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Emotional Dysregulation and ADHD

Updated: Jun 1

Emotional Dysregulation a Core of ADHD or

Just a Reaction to Another Distraction



The overreaction and ensuing emotional dysregulation are devastating to indiviudals and families.


What is Emotion Dysregulation?

Emotion Dysregulation may be thought of as the inability to manage the intensity and duration of negative emotions such as fear, sadness, or anger. If you are struggling with emotion regulation, an upsetting situation will bring about strongly felt emotions that are difficult to recover from. The effects of a prolonged negative emotion may be physically, emotionally, and behaviorally intense. ( Franco, F. (2018). What Is Affect or Emotion Dysregulation?. Psych Central. Retrieved on March 21, 2019, from https://

psychcentral. com/blog/what is affect or emotion dysregulation/)


Emotional Dysregulation a Core of ADHD or

Just a Reaction to Another Distraction

by Robert Rigg


Attention deficit hyperactivity disorder (ADHD) has been a controversial topic among families, educators, and politicians for a number of years. The debate usually centers on whether ADHD is truly a disorder or something parents, educators and pharmaceutical companies promote to satisfy their own needs. (Quinn, & Lynch, 2016). Psychologists and researchers accept ADHD as a true disorder that can have a damaging effect on a person’s professional and personal life. The affect ADHD has on marriage is discussed and debated to a lesser extent than the big debate noted above. Many believe that ADHD has a strong negative effect on the ability for a married couple to stay in an emotionally healthy place without the emotional turmoil that ADHD can cause. One of the greatest problems that ADHD presents to a marriage is the emotional disconnect that ADHD creates do to emotional dysregulation exhibited by the ADHD spouse. Arguments, feelings of isolation, abandonment and other problems seem to arise in higher rate in marriages affected by ADHD. (Orlov, 2010).


For the purposes of this critique we will take the affirmative hypothesis that ADHD is a true disorder as it its listed in the DSM-V. (American Psychiatric Association, 2013). New controversies have developed out of the ADHD debate. Over time there has been disagreement on whether “emotional dysregulation is an important feature of ADHD” (Mitchell, J.T., et al., 2012) or as stated by Shaw, Stringaris, Nigg, and Leibenluft (2014), “emotional dysregulation is a dimensional entity, not a categorical diagnosis” (P.1) that coexists with ADHD and sometimes has a correlation with ADHD. (Shaw, 2014). At first appearances one may think these two research articles have only subtle differences. But the response to these statements may have a great influence on the type of ADHD treatment scientist, researchers and clinicians will study, develop and implement in the future. It is highly important to the harmony of marriages and families who are affected by ADHD that the research and counseling communities find the best answers for this problem.

When addressing ADHD and emotional dysregulation the Shaw (2014) study states,

Emotion dysregulation is a dimensional trait that is not unique to ADHD; rather, it undercuts the traditional divide between internalizing and externalizing diagnoses and, indeed, may partly explain their high correlation. (P.276).


Whereas the Mitchell (2012) study relates the following thought,


Empirical support for the inclusion of emotion dysregulation as a core feature of the

disorder comes from several sources…According to one account of emotion

dysregulation in ADHD (Barkley 2010), those with the disorder are less likely to inhibit

their emotions, particularly those pertaining to frustration, impatience, and anger, as a

result of deficient cognitive control. (P. 2)


Finding the best answer to the question, do we treat ADHD patients who experience emotional dysregulation as one disorder as the Mitchell study would indicate or do we separate the two and treat ADHD independent of emotional dysregulation as the Shaw report supports?



