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This article was downloaded by: [Memorial University of Newfoundland] On: 06 September 2013, At: 12:28 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ncny20 Processing Affective Stimuli in Children with Attention-Deficit Hyperactivity Disorder Blythe Corbett & Howard Glidden Published online: 09 Aug 2010. To cite this article: Blythe Corbett & Howard Glidden (2000) Processing Affective Stimuli in Children with Attention- Deficit Hyperactivity Disorder, Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 6:2, 144-155 To link to this article: http://dx.doi.org/10.1076/chin.6.2.144.7056 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions

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Page 1: Processing Affective Stimuli in Children with Attention-Deficit Hyperactivity Disorder

This article was downloaded by: [Memorial University of Newfoundland]On: 06 September 2013, At: 12:28Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registered office: MortimerHouse, 37-41 Mortimer Street, London W1T 3JH, UK

Child Neuropsychology: A Journal on Normaland Abnormal Development in Childhood andAdolescencePublication details, including instructions for authors and subscription information:http://www.tandfonline.com/loi/ncny20

Processing Affective Stimuli in Children withAttention-Deficit Hyperactivity DisorderBlythe Corbett & Howard GliddenPublished online: 09 Aug 2010.

To cite this article: Blythe Corbett & Howard Glidden (2000) Processing Affective Stimuli in Children with Attention-Deficit Hyperactivity Disorder, Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood andAdolescence, 6:2, 144-155

To link to this article: http://dx.doi.org/10.1076/chin.6.2.144.7056

PLEASE SCROLL DOWN FOR ARTICLE

Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) containedin the publications on our platform. However, Taylor & Francis, our agents, and our licensors make norepresentations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose ofthe Content. Any opinions and views expressed in this publication are the opinions and views of the authors,and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be reliedupon and should be independently verified with primary sources of information. Taylor and Francis shallnot be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and otherliabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to orarising out of the use of the Content.

This article may be used for research, teaching, and private study purposes. Any substantial or systematicreproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in anyform to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions

Page 2: Processing Affective Stimuli in Children with Attention-Deficit Hyperactivity Disorder

* This work was supported in part by a grant from Valley Children’s Hospital, University of California, SanFrancisco.Address correspondence to: Blythe Corbett, University of Minnesota, Division of Pediatric Neurology, MayoMail Code 486, 420 Delaware S.E., Minneapolis, MN 55455, USA. E-mail: [email protected] for publication: August 7, 2000.

Child Neuropsychology 0929-7049/00/0602-144$15.002000, Vol. 6, No. 2, pp. 144-155 © Swets & Zeitlinger

Processing Affective Stimuli in Children withAttention-Deficit Hyperactivity Disorder*

Blythe Corbett1 and Howard Glidden2

1Division of Pediatric Neurology, University of Minnesota, Minneapolis, and 2Valley Children’s Hospital,University of California, San Francisco, USA

ABSTRACT

Neuropsychological investigations have suggested a contribution of right hemisphere dysfunction in atten-tion-deficit hyperactivity disorder (ADHD). Right hemisphere dysfunction has been implicated in deficitsof attention, motor impersistence, and processing emotion-laden stimuli. The current study investigated theability of ADHD children to perceive emotional stimuli in the form of facial expressions and speech into-nation. The subjects consisted of 37 ADHD and 37 control children aged 7 to 12 years. ANCOVA analysisindicated that ADHD children demonstrate mild-to-moderate deficits in the perception of affect. Further-more, deficits in attention may contribute to inaccurate or incomplete encoding of stimulus properties. Theresults lend tentative support for the notion that the right cerebral hemisphere may play a critical role inADHD.

Attention-deficit hyperactivity disorder (ADHD)is a prevalent developmental disorder that ischaracterized by behavioral disinhibition, inat-tention, and hyperactivity (Barkley, 1990).ADHD children often appear inflexible, impul-sive, and aggressive in their social responding.Typically, they exhibit habitual responses, ne-glecting to adjust their behavior to changing so-cial cues despite knowledge of appropriate so-cial rules (Whalen, Henker, Collins, McAuliffe,& Vaux, 1979). This inappropriate social behav-ior often results in communication problems andpoor relationships with peers, family, and teach-ers (Barkley, 1990).

