Biological Bases of Empathy and Social Cognition in Patients with Attention-Deficit/Hyperactivity Disorder: A Focus on Treatment with Psychostimulants.

Pamela Fantozzi,Gabriele Masi,Annarita Milone,Gianluca Sesso,Pietro Muratori

doi:10.3390/brainsci11111399

Abstract

In recent years, there has been growing interest in investigating the effect of specific pharmacological treatments for ADHD not only on its core symptoms, but also on social skills in youths. This stands especially true for ADHD patients displaying impulsive aggressiveness and antisocial behaviors, being the comorbidity with Disruptive Behavior Disorders, one of the most frequently observed in clinical settings. This systematic review aimed to synthesize research findings on this topic following PRISMA guidelines and to identify gaps in current knowledge, future directions, and treatment implications. Search strategies included the following terms: ADHD; methylphenidate and other ADHD drugs; empathy, theory of mind and emotion recognition. Full-text articles were retrieved and data from individual studies were collected. Thirteen studies were finally included in our systematic review. Ten studies assessing changes in empathy and/or theory of mind in patients with ADHD treated after pharmacological interventions were identified. Similarly, seven partially overlapping studies assessing changes in emotion recognition were retrieved. Despite a great heterogeneity in the methodological characteristics of the included studies, most of them reported an improvement in emphatic and theory of mind abilities in youths with ADHD treated with psychostimulants and nonstimulant drugs, as well as positive but less consistent results about emotion recognition performances.

Highlights

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders, with a pooled worldwide prevalence of 7.2% among children and adolescents [1]
724 records were screened by two authors (G.S. and P.F.) and any disagreement was resolved by consensus
Fifteen articles were included in our systematic review and were non-mutually subdivided into two partially overlapping groups as follows: (1) empathy and theory of mind (n = 10 studies); (2) emotion recognition (n = 7 studies)

Summary

Introduction

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders, with a pooled worldwide prevalence of 7.2% among children and adolescents [1]. In addition to the core symptoms of inattention, hyperactivity, and impulsivity [2], subjects with ADHD frequently exhibit difficulties in establishing and keeping relationships with peers and are perceived as less socially competent than peers [3] They tend to show a high rate of social and interpersonal problems during their whole life span, since reduced social cognition skills are usually found to be highly associated with the disorder, which may be considered to be an independent risk factor for negative outcome and poor quality of life in ADHD [3]. Attention deficits interfere with a proper coding and interpretation of social information, i.e., focusing and sustaining attention during conversations or appropriately reading social cues during play [4]. Impulsivity involves inappropriately intruding in conversations or play, and disinhibition of motor, verbal, and behavioral responses can lead to fewer opportunities for social interaction due to peer rejection [5]

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