Study sketchnote
Research summary by Kristen McClure, MSW, LCSW
Flourishing Women LLC
Study: Soler-Gutiérrez, A.-M., Sánchez-Carmona, A. J., Albert, J., Hinojosa, J. A., Cortese, S., Bellato, A., & Mayas, J. (2025). Emotion processing difficulties in ADHD: A Bayesian meta-analysis study. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-025-02647-3
Why was this research done?
Researchers have long suspected that some ADHD people have difficulty noticing, identifying, or interpreting emotional information. Individual studies, however, have not always agreed. They also used very different methods: photographs of faces, voices, written words, social scenes, questionnaires, reaction times, and accuracy scores.
The researchers wanted to combine the available evidence and answer three questions:
- Do ADHD people, as a group, perform differently from people without a psychiatric diagnosis on measures of emotion processing?
- Are differences limited to particular emotions, such as anger or fear?
- Do age, sex, medication status, the type of stimulus, or the way performance is measured help explain differences between studies?
What kind of study was this?
This was a systematic review and Bayesian meta-analysis.
A systematic review uses a planned method to search for, select, and evaluate all studies that meet specific rules.
A meta-analysis combines numerical results from many studies to estimate the overall pattern. It does not recruit a new group of participants.
Bayesian analysis estimates how strongly the collected evidence supports different possible conclusions. It combines the study data with a stated starting assumption, called a prior, and updates that assumption as evidence is added. The researchers repeated their analyses using different priors to check whether the results remained stable.
The review followed PRISMA reporting guidelines and was preregistered. Preregistration means the researchers publicly recorded their intended questions and methods before completing the analysis. This makes it harder to quietly change the plan after seeing the results.
How many people and studies were included?
The researchers included:
- 80 studies
- 6,191 participants
- 465 separate comparisons or effect-size observations
- About 53% of participants had ADHD
- About 77% were children or adolescents
- About 72% were male
Each included study compared people diagnosed with ADHD under DSM or ICD criteria with a control group that did not have a psychiatric diagnosis.
The individual studies ranged from 20 to 364 participants. Only 53% reported ADHD presentation or subtype. Information about co-occurring diagnoses and medication was inconsistent.
What did “emotion processing” mean in this review?
The term covered several different abilities and experiences. Studies asked participants to interpret emotion in:
- faces
- eyes
- voices
- words
- scenes
- questionnaires or rating scales
Researchers measured accuracy, reaction time, self-reported experiences, emotional ratings, or body and brain responses.
This is broader than emotion regulation. Emotion regulation is how a person responds to or works with an emotion once it is happening. Emotion processing can include noticing an emotional cue, identifying what it might mean, and preparing a response.
What were the main findings?
1. The ADHD group performed less well overall
Across the combined studies, ADHD participants performed less well than comparison participants on emotion-processing measures. The overall difference was moderate to large (Hedges’ g = -0.65).
Hedges’ g describes the size of the average difference between two groups while adjusting for differences in study size. A negative number here means the ADHD group scored lower on the measures as they were defined by the researchers.
This is a group average. It does not mean every ADHD person has difficulty reading emotions.
2. Differences were found across all emotion categories
The ADHD group had lower average performance for anger, disgust, fear, sadness, surprise, happiness or positive emotion, negative emotion, and neutral stimuli. These emotion-specific differences were smaller than the overall difference.
The study therefore did not identify one emotion that fully explained the pattern.
3. Accuracy detected differences more consistently than speed
Studies measuring whether participants gave a correct answer found clearer group differences than studies measuring how quickly they responded.
This suggests that response speed and correct interpretation should not be treated as interchangeable. A person may respond at a similar speed but interpret fewer cues accurately.
4. Age, sex, and medication status did not explain the findings
The available data did not show that the overall group difference changed according to age, proportion of male participants, or medication status.
This does not prove that these factors never matter. Many included studies had limited or inconsistent information, and most participants were male children or adolescents.
