Objective: The objective of this study was to investigate the extent to which neuropsychological performance parameters implicated in ADHD might mediate the relationship between emotional lability (EL) and this disorder. Method: Eight hundred twelve adult patients with ADHD were examined. EL was assessed using the EL subscale of Conners’ Adult ADHD Rating Scales (CAARS). To assess cognitive and executive functions, a battery of neuropsychological tests was performed in 262 patients with ADHD and high EL symptomatology and 550 patients with ADHD and low EL symptomatology. Results: Several differences between groups were found regarding neuropsychological performance; however, nearly all significant differences disappeared when the effect of gender, inattention, and hyperactive symptoms and psychiatric comorbidities were taken into account. Conclusion: Our results do not support the hypothesis that neuropsychological deficits are associated with EL in adults with ADHD.
AbleS. L.JohnstonJ. A.AdlerL. A.SwindleR. W. (2007). Functional and psychosocial impairment in adults with undiagnosed ADHD. Psychological Medicine, 37, 97-107. doi:10.1017/S0033291706008713
2.
AhmedS. P.Bittencourt-HewittA.SebastianC. L. (2015). Neurocognitive bases of emotion regulation development in adolescence. Developmental Cognitive Neuroscience, 15, 11-25. doi:10.1016/j.dcn.2015.07.006
3.
Amador-CamposJ. A.Gómez-BenitoJ.Ramos-QuirogaJ. A. (2014). The Conners’ Adult ADHD Rating Scales—Short self-report and observer forms: Psychometric properties of the Catalan version. Journal of Attention Disorders, 18, 671-679. doi:10.1177/1087054712446831
4.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
5.
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 AD/HD. Journal of Attention Disorders, 15, 583-592. doi:10.1177/1087054710370567
6.
BanaschewskiT.Jennen-SteinmetzC.BrandeisD.BuitelaarJ. K.KuntsiJ.PoustkaL.. . . AshersonP. (2012). Neuropsychological correlates of emotional lability in children with ADHD. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 53, 1139-1148. doi:10.1111/j.1469-7610.2012.02596.x
7.
BarkleyR. A. (1997). Behavioral inhibition, sustained attention, and executive functions: Constructing a unifying theory of ADHD. Psychological Bulletin, 121, 65-94. doi:10.1037/0033-2909.121.1.65
8.
BarkleyR. A. (2010). Deficient emotional self-regulation: A core component of attention-deficit/hyperactivity disorder. Journal of ADHD and Related Disorders, 1(2), 5-37.
9.
BarkleyR. A.FischerM. (2010). The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. Journal of the American Academy of Child & Adolescent Psychiatry, 49, 503-513.
10.
BeckerA.SteinhausenH. C.BaldurssonG.DalsgaardS.LorenzoM. J.RalstonS. J.. . . VlasveldL. (2006). Psychopathological screening of children with ADHD: Strengths and difficulties questionnaire in a pan-European study. European Child & Adolescent Psychiatry, 15(Suppl. 1), i56-i62. doi:10.1007/s00787-006-1008-7
11.
BiedermanJ.PettyC. R.DayH.GoldinR. L.SpencerT.FaraoneS. V.. . . WozniakJ. (2012). Severity of the aggression/anxiety-depression/attention child behavior checklist profile discriminates between different levels of deficits in emotional regulation in youth with attention-deficit hyperactivity disorder. Journal of Developmental & Behavioral Pediatrics, 33, 236-243. doi:10.1097/DBP.0b013e3182475267
12.
BiedermanJ.PettyC. R.WoodworthK. Y.LomedicoA.HyderL. L.FaraoneS. V. (2012). Adult outcome of attention-deficit/hyperactivity disorder: A controlled 16-year follow-up study. The Journal of Clinical Psychiatry, 73, 941-950. doi:10.4088/JCP.11m07529
13.
BiedermanJ.SpencerT.LomedicoA.DayH.PettyC. R.FaraoneS. V. (2012). Deficient emotional self-regulation and pediatric attention deficit hyperactivity disorder: A family risk analysis. Psychological Medicine, 42, 639-646. doi:10.1017/s0033291711001644
14.
BiedermanJ.SpencerT.PettyC. R.HyderL. L.O’ConnorK. B.SurmanC. B.FaraoneS. (2012). Longitudinal course of deficient emotional self-regulation CBCL profile in youth with ADHD: Prospective controlled study. Neuropsychiatric Disease and Treatment, 8, 267-276. doi:10.2147/NDT.S29670
15.
BoonstraA. M.OosterlaanJ.SergeantJ. A.BuitelaarJ. K. (2005). Executive functioning in adult ADHD: A meta-analytic review. Psychological Medicine, 35, 1097-1108. doi:10.1017/S003329170500499X
16.
BrotmanM. A.SchmajukM.RichB. A.DicksteinD. P.GuyerA. E.CostelloE. J.. . . LeibenluftE. (2006). Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biological Psychiatry, 60, 991-997. doi:10.1016/j.biopsych.2006.08.042
17.
