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Attention-Deficit Hyperactivity Disorder and Children’s Emotion Dysregulation: A meta-analysis

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... Poor emotion regulation, defined as an individual's ability to modify an emotional state so as to promote adaptive, goal-oriented behaviours has been suggested as an important intermediate psychological risk factor for ADHDdepression comorbidity during adolescence [18][19][20][21]. However, emotion regulation is a broad psychological construct [22], and research is needed to clarify which components of emotion regulation are altered in youth with ADHD [23][24][25][26] and are associated with co-morbid depression or depression risk. ...
... Importantly, irritability has been associated with co-morbid depressive symptoms and depression risk in children with ADHD as shown in crosssectional and longitudinal studies [18,20,31]. In addition, some evidence suggests that youth with ADHD also have difficulties in effectively modulating the intensity of inappropriate emotions in response to the initial emotional experience, and generating and maintaining appropriate emotions [24,26]. However, it is not known to what degree alterations in these regulatory abilities are associated with co-morbid depressive symptomatology and depression risk. ...
... These findings suggest that the identified alterations in the use of adaptive and maladaptive strategies were linked to depressive rather than core ADHD symptoms. This finding does not exclude that other aspects of emotion dysregulation (e.g., increased emotional reactivity/impulsivity [24,25,107] may reflect a fundamental aspect of ADHD per se [29,108,109]. ...
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Youth with attention-deficit/hyperactivity disorder (ADHD) are at increased risk to develop co-morbid depression. Identifying factors that contribute to depression risk may allow early intervention and prevention. Poor emotion regulation, which is common in adolescents, is a candidate risk factor. Impaired cognitive emotion regulation is a fundamental characteristic of depression and depression risk in the general population. However, little is known about cognitive emotion regulation in youth with ADHD and its link to depression and depression risk. Using explicit and implicit measures, this study assessed cognitive emotion regulation in youth with ADHD (N = 40) compared to demographically matched healthy controls (N = 40) and determined the association with depressive symptomatology. As explicit measure, we assessed the use of cognitive emotion regulation strategies via self-report. As implicit measure, performance in an ambiguous cue-conditioning task was assessed as indicator of affective bias in the processing of information. Compared to controls, patients reported more frequent use of maladaptive (i.e., self-blame, catastrophizing, and rumination) and less frequent use of adaptive (i.e., positive reappraisal) emotion regulation strategies. This pattern was associated with the severity of current depressive symptoms in patients. In the implicit measure of cognitive bias, there was no significant difference in response of patients and controls and no association with depression. Our findings point to depression-related alterations in the use of cognitive emotion regulation strategies in youth with ADHD. The study suggests those alterations as a candidate risk factor for ADHD-depression comorbidity that may be used for risk assessment and prevention strategies.
... emotions is essential for good social relationships, and emotional difficulties may manifest in social behaviors such as withdrawing from or acting aggressively toward peers (Eisenberg et al., 1998). Emotional difficulties are common in children with attention-deficit/hyperactivity disorder (ADHD; Graziano & Garcia, 2016), and, in part, contribute to their social difficulties (Bunford et al., 2015a, b). As such, parental behaviors may be particularly important for emotion socialization in this population. ...
... Emotional functioning includes emotional reactivity (intensity in response), regulation (modulating emotions to function optimally), and understanding (ability to identify emotions and empathize; Graziano & Garcia, 2016). Each has implications for children's social relationships with real-life peers (Bunford et al., 2015a, b). ...
... Each has implications for children's social relationships with real-life peers (Bunford et al., 2015a, b). Understanding emotions in oneself and in peers may foster prosocial behavior (Graziano & Garcia, 2016), while emotional reactivity and dysregulation can result in aggressive (Calkins et al., 2019) or withdrawn/depressed behaviors around peers (Lindblom et al., 2017). Emotional functioning may be particularly relevant in a friendship, as friendship requires high emotional investment. ...
Article
https://rdcu.be/cln9T Parental emotion-related socialization behaviors shape children’s socioemotional functioning and appear important for children with attention-deficit/hyperactivity disorder (ADHD). The Parental Friendship Coaching (PFC) intervention teaches parents to coach their children with ADHD in friendship skills, which includes managing emotions. We examined whether PFC, relative to psychoeducation and social support (Coping with ADHD through Relationships and Education; CARE), improved parental emotion-related socialization behaviors, child affect with a friend, and child social behaviors related to emotional difficulties. Participants were 172 families of children with ADHD (ages 6–11, 30% female), randomized to PFC or CARE. At baseline, children and their real-life friends interacted and their affect was coded. Parents coached their child in friendship skills before and after the child-friend interaction, and parents’ praise, warmth, criticism, and discussion of emotion-related friendship strategies were coded. Parents and teachers reported children’s withdrawn/depressed and aggressive behaviors. Results suggested that PFC (relative to CARE) led to parents providing more emotion strategies and praise at post-treatment and follow-up, and more warmth at follow-up, and to children showing less withdrawn/depressed behavior at follow-up. For bidirectional relationships from baseline to post-treatment, more parental warmth was associated with less child withdrawn/depressed behavior, and more parental criticism with more child aggression. More child withdrawn/depressed behavior and positive affect at post-treatment were associated with more parental criticism at follow-up. After corrections for multiple comparisons, only PFC effects on praise and emotion strategies at post-treatment, and praise and withdrawn/depressed behavior at follow-up, maintained. Implications are discussed for supporting socioemotional functioning in children with ADHD.
... A critical aspect of ED in ADHD is impaired emotional reactivity (ER): the threshold, intensity, or duration of affective arousal, which can be measured through the processing of emotionally salient stimuli (Graziano & Garcia, 2015). Adult participants with ADHD do not appear to have deficits in the explicit regulation of emotions, but display emotional hyper-responsivity (Materna et al., 2019). ...
... As such, amygdala hyperactivity in participants with ADHD might be related to deficits in the processing of specific negative stimuli (e.g., loss anticipation), instead of general deficits in emotion regulation. This is in line with an earlier notion that ER, as an aspect of ED in participants with ADHD, is influenced by many factors including age and is much more complex than originally thought (Graziano & Garcia, 2015). ...
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Understanding the neural mechanisms of emotional reactivity in Attention-Deficit/Hyperactivity Disorder (ADHD) may help develop more effective treatments that target emotion dysregulation. In adult ADHD, emotion regulation problems cover a range of dimensions, including emotional reactivity (ER). One important process that could underlie an impaired ER in ADHD might be impaired working memory (WM) processing. We recently demonstrated that taxing WM prior to the exposure of emotionally salient stimuli reduced physiological and subjective reactivity to such cues in heavy drinkers, suggesting lasting effects of WM activation on ER. Here, we investigated neural mechanisms that could underlie the interaction between WM and ER in adult ADHD participants. We included 30 male ADHD participants and 30 matched controls. Participants performed a novel functional magnetic resonance imaging paradigm in which active WM-blocks were alternated with passive blocks of negative and neutral images. We demonstrated group-independent significant main effects of negative emotional images on amygdala activation, and WM-load on paracingulate gyrus and dorsolateral prefrontal cortex activation. Contrary to earlier reports in adolescent ADHD, no impairments were found in neural correlates of WM or ER. Moreover, taxing WM did not alter the neural correlates of ER in either ADHD or control participants. While we did find effects on the amygdala, paCG, and dlPFC activation, we did not find interactions between WM and ER, possibly due to the relatively unimpaired ADHD population and a well-matched control group. Whether targeting WM might be effective in participants with ADHD with severe ER impairments remains to be investigated.
... We report that educators' information about ADHD was low with the mean general information score being under half right. Our outcome is reliable with research directed in Caribbean Nation, South Africa and Sri Lanka and which likewise report information scores beneath half (50) In the ebb and flow study, the most elevated recurrence of right answers about information on causes and danger variables of ADHD was additionally accomplished for food added substances (20) which indicated that parent ruining might be a reason for ADHD and [50] in which a large portion of members answers concur with that poor child rearing, natural and hereditary inclination could cause ADHD. ...
... ADHD kids need mental help (62.5%). Also, Brook et al;(2000) and (20) considers detailed that the majority of the instructors erroneously accept that the disciplinary edge and discipline ought to be the equivalent for ADHD students just as different colleagues (without ADHD). ...
... Former research has shown that EL is strongly associated with ADHD and occurs in between 38%-78% of children and adolescents with ADHD (Banaschewski et al. 2012;Childress and Sallee 2015;Graziano and Garcia 2016;Sobanski et al. 2010). EL is associated with both symptoms of inattention as hyperactivity-impulsivity but is most strongly associated with the ADHD combined presentation (Childress and Sallee 2015;Liu et al. 2017). ...
... Given their strong degree of overlap it has been argued that EL may share certain features of its neuropsychological profile with attention deficit/hyperactivity disorder (ADHD; (Banaschewski et al. 2012;Graziano and Garcia 2016;Sobanski et al. 2010). ADHD is a neuropsychological heterogeneous disorder with associated deficits in a range of domains (Coghill et al. 2013;Sonuga-Barke et al. 2010). ...
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Emotional Lability (EL) is a source of impairment in multiple mental disorders of children, including attention-deficit/hyperactivity disorder (ADHD). It has been proposed that the overlap between EL and ADHD symptoms is the result of common neuropsychological deficits. The aim of the present study was to test this hypothesis by using a multi-method approach. In a mixed sample of 61 children (49 community sample and 12 children with an ADHD diagnosis) aged between 8 and 12 years, we examined the relationship between parental reports of ADHD and EL, real-time children’s emotional expressions in an experimental context, children’s performance on neuropsychological tasks and parental ratings of neuropsychological functioning. Parental EL ratings were significantly predicted by task-based reaction time variability and by questionnaire measures of Self-Direction & Organization and Arousal Regulation. Parental EL ratings were also significantly related to both ADHD symptom dimensions. After controlling for shared neuropsychological factors, ADHD symptoms no longer predicted parental EL ratings. Neuropsychological task performance was not significantly related to real time emotional expressions. However, positive emotional expressions were significantly predicted by higher parental ratings of Cognition and negative emotional expressions by parental ratings of low Effort engagement – accounting for some of the correlation with ADHD symptoms. The current results highlight the plausible role of cognitive energetic processes in explaining the EL and ADHD symptom association.
... Emotional difficulties, most commonly irritability as a dispositional mood state (and anger as the emotion), depression, and anxiety, are common in individuals with Attention Deficit Hyperactivity Disorder (ADHD) (1,2). These findings have led some to conclude that emotional impulsivity and/or poor emotion regulation may be core features of ADHD that help to explain the persistence of ADHD and its impact on overall functioning (3)(4)(5). ...
... Of course, irritability and other emotional difficulties are common to a wide range of disorders and may be common comorbidities rather than core features of ADHD (6). Setting aside the diagnostic issues, the course and outcome of emotional difficulties in individuals with ADHD, and whether the core features of ADHD impact their trajectory, remain understudied and poorly understood (1,2). ...
