Practitioner Review: Emotional dysregulation in attention‐deficit/hyperactivity disorder – implications for clinical recognition and intervention

<jats:sec><jats:title>Background</jats:title><jats:p>Because emotional symptoms are common in attention‐deficit/hyperactivity disorder (<jats:styled-content style="fixed-case">ADHD</jats:styled-content>) patients and associate with much morbidity, some consider it to be a core feature rather than an associated trait. Others argue that emotional symptoms are too nonspecific for use as diagnostic criteria. This debate has been difficult to resolve due, in part, to the many terms used to describe emotional symptoms in <jats:styled-content style="fixed-case">ADHD</jats:styled-content> and to concerns about overlap with mood disorders.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We sought to clarify the nature of emotional symptoms in <jats:styled-content style="fixed-case">ADHD</jats:styled-content> by reviewing conceptual and measurement issues and by examining the evidence base regarding specificity of such symptoms for <jats:styled-content style="fixed-case">ADHD</jats:styled-content>. We reviewed the various terms used to define emotional symptoms in <jats:styled-content style="fixed-case">ADHD</jats:styled-content>, clarify how these symptoms are demarcated from mood disorders, and assess the possibility that symptoms of emotional impulsivity and deficient emotional self‐regulation should be considered as core symptoms. We addressed psychiatric comorbidities, the effects of <jats:styled-content style="fixed-case">ADHD</jats:styled-content> treatments on associated emotional dysregulation, and the utility of current rating scales to assess emotional symptoms associated with <jats:styled-content style="fixed-case">ADHD</jats:styled-content>.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Emotional symptoms are common and persistent in youth and adults with <jats:styled-content style="fixed-case">ADHD</jats:styled-content>. Although emotional symptoms are common in other psychiatric disorders, emotional impulsivity (<jats:styled-content style="fixed-case">EI</jats:styled-content>), and deficient emotional self‐regulation (<jats:styled-content style="fixed-case">DESR</jats:styled-content>) may be sufficiently specific for <jats:styled-content style="fixed-case">ADHD</jats:styled-content> to function as diagnostic criteria.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Emotional symptoms in <jats:styled-content style="fixed-case">ADHD</jats:styled-content> cause clinically significant impairments. Although there is a solid theoretical rationale for considering <jats:styled-content style="fixed-case">EI</jats:styled-content> and <jats:styled-content style="fixed-case">DESR</jats:styled-content> to be core symptoms of <jats:styled-content style="fixed-case">ADHD</jats:styled-content>, there is no consensus about how to define these constructs sin a manner that would be specific to the disorder. An instrument to measure <jats:styled-content style="fixed-case">EI</jats:styled-content> and <jats:styled-content style="fixed-case">DESR</jats:styled-content> which demarcates them from irritability and other emotional symptoms could improve the accuracy of diagnostic criteria for <jats:styled-content style="fixed-case">ADHD</jats:styled-content>.</jats:p></jats:sec>