European Child & Adolescent Psychiatry

, Volume 17, Issue 2, pp 63–72 | Cite as

Do hyperactivity, impulsivity and inattention have an impact on the ability of facial affect recognition in children with autism and ADHD?

  • Judith SinzigEmail author
  • Dagmar Morsch
  • Gerd Lehmkuhl


Psychopathological, genetic and neuropsychological findings indicate an association between autism and attention deficit/hyperactivity disorder (ADHD). The goal of this study was to assess possible differences in facial affect recognition in children with autism (with and without comorbid ADHD), with ADHD and healthy controls. Children aged 6–18 years old with DSM-IV-diagnosis ADHD (n = 30) or autism (n = 40) were included consecutively in the study. Facial affect recognition was assessed with a computer-based program used for teaching emotion processing called the Frankfurt Test and Training of Social Affect (FEFA) using faces and eye-pairs as target material. Additionally three attention-tasks (Sustained attention, Inhibition, Set-Shifting) were administered. Approximately 52% of the autistic children met the criteria for the comorbid diagnosis of ADHD. A MANOVA with post-hoc Scheffé tests revealed a significant difference in the recognition of faces and eye pairs between the group ADHD and controls (P = 0.009). Children with autism and ADHD also differed significantly from healthy participants in the recognition of eye-pairs (P = 0.009). Neither correlations with PDD nor with ADHD symptom scores were able to explain these results. Sustained attention and inhibition deficits had a significant influence on emotion recognition in children with ADHD. Our findings imply that the ability of facial affect recognition is reduced in children suffering from ADHD symptoms, both in autistic and pure ADHD children. ADHD symptoms need to be taken into account in future studies assessing emotion recognition in autistic children and adolescents.

