ADHD and Emotion Regulation over the Life Span

Background: Although there is a consensus that emotions and emotion regulation are of clinical relevance for attention deficit/hyperactivity disorder (ADHD) in both, children and adults, no consensus has been reached on how to conceptualize dysfunctions in this domain with respect to ADHD. The talk will outline why emotions and emotion regulation are clinically relevant, and then turn to the current model of emotion generation and regulation by Gross (2015) and present three competing models as introduced by Shaw et al. (2014) to explain the overlap between emotion dysregulation and ADHD. We follow the definition of emotion as temporally limited, qualitative states that are associated with a change on the level of feelings, expression and physical states. Two studies will then be described that analyse a) longitudinal data of N = 136 pre-school children with respect to emotion regulation and attention deficits; b) cross-sectional data of N = 213 adult patients newly diagnosed with ADHD with respect to their emotion regulation, ADHD symptoms and neuropsychological deficits.

Methods: We studied N = 136 pre- and elementary school children over one year with three assessments that included ADHD symptoms as assessed with the Conners’ scales as well as emotion regulation assessed with a computer based task. Further, N = 213 newly diagnosed adults with ADHD were cross-sectionally assessed via self-/observer report (Conners Adult ADHD Rating Scales/CAARS), a modified version of the Positive and Negative Affect Scale, the Emotion Regulation Skill Questionnaire and the Quantified Behavior Test (QbTest).

Results: Differing from previous studies, we found no significant effect between emotional competence and ADHD symptoms in pre- and elementary school children from T1 to T2. There was, however, a significant effect of inattention on emotional competence from T2 to T3. For the adult sample, positive and negative affect and emotion regulation skills could be identified as distinct dimensions. Interestingly, EMO-Check positive only correlated negatively with the CAARS self-concept subscale, but not with the subscales assessing core symptoms, while EMO-Check negative correlated positively with all CAARS subscales. We could not establish any correlations between emotion regulation skills and the QbTest.

Discussion: Associations between ADHD symptoms and emotion regulation in childhood that were found in other studies could not be replicated. Emotional competence and ADHD symptoms proved to be relatively stable in our study, but emotional competence did not predict ADHD symptoms at any measuring time, though inattention at T2 was a predictor of emotional competences at T3. Thus, to clarify the development of emotion regulation competences in conjunction with ADHD symptoms, further studies are needed. For the adult sample, significant relations between clinically and therapeutically relevant symptoms in adult ADHD with emotion regulation could be established, thus potentially informing future therapeutic interventions by targeting the successful and flexible use of adaptive emotion regulation skills. We could not find any associations between neuropsychological deficits as assessed with the QbTest and emotion regulation skills. This supports Shaw’s et al. (2014) model 1, that assumed emotion regulation deficits to be a core symptom of ADHD.