1
|
Bellato A, Sesso G, Milone A, Masi G, Cortese S. Systematic Review and Meta-Analysis: Altered Autonomic Functioning in Youths With Emotional Dysregulation. J Am Acad Child Adolesc Psychiatry 2024; 63:216-230. [PMID: 36841327 DOI: 10.1016/j.jaac.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/20/2023] [Accepted: 02/16/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To systematically investigate if there is a significant association between markers of autonomic functioning and emotional dysregulation (ED) in children and adolescents. METHOD Based on a preregistered protocol (PROSPERO: CRD42021239635), PubMed, Web of Knowledge/Science, Ovid MEDLINE, Embase, and APA PsycInfo databases were searched until April 21, 2021, to identify empirical studies reporting indices of autonomic nervous system (ANS) functioning in youths meeting DSM (version III, IV, IV-TR, 5 or 5-TR) or International Classification of Diseases (ICD) (version 9 or 10) criteria for any psychopathological/neurodevelopmental condition and assessed for ED with a validated scale. Eligible outcomes included correlation coefficients between ED and ANS measures or differences in ANS measures between youths with and without ED. Study quality was assessed with the Appraisal tool for Cross-Sectional Studies (AXIS) and the Newcastle-Ottawa Scale (NOS) for cohort studies. Random-effects meta-analyses were used for data synthesis. RESULTS There were 12 studies (1,016 participants) included in the descriptive review and 9 studies (567 participants) included in the meta-analyses. No evidence of a significant association between ED and altered cardiac or electrodermal functioning was found. However, exploratory meta-regressions suggested a possible association between reduced resting-state cardiac vagal control and increased ED. CONCLUSION This study did not find evidence of an association between ED and autonomic dysfunction. However, preliminary evidence that reduced vagal control at rest might be a transdiagnostic marker of ED in young people was found. Additional studies comparing autonomic measures in youths with and without ED are needed and should also assess the effects of interventions for ED on ANS functioning. STUDY PREREGISTRATION INFORMATION Systematic Review and Meta-Analysis: Is Autonomic Nervous System Functioning Atypical in Children and Adolescents With Emotional Dysregulation? https://www.crd.york.ac.uk/prospero/; CRD42021239635.
Collapse
Affiliation(s)
- Alessio Bellato
- University of Nottingham Malaysia, Malaysia; King's College London, United Kingdom.
| | - Gianluca Sesso
- IRCCS Stella Maris Foundation, Pisa, Italy; University of Pisa, Italy
| | | | | | - Samuele Cortese
- University of Southampton, United Kingdom; New York University Langone Health, New York
| |
Collapse
|
2
|
Sökmen Z, Karaca S. The effect of Self-Regulation Based Cognitive Psychoeducation Program on emotion regulation and self-efficacy in children diagnosed with attention deficit hyperactivity disorder. Arch Psychiatr Nurs 2023; 44:122-128. [PMID: 37197856 DOI: 10.1016/j.apnu.2023.04.005] [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] [Received: 09/06/2022] [Revised: 02/18/2023] [Accepted: 04/17/2023] [Indexed: 05/19/2023]
Abstract
AIM This study aimed to determine the effect of Self-Regulation Based Cognitive Psychoeducation Program on emotion regulation and self-efficacy in children diagnosed with attention deficit hyperactivity disorder (ADHD) and receiving medication. METHOD The sample of this study with control group and pre-test, post-test and follow-up randomized experimental design consisted of children followed in the child and adolescent mental health outpatient clinic of a state hospital. The data were evaluated by parametric and non-parametric analyses. RESULTS A statistically significant increase was determined in the internal functional emotion regulation mean scores of children, who participated in the Self-Regulation Based Cognitive Psychoeducation Program, measured before, immediately after, and 6 months after the intervention (p < 0.05). A statistically significant increase was also found in their external functional emotion regulation mean scores measured before and 6 months after the intervention (p < 0.05). In addition, a statistically significant difference was found between their internal dysfunctional and external dysfunctional emotion regulation mean scores measured before and 6 months after the intervention; however the mean scores of those in the control group 6 months after the intervention were higher than those in the intervention group (p < 0.05). Furthermore, there was a statistically significant increase in their self-efficacy mean scores measured before and 6 months after the intervention (p < 0.05). CONCLUSION The Self-Regulation Based Cognitive Psychoeducation Program was found be effective in increasing the levels of emotion regulation and self-efficacy in children with ADHD.
