Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2021

01-12-2021 | Attention Deficit Hyperactivity Disorder | Research

Emotional dysregulation and health related quality of life in young adults with ADHD: a cross sectional study

Authors: Maayan Ben-Dor Cohen, Eran Eldar, Adina Maeir, Mor Nahum

Published in: Health and Quality of Life Outcomes | Issue 1/2021

Login to get access

Abstract

Objective

Attention Deficit Hyperactivity Disorder (ADHD) is associated with emotional dysregulation (ED) and impaired health related quality of life (HRQoL). However, the role of ED in explaining the relationship between ADHD and HRQoL is unclear. The purpose of the present study was to do so in a sample of non-referred young adults with and without ADHD.

Method

The study design was cross-sectional. A non-clinical sample of 63 young adults with ADHD (mean age = 24.86 years, SD = 3.25, 78% university students) and 69 gender-matched controls (mean age = 23.84 years, SD = 2.59, 89% university students) were recruited. The Adult ADHD Quality-of-Life scale was used to measure HRQoL; The Self-Report Wender–Reimherr Adult Attention Deficit Disorder Scale and the Difficulties in Emotion Regulation Scale were used to measure ED. Group differences on all measures were tested using univariate and multivariate analyses of covariance, while controlling for age. Finally, a moderation analysis was used in order to examine the impact of ED on HRQoL beyond that accounted for by ADHD symptoms.

Results

Both HRQoL and ED were significantly worse for the ADHD group compared to the control group. The medication status of the ADHD group participants had no significant effect on the level of ADHD symptoms, ED or HRQoL. ED moderated the effect of ADHD symptoms on HRQoL for the ADHD group.

