Emotion regulationdifficulties refer to problems effectively modulating emotional experiences and expressions. This can involve heightened emotional reactivity, suddenmood swings, and poor control overimpulsive behaviorswhen upset.
People with ADHD often exhibit such emotion dysregulation alongside attention deficits and hyperactive symptoms, indicating shared underlying brain dysfunction. Difficulties controlling cognitive processes also lead to issues managing internal emotional states.
Key Points
Rationale
Attention deficit hyperactivity disorder (ADHD)involves problems with inattention, hyperactivity, and impulsivity.
However, people with ADHD also exhibit emotion regulation difficulties not captured in diagnostic criteria (Shaw et al., 2014). The relationship between emotional dysregulation and classical ADHD symptoms is unclear (Vidal et al., 2014).
Understanding this could provide insight into the underlying pathophysiology of ADHD and reveal new treatment targets, as treating emotion dysregulation may also treat classical symptoms (Reimherr et al., 2005).
For example, deficits in emotional self-regulation could arise from impaired executive function, which theoretically underlies all ADHD symptoms (Barkley, 2022). Alternatively, emotional dysregulation may relate to hyper-reactivity of the superior colliculus, a midbrain structure involved in distractibility (Overton, 2008).
This study aimed to clarify the relationship between emotion dysregulation and classical ADHD symptoms.
Method
The study useda cross-sectional, non-experimental survey design.
Materials were the AdultADHD Self-Report Scale(ASRS; Kessler et al., 2005), measuring inattention and hyperactivity/impulsivity symptoms, and theDifficulties in Emotion Regulation Scale(DERS; Gratz & Roemer, 2004) assessing aspects of emotion dysregulation. Participants completed demographic questions and the two scales online.
Sample
Participants were 1074 non-clinically diagnosed adults (mean age 30.27 years, 656 females) recruited online. 76.8% identified as white. 20.7% had ASRS symptom severity in the clinical range.
Statistical Analysis
Overall, ASRS and DERS scores were compiled. Non-parametric correlations compared ASRS and DERS scores due to non-normality. Multiple regressions examined predictive relationships between DERS subscales and ASRS subscales, controlling for age and gender.
Results
The ASRS inattention subscale significantly positively correlated with all DERS subscales (p<0.001) except lack of emotional awareness.
The ASRS hyperactivity/impulsivity subscale correlated significantly with all DERS subscales (p<0.001) except lack of emotional awareness. As ADHD symptoms increased in severity, most aspects of emotion dysregulation increased correspondingly.
A multiple regression model explained 28.8% of variance in ASRS inattention scores. Lack of emotional clarity and difficulty engaging in goal-directed behavior were significant positive predictors. Gender was a significant predictor, with females having higher inattention when controlling for other variables.
Another model explained 23.3% of variance in ASRS hyperactivity/impulsivity scores. Significant positive predictors were non-acceptance of emotional responses, difficulty engaging in goal-directed behavior, impulse control difficulties, and lack of emotional clarity.
Gender and age were significant negative predictors, indicating that females had higher hyperactivity/impulsivity scores than males when controlling for other variables and that scores decreased with age.
Insight
This study clearly demonstrates a close relationship between difficulties in emotion regulation and the classical symptoms of ADHD in adults. As symptoms of inattention or hyperactivity/impulsivity become more severe, most aspects of emotion dysregulation worsen, too.
The fact that ADHD symptoms correlate significantly with and even predict increases in aspects of emotion dysregulation suggests the two symptom clusters have an underlying shared pathology.
For example, deficits in engaging in goal-directed behavior and controlling impulses seem intrinsically linked to problems with distractibility and response inhibition that characterize ADHD.
Furthermore, medications that alleviate classical ADHD symptoms also treat emotion dysregulation (Reimherr et al., 2005), hinting at shared neural substrates.
Determining common causal pathways has major implications for refining ADHD treatment. Treating emotion regulation problems could ameliorate classical symptoms like attention deficits, suggesting novel therapeutic targets beyond stimulant medications.
Additionally, the study sampled the general population using dimensional measures of ADHD traits. Finding similar relationships along a continuum of severity demonstrates these connections persist even in non-clinical cases and are not just artifacts of extreme psychopathology.
This further cements ADHD’s dimensional nature.
Strengths
The study benefitted methodologically from several strengths:
Limitations
Implications
These findings hold important real-world implications for the conceptualization and treatment of ADHD. The results reinforce theories positing executive function deficits as a core impairment underlying both regulatory aspects of ADHD – emotional and cognitive (Barkley, 2022).
Shared inability to modulate behavior and internal states could arise from fundamental problems with top-down control processes involved in judgment, organization, and self-monitoring.
Relatedly, emotion regulation strategies like cognitive reappraisal or problem-solving techniques could have positive crossover effects in alleviating attention deficits and hyperactivity stemming from executive dysfunction.
Incorporating emotion regulation modules into existing evidence-based ADHD interventions is a promising avenue for amplifying treatment gains.
Research should also examine whether startingemotion-focused therapyearlier prevents worsening of classically defined ADHD symptoms later on. Detecting malleable precursors on the pathway to entrenched ADHD psychopathology may offer windows for effective prevention efforts.
Additionally, the current findings indicate a need to broaden diagnostic conceptualizations of ADHD. Emotion dysregulation clearly constitutes a clinically significant area of impairment for those exhibiting attentional and behavioral control deficits.
However, future research must replicate links between emotion dysregulation and ADHD using behavioral measures rather than self-report to convincingly demonstrate these are features of a common syndrome.
References
Primary reference
Albesisi, S., & Overton, P. G. (2023). Relationship Between ADHD-Like Traits and Emotion Dysregulation in the Adult General Population.Advances in Neurodevelopmental Disorders, 1-11.https://doi.org/10.1007/s41252-023-00381-y
Other references
Barkley, R. (2022). DESR: Why defcient emotional self-regulation is central to ADHD (and largely overlooked). ADDitude.https://www.additudemag.com/desr-adhd-emotional-regulation/
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale.Journal of psychopathology and behavioral assessment,26, 41-54.https://doi.org/10.1023/B:JOBA.0000007455.08539.94
x Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256.https://doi.org/10.1017/s0033291704002892
Overton, P. G. (2008). Collicular dysfunction in attention deficit hyperactivity disorder. Medical Hypotheses, 70(6), 1121–1127.https://doi.org/10.1016/j.mehy.2007.11.016
Reimherr, F. W., Marchant, B. K., Strong, R. E., Hedges, D. W., Adler, L., Spencer, T. J., West, S. A., & Soni, P. (2005). Emotional dysregulation in adult ADHD and response to atomoxetine. Biological Psychiatry, 58(2), 125–131.https://doi.org/10.1016/j.biopsych.2005.04.040
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention defcit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276–293.https://doi.org/10.1176/appi.ajp.2013.13070966
Vidal, R., Valero, S., Nogueira, M., Palomar, G., Corrales, M., Richarte, V., Bosch, R., Gómez-Barros, N., Corominas, M., Casas, M., & Ramos-Quiroga, J. A. (2014). Emotional lability: The discriminative value in the diagnosis of attention defcit/hyperactivity disorder in adults. Comprehensive Psychiatry, 55, 1712–1719.https://doi.org/10.1016/j.comppsych.2014.07.001
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Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
