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Face emotion labeling deficits in children with bipolar disorder and severe mood dysregulation

  • Brendan A. Rich (a1), Mary E. Grimley (a1), Mariana Schmajuk (a1), Karina S. Blair (a1), R. J. R. Blair (a1) and Ellen Leibenluft (a1)...

Children with narrow phenotype bipolar disorder (NP-BD; i.e., history of at least one hypomanic or manic episode with euphoric mood) are deficient when labeling face emotions. It is unknown if this deficit is specific to particular emotions, or if it extends to children with severe mood dysregulation (SMD; i.e., chronic irritability and hyperarousal without episodes of mania). Thirty-nine NP-BD, 31 SMD, and 36 control subjects completed the emotional expression multimorph task, which presents gradations of facial emotions from 100% neutrality to 100% emotional expression (happiness, surprise, fear, sadness, anger, and disgust). Groups were compared in terms of intensity of emotion required before identification occurred and accuracy. Both NP-BD and SMD youth required significantly more morphs than controls to label correctly disgusted, surprised, fearful, and happy faces. Impaired face labeling correlated with deficient social reciprocity skills in NP-BD youth and dysfunctional family relationships in SMD youth. Compared to controls, patients with NP-BD or SMD require significantly more intense facial emotion before they are able to label the emotion correctly. These deficits are associated with psychosocial impairments. Understanding the neural circuitry associated with face-labeling deficits has the potential to clarify the pathophysiology of these disorders.

Corresponding author
Address correspondence and reprint requests to: Brendan A. Rich, National Institute of Mental Health, National Institutes of Health, Building 15K, Room 204, MSC 2670, Bethesda, MD 20892-2670; E-mail:
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S. Baron-Cohen , H. A. Ring , S. Wheelwright , E. T. Bullmore , M. J. Brammer , A. Simmons , (1999). Social intelligence in the normal and autistic brain: an fMRI study. European Journal Neuroscience, 11, 18911898.

S. K. Berument , M. Rutter , C. Lord , A. Pickles , & A. Bailey (1999). Autism Screening Questionnaire: Diagnostic validity. British Journal of Psychiatry, 175, 444451.

D. V. Bishop (1998). Development of the Children's Communication Checklist (CCC): A method for assessing qualitative aspects of communicative impairment in children. Journal of Child Psychology and Psychiatry, 39, 879891.

D. V. Bishop , & G. Baird (2001). Parent and teacher report of pragmatic aspects of communication: Use of the children's communication checklist in a clinical setting. Developmental Medicine and Child Neurology, 43, 809818.

R. J. Blair , & M. Coles (2000). Expression recognition and behavioural problems in early adolescence. Cognitive Development, 15, 421434.

R. J. Blair , L. Jones , F. Clark , & M. Smith (1997). The psychopathic individual: A lack of responsiveness to distress cues? Psychophysiology, 34, 192198.

R. J. Blair , J. S. Morris , C. D. Frith , D. I. Perrett , & R. J. Dolan (1999). Dissociable neural responses to facial expressions of sadness and anger. Brain, 122, 883893.

H. P. Blumberg , C. Fredericks , F. Wang , J. H. Kalmar , L. Spencer , X. Papademetris , (2005). Preliminary evidence for persistent abnormalities in amygdala volumes in adolescents and young adults with bipolar disorder. Bipolar Disorders, 7, 570576.

L. Brody (1985). Gender differences in emotional development: A review of theories and research. Journal of Personality, 53, 102149.

K. Chang , N. E. Adleman , K. Dienes , D. I. Simeonova , V. Menon , & A. Reiss (2004). Anomalous prefrontal–subcortical activation in familial pediatric bipolar disorder: A functional magnetic resonance imaging investigation. Archives of General Psychiatry, 61, 781792.

D. Cicchetti , & W. J. Curtis (2005). An event-related potential study of the processing of affective facial expressions in young children who experienced maltreatment during the first year of life. Developmental Psychopathology, 17, 641677.

L. M. De Sonneville , C. A. Verschoor , C. Njiokiktjien , V. Op het Veld , N. Toorenaar , & M. Vranken (2002). Facial identity and facial emotions: Speed, accuracy, and processing strategies in children and adults. Journal of Clinical and Experimental Neuropsychology, 24, 200213.

M. P. Delbello , M. E. Zimmerman , N. P. Mills , G. E. Getz , & S. M. Strakowski (2004). Magnetic resonance imaging analysis of amygdala and other subcortical brain regions in adolescents with bipolar disorder. Bipolar Disorders, 6, 4352.

D. P. Dickstein , E. E. Nelson , E. B. McClure , M. E. Grimley , L. Knopf , M. A. Brotman , (2007). Cognitive flexibility in phenotypes of pediatric bipolar disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 341355.

K. A. Dodge , J. E. Lansford , V. S. Burks , J. E. Bates , G. S. Pettit , R. Fontaine , (2003). Peer rejection and social information-processing factors in the development of aggressive behavior problems in children. Child Development, 74, 374393.

T. R. Goldstein , D. J. Miklowitz , & K. L. Mullen (2006). Social skills knowledge and performance among adolescents with bipolar disorder. Bipolar Disorders, 8, 350361.

M. L. Gorno-Tempini , S. Pradelli , M. Serafini , G. Pagnoni , P. Baraldi , C. Porro , (2001). Explicit and incidental facial expression processing: An fMRI study. NeuroImage, 14, 465473.

A. L. Gross , & B. Ballif (1991). Children's understanding of emotion from facial expression and situations: A review. Developmental Review, 11, 368398.