It is believed that brain function is impairedto some degree in the child evidencing ADHD.Lou, Henriksen, and Bruhn (1984) found thatADHD children have hypoperfusion in the cen-tral white matter of the frontal lobes and in thecaudate nucleus relative to the normal perfusionobserved in control subjects. Furthermore, the

diminished perfusion to the striatum and orbitalprefrontal regions is observed more in the righthemisphere than in the left hemisphere (Lou,Henriksen, Bruhn, Borner, & Nielsen, 1989).Lou and colleagues reported that pure ADHDsubjects, those void of other neuropsychologicor neurologic conditions, exhibit hypoperfusionexclusively in the right hemisphere. Accordingto the authors, the findings implicate a centralnervous system mechanism located in the con-nections between the prefrontal areas and thelimbic systems, resulting in orbito-frontal andorbital-limbic impairments (Lou et al., 1984;Stuss & Benson, 1986).

Consistent with these findings, magnetic res-onance imaging (MRI) reveals that the brains ofADHD children do not show the normal frontalasymmetry with the right being larger than theleft (Hynd, Semrud-Clikeman, Lorys, Novey, &Eliopolus, 1990). Instead, ADHD children ex-hibit a smaller right frontal width resulting in

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PROCESSING AFFECTIVE STIMULI IN ADHD 145

symmetrical frontal lobes. Branch, Cohen, andHynd (1995) examined the influence of rightversus left hemisphere neuropsychological dys-function on attention with two groups of learn-ing-disabled children and a control group. Chil-dren in the right hemisphere dysfunction (RHD)group (N = 3 with verified CT/MRI scan) re-ceived higher scores on a measure of impulsivityand poorer scores on a digit cancellation taskproviding support for the theory that the righthemisphere plays a significant role in attentionand concentration.

The right frontal region has also been impli-cated in motor impersistence or difficulty main-taining motor behavior (Kertesz, Nicholson,Cancelliere, Kassa, & Black, 1985), which hasbeen shown to be deficient in ADHD children(Voeller, Alexander, Carter, & Heilman, 1989;Voeller & Heilman, 1988). Other studies exam-ining ADHD have also implicated a right hemi-sphere dysfunction (Brumback & Staton, 1982;Heilman, Voeller, & Nadeau, 1991; Semrud-Clikeman et al., 1996; Shaughency & Hynd,1989; Voeller, 1986).

It is important to stress that ADHD is a disor-der with numerous etiologies, behavioral corre-lates, and severity of presentation. The neurobi-ological foundations of attention are vast, aris-ing from the reticular activating system of thebrainstem to the basal ganglia and on into thefrontal cortex (Mirsky, Anthony, Duncan,Ahearn, & Kellam, 1991). Recent investigationshave documented differences in anatomicalmass (Semrud-Clikeman et al., 1994), cerebralvolume (Castellanos et al., 1996), glucose me-tabolism in adults (Zametkin et al., 1990) andchildren (Casey et al., 1997), and hemisphericanomalies (Filipek et al., 1997) in individualswith ADHD. Also, gender differences have beennoted in adolescents with ADHD (Ernst, Cohen,Liebenauer, Jons, & Zametkin, 1997; Ernst etal., 1994). Posner (1987) stressed that the pro-cesses of attention are part of a multilevel, hier-archical system. Thus, one cannot assume thatsuch a syndrome can be exclusively localized orisolated to one area of the brain (e.g., righthemisphere). What is more feasible is that‘‘ADHD may represent a label for a heteroge-neous group of dysfunctions related to each of

the several identifiable ‘nodes’ along the distrib-uted attentional/intentional network’’ (Denckla,1991, p. x).

With this caveat in mind, the right hemi-sphere may represent not the only area, but per-haps one of the most intrinsically important ar-eas of cerebral involvement in ADHD. Resultsof the aforementioned studies provide supportfor the theory of Voeller (1986) and Voeller andHeilman (1988) that RHD is directly associatedwith attention-deficit hyperactivity disorder.Right hemisphere dysfunction has a profoundeffect on a child’s ability to perceive the emo-tional states of others and to respond appropri-ately in social situations.

It is well-established that hyperactive chil-dren exhibit difficulty negotiating their socialenvironments (Hinshaw, Henker, & Whalen,1984). ADHD boys appear less responsive todifferential cues for role-appropriate behaviors,inflexible in their responding, unable to modifytheir behavior in response to changes in environ-mental demands, and ignorant of subtle, but rel-evant social cues (Landau & Milich, 1988;Whalen et al., 1979). The findings suggest thatthe ADHD boys are limited in their ability todecode pertinent social cues or are inefficient insuppressing their inappropriate, inflexible be-havior.

