Article

“Turning down the heat”: Is poor performance of children with ADHD on tasks tapping “hot” emotional regulation caused by deficits in “cool” executive functions?

December 2015
Research in Developmental Disabilities 47:199-207

DOI:10.1016/j.ridd.2015.09.012

Authors:

Hoppenbrouwers Karel

KU Leuven

Karla Van Leeuwen

KU Leuven

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Emotional dysregulation in daily life is very common in children with attention deficit hyperactivity disorder (ADHD). It is however not clear whether this reflects a specific deficit or that it may be the result of generic executive function (EF) deficits. The current study addresses this question by means of an emotional working memory (WM) task with 2 memory load conditions and four possible backgrounds (blank screen, neutral, positive or negative picture), which was administered to 38 typically developing children and 29 children with ADHD. Children responded slower on trials when negative pictures were presented at the background versus when neutral pictures were presented, indicating an emotional interference effect; however crucially, groups did not differ in this respect. Reaction times were also slower on trials with a neutral picture as background versus trials without a picture, with children with ADHD showing an enhanced interference effect. There was a main effect of WM load on performance, but it did not interact with interference or group effects. To summarize, the findings indicate a generic interference control deficit in the children with ADHD in the current sample, while they could not provide support for an emotional interference deficit.

Emotional scene processing in children and adolescents with attention deficit/hyperactivity disorder: a systematic review

Article

Full-text available

Mar 2021
EUR CHILD ADOLES PSY

“Impairments in emotional information processing are frequently reported in attention deficit hyperactivity disorder (ADHD) at a voluntary, explicit level (e.g., emotion recognition) and at an involuntary, implicit level (e.g., emotional interference). Most of previous studies have used faces with emotional expressions, rarely examining other important sources of information usually co-occurring with faces in our every day experience. Here, we examined how the emotional content of an entire visual scene depicting real-world environments and situations is processed in ADHD. We systematically reviewed in PubMed, SCOPUS and ScienceDirect, using the PRISMA guidelines, empirical studies published in English until March 2019, about processing of visual scenes, with or without emotional content, in children and adolescents with ADHD. We included 17 studies among the 154 initially identified. Fifteen used scenes with emotional content (which was task-relevant in seven and irrelevant in eight studies) and two used scenes without emotional content. Even though the interpretation of the results differed according to the theoretical model of emotions of the study and the presence of comorbidity, differences in scene information processing between ADHD and typically developing children and adolescents were reported in all but one study. ADHD children and adolescents show difficulties in the processing of emotional information conveyed by visual scenes, which may stem from a stronger bottom-up impact of emotional stimuli in ADHD, increasing the emotional experience, and from core deficits of the disorder, decreasing the overall processing of the scene”. Read and share full-text here : https://rdcu.be/b1ngm

Regulation of emotion in ADHD: Can children with ADHD override the natural tendency to approach positive and avoid negative pictures?

Article

Full-text available

Mar 2017
J NEURAL TRANSM

Studies have demonstrated inefficient use of antecedent-focused emotion regulation strategies in children with ADHD attention-deficit/hyperactivity disorder (ADHD). In the current study we tested for the first time if ADHD is also associated with difficulties in response-focused strategies by measuring the ability to override action tendencies induced by emotional information. Performance data on a computer-based approach-avoidance paradigm of 28 children with ADHD and 38 typically developing children between 8 and 15 years of age were analyzed, by comparing a congruent condition in which they were instructed to approach positive and avoid negative pictures and an incongruent condition where they had to override these automatic reactions and approach negative and avoid positive pictures. Children also rated the valence and salience of the pictures. Children with ADHD and typically developing children rated the emotional valence of the pictures appropriately and similarly, while positive pictures were rated as more arousing by children with ADHD. Solid congruency effects were found indicating that the task measured response-focused emotion regulation; however groups did not differ in this respect. Our findings do not support a deficit in emotion regulation in ADHD in terms of the ability to override natural tendencies to approach positive and avoid negative pictures.

The Mediating Role of ADHD Symptoms and Emotion Regulation in the Association Between Executive Functions and Internalizing Symptoms: a Study Among Youths with and Without ADHD and/or Dyslexia

Article

Full-text available

Dec 2021

Objectives The present study aimed at combining previous separate research findings having shown that executive functions (EF) contribute to a large range of emotional and behavioral problems among youths with and without neurodevelopmental disorders such as dyslexia and ADHD. Within a unifying framework, it investigated the mediational roles of ADHD symptoms and emotion regulation (ER) difficulties in the association between various EF and internalizing symptoms.Methods The sample included 82 adolescents with ADHD, dyslexia, comorbid ADHD/dyslexia, and typically developing adolescents, thus showing varying EF deficits. Whereas EF (attentional control, inhibition, shifting, working memory) were assessed in behavioral tasks, parents reported on ADHD symptoms, and ER and internalizing (anxiety, depression) symptoms were assessed via self-reports.ResultsIn two-path mediation analyses, ADHD symptoms and ER problems mediated the association between working memory and anxiety (via inattention and ER, a1d21b2 = − .27, 95% CI [− .58, − .04]; via hyperactivity and ER, a1d21b2 = − .19, 95% CI [− .42, − .02]) and depression symptoms (via inattention and ER, a1d21b2 = − .20, 95% CI [− .54, − .03]; via hyperactivity and ER, a1d21b2 = − .24, 95% CI [− .48, − .03]). Hyperactivity and ER, but not inattention and ER, mediated the association between inhibition and internalizing symptoms (predicting anxiety, a1d21b2 = .003, 95% CI [.0001, .009]; predicting depression, a1d21b2 = .004, 95% CI [.002, .009]) as well as between attentional control and internalizing symptoms (predicting anxiety, a1d21b2 = .01, 95% CI [.001, .03]; predicting depression, a1d21b2 = .01, 95% CI [.004, .03]).Conclusions These results offer an insight into how ADHD symptoms and ER problems mediate the association between EF components and internalizing symptoms, with potential implications for prevention and intervention measures.

Anterior insula hyperactivation in ADHD when faced with distracting negative stimuli

Article

Full-text available

Mar 2018

Patients with attention deficit hyperactivity disorder (ADHD) suffer from poor emotion regulation that might arise from problems in the distribution of attentional resources when confronted with emotional distractors. Previous studies investigating the neurocognitive basis of these problems remain inconclusive. Moreover, most of these studies did not exclude participants with comorbidity, particularly of conduct or oppositional defiant disorder. The aim of this study was to assess alterations in fronto‐limbic activation in ADHD adolescents specifically during negative distractors in an emotional attention task. For this purpose, we used functional magnetic resonance imaging to assess 25 boys with noncomorbid ADHD and 25 typically developing (TD) boys while they performed an emotional attention task with positive, negative, and neutral emotional distractors. Boys with ADHD had increased activation relative to TD boys specifically during the negative valenced stimuli in an emotional processing network comprising left anterior insula reaching into the inferior frontal gyrus. The findings suggest altered salience processing in ADHD of negative valenced emotional stimuli that may lead to higher distractibility in ADHD specifically when faced with negative emotional distractors.

Distraction by Salient Stimuli in Adults with Attention-Deficit/Hyperactivity Disorder: Evidence for the Role of Task Difficulty in Bottom-Up and Top-Down Processing

Article

Feb 2018
CORTEX

The cognitive mechanisms of increased distractibility in attention-deficit/hyperactivity disorder (ADHD) are poorly understood. The current study investigated the influence of two major modulating factors (emotional saliency, task difficulty) on behavioral and electrophysiological parameters underlying distractibility in ADHD. In addition, the attentional focus (indirect and direct processing of distractors) was examined. Thirty-six adults with ADHD and 37 healthy controls completed two experimental tasks while electroencephalography (EEG) data was collected. Task 1 assessed indirect processing of emotional or neutral distractors during a perceptual judgment task with varying task difficulty. Task 2 measured direct processing of the emotional or neutral stimuli and required participants to rate the stimuli regarding valence and arousal. Adults with ADHD exhibited generally higher behavioral distractibility than healthy controls. Electrophysiological data in the ADHD group indicated an enhanced bottom-up processing (increased early posterior negativity [EPN] amplitudes) of distractors in trials with high task difficulty as well as enhanced top-down processing (increased late positive potential [LPP] amplitudes) in trials with low task difficulty. However, no group differences were evident in the neural processing of emotional content or between attentional focus conditions. These findings support the notion that distractibility in ADHD results from impairments to both top-down as well as bottom-up processes and underscore the importance of task difficulty as a modulating factor.

Differences in Real World Executive Function between Children with Pediatric Bipolar Disorder and Children with ADHD

Article

Oct 2016

Background: Recent research evidence suggests that executive function (EF) is impaired in both pediatric bipolar disorder (PBD) and attention deficit-hyperactivity disorder (ADHD), although the underlying cognitive mechanisms are still unclear. In this study we examined EF, including cognitive and emotional control, in three pediatric groups with overlapping symptoms. Methods: Sixteen children and adolescents with PBD, 17 children and adolescents with ADHD, Type Combined, and 13 children and adolescents with PBD and comorbid ADHD (PBD+ADHD) (mean age=12.70, SD=2.21) were assessed using the Behavioral Rating Inventory of Executive Function - Parental Report (BRIEF-PR), clinical scales and neuropsychological tests of attention, working memory and executive function. Results: All groups showed impairment on the Trails A and B tests. However, there were no significant group differences. On the BRIEF-PR while all three groups were impaired in General Executive Functioning and Metacognition only the two PBD groups revealed more extensive EF dysfunction, in both cognitive and emotional control domains, relative to the ADHD group. Conversely, the ADHD group exhibited selective deficits in cognitive domains such as working memory, planning/organization, monitoring, and metacognition. The two PBD groups showed greater impairment than the ADHD group in the domains of Inhibition, Shifting, Monitoring and Emotional Control. Furthermore, results from regression analyses suggest cognitive predictors of EF impairment in ADHD and mood predictors for inhibition in PBD. Conclusions: The current results contribute new knowledge on domain-specific similarities and differences in executive dysfunction between PBD, ADHD, and the comorbid phenotype, which may inform the diagnostic process and cognitive intervention.

