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

Do emotional intelligence, dysregulation and theory of mind predict irritability in adolescents with DMDD and ADHD?

OBJECTIVE

The aim of this study was to compare adolescents with disruptive mood dysregulation disorder (DMDD) and comorbid attention deficit hyperactivity disorder (ADHD) and healthy control adolescents in terms of emotional intelligence (EI), emotion regulation (ER) and theory of mind (ToM) abilities.

METHODS

Twenty-eight adolescents with DMDD and ADHD formed the DMDD group were compared to 31 healthy controls. We administered the Affective Reactivity Index (ARI), Difficulties in Emotion Regulation Scale (DERS), Kiddie-SADS, Bar-On Emotional Intelligence Test, Faux Pas, Comprehension Test, Unexpected Outcomes Test, Faces Test and Reading Mind in the Eyes Test (RMET) as ToM skills.

RESULTS

ARI and DERS scores were significantly elevated in the DMDD-ADHD group. The DMDD-ADHD group had significantly lower ToM skills and emotional intelligence (p < .05). When RMET, Bar-On Emotional Intelligence Test -general mood, DERS- impulsivity scores were compared between the groups, their effect sizes were as follows: 0.52, 0.81, 0.79, respectively. DERS, emotional intelligence and ToM scores were correlated in the DMDD group. In the linear regression analysis, the sole significant predictors of self-reported irritability were EI and ED total scores.

CONCLUSIONS

This study suggests that adolescents with DMDD and ADHD face difficulties in peer relationships, mentalizing, various domains of emotional intelligence andregulation. .

Annual Research Review: What processes are dysregulated among emotionally dysregulated youth? - a systematic review

Proliferation of the term "emotion dysregulation" in child psychopathology parallels the growing interest in processes that influence negative emotional reactivity. While it commonly refers to a clinical phenotype where intense anger leads to behavioral dyscontrol, the term implies etiology because anything that is dysregulated requires an impaired regulatory mechanism. Many cognitive, affective, behavioral, neural, and social processes have been studied to improve understanding of emotion dysregulation. Nevertheless, the defective regulatory mechanism that might underlie it remains unclear. This systematic review of research on processes that affect emotion dysregulation endeavors to develop an integrative framework for the wide variety of factors investigated. It seeks to ascertain which, if any, constitutes an impaired regulatory mechanism. Based on this review, we propose a framework organizing emotion-relevant processes into categories pertaining to stimulus processing, response selection and control, emotion generation, closed- or open-loop feedback-based regulation, and experiential influences. Our review finds scant evidence for closed-loop (automatic) mechanisms to downregulate anger arousal rapidly. Open-loop (deliberate) regulatory strategies seem effective for low-to-moderate arousal. More extensive evidence supports roles for aspects of stimulus processing (sensory sensitivity, salience, appraisal, threat processing, and reward expectancy). Response control functions, such as inhibitory control, show robust associations with emotion dysregulation. Processes relating to emotion generation highlight aberrant features in autonomic, endocrine, reward functioning, and tonic mood states. A large literature on adverse childhood experiences and family interactions shows the unique and joint effects of interpersonal with child-level risks. We conclude that the defective closed-loop regulatory mechanisms that emotion dysregulation implies require further specification. Integrating research on emotion-relevant mechanisms along an axis from input factors through emotion generation to corrective feedback may promote research on (a) heterogeneity in pathogenesis, (b) interrelationships between these factors, and (c) the derivation of better-targeted treatments that address specific pathogenic processes of affected youth.

The role of functional emotion circuits in distinct dimensions of psychopathology in youth

Several mental disorders emerge during childhood or adolescence and are often characterized by socioemotional difficulties, including alterations in emotion perception. Emotional facial expressions are processed in discrete functional brain modules whose connectivity patterns encode emotion categories, but the involvement of these neural circuits in psychopathology in youth is poorly understood. This study examined the associations between activation and functional connectivity patterns in emotion circuits and psychopathology during development. We used task-based fMRI data from the Philadelphia Neurodevelopmental Cohort (PNC, N = 1221, 8-23 years) and conducted generalized psycho-physiological interaction (gPPI) analyses. Measures of psychopathology were derived from an independent component analysis of questionnaire data. The results showed positive associations between identifying fearful, sad, and angry faces and depressive symptoms, and a negative relationship between sadness recognition and positive psychosis symptoms. We found a positive main effect of depressive symptoms on BOLD activation in regions overlapping with the default mode network, while individuals reporting higher levels of norm-violating behavior exhibited emotion-specific lower functional connectivity within regions of the salience network and between modules that overlapped with the salience and default mode network. Our findings illustrate the relevance of functional connectivity patterns underlying emotion processing for behavioral problems in children and adolescents.