The capacity to communicate with one an-other through language is one of the most essen-tial human characteristics (Robertson, 1987). Inthis context, communication refers to the per-ception and expression of social information vialanguage, gestures, and symbols: symbols beingthe nonverbal representations of ideas, such asfacial expressions, speech intonation, gestures,and written words. Effective social interactionrelies on the shared conveyance and understand-ing of such symbols.

Emotions are of critical importance in humanfunctioning. For this investigation, emotion re-fers to a patterned bodily reaction with psycho-logical and physiological processes that arise inresponse to a perceived stimulating event. Thereare three primary means of emotional communi-cation: facial expression, gestures, and speechprosody (Etcoff, 1986). Heilman and Valenstein(1993) suggested that the development of an

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146 BLYTHE CORBETT AND HOWARD GLIDDEN

appropriate emotional state may rely on the ac-curate perception and comprehension of visualstimuli, such as facial expressions. Kinsbourneand Bemporad (1984) highlighted that the im-paired ability to interpret emotional informationis associated with inappropriate behavior. Cico-ne, Wapner, and Gardner (1980) suggested thatright hemisphere injured patients frequently ex-hibit inappropriate social behavior which, theyconcluded, was in part related to difficulty un-derstanding the emotion communicated in facialexpressions. Thus, a diminished ability to pro-cess affective stimuli may produce an inabilityto inhibit habitual responses characteristic ofADHD. Behavioral disinhibition has been con-sidered primarily a problem of self-regulation orexecutive functioning conceptualized as primar-ily a frontal lobe function (Stuss & Benson,1986).

Recent investigations indicate that neocorticalstructures significantly contribute to the pro-cessing of emotional stimuli (Borod, 1992). Sev-eral recent studies have indicated a special func-tion of the right cerebral hemisphere concerningthe perception and expression of facial emotion(Ahern et al., 1991; Borod, 1992; Borod et al.,1990; Etcoff, 1984) and emotional aspects ofcommunication, generally referred to as prosody(Bell, Davis, Morgan-Fisher, & Ross, 1990; Co-hen, Branch & Hynd, 1994; Cohen, Prather,Town & Hynd, 1990; Cohen, Riccio & Flannery,1994; Deonna, Chevrie & Hornung, 1987; Ross,Edmondson, Seibert & Horman, 1988; Ross,Thompson & Yenkosky, 1997). A study of neu-rologically healthy subjects utilizing positronemission tomography reported the activation ofright prefrontal regions during emotional pros-ody recognition (George et al., 1996).

Emotional aspects of language appear to beprimarily organized in the right hemisphere andare presumed to be comparable in children, ado-lescent, and adult populations (Cohen et al.,1990; Cohen et al., 1994). Cohen and colleagues(1994) provided support for the hypothesis thatthe right hemisphere subserves functions relatedto prosody and that ‘‘disturbances of prosodycan occur in children with neuropsychologicaldysfunction of the right hemisphere, in the ab-sence of documented neuropathology, as well as

in children with documented right hemisphereneuropathology’’ (Cohen et al., 1994, p. 179).Furthermore, there appears to be a gradual ac-quisition of prosodic ability which improveswith maturation (Cohen et al., 1990).

Current investigations highlight the signifi-cance of the frontal lobe in emotional process-ing. For example, the frontal lobes play a criticalrole in the emotional experience correspondingwith valence, which is the positive or negativevalue an individual ascribes to an emotion(Davidson, Schwartz, Saron, Bennett, & Gold-man, 1979). This structure and its related func-tions have been implicated in the symptomatol-ogy of ADHD (Grodzinsky & Diamond, 1992;Lou et al., 1984). Effects of lesions to the frontallobe often show what has been referred to as thedisinhibition syndrome, consisting of inappro-priate affective responses coupled with the dis-inhibition of impulses (Damasio & Van Hoesen,1983; Luria, 1973; Tucker, 1986).

Results of the aforementioned studies providesupport for the notion that RHD is directly asso-ciated with ADHD (Voeller, 1986; Voeller andHeilman, 1988). Right hemisphere dysfunctionhas a profound effect on a child’s ability to per-ceive the emotional states of others and to re-spond appropriately in social situations. Thus,deficits in perceiving social stimuli may be man-ifested in inappropriate responding, characteris-tic of ADHD. Semrud-Clikeman and Hynd(1991) stressed the need for further study intothe relationship between ADHD and right hemi-sphere dysfunction. A case in point is a recentinvestigation that examined the processing ofemotional information in ADHD children (Sha-piro, Hughes, August, & Bloomquist, 1993).

The present study was designed to examinethis proposed relationship between ADHD andone aspect of right hemisphere functioning,emotional perception. The investigation lookedat whether the failure to modify responding inADHD is primarily a perceptual problem, anattention problem, or a problem with behavioraldyscontrol. The researchers hypothesized thatADHD children would demonstrate deficits per-taining to the perception of relevant social stim-uli via facial expression and speech prosody.

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PROCESSING AFFECTIVE STIMULI IN ADHD 147

METHOD

SubjectsThe experimental group consisted of 37 elemen-tary school children between the ages of 6 years, 8months to 12 years, 8 months who had been diag-nosed with ADHD based on DSM-IV criteria. Thesubjects met criteria for combined subtype basedon clinical referral and parental information. Allsubjects were assessed for learning disabilities.The experimental group was matched with 37 sub-jects for age, gender, and socioeconomic status(SES; Hollingshead, 1975) to form the controlgroup. The experimental group was recruited fromreferral sources whose diagnostic criteria werecompatible with the researcher’s criteria discussedbelow. The control group was recruited throughFresno and Central Unified School Districts(Fresno, California).

Criteria for acceptance into the ADHD groupincluded the following: a primary diagnosis ofADHD as developed in the DSM-IV (AmericanPsychiatric Association, 1994). The diagnosis wasprovided by a licensed developmental neuropsy-chologist, psychologist, pediatrician, or psychia-trist who referred subjects to the investigation. Theclinicians utilized the subject’s history, academicperformance, parental interview, rating forms, andbehavioral observations in diagnostic decisionmaking. The majority of the subjects (N = 22) werealso assessed via neuropsychological instruments(i.e. Stroop, cancellation tasks, memory for sen-tences) as part of a comprehensive evaluation. Inaddition, the Conner’s Parent Rating Scale (Goyet-te, Conners, & Ulrich, 1978) was administered aspart of the research protocol to corroborate diagno-sis. Inclusionary criteria was as follows: subjectsreceived an estimated IQ of 80 or above; no evi-dence of apparent emotional disturbance or neuro-pathology; absence of acute family distress; and noconcurrent treatment with psychotropic medicationother than stimulant medication (e.g., Methylphe-nidate). Also, in an attempt to obtain a pure ADHDgroup, the subjects could not exhibit a learningdisability as demonstrated by their performance onthe Wechsler Individual Achievement Test(WIAT) subtests: Basic Reading, MathematicsReasoning, and Spelling. These subtests were usedto screen for learning disabilities in the experimen-tal and control groups. Subjects who obtained ascore of 1½ standard deviations below their esti-mated IQ score in any area (i.e., 22 points) wereclassified in this study as potentially learning dis-abled. This clarification is adopted from Title V ofthe California Administrative Code Regulations. It

is important to note that this procedure was notused to provide a diagnosis of a learning disability.Rather, it simply served as an inclusionary/ex-clusionary measure for this study. Although moreconservative criteria could have been employed, itwould have significantly prohibited obtaining sub-jects. Even with the current criteria, many poten-tial ADHD subjects were not considered due tohigh rates of learning disabilities in this popula-tion.

The criteria for acceptance into the normal con-trol group included the following: an estimated IQof 80 or above, an absence of a present diagnosisor a history of ADHD as determined by parentalinterview and the completion of the Connor’s Par-ent Rating Scale; no evidence of apparent emo-tional disturbance or neuropathology; absence ofacute family distress; no concurrent treatment withpsychotropic medication, including Methylpheni-date. In addition, the subjects did not exhibit alearning disability as demonstrated on the WIATsubtests.

Following a screening for intelligence and thepresence of learning disabilities, all subjects wereassessed on two measures each of attention, per-ception, and disinhibition. A verbal and nonverbalinstrument from each domain was administered.

Instruments

The Wechsler Intelligence Scale for Children-III,Vocabulary, Information, Block Design, and Pic-ture Completion SubtestsFour of the subtests of the Wechsler IntelligenceScale for Children-III (WISC-III; Wechsler, 1991)were used in this study. The Vocabulary subtestrequires the child to orally define words presentedby the examiner. The Information subtest consistsof a series of questions concerning commonevents, places, objects, and people. The Block De-sign subtest requires the subject to construct de-signs out of blocks from a pictorial model. PictureCompletion consists of 31 pictures which have animportant part missing. Scaled scores are con-verted to deviation quotients (Sattler, 1992, TableL-12, p. 1171).

