Facial affect interpretation in boys with attention deficit/hyperactivity disorder

Facial emotion recognition in children with attention deficit hyperactivity disorder

OBJECTIVE

Attention Deficit Hyperactivity Disorder (ADHD) is defined as a persistent pattern of inattention and hyperactivity-impulsivity that interferes with functioning anofd development. Increased emotional reactivity and impaired emotion regulation are established findings in children with ADHD. Impairments in executive functions such as impulse control and working memory, in turn, have also been suggested to have a negative effect on emotion recognition. However, studies exploring suspected deficits in the ability to recognise facial emotions in ADHD have to date yielded controversial results. We sought to clarify the mechanism of possible emotion recognition dysfunction in children with ADHD.

METHODS

Sixty-one children diagnosed with ADHD (aged 10.36 ± 1.89 years) and a control group (N = 78; aged 9.6 ± 1.8 years) were evaluated with questionnaires and computerized tests for cognitive and facial emotion recognition capacity.

RESULTS

The ADHD group displayed more behavioural issues and performed worse in cognitive tests compared to the control group. Group status (i.e. ADHD vs. control group) did not predict facial emotion recognition when controlled for age, IQ and sex in linear regression models. Performance in Divided Attention predicted facial emotion recognition in linear regression in the ADHD group.

CONCLUSIONS

Individuals with ADHD showed facial emotion recognition capacity similar to a typically developing control group. Good performance in a cognitive test assessing divided attention predicted capacity for facial emotion recognition, but only in the ADHD group.

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).

The impact of transcranial direct current stimulation on attention bias modification in children with ADHD

Individuals with attention deficit-hyperactivity disorder (ADHD) struggle with the interaction of attention and emotion. The ventromedial prefrontal cortex (vmPFC) and dorsolateral prefrontal cortex (dlPFC) are assumed to be involved in this interaction. In the present study, we aimed to explore the effect of stimulation applied over the dlPFC and vmPFC on attention bias in individuals with ADHD. Twenty-three children with ADHD performed the emotional Stroop and dot probe tasks during transcranial direct current stimulation (tDCS) in 3 conditions: anodal dlPFC (F3)/cathodal vmPFC (Fp2), anodal vmPFC (Fp2)/cathodal dlPFC (F3), and sham stimulation. Findings suggest reduction of attention bias in both real conditions based on emotional Stroop task and not dot probe task. These results were independent of emotional states. The dlPFC and vmPFC are involved in attention bias in ADHD. tDCS can be used for attention bias modification in children with ADHD.

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.

Global-Local Processing in ADHD Is Not Limited to the Visuospatial Domain: Novel Evidence From the Auditory Domain

OBJECTIVE

Global-local visuospatial processing has been widely investigated in both healthy and clinical populations. Recent studies indicated that individuals with ADHD lack a global processing bias. However, the extant literature regarding global-local processing style focuses solely on the visual modality.

METHODS

ADHD (N = 21) and typically developed (TD) controls (N = 24) underwent an auditory global-local task, in which they had to decide whether the melody is ascending or descending in global or local conditions.

RESULTS

TD controls exhibited a classic global processing bias in the auditory task. The ADHD group exhibited no global processing bias, indicating similar processing for global and local dimensions, implying that individuals with ADHD are distracted by incongruent information in global and local conditions similarly, in both visual and auditory tasks.

CONCLUSION

A lack of global processing bias in ADHD is not limited to the visuospatial modality and likely reflects a broader and more general processing style.

Morphing Task: The Emotion Recognition Process in Children with Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder

Recognizing a person’s identity is a fundamental social ability; facial expressions, in particular, are extremely important in social cognition. Individuals affected by autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) display impairment in the recognition of emotions and, consequently, in recognizing expressions related to emotions, and even their identity. The aim of our study was to compare the performance of participants with ADHD, ASD, and typical development (TD) with regard to both accuracy and speed in the morphing task and to determine whether the use of pictures of digitized cartoon faces could significantly facilitate the process of emotion recognition in ASD patients (particularly for disgust). This study investigated the emotion recognition process through the use of dynamic pictures (human faces vs. cartoon faces) created with the morphing technique in three pediatric populations (7–12 years old): ADHD patients, ASD patients, and an age-matched control sample (TD). The Chi-square test was used to compare response latency and accuracy between the three groups in order to determine if there were statistically significant differences (p < 0.05) in the recognition of basic emotions. The results demonstrated a faster response time in neurotypical children compared to ASD and ADHD children, with ADHD participants performing better than ASD participants on the same task. The overall accuracy parameter between the ADHD and ASD groups did not significantly differ.