The Association Between Emotion Recognition and Internalizing Problems in Children and Adolescents: A Three-Level Meta-Analysis

Numerous studies have explored the link between how well youth recognize emotions and their internalizing problems, but a consensus remains elusive. This study used a three-level meta-analysis model to quantitatively synthesize the findings of existing studies to assess the relationship. A moderation analysis was also conducted to explore the sources of research heterogeneity. Through a systematic literature search, a total of 42 studies with 201 effect sizes were retrieved for the current meta-analysis, and 7579 participants were included. Emotion recognition was negatively correlated with internalizing problems. Children and adolescents with weaker emotion recognition skills were more likely to have internalizing problems. In addition, this meta-analysis found that publication year had a significant moderating effect. The correlation between emotion recognition and internalizing problems decreased over time. The degree of internalizing problems was also found to be a significant moderator. The correlation between emotion recognition and internalizing disorders was higher than the correlation between emotion recognition and internalizing symptoms. Deficits in emotion recognition might be relevant for the development and/or maintenance of internalizing problems in children and adolescents. The overall effect was small and future research should explore the clinical relevance of the association.

Diagnostic instruments for the assessment of disruptive mood dysregulation disorder: a systematic review of the literature

Disruptive mood dysregulation disorder (DMDD) involves non-episodic irritability and frequent severe temper outbursts in children. Since the inclusion of the diagnosis in the DSM-5, there is no established gold-standard in the assessment of DMDD. In this systematic review of the literature, we provide a synopsis of existing diagnostic instruments for DMDD. Bibliographic databases were searched for any studies assessing DMDD. The systematic search of the literature yielded K = 1167 hits, of which n = 110 studies were included. The most frequently used measure was the Kiddie Schedule for Affective Disorders and Schizophrenia DMDD module (25%). Other studies derived diagnostic criteria from interviews not specifically designed to measure DMDD (47%), chart review (7%), clinical diagnosis without any specific instrument (6%) or did not provide information about the assessment (9%). Three structured interviews designed to diagnose DMDD were used in six studies (6%). Interrater reliability was reported in 36% of studies (ranging from κ = 0.6-1) while other psychometric properties were rarely reported. This systematic review points to a variety of existing diagnostic measures for DMDD with good reliability. Consistent reporting of psychometric properties of recently developed DMDD interviews, as well as their further refinement, may help to ascertain the validity of the diagnosis.

Recognition of affective prosody in bipolar and depressive conditions: A systematic review and meta-analysis

BACKGROUND

Inconsistent results have been reported about the affective prosody recognition (APR) ability in patients with bipolar (BD) and depressive (DD) disorders. We aimed to (i) evaluate the magnitude of APR dysfunction in BD and DD patients, (ii) identify moderators for heterogeneous results, and (iii) highlight research trends in this field.

METHODS

A computerized literature search was conducted in five electronic databases from the inception to May 9th, 2022 to identify behavioural experiments that studied APR in BD or DD patients. Effect sizes were calculated using a random-effect model and recalculated after removing outliers and adjusting publication bias.

RESULTS

Twelve eligible articles totalling 16 studies were included in the meta-analysis, aggregating 612 patients and 809 healthy controls. Individual r² ranged from 0.008 to 0.355, six of which reached a medium-to-large association strength. A medium-to-large pooled effect size (Hedges g = -0.58, 95 % CI -0.75 to -0.40, p < 0.001) for overall APR impairment in BD and DD patients was obtained. The Beck Depression Inventory score and answer option number were significant moderators. Neuropsychological mechanisms, multi-modal interaction and comorbidity effects have become primary research concerns.

LIMITATIONS

Extant statistics were insufficient for disorder-specific analysis.

CONCLUSIONS

Current findings demonstrate deficits of overall APR in BD and DD patients at a medium-to-large magnitude. APR can clinically serve for early screening and prognosis, but the depression severity, task complexity and confounding variables influence patients' APR performance. Future studies should incorporate neuroimaging approaches and investigate the effects of tonal language stimuli and clinical interventions.

Intimate Partner Violence Exposure and Childhood Psychopathology: Associations with Discriminating Fearful and Angry Faces in Young Children

Purpose

Childhood exposure to traumatic violence may shape how children respond to threatening faces and increase risk for psychopathology. Maltreated children may exhibit altered processing of threatening faces; however, the effects of witnessing intimate partner violence (IPV) on children's discrimination of facial expressions is under-studied. Emotional face processing differentially relates to psychopathology, with some evidence suggesting improved detection of angry faces in children with fear-related anxiety symptoms, whereas externalizing symptoms are associated with poorer detection of fearful faces and perhaps emotional faces broadly.

