A systematic review published in the Journal of Attention Disorders found that facial emotion recognition (FER) among individuals with attention-deficit/hyperactivity disorder (ADHD) improves with age. However, little consensus about trends in the association between FER and ADHD was found.

Investigators from Universidad del Rosario in Columbia searched publication databases in September 2022. A total of 14 studies were included in this review.

The neurodevelopmental condition, ADHD, is characterized by persistent inattention, impulsivity, and hyperactivity. The prevalence rate is approximately 5% among children and adolescents and approximately 2.5% among adults. However, its diagnosis can be challenging as many ADHD symptoms overlap with other comorbid conditions.

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For example, patients with ADHD have emotional regulation deficits which often manifest as FER. However, FER is also associated with borderline personality disorder, autism spectrum disorders, Parkinson disease, and schizophrenia.

The aim of this review was to examine the trends of FER in ADHD. The researchers found that some patients with ADHD had intrinsic deficits which were identified when these patients performed FER tasks. When examining the FER tasks performed by patients with ADHD, some researchers found that patients with ADHD had emotional recognition deficits, while other studies classified abnormal FER as a secondary deficit of ADHD. Conversely, some studies found no evidence of FER in patients with ADHD.       

In studies where researchers classified FER as a primary deficit in ADHD, 8 studies reported this relationship among children and adolescents with confirmed ADHD and 1 study among those with subthreshold ADHD. In another study, researchers found that this relationship was robust when controlling for disruptive behaviors, while a different study found it to be robust when controlling for oppositional defiant disorder. In additional studies, researchers reported no correlation with intellectual quotient score, impulsive or inattentive behavior, attention-related variables, or hyperactivity. Higher FER task accuracy was associated with fewer challenges with peer interactions (P <.001) or emotional problems (P =.012).

In studies where researchers found FER was a secondary deficit in ADHD, they reported that among children and adolescents, FER accuracy was related to inattention (P <.001) or hyperactivity (P <.001). Oppositional behavior scores were also associated with FER accuracy in sad (P <.01) and surprised (P <.01) face recognition. In one study researchers reported that among adolescents, deficits in the recognition of fearful or neutral faces were related to conduct disorder symptoms, whereas among children, recognition was related to anxiety.

In a total of 5 studies, researchers found no differences in FER among patients with ADHD and controls. However, 3 studies noted that children with ADHD had slower responses than controls.

There were few studies of FER among adults (n=3), and in general, these studies showed slower response times but controls were more accurate.

The authors noted several limitations, such as the small number of studies that include adults and the lack of a standard FER evaluation technique.

Despite the conflicting evidence of FER deficits in patients with ADHD, the review authors concluded that “There is evidence for a FER deficit in children and adults with ADHD, as indicated by prolonged response latencies of emotion recognition. [… A]dults with ADHD showed improved recognition accuracy compared to children with ADHD, reflecting partial compensation of the deficit.”


Olaya-Galindo MD, Vargas-Cifentes OA, Van-Meerbeke AV, Talero-Gutiérrez C. Establishing the relationship between attention deficit hyperactivity disorder and emotional facial expression recognition deficit: a systematic reviewJ Atten Disord. 2023;10870547231154901. doi:10.1177/10870547231154901

This article originally appeared on Psychiatry Advisor