Impaired fixation to eyes during facial emotion labelling in children with bipolar disorder or severe mood dysregulation

Abstract

IntroductionSevere mood disorders in children, specifically bipolar disorder (BD) and severe mood dysregulation (SMD), have recently received increased attention, as researchers and clin icians acknowledge the substantial impairment and treatment needs of these populations. The BD and SMD phenotypes differ in that BD is characterized by distinct episodes of mania (and, frequently, depression), whereas SMD is characterized by severe, chronic, impairing irritability.1 Importantly, however, the 2 phenotypes are similar in that both are severe pediatric mood disorders that share Background: Children with bipolar disorder (BD) or severe mood dysregulation (SMD) show behavioural and neural deficits during facial emotion processing. In those with other psychiatric disorders, such deficits have been associated with reduced attention to eye regions while looking at faces. Methods: We examined gaze fixation patterns during a facial emotion labelling task among children with pediatric BD and SMD and among healthy controls. Participants viewed facial expressions with varying emotions (anger, fear, sadness, happiness, neutral) and emotional levels (60%, 80%, 100%) and labelled emotional expressions. Results: Our study included 22 children with BD, 28 with SMD and 22 controls. Across all facial emotions, children with BD and SMD made more labelling errors than controls. Compared with controls, children with BD spent less time looking at eyes and made fewer eye fixations across emotional expressions. Gaze patterns in children with SMD tended to fall between those of children with BD and controls, although they did not differ significantly from either of these groups on most measures. Decreased fixations to eyes correlated with lower labelling accuracy in children with BD, but not in those with SMD or in controls. Limitations: Most children with BD were medicated, which precluded our ability to evaluate medication effects on gaze patterns. Conclusion: Facial emotion labelling deficits in children with BD are associated with impaired attention to eyes. Future research should examine whether impaired attention to eyes is associated with neural dysfunction. Eye gaze deficits in children with BD during facial emotion labelling may also have treatment implications. Finally, children with SMD exhibited decreased attention to eyes to a lesser extent than those with BD, and these equivocal findings are worthy of further study.

Deficits in emotion recognition are associated with depressive symptoms in youth with disruptive mood dysregulation disorder

“…In addition, the association between CDI scores and emotion recognition was significant even after accounting for current irritability symptoms, with the latter not being associated with emotion recognition accuracy. These findings contrast with previous studies in which, compared with healthy volunteers, deficits in emotion recognition were found in youth with severe irritability (Deveney et al., ; Guyer et al., ; Kim et al., ; Rich et al., ). The discrepancy with previous studies may be explained by different operating definitions of chronic severe irritability, that is, previous works have employed youth with severe mood dysregulation, which encompasses hyperarousal symptoms, and includes sadness along anger as negative mood.…”

“…The discrepancy with previous studies may be explained by different operating definitions of chronic severe irritability, that is, previous works have employed youth with severe mood dysregulation, which encompasses hyperarousal symptoms, and includes sadness along anger as negative mood. Differences could also be attributed to the use of distinct tasks (Kim et al., ; Rich et al., ), less conservative analyses (Deveney et al., ; Guyer et al., ), distinct features of examined emotion labeling accuracy (Kim et al., ; Rich et al., ), or simply because the effects of depressive symptoms on emotion recognition were not tested or could not be tested (Guyer et al., ; Kim et al., ; Rich et al., ). Nevertheless, our longitudinal analysis showed that regardless of current depressive symptoms, emotion recognition deficits in youth with DMDD—who mostly had low depressive symptoms at baseline—were predictive of more depressive symptoms at follow‐up.…”

“…Emotion recognition, defined as the ability to identify emotions expressed by facial and vocal stimuli, plays a crucial role in the development of social competence and interpersonal well‐being. Deficits in emotion recognition have been reported in youth with severe irritability for faces (Guyer et al., ; Kim et al., ; Rich et al., ) and voices (Deveney, Brotman, Decker, Pine, & Leibenluft, ). Similarly, and consistent with previous reports (Demenescu, Kortekaas, den Boer, & Aleman, ; Kohler, Hoffman, Eastman, Healey, & Moberg, ), a recent meta‐analysis found deficits in recognition of facial emotions in depressed patients compared to healthy controls (HC; Dalili, Penton‐Voak, Harmer, & Munafo, ).…”

The categories, frequencies, and stability of idiosyncratic eye-movement patterns to faces

“…Deviations from characteristic spatial or temporal eye-movement patterns to faces have been shown to reflect disorders including autism spectrum disorders (Kliemann, Dziobek, Hatri, Steimke, & Heekeren, 2010; Klin, Jones, Schultz, Volkmar, & Cohen, 2002; Morris, Pelphrey, & McCarthy, 2007; Pelphrey et al, 2002; Pelphrey, Morris, & McCarthy, 2005; Snow et al, 2011), schizophrenia (Green, Williams, & Davidson, 2003a, 2003b; Manor et al, 1999; M L Phillips & David, 1997; Mary L. Phillips & David, 1997, 1998; Streit, Wölwer, & Gaebel, 1997; Williams, Loughland, Gordon, & Davidson, 1999), bipolar disorder (Bestelmeyer et al, 2006; E. Kim et al, 2009; P. Kim et al, 2013; Loughland, Williams, & Gordon, 2002; Streit et al, 1997), and prosopagnosia (Schwarzer et al, 2007; Stephan & Caine, 2009; Van Belle et al, 2011), among others (Horley, Williams, Gonsalvez, & Gordon, 2003, 2004; Loughland et al, 2002; Marsh & Williams, 2006), and are thought to relate to the social and perceptual deficits associated with such disorders (e.g., see the correlation of eye-region fixations to emotion recognition performance for children with bipolar disorder, but not for healthy control children, reported in P.…”

“…Kim et al, 2009; P. Kim et al, 2013; Loughland, Williams, & Gordon, 2002; Streit et al, 1997), and prosopagnosia (Schwarzer et al, 2007; Stephan & Caine, 2009; Van Belle et al, 2011), among others (Horley, Williams, Gonsalvez, & Gordon, 2003, 2004; Loughland et al, 2002; Marsh & Williams, 2006), and are thought to relate to the social and perceptual deficits associated with such disorders (e.g., see the correlation of eye-region fixations to emotion recognition performance for children with bipolar disorder, but not for healthy control children, reported in P. Kim et al, 2013).…”