Vocal emotion recognition in attention-deficit hyperactivity disorder: a meta-analysis

Figures & data

Figure 1. PRISMA flowchart of literature search.

Table 1a. Participant characteristics of included studies.

Study	Age Group	ADHD Outcome Variable / Type	ADHD (N)	Age, mean years (SD)	Female (%)	IQ, mean	Medication Status	Presence of CD or ODD	TD (N)	Age, mean years (SD)	Female (%)	IQ, mean (SD)
Chronaki, Garner, et al. (2015)	Children	Hyperactive/Impulsive (Continuous)	16	5.2 (0.9)	25	N/A	N/A	Mix	41	4.2 (0.7)	49	N/A
Chronaki, Benikos, et al. (2015)	Children	Combined (Categorical)	25	8.9 (1.5)	4	99.0 (10.8)	Medicated but withdrew (24hrs)	3 samples: with CD, excluded CD, mix	25	9.0 (1.5)	8	102.6 (10.2)
Sells et al. (Unpublished)	Adults	Inattentive, Hyperactive/Impulsive (Continuous)	0	N/A	N/A	N/A	N/A	N/A	26	26.7 (4.0)	65	N/A
	Adolescents		0	N/A	N/A	N/A	N/A	N/A	23	14.3 (1.4)	65	N/A
Kis et al. (2017)	Adults	Combined (Categorical)	28	33.8 (8.9)	36	109.4 (9.30)	N/A	CD excluded	29	36.5 (11.4)	52	110.2 (8.9)
Kochel et al. (2015)	Children	Combined (Categorical)	14	10.3 (17.4)	0	99.3 (11.9)	Medicated but withdrew (24 hrs)	N/A	14	10.2 (11.3)	0	107.3 (8.9)
Cadesky et al. (2000)	Children	Combined (Categorical)	86	9.0 (1.4)	17	97.3 (12.5)	Medicated but withdrew (24 hrs)	2 samples: with CD, excluded CD	27	9.3 (1.4)	40	108.4 (17.1)
Grabemann et al. (2013)	Adults	Combined (Categorical)	20	30.3 (9.4)	0	112.7 (11.2)	Medicated but withdrew (24 hrs)	N/A	20	27.9 (6.0)	0	112.7 (10.2)
Corbett and Glidden (2000)	Children	Combined (Categorical)	37	10.1 (1.78)	30	100 (11.1)	Medicated but withdrew (24 hrs)	N/A	37	9.5 (1.9)	49	113 (14.5)
Waddington et al. (2018)	Children and Adolescents	Combined (Categorical)	111	12.6 (1.7)	49	99.5 (14.1)	Mix	N/A	220	13.1 (2.3)	50	105.2 (12.4)
Noordermeer et al. (2020)	Adolescents	Combined (Categorical)	82	16.3 (3.0)	33	96.9 (11.0)	Medicated but withdrew (48 hrs)	2 samples: mix, with ODD	82	16.1 (3.3)	33	98.3 (7.3)
Hall et al. (1999)	Children	Combined (Categorical)	15	N/A	N/A	N/A	2 Samples: On Medication, Medicated but withdrew (24 hrs)	N/A	15	N/A	N/A	N/A
Plećević et al. (2021)	Children	Combined (Categorical)	31	9.25 (1.9)	N/A	N/A	Non-Medicated	N/A	29	9.25 (1.9)	N/A	N/A
Miller et al. (2011)	Adults	2 samples: Combined, (Categorical)	17	33.4 (11.45)	35	114.2 (8.3)	Medicated but withdrew (24 hrs)	N/A	18	31.9 (7.7)	28	121.9 (11.7)
		Inattentive		36.4 (10.7)		116.3 (14.4)
Rapport et al. (2002)	Adults	Combined (Categorical)	28	36.3 (10.9)	42	106.7 (8.8)	N/A	N/A	28	33.4 (11.5)	46	105.2 (8.4)
Norvilitis et al. (2000)	Children	Combined (Categorical)	44	10.0 (2.1)	30	N/A	On Medication	N/A	36	10.6 (3.1)	45	N/A
Hanford (2000)	Adults	2 samples(Categorical): Combined,	17	33.4 (11.5)	35	114.2 (8.3)	Mix	N/A	18	31.9 (7.7)	28	121.9 (11.7)
		Inattentive		36.4 (10.7)		116.3 (14.3)
Techentin (2009) (Unpublished)	Adolescents	Combined (Categorical)	39	12.4 (1.0)	0	N/A	Medicated but withdrew (24 hrs)	N/A	39	12.4 (1.04)	0	N/A
Abraham (2004) (Unpublished)	Adults	Combined (Categorical)	31	20.7 (SD not reported)	51	N/A	Mix	N/A	31	23.8 (SD not reported)	77	N/A
Friedman (2000) (Unpublished)	Adults	Combined (Categorical)	32	36.9 (11.2)	42	102.6 (14.6)	N/A	N/A	41	34.6 (11.6)	55	97.9 (15.1)
Zuberer et al. (2020)	Adults	Combined (Categorical)	44	30 (7.0)	23	N/A	Medicated but withdrew (24hrs)	N/A	43	28.2 (6.5)	42	N/A
Aldea (2013) (Unpublished)	Children	Combined (Categorical)	13	8.5 (SD not reported)	23	100.5 (15.5)	Medicated but withdrew (24 hrs)	N/A	16	8.4 (SD not reported)	56	118.3 (11.3)

