In ADHD, Attention Difficulty Concentrates at Noticing

What the research found

A child sits at a screen and is shown a photograph cropped to a narrow strip, a pair of eyes and nothing else. Four words appear underneath, and the child chooses the one that fits what the person is thinking or feeling. The task is called Reading the Mind in the Eyes, and some version of it recurs throughout this literature.

That task and its relatives supplied much of the evidence in a systematic review published in the journal Healthcare in 2023 by Olber Eduardo Arango-Tobón, Alexandra Guevara Solórzano and colleagues at Luis Amigó Catholic University in Medellín, Colombia. Searching PubMed and Scopus under the PRISMA protocol, they assembled fifty-one studies of social cognition and prosocial behaviour in children and adolescents with ADHD, published between 2000 and 2021, with 2,439 participants in total. Twenty-four examined theory of mind, the capacity to work out what another person knows, wants or believes.

The reviewers report that 96.4 percent of the pooled participants presented deficits in social cognition, although the review does not explain how that figure was derived. In Belgium, Mary and colleagues gave the eyes task and a faux pas recognition test to thirty-one children with ADHD and thirty-one without, aged eight to twelve, and the ADHD group performed more poorly. Not every study agreed. A Chinese sample of twenty-six children with ADHD and thirty controls showed no significant difference on classic false-belief tasks, and an Italian study of twenty-three and twenty found none on theory of mind or emotion regulation.

One distinction survived across the review. Children with ADHD performed worse when asked to work out what another person was thinking, and on affective theory of mind their performance matched that of control children, while affective recognition did not. Inferring what someone feels was intact; identifying the emotion on their face was not.

Prosocial behaviour, the review’s second term, was established by other means entirely: parent and teacher rating scales, social skills questionnaires and structured interviews. In a Dutch study of ninety-four children with ADHD and thirty-seven controls aged six and seven, teachers rated the children as less empathic and parents did not. The authors close by calling for behavioural measures, because the review contains none: not one of the fifty-one studies put a child where helping was possible and recorded what they did.

What it means for you and your child

What the review reports most consistently is difficulty working out what another person is thinking, tested as a still photograph of a pair of eyes. Whether children with ADHD then behave less kindly than other children is a different question, and the fifty-one studies answered it with questionnaires alone.

A rating scale asks an adult to compress a year of a child’s conduct into a number, and for that purpose it is a reasonable instrument. It gathers what a parent or a teacher has actually seen, across many days, in the rooms where children live. What it cannot do is separate a child who never registered that help was wanted from a child who registered it and was already halfway through something else. Both produce the same low rating from an adult who saw only the ending.

The review tested no spoken signals, so what follows is an extension of its finding rather than part of it: a friend who says out loud that they want a turn has removed the inference the task found hardest. Naming the change aloud as it happens restores the information that went missing.

There are real limits here. The cross-sectional studies supply much of the evidence in this review, most samples are small, and the reviewers themselves note that some instruments are questionable measures of social cognition. This is a narrative synthesis rather than a meta-analysis, with no pooled effect sizes, so it can report that the difficulty is consistent and cannot say how large it is in any individual child.

A low prosocial score, then, records what the adults around a child concluded from watching, and the review holds no evidence at all about whether these children would help when helping was possible. Nobody put them in the room. A number arrived at by that route has no verdict to deliver on your child’s kindness, whatever the report has done with it.