Emotional dysregulation (ED) in adult ADHD is frequent but definition and tools for its evaluation are not consensual. Our aim was to determine the core ADHD symptomatic domains via the Self-Reported Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS) following its validation in a large clinical sample of adults with ADHD and controls.
Method:
Three hundred sixty-nine adult patients with ADHD and 251 healthy participants completed the SR-WRAADDS and questionnaires about ADHD, depression, and ED. We analyzed the psychometric properties of the SR-WRAADDS and a factor analysis yielded symptomatic domains.
Results:
The SR-WRAADDS has good reliability. The 30 symptoms were best organized in a four-factor solution: attention/disorganization, hyperactivity/restlessness, impulsivity/emotional outbursts, and emotional lability.
Conclusions:
The symptomatic structure of the SR-WRAADDS includes two distinct dimensions related to ED: “impulsivity/emotional outbursts” and “emotional lability.” The SR-WRAADDS is a reliable and clinically useful tool that assesses all ADHD symptom domains, including facets of ED.
AdlerL. A.FaraoneS. V.SpencerT. J.BerglundP.AlperinS.KesslerR. C. (2017). The structure of adult ADHD. International Journal of Methods in Psychiatric Research, 26(1), e1555. https://doi.org/10.1002/mpr.1555
2.
AkiskalH. S.MendlowiczM. V.Jean-LouisG.RapaportM. H.KelsoeJ. R.GillinJ. C.SmithT. L. (2005). TEMPS-A: Validation of a short version of a self-rated instrument designed to measure variations in temperament. Journal of Affective Disorders, 85(1–2), 45–52. https://doi.org/10.1016/j.jad.2003.10.012
3.
AlexandrowiczR. W.FritzscheS.KellerF. (2014). A psychometric view on the applicability of the BDI-II in non-clinical populations. Neuropsychiatrie, 28(2), 63–73. https://doi.org/10.1007/s40211-014-0104-z
4.
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(8), 671–679. https://doi.org/10.1177/1087054712446831
5.
American Psychiatric Association. (2013). The Diagnostic and Statistical Manual of Mental Disorders (DSM 5). American Psychiatric Publishing, Inc.
6.
BeckA. T.SteerR. A.BallR.RanieriW. F. (1996). Comparison of Beck depression inventories-IA and-II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588–597. https://doi.org/10.1207/s15327752jpa6703_13
7.
BeheshtiA.ChavanonM.-L.ChristiansenH. (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder : A meta-analysis. BMC Psychiatry, 20(1), 120. https://doi.org/10.1186/s12888-020-2442-7
8.
CaciH. M.BouchezJ.BayléF. J. (2010). An aid for diagnosing attention-deficit/hyperactivity disorder at adulthood: Psychometric properties of the French versions of two Wender Utah Rating Scales (WURS-25 and WURS-K). Comprehensive Psychiatry, 51(3), 325–331. https://doi.org/10.1016/j.comppsych.2009.05.006
9.
CaciH. M.MorinA. J. S.TranA. (2014). Prevalence and correlates of attention deficit hyperactivity disorder in adults from a French community sample. The Journal of Nervous and Mental Disease, 202(4), 324–332. https://doi.org/10.1097/NMD.0000000000000126
10.
CaveltiM.CorbisieroS.BittoH.MoerstedtB.NewarkP.FaschinaS.ChanenA.MoggiF.StieglitzR.-D. (2019). A comparison of self-reported emotional regulation skills in adults with attention-deficit/hyperactivity disorder and borderline personality disorder. Journal of Attention Disorders, 23(12), 1396–1406. https://doi.org/10.1177/1087054717698814
11.
ChristiansenH.KisB.HirschO.PhilipsenA.HenneckM.PanczukA.PietrowskyR.HebebrandJ.SchimmelmannB. G. (2011). German validation of the Conners Adult ADHD Rating Scales–self-report (CAARS-S) I: Factor structure and normative data. European Psychiatry, 26(2), 100–107. https://doi.org/10.1016/j.eurpsy.2009.12.024
12.
ColeP.WeibelS.NicastroR.HaslerR.DayerA.AubryJ.-M.PradaP.PerroudN. (2016). CBT/DBT skills training for adults with attention deficit hyperactivity disorder (ADHD). Psychiatria Danubina, 28(Suppl. 1), 103–107.
13.
ConnersC. K.ErhardtD.EpsteinJ. N.ParkerJ. D. A.SitareniosG.SparrowE. (1999). Self-ratings of ADHD symptoms in adults I : Factor structure and normative data. Journal of Attention Disorders, 3(3), 141–151. https://doi.org/10.1177/108705479900300303
14.
CronbachL. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334. https://doi.org/10.1007/BF02310555
15.
FayyadJ.SampsonN. A.HwangI.AdamowskiT.Aguilar-GaxiolaS.Al-HamzawiA.AndradeL. H. S. G.BorgesG.de GirolamoG.FlorescuS.GurejeO.HaroJ. M.HuC.KaramE. G.LeeS.Navarro-MateuF.O’NeillS.PennellB.-E.PiazzaM.. . . KesslerR. C. (2017). The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. ADHD Attention Deficit and Hyperactivity Disorders, 9(1), 47–65. https://doi.org/10.1007/s12402-016-0208-3
16.
HarveyP. D. (1989). The affective lability scales: Development, reliability, and validity. Journal of Clinical Psychology, 45(5), 786–793.
17.
HirschO.ChavanonM.RiechmannE.ChristiansenH. (2018). Emotional dysregulation is a primary symptom in adult Attention-Deficit/Hyperactivity Disorder (ADHD). Journal of Affective Disorders, 232, 41–47. https://doi.org/10.1016/j.jad.2018.02.007
18.
KaiserH. F. (1958). The varimax criterion for analytic rotation in factor analysis. Psychometrika, 23(3), 187-200. https://doi.org/10.1007/BF02289233
19.
KesslerR. C.AdlerL. A.GruberM. J.SarawateC. A.SpencerT.Van BruntD. L. (2007). Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) screener in a representative sample of health plan members. International Journal of Methods in Psychiatric Research, 16(2), 52–65. https://doi.org/10.1002/mpr.208
20.
KesslerR. C.GreenJ. G.AdlerL. A.BarkleyR. A.ChatterjiS.FaraoneS. V.FinkelmanM.GreenhillL. L.GruberM. J.JewellM.RussoL. J.SampsonN. A.Van BruntD. L. (2010). Structure and diagnosis of adult attention-deficit/hyperactivity disorder: Analysis of expanded symptom criteria from the Adult ADHD Clinical Diagnostic Scale. Archives of General Psychiatry, 67(11), 1168–1178. https://doi.org/10.1001/archgenpsychiatry.2010.146
21.
LenziF.CorteseS.HarrisJ.MasiG. (2018). Pharmacotherapy of emotional dysregulation in adults with ADHD: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 84, 359–367. https://doi.org/10.1016/j.neubiorev.2017.08.010
22.
LookA. E.FloryJ. D.HarveyP. D.SieverL. J. (2010). Psychometric properties of a short form of the Affective Lability Scale (ALS-18). Personality and Individual Differences, 49(3), 187–191. https://doi.org/10.1016/j.paid.2010.03.030
23.
MarchantB. K.ReimherrF. W.RobisonD.RobisonR. J.WenderP. H. (2013). Psychometric properties of the Wender-Reimherr Adult Attention Deficit Disorder Scale. Psychological Assessment, 25(3), 942–950. https://doi.org/10.1037/a0032797
24.
MarchantB. K.ReimherrF. W.RobisonR. J.OlsenJ. L.KondoD. G. (2011). Methylphenidate transdermal system in adult ADHD and impact on emotional and oppositional symptoms. Journal of Attention Disorders, 15(4), 295–304. https://doi.org/10.1177/1087054710365986
25.