Emotion processing difficulties in ADHD: a Bayesian meta-analysis study

Article

Full-text available

Jan 2025
EUR CHILD ADOLES PSY

We investigated whether there is an emotional processing deficit in ADHD and whether this only applies to specific emotional categories. In this PRISMA-compliant systematic review based on a pre-registered protocol (https://osf.io/egp7d), we searched MEDLINE, PsycINFO, ERIC, Scopus and Web of Science databases until 3rd December 2023, to identify empirical studies comparing emotional processing in individuals meeting DSM (version III to 5-TR) or ICD (version 9 or 10) criteria for Attention Deficit/Hyperactivity Disorder (ADHD) and in a non-psychiatric control group. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS). Eighty studies were included and meta-analysed (encompassing 6191 participants and 465 observations). Bayesian meta-analyses were conducted to compare individuals with ADHD and non-psychiatric controls on overall emotional processing measures (meta-analysis 1) and across emotional categories (meta-analysis 2). The type of stimulus employed, outcome measurement reported, age, sex, and medication status were analysed as moderators. We found poorer performance in both overall emotion processing (g = − 0.65) and across emotional categories (anger g = − 0.37; disgust g = − 0.24; fear g = − 0.37; sadness g = − 0.34; surprise g = − 0.26; happiness/positive g = − 0.31; negative g = − 0.20; neutral g = − 0.25) for individuals with ADHD compared to non-psychiatric controls. Scales items and accuracy outcome being the most effective moderators in detecting such differences. No effects of age, sex, or medication status were found. Overall, these results show that impaired emotional processing is a relevant feature of ADHD and suggest that it should be systematically assessed in clinical practice.

Distinct patterns of emotional processing in ADHD and anxiety. Evidence from an eye-movement Go/No-Go task

Article

Sep 2024

Using Hot and Cool Measures to Phenotype and Predict Functional Outcomes Across Dimensions of ADHD and Typical Development in Adolescents

Article

Full-text available

Dec 2023

Multiple pathway models propose that attention deficit hyperactivity disorder (ADHD) arises from dysfunction in separate systems comprised of a "cool" or cognitive pathway versus a “hot” or emotional/reward pathway. Interactions between these pathways and the degree of maturation may further determine functional outcomes for adolescents ranging from those diagnosed with ADHD to typical development (TD). We used a latent profile analysis on rating scales and behavioral task performance assessing emotion, irritability, impulsivity, risk-taking, future orientation, and processing speed (PS) to identify subgroups of TD adolescents and adolescents with ADHD (N = 152) based on the hot and cool pathway model. We identified four classes: 1) High-Complex Challenges; 2) Moderate-Mixed Challenges; 3) Non-Emotive Impulsivity; and 4) High Regulation and Control. A multiple pathway model of ADHD is supported with classes differing in degree of emotional lability and irritability, types of impulsivity, and ability to use future consequences to modulate impulsivity and PS. The classes differed regarding functional behavior, with the High-Complex class demonstrating the most severe functional challenges in academic-related functioning. The Moderate-Mixed class also displayed significant functional challenges but with moderate emotional lability and irritability ratings. The Non-Emotive Impulsivity class exhibited low emotionality and low irritability, yet high impulsivity with limited negative functional consequences, and was composed of a mix of ADHD and TD adolescents. Differences between classes suggest ADHD symptomatology may represent both categorical and dimensional differences. Precision health interventions may be more effective in addressing the specific challenges associated with the classes rather than a one-size-fits-all approach to treating ADHD.

Étude des caractéristiques cliniques et neuropsychologiques du surplus de pensées et de la dysrégulation émotionnelle dans le Trouble du Déficit de l’Attention avec ou sans Hyperactivité (TDAH) de l’adulte

Thesis

Sep 2022

Emilie Martz

Le surplus de pensées et la dysrégulation émotionnelle (DE) sont deux expressions cliniques sous-évaluées dans le Trouble du Déficit de l’Attention avec ou sans Hyperactivité (TDAH) de l’adulte. Bien que qu’ils ne soient pas spécifiques au TDAH, ces deux symptômes sont pourtant au coeur des plaintes des patients. L’objectif de ce travail de thèse était de reconsidérer le tableau clinique du TDAH de l’adulte en investiguant les particularités psychopathologiques et cognitives des symptômes de surplus de pensées et de DE. Pour cela, différents auto-questionnaires ainsi qu’une évaluation cognitive comprenant la tâche de fluences verbales ont été proposés à des adultes avec TDAH. Sur le plan psychopathologique, le surplus de pensées et la DE représentent des caractéristiques centrales de la présentation clinique du TDAH de l’adulte, indépendantes d’un trouble de l’humeur associé. De plus, ces deux symptômes sont fortement associés et entretiennent des liens étroits avec l’arousal. Sur le plan cognitif, le surplus de pensées et la DE sont sous-tendus par des atypies du fonctionnement exécutif.

Dysrégulation émotionnelle chez les enfants et adolescents avec un trouble déficit d'attention/hyperactivité : apports des groupes de thérapies cognitivo-comportementales

Thesis

Nov 2021

Cécile Vacher

Le Trouble Déficit d’Attention/Hyperactivité (TDAH) est un trouble neurodéveloppemental s’accompagnant fréquemment d’une dysrégulation émotionnelle venant complexifier le tableau clinique de l’enfant.Ce travail de thèse a pour objectif d’évaluer l’efficacité d’une intervention multimodale de Thérapies Cognitivo-Comportementales (TCC) par rapport à une intervention médiation par le théâtre (MPT) sur la gestion émotionnelle chez l’enfant avec TDAH et dysrégulation émotionnelle.Un premier article consiste en une revue systématique d’études évaluant les effets d’interventions psychologiques chez l’enfant avec TDAH et dysrégulation émotionnelle. Les études montrent des résultats prometteurs avec une réduction des comportements agressifs et des symptômes émotionnels, néanmoins leur faible qualité méthodologique ne permet pas d’en tirer une conclusion générale. Deux articles sont dédiés à l’étude sur l’efficacité d’une intervention multimodale de TCC par rapport à une de MPT sur les comportements agressifs chez l’enfant avec TDAH et dysrégulation émotionnelle. Les résultats montrent que l’intervention de TCC tend à améliorer les comportements agressifs entre l’évaluation initiale et à six mois post-intervention par rapport au groupe MPT sans que cette différence soit significative. Les interventions multimodales de TCC ciblées sur la gestion émotionnelle représentent des traitements thérapeutiques prometteurs et supposent d’autres recherches cliniques. Le dernier article aborde l’intérêt clinique de mesurer les traits et les troubles de la personnalité chez l’enfant et l’adolescent avec TDAH et dysrégulation émotionnelle. Evaluer leur profil de personnalité s’avère pertinent afin de proposer précocement des interventions et prévenir des difficultés futures de fonctionnement.

Chapitre 5 Déficit des fonctions exécutives dans les troubles psychopathologiques de l’enfant

Chapter

Oct 2021

Hot and cold executive functions in the brain: A prefrontal-cingular network

Preprint

Mar 2021

Executive functions (EFs), or cognitive control, are higher-order cognitive functions needed for adaptive goal-directed behaviours and are significantly impaired in majority of neuropsychiatric disorders. Different models and approaches are proposed for describing how EFs are functionally organized in the brain. One popular and recently proposed organizing principle of EFs is the distinction between hot (i.e., reward or affective-related) vs cold (i.e., purely cognitive) domains of EFs. The prefrontal cortex is traditionally linked to EFs, but on the other hand, anterior and posterior cingulate cortices are involved in EFs as well. In this review, we first define EFs, their domains, and the appropriate methods for studying them. Second, we discuss how hot and cold EFs are linked to different areas of the prefrontal cortex. Third, we discuss the association of hot vs cold EFs with the cingulate cortex with a specific focus on anterior and posterior compartments. Finally, we propose a functional model for hot and cold EF organization in the brain with a specific focus on the fronto-cingular network. We also discuss clinical implications of hot vs cold cognition in major neuropsychiatric disorders (depression, schizophrenia, anxiety disorders, substance use disorder, attention-deficit hyperactivity disorder, and autism) and attempt to characterize their profile according to the functional dominance of hot-cold cognition. Our model proposes that the lateral prefrontal cortex, along with the dorsal anterior cingulate cortex are more relevant for cold EFs and the medial-orbital prefrontal cortex along with the ventral anterior cingulate cortex, and posterior cingulate cortex are more closely involved in hot EFs. This functional distinction, however, is not absolute and depends on several factors including task features, context, and the extent to which the measured function relies on cognition and emotion or both.

Hot and cold executive functions in the brain: A prefrontal- cingular network

Article

Full-text available

Mar 2021

The comparison of cool and hot executive functions profiles in children with ADHD symptoms and normal children

Article

Full-text available

Jan 2021

The study aimed to compare cool and hot executive functions profiles in children with ADHD symptoms and normal children. The statistical population consisted of all boys with ADHD symptoms and normal children in elementary school in Isfahan. In causal-comparative study, 200 participants were selected by multi-stage random sample method. Data were collected from Children Symptoms Inventory (CSI-4), Behavior Rating Inventory of Executive Function (BRIEF) and demographic inventory. Data were analyzed by using an analysis of covariance and Kruskal-Wallis test. There is significant difference between groups mean in variable of executive functions and all of their subscales (P < 0.05). Results from paired comparisons showed that in comparison with both subgroups of predominantly inattentive and predominantly hyperactive/ impulsive, combined subgroup indicate more damage to executive functions and all of subscales. In addition, subgroups of HD and AD are damaged more than normal group in executive functions and their subscales. Subgroups of HD and AD did not show any significant difference in inhibition, shifting and emotional control subscales (BRI). However, there were significant differences in initiation, monitoring, planning/organizing of materials subscales and total executive function. Negative mean difference in some variables indicates that in comparison with HD, AD has more problems in these subscales (MCI) and total executive function. Performing such studies can help to understand the underlying causes of treatment that has not been addressed so far in relation to this disorder and facilitate the establishment of optimal mechanisms and methods in treatment and standardization of psychological treatments.

Self-Regulation in Children with Neurodevelopmental Disorders “SR-MRehab: Un Colegio Emocionante”: A Protocol Study

Article

Full-text available

Jun 2020

Self-regulation refers to the ability to control and modulate behavior, and it can include both emotional and cognitive modulation. Children with neurodevelopmental disorders may show difficulties in self-regulation. The main objective of this study is to improve self-regulation skills in children between 6 and 11 years of age with neurodevelopmental disorders. Methodology: A randomised controlled trial will be conducted with the use of “SR-MRehab: Un colegio emocionante”, based on non-immersive virtual reality system where virtual objects can be managed by children in a natural way using their hands. Children will be recruited from several schools of Granada (Spain) and they will be randomly allocated to two groups. An assessment will be conducted before and after the intervention and 24 weeks after the end of the intervention process. The experimental group will receive the intervention using virtual reality. The control group will receive a standard self-regulation program. Both interventions will be performed once a week for a total of 10 sessions. Changes in self-regulation, as well as acceptability of technology with the use of SR-MRehab will be evaluated. The results will be published and will provide evidence regarding the use of this type of intervention in children with neurodevelopmental disorders.

