An assessment of dynamic facial emotion recognition and theory of mind in children with ADHD: An eye-tracking study

Deficits in social cognition in attention deficit hyperactivity disorder (ADHD) have been associated with difficulties in functioning. Since recognizing emotional facial expressions is essential for developing the perceptual components of the theory of mind (ToM), it is important to assess this relationship in children with ADHD. This study therefore compared the recognition of emotional stimuli and gaze patterns between children with ADHD and healthy children using eye-tracking with dynamic facial images. It also examined the relationship between facial emotion recognition accuracy, gaze patterns, ToM scores, and ADHD symptoms. Children with ADHD aged 8-13 (n = 47) and a control group (n = 38) completed a facial emotion recognition test, ToM tests, and the Conners' Parent Rating Scale. Participants' gaze patterns in response to dynamic facial emotion expressions were recorded using eye-tracking technology. Children with ADHD exhibited significantly lower accuracy in the recognition of the facial expressions of disgust and anger. The percentage fixation in the eye region was also significantly lower for happy, angry, sad, disgusted, and neutral emotions in the children with ADHD compared to the control group. No relationship was determined between the percentage of fixations on facial areas of interests and ADHD symptoms or ToM tests. This study provides evidence that children with ADHD experience deficits in visual attention to emotional cues. In addition, it suggests that facial emotion recognition deficits in children with ADHD represent a separate domain of social cognition that develops independently of ToM skills and core symptoms. Understanding and treating the social difficulties of individuals with ADHD may help improve their social functioning.