Do Neuropsychological Deficits Predict Anger Dysregulation in Adults with ADHD?

Abstract

Objective: To examine the relationship between anger and neuropsychological functioning in adults with ADHD.

Method: Seventy adults with ADHD were assessed. Correlational and hierarchical multiple regression analyses were performed using neurocognitive tasks and subscales of the State Trait Anger Expression Inventory (STAXI)-trait anger, anger out, anger control, while controlling for anxiety and depression (HADS), and full-scale IQ (WASI). Selective, divided, and shifting attention were assessed using the Test of Everyday Attention (TEA) subscales. Sustained attention was measured using Continuous Performance Test (CPT) scores. Response inhibition was measured using scores from the CPT and Matching Familiar Figures test (MFFT).

Results: Trait anger and anger out were both found to have a significant relationship to shifting attention (TEA - visual elevator task) and anxiety. Anger control was found to have a significant relationship to response inhibition (MFFT).

Conclusion: Anger was significantly related to two measures of neuropsychological functioning, and anxiety. Shifting attention was more significantly associated with trait anger and anger out than response inhibition, which was significantly related to anger control. These findings have the potential to inform targeted interventions in forensic psychiatry and may have implications regarding which model of ADHD best accounts for anger dysregulation.

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References

Babinski

L. M.

Hartsough

C. S.

Lambert

N. M

. (1999). Childhood conduct problems, hyperactivity‐impulsivity, and inattention as predictors of adult criminal activity. Journal of Child Psychology and Psychiatry, 40(3), 347–355.

Barkley

R. A.

(1997). Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychological bulletin, 121(1), 65.

Barkley

R. A.

(1998). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.). New York, NY: Guilford Press.

Bell

M. A.

Wolfe

C. D

. (2004). Emotion and cognition: An intricately bound developmental process. Child Development, 75(2), 366–370.

Berry

J. W.

Worthington

E. L.

O’Connor

L. E.

Parrott

Wade

N. G

. (2005). Forgivingness, vengeful rumination, and affective traits. Journal of Personality, 73(1), 183–226.

Biederman

. (2004). Impact of comorbidity in adults with attention deficit/hyperactivity disorder. The Journal of Clinical Psychiatry, 65(Suppl 3), 3–7.

Blair

R. J. R

. (2012). Considering anger from a cognitive neuroscience perspective. Wiley Interdisciplinary Reviews: Cognitive Science, 3(1), 65–74.

Braaten

E. B.

Rosén

L. A

. (2000). Self-regulation of affect in attention deficit-hyperactivity disorder (ADHD) and non-ADHD boys: Differences in empathic responding. Journal of Consulting and Clinical Psychology, 68(2), 313.

Cahill

B. S.

Coolidge

F. L.

Segal

D. L.

Klebe

K. J.

Marle

P. D.

Overmann

K. A

. (2012). Prevalence of ADHD and its subtypes in male and female adult prison inmates. Behavioral Sciences & the Law, 30(2), 154–166.

10.

Cairns

Cammock

. (1978). Development of a more reliable version of the Matching Familiar Figures Test. Developmental Psychology, 14(5), 555–560.

11.

Calkins

S. D.

Degnan

K. A

. (2006). Temperament in early development. Comprehensive Handbook of Personality and Psychopathology, 3, 64–84.

12.

Casey

B. J.

Tottenham

Liston

Durston

. (2005). Imaging the developing brain: what have we learned about cognitive development? Trends in Cognitive Sciences, 9(3), 104–110.

13.

Chapple

C. L.

Vaske

Hope

T. L

. (2010). Sex differences in the causes of self-control: An examination of mediation, moderation, and gendered etiologies. Journal of Criminal Justice, 38(6), 1122–1131.

14.

Collins

Bell

. (1997). Personality and aggression: The dissipation-rumination scale. Personality and Individual Differences, 22(5), 751–755.

15.

Compton

R. J

. (2000). Ability to disengage attention predicts negative affect. Cognition & Emotion, 14(3), 401–415.

16.

Conners

C. K.

Sitarenios

Parker

J. D.

Epstein

J. N

. (1998). The revised Conners' Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26(4), 257–268.

17.

Corbisiero

Stieglitz

R. D.

Retz

Rösler

. (2013). Is emotional dysregulation part of the psychopathology of ADHD in adults? ADHD Attention Deficit and Hyperactivity Disorders, 5(2), 83–92.

18.