The effects of sleep deprivation on the processing of emotional facial expressions in young adults with and without ADHD

The ability to recognize emotions from facial expressions is essential to the development of complex social cognition behaviors, and impairments in this ability are associated with poor social competence. This study aimed to examine the effects of sleep deprivation on the processing of emotional facial expressions and nonfacial stimuli in young adults with and without attention-deficit/hyperactivity disorder (ADHD). Thirty-five men (mean age 25.4) with (n = 19) and without (n = 16) ADHD participated in the study. During the five days preceding the experimental session, the participants were required to sleep at least seven hours per night (23:00/24:00–7:00/9:00) and their sleep was monitored via actigraphy. On the morning of the experimental session, the participants completed a 4-stimulus visual oddball task combining facial and nonfacial stimuli, and repeated it after 25 h of sustained wakefulness. At baseline, both study groups had poorer performance in response to facial rather than non-facial target stimuli on all indices of the oddball task, with no differences between the groups. Following sleep deprivation, rates of omission errors, commission errors and reaction time variability increased significantly in the ADHD group but not in the control group. Time and target type (face/non-face) did not have an interactive effect on any indices of the oddball task. Young adults with ADHD are more sensitive to the negative effects of sleep deprivation on attentional processes, including those related to the processing of emotional facial expressions. As poor sleep and excessive daytime sleepiness are common in individuals with ADHD, it is feasible that poor sleep quality and quantity play an important role in cognitive functioning deficits, including the processing of emotional facial expressions that are associated with ADHD.

Attachment Representation and Emotion Recognition Ability in Children with ADHD and Their Parents: A Study Protocol

Background: Few studies in clinical attachment research to date have examined children with an attention-deficit/hyperactivity disorder (ADHD) diagnosis. This is surprising for two reasons: first, there are a number of parallels between the behaviors of children with an insecure and disorganized attachment and the behaviors of children with an ADHD diagnosis. Second, secure attachment has a positive effect on the development of skills in areas in which children with ADHD demonstrate problems (e.g., attention span, impulse control). There are currently no findings on whether or not and how insecure and disorganized attachment and ADHD affect children’s emotion recognition ability. Methods: This is a cross-sectional study, part exploratory and part hypothesis-driven in the context of basic research. A clinical sample of 5- to 10-year-old children with an ADHD diagnosis and their parents is to be compared to a non-clinical unaffected control group. Over a period of 3 years, 80 subjects and their parents are to be recruited in each group for participation in the study. Discussion: This study is the first to examine links between attachment, emotion recognition ability, and ADHD. It is also the first to include not just children with ADHD but also their mothers and fathers in its design. The findings should help reduce the research gap and generate more knowledge for family interventions in the case of ADHD.

Facial emotion recognition in children with externalising behaviours: A systematic review

Difficulties in facial emotion recognition (FER) are associated with a range of mental health and antisocial presentations in adolescents and adults. Externalising behaviours in children are often one of the earliest signs of risk for the development of such difficulties. This article systematically reviews the evidence (from both group and correlational studies) for whether there is a relationship between FER and externalising behaviours in pre-adolescent children (aged 12 and under), both across and within externalising behaviour domains (hyperactivity, conduct problems, callous-unemotional traits, and aggression). Four electronic databases were searched producing 1,296 articles. Articles were included if they used validated measures of FER and externalising behaviours. Sixteen articles met criteria for inclusion in the review. Overall, the results suggested FER problems are present in ADHD, CP and callous-unemotional presentations, and in samples of children with higher levels of externalising problems rather than in community samples. However, there was no consistent evidence for specific emotions being implicated in the studies reviewed. Clinically, the findings suggest that FER difficulties are commonly associated with externalising behaviours, and hence this review offers some support that FER deficits could be a relevant target of intervention for externalising behaviours. However, more longitudinal studies are required, that control for other variables that might underlie FER difficulties (e.g. IQ or basic Theory of Mind abilities), to inform our knowledge of whether FER difficulties are a causal factor in externalising behaviours.

Evidence against emotion inference deficits in children with ADHD

Inconsistent evidence suggests that pediatric attention deficit/hyperactivity disorder (ADHD) may be associated with impairments in the ability to use context clues to infer the emotion states of others. However, the evidence base for these impairments is comprised of data from laboratory-based tests of emotion inference that may be confounded by demands on nonaffective cognitive processes that have been linked with ADHD. The current study builds on our previous study of facial affect recognition to address this limitation and investigate a potential mechanism underlying children's ability to infer emotion state from context clues. To do so, we used a fully crossed, counterbalanced experimental design that systematically manipulated emotion inference and working memory demands in 77 carefully phenotyped children ages 8-13 (M_age = 10.46, SD = 1.54; 66% Caucasian/Non-Hispanic; 42% female) with ADHD (n = 42) and without ADHD (n = 35). Results of Bayesian mixed-model ANOVAs indicated that using context clues to infer the emotion state of others competed for neurocognitive resources with the processes involved in rehearsing/maintaining information within working memory (BF₁₀ = 1.57 × 10¹⁹, d = 0.72). Importantly, there was significant evidence against the critical Group × Condition interaction for response times (BF₀₁ = 4.93), and no significant evidence for this interaction for accuracy (BF₀₁ = 2.40). In other words, children with ADHD do not infer emotions more slowly than children without ADHD (d = 0.13), and their small magnitude impairment in accuracy (d = 0.30) was attributable to their generally less accurate performance on choice-response tasks (i.e., across both emotion and control conditions). Taken together, the evidence indicates that emotion inference abilities are likely unimpaired in pediatric ADHD and that working memory is implicated in the ability to infer emotion from context for all children-not just children with ADHD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Effect of Sleep Deprivation on Recognition of Ambiguous Emotional Facial Expressions in Individuals With ADHD