Article
Background: Further knowledge is needed regarding long-term outcome of emotional symptoms, and the interplay between these symptoms and neuropsychological functioning in youth with attention deficit hyperactivity disorder (ADHD). Objective: We aimed to explore the effect of performance-based neurocognitive functions and parent-rated behavioral executive functioning (EF) on self-rated and parent-rated internalizing symptoms longitudinally in clinically referred youth with ADHD (n = 137; mean age = 12.4 years). We also aimed to examine the change in self-rated emotional symptoms in the ADHD group and a Control group (n = 59; mean age = 11.9 years). Method: At baseline, and three years later, parents completed rating scales of their child’s ADHD symptoms (Swanson Nolan Pelham Scale, Version IV – SNAP-IV), emotional symptoms (Five To Fifteen Questionnaire, Strengths and Difficulties Questionnaire), and EF (Behavior Rating Inventory of Executive Function). At the same time, the child completed self-report measures of Anxiety, Depression, and Anger Inventories (the Beck Youth Inventories) and neurocognitive measures (Conner’s Continuous Performance Test, Version II (CPT-II), Working Memory and Processing Speed composites (Wechsler Intelligence Scales). Statistical analyses were linear and logistic mixed models. Results: Using longitudinal data, parent- and self-ratings of emotional symptoms were associated with parent-ratings of EF behavior in youth with ADHD. Planning/organizing deficits were associated with Anxiety and Anger over and above other metacognitive subscales, while Emotional Control was related to Anger over and above other behavior regulation subscales. In the ADHD group, Anger symptoms improved across measuring points. When controlling for age, Anxiety, and Depression symptoms were largely stable in both groups, however at higher levels in the ADHD group. The differences in anxiety and depression symptoms across groups decreased over time. Conclusions: The current study emphasizes the importance of identification, monitoring, and treatment of emotional symptoms, and behavioral aspects of EF in youth with ADHD.
... La RE se refiere a la expresión fisiológica, experiencial y conductual de una emoción, así como la habilidad para modular la velocidad e intensidad del decremento e incremento de tal emoción (Bunford et al., 2014;Zelkowitz & Cole, 2016). La dificultad para su manejo se presenta de manera clínicamente significativa en aproximadamente del 48% al 54% de la población pediátrica con TDAH (Graziano & Garcia, 2016). ...
... Adicionalmente, nuestra medición se encuentra limitada en el sentido de comprender las variables que pueden estar subyaciendo a la desregulación emocional y al posible incremento de la reactividad o labilidad emocional en el TDAH, de tal forma que estas variables pudieran interactuar con el FE y la CS. A pesar de que este estudio se enfocó en el impacto que la RE tiene sobre la CS, hay evidencia de que la reactividad y la labilidad emocional representan el mismo constructo (Zelkowitz & Cole, 2016), se encuentran deterioradas en el TDAH (Graziano & Garcia, 2016) y han sido implicadas como variables potenciales que expliquen la desregulación emocional en el TDAH (Christiansen et al., 2019). ...
Article
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Los niños con trastorno por déficit de atención con hiperactividad (TDAH) presentan fallas en diversos componentes de las funciones ejecutivas (FE) como en el control inhibitorio y la memoria de trabajo (MT), las cuales además pueden predecir alteraciones en la regulación emocional (RE). Estas alteraciones son comunes en los niños con TDAH y pueden manifestarse mediante fallas en la conducta social (CS). El presente estudio tiene un diseño de investigación no experimental, transeccional correlacional-causal. El objetivo fue determinar qué componente de las FE media la interacción entre la RE y la CS en niños con TDAH. Participaron 234 niños de ambos sexos entre 6 y 12 años distribuidos en dos grupos: 138 niños con desarrollo típico y 96 niños con TDAH. Los resultados muestran que la MT fue el componente de las FE que medió de manera significativa la relación entre la RE y la CS principalmente para el grupo con TDAH en presentación combinada (β = -.16; IC 95% [-0.30, -0.01], p < .001). Se concluye que, para comprender las fallas en la RE en los niños con TDAH, es importante evaluar la MT y tomar en cuenta el tipo de presentación predominante del trastorno, lo cual pudiera predecir el impacto que tienen dichos déficits sobre la CS.
... To address this gap in the literature, the present study tested theoretical models (Eisenberg et al., 1998;Morris et al., 2007) proposing that parent reactions to children's negative emotions would indirectly affect adolescent peer problems through effects on emotion dysregulation using a longitudinal sample that ranged widely in child attention-deficit hyperactivity disorder (ADHD) symptoms. Youth with ADHD are a highly vulnerable population, often characterized by significant peer problems (McQuade, 2020) and emotion dysregulation (Graziano & Garcia, 2016). Additionally, youth with more severe ADHD symptoms may have parents who display higher rates of negative or non-supportive parenting practices (Kaiser et al., 2011). ...
... Theory has proposed that the peer problems displayed by youth with ADHD may result from emotion dysregulation that is caused by the symptoms of the disorder (Bunford et al., 2015b). Indeed, youth with ADHD often display high levels of emotion dysregulation (Graziano & Garcia, 2016), which predict their social impairments (e.g., Bunford et al., 2018). In addition, emotion dysregulation has been found to mediate the association between child ADHD symptoms and poorer social skills (Bunford et al., 2015a), lower peer acceptance (Lee et al., 2018), and greater peer victimization (Fogleman et al., 2019). ...
Article
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Although parent reactions to children’s negative emotions are important to the development of adolescent social and emotional functioning, there is a lack of research examining this aspect of parenting in samples that include youth with attention-deficit/hyperactivity disorder (ADHD). This study addresses this gap in the research by examining the independent effects of childhood ADHD symptoms and parent reactions to negative emotions in the longitudinal prediction of adolescent emotion dysregulation and peer problems. A sample of 124 youth (52% female) with and without clinical elevations in ADHD symptoms were assessed in childhood (8–12 years; M = 10.50) and followed up 5–6 years later in adolescence (13–18 years; M = 16.15). Path models tested the direct effects of childhood ADHD symptoms, supportive parent reactions, and non-supportive parent reactions on adolescent peer problems (friendship quality, deviant peer affiliation, peer aggression) and the indirect effects via adolescent emotion dysregulation. Emotion dysregulation mediated the effects of greater ADHD symptoms and of less parent supportive reactions on adolescent peer problems; parent reactions also independently predicted specific adolescent peer problems. Even for youth with clinical elevations in ADHD symptoms, parent reactions to children’s negative emotions may be important in understanding adolescent emotion dysregulation and peer problems.
... It is estimated that about 34% to 70% of people with inattention and or hyperactivity/high impulsivity have difficulties in emotion regulation (Shaw, Stringaris, Nigg, & Leibenluft, 2014). Indeed, while executive function deficits are the main focus of cognitive theories in ADHD, recent studies suggest that emotional regulation deficits can play a critical role in understanding the domains affected by this disorder (Graziano & Garcia, 2016). ...
... ADHD as a problem of the executive function includes difficulties in behavioral and cognitive self-regulation, such as planning and time management (Barkley, 2011;Knouse, Rawson, & Dunlosky, 2020). On the other hand, in emotion regulation dysfunction, one fails to adjust or regulate the emotional state that can lead to consistent be-haviors in achieving goals (Graziano & Garcia, 2016). Accordingly, a possible cause of academic problems in students with ADHD is the difficulty of using self-regulatory learning behaviors essential for successful academic performance (Knouse et al., 2020). ...
Article
Objective: This study aimed to predict cognitive emotion regulation and academic achievement based on symptoms of attention-deficit/hyperactivity disorder. Methods: The present study has a correlational design. The study population consisted of students at the University of Bojnord, Bojnord City, Iran, in the academic year 2017-18. Of these students, 190 were selected by a convenience sampling method. Adult self-report short-form Conners’ scale and cognitive emotion regulation questionnaire were used for data collection. Academic performance was determined by the grade point average. Multivariate regression analysis was used for analysis. Results: The results showed that hyperactivity and physical problems could predict self-blame, and hyperactivity can predict other blame and rumination. The variables of hyperactivity, impulsivity, and physical problems were also able to predict the catastrophizing strategy. Among the variables studied, only inattention predicted grade point average change. Conclusion: Thus, the findings of the study suggest that some components of cognitive emotion regulation and academic performance can be predicted based on symptoms of attention-deficit/hyperactivity disorder.
... ADHD presents emotional and motivational difficulties [64,65]. Similarly, SCT leads to emotional management difficulties, such as stress and anxiety [29,66], and motivational difficulties, such as a lack of initiative [31,67]. ...
... Although this information corroborates previous observations of the emotional and motivational management problems of ADHD [64,65], it seems to contradict some of the theoretical underpinnings of the characteristic symptomatology of SCT. While much of the scientific literature associates this disorder with emotional management difficulties, such as the presence of stress and anxiety [29,66], and motivational difficulties, such as the lack of initiative [14,67], it seems that the research implementing the BDEFS-CA does not fairly reflect the magnitude of these problems compared to those of ADHD. ...
Article
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The aim of the present study was to describe and compare the specific profiles of Attention Deficit Hyperactivity Disorder (ADHD) and Sluggish Cognitive Tempo (SCT) through the Hybrid Model of Executive Functioning (HMEF). The total sample of 1049 subjects, aged 6 to 18 years (M = 10.75; SD = 3.20), were classified into a non-pathologic group, an ADHD group and an SCT group, and assessed using the short version of the Barkley Deficit in Executive Functions Scale for Children and Adolescents (BDEFS-CA). The results revealed significant differences between the three groups in all executive domains (non-pathologic < SCT < ADHD). While the ADHD group demonstrated a consistently high profile of difficulties in each subscale, the SCT group showed an irregular profile of difficulties, with middle and low scores, depending on the executive function. Although the SCT group’s score was far away from the ADHD group’s score for Self-Motivation, Emotions Self-Regulation and Self-Restraint and Inhibition, the two groups’ scores were very close for Time Self-Management and Self-Organization and Problem Solving. Accordingly, through logistic regression analyses, the SCT group was exclusively related to these last two executive domains; however, the ADHD group was strongly associated with almost every executive function. The findings suggest that the short version of the BDEFS-CA discriminates between both disorders, supporting psychopedagogical assessment and differential diagnosis.
... ; arousal, therefore requiring extensive regulation/control (FIC & aMCC/pre-SMA) in healthy controls. In clinical populations at risk for reactive aggression, research indicates deficient regulatory mechanism when processing negative emotions (Coskunpinar, Dir, & Cyders, 2013;Fairchild et al., 2019;Graziano & Garcia, 2016;Hershberger, Um, & Cyders, 2017;Kohls et al., 2020). For instance, adolescents with bipolar disorder exhibit deficits in vmPFC-FIC functional connectivity when processing feedback in a reward-frustrating task (Ross et al., 2020). ...