Collapse
Affiliation(s)
- Zeynep Sökmen
- Marmara University, Institute of Health Science, Department of Psychiatric Nursing, Istanbul, Turkey.
| | - Semra Karaca
- Marmara University, Institute of Health Science, Department of Psychiatric Nursing, Istanbul, Turkey
| |
Collapse
|
3
|
Payen A, Chen MJ, Carter TG, Kilmer RP, Bennett JM. Childhood ADHD, Going Beyond the Brain: A Meta-Analysis on Peripheral Physiological Markers of the Heart and the Gut. Front Endocrinol (Lausanne) 2022; 13:738065. [PMID: 35299964 PMCID: PMC8921263 DOI: 10.3389/fendo.2022.738065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 01/17/2022] [Indexed: 12/03/2022] Open
Abstract
UNLABELLED Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder diagnosed in children. Questions regarding its increased diagnostic rates and pharmacological treatments in developing children have led to a more holistic review of the multi-system pathophysiology observed in ADHD. The dopaminergic neurotransmitter system, known for its influence on reward-motivated behaviors and motor control, and the frontostriatal systems, that mediate motor, cognition, and behavior, are associated with ADHD's development. However, studies have shown that these neural systems do not wholly account for ADHD's multilayered and heterogeneous symptom presentation. For instance, the literature suggests that emotional dysregulation, the inability to regulate one's emotional responses to provoking stimuli, is associated with increased risk for social impairment in ADHD. A broader examination of physiological systems in children with ADHD has found potential markers in the heart-brain and gut-brain axes that correspond with certain behaviors associated with emotional dysregulation in recent studies. Hence, the purpose of this meta-analysis is to aggregate ten applicable published case studies and analyze task-related heart rate reactivity (HRR; n = 5 studies) and gut microbiota (n = 5 studies) data in children with and without ADHD. Data from a total of 531 youth with ADHD and 603 youth without ADHD revealed significant small and medium effect sizes for higher Chao1 levels and Actinobacteria levels in the ADHD group, respectively, but no evidence of altered task-related HRR. Thus, further research into multi-system psychophysiological measures of emotional dysregulation and ADHD is warranted. The clinical, empirical, and educational implications of these findings are discussed. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/, identifier PROSPERO (CRD42021236819).
Collapse
Affiliation(s)
- Ameanté Payen
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Michelle J. Chen
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - T. Grace Carter
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Ryan P. Kilmer
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, United States
| | - Jeanette M. Bennett
- Health Psychology PhD Program, University of North Carolina at Charlotte, Charlotte, NC, United States
- Department of Psychological Science, University of North Carolina at Charlotte, Charlotte, NC, United States
- *Correspondence: Jeanette M. Bennett,
| |
Collapse
|
4
|
Tsai CJ, Lin HY, Tseng IWY, Gau SSF. Brain voxel-based morphometry correlates of emotion dysregulation in attention-deficit hyperactivity disorder. Brain Imaging Behav 2021; 15:1388-1402. [PMID: 32700253 DOI: 10.1007/s11682-020-00338-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Attention-deficit hyperactivity disorder (ADHD) has a high prevalence of co-occurring with emotion dysregulation (ED). Youths with ADHD and ED are more likely to have increased functional impairment. There is accumulating research on defining the features, behavioral, and physiological manifestations of ED, but there are currently few studies elucidating neuroanatomical correlations of ED in ADHD. Structural magnetic resonance imaging data from 118 children (aged 7-18 years) with ADHD (50 ADHD+high ED, 68 ADHD+low ED), and 104 typically developing controls (TDC) were processed using voxel-based morphometry. We used both dichotomous and continuous indices of ED to examine the possible correspondence between ED and ADHD. Relative to ADHD+high ED, ADHD+low ED had greater gray matter (GM) volumes over the left anterior prefrontal cortex (PFC). ADHD+low ED and ADHD+high ED shared a negative association of ED levels with the left middle temporal pole GM volume. TDC and ADHD+low ED also shared negative relationships of ED levels with the right temporal volume, and positive relationships with the left dorsolateral PFC volume. Besides, ED-by-group interactions were also noted. Specifically, medial PFC GM volumes increased and decreased with ED severity in ADHD+low ED and ADHD+high ED, respectively; and left cerebellum Crus GM volumes decreased and increased with ED severity in ADHD+low ED and ADHD+high ED, respectively. Our findings add to the evidence that some specific neural correlates are underpinning ED across ADHD and TDC. These findings suggest the importance of incorporating ED problems when considering heterogeneity in studies of ADHD.
