Abstract
ObjectiveConduct disorder (CD) is associated with impairments in facial emotion recognition. However, CD commonly co-occurs with attention-deficit/hyperactivity disorder (ADHD); thus, it is unclear whether these impairments are explained by ADHD or by one of its core features—inattention. We explored whether emotion recognition impairments are specific to individuals with ADHD and comorbid CD while also examining the mechanisms that might explain such deficits.MethodA total of 63 male and female adolescents with ADHD (mean age = 14.2 years, age range = 11–18 years) and with (ADHD+CD) or without (ADHD) comorbid CD, and 41 typically developing controls (healthy controls [HC]; mean age = 15.5, age range = 11–18 years) performed an emotion recognition task with concurrent eye-tracking.ResultsParticipants with ADHD+CD were less accurate at recognizing fear and neutral faces, and more likely to confuse fear with anger than participants with ADHD alone and HC. Both ADHD subgroups fixated the eye region less than HC. Although there was a negative correlation between ADHD symptom severity and eye fixation duration, only CD severity was inversely related to emotion recognition accuracy.ConclusionOnly ADHD participants with comorbid CD showed impairments in emotion recognition, suggesting that these deficits are specific to individuals with conduct problems. However, lack of attention to the eye region of faces appears to be a characteristic of ADHD. These findings suggest that emotion recognition impairments in those with ADHD+CD are related to misinterpretation rather than poor attention, offering interesting opportunities for intervention.
Highlights
We compared emotion recognition between ADHDþCD, attentiondeficit/hyperactivity disorder (ADHD) alone, and healthy control participants to ascertain whether emotion recognition impairments were evident in individuals with a diagnosis of ADHD
We found support for the hypothesis that these impairments are specific to those ADHD participants with additional Conduct disorder (CD), with evidence of specific impairments in the recognition of fear and neutral faces
A null result by itself cannot be taken as evidence of equivalent performance, when the absence of significant differences between ADHD and control participants is seen in the context of previous studies of individuals with conduct disorder, this supports the idea that emotion recognition deficits are specific to those with additional CD
Summary
Conduct disorder (CD) is associated with impairments in facial emotion recognition. CD commonly co-occurs with attentiondeficit/hyperactivity disorder (ADHD); it is unclear whether these impairments are explained by ADHD or by one of its core features— inattention. Dadds et al.[9,11] hypothesized that a lack of attention paid to the eye region of the face, as evidenced by fewer fixations to the eye region, leads to poorer recognition This could be especially impaired in those with ADHD, because inattention is a core symptom of this disorder. Others have proposed the existence of interpretational biases.[21] Aggressive individuals supposedly have a hostile attribution bias[22] whereby neutral expressions are misattributed as hostile or threatening It is unclear whether emotion recognition impairments result from impairments in the attentional processing of facial expressions or a misinterpretation of the features of emotional expressions, or perhaps a combination of the two. We predicted that both ADHD subgroups would demonstrate attentional problems compared to the healthy controls, but that the ADHDþCD subgroup would have a specific problem in focusing on the eye region of the face, over and above ADHD alone
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