Introduction
Literature search
References | Study population | Measures | Conclusions |
---|---|---|---|
Anastopoulos et al. (2011) | Age 5–12 years
n = 358 ADHD 74 % (ADHD-C, 52.8 %; ADHD-PI, 36.6 %; ADHD-HI, 10.6 %) | Parent-completed Conners’ Rating Scales–Revised Behavior assessment system for children–2nd edition | 46.92 % of the children affected by ADHD displayed significantly elevated levels of emotional lability versus 15.38 % of those without this disorder Emotional lability was strongly associated with both aggression and depression; deficits in the self-regulation of emotion may serve as a marker for these comorbid outcomes |
Beauchaine et al. (2013) | Age 4–6 years
n = 99 (ADHD) |
Psychopathology measures
Child Symptom Inventory Child behavior checklist Eyberg Child Behavior Inventory Conners’ Parent Rating Scale–Revised Social Competence Scale
Cardiovascular measures
Cardiac pre-ejection period Respiratory sinus arrhythmia | Lengthened cardiac pre-ejection period at rest and reduced pre-ejection period reactivity to incentives led to higher scores on measures of conduct problems and aggression Lower baseline respiratory sinus arrhythmia and greater respiratory sinus arrhythmia withdrawal led to lower scores on prosocial behavior Greater respiratory sinus arrhythmia withdrawal led to lower scores on emotion regulation |
Berlin et al. (2004) | Age 7–10 years Total, n = 63 ADHD, n = 21; ODD, n = 7; TS, n = 4; DCD, n = 3; dyslexia, n = 8; control, n = 42 | Go/No-Go task Stroop-like task Kaufman hand movements test Puzzle cheating task Emotion regulation using a parental rating scale (Rydell et al. 2003) Story reconstruction test | Children with ADHD differed significantly from controls with regard to measures of inhibition as well as all other executive function measures, except repetition of hand movements In logistic regression models, three different measures (tapping inhibition, working memory, and emotion regulation) were shown to be significant independent predictors of group membership Children with ADHD differed from controls when studying mean group differences in all of the components in Barkley’s model; the measures discriminated well between groups; the results concerning independent effects pointed to inhibition and working memory as salient aspects |
Braaten and Rosen (2000) | Age 6–12 years ADHD, n = 24; controls, n = 19 | Developmental Questionnaire (Gordon 1995) Peabody picture vocabulary test-revised Empathy response task (Ricard and Kamberk-Kilicci 1995) Emotions behavior checklist Emotional Intensity Scale for Children Emotional reactions to external Contingencies Scale for children | Children with ADHD were less likely than those without ADHD to match their emotion with the emotion of a child in a story eliciting negative emotions and gave significantly fewer character-centered interpretations in their descriptions of the character’s emotion Children with ADHD appear to show more negative emotion, particularly depression, anger, and guilt, than do children without ADHD; children with ADHD may be able to self-regulate their positive emotions but not negative emotions |
Brotman et al. (2010) | Age 8–17 years ADHD, n = 18; BD, n = 43; SMD, n = 29; controls, n = 37 | Children’s Depression Rating Scale Young Mania Rating Scale Whole brain blood-oxygen level-dependent functional MRI | Relative to healthy comparison participants, patients with ADHD manifested hyperactivation in the left, but not right, amygdala Significant group effect in the left amygdala, with patients with severe mood dysregulation showing hyperactivation While rating subjective fear of neutral faces, youths with ADHD demonstrated left amygdala hyperactivity relative to the other three groups, whereas youths with severe mood dysregulation demonstrated hypoactivity |
Gow et al. (2013) | Age (StDev) ADHD, 14.46 (1.12) years Controls, 14.00 (1.10) years ADHD, n = 31; controls, n = 39 | Event-related potentials Electroencephalograms Blood analysis | Children with ADHD had lower mean omega-3/6 levels and event-related potential abnormalities in emotion processing, independent of emotional valence relative to control children Lower omega-3 fatty acid levels were associated with impaired emotion processing in children with ADHD |
