Psychological Medicine

Original Articles

Affective functioning and social cognition in Noonan syndrome

E. Wingbermühlea1a2 c1, J. I. M. Eggera1a2a3, W. M. A. Verhoevena1a4, I. van der Burgta5 and R. P. C. Kesselsa1a2a6

a1 Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands

a2 Donders Institute for Brain, Cognition and Behaviour, Centre for Cognition, Radboud University Nijmegen, The Netherlands

a3 Behavioural Science Institute, Radboud University Nijmegen, The Netherlands

a4 Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, The Netherlands

a5 Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

a6 Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands


Background Noonan syndrome (NS) is a common genetic disorder, characterized by short stature, facial dysmorphia, congenital heart defects and a mildly lowered IQ. Impairments in psychosocial functioning have often been suggested, without, however, systematic investigation in a clinical group. In this study, different aspects of affective processing, social cognition and behaviour, in addition to personal well-being, were assessed in a large group of patients with NS.

Method Forty adult patients with NS were compared with 40 healthy controls, matched with respect to age, sex, intelligence and education level. Facial emotion recognition was measured with the Emotion Recognition Task (ERT), alexithymia with both the 20-item Toronto Alexithymia Scale (TAS-20) and the Bermond–Vorst Alexithymia Questionnaire (BVAQ), and mentalizing with the Theory of Mind (ToM) test. The Symptom Checklist-90 Revised (SCL-90-R) and the Scale for Interpersonal Behaviour (SIB) were used to record aspects of psychological well-being and social interaction.

Results Patients showed higher levels of cognitive alexithymia than controls. They also experienced more social distress, but the frequency of engaging in social situations did not differ. Facial emotion recognition was only slightly impaired.

Conclusions Higher levels of alexithymia and social discomfort are part of the behavioural phenotype of NS. However, patients with NS have relatively intact perception of emotions in others and unimpaired mentalizing. These results provide insight into the underlying mechanisms of social daily life functioning in this patient group.

(Received April 05 2011)

(Revised June 02 2011)

(Accepted June 03 2011)

(Online publication July 11 2011)


c1 Address for correspondence: E. Wingbermühle, M.Sc., Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Stationsweg 46, 5803 AC Venray, The Netherlands. (Email: