emotional dysregulation subgroups in patients with adult Attention- Deficit/Hyperactivity Disorder (ADHD): a cluster analytic approach OPEN (original) (raw)
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Journal of Child Psychology and Psychiatry, 2018
Background: Because emotional symptoms are common in attention-deficit/hyperactivity disorder (ADHD) patients and associate with much morbidity, some consider it to be a core feature rather than an associated trait. Others argue that emotional symptoms are too nonspecific for use as diagnostic criteria. This debate has been difficult to resolve due, in part, to the many terms used to describe emotional symptoms in ADHD and to concerns about overlap with mood disorders. Methods: We sought to clarify the nature of emotional symptoms in ADHD by reviewing conceptual and measurement issues and by examining the evidence base regarding specificity of such symptoms for ADHD. We reviewed the various terms used to define emotional symptoms in ADHD, clarify how these symptoms are demarcated from mood disorders, and assess the possibility that symptoms of emotional impulsivity and deficient emotional self-regulation should be considered as core symptoms. We addressed psychiatric comorbidities, the effects of ADHD treatments on associated emotional dysregulation, and the utility of current rating scales to assess emotional symptoms associated with ADHD. Results: Emotional symptoms are common and persistent in youth and adults with ADHD. Although emotional symptoms are common in other psychiatric disorders, emotional impulsivity (EI), and deficient emotional self-regulation (DESR) may be sufficiently specific for ADHD to function as diagnostic criteria. Conclusions: Emotional symptoms in ADHD cause clinically significant impairments. Although there is a solid theoretical rationale for considering EI and DESR to be core symptoms of ADHD, there is no consensus about how to define these constructs sin a manner that would be specific to the disorder. An instrument to measure EI and DESR which demarcates them from irritability and other emotional symptoms could improve the accuracy of diagnostic criteria for ADHD.
Emotion Regulation and heterogeneity in Attention-Deficit/Hyperactivity Disorder
Objective: How best to capture heterogeneity in attention-deficit/hyperactivity disorder (ADHD) using biomarkers has been elusive. This study evaluated whether emotion reactivity and regulation provide a means to achieve this. Method: Participants were classified into three groups: children with ADHD plus low prosocial behavior (hypothesized to be high in callous/unemotional traits; n ¼ 21); children with ADHD with age-appropriate prosocial behavior (n ¼ 54); and typically developing children (n ¼ 75). Children completed a task with four conditions: negative induction, negative suppression, positive induction, and positive suppression of affect. The task required children to view an emotion-laden film clip, while either facially mimicking (induction) or masking (suppression) the emotion of the main character. Parasympathetic and sympathetic nervous system activity were assessed via respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP), respectively. Symptoms of anxiety, conduct, and oppositional defiant disorders were treated as covariates. Results: The ADHDtypical- prosocial group displayed atypically elevated parasympathetic reactivity (emotion dysregulation) during positive induction, along with increased sympathetic activity (elevated arousal) across conditions. In contrast, the ADHD-low-prosocial group displayed reduced parasympathetic reactivity and reduced sympathetic activity (low emotional arousal) across baseline and task conditions. Thus, both ADHD groups had altered patterns of autonomic functioning, but in two distinct forms. Conclusion: Although ADHD is heterogeneous clinically, results suggest that ADHD is also heterogeneous with regard to physiological indices of emotion and regulation. Future studies of emotion, regulation, and ADHD should take this into account. Further study of physiological responding in ADHD may yield clinically and etiologically distinct domains or groups. J. Am. Acad. Child Adolesc. Psychiatry; 2013; 52(2):163-171. Key Words: attention-deficit/hyperactivity disorder, autonomic nervous system, callous/unemotional traits, emotionality, emotion regulation
Borderline Personality Disorder and Emotion Dysregulation
Background: Emotional dysregulation (ED) is now considered as an important symptom of attention deficit hyperactivity disorder (ADHD). It is believed to have a considerable impact on the severity of the disorder, one's global functioning, and the prognosis. Our research aimed to evaluate and compare ED and cognitive emotional regulation strategies between ADHD and borderline personality disorder (BPD) patients. Methods: Four hundred six French-speaking outpatients (N = 279 ADHD, N = 70 BPD, N = 60 BPD + ADHD) were assessed with the Emotion Reactivity Scale (ERS), the Cognitive Emotional Regulation Questionnaire (CERQ), The Basic Empathy Scale (BES-A), the Adult ADHD Self-Report Scale (ARSV-v1.1) and the Beck Depression Inventory II (BDI-II). ADHD, BPD and comorbid patients were compared with each other and with samples of controls extracted from already published data. Results: ADHD patients, although having higher ED than samples derived from the general population, had less ED, better control over their emotions with higher use of adaptive cognitive strategies and lesser use of non-adaptive strategies than BPD patients. However, ADHD subjects had similar scores as BPD subjects when looking at difficulties in perceiving self and others. ED generated considerable distress in all groups and was also positively associated with ADHD symptomatology. ADHD patients with comorbid BPD had the highest scores of ED. Conclusions: Our results suggest that there may be similarly inefficient cognitive emotional regulation skills leading to ED in both disorders (ADHD and BPD). However, ADHD patients showed a higher use of adaptive cognitive emotional strategies and a lower level of ED than BPD patients.
