The role of linguistic and cognitive factors in emotion recognition difficulties in children with ASD, ADHD or DLD

The Role of Empathy in ADHD Children: Neuropsychological Assessment and Possible Rehabilitation Suggestions-A Narrative Review

Background and Objectives: Theory of mind (ToM) deficits in children with ADHD are closely related to social difficulties and problems in interpersonal interactions. Evidence suggests that these cognitive deficits negatively affect the ability to understand and respond to others' emotions and intentions, thus contributing to social isolation and a lower quality of life. However, the findings across studies vary, indicating that ADHD subtype and comorbidities, such as anxiety and mood disorders, can significantly influence sociocognitive deficits, modulating the extent of social problems. Materials and Methods: This review examines the relationship among ADHD, ToM, and empathy, analyzing studies comparing children with ADHD with peers with typical development or other neurodevelopmental conditions. A search in PubMed, Scopus, and the Cochrane Library prior to January 10, without time restrictions, using "ADHD", "Cognitive Empathy", and "Theory of Mind" identified relevant studies assessing these abilities through neuropsychological tests or questionnaires. Results: Of the initial 243 studies, 23 studies met the inclusion criteria. Children with ADHD exhibited significant impairments in ToM and empathy, affecting social cognition and interpersonal understanding. Various assessment tools revealed difficulties in understanding beliefs, emotions, and intentions, with executive function deficits playing a crucial role in shaping these social challenges. Conclusions: This review highlights the need for targeted therapeutic interventions that not only address cognitive deficits but consider emotional and metacognitive aspects, such as emotion regulation and self-awareness. Future research should focus on integrating executive function training with approaches that develop metacognitive and emotional skills, thus providing more comprehensive support.

Emotion-specific recognition biases and how they relate to emotion-specific recognition accuracy, family and child demographic factors, and social behaviour

The errors young children make when recognising others' emotions may be systematic over-identification biases and may partially explain the challenges some have socially. These biases and associations may be differential by emotion. In a sample of 871 ethnically and racially diverse preschool-aged children (i.e. 33-68 months; 49% Hispanic/Latine, 52% Children of Colour), emotion recognition was assessed, and scores for accuracy and bias were calculated by emotion (i.e. anger, sad, happy, calm, and fear). Child and family characteristics and teacher-reported social behaviour were also collected. Multilevel structural equation modelling revealed emotion-specific recognition accuracies varied between 36 and 65% whereas biases varied between 4 and 13%. Anger was the strongest bias followed by sad, happy, fear, and calm, in contrast to the pattern for accuracy - happy, sad, angry, fear, and calm. More variance was explained in emotion-specific recognition accuracies by child and family characteristics - 7-38% - than biases - 3-7%. Negatively-valanced emotion recognition biases associated with positively-valanced accuracies, and positively-valued emotion recognition biases associated with negatively-valued accuracies. Biases did not have meaningful associations with social behaviour. This study highlights that children's emotion recognition errors may partially be systematic, but future studies are needed to understand the underlying cognitive mechanisms.

Emotion Recognition Accuracy Among Individuals With ADHD: A Systematic Review

OBJECTIVE

The aim of the present systematic review was to consolidate findings related to emotion recognition accuracy among individuals with attention deficit hyperactivity disorder (ADHD). The review also examined emotion recognition accuracy assessment methods as well as the contribution of gender to emotional recognition accuracy.

METHOD

A total of 43 articles were identified based on inclusion criteria using PRISMA guidelines for article retrieval.

RESULTS

58% of retrieved articles reported significantly decreased emotion recognition accuracy among individuals with ADHD relative to neurotypical peers, with either global or emotion-specific differences identified. Notably, studies finding a significant difference in emotion recognition accuracy were of significantly lower quality according to a quality review checklist than the articles finding no difference (p < .001). For example, when use of control conditions and multiple measures of emotion recognition accuracy were employed, no study found a significant difference in emotion recognition accuracy between individuals with and without ADHD. Regarding potential gender differences, not a single study included gender diversity beyond sex assigned at birth. The majority (86%) of studies included a predominantly male sample, with 15% including only male participants. While differences in emotion recognition accuracy were found between male and female participants in 7% of cases, future research is needed to identify the contribution of gender diversity.