Cornblatt

B. A.

Erlenmeyer-Kimling

. (1985). Global attentional deviance as a marker of risk for schizophrenia: specificity and predictive validity. Journal of Abnormal Psychology, 94(4), 470–486.

19.

Cumyn

French

Hechtman

. (2009). Comorbidity in adults with attention-deficit hyperactivity disorder. The Canadian Journal of Psychiatry, 54(10), 673–683.

20.

Dennis

T. A.

Brotman

L. M

. (2003). Effortful control, attention, and aggressive behavior in preschoolers at risk for conduct problems. Annals of the New York Academy of Sciences, 1008(1), 252–255.

21.

DiGiuseppe

Tafrate

R. C

. (2007). Understanding anger disorders. Oxford, UK: Oxford University Press.

22.

Eckhardt

Norlander

Deffenbacher

. (2004). The assessment of anger and hostility: A critical review. Aggression and Violent Behavior, 9(1), 17–43.

23.

Ellenbogen

M. A.

Schwartzman

A. E

. (2009). Selective attention and avoidance on a pictorial cueing task during stress in clinically anxious and depressed participants. Behaviour Research and Therapy, 47(2), 128–138.

24.

Fischer

A. G.

Bau

C. H. D.

Grevet

E. H.

Salgado

C. A. I.

Victor

M. M.

Kalil

K. L. S.

Belmonte-de-Abreu

. (2007). The role of comorbid major depressive disorder in the clinical presentation of adult ADHD. Journal of Psychiatric Research, 41(12), 991–996.

25.

Glancy

Saini

M. A

. (2005). An evidenced-based review of psychological treatments of anger and aggression. Brief Treatment and Crisis Intervention, 5(2), 229–249. doi:10.1093/brief-treatment/mhi013

26.

Gross

J. J

. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2(3), 271.

27.

Gudjonsson

G. H.

Young

. (2006). An overlooked vulnerability in a defendant: Attention deficit hyperactivity disorder and a miscarriage of justice. Legal and Criminological Psychology, 11(2), 211–218.

28.

Gudjonsson

G. H.

Sigurdsson

J. F.

Young

Newton

A. K.

Peersen

. (2009). Attention Deficit Hyperactivity Disorder (ADHD). How do ADHD symptoms relate to personality among prisoners? Personality and Individual Differences, 47(1), 64–68.

29.

Hechtman

Weiss

. (1986). Controlled prospective fifteen year follow-up of hyperactives as adults: non-medical drug and alcohol use and anti-social behaviour. The Canadian Journal of Psychiatry, 31(6), 557–567.

30.

Heim

Nemeroff

C. B

. (2001). The role of childhood trauma in the neurobiology of mood and anxiety disorders: Preclinical and clinical studies. Biological Psychiatry, 49(12), 1023–1039.

31.

Holroyd

C. B.

Coles

M. G

. (2002). The neural basis of human error processing: Reinforcement learning, dopamine, and the error-related negativity. Psychological Review, 109(4), 679.

32.

Isaacowitz

D. M.

Toner

Neupert

S. D

. (2009). Use of gaze for real-time mood regulation: Effects of age and attentional functioning. Psychology and Aging, 24(4), 989.

33.

Linden

Hogan

B. E.

Rutledge

Chawla

Lenz

J. W.

Leung

. (2003). There is more to anger coping than “in” or “out”. Emotion, 3(1), 12.

34.

Mannuzza

Klein

R. G.

Addalli

K. A

. (1991). Young adult mental status of hyperactive boys and their brothers: A prospective follow-up study. Journal of the American Academy of Child & Adolescent Psychiatry, 30(5), 743–751.

35.

Mannuzza

Klein

R. G.

Bessler

Malloy

LaPadula

. (1993). Adult outcome of hyperactive boys: Educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry, 50(7), 565–576.

36.

Marchant

B. K.

Reimherr

F. W.

Halls

Williams

E. D.

Strong

R. E.

Kondo

Robison

R. J

. (2011). Long-term open-label response to atomoxetine in adult ADHD: influence of sex, emotional dysregulation, and double-blind response to atomoxetine. ADHD Attention Deficit and Hyperactivity Disorders, 3(3), 237–244.

37.

Martel

M. M

. (2009). Research Review: A new perspective on attention‐deficit/hyperactivity disorder: emotion dysregulation and trait models. Journal of Child Psychology and Psychiatry, 50(9), 1042–1051.

38.

