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Karalunas SL, Dude J, Figuracion M, Lane SP. Momentary Dynamics Implicate Emotional Features in the ADHD Phenotype. Res Child Adolesc Psychopathol 2024; 52:1343-1356. [PMID: 38771497 DOI: 10.1007/s10802-024-01206-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 05/22/2024]
Abstract
Emotional dysregulation is increasingly recognized as important to the attention-deficit/hyperactivity disorder (ADHD) phenotype alongside inattention and hyperactivity-impulsivity. Studies of ADHD have relied primarily on trait-based conceptualizations that emphasize stability of symptoms across moderate developmental timescales (i.e., months to years). Trait-based conceptualizations provide a critical view but fail to account for short-term dynamic variations in the expression of ADHD symptoms and emotion. This leaves a gap in our understanding of the short-term variation in ADHD symptom expression and the dynamic relationships among ADHD symptoms and emotion. Here, we assessed caregiver report of ADHD symptoms and positive and negative emotion using ecological momentary approaches over 2 weeks in a sample of 36 children with and without ADHD between the ages of 7-12 years old. Between-person (RKF) and within-person (RC) reliability were estimated. Multilevel models tested specific covariation hypotheses between ADHD symptoms and emotion. Analyses confirmed that ADHD and emotion ratings were reliable as individual differences (i.e., between-person; RKF range 0.93-1.0) and moment-to-moment change (i.e., within-person; Rc range 0.66-0.88) measures. Multilevel models found little evidence for lagged effects between domains, but consistently identified concurrent expression of ADHD symptoms and emotions; inattention covaried most strongly with negative emotion and hyperactivity-impulsivity covaried most strongly with positive emotion. Results demonstrate the importance of complementing trait-level conceptualizations with assessment of momentary dynamics. Momentary assessment suggests important covariation of ADHD symptoms and emotion as part of the ADHD phenotype.
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Affiliation(s)
| | - Jason Dude
- Washington University in Saint Louis, Saint Louis, MO, USA
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2
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Olczyk AR, Rosen PJ, Alacha HF, Flynn MM. Indirect effect of ADHD on parenting stress through increased child anxiety and decreased emotional regulatory coping. Eur Child Adolesc Psychiatry 2024; 33:1407-1417. [PMID: 37351660 DOI: 10.1007/s00787-023-02246-0] [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: 11/04/2022] [Accepted: 06/15/2023] [Indexed: 06/24/2023]
Abstract
Parents of children with ADHD experience significantly more parenting stress in comparison to parents of typically developing children due to the emotional and behavioral difficulties related to ADHD. Additionally, approximately 30% of children with ADHD experience co-occurring anxiety. Parents of children with co-occurring anxiety and ADHD report increased stress due to role restriction and isolation compared to parents of children with ADHD alone. Poor emotional regulatory coping in children with ADHD has been linked to elevated negative affect and irritability, which also contributes to increased stress among parents. The present study examined the direct and indirect associations of child anxiety symptoms and emotional regulatory coping on elevated ADHD symptoms and parenting stress. Participants were 203 children aged 7-12-years-old and their parents. Parents completed a self-report measure of parenting stress and measures of their child's ADHD symptoms, anxiety, and emotional regulatory coping. Additionally, children completed self-report measures of emotional regulatory coping. Model testing indicated that the overall model demonstrated excellent fit to the data. Parameter testing supported an indirect effect of child ADHD symptoms on parenting stress through child anxiety symptoms and an indirect effect of child ADHD symptoms on parenting stress through child emotional regulatory coping. These results suggest that child anxiety and emotion dysregulation in children with ADHD have a negative impact on parental stress. The current study adds to the understanding of the important roles emotional regulatory coping and anxiety play in children with ADHD to contribute to increased parenting stress.
