Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review

Summary & key facts

This paper reviewed studies about how adults with Attention Deficit Hyperactivity Disorder (ADHD) handle emotions. The authors searched scientific databases and found about 20 studies of adults with diagnosed ADHD that measured emotion regulation. Overall, people with adult ADHD used more unhelpful ways to manage emotions than people without ADHD. Emotion problems were linked to worse ADHD symptoms, weaker thinking skills that help you plan and control impulses, more psychiatric problems, and even a higher chance of criminal conviction. The studies also found different brain activity when people with and without ADHD processed emotions. The authors say the evidence is limited and mixed, and that medicines and behavioral therapy might help but more research is needed.

Key facts:

• The authors looked through major scientific databases and selected about 20 empirical studies of adults with a clinical ADHD diagnosis who had measures of emotion regulation.
• Adults with ADHD tended to use non-adaptive emotion regulation strategies more often than people without ADHD. Non-adaptive strategies are ways of handling feelings that usually make problems worse, not better.
• Greater emotion dysregulation was linked to more severe ADHD symptoms.
• Emotion dysregulation was also linked to weaker executive functioning, meaning it was related to problems with planning, controlling impulses, and organizing behavior.
• The review found an association between emotion dysregulation and psychiatric comorbidities, which means people with ADHD and emotion problems often had other mental health diagnoses as well.
• Some studies reported that adults with ADHD who had emotion regulation problems were more likely to have a criminal conviction, though the evidence is limited.
• Brain and body activity measurements showed different patterns for people with and without ADHD when processing emotional information.
• The authors judged the overall literature as scarce and very heterogeneous, so conclusions are tentative and more consistent studies are needed.
• The review suggests that both medication and behavioral therapies could be useful for emotional problems in adult ADHD, but the existing studies do not prove this and more research is required.

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder, with an onset in childhood, that accompanies the person throughout their life, with prevalence between 3 and 5% in adults. Recent studies point towards a fourth core symptom of the disorder related to the emotional information processing that would explain the repercussions that ADHD has on the social, academic, and professional life of the people affected. This review aims to describe emotion dysregulation features as well as the brain activity associated in adults with ADHD. A search of the scientific literature was launched in specialized databases: PsycInfo, Medline, Eric, PsycArticle, Psicodoc and Scopus, following PRISMA guidelines. Twenty-two articles met the inclusion criteria: (a) an ADHD clinical diagnosis, (b) participants over 18 years old, (c) emotion regulation measurement, (d) empirical studies, and (c) in English. Due to the heterogeneity of the studies included, they were classified into three sections: measures and features of emotion regulation (ER) in people with ADHD, neurological and psychophysiological activity related to ER, and treatments. The studies found that meet the selection criteria are scarce and very heterogeneous both in aims and in sample features. Adults with ADHD show a more frequent use of non-adaptive emotion regulation strategies compared to people without ADHD symptoms. Moreover, emotion dysregulation was associated with symptom severity, executive functioning, psychiatric comorbidities, and even with criminal conviction. Different patterns of brain activity were observed when people with and without ADHD were compared. These results may suggest that psychopharmacological treatments as well as behavioral therapies could be useful tools for improving emotional difficulties in adult ADHD.

Topics

Attention Deficit Hyperactivity Disorder Functional Brain Connectivity Studies Neural and Behavioral Psychology Studies

Categories

Health Sciences Medicine Psychiatry and Mental health

Tags

Attention deficit hyperactivity disorder Clinical psychology Comorbidity Emotional dysregulation Law Medicine MEDLINE Political science Psychiatry Psychology PsycINFO

Conditions & symptoms

ADHD Anxiety Depression Anxiety or worry Difficulty focusing Sadness or low mood