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Disrupted Association between Empathy and Brain Structure in Attention-Deficit/Hyperactivity Disorder
J Korean Acad Child Adolesc Psychiatry
Published online July 27, 2021
© 2021 Korean Academy of Child and Adolescent Psychiatry.

Jeonghwan Lee1,2, Jung-Woo Son1,2, Siekyeong Kim1,2, Ji-eun Kim3, Seungwon Chung1,2, Hei-Rhee Ghim4, Sang-Ick Lee1,2, Chul-Jin Shin1,2, and Gawon Ju1,2

1Department of Psychiatry, Chungbuk National University Hospital, Cheongju, Korea
2Department of Neuropsychiatry, College of Medicine, Chungbuk National University, Cheongju, Korea
3Ma-Eum Pyong-On Psychiatric Clinic, Yongin, Korea
4Department of Psychology, Chungbuk National University, Cheongju, Korea
Correspondence to: Jung-Woo Son, Department of Neuropsychiatry, College of Medicine, Chungbuk National University, 1 Chungdae-ro, Seo-won-gu, Cheongju 28644, Korea
Tel: +82-43-269-6187, Fax: +82-43-267-7951, E-mail:
Received March 28, 2021; Revised April 25, 2021; Accepted May 7, 2021.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objectives: To investigate the relationship between brain structure and empathy in early adolescents with attention-deficit/hyperactivity disorder (ADHD).
Methods: Nineteen early adolescents with ADHD and 20 healthy controls underwent 3T MRI. All the participants were assessed for different aspects of empathy using measures including the Interpersonal Reactivity Index and Empathy Quotient. Cortical thickness and subcortical structural volume based on T1-weighted scans were analyzed using FreeSurfer.
Results: Cognitive empathy (t=-2.52, p=0.016) and perspective taking (t=-2.10, p=0.043) were impaired in the ADHD group compared with the control group. The cluster encompassing the left posterior insular, supramarginal, and transverse temporal cortices [cluster-wise p-value (CWP)=0.001], which are associated with emotional empathy, was significantly smaller in the ADHD group, and the volume of the left nucleus accumbens was greater than that of the control group (F=10.12, p=0.003, effect size=0.22). In the control group, the left superior temporal (CWP=0.002) and lingual cortical (CWP=0.035) thicknesses were positively associated with cognitive empathy, while the right amygdala volume was positively associated with empathic concern (Coef=14.26, t=3.92, p=0.001). However, there was no significant correlation between empathy and brain structure in the ADHD group.
Conclusion: The ADHD group had a smaller volume of the cortical area associated with emotional empathy than the control group, and there was no brain region showing significant correlation with empathy, unlike in the control group.
Keywords : Attention-deficit/hyperactivity disorder; Adolescent; Neuroimaging; Brain cortical thickness; Empathy.

July 2021, 32 (3)
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