Complex Emotion Recognition in Neurological and Neurodevelopmental Conditions

Social cognition deficits are prevalent but under-recognised in neurological and neurodevelopmental disorders. Complex emotion recognition (CER) - encompassing mentalising, theory of mind, and perspective-taking - is crucial for social functioning but lacks a standardised clinical assessment. We evaluated CER performance across neurological and neurodevelopmental populations using a novel digital screening instrument. A novel online assessment tool using muted video clips of dyadic interactions was administered to six clinical cohorts compared to controls (HC, N = 449): temporal lobe epilepsy (TLE, N = 36), multiple sclerosis (MS, N = 64), autism spectrum disorder (ASD, N = 90), attention deficit hyperactivity disorder (ADHD, N = 54), and healthy adults aged >65 years (H65+, N = 35). Reduced CER scores were observed across all clinical groups compared with HC (n = 455): ASD (Hedges g = -1.12, 95% CI -1.35 to -0.88), TLE (g = -0.93, 95% CI -1.29 to -0.60), H65+ (g = -0.73, 95% CI -1.07 to -0.38), MS (g = -0.65, 95% CI -0.91 to -0.38), and ADHD (g = -0.35, 95% CI -0.63 to -0.06). Significantly reduced scores were most prevalent for ASD (37%), H65+ (28%), and TLE (19%). Complex emotion recognition deficits are pervasive across clinical conditions, with the highest prevalence in individuals with ASD, TLE, and H65+. Our findings demonstrate the clinical importance of routine CER screening in these populations. The COSIMO test provides a practical solution for identifying patients at risk of social cognitive impairment who may benefit from counselling and targeted interventions.