MarchantB. K.ReimherrF. W.WenderP. H. (2015). Psychometric properties of the self-report Wender-Reimherr Adult Attention Deficit Disorder Scale. Annals of Clinical Psychiatry, 27(4), 267–277.
26.
MartzE.BertschyG.KraemerC.WeibelS.WeinerL. (2021). Beyond motor hyperactivity: Racing thoughts are an integral symptom of adult attention deficit hyperactivity disorder. Psychiatry Research, 301, 113988. https://doi.org/10.1016/j.psychres.2021.113988
27.
MarwahaS.HeZ.BroomeM.SinghS. P.ScottJ.EydenJ.WolkeD. (2014). How is affective instability defined and measured? A systematic review. Psychological Medicine, 44(9), 1793–1808. https://doi.org/10.1017/S0033291713002407
28.
MerwoodA.ChenW.RijsdijkF.SkirrowC.LarssonH.ThaparA.KuntsiJ.AshersonP. (2014). Genetic associations between the symptoms of attention-deficit/hyperactivity disorder and emotional lability in child and adolescent twins. Journal of the American Academy of Child & Adolescent Psychiatry, 53(2), 209–220.e4. https://doi.org/10.1016/j.jaac.2013.11.006
29.
MörstedtB.CorbisieroS.BittoH.StieglitzR.-D. (2016). Emotional symptoms and their contribution to functional impairment in adults with attention-deficit/hyperactivity disorder. Attention Deficit and Hyperactivity Disorders, 8(1), 21–33. https://doi.org/10.1007/s12402-015-0181-2
30.
MurrayA. L.WongS.-C.ObsuthI.RhodesS.EisnerM.RibeaudD. (2021). An ecological momentary assessment study of the role of emotional dysregulation in co-occurring ADHD and internalising symptoms in adulthood. Journal of Affective Disorders, 281, 708–713. https://doi.org/10.1016/j.jad.2020.11.086
31.
PerroudN.BadoudD.WeibelS.NicastroR.HaslerR.KüngA.-L.LuytenP.FonagyP.DayerA.AubryJ.-M.PradaP.DebbanéM. (2017). Mentalization in adults with attention deficit hyperactivity disorder : Comparison with controls and patients with borderline personality disorder. Psychiatry Research, 256, 334–341. https://doi.org/10.1016/j.psychres.2017.06.087
32.
Ramos-QuirogaJ. A.NasilloV.RicharteV.CorralesM.PalmaF.IbáñezP.MichelsenM.Van de GlindG.CasasM.KooijJ. J. S. (2019). Criteria and concurrent validity of DIVA 2.0: A semi-structured diagnostic interview for adult ADHD. Journal of Attention Disorders, 23(10), 1126–1135. https://doi.org/10.1177/1087054716646451
33.
ReimherrF. W.MarchantB. K.StrongR. E.HedgesD. W.AdlerL.SpencerT. J.WestS. A.SoniP. (2005). Emotional dysregulation in adult ADHD and response to atomoxetine. Biological Psychiatry, 58(2), 125–131. https://doi.org/10.1016/j.biopsych.2005.04.040
34.
ReimherrF. W.RoeslerM.MarchantB. K.GiftT. E.RetzW.Philipp-WiegmannF.ReimherrM. L. (2020). Types of adult attention-deficit/hyperactivity disorder: A replication analysis. The Journal of Clinical Psychiatry, 81(2), 19m13077. https://doi.org/10.4088/JCP.19m13077
35.
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. The Journal of Clinical Psychiatry, 68(1), 93–101.
36.
Richard-LepourielH.EtainB.HaslerR.BellivierF.GardS.KahnJ.-P.PradaP.NicastroR.ArduS.DayerA.LeboyerM.AubryJ.-M.PerroudN.HenryC. (2016). Similarities between emotional dysregulation in adults suffering from ADHD and bipolar patients. Journal of Affective Disorders, 198, 230–236. https://doi.org/10.1016/j.jad.2016.03.047
37.