Variability of theory of mind versus pragmatic ability in typical and atypical development

INTRODUCTION

Numerous studies have linked deficits in Theory of Mind (ToM) with language problems. We aimed to explore the similarities and differences between children's patterns of performance on a ToM task that requires minimal linguistic skill and a pragmatic inference task that relies on both ToM and language. We assessed variability in pragmatic inference skills and ToM across populations of children (8-14 years) displaying varying cognitive profiles. We further compared the sensitivity of ToM versus pragmatic ability to core language skills, memory and executive functioning (EF).

METHOD

ToM was tested using the Social Attribution Task (SAT-MC-II). Pragmatic ability was assessed in an implicature comprehension task. Receptive vocabulary, grammar comprehension, short-term and working memory (STM and WM) capacity and EF were measured using Hungarian adaptations of standard tasks and tests developed by the authors' lab. In addition to typically developing (TD) children (n = 33), we included children with neurodevelopmental disorders where ToM and/or language abilities are vulnerable: autism spectrum disorder (ASD, n = 26), attention deficit hyperactivity disorder (ADHD, n = 25) and developmental language disorder (DLD, n = 18).

RESULTS

Results revealed a significant but only moderate positive correlation between pragmatic inference and ToM indicating that the two abilities are related but distinct. The ASD group showed impairments in both ToM and pragmatic inference ability but no significant deficit was observed in ADHD or DLD relative to TD children in either skill. However, while SAT-MC-II results were only affected by verbal WM and vocabulary measures, pragmatic performance was associated with STM, verbal WM, EF, grammatical skills and vocabulary.

CONCLUSION

Our findings indicate that disentangling the contributions of different cognitive skills to ToM tasks may help clarify the role of ToM in language skills and identify distinct patterns of ToM and pragmatic skills in developmental disorders.

Recognition of Emotional Prosody in Mandarin-Speaking Children: Effects of Age, Noise, and Working Memory

Age, babble noise, and working memory have been found to affect the recognition of emotional prosody based on non-tonal languages, yet little is known about how exactly they influence tone-language-speaking children's recognition of emotional prosody. In virtue of the tectonic theory of Stroop effects and the Ease of Language Understanding (ELU) model, this study aimed to explore the effects of age, babble noise, and working memory on Mandarin-speaking children's understanding of emotional prosody. Sixty Mandarin-speaking children aged three to eight years and 20 Mandarin-speaking adults participated in this study. They were asked to recognize the happy or sad prosody of short sentences with different semantics (negative, neutral, or positive) produced by a male speaker. The results revealed that the prosody-semantics congruity played a bigger role in children than in adults for accurate recognition of emotional prosody in quiet, but a less important role in children compared with adults in noise. Furthermore, concerning the recognition accuracy of emotional prosody, the effect of working memory on children was trivial despite the listening conditions. But for adults, it was very prominent in babble noise. The findings partially supported the tectonic theory of Stroop effects which highlights the perceptual enhancement generated by cross-channel congruity, and the ELU model which underlines the importance of working memory in speech processing in noise. These results suggested that the development of emotional prosody recognition is a complex process influenced by the interplay among age, background noise, and working memory.

Facial expression recognition ability and its neuropsychological mechanisms in children with attention deficit and hyperactive disorder

