ADHD and Emotion Dysregulation Among Children and Adolescents

Abstract

Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527-551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.

Attentional Control and other Executive Functions

“…Overall, by establishing a reciprocal connection between individuals' attentiomal control and emotional/motivational regulation, individuals will be benefited in multiple ways: first, holistic therapies can be adopted in improving children's and adolescents' with ADHD cognitive and social behavior (Bunford et al, 2015) as well as enhancing individuals' cognition and behavior, in general (Vanlessen, 2016). Second, the interweaving of metacognitive and emotional/motivational executive functions shall proclaim the need for discovering one's own "self-consciousness" (Posner et al, 1998) in order to improve his behavior; and "self-consciousness" refers to the interdependence between one's cognition/metacognition and his inner emotions or even further, the interdependence between one's cognition/metacognition and his social emotion (theory of mind).…”

The Impact of Inhibition Training on Symptoms of Attention Deficit/ Hyperactivity Disorder and Social Skills

“…In this regard, Barkley [30] argues that in individuals with ADHD, attention deficit is related to deficiencies in response inhibition. More recently, Bunford et al [8] illustrated the link between working memory deficits and ADHD inattention symptoms on social impairment. In other words, attention deficit might be a secondary deficiency related to poor response inhibition in self-regulation or executive control of behavior.…”

“…Further, recent studies suggest ADHD symptoms mediate the effect of executive function deficits on social impairment [8][9][10]. Specifically, the relationship between inhibition and social impairment is mediated by the hyperactivity/impulsivity symptoms of ADHD [11].…”

“…Further, these children have difficulties in thinking before they respond, planning their actions and managing their time to accomplish goals, and predicting the probable outcomes of inappropriate or dangerous behavior. These deficits in regulation stem, in part, from disinhibition and have been found to increase risk for engagement in behaviors like driving aggressively, abusing drugs, or engaging in risky sexual activity [8,18] and these risks may occur in adolescence if these children are not adequately treated in a psychological way. …”

The Relationship Between Child-Reported Positive Affect and Parent-Reported Emotional and Behavioral Problems in ADHD Youth

“…On the one hand, parents might see more problems in youth with ADHD in part related to their child's high PA level (e.g., making attributions about the child's intent, ''He seems not to care when I correct him'', ''she hurts others and seems not to show remorse''). Any such parental attributions might interfere with parent-child relationships, as parents might respond to their exuberant child in more negative ways, leading to additional conflicts between parent and child (e.g., Bunford et al 2015b). In a review by Bunford et al (2015b), the authors suggest that children who experience invalidating responses to their emotions as well as a predisposition to emotion dysregulation might be at a higher risk for developing emotion dysregulation difficulties.…”