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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    • "Using real-time ambulatory assessment of emotions, we confirm our hypotheses of increased instability and intensity of negative emotions in ADHD, complementing clinical descriptions (Wender et al. 1985; Asherson, 2005; Reimherr et al. 2005) and research using rating scales (Barkley & Fischer, 2010; Barkley & Murphy, 2010; Surman et al. 2011). Specifically, ADHD in adults is associated with both increased intensity of anger, frustration and irritability and heightened instability of frustration and irritability, in comparison with healthy controls. "
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    ABSTRACT: Background: Emotional lability (EL), characterized by negative emotional traits and emotional instability, is frequently reported in children and adults with attention deficit hyperactivity disorder (ADHD). However, EL is primarily assessed using retrospective self-report, which is subject to reporting bias and does not consider the potential influence of positive and negative everyday experiences. Method: Ambulatory assessment was carried out in 41 men with ADHD without co-morbidity, current medication or substance abuse, and 47 healthy control participants. Reports of negative and positive emotions (irritability, frustration, anger, happiness, excitement) and the occurrence of bad and good events were completed eight times daily during a working week. Group differences in emotional intensity and instability were investigated using multilevel models, and explored in relation to bad and good events and the Affective Lability Scale - Short Form (ALS-SF), an EL questionnaire. Results: The ADHD group reported significantly more frequent bad events, heightened intensity and instability of irritability and frustration, and greater intensity of anger. The results for positive emotions were equivocal or negative. Bad events significantly contributed to the intensity and instability of negative emotions, and showed a stronger influence in the ADHD group. However, covariation for their effect did not eliminate group differences. Small-to-moderate correlations were seen between intensity and instability of negative emotions and the ALS-SF. Conclusions: Adults with ADHD report heightened intensity and instability of negative emotions in daily life. The results suggest two components of EL in ADHD: a reactive component responsive to bad events and an endogenous component, independent of negative everyday events.
    Psychological Medicine 12/2014; 44(16):3571-83. DOI:10.1017/S0033291714001032 · 5.94 Impact Factor
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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.
    Psychiatry Research 07/2014; 220(1-2). DOI:10.1016/j.psychres.2014.07.017 · 2.47 Impact Factor
    • "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: To review the negative effects of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood on work productivity and occupational health. A review of the MEDLINE database was carried out to identify direct and indirect effects of ADHD on work, employment and occupational health. ADHD is associated with higher levels of unemployment versus controls. Adults with ADHD who are employed experience workplace impairment and reduced productivity, as well as behavioural issues such as irritability and low frustration tolerance. Adults with ADHD are also at increased risk of accidents, trauma and workplace injuries, particularly traffic accidents. Indirect effects of ADHD on occupational health include reduced educational achievement and increased rates of substance abuse and criminality. Overall, ADHD in adults has a substantial economic impact as a result of absenteeism and lost productivity. Psychoeducation, combined with stimulant medications if necessary, is recommended as first-line treatment for adults with ADHD. Limited data available suggest that stimulant treatment can improve work productivity and efficacy, and reduce the risks associated with driving, although further studies are necessary. ADHD can affect the ability to gain and maintain employment and to work safely and productively. As ADHD is a treatable condition, patients, employers and physicians have a role to play in ensuring optimal occupational health.
    International Archives of Occupational and Environmental Health 07/2012; 85(8):837-47. DOI:10.1007/s00420-012-0794-0 · 2.20 Impact Factor
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