Is emotional dysregulation part of the psychopathology of ADHD in adults?
ADHD Attention Deficit and Hyperactivity Disorders, 2013
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Emotional deficits in adult ADHD patients: an ERP study
Social Cognitive and Affective Neuroscience, 2009
This study examined general deficits in positive stimuli evaluation in adults with Attention Deficit Hyperactivity Disorder (ADHD). We investigated the event-related potentials to positive, negative and neutral pictures in 32 adults with ADHD and 32 control subjects. For this study we measured 21 electrodes placed in accordance with the international 10-20 system and calculated the early posterior negativity (EPN), which physiologically is characterized by more negative values for emotional as compared to neutral stimuli. We found significantly reduced EPN values for the ADHD patients compared to the healthy controls, but only in the positive stimuli condition, without any significant differences in the negative stimuli condition. Our data indicate that ADHD patients show less reactivity to positive visual stimuli which might be relevant in the context of described dysfunctions of the motivational-reward system in ADHD.
Journal of Abnormal Child Psychology, 2011
Despite growing interest in conceptualizing ADHD as involving disrupted emotion regulation, few studies have examined the physiological mechanisms related to emotion regulation in children with this disorder. This study examined parasympathetic and sympathetic nervous system reactivity via measures of respiratory sinus arrhythmia (RSA) and cardiac pre-ejection period (PEP) in children with ADHD (n=32) and typically developing controls (n=34), using a novel emotion task with four conditions: negative induction, negative suppression, positive induction, and positive suppression of affect. Both groups showed strong task-response effects in RSA. However, typically developing children showed systematic variation in parasympathetic activity (RSA) depending on both emotion valence (more activation for negative emotion, reduced activation for positive emotion) and task demand (more activation for suppression than induction). In contrast, children with ADHD displayed a stable pattern of elevated parasympathetic activity (RSA) across all task conditions compared to baseline. No group differences in sympathetic Attention-deficit/hyperactivity disorder (ADHD) has been previously theorized to involve dysfunctions in the physiological and neural systems supporting behavioral inhibition and control , with an emphasis on inability to regulate behavior. Yet, emotional dysregulation has long been seen as part of the condition. For example, Wender's work in the 1970s pointed to the role of emotion dysregulation in ADHD, as he described that that adults with ADHD are characterized by a number of emotional and internalizing problems as well as emotional labiality (reviewed in Wender 1995). However, this work in adults left it unclear whether emotional dysregulation is a secondary symptom present in only some individuals or a core feature by which we may understand the condition. A developmental view of the centrality of regulatory difficulty in ADHD from early childhood has been offered by . Concomitantly, and more recently with the recognition similar control processes are also involved in emotion and its regulation, interest has crystallized in clarifying the role of emotion regulation in ADHD ( . Given how critical this idea of emotion dysregulation is for conceptualizing ADHD, it warrants further empirical evaluation.
Similarities between emotional dysregulation in adults suffering from ADHD and bipolar patients
Journal of Affective Disorders, 2016
Background: Emotional dysregulation in subjects with attention deficit and hyperactivity disorder (ADHD) is a topic of growing interest among clinicians and researchers. The present study aims at investigating components of emotional dysregulation in adults ADHD compared to subjects suffering from bipolar disorder (BD). Methods: A total of 150 adults ADHD, 335 adults BD subjects and 48 controls were assessed using the Affective Lability Scale (ALS) and the Affect Intensity Measure (AIM), measuring respectively emotion lability and emotion responsiveness. Results: ADHD and BD subjects scored significantly higher on the ALS compared to controls (p¼0.0001). BD subjects scored above ADHD ones (3.07 (SD¼0.66) vs. 2.30 (SD¼ 0.68); po0.0001). The average total scores achieved on the AIM were significantly different for the three groups (p¼0.0001) with significantly higher scores for ADHD subjects compared to BD ones (3.74 (SD¼ 0.59) vs. 3.56 (SD¼0.69); po0.0001). Limitations: Suspected cases of ADHD in the BD and control groups were derived from the Wender Utah Rating Scale (WURS). This study is a retrospective one. Conclusion: Our study thus highlights the importance of emotional dysregulation in adults suffering from ADHD, showing that they display higher emotional intensity than bipolar disorder subjects and controls. Although the current diagnostic criteria of ADHD do not contain an emotional dimension, a better recognition of the significance of emotional responsiveness in ADHD patients can improve the care afforded to these patients, beyond the inattentive and hyperactive/impulsive components.
Proposal for an Integrative Cognitive-Emotional Conception of ADHD
International Journal of Environmental Research and Public Health
Although numerous efforts have been made to deepen our understanding of the etiology of Attention Deficit Hyperactivity Disorder (ADHD), no explanation of its origins, nor of its consequences, has yet found a consensus within the scientific community. This study performs a theoretical review of various research studies and provides a reflection on the role of emotions in the origin of the disorder, at the neuroanatomical and functional level. To this end, theoretical models (single and multiple origin) and applied studies are reviewed in order to broaden the perspective on the relevance of the executive system in ADHD; it is suggested that this construct is not only composed and activated by cognitive processes and functions, but also includes elements of an emotional and motivational nature. Consequently, it is shown that ADHD is involved in social development and in a person’s ability to adapt to the environment.