimulant treatment. Recent findings suggest that dysfunction in catecholaminergic systems may also be a factor in at least a subgroup of ASD. In this review we scrutinize the evidence for catecholaminergic mechanisms underlying ASD symptoms, and also include in this analysis a third classic ascending arousing system, the acetylcholinergic (ACh) network. We complement this with a comprehensive review of DA-, NE-, and ACh-targeted interventions in ASD, and an exploratory search for potential treatment-response predictors (biomarkers) in ASD, genetically or otherwise. Based on this review and analysis we propose that (1) stimulant treatment may be a viable option for an ASD subcategory, possibly defined by genetic subtyping; (2) cerebellar dysfunction is pronounced for a relatively small ADHD subgroup but much more common in ASD and in both cases may point toward NE- or ACh-directed intervention; (3) deficiency of the cortical salience network is sizable in subgroups of both disorders, and biomarkers such as eye blink rate and pupillometric data may predict the efficacy of targeting this underlying deficiency via DA, NE, or ACh in both ASD and ADHD.

Cerebral blood flow characteristics of drug-naïve attention-deficit/hyperactivity disorder with social impairment: Evidence for region-symptom specificity

Background

Social deficits are among the most important functional impairments in attention-deficit/hyperactivity disorder (ADHD). However, the relationship between social impairment and ADHD core symptoms as well as the underlying cerebral blood flow (CBF) characteristics remain unclear.

Methods

A total of 62 ADHD subjects with social deficits (ADHD + SD), 100 ADHD subjects without social deficits (ADHD-SD) and 81 age-matched typically developing controls (TDC) were enrolled. We first examined the correlation between the Social Responsiveness Scale (SRS-1) and ADHD core symptoms (inattention, hyperactivity, and impulsion) and then explored categorical and dimensional ADHD-related regional CBF by arterial spin labeling (ASL). For the categorical analysis, a voxel-based comparison of CBF maps between the ADHD + SD, ADHD-SD, and TDC groups was performed. For the dimensional analysis, the whole-brain voxel-wise correlation between CBF and ADHD symptoms (inattention, hyperactivity/impulsivity, and total scores) was evaluated in three groups. Finally, correlations between the SRS-1 and ADHD-related regional CBF were investigated. We applied Gaussian random field (GRF) for the correction of multiple comparisons in imaging results (voxel-level P < 0.01, and cluster-level P < 0.05).

Results

The clinical characteristics analysis showed that social deficits positively correlated with ADHD core symptoms, especially in social communication and autistic mannerisms domains. In the categorical analysis, we found that CBF in the left middle/inferior temporal gyrus in ADHD groups was higher than TDCs and was negatively correlated with the social motivation scores. Moreover, in dimensional analysis, we found that CBF in the left middle frontal gyrus was negatively correlated with the inattention scores, SRS total scores and autistic mannerisms scores in ADHD + SD subjects.

Conclusion

The present study shows that inattention, hyperactivity, and impulsivity may be responsible for the occurrence of social deficits in ADHD, with autistic traits being another significant contributing factor. Additionally, CBF in the left middle/inferior temporal gyrus and the left middle frontal gyrus might represent the corresponding physiological mechanisms underlying social deficits in ADHD.

