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Soler-Gutiérrez AM, Pérez-González JC, Mayas J. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review. PLoS One 2023; 18:e0280131. [PMID: 36608036 PMCID: PMC9821724 DOI: 10.1371/journal.pone.0280131] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023] Open
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) is a developmental disorder, with an onset in childhood, that accompanies the person throughout their life, with prevalence between 3 and 5% in adults. Recent studies point towards a fourth core symptom of the disorder related to the emotional information processing that would explain the repercussions that ADHD has on the social, academic, and professional life of the people affected. This review aims to describe emotion dysregulation features as well as the brain activity associated in adults with ADHD. A search of the scientific literature was launched in specialized databases: PsycInfo, Medline, Eric, PsycArticle, Psicodoc and Scopus, following PRISMA guidelines. Twenty-two articles met the inclusion criteria: (a) an ADHD clinical diagnosis, (b) participants over 18 years old, (c) emotion regulation measurement, (d) empirical studies, and (c) in English. Due to the heterogeneity of the studies included, they were classified into three sections: measures and features of emotion regulation (ER) in people with ADHD, neurological and psychophysiological activity related to ER, and treatments. The studies found that meet the selection criteria are scarce and very heterogeneous both in aims and in sample features. Adults with ADHD show a more frequent use of non-adaptive emotion regulation strategies compared to people without ADHD symptoms. Moreover, emotion dysregulation was associated with symptom severity, executive functioning, psychiatric comorbidities, and even with criminal conviction. Different patterns of brain activity were observed when people with and without ADHD were compared. These results may suggest that psychopharmacological treatments as well as behavioral therapies could be useful tools for improving emotional difficulties in adult ADHD.
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Affiliation(s)
- Ana-María Soler-Gutiérrez
- Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
- Escuela Internacional de Doctorado de la UNED (EIDUNED), Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
| | | | - Julia Mayas
- Faculty of Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain
- * E-mail:
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Liu J, Fan L, Jiang J, Li C, Tian L, Zhang X, Feng W. Evidence for dynamic attentional bias toward positive emotion-laden words: A behavioral and electrophysiological study. Front Psychol 2022; 13:966774. [PMID: 36051211 PMCID: PMC9426460 DOI: 10.3389/fpsyg.2022.966774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/20/2022] [Indexed: 11/13/2022] Open
Abstract
There has been no consensus on the neural dissociation between emotion-label and emotion-laden words, which remains one of the major concerns in affective neurolinguistics. The current study adopted dot-probe tasks to investigate the valence effect on attentional bias toward Chinese emotion-label and emotion-laden words. Behavioral data showed that emotional word type and valence interacted in attentional bias scores with an attentional bias toward positive emotion-laden words rather than positive emotion-label words and that this bias was derived from the disengagement difficulty in positive emotion-laden words. In addition, an attentional bias toward negative emotion-label words relative to positive emotion-label words was observed. The event-related potential (ERP) data demonstrated an interaction between emotional word type, valence, and hemisphere. A significant hemisphere effect was observed during the processing of positive emotion-laden word pairs rather than positive emotion-label, negative emotion-label, and negative emotion-laden word pairs, with positive emotion-laden word pairs eliciting an enhanced P1 in the right hemisphere as compared to the left hemisphere. Our results found a dynamic attentional bias toward positive emotion-laden words; individuals allocated more attention to positive emotion-laden words in the early processing stage and had difficulty disengaging attention from them in the late processing stage.