5. The results varied substantially across studies
There was meaningful heterogeneity, which means the size of the group difference was not the same in every study. Different samples, tasks, settings, and definitions of emotion processing probably contributed to this variation.
6. Publication bias was a serious concern
The researchers found a high risk of publication bias. Studies finding a difference are more likely to be published than studies finding no difference. This can make the combined effect look larger than it truly is.
For that reason, the exact size of the reported difference should be interpreted cautiously.
Was the study neurodivergent affirming?
The study was useful, but its language was mainly deficit-based. It repeatedly described a broad emotional-processing “deficit” or “impairment.” This framing can make a group-level difference sound universal and located entirely inside the ADHD person.
More affirming language would describe differences or difficulties in certain emotion-processing tasks and consider the interaction between the person, task, context, attention, stress, familiarity, culture, and communication style.
The control participants were sometimes called “neurotypical,” but the study only established that they did not have a psychiatric diagnosis. Those terms are not necessarily equivalent.
The review also combined many different measures. A questionnaire about one’s emotional experiences is not the same thing as identifying a posed facial expression in a laboratory. Combining them may hide important differences.
The authors acknowledged several limitations and recommended more realistic, dynamic tasks. That is an important strength. Real-life emotion understanding involves context, movement, relationships, language, culture, and time—not only choosing a label for a still photograph.
What can we conclude?
We can reasonably conclude that ADHD groups tend to score lower than non-psychiatric comparison groups on many research measures of emotion processing.
The pattern appears across several emotional categories and is not limited to one age group in the available data.
We cannot conclude that:
- every ADHD person has difficulty understanding emotions
- ADHD people lack empathy
- a person who misreads an expression does not care about others
- the difference is caused directly by ADHD
- medication does not affect emotion processing for any individual
- emotion-processing tasks can diagnose ADHD
- the reported effect size is exact, given the publication-bias risk
The study also could not determine whether the differences were primary or whether they were partly related to attention, working memory, impulsivity, language, co-occurring conditions, task design, or other factors.
What may be useful in real life?
For therapists
Do not assume that a client has understood a facial expression, tone, pause, or change in the room in the same way you intended it.
Use direct, non-shaming questions:
- “What did you notice in their face or voice?”
- “What did you think that cue meant?”
- “Were there other possible meanings?”
- “Would more context make this easier to interpret?”
Offer explicit emotional information when ambiguity is creating distress. Assess attention, working memory, sensory load, anxiety, trauma, autism, language, and relationship history rather than assigning every misunderstanding to ADHD.
For parents and teachers
Avoid interpreting a missed emotional cue as indifference, defiance, or lack of empathy.
State important information clearly: “I’m frustrated because the noise is making it hard for me to think. You are not in trouble. I need the volume lowered.”
After a confusing interaction, help the child reconstruct the context without quizzing or shaming them. Use stories, videos, or real situations with multiple possible interpretations rather than teaching that every facial expression has one correct meaning.
For ADHD people
Missing or misreading a cue does not mean you are uncaring. Emotional information can be fast, subtle, incomplete, or competing with many other demands on attention.
You can ask for clarity:
- “I’m not sure how you meant that.”
- “Could you tell me directly what you’re feeling?”
- “I noticed your tone changed. Is something wrong, or am I reading it differently?”
External clarity is an accommodation, not a failure.
The most important takeaway
Some ADHD people may need emotional information to be clearer, slower, more contextual, or more explicit. Support should improve access to emotional information without treating one communication style as morally superior or assuming that difficulty reading a cue means lack of empathy.
Kristen McClure, MSW, LCSW | Flourishing Women LLC
Soler-Gutiérrez, A.-M., Sánchez-Carmona, A. J., Albert, J., Hinojosa, J. A., Cortese, S., Bellato, A., & Mayas, J. (2025). Emotion processing difficulties in ADHD: A Bayesian meta-analysis study. European Child & Adolescent Psychiatry. https://doi.org/10.1007/s00787-025-02647-3