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Early evidence suggests that unexpected non-reward may increase the risk for aggressive behaviors. Despite the growing interest in understanding brain functions that may be implicated in aggressive behaviors, the neural processes underlying such frustrative events remain largely unknown. Furthermore, meta-analytic results have produced discrepant results, potentially due to substantial differences in the definition of anger/aggression constructs. Therefore, coordinate-based meta-analyses on unexpected non-reward and retaliatory behaviors in healthy subjects were conducted. Conjunction analyses were further examined to discover overlapping brain activations across these meta-analytical maps. Frustrative non-reward deactivated the orbitofrontal cortex, ventral striatum and posterior cingulate cortex, whereas increased activations were observed in midcingulo-insular regions, as well as dorsomedial prefrontal cortex, amygdala, thalamus and periaqueductal gray, when using liberal threshold. Retaliation activated of midcingulo-insular regions, the dorsal caudate and the primary somatosensory cortex. Conjunction analyses revealed that both strongly activated midcingulo-insular regions. Our results underscore the role of anterior midcingulate/pre-supplementary motor area and fronto-insular cortex in both frustration and retaliatory behaviors. A neurobiological framework for understanding frustration-based impulsive aggression is provided.
... Emotion dysregulation has been particularly prominent in this research and has been identified as a transdiagnostic mechanism for both the development and maintenance of many forms of psychopathology (Beauchaine & Cicchetti, 2019;Cludius et al., 2020). Indeed, much research has shown that emotion dysregulation is a key feature of externalizing problems among children and adolescents, including attention-deficit/hyperactivity disorder (ADHD; Graziano & Garcia, 2016) and oppositional defiant disorder (ODD; Cavanagh et al., 2017). Emotion dysregulation has also been associated with conduct disorder (CD), although to a lesser extent than ADHD and ODD, and more commonly when CD is comorbid with internalizing problems (Fanti, 2018). ...
Article
The Affect Regulation Checklist (ARC) was designed to capture affect dysregulation, suppression, and reflection. Importantly, affect dysregulation has been established as a transdiagnostic mechanism underpinning many forms of psychopathology. We tested the ARC psychometric properties across clinical and community samples and through both parent‐report and youth self‐report information. Clinical sample: Participants included parents (n = 814; Mage = 43.86) and their child (n = 608; Mage = 13.98). Community sample: Participants included independent samples of parents (n = 578; Mage = 45.12) and youth (n = 809; Mage = 15.67). Exploratory structural equation modeling supported a three‐factor structure across samples and informants. Dysregulation was positively associated with all forms of psychopathology. In general, suppression was positively associated with many forms of psychopathology, and reflection was negatively associated with externalizing problems and positively associated with internalizing problems.
... In youths with ADHD, both EF deficits and ER impairments have been associated with psychopathology, with ER having been termed a risk factor in the development of psychopathological symptoms in youths with ADHD (Steinberg & Drabick, 2015). EF deficits among youths with ADHD, aside from underlying inattention symptoms (Martel et al., 2007), also seem to sustain ER difficulties which are highly prevalent in populations with ADHD (Graziano & Garcia, 2016) and consist of problems in adaptively implementing ER strategies towards a goal (Gross & Jazaieri, 2014). Variability in ER has been found to be predicted by behavioral inhibition in young boys with ADHD (Walcott & Landau, 2004). ...
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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.
... Interesting, a neurocognitive evidence based model proposed that normal dreaming serves as a fear extinction function, then nightmares would reflect failures in emotion regulation (Levin and Nielsen, 2009). ADHD is highly associated with emotion dysregulation (Graziano and Garcia, 2016), which may indicate that emotion regulation mechanisms might link nightmares and ADHD. Emotion regulation's role should be addressed in further studies to better understand the mechanisms involved in the association between nightmares and ADHD. ...
Article
Objective: Investigate effects of persistent sleep disturbances during early childhood over ADHD during the adolescence, and the potential attention-related executive functions mediating this effect. Methods: We used data from the 2004 Pelotas Birth Cohort. Children's Sleep disturbances were reported by their mothers at 12, 24, and 48 months of age, whereas the Test-of-Everyday-Attention-for-Children (TEA-Ch) and the Development and Well Being Assessment (DAWBA) were applied at 11 years of age to evaluate attention-related executive functions and ADHD, respectively. Persistent sleep problems were defined as reporting have two or more points of difficulty to sleep, nightmares, restless sleeps, and/or <10h/24h sleep duration. Logistic regression and mediation models were used, adjusting for maternal and child sociodemographic, behavior and health related variables. Results: The highest prevalence of adolescent ADHD (15.4%) was on the group who reported having nightmares at 2,4 and 6 years. In adjusted models, we observed an odd of ADHD in the adolescence 2.26 higher in those who reported persistent nightmares (CI95% 1.33, 4.01) compared to those reported transitory or no nightmares. Persistent difficulty to sleep (OR=1.74 CI95% 1.13, 2.66) and restless sleep (OR=1.80, CI95% 1.23, 2.64) during childhood also increased ADHD odds at 11 years. No indirect effect through attention related executive functions was found using mediating models. Discussion: Persistent early sleep disturbances may increase odds of ADHD among adolescents and could be consider as early marker of such disorder, specially nightmares problems. These effects were not mediated by attention-related executive functions. Nevertheless, we had 75% of cohort inception response.
... Difficulties in either of these phases can emerge with emotions of any valence; both positive and negative emotions can be dysregulated and adversely impact functioning. In a meta-analysis of youth with ADHD, difficulties with emotional reactivity were most prominent, followed by difficulties with emotion regulation (Graziano & Garcia, 2016). Neuroimaging studies of children with ADHD have demonstrated that such difficulties with emotion regulation, as evidenced by emotional lability and severe temper outbursts are associated with disruptions in neural circuits (Hulvershorn et al., 2014;Roy et al., 2018). ...
Article
Emotion dysregulation (ED) is prevalent among youth with Attention-Deficit/Hyperactivity Disorder (ADHD) and significantly impacts functioning. Nuanced measurement of ED is central to understanding its role in this disorder and informing treatment approaches. The present study examined the factor structure of the Emotion Regulation Checklist (ERC) among children with ADHD with and without Oppositional Defiant Disorder (ODD). Exploratory factor analysis (EFA) conducted in a sample of 328 youth (mean age=6.08) with ADHD indicated a four-factor solution, comprised of the following factors: Negative Emotion Lability, Positive Emotion Lability, Socially Appropriate Affect, and Socially Incongruent Affect. The Negative and Positive Emotion Lability subscales assess the reactivity of negatively and positively valenced emotions, respectively. The Socially Appropriate and Socially Incongruent Affect subscales provide an assessment of social-emotional functioning. All subscales discriminated between children with ADHD only and ADHD with co-morbid ODD, such that children with ODD had greater emotional lability and social-emotional difficulties. This revised factor structure of the ERC facilitates a uniquely brief, yet multifaceted and specific, assessment of emotional difficulties in children with ADHD that can inform treatment planning and operationalize emotional reactivity and social-emotional functioning in future research efforts.
... There is growing recognition that adolescents with attention-deficit/hyperactivity disorder (ADHD) experience significant emotion dysregulation (ED; see Graziano & Garcia, 2016;Shaw et al., 2014, for reviews). ED is defined as a limited ability to initiate and regulate one's emotional and behavioral reaction in a manner consistent with the situation (Eisenberg & Spinrad, 2004). ...
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Regulating Emotions Like An eXpert (RELAX) is a group-based intervention that targets emotion dysregulation (ED) and interpersonal conflict among adolescents diagnosed with attention-deficit/hyperactivity disorder (ADHD). This study is a preliminary evaluation of the feasibility, acceptability, and efficacy of RELAX across in-person and telehealth groups, examining differences in treatment outcomes and feedback based on format. Participants included 32 families (18 in-person, 14 telehealth) with adolescents diagnosed with ADHD, ages 11-16. Caregiver-, clinician- and adolescent-report of adolescent ED, adolescent communication, and caregiver-adolescent/family conflict, as well as caregiver self-report of ED and emotion socialization were collected pre- and post-RELAX; caregivers and adolescents completed a feedback survey post-RELAX. Attendance was higher for telehealth (95% vs. 87%), but homework completion was higher for in-person (85% vs. 70%). Caregiver and adolescent feedback indicated very high rates of satisfaction with RELAX, with no significant differences in caregiver satisfaction and minimal differences in adolescent satisfaction between the in-person and telehealth groups. Large improvements were found for caregiver and clinician ratings of adolescent ED (η2=.18-.48) and family conflict (η2=.26 and .43), moderate decreases in non-supportive emotion socialization were found (η2=.11), and small improvements were found for caregiver ED (η2=.03). Treatment outcomes were similar for in-person and telehealth groups, with some evidence for larger improvement of adolescent ED for telehealth, whereas larger improvement in family conflict emerged for in-person. RELAX was successfully adapted to be administered via telehealth with similar feasibility, acceptability, and efficacy to the in-person intervention. Efforts to continue disseminating and evaluating ED-focused interventions are warranted and imperative.
... Emotional dysregulation, defined as a limited ability to initiate and regulate one's emotional reaction and response in a manner consistent with the situation (1), is a major challenge for children and adolescents who struggle with anger and aggression (2)(3)(4). Emotional dysregulation is also a common feature of behavioral health and neurodevelopmental disorders including ADHD, Autism Spectrum Disorders, oppositional defiant disorder, and others (5)(6)(7). Irritability, an increase studied facet of emotional dysregulation, is becoming transdiagnostic hallmark of child and adolescent psychopathology (8). Several evidence-based treatments including medication, cognitive behavioral therapies (CBT), and parent management training have been developed to address emotional dysregulation, anger, and aggression in youth (2,9,10). ...
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Emotional dysregulation leading to clinically significant anger and aggression is a common and substantial concern for youth and their families. While psychotropic medications and cognitive behavioral therapies can be effective, these modalities suffer from drawbacks such as significant side effects, high rates of attrition, and lack of real-world skill translation. Regulate and Gain Emotional Control (RAGE-Control) is a video game designed as an engaging augment to existing treatments. The game facilitates emotional regulation skill building through practice modulating physiological arousal while completing a challenging inhibitory task. We compared reduction in anger, aggression, oppositionality, and global severity between two treatment conditions: Anger Control Training (ACT) augmented with RAGE-Control and ACT with a sham version of the game, in a pilot double-blind randomized controlled trial. To begin to understand mechanisms of change, we examined heart rate during game play over the course of the study and explored associations between symptom changes and heart rate changes. Forty youth with clinically significant anger dyscontrol (age 10-17) were randomly assigned to 10 sessions of ACT with RAGE-Control or ACT with sham videogame. Both treatments similarly reduced self-reported anger. However, ACT with RAGE-Control led to larger improvements in aggression (CI: -17 to -1.0, ES: 0.55, p=0.015); oppositionality (CI: -9.0 to -7e-6, ES:0.48, p=0.032); and global severity (CI: -1.0 to-5e-6, ES: 0.51, p=0.023) relative to sham. Participants in the RAGE-Control group saw a decrease in median heart rate during game play (β = 1.2, p<0.001). Larger pre to post decreases in heart rate were significantly associated with larger pre to post decreases in aggression and oppositional behaviors. Augmenting ACT with RAGE-Control reduced behavioral expression of anger, but not the experience of angry feelings, as compared to ACT with a sham version of the game. Increased heart rate control, demonstrated by reduction in median heart rate during gameplay, was associated with decreased aggression and oppositional behavior. Together these findings support that augmenting traditional treatment with technology facilitating heart rate control through skill practice translates to enhancements in real-life behavioral change. Therefore, further exploration into engaging skill-focused games such as RAGE-Control is warranted.
