Emotional dysregulation refers to the poor ability to manage emotional responses considered in appropriate for the developmental age of the child. This can refer to any emotional state such as anger, sadness, or joy. This is a frequent presenting complaint in children with Attention Deficit Hyperactivity Disorder (ADHD).
Children with ADHD have long been recognised to have explosive behaviours, but at present these do not make up the core symptoms of ADHD or feature in the diagnostic criteria. Over time there has been an increasing interest in recognising emotional dysregulation as a core feature of ADHD, as it is a major contributor to impairment of function.
At present there is no standardised test of emotional regulation, though the Behaviour Rating Inventory of Executive Functioning (BRIEF) which is made up of Behavioural Regulation and Metacognition does so partly. The first component of the BRIEF comprises elements of emotional dysregulation which have been looked at in children with ADHD. It does not tell the whole story.
What we know is that the processing of emotions is impaired in those with ADHD. Sometimes the inability to regulate the emotion can lead to internalising symptoms such as withdrawal or sadness. At other times dysregulation leads to externalising symptoms such as aggression, argumentative or volatile explosions.
It appears that there are many factors in ADHD as to how it presents or is modified in the individual from temperament to environment. This is reflected in the multiple pathway models of the disorder. This confirms to me what I see clinically that no two children with ADHD are the same.
Our understanding of emotional regulation is incomplete, we do not have a good measure available. We are left with listening carefully to the parents of the children we see and finding other observers’ information to supplement this data to enable a clear clinical picture to develop.
There may be improvement in emotional regulation with treatment of ADHD pharmacologically (or with medication), however this does not address the impairment in cognitive control skills. Cognitive skills to help regulate emotions are still needed with the help of the parents, or a trained therapist.
Emotional dysregulation does not always mean ADHD, and ADHD is not always accompanied with emotional dysregulation. Medication for ADHD may help with emotional regulation, but this should not be the sole reason for treating, nor should it be the only modality.
References:
Schneider H, Ryan M, Mahone M. 2019. "parent versus teacher ratings on the BRIEF - preschool version in children with and without ADHD." Child Neuropsychology 113-128.
Stralen, Judy van. 2016. "Emotional dyregulation inchildren with attention deficit hyperactivity disorder." Attention Deficit Hyperactivity Disorder 175-187.