Conclusion

The findings support the centrality of ED in ADHD and its crucial influence on HRQoL. Young adults with ADHD and high levels of ED are at risk for aversive impact on their well-being regardless of their ADHD symptoms level.
Literature
1.
The World Health Organization quality of life assessment (WHOQOL). Position paper from the World Health Organization. Soc Sci Med. 1995;41(10):1403–9.CrossRef
2.
Wehmeier PM, Schacht A, Barkley RA. Social and emotional impairment in children and adolescents with ADHD and the impact on quality of life. J Adolesc Health. 2010;46(3):209–17.PubMedCrossRef
3.
Karimi M, Brazier J. Health, health-related quality of life, and quality of life: what is the difference? Pharmacoeconomics. 2016;34(7):645–9.PubMedCrossRef
4.
ICF. International classification of functioning, disability and health. Geneva: World Health Organization; 2001.
5.
Brod M, Perwien A, Adler L, Spencer T, Johnston J. Conceptualization and assessment of quality of life for adults with attention-deficit/hyperactivity disorder. Prim Psychiatry. 2005;12(6):58–64.
6.
Goffer A, Cohen M, Berger I, Maeir A. Beyond academic outcomes: occupational profile and quality of life among college students with and without attention deficit hyperactivity disorder. Br J Occup Ther. 2019;82(3):170–8.CrossRef
7.
Stern A, Pollak Y, Bonne O, Malik E, Maeir A. The relationship between executive functions and quality of life in adults with ADHD. J Atten Disord. 2017;21(4):323–30.PubMedCrossRef
8.
Stern A, Maeir A, Pollak Y, Bonne O, Malik E, Maeir A. The relationship between executive functions and quality of life in adults with ADHD. J Atten Disord. 2013;68(6):1087054713504133.
9.
Rotenberg Shpigelman S, Sternberg S, Maeir A. Beyond memory problems: multiple obstacles to health and quality of life in older people seeking help for subjective memory complaints. Disabil Rehabil. 2019;41(1):19–25.PubMedCrossRef
10.
Gjervan B, Hjemdal O, Nordahl HM. Functional impairment mediates the relationship between adult ADHD inattentiveness and occupational outcome. J Atten Disord. 2016;20(6):510–8.PubMedCrossRef
11.
Fride Y, Adamit T, Maeir A, Ben Assayag E, Bornstein NM, Korczyn AD, et al. What are the correlates of cognition and participation to return to work after first ever mild stroke. Top Stroke Rehabil. 2015;22(5):317–25.PubMedCrossRef
12.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Philadelphia: American Journal of Psychiatry, American Psychiatric Association; 2013. p. 991.CrossRef
13.
14.
Matza LS, Johnston JA, Faries DE, Malley KG, Brod M. Responsiveness of the Adult Attention-Deficit/Hyperactivity Disorder Quality of Life Scale (AAQoL). Qual Life Res. 2007;16(9):1511–20.PubMedCrossRef
15.
Quintero J, Morales I, Vera R, Zuluaga P, Fernández A. The impact of adult ADHD in the quality of life profile. J Atten Disord. 2019;23(9):1007–16.PubMedCrossRef
16.
Pinho TD, Manz PH, DuPaul GJ, Anastopoulos AD, Weyandt LL. Predictors and moderators of quality of life among college students with ADHD. J Atten Disord. 2019;23(14):1736–45.PubMedCrossRef
17.
Joseph A, Kosmas CE, Patel C, Doll H, Asherson P. Health-related quality of life and work productivity of adults with ADHD: a U.K. web-based cross-sectional survey. J Atten Disord. 2019;23(13):1610–23.PubMedCrossRef
18.
Gjervan B, Torgersen T, Rasmussen K, Nordahl HM. ADHD symptoms are differentially related to specific aspects of quality of life. J Atten Disord. 2014;18(7):598–606.PubMedCrossRef
19.
20.
Agarwal R, Goldenberg M, Perry R, Ishak WW. The quality of life of adults with attention deficit hyperactivity disorder: a systematic review. Innov Clin Neurosci. 2012;9(5–6):10–21.PubMedPubMedCentral
21.
Mattos P, Louzã MR, Palmini ALF, de Oliveira IR, Rocha FL. A multicenter, open-label trial to evaluate the quality of life in adults with ADHD treated with long-acting methylphenidate (OROS MPH): Concerta Quality of Life (CONQoL) study. J Atten Disord. 2013;17(5):444–8.PubMedCrossRef
22.
Adler LA, Liebowitz M, Kronenberger W, Qiao M, Rubin R, Hollandbeck M, et al. Atomoxetine treatment in adults with attention-deficit/hyperactivity disorder and comorbid social anxiety disorder. Depress Anxiety. 2009;26(3):212–21.PubMedCrossRef
23.
Faraone SV, Asherson P, Banaschewski T, Biederman J, Ramos-quiroga JA, Rohde LA, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Prim. 2015;1:1–23.
24.
Mulraney M, Giallo R, Sciberras E, Lycett K, Mensah F, Coghill D. ADHD symptoms and quality of life across a 12-month period in children with ADHD: a longitudinal study. J Atten Disord. 2019;23(13):1675–85.PubMedCrossRef
25.
26.
Asherson P, Buitelaar J, Faraone SV, Rohde LA. Adult attention-deficit hyperactivity disorder: key conceptual issues. Lancet Psychiatry. 2016;3(6):568–78.PubMedCrossRef
27.
Barkley RA, Fischer M. The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. J Am Acad Child Adolesc Psychiatry. 2010;49(5):503–13.PubMed
28.