Method

In this cross-sectional study, we examined discrimination of threatening emotional faces (angry, fearful) in relation to experiences of probable abuse and witnessing of physical IPV, as well as psychopathology. Children (N = 137, mean age = 5.01 years, SD = 0.81) completed a "face in the crowd task" designed to examine discrimination of angry and fearful faces. Children either searched for an angry face among fearful distractor faces or a fearful face among angry distractors. Probable child abuse, witnessed IPV, and symptoms were assessed in semi-structured maternal interviews.

Results

Children who witnessed violence showed poorer accuracy when fearful faces were the target; however, effects for probable abuse were non-significant. Greater fear-related anxiety symptoms were associated with poorer accuracy for fearful faces. Externalizing symptoms were associated with poorer overall accuracy.

Conclusions

Findings suggest that IPV and fear-related anxiety symptoms were associated with difficulty detecting fearful faces when angry distractors were present, consistent with prior research. Implications of violence- and symptom-associated deficits in emotional face processing are discussed.

The Relationship Between Facial Expression and Cognitive Function in Patients With Depression

Objective: Considerable evidence has shown that facial expression recognition ability and cognitive function are impaired in patients with depression. We aimed to investigate the relationship between facial expression recognition and cognitive function in patients with depression.

Methods: A total of 51 participants (i.e., 31 patients with depression and 20 healthy control subjects) underwent facial expression recognition tests, measuring anger, fear, disgust, sadness, happiness, and surprise. The Chinese version of the MATRICS Consensus Cognitive Battery (MCCB), which assesses seven cognitive domains, was used.

Results: When compared with a control group, there were differences in the recognition of the expressions of sadness (p = 0.036), happiness (p = 0.041), and disgust (p = 0.030) in a depression group. In terms of cognitive function, the scores of patients with depression in the Trail Making Test (TMT; p < 0.001), symbol coding (p < 0.001), spatial span (p < 0.001), mazes (p = 0.007), the Brief Visuospatial Memory Test (BVMT; p = 0.001), category fluency (p = 0.029), and continuous performance test (p = 0.001) were lower than those of the control group, and the difference was statistically significant. The accuracy of sadness and disgust expression recognition in patients with depression was significantly positively correlated with cognitive function scores. The deficits in sadness expression recognition were significantly correlated with the TMT (p = 0.001, r = 0.561), symbol coding (p = 0.001, r = 0.596), maze (p = 0.015, r = 0.439), and the BVMT (p = 0.044, r = 0.370). The deficits in disgust expression recognition were significantly correlated with impairments in the TMT (p = 0.005, r = 0.501) and symbol coding (p = 0.001, r = 0.560).

Conclusion: Since cognitive function is impaired in patients with depression, the ability to recognize negative facial expressions declines, which is mainly reflected in processing speed, reasoning, problem-solving, and memory.

How and Why Are Irritability and Depression Linked?

Based on its course over time, irritability is linked to depression cross-sectionally and longitudinally. Cross-sectionally, irritability takes an episodic form as a symptom in pediatric depression; yet, irritability in the absence of depressed mood or anhedonia is rare. Longitudinally, chronic irritability has been shown to predict depression rather than bipolar disorder or externalizing disorders. Evidence suggests that the link between irritability and depression is explained mostly by shared genetic risk. Both conditions are also associated with higher rates of family history of depression, childhood temperaments and personality styles, and negative parenting styles. The treatment implications are discussed.

Labeling Emotional Stimuli in Early Childhood Predicts Neural and Behavioral Indicators of Emotion Regulation in Late Adolescence

BACKGROUND

Effective emotion regulation (ER) may be supported by 1) accurate emotion identification, encoding, and maintenance of emotional states and related brain activity of regions involved in emotional response (i.e., amygdala, ventral/posterior insula) and 2) cognitive processes that implement reframing, supported by activation in cognitive control brain regions (e.g., frontal, insular, and parietal cortices). The purpose of this project was to examine how emotion labeling ability in early childhood is related to ER concurrently and prospectively.

METHODS

Data from a prospective longitudinal study of youths at risk for depression, including measures of emotion labeling (i.e., Facial Affect Comprehension Evaluation) and ER ability (i.e., Emotion Regulation Checklist) and strategy use (i.e., Cognitive Emotion Regulation Questionnaire, Children's Response Style Questionnaire), and functional magnetic resonance imaging data during a sadness ER task (N = 139) were examined.