... , dans des domaines des FE froides comme l'inhibition ou la MDT (voir aussi Van Cauwenberge, Sonuga-Barke,Pennington, 2005) ou des FE chaudes, notamment une dysrégulation émotionnelle(Graziano & Garcia, 2016 ;Shaw, Stringaris, Nigg, & Leibenluft, 2014). Le consensus est moins grand sur la présence de déficits exécutifs dans le trouble d'opposition avec provocation (du fait des comorbidités fréquentes avec le TDAH). ...
... High emotional reactivity, deficits in emotional understanding, and difficulty in managing negative emotions have been linked to aggressive behavior among youth both concurrently (33)(34)(35) and prospectively (36). And youth with ADHD are more likely to experience intense negative and positive emotions and show deficits in emotion regulation (37,38). Importantly, emotion regulation strategies are not only a feature or correlate of psychopathology; they also predict increasing psychopathology over time (e.g., rumination and internalizing problems) (39,40). ...
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Background: Severe irritability is a common, impairing problem among youth referred for mental health services, but evidence to guide care is limited. Treatment research can be advanced by adopting a transdiagnostic perspective, leveraging existing evidence-based treatment (EBT) techniques, and situating irritability within the context of emotion dysregulation. Accordingly, this study examined treatment outcomes for youth with different levels of irritability and dysregulation who received cognitive-behavioral therapy (CBT) or behavioral parent training (BPT) in a modular EBT framework. Method: We analyzed data from a community-based implementation trial of a transdiagnostic youth psychotherapy. Two-hundred treatment-referred youths (7-15 years; 47% female; 33% White, 28% Black, 24% Latinx, 14% multiracial, 2% other) and their caregivers completed measures of clinical problems and emotion dysregulation at baseline, with repeated outcomes assessments over 18 months. First, latent profile analysis was applied to baseline irritability and emotion dysregulation data; then, latent growth curve models were used to examine outcome trajectories, controlling for covariates. Results: A two-class solution fit well, differentiating youth with high ( n = 54) vs. low ( n = 146) levels of dysregulation and irritability at baseline. Nearly all high-dysregulation youth received either BPT ( n = 26) or CBT-Depression ( n = 23). Across measures, both groups showed statistically and clinically significant improvements over time. High-dysregulation youth had greater baseline severity than low-dysregulation youth, but otherwise their longitudinal trajectories were mostly similar, with few between-group slope differences. There was virtually no evidence of differential effects for BPT vs. CBT on clinical outcomes. Conclusions: Youth with severe irritability and dysregulation, treated with a transdiagnostic, modular, EBT approach, showed significant within-person improvements over time. Their outcome trajectories did not differ according to whether they received BPT or CBT. Findings extend the literature on modular, transdiagnostic, and EBT approaches for irritability and dysregulation, suggesting comparable benefits associated with BPT and CBT when treatment selection is guided by comprehensive assessment. Clinical Trial Registration: www.ClinicalTrials.gov , identifier: NCT03153904.
... Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder of childhood (Perou et al., 2013), with an estimated worldwide prevalence ranging from 3 to 7% (Polanczyk, Willcutt, Salum, Kieling, & Rohde, 2014;Thomas, Sanders, Doust, Beller, & Glasziou, 2015) and approximately 6.1 million children and adolescents in the United States with a current diagnosis (Danielson et al., 2018). ADHD is characterized by persistent and pervasive hyperactivity, inattention, and/or impulsivity that leads to functional impairment in multiple settings (American Psychiatric Association, 2013) and is associated with adverse outcomes that significantly affect children, adolescents, and adults throughout the lifespan (Shaw et al., 2012;Spencer, Biederman, & Mick, 2007), such as academic underachievement (Daley & Birchwood, 2010), social difficulties (Kofler et al., 2011), emotion dysregulation (Graziano & Garcia, 2016;Tarle, Alderson, Arrington, & Roberts, 2019), and increased risk-taking (Dekkers, Popma, van Rentergem, Bexkens, & Huizenga, 2016;Groen, Gaastra, Lewis-Evans, & Tucha, 2013;Mowinckel, Pedersen, Eilertsen, & Biele, 2015). ...
Article
Meta-analytic methods were used to examine ADHD-related risk-taking in children and adults, and to compare the magnitude of risk taking across behavioral, self-report, and virtual reality metrics. Potential moderators of effect size heterogeneity were also examined via a three-level multi-level approach and a hybrid meta-analytic/systematic review approach. Aggregated effect sizes obtained from 56 behavioral-task studies (82 effect sizes; ADHDN = 2577; TDN = 2606), 51 self-report studies (130 effect sizes; ADHDN = 18,641; TDN = 113,163), and 8 virtual reality studies (16 effect sizes; ADHDN = 382; TDN = 436) suggest that children and adults with ADHD exhibit moderately more risk-taking compared to children and adults without the disorder. Notably, the aggregated effect size obtained from virtual reality simulations (Hedges', g = 0.43) was 30–40% larger than effect sizes obtained from self-report and behavioral task metrics (Hedges' g = 0.31 and 0.27), respectively. Suboptimal Decision Making was the only significant moderator identified via multi-level modeling; however, comparison of subgroup effect sizes revealed potential moderating effects of ADHD presentation and trial-by-trial feedback on behavioral tasks. Collectively, findings suggest that ADHD is reliably associated with small to moderate magnitude greater risk-taking behavior and virtual reality simulations appear be the most sensitive currently available metric.
... ADHD is one of the most prevalent mental disorders in children and usually lasts into adulthood, with a worldwide prevalence of about 5.9% (1). In addition to the "core symptoms" of inattention, impulsivity, and hyperactivity, children with ADHD also often combine cognitive and behavioral problems, which cause multidimensional difficulties for their academic, emotional, and social functions (2)(3)(4)(5)(6)(7). ...
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Objective: To assess the effectiveness of physical activity (PA) intervention on attention-deficit/hyperactivity disorder (ADHD)-related symptoms. Method: Studies that investigated PA intervention for ADHD-related symptoms were identified through searching PubMed, Web of Science, Cochrane Library, and Embase databases from inception through June 2021. Standardized mean difference (SMD) with 95% confidence interval (CI) was used to assess the effectiveness of PA intervention on improving ADHD-related symptoms. The meta-analyses were conducted using fixed-effect or random-effect models according to the heterogeneity of the studies. Results: Nine before–after studies (232 participants) and 14 two-group control studies (162 participants/141 controls) were included in this meta-analysis. Combined results for before–after studies indicated significant improvements on all studied ADHD-related symptoms (inattention: SMD = 0.604, 95% CI: 0.374–0.834, p < 0.001; hyperactivity/impulsivity: SMD = 0.676, 95% CI: 0.401–0.950, p < 0.001; emotional problems: SMD = 0.416, 95% CI: 0.283–0.549, p < 0.001; behavioral problems: SMD = 0.347, 95% CI: 0.202–0.492, p < 0.001). Meta-analyses for two-group control studies further confirmed that PA intervention significantly improved the inattentive symptom (SMD = 0.715, 95% CI: 0.105, 1.325, p = 0.022). Subgroup analyses suggested significant beneficial effect on inattention symptoms in children. Moreover, closed motor skills were beneficial for hyperactive/impulsive problems (SMD = 0.671, p < 0.001), while open motor skills were beneficial for attention problems (SMD = 0.455, p = 0.049). When excluding studies with combined medication, the studies in unmedicated participants in before–after studies still showed significant results in all studied ADHD-related symptoms as in the overall analysis. Given the limited sample size, the best frequency and intensity of PA intervention need further investigation. Conclusion: Our results suggested that PA intervention could possibly improve ADHD-related symptoms, especially inattention symptoms. Closed-skill and open-skill activities could be beneficial for hyperactivity/impulsivity and inattention symptoms, respectively. Further high-quality randomized clinical trials with large sample size are needed.
... More focused dissociation of CP with and without high levels of CU behaviors is also needed. To maximize our understanding of CP and CU behaviors, it is important to also include young children with only ADHD, given that this group of children are at a much higher risk for developing future CP (Mannuzza, Klein, Abikoff, & Moulton Iii, 2004) and can also exhibit CU behaviors that are independent from CP (Graziano & Garcia, 2016;Haas et al., 2011). Thus, to further our understanding of the neurobiology of CP, more pediatric connectivity studies are needed that take into account CP, CU behaviors, and high comorbidity of ADHD. ...
Article
Background: Callous-unemotional (CU) behaviors are important for identifying severe patterns of conduct problems (CP). One major fiber tract implicated in the development of CP is the uncinate fasciculus (UF), which connects amygdala and orbitofrontal cortex (OFC). The goals of the current study were to (a) explore differences in the white matter microstructure in the UF and other major fiber tracks between young typically developing (TD) children and those with a disruptive behavior disorder (DBD) and (b) explore, within the DBD group, whether individual differences in these white matter tracts relate to co-occurring CP and CU behaviors. Methods: Participants included 198 young children (69% boys, Mage = 5.66 years; 80% Latinx; 48.5% TD). CU behaviors and CP were measured via a combination of teacher/parent ratings. Non-invasive diffusion-weighted imaging (DWI) was used to measure fractional anisotropy (FA), an indirect indicator of white matter properties. Results: Relative to TD children, children in the DBD group had reduced FA on four out of the five fiber tracks we examined (except for cingulum and right ILF), even after accounting for whole brain FA, sex, movement, parental income, and IQ. Within the DBD group, no associations were found between CP and reduced white matter integrity across any of the fiber tracks examined. However, we found that even after accounting for CP, ADHD symptomology, and a host of covariates (whole brain FA, sex, movement, parental income, and IQ), CU behaviors were independently related to reduced FA in bilateral UF and left inferior fronto-occipital fasciculus (IFOF) in the DBD group, but this was not the case for TD children. Conclusions: Alterations in the white matter microstructure within bilateral UF and left IFOF may be biomarkers of CU behaviors, even in very young children.
... Children with neurodevelopmental disorders (NDD) such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID), are at a higher risk of developing mental health and behavioral problems (6,7). Hence, it is possible that children with NDD are more susceptible to the effects of COVID-19 pandemic, as well as to the subsequent changes in human activities, in comparison to neurotypical children. ...
