Cambridge scientists have shown that problems with emotion regulation, which can manifest as depression, anxiety and explosive outbursts, can be a key symptom of ADHD. attention deficit hyperactivity disorder (ADHD).
ADHD: Emotion regulation problems
In research published on Nature Mental Health , the team found that as many as one in two children with ADHD show signs of emotional dysregulation and that Ritalin, the drug commonly prescribed to alleviate the condition, appears to be less effective in treating this symptom. The article is titled “Emotional dysregulation and the right pars orbitalis constitute a neuropsychological pathway to attention deficit hyperactivity disorder.”
ADHD affects around one in 14 young people under the age of 18 and in around half of these cases persists into adulthood. The condition causes problems including hyperactivity, impulsiveness and difficulty focusing attention.
It has become increasingly clear that some people with attention deficit hyperactivity disorder also have self-control problems, which affect their ability to regulate emotions. For example, one in 50 children (2.1%) diagnosed with attention deficit hyperactivity disorder also suffers from a mood disorder, such as depression, while more than one in four (27.4%) suffers from a of anxiety. Many also have verbal or physical outbursts due to an inability to regulate their emotions.
These problems were thought to be the result of other symptoms associated with ADHD, such as cognitive and motivational problems. But today’s study shows that emotional dysregulation occurs independently of these.
The researchers examined data from the ABCD Study, a large longitudinal cohort that tracks the brain development and mental health of children across the United States. Data on ADHD symptoms was available for just over 6,000 of these children, allowing researchers to give each individual a score indicating their likelihood of having attention deficit hyperactivity disorder.
A team of scientists from Fudan University in Shanghai, China, and the University of Cambridge identified 350 individuals within the cohort who had high symptom scores that met the clinical cutoff for ADHD. Two-thirds (65.7%) of these were men.
Parents or guardians of the children and adolescents in the group had previously completed a series of questionnaires, which included questions related to emotional behavior, for example:
•When my son is upset, he has difficulty controlling his behaviors.
•When my son is angry, he knows he can find a way to feel better.
•When my son is angry, he starts to feel very bad about himself.
The researchers found that half (51.4%) of individuals in the high symptom group showed signs of emotional dysregulation, and this was independent of cognitive and motivational problems.
Among children with only low ADHD symptoms at ages 12 and 13, those with a high emotional dysregulation score at age 13 were 2.85 times more likely to develop high attention deficit hyperactivity disorder symptoms at age 14 compared to those with a low score. emotional dysregulation score.
When the researchers looked at brain imaging data available for some participants, they discovered a particular region of the brain known as the pars orbitalis that was smaller among children who had high scores for attention deficit hyperactivity disorder and emotional problems. The pars orbitalis is located at the front of the brain and plays an important role in understanding and processing emotions and communication, as well as inhibitory control over behavior, which may explain some of the behaviors seen in ADHD.
Professor Barbara Sahakian of the University of Cambridge’s Department of Psychiatry and a member of Clare Hall said: “The pars orbitalis is a well-connected part of the brain and, if it has not developed correctly, it could make it difficult for individuals to control their emotions and communicate with others appropriately, especially in social situations.
“Parents and teachers often say they have trouble controlling children with attention deficit hyperactivity disorder, and it may be that when children cannot express themselves well – when they experience emotional difficulties – they may not be able to control their emotions and have a tantrum rather than communicating with the parent, teacher, or other child.”
Professor Sahakian hopes that recognizing emotional dysregulation as a key part of ADHD will help people better understand the problems their child is experiencing. This could lead to the use of effective treatments for emotion regulation, such as cognitive behavioral therapy.
The findings may also point to potential ways to help your child manage their emotions, for example by using cognitive behavioral techniques to learn to stop and think before reacting and verbally expressing their feelings, or using techniques such as exercise or relaxation to to calm down. or relieve symptoms of depression and anxiety.
This may be especially important as researchers have found that Ritalin, the drug used to help manage ADHD symptoms, does not appear to fully treat the symptoms of emotional dysregulation. Identifying the problem early would allow for alternative, more effective interventions to help the child better manage their emotions, potentially helping the individual in adulthood.
Professor Qiang Luo of Fudan University and life member of Clare Hall, Cambridge, said: “If you have problems controlling your emotions, this can lead to problems with social interactions, which further exacerbates any depression or anxiety you may have have. It could also mean that you are saying things or doing things that exacerbate a situation instead of calming it.
“Teaching vulnerable individuals from an early age how to manage their emotions and express themselves could help them overcome such problems in the future.”
While it’s unclear exactly what causes these problems, researchers have found signs of a link to possible immune system dysfunction, with individuals showing signs of emotional dysregulation displaying higher percentages of certain types of immune cells.
Professor Sahakian added: “We already know that problems with the immune system can be linked to depression and have seen similar patterns in individuals with ADHD who experience emotional dysregulation.”
How parents can help moderate the development of ADHD symptoms
According to a study written by a University of Waterloo researcher, parents of young children with an excitable or exuberant temperament could adapt their parenting style to help moderate the potential development of attention-deficit/hyperactivity disorder in their children.
Developmental psychologists know that temperament, parenting, and the brain’s executive functions are interconnected factors in the development of ADHD symptoms in childhood. But the study found specific factors that predict a greater likelihood of attention deficit hyperactivity disorder symptoms, underscoring the importance of early targeted intervention.
“A set of early traits we call exuberance in childhood temperament, such as high arousal, curiosity and positive responses to unfamiliar people and contexts, combined with family factors could predispose some children to developing ADHD symptoms,” said Dr. Heather Henderson, professor of attention deficit hyperactivity disorder. developmental psychology at Waterloo and co-authored the study.
“This work demonstrates that parents can really help break down the pathways that lead to ADHD through more directive and engaged parenting behaviors, such as guiding the child with verbal and physical cues as he or she encounters new situations.”
While exuberance in preschoolers can be very positive, research shows that exuberant children may also have difficulties with self-regulation and executive functions, such as working memory and flexible thinking.
Following 291 children aged just four months to 15 years, researchers observed child temperament and parent-child interactions at three years old, assessed the child’s executive functioning at four years old, and analyzed ADHD symptoms reported by parents six times between the ages of five and 15. The study established that temperament and parenting work together to influence the development of a child’s executive functions.
The findings suggest that ADHD symptoms increase throughout childhood as a child displays early exuberant temperament, low to normal executive functioning, and receives less directive and engaged parenting as the child faces new situations.
“ADHD symptoms typically stabilize by ages five to nine and decline by ages nine to 15. But for predictable cases of very young children with exuberant temperaments and less directive parenting, such stabilization may not occur,” Henderson said.
“More directive parenting, which does not control but guides the child with verbal and physical cues, can help develop the child’s self-regulation skills and prevent the increase in ADHD symptoms.”
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