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李 思, 王 美, 杨 燕, 王 卓, 刘 沛, 罗 婷, 陶 煜, 黄 颐. [Effect of Emotion Regulation on Anxiety/Depression Symptoms in Children With Attention-Deficit/Hyperactivity Disorder: The Mediating Role of Social Problems and the Moderating Role of Family Functioning]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:346-352. [PMID: 38645874 PMCID: PMC11026903 DOI: 10.12182/20240360601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Indexed: 04/23/2024]
Abstract
Objective To investigate the mediating effect of social problems in the effect pathway of emotional dysregulation influencing anxiety/depression emotions in children with attention-deficit/hyperactivity disorder (ADHD) and to explore the potential moderating effect of family functionality. Methods A total of 235 children diagnosed with ADHD were enrolled in the study. The paticipants' age ranged from 6 to 12. Emotion Regulation Checklist, Achenbach's Child Behavior Checklist (CBCL) Social Problems Subscale, CBCL Anxious/Depressed Subscale, and Family Assessment Device were used to evaluate the emotional regulation, social problems, anxiety/depression emotions, and family functionality of the participants. A moderated mediation model was employed to analyze whether social problems and family functionality mediate and moderate the relationship between emotional regulation and anxiety/depression emotions. Results Social problems partially mediated the impact of emotional dysregulation on anxiety/depression emotions in ADHD children, with the direct effect being 0.26 (95% confidence interval [CI]: [0.17, 0.36], P<0.001), the indirect effect being 0.13 (95% CI: [0.07, 0.19], P<0.001), and the mediating effect accounting for 33% of the total effect. Family functionality exhibited a positive moderating effect on the relationship between social problems and anxiety/depression emotions. Conclusion This study contributes to the understanding of complex factors influencing anxiety/depression in children with ADHD, providing reference for the further development of targeted interventions for children with ADHD and the improvement of prognosis.
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Affiliation(s)
- 思迅 李
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 美雯 王
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 燕平 杨
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 卓 王
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 沛 刘
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 婷婷 罗
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 煜杰 陶
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
| | - 颐 黄
- 四川大学华西医院 精神科 (成都 610041)Department of Psychiatry, West China Hospital, Sichuan University, Chengdu 610041, China
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Evans SC, Hamilton JL, Boyd SI, Karlovich AR, Ladouceur CD, Silk JS, Bylsma LM. Daily Associations Between Sleep and Affect in Youth at Risk for Psychopathology: The Moderating Role of Externalizing Symptoms. Res Child Adolesc Psychopathol 2024; 52:35-50. [PMID: 37405590 PMCID: PMC10766867 DOI: 10.1007/s10802-023-01087-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 07/06/2023]
Abstract
Problems with sleep, emotion regulation, and externalizing psychopathology are interrelated, but little is known about their day-to-day associations in youth. We examined self-reported daily sleep quality as a bidirectional predictor of next-day positive and negative affect (PA/NA), with externalizing symptoms as a moderator. Data were drawn from an ecological momentary assessment (EMA) study involving 82 youths (ages 9-13; 50% female; 44% White, 37% Black/African American) at high (n = 41) or low (n = 41) familial risk for psychopathology. Parents rated youths' externalizing symptoms at baseline. Youths then completed a 9-day EMA protocol, reporting sleep quality 1x/day and affect 4-8x/day. Daily means, peaks, and variability in PA and NA were computed. Multilevel models examined bidirectional associations between sleep and affect (between- and within-person), testing externalizing symptoms as a moderator and controlling for age and sex. In models of sleep predicting affect: Within-person, poorer-than-usual sleep quality predicted greater variability and higher peaks in next-day NA, but only for youth with higher levels of externalizing symptoms. Between-person, poor sleep quality and higher levels of externalizing symptoms predicted lower mean and peak PA. In models of affect predicting sleep: Within-person, lower-than-usual mean PA predicted poorer subsequent sleep quality, but only for youth with higher levels of externalizing symptoms. Between-person, youths with higher mean and peak PA had better sleep quality. These findings suggest that affective functioning is bidirectionally linked to daily self-reported sleep quality among high- and low-risk youth. Specific disturbances in daily sleep-affect cycles may be distinctly associated with externalizing psychopathology.