Key words

ADHD autism emotion recognition facial affect recognition 


  1. 1.
    American Academy of Child & Adolescent Psychiatry (1999) Practice Parameters for The Assessment And Treatment Of Children, Adolescents, And Adults With Autism And Other Pervasive Developmental DisordersGoogle Scholar
  2. 2.
    American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, text revision (DSM-IV-TR), 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  3. 3.
    Bailey A, Philips W, Rutter M (1996) Autism: towards an integration of clinical, genetic, neuropsychological and neurobehavioral perspectives. J Child Psychol Psychiat 37:89–126PubMedCrossRefGoogle Scholar
  4. 4.
    Bakker SC, van der Meulen EM, Buitelaar JK, Sandkuijl LA, Pauls DL, Monsuur AJ, van’t Slot R, Minderaa RB, Gunning WB, Pearson PL, Sinke RJ (2003) A whole-genome scan in 164 Dutch sib pairs with attention-deficit/hyperactivity disorder: suggestive evidence for linkage on chromosomes 7p and 15q. Am J Human Gen 72:1251–1260CrossRefGoogle Scholar
  5. 5.
    Baron-Cohen S, Leslie AM, Frith U (1985) Does the autistic child have a “theory of mind”? Cognition 21:37–46PubMedCrossRefGoogle Scholar
  6. 6.
    Baron-Cohen S, Tager-Flusberg H, Cohen DJ (2000) Understanding other minds. Oxford University Press, OxfordGoogle Scholar
  7. 7.
    Boelte S, Feineis-Matthews S, Leber S, Dierks T, Hubl D, Poustka F (2002) The development and evaluation of a computer-based program to test and to teach the recognition of facial affect. Int J Circumpolar Health 61(Suppl. 2):61–68Google Scholar
  8. 8.
    Boelte S, Hubl D, Feineis-Matthews S, Prvulovic D, Dierks T, Poustka F (2006) Facial affect recognition training in autism: can we animate the fusiform gyrus? Behav Neurosci 120:211–216CrossRefGoogle Scholar
  9. 9.
    Boelte S, Poustka F (2001) Die Faktorenstruktur des Autismus Diagnostischen Interviews-Revision (ADI-R). Eine Untersuchung zur dimensionalen versus kategorialen Klassifikation autistischer Störungen. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 29:221–229CrossRefGoogle Scholar
  10. 10.
    Boelte S, Poustka F (2003) The recognition of facial affect in autistic and schizophrenic subjects and their first-degree relative. Psycholog Med 33:907–915CrossRefGoogle Scholar
  11. 11.
    Buitelaar JK, van der Wees M, Swaab-Barnevield H, van der Gaag RJ (1999) Theory of Mind and emotion-recognition in autistic spectrum disorders and in psychiatric control and normal children. Dev Psychopathol 11:39–58PubMedCrossRefGoogle Scholar
  12. 12.
    Cadesky EB, Mota VL, Schachar RJ (2000) Beyond words: how do children with ADHD and/or conduct problems process nonverbal information about affect? Am Acad Child Adolescent Psychiat 39:1160–1167CrossRefGoogle Scholar
  13. 13.
    Castelli F (2005) Understanding emotions from standardized facial expressions in autism and normal development. Autism 9:428–449PubMedCrossRefGoogle Scholar
  14. 14.
    Chugani DC (2000) Autism. In: Ernst M, Rumsey JM (eds) Functional neuroimaging in child psychiatry, 2nd edn. University Press, Cambridge, pp 171–188Google Scholar
  15. 15.
    Corbett B, Glidden H (2000) Processing affective stimuli in children with attention-deficit/hyperactivity disorder. Neuropsychol Dev Cognitive Child Neuropsychol 6:144–155CrossRefGoogle Scholar
  16. 16.
    Courchesne C, Yeung-Courchesne R, Press GA, Hesselink JR, Jernigan TL (1988) Hypoplasia of cerebellar vermal lobules VI and VII in autism. New Engl J Med 318:1349–1354PubMedCrossRefGoogle Scholar
  17. 17.
    Dalton KM, Naceeicz BM, Johnstone T, Schaefer H, Gernsbacher MA, Goldsmith HH, Alexander AL, Davidson RJ (2005) Gaze fixation and the neural circuitry of face processing in autism. Nat Neurosci 8:519–526PubMedGoogle Scholar
  18. 18.
    Davies S, Bishop D, Manstead A, Tantam D (1994) Face perception in children with autism and Asperger syndrome. J Child Psychol Psychiat 35:1033–1057PubMedCrossRefGoogle Scholar
  19. 19.
