October 4, 2024

Meta-analysis Finds Vocal Emotion Recognition Accuracy is Significantly Lower in ADHD

Meta-analysis finds vocal emotion recognition accuracy is significantly lower in ADHD

Emotion dysregulation (ED) refers to the difficulty someone has in managing their emotions. People with ED might experience strong reactions like anger, irritability, emotional outbursts, or even excessive happiness. This issue affects 25% to 45% of children with ADHD and 30% to 70% of adults with ADHD. ED may come from challenges in recognizing emotions—like anger, sadness, fear, or happiness—based on facial expressions or tone of voice. People with ADHD struggle to control their emotions in a similar way that they have trouble controlling their attention and behavior.

Emotion Recognition in ADHD

One way researchers study ED in people with ADHD is by testing how well they recognize emotions. In these studies, participants are shown faces or hear voices expressing different emotions, and they are asked to identify which emotion is being shown. This helps measure how accurately people with ADHD recognize emotions compared to people without ADHD (referred to as typically developing, or TD, individuals).

Research Findings

A group of psychologists from the UK reviewed many studies that compared how well people with ADHD and TD individuals performed on emotion recognition tasks. They focused on studies that looked specifically at how well participants could recognize emotions through vocal expressions (such as changes in tone of voice).

They combined the results of 20 different studies, which together included 1,651 participants, and found that people with ADHD had more difficulty recognizing emotions than those without ADHD. The overall difference between the two groups was moderate, meaning the ADHD group consistently had more trouble, but the differences weren’t extreme. Only two of the 20 studies showed slightly different results, and there was no sign that the studies were biased. Whether or not participants were taking medication for ADHD didn’t change the outcomes.

Recognizing Positive and Negative Emotions

The study found that people with ADHD had more trouble recognizing both positive and negative emotions compared to the TD group:

  • Anger and sadness: People with ADHD showed a moderate level of difficulty in recognizing these emotions.
  • Happiness: There was a small-to-moderate level of difficulty in recognizing happiness.
  • Overall: There was no clear pattern showing that ADHD participants struggled more with certain types of emotions; instead, their errors seemed random. This suggests that their difficulties in recognizing emotions may be linked to their general attention problems.
Age Differences

The study found that emotion recognition difficulties were more pronounced in children with ADHD than in adults. Among children, the deficit was large, while among adults, the difference was moderate.

Conclusion

The psychologists concluded that their analysis provides strong evidence that people with ADHD struggle with recognizing emotions, particularly through vocal expressions. They also found that these difficulties aren’t specific to certain emotions (like only anger or sadness), but rather seem to affect emotion recognition in general. This supports the idea that ED in ADHD is partly due to the same attention problems that make it difficult for people with ADHD to focus or control their behavior. The findings highlight that emotion dysregulation in ADHD may be a secondary problem caused by these underlying attention issues.

Rohanna C. Sells, Simon P. Liversedge, and Georgia Chronaki, “Vocal emotion recognition in attention-deficit hyperactivity disorder: a meta-analysis,” Cognition and Emotion (2023), https://doi.org/10.1080/02699931.2023.2258590.

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Swedish nationwide population study identifies top predictors of ADHD diagnoses among preschoolers

Most preschool-aged children diagnosed with ADHD also exhibit comorbid mental or developmental conditions. Long-term studies following these children into adulthood have demonstrated that higher severity of ADHD symptoms in early childhood is associated with a more persistent course of ADHD. 

The Study: 

Sweden has a single-payer national health insurance system that covers virtually all residents, facilitating nationwide population studies. An international study team (US, Brazil, Sweden) searched national registers for predictors of ADHD diagnoses among all 631,695 surviving and non-emigrating preschoolers born from 2001 through 2007.  

Preschool ADHD was defined by diagnosis or prescription of ADHD medications issued to toddlers aged three through five years old.  

Predictors were conditions diagnosed prior to the ADHD diagnosis. 

A total of 1,686 (2.7%) preschoolers were diagnosed with ADHD, with the mean age at diagnosis being 4.6 years. 

The Numbers:

Adjusting for sex and birth year, the team reported the following predictors, in order of magnitude: 

  • Previous diagnosis of autism spectrum disorder increased subsequent likelihood of ADHD diagnosis twentyfold. 
  • Previous diagnosis of intellectual disability increased subsequent likelihood of ADHD diagnosis fifteenfold. 
  • Previous diagnosis of speech/language developmental disorders and learning disorders, as well as motor and tic disorders, increased subsequent likelihood of ADHD diagnosis thirteen-fold. 
  • Previous diagnosis of sleep disorders increased subsequent likelihood of ADHD diagnosis fivefold. 
  • Previous diagnosis of feeding and eating disorders increased subsequent likelihood of ADHD diagnosis almost fourfold. 
  • Previous diagnosis of gastroesophageal reflux disease (GERD) increased subsequent likelihood of ADHD diagnosis 3.5-fold. 
  • Previous diagnosis of asthma increased subsequent likelihood of ADHD diagnosis 2.4-fold. 
  • Previous diagnosis of allergic rhinitis increased subsequent likelihood of ADHD diagnosis by 70%. 
  • Previous diagnosis of atopic dermatitis or unintentional injuries increased subsequent likelihood of ADHD diagnosis by 50%. 

