Recognition of emotional face expressions, social-empathic skills and their association with their parent social skills and depression levels in children with attention deficit and hyperactivity disorder and specific learning disorder

Purpose: The aim of this study was to evaluate social responsiveness, recognition of emotional facial expressions, empathy skills and parental depression level, broad autism phenotype findings and the relationship between them in children with attention deficit and hyperactivity disorder (ADHD), specific learning disorder and healthy children. Method: According to the DSM-V diagnostic criteria, the study sample was in the 8-12 age group who applied to the K.T.U Faculty of Medicine Child-Adolescent Psychiatry outpatient clinic between 01.02.2020 – 01.04.2021; It consisted of 37 children diagnosed with attention deficit predominant type (AD-ADHD) ADHD, 41 children with combined type (MIX-ADHD), 41 children with SLD, and 42 healthy children. Schedule for Affective Disorders and Schizophrenia for School Aged Children- Present and Lifetime version (K-SADS-PL) was interviewed with all children and SLD battery was applied for children diagnosed with SLD. All children were asked to complete the Revised Children's Anxiety and Depression Scale (RCADS), the KA-SI Empathic Tendency Scale, and to follow the instructions on the emotion recognition task (ERT) computer program to evaluate emotional facial expressions. In addition, parents were asked to fill in the social responsiveness scale (SRS), which evaluates children's social skills. Finally, parents were asked to fill out the Beck depression scale to assess their own depression symptoms and an Autism Spectrum Quotient (AQ) to evaluate broad autism phenotype characteristics. The higher scores of KA-Sİ empathy tendency scale indicate higher empathy skills and high SRS scores represent greater social dysfunction. The obtained data were entered into the SPSS 25.0 program and the necessary statistical analyses were made. Findings: The mean age of the participants was 9.81 ± 1.45 years, with 55.9% male (n=90) and 44.1% (n=71) female. There was no significant difference between the MIX-ADHD, AD-ADHD, SLD and healthy groups in terms of age and gender. The anxiety level of all study groups was significantly higher than the healthy group (p<0,001). The depression level of groups other than MIX-ADHD was found to be significantly higher than the healthy group. The SRS total score of children diagnosed with MIX-ADHD, AD-ADHD, SLD was significantly higher (all p <0,001), the total score of KA-Sİ empathic tendency scale was significantly lower than the healthy controls (all p <0,001). When the mean ERT total scores of children with MIX-ADHD and SLD were compared with healthy children, a significant difference was found. The recognition of fear was significantly lower in MIX-ADHD, compared to the healthy children. In addition, Beck depression scale scores were found to be statistically significantly higher in mothers of children with MIX-ADHD, AD-ADHD, and SLD than mothers of healthy children (respectively p=0.002, p=0.006, p=0.001). It was observed that the mean AQ/total score was higher in the mothers of the children in all patient groups compared to the mothers of the healthy children, but there was no significant difference. The AQ/social skills and imagination subscale scores of the mothers of only SLD group children were statistically significantly higher than the mothers of healthy children (p= 0.026, p= 0.027, respectively). In the AD-ADHD group, a significant positive correlation was found between the SCQ total score and the maternal Beck depression scale score (p= 0.027; r= 0,365). In the MIX-ADHD group, there was a significant negative correlation between the ERT total score and the mother's AQ total score (p=0.006; r=-0.424 ). Among the participants in the MIX-ADHD, AD-ADHD, and SLD groups, the mean ERT total score was found to be significantly lower in those with a history of speech disorders than those without a history of speech disorders (p=0.005, p=0.012, p=0.041, respectively). Results: In this study, it was shown that children with ADHD and SLD performed worse in tests measuring social responsiveness, recognizing emotional facial expressions, and empathy skills compared to healthy children, in line with the literature. However, it was observed that there was no difference between the tests measuring children's social skills between these two disorders. This result indicates that ADHD and SLD cases, which are known to be based on common etiology, show similar clinical features in terms of social skills. In these cases, it can be thought that there is a need for new research to elucidate the biological basis of social skills such as social responsiveness, empathy skills and recognizing emotional facial expressions. On the other hand, mothers of children with ADHD and SLD were found to have higher depression levels and more broad autism phenotype characteristics than mothers of healthy children. However, in this study, it was thought that the cross-sectional design of the research and the fact that the social skills of mothers and children were evaluated with self-report scales may have affected the results of the analysis evaluating the relationship. In this context, it can be said that longitudinal follow-up studies including clinician evaluation are needed. Finally, it was shown in the study that a history of speech disorder negatively affected facial expression recognition skills in all groups. It is known that speaking skill is an important component of social skill developmentally. It was thought that supportive interventions for speech might be protective against the inadequacy of facial recognition skills accompanying these disorders, especially in children with speech disorders and ADHD or SLD clinic. Follow-up studies are needed in this direction. It is known that children with ADHD and SLD may experience devastating consequences both academically and socially, and these children have more difficulty in resolving interpersonal conflicts, exhibit fewer positive behaviors, and experience more adjustment problems in adolescence than their peers. Therefore, it can be said that intervention programs such as social skills training in the early stages for social deficiencies in the determined areas and family-based interventions in families with parental psychopathology gain importance. Keywords: ADHD, SLD, social skills, depression, broad autism phenotype