Article
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Human activities have been changing in conjunction with the status of the coronavirus disease 2019 (COVID-19) pandemic, with school closures and activity cancellations becoming commonplace. As such, the COVID-19 pandemic likely also has had a detrimental impact on the behavioral problems of children with neurodevelopmental disorders (NDD). In Japan, the government issued a stay-at-home order causing children to stop participating in school activities following the first declaration of a state of emergency (April 7 to May 25, 2020). During winter 2020, the stay-at-home order and school closures were lifted. Using longitudinal data of children with NDD, we compared the behavioral problems of children with NDD between October 1 and December 31, 2020 (i.e., winter 2020) with their behavioral problems before the COVID-19 pandemic (pre-COVID-19). In this study, 143 caregivers of children with NDD evaluated their behavioral problems using the Japanese version of the Aberrant Behavior Checklist (ABC-J) in the pre-COVID-19 period and winter 2020. We found no scores that were higher in winter 2020 compared to pre-COVID-19. Moreover, irritability and hyperactivity scores were significantly lower in winter 2020 compared to pre-COVID-19. These findings suggest weak negative impacts of the COVID-19 pandemic on the behavioral problems of children with NDD. In schools and clinical practice, children learned knowledge about COVID-19 and related preventive behaviors. Therefore, these practices may have alleviated the negative impact of the COVID-19 pandemic on children with NDD.
... On the same note, future work can examine the underlying mechanisms associated with ADHD in parents. For example, emotion regulation is a significantly impaired domain in individuals with ADHD (Graziano & Garcia, 2016). There is literature to support the notion that parents with ADHD and poor ER functioning also report greater parenting stress and poorer child outcomes (Chronis-Tuscano et al., 2017, Woods, Mazursky-Horowitz, Thomas, Dougherty, & Chronis-Tuscano, 2021. ...
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The goal of this study was to examine whether parent attention-deficit/hyperactivity disorder (ADHD) symptoms impact parenting outcomes (i.e., parenting practices and stress) after group-based Parent Child Interaction Therapy (PCIT). The study included parents of preschoolers (Mage = 4.97) with autism spectrum disorder and co-occurring externalizing behavior problems (ASD + EBP; 37) and parents of children with EBP-only (n = 41) who participated in a multimodal behavioral intervention, including an 8-week group-based PCIT. Parents reported on their own ADHD symptoms, practices, and stress at pre-and-post-treatment. Accounting for child EBP, parental ADHD symptoms were predictive of higher negative and lower positive parenting at post-treatment, for parents in the ASD + EBP group but not the EBP-only group. Parental ADHD symptoms also predicted higher parenting stress for the ASD + EBP group only. Results of mediational analyses indicated that for the ASD + EBP group, the indirect effect of parental ADHD symptoms on negative and positive parenting through parenting stress was significant. Findings highlight the differential impact of parental mental health challenges on parenting outcomes. Specifically, parental ADHD symptoms seem to have a larger impact on treatment outcomes for parents of children with co-occurring presentations, which seems to be partially mediated by parenting stress.
... Children with ADHD demonstrate premorbid deficits on many behavioral and neurocognitive outcomes traditionally associated with concussion, including impaired attention, concentration, working memory, and task-switching [American Psychiatric Association (APA), 2013; Harmon et al., 2013;Howell et al., 2013;Martel et al., 2007;Mayr et al., 2014;Rabinowitz & Levin, 2014;Sjowall et al., 2013]. Furthermore, ADHD and concussion share emotional and sleep-related features, such as irritability, emotional lability, and sleep disturbances (APA, 2013;Chiang et al., 2010;Graziano & Garcia, 2016;Harmon et al., 2013;McCrory et al., 2017). Lastly, the relationship between ADHD and concussion is further complicated by research demonstrating that children who suffer traumatic brain injuries are at risk for developing ADHD (Yang et al., 2016). ...
Article
Objective: Having attention-deficit/hyperactivity disorder (ADHD) is a risk factor for concussion that impacts concussion diagnosis and recovery. The relationship between ADHD and repetitive subconcussive head impacts on neurocognitive and behavioral outcomes is less well known. This study evaluated the role of ADHD as a moderator of the association between repetitive head impacts on neurocognitive test performance and behavioral concussion symptoms over the course of an athletic season. Method: Study participants included 284 male athletes aged 13-18 years who participated in high school football. Parents completed the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior (SWAN) ratings about their teen athlete before the season began. Head impacts were measured using an accelerometer worn during all practices and games. Athletes and parents completed behavioral ratings of concussion symptoms and the Attention Network Task (ANT), Digital Trail Making Task (dTMT), and Cued Task Switching Task at pre- and post-season. Results: Mixed model analyses indicated that neither head impacts nor ADHD symptoms were associated with post-season athlete- or parent-reported concussion symptom ratings or neurocognitive task performance. Moreover, no relationships between head impact exposure and neurocognitive or behavioral outcomes emerged when severity of pre-season ADHD symptoms was included as a moderator. Conclusion: Athletes' pre-season ADHD symptoms do not appear to influence behavioral or neurocognitive outcomes following a single season of competitive football competition. Results are interpreted in light of several study limitations (e.g., single season, assessment of constructs) that may have impacted this study's pattern of largely null results.
... The authors found significant benefits of intervention participation on children's emotion regulation abilities and internalizing and externalizing behaviors. These results are promising given the cooccurrence of ADHD and emotion dysregulation (Graziano & Garcia, 2016), and research documenting associations between emotion regulation difficulties and social impairment among children with ADHD (Bunford et al., 2015(Bunford et al., , 2018. Further, the results of Rosen et al. (2019) support the utility of incorporating specific social-emotional and social cognitive skills in efforts aimed at addressing emotional and behavioral difficulties associated with ADHD behaviors. ...
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This study examined the moderating role of emotion recognition on the association between preschoolers’ ADHD behaviors and social functioning outcomes. Sixty preschoolers (48.3% female; Mage = 3.94, SDage = .56) were recruited from Head Start-affiliated classrooms. Teacher-rated ADHD behaviors and an objective measure of children’s emotion recognition were assessed at the beginning of the school year. Teacher ratings of social functioning outcomes were obtained approximately three months after the start of school. Hierarchical regressions examined the unique and interactive effects of ADHD behaviors and emotion recognition on preschoolers’ social functioning outcomes (i.e., oppositional behaviors, peer behavior problems, and social-emotional school readiness). The interaction between ADHD behaviors and emotion recognition predicted oppositional behaviors, peer behavior problems and social-emotional school readiness such that higher levels of emotion recognition appear to buffer the negative association between ADHD behaviors and adaptive social functioning. Preliminary considerations for interventions aimed at promoting preschoolers’ social functioning are discussed.
... Parent ESB are thought to play a key role in shaping risk for youth psychopathology, particularly through their influence on children's emotion regulation development. Indeed, across many studies, there is evidence that children with internalizing (e.g., anxiety disorders, depression), externalizing [e.g., oppositional defiant disorder (ODD), conduct disorder], and neurodevelopment [e.g., attention-deficit/ hyperactivity disorder (ADHD), autism spectrum disorder (ASD)] psychopathologies have more emotional difficulties relative to typically developing children, including problems with understanding of emotions, emotion reactivity, and emotion regulation (e.g., Bunford et al., 2015;Cappadocia et al., 2009;Graziano & Garcia, 2016;Schäfer et al., 2017;Suveg & Zeman, 2004). Further, there is increasing support for the role of parental ESB in developmental psychopathology, although the existing literature focuses heavily on socialization of negative emotions. ...
Article
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The majority of the emotion socialization behaviors (ESB) literature has focused on community samples and socialization of negative emotions. However, it is becoming increasingly apparent that ESB are also critical in setting the foundations for the healthy development of positive emotions, with implications for developmental psychopathology. We conducted a systematic review of research examining parent ESB and youth positive emotions in clinical child and adolescent samples. A literature search was conducted in March 2021, resulting in 563 abstracts being reviewed. Two reviewers independently screened the titles and abstracts to identify relevant papers, with 53 articles being reviewed in full. Seven articles (four cross-sectional and correlational, three intervention) were included in the current review, of which one was with an internalizing sample, three were with an externalizing sample, and three were with a neurodevelopmental disorder sample. Results varied regarding the role of parent ESB in youth positive emotions across clinical populations. In correlational studies, minimal evidence was found for the association between parent ESB and youth positive emotions, but across the three intervention studies, there was evidence that both parent ESB and children's positive emotions can be improved through intervention. We present a preliminary model of relations between youth psychopathology, parent ESB, and child positive emotions, with consideration of potential moderators of links between ESB and positive emotions. Finally, we discuss limitations of the existing body of research, and offer specific recommendations for future research directions.
... ED in children is best seen as a significant self-regulatory challenge across multiple domains that includes affective, behavioral, and cognitive functions [17][18][19]. Emotional dysregulation is also described as a failure to modify an emotional state to promote adaptive behaviors that are necessary to accomplish their goals [20]. In addition, ED has been divided into multiple components each with potential disruptions. ...
Article
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Purpose of Review Emotion dysregulation and outbursts are very common reasons for referral to child and adolescent mental health services and a frequent cause of admission to hospitals and residential programs. Symptoms of emotion dysregulation and outburst are transdiagnostic, associated with many disorders, have the potential to cause severe impairment and their management presents a major challenge in clinical practice. Recent Findings There are an increasing number of psychosocial interventions that demonstrate promise in improving emotion dysregulation and outbursts. Acute care systems to manage the most severely ill patients have limited best practice guidelines but program advancements indicate opportunities to improve care models. Pharmacotherapy may be of assistance to psychosocial interventions but must be used with caution due to potential adverse effects. Summary Much remains to be discovered however evidence informed, targeted treatments for specific populations show potential for future improvements in outcomes.
... A meta-analysis of 22 studies with over 21,000 participants found that youth with ADHD were strongly impaired in the ability to modulate their reactivity to novel or stressful events (Graziano and Garcia, 2016 A nationwide cohort study of over 50,000 youths with ADHD and an equal number of age-, sex-, and comorbidity-matched controls drawn from Taiwan's National Health ...
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Background: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. Methods: We reviewed studies with more than 2,000 participants or meta-analyses from five or more studies or 2,000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. Results: We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 79 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 362 people who have read this document and agree with its contents. Conclusions: Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.
... tenidoRonk et al., 2011).Además de los problemas académicos y en el área social, también se debe considerar el deterioro emocional que conlleva el TDAH, resultado de la interiorización de las consecuencias negativas que conllevan sus manifestaciones, o como ya se ha comentado, resultado de las propias dificultades en la regulación de las emociones, tanto las positivas como las negativas(Graziano & Garcia, 2016;Okado et al., 2016;Seymour & Miller, 2017).Puede que los niños y adolescentes con este problema expresen las emociones, sobre todo las negativas como la ira, de una forma demasiado agresiva, que tengan una baja tolerancia a la frustración, poca empatía y sean demasiado reactivos en general ante cualquier estímulo. En este sentido, segúnBarkley (2010), la desregulación emocional asociada con el TDAH implica dos déficits primarios: déficit inhibitorio, es decir en la capacidad de inhibir conductas socialmente inadecuadas, y déficit a nivel de autorregulación, que supone una incapacidad para calmar la respuesta fisiológica que produce una emoción fuerte. ...
