Social cognition in ADHD: The hidden impairments behind social interaction challenges

In the traditional diagnostic criteria of attention deficit and hyperactivity disorder (ADHD), the emphasis given to inattention, impulsivity and hyperactivity symptoms cloud over other deficits that are important for a deep understanding and treatment of the disorder. Such is the case of social cognition impairments. In this chapter, we summarize the literature on social cognition and its neural correlates in children and adults with ADHD. We consider neurophysiological research and behavioral/ neuropsychological studies assessing social cognition in ADHD. In particular, we focus our review in studies on emotion recognition, theory of mind, empathy, moral cognition and social decision-making. We emphasize the variability in the degree of social cognition impairments in ADHD and compare them between other comorbid disorders. Finally, we address the pharmacological and non-pharmacological treatments employed for social cognition impairments in ADHD. More generally, we analyze the extent to which social cognition research can help to understand this multidimensional disorder from a more ecological point of view, especially considering the relevance and impact of establishing fulfilling interpersonal relations.