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Affiliation(s)
- Spencer C Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | | | | | - Cecile D Ladouceur
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jennifer S Silk
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren M Bylsma
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA.
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Pouchon A, Nasserdine R, Dondé C, Bertrand A, Polosan M, Bioulac S. A systematic review of pharmacotherapy for attention-deficit/hyperactivity disorder in children and adolescents with bipolar disorders. Expert Opin Pharmacother 2023; 24:1497-1509. [PMID: 37300473 DOI: 10.1080/14656566.2023.2224920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The data suggests that in children and adolescents, bipolar disorder (BD) and attention deficit hyperactivity disorder (ADHD) may be strongly correlated. Even though drugs for ADHD and BD are largely accepted, there is relatively little research on the management of comorbidity in children and adolescents, particularly in terms of safety. We provide a synthesis of these findings because one hasn't been made yet. AREAS COVERED As a primary outcome, we wanted to determine whether stimulant or non-stimulant treatment of children and adolescents with ADHD and comorbid BD was effective. As a secondary outcome, we wanted to determine tolerability, especially the risk of mood switch. EXPERT OPINION The findings of this systematic review suggest that methylphenidate, when used with a mood stabilizer, may be safe and not significantly increase the risk of a manic switch or psychotic symptoms when used to treat ADHD that co-occurs with a BD. In situations where stimulants are ineffective or have low tolerance, atomoxetine also seems to be a good alternative, and also in cases of co-morbid anxiety, oppositional defiant disorder, conduct disorders, ICT disorders, and substance use disorders. Additional research with a higher level of evidence is necessary to corroborate these preliminary findings.
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Affiliation(s)
- Arnaud Pouchon
- Grenoble Institut Neurosciences, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble, France
| | - Rayan Nasserdine
- Department of Psychiatry, University Grenoble Alpes, CHU Grenoble Alpes, Grenoble, France
| | - Clément Dondé
- Grenoble Institut Neurosciences, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble, France
- Psychiatry Department, CH Alpes-Isère, Saint-Egrève, France
| | - Antoine Bertrand
- Grenoble Institut Neurosciences, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble, France
| | - Mircea Polosan
- Grenoble Institut Neurosciences, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble, France
| | - Stéphanie Bioulac
- Grenoble Institut Neurosciences, University Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble, France
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Masi G, Carucci S, Muratori P, Balia C, Sesso G, Milone A. Contemporary diagnosis and treatment of conduct disorder in youth. Expert Rev Neurother 2023; 23:1277-1296. [PMID: 37853718 DOI: 10.1080/14737175.2023.2271169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/04/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Conduct disorder (CD) is characterized by repetitive and persistent antisocial behaviors, being among the most frequently reported reasons of referral in youth. CD is a highly heterogeneous disorder, with possible specifiers defined according to age at onset, Limited Prosocial Emotions (LPE) otherwise known as Callous-Unemotional (CU) traits, Emotional Dysregulation (ED), and patterns of comorbidity, each with its own specific developmental trajectories. AREAS COVERED The authors review the evidence from published literature on the clinical presentations, diagnostic procedures, psychotherapeutic and psychoeducational approaches, and pharmacological interventions from RCT and naturalistic studies in youth. Evidence from studies including youths with LPE/CU traits, ED and aggression are also reviewed, as response moderators. EXPERT OPINION Due to its clinical heterogeneity, relevant subtypes of CD should be carefully characterized to gain reliable information on prognosis and treatments. Thus, disentangling this broad category in subtypes is crucial as a first step in diagnosis. Psychosocial interventions are the first option, possibly improving LPE/CU traits and ED, especially if implemented early during development. Instead, limited information, based on low-quality studies, supports pharmacological options. Second-generation antipsychotics, mood stabilizers, and stimulants are first-line medications, according to different target symptoms, such as aggression and emotional reactivity. Developmental pathways including ADHD suggest a specific role of psychostimulants.
