Combination of ADHD and poor emotional control runs in families

May 5, 2011

A subgroup of adults with attention-deficit hyperactivity disorder (ADHD) also exhibit excessive emotional reactions to everyday occurrences, and this combination of ADHD and emotional reactivity appears to run in families. A study from a Massachusetts General Hospital (MGH)-based research team finds that siblings of individuals with both ADHD and deficient emotional self-regulation (DESR) had a significantly greater risk of having both conditions than did siblings of those with ADHD alone. The study, which will appear in the American Journal of Psychiatry, has received early online release.

"Our research offers strong evidence that heritable factors influence how we control our emotions," says Craig Surman, MD, of the MGH Pediatric Psychopharmacology and Adult Program, the study's lead author. "Emotion – like capacities such as the ability to pay attention or control physical movement – is probably under forms of brain control that we are just beginning to understand. Our findings also indicate that ADHD doesn't just impact things like reading, listening and getting the bills paid on time; it also can impact how people regulate themselves more broadly, including their emotional expression."

Along with the classic ADHD symptoms of trouble paying attention, excessive physical activity and poor impulse control, many individuals with ADHD display high levels of anger, frustration and impatience. In contrast to mood disorders, which are characterized by the persistence of specific emotions and behaviors, DESR involves emotional expressions that are brief and occur in reaction to situations that would be expected to produce similar but much less extreme responses in most individuals. For example, an individual who consistently reacts to minor disappointments by snapping at family members or co-workers or who displays great distress in response to small inconveniences may have DESR.

While some investigators have proposed that poor emotional control be included among the defining symptoms of ADHD, previous studies have not clarified whether the two conditions are separate conditions that appear together by chance or if they are related. Also previously unknown was whether DESR is transmitted among family members, something that is well known to be the case for ADHD.

The current study began with a group of 83 participants – 23 with ADHD alone, 27 with ADHD plus DESR, and 33 comparison participants with neither condition – and then enrolled one or more siblings of each of the original participants. Researchers conducted standardized diagnostic interviews with all participants to determine whether they met the criteria for ADHD and other mental health conditions. Diagnoses were confirmed by expert clinicians who were blinded to participants' diagnoses or their sibling status. Participants also reported their current frequency of DESR-associated symptoms and were determined to have DESR if their control of was worse than that of 95 percent of a large group of individuals without ADHD, which included the comparison sample in this study.

As expected, ADHD was more common, in the siblings of original participants with ADHD than in the comparison group. However, co-occurrence of both ADHD and DESR was found almost exclusively among siblings of the original participants who reported both conditions.

"Other research that we and another group have conducted found that individuals with ADHD who also display emotional overreaction have a reduced quality of life and difficulties with personal relationships and social success," Surman says. "Studies have shown that 4 percent of the adult population has ADHD, and this investigation is part of a larger study that found DESR in more than half of the enrolled adults with ADHD, suggesting that roughly 5 million adults in the U.S. may have the combination of ADHD and poor emotional control."

He adds, "Increased recognition of emotional dysregulation, its frequency in adults with ADHD and the potential consequences of both conditions will help people get support for these challenges. Future research needs to examine both medication- and non-medication-based therapies and improve our understanding of who could benefit from these therapies." Surman is an instructor in Psychiatry at Harvard Medical School.

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