    Doepfner M, Lehmkuhl G (2000) Diagnostik-System für Psychische Störungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV (DISYPS-KJ), 2nd edn. Bern, HuberGoogle Scholar
  20. 20.
    Downs A, Smith T (2004) Emotional understanding, cooperation, and social behaviour in high-functioning children with autism. J Autism Dev Disorders 34:625–635CrossRefGoogle Scholar
  21. 21.
    Durston S, Hulshoff Pol HE, Schnack HG, Buitelaar JK, Steenhuis MP, Minderaa RB, Kahn RS, van Engeland H (2004) Magnetic resonance imaging of boys with attention-deficit/hyperactivity disorder and their unaffected siblings. J Am Acad Child Adolescent Psychiat 43:332–340CrossRefGoogle Scholar
  22. 22.
    Dyck MJ, Ferguson K, Shochet IM (2001) Do autism spectrum disorders differ from each other and from non-spectrum disorders on emotion recognition tests? Eur Child Adolescent Psychiat 10:105–116CrossRefGoogle Scholar
  23. 23.
    Ekman P, Friesen WU, Ellsworth P (1972) Emotion in the human face. Pergamon, New YorkGoogle Scholar
  24. 24.
    Eliez S, Reiss A (2000) MRI Neuroimaging of childhood Psychiatric Disorders: a selective review. J Child Psychol Psychiat 41:679–694PubMedCrossRefGoogle Scholar
  25. 25.
    Faraone SV, Biedermann J (1998) Neurobiology of attention-deficit hyperactivity disorder. Biol Psychiat 44:951–958PubMedCrossRefGoogle Scholar
  26. 26.
    Filipek PA, Accardo PJ, Baranek GT, Cook EH Jr., Dawson G, Gordon B, Gravel JS, Johnson CP, Kallen RJ, Levy SE, Minshew N, Prizant BM, Rapin I, Rogers SJ, Stone WL, Teplin S, Tuchmann RF, Volkmar FR (1999) The screening and diagnosis of autistic spectrum disorders. J Autism Dev Disorders 29:439–484CrossRefGoogle Scholar
  27. 27.
    Fisher SE, Francks C, McCracken JT, McCough JJ, Marlow AJ, MacPhie IL, Newbury DF, Crawford LR, Palmer CG, Woodward JA, Del’Homme M, Cantwell DP, Nelson SF, Monaco AP, Smalley SL (2002) A genomwide scan for loci involved in attention-deficit/hyperactivity disorder. Am J Human Gen 70:1183–1196CrossRefGoogle Scholar
  28. 28.
    Frith U (1989) A new look at language and communication in autism. Brit J Autism Commun 24:123–150CrossRefGoogle Scholar
  29. 29.
    Geurts H, Verte S, Oosterlaan J, Roeyers H, Sergeant J (2004) How specific are executive functioning deficits in attention deficit hyperactivity disorder and autism? J child Psychol Psychiat 45:836–854PubMedCrossRefGoogle Scholar
  30. 30.
    Gillberg C (1989) Asperger-syndrome in 23 Swedish children. Dev Med Child Neurol 31:520–531PubMedCrossRefGoogle Scholar
  31. 31.
    Goldstein S, Schwebach AJ (2004) The comorbidity of pervasive developmental disorder and attention deficit hyperactivity disorder: results of a retrospective chart review. J Autism Dev Disorders 34:329–339CrossRefGoogle Scholar
  32. 32.
    Gross TF (2004) The perception of four basic emotions in human and nonhuman faces by children with autism and other developmental disabilities. J Abnormal Child Psychol 32:469–480CrossRefGoogle Scholar
  33. 33.
    Hale TS, Hariri AR, McCracken JT (2000) ADHD: Perspectives from neuro-imaging. Ment Retard Dev Disabilit Res Rev 6:214–219CrossRefGoogle Scholar
  34. 34.
    Harris NS, Courchesne E, Townsend J, Caper RA, Lord C (1999) Neuroanatomic contributions to slowed orienting of attention in children with autism. Cognitive Brain Res 8:61–71CrossRefGoogle Scholar
  35. 35.
    Hebebrand J, Dempfle A, Saar K, Thiele H, Herpertz-Dahlmann B, Linder M, Kiefl H, Remschmidt H, Hemminger U, Warnke A, Knolker U, Heiser P, Friedel S, Hinney A, Schafer H, Nurnberg P, Konrad K (2005) A genome-wide scan for attention-deficit/hyperactivity disorder in 155 German sib-pairs. Mol Psychiat 11:196–205CrossRefGoogle Scholar
  36. 36.
    Hynd GW, Her KL, Novey ES, Eliopulos D, Marshall R, Gonzales JJ,Voeller KK (1993) ADHD and asymmetry of the caudate nucleus. J Child Neurol 8:339–347PubMedGoogle Scholar
  37. 37.
    Hynd GW, Semrud-Clikeman M, Lorys AR, Novey ES, Eliopulos D, Lyytinen H (1991) Corpus callosum morphology in ADHD: morphometric analysis of MRI. J Learn Disabilit 24:141–146Google Scholar