The Differential Effect of Anxiety and ADHD Symptoms on Inhibitory Control and Sustained Attention for Threat Stimuli: A Go/No-Go Eye-Movement Study

Article

Full-text available

Nov 2021
J Attention Disord

Objective: This study examined the synergistic effects of ADHD and anxiety symptoms on attention and inhibitory control depending on the emotional content of the stimuli. Method: Fifty-four typically developing individuals (27 children/adolescents and 27 adults) completed an eye-movement based emotional Go/No-Go task, using centrally presented (happy, angry) faces and neutral/symbolic stimuli. Sustained attention was measured through saccade latencies and saccadic omission errors (Go trials), and inhibitory control through saccadic commission errors (No-Go trials). ADHD and anxiety were assessed dimensionally. Results: Elevated ADHD symptoms were associated with more commission errors and slower saccade latencies for angry (vs. happy) faces. In contrast, angry faces were linked to faster saccade onsets when anxiety symptoms were high, and this effect prevailed when both anxiety and ADHD symptoms were high. Conclusion: Social threat impacted performance in individuals with sub-clinical anxiety and ADHD differently. The effects of anxiety on threat processing prevailed when both symptoms were high.

Emotional dysregulation subgroups in patients with adult Attention-Deficit/Hyperactivity Disorder (ADHD): a cluster analytic approach

Article

Full-text available

Apr 2019

Emotion regulation deficits (ERD) are evident in about 34–70% of the adults with ADHD. In contrast to this, they are not considered in the diagnostic criteria of the disorder. In a recent study of our research group using confirmatory factor analysis, we modeled positive and negative emotion as well as emotion regulation skills along with the classical ADHD-core symptoms. We showed that negative affect and the failure to apply adaptive emotion regulation skills were distinct and indicative dimensions in adult ADHD. In this study, we used a person-centered approach based on cluster analysis to subtype patients on the presence or relative absence of ERD. This results in important information to individualize treatment decisions. We found two clusters, with cluster 2 showing high ERD that were associated with higher impairments indicated by depressive mood, negative affect and elevated psychological distress. There were also higher rates of comorbidity in cluster 2 such as somatoform disorders which were associated with ERD. Women were overrepresented in this cluster 2. Neuropsychological variables did not contribute significantly to cluster formation. In conclusion, ADHD in adults is a heterogeneous disorder with specific subgroups that need differential treatment approaches.

Attention-Deficit/Hyperactivity Disorder (ADHD) and Emotion Regulation Over the Life Span

Article

Full-text available

Mar 2019
Curr Psychiatr Rep

Purpose of Review Emotional symptoms are common and persistent in youth and adults with attention-deficit/hyperactivity disorder (ADHD) and cause clinically significant impairments. We review recent neuropsychological, neurophysiological, and peripheral psychophysiological evidence for emotion and emotion regulation deficits in ADHD across youth and adults. Recent Findings Central and autonomous nervous system correlates argue in favor of more general self-regulation deficits and also specific emotional deficits in ADHD. These include general performance deficits in executive functions, and structural as well as functional impairments in neuronal networks associated with top-down self-regulation. Specific deficits with bottom-up emotional activation in the amygdala and emotion evaluation associated with the orbitofrontal cortex have also been described. Furthermore, vagally mediated, high-frequency heart rate variability is associated with emotional self-regulation deficits throughout the life span. The current evidence is based on multilevel studies that assess associations of emotion regulation. However, further studies that adequately consider the processual recursive character of emotion generation and regulation may give important new insights into emotional regulation of ADHD. Summary Emotion regulation deficits in ADHD are associated with specific as well as general self-regulation deficits traceable on the level of neuropsychological, neurophysiological, and psychophysiological assessments. The temporal dynamics of the interplay of those different systems need further study in order to optimize and personalize treatment of emotion regulation difficulties, including emotional reactivity, in patients with ADHD.

Interoceptive awareness in attention deficit hyperactivity disorder

Article

Full-text available

Oct 2018
PLOS ONE

ADHD is considered a disorder of self-regulation. Recent research has shown that awareness of bodily states, referred to as interoceptive awareness, crucially contributes to self-regulatory processes. Impaired self-regulation in ADHD has been explained in terms of arousal regulation deficits in ADHD (the state regulation deficit (SRD) account). There is now ample support for the SRD account, however the exact reason for arousal regulation difficulties is not yet known. The SRD account explicitly refers to the ability to monitor one’s momentary bodily state as a prerequisite for effective state regulation. However, surprisingly, no study to date has tested the ability to become aware of bodily signals, i.e. interoceptive awareness, in ADHD. In the current study, we therefore compared interoceptive awareness between 24 adults with ADHD and 23 controls by means of both an objective (heartbeat perception task) and subjective measure (questionnaire) of interoceptive awareness. Results revealed a strikingly similar performance for both groups on both measures, suggesting preserved interoceptive awareness in adult ADHD.

Executive Functioning Heterogeneity in Pediatric ADHD

Article

Apr 2018

Neurocognitive heterogeneity is increasingly recognized as a valid phenomenon in ADHD, with most estimates suggesting that executive dysfunction is present in only about 33%–50% of these children. However, recent critiques question the veracity of these estimates because our understanding of executive functioning in ADHD is based, in large part, on data from single tasks developed to detect gross neurological impairment rather than the specific executive processes hypothesized to underlie the ADHD phenotype. The current study is the first to comprehensively assess heterogeneity in all three primary executive functions in ADHD using a criterion battery that includes multiple tests per construct (working memory, inhibitory control, set shifting). Children ages 8–13 (M = 10.37, SD = 1.39) with and without ADHD (N = 136; 64 girls; 62% Caucasian/Non-Hispanic) completed a counterbalanced series of executive function tests. Accounting for task unreliability, results indicated significantly improved sensitivity and specificity relative to prior estimates, with 89% of children with ADHD demonstrating objectively-defined impairment on at least one executive function (62% impaired working memory, 27% impaired inhibitory control, 38% impaired set shifting; 54% impaired on one executive function, 35% impaired on two or all three executive functions). Children with working memory deficits showed higher parent- and teacher-reported ADHD inattentive and hyperactive/impulsive symptoms (BF10 = 5.23 × 10⁴), and were slightly younger (BF10 = 11.35) than children without working memory deficits. Children with vs. without set shifting or inhibitory control deficits did not differ on ADHD symptoms, age, gender, IQ, SES, or medication status. Taken together, these findings confirm that ADHD is characterized by neurocognitive heterogeneity, while suggesting that contemporary, cognitively-informed criteria may provide improved precision for identifying a smaller number of neuropsychologically-impaired subtypes than previously described.

Mediating Role of the Conflict Tactics between ADHD Symptom Levels and Dyadic Adjustment

Article

Jan 2017

Exploring deficient emotion regulation in adult ADHD: electrophysiological evidence

Article

Full-text available

Jun 2018
EUR ARCH PSY CLIN N

Emotional dysregulation (ED) is being increasingly recognized as a core feature of attention-deficit/hyperactivity disorder (ADHD), but the pathophysiological underpinnings remain unclear. In this study, we provide meaningful electrophysiological evidence of ED in adult patients with ADHD (n = 39) compared to healthy controls (n = 40) by exploring the electrophysiological correlates of the emotion regulation strategies reappraisal, distraction, and expressive suppression. Event-related potentials (ERPs) were recorded during passive viewing of neutral and negative images, as well as during emotion regulation. The patients with ADHD exhibited increased frontal late positive potential (LPP) amplitudes during passive viewing of the aversive images and during emotion regulation. Compared with the healthy controls, a subgroup of medication-naïve patients with ADHD (n = 25) also exhibited larger centroparietal LPP amplitudes and provided more negative ratings of the aversive and neutral images. Both the frontal and centroparietal LPP amplitudes were associated with ADHD symptom severity. However, no significant deficit in LPP modulation during emotion regulation was found. These findings strongly support the clinical observation of increased emotional responsivity toward negative stimuli and difficulty during the implementation of emotion regulation strategies and thus encourage the implementation of emotion regulation modules in the treatment of adult patients with ADHD.

Attentional Control of Emotional Interference in Children with ADHD and Typically Developing Children: An Emotional N-back Study

Article

Apr 2017

Emotional interference control refers to the ability to remain focused on goal-oriented processes when confronted with disrupting but irrelevant emotional stimuli, a process that may be impaired in children and adults with attention deficit/hyperactivity disorder (ADHD). However, emotional interference levels are known to be associated with trait anxiety, and patients with ADHD often display elevated levels of trait anxiety, such as these may have confounded previous findings of decreased emotional interference control in this population. In the present study, male and female 8–13 years old (mean = 11.0 years) children with ADHD (n=33) and typically developing (TD) children (n=24) performed a visual emotional working memory (n-back) task with 2 memory loads and three different background pictures (neutral/positive/negative), and trait anxiety measures were obtained. Children with ADHD performed less well, and displayed increased emotional interference in the presence of aversive distractors when compared with TD children. Contrary to our expectations, trait anxiety did not mediate the association between diagnostic group membership and the degree of emotional interference control; however, co-morbid ODD was associated with decreased levels of emotional interference in ADHD. Future research should aim at characterizing the mechanisms subtending decreased emotional interference control in the ADHD population.

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Data

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Dec 2016

Annual Research Review: What processes are dysregulated among emotionally dysregulated youth? – a systematic review

Article

Full-text available

Feb 2025
J CHILD PSYCHOL PSYC

Proliferation of the term “emotion dysregulation” in child psychopathology parallels the growing interest in processes that influence negative emotional reactivity. While it commonly refers to a clinical phenotype where intense anger leads to behavioral dyscontrol, the term implies etiology because anything that is dysregulated requires an impaired regulatory mechanism. Many cognitive, affective, behavioral, neural, and social processes have been studied to improve understanding of emotion dysregulation. Nevertheless, the defective regulatory mechanism that might underlie it remains unclear. This systematic review of research on processes that affect emotion dysregulation endeavors to develop an integrative framework for the wide variety of factors investigated. It seeks to ascertain which, if any, constitutes an impaired regulatory mechanism. Based on this review, we propose a framework organizing emotion‐relevant processes into categories pertaining to stimulus processing, response selection and control, emotion generation, closed‐ or open‐loop feedback‐based regulation, and experiential influences. Our review finds scant evidence for closed‐loop (automatic) mechanisms to downregulate anger arousal rapidly. Open‐loop (deliberate) regulatory strategies seem effective for low‐to‐moderate arousal. More extensive evidence supports roles for aspects of stimulus processing (sensory sensitivity, salience, appraisal, threat processing, and reward expectancy). Response control functions, such as inhibitory control, show robust associations with emotion dysregulation. Processes relating to emotion generation highlight aberrant features in autonomic, endocrine, reward functioning, and tonic mood states. A large literature on adverse childhood experiences and family interactions shows the unique and joint effects of interpersonal with child‐level risks. We conclude that the defective closed‐loop regulatory mechanisms that emotion dysregulation implies require further specification. Integrating research on emotion‐relevant mechanisms along an axis from input factors through emotion generation to corrective feedback may promote research on (a) heterogeneity in pathogenesis, (b) interrelationships between these factors, and (c) the derivation of better‐targeted treatments that address specific pathogenic processes of affected youth.

