Examining the contribution of mentalization in adolescent attentional difficulties

Attention-Deficit /Hyperactivity disorder (ADHD) is currently conceptualized as a neurodevelopmental disorder, characterized by inattention, impulsivity and hyperactivity. Recent empirical results put into question a strict psychiatric definition of ADHD. First, longitudinal research reveals that the prevalence of ADHD diagnosis in youth decreases with age. Furthermore, functional impairments in daily life tend to persist into adolescence and adulthood even in the absence of a diagnosis. Accumulating evidence suggests that over and above the core cognitive and behavioural symptoms of ADHD, emotion dysregulation and social cognitive impairments (socio-emotional difficulties) represent additional core problems in ADHD. Recent psychological, clinical and neuroscientific studies demonstrate that adolescence represents the critical developmental period where such socio-emotional difficulties can take root. During adolescence, the pubertal as well as academic and social pressures of adolescence fuel socio-emotional maturation until de mid-20s. This maturation process confers to the young adult the possibility to understand self and others in highly complex interpersonal and social interactions. For adolescents diagnosed with ADHD, we hypothesize that attentional difficulties hinder the developmental process of mentalization, that is, the imaginative capacity to understand self and others’ behaviours as driven by intentional mental states such as emotions, desires, beliefs, and the like; in turn, poor mentalization skills come to underlie functional impairments in the interpersonal and professional domains in late adolescence and early adulthood. Consistent with this line of argumentation, emerging evidence suggests that socio-emotional difficulties in ADHD may be associated with disruptions in the development of social cognitive abilities. Importantly, we note that while ADHD as a diagnosis may resorb, important functional impairments, and related societal costs, persist into late adolescence and early adulthood. Therefore, we conceptualize adolescents with ADHD as a heterogeneous population of youth which, however heterogeneous, share a common socio-emotional vulnerability during adolescence linked to impaired mentalization.In this context, the current project has three main objectives. First, we aim to characterize the profile of mentalization impairments in adolescents with ADHD, examining the links between mentalizing, core ADHD symptoms (inattention and hyperactivity/impulsivity), emotion dysregulation and functional impairments, while controlling for executive functions. Second, we wish to identify the neural dynamics underlying mentalization impairments in youth with ADHD, using a sophisticated network approach. Finally, we plan to evaluate a time-limited, focused psycho-educational intervention targeting mentalization skills specifically adapted for youths with ADHD. In order to achieve these objectives, we will combine tools from clinical, developmental and experimental psychology, neuroimaging and evidence-based clinical practice. Our results will allow to elucidate the currently under-investigated profile of social cognition development in adolescents with ADHD, and reveal the associated neural network mechanisms underlying attentional and socio-cognitive processes in ADHD. Aside from the scientific impact of this research, this project offers the opportunity to develop and validate an innovative intervention targeting socio-emotional difficulties in ADHD youth. This intervention represents a valuable complementary approach to standard psychosocial and pharmacological treatments, directly oriented towards improving adolescents’ long-term adaptive functioning and integration in society.