Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: a controlled study

Abstract

While symptoms of deficient emotional self-regulation (DESR) such as low frustration tolerance, temper outbursts, emotional impulsivity, and mood lability are commonly associated with attention deficit hyperactivity disorder (ADHD), little is known about their nature. The main aim of this post hoc study was to examine the correlates of DESR in a large sample of adults with and without ADHD. Subjects were 206 adults with ADHD and 123 adults without ADHD from a family study of ADHD. Emotional impulsivity was operationalized using items from the Barkley Current Behavior Scale. Subjects were comprehensively assessed for psychiatric comorbidity using structured diagnostic interview methodology. We used the Quality of Life, Enjoyment, and Satisfaction Questionnaire-Short Form (QLES-Q-SF) and Social Adjustment Scale-Self-report (SAS-SR) to assess quality of life and psychosocial functioning. DESR was more common among ADHD compared with non-ADHD adults, and 55 % of adults with ADHD reported extreme DESR of greater severity than 95 % of control subjects. The association of ADHD and DESR was not entirely accounted for by either current or lifetime comorbid disorders. DESR was also associated with significant functional impairment as evaluated by the QLES-Q-SF and SAS-SR, and with reduced marital status, as well as higher risk for traffic accidents and arrests. DESR adversely impacts quality of life in adults with ADHD. More work is needed to further evaluate DESR in clinical and investigational studies of subjects with ADHD.

Types of adult attention-deficit hyperactivity disorder (ADHD): baseline characteristics, initial response, and long-term response to treatment with methylphenidate

“…We also reported an association between adult oppositional defiant disorder and emotional dysregulation Reimherr et al 2010aReimherr et al , 2013. A number of other researchers have found that among adults with ADHD, ongoing emotional symptoms are associated with increased impairment (Barkley and Fischer 2010;Biederman et al 2012;Bunford et al 2014;Surman et al 2013). It could perhaps be argued that the emotional symptoms of ADHD that we have described in this report could be better understood as ''comorbidity'' than as an integral element of the illness.…”

“…In 2012, Biederman et al showed that high levels of emotionality led to a more adverse outcome in children with ADHD. Surman et al (2013) also reported higher emotional symptoms leading to increased impairment in adults with ADHD. Corbisiero et al (2013) and Barkley (2010) argued that emotional symptoms are a fundamental part of the disorder, and Merwood et al (2014) presented genetic data pointing to a close association between hyperactivity/restlessness, impulsivity, inattention, and emotional dysregulation.…”

Similarities between emotional dysregulation in adults suffering from ADHD and bipolar patients

“…Previous studies (Sobanski et al, 2010;Surman et al, 2013;Vidal et al, 2014) have shown similar results, without differentiating between BD and other axis-1 comorbidities. These two scales therefore seem useful to assess the weight of comorbidities in emotional dysregulation among ADHD sufferers.…”

Genetics in child and adolescent psychiatry: methodological advances and conceptual issues

“…For example, investigators have attempted to clarify the role of emotional lability, a set of symptoms including irritability, hot temper and low frustration tolerance, in ADHD. Strong phenotypic [10,16,136,138], familial [16,139], and genetic association between emotional lability and ADHD [87] has been shown. This relationship occurs independently from the association with common ADHDrelated neuropsychological dysfunctions, suggesting that the association between emotional lability and ADHD might reflect the result of pleiotropic effects [10].…”