Hot and cold executive function among pediatric attention deficit hyperactivity disorder with and without coexisting oppositional defiant disorder

Article

Jun 2024
INT J DEV NEUROSCI

Background Executive function is a high‐level set of cognitive processes related to goal‐directed behaviors including two conceptual subtypes of hot (emotional) and cold (cognitive) executive function (to abbreviate EF). EF deficits in attention deficit hyperactivity disorder (ADHD) leads to significant social impairments in the home, school, and community. Today the type and the extent of executive function defects in ADHD are still debated in studies. We aimed to evaluate hot and cold executive function among medication‐naive children with ADHD, with and without oppositional defiant disorder (ODD). Methods Forty‐five children including suffering ADHD with ODD ( n = 15), without ODD ( n = 15), or typically developed (TD, n = 15) participated in this cross‐sectional study (the age of children was between 7 and 12 years old). The Child Symptom Inventory‐4 (CSI‐4) was used to screen behavioral and emotional symptoms. Wechsler Adult Intelligence Scale‐Revised‐Digit Span Task (WAIS‐R‐DST), Corsi Block Task (CBT), and Wisconsin Card Sorting Test (WCST) were used for assessing cold executive function. Assessing hot executive function was done with Delay Discounting Task (DDT) and Iowa Gambling Task (IGT). Results Evaluating the cold executive function, total WAIS‐R‐DST score, Backward DST, total CBT score, and Backward CBT were significantly lower among ADHD than TD groups ( p < 0.05). Assessing the hot executive function showed that the score of DDT and IGT was significantly lower among ADHD than TD groups ( p < 0.05). Conclusion Both hot and cold executive functions are defective in children with ADHD, while the comorbid of ODD has no significant effect. We suggest the clinicians to consider cognitive rehabilitation interventions as a necessary treatment modality for ADHD patients.

A critical review of hot executive functioning in youth attention-deficit/hyperactivity disorder: Methodological limitations, conceptual considerations, and future directions

Article

Full-text available

Feb 2023
DEV PSYCHOPATHOL

Hot executive functioning (EF) - EF under emotionally or motivationally salient conditions - is a putative etiology of attention-deficit/hyperactivity disorder (ADHD), disruptive behavior problems (DBPs), and their related impairments. Despite two decades of research, the present study is the first review of the construct in youth ADHD, with a particular focus on the role of task design, age, and DBPs, as well as relevant conceptual and methodological considerations. While certain hot EF tasks have been investigated extensively (e.g., choice impulsivity), substantial inconsistency in measurement of the broader construct remains, severely limiting conclusions. Future research should a) consider the extent to which various hot EF tasks relate to one another, a higher order factor, and other related constructs; b) further investigate task design, particularly the elicitation of emotion or motivation and its anticipated effect on EF; and c) incorporate multiple levels of analysis to validate similarities and differences among tasks with regard to the affective experiences and cognitive demands they elicit. With improved measurement and conceptual clarity, hot EF has potential to advance the literature on etiological pathways to ADHD, DBPs and associated impairments and, more broadly, may represent a useful tool for understanding the influence of emotion and motivation on cognition.

Chapitre 12 Les troubles des fonctions exécutives

Chapter

Jul 2020

Emotionsregulation: Konzepte, Modellvorstellungen und aktuelle Befunde bei ADHS

Article

Jul 2017

Obwohl inzwischen durchaus ein Konsensus darüber besteht, dass Emotionen und Emotionsregulation von klinischer Relevanz für die Aufmerksamkeitsdefizit- / Hyperaktivitätsstörung (ADHS) im Kindes- und Erwachsenenalter und deren Verlauf sind, existieren in der Literatur noch sehr unterschiedliche Vorstellungen über die Konzeption von Emotion, Emotionsregulation und die Dysfunktionen, die in diesen Bereichen bei ADHS von Bedeutung sein können. Im vorliegenden ersten Teil unserer Übersichtsarbeit werden wir zunächst darlegen, warum Emotionen und Emotionsregulation klinisch relevant sind. Anschließend werden das gängige Modell der Emotionsregulation von Gross (2015) und drei konkurrierende Modellvorstellungen (Shaw et al., 2014) über den Zusammenhang von ADHS und Emotionsregulation skizziert. Ausgehend von der Modellannahme, dass Emotionen zeitlich begrenzte, qualitativ beschreibbare Zustände sind, die mit einer Veränderung auf Ebene der Gefühle, des Ausdrucks und körperlicher Zustände einhergehen, werden wir zunächst einen narrativen Überblick zum aktuellen Forschungsstand für die Emotionskomponenten des Erlebens und Ausdrucks geben und diesen in Hinblick auf Anwendung und zukünftige Forschung diskutieren.

Psychometric Properties and Factor Structure of the Short Form of the Affective Lability Scale in Adult Patients With ADHD

Article

Full-text available

Aug 2019
J Attention Disord

Objective: Affective lability is an important dimension of adult ADHD, associated with marked impairments and worse outcomes. A valid and quick tool to measure affective lability may therefore be of interest. Method: In 187 adult ADHD patients, we explored psychometric properties of the Affective Lability Scale–Short Form (ALS-18 items). We analyzed the construct validity and the external validity of the scale. Patients were compared with 48 healthy adult controls. Results: The three-factor structure of the ALS-18 presented a good fit and a good internal consistency. The correlations between the ALS-18 and ADHD symptoms and other psychological dimensions were, respectively, low and moderate. ALS-18 scores were higher in patients than in healthy adults. Conclusion: ALS-18 showed good psychometric properties in ADHD adult patients, allowing us to recommend the implementation of ALS-18 in assessing affective lability for clinical and research purposes. Use of ALS-18 should improve the clinical assessment of affective lability in adult ADHD patients.

Effortful control and executive attention in typical and atypical development: An event-related potential study

Article

Full-text available

May 2014

Executive attention and its relationship with effortful control (EC) were investigated in children with ADHD (n = 24), autism spectrum disorder (ASD; n = 20), and controls (n = 21). Executive attention measures included flanker-performance and event-related potentials (N2, P3, and ERN). EC was assessed using questionnaires. Only the ERN was found to be robustly related to EC across groups. N2 did not differ between groups and only children with ADHD + ODD showed diminished executive attention as expressed in RT and P3. In ADHD, monitoring of incorrect (ERN) and correct (CRN) responses was diminished. Overall, the link between EC and executive attention was less strong as expected and varied depending on group and measure considered. All groups were able to detect conflict (N2) and all but ADHD + ODD were able to allocate extra attention in order to respond correctly (P3). Findings indicate a general reduced response monitoring in ADHD.

Emotion Dysregulation in Attention Deficit Hyperactivity Disorder

Article

Full-text available

Jan 2014
AM J PSYCHIAT

Although it has long been recognized that many individuals with attention deficit hyperactivity disorder (ADHD) also have difficulties with emotion regulation, no consensus has been reached on how to conceptualize this clinically challenging domain. The authors examine the current literature using both quantitative and qualitative methods. Three key findings emerge. First, emotion dysregulation is prevalent in ADHD throughout the lifespan and is a major contributor to impairment. Second, emotion dysregulation in ADHD may arise from deficits in orienting toward, recognizing, and/or allocating attention to emotional stimuli; these deficits implicate dysfunction within a striato-amygdalo-medial prefrontal cortical network. Third, while current treatments for ADHD often also ameliorate emotion dysregulation, a focus on this combination of symptoms reframes clinical questions and could stimulate novel therapeutic approaches. The authors then consider three models to explain the overlap between emotion dysregulation and ADHD: emotion dysregulation and ADHD are correlated but distinct dimensions; emotion dysregulation is a core diagnostic feature of ADHD; and the combination constitutes a nosological entity distinct from both ADHD and emotion dysregulation alone. The differing predictions from each model can guide research on the much-neglected population of patients with ADHD and emotion dysregulation.

Multiple deficits in ADHD: Executive dysfunction, delay aversion, reaction time variability, and emotional deficits

Article

Full-text available

Oct 2012
J CHILD PSYCHOL PSYC

Background The notion that ADHD constitutes a heterogeneous disorder is well accepted. However, this study contributes with new important knowledge by examining independent effects of a large range of neuropsychological deficits. In addition, the study investigated whether deficits in emotional functioning constitute a dissociable component of ADHD. Method The study included children with ADHD (n = 102; 7–13 years) and a control sample individually matched with regard to age and gender. The administered tasks were designed to tap into three different neuropsychological domains: executive functions (i.e., working memory, inhibition, and shifting), delay aversion, and reaction time variability. Parent ratings of emotion regulation and a test of emotion recognition were also included. Results Children with ADHD differed significantly from controls on all measures, except for delay aversion and recognition of disgust. No main effects of gender or interaction effects of gender and group were found. More importantly, executive functioning, reaction time variability, and emotional functioning all contributed independently to distinguishing between children with ADHD and controls. Conclusions The current study supports the view of ADHD as a heterogeneous disorder related to multiple neuropsychological deficits. In addition, emotional functioning appears to be an area of importance for ADHD that needs to be incorporated into future theoretical models.

Neuropsychological correlates of emotional lability in children with ADHD

Article

Full-text available

Aug 2012
J CHILD PSYCHOL PSYC

BACKGROUND: Emotional lability (EL) is commonly seen in patients with attention-deficit/hyperactivity disorder (ADHD). The reasons for this association remain currently unknown. To address this question, we examined the relationship between ADHD and EL symptoms, and performance on a range of neuropsychological tasks to clarify whether EL symptoms are predicted by particular cognitive and/or motivational dysfunctions and whether these associations are mediated by the presence of ADHD symptoms. METHODS: A large multi-site sample of 424 carefully diagnosed ADHD cases and 564 unaffected siblings and controls aged 6-18 years performed a broad neuropsychological test battery, including a Go/No-Go Task, a warned four-choice Reaction Time task, the Maudsley Index of Childhood Delay Aversion and Digit span backwards. Neuropsychological variables were aggregated as indices of processing speed, response variability, executive functions, choice impulsivity and the influence of energetic and/or motivational factors. EL and ADHD symptoms were regressed on each neuropsychological variable in separate analyses controlling for age, gender and IQ, and, in subsequent regression analyses, for ADHD and EL symptoms respectively. RESULTS: Neuropsychological variables significantly predicted ADHD and EL symptoms with moderate-to-low regression coefficients. However, the association between neuropsychological parameters on EL disappeared entirely when the effect of ADHD symptoms was taken into account, revealing that the association between the neuropsychological performance measures and EL is completely mediated statistically by variations in ADHD symptoms. Conversely, neuropsychological effects on ADHD symptoms remained after EL symptom severity was taken into account. CONCLUSIONS: The neuropsychological parameters examined, herein, predict ADHD more strongly than EL. They cannot explain EL symptoms beyond what is already accounted for by ADHD symptom severity. The association between EL and ADHD cannot be explained by these cognitive or motivational deficits. Alternative mechanisms, including overlapping genetic influences (pleiotropic effects) and/or alternative neuropsychological processes need to be considered.