Collapse
Affiliation(s)
- Chia-Jui Tsai
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsiang-Yuan Lin
- Azrieli Adult Neurodevelopmental Centre and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Isaac Wen-Yih Tseng
- Institute of Medical Device and Imaging, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Susan Shur-Fen Gau
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- Graduate Institute of Brain and Mind Sciences and Department of Psychology, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
5
|
Emotion Regulation via the Autonomic Nervous System in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): Replication and Extension. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2021; 48:361-373. [PMID: 31808007 DOI: 10.1007/s10802-019-00593-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent disorder characterized by symptoms of inattention, hyperactivity, and/or impulsivity, as well as executive dysfunction. Recent work underlines the importance in understanding the role of emotion reactivity and regulatory deficits in the context of the disorder. One study (i.e., Musser et al. 2011) utilized a positive and negative emotion induction and suppression task, as well as indexes of autonomic nervous system reactivity, to examine emotional functioning in youth with ADHD. This study revealed inflexible parasympathetic-based regulation across emotion conditions among youth with ADHD compared to typically developing youth. The present study sought to replicate and extend these findings to a clinically recruited, diverse sample, while also examining sympathetic functioning. Two hundred fifty-nine participants (160 youth with ADHD), aged 5 to 13, completed the task utilized in Musser et al. 2011, while indexes of parasympathetic (i.e., respiratory sinus arrhythmia [RSA]) and sympathetic (i.e., pre-ejection period [PEP] and electrodermal activity [EDA]) reactivity were obtained. ADHD was associated with significantly elevated parasympathetic (i.e., augmented RSA) and sympathetic (as indexed by EDA) reactivity. Overall, results replicate and extend Musser et al. 2011, revealing sympathetic-linked disruptions in emotion reactivity and parasympathetic-linked disruptions in emotion regulation among youth with ADHD. Future studies of behavioral therapies for ADHD should consider the efficacy of adding an emotion regulation skills training component.
Collapse
|
6
|
Leroy A, Spotorno S, Faure S. Emotional scene processing in children and adolescents with attention deficit/hyperactivity disorder: a systematic review. Eur Child Adolesc Psychiatry 2021; 30:331-346. [PMID: 32034554 DOI: 10.1007/s00787-020-01480-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Abstract
"Impairments in emotional information processing are frequently reported in attention deficit hyperactivity disorder (ADHD) at a voluntary, explicit level (e.g., emotion recognition) and at an involuntary, implicit level (e.g., emotional interference). Most of previous studies have used faces with emotional expressions, rarely examining other important sources of information usually co-occurring with faces in our every day experience. Here, we examined how the emotional content of an entire visual scene depicting real-world environments and situations is processed in ADHD. We systematically reviewed in PubMed, SCOPUS and ScienceDirect, using the PRISMA guidelines, empirical studies published in English until March 2019, about processing of visual scenes, with or without emotional content, in children and adolescents with ADHD. We included 17 studies among the 154 initially identified. Fifteen used scenes with emotional content (which was task-relevant in seven and irrelevant in eight studies) and two used scenes without emotional content. Even though the interpretation of the results differed according to the theoretical model of emotions of the study and the presence of comorbidity, differences in scene information processing between ADHD and typically developing children and adolescents were reported in all but one study. ADHD children and adolescents show difficulties in the processing of emotional information conveyed by visual scenes, which may stem from a stronger bottom-up impact of emotional stimuli in ADHD, increasing the emotional experience, and from core deficits of the disorder, decreasing the overall processing of the scene".
