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Reduced Emotional Empathy in Adults with Subclinical ADHD Groen, Y.; Den Heijer, A.E.; Fuermaier, A.B.M.; Althaus, M.; Tucha, O

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Reduced Emotional Empathy in Adults with Subclinical ADHD Groen, Y.; Den Heijer, A.E.; Fuermaier, A.B.M.; Althaus, M.; Tucha, O View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by University of Groningen University of Groningen Reduced emotional empathy in adults with subclinical ADHD Groen, Y.; den Heijer, A.E.; Fuermaier, A.B.M.; Althaus, M.; Tucha, O. Published in: ADHD Attention Deficit and Hyperactivity Disorders DOI: 10.1007/s12402-017-0236-7 IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite from it. Please check the document version below. Document Version Publisher's PDF, also known as Version of record Publication date: 2018 Link to publication in University of Groningen/UMCG research database Citation for published version (APA): Groen, Y., den Heijer, A. E., Fuermaier, A. B. M., Althaus, M., & Tucha, O. (2018). Reduced emotional empathy in adults with subclinical ADHD: Evidence from the empathy and systemizing quotient. ADHD Attention Deficit and Hyperactivity Disorders, 10(2), 141–150. https://doi.org/10.1007/s12402-017-0236-7 Copyright Other than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons). Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons the number of authors shown on this cover page is limited to 10 maximum. Download date: 12-11-2019 ADHD Atten Def Hyp Disord DOI 10.1007/s12402-017-0236-7 ORIGINAL ARTICLE Reduced emotional empathy in adults with subclinical ADHD: evidence from the empathy and systemizing quotient 1 1 1 2 Y. Groen • A. E. den Heijer • A. B. M. Fuermaier • M. Althaus • O. Tucha1 Received: 18 March 2017 / Accepted: 7 August 2017 Ó The Author(s) 2017. This article is an open access publication Abstract Studies in children with ADHD suggest impair- empathy were unrelated. These findings should be cor- ments in social cognitive functions, whereas studies in roborated in clinical patients with ADHD, employing adults with ADHD are scarce and inconclusive. The aim of neuropsychological tests rather than self-report this study was to investigate the relationship between questionnaires. ADHD traits and self-reported social cognitive style in a sample of adults from the general population. For this Keywords ADHD Á Adults Á Social cognition Á Emotional Á purpose, a community sample of 685 adults filled out Empathy online self-report questionnaires about ADHD symptoms (ADHD Rating Scale, ARS), social cognitive functioning and friendships. The Empathy Quotient (EQ) with the Introduction subscales Cognitive Empathy (CE), Emotional Empathy (EE) and Social Skills (SS), and the Systemizing Quotient Attention deficit hyperactivity disorder (ADHD) is not only (SQ) were included for measuring social cognitive style associated with symptoms of inattention, impulsivity, and the Friendship Questionnaire (FQ) for the quality of impaired inhibition and hyperactivity (American Psychi- friendships. Participants who met the DSM-5 criteria on the atric Association, APA 2013) but also associated with a ARS (‘subclinical ADHD’; n = 56) were compared range of (psycho-)social problems across the lifespan regarding their social cognitive functioning scores with a (Asherson et al. 2007; Kooij et al. 2010; Canu and Carlson control group (n = 56) that was matched for age, sex and 2007). Children with ADHD often demonstrate problem- student status. With small effect sizes, the subclinical atic peer functioning, including peer rejection and social ADHD group showed reduced EE scores on the EQ and a isolation (De Boo and Prins 2007; Hinshaw 2002; Hoza more male social cognitive profile. This result was not et al. 2005), that may be a result of inappropriate social influenced by sex or ADHD subtype. This study points to a behavior such as frequently interrupting and not listening relationship between traits of ADHD and the emotional to others carefully (Guevremont and Dumas 1994). Several aspect of empathy, whereas more complex aspects of studies have, however, related the difficulties in social and interpersonal functioning in ADHD to traits of autism spectrum disorders (ASD) (Nijmeijer et al. 2008), a dis- Y. Groen and A. E. den Heijer contributed equally to this work. order that is characterized by specific impairments in & Y. Groen empathy (Baron-Cohen and Wheelwright 2004; Wheel- [email protected] wright et al. 2006). Part of the childhood population of 1 patients with ADHD have been shown to present problems Faculty of Behavioral and Social Sciences, Clinical and in social cognition similar to those in ASD and have been Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands described as ‘autistic-like’ (Matson et al. 2013; Luteijn et al. 2000; Mulligan et al. 2009; Santosh and Mijovic 2 Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The 2004; Buitelaar et al. 1999; Greene et al. 