... V zahraničnej literatúre sa okrem konceptu regulácie emócií často vyskytuje aj pojem dysregulácia emócií (ED). Pre deti s ADHD je príznačná emočná impulzivita a ťažkosti s reguláciou emócií (Faraone et al., 2019;Graziano, Garcia, 2016). Aj z toho dôvodu sa koncept dysregulácie emócií začína čoraz viac spomínať v kontexte problémov, s ktorými sa musia sa stretávajú deti a dospelí s ADHD (Barkley, 2015). ...
Article
Individuals with attention-deficit/hyperactivity disorder (ADHD) frequently experience strong reactions to emotionally evocative situations. Difficulties modulating anger and other upsets have clinically significant behavioral consequences. Those with ADHD may have anomalies in emotion generation, emotion expression, or both that predispose to these problems. The association between ADHD and emotion dysregulation raises Important clinical and research issues, including possible heterogeneity in the mechanisms by which they are related. Although first-line treatments for ADHD often help to resolve emotional dysregulation symptoms as well, the evidence base for widespread practice of combination pharmacotherapy remains sparse. Psychosocial treatments that engage processes underlying emotional dysregulation are in development.
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النسخة العربية المترجمة (إشراق) من: البيان الدولي الصادر بالإجماع عن الاتحاد الدولي لفرط الحركة وتشتت الانتباه نسخة الموقع الرسمي I'm extremely proud and honoured to have been part of this amazing international team. A The ARABIC Version of the International Consensus Statement on ADHD is here: https://www.adhd-federation.org/publications/international-consensus-statement.html نسخة الوثيقة العلمية المنشورة The main article link: https://lnkd.in/dMQNrqx شكرا جزيلا جمعية إشراق بهذا لهذا الوقف العلمي المميز Thank you Saudi ADHD Society | جمعية إشراق: ‎الجمعية السعودية لاضطراب فرط الحركة https://adhd.org.sa/en/
Article
Objective The purpose of this study is to analyse DESR and its influence on sleep parameters in three different groups of children and adolescents: a group newly diagnosed with ADHD naïve, a group with ADHD under pharmacological treatment and a control group. Method Subjects were a total of 327 children and adolescents. Two groups diagnosed with ADHD: 108 medication-naïve and 80 under pharmacological treatment; and one group with 136 healthy subjects. DESR was defined using anxious/depressed, attention problems and aggressive behaviors (AAA) scales from the Child Behavior Checklist (CBCL), and sleep through the Sleep Disturbance Scale for Children. Results Significant differences were found comparing the three groups ( p = .001), with a significantly higher profile on DESR in ADHD subjects, especially those who did not undergo treatment, and a positive correlation between DESR and sleep. Conclusion Children and adolescents with ADHD without treatment present higher DESR than healthy controls and consequently higher sleep problems.
Article
Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent disorder commonly identified in childhood. Affective and cognitive characteristics that are identifiable as early as infancy could be signals of risk for developing ADHD. Specifically, the interplay between emotionality and cognition may be important in predicting early symptoms of ADHD. This study examined the independent and interactive effects of infant negative emotionality and cognition on the development of inattention and hyperactivity/impulsivity in toddlerhood among infants at high and low familial likelihood for ADHD. Participants were 64 infants (M = 8.7, SD = 1.8) at high (n = 32) and low (n = 32) familial likelihood for ADHD, defined as at least one parent with ADHD or two parents without ADHD, respectively. Negative emotionality and cognition in infancy were assessed using the Infant Behavior Questionnaire and the Bayley’s Scales of Infant and Toddler Development, and ADHD symptoms were assessed at toddler follow-up (M= 20.0, SD= 3.2) using the Child Behavior Checklist. Accounting for the quality of parent-child interaction, infants’ negative emotionality (β = .033, p = .938) and cognition (β = .006, p = .884) did not independently predict toddlers’ ADHD-related behaviors, but their interaction did (β = .110, p = .019). For infants with higher levels of cognition (>95th percentile), higher negative emotionality predicted more ADHD-related behaviorss. For infants with lower levels of cognition (<11th percentile), higher negative emotionality predicted fewer ADHD-related behaviors. There may be two affective-cognitive pathways to inattention and hyperactivity/impulsivity in toddlerhood. The combination of higher levels of negative emotionality and cognition may result in greater frustration when goals are blocked, resulting in the expression of dysregulated behaviors (i.e., ADHD symptoms). Alternatively, low levels of negative emotionality and cognition combined may lead to dysregulation that is primarily cognitive in nature (such as the inattention symptoms of ADHD). Investigating affective and cognitive processes simultaneously may be important for increasing understanding of the early signals of ADHD risk.
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This study investigated whether poor performance in the Reading the Mind in the Eyes Test (RMET) and emotion dysregulation (ED) contributes to involvement in bullying among adolescents with attention-deficit/hyperactivity disorder (ADHD). Altogether, 105 adolescents with ADHD aged 10–18 years (mean: 13.91.8 years, 77% boys) were recruited. RMET was applied to evaluate the ToM abilities. Participants completed the Difficulties in Emotion Regulation Scale (DERS) and the Olweus Bully/Victim Questionnaire to measure ED and evaluate involvement in bullying, respectively. Among the subjects, 24.8% were victims, 23.8% were perpetrators. The perpetrators and victims exhibited significantly lower RMET scores and higher DERS awareness scores than non-victims/non-perpetrators. The perpetrators also exhibited significantly higher DERS impulse scores and DERS total scores than non-victims/non-perpetrators. Binary logistic regression analysis revealed that a 1-point decrease in the RMET score increased the odds of bullying victimization by 53% and bullying perpetration by 21.6%, while a 1-point increase in DERS impulse scores increased the risk of bullying perpetration by 14.9%. This study is the first to show an association between poor ToM ability and involvement in bullying as victims/perpetrators among children with ADHD. Both victims and perpetrators had problems with emotional awareness, while only perpetrators had difficulties controlling their impulses.
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To date, only three studies have examined the role of emotion socialization in the emotional functioning of youth with neurodevelopmental disorders. As such, this review article with pilot data sought to provide a call to action and first step in addressing this limited research body. Pilot data was collected with 18 adolescents (Mage = 13.5, SD = 1.6; 70% male) with a neurodevelopmental disorder and their primary caregiver. All adolescents were diagnosed with attention-deficit/hyperac-tivity disorder and displayed a range of comorbid disorders: autism spectrum disorder (27.8%), anxiety (66.7%), depression (44.4%), and disruptive behavior disorders (50%). Adolescents and caregivers completed a conflict discussion task while physiological, observational, and self-report measures of emotion socialization and emotional functioning were measured. Observed supportive parent emotion socialization behaviors were significantly associated with more observed adaptive emotion regulation strategies, and decreased observed and adolescent-reported negative affect, whereas non-supportive emotion socialization behaviors were associated with more observed negative affect and less observed adaptive emotion regulation strategies. Our pilot findings support growing research suggesting that adaptive parent emotion socialization practices can help foster less negative emotionality and better emotion regulation in youth with neurodevelopment disorders. We make a call to action for more emotion socialization research focused on youth with neurodevelopmental disorders, and propose four important directions for future research: 1) Research examining emotion socialization behaviors during daily life, 2) Understanding the nuanced role of emotion socialization practices, 3) Considering diversity in emotion socialization practices with clinical populations, and 4) Longitudinal and intervention research studies.
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Psychostimulants are commonly prescribed medications for youth with attention-deficit/hyperactivity disorder (ADHD). Limited studies have evaluated how psychostimulants (e.g., methylphenidate [MPH]) impact autonomic nervous system (ANS) indexes among youth with ADHD. Understanding the effects of MPH on autonomic functioning is essential, given that youth with ADHD have been shown to experience atypical autonomic functioning (i.e., reduced activity across both sympathetic and parasympathetic branches) compared to typically developing youth. The current study investigated how a specific psychostimulant, Osmotic Release Oral System [OROS] MPH, impacts parasympathetic (indexed by respiratory sinus arrhythmia [RSA]) and sympathetic (indexed by electrodermal activity [EDA]) functioning among youth with ADHD via a within-subjects, double-masked, cross-over design. Two hundred fifty-six participants (157 youth with ADHD), ages 5 to 13 years, completed a two-minute resting baseline task while electrocardiograph and electrodermal data were obtained. Youth with ADHD completed the resting baseline task twice, 3 weeks apart, once during active medication and once during placebo conditions (counterbalanced). Typically developing youth were assessed without medication or placebo. Youth with ADHD during the placebo condition exhibited reduced RSA and EDA compared to typically developing youth. In contrast, youth with ADHD during the medication condition did not differ significantly from typically developing youth with respect to either RSA nor EDA. As such, OROS MPH appears to normalize RSA and EDA levels among youth with ADHD to levels comparable to typically developing youth. Future studies including indexes of the ANS among youth with ADHD are urged to consider the impact of MPH.
Article
Atypical motor coordination and cognitive processes, such as response inhibition and working memory, have been extensively researched in individuals with attention deficit hyperactivity disorder (ADHD). Oculomotor neural circuits overlap extensively with regions involved in motor planning and cognition, therefore studies of oculomotor function may offer unique insights into motor and cognitive control in ADHD. We performed a series of pairwise meta-analyses based on data from 26 oculomotor studies in ADHD to examine whether there were differences in performance on visually-guided saccade, gap, antisaccade, memory-guided, pursuit eye movements and fixation tasks. These analyses revealed oculomotor disturbances in ADHD, particularly for difficulties relating to saccade inhibition, memorizing visual target locations and initiating antisaccades. There was no evidence for pursuit eye movement disturbances or saccade dysmetria. Investigating oculomotor abnormalities in ADHD may provide insight into top-down cognitive control processes and motor control, and may serve as a promising biomarker in ADHD research and clinical practice.