Collapse
Affiliation(s)
- Anaïs Leroy
- Laboratoire D'Anthropologie Et de Psychologie Cliniques, Cognitives Et Sociales (LAPCOS), MSHS Sud Est, Université Côte D'Azur, Pôle Universitaire Saint Jean D'Angely, 24 avenue des Diables Bleus, 06357, Nice Cédex 4, France. .,CERTA, Reference Centre for Learning Disabilities, Fondation Lenval, Hôpitaux Pédiatriques de Nice CHU-Lenval, Nice, France.
| | | | - Sylvane Faure
- Laboratoire D'Anthropologie Et de Psychologie Cliniques, Cognitives Et Sociales (LAPCOS), MSHS Sud Est, Université Côte D'Azur, Pôle Universitaire Saint Jean D'Angely, 24 avenue des Diables Bleus, 06357, Nice Cédex 4, France
| |
Collapse
|
7
|
Tonacci A, Billeci L, Calderoni S, Levantini V, Masi G, Milone A, Pisano S, Muratori P. Sympathetic arousal in children with oppositional defiant disorder and its relation to emotional dysregulation. J Affect Disord 2019; 257:207-213. [PMID: 31301625 DOI: 10.1016/j.jad.2019.07.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/07/2019] [Accepted: 07/04/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Emotional dysregulation (ED) is a trans-nosographical condition characterized by mood instability, severe irritability, aggression, temper outburst, and hyper-arousal. Pathophysiology of emotional dysregulation and its potential biomarkers are an emerging field of interest. A Child Behaviour Checklist (CBCL) profile, defined as Dysregulation Profile (DP), has been correlated to ED in youth. We examined the association between the CBCL-DP and indices of sympathetic arousal in children with Oppositional Defiant Disorder (ODD) and healthy controls. METHOD The current study sought to compare the arousal level measured via electrodermal activity in response to emotional stimuli in three non-overlapping groups of children: (1) ODD+CBCL-DP (n = 28), (2) ODD without CBCL-DP (n = 35), and (3) typically developing controls (n = 25). RESULTS Analyses revealed a distinct electrodermal activity profile in the three groups. Specifically, children with ODD+CBCL-DP presented higher levels of sympathetic arousal for anger and sadness stimuli compared to the other two groups. LIMITATIONS The relatively small sample and the lack of assessing causality limit the generalizability of this study which results need to be replicated in larger, different samples. CONCLUSION The CBCL-DP was associated to higher levels of arousal for negative emotions, consistently with previous reports in individuals with depression and anxiety. Further work may identify potential longitudinal relationships between this profile and clinical outcomes.
Collapse
Affiliation(s)
- Alessandro Tonacci
- Institute of Clinical Physiology, National Research Council of Italy, (CNR), Via Moruzzi 1, 56124, Pisa, Italy
| | - Lucia Billeci
- Institute of Clinical Physiology, National Research Council of Italy, (CNR), Via Moruzzi 1, 56124, Pisa, Italy.
| | - Sara Calderoni
- Department of Developmental Neuroscience, IRCCS Stella Maris, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valentina Levantini
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Gabriele Masi
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Annarita Milone
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| | - Simone Pisano
- Department of Neuroscience, AORN Santobono-Pausilipon, Naples, Italy
| | - Pietro Muratori
- IRCCS Fondazione Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Pisa, Italy
| |
Collapse
|