1996). Another Netherlands explanation for social difficulties is the co-occurrence of 123 Y. Groen et al. callous unemotional traits in childhood ADHD. Behavior with social cognitive deficits, this can have substantial of children with ADHD may overlap considerably with consequences for their quality of social functioning and oppositional defiant disorder or conduct disorder, which in quality of life. The present study therefore focuses on the turn aggravates social and emotional impairment (Fowler relation between social cognitive style, quality of friend- et al. 2009; Kahn et al. 2012; Nijmeijer et al. 2008). ships and ADHD symptoms in adults. Social problems of children with ADHD might be While the use of objective neuropsychological measures related to deficits in social cognition that are often reported is valuable for estimating different aspects of social cog- in children with ADHD (Uekermann et al. 2010), which nitive functions, they are time-consuming and many rele- may directly or indirectly stem from executive functions vant aspects of our social life are not accessible via deficits (Bora and Pantelis 2016; Hughes 1998; Geurts objective testing. This is particularly due to the low eco- et al. 2010). Social cognition deficits encompass problems logical validity of neuropsychological measures. Therefore, in perceiving emotions in others, for instance affective self-report questionnaires represent a valuable approach for prosody, facial expression and body posture, which can be the assessment of social cognitive functioning in everyday regarded as affective social cognition deficits (Uekermann life. For instance, the quality of friendships can be mea- et al. 2010; Maoz et al. 2014). Complex social cognition sured by means of the Friendship Questionnaire (FQ), deficits have been reported in children with ADHD as well, measuring the social engagement and the enjoyment and such as problems in the ability to reason about the mental importance of friendships (Baron-Cohen and Wheelwright state of others (theory of mind, ToM). A recently published 2004). From the literature on ASD, particularly the meta-analysis on social cognition in lifespan ADHD Empathy Questionnaire (EQ) (Baron-Cohen and Wheel- reported that adults with ADHD show diminished and less wright 2004) and the Systemizing Questionnaire (SQ) pronounced problems with social cognition than children (Baron-Cohen and Wheelwright 2003) have been described with ADHD (Bora and Pantelis 2016). Especially ToM (an as reliable and valid tools for assessing a person’s social aspect of complex social cognition) appeared to improve cognitive style (see for a review: Groen et al. 2015). Based significantly with age, with no evident ToM deficits in on the empathizing–systemizing theory (Baron-Cohen adulthood compared to childhood. Deficits in facial emo- 2009), the EQ and SQ assess two complementary cognitive tion recognition (an aspect of affective social cognition) on styles that allow people to efficiently process and react to the other hand did not diminish over time (Bora and Pan- complex social or non-social information. A person’s telis 2016). cognitive style can on the one hand be relatively Although ADHD research generally focuses on the empathizing and on the other hand relatively more sys- childhood period, it has become clear that ADHD can be a temizing, which is characterized by a drive to construct lifelong condition, with clinical as well as psychosocial systems, to analyze its variables and to derive its under- impairments continuing into adulthood (Asherson et al. lying rules (Baron-Cohen 2002). Based on numerous 2007; Kooij et al. 2010; Canu and Carlson 2007). Studies studies, it can be stated that on average, females adopt a on adults with ADHD reported friendship problems and more empathizing cognitive style, whereas males adopt a poorer social interactions (Young et al. 2003; Kooij et al. more systemizing cognitive style (see for a review: Groen 2010), loneliness (Philipsen et al. 2009) as well as poorer et al. 2015). A short version of the EQ has also become intimate relationships and marital adjustment (Eakin et al. available, which additionally allows examination of dif- 2004). Furthermore, social deficits in adulthood were ferent aspects of empathy by means of the subscale Emo- associated with mood instability and a lack of job and tional Empathy (EE) and subjectively experienced complex relationship continuity (Kooij et al. 2010). Adults with social cognitive functioning by means of the subscales ADHD also reported experiencing social isolation and a Cognitive Empathy (CE) and Social Skills (SS) (Groen lifetime burden of the disorder (e.g., due to lower educa- et al. 2015; Lawrence et al. 2004). Large sex differences tional achievement), and these accumulative problems in have been demonstrated for EE, but only small sex dif- social, emotional and occupational areas were linked to a ferences for the CE and SS subscales (Groen et al.
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