One in two people with ADHD experience emotional issues

Key points:

• Approximately one in every 20 Australians has attention-deficit hyperactivity disorder

• Although ADHD is more common in boys — it’s underdiagnosed in girls and adults

• In Australia, ADHD medication levels have more than doubled in the past five years

Researchers have revealed that the ADHD medication Ritalin may not be effective at treating symptoms of emotional dysregulation.

A new study, published in Nature Mental Health, shows that as many as one in two children with ADHD have signs of emotional dysregulation and the condition often persists into adulthood.

Scientists found that one in 50 children with a diagnosis of ADHD also have a mood disorder, such as depression, while more than one in four have an anxiety disorder. The research team believe these symptoms — related to poor self-control — occur independently of problems with cognition and motivation.

These findings were considered significant by researchers from Fudan University in Shanghai, China and the University of Cambridge, as verbal or physical outbursts were previously thought to result from other ADHD symptoms.

After analysing data on children and adolescents with low- and high-level ADHD symptoms, parents and guardians were asked about their emotional behaviour.

Among children with only low-level ADHD symptoms at both ages 12 and 13 years, those with high scores of emotion dysregulation at age 13 were 2.85 times more likely to have developed high-level ADHD symptoms by age 14 compared with those with a low score of emotion dysregulation.

When the researchers examined brain imaging data available for some of the participants, they discovered a particular region of the brain known as the ‘pars orbitalis’ that was smaller among children who scored highly for ADHD and emotional problems.

The pars orbitalis is at the front of the brain and plays an important role in understanding and processing emotion and communication, as well as inhibitory control over behaviour, which may explain some of the behaviours seen in ADHD.

Professor Barbara Sahakian from the Department of Psychiatry at the University of Cambridge and a Fellow of Clare Hall said the pars orbitalis is a well-connected part of the brain and, if it hasn’t developed properly, it might make it difficult for individuals to control their emotions and communicate with others appropriately, especially in social situations.

“Parents and teachers often say they have problems controlling children with ADHD and it could be that when the children can’t express themselves well — when they hit emotional difficulties — they may not be able to control their emotions and have an outburst rather than communicating with the parent, teacher or the other child,” she said.

Professor Sahakian hoped that acknowledging emotion dysregulation as a key part of ADHD could help people better understand the problems the child is experiencing. Researchers believe this could lead to using effective treatments for emotional regulation, such as cognitive behavioural therapy.

Methylphenidate, sold under the brand name ‘Ritalin,’ is often used to treat ADHD in Australia, but researchers found that the drug may not account for symptoms of emotional dysregulation.

Professor Qiang Luo from Fudan University and a Life Member at Clare Hall, Cambridge, said that if a person is not able to control their emotions, it may lead to problems socialising, which could heighten feelings of depression.

“It also might mean that you’re saying things or doing things that exacerbate a situation rather than calming it down. Teaching vulnerable individuals from an early age how to manage [their] emotions and express [themselves] could help them overcome such problems further down the line,” he said.

As seen in the Disability Support Guide on disabilities not covered by the NDIS, access to funding is not typically available to people with ADHD as a primary disability.

However, the support guide portal for therapists and specialists may help with behavioural training, ongoing support and professional development.

Additionally, the guide to creating a Behaviour Support Plan may be of value to people with ADHD or know someone with the condition, to manage cognitive, motivation and emotion regulation.

If you or someone you know lives with ADHD, do they have difficulties with emotional regulation? Let the team at Talking Disability know and subscribe to the newsletter for more information, news and industry updates.

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Education rights for students with disability

How does a Behaviour Support Plan improve quality of life?

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