The Wechsler Individual Achievement Test (WIAT)In order to screen for learning disabilities, theWechsler Individual Achievement Test (WIAT;Wechsler, 1995) was given. The WIAT assessesacademic performance in several areas. Three ofthe subtests were administered: Basic Reading,Mathematics Reasoning, and Spelling.

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148 BLYTHE CORBETT AND HOWARD GLIDDEN

Memory for SentencesThe Sentence Memory Test (cf. Spreen & Benton,1977), presented via audiotape, was used as a mea-sure of attention. Sentence repetition tests assessattention by determining how well a child can holdonto information and then process it (Spreen &Strauss, 1998). This test requires a child to repeata sentence verbatim as it is presented by the exam-iner. Raw scores were used in the analysis.

Knox Cube TestThe Knox Cube Test (KCT: Arthur, 1947) mea-sures immediate visuospatial attention span andworking memory. This measure was chosen basedon previous research distinguishing it as a usefulmeasure of nonverbal attention (Corbett &Glidden, 1997). The task requires the subject to tapa prearranged sequence on four blocks that are af-fixed to a board. The sequence is progressive, in-creasing in both length and complexity. Thus, thisinstrument is also considered an indice of sequenc-ing ability. The number of correct items or the rawscore was used in the analysis.

The Prosody TestThe perception of speech prosody was investigatedthrough the administration of the Prosody Test(Tucker, Watson, & Heilman, 1977). This instru-ment requires the subject to identify the emotiondepicted in tape recordings of emotionally intonedsentences. The subject must choose from one offour emotionally intoned sentences (anger, happi-ness, sadness, and neutral) that contain emotion-ally neutral content. Four sentences were presenteddepicting the four emotional intonations, resultingin a total of 16 trials. The four sentences include:‘‘The boy went to the store,’’ ‘‘The game ended at4 o’clock,’’ ‘‘Fish can jump out of the water,’’ and‘‘He tossed the bread to the pigeons.’’ The record-ing of the 16 sentences and four practice itemswere tape recorded by the principle investigator.During a pilot study, 10 control subjects consis-tently identified the stimuli with greater than 90%accuracy. Written choices were presented in a ver-tical fashion on a laminated sheet. Prior to the ad-ministration of the test, subjects were asked to readaloud the printed choices on the sheet. The rawscores were converted to percentage correct. Thesescores were used as part of the analysis regardingthe accuracy of emotional perception in ADHD.

Pictures of Facial AffectSelected slides from the Pictures of Facial Affect(Ekman, 1976) were used to determine the sub-jects’ ability to identify the emotion portrayed.These 110 slides depict actors displaying six fun-

damental emotions and a neutral response (anger,disgust, fear, happiness, sadness, surprise, andneutral) in the form of photographic slides of facialexpressions. Slides were presented for as long asnecessary for the subject to give a response on alaminated sheet listing the seven expressions. Theslides were shown in a dimly lit room free of audi-tory and visual distraction. Four slides, which havea reported reliability of .90 or greater, from each ofthe seven categories were randomly selected fromthe collection. Thus, a total of 28 slides were pre-sented, 8 of which served as sample items. In addi-tion, during a pilot study 10 control subjects con-sistently identified the stimuli with greater than90% accuracy. Each of the 2l test items was scoredfor accuracy, receiving a score of 0 for incorrectand l for correct responses. The raw scores werethen converted to percentage correct. These scoreswere used to test the hypotheses concerning theaccuracy of emotional perception in ADHD.

Go No-Go TestThe go no-go paradigm was given to measure thechild’s behavioral disinhibition (e.g., impulsivity).This instrument was presented via audiotape asdescribed by Mesulam (1985) and Trommer,Hoeppner, Lorber, and Armstrong (1988). The tapeconsisted of verbal presentations of two identicaltrials of 10 stimuli. Following practice trials, 10 gosignals were indicated by a single syllable word(car) and 10 no-go signals indicated by a two-syl-lable word (car-toon). The stimuli were presentedat three-second intervals in a fixed random se-quence. The interval between syllables for the no-go stimulus was approximately 0.25 seconds. Thisformat requires the subject to perform a simplemotor function of raising the index finger follow-ing one cue (car) and to inhibit responding in thepresence of the no-go cue (cartoon). The subjects’responses were measured based on commissionerrors (e.g., impulsive responding to inappropriatestimuli). Raw scores were used in the analysis.