A. E. Guyer , E. B. McClure , A. Adler , M. A. Brotman , B. A. Rich , D. S. Pine , (2007). Specificity of facial expression labeling deficits in childhood psychopathology. Journal of Clinical Psychology and Psychiatry, 48, 863871.

J. Kaufman , B. Birmaher , D. Brent , U. Rao , C. Flynn , P. Moreci , (1997). Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (K-SADS-PL): Initial reliability and validity data. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 980988.

P. M. Lewinsohn , J. R. Seeley , & D. N. Klein (2003). Bipolar disorders during adolescence. Acta Psychiatrica Scandinavica Supplementum, 4750.

J. S. March , J. D. Parker , K. Sullivan , P. Stallings , & C. K. Conners (1997). The Multidimensional Anxiety Scale for Children (MASC): Factor structure, reliability, and validity. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 554565.

R. Markham & K. Adams (1992). The effect of type of task on childrens' identification of facial expressions. Journal of Nonverbal Behavior, 16, 2139.

E. B. McClure (2000). A meta-analytic review of sex differences in facial expression processing and their development in infants, children, and adolescents. Psychological Bulletin, 126, 424453.

E. B. McClure , J. E. Treland , J. Snow , M. Schmajuk , D. P. Dickstein , K. E. Towbin , (2005). Deficits in social cognition and response flexibility in pediatric bipolar disorder. American Journal of Psychiatry, 162, 16441651.

J. S. Morris , C. D. Frith , D. I. Perrett , D. Rowland , A. W. Young , A. J. Calder , (1996). A differential neural response in the human amygdala to fearful and happy facial expressions. Nature, 383, 812815.

S. W. Parker , & C. A. Nelson (2005). The impact of early institutional rearing on the ability to discriminate facial expressions of emotion: An event-related potential study. Child Development, 76, 5472.

D. L. Penn , K. T. Mueser , W. Spaulding , D. A. Hope , & D. Reed (1995). Information processing and social competence in chronic schizophrenia. Schizophrenia Bulletin, 21, 269281.

M. L. Phillips , E. T. Bullmore , R. Howard , P. W. Woodruff , I. C. Wright , S. C. Williams , (1998). Investigation of facial recognition memory and happy and sad facial expression perception: An fMRI study. Psychiatry Research, 83, 127138.

M. L. Phillips , A. W. Young , C. Senior , M. Brammer , C. Andrew , A. J. Calder , (1997). A specific neural substrate for perceiving facial expressions of disgust. Nature, 389, 495498.

D. L. Pogge , D. Wayland-Smith , M. Zaccario , S. Borgaro , J. Stokes , & P. D. Harvey (2001). Diagnosis of manic episodes in adolescent inpatients: Structured diagnostic procedures compared to clinical chart diagnoses. Psychiatry Research, 101, 4754.

S. D. Pollak , D. Cicchetti , K. Hornung , & A. Reed (2000). Recognizing emotion in faces: Developmental effects of child abuse and neglect. Developmental Psychology, 36, 679688.

S. D. Pollak , & D. J. Kistler (2002). Early experience is associated with the development of categorical representations for facial expressions of emotion. Proceedings of the National Academy of Sciences of the United States of America, 99, 90729076.

B. A. Rich , M. Schmajuk , K. E. Perez-Edgar , N. A. Fox , D. S. Pine , & E. Leibenluft (2007). Different psychophysiological and behavioral responses elicited by frustration in pediatric bipolar disorder and severe mood dysregulation. American Journal of Psychiatry, 164, 309317.

B. A. Rich , D. Vinton , R. Roberson-Nay , R. Hommer , L. Berghorst , E. McClure , (2006). Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder. Proceedings of the National Academy of Sciences of the United States of America, 103, 89008905.

J. J. Rucklidge (2006). Psychosocial functioning of adolescents with and without paediatric bipolar disorder. Journal of Affective Disorders, 91, 181188.

D. Shaffer , M. S. Gould , J. Brasic , P. Ambrosini , P. Fisher , H. Bird , (1983). A Children's Global Assessment Scale (CGAS). Archives of General Psychiatry, 40, 12281231.

R. Sprengelmeyer , M. Rausch , U. T. Eysel , & H. Przuntek (1998). Neural structures associated with recognition of facial expressions of basic emotions. Proceedings in Biological Sciences/ The Royal Society, 265, 19271931.

D. Stevens , T. Charman , & R. J. Blair (2001). Recognition of emotion in facial expressions and vocal tones in children with psychopathic tendencies. The Journal of Genetic Psychology, 162, 201211.

M. J. Taylor , M. Batty , & R. J. Itier (2004). The faces of development: A review of early face processing over childhood. Journal of Cognitive Neuroscience, 16, 14261442.

M. Wilke , R. A. Kowatch , M. P. Delbello , N. P. Mills , & S. K. Holland (2004). Voxel-based morphometry in adolescents with bipolar disorder: First results. Psychiatry Research, 131, 5769.

D. Wilkinson & P. Halligan (2004). The relevance of behavioural measures for functional-imaging studies of cognition. Nature Reviews. Neuroscience, 5, 6773.

R. C. Young , J. T. Biggs , V. E. Ziegler , & D. A. Meyer (1978). A rating scale for mania: Reliability, validity and sensitivity. Britsh Journal of Psychiatry, 133, 429435.

D. A. Yurgelun-Todd , S. A. Gruber , G. Kanayama , W. D. Killgore , A. A. Baird , & A. D. Young (2000). fMRI during affect discrimination in bipolar affective disorder. Bipolar Disorders, 2, 237248.

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Development and Psychopathology
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