The Conclusion: 

This large population study underscores that many conditions present in early childhood can help predict an ADHD diagnosis in preschoolers. Recognizing these risk factors early may aid in identifying and addressing ADHD sooner, hopefully improving outcomes for children as they grow

July 2, 2025

Northern Finnish Population Study Finds ADHD Slashes Higher Education Attainment, Comorbidity of ADHD + ODD much worse

Background:

Although ADHD typically begins in childhood, its symptoms frequently continue into adulthood, and it is widely acknowledged as having a lifelong prevalence for most persons with ADHD. 

ADHD symptoms are linked to poor academic performance, mainly due to cognitive issues like compromised working memory. These symptoms lead to long-term negative academic outcomes and difficulty in achieving higher educational degrees. 

Oppositional Defiant Disorder (ODD) often co-occurs with ADHD. In community samples, it appears in about 50–60% of those with ADHD. ODD symptoms include an angry or irritable mood, vindictiveness toward others, and argumentative or defiant behavior that lasts more than 6 months and significantly disrupts daily life.  

Since ODD tends to co-occur with ADHD, research on pure ODD groups without ADHD is limited, especially in community samples. This longitudinal study aimed to examine the impact of ADHD and ODD symptoms in adolescence on academic performance at age 16 and educational attainment by age 32. 

Study:

Finland, like other Nordic countries, has a single-payer health insurance system that includes virtually all residents. A Finnish research team used the Northern Finnish Birth Cohort to include all 9,432 children born from July 1, 1985, through June 30, 1986, and followed since then. 

ADHD symptoms were measured at age 16 using the Strengths and Weaknesses of ADHD symptoms and Normal-behaviors (SWAN) scale. 

Symptoms of ODD were screened using a 7-point rating scale similar to the SWAN scale, based on eight DSM-IV-TR criteria: “Control temper”, “Avoid arguing with adults”, “Follow adult requests or rules”, “Avoid deliberately annoying others”, “Assume responsibility for mistakes or misbehaviour”, “Ignore annoyances from others”, “Control anger and resentment”, and “Control spitefulness and vindictiveness.” 

Higher education attainments were determined at age 32. 

Results:

After adjusting for the educational attainments of the parents of the subjects, family type, and psychiatric disorders other than ADHD or ODD, males with ADHD symptoms at age 16 had a quarter, and females a little over a third, of the higher education attainments of peers without ADHD symptoms at age 32.  

With the same adjustments, males with ODD symptoms alone had two-thirds, and females 80%, of the higher education attainments of peers without ODD, but neither outcome was statistically significant. 

However, all participants with combined ADHD and ODD symptoms at age 16 had roughly one-fifth of the higher education attainments of peers without such symptoms upon reaching age 32. 

Interpretation: 

The team concluded, “The findings that emerged from this large longitudinal birth cohort study showed that the co-occurrence of ODD and ADHD symptoms in adolescence predicted the greatest deficits of all in educational attainment in adulthood.” 

This study highlights the significant, long-lasting impact that co-occurring ADHD and ODD symptoms can have on educational outcomes well into adulthood. It underscores the importance of addressing both disorders together during adolescence to help improve future academic success.

July 1, 2025

U.S. Nationwide Study Finds Down Syndrome Associated with 70% Greater Odds of ADHD

The Background:

Down syndrome (DS) is a genetic disorder resulting from an extra copy of chromosome 21. It is associated with intellectual disability. 

Three to five thousand children are born with Down syndrome each year. They have higher risks for conditions like hypothyroidism, sleep apnea, epilepsy, sensory issues, infections, and autoimmune diseases. Research on ADHD in patients with Down syndrome has been inconclusive. 

The Study:

The National Health Interview Survey (NHIS) is a household survey conducted by the National Center for Health Statistics at the CDC. 

Due to the low prevalence of Down syndrome, a Chinese research team used NHIS records from 1997 to 2018 to analyze data from 214,300 children aged 3 to 17, to obtain a sufficiently large and nationally representative sample to investigate any potential association with ADHD. 

DS and ADHD were identified by asking, “Has a doctor or health professional ever diagnosed your child with Down syndrome, Attention Deficit Hyperactivity Disorder (ADHD), or Attention Deficit Disorder (ADD)?” 

After adjusting for age, sex, and race/ethnicity, plus family highest education level, family income-to-poverty ratio, and geographic region, children and adolescents with Down syndrome had 70% greater odds of also having ADHD than children and adolescents without Down syndrome. There were no significant differences between males and females. 

The Take-Away:

The team concluded, “in a nationwide population-based study of U.S. children, we found that a Down syndrome diagnosis was associated with a higher prevalence of ASD and ADHD. Our findings highlight the necessity of conducting early and routine screenings for ASD and ADHD in children with Down syndrome within clinical settings to improve the effectiveness of interventions.” 

June 27, 2025