Stroop Interference and Attention-Deficit/Hyperactivity Disorder: A Review and Meta-Analysis

Article

Full-text available

Mar 2007

Previous reviews and meta-analyses that addressed abnormal Stroop interference in attention-deficit/hyperactivity disorder (ADHD) yielded mixed results. The authors of the present study argue that the inconsistencies may reflect the problematic nature of 2 frequently used methods to quantify Stroop interference-the difference score and Golden's method (C. J. Golden, 1978). Golden's method correction for base-word reading is inadequate, and the difference score is sensitive to the nature of the outcome variable. The latter can be remedied with a ratio score. Contrasting previous meta-analyses, this meta-analysis covers all age groups and all Stroop test variants, and it excludes studies using the Golden quantification method. Mean effect sizes for interference in ADHD as quantified by difference scores relative to control scores were 0.24 across all studies but 1.11 for time-per-item studies; outcome variable was a significant moderator variable, reflecting the sensitivity of the difference score to this variable. Consistency analysis of ratio scores across 19 studies reveals more interference for the ADHD groups relative to the control groups. It is concluded that interference control is consistently compromised in individuals with ADHD.

Self-Regulation of Emotion, Functional Impairment, and Comorbidity Among ChildrenWith AD/HD

Article

Full-text available

Oct 2011
J Attention Disord

Objective: This study investigated the role of self-regulation of emotion in relation to functional impairment and comorbidity among children with and without AD/HD. Method: A total of 358 probands and their siblings participated in the study, with 74% of the sample participants affected by AD/HD. Parent-rated levels of emotional lability served as a marker for self-regulation of emotion. Results: Nearly half of the children affected by AD/HD displayed significantly elevated levels of emotional lability versus 15% of those without this disorder. Children with AD/HD also displayed significantly higher rates of functional impairment, comorbidity, and treatment service utilization. Emotional lability partially mediated the association between AD/HD status and these outcomes. Conclusion: Findings lent support to the notion that deficits in the self-regulation of emotion are evident in a substantial number of children with AD/HD and that these deficits play an important role in determining functional impairment and comorbidity outcomes.

Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): Clinical correlates and familial prevalence

Article

Full-text available

Aug 2010
J CHILD PSYCHOL PSYC

The goal of this study was to investigate the occurrence, severity and clinical correlates of emotional lability (EL) in children with attention deficit/hyperactivity disorder (ADHD), and to examine factors contributing to EL and familiality of EL in youth with ADHD. Methods: One thousand, one hundred and eighty-six children with ADHD combined type and 1827 siblings (aged 6-18 years) were assessed for symptoms of EL, ADHD, associated psychopathology and comorbid psychiatric disorders with a structured diagnostic interview (PACS) as well as parent and teacher ratings of psychopathology (SDQ; CPRS-R:L; CTRS-R:L). Analyses of variance, regression analyses, chi 2-tests or loglinear models were applied. Results: Mean age and gender-standardized ratings of EL in children with ADHD were > 1.5 SD above the mean in normative samples. Severe EL (> 75th percentile) was associated with more severe ADHD core symptoms, primarily hyperactive-impulsive symptoms, and more comorbid oppositional defiant, affective and substance use disorders. Age, hyperactive-impulsive, oppositional, and emotional symptoms accounted for 30% of EL variance; hyperactive-impulsive symptoms did not account for EL variance when coexisting oppositional and emotional problems were taken into account, but oppositional symptoms explained 12% of EL variance specifically. Severity of EL in probands increased the severity of EL in siblings, but not the prevalence rates of ADHD or ODD. EL and ADHD does not co-segregate within families. Conclusion: EL is a frequent clinical problem in children with ADHD. It is associated with increased severity of ADHD core symptoms, particularly hyperactivity-impulsivity, and more symptoms of comorbid psychopathology, primarily symptoms of oppositional defiant disorder (ODD), but also affective symptoms, and substance abuse. EL in ADHD seems to be more closely related to ODD than to ADHD core symptoms, and is only partly explainable by the severity of ADHD core symptoms and associated psychopathology. Although EL symptoms are transmitted within families, EL in children with ADHD does not increase the risk of ADHD and ODD in their siblings.

Multidimensional Assessment of Emotion Regulation Difficulties in Adolescents Using the Difficulties in Emotion Regulation Scale

Article

Full-text available

Mar 2010
ASSESSMENT

The authors explored the utility of the Difficulties in Emotion Regulation Scale (DERS) in assessing adolescents’ emotion regulation. Adolescents (11-17 years; N = 870) completed the DERS and measures of externalizing and internalizing problems. Confirmatory factor analysis suggested a similar factor structure in the adolescent sample of the authors as demonstrated previously among adults. Furthermore, results indicated no gender bias in ratings of DERS factors on three scales (as evidenced by strong factorial gender invariance) and limited gender bias on the other three scales (as evidenced by metric invariance). Female adolescents scored higher on four of six DERS factors than male adolescents. DERS factors were meaningfully related to adolescents’ externalizing and internalizing problems. Results suggest that scores on the DERS show promising internal consistency and validity in a community sample of adolescents.

Differential engagement of cognitive and affective neural systems in pediatric bipolar disorder and attention deficit hyperactivity disorder

Article

Full-text available

Oct 2009
J INT NEUROPSYCH SOC

This fMRI study investigates the neural bases of cognitive control of emotion processing in pediatric bipolar disorder (PBD) and attention deficit hyperactivity disorder (ADHD). Seventeen un-medicated PBD patients, 15 un-medicated ADHD patients, and 14 healthy controls (HC) (mean age = 13.78 +/- 2.47) performed an emotional valence Stroop Task, requiring them to match the color of an emotionally valenced word to the color of either of two adjacent circles. Both patient groups responded significantly slower than HC, but there were no group differences in accuracy. A voxel-wise analysis of variance on brain activation revealed a significant interaction of group by word valence [F(2,41) = 4.44; p = .02]. Similar group differences were found for negative and positive words. For negative versus neutral words, both patient groups exhibited greater activation in dorsolateral prefrontal cortex (DLPFC) and parietal cortex relative to HC. The PBD group exhibited greater activation in ventrolateral prefrontal cortex (VLPFC) and anterior cingulate cortex (ACC) relative to HC. The ADHD group exhibited decreased VLPFC activation relative to HC and the PBD group. During cognitive control of emotion processing, PBD patients deployed the VLPFC to a greater extent than HC. The ADHD patients showed decreased VLPFC engagement relative to both HC and PBD patients.

Interference Control in Children with and without ADHD: A Systematic Review of Flanker and Simon Task Performance

Article

Full-text available

Nov 2008
CHILD NEUROPSYCHOL

The present review systematically summarizes the existing research that has examined two reaction-time-based interference control paradigms, known as the Eriksen Flanker task and the Simon task, in children with and without ADHD. Twelve studies are included, yielding a combined sample size of 272 children with ADHD (M age 9.28 yrs) and 280 typically developing children (M age 9.38 yrs). As predicted, specific disadvantages were found in the ADHD group in terms of reaction time, percentage of errors, and efficiency of performance on incongruent relative to congruent trials, providing evidence for weaker interference control in this group.

Behavioral Inhibition, Sustained Attention, and Executive Functions: Constructing a Unifying Theory of ADHD

Article

Full-text available

Jan 1997

Russell A. Barkley

Attention deficit hyperactivity disorder (ADHD) comprises a deficit in behavioral inhibition. A theoretical model is constructed that links inhibition to 4 executive neuropsychological functions that appear to depend on it for their effective execution: (a) working memory, (b) self-regulation of affect-motivation-arousal, (c) internalization of speech, and (d) reconstitution (behavioral analysis and synthesis). Extended to ADHD, the model predicts that ADHD should be associated with secondary impairments in these 4 executive abilities and the motor control they afford. The author reviews evidence for each of these domains of functioning and finds it to be strongest for deficits in behavioral inhibition, working memory, regulation of motivation, and motor control in those with ADHD. Although the model is promising as a potential theory of self-control and ADHD, far more research is required to evaluate its merits and the many predictions it makes about ADHD.

Neuropsychological Performance in DSM-IV ADHD Subtypes: An Exploratory Study with Untreated Adolescents

Article

Full-text available

Dec 2002

To explore neuropsychological performance in untreated Brazilian adolescents suffering from attention-deficit hyperactivity disorder (ADHD). We assessed 30 untreated adolescents with ADHD and 60 healthy control subjects, aged 12 to 16 years, using a neuropsychological battery including the Wisconsin Card-Sorting Test (WCST), the Stroop Test (ST), the Digit Span, and the Word Span. We found neuropsychological differences among the DSM-IV ADHD subtypes. Adolescents with the predominantly inattentive subtype (ADHD-I) performed more poorly than did control subjects on both the Digit Span and the ST. On both the Digit Span and the WCST, adolescents with the combined subtype (ADHD-C) presented significantly more impairments than did control subjects. Adolescents with the predominantly hyperactive-impulsive type (ADHD-HI) did not differ significantly from the control subjects in any measure assessed, but had a better performance than did those with ADHD-C on both the Digit Span and the WCST. In addition, adolescents with ADHD-HI performed better on the ST than did adolescents with ADHD-I. These findings suggest cognitive differences among ADHD subtypes, supporting the diagnostic distinction among them. Adolescents with ADHD-HI do not seem to have significant cognitive deficits.

Emotion Regulation in Children With Anxiety Disorders

Article

Full-text available

Jan 2005

This study examined emotion management skills in addition to the role of emotional intensity and self-efficacy in emotion regulation in 26 children with anxiety disorders (ADs) ages 8 to 12 years and their counterparts without any form of psychopathology. Children completed the Children's Emotion Management Scales (CEMS) and Emotion Regulation Interview (ERI), and mothers reported on their children's emotion regulation using the Emotion Regulation Checklist (ERC). Results indicated that children who met Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric Association, 1994) criteria for an anxiety disorder had difficulty managing worried, sad, and anger experiences, potentially due to their report of experiencing emotions with high intensity and having little confidence in their ability to regulate this arousal. These findings indicate that emotion regulation needs to be considered centrally in research with anxious populations.

Altered Emotional Processing in Pediatric Anxiety, Depression, and Comorbid Anxiety-Depression

Article

Full-text available

May 2005

The goal of this study was to examine some of the mechanisms underlying emotion regulation in childhood affective disorders by examining the impact of distracting emotional information during performance on a working memory task ("Emotional n-back" or E-n-back). The sample included 75 children (38 girls and 37 boys) between 8 and 16 years of age meeting criteria for: Anxiety disorder (ANX, n = 17), Major depressive disorder (MDD, n = 16), Comorbid anxiety and depression (CAD, n = 24), or Low-risk normal control (LRNC, n = 18). Results showed that the MDD and CAD groups had significantly longer reaction times on negative emotional backgrounds compared to neutral backgrounds, whereas the LRNC group had significantly longer reaction times on positive backgrounds. These results suggest altered processing of emotional information particularly associated with depression. Because the E-n-back task engages higher-order cognitive processes, these results suggest that these alterations in processing emotional information also interfere with the cognitive processes that govern how attentional resources are allocated. Further, research is needed to replicate this study and delineate underlying neural mechanisms.