Objective: The present study sought to investigate whether young adults with ADHD have more difficulty recognizing emotional facial expressions compared with young adults without ADHD, and whether such a difference worsens following sleep deprivation. Method: Thirty-one young men (M = 25.6) with (n = 15) or without (n = 16) a diagnosis of ADHD were included in this study. The participants were instructed to sleep 7 hr or more each night for one week, and their sleep quality was monitored via actigraph. Subsequently, the participants were kept awake in a controlled environment for 30 hr. The participants completed a visual emotional morph task twice-at the beginning and at the end of this period. The task included presentation of interpolated face stimuli ranging from neutral facial expressions to fully emotional facial expressions of anger, sadness, or happiness, allowing for assessment of the intensity threshold for recognizing these facial emotional expressions. Results: Actigraphy data demonstrated that while the nightly sleep duration of the participants with ADHD was similar to that of participants without ADHD, their sleep efficiency was poorer. At the onset of the experiment, there were no differences in recognition thresholds between the participants with ADHD and those without ADHD. Following sleep deprivation, however, the ADHD group required clearer facial expressions to recognize the presence of angry, sad, and, to a lesser extent, happy faces. Conclusion: Among young adults with ADHD, sleep deprivation may hinder the processing of emotional facial stimuli.

Are emotion recognition abilities intact in pediatric ADHD?

Extant studies suggest that children with attention-deficit/hyperactivity disorder (ADHD) may make more errors and respond more slowly on tasks that require them to identify emotions based on facial affect. It is unclear, however, whether these findings reflect a unique deficit in emotion recognition, or more general difficulty with choice-response tasks (i.e., tasks that require participants to select among a set of competing options). In addition, ADHD is associated with executive dysfunction, but there is inconsistent evidence regarding the extent to which top-down cognitive control is involved in emotion recognition. The current study used a series of four counterbalanced tasks to systematically manipulate emotional content and working memory demands to determine (a) whether children with ADHD exhibit a unique facial affect recognition deficit and (b) the extent to which facial affect recognition is an automatic versus controlled process that depends in part on working memory. Bayesian results from a carefully phenotyped sample of 64 children ages 8 to 13 (M = 10.42, SD = 1.56; 26 girls; 67% Caucasian/non-Hispanic) with ADHD (n = 35) and without ADHD (n = 29) indicated that working memory is involved in children's ability to efficiently infer emotional state from facial affect (BF₁₀= 4.59 × 10¹⁴). Importantly, there was significant evidence against deficits in emotion recognition for children with ADHD. The ADHD/non-ADHD groups were statistically equivalent in terms of recognition accuracy (BF₀₁ = 1.32 × 10⁵⁴, d = -0.18), and the ADHD group's slower recognition speed was parsimoniously explained by difficulty with choice-response tasks rather than unique to emotional stimuli (BF₁₀ = 3.23, d = 0.31). These findings suggest that emotion recognition abilities are intact in children with ADHD, and highlight the need to control for impaired bottom-up (choice-response) and top-down abilities (working memory) when investigating emotional functioning in ADHD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Interpretation of ambiguous facial affect in adults with attention-deficit/hyperactivity disorder

In addition to impairments in cognitive functioning, attention-deficit/hyperactivity disorder (ADHD) is associated with deficits in interpersonal functioning as well which are assumed to stem from a distorted perception or interpretation of affective information. While previous research suggests that the decoding of negatively valenced facial stimuli is impaired, less is known about the potential interpretation biases in ADHD which are linked to other externalizing psychopathologies. The present study investigated interpretation biases in adults with ADHD (N = 65) and controls (N = 49) using ambiguous facial stimuli (angry/happy, angry/fearful, fearful/happy blends) with different proportions of each emotion. Participants indicated the dominant emotion and rated the perceived intensity of each image. While impaired processing of fearful expressions was evident in the ADHD group, the results of the current study do not provide support for an interpretation bias in adults with ADHD. These findings suggest that interpretation biases may be restricted to aggressive psychopathology and cannot be generalized to individuals with ADHD.

