Objective: A subset of children with ADHD experience more frequent, sudden, and intense shifts toward negative emotions. The current study utilized ecological momentary assessment (EMA) to provide a valid assessment of the impact of comorbid internalizing and externalizing disorders on negative emotional lability (EL) among children with ADHD. Method: Parents of 58, 8- to 12-year-old children with ADHD were administered a diagnostic interview to assess for ADHD and for the presence of comorbid disorders. Parents completed EMA-based ratings of their child’s negative emotions three times daily for a total of 28 days. Results: Children with a comorbid internalizing disorder or children with comorbid oppositional defiant disorder (ODD) experienced significantly greater EMA-derived negative EL than children without comorbid disorders over time. Children with multiple comorbidities experienced greater EL than children with single comorbidities. Conclusion: Overall, this study suggested that both comorbid ODD and comorbid internalizing disorders contribute to negative EL among children with ADHD.
American Academy of Pediatrics. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128, 1-16. doi:10.1542/peds20112654
2.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
3.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
4.
AnastopoulosA. D.SmithT. F.GarrettM. E.Morrissey-kaneE.SchatzN. K.SommerJ. L.. . .Ashley-kochA. (2011). Self-regulation of emotion, functional impairment, and comorbidity among children with ADHD. Journal of Attention Disorders, 15, 583-592. doi:10.1177/1087054710370567
5.
AnestisM. D.SelbyE. A.CrosbyR. D.WonderlichS. A.EngelS. G.JoinerT. E. (2010). A comparison of retrospective self-report versus ecological momentary assessment measures of affective lability in the examination of its relationship with bulimic symptomatology. Behaviour Research and Therapy, 48, 607-613.
6.
BanaschewskiT.Jennen-SteinmetzC.BrandeisD.BuitelaarJ. K.KuntsiJ.PoustkaL.. . .ChenW. (2012). Neuropsychological correlates of emotional lability in children with ADHD. Journal of Child Psychology and Psychiatry, 53, 1139-1148.
7.
BarkleyR. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychology Bulletin, 121, 65-94. doi:10.1037/0033-2909.121.1.65
8.
BarkleyR. A. (2010). Why emotional impulsiveness should be a central feature of ADHD. The ADHD Report, 18, 1-5.
9.
BarkleyR. A.FischerM. (2010). The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive adults and children. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 503-513.
10.
BauermeisterJ. J.ShroutP. E.RamirezR.BravoM. (2007). ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. Journal of Abnormal Child Psychology, 35, 883-898. doi:10.1007/s10802-007-9141-4
11.
BorsboomD.CramerA. O.SchmittmannV. D.EpskampS.WaldorpL. J. (2011). The small world of psychopathology. PLoS ONE, 6(11), Article e27407.
12.
CarlsonG. A. (1998). Mania and ADHD: Comorbidity or confusion. Journal of Affective Disorders, 51, 177-187. doi:10.1016/S0165-0327(98)00179-7
13.
CaspiA.HoutsR. M.BelskyD. W.Goldman-MellorS. J.HarringtonH.IsraelS.. . .MoffittT. E. (2014). The p factor: One general psychopathology factor in the structure of psychiatric disorders?Clinical Psychological Science, 2, 119-137. doi:10.1177/2167702613497473
14.
CohnA. M.ZeichnerA.SeibertL. A. (2008). Labile affect as a risk factor for aggressive behavior in men. Psychology of Men & Masculinity, 9(1), 29-39.
15.
EbesutaniC.ReganJ.SmithA.ReiseS.Higa-McMillanC.ChorpitaB. F. (2012). The 10-item positive and negative affect schedule for children, child and parent shortened versions: Application of item response theory for more efficient assessment. Journal of Psychopathology and Behavioral Assessment, 34, 191-203.
16.
FactorP. I.ReyesR. A.RosenP. J. (2014). Emotional impulsivity in children with ADHD associated with comorbid-not ADHD-symptomatology. Journal of Psychopathology and Behavioral Assessment, 36, 530-541. doi:10.1007/s10862-014-9428-z
17.
FantuzzoJ. W.Bulotsky-ShearerR. J.FuscoR. A.McWayneC. (2005). An investigation of preschool classroom behavioral adjustment problems and social–emotional school readiness competencies. Early Childhood Research Quarterly, 20, 259-275. doi:10.1016/j.ecresq.2005.07.001
18.
GarnefskiN.KraaijV.van EttenM. (2005). Specificity of relations between adolescents’ cognitive emotion regulation strategies and Internalizing and Externalizing psychopathology. Journal of Adolescence, 28, 619-631. doi:10.1016/j.adolescence.2004.12.009
19.
GoodmanR. (2001). Psychometric properties of the strengths and difficulties questionnaire. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1337-1345.
20.
HannesdottirD. K.OllendickT. H. (2007). The role of emotion regulation in the treatment of child anxiety disorders. Clinical Child and Family Psychology Review, 10, 275-293. doi:10.1007/s10567-007-0024-6
21.
