The Relationship Between Emotion Dysregulation and ADHD-Like Traits

Emotion regulation difficulties refer to problems effectively modulating emotional experiences and expressions. This can involve heightened emotional reactivity, sudden mood swings, and poor control over impulsive behaviors when upset.

People with ADHD often exhibit such emotion dysregulation alongside attention deficits and hyperactive symptoms, indicating shared underlying brain dysfunction. Difficulties controlling cognitive processes also lead to issues managing internal emotional states.

Albesisi, S., & Overton, P. G. (2023). Relationship Between ADHD-Like Traits and Emotion Dysregulation in the Adult General Population. Advances in Neurodevelopmental Disorders, 1-11. https://doi.org/10.1007/s41252-023-00381-y

Key Points

• The study found significant positive correlations between ADHD symptoms (inattention and hyperactivity/impulsivity) and difficulties in emotion regulation. As ADHD symptoms increased, there were corresponding increases in most aspects of emotion dysregulation.
• Difficulty engaging in goal-directed behavior and lack of emotional clarity were significant positive predictors of inattention scores. Non-acceptance of emotional responses, difficulty engaging in goal-directed behavior, impulse control difficulties, and lack of emotional clarity were significant positive predictors of hyperactivity/impulsivity scores.
• The close relationship between ADHD symptoms and emotion dysregulation suggests they may arise from a common underlying dysfunction, such as impaired executive function. Treating emotion dysregulation may help treat classical ADHD symptoms.
• Limitations include the use of self-report measures rather than behavioral assessments, a convenience sample, exclusion of those with an ADHD diagnosis, and not accounting for potential comorbidities.

Rationale

Attention deficit hyperactivity disorder (ADHD) involves problems with inattention, hyperactivity, and impulsivity.

However, people with ADHD also exhibit emotion regulation difficulties not captured in diagnostic criteria (Shaw et al., 2014). The relationship between emotional dysregulation and classical ADHD symptoms is unclear (Vidal et al., 2014).

Understanding this could provide insight into the underlying pathophysiology of ADHD and reveal new treatment targets, as treating emotion dysregulation may also treat classical symptoms (Reimherr et al., 2005).

For example, deficits in emotional self-regulation could arise from impaired executive function, which theoretically underlies all ADHD symptoms (Barkley, 2022). Alternatively, emotional dysregulation may relate to hyper-reactivity of the superior colliculus, a midbrain structure involved in distractibility (Overton, 2008).

This study aimed to clarify the relationship between emotion dysregulation and classical ADHD symptoms.

Method

The study used a cross-sectional, non-experimental survey design.

Materials were the Adult ADHD Self-Report Scale (ASRS; Kessler et al., 2005), measuring inattention and hyperactivity/impulsivity symptoms, and the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) assessing aspects of emotion dysregulation. Participants completed demographic questions and the two scales online.

Sample

Participants were 1074 non-clinically diagnosed adults (mean age 30.27 years, 656 females) recruited online. 76.8% identified as white. 20.7% had ASRS symptom severity in the clinical range.

Statistical Analysis

Overall, ASRS and DERS scores were compiled. Non-parametric correlations compared ASRS and DERS scores due to non-normality. Multiple regressions examined predictive relationships between DERS subscales and ASRS subscales, controlling for age and gender.

Results

The ASRS inattention subscale significantly positively correlated with all DERS subscales (p<0.001) except lack of emotional awareness.

The ASRS hyperactivity/impulsivity subscale correlated significantly with all DERS subscales (p<0.001) except lack of emotional awareness. As ADHD symptoms increased in severity, most aspects of emotion dysregulation increased correspondingly.

A multiple regression model explained 28.8% of variance in ASRS inattention scores. Lack of emotional clarity and difficulty engaging in goal-directed behavior were significant positive predictors. Gender was a significant predictor, with females having higher inattention when controlling for other variables.

Another model explained 23.3% of variance in ASRS hyperactivity/impulsivity scores. Significant positive predictors were non-acceptance of emotional responses, difficulty engaging in goal-directed behavior, impulse control difficulties, and lack of emotional clarity.

Gender and age were significant negative predictors, indicating that females had higher hyperactivity/impulsivity scores than males when controlling for other variables and that scores decreased with age.

Insight

This study clearly demonstrates a close relationship between difficulties in emotion regulation and the classical symptoms of ADHD in adults. As symptoms of inattention or hyperactivity/impulsivity become more severe, most aspects of emotion dysregulation worsen, too.

The fact that ADHD symptoms correlate significantly with and even predict increases in aspects of emotion dysregulation suggests the two symptom clusters have an underlying shared pathology.

For example, deficits in engaging in goal-directed behavior and controlling impulses seem intrinsically linked to problems with distractibility and response inhibition that characterize ADHD.

Furthermore, medications that alleviate classical ADHD symptoms also treat emotion dysregulation (Reimherr et al., 2005), hinting at shared neural substrates.

Determining common causal pathways has major implications for refining ADHD treatment. Treating emotion regulation problems could ameliorate classical symptoms like attention deficits, suggesting novel therapeutic targets beyond stimulant medications.

Additionally, the study sampled the general population using dimensional measures of ADHD traits. Finding similar relationships along a continuum of severity demonstrates these connections persist even in non-clinical cases and are not just artifacts of extreme psychopathology.

This further cements ADHD’s dimensional nature.