Martel

M. M.

Nigg

J. T

. (2006). Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality. Journal of Child Psychology and Psychiatry, 47(11), 1175–1183.

39.

Martin

R. C.

Dahlen

E. R

. (2005). Cognitive emotion regulation in the prediction of depression, anxiety, stress, and anger. Personality and Individual Differences, 39(7), 1249–1260.

40.

Matthies

Philipsen

. (2016). Comorbidity of personality disorders and adult attention deficit hyperactivity disorder (ADHD): Review of recent findings. Current Psychiatry Reports, 18(4), 33.

41.

Melnick

S. M.

Hinshaw

S. P

. (2000). Emotion regulation and parenting in AD/HD and comparison boys: Linkages with social behaviors and peer preference. Journal of Abnormal Child Psychology, 28(1), 73–86.

42.

Murray-Close

Hoza

Hinshaw

S. P.

Arnold

L. E.

Swanson

Jensen

P. S.

Wells

. (2010). Developmental processes in peer problems of children with attention-deficit/hyperactivity disorder in The Multimodal treatment study of children with ADHD: Developmental cascades and vicious cycles. Development and Psychopathology, 22(4), 785–802.

43.

Neumann

I. D.

Veenema

A. H.

Beiderbeck

D. I

. (2010). Aggression and anxiety: Social context and neurobiological links. Frontiers in Behavioral Neuroscience, 4, 12.

44.

Nigg

J. T

. (2000). On inhibition/disinhibition in developmental psychopathology: views from cognitive and personality psychology and a working inhibition taxonomy. Psychological Bulletin, 126(2), 220.

45.

Nigg

J. T

. (2005). Neuropsychologic theory and findings in attention-deficit/hyperactivity disorder: the state of the field and salient challenges for the coming decade. Biological Psychiatry, 57(11), 1424–1435.

46.

Novaco

R. W

. (1975). Anger control: The development and evaluation of an experimental treatment. Oxford, UK: Lexington

47.

Posne

M. I.

Rothbart

M. K

. (2000). Developing mechanisms of self-regulation. Development and Psychopathology, 12(3), 427–441.

48.

Pratt

T. C.

Cullen

F. T.

Blevins

K. R.

Daigle

Unnever

J. D

. (2002). The relationship of attention deficit hyperactivity disorder to crime and delinquency: A meta-analysis. International Journal of Police Science & Management, 4(4), 344–360.

49.

Rabinovitz

B. B.

O’Neill

Rajendran

Halperin

J. M

. (2016). Temperament, executive control, and attention-deficit/hyperactivity disorder across early development. Journal of Abnormal Psychology, 125(2), 196.

50.

Ramirez

C. A.

Rosén

L. A.

Deffenbacher

J. L.

Hurst

Nicoletta

Rosencranz

Smith

. (1997). Anger and anger expression in adults with high ADHD symptoms. Journal of Attention Disorders, 2(2), 115–128.

51.

Ramírez

J. M.

Andreu

J. M

. (2006). Aggression, and some related psychological constructs (anger, hostility, and impulsivity) Some comments from a research project. Neuroscience & Biobehavioral Reviews, 30(3), 276–291.

52.

Robertson

I. H.

Ward

Ridgeway

Nimmo-Smith

. (1994). Test of Everyday Attention. Bury St Edmunds: Thames Valley Test Company.

53.

Rösler

Retz

Yaqoobi

Burg

Retz-Junginger

. (2009). Attention deficit/hyperactivity disorder in female offenders: prevalence, psychiatric comorbidity and psychosocial implications. European Archives of Psychiatry and Clinical Neuroscience, 259(2), 98–105.

54.

Rothbart

M. K.

Sheese

B. E.

Posner

M. I

. (2007). Executive attention and effortful control: Linking temperament, brain networks, and genes. Child Development Perspectives, 1(1), 2–7.

55.

Sagvolden

Aase

Zeiner

Berger

. (1998). Altered reinforcement mechanisms in attention-deficit/hyperactivity disorder. Behavioural Brain Research, 94(1), 61–71.

56.

Saini

. (2009). A meta-analysis of the psychological treatment of anger: Developing guidelines for evidence-based practice. Journal of the American Academy of Psychiatry and the Law, 37(4), 473.

57.

Sander

Grandjean

Pourtois

Schwartz

Seghier

M. L.

Scherer

K. R.

Vuilleumier

. (2005). Emotion and attention interactions in social cognition: Brain regions involved in processing anger prosody. Neuroimage, 28(4), 848–858.