Article
Background Problems with emotional processing are widely reported in individuals with attention-deficit/hyperactivity disorder (ADHD). Although methylphenidate (MPH) effectively alleviates inattention and hyperactivity symptoms in ADHD, its effects on emotional processing and internalizing symptoms have remained elusive. While we previously found that acute MPH administration modulated neural mechanisms underlying emotional processing in an age-dependent manner, the effects of prolonged administration remained unknown. Objectives Therefore, we investigated: (i) whether prolonged MPH treatment influences neural substrates (amygdala reactivity and connectivity) of emotional processing, and (ii) whether these effects are modulated by age. Methods The “effects of Psychotropic drugs On Developing brain-MPH” (“ePOD-MPH”) randomized controlled trial was a 16-week double-blind, placebo-controlled, multi-center trial with MPH in 50 boys (10–12 years of age) and 49 men (23–40 years of age), all stimulant treatment-naive and diagnosed with ADHD. Participants performed an emotional face-matching task during functional magnetic resonance imaging. We assessed their symptoms of ADHD and internalizing symptoms at baseline, during the trial (8 weeks), and 1 week after the trial end (17 weeks). Results and Conclusions We did not find effects of prolonged MPH treatment on emotional processing, as measured by amygdala reactivity and connectivity and internalizing symptoms in this trial with stimulant treatment-naive participants. This differs from our findings on emotional processing following acute MPH administration and the effects of prolonged MPH treatment on the dopamine system, which were both modulated by age. Interestingly, prolonged MPH treatment did improve ADHD symptoms, although depressive and anxiety symptoms showed a medication-independent decrease. Furthermore, our data indicate that baseline internalizing symptoms may be used to predict MPH treatment effects on ADHD symptoms, particularly in (male) adults with ADHD.
Article
Difficulties with emotion regulation affect the majority of youth with attention-deficit/hyperactivity disorder (ADHD) and predict greater functional impairment than ADHD symptoms alone. Deficits in executive functioning are also present for most children with ADHD, and have been linked with emotion regulation difficulties in both clinical and neurotypical populations throughout development. The current study was the first to assess all three core executive functions (working memory, inhibitory control, set shifting) simultaneously in a clinically-diverse sample of children with and without ADHD and common comorbidities and investigate the extent to which they uniquely predict emotion dysregulation. A sample of 151 children ages 8–13 years (M = 10.36, SD = 1.52; 52 girls; 70.2% White/Non-Hispanic) were assessed using a criterion battery of executive functioning tasks, teacher-reported ADHD symptoms, and parent-reported emotion regulation. Results of the bias-corrected, bootstrapped conditional effects path model revealed that better-developed working memory predicted better emotion regulation (β = 0.23) and fewer ADHD symptoms (β = -0.21 to -0.37), that ADHD symptoms (β = -0.18 to -0.20) independently predicted emotion dysregulation, and that working memory exerted indirect effects on emotion regulation through both inattention and hyperactivity/impulsivity (β = 0.04–0.07). Sensitivity analyses indicated that these effects were generally robust to control for age, sex, executive function interrelations, and inclusion/exclusion of children with co-occurring ASD. These findings underscore the importance of working memory (relative to inhibitory control and set shifting) and its relations with ADHD symptoms for understanding children’s emotion regulation skills, and may help explain the limited efficacy of first-line ADHD treatments, which do not target working memory, for improving emotion regulation skills.
Article
While children with ADHD are reported to have language problems, it is less clear if their ability to use language to tell a story (i.e., form a narrative) is impaired. Therefore, a systematic review and meta-analysis of studies examining the oral production of fictional stories in children with ADHD was conducted. Databases were systematically searched in January 2019 and December 2020 (follow-up). Studies comparing children (≤ 18 years) with ADHD to a control group of typically developing children were included. The meta-analysis adhered to PRISMA guidelines and was preregistered with PROSPERO [CRD42019122040]. Sixteen studies were retained. Results indicated that compared to typically developing children, children with ADHD produced less coherent narratives (Hedges’ g = 0.58 p < .001), gave more ambiguous references (Hedges’ g = 0.52, p < .001), made more disruptive errors (Hedges’ g = 0.41, p < .001), and produced language that was less syntactically complex (Hedges’ g = 0.39, p < .05). Children with ADHD also produced less language overall (Hedges’ g = 0.27, p < .05), although this result appeared to be an artefact of publication bias. Two studies investigated internal state language and both found children with ADHD to produce narratives with less internal state language. Children with ADHD did not produce less fluent narratives (Hedges’ g = 0.23, p = .47), although a scarcity of studies [K = 4] preclude firm conclusions. In conclusion, children with ADHD were impaired in several areas of oral narrative production and screening for narrative language problems should be considered when assessing language and communicative abilities in children with ADHD.
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Bu çalışmada kekemeliği olan ve olmayan ergenlerin duygusal reaktivite, dürtüsellik ve karar verme stratejileri açısından karşılaştırılması amaçlanmıştır. Çalışmanın diğer amacı ise kekemeliği olan grupta kekemelik şiddeti değişkenleri ile ele alınan diğer değişkenler arasındaki ilişkilerin incelenmesidir. Çalışma grubu 12-18 yaş arasındaki kekemeliği olan ve olmayan toplam 52 ergenden oluşmaktadır (26 kekemeliği olan ve 26 kekemeliği olmayan). İki grup Duygusal Reaktivite İndeksi (DRİ), Barratt Dürtüsellik Ölçeği-11-KF (BIS-11-KF) ve Karar Stratejileri Ölçeği’ni (KSÖ) yanıtlamıştır. Kekemeliği olan grubun kekemelik şiddeti ise üç dil ve konuşma terapisti tarafından Kekemelik Şiddetini Değerlendirme Aracı-4 (KEŞİDA-4) kullanılarak hesaplanmıştır. İki grup arasında duygusal reaktivite ve dürtüsellik puanları bakımından fark bulunmamıştır. Karar verme stratejileri ölçeğinin Kararsızlık alt boyutunda ise anlamlı bir fark bulunmuştur. Kekemeliği olan ergenlerin kekemelik sıklığı ile duygusal reaktivite düzeyi arasında orta düzeyde ilişki bulunmuştur (r=.577). Regresyon modelinde duygusal reaktivite düzeyinin kekemeliğin sıklığı için anlamlı olduğu bulunmuştur. Böylece, duygusal reaktivitedeki bir birimlik artışın kekemelik sıklığında.626 birimlik bir artışa neden olduğu görülmüştür. Literatürde kekemeliği olan çocuklar, duygusal reaktivite ya da DEHB ile ilgili nitelikler ile tanımlanmaktadır. Bu çalışmada kekemeliği olan ergenlerin incelenen nitelikler bakımından akranlarından farklı olmadığı sonucuna ulaşılmıştır. Öte yandan duygusal reaktivitenin kekemelik frekansını yorduyor olması ve kekemeliği olan ergenlerin Kararsızlık boyutunda yüksek puanlar alması, kanıt temelli uygulamalar perspektifi ile kekemelik yönetiminin akıcılığa müdahaleden çok daha kapsamlı bir yaklaşım gerektirdiğini göstermiştir.
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Background Current DSM and ICD classifications of Attention-Deficit/Hyperactivity Disorder (ADHD) exclude emotional dysregulation (ED) in their diagnostic criteria, despite ED symptoms frequently co-occurring in ADHD and likely sharing common neurobiological substrates. In this study, we examined whether consideration of ED symptoms could delineate more informative “ADHD+ED” subphenotypes. Method 4106 children with ADHD were recruited. ED and inattentive (IA) and hyperactive/impulsive (HI) symptoms were profiled using latent class analyses (LCA). The derived latent class (LC) subphenotypes were evaluated and validated in relation to comorbidity patterns, executive functions, and functional impairments. Results Five LC subphenotypes with ED symptoms were identified: IA/HI + ED profile (LC1); HI + ED profile (LC2); IA + ED profile (LC3); IA/HI profile (LC4); and IA profile (LC5). Cross-validation of the LCA model using support vector machine analysis confirmed 83% accuracy. ED positive (ED+ve) subphenotypes were associated with higher rates of oppositional defiant disorder, mood disorders, anxiety disorders, as well as more severe autistic traits and sluggish cognitive tempo symptoms. Higher rates of ecological executive functioning impairments (BRIEF ratings) were found among ED+ve subphenotypes (though no differences were detected by laboratory-based measures). Functional impairments were also more severe among participants with ED+ve subphenotypes. Limitations The data for our LCA were cross-sectional and based primarily on parent ratings. Conclusion Our classification model has parcellated IA, HI, and ED symptoms into novel informative subphenotypes. These classifications provide preliminary evidence that ED symptoms could serve as sentinel features to identify a potential “ADHD-complex” syndrome, which demarcates a more pervasive condition of greater severity, complexity, and impairment.
Article
Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by pervasive alterations in self-regulation. Attachment patterns could be involved in maintaining the clinical features of ADHD during development. This meta-analytic review summarizes the findings of 26 cross-sectional and longitudinal studies that assessed correlations between attachment styles and ADHD features among children and adolescents. Results show that insecure attachment highlighted significant correlations with ADHD inattention and hyperactivity symptoms. Dismissive/avoidant attachment was associated with inattention features. Ambivalent/preoccupied attachment correlated with hyperactivity symptoms. Disorganized attachment was associated with inattentive symptoms. Insecure attachment was prospectively associated with later ADHD symptoms. Cross-sectional correlations between insecure attachment and ADHD symptoms were comparable to longitudinal ones. This might suggest a transactional developmental model of ADHD considering mutual reinforcement effects of insecure attachment patterns and core clinical features of the disorder. Clinical samples with ADHD should be assessed in order to support this theoretical framework.
Article
Emotional dysregulation (ED) manifesting as irritability or aggression produces appreciable impairment in children with attention deficit hyperactivity disorder and a main reason why they present for treatment. Central nervous system (CNS) stimulants seem to be a safe and tolerable treatment of most youth with these presentations. Optimization of CNS stimulants dose in combination with psychosocial interventions led to reductions in ED. Randomized controlled trials support that addition of risperidone further reduces aggression when these treatments are not sufficient. There is evidence for the efficacy of divalproex, molindone and selective serotonin reuptake inhibitor improve these outcomes when used as adjunct to CNS stimulants.
Article
While practitioners might engage caregivers on their understandings of the disruptive behavioural disorders of their children, their perspectives are yet to be examined in a qualitative study. This study explored perspectives of primary caregivers on the disruptive behaviour of children who attended the child unit of Weskoppies Psychiatric Hospital, in South Africa. Qualitative methods were used in a case study design. Nineteen participants were purposively sampled. The participants were interviewed using individual in-depth, semi-structured interviews. Data were analysed using typological and bracketed grounded theory methods. Both methods revealed these themes: confusion, emotional build-up towards a meltdown; loss of others; spiritual and cultural (dis)connectedness; behaviour of others towards the children; something being wrong medically; behavioural difficulties when "I want my way"; emotional turmoil of caregivers; and corrective responses. Differences yielded by the analytic methods were a yearning for a better future, and the perspective that trauma had impacted the child's behaviour. These findings suggest that practitioners may anticipate and support caregivers in their experiences of emotional turmoil, uncertainty and confusion. Caregivers may be informed regarding emotional dysregulation and that a therapeutic resource may be found in the knowledge that the caregivers have a yearning for a better future for their children.