History of ADHD and Emotional Dysregulation


As far back as 1798 one can find evidence of identifying a disorder that resembles ADHD. Sir Alexander Crichton formulated the idea that dysfunction in attention could be studied and diagnosed. His observations echo the idea even back in the 18 century. Lange (2012) reports this thought from Crichton,


On Attention and its ‘When any object of external sense, or of thought, occupies the

mind in such a degree that a person does not receive a clear perception from any

other one, he is said to attend to it The morbid alterations to which attention is

subject, may all be reduced under the two following heads: First. The incapacity of

attending with a necessary degree of constancy to any one object. Second. A total

suspension of its effects on the brain. The incapacity of attending with a necessary

degree of constancy to any one object, almost always arises from an unnatural or

morbid sensibility of the nerves, by which means this faculty is incessantly withdrawn

from one impression to another. It may be either born with a person, or it may be the

effect of accidental diseases. (Crichton 1798, reprint p. 200)


Later in 1902 Sir George Still made a statement that predates our modern version of ADHD by over 100 years when he related that he noticed “an abnormal defect of moral control in children.” (Lange, 2012, P. 245). Once again one can see the early reference to lack of control. The ADHD history is interesting in that there is a long term connection between older observations and the modern DSM-5 symptoms of ADHD.


As early as 1932 the symptoms of ADHD were being listed and recognized in a report by Kramer and Pollnow “on a hyperkinetic disease of infancy’’. They report symptoms similar to the modern DSM determiners such as driven by a motor, unable to sit still, easily distracted, and attention difficulties. (Lange, 2012, P. 247). The findings of Kramer and Pollnow seem to support the inclusion of emotional dysregulation as symptomatic as stated in this observation by Lange (2012),


Kramer and Pollnow observations included, “the children are unstable in their mood.

They observed an increased excitability, frequent fits of rage, and a tendency to

become aggressive or to burst into tears for marginal reasons (Kramer and Pollnow

1932, p. 11). These are characteristic signs of impulsivity, and all main symptoms of

ADHD are therefore, present in the record of Kramer and Pollnow. (P. 248)


In 1952 the first version of the “Diagnostic and Statistical Manual of Mental Disorders” was produced by the APA. This first version did not include a diagnosis for ADHD. That award goes to the DSM-2 published in 1968 which included “hyper-kinetic impulse disorder” diagnosed by these symptoms over activity, restlessness, distractability, and short attention span. The DSM-2 did not include a reference to emotional symptoms. (American Psychiatric Association, 1968).


The Shaw research report that supports separating emotional dysregulation from a strong attachment to ADHD is weekend by its own observation that emotional dysregulation was added to the 1980 DSM III description of ADHD (Shaw, 2014, P. 2).


The historical perspective of ADHD research and treatment unfolds along the same lines as the progress of psychology in general. Definitions, diagnosis, and treatment theories for ADHD have become more defined and detailed as the field of psychology matures. From 1798 Crichton report to 2013 DSM-5 ADHD and its forerunners have gone through scrutiny, research, peer review, public debate and discussion, reevaluation and ongoing experimentation. As psychology matures and improves its theories also change to serve mankind better and with higher moral and ethical standards.


The APA code of ethics is the foundation for the psychology professions. The six defining principals of the Code of Ethics: competence, integrity, professional and scientific responsibility, respect for people’s rights and dignity, concern for others’ welfare and social responsibility are the foundation for the moral and ethical responsibility of the psychology field. The progression of practices relating to ADHD have followed the progression of the APA code of ethics (American Psychological Association, 2010).


Thoughts


ADHD is a serious disorder that can have negative effects on a person’s life. (Orlov, 2010). Emotional dysregulation can be devastating to professional, familial, and social relationships. Emotional competence and deficits often disrupt interpersonal interactions. ADHD and emotional dysregulation are identified together often in research studies (Rapport, Friedman, Tzelepis, & Van Voorhis, 2002, P.1). From early on the identification of ADHD like disorders connected with emotional dysregulation such as referenced in the Crichton report (Lange, 2012) to the more recent findings in research reports such as the (Mitchell, et al., 2012) which support combining research and treatment of emotional dysregulation and ADHD to help those who suffer.


The Shaw (2014) report has difficulty making the point that it will serve the ADHD person, their marriage and family well to separate ADHD research and treatment from emotional dysregulation research and treatment. The Shaw report falls into the either/or logical fallacy as the report assumes that treating ADHD with the inclusion of emotion dysregulation as a core feature of ADHD cannot coexist with the idea emotional dysregulation is a dimensional trait that is not unique to ADHD. Shaw (2014) states,


We focus on emotion dysregulation itself, rather than on diagnoses that may include

emotion dysregulation and be comorbid with ADHD, because it is a simpler symptom

construct that is familiar to clinicians and, consistent with the Research Domain Criteria

initiative, may be more readily tied to underlying neurobiological mechanisms. (P.1)


The APA code of ethics requires that we follow a path that will do no harm to the client.