58.

Satterfield

J. H.

Faller

K. J.

Crinella

F. M.

Schell

A. M.

Swanson

J. M.

Homer

L. D

. (2007). A 30-year prospective follow-up study of hyperactive boys with conduct problems: adult criminality. Journal of the American Academy of Child & Adolescent Psychiatry, 46(5), 601–610.

59.

Scherer

K. R

. (2001). Appraisal considered as a process of multilevel sequential checking. Appraisal Processes in Emotion: Theory, Methods, Research, 92, 120.

60.

Shaw

Stringaris

Nigg

Leibenluft

. (2015). Emotion dysregulation in attention deficit hyperactivity disorder. FOCUS, 14(1), 127–144.

61.

Skirrow

McLoughlin

Kuntsi

Asherson

. (2009). Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Review of Neurotherapeutics, 9(4), 489–503.

62.

Soderstrom

Sjodin

A. K.

Carlstedt

Forsman

. (2004). Adult psychopathic personality with childhood-onset hyperactivity and conduct disorder: A central problem constellation in forensic psychiatry. Psychiatry Research, 121(3), 271–280.

63.

Spielberger

C. D

. (1988). Manual for the state-trait anger expression scale (STAXI). Odessa, FL: Psychological Assessment Resources.

64.

Spielberger

C. D.

Jacobs

Russell

Crane

R. S

. (1983). Assessment of anger: The state-trait anger scale. Advances in Personality Assessment, 2, 159–187.

65.

Sukhodolsky

D. G.

Golub

Cromwell

E. N

. (2001). Development and validation of the anger rumination scale. Personality and Individual Differences, 31(5), 689–700.

66.

Surman

C. B.

Biederman

Spencer

Miller

C. A.

McDermott

K. M.

Faraone

S. V

. (2013). Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: A controlled study. ADHD Attention Deficit and Hyperactivity Disorders, 5(3), 273–281.

67.

Surman

C. B.

Biederman

Spencer

Miller

C. A.

Petty

C. R.

Faraone

S. V

. (2015). Neuropsychological deficits are not predictive of deficient emotional self-regulation in adults with ADHD. Journal of Attention Disorders, 19(12), 1046–1053.

68.

Wadlinger

H. A.

Isaacowitz

D. M

. (2011). Fixing our focus: Training attention to regulate emotion. Personality and Social Psychology Review, 15(1), 75–102.

69.

Wechsler

(1999). Manual for the Wechsler abbreviated intelligence scale (WASI). San Antonio, TX: The Psychological Corporation.

70.

Widom

C. S

. (1989). The cycle of violence. Science (New York, N.Y.), 244(4901), 160–166.

71.

Wilens

T. E.

Faraone

S. V.

Biederman

. (2004). Attention-deficit/hyperactivity disorder in adults. Jama, 292(5), 619–623.

72.

Wilkowski

B. M.

Robinson

M. D

. (2008). The cognitive basis of trait anger and reactive aggression: An integrative analysis. Personality and Social Psychology Review, 12(1), 3–21.

73.

Wilkowski

B. M.

Robinson

M. D

. (2010). The anatomy of anger: An integrative cognitive model of trait anger and reactive aggression. Journal of Personality, 78(1), 9–38.

74.

Wilkowski

B. M.

Robinson

M. D.

Troop-Gordon

. (2010). How does cognitive control reduce anger and aggression? The role of conflict monitoring and forgiveness processes. Journal of Personality and Social Psychology, 98(5), 830.

75.

Young

Thome

. (2011). ADHD and offenders. The World Journal of Biological Psychiatry, 12(sup1), 124–128.

76.

Young

Sedgwick

Fridman

Gudjonsson

Hodgkins

Lantigua

González

R. A

. (2015). Co-morbid psychiatric disorders among incarcerated ADHD populations: a meta-analysis. Psychological Medicine, 45(12), 2499–2510.

77.

Young

Wells

Gudjonsson

G. H.

(2011). Predictors of offending among prisoners: the role of attention-deficit hyperactivity disorder and substance use. Journal of Psychopharmacology, 25(11), 1524–1532.

78.

Liu

Chen

Cao

Zepf

F. D.

Wang

. (2016). Integrity of amygdala subregion-based functional networks and emotional lability in drug-naïve boys with ADHD. Journal of Attention Disorders, 2016, 108705471666141.

79.

Zigmond

A. S.

Snaith

R. P

. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370.