Attention deficit and hyperactive disorder (ADHD) is a chronic neurodevelopmental disorder characterized by inattention, hyperactivity-impulsivity, and working memory deficits. Social dysfunction is one of the major challenges faced by children with ADHD. It has been found that children with ADHD can't perform as well as typically developing children on facial expression recognition (FER) tasks. Generally, children with ADHD have some difficulties in FER, while some studies suggest that they have no significant differences in accuracy of specific emotion recognition compared with typically developing children. The neuropsychological mechanisms underlying these difficulties are as follows. First, neuroanatomically. Compared to typically developing children, children with ADHD show smaller gray matter volume and surface area in the amygdala and medial prefrontal cortex regions, as well as reduced density and volume of axons/cells in certain frontal white matter fiber tracts. Second, neurophysiologically. Children with ADHD exhibit increased slow-wave activity in their electroencephalogram, and event-related potential studies reveal abnormalities in emotional regulation and responses to angry faces when facing facial stimuli. Third, psychologically. Psychosocial stressors may influence FER abilities in children with ADHD, and sleep deprivation in ADHD children may significantly increase their recognition threshold for negative expressions such as sadness and anger. This article reviews research progress over the past three years on FER abilities of children with ADHD, analyzing the FER deficit in children with ADHD from three dimensions: neuroanatomy, neurophysiology and psychology, aiming to provide new perspectives for further research and clinical treatment of ADHD.

Vocal emotion recognition in attention-deficit hyperactivity disorder: a meta-analysis

There is debate within the literature as to whether emotion dysregulation (ED) in Attention-Deficit Hyperactivity Disorder (ADHD) reflects deviant attentional mechanisms or atypical perceptual emotion processing. Previous reviews have reliably examined the nature of facial, but not vocal, emotion recognition accuracy in ADHD. The present meta-analysis quantified vocal emotion recognition (VER) accuracy scores in ADHD and controls using robust variance estimation, gathered from 21 published and unpublished papers. Additional moderator analyses were carried out to determine whether the nature of VER accuracy in ADHD varied depending on emotion type. Findings revealed a medium effect size for the presence of VER deficits in ADHD, and moderator analyses showed VER accuracy in ADHD did not differ due to emotion type. These results support the theories which implicate the role of attentional mechanisms in driving VER deficits in ADHD. However, there is insufficient data within the behavioural VER literature to support the presence of emotion processing atypicalities in ADHD. Future neuro-imaging research could explore the interaction between attention and emotion processing in ADHD, taking into consideration ADHD subtypes and comorbidities.

How word meaning structure relates to executive functioning and theory of mind in children with developmental language disorder: A multiple case study

Background and aims

Many children with developmental language disorder (DLD) have difficulties in executive functioning (EF) and theory of mind (ToM). These difficulties might be explained by the theory that children's conceptual understanding changes over five stages of word meaning structure, from concrete and context-dependent to abstract and precise. We present a multiple case study examining how word meaning structure relates to EF and ToM in children with DLD.

Methods

Participants were five children with DLD aged 9-12 and five typically developing children matched for age, gender, and nonverbal intelligence. Word meaning structure was assessed using new dynamic test. EF was assessed using the Zoo Map Task and Behavioral Rating Inventory for EF. ToM was assessed using the ToM test, Frith-Happé Animations, and Bermond-Vorst Alexithymia Questionnaire. Behavioral problems were measured using the Child Behavior Checklist. Anamnestic interviews with the parents were conducted to describe the case histories.

Results

For the children with DLD, lower scores in the word meaning structure task were observed compared to those observed for their matched peers, with no statistical test applied. Word meaning structure related positively to EF and ToM, but not to behavioral problems. Instances in which word meaning structure dissociates from EF and ToM are discussed in individual case descriptions.

Conclusions

By linking language to conceptual development, variations in word meaning structure may explain some EF and ToM difficulties in children with DLD.

Implications

The present study offers a basis for future research on the relationships among word meaning structure, EF, and ToM.

Language abilities in children and adolescents with DLD and ADHD: A scoping review

PURPOSE

There is an emerging view that attention-deficit/hyperactivity disorder (ADHD) is marked by problems with language difficulties, an idea reinforced by the fact that ADHD is highly comorbid with developmental language disorder (DLD). This scoping review provides an overview of literature on language abilities in children with DLD and ADHD while highlighting similarities and differences.

METHOD

A comprehensive search was performed to examine the literature on language abilities in the two disorders, yielding a total of 18 articles that met the inclusion criteria for the present review. Qualitative summaries are provided based on the language domain assessed.