If clinicians were to follow the logic of the Shaw et. el. report, they may miss the best opportunity to help the client (American Psychological Association, 2010). On the other hand, the Mitchell (2012) report supports addressing emotional dysregulation as a core feature of ADHD and therefore they should be researched and treated together to support the best outcome for the ADHD affected person and family. If the code of ethics holds the clinician to the highest moral and ethical standards, then the Mitchell (2012) report supports this concept.


Conclusion


The affect ADHD has on individuals, families, friendships, employer and employee can be devastating. One of the greatest barrier to the healing of those relationships is the emotional disconnect and irritability that the person with ADHD has to walk with every day (Ben-Naim, Marom, Krashin, Gifter, & Arad, 2016). Emotion dysregulation can be the cause for emotional disconnect, misunderstandings, irritability, anger and more. Emotional dysregulation is a core component of many ADHD diagnosis (Rapport, et. El. 2002, P.1). In conclusion the resources investigated support the Mitchell reports hypothesis that emotional dysregulation is a core feature of ADHD and should be researched and treated together in most cases to give the ADHD person the best opportunity to live a healthy life with healthy relationships.


One thing we do know is that ADHD is hard on individuals and families. At the same time emotion dysregulation is also hard for individuals and families. Whether one is a subset of the other may be continually debated, but ignoring one and/or the other is not healthy for individuals and there loved ones.










References


American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders

(2nd ed.). Washington, D.C.: Author. Retrieved from:

http://www.behaviorismandmentalhealth.com/wp-content/7 uploads/2015/08/DSM-II.pdf

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders

(3nd ed.). Washington, D.C.: Author. Retrieved from: https://behavenet.com/diagnostic-

and-statistical-manual-mental-disorders-third-edition

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(DSM-5). American Psychiatric Pub.

American Psychological Association. (2010). Ethical principles of psychologists and code of

conduct. Retrieved from: http://www.apa.org/ethics/code/

Barkley, R. A. (1982). Guidelines for defining hyperactivity in children: Attention deficit

disorder with hyperactivity,” In B. Lahey & Kazdin (Eds.), Advances in Child Clinical

Psychology, New York: Plenum.

Ben-Naim, S., Marom, I., Krashin, M., Gifter, B., & Arad, K. (2016). Life with a partner with

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DOI 10.1007/s10826-016-0653-9

Lange, K. W., Reichl, S., Lange, K. M., Tucha, L., & Tucha, O. (2010). The history of attention

deficit hyperactivity disorder. Attention Deficit and Hyperactivity Disorders, 2(4), 241–

255. http://doi.org/10.1007/s12402-010-0045-8

Mitchell, J.T., Robertson, C.D., Anastopolous, A.D. Nelson-Gray & Kollins, S. H. (2012)

Emotion dysregulation and emotional impulsivity among adults with attention-

deficit/hyperactivity disorder: Results of a preliminary study. Journal of Psychopathology

and Behavioral Assessment 34. 1-22. doi:10.1007/s10862-012-9297-2

Orlov, M. (2010). The ADHD effect on marriage: Understand and rebuild your relationship in

six steps. Plantation Fl.: Specialty Press, Inc.

Quinn, M., & Lynch, A. (2016). Is ADHD a ‘real’ disorder? Support For Learning, 31(1), 59-70

Doi:10.1111/1467-9604.12114

Rapport, L. J., Friedman, S.L., Tzelepis, A., & Van Voorhis, A. (2002). Experienced emotion

and affect recognition in adult attention-deficit hyperactivity disorder. Neuropsychology,

16(1), 102-110. doi:10.1037/0894-4105.16.1.102

Shaw, P., Stringaris, A., Nigg, J. & Leibenluft, E. (2014). Emotion dysregulation in attention

deficit hyperactivity disorder American Journal of Psychiatry171:3, 276-293. Retrieved

from: https://doi.org/10.1176/appi.ajp.2013.13070966

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