  38. 38.
    Kaufman J, Birmaher B, Brent DA, Ryan ND, Rao U (2000) K-SADS-PL. J Am Acad Child Adolescent Psychiat 39:1208CrossRefGoogle Scholar
  39. 39.
    Klin A (2000) Attributing social meaning to ambiguous visual stimuli in higher-functioning autism and Asperger Syndrome: the Social Attribution Task. J Child Psychol Psychiat 41:831–846PubMedCrossRefGoogle Scholar
  40. 40.
    Klorman R (1991) Cognitive event-related potentials in attention deficit disorder. J Learn Disabilit 24:130–40CrossRefGoogle Scholar
  41. 41.
    Nyden A, Gillberg C, Hjelmquist E, Heiman M (1999) Executive function/attention deficits in boys with Asperger syndrome, attention disorder and reading/writing disorder. Autism 3:213–228CrossRefGoogle Scholar
  42. 42.
    Ornitz EM, Hanna G, de Traversay J (1992) Presimulation-induced startle modulation in attention-deficit disorder and nocturnal enuresis. Psychophysiology 29:437–451PubMedCrossRefGoogle Scholar
  43. 43.
    Ozonoff S, Cook I, Coon H, Dawson G, Joseph RM, Klin A, McMahon WM, Minshew N, Munson JA, Pennington BF, Rogers SJ, Spence MA, Tager-Flusberg H, Volkmar FR, Wrathall D (2004) Performance on cambridge neuropsychological test automated battery subtests sensitive to frontal lobe function in people with autistic disorder: evidence from the Collaborative Programs of Excellence in Autism network. J Autism Dev Disorders 34:139–150CrossRefGoogle Scholar
  44. 44.
    Ozonoff S, Jensen J (1999) Brief report: specific executive function profiles in three neurodevelopmental disorders. J Autism Dev Disorders 29:171–177CrossRefGoogle Scholar
  45. 45.
    Pelphrey KA, Sasson NJ, Reznick JS, Paul G, Goldman BD, Piven J (2002) Visual scanning of faces in autism. J Autism Dev Disorders 32:249–261CrossRefGoogle Scholar
  46. 46.
    Piven J, Bailey J, Ranson BJ, Arndt S (1997) An MRI-study of the corpus callosum in autism. Am J Psychiat 154:1051–1056PubMedGoogle Scholar
  47. 47.
    Premack D, Woodruff G (1978) Does the chimpanzee have a theory of mind? Behav Brain Sci 1:515–526CrossRefGoogle Scholar
  48. 48.
    Rapport LJ, Friedman SR, Tzelepis A, Van Voorhis A (2002) Experienced emotion and affect recognition in adult attention-deficit/hyperactivity disorder. Neuropsychology 16:102–110PubMedCrossRefGoogle Scholar
  49. 49.
    Ruehl D, Boelte S, Feineis-Matthews S, Poustka F (2004) Diagnostische Beobachtungsskala für Autistische Störungen. Bern, HuberGoogle Scholar
  50. 50.
    Santosh PJ (2002) Neuroimaging in child and adolescent psychiatric disorders. Arch Disease Childhood 82:412–419CrossRefGoogle Scholar
  51. 51.
    Singh SD, Ellis CR, Winton AS, Singh NN, Leung JP, Oswald DP (1998) Recognition of facial expressions of emotion by children with attention-deficit/hyperactivity disorder. Behav Modificat 22:128–142CrossRefGoogle Scholar
  52. 52.
    Sinzig J, Lehmkuhl G (2007) Autism and ADHD- are there common traits. Fortschritte der Neurologie und Psychiatrie 75:267–274Google Scholar
  53. 53.
    Smalley SL, Kustanovich V, Minassian SL, Stone JL, Ogdie MN, McCough JJ, McCracken JT, MacPhie IL, Francks C, Fisher SE, Cantor RM, Monaco AP, Nelson SF (2002) Genetic linkage of attention-deficit/hyperactivity disorder on chromosome 16p13, in a region implicated in autism. Am J Human Gen 71:959–963CrossRefGoogle Scholar
  54. 54.
    Spence SJ (2004) The genetics of autism. Seminares Pediatric Neurol 11:196–204CrossRefGoogle Scholar
  55. 55.
    Sugawara M, Sadeghpour M, De Traversay J, Ornitz E (1994) Presimulation induced modulation of the p300 component of event related potentials accompanying startle in children. Electroencephalogr Clin Neurophysiol 26:201–223Google Scholar
  56. 56.
    Zimmermann P, Fimm B (1993) Testbatterie zur Aufmerksamkeitsprüfung (TAP), Version 1.0, PsytestGoogle Scholar

Copyright information

© Steinkopff Verlag 2007

Authors and Affiliations

  1. 1.Dept. of Child and Adolescent Psychiatry and PsychotherapyUniversity of CologneKölnGermany

Personalised recommendations