Exploring deficient emotion regulation in adult ADHD: electrophysiological evidence

Abstract

Emotional dysregulation (ED) is being increasingly recognized as a core feature of attention-deficit/hyperactivity disorder (ADHD), but the pathophysiological underpinnings remain unclear. In this study, we provide meaningful electrophysiological evidence of ED in adult patients with ADHD (n = 39) compared to healthy controls (n = 40) by exploring the electrophysiological correlates of the emotion regulation strategies reappraisal, distraction, and expressive suppression. Event-related potentials (ERPs) were recorded during passive viewing of neutral and negative images, as well as during emotion regulation. The patients with ADHD exhibited increased frontal late positive potential (LPP) amplitudes during passive viewing of the aversive images and during emotion regulation. Compared with the healthy controls, a subgroup of medication-naïve patients with ADHD (n = 25) also exhibited larger centroparietal LPP amplitudes and provided more negative ratings of the aversive and neutral images. Both the frontal and centroparietal LPP amplitudes were associated with ADHD symptom severity. However, no significant deficit in LPP modulation during emotion regulation was found. These findings strongly support the clinical observation of increased emotional responsivity toward negative stimuli and difficulty during the implementation of emotion regulation strategies and thus encourage the implementation of emotion regulation modules in the treatment of adult patients with ADHD.

Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD)

“…Part of the differences between groups was related to the level of distress as measured by the BDI-II [32]. Our results showed a high level of correlation between current distress, emotional reactivity and the use of poor cognitive emotion regulation strategies in ADHD but also in BPD.…”

“…All participants completed the Beck Depression Inventory II (BDI-II) to assess the current level of depression as an indirect tool to evaluate the current distress associated with suffering from ADHD or BPD [37]. BDI-II has been shown to be a good proxy to assess subjective distress associated with ADHD [32,38].…”

“…Although several hypotheses explaining ED in ADHD have been suggested, including executive function deficits, social cognitions deficit, impaired emotional perception/processing, lack of empathy and impairment in first and second order theory of mind and poor mentalizing capacities [14,[23][24][25][26][27][28][29][30][31], less is known about the efficiency of cognitive emotion regulation strategies used by ADHD patients to cope with emotional outbursts. Some studies on adults suffering from ADHD have associated ED and poor emotional regulation strategies such as less use of 'cognitive reappraisal' and more use of 'suppression' [32]. Poor cognitive emotion regulation skills in ADHD have also been linked to impaired metacognitive abilities, including difficulties to focus oneself, and a diminished ability to re-evaluate goals and behaviours, prompting poor situation evaluations, thereby magnifying the associated emotional state [3,4,24,32].…”

“…Some studies on adults suffering from ADHD have associated ED and poor emotional regulation strategies such as less use of 'cognitive reappraisal' and more use of 'suppression' [32]. Poor cognitive emotion regulation skills in ADHD have also been linked to impaired metacognitive abilities, including difficulties to focus oneself, and a diminished ability to re-evaluate goals and behaviours, prompting poor situation evaluations, thereby magnifying the associated emotional state [3,4,24,32]. A better understanding of ED, cognitive emotion regulation strategies and their correlation with ADHD disorder severity is clearly needed.…”

Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis

“…According to Kring and Sloan [15], such a limitation occurred due to the fact that ED is still a transdiagnostic concept and can be applied to psychopathological aspects of various disorders not limited to ADHD. Although focusing on emotion regulation and dysregulation might provide a) new insights into the underlying pathophysiological mechanisms (e.g., Shushakova, Ohrmann & Pedersen, [16], b) a more accurate differentiation of symptoms and disorders (e.g., oppositional defiant disorder or conduct disorder vs. ADHS), and c) novel treatment approaches [17][18][19], research on ED still lacks a consensual and refined definition and depiction of ED and related constructs in general (e.g., [20,21]), and theoretical frameworks and conceptual models of ED in ADHD in particular. Terms like ED, emotional lability, emotional instability (i.e., irregular shifting between emotional states) and emotional impulsivity (i.e., overshooting emotional responses) are often applied interchangeably or rather idiosyncratically (for a review see [17]).…”