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BACKGROUND: Emotion dysregulation (ED) is common in attention-deficit/hyperactivity disorder (ADHD) and often results in adverse outcomes. However, ED has been suggested as a transdiagnostic construct, why the specific association between ADHD and ED when adjusting for other mental health conditions needs further investigation. It is also important to determine the aetiological basis of the association between ADHD and ED to inform the theoretical conceptualization of ADHD.

METHOD: This study used a co-twin control design, including a sample of dizygotic (DZ) and monozygotic (MZ) twins (N = 389; 45.8% females, age = 8-31 years, MZ twin pairs 57.6%). ED was assessed using the dysregulation profile from the parent-rated Child Behaviour Checklist and its adult version. Regression analyses were used across individuals and within the pairs, while adjusting for diagnoses of autism, intellectual disability, other neurodevelopmental conditions and affective conditions.

RESULTS: ADHD was significantly associated with ED, even when adjusting for age, sex, attention problems and other mental health conditions, and was the diagnosis most strongly associated with ED. Within-pair analyses revealed that twins with ADHD had higher levels of ED compared to their co-twin without ADHD. This association remained within DZ twins and was non-significant in the MZ subsample, with non-overlapping confidence intervals between the DZ and MZ estimates.

CONCLUSION: ADHD is strongly and in part independently linked to ED, stressing the importance of early detection and treatment of emotional difficulties within this group. The findings from the within-pair analyses indicate a genetic influence on the association between ADHD and ED.

BackgroundEmotional difficulties are common in attention-deficit/hyperactivity disorder (ADHD), but previous research lack specificity regarding how reactivity and regulation of distinct emotions relate to categorical (diagnostic) and dimensional (trait-level) ADHD, while also clarifying sex- and age-related patterns. Considering co-occurring psychiatric traits is important due to the transdiagnostic nature of emotional challenges.

MethodThis cross-sectional study included two samples: a diagnostic cohort (N = 104, 10–17 years, 56.7% females) consisting of participants with an ADHD diagnosis (n = 56) and typically developing controls (n = 48), and a cohort referred to a first visit to a specialist psychiatric unit (N = 85, 13–18 years, 78.8% females) for which a dimensional measure of ADHD was used. Linear regressions were used to assess associations between ADHD and self- and caregiver-rated reactivity (frequency/intensity) and regulation (by oneself or with the help of others) of four different emotions (sadness, fear, anger and exuberance) using the Emotion Questionnaire. Effects of sex were explored. Adjustments were made for age and co-occurring psychiatric traits (anxiety, depression, conduct problems and autism) within the referred cohort. Findings were validated through caregiver ratings for the diagnostic cohort (N=103) and the referred cohort (N=212).

ResultsDiagnostic and trait-level ADHD were robustly linked to reactivity and a limited ability to regulate (i.e., dysregulation) anger. Diagnostic ADHD was also related to dysregulation of exuberance and fear, and higher levels of sadness and fear reactivity. Trait-level ADHD was, in addition to anger, associated with elevated reactivity and dysregulation of exuberance, adjusting for co-occurring psychiatric symptoms. No interaction effects of sex by ADHD were identified.

ConclusionAnger may be particularly relevant for ADHD. Reactivity and dysregulation of exuberance may also be important for ADHD, although further research is needed to clarify the relation between ADHD and positive emotions. Potential effects of sex and co-occurring psychiatric traits are discussed.

BACKGROUND: Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience difficulties with emotion regulation. Specific use of cognitive emotion regulation strategies may contribute to these challenges, albeit research in this area remain limited.

METHOD: Self-rated and task-specific use of adaptive and maladaptive cognitive emotion regulation strategies was assessed in children and adolescents with ADHD and typically developing controls (N=176, 10-17 years, 55.1% girls; subsample for self-rated use: N=94, 13-17 years, 61.7% girls). Self-rated use was measured with the short version of the Cognitive Emotion Regulation Questionnaire. Task-specific use was assessed by an experimental task involving viewing emotion-eliciting photos. Regression analyses were utilized to assess associations between ADHD and cognitive emotion regulation. Effects of sex and age were explored. Adjustments were made for co-occurring psychiatric symptoms.

RESULTS: ADHD was associated with lower self-rated (β =-0.21, p = .044) and task-specific (β =-0.09, p = .015) use of adaptive strategies, and greater use of self-rated maladaptive strategies (β =0.27, p = .010). No associations remained after adjusting for co-occurring psychiatric symptoms and multiple comparisons. Rather, depressive symptoms may contribute to the self-rated use of maladaptive strategies. Post-hoc analyses revealed that ADHD was robustly linked to less self-rated use of acceptance (β =-0.38, p = .005).

CONCLUSION: Lower use of self-rated acceptance may be characteristic for ADHD. Depressive symptoms may play a more vital role for maladaptive cognitive emotion regulation than ADHD. More studies are needed to explore the longitudinal relation between ADHD, emotion regulation and depression.

Adolescents with attention-deficit/hyperactivity disorder (ADHD) often experience difficulties with emotion regulation, but treatment alternatives remain limited. This study investigates the feasibility and effectiveness of a newly developed psychological intervention aiming to increase emotion regulation skills in adolescent ADHD. A single-case experimental design with multiple baselines across participants was employed. Seven girls aged 13-17 years with ADHD completed the intervention. Outcomes of feasibility included attrition and retention rates, therapist-rated adherence, homework completion and engagement with the intervention material, as well as self- and caregiver ratings of client satisfaction and adverse outcomes. Primary outcomes of emotion dysregulation included weekly self- and caregiver ratings of the Difficulties in Emotion Regulation Scale Short Form during baseline, the intervention and a follow-up period of 2 weeks. Data was analyzed through descriptive statistics, visual inspection and effect size (Tau). The intervention was deemed feasible, although homework completion and engagement between sessions proved challenging. Six adolescents and caregivers reported lower emotion dysregulation after the intervention. However, six adolescent and four caregiver ratings demonstrated improvement before the intervention during baseline, complicating determination of intervention effects. Nevertheless, four participants showed a visual and/or statistical improvement from the intervention. Sensitivity analyses suggest that the intervention may have positive effects on emotional clarity.