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Affiliation(s)
- Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Sara Carucci
- Department of Biomedical Science, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatric Unit, "A. Cao" Paediatric Hospital-ARNAS "G. Brotzu" Hospital Trust, Department of Paediatrics, Cagliari, Italy
| | - Pietro Muratori
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
| | - Carla Balia
- Department of Biomedical Science, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
- Child & Adolescent Neuropsychiatric Unit, "A. Cao" Paediatric Hospital-ARNAS "G. Brotzu" Hospital Trust, Department of Paediatrics, Cagliari, Italy
| | - Gianluca Sesso
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
- Social and Affective Neuroscience Group, Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca, Italy
| | - Annarita Milone
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, Pisa, Italy
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Antony EM, Pihlajamäki M, Speyer LG, Murray AL. Does emotion dysregulation mediate the association between ADHD symptoms and internalizing problems? A longitudinal within-person analysis in a large population-representative study. J Child Psychol Psychiatry 2022; 63:1583-1590. [PMID: 35484998 PMCID: PMC9790420 DOI: 10.1111/jcpp.13624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Previous research has suggested that children with attention-deficit/hyperactivity disorder (ADHD) symptoms commonly show emotion dysregulation difficulties. These difficulties may partly explain the strong tendency for internalizing problems such as anxiety and depression to co-occur with ADHD symptoms. However, no study has yet provided a longitudinal analysis of the within-person links between ADHD symptoms, emotion dysregulation, and internalizing problems necessary to examine this hypothesis from a developmental perspective. METHODS We used data from the age 3, 5, and 7 waves of the large UK population-representative Millennium Cohort Study (n = 9,619, 4,885 males) and fit gender-stratified autoregressive latent trajectory models with structured residuals (ALT-SR) to disaggregate within- and between-person relations between ADHD symptom, emotion dysregulation, and internalizing problem symptoms. RESULTS We found that emotion dysregulation significantly mediated the longitudinal within-person association between ADHD symptoms and internalizing problems. CONCLUSIONS Results underline the promise of targeting emotion dysregulation as a means of preventing internalizing problems co-occurring with ADHD symptoms.
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Naim R, Shaughnessy S, Smith A, Karalunas SL, Kircanski K, Brotman MA. Real-time assessment of positive and negative affective fluctuations and mood lability in a transdiagnostic sample of youth. Depress Anxiety 2022; 39:870-880. [PMID: 36325887 PMCID: PMC9729410 DOI: 10.1002/da.23293] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 09/30/2022] [Accepted: 10/22/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Emotional lability, defined as rapid and/or intense affect fluctuations, is associated with pediatric psychopathology. Although numerous studies have examined labile mood in clinical groups, few studies have used real-time assessments in a well-characterized transdiagnostic sample, and no prior study has included participants with disruptive mood dysregulation disorder (DMDD). The present study leverages ecological momentary assessment (EMA) to assess emotional lability in a transdiagnostic pediatric sample. METHODS One hundred thirty participants ages 8-18 with primary diagnoses of DMDD, attention-deficit/hyperactivity disorder (ADHD), an anxiety disorder (ANX), or healthy volunteers completed a previously validated 1-week EMA protocol. Clinicians determined diagnoses based on semi-structured interviews and assessed levels of functional impairment. Participants reported momentary affective states and mood change. Composite scores of fluctuations in positive and negative affect were generated. Affect fluctuations were compared between diagnostic groups and tested for their association with functional impairment. RESULTS Diagnostic groups differed in levels of negative and positive emotional lability. DMDD patients demonstrated the highest level of labile mood compared with other groups. Emotional lability was associated with global impairment in the whole sample. CONCLUSIONS Both positive and negative emotional lability is salient in pediatric psychopathology and is associated with functional impairment, particularly in DMDD youth.