BunfordN.EvansS. W.LangbergJ. M. (2018). Emotion dysregulation is associated with social impairment among young adolescents with ADHD. Journal of Attention Disorders, 22, 66-82. doi:10.1177/1087054714527793
18.
BunfordN.EvansS. W.WymbsF. (2015). ADHD and emotion dysregulation among children and adolescents. Clinical Child and Family Psychology Review, 18, 185-217. doi:10.1007/s10567-015-0187-5
19.
CheungC. H. M.RijsdijkF.McLoughlinG.BrandeisD.BanaschewskiT.AshersonP.KuntsiJ. (2016). Cognitive and neurophysiological markers of ADHD persistence and remission. The British Journal of Psychiatry: The Journal of Mental Science, 208, 548-555. doi:10.1192/bjp.bp.114.145185
20.
ChildressA. C.SalleeF. R. (2015). Emotional lability in patients with attention-deficit/hyperactivity disorder: Impact of pharmacotherapy. CNS Drugs, 29, 683-693. doi:10.1007/s40263-015-0264-9
21.
ConnersC. K. (2004). Conners’ Continuous Performance Test (2nd ed.). Toronto, Ontario, Canada: Multi-Health Systems.
22.
ConnersC. K.ErhardtD.SparrowE. P. (1999). Conners Adult ADHD Rating Scales. North Tonawanda, NY: Multi-Health Systems.
23.
CorbisieroS.StieglitzR.-D.RetzW.RöslerM. (2013). Is emotional dysregulation part of the psychopathology of ADHD in adults?ADHD Attention Deficit and Hyperactivity Disorders, 5, 83-92. doi:10.1007/s12402-012-0097-z
24.
DelisD. C.KramerJ. H.KaplanE.OberB. A. (2000). California Verbal Learning Test–Second edition. San Antonio, TX: The Psychological Corporation.
25.
DupaulG. J.PowerT. J.AnastopoulosA. D.ReidR. (2006). ADHD Rating Scale-IV: Checklists, norms, and clinical interpretation. Journal of Psychoeducational Assessment, 24, 172-178. doi:10.1177/0734282905285792
26.
EpsteinJ. N.JohnsonD. E.ConnersC. K. (2001). Conners’ adult ADHD diagnostic interview for DSM-IV. North Tonawanda, NY: Multi-Health Systems.
FirstM. B.GibbonM.SpitzerR. L.WilliamsJ. B. W.BenjaminL. S. (1997). Structured Clinical Interview for DSM-IV Axis II Personality Disorders, (SCID-II). Washington, DC: American Psychiatric Press.
29.
FirstM. B.SpitzerR. L.GibbonM.WilliamsJ. B. W. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders. Washington, DC: American Psychiatric Publishing.
30.
GisbertL.RicharteV.CorralesM.IbáñezP.BoschR.CasasM.Ramos-QuirogaJ. A. (2018). The impact of emotional lability symptoms during childhood in adults with ADHD. Journal of Attention Disorders, 22, 581-590. doi:10.1177/1087054717719534
31.
HoogmanM.BraltenJ.HibarD. P.MennesM.ZwiersM. P.SchwerenL. S. J.. . . FrankeB. (2017). Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: A cross-sectional mega-analysis. The Lancet Psychiatry, 4, 310-319. doi:10.1016/S2215-0366(17)30049-4
32.
HulvershornL. A.MennesM.CastellanosF. X.Di MartinoA.MilhamM. P.HummerT. A.RoyA. K. (2014). Abnormal amygdala functional connectivity associated with emotional lability in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 53, 351-361. doi:10.1016/j.jaac.2013.11.012
33.
KooijS. J. J.BoonstraA. M.SwinkelsS. H. N.BekkerE. M.De NoordI.BuitelaarJ. K. (2008). Reliability, validity, and utility of instruments for self-report and informant report concerning symptoms of ADHD in adult patients. Journal of Attention Disorders, 11, 445-458. doi:10.1177/1087054707299367
34.
MelnickS. M.HinshawS. 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, 73-86. doi:10.1023/A:1005174102794
35.
Ramos-QuirogaJ. A.BoschR.RicharteV.ValeroS.Gómez-BarrosN.NogueiraM.. . . CasasM. (2012). Criterion and concurrent validity of Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID) Spanish version. Revista de Psiquiatria y Salud Mental, 5, 229-235. doi:10.1016/j.rpsm.2012.05.004
36.
ReimherrF. W.MarchantB. K.StrongR. E.HedgesD. W.AdlerL.SpencerT. J.. . . SoniP. (2005). Emotional dysregulation in adult ADHD and response to atomoxetine. Biological Psychiatry, 58, 125-131. doi:10.1016/j.biopsych.2005.04.040
37.
ReimherrF. W.WilliamsE. D.StrongR. E.MestasR.SoniP.MarchantB. K. (2007). A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. Journal of Clinical Psychiatry, 68, 93-101. doi:10.4088/jcp.v68n0113
38.
ReitanR. M. (1992). Trail Making Test: Manual for administration and scoring. Tuscon, AZ: Reitan Neuropsychology Laboratory.
