Emotion Dysregulation and Externalizing Spectrum Disorders

Abstract

As described in the literature for many years, a sizable number of children with hyperactive-impulsive and combined subtypes/presentations of attention-deficit/hyperactivity disorder (ADHD)—especially males—progress to more serious externalizing syndromes across development. Such outcomes include oppositional defiant disorder, conduct problems, delinquency, substance use disorders, and in some cases antisocial personality disorder, incarceration, and recidivism. This chapter summarizes a developmental model that emphasizes different contributions of trait impulsivity, a highly heritable, subcortically mediated vulnerability, versus emotion dysregulation, a highly socialized, cortically mediated vulnerability, to externalizing progression. According to this perspective, trait impulsivity confers vulnerability to all externalizing disorders, but this vulnerability is unlikely to progress beyond ADHD in protective environments. In contrast, for children who are reared under conditions of adversity—including poverty, family violence, deviant peer influences, and neighborhood violence/criminality—neurodevelopment of prefrontal cortex structure and function is compromised, resulting in failures to achieve age-expected gains in emotion regulation and other forms of executive control. For these children, subcortical vulnerabilities to trait impulsivity are amplified by deficient cortical modulation, which facilitates progression along the externalizing spectrum.

Revisiting ecological systems theory: Practice implications for juvenile justice youth.

“…Practitioners may thus seek to assess whether the individual has positive peer relationships and reinforce seeking support and interactions with such peers. However, research has focused more on the possibility of negative peer influences, especially when working with those in the JJ system, as these relationships can indeed normalize problem behaviors (Shader & Beauchaine, 2020). A phenomenon to keep in mind for practitioners is the contagion effect or deviant peer influence; where bringing together multiple youth with similar problem behaviors can lead to an amplification and reinforcement of those behaviors (Dishion & Piehler, 2009).…”