JahngA.WoodP. K.TrullT. J. (2008). Analysis of affective instability in ecological momentary assessment: Indices using successive difference and group comparison via multilevel modeling. Psychological Methods, 13, 354-375. doi:10.1037/a0014173
22.
JensenS. A.RosénL. A. (2004). Emotional reactivity in children with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 8, 53-61.
23.
JoinerT. E.CatanzaroS. J.LaurentJ. (1996). Tripartite structure of positive and negative affect, depression, and anxiety in child and adolescent psychiatric inpatients. Journal of Abnormal Psychology, 105, 401-409.
24.
LarsonK.RussS. A.KahnR. S.HalfonN. (2011). Patterns of comorbidity, functioning, and service use for children with ADHD, 2007. Pediatrics, 127, 462-470. doi:10.1542/peds.2010-0165
25.
LiuL.ChenW.VitoratouS.SunL.YuX.Hagger-JohnsonG.. . . WangY. (2019). Is emotional lability distinct from “angry/irritable mood,” “negative affect,” or other subdimensions of oppositional defiant disorder in children with ADHD?Journal of Attention Disorders, 23, 859-868. doi:10.1177/1087054715624228
26.
MaciejewskiD. F.LierP. A. C.Van BranjeS. J. T.KootH. M. (2015). A 5-Year longitudinal study on mood variability across adolescence using daily diaries. Child Development, 86, 1908-1921. doi:10.1111/cdev.12420
27.
MaedgenJ. W.CarlsonC. L. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29, 30-42. doi:10.1207/S15374424jccp2901_4
28.
MartelM. M.NiggJ. T. (2006). Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality. Journal of Child Psychology and Psychiatry, 47, 1175-1183. doi:10.1111/j.1469-7610.2006.01629.x
29.
MarwahaS.HeZ.BroomeM.SinghS. P.ScottJ.EydenJ.WolkeD. (2014). How is affective instability defined and measured? A systematic review. Psychological Medicine, 44, 1793-1808. doi:10.1017/S0033291713002407
30.
MaughanB.RoweR.MesserJ.GoodmanR.MeltzerH. (2004). Conduct disorder and oppositional defiant disorder in a national sample: Developmental epidemiology. Journal of Child Psychology and Psychiatry, 45, 609-621.
31.
NewmanJ.WallaceJ. (1993). Diverse pathways to deficient self-regulation: Implications for disinhibitory psychopathology in children. Clinical Psychology Review, 13, 699-720.
32.
NiggJ. T. (2001). Is ADHD a disinhibitory disorder?Psychological Bulletin, 127, 571-598. doi:10.1037/0033-2909.127.5.571
33.
OkadoI.MuellerC. W.NakamuraB. J. (2016). Positive and negative affect in clinic-referred youth with ADHD. Journal of Attention Disorders, 20, 53-62. doi: 10.1177/1087054713478466.
34.
OvergaardK. R.OerbeckB.AaseH.TorgersenS.Reichborn-KjennerudT.ZeinerP. (2018). Emotional lability in preschoolers with symptoms of ADHD. Journal of Attention Disorders, 22, 787-795. doi:10.1177/1087054715576342
35.
PhillipsB. M.LoniganC. J.DriscollK.HooeE. S. (2002). Positive and negative affectivity in children: A multitraitmultimethod investigation. Journal of Clinical Child and Adolescent Psychology, 31, 465-479.
36.
RosenP. J.EpsteinJ. N.Van OrdenG. (2013). I know it when I quantify it: Ecological momentary assessment and recurrence quantification analysis of emotion dysregulation in children with ADHD. Attention Deficit and Hyperactivity Disorders, 5, 283-294.
37.
RosenP. J.FactorP. I. (2015). Emotional impulsivity and emotional and behavioral difficulties among children with ADHD: An ecological momentary assessment study. Journal of Attention Disorders, 19, 779-793. doi:10.1177/1087054712463064
38.
RosenP. J.WaleriusD. M.FoglemanN. D.FactorP. I. (2015). The association of emotional lability and emotional and behavioral difficulties among children with and without ADHD. Attention Deficit and Hyperactivity Disorders, 7, 281-294.
39.
ShafferD.FisherP.LucasC. P.DulcanM. K.Schwab-StoneM. E. (2000). NIMH Diagnostic Interview Schedule for Children Version IV (NIMH DISC-IV): Description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child & Adolescent Psychiatry, 39, 28-38.
40.
ShawP.StringarisA.NiggJ.LeibenluftE. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry, 171, 276-293. doi:10.1176/appi.ajp.2013.13070966
41.
SilkJ. S.ForbesE. E.WhalenD. J.JakubcakJ. L.ThompsonW. K.RyanN. D.. . .DahlR. E. (2011). Daily emotional dynamics in depressed youth: A cell phone ecological momentary assessment study. Journal of Experimental Child Psychology, 110, 241-257.
42.