RESULTS

The current literature suggests children and adolescents with ADHD have better morphosyntax/grammar, general/core language abilities, receptive, and expressive abilities than those with DLD. Further, that performance is comparable on assessments of semantic and figurative language but varies by sample on assessments of phonological processing, syntax, narrative language, and vocabulary.

CONCLUSION

Evidence presented points to children and adolescents with DLD as having greater language difficulties compared to those with ADHD, but with some important caveats. Despite limitations related to the paucity of studies and inconsistencies in how the two types of disorders are identified, our review provides a necessary and vital step in better understanding the language profiles of these two highly prevalent childhood disorders. These findings are useful in optimizing language outcomes and treatment efficacy for children and adolescents with ADHD and DLD.

Development of Mandarin Lexical Tone Identification in Noise and Its Relation With Working Memory

PURPOSE

This study aimed to examine the developmental trajectory of Mandarin tone identification in quiet and two noisy conditions: speech-shaped noise (SSN) and multitalker babble noise. In addition, we evaluated the relationship between tonal identification development and working memory capacity.

METHOD

Ninety-three typically developing children aged 5-8 years and 23 young adults completed categorical identification of two tonal continua (Tone 1-4 and Tone 2-3) in quiet, SSN, and babble noise. Their working memory was additionally measured using auditory digit span tests. Correlation analyses between digit span scores and boundary widths were performed.

RESULTS

Six-year-old children have achieved the adultlike ability of categorical identification of Tone 1-4 continuum under both types of noise. Moreover, 6-year-old children could identify Tone 2-3 continuum as well as adults in SSN. Nonetheless, the child participants, even 8-year-olds, performed worse when tokens from Tone 2-3 continuum were masked by babble noise. Greater working memory capacity was associated with better tone identification in noise for preschoolers aged 5-6 years; however, for school-age children aged 7-8 years, such correlation only existed in Tone 2-3 continuum in SSN.

CONCLUSIONS

Lexical tone perception might take a prolonged time to achieve adultlike competence in babble noise relative to SSN. Moreover, a significant interaction between masking type and stimulus difficulty was found, as indicated by Tone 2-3 being more susceptible to interference from babble noise than Tone 1-4. Furthermore, correlations between working memory capacity and tone perception in noise varied with developmental stage, stimulus difficulty, and masking type.

Impaired social concept processing in persons with autistic-like traits

Situated models suggest that social concepts are grounded in interpersonal experience. However, few studies have tested this notion experimentally, and none has targeted individuals with reduced social interaction. Here, we assessed comprehension of text-level social and non-social concepts in persons with and without autistic-like traits. Participants read a social and a non-social text and answered questionnaires targeting social and non-social concepts, respectively. We compared behavioral outcomes, gauged their contribution to subject-level classification, and examined their association with validated measures of autism. Persons with autistic-like traits showed selective deficits in grasping text-level social concepts, even adjusting for intelligence, memory, and vocabulary. Also, social concept comprehension was the only variable that significantly classified between groups. Finally, social concept outcomes correlated negatively with measures of autism, including social interaction. Our results suggest that reduced interpersonal experience selectively compromises text-level social concept processing, offering empirical constraints for situated models of social semantics.

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

OBJECTIVE

In this review, we examined if there is a deficit in facial recognition of emotion (FER) in children, adolescents, and adults with attention deficit hyperactivity disorder (ADHD).

BACKGROUND

Emotional regulation is impaired in ADHD. Although a facial emotion recognition deficit has been described in this condition, the underlying causal mechanisms remain unclear.

METHODS

The search was performed in six databases in September 2022. Studies assessing children, adolescents, or adults with isolated or comorbid ADHD that evaluated participants using a FER task were included.

RESULTS

Twelve studies out of 385 were selected, with participants ranging in age from 6 to 37.1 years. A deficit in FER specific to ADHD, or secondary to comorbid autism spectrum disorder, anxiety, and oppositional symptoms, was found.

CONCLUSIONS

There is a FER deficit in patients with ADHD. Adults showed improved recognition accuracy, reflecting partial compensation. ADHD symptoms and comorbidities appear to influence FER deficits.