Table 1b. Design characteristics of included studies.

Study	How study diagnosed ADHD	Definition of ADHD	Informants of Categorical Diagnosis	Continuous Measure of ADHD	Informants of Continuous Measure	VER Task / Battery	Task Response	Linguistic Stimuli / Voice	Emotion Types Included	Total no. Trials
Chronaki, Garner, et al. (2015)	NA (Continuous Study)	DSM-IV	Professional	SDQ (Goodman, 1997)	Parent	DANVA 2	Verbal Naming	Semantically neutral phrase (English Adult Female)	Generic, Ang, Sad, Hap, Neu	70
Chronaki, Benikos, et al. (2015)	Research and Clinical Diagnosis	DISC-IV	Professional	SDQ (Goodman, 1997)	Parent and Teacher	Maurage et al. (2007)	Button Press	Interjection sound “ahh” (Adult Female)	Generic, Ang, Sad, Neu	360
Sells et al. (Unpublished)	NA (Continuous Study)	DSM-IV	NA	SDQ (Goodman, 1997)	Self	Maurage et al. (2007)	Button Press	Interjection sound “ahh” (Adult)	Generic, Ang, Hap, Neu	156
Kis et al. (2017)	Clinical Diagnosis	DSM-IV-TR	Professional	ADHS (Rösler et al., 2004), WURS-K (Retz-Junginger et al., 2002)	Self	Tübinger Affect Battery (TAB; Breitenstein et al., 1996)	Verbal Naming	Semantically neutral phrase (German Adult Female)	Generic, Ang, Sad, Fear, Hap, Neu	20
Kochel et al. (2015)	Clinical Diagnosis	DSM-IV-TR	Professional and Parent	FBB-ADHS (Döpfner, Görtz-Dorten, Lehmku, 2008), CBCL (Döpfner, Schmeck & Berner, 1994)	Parent/ Teacher	TAB	Verbal Naming	Semantically neutral phrase (German Adult Female)	Generic, Ang, Sad, Fear, Hap, Neu	12
Cadesky et al. (2000)	Research Diagnosis	DSM-IV	Parent and Teacher	Parent and Teacher Interview (Schacher et al., 1995),	Parent / Teacher	DANVA 2	Verbal Naming	Semantically Neutral (English Adult & Child)	Generic	40
Grabemann et al. (2013)	Clinical Diagnosis	DSM-IV	Professional	ADHS (Rösler et al., 2004), WURS-K (Retz-Junginger et al., 2002)	Self	TAB	Verbal Naming	Semantically Neutral Phrase (German Adult Female)	Generic	15
Corbett and Glidden (2000)	Clinical Diagnosis and Parent Account	DSM-IV	Professional and Parent	CPRS (Goyette, Conners & Ulrich, 1978)	Parent	The Prosody Test (Tucker et al., 1977)	Point	Semantically Neutral Phrase (English)	Generic	16
Waddington et al. (2018)	Clinical and Research Diagnosis and Parent Account	DSM-IV	Professional and Parent	SCQ (Rutter, Baily & Lord, 2003), CPRS (Goyette et al. 1978)	Self and Parent	Amsterdam Neuropsychological Tasks (ANT; De Sonneville, 1999),	Verbal Naming	Semantically Neutral Phrase (Dutch Adult)	Generic, Ang, Hap, Sad, Fear	48
Noordermeer et al. (2020)	Clinical and Research Diagnosis	DSM-IV	Professional, Parent, Teacher	CTRS-R:L, CAARS-S:L (Conners 1990; Goyette et al. 1978)	Self and Teacher	ANT	Verbal Naming	Semantically Neutral Phrase (Dutch Adult)	Ang, Hap, Sad, Fear	48
Hall et al. (1999)	Clinical Diagnosis	DSM-IV	Professional	HESB, WPBIC	Parent and Teacher	DANVA	Verbal Naming	Semantically Neutral (English Child Female)	Generic	16
Plećević et al. (2021)	Clinical Diagnosis	DSM-IV-TR	Professional and Parent	SNAP-IV	Parent and Teacher	GEES (Jovičić et al., 2004)	Verbal Naming	Semantically Neutral Phrase (Serbian Adult)	Generic, Ang, Hap, Sad, Fear	18
Miller et al. (2011)	Clinical and Research Diagnosis	DSM-IV	Professional	DSM-IV Subscales (Murphy & Barkley, 1995)	Self and Other (Spouse, Friend or Parent)	DANVA 2	Verbal Naming	Semantically Neutral Phrase (English Adult)	Generic, Ang, Hap, Sad, Fear	24
Rapport et al. (2002)	Clinical Diagnosis	DSM-IV	Professional	ADHD Symptom Checklists (Barkley & Murphy, 1998)	Self	DANVA 2	Verbal Naming	Semantically Neutral Phrase (English Adult)	Generic	24
Norvilitis et al. (2000)	Clinical and Research Diagnosis	DSM-IV	Professional and Parent	CPRS (Conners, 1990)	Parent	Rothenberg (1970)	Verbal Naming	Semantically Neutral Phrase	Generic	N/A
Hanford (2000) (Unpublished)	Clinical and Research Diagnosis	DSM-IV	Professional	DSM-IV Subscale (Murphy & Barkley, 1995)	Self	DANVA 2	Verbal Naming	Semantically Neutral Phrase (Adult)	Generic	24
Techentin (2009) (Unpublished)	Clinical Diagnosis	DSM-IV	Professional	CBLC – Attention Scale (Dopfner, Schmeck & Berner, 1994)	Parent	Binaural Word Task	Verbal Naming	Pseudo Word (Adult Female)	Generic	18
Abraham (2004) (Unpublished)	Standardised Self-Report Questionnaire, and Clinical Diagnosis	DSM-IV	Self and Professional	CAARS (Conners, 1990)	Self	DANVA 2	Verbal Naming	Semantically Neutral Phrase (English Adult)	Generic, Ang, Hap, Sad, Fear	24
Friedman (2000) (Unpublished)	Clinical and Research Diagnosis	DSM-IV	Professional, Patients, Parents, Spouse	ADHD Symptom Checklist (Barkley & Murphy, 1998)	Self	DANVA 2	Verbal Naming	Semantically Neutral Phrase (English Adult)	Generic	24
Zuberer et al. (2020)	Clinical Diagnosis	DSM-IV	Professional	ADHS (Rösler et al., 2004), WURS-K (Retz-Junginger et al., 2002)	Self	Bisch et al. (2016)	Button Press	Meaningful Word (German Adult)	Generic, Ang, Hap, Sad, Dis, Ero	60
Aldea (2013) (Unpublished)	Clinical Diagnosis and Parent Account	DSM-IV-TR	Professional and Parent	CBCL (Dopfner, Schmeck & Berner, 1994)	Parent	DANVA 2	Verbal Naming	Semantically Neutral Phrase (English Adult & Child)	Generic	24