A Meta-Analytic Review of Stopping Performance in Attention-Deficit/Hyperactivity Disorder: Deficient Inhibitory Motor Control?

Article

Full-text available

May 2005

This review discusses whether deficient inhibitory motor control is the core deficit of attention-deficit/hyperactivity disorder (ADHD). Inhibitory motor control is commonly assessed using the stop-signal paradigm. Since the last meta-analysis that was performed, 33 new studies have appeared. The current meta-analysis revealed a significant difference between ADHD patients and matched controls in stop latency (stop-signal reaction time) in both children and adults. Basic reaction time was significantly longer in children with ADHD, but not in adults, and there was a significant interaction between the elongation of the latency to stop and to respond in adults, but not in children. Deficient inhibitory motor control may be less crucial in children than in adults with ADHD.

The Worldwide Prevalence of ADHD: A Systematic Review and Metaregression Analysis

Article

Full-text available

Jul 2007

The worldwide prevalence estimates of attention deficit hyperactivity disorder (ADHD)/hyperkinetic disorder (HD) are highly heterogeneous. Presently, the reasons for this discrepancy remain poorly understood. The purpose of this study was to determine the possible causes of the varied worldwide estimates of the disorder and to compute its worldwide-pooled prevalence. The authors searched MEDLINE and PsycINFO databases from January 1978 to December 2005 and reviewed textbooks and reference lists of the studies selected. Authors of relevant articles from North America, South America, Europe, Africa, Asia, Oceania, and the Middle East and ADHD/HD experts were contacted. Surveys were included if they reported point prevalence of ADHD/HD for subjects 18 years of age or younger from the general population or schools according to DSM or ICD criteria. The literature search generated 9,105 records, and 303 full-text articles were reviewed. One hundred and two studies comprising 171,756 subjects from all world regions were included. The ADHD/HD worldwide-pooled prevalence was 5.29%. This estimate was associated with significant variability. In the multivariate metaregression model, diagnostic criteria, source of information, requirement of impairment for diagnosis, and geographic origin of the studies were significantly associated with ADHD/HD prevalence rates. Geographic location was associated with significant variability only between estimates from North America and both Africa and the Middle East. No significant differences were found between Europe and North America. Our findings suggest that geographic location plays a limited role in the reasons for the large variability of ADHD/HD prevalence estimates worldwide. Instead, this variability seems to be explained primarily by the methodological characteristics of studies.

How Well Do Measures of Inhibition and Other Executive Functions Discriminate Between Children With ADHD and Controls?

Article

Full-text available

Apr 2004

The aim of the present study was to evaluate the usefulness of Barkley's (1997a) model of inhibition and executive functioning in describing the deficits associated with Attention Deficit Hyperactivity Disorder (ADHD). Besides group differences, the present study addressed the question of independent effects of inhibition and the other executive functions in discriminating between children with ADHD and controls and how well, in terms of sensitivity and specificity, these measures can classify the children into the correct group. The results showed that children with ADHD differed significantly from controls with regard to measures of inhibition as well as all other executive function measures, except repetition of hand movements. In logistic regression models, three different measures tapping inhibition, working memory and emotion regulation were shown to be significant independent predictors of group membership. The sensitivity for these three variables as a set was 76.2, the specificity was 90.5, with a total of 86% of the sample correctly classified. When excluding the parental rating of emotion regulation, the overall classification rate decreased some, but was still relatively high in comparison with previous studies within this area of research.

Behavioral inhibition, sustained attention, and executive Functioning: Constructing a unifying theory of ADHD

Article

Jan 1997

R.A. Barkley

Everyday emotional experience of adults with attention deficit hyperactivity disorder: Evidence for reactive and endogenous emotional lability

Article

Dec 2014
PSYCHOL MED

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.

International Affective Picture System (IAPS): Affective Ratings of Pictures and Instruction Manual (Rep. No. A-8)

Article

Jan 2008

Emotion dysregulation and anxiety in children and adolescents: Gender differences

Article

Aug 2012
PERS INDIV DIFFER

An increasing number of studies has shown that emotion dysregulation plays a key role in relation to childhood anxiety. While gender differences are commonly associated with emotional competence, no study has yet examined whether the relation between emotion dysregulation and anxiety is the same for girls as it is for boys. The present study investigated the possibility of gender differences in the relation between emotion dysregulation and anxiety in a community sample of 544 children and adolescents (298 girls and 246 boys) in the age of 9–16 years. Anxiety was assessed using the Screen for Child Anxiety Related Emotional Disorders-Revised (SCARED-R). Emotion dysregulation was measured by the Difficulties in Emotion Regulation Scale (DERS). Four results emerged from this study. In accordance with previous research, (1) girls experience more anxiety and greater difficulties regulating their negative emotions than boys, and (2) emotion dysregulation has a significant impact on anxiety. Not previously shown, (3) emotion dysregulation is more predictive of anxiety in girls than in boys, and (4) different types of emotion regulation difficulties account for anxiety in girls and boys. Participants’ age did not have an impact on anxiety scores. Findings are discussed with respect to clinical implications and future directions.

Cognitive and Behavioral Probes of Developmental Landmarks for use in Functional Neuroimaging

Article

Oct 2000

Emotional distraction in boys with ADHD: Neural and behavioral correlates

Article

Jul 2013
BRAIN COGNITION

Although, in everyday life, patients with attention deficit hyperactivity disorder (ADHD) are frequently distracted by goal-irrelevant affective stimuli, little is known about the neural and behavioral substrates underlying this emotional distractibility. Because some of the most important brain responses associated with the sudden onset of an emotional distracter are characterized by their early latency onset and short duration, we addressed this issue by using a temporally agile neural signal capable of detecting and distinguishing them. Specifically, scalp event-related potentials (ERPs) were recorded while 20 boys with ADHD combined type and 20 healthy comparison subjects performed a digit categorization task during the presentation of three types of irrelevant, distracting stimuli: arousing negative (A-), neutral (N) and arousing positive (A+). Behavioral data showed that emotional distracters (both A- and A+) were associated with longer reaction times than neutral ones in the ADHD group, whereas no differences were found in the control group. ERP data revealed that, compared with control subjects, boys with ADHD showed larger anterior N2 amplitudes for emotional than for neutral distracters. Furthermore, regression analyses between ERP data and subjects' emotional ratings of distracting stimuli showed that only in the ADHD group, emotional arousal (ranging from calming to arousing) was associated with anterior N2: its amplitude increased as the arousal content of the visual distracter increased. These results suggest that boys with ADHD are more vulnerable to the distracting effects of irrelevant emotional stimuli than control subjects. The present study provides first data on the neural substrates underlying emotional distractibility in ADHD.

Disrupted Response Inhibition Toward Facial Anger Cues in Children With Attention-Deficit Hyperactivity Disorder (ADHD) An Event-Related Potential Study

Article

Feb 2013

This event-related potential study focused on neural correlates of inhibitory affective control in attention-deficit hyperactivity disorder (ADHD). Sixteen boys with ADHD and 16 healthy boys underwent an emotional Go/NoGo task with pictures of facial expressions from the categories anger, sadness, happiness, and neutral. The participants were instructed to execute or withhold a motor response to specific emotions. Patients relative to controls displayed a severe impairment in response inhibition toward anger cues, which was accompanied by a reduced P300 amplitude (positive voltage deflection about 300 ms after picture onset). The control group showed a P300 differentiation of the affective categories that was absent in the ADHD group. The pronounced anger-processing deficit in ADHD patients might be linked to their interpersonal difficulties and should be addressed in psychotherapy.

The Prevalence of DSM-IV Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Article

Jul 2012
NEUROTHERAPEUTICS

Erik G. Willcutt

This article describes a comprehensive meta-analysis that was conducted to estimate the prevalence of attention-deficit/hyperactivity disorder (ADHD), as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). A systematic literature review identified 86 studies of children and adolescents (N = 163,688 individuals) and 11 studies of adults (N = 14,112 individuals) that met inclusion criteria for the meta-analysis, more than half of which were published after the only previous meta-analysis of the prevalence of ADHD was completed. Although prevalence estimates reported by individual studies varied widely, pooled results suggest that the prevalence of DSM-IV ADHD is similar, whether ADHD is defined by parent ratings, teacher ratings, or a best estimate diagnostic procedure in children and adolescents (5.9-7.1 %), or by self-report measures in young adults (5.0 %). Analyses of diagnostic subtypes indicated that the predominantly inattentive type is the most common subtype in the population, but individuals with the combined type are more likely to be referred for clinical services. Additional research is needed to determine the etiology of the higher prevalence of ADHD in males than females and to clarify whether the prevalence of ADHD varies as a function of socioeconomic status or ethnicity. Finally, there were no significant prevalent differences between countries or regions of the world after controlling for differences in the diagnostic algorithms used to define ADHD. These results provide important support for the diagnostic validity of ADHD, and argue against the hypothesis that ADHD is a cultural construct that is restricted to the United States or any other specific culture.

Behavioral treatment and bio-behavioral assessment: Computer applications

Conference Paper

Jan 1980

P. J. Lang

Enhanced emotional interference on working memory performance in adults with ADHD

Article

Sep 2011
WORLD J BIOL PSYCHIA

Subjects with attention-deficit/hyperactivity disorder (ADHD) suffer from both executive dysfunction and deficits in emotion regulation. However, up to now, there has been no research demonstrating a clear impact of emotional dysregulation on cognitive performance in subjects with ADHD. Male and female adults with ADHD (n=39) and gender- and IQ-matched control subjects (n=40) performed an emotional working memory task (n-back task). In the background of the task, we presented neutral and negative stimuli varied in emotional saliency (negative pictures with low saliency, negative pictures with high saliency), but subjects were instructed to ignore these pictures and to process the working memory task as quickly and as accurately as possible. Compared to control subjects, ADHD patients showed both a general working memory deficit and enhanced distractability by emotionally salient stimuli in terms of lower n-back performance accuracy. In particular, while controls showed impaired WM performance when presented with highly arousing negative background pictures, a comparable decrement was observed in the ADHD group already with lowly arousing pictures. Our results suggest that difficulties in suppressing attention towards emotionally laden stimuli might result from deficient executive control in ADHD.

The attenuation of dysfunctional emotional processing with stimulant medication: An fMRI study of adolescents with ADHD

Article

Sep 2011
PSYCHIAT RES

Functional neuroimaging studies of attention-deficit/hyperactivity disorder (ADHD) have focused on the neural correlates of cognitive control. However, for many youths with ADHD, emotional lability is an important clinical feature of the disorder. We aimed to identify the neural substrates associated with emotional lability that were distinct from impairments in cognitive control and to assess the effects that stimulants have on those substrates. We used functional magnetic resonance imaging (fMRI) to assess neural activity in adolescents with (N=15) and without (N=15) ADHD while they performed cognitive and emotional versions of the Stroop task that engage cognitive control and emotional processing, respectively. The participants with ADHD were scanned both on and off stimulant medication in a counterbalanced fashion. Controlling for differences in cognitive control, we found that during the emotional Stroop task, adolescents with ADHD as compared with controls demonstrated atypical activity in the medial prefrontal cortex (mPFC). Stimulants attenuated activity in the mPFC to levels comparable with controls.