Matching Familiar Figures TestThe Matching Familiar Figures Test (MFFT;Kagan, Rosman, Day, Albert, & Phillips, 1964) isa match to sample task which has been employedextensively in the measurement of impulse controlin children with ADHD (Pennington, Groisser, &Welsh, 1993; Schaughency & Hynd, 1989; Zentall,1988). The MFFT requires the subject to choose anidentical picture from among six choices andmatch it to a target picture presented by the exam-iner. The subject must attempt to inhibit impulsiveresponding in order to study the alternative pic-tures. Scores are derived by taking the mean time

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PROCESSING AFFECTIVE STIMULI IN ADHD 149

Table 1. Descriptive Statistics.

Variable ADHDa Controlb

M (SD) M (SD)

Age (years)SES

10.0850.89

(1.78)(6.28)

19.4950.29

1(1.92)(11.27)

Note. SES = socioeconomic status (parental). aADHD = 37 (28 boys, ll girls); bControl = 37 (19 boys, l8 girls).

to the initial response (latency) and/or the totalnumber of incorrectly identified pictures (errors).For this investigation, the mean latency was used.

ProceduresProspective subjects in the experimental groupwere referred to the study by local psychologists,pediatricians, and psychiatrists. Children who werecurrently receiving stimulant medication were toldto abstain from medication the day of testing sothat their performance would be observed off med-ication. For most of the ADHD subjects this meantthat the last dose of medication was given 18 to 24hours prior to testing.

Subjects in the control group were individualswho responded to advertisements requesting re-search volunteers. Parents of participants weregiven a parental consent form and a demographicsinformation sheet. All subjects were assigned anumerical code to maintain anonymity of the chil-dren and their test results and to comply with theethical standards of the American PsychologicalAssociation.

Demographic information on each subject, in-formed consent, and written consent from the childwere obtained prior to testing. Following the intro-duction to the child, the examiner explained thetesting procedures. The casual explanation wassimilar to the following:

Today, you will be given several brief tasks todo. Some will be easier than others. And someyou may actually think are kind of fun. All Iwant is for you to do the best job that you can.If at any time you want to stop or take a break,you just let me know, okay? Before we beginwith the first one, do you have any questions?

Testing was conducted in a quiet room free fromvisual and auditory distractions. In order to obtainthe subject’s optimal performance, consistentchecks for readiness (i.e., ‘‘Are you ready?’’,‘‘Pay attention.’’) were given during testing proce-dures.

Analysis of the DataPower for this research design was calculated us-ing PC-SIZE: Consultant (Dallal, 1990). Using analpha of .05, equal sample sizes of 37, 4 of the 6variables had a power above .93. Specifically, thepower analysis results were as follows: .99 for Pic-tures of Affect, .99 for Knox Cube, .95 for ProsodyTest, .93 for Sentence Memory, .80 for MFFT, and.48 for the Go No-Go test.

Data analysis was designed to yield informationrelative to the perception of affect (i.e., facial ex-pressions and prosody) in children with ADHD. Itwas hypothesized that the dependent measures ofattention, perception of affect, and behavioral dis-inhibition would consistently discriminate thegroups of children with and without ADHD. Anal-ysis of variance was covaried for age (MAN-COVA) to account for the developmental differ-ences between the five year age span of the sub-jects. Following the analysis, discriminant functionanalysis (DFA) was performed.

RESULTS

Descriptive statistics for the 37 experimentaland 37 control subjects are presented in Table 1.The groups were balanced in terms of age, gen-der, and parental SES. Chi-square analysis dem-onstrated that the two groups did not differ rela-tive to gender, P2(1, N = 74) = 3.36, p = .067.Hotelling’s T2 was performed to determine thatthe results of the variables did not occur bychance alone, and the results were statisticallysignificant, F(6, 67) = 7.40, p < .000. Means andstandard deviations on the six dependent mea-sures were compared between the experimentaland control groups and are presented in Table 2.Significant differences were observed on all ofthe measures, except for the Verbal Go No-GoTest.D

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150 BLYTHE CORBETT AND HOWARD GLIDDEN

Table 3. Means and Standard Deviations for Dependent Variables.