Harty et al. (2009) | Age 7–11 years at initial diagnosis. ~10 years follow-up ADHD, n = 85 (ODD 52 %, CD 26 %); control, n = 83 | Buss–Perry Aggression Questionnaire State-Trait Anger Expression Inventory-2 | ADHD plus conduct disorder in childhood led to elevated levels of physical aggression when compared with controls and the ADHD-only group. ADHD plus oppositional defiant disorder led to elevated levels of verbal aggression compared with controls Adolescents diagnosed with ADHD and comorbid disruptive behavior disorders during childhood reported high levels of aggression associated with increased emotionality in the form of anger, but not hostile cognitions |
Hulvershorn et al. (2014) | Age (StDev), 9.2 (2.0) years
n = 63 | Kiddie SADS–present and lifetime version Conners’ Teacher Rating Scale–revised, long version Conners’ Parent Rating Scale–revised, long version Resting-state functional MRI | Children with ADHD who were impaired by high emotional lability exhibited aberrant amygdala-cortical intrinsic functional connectivity, i.e., in regions associated with emotion regulation Findings suggested that a subset of youth with ADHD have specific disruptions in amygdala networks that underlie emotion regulation impairments Resting-state functional connectivity appears to be suitable for detecting emotion relevant differences in intrinsic functional connectivity in youth with ADHD |
Jensen and Rosen (2004) | Age 6–15 years ADHD, n = 30; controls, n = 37 Depression, BD, OCD, FAS, etc. excluded | Disruptive Behavior Rating Scale–Parent Emotional intensity scale–parent version (Intensity Scale) Emotional reactions to external contingencies scale–parent version | Children with ADHD were rated as significantly more emotionally reactive to both immediate and future events than were children without ADHD Differences at both the immediate and future time periods were stronger in response to negative as opposed to positive emotional events In response to the consequences of their behavior, children with ADHD were rated as less emotionally reactive than children without ADHD |
Maedgen and Carlson (2000) | Age 8–11 years Total ADHD, n = 30 (ADHD-C, n = 16; ADHD-I, n = 14); controls, n = 17 | Children’s Assertive Behavior Scale Revised behavior problem checklist Duncan’s socioeconomic index of occupational status Wide range achievement test–third edition Wechsler Intelligence Scale for children–3rd edition Facial and non-facial coding | Children with ADHD–C were rated as showing more aggressive behavior; they displayed emotional dysregulation characterized by high intensity and high levels of both positive and negative behavior Children with ADHD–I displayed social passivity and showed deficits in social knowledge on the self-report measure but did not evidence problems in emotional regulation ADHD subtypes may benefit from different treatment approaches |
Martel and Nigg (2006) | Age 6–12 years ADHD, n = 92 (ADHD-I, n = 24; ADHD-C, n = 68); borderline, n = 35; controls, n = 52 | California child Q-sort Early Adolescent Temperament Questionnaire | Reactive Control was related to hyperactivity–impulsivity as rated by both parents and teachers. Negative Emotionality was related to oppositional defiance. Resiliency was primarily related to inattention–disorganization as rated by both parents and teachers; Effortful Control was related uniquely to inattention in parent but not teacher data Low levels of Reactive Control may have led to high levels of hyperactivity–impulsivity, and low levels of resiliency or Effortful Control may have been related to high levels of inattention Children with ADHD may have arrived at their disorder via multiple streams of temperamental vulnerability |
Meehan et al. (2008) | Age 7–10 years Total, n = 42 (27 boys, 15 female) ODD, CD, anxiety disorder, depressive disorder | Schedule for affective disorders and schizophrenia for school aged children Rorschach inkblot method | Children with greater ADHD symptoms displayed lower scores on variables indicating internal resources for emotional self-regulation and stress tolerance relative to a comparison group |