Sosyal Biliş Becerilerinin Sosyal Kaygı Üzerindeki Yordayıcı Etkisi

Bu çalışmanın temel amacı sosyal kaygı ile sosyal biliş becerileri (duygu tanıma/ayırt etme, zihin kuramı, atıf yanlılığı, sosyal işlevsellik) arasındaki ilişkiyi incelemek ve sosyal biliş becerilerinin sosyal kaygıyı yordama gücünü araştırmaktır. Çalışmada ayrıca sosyal kaygı, sosyal biliş becerileri ve depresyon puanlarının cinsiyet, yaş, bildirilen tanı durumu ve sosyal kaygı düzeyine göre farklılaşıp farklılaşmadığı araştırılmıştır. Çalışmanın örneklemini, 18-60 yaşları arasında bulunan toplam 385 kişi oluşturmuştur. Araştırma verileri çevrimiçi olarak Liebowitz Sosyal Anksiyete Ölçeği, Yüzde Dışavuran Duyguların Tanınması ve Ayırt Edilmesi Testi, Gözlerden Zihin Okuma Testi, İçsel, Kişisel ve Durumsal Atıflar Ölçeği, Sosyal İşlevsellik Ölçeği, Beck Depresyon Envanteri ve Sosyodemografik Bilgi Formu kullanılarak katılımcılardan toplanmıştır. Sosyal kaygı ile duygu tanıma, duygu ayırt etme ve gözlerden zihin okuma arasında negatif, dışsallaştırma yanlılığı ve depresyon ile ise pozitif yönde anlamlı ilişki olduğu belirlenmiştir. Depresyon, duygu tanıma ve ayırt etme, gözlerden zihin okuma ve öncül sosyal etkinlikler ölçek puanlarının sosyal kaygıyı anlamlı düzeyde yordadığı bulunmuştur. Bu değişkenler sosyal kaygıya ilişkin toplam varyansın %52’sini açıklamaktadır. Ayrıca, depresyon etkisi kontrol edildiğinde sosyal biliş becerilerinin sosyal kaygıya ilişkin varyansın %32’sini açıkladığı görülmüştür. Sosyal biliş becerilerindeki bozulmanın ve depresyon puanlarının sosyal kaygının artışıyla ilişkili olduğu belirlenmiştir. Araştırmadan elde edilen sonuçlara göre, sosyal kaygıyı önlemeye yönelik önerilerde bulunulmuştur. Müdahale programları içerisinde bireylerin kişilerarası iletişimi için önemli olan sosyal biliş becerilerini geliştirmeye yönelik etkinliklere yer verilmesinin yararlı olacağı önerilmektedir.

Effect of short-term methylphenidate on social impairment in children with attention deficit/hyperactivity disorder: systematic review

Attention Deficit/Hyperactivity disorder (ADHD) is one of the most common disorders in school-age children. In addition to learning difficulties associated with the disorder's core symptoms of inattention and hyperactivity, children with ADHD display substantial social impairments. Methylphenidate (MPH) in formulations such as Ritalin or Concerta mitigates inattention and hyperactivity, but the effects of the therapy on social behavior in children with ADHD are not clear. This review aims to determine the effectiveness of short term (up to 6 months) MPH treatment on three domains of social skills in children aged 6-14 with ADHD: (i) Recognition of nonverbal emotional expressions, which are a marker of inherent (unlearned) social understanding, (ii) theory of mind (ToM) components that relate to learned cognition and social communication, and (iii) social competence in everyday environments. 15 relevant studies were identified based on inclusion/exclusion criteria. The results show mixed effects: the overall social performance as evaluated by parents, teachers or peers, and some components of ToM, were found to improve following a weeks-long course of MPH treatment. However, the effects of the medication are less clear when evaluating momentary/nonverbal social responses such as reactions to emotional facial expressions. While the findings of this review indicate that an MPH medication regime of order weeks to months could improve, to a degree, social impairment in children with ADHD, more studies are required to identify the medications' mechanism and confirm such a conclusion.

Social cognition and empathy in adults with obsessive compulsive disorder: A meta-analysis

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts (obsessions) and compulsions and has been associated with psychosocial impairment. Indeed, a number of studies have highlighted impairments in both social cognitive functions and empathic skills in OCD, despite several inconsistencies. This study aimed to investigate social cognitive dysfunction and empathy deficits in patients with OCD using a meta-analytic approach. A literature search was conducted using the databases Pubmed, PsycINFO, ProQuest and Scopus to identify the relevant studies (January 1980 to March 2020). Following the systematic review of relevant OCD studies, a random-effects meta-analysis was conducted. The current meta-analysis included 25 studies consisting of 1161 patients with OCD and 1329 healthy controls. OCD was associated with decreased performance in theory of mind (ToM). In the facial emotion recognition domain, patients with OCD significantly underperformed healthy controls only in their recognition of disgust. OCD was significantly related to reduced cognitive empathy. OCD was associated with medium-sized impairments in ToM and cognitive empathy, which can likely contribute to psychosocial impairment in this disorder. Further studies are needed to investigate state and trait-related factors using experimental measures of empathy.