Response Patterns to Emotional Faces Among Adolescents Diagnosed With ADHD

OBJECTIVE

The present study investigated differences in emotional face processing between adolescents (age 15-18) with ADHD-Combined type (ADHD-CT) and typically developing controls.

METHOD

Participants completed a visual emotional task in which they were asked to rate the degree of negativity/positivity of four facial expressions (taken from the NimStim face stimulus set).

RESULTS

Participants' ratings, ratings' variability, response times (RTs), and RTs' variability were analyzed. Results showed a significant interaction between group and the type of presented stimuli. Adolescents with ADHD-CT discriminated less between positive and negative emotional expressions compared with those without ADHD. In addition, adolescents with ADHD-CT exhibited greater variability in their RTs and in their ratings of facial expressions when compared with controls.

CONCLUSION

The present results lend further support to the existence of a specific deficit or alteration in the processing of emotional face stimuli among adolescents with ADHD-CT.

Emotional Understanding, Reactivity, and Regulation in Young Children with ADHD Symptoms

The goal of the present study was to examine whether young children with attention-deficit/hyperactivity disorder (ADHD) symptoms experience difficulties with emotional understanding, reactivity, and regulation. Participants were 64 children, 4 to 7 years of age (43 boys, 20 girls), 29 with ADHD symptoms and 34 typically developing children. Children completed an emotion matching task and parents reported on child lability and emotional regulation. Children also completed a frustrating computer task. Facial expressions of emotions were coded and children self reported affect during the task. Parent reports indicated heightened lability and impaired emotional regulation abilities in children with ADHD symptoms. Compared to typically developing children, children with ADHD symptoms demonstrated emotional understanding impairments in matching similar expressions and matching expressions to situations, but not in producing expression labels or matching expression labels to images. Self-reports of negative affect during the frustration task indicated that children with ADHD symptoms experienced more difficulty with emotional regulation than typically developing children. Behavioral observations during the frustration task indicated that the two groups demonstrated a similar increase in expressed negative affect during frustration; however, children with ADHD symptoms showed higher levels of negative affect across all four conditions of the task. This study suggests that the deficits documented in older children with ADHD are already evident during the preschool years, and distinct from the developmentally appropriate emotional dysregulation seen in typically developing preschoolers.

Where Children With ADHD Direct Visual Attention During Emotion Knowledge Tasks: Relationships to Accuracy, Response Time, and ADHD Symptoms

OBJECTIVE

Inattention may contribute to emotion recognition deficits in children with ADHD. In the current study, we compared the viewing patterns for emotion stimuli between children with and without ADHD and examined the relationship between viewing patterns, emotion knowledge accuracy, response time, and ADHD symptoms.

METHOD

Eye-tracking technology recorded viewing patterns for emotion stimuli among 45 children (60% male; control n = 26, ADHD n = 19).

RESULTS

Overall, viewing patterns of children with and without ADHD were strikingly similar; however, small to large effect sizes (Cohen's d = -0.73 to 0.93) across emotions suggest that, for some emotions, children with ADHD spend less time viewing relevant areas of images and take longer to respond (i.e., detect an emotion) compared with children without ADHD.

CONCLUSION

Children with ADHD view some emotions differently from children without ADHD. The results provide an important foundation for additional work in this area.

Face memory and face recognition in children and adolescents with attention deficit hyperactivity disorder: A systematic review

This review focuses on facial recognition abilities in children and adolescents with attention deficit hyperactivity disorder (ADHD). A systematic review, using PRISMA guidelines, was conducted to identify original articles published prior to May 2017 pertaining to memory, face recognition, affect recognition, facial expression recognition and recall of faces in children and adolescents with ADHD. The qualitative synthesis based on different studies shows a particular focus of the research on facial affect recognition without paying similar attention to the structural encoding of facial recognition. In this review, we further investigate facial recognition abilities in children and adolescents with ADHD, providing synthesis of the results observed in the literature, while detecting face recognition tasks used on face processing abilities in ADHD and identifying aspects not yet explored.

Facial emotion recognition in children with or without Attention Deficit/Hyperactivity Disorder: Impact of comorbidity

OBJECTIVES

This study sought to assess facial emotion recognition deficit in children with Attention Deficit/Hyperactivity Disorder (ADHD) and to test the hypothesis that it is increased by comorbid features.

METHOD

Forty children diagnosed with ADHD were compared with 40 typically developing children, all aged from 7 to 11years old, on a computerized facial emotion recognition task (based on the Pictures of Facial Affect). Data from parents' ratings of ADHD and comorbid symptoms (on the Conners' Revised Parent Rating Scale) were also collected.

