Attention and the specificity of emotion processing impairments in adolescents with a diagnosis of Attention-Deficit/Hyperactivity Disorder with or without comorbid Conduct Disorder

Impairments in emotion processing have been separately associated with Attention-Deficit/Hyperactivity Disorder (ADHD) and Conduct Disorder (CD). However, due to their common co-occurrence it is unclear if these impairments are general to ADHD or are specific to ADHD with comorbid CD. In addition, the extent to which they are associated with ADHD or CD symptom severity or callous-unemotional (CU) traits is uncertain and the role atypical attentional allocation to facial features plays in these impairments also remains poorly understood. Participants with a diagnosis of ADHD either with or without comorbid CD performed four emotion processing tasks. Participants with ADHD and comorbid CD showed impairments in all emotion processing tasks compared to ADHD alone. They showed specific impairments in both the conscious recognition and automatic processing of fear faces, general impairments across emotion categories in affective (but not cognitive) empathy, and both reduced differential fear conditioning and a faster rate of extinction learning than ADHD alone. Groups did not differ in processing of the eye region of faces during emotion recognition or empathy tasks, suggesting other mechanisms may account for differences in emotion processing. As opposed to CD severity or CU traits, ADHD severity was the only predictor of reduced attention to the eye region. Further, while CD severity was most strongly negatively associated with both the conscious recognition and automatic processing of fear faces, and to affective empathy for happiness, CU traits were strongly associated with the ability to affectively empathise with negative emotions. The findings of the current thesis highlight the importance of assessing emotion processing and clinical heterogeneity in those with ADHD in order to offer appropriate and tailored interventions