Table 2. Numerical trends (SMD and Standard Error) of vocal emotion recognition deficits for all categorical exploratory moderator variables.

Variable	Condition	SMD	Standard Error	Outcomes (k)	No. Studies
Theoretical Moderators
Emotion Type	Angry	−0.45**	0.14	18	11
	Happy	−0.31***	0.07	16	11
	Sad	−0.43**	0.13	10	8
	Fearful	−0.30	0.20	8	6
	Neutral	−0.44	0.06	9	6
Emotion Valence	Positive	−0.31***	0.07	16	11
	Negative	−0.47***	0.12	34	11
Participant Characteristics
Age Group	Children	−0.75***	0.21	14	9
	Adolescents	−0.195	0.18	11	4
	Adults	−0.47***	0.07	11	9
Outcome Variable	Continuous	−0.56	0.03	3	2
	Categorical	−0.53***	0.19	33	19
ADHD- Subtype	ADHD-Predominantly Inattentive	−0.65	0.11	8	3
	ADHD- Predominantly Hyperactive/Impulsive	−0.54	0.05	7	2
	ADHD- Combined	−0.51***	0.11	33	20
ADHD Comorbid CD	ADHD with comorbid CD	−0.43	0.58	5	2
	ADHD without CD	−0.20	0.13	10	4
ADHD Medication Status	Withdrew for study	−0.39**	0.13	23	11
	Not reported or Mixed Status	0.46***	0.08	10	8
	Non-medicated	−2.25	0.11	1	1
	On medication	−0.52	0.34	2	2
Design Characteristics
VER Task	DANVA	−0.45***	0.11	16	9
	Maurage et al	−0.61	0.13	3	2
	TAB	−0.65	0.09	3	3
	Prosody Test	−0.78	0.06	1	1
	ANT	−0.17	0.14	9	2
	GEES	−2.25	0.11	1	1
	Rothenberg	−0.79	0.01	1	1
	Binaural Word	0.26	0.05	1	1
	Bisch et al	−0.38	0.05	1	1
Response Type	Verbal Naming	−0.52***	0.13	31	17
	Button Press	−0.63	0.14	5	3
	Point	−0.78	0.06	1	1
Linguistic Stimuli Type	Semantic Neutral Phrase	−0.58***	0.12	31	17
	Interjection Sound	−0.61	0.13	3	2
	Nonsense Word	0.26	0.05	1	1
	Meaningful Word	−0.38	0.05	1	1
Voice Type	Adult Female	−0.48**	0.17	6	6
	Adult Mix Gender	−0.54***	0.17	23	12
	Child	−0.39	0.30	5	3
Language of Stimuli	English	−0.54***	0.1	18	11
	German	−0.54	0.11	4	4
	Dutch	−0.17	0.14	9	2
	No Language	−0.33	0.31	4	3
	Serbian	−2.25	0.11	1	1
Source Characteristics
Publication Status	Published	−0.58***	0.12	29	16
	Unpublished	−0.37	0.22	7	5