Melnick and Hinshaw (2000) | Age 6–12 years ADHD, n = 45; controls, n = 34 | Video-taped family interactions and summer camp interactions rated by trained observers Parenting behaviors rated by assessors based on positive/negative parenting and parents’ ability to self-regulate their own emotions Peer-nominated sociometric assessments | Differences in emotion regulation were not attributable to severity of ADHD symptoms A generalized difficulty with emotion regulation was not shown in the ADHD population, but was a specific vulnerability among the highly aggressive subgroup Emotion regulation abilities were modestly related to underlying problems with impulse control and hyperactivity The aggressive subgroup of boys with ADHD had a slight tendency toward more intense emotional reactivity, however, emotional reactivity was predictive of neither core ADHD symptomatology nor social outcomes |
Musser et al. (2011) | Age 7–9 years ADHD, n = 32 (ADHD-C, n = 19; ADHD-I, n = 13 [AD, 10 %; OD, 13.3 %; SD, 13.3 %]); controls, n = 34 (AD, 5.6 %; OD, 2.8 %; SD, 2.8 %) | Conners’ Rating Scale Strengths and Difficulties Questionnaire Wechsler’s intelligence scale for children—4th version Wechsler individual achievement test–2nd edition Cardiac pre-ejection period Respiratory sinus arrhythmia | Children with ADHD displayed a stable pattern of elevated parasympathetic activity across all task conditions compared to baseline ADHD in childhood was associated with abnormal parasympathetic mechanisms involved in emotion regulation |
Musser et al. (2013) | Age 7–11 years ADHD-C, n = 75 ([ADHD only, n = 54; MD, 3.7 %; AD, 23.9 %; ODD 24.7 %; tic disorder, 3.7 %; SD, 7.1 %]; [ADHD + low prosocial, n = 21; MD, 3.7 %, AD, 4.7 %; ODD 23.8 %; SD, 4.7 %]); controls, n = 75 (MD, 2.7 %; AD, 21.3 %; ODD 8.1 %; SD, 5.4 %) | Strengths and Difficulties Questionnaire Prosocial Behavior Scale Cardiac pre-ejection period Respiratory sinus arrhythmia | ADHD-typical prosocial group displayed atypically elevated parasympathetic reactivity (emotion dysregulation) during positive induction, along with increased sympathetic activity (elevated arousal) ADHD-low prosocial group displayed reduced parasympathetic reactivity and reduced sympathetic activity (low emotional arousal) across baseline and task conditions Both ADHD groups had altered patterns of autonomic functioning In addition to clinical heterogeneity, results suggested that ADHD is heterogeneous with regard to physiological indices of emotion and regulation |
Posner et al. (2013) | Age 7–12 years ADHD, n = 22 (ADHD-C, n = 19; ADHD-I, n = 3 [ODD, n = 6; SAD, n = 1]; controls, n = 20 | DuPaul Barkley ADHD Rating Scale Conners’ Parent Rating Scale–Revised Child behavior Checklist Hollingshead index of social position Edinburgh Handedness Inventory Wechsler Abbreviated Scale of Intelligence Resting-state functional connectivity MRI | Children with ADHD had reduced connectivity in two neural circuits: one underlying executive attention and the other emotional regulation A double dissociation was seen between these two neural circuits and their behavioral correlates Reduced connectivity in the executive attention circuit correlated with executive attention deficits, but not with emotional lability Reduced connectivity in the emotional regulation circuit correlated with emotional lability, but not with executive attention deficits |
Rosen et al. (2013) |
Study 1
Age 8–11 years ADHD, n = 11; (ADHD-C, n = 9; ADHD-I, n = 2); comorbidities, n = 9, including mood, anxiety and behavioral | Ecological momentary assessment Recurrence quantification analysis Emotion regulation checklist Child behavior Checklist Children’s Depression Inventory–2nd edition | A link was established between nonlinear patterning of emotional variability over time and conventional measures of emotional functioning A 4-week parent-reported, but not child-reported, ecological momentary assessment-based protocol was a feasible means of assessing emotion dysregulation in children |
Study 2 (subset of study 1)
Age 8–11 years ADHD, n = 5 (ADHD-C, n = 4; ADHD-I, n = 1) | As above—ecological momentary assessment completed by the child (self-reported) | ||
Semrud-Clikeman et al. (2010) | Age 9–17 years ADHD, n = 64 (ADHD-C, n = 21; ADHD-I, n = 28; AS, n = 15); controls, n = 32 | Woodcock–Johnson cognitive battery III Delis–Kaplan executive functioning system The structured interview for diagnostic assessment of children Behavior Rating Inventory of Executive Function | Children with ADHD-C had significantly more difficulty with behavioral regulation and more difficulty in emotional control compared with children with ADHD-PI or healthy controls The Behavior Rating Inventory of Executive Function indicated significant problems in the areas of flexibility, shifting, and inhibition for children with ADHD-C The ability to be flexible and to shift from one activity to the next was important for social and emotional functioning and development |
