Emotion Regulation Mediates the Association Between ADHD and Depressive Symptoms in a Community Sample of Youth

Abstract

The purpose of this study was to examine the longitudinal relationship between attention-deficit/ hyperactivity disorder (ADHD) symptoms, emotion regulation (ER) ability, and depressive symptoms within a diverse community sample of 277 youth, ages 9–12 (56 % male). Participants were drawn from a larger study examining adolescent risk behaviors, and completed annual assessments over 3 years. Youth ADHD symptoms were assessed at Time 1 (T1) using the parent-reported Disruptive Behavior Disorders Rating Scale, ER was assessed with the parent-reported Emotion Regulation Checklist at Time 2 (T2), and youth depressive symptoms were assessed using the self-reported Revised Child Anxiety and Depression Scales at Time 3 (T3). Analyses examined T2 ER as a mediator between T1 ADHD symptoms (including the unique contributions of inattentive [IA] versus hyperactive/impulsive [HI] symptoms) and T3 depressive symptoms. Structural equation modeling (SEM) indicated the path model specified provided an excellent fit to the data. Tests of indirect effects suggested that T2 ER appears to be a significant mechanism that underlies the relationship between T1 ADHD and T3 depression, even when accounting for T1 oppositional defiant and depressive symptoms. Furthermore, while both T1 IA and HI symptoms had significant indirect effects on T3 depression through the mechanism T2 ER, HI proved a more robust predictor of T2 ER than IA. Results of this prospective study support cross-sectional findings pointing to ER as a potential mechanism linking ADHD and depressive symptoms in youth. Clinical implications and future directions are discussed.

ADHD and Emotion Dysregulation Among Children and Adolescents

“…14 Many investigators measure ED among youth with ADHD using rating scales (e.g., Bunford et al 2014Bunford et al , 2015bSeymour et al 2012Seymour et al , 2014. Rating scales are appropriate for sampling a large number of situations (as opposed to a single experimental task) and can thus be representative of the multiple contexts of an individual's day.…”

The Development of a Depression Preventive Intervention for Adolescents with Attention-Deficit/Hyperactivity Disorder

“…Using a cross-sectional design, results indicated that parent rated emotion regulation mediated the relationship between a diagnosis of ADHD and youth-reported ratings of depressive symptoms (Seymour, et al, 2012). Findings from their 2012 study subsequently were replicated using a longitudinal design (Seymour, et al, 2014). Youth between 9 and 12 years old were followed prospectively for 3 years, undergoing annual assessments.…”

“…Reward responsivity and emotion regulation may be distal variables that predict both ADHD and depression (Anastopoulos et al, 2011;Meinzer et al, Unpublished manuscript;Seymour et al, 2012;Seymour et al, 2014), and thus focusing on reward responsivity and emotion regulation may reduce risk processes common to both disorders. Lack of family support may develop as a consequence of the turmoil (i.e., oppositional behavior, substance abuse, and academic failure) that many parents with a child with ADHD experience.…”

“…The persistence of ADHD into adolescence and adulthood has been suggested to account for the increased levels of depressive symptoms in emerging adults (Meinzer et al, under review In addition to moderation analyses, the prospective association between ADHD and depression as well as the mediators responsible for their covariation could be tested within such a research design. For example, a future, larger-scale investigation of the BEAM program could include the measurement of the mediators of the association between ADHD and depression such as reward responsivity , emotion regulation (Seymour et al, 2012(Seymour et al, , 2014, and family support (Humphreys et al, 2013;, Ostrander & Herman, 2006 Lastly, future research should employ the use of a different emotion regulation task. More specifically, a task that relies on psychophysiological data rather than participant self-report of heightened emotions may prove useful when assessing emotion regulation in adolescents with ADHD.…”

“…The BEAM program was tailored to the developmental levels of adolescents with ADHD and targeted constructs that have been shown to account for ADHD-depression covariation. Three areas have been empirically identified as potential explanations for the comorbidity between ADHD and depression: family support (Humphreys et al, 2013;Ostrander & Herman, 2006), reward responsivity (Meinzer et al, Unpublished manuscript;, and emotion regulation (Seymour et al, 2012;Seymour, Chronis-Tuscano, Iwamoto, Kurdziel, & Macpherson, 2014). As such, modules were developed to target family support, reward responsivity, and emotion regulation within the BEAM program.…”