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Affiliation(s)
- Reut Naim
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD,Corresponding author- Reut Naim, National
Institute of Mental Health, Bldg. 15K, MSC 2670, Bethesda, MD 20892-2670, Phone:
301-827-6138,
| | - Shannon Shaughnessy
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
| | - Ashley Smith
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
| | - Sarah L. Karalunas
- Department of Psychological Sciences, Purdue University,
West Lafayette, IN
| | - Katharina Kircanski
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
| | - Melissa A. Brotman
- Emotion and Development Branch, National Institute of
Mental Health, Bethesda, MD
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Yue X, Liu L, Chen W, Preece DA, Liu Q, Li H, Wang Y, Qian Q. Affective-cognitive-behavioral heterogeneity of Attention-Deficit/Hyperactivity Disorder (ADHD): Emotional dysregulation as a sentinel symptom differentiating "ADHD-simplex" and "ADHD-complex" syndromes? J Affect Disord 2022; 307:133-141. [PMID: 35367500 DOI: 10.1016/j.jad.2022.03.065] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Current DSM and ICD classifications of Attention-Deficit/Hyperactivity Disorder (ADHD) exclude emotional dysregulation (ED) in their diagnostic criteria, despite ED symptoms frequently co-occurring in ADHD and likely sharing common neurobiological substrates. In this study, we examined whether consideration of ED symptoms could delineate more informative "ADHD+ED" subphenotypes. METHOD 4106 children with ADHD were recruited. ED and inattentive (IA) and hyperactive/impulsive (HI) symptoms were profiled using latent class analyses (LCA). The derived latent class (LC) subphenotypes were evaluated and validated in relation to comorbidity patterns, executive functions, and functional impairments. RESULTS Five LC subphenotypes with ED symptoms were identified: IA/HI + ED profile (LC1); HI + ED profile (LC2); IA + ED profile (LC3); IA/HI profile (LC4); and IA profile (LC5). Cross-validation of the LCA model using support vector machine analysis confirmed 83% accuracy. ED positive (ED+ve) subphenotypes were associated with higher rates of oppositional defiant disorder, mood disorders, anxiety disorders, as well as more severe autistic traits and sluggish cognitive tempo symptoms. Higher rates of ecological executive functioning impairments (BRIEF ratings) were found among ED+ve subphenotypes (though no differences were detected by laboratory-based measures). Functional impairments were also more severe among participants with ED+ve subphenotypes. LIMITATIONS The data for our LCA were cross-sectional and based primarily on parent ratings. CONCLUSION Our classification model has parcellated IA, HI, and ED symptoms into novel informative subphenotypes. These classifications provide preliminary evidence that ED symptoms could serve as sentinel features to identify a potential "ADHD-complex" syndrome, which demarcates a more pervasive condition of greater severity, complexity, and impairment.
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Affiliation(s)
- Xinxin Yue
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Lu Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Wai Chen
- Mental Health Service, Fiona Stanley Hospital, Perth, Australia; Graduate School of Education, University of Western Australia, Australia; School of Medicine, University of Notre Dame Australia, Fremantle, Australia; School of Psychology, Murdoch University, Perth, Australia; Curtin Medical School, Curtin University, Perth, Australia; The enAble Institute, Curtin University, Perth, Australia.
| | - David A Preece
- The enAble Institute, Curtin University, Perth, Australia; School of Psychology, Curtin University, Perth, Australia; School of Psychological Science, University of Western Australia, Perth, Australia
| | - Qianrong Liu
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Haimei Li
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Yufeng Wang
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China
| | - Qiujin Qian
- Peking University Sixth Hospital/Institute of Mental Health, Beijing 100191, China; National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital) & NHC Key Laboratory of Mental Health (Peking University), Beijing 100191, China.
