Facial Emotion Recognition and Eye Gaze in Attention-Deficit/Hyperactivity Disorder With and Without Comorbid Conduct Disorder

Objective Conduct 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. Method A 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. Results Participants 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. Conclusion Only 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.

[1]  D. Waschbusch,et al.  Emotional processing in children with conduct problems and callous/unemotional traits. , 2008, Child: care, health and development.

[2]  E. Foster,et al.  The high costs of aggression: public expenditures resulting from conduct disorder. , 2005, American journal of public health.

[3]  K. Dodge,et al.  Hostile attributional biases in severely aggressive adolescents. , 1990, Journal of abnormal psychology.

[4]  H. Meltzer,et al.  The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. , 2000, Journal of child psychology and psychiatry, and allied disciplines.

[5]  S. V. van Goozen,et al.  Improving Negative Emotion Recognition in Young Offenders Reduces Subsequent Crime , 2015, PloS one.

[6]  Abigail A. Marsh,et al.  Deficits in facial affect recognition among antisocial populations: A meta-analysis , 2008, Neuroscience & Biobehavioral Reviews.

[7]  Katya Rubia,et al.  Identifying mechanisms that underlie links between COMT genotype and aggression in male adolescents with ADHD , 2015, Journal of child psychology and psychiatry, and allied disciplines.

[8]  S. V. van Goozen,et al.  Young Offenders’ Emotion Recognition Dysfunction Across Emotion Intensities: Explaining Variation Using Psychopathic Traits, Conduct Disorder and Offense Severity , 2013, Journal of Psychopathology and Behavioral Assessment.

[9]  Joseph Biederman,et al.  Attention-Deficit/Hyperactivity Disorder: A Selective Overview , 2005, Biological Psychiatry.

[10]  D. Wechsler.  Wechsler Abbreviated Scale of Intelligence--Second Edition , 2018 .

[11]  K. Dodge,et al.  Biased decision-making processes in aggressive boys. , 1981, Journal of abnormal psychology.

[12]  A. Thapar,et al.  Emotion Regulation in Adolescent Males with Attention-Deficit Hyperactivity Disorder: Testing the Effects of Comorbid Conduct Disorder , 2015, Brain sciences.

[13]  R. Blair,et al.  Facial expressions, their communicatory functions and neuro-cognitive substrates. , 2003, Philosophical transactions of the Royal Society of London. Series B, Biological sciences.

[14]  Bernard Dan,et al.  Recognition of emotional facial expressions in attention-deficit hyperactivity disorder. , 2006, Pediatric neurology.

[15]  P. Ekman.  Pictures of Facial Affect , 1976 .

[16]  A. Calder,et al.  Deficits in facial expression recognition in male adolescents with early-onset or adolescence-onset conduct disorder , 2009, Journal of child psychology and psychiatry, and allied disciplines.

[17]  M. Campbell,et al.  Validity and Stability of the Youth Psychopathic Traits Inventory in a Nonforensic Sample of Young Adults , 2009, Journal of personality assessment.

[18]  Nirbhay N. Singh,et al.  Recognition of Facial Expressions of Emotion by Children with Attention-Deficit Hyperactivity Disorder , 1998, Behavior modification.

[19]  P. Greenbaum,et al.  Construct Validity of the Youth Psychopathic Traits Inventory (YPI) and the Antisocial Process Screening Device (APSD) With Justice-Involved Adolescents , 2006 .

[20]  H Meltzer,et al.  Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample , 2003, International review of psychiatry.

[21]  M Knapp,et al.  Financial cost of social exclusion: follow up study of antisocial children into adulthood , 2001, BMJ : British Medical Journal.

[22]  R. Blair,et al.  Expression recognition and behavioural problems in early adolescence , 2000 .

[23]  H. Andershed,et al.  Convergent Validity of the Youth Psychopathic Traits Inventory (YPI) , 2007, Assessment.

[24]  Ian M. Goodyer,et al.  Facial Expression Recognition, Fear Conditioning, and Startle Modulation in Female Subjects with Conduct Disorder , 2010, Biological Psychiatry.

[25]  M. Dadds,et al.  Attention to the eyes and fear-recognition deficits in child psychopathy , 2006, British Journal of Psychiatry.

[26]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[27]  R. Blair.  Responding to the emotions of others: Dissociating forms of empathy through the study of typical and psychiatric populations , 2005, Consciousness and Cognition.

[28]  M. Kerr,et al.  Psychopathic traits in non-referred youths : a new assessment tool , 2002 .

[29]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[30]  R. Blair.  Applying a cognitive neuroscience perspective to the disorder of psychopathy , 2005, Development and Psychopathology.

[31]  E. Sonuga-Barke,et al.  The familial basis of facial emotion recognition deficits in adolescents with conduct disorder and their unaffected relatives , 2015, Psychological Medicine.

[32]  Ran R. Hassin,et al.  Angry, Disgusted, or Afraid? , 2008, Psychological science.

[33]  Wolfgang Schneider,et al.  Emotion recognition in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) , 2013, ADHD Attention Deficit and Hyperactivity Disorders.

[34]  A. Guastella,et al.  Reduced eye gaze explains "fear blindness" in childhood psychopathic traits. , 2008, Journal of the American Academy of Child and Adolescent Psychiatry.

[35]  Elinor McKone,et al.  Not just fear and sadness: Meta-analytic evidence of pervasive emotion recognition deficits for facial and vocal expressions in psychopathy , 2012, Neuroscience & Biobehavioral Reviews.

[36]  M. Casagrande,et al.  Controlling attention to gaze and arrows in attention deficit hyperactivity disorder , 2017, Psychiatry Research.