Note. We can only reliably interpret those in bold, as the df was more than 4 when undertaking the analysis using RVE. All other results should be interpreted with caution due to paucity of data.

Figure 2. Forest plot showing SMD (hedges g) for 20 studies which included a generic VER accuracy score, and the corresponding weight of each effect size.

Table 4. Table showing the effect size (Standardise Mean Difference; SMD) and associated statistics for the sensitivity analyses, with and without outliers (w/o).

	Meta-Analyses									Tests for Publication Bias
Distribution										Eggers Test		Trim and Fill.
	Type	k	No. Studies	SMD	CI (95%)	PI (95%)	Q	I²(%)	Tau	z	p (sig)	No. Inputted Studies (Left or Right Side)	t&f SMD	t&f CI (95%)	Associated Funnel Plot
Generic VER (w/o)	RVE	26	18	−0.52	[−0.67, −0.38]	N/A	N/A	40	.03	N/A	N/A	N/A
Generic VER (No Medication)	RVE	19	13	−0.59	[−0.96, −0.24]	N/A	N/A	77.90	.23	N/A	N/A	N/A
Generic VER	Naïve	25	20	−0.53	[−0.71, −0.35]	[−1.26, 0.19]	69.83	70.19	.36	0.26	.793	6 (L)	−0.696	[−0.89, −0.50]	Figure 3
Generic VER (w/o)	Naïve	23	18	−0.51	[−0.63, −0.39]	[−0.83, −0.19]	30.66	30.05	.15	0.21	.835	1(L)	−0.512	[−0.63, −0.39]	Figure 4

Note. Columns 1–4 display the generic VER distribution of means analysed with or without outliers (w/o), the type of analyses (Robust Variance Estimation; RVE, or a Naïve Random-Effects analyses), the number of effects included (k), and the number of studies included in the analysed distributions respectively. Columns 5 to 9 provide the estimated mean standardised mean difference (SMD) effect size, 95% confidence intervals (CI), 95% prediction intervals (PI), the weighted sum of squared deviations from the mean (Q) and the ratio of true heterogeneity to total variance across observed effect sizes (I²) and the estimate of between study variance (tau) for each analysed distribution. Columns 10 to 14 report the publication bias results. This includes the eggers test for funnel plot asymmetry statistics (z and p), and the trim and fill (t&f) analyses statistics, including the estimated number of missing studies on the left (L) or right (R) side, the trim and fill adjusted observed standardise mean difference (t&f SMD), and the trim and fill adjusted 95% confidence intervals (t&f CI). Funnel plots for sensitivity analyses are displayed in Figures 3 and 4.

Figure 3. Funnel plot for generic VER analysis.

Figure 4. Funnel plot for generic VER analysis without outliers.

Table 3. Table showing coefficient estimate, and associated t values, significance (p values), and CI of emotion type and valence moderator analyses.²

Moderator	Coefficient	T	p	CI	df
Emotion Type
Anger vs Happiness	−0.18	1.39	.194	[−0.11, 0.46]	9.20
Anger vs Fear	−0.18	1.04	.333	[−0.24, 0.60]	6.58
Anger vs Neutral	−0.01	0.06	.951	[−0.42, 0.44]	6.36
Anger vs Sadness	−0.02	0.25	.812	[−0.18, 0.22]	8.20
Valence
Negative vs Positive	−0.13	1.04	.323	[−0.15, 0.40]	9.32
Negative vs Neutral	0.04	0.22	.836	[−0.44, 0.39]	5.83

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Data availability statement

The data that support the findings of this study are openly available in Open Science Framework at DO I 10.17605/OSF.IO/GJM4D.