“Cool” Inferior Frontostriatal Dysfunction in Attention-Deficit/Hyperactivity Disorder Versus “Hot” Ventromedial Orbitofrontal-Limbic Dysfunction in Conduct Disorder: A Review

Article

Nov 2010

Katya Rubia

Attention-deficit/hyperactivity disorder (ADHD) and conduct disorder overlap behaviorally, clinically, and cognitively. An important question of potential future clinical relevance is whether these two overlapping disorders are mediated by similar or distinct underlying brain substrates. This article reviews the modern neuroimaging literature on brain structure, function, and connectivity in both disorders, shaping out commonalities and differences. Findings show that ADHD is characterized predominantly by abnormalities in inferior frontal, striatal, parietotemporal, and cerebellar regions and networks that mediate "cool"-cognitive, i.e., inhibitory, attention and timing functions associated with the disorder. Conduct disorder, by contrast, has consistently been associated with abnormalities of the "hot" paralimbic system that regulates motivation and affect, comprising lateral orbital and ventromedial prefrontal cortices, superior temporal lobes, and underlying limbic structures, most prominently the amygdala. Direct comparisons in functional imaging show that these associations of cool inferior fronto-striato-cerebellar dysfunction in ADHD and of hot orbitofrontal-paralimbic dysfunction in conduct disorder are disorder-specific. There is, hence, evidence for dissociated underlying pathophysiologies for these two disorders that may have implications for future anatomy-based differential diagnosis and prevention and intervention.

Wechsler Intelligence Scale for Children-III

Article

Jan 1991

David Wechsler

Emotion Processing Influences Working Memory Circuits in Pediatric Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder

Article

Oct 2010

This functional magnetic resonance imaging (fMRI) study examined how working memory circuits are affected by face emotion processing in pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD). A total of 23 patients with PBD, 14 patients with ADHD, and 19 healthy control (HC) subjects (mean age, 13.36 ± 2.55 years) underwent an affective, two-back fMRI task with blocks of happy, angry, and neutral faces. For angry versus neutral faces PBD patients, relative to ADHD patients, exhibited increased activation in the subgenual anterior cingulate cortex (ACC) and orbitofrontal cortex, and reduced activation in the dorsolateral prefrontal cortex (DLPFC) and premotor cortex. Relative to the HC group, the PBD group showed no increased activation and reduced activation at the junction of DLPFC and ventrolateral prefrontal cortex (VLPFC). Relative to HC, the ADHD patients exhibited greater activation in the DLPFC and reduced activation in the ventral and medial PFC, pregenual ACC, striatum, and temporo-parietal regions. For happy versus neutral faces, relative to the ADHD group, the PBD group exhibited greater activation in the bilateral caudate, and relative to the HC group the ADHD group showed increased activation in the DLPFC, striatal, and parietal regions, and no reduced activation. The ADHD group, compared with the HC group, showed no reduced activation and increased activation in regions that were underactive for the angry face condition. Relative to the ADHD group, the PBD group exhibited greater deployment of the emotion-processing circuitry and reduced deployment of working memory circuitry. Commonalities across PBD and ADHD patients, relative to the HC individuals, entailed cortico-subcortical activity that was reduced under negative emotional challenge and increased under positive emotional challenge.

Response inhibition and interference control in children with AD/HD: A visual ERP investigation

Article

May 2009

Children with Attention-deficit Hyperactivity Disorder (AD/HD) show deficits in executive inhibitory functions such as behavioral inhibition and interference control, but investigations of both of these domains in the same groups of children is scarce, especially with concurrent consideration of ERP indices of inhibitory processes. Twenty children with AD/HD and 20 matched controls aged between 8 and 14 years performed visual Go-Nogo (30% Nogo) and Flanker tasks while EEG was recorded. Results indicated that children with AD/HD traded off speed for accuracy in the Go-Nogo task, resulting in similar levels of response inhibition accuracy; in the Flanker task response speed and errors were at control levels, while misses were increased and showed an enhanced interference effect. In the Go-Nogo task, the AD/HD group showed reduced Go/Nogo P2, a reduced central N2 Nogo>Go effect, and a more anterior Go/Nogo P3 compared to controls. For the Flanker task, the AD/HD group showed delayed N1 and P2, dramatically reduced N2 to Incongruent stimuli, enhanced N2 to Neutral stimuli, as well as increased P3 to Incongruent stimuli, compared to controls. These results indicate that Go-Nogo behavioral inhibition and Flanker interference control were not equally impaired in children with AD/HD, and that factors such as effort, arousal and motivation require further investigation.

Teacher Ratings of DSM-III-R Symptoms for the Disruptive Behavior Disorders

Article

Apr 1992
J AM ACAD CHILD PSY

Ratings were collected on a rating scale comprised of the DSM-III-R diagnostic criteria for disruptive behavior disorders. Teacher ratings were obtained for 931 boys in regular classrooms in grades K through 8 from around North America. Means and standard deviations for attention-deficit hyperactivity disorder (ADHD), oppositional-defiant disorder (ODD), and conduct disorder (CD) scales are reported by age. Frequencies of DSM-III-R symptoms are reported by age, and suggested diagnostic cutoffs are discussed. A factor analysis revealed three factors: one reflecting ODD and several CD symptoms, one on which ADHD symptoms of inattention loaded, and one comprised of ADHD impulsivity/overactivity symptoms. Conditional probability analyses revealed that several hallmark symptoms of ADHD had very poor predictive power, whereas combinations of symptoms from the two ADHD factors had good predictive power. Combinations of ODD symptoms also had very high predictive power. The limited utility of teacher ratings in assessing symptoms of conduct disorder in this age range is discussed.

The Disruptive Behavioral Disorder in Children and Adolescents: Comorbidity and Clinical Course

Article

Apr 1992
J AM ACAD CHILD PSY

Comorbidity, time to recovery, rate of chronicity, and probability of recurrence following recovery were studied in 51 children diagnosed with attention deficit disorder, conduct disorder, and oppositional defiant disorder. Thirty-three percent of the children had two of the above diagnoses, and one child had all three diagnoses. The mean duration of attention deficit disorder was 8 years up to the time of the interview; the mean duration of oppositional defiant disorder was 4.5 years, and the mean duration of conduct disorder was 3 years. Life-table estimates showed that 14% of the children would not have recovered 15 years after the onset of their disorder. Rates of recurrence were high following recovery from each of these disorders.

Measuring Emotion: The Self-Assessment Manikin and the Semantic Differential

Article

Apr 1994
J BEHAV THER EXP PSY

The Self-Assessment Manikin (SAM) is a non-verbal pictorial assessment technique that directly measures the pleasure, arousal, and dominance associated with a person's affective reaction to a wide variety of stimuli. In this experiment, we compare reports of affective experience obtained using SAM, which requires only three simple judgments, to the Semantic Differential scale devised by Mehrabian and Russell (An approach to environmental psychology, 1974) which requires 18 different ratings. Subjective reports were measured to a series of pictures that varied in both affective valence and intensity. Correlations across the two rating methods were high both for reports of experienced pleasure and felt arousal. Differences obtained in the dominance dimension of the two instruments suggest that SAM may better track the personal response to an affective stimulus. SAM is an inexpensive, easy method for quickly assessing reports of affective response in many contexts.

Shaffer D, Fisher P, Lucas CP, Dulcan MK, Schwab-Stone ME. NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. J Am Acad Child Adolesc Psychiatry 39: 28-38

Article

Feb 2000
J AM ACAD CHILD PSY

To describe the National Institute of Mental Health Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV) and how it differs from earlier versions of the interview. The NIMH DISC-IV is a highly structured diagnostic interview, designed to assess more than 30 psychiatric disorders occurring in children and adolescents, and can be administered by "lay" interviewers after a minimal training period. The interview is available in both English and Spanish versions. An editorial board was established in 1992 to guide DISC development and ensure that a standard version of the instrument is maintained. Preliminary reliability and acceptability results of the NIMH DISC-IV in a clinical sample of 84 parents and 82 children (aged 9-17 years) drawn from outpatient child and adolescent psychiatric clinics at 3 sites are presented. Results of the previous version in a community sample are reviewed. Despite its greater length and complexity, the NIMH DISC-IV compares favorably with earlier versions. Alternative versions of the interview are in development (the Present State DISC, the Teacher DISC, the Quick DISC, the Voice DISC). The NIMH DISC is an acceptable, inexpensive, and convenient instrument for ascertaining a comprehensive range of child and adolescent diagnoses.

Social Functioning and Emotional Regulation in the Attention Deficit Hyperactivity Disorder Subtypes

Article

Apr 2000
J Clin Child Psychol

Compared 16 children with attention deficit hyperactivity disorder (ADHD) combined type (ADHD-C), 14 children with ADHD predominantly inattentive type (ADHD-I), and 17 controls on parent and teacher ratings of social status and performance, self-report of social knowledge and performance, and observations of behavior on an emotional regulation task. Analyses revealed distinct patterns of social dysfunction between ADHD subgroups. Children with ADHD-C were rated as showing more aggressive behavior; furthermore, they displayed emotional dysregulation characterized by high intensity and high levels of both positive and negative behavior. In contrast, children with ADHD-I were perceived as displaying social passivity and showed deficits in social knowledge on the self-report measure but did not evidence problems in emotional regulation. Regression analyses revealed that social performance, emotional regulation, and, to a lesser degree, social knowledge, were predictive of social status. The application of these findings to understanding the nature of the social deficits in the ADHD subtypes and directions for future research are discussed.

Emotion Regulation and Parenting in AD/HD and Comparison Boys: Linkages with Social Behaviors and Peer Preference

Article

Mar 2000

Children's emotion regulation strategies and parenting responses in a family task that elicited frustration are investigated by comparing core attention-deficit/hyperactivity disorder (AD/HD) symptomatology, emotional reactivity, and emotional regulation in the prediction of social behaviors and peer social preference. Participants were boys, ages 6-12 years, either with AD/HD (n = 45) or without problem behaviors (comparison; n = 34). A high-aggressive subgroup of AD/HD boys showed a significantly less constructive pattern of emotional coping than did both a low-aggressive AD/HD subgroup of boys and nondiagnosed comparison boys, who did not differ. With statistical control of core AD/HD symptomatology, noncompliance in a naturalistic summer camp was predicted by boys' overall emotion regulation and three specific strategies (emotional accommodation, problem solving, negative responses) during the parent-child interaction. Emotional accommodation and negative responses to the frustration task also marginally predicted social preference at the camp. These emotion regulation variables outperformed emotional reactivity in predicting such outcomes. Some emotion-related parenting behaviors were associated with child coping in the task. We discuss the relationship of emotion regulation to core AD/HD symptomatology and emotional reactivity, and the role of parents' behaviors in influencing children's emotional responses.

