Executive function and clinical characteristics in children with attention-deficit hyperactivity disorder and emotional dysregulation

Abstract

BackgroundComorbid attention-deficit/hyperactivity disorder （ADHD） and emotional dysregulation may represent a distinct subtype of ADHD， which is characterized by an increased risk of anxiety or depressive disorder and a poor clinical prognosis， so research is urgently required to explore its unique executive functioning profile and clinical characteristics. However， there is limited research comparing the clinical symptoms and executive function in children with ADHD in terms of the presence or absence of emotional dysregulation.ObjectiveTo explore the executive function and clinical characteristics of ADHD children with emotional dysregulation.MethodsFrom June 2020 to December 2023， 118 children aged 7 to 12 with ADHD attending the Mental Health Center of West China Hospital， Sichuan University and fulfilling the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） diagnostic criteria were enrolled. Children were classified into emotional dysregulation group （n=68） and non-emotional dysregulation group （n=50） based on the standard T-scores of Achenbach's Child Behavior Checklist （CBCL）- anxious/depressed， aggressive behavior and attention problems subscales. All children were then subjected to complete the Chinese version of Swanson Nolan and Pelham，Version IV Scale-parent form （SNAP-IV）， Chinese Wechsler Intelligence Scale for Children （C-WISC）， Weiss Functional Impairment Scale-Parent form （WFIRS-P） and 4 tests of the Cambridge Neuropsychological Test Automated Battery （CANTAB）： ①Stockings of Cambridge （SOC） testing spatial planning. ②Intradimensional-extradimensional Set Shifting（IED） testing cognitive/attentional flexibility， adjusting the total errors across the task. ③Spatial Working Memory （SWM） testing spatial working memory. ④Rapid Visual Information Processing （RVP） testing sustained attention.ResultsThe SNAP-IV Inattention， Hyperactivity/Impulsivity and Oppositional Defiant Disorder domain scores and total score were all higher in emotional dysregulation group compared with non-emotional dysregulation group （t=3.206， 5.088， 6.316， 6.553， P<0.01）. The WFIRS-P family， school learning， life skills， self-concept， social activities and risky activities domain scores and total score were all higher in emotional dysregulation group compared with non-emotional dysregulation group （t=6.074， 4.406， 4.143， 3.984， 6.575， 6.662， 8.254， P<0.01）. In CANTAB， emotional dysregulation group made more total adjusted errors across the IED task compared with non-emotional dysregulation group （t=2.168， P<0.05）.ConclusionChildren with ADHD who exhibit emotional dysregulation have been observed to experience more severe core symptoms， impaired social functioning and poorer performance on tests assessing executive function， particularly in the area of cognitive flexibility. ［Funded by 1·3·5 Project for Disciplines of Excellence-Clinical Research Incubation Project， West China Hospital， Sichuan University （number， 2018HXFH045）]

Keywords

• attention-deficit/hyperactivity disorder
• emotional dysregulation
• clinical symptoms
• executive function