Strengths

The study benefitted methodologically from several strengths:

• Using validated scales (ASRS, DERS) with strong psychometric properties like internal consistency.
• Large general population sample of 1074, enhancing generalizability. Wide distribution of ADHD severity allowed correlational analyses across a continuum.
• Dimensional conceptualization of ADHD traits fits the modern paradigm.
• Statistically rigorous data analysis involved both predictive modeling (regressions) and relationship testing (correlations). Controlled for covariates like age and gender.
• Multi-scale design dissected the interplay between different ADHD symptom facets (inattention, hyperactivity/impulsivity) and discrete aspects of emotion dysregulation.
• Provided empirical evidence bolstering theories about shared deficits underlying ADHD’s cognitive and emotional symptoms.

Limitations

• Relied solely on self-report. Participants may misjudge behaviors or stretch truth.
• Non-clinical convenience sample from online research platform limits generalizability to clinically diagnosed populations. Specifically excluded participants with ADHD diagnoses.
• Failed to account for comorbid conditions like depression that may independently relate to emotion regulation abilities.
• Used cross-sectional design measuring ADHD and emotion regulation concurrently. Cannot infer causality or directionality of relationships.
• Did not explore interaction effects between demographic variables and study variables. Relationship strength between ADHD-emotion regulation could differ across ages or biological sex categories.
• Lacked behavioral measures of cognitive abilities, emotion regulation capacities, or real-world functional outcomes. Cannot confirm links between self-reported symptoms and observable deficits.
• Hyperactivity/impulsivity correlated more strongly with aspects of emotion dysregulation than did inattention. Indicates the precise relationship depends partially on specific symptoms.

Implications

These findings hold important real-world implications for the conceptualization and treatment of ADHD. The results reinforce theories positing executive function deficits as a core impairment underlying both regulatory aspects of ADHD – emotional and cognitive (Barkley, 2022).

Shared inability to modulate behavior and internal states could arise from fundamental problems with top-down control processes involved in judgment, organization, and self-monitoring.

Relatedly, emotion regulation strategies like cognitive reappraisal or problem-solving techniques could have positive crossover effects in alleviating attention deficits and hyperactivity stemming from executive dysfunction.

Incorporating emotion regulation modules into existing evidence-based ADHD interventions is a promising avenue for amplifying treatment gains.

Research should also examine whether starting emotion-focused therapy earlier prevents worsening of classically defined ADHD symptoms later on. Detecting malleable precursors on the pathway to entrenched ADHD psychopathology may offer windows for effective prevention efforts.

Additionally, the current findings indicate a need to broaden diagnostic conceptualizations of ADHD. Emotion dysregulation clearly constitutes a clinically significant area of impairment for those exhibiting attentional and behavioral control deficits.

Quantifying emotional volatility could augment accuracy when screening for ADHD by capturing a fuller symptom profile.

However, future research must replicate links between emotion dysregulation and ADHD using behavioral measures rather than self-report to convincingly demonstrate these are features of a common syndrome.

References

Primary reference

Albesisi, S., & Overton, P. G. (2023). Relationship Between ADHD-Like Traits and Emotion Dysregulation in the Adult General Population. Advances in Neurodevelopmental Disorders, 1-11. https://doi.org/10.1007/s41252-023-00381-y

Other references

Barkley, R. (2022). DESR: Why defcient emotional self-regulation is central to ADHD (and largely overlooked). ADDitude. https://www.additudemag.com/desr-adhd-emotional-regulation/

Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of psychopathology and behavioral assessment, 26, 41-54. https://doi.org/10.1023/B:JOBA.0000007455.
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x Kessler, R. C., Adler, L., Ames, M., Demler, O., Faraone, S., Hiripi, E., Howes, M. J., Jin, R., Secnik, K., Spencer, T., Ustun, T. B., & Walters, E. E. (2005). The World Health Organization Adult ADHD Self-Report Scale (ASRS): A short screening scale for use in the general population. Psychological Medicine, 35(2), 245–256. https://doi.org/10.1017/s0033291704002892

Overton, P. G. (2008). Collicular dysfunction in attention deficit hyperactivity disorder. Medical Hypotheses, 70(6), 1121–1127. https://doi.org/10.1016/j.mehy.2007.11.016

Reimherr, F. W., Marchant, B. K., Strong, R. E., Hedges, D. W., Adler, L., Spencer, T. J., West, S. A., & Soni, P. (2005). Emotional dysregulation in adult ADHD and response to atomoxetine. Biological Psychiatry, 58(2), 125–131. https://doi.org/10.1016/j.biopsych.2005.04.040

Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention defcit hyperactivity disorder. American Journal of Psychiatry, 171(3), 276–293. https://doi.org/10.1176/appi.ajp.2013.13070966

Vidal, R., Valero, S., Nogueira, M., Palomar, G., Corrales, M., Richarte, V., Bosch, R., Gómez-Barros, N., Corominas, M., Casas, M., & Ramos-Quiroga, J. A. (2014). Emotional lability: The discriminative value in the diagnosis of attention defcit/hyperactivity disorder in adults. Comprehensive Psychiatry, 55, 1712–1719. https://doi.org/10.1016/j.comppsych.2014.07.001

Keep Learning

Here are some potential Socratic discussion questions for a college class based on this research:

1. How might deficits in executive function lead to problems regulating both cognition and emotion? Can you think of real-world examples showing this relationship?
2. Do you think ADD/ADHD medications treat emotional and cognitive symptoms through shared neural mechanisms? Why or why not?
3. If emotion dysregulation arises earlier in development, could teaching kids better coping strategies prevent worsening attention deficits later on? What are the challenges surrounding early emotion-focused interventions?
4. How might men and women experience the relationship between attention struggles and emotion regulation difficulties differently? What might account for potential gender differences?
5. This study relied completely on self-report data. What are the limitations surrounding self-report and how could we improve methodology to obtain more objective information? What tradeoffs exist with more objective behavioral measures?