Barkley RA, Murphy KR. Deficient emotional self-regulation in adults with ADHD: the relative contributions of emotional impulsiveness and ADHD symptoms to adaptive impairments in major life activities. J ADHD Relat Disord. 2010;1(4):5–28.
29.
Corbisiero S, Mörstedt B, Bitto H, Stieglitz RD. Emotional dysregulation in adults with attention-deficit/hyperactivity disorder-validity, predictability, severity, and comorbidity. J Clin Psychol. 2017;73(1):99–112.PubMedCrossRef
30.
Reimherr FW, Marchant BK, Strong RE, Hedges DW, Adler L, Spencer TJ, et al. Emotional dysregulation in adult ADHD and response to atomoxetine. Biol Psychiatry. 2005;58(2):125–31.PubMedCrossRef
31.
Reimherr FW, Marchant BK, Olsen JL, Williams ED, Robison RJ. Emotional dysregulation as a core feature of adult ADHD: its relationship with clinical variables and treatment response in two methylphenidate trials. J ADHD Relat Disord. 2010;1(4):53.
32.
Skirrow C, McLoughlin G, Kuntsi J, Asherson P. Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Rev Neurother. 2009;9(4):489–503.PubMedCrossRef
33.
Faraone SV, Rostain AL, Blader J, Busch B, Childress AC, Connor DF, et al. Practitioner review: emotional dysregulation in attention-deficit/hyperactivity disorder—implications for clinical recognition and intervention. J Child Psychol Psychiatry Allied Discip. 2019;60(2):133–50.CrossRef
34.
Marchant BK, Reimherr FW, Wender PH, Gift TE. Psychometric properties of the Self-Report Wender–Reimherr Adult Attention Deficit Disorder Scale. Ann Clin Psychiatry. 2015;27(4):267–77.PubMed
35.
Barkley RA. Emotional dysregulation is a core component of ADHD. In: Barkley RA, editor. Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. 4th ed. New York: The Guilford Press; 2015. p. 81–115.
36.
Skirrow C, Asherson P. Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. J Affect Disord. 2013;147(1–3):80–6.PubMedCrossRef
37.
Reimherr FW, Roesler M, Marchant BK, Gift TE, Retz W, Philipp-Wiegmann F, et al. Types of adult attention-deficit/hyperactivity disorder: a replication analysis. J Clin Psychiatry. 2020;81(2):19m13077.PubMedCrossRef
38.
Rösler M, Retz W, Fischer R, Ose C, Alm B, Deckert J, et al. Twenty-four-week treatment with extended release methylphenidate improves emotional symptoms in adult ADHD. World J Biol Psychiatry. 2010;11(5):709–18.PubMedCrossRef
39.
Retz W, Rösler M, Ose C, Scherag A, Alm B, Philipsen A, et al. Multiscale assessment of treatment efficacy in adults with ADHD: a randomized placebo-controlled, multi-centre study with extended-release methylphenidate. World J Biol Psychiatry. 2012;13(1):48–59.PubMedCrossRef
40.
Rostain AL, Ramsay JR. A combined treatment approach for adults with ADHD—results of an open study of 43 patients. J Atten Disord. 2006;10(2):150–9.PubMedCrossRef
41.
Solanto MV, Marks DJ, Mitchell KJ, Wasserstein J, Kofman MD. Development of a new psychosocial treatment for adult ADHD. J Atten Disord. 2008;11(6):728–36.PubMedCrossRef
42.
Virta M, Vedenpää A, Grönroos N, Chydenius E, Partinen M, Vataja R, et al. Adults with ADHD benefit from cognitive-behaviorally oriented group rehabilitation: a study of 29 participants. J Atten Disord. 2008;12(3):218–26.PubMedCrossRef
43.
Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation. J Psychopathol Behav Assess. 2004;26(1):41–54.CrossRef
44.
Surman CBH, Biederman J, Spencer T, Miller CA, McDermott KM, Faraone SV. Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: a controlled study. ADHD Atten Deficit Hyperact Disord. 2013;5(3):273–81.CrossRef
45.
Bodalski EA, Knouse LE, Kovalev D. Adult ADHD, emotion dysregulation, and functional outcomes: examining the role of emotion regulation strategies. J Psychopathol Behav Assess. 2019;41(1):81–92.CrossRef
46.
Bruner MR, Kuryluk AD, Whitton SW. Attention-deficit/hyperactivity disorder symptom levels and romantic relationship quality in college students. J Am Coll Heal. 2015;63(2):98–108.CrossRef
47.
Biederman J, DiSalvo M, Woodworth KY, Fried R, Uchida M, Biederman I, et al. Toward operationalizing deficient emotional self-regulation in newly referred adults with ADHD: a receiver operator characteristic curve analysis. Eur Psychiatry. 2020;63(1):e21.PubMedPubMedCentralCrossRef
48.
Thorell LB, Holst Y, Sjöwall D. Quality of life in older adults with ADHD: links to ADHD symptom levels and executive functioning deficits. Nord J Psychiatry. 2019;73(7):409–16.PubMedCrossRef
49.
Zohar AH, Konfortes H. Diagnosing ADHD in Israeli adults: The psychometric properties of the adult ADHD self report scale (ASRS) in Hebrew. Isr J Psychiatry Relat Sci. 2010;47(4):308–13.PubMed
50.
Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245–56.PubMedCrossRef
51.
American Psychiatric Association [APA]. DSM-IV. Diagnostic and statistical manual of mental disorders. 4th ed. Philadelphia: American Psychiatric Association; 2000. (text rev.).
52.
Corbisiero S, Mörstedt B, Bitto H, Stieglitz RD. Emotional dysregulation in adults with attention-deficit/hyperactivity disorder-validity, predictability, severity, and comorbidity. J Clin Psychol. 2017;73(1):99–112.PubMedCrossRef