Variable

ADHDa Controlb

M (SD) M (SD) t p

Prosody TestPictures of AffectSentence MemoryKnox Cube TestVerbal Go No-GoMFFTc

.84

.7611.4610.5l

l.469.78

(.17)(.10)

(2.35)(2.54)(l.07)(4.56)

.94

.8912.8612.67

1.1614.07

(.06)(.06)

(2.29)(3.00)(1.12)(7.99)

3.176.392.6l3.34

–1.172.84

.002

.000

.011

.001

.246

.006

aADHD = 37 (28 boys, ll girls); bControl = 37 (19 boys, l8 girls); cMatching Familiar Figures Test.

Table 2. Means and Standard Deviations for Screening Variables.

Variable

ADHDa Controlb

M (SD) M (SD) t p

WISC-IIIReadingMathSpelling

100969892

(11.14)(10.69)(10.41)

(9.87)

113107109106

(14.49)(13.13)(15.45)(16.88)

4.214.193.574.61

.000

.000

.001

.000

aADHD = 37 (28 boys, ll girls); bControl = 37 (19 boys, l8 girls).

The means and standard deviations are re-ported in Table 2 for the screening variables thatincluded the estimated IQ from the WISC-IIIsubtests and the WIAT Math, Reading, andSpelling subtests. The groups differed signifi-cantly on all aforementioned screening vari-ables.

Table 4 presents the results of the MAN-COVA analysis which was statistically signifi-cant for all variables except for the Go No-Gotest which approached significance F(6, 67) =3.80, p = .055. Lastly, a stepwise discriminantfunction analysis was performed to determinethe contributions of the variables in predictingADHD. DFA looks at the variables and deter-mines how much each one is able to discrimi-nate the groups of interest. Pictures of Affectwas the first variable entered, followed by KnoxCube Test, Prosody Test, MFFT, and SentenceMemory. The discriminant function was signifi-cant in classifying subjects as either ADHD orcontrol, P2(6, N = 74) = 35.07, p < .0000. Thestructured coefficients, which are the pooled

within-group correlations between the discrimi-nating variables and the canonical discriminantfunction, suggests that 85% of the variance isexplained by Pictures of Affect (Table 5). Thus,the discriminant function is comprised of pri-marily Pictures of Affect or the perception offacial expression. The correlation of the othervariables seems essentially the result of howthey correlate with the Pictures of Affect vari-able.

DISCUSSION

The present study was designed to further exam-ine the perception of relevant social stimuli inADHD children by asking whether the failure tomodify responding is primarily a problem withattention, perception, behavioral disinhibition,or a combination of these factors. Specifically,the investigation attempted to examine whetherADHD children demonstrate deficits pertainingto the perception of emotion-laden material. The

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PROCESSING AFFECTIVE STIMULI IN ADHD 151

Table 5. Discriminant Function Analysis.

Variable Structure Coefficients Standardized Coefficients

Pictures of AffectKnox Cube TestProsody TestMFFTSentence MemoryGo No-Go

.926

.484

.459

.411

.377–.169

.847

.251–.007

.258–.021

.003

Table 4. Results of MANCOVA.

Variable F p

Prosody TestPictures of AffectSentence MemoryKnox Cube TestGo No-GoMFFT

13.4345.2912.2424.9313.8018.14

.000

.000

.001

.000

.055

.006

MFFT = Matching Familiar Figures Test.

results demonstrate significant differences be-tween children with and without ADHD on indi-ces of attention, perception of affect, and behav-ioral disinhibition.

Based on the findings, it appears that, in addi-tion to the notable attention deficits observed inthe ADHD population, children with the disor-der also demonstrate mild-to-moderate deficitsin their ability to perceive facial expression andprosody. The results lend tentative support to thenotion that the right cerebral hemisphere, whichis important in the perception and expression ofemotional stimuli (Ahern et al., 1991; Borod,1992; Borod et al., 1990; Cicone et al., 1980;Etcoff, 1984, George et al., 1996), may be dys-functional in ADHD (Brumback & Staton, 1982;Heilman et al., 1991; Schaughency & Hynd,1989; Semrud-Clikeman et al., 1996; Voeller,1986). A right hemisphere dysfunction has beensuggested in children and adults with distur-bances of prosody (Bell et al., 1990; Cohen etal., 1994; Cohen et al., 1990; Cohen et al., 1994;Deonna et al., 1987; Ross et al., 1988; Ross etal., 1997).

