Exploring Social Attention in Attention-Deficit/Hyperactivity Disorder: A Dimensional Approach

Abstract

There is a well-established finding that individuals with ADHD experience social impairment in their daily lives. This likely arises from symptoms of the disorder coupled with deficits in cognitive factors important for effective social function. However, the exact nature of the social impairment remains poorly understood. That is, despite a substantial literature documenting the existence of social problems in daily life, it remains unclear which social cognitive processes may underlie these deficits. Because we lack a clear understanding of the mechanism behind social deficits in ADHD, extant social skills interventions have proven ineffective in ameliorating social functioning for individuals with ADHD. This is particularly notable given the detrimental effect of social impairment on overall wellbeing for those with ADHD. The complexity of social interactions places a high demand on attentional skills; thus, it is plausible that social attentional processes may subserve social impairment in ADHD. The current dissertation aims to elucidate the relationship between ADHD and two core social attentional constructs: self-referential processing and orienting to gaze cues. In line with the RDoC, this dissertation conceptualizes ADHD through a dimensional lens, measuring traits of ADHD along a continuum in three large undergraduate samples. Traits of Autism Spectrum Disorder were also included (and measured dimensionally) given commonalities between the disorders. In Study 1, I examined self-referential processing in a large sample of undergraduates (n=265) varying in ADHD traits. Self-referential processing was assessed online using the self-referential encoding task (SRET), a common implicit memory paradigm. Contrary to hypotheses, neither ADHD traits (nor ASD traits) influenced SRET performance. The self-reference effect also did not emerge when memory was assessed using the most robust metric from the SRET, recognition sensitivity (d’), despite adequate power and careful quality control of data. These findings question self-referential processing as a mechanism underlying social impairment in ADHD and, more broadly, highlight the need for further evaluation of the SRET. Building upon these findings, in Study 2 I adapted the SRET to explore self-referential processing in a socially evaluative context to determine whether prioritization of self-referential information was reduced in ADHD in situations of social threat. This study employed another large undergraduate sample (n=302) expressing a varying level of ADHD traits. Consistent with Study 1, traits of ADHD and ASD did not modulate the self-reference effect, providing further support that ADHD and ASD traits do not impair prioritization of self-relevant information. Additionally, an unexpected finding emerged whereby participants with higher levels of neurodevelopmental traits demonstrated better overall performance on the implicit memory task. Finally, Study 3 (n=169) focused on a different core social attentional process: orienting towards eye gaze cues. This study employed an online adaptation of the classic gaze cueing paradigm to investigate whether ADHD and ASD traits modulate orienting to both neutral and emotional eye gaze cues. Results did not support a modulation in gaze orienting by ADHD (nor ASD) traits; that is, participants demonstrated spontaneous orienting towards eye gaze cues across all levels of neurodevelopmental trait expression. Further, there was no indication of reduced emotional modulation of gaze orienting in ADHD or ASD. Overall, the studies presented in this dissertation suggest that ADHD traits do not modulate two core social attentional processes. However, across the three studies – and over 700 participants – results consistently demonstrate a correlation between ADHD and ASD traits and social impairment in daily life, as measured through a self-report questionnaire of everyday social problems (e.g., getting into arguments, difficulty maintaining friendships, etc.). Thus, although real-world social outcomes are negatively impacted by traits of both disorders, the two social attentional skills evaluated here do not appear to account for these deficits. Findings of this work address a gap in our understanding of the state of social cognitive abilities – specifically social attentional skills – in ADHD, with the ultimate aim of contributing to the literature seeking to develop successful interventions to remediate social impairment in this population.