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Posted November, 2012

ADHD and Severity of Emotional Dysregulation

As research on ADHD has advanced, it has become clear that children who qualify for diagnoses of ADHD vary in many important ways. As an example, children diagnosed as having ADHD may have problems of aggression, anxiety, and depression as well as attention problems. A CBCL profile pattern of elevated scores on the Aggressive Behavior, Anxious/Depressed, and Attention Problems syndromes has come to be designated as the Dysregulation Profile, which has been found to be associated with diagnoses of bipolar disorder. Because children who obtain peaks on the Aggressive Behavior, Anxious/Depressed, and Attention Problems syndromes may differ with respect to the levels of their scores, it is important to determine whether different levels of scores are associated with other important differences. To test this possibility, Joseph Biederman and colleagues (2012) compared children who had exceptionally high scores on the three syndromes defining the profile (sum of T scores on the three syndromes >2 SD above the mean, designated as "Severe Dysregulation") with children who had moderately high scores on the three scales defining the profile (sum of T scores on the three scales between 1 and 2 SD above the mean). Biederman et al. designated this less severely deviant profile as "Deficient Emotional Self-Regulation" ("DESR Profile"). Children who did not have either of these profiles were also included in the study. Children were further divided by those who did vs. did not meet diagnostic criteria for ADHD. Thirty-six percent of children with ADHD had the DESR profile, while 19% had the Severe Dysregulation profile. Children with the Severe Dysregulation Profile had significantly higher rates of unipolar and bipolar mood disorders, oppositional defiant disorders, conduct disorders, and psychiatric hospitalizations than children with the DESR Profile. The diagnostic efficiency of the Severe Dysregulation Profile was very high for prediction of current (.97) and lifetime (.89) bipolar disorder. Children with the DESR Profile had significantly higher rates of disruptive behavior, anxiety disorders, and impaired interpersonal functioning than children who were diagnosed as having ADHD but had neither the DESR Profile nor the Severe Dysregulation Profile. The authors concluded that their findings indicated that the Severe Dysregulation Profile is associated with extreme mood dysregulation, whereas the DESR Profile reflects difficulties in regulation of emotions but not dysregulation of moods.

Reference: Biederman, J., Petty, C.R., Day, H., Goldin, R. L., Spencer, T., Faraone, S. V., et al. (2012). Severity of the Aggression/Anxiety-Depression/Attention Child Behavior Checklist Profile Discriminates Between Different Levels of Deficits in Emotional Regulation in Youth With Attention-Deficit Hyperactivity Disorder. Journal of Developmental & Behavioral Pediatrics, 33, 236-243.


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