The role of affective touch in modulating emotion processing among preschool children

Recognizing emotional expressions is a prerequisite for understanding others' feelings and intentions, a key component of social interactions that develops throughout childhood. In multisensory social environments, touch may be crucial for emotion processing, linking external sensory information with internal affective states. The current study investigated whether affective touch facilitates recognition of emotional expressions throughout childhood. Preschool children (N = 121 3- to 6-year-olds) were presented with different tactile stimulations followed by an emotion-matching task. Results revealed that affective touch fosters the recognition of negative emotions and increases the speed of association of positive emotions, highlighting the centrality of tactile experiences for socioemotional understanding. The current research opens new perspectives on how to support emotional recognition with potential consequences for the development of social functioning.

Correlations Between Psychological Status and Perception of Facial Expression

OBJECTIVE

Facial affect recognition is associated with neuropsychological status and psychiatric diseases. We hypothesized that facial affect recognition is associated with psychological status and perception of other affects.

METHODS

A total of 80 images depicting facial affect, including 20 Neutral, 20 Angry, 20 Fear, and 20 Sad, were screened for use in our research. A total of 100 healthy individuals were asked to rate these images using a 10-point Likert scale and complete psychological scales assessing the emotional statuses and cognitive functions.

RESULTS

The participants' emotional state of aggression, attention, and impulsivity may have been associated with their interpretation of the Angry facial expressions. The participants often rated the Angry facial expressions as Fear. The participants rated Fear images as Angry or Sad. In response to a Sad facial expression, the participants reported psychological statuses of attention and impulsivity which were associated with the facial expression rating. The participants rated the Sad expression as Angry or Fear.

CONCLUSION

The psychological statuses of the participants were significantly correlated with their interpretation of facial affects. In particular, a psychological state of attention was often correlated with incorrect affect ratings. Attention and impulsivity could affect the rating of the sad facial expressions.

Emotion Recognition in Preterm and Full-Term School-Age Children

Children born preterm (<37 weeks’ gestation) show a specific vulnerability for socio-emotional difficulties, which may lead to an increased likelihood of developing behavioral and psychiatric problems in adolescence and adulthood. The accurate decoding of emotional signals from faces represents a fundamental prerequisite for early social interactions, allowing children to derive information about others’ feelings and intentions. The present study aims to explore possible differences between preterm and full-term children in the ability to detect emotional expressions, as well as possible relationships between this ability and socio-emotional skills and problem behaviors during everyday activities. We assessed 55 school-age children (n = 34 preterm and n = 21 full-term) with a cognitive battery that ensured comparable cognitive abilities between the two groups. Moreover, children were asked to identify emotional expressions from pictures of peers’ faces (Emotion Recognition Task). Finally, children’s emotional, social and behavioral outcomes were assessed with parent-reported questionnaires. The results revealed that preterm children were less accurate than full-term children in detecting positive emotional expressions and they showed poorer social and behavioral outcomes. Notably, correlational analyses showed a relationship between the ability to recognize emotional expressions and socio-emotional functioning. The present study highlights that early difficulties in decoding emotional signals from faces may be critically linked to emotional and behavioral regulation problems, with important implications for the development of social skills and effective interpersonal interactions.

Social Communication and pragmatic skills of children with Autism Spectrum Disorder and Developmental Language Disorder

PURPOSE

to assess the pragmatic and social communicative abilities of children with Typical Language Development (TLD), Autism Spectrum disorder (ASD) and Developmental Language Disorder (DLD).

METHODS

Participants were 40 parents and 29 teachers of 40 children ages between 3 and 6 years. Ten children had DLD, ten had ASD and 20 had typical development. All participants answered to the questionnaire of the "Assessment of Pragmatic Language and Social Communication - APLSC - parent and professional reports - beta research version. Data were submitted to statistical analysis.

RESULTS

The assessment tool was useful in identifying the difference in performance of children with different social communicative profiles.

