Deficits in Response Inhibition in Patients with Attention-Deficit/Hyperactivity Disorder: The Impaired Self-Protection System Hypothesis

Abstract

Problems in inhibitory control are regarded in Psychology as a key problem associated with attention-deficit/hyperactivity disorder (ADHD). They, however, might not be primary deficits, but instead a consequence of inattention. At least two components have been identified and dissociated in studies in regards to inhibitory control: interference suppression, responsible for controlling interference by resisting irrelevant or misleading information, and response inhibition, referring to withholding a response or overriding an ongoing behavior. Poor error awareness and self-monitoring undermine an individual’s ability to inhibit inadequate responses and change course of action. In non-social contexts, an individual depends on his own cognition to regulate his mistakes. In social contexts, however, there are many social cues that should help that individual to perceive his mistakes and inhibit inadequate responses. The processes involved in perceiving and interpreting those social cues are arguably part of a self-protection system (SPS). Individuals with ADHD not only present impulsive behaviors in social contexts, but also have difficulty perceiving their inadequate responses and overriding ongoing actions toward more appropriate ones. In this paper, we discuss that those difficulties are arguably a consequence of an impaired SPS, due to visual attention deficits and subsequent failure in perceiving and recognizing accurately negative emotions in facial expressions, especially anger. We discuss evidence that children with ADHD exhibit problems in a series of components involved in the activation of that system and advocate that the inability to identify the anger expressed by others, and thus, not experiencing the fear response that should follow, is, ultimately, what prevents them from inhibiting the ongoing inappropriate behavior, since a potential threat is not registered. Getting involved in high-risk situations, such as reckless driving, could also be a consequence of not registering a threat and thus, not experiencing fear.

Common Venues in Romantic Relationships of Adults With Symptoms of Autism and Attention Deficit/Hyperactivity Disorder

“…Although individuals with ADHD may often seem as outgoing and amusing people, they frequently suffer from social and interpersonal problems (15,16). These social impairments encompasses a broad range manifestations as deficits in processing negative emotions in facial expressions or perceiving their inadequate behavior and inhibit ongoing actions toward more appropriate ones (17). They have poor social skills being commonly rejected by their peers and having difficulty to establish a relationship with a partner (15,18).…”

Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD)

“…Although several hypotheses explaining ED in ADHD have been suggested, including executive function deficits, social cognitions deficit, impaired emotional perception/processing, lack of empathy and impairment in first and second order theory of mind and poor mentalizing capacities [14,[23][24][25][26][27][28][29][30][31], less is known about the efficiency of cognitive emotion regulation strategies used by ADHD patients to cope with emotional outbursts. Some studies on adults suffering from ADHD have associated ED and poor emotional regulation strategies such as less use of 'cognitive reappraisal' and more use of 'suppression' [32].…”

Participant–experimenter rapport in experimental settings: A test case of executive functions among children with ADHD.

“…Resorting to reduced social monitoring, together with difficulty in perceiving the emotional cues of the experimenter (Berggren, Engström, & Bölte, 2016; Boakes, Chapman, Houghton, & West, 2008; Da Fonseca, Seguier, Santos, Poinso, & Deruelle, 2009), result in the children’s lack of awareness of the interactional incongruence, and therefore lack of effect on the task performance. Reminiscent of a difficulty faced by children with ADHD in utilizing social cues (Coutinho, Reis, da Silva, Miranda, & Malloy-Diniz, 2018), current findings of lack of correlation between observed positivity and perceived rapport congruency among children with ADHD, show their misuse of the positivity signals apparent in the interaction. In practice, this may be both a hardship and a defense mechanism among children with ADHD.…”