An additional explanation is that ADHD chil-dren exhibit deficits in verbal and nonverbalattention, which may contribute to inaccurate orincomplete encoding of stimulus properties.Therefore, they may only attend to the most sa-lient stimuli or the most salient features of thestimulus in the environment. In the process, themore subtle nuances of communication and ex-pression may be missed and, thus, are not en-coded by the child. The effect is a child who candiscriminate between vastly different emotions,such as happy and sad, but who is unable to dis-cern the more refined differences between emo-tions like fear and surprise. If such is the case,then deficiencies in encoding may contribute toinsensitivity to verbal and visual reinforcement,especially to stimuli that are subtle. To test thishypothesis, analysis of stimuli-specific responseis under investigation by the first author.

Other plausible explanations for the currentfindings include underlying deficits in visuo-perceptual abilities and gender differences. Totest the former hypothesis, Pictures of Affectwas correlated with the Picture Completionsubtest of the WISC-III, an index of general per-

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152 BLYTHE CORBETT AND HOWARD GLIDDEN

ceptual skill. The results were not statisticallysignificant, yet subject performance on othermore robust measures of perceptual integritymay be appropriate for future studies. Regardingthe latter explanation, preliminary chi squareanalysis did not indicate any gender differencesbetween the groups. Despite this result, a com-parison between the performance of ADHD girlsand boys seemed warranted based on the recentfindings of potential gender differences in ado-lescents (Ernst et al., 1994). Using gender andage as covariates, the investigators employedmultivariate analysis between the groups on theperception of affect measures, and the resultswere statistically significant. Based on theseinteresting findings, a follow-up investigation ofgender differences is planned. Future ADHDresearch will benefit from assessing differencesin gender, age and classification differences (i.e.predominantly inattentive versus hyperac-tive/impulsive features).

The results of this study may have implica-tions for treatment of children with ADHD. Re-cent approaches tend to focus on the enhance-ment of attention (e.g., stimulant medication)and inhibition of inappropriate behavioral re-sponses (e.g., differential response training).The misperception of social information sug-gests other interventions may be warranted.Also, subjects in the current study were asked toabstain from stimulant medication; it would beinteresting to determine if the provision of medi-cation would enhance performance on the per-ception of emotional stimuli.

The verbal measure of behavioral disinhibi-tion (Go No-go test) was unable to discriminatethe groups. It appears that the instrument did notprovide a long enough trial to assess theimpulsivity of the subjects or their ability to sus-tain attention. Furthermore, it may not have beena robust measure for the age span selected.

Preliminary comparison of the results of thepresent study appear largely consistent with thefindings of Shapiro and colleagues (1993), whoinvestigated the ability of ADHD children toaccurately evaluate emotional stimuli via a bat-tery of tests. Overall, ADHD children did notperform differently from normal children on theMinnesota Tests of Affective Processing

(MNTAP; Shapiro et al., 1993). The investiga-tors concluded that social impairment in ADHDchildren was not primarily the result of deficitsin the processing of emotional information.However, the researchers reported significantdeficits in discriminating facial affective stimuliin a subgroup of younger ADHD children. Theyconcluded that young ADHD children may beimpaired in their ability to process emotionalcues. Furthermore, significant differences wereobserved between ADHD and normal childrenon tasks assessing working memory and com-plex auditory processing ability. This latter find-ing may be consistent with results of the currentinvestigation and the inferior performance ofADHD children on the Prosody Test. Regard-less, direct comparisons between the currentinvestigation and Shapiro et al. (1993) cannot bemade because the methodology and battery werenot equivalent. For example, the photographicmaterial in the current investigation utilizedadult faces developed by Ekman and Friesen(1976), whereas Shapiro et al. (1993) used pho-tographs of children (Voeller, Hanson, &Wendt, 1988).

The present study underscores the need tofurther investigate the perceptual abilities ofchildren with ADHD, especially since percep-tual control tasks were not employed. Therefore,one can not definitively conclude that these chil-dren evidence a specific problem perceiving orunderstanding emotions. In addition, the produc-tion of emotional prosody and emotional faces,which is far more difficult to quantify, was notinvestigated. Currently, a lack of objective, stan-dardized measures exist to assess emotional pro-duction to elucidate the proposed relationshipbetween expressing or understanding emotionalinformation and ADHD.

Despite the interesting findings, there aremany unanswered questions. For example, whatmight be the affect of emotional perception onsocial behavior? Although this study did not di-rectly ask such a question, it is quite plausiblethat these children may, in part, demonstrateinappropriate social behavior as a result of theirdeficiencies in accurately perceiving the envi-ronment. In view of the potentially significantresults of the current investigation, additional

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research is warranted and encouraged to revealand elucidate the proposed relationship betweenADHD and the perception of affect.

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