Nahit Motavalli Mukaddes MD
Professor of Child, Adolescent & Adult Psychiatry
Istanbul Institute of Child and Adolescent Psychiatry
The majority of individuals with ADHD show impairments in emotional regulation (ED). However, the current diagnostic system such as DSM-5, does not include emotional problems as core symptoms of ADHD, but only mentions them as associated symptoms with ADHD. One of the important reasons for this is that emotional dysregulation is still a transdiagnostic concept that can be applied also to other psychopathological conditions than ADHD. Another problem is the lack of clinical consensus on the definition of ED in ADHD.
In adulthood, many individulas with ADHD present for diagnostic assessment with persistence of problems with inattention and emotional dysregulation, and without clear symptoms of hyperactivity. They may have developed some adaptive mechanisms and/or made decisions for less demanding living conditions (i.e., vocational choices) for inattention. Thus, many of them seek treatment mainly for ED problems, which have an important negative impact on their quality of life. Clinicians with less experience in ADHD may skip a developmental history and detailed assessment of attention and other excutive functions in these patients who come to clinical assessment due to ED.
This may lead to underdiagnosis/misdiagnosis of ADHD in this group. Therefore, it seems necessary to conceptualize the ED in individuals with ADHD more clearly. There is a meta-analysis study on features of ED in children and adolescents with ADHD (Grazino & Garcia 2016), however symptoms of ADHD may change from childhood to adulthood, therefore it is not clear if the emotional dysregulation manifestation is similar in children and adults.
The following paper aimed to quantify the emotional dysregulation in adults with ADHD (n=2535) and compared them with healthy controls. They included only case-control studies (n=13) that were published in peer reviewed journals. After the final screening, they searched for three main dimensions of ED namely ‘emotional lability’, ‘negative emotional responses’ and ‘emotion recognition’. Besides comparing these ED dimensions between the two groups, they studied the association of ED with the severity of ADHD symptoms. Here is the link to the abstract of the paper: