By: Joel Young

The consequences of emotion dysregulation (ED) is a major problem for adolescents with ADHD, whether the behavior is shrieking at a teacher who confiscates a cell phone not allowed during class or punching another student who crashed into the teen, maybe not on purpose. But does it matter which subtype of ADHD the adolescent carries, whether the child is male or female, or if the adolescent also has oppositional defiant disorder (ODD)? Researcher Nora Bunford and colleagues studied 180 adolescents with ADHD, ages 12-16 years old to evaluate aspects of emotion dysregulation affecting adolescents with ADHD.

In this study, the adolescent subjects were previously diagnosed with ADHD with either the inattentive subtype of ADHD or the ADHD combined type. Some subjects were comorbid for  ODD. The subjects were recruited by flyers sent to middle schools in Ohio. All children had a minimum intelligence quotient of 80 on the Wechsler Abbreviated Scale of Intelligence. The study occurred over 1 academic year and six months.

The researchers found three key aspects of emotion dysregulation were predictive for both parent-reported and child-reported social impairment, regardless of the ADHD subtype, gender, or presence or absence of ODD. These factors were the following:

  • A low threshold for emotional excitability/impatience
  • Behavioral dyscontrol accompanying strong emotions
  • Inflexibility/slow return to baseline

The researchers explained ED is comprised of two main deficits. “These are an inhibitory deficit, which manifests in socially inappropriate behavioral responses to strong emotion, and a self-regulatory deficit, which manifests in an inability to (a) self-soothe physiological arousal that strong emotion induces, (b) refocus attention, and (c) organize the self for coordinated action in the service of an external goal.”

Many different scales were used to evaluate the adolescents, such as the Difficulties in Emotion Regulation Scale (DERS), the Emotion Regulation Index for Children and Adolescents (ERICA), the Social Skills Improvement System-Rating Scales (SSIS-RS), and others. The researchers also compared the teens with ADHD to those from a community sample of youth without ADHD.

There were no significant differences between subtypes of ADHD in the subjects in terms of social impairment and emotion dysregulation, nor was it significant if the adolescent had ODD.

The researchers did discover that, compared to females in the community, females with ADHD and emotion dysregulation exhibited a lack of awareness and inattention to emotional responses. They also experienced difficulties in controlling their behavior in the face of negative em0tions and lacked confidence in their ability to control their emotions. Among the males with ADHD experiencing ED, compared to a community sample of males without ADHD, the ADHD males were significantly more emotionally inflexible with a slower return to emotional baseline. They had difficulty with socially appropriate emotional responses, lacked awareness and were inattentive emotional responses. In addition, the ADHD males struggled to control their behavior while experiencing negative emotions and lacked knowledge and clarity about the emotions they were experiencing.

The researchers noted psychosocial interventions with adolescents resembling the subjects in the study may fail because such an intervention could miss the importance of emotion dysregulation. The researchers recommended mindfulness mediation or dialectical behavior therapy as possible therapeutic techniques for these subjects.

It is unknown if the adolescents in this study were medicated, but it seems likely at least some were receiving ADHD medications. A further study on subjects taking ADHD medications and considering their levels of ED would be useful to determine if ADHD medications may help affected subjects improve their emotion dysregulation. In addition, including a group of teens with  the predominantly hyperactive-impulsive subtype as a comparison basis with the other subtypes could provide useful information. One wonders if hyperactive and impulsive teens might be more emotionally labile than adolescents who are inattentive or have the mixed subtype of ADHD.

The researchers provided important food for thought in this unique study.

Nora Bunford, Steven W. Evans, and Joshua M. Langberg, “Emotion Dysregulation Is Associated with Social Impairment Among Young Adolescents with ADHD,” Journal of Attention Disorders 32, n. 1 (2018):66-82.