53.
Marchant BK, Reimherr FW, Robison D, Robison RJ, Wender PH. Psychometric properties of the Wender–Reimherr Adult Attention Deficit Disorder Scale. Psychol Assess. 2013;25(3):942–50.PubMedCrossRef
54.
Reimherr FW, Williams ED, Strong RE, Mestas R, Soni P, Marchant BK. A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. J Clin Psychiatry. 2007;68(1):93–101.PubMedCrossRef
55.
Segal A. Differences in emotion regulation along the eating disorder spectrum: cross sectional study in adolescents out patient care. J Psychol Clin Psychiatry. 2016;6(1):1.CrossRef
56.
Gjervan B, Torgersen T, Hjemdal O. The Norwegian translation of the adult attention-deficit/hyperactivity disorder quality of life scale: validation and assessment of QoL in 313 adults with ADHD. J Atten Disord. 2019;23(9):931–9.PubMedCrossRef
57.
Brod M, Adler LA, Lipsius S, Tanaka Y, Heinloth AN, Upadhyaya H. Validation of the adult attention-deficit/hyperactivity disorder quality-of-life scale in European patients: comparison with patients from the USA. ADHD Atten Deficit Hyperact Disord. 2015;7(2):141–50.CrossRef
58.
IBM Corp. IBM SPSS statistics for Windows, Version 25.0. Armonk, NY: IBM Corp; 2017.
59.
Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: The Guilford Press; 2013.
60.
Van Eck K, Ballard E, Hart S, Newcomer A, Musci R, Flory K. ADHD and suicidal ideation: the roles of emotion regulation and depressive symptoms among college students. J Atten Disord. 2015;19(8):703–14.PubMedCrossRef
61.
Hirsch O, Chavanon ML, Riechmann E, Christiansen H. Emotional dysregulation is a primary symptom in adult Attention-Deficit/Hyperactivity Disorder (ADHD). J Affect Disord. 2018;232(January):41–7.PubMedCrossRef
62.
Beheshti A, Chavanon ML, Christiansen H. Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry. 2020;20(1):1–11.CrossRef
63.
Hirsch O, Chavanon ML, Christiansen H. Emotional dysregulation subgroups in patients with adult Attention-Deficit/Hyperactivity Disorder (ADHD): a cluster analytic approach. Sci Rep. 2019;9(1):1–11.CrossRef
64.
Cunill R, Castells X, Tobias A, Capellà D. Efficacy, safety and variability in pharmacotherapy for adults with attention deficit hyperactivity disorder: a meta-analysis and meta-regression in over 9000 patients. Psychopharmacology. 2016;233(2):187–97.PubMedCrossRef
65.
Lenzi F, Cortese S, Harris J, Masi G. Pharmacotherapy of emotional dysregulation in adults with ADHD: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2018;84:359–67.PubMedCrossRef
66.
Moukhtarian TR, Cooper RE, Vassos E, Moran P, Asherson P. Effects of stimulants and atomoxetine on emotional lability in adults: a systematic review and meta-analysis. Eur Psychiatry. 2017;44:198–207.PubMedCrossRef
67.
Coghill DR, Banaschewski T, Soutullo C, Cottingham MG, Zuddas A. Systematic review of quality of life and functional outcomes in randomized placebo-controlled studies of medications for attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry. 2017;26:1283–307.PubMedPubMedCentralCrossRef
68.
Geurts DEM, Schellekens MPJ, Janssen L, Speckens AEM. Mechanisms of change in mindfulness-based cognitive therapy in adults with ADHD. J Atten Disord. 2020;25(9):1331–42.PubMedCrossRef
69.
Willoughby D, Evans MA. Self-processes of acceptance, compassion, and regulation of learning in university students with learning disabilities and/or ADHD. Learn Disabil Res Pract. 2019;34(4):175–84.CrossRef
70.
Beaton DM, Sirois F, Milne E. Self-compassion and perceived criticism in Adults with Attention Deficit Hyperactivity Disorder (ADHD). Mindfulness (N Y). 2020;11(11):2506–18.CrossRef
71.
Neff K. Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self Identity. 2003;2(2):85–101.CrossRef
Metadata
Title
Emotional dysregulation and health related quality of life in young adults with ADHD: a cross sectional study
Authors
Maayan Ben-Dor Cohen
Eran Eldar
Adina Maeir
Mor Nahum
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2021
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-021-01904-8

Other articles of this Issue 1/2021

Health and Quality of Life Outcomes 1/2021 Go to the issue

Research

Predicting the quality of life based on pain dimensions and psychiatric symptoms in patients with Painful diabetic neuropathy: a cross-sectional prevalence study in Iranian patients

Research

Mothers’ quality of life delivering kangaroo mother care at Malawian hospitals: a qualitative study

Research

Health-related quality of life in men and women who experienced cardiovascular diseases: Tehran Lipid and Glucose Study

Research

Developing a short-form version of the HIV Disability Questionnaire (SF-HDQ) for use in clinical practice: a Rasch analysis

Research

A poorer nutritional status impacts quality of life in a sample population of elderly cancer patients

Research

Typology of changes in quality of life over 12 months among currently or formerly homeless individuals using different housing services in Quebec, Canada