CONCLUSION

Children with ASD presented social and pragmatic impairments that were more significant than those presented by children with DLD. However, both children with ASD and with DLD presented more social pragmatic difficulties than children with TLD.

A Subtle Profile With a Significant Impact: Language and Communication Difficulties for Autistic Females Without Intellectual Disability

The presentation of autism in females is poorly understood, which is thought to contribute to missed or later- age diagnosis, especially for those without intellectual disability. Dedicated research into social and behavioral differences has indicated a specific female phenotype of autism. However, less has been done to explore language and communication profiles, despite known sex/gender differences in typically developing populations. This article provides a synthesis of recent work from this small but emerging field. It focuses on a series of four preliminary and explorative studies conducted by the authors and embeds this within the wider literature. Findings suggest a specific profile of language and communication strengths and weaknesses for autistic females without intellectual disability (compared to autistic males and typically developing females). Furthermore, despite the relatively subtle presentation of difficulties (compared to autistic males), the impact on functionality, social inter-relations and emotional well-being, appears to be equitable and significant. The discussion highlights the need for further empirical research and proposes areas for investigation. Implications for clinical practice include the need for better recognition, testing and provision of interventions dedicated to the language and communication difficulties for autistic females. This has relevance for diagnostic, mental health and speech and language therapy services.

Social Cognition in Neurodevelopmental Disorders and Epilepsy

Introduction: The purpose of our study was to perform a comparative analysis of social cognition in children and adolescents with epilepsy, autism spectrum disorder (ASD), specific learning disorder (SLD) and in typical development (TD) controls. The secondary aim was to relate social cognition to some clinical and demographic characteristics.

Methods: Our work is a transversal observational study. The recruits were 179 children and adolescents aged between 6 and 18 years diagnosed with epilepsy, ASD, or SLD and 32 subjects with TD. All the participants underwent neuropsychological assessment of Emotion Recognition (ER) and Theory of Mind (ToM) skills.

Results: All three clinical groups performed significantly worse than controls in ER and ToM. The ASD group achieved significantly lower performance than the other groups; however, the scores of SLD and epilepsy groups were comparable. The ER performances are related to non-verbal intelligence only in the group with epilepsy.

Conclusion: Children and adolescents with focal epilepsy, SLD, or ASD may present a deficit of varying extent in emotion recognition and ToM, compared with TD peers. These difficulties are more pronounced in individuals with ASD, but impairment worthy of clinical attention also emerges in individuals with SLD and epilepsy.

A Multimodal Comparison of Emotion Categorization Abilities in Children With Developmental Language Disorder

Purpose Current research has demonstrated that behavioral, emotional, and/or social difficulties often accompany developmental language disorder (DLD). It is an open question to what degrees such difficulties arise as consequence of impaired language and communicative skills, or whether they might also be driven by deficits in verbal and nonverbal emotion processing (e.g., the reduced ability to infer and verbalize emotional states from facial expressions). Regarding the existence of nonverbal deficits, previous research has yielded inconsistent findings. This study was aimed at gaining deeper knowledge of the basic aspects of emotion understanding in children with DLD by comparing their performance on nonverbal and verbal emotion categorization tasks to that of typically developing children. Method Two verbal tasks (Lexical Decision and Valence Decision With Emotion Terms) and two nonverbal tasks (Face Decision and Valence Decision With Facial Expressions) were designed to parallel each other as much as possible, and conducted with twenty-six 6- to 10-year-old children diagnosed with DLD. The same number of typically developed children, carefully matched by age and gender, served as a control group. Results The children with DLD showed lower performance in both verbal tasks and exhibited noticeable problems in the nonverbal emotion processing task. In particular, they achieved lower accuracy scores when they categorized faces by their valence (positive or negative), but did not differ in their ability to distinguish these faces from pictures displaying animals. Conclusions This study provides evidence for the hypothesis that problems in emotion processing in children with DLD might be multimodal. Therefore, the results support the idea of mutual influences in the development of language and emotion skills and contribute to the current debate about the domain specificity of DLD (formerly referred to as specific language impairment).