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Youth Psychopathology in Daily Life: Systematically Reviewed Characteristics and Potentials of Ecological Momentary Assessment Applications. Child Psychiatry Hum Dev 2022; 53:1129-1147. [PMID: 34075490 PMCID: PMC9560926 DOI: 10.1007/s10578-021-01177-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 11/25/2022]
Abstract
Traditionally, symptoms of youth psychopathology are assessed with questionnaires, clinical interviews, or laboratory observations. Ecological Momentary Assessment (EMA) could be a particularly valuable additional methodology, since EMA enables examining the daily lives of youths near real-time, considering fluctuations and specific contexts of symptoms. This systematic review aimed to review the characteristics of current EMA applications and to provide a synthesis of their potential in studying youth psychopathology. Following a systematic search in PsycInfo and Medline, we identified 50 studies in clinical samples. Most studies used EMA to examine fluctuations in symptoms, affect, and behavior, and the relation with contextual factors. EMA was also used to investigate interactions between parents and their children over time, and to monitor and predict treatment response. EMA appeared feasible in youth and could provide valuable insights that contribute to understanding youth psychopathology. Benefits, gaps, and suggestions for future research and clinical practice are discussed.
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11
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Paulus FW, Ohmann S, Möhler E, Plener P, Popow C. Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review. Front Psychiatry 2021; 12:628252. [PMID: 34759846 PMCID: PMC8573252 DOI: 10.3389/fpsyt.2021.628252] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/27/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Emotional dysregulation (ED) is a transdiagnostic construct defined as the inability to regulate the intensity and quality of emotions (such as, fear, anger, sadness), in order to generate an appropriate emotional response, to handle excitability, mood instability, and emotional overreactivity, and to come down to an emotional baseline. Because ED has not been defined as a clinical entity, and because ED plays a major role in child and adolescent psychopathology, we decided to summarize current knowledge on this topic based on a narrative review of the current literature. Methods: This narrative review is based on a literature search of peer-reviewed journals. We searched the databases ERIC, PsycARTICLES, PsycINFO and PSYNDEX on June 2, 2020 for peer reviewed articles published between 2000 and 2020 in English language for the preschool, school, and adolescent age (2-17 years) using the following search terms: "emotional dysregulation" OR "affect dysregulation," retrieving 943 articles. Results: The results of the literature search are presented in the following sections: the relationship between ED and psychiatric disorders (ADHD, Mood Disorders, Psychological Trauma, Posttraumatic Stress Disorder, Non-suicidal Self-Injury, Eating Disorders, Oppositional Defiant Disorder, Conduct Disorder, Disruptive Disruptive Mood Dysregulation Disorder, Personality Disorders, Substance Use Disorder, Developmental Disorders, Autism Spectrum Disorder, Psychosis and Schizophrenia, and Gaming Disorder), prevention, and treatment of ED. Conclusion: Basic conditions of ED are genetic disposition, the experience of trauma, especially sexual or physical abuse, emotional neglect in childhood or adolescence, and personal stress. ED is a complex construct and a comprehensive concept, aggravating a number of various mental disorders. Differential treatment is mandatory for individual and social functioning.
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Affiliation(s)
- Frank W Paulus
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Susanne Ohmann
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Saarland University Medical Center, Homburg, Germany
| | - Paul Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Christian Popow
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria.,Austrian Society of Cognitive Behavioral Therapy (OeGVT), Vienna, Austria.,Department of Child and Adolescent Psychiatry and Psychotherapy, Regional Psychiatric Hospital, Mauer, Austria
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Breaux R, Langberg JM, Swanson CS, Eadeh HM, Becker SP. Variability in Positive and Negative Affect Among Adolescents with and without ADHD: Differential Associations with Functional Outcomes. J Affect Disord 2020; 274:500-507. [PMID: 32663982 PMCID: PMC8010584 DOI: 10.1016/j.jad.2020.05.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 03/25/2020] [Accepted: 05/10/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study examined whether adolescents with and without attention-deficit/hyperactivity disorder (ADHD) differed in affect variability and whether variability in positive and negative affect was associated with functional outcomes. METHOD Participants were 302 adolescents (12-14 years, Mage=13.17, 55% male; 54% diagnosed with ADHD; 82% white) and their caregivers who each completed the 10-item Positive and Negative Affect Scale via daily diaries for approximately two weeks. Multi-informant ratings of emotional, behavioral, social, and academic outcomes were assessed. RESULTS Adolescents with ADHD were found to experience greater variability in self- and parent-reported positive affect, fear, and distress. For adolescents with ADHD, greater variability in self- and parent-reported positive affect, fear, and distress were associated with more internalizing symptoms, greater variability in parent-reported positive affect was associated with worse social functioning, and greater variability in self- and parent-reported fear was associated with more externalizing symptoms. In contrast, greater variability in self- and parent-reported positive affect, fear, and distress were associated with better social functioning in adolescents without ADHD. LIMITATIONS Future work should examine affect variability in adolescents with ADHD within the same day rather than across days. The limited age range and demographic diversity of our sample may limit generalizability of findings. CONCLUSIONS Findings suggest the significant affect variability found among children with ADHD is also present in adolescents with ADHD and is associated with social and behavior impairment. Interventions for adolescents with ADHD should target emotion regulation abilities to help reduce the extremes of and shifts in affective experiences in this population.