39.
RetzW.StieglitzR.-D.CorbisieroS.Retz-JungingerP.RöslerM. (2012). Emotional dysregulation in adult ADHD: What is the empirical evidence?Expert Review of Neurotherapeutics, 12, 1241-1251. doi:10.1586/ern.12.109
40.
RobisonR. J.ReimherrF. W.MarchantB. K.FaraoneS. V.AdlerL. A.WestS. A. (2008). Gender differences in 2 clinical trials of adults with attention-deficit/hyperactivity disorder: A retrospective data analysis. The Journal of Clinical Psychiatry, 69, 213-221. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18211131
41.
RöslerM.RetzW.FischerR.OseC.AlmB.DeckertJ.. . . AmmerR. (2010). Twenty-four-week treatment with extended release methylphenidate improves emotional symptoms in adult ADHD. The World Journal of Biological Psychiatry: The Official Journal of the World Federation of Societies of Biological Psychiatry, 11, 709-718. doi:10.3109/15622971003624197
42.
ShawP.StringarisA.NiggJ.LeibenluftE. (2014). Emotional dysregulation and attention-deficit/hyperactivity disorder. The American Journal of Psychiatry, 171, 276-293. doi:10.1176/appi.ajp.2013.13070966
43.
SheehanD. V.Harnett-SheehanK.RajB. A. (1996). The measurement of disability. International Clinical Psychopharmacology, 11, 89-95. doi:10.1097/00004850-199606003-00015
44.
SjöwallD.RothL.LindqvistS.ThorellL. B. (2013). Multiple deficits in ADHD: Executive dysfunction, delay aversion, reaction time variability, and emotional deficits. The Journal of Child Psychology and Psychiatry and Allied Disciplines, 54, 619-627. doi:10.1111/jcpp.12006
45.
SkirrowC.AshersonP. (2013). Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. Journal of Affective Disorders, 147, 80-86. doi:10.1016/j.jad.2012.10.011
46.
SkirrowC.McLoughlinG.KuntsiJ.AshersonP. (2009). Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Review of Neurotherapeutics, 9, 489-503. doi:10.1586/ern.09.2
47.
SobanskiE.BanaschewskiT.AshersonP.BuitelaarJ.ChenW.FrankeB.. . . FaraoneS. V. (2010). Emotional lability 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.x
48.
SpencerT. J.FaraoneS. V.SurmanC. B. H.PettyC.ClarkeA.BatchelderH.. . . BiedermanJ. (2011). Toward defining deficient emotional self-regulation in children with attention-deficit/hyperactivity disorder using the Child Behavior Checklist: A controlled study. Postgraduate Medicine, 123(5), 50-59. doi:10.3810/pgm.2011.09.2459
49.
SurmanC. B. H.BiedermanJ.SpencerT.MillerC. A.McDermottK. M.FaraoneS. V. (2013). Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: A controlled study. ADHD Attention Deficit and Hyperactivity Disorders, 5, 273-281. doi:10.1007/s12402-012-0100-8
50.
SurmanC. B. H.BiedermanJ.SpencerT.MillerC. A.PettyC. R.FaraoneS. V. (2015). Neuropsychological deficits are not predictive of deficient emotional self-regulation in adults with ADHD. Journal of Attention Disorders, 19, 1046-1053. doi:10.1177/1087054713476548
51.
SurmanC. B. H.BiedermanJ.SpencerT.YorksD.MillerC. A.PettyC. R.FaraoneS. V. (2011). Deficient emotional self-regulation and adult attention deficit hyperactivity disorder: A family risk analysis. American Journal of Psychiatry, 168, 617-623. doi:10.1176/appi.ajp.2010.10081172
52.
Van LieshoutM.LumanM.BuitelaarJ.RommelseN. N. J.OosterlaanJ. (2013). Does neurocognitive functioning predict future or persistence of ADHD? A systematic review. Clinical Psychology Review, 33, 539-560. doi:10.1016/j.cpr.2013.02.003
53.
VidalR.ValeroS.NogueiraM.PalomarG.CorralesM.RicharteV.. . . Ramos-QuirogaJ. A. (2014). Emotional lability: The discriminative value in the diagnosis of attention deficit/hyperactivity disorder in adults. Comprehensive Psychiatry, 55, 1712-1719. doi:10.1016/j.comppsych.2014.07.001
54.
WalcottC. M.LandauS. (2004). The relation between disinhibition and emotion regulation in boys with attention deficit hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 33, 772-782. doi:10.1207/s15374424jccp3304_12
55.
WardM. F.WenderP. H.ReimherrF. W. (1993). The Wender Utah Rating Scale: An aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. American Journal of Psychiatry, 150, 885-890. doi:10.1176/ajp.150.6.885
56.
WechslerD. (1981). Wechsler Adult Intelligence Scale–Revised (3rd ed.). San Antonio, TX: The Psychological Corporation.
57.
WechslerD. (1987). Wechsler Memory Scale–Revised manual. San Antonio, TX: The Psychological Corporation.
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