Comparison of emotion recognition, face recognition and subclinical autistic traits in patients with different subtypes/presentations of Attention Deficit Hyperactivity Disorder with healthy controls, and the relationship between face and emotion recognition and autistic traits

Objective: Previous studies conducted with adults diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) suggest a general consensus regarding the presence of facial emotion recognition deficits in this population. However, research examining the effects of ADHD subtypes and subclinical autistic traits on facial and emotion recognition in adults remains highly limited. The aim of this study is to investigate whether individuals with different ADHD subtypes differ from healthy controls in facial and emotion recognition performance and in subclinical autistic traits, and to examine whether facial and emotion recognition in ADHD are associated with subclinical autistic traits. Materials and Methods: The study was conducted on adults 18 years or older diagnosed with ADHD without psychiatric comorbidities, and provided verbal and written informed consent. A total of 131 participants were included: 34 with predominantly inattentive presentation, 12 with predominantly hyperactive/impulsive presentation, 54 with combined presentation, and 31 healthy controls (HC). Participants completed the Sociodemographic Data Form; the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to assess comorbidities; the Diagnostic Interview for ADHD in Adults–5 (DIVA-5) and the Adult ADHD Self-Report Scale (ASRS) to evaluate ADHD symptoms; the Wender Utah Rating Scale (WURS) for childhood symptoms; the Difficulties in Emotion Regulation Scale–Short Form (DERS-16) for emotion regulation difficulties; the Barratt Impulsiveness Scale–11 (BIS-11) for impulsivity traits; the Autism Spectrum Quotient (AQ) for autistic traits; the Reading the Mind in the Eyes Test (RMET) for theory of mind and emotion recognition; the Benton Facial Recognition Test (BFRT) for facial recognition; and the Ekman Affect Recognition Battery for emotion recognition. ADHD subtypes (predominantly inattentive, predominantly hyperactive/impulsive, and combined) were classified according to DIVA-5 subscales. Results: All ADHD subtypes exhibited significantly higher scores than controls on the AQ total score and its subscales of social skills, attention switching, communication, and imagination; no significant difference was observed only in the attention to detail dimension. Facial and emotion recognition performance was significantly lower in the ADHD group overall: RMET, Benton, and Ekman total scores, as well as recognition of sad, fearful, angry, and neutral faces, were found to be significantly lower. There were no significant differences between ADHD subtypes regarding facial and emotion recognition. Although facial recognition ability did not differ across subtypes, a negative correlation was observed between childhood ADHD symptoms and facial recognition. Compared with controls, the combined and hyperactive/impulsive subtypes showed poorer recognition of negative emotions (sad, fearful, angry), whereas the inattentive subtype did not differ from healthy controls in this regard. Correlation analyses revealed no association between ADHD symptom severity and emotion recognition performance; however, certain AQ subscales—particularly attention to detail—were associated with emotion recognition. This subscale emerged as a significant predictor of Ekman facial recognition performance. Overall, adults with ADHD exhibited elevated autistic traits and impaired facial/emotion recognition, and these impairments appeared to be associated more strongly with specific components of autistic traits than with subtype differences. Conclusion: To the best of our knowledge, this is the first study to investigate the relationship between facial and emotion recognition and subclinical autistic traits across adult ADHD subtypes. The association between facial recognition abilities and childhood symptoms suggests a developmental deficit, whereas emotion recognition performance appears to be related to subtype (combined and hyperactive/impulsive) and to the level of subclinical autistic traits. These findings indicate that social cognitive difficulties in individuals with ADHD are linked not only to ADHD symptom severity but also to co-occurring subclinical autistic traits and a detail-focused cognitive processing style. Considering subtype-specific social cognition profiles and subclinical autistic traits in the clinical assessment of adult ADHD may enhance functional outcomes through interventions targeting social skills and emotion regulation.