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Affiliation(s)
- Rosanna Breaux
- Virginia Polytechnic Institute and State University, Department of Psychology.
| | | | - Courtney S Swanson
- Virginia Polytechnic Institute and State University, Department of Psychology
| | - Hana-May Eadeh
- University of Iowa, Department of Psychological and Brain Sciences
| | - Stephen P Becker
- Cincinnati Children's Hospital Medical Center, Division of Behavioral Medicine and Clinical Psychology; University of Cincinnati College of Medicine, Department of Pediatrics
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Eadeh HM, Breaux R, Langberg JM, Nikolas MA, Becker SP. Multigroup multilevel structure of the child and parent versions of the Positive and Negative Affect Schedule (PANAS) in adolescents with and without ADHD. Psychol Assess 2020; 32:374-382. [PMID: 31886686 PMCID: PMC7093246 DOI: 10.1037/pas0000796] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Positive and Negative Affect Schedule (PANAS) has been widely used to assess affect expression. Shortened and adolescent versions of the measure have been created, such as the 10-item PANAS for Children (PANAS-C). However, affect expression often involves substantial intraindividual variability, and no research has examined within-person differences using the 10-item PANAS-C. Moreover, intraindividual variability is a key characteristic of attention-deficit hyperactivity disorder (ADHD), and emotion dysregulation is a key feature of ADHD. The present study examined the factor structure of the 10-item PANAS-C in a sample of adolescents (Mage = 13.17 years) with (n = 156) and without (n = 139) ADHD. A 3-factor (Positive Affect, Fear, Distress) within and a 2-factor (Positive Affect, Negative Affect) between model was found to be best fitting using both parent and adolescent reports. The model demonstrated configural invariance for the adolescent report and scalar invariance for the parent report. These results support the multidimensionality of negative affect in youth with ADHD, even when assessed via the short-version PANAS-C. In future work, it will be important to consider the implications of more discrete types of negative affect expression (fear and distress) found across time at the individual level for assessment and intervention practice. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Hana-May Eadeh
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA
| | - Rosanna Breaux
- Department of Psychology, Virginia Polytechnic Institute and State University, Blacksburg, VA
| | - Joshua M. Langberg
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Molly A. Nikolas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA
| | - Stephen P. Becker
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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Rosen PJ, Leaberry KD, Slaughter K, Fogleman ND, Walerius DM, Loren RE, Epstein JN. Managing Frustration for Children (MFC) Group Intervention for ADHD: An Open Trial of a Novel Group Intervention for Deficient Emotion Regulation. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Miguelez-Fernandez C, de Leon SJ, Baltasar-Tello I, Peñuelas-Calvo I, Barrigon ML, Capdevila AS, Delgado-Gómez D, Baca-García E, Carballo JJ. Evaluating attention-deficit/hyperactivity disorder using ecological momentary assessment: a systematic review. ACTA ACUST UNITED AC 2018; 10:247-265. [DOI: 10.1007/s12402-018-0261-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 08/16/2018] [Indexed: 11/25/2022]
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