RESULTS

Children with ADHD had significantly fewer correct answer scores than typically developing controls on the emotional task while they performed similarly on the control task. Recognition of sadness was especially impaired in children with ADHD. While ADHD symptoms were slightly related to facial emotion recognition deficit, oppositional symptoms were related to a decrease in the number of correct answers on sadness and surprise recognition.

CONCLUSION

Facial emotion recognition deficit in children with ADHD might be related to an impaired emotional process during childhood. Moreover, Oppositional Defiant Disorder seems to be a risk factor for difficulties in emotion recognition especially in children with ADHD.

Emotional face recognition in individuals withattention-deficit/hyperactivity disorder: a review article

This review focuses on facial emotion recognition (FER) in individuals with attention- deficit/hyperactivity disorder (ADHD). Behavioral studies of FER in ADHD have resulted in inconsistent findings. Here, we discuss the factors that vary across studies and the way that they influence FER processes in ADHD. Across reviewed studies, fear was the most deficient facial expression to be recognized. Our review suggested that FER deficit in ADHD does not alleviate across development and is partially distinct from ADHD symptoms. In conclusion, assessment of FER in ADHD and targeting that in interventional plans could lead to social skills improvement in ADHD.

Emotional Face Recognition in Children With Attention Deficit/Hyperactivity Disorder: Evidence From Event Related Gamma Oscillation

Introduction

Children with attention-deficit/hyperactivity disorder (ADHD) have some impairment in emotional relationship which can be due to problems in emotional processing. The present study investigated neural correlates of early stages of emotional face processing in this group compared with typically developing children using the Gamma Band Activity (GBA).

Methods

A total of 19 children diagnosed with ADHD (Combined type) based on DSM-IV classification were compared with 19 typically developing children matched on age, gender, and IQ. The participants performed an emotional face recognition while their brain activities were recorded using an event-related oscillation procedure.

Results

The results indicated that ADHD children compared to normal group showed a significant reduction in the gamma band activity, which is thought to reflect early perceptual emotion discrimination for happy and angry emotions (P<0.05).

Conclusion

The present study supports the notion that individuals with ADHD have some impairments in early stage of emotion processing which can cause their misinterpretation of emotional faces.

Is emotion recognition the only problem in ADHD? effects of pharmacotherapy on face and emotion recognition in children with ADHD

The objectives of this study were to evaluate both face and emotion recognition, to detect differences among attention deficit and hyperactivity disorder (ADHD) subgroups, to identify effects of the gender and to assess the effects of methylphenidate and atomoxetine treatment on both face and emotion recognition in patients with ADHD. The study sample consisted of 41 male, 29 female patients, 8-15 years of age, who were diagnosed as having combined type ADHD (N = 26), hyperactive/impulsive type ADHD (N = 21) or inattentive type ADHD (N = 23) but had not previously used any medication for ADHD and 35 male, 25 female healthy individuals. Long-acting methylphenidate (OROS-MPH) was prescribed to 38 patients, whereas atomoxetine was prescribed to 32 patients. The reading the mind in the eyes test (RMET) and Benton face recognition test (BFRT) were applied to all participants before and after treatment. The patients with ADHD had a significantly lower number of correct answers in child and adolescent RMET and in BFRT than the healthy controls. Among the ADHD subtypes, the hyperactive/impulsive subtype had a lower number of correct answers in the RMET than the inattentive subtypes, and the hyperactive/impulsive subtype had a lower number of correct answers in short and long form of BFRT than the combined and inattentive subtypes. Male and female patients with ADHD did not differ significantly with respect to the number of correct answers on the RMET and BFRT. The patients showed significant improvement in RMET and BFRT after treatment with OROS-MPH or atomoxetine. Patients with ADHD have difficulties in face recognition as well as emotion recognition. Both OROS-MPH and atomoxetine affect emotion recognition. However, further studies on the face and emotion recognition are needed in ADHD.

Facial affect recognition in autism, ADHD and typical development

INTRODUCTION

Autism spectrum disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) have been associated with facial affect recognition (FAR) alterations.

METHODS

This study examined accuracy and response times for general and specific FAR in whole face and eye-region stimuli. FAR was assessed in matched samples of children and adolescents with ASD (n = 35), ADHD (n = 32), and typical development (TD) (n = 32) aged 8.6-15.9 years (M = 11.6; SD = 2.0).

RESULTS

Compared to TD, the ASD group performed less accurate and showed longer response times for general and specific FAR, mostly driven by problems in neutral and happy face identification. The ADHD group responded faster than the ASD group for global FAR. No differences between ADHD and TD were found. Attentional distractibility had a significant effect on FAR performance in ASD and ADHD.

CONCLUSIONS

Findings confirm FAR alterations in ASD, but not ADHD, and endorse effects of attentional distractibility on FAR in ASD and ADHD. FAR and attention function training is clinically meaningful in ASD. Future studies should include control for visual attention and facial configuration skills, use naturalistic FAR material and also investigate implicit FAR.

