Assessment of relationship between comorbid oppositional defiant disorder and recognition of emotional facial expressions in children with attention-deficit/hyperactivity disorder

Abstract

Objectives: Attention-deficit/hyperactivity disorder (ADHD) is the most frequent neurobehavioural disorder in childhood. ADHD is associated with impaired academic performance, cognitive, and emotional deficits. Moreover, comorbid oppositional defiant disorder (ODD) is leading to more severe impairment in social performance. Social cognition involves recognition, encoding, and interpretation of emotions from faces. Basic facial expressions that include sadness, happiness, anger, disgust, fear, and surprise are the easiest emotions to recognize. We aimed to demonstrate facial expression recognition impairments that might occur more frequently in children with co-occurring ADHD/ODD than patients with ADHD only. Thus, children with the co-occurrence of ODD may suffer more severely from social and behavioural difficulties. Methods: Forty patients diagnosed with ADHD and/or co-occurring ADHD/ODD according to DSM-IV-TR criteria were compared with a parallel (by gender, age, and educational state) 11 healthy children as a control group in this study. Clear facial images of each emotion were used as well as two additional sets of photos include 50% blurred images and cropped eye images were added as distractors then all images represented with black and white tone for emotion recognition task via facial expression. Angry expressions presented as target expressions. DSM-IV-Based Screening and Rating Scale for Children and Adolescents with attention deficit and disruptive behaviour disorders, the Conners' Teachers Rating Scale/ Revised Long Form and the Conners' Parent Rating Scale/Revised Long Form were used to provide diagnostic objectivity. Results: Control group statistically performed better than ADHD group on recognition of emotional facial expressions. Results showed no statistically significant differences between the ADHD and ADHD/ODD group on recognition of emotional facial expressions. However, according to results of emotion recognition task via facial expressions, there were statistically significant differences between pure ADHD and comorbid ADHD+ODD groups in happy and neutral expressions. ADHD/ODD group tend to attribute more meaning to neutral facial expressions. Additionally there was statistically significant difference between control group and ADHD group according to recognition of angry expressions. There were statistically significant differences between the groups according to recognition of sad expressions in all clear, blurred, and eye photographs. Conclusions: Difficulties in recognizing emotional facial expressions were observed in children with ADHD. A statistically significant association was established between presence of ADHD and impaired recognition of facial emotion expressions independent from the scores of the disruptive behaviour rating scale. Comorbid ODD was not associated with recognition of emotional facial expressions including angry expressions. Recognition of angry expressions was not found as a predictor for disruptive behaviour disorders.

Establishing the Relationship Between Attention Deficit Hyperactivity Disorder and Emotional Facial Expression Recognition Deficit: A Systematic Review

“…This was supported by Greco et al (2021), who found that children with ADHD had a higher percentage of error recognition for surprised human faces compared with controls (p = .049) Neutral Expressions Airdrie et al (2018) reported significantly lower accuracy in identifying neutral facial expressions in adolescents with ADHD compared with that in control participants (p < .5). This was consistent with the results of children assessed by Kara et al (2017) (clear face emotions, p = .03; cropped eye emotions p = .026) and Buongiorno et al (2020) (p = .00). Difficulty recognizing neutral facial expressions was accentuated in individuals with both ADHD and conduct disorder (p < .001) (Airdrie et al, 2018).…”

“…The studies encompassed a wide range of ages in the samples that were evaluated. Age varied from six ( Kara et al, 2017 ; Löytömäki et al, 2020 ; Staff et al, 2022 ) to 37.1 (standard deviation, SD = 10.2) years ( Helfer et al, 2021 ). Among these, one article included children ( Löytömäki et al, 2020 ), two included adolescents ( Airdrie et al, 2018 ; Jusyte et al, 2017 ), eight combined children and adolescents ( Buongiorno et al, 2020 ; Greco et al, 2021 ; Jusyte et al, 2017 ; Kara et al, 2017 ; Maire et al, 2019 ; Staff et al, 2022 ; Waddington et al, 2018 ; Wells et al, 2019 ), and two included adults ( Helfer et al, 2021 ; Thoma et al, 2020 ).…”

“…ADHD has been associated with particular comorbidities that were described in some of the studies. This included conduct disorder ( n = 2) ( Airdrie et al, 2018 ; Staff et al, 2022 ), anxiety ( n = 1) ( Wells et al, 2019 ), depression ( n = 2) ( Thoma et al, 2020 ; Wells et al, 2019 ), oppositional defiant disorder (ODD) ( n = 2) ( Kara et al, 2017 ; Wells et al, 2019 ), learning disabilities ( n = 1) ( Wells et al, 2019 ), language disorder ( n = 2) ( Löytömäki et al, 2020 ; Staff et al, 2022 ), ASD ( n = 3) ( Löytömäki et al, 2020 ; Thoma et al, 2020 ; Waddington et al, 2018 ), obsessive-compulsive disorder ( n = 1) ( Thoma et al, 2020 ), bipolar disorder ( n = 1) ( Thoma et al, 2020 ), and alcohol use disorder ( n = 1) ( Thoma et al, 2020 ).…”

“…Many studies reported significantly higher FER performance in control groups compared with that in children and adolescents with confirmed (Buongiorno et al, 2020;Greco et al, 2021;Jusyte et al, 2017;Kara et al, 2017;Löytömäki et al, 2020;Maire et al, 2019;Tehrani-Doost et al, 2017;Waddington et al, 2018) and subthreshold ADHD (Staff et al, 2022). Some authors reported that the difference remained significant after controlling for disruptive behavior scores (Kara et al, 2017) and ODD symptoms (p = .463) (Staff et al, 2022), and that there was no correlation with impulsive or inattentive behavior (Jusyte et al, 2017), attention-related variables (Buongiorno et al, 2020), hyperactivity (Maire et al, 2019), or IQ (Buongiorno et al, 2020;Waddington et al, 2018). Staff et al (2022) found that higher FER task accuracy scores were associated with fewer emotional problems (p = .012) and decreased challenges with peer interactions (p < .001).…”

Social Cognition and Prosocial Behavior in Children with Attention Deficit Hyperactivity Disorder: A Systematic Review

“…By means of an animated transformation task (Radboud Faces Database) [53] and Software Neurobehavioral System, they achieve lower scores in the emotional categories of children with ADHD [54] (Jusyte et al, 2017) and confirm the difference between the control group and ADHD group in the recognition of angry expressions [55]. Facial and auditory emotion recognition problems are confirmed to be characteristic of ADHD; however, children with ADHD did not show emotion recognition deficits as strong as adolescents with ADHD, which gives the impression that emotion recognition deficits worsen from childhood to adolescence [30,56].…”