Seymour et al. (2012) | Age 10–14 years ADHD, n = 37; controls, n = 32 ODD, CD, disruptive behavior disorders | Behavioral assessment system for children or adolescents-parent report Children’s Depression Inventory Emotion regulation checklist Difficulties in Emotion Regulation Scale | ADHD status was positively related to both depressive symptoms and emotion dysregulation, and depressive symptoms were positively related to emotion dysregulation Youth in the ADHD group demonstrated significantly higher levels of depression and emotion dysregulation than those in the non-ADHD control group |
Seymour et al. (2014) | Age 9–12 years
n = 227 (156 boys) | Emotion regulation checklist (maternal report) Revised Child Anxiety and Depression Scales (self-report) | Emotion regulation in youth with ADHD was monitored over a 3-year study Emotion regulation was identified as a potential mechanism linking ADHD and depressive symptoms in these individuals |
Sjowall et al. (2013) | Age 7–13 years ADHD, n = 102 [ADHD-C, 70 %; ADHD-HI, 4 %; ADHD-PI, 26 %; (ODD or CD, 46 %; GAD/anxiety NOS, 7 %; OCD, 1 %; TS, 4 %)]; controls, n = 102 | ‘Find the phone’ Children’s size-ordering task Digit span Go/No-Go task Navon-like test Choice delay task Emotion Questionnaire | Children with ADHD differed significantly from controls, except for delay aversion and recognition of disgust Executive functioning, reaction time variability, and emotional functioning all contributed independently to distinguishing between children with ADHD and controls Emotional functioning appears to be an area of importance for ADHD that needs to be incorporated into future theoretical models |
Sorensen et al. (2011) | Age 7–9 years ADHD, n = 23; ADHD + anxiety, n = 11; anxiety, n = 24 CD, TS, OCD, mania, depression, dysthymia excluded from study | Behavior Rating Inventory of executive function | Behavioral dysregulation in ADHD children was aggravated by comorbid anxiety |
Wahlstedt et al. (2008) | Age 4–6 years Total, n = 87 (ADHD + EF, n = 16; ADHD, n = 19; EF, n = 17); controls, n = 35 | Stroop test Go/No-Go test ‘Find the pig’ Digit span test Number of items in a stated category Parent-reported Prosocial Orientation Scale questionnaire [Rydell et al. (2003)] Strengths and Difficulties Questionnaire | Only ADHD symptoms predicted other aspects of socioemotional functioning such as dysfunctional emotional regulation and lower levels of social competence Both ADHD symptoms and impaired executive function acted as early predictors of problem behaviors |
Walcott et al. (2004) | Age 6–11 years ADHD, n = 26; controls, n = 23 | Stop signal reaction time Competitive puzzle task: race to complete Lego puzzle with missing piece
Recorded and coded by trained observers Emotion control condition (half of participants told to hide emotions) | Boys with impulsive ADHD displayed greater behavioral disinhibition and were less effective at emotion regulation than comparison boys Boys with ADHD were unsuccessful in masking their emotions or changing their emotion regulation or disinhibition even when instructed to do so Comparison boys were more successful at emotion regulation when given instruction to self-regulate A small, but significant, relation was seen between executive behavior disinhibition and subsequent deficits in self-regulation of emotion |
Wiersema and Roeyers (2009) | Age 8–13 years ADHD, n = 10 (ADHD-C, n = 8; ADHD-HI, n = 2); controls, n = 16 | Disruptive Behavior Disorder Rating Scale Effortful Control Scale Attentional Control Scale Go/No-Go task Electroencephalogram Event-related potential | The P3 wave is an event-related potential component elicited in the process of decision making; the N2 is known as a mismatch detector, but has also been found to reflect executive cognitive control functions Children scoring high on ADHD symptoms made more errors of commission and showed smaller No-Go P3 amplitudes Effortful Control Scale and Attentional Control Scale scores were not related uniquely to inattention or hyperactive–impulsive symptoms Effortful Control was implicated in ADHD symptomatology, as children scoring high on ADHD symptoms scored low on Effortful Control questionnaires, made more errors of commission, and showed smaller No-Go P3 amplitudes |