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

BACKGROUND

Impairment in social cognition is an established finding in autism spectrum disorders (ASD). Emerging evidence suggests that attention-deficit/hyperactivity disorder (ADHD) might be also associated with deficits in theory of mind (ToM) and emotion recognition. However, there are inconsistent findings, and it has been debatable whether such deficits persist beyond childhood and how similar social cognitive deficits are in ADHD v. ASD.

METHOD

We conducted a meta-analysis of social cognition, including emotion recognition and ToM, studies in ADHD compared with healthy controls and ASD. The current meta-analysis involved 44 studies comparing ADHD (n = 1999) with healthy controls (n = 1725) and 17 studies comparing ADHD (n = 772) with ASD (n = 710).

RESULTS

Facial and vocal emotion recognition (d = 0.40-0.44) and ToM (d = 0.43) abilities were significantly impaired in ADHD. The most robust facial emotion recognition deficits were evident in anger and fear. Social cognitive deficits were either very subtle (emotion recognition) or non-significant (ToM) in adults with ADHD. Deficits in social cognition, especially ToM, were significantly more pronounced in ASD compared with ADHD. General cognitive impairment has contributed to social cognitive deficits in ADHD.

CONCLUSIONS

Performance of individuals with ADHD on social cognition lies intermediate between ASD and healthy controls. However, developmental trajectories of social cognition probably differ between ADHD and ASD as social cognitive deficits in ADHD might be improving with age in most individuals. There is a need for studies investigating a potential subtype of ADHD with persistent social cognitive deficits and exploring longitudinal changes in social cognition during development.

Emotion perception in adult attention-deficit hyperactivity disorder

This study examined identification of emotional information in facial expression, prosody, and their combination in 23 adult patients with combined attention deficit-hyperactivity disorder (ADHD) versus 31 healthy controls (HC) matched for gender, age, and education. We employed a stimulus set which was carefully balanced for valence as well as recognizability of the expressed emotions as determined in an independent sample of HC to avoid potential biases due to different levels of task difficulty. ADHD patients were characterized by impaired recognition of all employed categories (neutral, happiness, eroticism, disgust, anger). Basic cognitive functions as assessed by neuropsychological testing, such as sustained attention, constancy of alertness, and verbal intelligence partially explained lower recognition rates. Removal of the correlated variance by means of regression analyses did not abolish lower performance in ADHD indicating deficits in social cognition independent of these neuropsychological factors (p < 0.05). Lower performance correlated with self-rated emotional intelligence (r = 0.38, p < 0.05) indicating that adults with ADHD are aware of their problems in emotion perception. ADHD patients could partly compensate their deficit in unimodal emotion perception by audiovisual integration as revealed by larger gains in emotion recognition accuracy during bimodal presentation (p < 0.05) as compared to HC. These behavioral results can serve as foundation for future neuroimaging studies and point rather towards sensory-specific regions than audiovisual integration areas in perception of emotional information in adult ADHD.

Differences in autonomic functions as related to induced stress between children with and without cerebral palsy while performing a virtual meal-making task

BACKGROUND

Efforts to improve the participation and performance of children with cerebral palsy (CP) are often related to the adaptation of environmental conditions to meet their cognitive and motor abilities. However, the influence of affective stimuli within the environment on emotion and performance, and their ability to improve or impede the children's participation has not been investigated in any systematic way although the emerging evidence suggests that it affects the individuals in many levels.

OBJECTIVES

(1) To measure autonomic responses to affective stimuli during a simulated Meal-Maker task in children with CP in comparison to children who are typically developing, and (2) to examine the interactions between autonomic functions, subjective reports of stress, and task performance among children with and without CP.

METHODS

Fifteen children with CP and 19 typically developing peers (6 to 12 years) participated. After completing behavioral questionnaires (e.g., State and Trait Anxiety Inventories), children prepared meals within a camera tracking virtual Meal-Maker environment. Either a negative, positive, or neutral visual stimulus was displayed, selected from the International Affective Picture System. Children also passively viewed the same pictures while rating their valence and arousal levels. Heart rate (HR) and skin conductance were recorded synchronously with stimulus onset.

RESULTS

Significant differences in autonomic functions were found between groups, i.e., a higher "low frequency" to "high frequency" (LF:HF) ratio in the children with CP during the meals associated with a negative stimulus (p=0.011). Only children with CP had significant positive correlations between trait anxiety and LF:HF ratio during virtual meal-making associated with positive (p=0.049) and negative stimuli (p=0.003) but not during neutral stimuli. For children with CP the amplitude of skin conductance response during passive picture viewing was significantly higher for negative than for positive stimuli (p=0.017) but there were no significant changes in autonomic responses during virtual Meal-Maker task. Significant correlations between trait anxiety, autonomic activity during the calm state and Meal-Maker performance outcomes were found only for children with CP.