SkirrowC.McloughlinG.KuntsiJ.AshersonP. (2009). Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Reviews, 9, 489-503.
43.
SobanskiE.BanaschewskiT.AshersonP.BuitelaarJ.ChenW.FrankeB.. . .FaraoneS. V. (2010). EL in children and adolescents with attention deficit/hyperactivity disorder (ADHD): Clinical correlates and familial prevalence. Journal of Child Psychology and Psychiatry and Allied Disciplines, 51, 915-923. doi:10.1111/j.1469-7610.2010.02217
44.
SolhanM. B.TrullT. J.JahngS.WoodP. K. (2009). Clinical assessment of affective instability: Comparing EMA indices, questionnaire reports, and retrospective recall. Psychological Assessment, 21, 425-436.
45.
StringarisA.GoodmanR. (2009). Mood lability and psychopathology in youth. Psychological Medicine, 39, 1237-1245. doi:10.1017/S0033291708004662
46.
SurmanC. H.MonuteauxM. C.PettyC. R.FaraoneS. V.SpencerT. J.ChuN. F.BiedermanJ. (2010). Representativeness of participants in a clinical trial for attention-deficit/hyperactivity disorder? Comparison with adults from a large observational study. The Journal of Clinical Psychiatry, 71, 1612-1616. doi: 10.1176/appi.ajp.2010.10081172.
47.
SuvegC.KendallP. C.ComerJ. S.RobinJ. (2006). Emotion-focused cognitive-behavioral therapy for anxious youth: A multiple baseline evaluation. Journal of Contemporary Psychotherapy, 36, 77-85.
48.
TanP. Z.ForbesE. E.DahlR. E.RyanN. D.SiegleG. J.LadouceurC. D.SilkJ. S. (2012). Emotional reactivity and regulation in anxious and nonanxious youth: A cell-phone ecological momentary assessment study. Journal of Child Psychology and Psychiatry, 53, 197-206.
49.
ThompsonR. A. (1991). Emotional regulation and emotional development. Educational Psychology Review, 3, 269-307.
50.
ThompsonE. R. (2007). Development and validation of an internationally reliable short-form of the positive and negative affect schedule (PANAS). Journal of Cross-Cultural Psychology, 38, 227-242.
51.
ThompsonR. J.MataJ.JaeggiS. M.BuschkuehlM.JonidesJ.GotlibI. H. (2012). The everyday emotional experience of adults with major depressive disorder: Examining emotional instability, inertia, and reactivity. Journal of Abnormal Psychology, 121, 819-829.
52.
Tortella-FeliuM.BalleM.SeséA. (2010). Relationships between negative affectivity, emotion regulation, anxiety, and depressive symptoms in adolescents as examined through structural equation modeling. Journal of Anxiety Disorders, 24, 686-693. doi:10.1016/j.janxdis.2010.04.012
Van LangN.TulenJ.KallenV. L.RosbergenB.DielemanG.FerdinandR. F. (2007). Autonomic reactivity in clinically referred children attention deficit hyperactivity disorder versus anxiety disorder. European Child & Adolescent Psychiatry, 16, 71-78. doi:10.1007/s00787-006-0575-y
55.
WaleriusD. M.ReyesR. A.RosenP. J.FactorP. I. (2018). Functional impairment variability in children with ADHD due to emotional impulsivity. Journal of Attention Disorders, 22, 724-737. doi:10.1177/1087054714561859
56.
WatsonD.ClarkL. a.CareyG. (1988). Positive and negative affectivity and their relation to anxiety and depressive disorders. Journal of Abnormal Psychology, 97, 346-353. doi:10.1037/0021-843X.97.3.346
57.
WaxmonskyJ. G.WymbsF. A.PariseauM. E.BelinP. J.WaschbuschD. A.BabocsaiL.. . .PelhamW. E. (2013). A novel group therapy for children with ADHD and severe mood dysregulation. Journal of Attention Disorders, 17, 527-541. doi:10.1177/1087054711433423
58.
Webster-StrattonC. H.ReidM. J.BeauchaineT. (2011). Combining parent and child training for young children with ADHD. Journal of Clinical Child & Adolescent Psychology, 40, 191-203.
59.
WeissH.BealD. J.LucyS. L.MacDermidS. M. (2004). Constructing EMA studies with PMAT: The Purdue Momentary Assessment Tool user’s manual. West Lafayette, IN: Military Family Research Institute, Purdue University.
60.
WhalenC. K.HenkerB.IshikawaS. S.FloroJ. N.EmmersonN. A.JohnstonJ. A.. . .SwindleR. (2009). ADHD and anger contexts: Electronic diary mood reports from mothers and children. Journal of Pediatric Psychology, 34, 940-953. doi:10.1093/jpepsy/jsn138
61.
ZemanJ.CassanoM.Perry-ParrishC.StegallS. (2006). Emotion regulation in children and adolescents. Journal of Developmental & Behavioral Pediatrics, 27, 155-168.