Emotional reactions in children: Verbal, physiological, and behavioral responses to affective pictures

Article

Apr 2001

Many studies have shown a consistent pattern in adults' responses to affective pictures and there is growing evidence of gender differences, as well. Little is known, though, about children's verbal, behavioral, and physiological responses to affective pictures. Two experiments investigated children's responses to pictures. In Experiment 1, children, adolescents, and adults viewed pictures varying in affective content and rated them for pleasure, arousal, and dominance. Results indicated that children and adolescents rated the pictures similarly to adults. In Experiment 2, physiological responses, self-report, and viewing time were measured while children viewed affective pictures. As with adults, children's responses reflected the affective content of the pictures. Gender differences in affective evaluations, corrugator activity, skin conductance, startle modulation, and viewing time indicated that girls were generally more reactive to unpleasant materials.

A comparison of the neuropsychological profiles of the DSM-IV Subtypes of ADHD

Article

Jan 2002

Recent research on the DSM-IV subtypes of attention-deficit/hyperactivity disorder (ADHD) has demonstrated that the subtypes differ in demographic characteristics, types of functional impairment, and profiles of comorbidity with other childhood disorders. However, little research has tested whether the subtypes differ in underlying neuropsychological deficits. This study compared the neuropsychological profiles of children without ADHD (n = 82) and children who met symptom criteria for DSM-IV Predominantly Inattentive subtype (ADHD-IA; n = 67), Predominantly Hyperactive Impulsive subtype (ADHD-HI; n = 14), and Combined subtype (ADHD-C; n = 33) in the areas of processing speed, vigilance, and inhibition. We hypothesized that children with elevations of inattention symptoms (ADHD-IA and ADHD-C) would be impaired on measures of vigilance and processing speed, whereas children with significant hyperactivity/impulsivity (ADHD-HI and ADHD-C) would be impaired on measures of inhibition. Contrary to prediction, symptoms of inattention best predicted performance on all dependent measures, and ADHD-IA and ADHD-C children had similar profiles of impairment. In contrast, children with ADHD-HI were not significantly impaired on any dependent measures once subclinical symptoms of inattention were controlled. Our results do not support distinct neuropsychological deficits in ADHD-IA and ADHD-C children, and suggest that symptoms of inattention, rather than symptoms of hyperactivity/impulsivity, are associated with neuropsychological impairment.

The Relation Between Disinhibition and Emotion Regulation in Boys With Attention Deficit Hyperactivity Disorder

Article

Jan 2005

This study examined group differences of 49 boys ages 6 to 11 years with and without attention deficit hyperactivity disorder (ADHD) in emotion regulation during frustrating peer competition. Half of all boys in each group were explicitly instructed to hide their feelings if they became upset during the competition. Behavioral inhibition, both before and after the competitive task, was examined using the Stop Signal Task (SST), and emotion regulation was assessed via structured observation data. Effect sizes indicated that impulsive ADHD boys displayed greater disinhibition and were less effective at emotion regulation than comparison boys. In addition, boys with ADHD were unsuccessful in masking their emotions even when instructed to do so. In contrast, comparison boys were more successful at emotion regulation when given instruction to self-regulate, and these regulatory attempts predicted later inhibitory control. Findings are discussed in the context of current ADHD-related theories of inhibitory deficit, and suggestions for future research are provided.

The Stroop revisited: A meta-analysis of interference control in AD/HD

Article

Mar 2005

An inhibition deficit, including poor interference control, has been implicated as one of the core deficits in AD/HD. Interference control is clinically measured by the Stroop Colour-Word Task. The aim of this meta-analysis was to investigate the strength of an interference deficit in AD/HD as measured by the Stroop Colour-Word Task and to assess the role of moderating variables that could explain the results. These moderating variables included: methods of calculating the interference score, comorbid reading and psychiatric disorders, AD/HD-subtypes, gender, age, intellectual functioning, medication, and sample size. Seventeen independent studies were located including 1395 children, adolescents, and young adults, in the age range of 6-27 years. A meta-analysis was conducted to assess the effect sizes for the scores on the word and the colour card as well as the interference score. Children with AD/HD performed more poorly on all three dependent variables. The effect sizes for word reading (d=.49) and colour naming (d=.58) were larger and more homogeneous than the effect size for the interference score (d=.35). The method used to calculate the interference score strongly influenced the findings for this measure. When interference control was calculated as the difference between the score on the colour card minus the score on the colour-word card, no differences were found between AD/HD groups and normal control groups. The Stroop Colour-Word Task, in standard form, does not provide strong evidence for a deficit in interference control in AD/HD. However, the Stroop Colour-Word Task may not be a valid measure of interference control in AD/HD and alternative methodologies may be needed to test this aspect of the inhibitory deficit model in AD/HD.

A Meta-Analysis of Working Memory Impairments in Children With Attention-Deficit/Hyperactivity Disorder

Article

May 2005
J AM ACAD CHILD PSY

To determine the empirical evidence for deficits in working memory (WM) processes in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Exploratory meta-analytic procedures were used to investigate whether children with ADHD exhibit WM impairments. Twenty-six empirical research studies published from 1997 to December, 2003 (subsequent to a previous review) met our inclusion criteria. WM measures were categorized according to both modality (verbal, spatial) and type of processing required (storage versus storage/manipulation). Children with ADHD exhibited deficits in multiple components of WM that were independent of comorbidity with language learning disorders and weaknesses in general intellectual ability. Overall effect sizes for spatial storage (effect size = 0.85, CI = 0.62 - 1.08) and spatial central executive WM (effect size = 1.06, confidence interval = 0.72-1.39) were greater than those obtained for verbal storage (effect size = 0.47, confidence interval = 0.36-0.59) and verbal central executive WM (effect size = 0.43, confidence interval = 0.24-0.62). Evidence of WM impairments in children with ADHD supports recent theoretical models implicating WM processes in ADHD. Future research is needed to more clearly delineate the nature, severity, and specificity of the impairments to ADHD.

Validity of the Executive Function Theory of Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review

Article

Jul 2005
BIOL PSYCHIAT

One of the most prominent neuropsychologic theories of attention-deficit/hyperactivity disorder (ADHD) suggests that its symptoms arise from a primary deficit in executive functions (EF), defined as neurocognitive processes that maintain an appropriate problem-solving set to attain a later goal. To examine the validity of the EF theory, we conducted a meta-analysis of 83 studies that administered EF measures to groups with ADHD (total N = 3734) and without ADHD (N = 2969). Groups with ADHD exhibited significant impairment on all EF tasks. Effect sizes for all measures fell in the medium range (.46-.69), but the strongest and most consistent effects were obtained on measures of response inhibition, vigilance, working memory, and planning. Weaknesses in EF were significant in both clinic-referred and community samples and were not explained by group differences in intelligence, academic achievement, or symptoms of other disorders. ADHD is associated with significant weaknesses in several key EF domains. However, moderate effect sizes and lack of universality of EF deficits among individuals with ADHD suggest that EF weaknesses are neither necessary nor sufficient to cause all cases of ADHD. Difficulties with EF appear to be one important component of the complex neuropsychology of ADHD.

Emotion Regulation in Children and Adolescents

Article

May 2006
J DEV BEHAV PEDIATR

Within the past two decades, an "affect revolution" [Fischer and Tangney, Self-conscious Emotions: The Psychology of Shame, Guilt, Embarrassment, and Pride 1995:3-22] in research has revolutionized the ways in which emotion processes have been conceptualized and subsequently studied. This review discusses the literature on emotion regulation (ER) in childhood and adolescence by first summarizing the trajectory of emotional development from infancy through adolescence, followed by a discussion of the biological and environmental influences on ER, and then a review of the literature linking ER to psychosocial functioning. The penultimate section offers practical suggestions for identifying ER difficulties in children and strategies for intervention efforts. Potential areas for future research conclude the review.

ADHD and Stroop interference from age 9 to age 41 years: A meta-analysis of developmental effects

Article

Feb 2008

In this meta-analysis, we investigated whether response inhibition is sensitive to attention deficit hyperactivity disorder (ADHD) status and, if so, what influence maturation has on this attentional symptom of ADHD. We examined 25 studies that reported data on the Stroop color word test in children and adults with ADHD and in age-matched controls; average ages ranged from 9 to 41 years. We utilized a hierarchical approach to analyze the strength of the Stroop effect and whether the effect varies as a function of age. Additionally, we assessed potential differences in maturation rates based on reaction time (RT) of color and color-word conditions. First, we found that the relationship between color-word and color RT was multiplicative, and the slope of this function (the ratio of color-word RT over color RT) was identical across age groups and ADHD status. Second, we found that although ADHD individuals were on average 1.14 times slower than age-matched controls in both the color and the color-word condition, the maturation rate was identical for both groups. The results from this analysis indicate that the Stroop interference effect is not larger in ADHD individuals than in age-matched controls. Further, we did not find evidence for differential maturation rates for persons with ADHD and the control groups. The Stroop interference effect appears to be immune to age, regardless of ADHD status.

Inquisit version 2.0.603030

Jan 2006

Millisecond

Millisecond (2006). Inquisit version 2.0.603030. Seattle, WA: Millisecond Software.

The international affective picture system: Digitized photographs. Gainesville, FL: The Center for Research in Psychophysiology

Jan 1999

Center For
Study

Center for the Study of Emotion and Attention (CSEA-NIMH) (1999). The international affective picture system: Digitized photographs. Gainesville, FL: The Center for Research in Psychophysiology, University of Florida.

Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development The Stroop revisited: A meta-analysis of interference control in AD/HD

Jan 1994
25-52

R A R Thompson
J Oosterlaan
J A Sergeant

Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs of the Society for Research in Child Development, 59, 25–52. http:// dx.doi.org/10.1111/j.1540-5834.1994.tb01276.x van Mourik, R., Oosterlaan, J., & Sergeant, J. A. (2005). The Stroop revisited: A meta-analysis of interference control in AD/HD. Journal of Child Psychology and Psychiatry, 46(2), 150–165. http://dx.doi.org/10.1111/j.1469-7610.2004.00345.x

Handleiding Vragenlijst voor Gedragsproblemen bij Kinderen (VvGK)

Jan 2008

J Oosterlaan
D Baeyens
A Scheres
I Antrop
H Roeyers
J A Sergeant

Oosterlaan, J., Baeyens, D., Scheres, A., Antrop, I., Roeyers, H., & Sergeant, J. A. (2008). Handleiding Vragenlijst voor Gedragsproblemen bij Kinderen (VvGK). Amsterdam, The Netherlands: Harcourt.

“Turning down the heat”: Is poor performance of children with ADHD on tasks tapping “hot” emotional regulation caused by deficits in “cool” executive functions?

Abstract

No full-text available

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