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.
When post-traumatic stress disorder (PTSD) co-occurs with obsessive compulsive disorder (OCD), symptoms of the former can interfere with evidence-based treatment of the latter. As a result, exposure-based treatments are recommended for both OCD and PTSD, potentially facilitating a concurrent treatment approach. This case study describes the application of concurrent cognitive behaviour therapy (CBT including exposure and response prevention; ERP) for OCD and narrative exposure therapy to treat a patient whose PTSD symptoms of intrusive images of memories and hyperarousal were interfering with standard CBT (including ERP) treatment for OCD. Following this concurrent approach, the patient’s symptoms of OCD reduced to non-clinical levels and showed reliable improvement in PTSD symptoms. Whilst further methodologically robust research is required, this case study highlights that this approach may be beneficial to the treatment of OCD where PTSD symptoms are impacting on treatment.
Key learning aims
(1)
To explore the literature considering explanations of the co-occurrence of OCD and PTSD symptomology.
(2)
To consider how symptoms of two mental health conditions can maintain one another and attenuate the effectiveness of evidence-based treatment for the other mental health condition.
(3)
Consider the use of concurrent therapeutic approaches to treat co-occurring mental health conditions.
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