J Psychiatry Neurosci 2013; 38(6): 407-416
Pilyoung Kim, PhD; Joseph Arizpe, BS; Brooke H. Rosen, BA; Varun Razdan, BS; Catherine T. Haring, BA; Sarah E. Jenkins, BA; Christen M. Deveney, PhD; Melissa A. Brotman, PhD; R. James R. Blair, PhD; Daniel S. Pine, MD; Chris I. Baker, PhD; Ellen Leibenluft, MD
Kim, Rosen, Razdan, Haring, Jenkins, Deveney, Brotman, Blair, Pine, Leibenluft — Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Md., USA; Kim — Department of Psychology, University of Denver, Denver, Colo., USA; Arizpe, Baker — Laboratory of Brain and Cognition, National Institute of Mental Health, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Md., USA
Background: Children with bipolar disorder (BD) or severe mood dysregulation (SMD) show behavioural and neural deficits during facial emotion processing. In those with other psychiatric disorders, such deficits have been associated with reduced attention to eye regions while looking at faces.
Methods: We examined gaze fixation patterns during a facial emotion labelling task among children with pediatric BD and SMD and among healthy controls. Participants viewed facial expressions with varying emotions (anger, fear, sadness, happiness, neutral) and emotional levels (60%, 80%, 100%) and labelled emotional expressions.
Results: Our study included 22 children with BD, 28 with SMD and 22 controls. Across all facial emotions, children with BD and SMD made more labelling errors than controls. Compared with controls, children with BD spent less time looking at eyes and made fewer eye fixations across emotional expressions. Gaze patterns in children with SMD tended to fall between those of children with BD and controls, although they did not differ significantly from either of these groups on most measures. Decreased fixations to eyes correlated with lower labelling accuracy in children with BD, but not in those with SMD or in controls.
Limitations: Most children with BD were medicated, which precluded our ability to evaluate medication effects on gaze patterns.
Conclusion: Facial emotion labelling deficits in children with BD are associated with impaired attention to eyes. Future research should examine whether impaired attention to eyes is associated with neural dysfunction. Eye gaze deficits in children with BD during facial emotion labelling may also have treatment implications. Finally, children with SMD exhibited decreased attention to eyes to a lesser extent than those with BD, and these equivocal findings are worthy of further study.
Submitted Nov. 15, 2012; Revised Mar. 9, 13, 2013; Accepted Mar. 13, 2013.
Acknowledgements: Funding for this study was provided exclusively by the Intramural Research Program of the National Institute of Mental Health (NIMH), National Institutes of Health. We thank the staff of the Emotion and Development Branch at NIMH and the children and families for their participation.
Conflict of interest: None declared.
Contributors: P. Kim, J. Blair, D. Pine, C. Baker, E. Leibenluft and J. Arizpe designed the study. P. Kim, B. Rosen, V. Razdan, C. Haring, S. Jenkins, C. Deveney, M.A. Brotman and D. Pine acquired the data, which P. Kim, V. Razdan, C. Haring, M.A. Brotman, D. Pine, C. Baker, E. Leibenluft and J. Arizpe analyzed. P. Kim, C. Haring, J. Blair and D. Pine wrote the article, which all authors reviewed and approved for publication.
Correspondence to: P. Kim, Department of Psychology, University of Denver, 2155 South Race St., Denver CO 80208-3500; firstname.lastname@example.org