Deficient Emotional Self-Regulation and Adult Attention Deficit Hyperactivity Disorder: A Family Risk Analysis

Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Yawkey Center for Outpatient Care, Boston, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 06/2011; 168(6):617-23. DOI: 10.1176/appi.ajp.2010.10081172
Source: PubMed


A growing body of research suggests that deficient emotional self-regulation (DESR) is prevalent and morbid among patients with attention deficit hyperactivity disorder (ADHD). Family studies provide a method of clarifying the co-occurrence of clinical features, but no family studies have yet addressed ADHD and DESR.
Participants were 83 probands with and without ADHD and 128 siblings. All were assessed for axis I DSM-IV conditions with structured diagnostic interviews. The authors defined DESR in adult probands and siblings using items from the Barkley Current Behavior Scale. Analyses tested hypotheses about the familial relationship between ADHD and DESR.
Siblings of ADHD probands were at elevated risk of having ADHD, irrespective of the presence or absence of DESR in the proband. The risk for DESR was elevated in siblings of ADHD plus DESR probands but not in siblings of ADHD probands. ADHD and DESR cosegregated in siblings. The risk for other psychiatric disorders was similar in siblings of the ADHD proband groups.
The pattern of inheritance of ADHD with DESR preliminarily suggests that DESR may be a familial subtype of ADHD. Our data suggest that DESR is not an expression of other axis I DSM-IV disorders or of nonfamilial environmental factors. The authors cannot exclude contribution of non-axis-I DSM-IV disorders to risk for DESR and cannot determine whether the cosegregation of ADHD in DESR within families is a result of genes or familial environmental risk factors. Further investigation of DESR and its correlates and treatment both in and outside the context of ADHD is warranted.

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Available from: Craig B Surman, Oct 17, 2015
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    • "Emotional symptoms such as lability of mood, emotional excitability, stress sensitivity and irritability are considered relevant components of Attention Deficit Hyperactivity Disorder (ADHD) symptomatology since the publication of the Wender Utah criteria (Wender et al., 1981) even if they have not been included in DSM-V (Barkley and Murphy, 2010; Sobanski et al., 2010; Surman et al., 2011; American Psychiatric Association, 2013; Corbisiero et al., 2013). Sjowall et al. (2013) provided evidence for the central importance of emotion regulation difficulties in ADHD children independent of neuropsychological impairments. "
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    ABSTRACT: Emotion dysregulation is a recognized symptom of adult Attention Deficit Hyperactivity Disorder (ADHD). The aim of this study is to induce sadness in adults suffering from ADHD and to investigate the impact of emotion regulation strategies on sadness intensity, and psychophysiological measures. Thirty-six adults diagnosed with ADHD were randomly assigned to either expressive suppression (SUPP) or acceptance (ACC) of emotion. Sadness was induced using a film clip. Participants estimated the intensity of sadness and the perception of being overwhelmed with emotion before (T1), immediately after (T2) and 2min after the film (T3). Physiological measures were obtained. Sadness induction was effective in both conditions. The perception of being overwhelmed with emotion increased between T1 and T2 in both conditions, but persisted until T3 only in the expressive suppression condition whereas a decrease was observed in the acceptance condition. In ADHD expressive suppression of sadness seems to be associated to a prolonged recovery from the perception of being overwhelmed with emotion. Emotion-regulation via acceptance in contrast appears to allow faster recovery from the perception of being overwhelmed with emotion. To our knowledge, this is the first study to identify suppression as a critical mediator between an induced emotion and delayed recovery from emotional reactions in adult ADHD.
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    • "In addition to symptoms of inattention, hyperactivity and impulsivity, adults with ADHD often experience mood instability in the form of irritability, volatility, swift changes in mood, hot temper and low frustration tolerance (Skirrow et al. 2009; Surman et al. 2011). The co-occurrence of these symptoms suggests that they may be interlinked and that mood instability may be understood as a core feature of the ADHD syndrome. "
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    ABSTRACT: Although deficient emotional self-regulation (DESR) is associated with attention deficit hyperactivity disorder (ADHD), little research investigates this association and little is known about its etiology. Family studies provide a method of clarifying the co-occurrence of clinical features, but no family studies have yet addressed ADHD and DESR in children. Subjects were 242 children with ADHD and 224 children without ADHD. DESR was operationalized using an aggregate score ≥180 and <210 in the anxious/depressed, attention and aggression scales (AAA profile) of the Child Behavior Checklist (CBCL), termed the CBCL-DESR profile. The CBCL-bipolar (CBCL-BP) profile was defined as ≥210 on the CBCL-AAA scale. We examined the familial transmission of ADHD and the CBCL-AAA scale in families selected through probands with and without these conditions. We found a linear increase in the prevalence of CBCL-DESR in siblings as indexed by the Control, ADHD, ADHD+CBCL-DESR and ADHD+CBCL-BP proband groups. While the ADHD siblings were at elevated risk for both the CBCL-DESR and CBCL-BP compared with non-ADHD siblings, a significantly higher rate of CBCL-BP in the siblings of ADHD+CBCL-BP probands was found compared with siblings of the Control probands. ADHD shows the same degree of familial transmission in the presence or absence of DESR. CBCL-DESR and CBCL-BP are familial, but further work is needed to determine if these definitions are distinctly familial or represent a continuum of the same psychopathology.
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