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Affiliation(s)
- Jia Liu
- School of Foreign Studies, Hebei Normal University, Shijiazhuang, China
| | - Lin Fan
- National Research Centre for Foreign Language Education, Beijing Foreign Studies University, Beijing, China
- Artificial Intelligence and Human Languages Lab, Beijing Foreign Studies University, Beijing, China
- *Correspondence: Lin Fan, ;
| | - Jiaxing Jiang
- Research Institute of Foreign Languages, Beijing Foreign Studies University, Beijing, China
| | - Chi Li
- Research Institute of Foreign Languages, Beijing Foreign Studies University, Beijing, China
| | - Lingyun Tian
- National Research Centre for Foreign Language Education, Beijing Foreign Studies University, Beijing, China
| | - Xiaokun Zhang
- National Research Centre for Foreign Language Education, Beijing Foreign Studies University, Beijing, China
| | - Wangshu Feng
- Artificial Intelligence and Human Languages Lab, Beijing Foreign Studies University, Beijing, China
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Schuthof CC, Tendolkar I, Bergman MA, Klok M, Collard RM, van Eijndhoven PFP, Schene AH, Vrijsen JN. Depressive Symptoms Account for Loss of Positive Attention Bias in ADHD Patients: An Eye-Tracking Study. J Atten Disord 2022; 26:1325-1334. [PMID: 34963365 DOI: 10.1177/10870547211063640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Depression and ADHD often co-occur and are both characterized by altered attentional processing. Differences and overlap in the profile of attention to emotional information may help explain the co-occurence. We examined negative attention bias in ADHD as neurocognitive marker for comorbid depression. METHODS Patients with depression (n = 63), ADHD (n = 43), ADHD and depression (n = 25), and non-psychiatric controls (n = 68) were compared on attention allocation toward emotional faces. The following eye-tracking indices were used: gaze duration, number of revisits, and location and duration of first fixation. RESULTS Controls revisited the happy faces more than the other facial expressions. Both the depression and the comorbid group showed significantly less revisits of the happy faces compared to the ADHD and the control group. Interestingly, after controlling for depressive symptoms, the groups no longer differed on the number of revisits. CONCLUSION ADHD patients show a relative positive attention bias, while negative attention bias in ADHD likely indicates (sub)clinical comorbid depression.
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Affiliation(s)
- Cassandra C Schuthof
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Indira Tendolkar
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Maria Annemiek Bergman
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Margit Klok
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rose M Collard
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Philip F P van Eijndhoven
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Janna N Vrijsen
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen, Nijmegen, The Netherlands.,Depression Expertise Center, Pro Persona Mental Health Care, Nijmegen, The Netherlands
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Can electroencephalography (EEG) identify ADHD subtypes? A systematic review. Neurosci Biobehav Rev 2022; 139:104752. [PMID: 35760387 DOI: 10.1016/j.neubiorev.2022.104752] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 06/12/2022] [Accepted: 06/22/2022] [Indexed: 11/21/2022]
Abstract
Attention Deficit/Hyperactivity Disorder (ADHD) has been associated with atypical patterns of neural activity measured by electroencephalography (EEG). However, the identification of EEG diagnostic biomarkers has been complicated by the disorder's heterogeneity. The objective of this review was to synthesize the literature investigating EEG variation in patients diagnosed with ADHD, addressing the following questions: 1) Are the diagnostic ADHD subtypes associated with different EEG characteristics? 2) Are EEG measures correlated with ADHD traits and/or symptom severity? and 3) Do classification techniques using EEG measures reveal different clinical presentations of ADHD? Outcomes highlight the potential for electrophysiological measures to provide meaningful insights into the heterogeneity of ADHD, although direct translation of EEG biomarkers for diagnostic purposes is not yet supported. Key measures that show promise for the discrimination of existing ADHD subtypes and symptomatology include: resting state and task-related modulation of alpha, beta and theta power, and the event-related N2 and P3 components. Prescriptions are discussed for future studies that may help to bridge the gap between research and clinical application.