Article
The risk for major depressive disorder (MDD) is considerably increased in young adults with attention-deficit/hyperactivity disorder (ADHD) but underlying mechanisms are poorly understood. This review explores ADHD-specific neurocognitive impairments as possible underlying mechanisms for ADHD-depression comorbidity. Two systematic literature searches were conducted in EBSCOhost, PubMED, and Cochrane Reviews databases according to PRISMA guidelines. The first search identified 18 meta-analyses of cross-sectional and longitudinal studies on cognitive dysfunctions in MDD across the lifespan. The second search identified six original studies on reaction time variability in MDD. During acute depression, children and adults showed cognitive deficits that overlapped with some of the ADHD-related impairments. Findings from remitted patients, high-risk individuals, and few prospective studies suggest that a subset of these shared impairments, specifically executive dysfunctions (selective attention, verbal fluency, working memory) and long-term memory problems, are candidate pre-existing risk markers of depression. We discuss if and how these specific neurocognitive mechanisms may mediate developmental pathways from ADHD to depression. If replicated by longitudinal studies, these findings may guide future prevention strategies.
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Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527–551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.
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Individuals with attention-deficit/hyperactivity disorder (ADHD) experience impairments in a number of functional domains. Although current evidence-based treatments for ADHD reduce symptoms and improve academic and behavioral functioning, they have minimal impact on social functioning or on risky behaviors (see Evans et al. in J Clin Child Adolesc Psychol, 43:527–551, 2014 for review). Preliminary evidence indicates that emotion dysregulation (ED) is associated with impairments across the developmental spectrum, such as social impairment and risky behaviors, and that its relative absence/presence is differentially associated with treatment response. It thus stands to reason that by incorporating a focus on ED in interventions targeting social impairment and risky behaviors, we may be able to increase the number of youth who respond to such interventions and decrease the prevalence or degree of these impairments and behaviors among youth and adults with ADHD. However, a number of questions remain unaddressed about the association between ADHD and ED, such as the portion of individuals with ADHD who experience ED, the extent to which ED is associated with the above impairments and behaviors, and whether or not ED is malleable. To begin addressing these questions, we summarize and critically evaluate the literature on the association between ADHD and ED and make recommendations for future basic, translational, and treatment outcome research.
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An emerging body of mental health research provides evidence that callous-unemotional (CU) traits explain significant and meaningful variance among children with disruptive behavior disorders. However, the classroom behavior of students with CU traits has not yet been adequately studied. This study examined this issue using teacher-recorded classroom rule violations (RVs). Participants were 648 children (346 boys; M age = 8.14) from 28 classrooms (kindergarten–sixth grade) distributed across three schools participating in a schoolwide behavioral intervention. Teachers completed rating scales approximately 4 to 6 weeks after the start of the school year, prior to initiating the schoolwide intervention. After completing ratings, teachers recorded daily frequency counts of RVs for each student in their classroom for the remainder of the school year. Growth curve modeling analyses indicated that (a) CU traits were associated with elevated rates of RVs at the start of the school year even after taking attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder/conduct disorder (ODD/CD) into account and (b) CU traits were associated with a significant decrease in rates of RVs across the school year. CU traits appear to explain significant and important variance in classroom RVs among elementary school age students.
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A meta-analysis evaluating the effects of school-based interventions for students with attention deficit hyperactivity disorder was conducted by examining 60 outcome studies between 1996 and 2010 that yielded 85 effect sizes. Separate analyses were performed for studies employing between-subjects, within-subjects, and single-subject experimental designs. The overall mean effect sizes for dependent measures of behavior were positive and significant for within-subjects (0.72) and single-subject (2.20) designs, but not for between-subjects (0.18) designs. Mean effect sizes for academic outcomes were positive but not significant for between-subjects (0.43) and within-subjects (0.42) design studies, but were positive and significant for single-subject (3.48) design studies. Contingency management, academic intervention, and cognitive-behavioral intervention strategies were all associated with positive effects for academic and behavioral outcomes. Other moderators (e.g., school setting, publication status) are discussed along with implications for school-based management of students with attention deficit hyperactivity disorder and future treatment studies for this population.
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It is now well established that there are important behavioral differences between conduct problem (CP) children with and without callous-unemotional traits (CU). Although various externalizing symptoms are differentially related to how youth perceive or explain their own behaviors (e.g., self-perceptions), no research has yet examined whether children with CP-only differ from children with CP/CU in how they perceive or explain their own behaviors. The current study addressed this topic by examining the self-perceptions and attributions for positive and negative social situations of CP children with and without CU traits. Participants were 72 (76 % boys) elementary school-aged children (M=9.72, SD=1.65) who were divided into three groups: typically developing controls (n=17), CP/ADHD-only (n=40), or CP/ ADHD-CU (n=15). Results showed that, compared to other groups, children in the CP/ADHD-CU group had lower global self worth yet equal (or higher) pereceived self-competence about their behavior conduct. In addition, the CP/ADHD-CU group made stronger attributions to their own behavior problems as a reason for negative social outcomes, and they made strong external attributions for both negative and positive outcomes. These differences were significant after controlling for depression, narcissism, and CP. These findings may suggest that children with CP/ADHD-CU do not feel as badly as typically developing children about their misbehavior and are thus unmotivated to change it.
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There is a trend toward diagnosing ADHD prior to school entry. Despite this, there is a lack of studies investigating ADHD in the preschool years, at least studies including a large range of different neuropsychological functions. Our knowledge of the independent effects of different neuropsychological functions in relation to preschool ADHD is therefore limited. In order to address this issue, the present study investigated cognitive, affective, and motivation-based regulation in relation to ADHD symptoms in 104 preschool children (age M = 67.33 months, SD = 10.10; 65 % boys). Results showed that these regulatory processes were all significantly related to ADHD symptoms and that most of these relations remained after controlling for comorbid conduct problems. Most previous preschool studies have only included cognitive regulation, and to some extent motivation-based regulation. By also including affective regulation, we were able to explain a larger proportion of the variance in ADHD symptoms. However, it should be noted that the amount of variance explained was still small in comparison with what has been found in previous studies of school-aged children. This finding could be taken as an indication that further studies examining the nature of preschool ADHD are needed, and that it may be necessary to look beyond the neuropsychological factors that have been linked to the disorder in older children and adults.
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. Social and emotional deficits were recently considered as inherent features of individuals with attention-deficit hyperactivity disorder (ADHD), but only sporadic literature data exist on emotion recognition in adolescents with ADHD. The aim of the present study was to establish emotion recognition profile in adolescent boys with ADHD in comparison with control adolescents. Methods . Forty-four adolescent boys (13–16 years) participated in the study after informed consent; 22 boys had a clinical diagnosis of ADHD, while data were also assessed from 22 adolescent control boys matched for age and Raven IQ. Parent- and self-reported behavioral characteristics were assessed by the means of the Strengths and Difficulties Questionnaire. The recognition of six basic emotions was evaluated by the “Facial Expressions of Emotion-Stimuli and Tests.” Results . Compared to controls, adolescents with ADHD were more sensitive in the recognition of disgust and, worse in the recognition of fear and showed a tendency for impaired recognition of sadness. Hyperactivity measures showed an inverse correlation with fear recognition. Conclusion . Our data suggest that adolescent boys with ADHD have alterations in the recognition of specific emotions.
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We investigated whether symptoms of attention-deficit/hyperactivity disorder (ADHD) are pathways through which deficits in inhibition and working memory are associated with teacher- and parent-rated social impairment in children. Participants were 64 children (55 % males; 53 % with ADHD) in grades 3-6. Consistent with our hypotheses, the association between inhibition and social impairment was mediated by hyperactivity/impulsivity and the association between working memory and social impairment was mediated by inattention. Support was not obtained for alternative models wherein the association between inhibition and social impairment was mediated by inattention, and the association between working memory and social impairment was mediated by hyperactivity/impulsivity. Further, tests of hierarchical models suggest that neither inhibition nor working memory is primary but, rather, that these cognitive processes are related to one another and that they collectively (but not uniquely) contribute to hyperactivity/impulsivity and inattention. These findings have implications for conceptual models of ADHD, for understanding factors that influence and sustain social impairment among youth with symptoms of the disorder, and for interventions aimed to addressing such impairment.
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Objective: We aimed to elucidate how cognitive and affective empathy differ across age groups and how these differences might relate to executive dysfunction. Methods: In study I, we assessed 108 healthy participants in three consecutive age groups (20-39 years/40-59 years/60-79 years) using a self-report measure of trait cognitive and affective empathy (interpersonal reactivity index: IRI). In study II, 54 younger (20-35 years) and 54 older (55-70 years) individuals completed a test of state cognitive and affective empathy (multifaceted empathy test: MET). Additionally, measures of cognitive flexibility, response inhibition, and working memory were administered. Results: Older and younger adults were comparable with regard to trait empathy (study I). Contrary to most previous findings, older adults did not show impaired state-cognitive empathy, but scored higher on subtests of state-affective empathy relative to the younger group, irrespective of the valence of the stimulus material (study II). Performance on the executive subtests was related to empathy in both studies. Discussion: While older and younger cohorts might not differ with regard to trait empathy, and state-cognitive empathy performance might be task-dependent, this investigation provides first evidence of potentially increased state affective empathic responding in older age. This might be related to executive dysfunction, in particular poor inhibitory control.
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Children with attention-deficit/hyperactivity disorder (ADHD) often engage in ineffective or inappropriate social interactions and have been shown to be less accurate at interpreting emotions than typically developing controls. Twenty-four children with a clinical diagnosis of ADHD were compared with 24 age and verbal IQ matched controls using an Emotion Evaluation Test (EET) from The Awareness of Social Inference Test (TA SIT). The task assessed interpretation of naturalistic emotional displays including facial movement, tone of voice, and gestures. In each form, 28 vignettes of neutral scripts were enacted by professional actors to represent seven basic emotional categories: Fear, Anger, Sadness, Disgust, Surprise, Happiness as well as a neutral category. The children with ADHD performed more poorly than their age and intelligence matched controls and errors were observed across both positive and negative emotions. The results are discussed in light of problems in recognizing social and contextual cues of emotion.
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Objective: The purpose of this study was to evaluate aspects of emotion dysregulation (ED) that characterize young adolescents with ADHD, examine the effects of subtype and comorbidity, and determine the extent to which ED is related to aggression and rule-breaking and social impairment. Method: We examined which aspects of ED are most relevant to ADHD in 180 young adolescents (75% boys), as well as whether ED differs across ADHD subtypes or comorbid oppositional defiant disorder (ODD) status. We also examined the association between ED and aggression, rule-breaking, and social impairment. Results: Young adolescent females and males with ADHD exhibited various manifestations of ED, including behavioral dyscontrol in the presence of strong emotions and inflexibility/slow return to emotional baseline. ED did not differ as a function of ADHD subtype or comorbid ODD. Three aspects of ED, namely, low threshold for emotional excitability/impatience, behavioral dyscontrol in the face of strong emotions, and inflexibility/slow return to baseline, predicted three of six measured indices of parent- and self-reported social impairment, above and beyond comorbid ODD. Conclusions: ED is associated with ADHD among young adolescents, does not differ based on ADHD subtype or ODD status, and is associated with social impairment.
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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.
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