RüfenachtE.EulerS.PradaP.NicastroR.DiebenK.HaslerR.PhamE.PerroudN.WeibelS. (2019). Emotion dysregulation in adults suffering from attention deficit hyperactivity disorder (ADHD), a comparison with borderline personality disorder (BPD). Borderline Personality Disorder and Emotion Dysregulation, 6(1), 11. https://doi.org/10.1186/s40479-019-0108-1
38.
ShawP.StringarisA.NiggJ.LeibenluftE. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. The American Journal of Psychiatry, 171(3), 276–293. https://doi.org/10.1176/appi.ajp.2013.13070966
39.
SheehanD. V.LecrubierY.SheehanK. H.AmorimP.JanavsJ.WeillerE.HerguetaT.BakerR.DunbarG. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. The Journal of Clinical Psychiatry, 59(Suppl. 20), 22–33; quiz 34–57.
40.
SilversteinM. J.FaraoneS. V.AlperinS.BiedermanJ.SpencerT. J.AdlerL. A. (2018). How informative are self-reported adult attention-deficit/hyperactivity disorder symptoms? An examination of the agreement between the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale V1.1 and Adult Attention-Deficit/Hyperactivity Disorder Investigator Symptom Rating Scale. Journal of Child and Adolescent Psychopharmacology, 28(5), 339–349. https://doi.org/10.1089/cap.2017.0082
41.
SkirrowC.AshersonP. (2013). Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. Journal of Affective Disorders, 147(1–3), 80–86. https://doi.org/10.1016/j.jad.2012.10.011
42.
ThompsonR. A. (2019). Emotion regulation: A theme in search of definition. Development and Psychopathology, 31(3), 805–815. https://doi.org/10.1017/S0954579419000282
43.
TruxilloC. (2005). Maximum likelihood parameter estimation with incomplete data. Proceedings of the thirtieth annual SAS (r) users group international conference, 111‑130.
44.
VidalR.ValeroS.NogueiraM.PalomarG.CorralesM.RicharteV.BoschR.Gómez-BarrosN.CorominasM.CasasM.Ramos-QuirogaJ. A. (2014). Emotional lability: The discriminative value in the diagnosis of attention deficit/hyperactivity disorder in adults. Comprehensive Psychiatry, 55(7), 1712–1719. https://doi.org/10.1016/j.comppsych.2014.07.001
45.
WardF. (1993). The Wender Utah Rating Scale : An aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. American Journal of Psychiatry, 150(6), 885–890.
46.
WeaverB.MaxwellH. (2014). Exploratory factor analysis and reliability analysis with missing data: A simple method for SPSS users. The Quantitative Methods for Psychology, 10(2), 143‑152.
47.
WeibelS.Micoulaud-FranchiJ.-A.BrandejskyL.LopezR.PradaP.NicastroR.ArduS.DayerA.LançonC.PerroudN. (2019). Psychometric properties and factor structure of the short form of the affective lability scale in adult patients with ADHD. Journal of Attention Disorders, 23(10), 1079–1089. https://doi.org/10.1177/1087054717690808
48.
WenderP. H. (1981). Attention deficit disorder (‘minimal brain dysfunction’) in adults: A replication study of diagnosis and drug treatment. Archives of General Psychiatry, 38(4), 449. https://doi.org/10.1001/archpsyc.1981.01780290083009
49.
WilensT. E.BiedermanJ.FaraoneS. V.MartelonM.WesterbergD.SpencerT. J. (2009). Presenting ADHD symptoms, subtypes, and comorbid disorders in clinically referred adults with ADHD. The Journal of Clinical Psychiatry, 70(11), 1557–1562. https://doi.org/10.4088/JCP.08m04785pur