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Ahumada-Méndez F, Lucero B, Avenanti A, Saracini C, Muñoz-Quezada MT, Cortés-Rivera C, Canales-Johnson A. Affective modulation of cognitive control: A systematic review of EEG studies. Physiol Behav 2022; 249:113743. [DOI: 10.1016/j.physbeh.2022.113743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/24/2022] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
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Mayer JS, Brandt GA, Medda J, Basten U, Grimm O, Reif A, Freitag CM. Depressive symptoms in youth with ADHD: the role of impairments in cognitive emotion regulation. Eur Arch Psychiatry Clin Neurosci 2022; 272:793-806. [PMID: 35107603 PMCID: PMC9279209 DOI: 10.1007/s00406-022-01382-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 01/14/2022] [Indexed: 12/21/2022]
Abstract
Youth with attention-deficit/hyperactivity disorder (ADHD) are at increased risk to develop co-morbid depression. Identifying factors that contribute to depression risk may allow early intervention and prevention. Poor emotion regulation, which is common in adolescents, is a candidate risk factor. Impaired cognitive emotion regulation is a fundamental characteristic of depression and depression risk in the general population. However, little is known about cognitive emotion regulation in youth with ADHD and its link to depression and depression risk. Using explicit and implicit measures, this study assessed cognitive emotion regulation in youth with ADHD (N = 40) compared to demographically matched healthy controls (N = 40) and determined the association with depressive symptomatology. As explicit measure, we assessed the use of cognitive emotion regulation strategies via self-report. As implicit measure, performance in an ambiguous cue-conditioning task was assessed as indicator of affective bias in the processing of information. Compared to controls, patients reported more frequent use of maladaptive (i.e., self-blame, catastrophizing, and rumination) and less frequent use of adaptive (i.e., positive reappraisal) emotion regulation strategies. This pattern was associated with the severity of current depressive symptoms in patients. In the implicit measure of cognitive bias, there was no significant difference in response of patients and controls and no association with depression. Our findings point to depression-related alterations in the use of cognitive emotion regulation strategies in youth with ADHD. The study suggests those alterations as a candidate risk factor for ADHD-depression comorbidity that may be used for risk assessment and prevention strategies.
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Affiliation(s)
- Jutta S Mayer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528, Frankfurt am Main, Germany.
| | - Geva A Brandt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5, 68159, Mannheim, Germany
| | - Juliane Medda
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528, Frankfurt am Main, Germany
| | - Ulrike Basten
- Department of Psychology, University of Koblenz-Landau, Fortstraße 7, 76829, Landau in der Pfalz, Germany
| | - Oliver Grimm
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Heinrich-Hoffmann-Str. 10, 60528, Frankfurt am Main, Germany
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Heinrich-Hoffmann-Str. 10, 60528, Frankfurt am Main, Germany
| | - Christine M Freitag
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt, Goethe University, Deutschordenstraße 50, 60528, Frankfurt am Main, Germany
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Abstract
PURPOSE OF REVIEW Emotional symptoms are common and persistent in youth and adults with attention-deficit/hyperactivity disorder (ADHD) and cause clinically significant impairments. We review recent neuropsychological, neurophysiological, and peripheral psychophysiological evidence for emotion and emotion regulation deficits in ADHD across youth and adults. RECENT FINDINGS Central and autonomous nervous system correlates argue in favor of more general self-regulation deficits and also specific emotional deficits in ADHD. These include general performance deficits in executive functions, and structural as well as functional impairments in neuronal networks associated with top-down self-regulation. Specific deficits with bottom-up emotional activation in the amygdala and emotion evaluation associated with the orbitofrontal cortex have also been described. Furthermore, vagally mediated, high-frequency heart rate variability is associated with emotional self-regulation deficits throughout the life span. The current evidence is based on multilevel studies that assess associations of emotion regulation. However, further studies that adequately consider the processual recursive character of emotion generation and regulation may give important new insights into emotional regulation of ADHD. Emotion regulation deficits in ADHD are associated with specific as well as general self-regulation deficits traceable on the level of neuropsychological, neurophysiological, and psychophysiological assessments. The temporal dynamics of the interplay of those different systems need further study in order to optimize and personalize treatment of emotion regulation difficulties, including emotional reactivity, in patients with ADHD.
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