CONCLUSIONS

In general, the Meal-Maker virtual environment was shown to be a feasible platform for the investigation of the effect of emotionally loaded stimuli on the balance of autonomic functions in children with and without CP. Anxiety level appears to play a significant role in children with CP and should be considered as a potentially important factor during clinical evaluation and intervention. Further studies are needed to develop additional measurements of emotional responses and to refine the types of affective interference.

Processing of affective prosody in boys suffering from attention deficit hyperactivity disorder: A near-infrared spectroscopy study

Neurobiological studies on facial affect recognition have demonstrated reduced response amplitudes to anger cues in patients suffering from attention deficit hyperactivity disorder (ADHD). It is still unclear whether a similar deficit exists in the auditory domain. Therefore, this near-infrared spectroscopy study focused on neuronal correlates of affective prosody processing. Fourteen boys suffering from ADHD and fourteen healthy boys were exposed to emotionally intoned, standardized sentences of the categories anger, sadness, happiness, and to affectively neutral sentences. Relative to controls, the patients displayed a diminished activation of the right superior temporal gyrus (STG) when processing anger prosody, which was correlated with aggressive behavior. There were no group differences for the other emotions. Additionally, the ADHD group showed increased supramarginal gyrus (SMG) activation in the anger condition. This might mirror compensatory attention allocation. In summary, we identified a selectively lowered STG activation to auditory anger cues in ADHD patients. Consequently, STG recruitment during anger exposure might be used for evaluation of psychotherapy effects.

Emotion recognition pattern in adolescent boys with attention-deficit/hyperactivity disorder

Background. Social and emotional deficits were recently considered as inherent features of individuals with attention-deficit hyperactivity disorder (ADHD), but only sporadic literature data exist on emotion recognition in adolescents with ADHD. The aim of the present study was to establish emotion recognition profile in adolescent boys with ADHD in comparison with control adolescents. Methods. Forty-four adolescent boys (13–16 years) participated in the study after informed consent; 22 boys had a clinical diagnosis of ADHD, while data were also assessed from 22 adolescent control boys matched for age and Raven IQ. Parent- and self-reported behavioral characteristics were assessed by the means of the Strengths and Difficulties Questionnaire. The recognition of six basic emotions was evaluated by the “Facial Expressions of Emotion-Stimuli and Tests.” Results. Compared to controls, adolescents with ADHD were more sensitive in the recognition of disgust and, worse in the recognition of fear and showed a tendency for impaired recognition of sadness. Hyperactivity measures showed an inverse correlation with fear recognition. Conclusion. Our data suggest that adolescent boys with ADHD have alterations in the recognition of specific emotions.

Disrupted response inhibition toward facial anger cues in children with attention-deficit hyperactivity disorder (ADHD): an event-related potential study

This event-related potential study focused on neural correlates of inhibitory affective control in attention-deficit hyperactivity disorder (ADHD). Sixteen boys with ADHD and 16 healthy boys underwent an emotional Go/NoGo task with pictures of facial expressions from the categories anger, sadness, happiness, and neutral. The participants were instructed to execute or withhold a motor response to specific emotions. Patients relative to controls displayed a severe impairment in response inhibition toward anger cues, which was accompanied by a reduced P300 amplitude (positive voltage deflection about 300 ms after picture onset). The control group showed a P300 differentiation of the affective categories that was absent in the ADHD group. The pronounced anger-processing deficit in ADHD patients might be linked to their interpersonal difficulties and should be addressed in psychotherapy.

Emotion dysregulation in attention deficit hyperactivity disorder

Although it has long been recognized that many individuals with attention deficit hyperactivity disorder (ADHD) also have difficulties with emotion regulation, no consensus has been reached on how to conceptualize this clinically challenging domain. The authors examine the current literature using both quantitative and qualitative methods. Three key findings emerge. First, emotion dysregulation is prevalent in ADHD throughout the lifespan and is a major contributor to impairment. Second, emotion dysregulation in ADHD may arise from deficits in orienting toward, recognizing, and/or allocating attention to emotional stimuli; these deficits implicate dysfunction within a striato-amygdalo-medial prefrontal cortical network. Third, while current treatments for ADHD often also ameliorate emotion dysregulation, a focus on this combination of symptoms reframes clinical questions and could stimulate novel therapeutic approaches. The authors then consider three models to explain the overlap between emotion dysregulation and ADHD: emotion dysregulation and ADHD are correlated but distinct dimensions; emotion dysregulation is a core diagnostic feature of ADHD; and the combination constitutes a nosological entity distinct from both ADHD and emotion dysregulation alone. The differing predictions from each model can guide research on the much-neglected population of patients with ADHD and emotion dysregulation.