RESULTS

Findings from multilevel modeling and linear regression suggested that greater emotion labeling ability of more difficult emotions in early childhood was associated with enhanced parent-reported ER in adolescence, but not with a tendency to engage in adaptive or maladaptive ER strategies. Recognition of fear and surprise predicted greater activation in cortical regions involved in cognitive control during an ER of sadness task, including in the insula, anterior cingulate cortex, dorsal medial prefrontal cortex, and inferior frontal gyrus.

CONCLUSIONS

These findings suggest that early ability to identify and label difficult facial emotions in early childhood is associated with better ER in adolescence and enhanced activity of cognitive control regions of the brain.

Are youths with disruptive mood dysregulation disorder different from youths with major depressive disorder or persistent depressive disorder?

BACKGROUND

Although the disruptive mood dysregulation disorder (DMDD) was included in the depressive disorders (DD) section of the DSM-5, common and distinctive features between DMDD and the pre-existing DD (i.e., major depressive disorder, MDD, and persistent depressive disorder, PDD) received little scrutiny.

METHODS

Youths consecutively assessed as outpatients at two Canadian mood clinics over four years were included in the study (n = 163; mean age:13.4 ± 0.3; range:7-17). After controlling for inter-rater agreement, data were extracted from medical charts, using previously validated chart-review instruments.

RESULTS

Twenty-two percent of youths were diagnosed with DMDD (compared to 36% for MDD and 25% for PDD), with substantial overlap between the three disorders. Youths with DMDD were more likely to have a comorbid non-depressive psychiatric disorder - particularly attention deficit hyperactivity disorder, odds ratio (OR=3.9), disruptive, impulse-control and conduct disorder (OR=3.0) or trauma- and stressor-related disorder (OR=2.5). Youths with DMDD did not differ with regard to the level of global functioning, but reported more school and peer-relationship difficulties compared to MDD and/or PDD. The vulnerability factors associated with mood disorders (i.e., history of parental depression and adverse life events) were found at a comparable frequency across the three groups.

LIMITATIONS

The retrospective design and the selection bias for mood disordered patients restricted the generalizability of the results.

CONCLUSIONS

Youths with DMDD share several clinical features with youths with MDD and PDD. Further studies are required to determine the developmental trajectories and the benefits of expanding pharmacotherapy for DD to DMDD.

Mentalizing Self and Other and Affect Regulation Patterns in Anorexia and Depression

The study aimed to examine two constructs: general mentalizing processes and the specific component of affective mentalizing regarding self and others alongside the construct of affect regulation patterns in female adolescent and young adult inpatients with anorexia nervosa (AN; n = 41), depression (n = 20) and controls (n = 53). We further examined the predictive ability of affect regulation to eating-disorder (ED) symptoms beyond that of the mentalizing variables, and their potential role in mediating between mentalizing, depression and ED symptoms. We used tools assessing reflective functioning (RF), complex emotion recognition and theory of mind (ToM), alexithymia, affect regulation, depression, and ED symptoms. The AN and depression groups exhibited lower general mentalizing and higher alexithymia, emotional reactivity, and emotional cutoff patterns than controls, but showed no greater disturbance in ToM. The two clinical groups did not differ on any of these variables. Elevated mentalizing and adequate affect regulation patterns separately predicted lower severity of ED symptoms. Nonetheless, affect regulation did not add to the predictive value of mentalizing variables. Specifically, elevated alexithymia, and depressive symptomatology, but not RF, predicted greater ED symptomatology. Moreover, alexithymia directly accounted for elevated ED symptoms and also indirectly connected with ED symptoms via emotional hyperactivation and elevated depressive symptoms. These findings suggest that deficiencies in mentalization and affect regulation are not unique to AN, but may rather associated with psychopathology in general. Nonetheless, alexithymia and depression may increase ED-related symptomatology. Affect regulation deficiencies are mainly related with depressive symptoms and emotional hyperactivation is indirectly related with AN via the depressive symptoms.

On Defining Irritability and its Relationship to Affective Traits and Social Interpretations

Irritability has gained recognition as a clinically significant trait in youth and adults that when persistent and severe, predicts poor outcomes throughout life. However, its definition, measurement, and relationship to similar constructs remain poorly understood. In a community sample of adults (N=458; 19-74 years; M=40.5), we sought to identify a unitary irritability factor from independently constructed self-reported measures of irritability distinct from the related constructs of aggression, depression, and anxiety, and whether it was associated with face emotion identification deficits and hostile interpretation biases previously established in clinical pediatric samples. The three measures of irritability generated a common factor characterized by a rapid, angry response to provocation. This irritability factor had unique associations with tendencies to judge ambiguous stimuli as reflecting hostility, but not with face emotion identification performance. These findings clarify the nature of irritability and its associations with neurocognitive phenomenon.