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      Impaired empathy but no theory of mind deficits in adult attention deficit hyperactivity disorder

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          The cognitive capacity to change perspective is referred to as theory of mind (ToM). ToM deficits are detectable in a variety of psychiatric and neurological disorders. Since executive abilities are closely associated with ToM skills, we suspected that due to a common neuropsychological basis, ToM deficits exist in treatment‐naïve adults with attention‐deficit/hyperactivity disorder (ADHD).


          Performance of treatment‐naïve adults with ADHD ( N = 30) in tasks assessing executive functions (Trail Making Test, Stroop color–word test, and Test Battery for Attentional Performance), empathy skills (Cambridge Behaviour Scale), and ToM (Movie for Assessment of Social Cognition) was compared with that of a healthy control group ( N = 30) matched according to basic demographic variables.


          Compared to healthy controls, treatment‐naïve adults with ADHD showed deficits in various executive functions and the ability to empathize (all p < .05). However, no performance differences were found with regard to ToM (all n.s.).


          Since studies in juveniles with ADHD often show impaired ToM performance, it is conceivable that ToM deficits may become attenuated due to neuronal development in adolescence. Furthermore, our findings imply that ToM impairments, even when present in adult ADHD, appear to be independent of executive deficits and might be explained by comorbid disorders.


          This study explored the extent to which social interaction problems of treatment‐naïve adults with ADHD can be attributed to deficits in theory of mind using established neuropsychological tests. The results revealed that adults with ADHD showed impairment in various executive functions and the ability to empathize but no theory of mind deficits. Our findings imply that ToM impairments, even when present in adult ADHD, appear to be independent of executive deficits and might be explained by comorbid disorders.

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          Most cited references 26

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          Storage and executive processes in the frontal lobes.

          The human frontal cortex helps mediate working memory, a system that is used for temporary storage and manipulation of information and that is involved in many higher cognitive functions. Working memory includes two components: short-term storage (on the order of seconds) and executive processes that operate on the contents of storage. Recently, these two components have been investigated in functional neuroimaging studies. Studies of storage indicate that different frontal regions are activated for different kinds of information: storage for verbal materials activates Broca's area and left-hemisphere supplementary and premotor areas; storage of spatial information activates the right-hemisphere premotor cortex; and storage of object information activates other areas of the prefrontal cortex. Two of the fundamental executive processes are selective attention and task management. Both processes activate the anterior cingulate and dorsolateral prefrontal cortex.
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            Attention-deficit/hyperactivity disorder and social dysfunctioning.

            Attention-deficit/hyperactivity disorder (ADHD) is associated with functional impairments in different areas of daily life. One such area is social functioning. The purpose of this paper is to critically review research on social dysfunctioning in children with ADHD. Children with ADHD often have conflicts with adults and peers, and suffer from unpopularity, rejection by peers, and a lack of friendships, in part as a consequence of their ADHD symptoms. Comorbid oppositional defiant or conduct disorder aggravates these impairments. In some cases the inadequate social behavior of children with ADHD may be phenomenologically and etiologically related to pervasive developmental disorders (PDD). However, the causes and consequences of PDD symptoms in ADHD are understudied. Also, the relative contributions of ADHD, on the one hand, and comorbid disorders, on the other, to the course of social impairments are unknown. Social dysfunctioning in children with ADHD appears to increase their risk of later psychopathology other than ADHD. Thus far effective treatment for social dysfunctioning is lacking. Future research should address the exact nature and long-term consequences of social dysfunctioning in children with ADHD, and focus on development of effective treatment strategies.
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              Social cognition in attention-deficit hyperactivity disorder (ADHD).

              Attention-deficit hyperactivity disorder (ADHD) is associated with a range of cognitive deficits and social cognition impairments, which might be interpreted in the context of fronto-striatal dysfunction. So far only few studies have addressed the issue of social cognition deficits in ADHD. Medline and Psyclit searches were performed for a 30-year period (1979-2009) using the words 'ADHD' and 'social cognition', 'theory of mind', 'prosody', 'face perception', 'humour' or 'social information processing'. Inclusion criteria consisted of a diagnosis according to DSM as well as the inclusion of a control group or a follow-up assessment following the treatment with methylphenidate. ADHD is clearly associated with social cognition impairments involving emotional face and prosody perception. Although the database is sparse so far, there is some evidence for theory of mind deficits and reduced empathy in ADHD. In summary, the social cognition impairments are consistent with fronto-striatal dysfunction in ADHD, but other functional networks of brain areas also appear to be implicated. Copyright 2009 Elsevier Ltd. All rights reserved.

                Author and article information

                Brain Behav
                Brain Behav
                Brain and Behavior
                John Wiley and Sons Inc. (Hoboken )
                02 September 2019
                October 2019
                : 9
                : 10 ( doiID: 10.1002/brb3.v9.10 )
                [ 1 ] Department of Psychiatry and Psychotherapy University Medical Center Göttingen (UMG) Göttingen Germany
                [ 2 ] LVR Hospital Essen Department of Psychiatry and Psychotherapy Faculty of Medicine University of Duisburg‐Essen Essen Germany
                [ 3 ] Institute of Diagnostic and Interventional Radiology and Neuroradiology University Hospital Essen Essen Germany
                [ 4 ] Department of Neurology Alfried Krupp von Bohlen and Halbach Hospital Essen Germany
                [ 5 ] Department of Neurology Heinrich Heine University Düsseldorf Düsseldorf Germany
                [ 6 ] Berlin School of Mind and Brain Humboldt University Berlin Germany
                [ 7 ] Department of Psychiatry, Psychotherapy and Psychosomatics St. Elisabeth-Hospital Niederwenigern, Contilia Group Hattingen Germany
                Author notes
                [* ] Correspondence

                Bernhard Kis, Department of Psychiatry, Psychotherapy and Psychosomatics, St. Elisabeth-Hospital Niederwenigern, Contilia Group, Essener Str. 31, D-45529 Hattingen, Germany.

                Email: b.kis@ 123456contilia.de

                © 2019 The Authors. Brain and Behavior published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 0, Tables: 3, Pages: 8, Words: 6228
                Original Research
                Original Research
                Custom metadata
                October 2019
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.7.0 mode:remove_FC converted:13.10.2019


                adult adhd, comorbidity, empathy, executive functions, theory of mind


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