Emotion-recognition abilities and behavior problem dimensions in preschoolers: evidence for a specific role for childhood hyperactivity

Facial emotion-recognition difficulties have been reported in school-aged children with behavior problems; little is known, however, about either this association in preschool children or with regard to vocal emotion recognition. The current study explored the association between facial and vocal emotion recognition and behavior problems in a sample of 3 to 6-year-old children. A sample of 57 children enriched for risk of behavior problems (41 were recruited from the general population while 16 had been referred for behavior problems to local clinics) were each presented with a series of vocal and facial stimuli expressing different emotions (i.e., angry, happy, and sad) of low and high intensity. Parents rated children's externalizing and internalizing behavior problems. Vocal and facial emotion recognition accuracy was negatively correlated with externalizing but not internalizing behavior problems independent of emotion type. The effects with the externalizing domain were independently associated with hyperactivity rather than conduct problems. The results highlight the importance of using vocal as well as facial stimuli when studying the relationship between emotion-recognition and behavior problems. Future studies should test the hypothesis that difficulties in responding to adult instructions and commands seen in children with attention deficit/hyperactivity disorder (ADHD) may be due to deficits in the processing of vocal emotions.

Emotional face identification in youths with primary bipolar disorder or primary attention-deficit/hyperactivity disorder

OBJECTIVE

Bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) are often comorbid or confounded; therefore, we evaluated emotional face identification to better understand brain/behavior interactions in children and adolescents with either primary BD, primary ADHD, or typically developing controls (TDC).

METHOD

Participants included individuals 7 to 17 years of age (overall sample mean age 12.40 ± 3.01 years), with "narrow-phenotype" pediatric BD (n = 30) or ADHD (n = 38), or typically developing controls (TDC) with no psychiatric disorders themselves or in their first-degree relatives (n = 41). In the BD group, comorbid diagnoses were allowed; however, youth in the ADHD group were excluded for comorbid mood or anxiety disorders. Patient groups were not excluded for psychotropic medication use. Emotional face identification was assessed using the computerized Diagnostic Analysis of Non-Verbal Accuracy (DANVA).

RESULTS

Participants with BD made significantly more identification errors on child happy faces than either TDCs (p = .03) or participants with ADHD (p = .01). Furthermore, youth with BD (0.33 ± 0.55) were more likely than youth with ADHD (0.11 ± 0.31) to make errors on low-intensity child happy faces (p = .05) but not high-intensity happy faces (p = NS). Participants with BD and ADHD made significantly more total errors in child face labeling than did TDCs, although participants with BD and ADHD did not differ from one another.

CONCLUSION

Our data suggest that youths with BD have specific alterations in emotional face identification of happy faces, an important finding that supports theories that response to positively valenced emotional stimuli may be especially salient in BD. Clinical trial registration information-Brain Imaging and Computer Games in Children With Either Bipolar Disorder, ADHD, Anxiety or Healthy Controls (BBPP); http://clinicaltrials.gov/; NCT01570426.

Facial emotion recognition in child psychiatry: a systematic review

This review focuses on facial affect (emotion) recognition in children and adolescents with psychiatric disorders other than autism. A systematic search, using PRISMA guidelines, was conducted to identify original articles published prior to October 2011 pertaining to face recognition tasks in case-control studies. Used in the qualitative synthesis were: 2 studies on schizophrenia, 18 on mood disorders, 16 on anxiety disorders, 4 on eating disorders, 14 on ADHD and 9 on conduct disorder. Our review suggests that there are abnormalities in facial emotion recognition in a wide range of child psychiatric disorders and that these are likely to have a negative effect on both family and peer relationships. Scope for further research has been identified.

Hyperresponsiveness to social rewards in children and adolescents with attention-deficit/hyperactivity disorder (ADHD)

Background

Current research suggests that attention-deficit/hyperactivity disorder (ADHD) is associated with larger behavioral sensitivity to reinforcement contingencies. However, most studies have focused thus far on the enhancing effects of tangible rewards such as money, neglecting that social-emotional stimuli may also impact task performance in ADHD patients.

Methods

To determine whether non-social (monetary) and social (positive facial expressions) rewards differentially improve response inhibition accuracy in children and adolescents with ADHD, we applied an incentive go/no-go task with reward contingencies for successful inhibition and compared ADHD subjects with typically developing individuals.

Results

Both social and monetary contingencies improved inhibition accuracy in all participants. However, individuals with ADHD displayed a particularly higher profit from social reward than healthy controls, suggesting that cognitive control in ADHD patients can be specifically improved by social reinforcement. By contrast, self-rated motivation associated with task performance was significantly lower in ADHD patients.

Conclusion

Our findings provide evidence for hyperresponsiveness to social rewards in ADHD patients, which is accompanied by limited self-awareness. These data suggest that social reward procedures may be particularly useful in behavioral interventions in children with ADHD.