Proactive inhibitory control as a cognitive contributor to social difficulties in adolescents with ADHD traits

Abstract

Adolescents with attention deficit hyperactivity disorder (ADHD) represent a significantly heterogenous group in terms of cognitive and social ability. Given the high co-occurrence of ADHD and autism, it is unclear whether the social difficulties seen in ADHD may be attributed to the same underlying factors which contribute to social difficulties in autism, or are a unique feature of ADHD. This study explores differences in cognition in adolescents with clinically elevated ADHD symptoms with and without social difficulties, and adolescents with ADHD symptoms and autism. Thirty-nine adolescents completed objective measures of cognition (attention, working memory, inhibition) and social cognition (affect recognition, theory of mind [ToM]). Adolescents with ADHD symptoms and social difficulties had poorer proactive inhibition than both those without social difficulties, and those with autism. Lower cognitive performance was only significantly related to social functioning for adolescents with ADHD who experienced social difficulties. ToM was weakest in those with autism. Social difficulties in adolescents with clinically elevated ADHD symptoms are associated with poor proactive inhibition, working memory and affect recognition. This highlights the potential benefit of cognitive strategies for remediating social difficulties in ADHD, and the need for ADHD specific interventions. Lay abstract Around half of teenagers with attention deficit hyperactivity disorder (ADHD) experience significant difficulties forming and maintaining friendships. This in turn often has negative effects on schooling and mental health. There is a large body of research that suggests the social difficulties commonly seen in ADHD may be due to weaknesses in skills such as impulse control, working memory, recognising emotions, and perspective taking. Given teenagers with autism often present with similar weaknesses and social difficulties, it is not known whether the social difficulties experienced by teenagers with ADHD have the same underlying causes. If so, this may suggest that social difficulties in ADHD represent undiagnosed autism, or low-level autism traits. This study compared these key skills in teenagers with clinical ADHD symptoms who experience social difficulties, with those who don’t experience social difficulties, and those with co-occurring autism. The results showed that social difficulties in ADHD and autism appear to have different underlying causes, suggesting that the social difficulties seen in teenagers with ADHD are unique to this disorder, and are not due to underlying autism, or autism traits. This highlights the need for social skills interventions, particularly those that target impulse control, emotion recognition and working memory, that are specifically tailored to the needs and weaknesses of teenagers with ADHD, rather than using existing interventions designed for teenagers with autism.