Skip to main content

Advertisement

Log in

Attention-Deficit/Hyperactivity Disorder and Social Skills in Youth: A Moderated Mediation Model of Emotion Dysregulation and Depression

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

Although studies document an association between Attention-Deficit/Hyperactivity Disorder (ADHD) and social problems, little is known about mediating or moderating mechanisms underlying this association. We examined whether, among youth, emotion dysregulation (ED) mediates the negative association between ADHD and social skills, and whether this mediational process is moderated by symptoms of depression. A total of 171 youth with ADHD (76 % male; Mage = 12.15, SD = 0.95) and their parents completed measures of ED, depression, and social skills. Results indicated that, after controlling for oppositional defiant disorder, the negative association between ADHD and social skills was mediated by ED. Further, this indirect effect was relevant for youth with non-clinical and subclinical levels of depression but not for those with clinical levels of depression. These findings underscore the importance of ED in the association between ADHD and social functioning among youth and suggest a need for additional research to understand how and when ED impacts such functioning.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

Notes

  1. Currently, many different and at times conflicting definitions of emotion regulation are accepted in the field. As such, there is often limited theoretical and empirical agreement on conceptualizations of the construct. We adopt Barkley’s definition of ED as this definition is most specific to ADHD.

  2. Constructive emotional coping includes, for example, an inability to continue a task in the wake of frustration, an inability to seek help from parents when frustrated, extreme levels of negative affect, poor problem solving, and an extreme focus on negative aspects of a task.

  3. As measured by teacher ratings of cooperation, assertiveness, and self-control and by peer-ratings of desirability as play- or study-partners.

  4. The macros provide a 95 % confidence interval around the indirect effect. When zero is not in the 95 % confidence interval (i.e., both numbers fall on the same side of 0), it can be concluded that the indirect effect is significantly different from zero at p < 0.05 (two tailed).

  5. When controlling for gender and age in our analyses, by including gender and age as covariates in the models, neither emerged as a significant covariate (gender ps ranging from 0.304 to 0.810; age ps ranging from 0.146 to 0.603).Thus, the models on which we report data do not include gender or age as a covariate.

References

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders DSM (4th ed., text revision).

  • Bagwell, C. L., Molina, B. S., Pelham Jr, W. E., & Hoza, B. (2001). Attention-deficit hyperactivity disorder and problems in peer relations: predictions from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11), 1285–1292.

  • Barkley, R. A. (2008). Challenges in diagnosing adults with ADHD. The Journal of Clinical Psychiatry, 69(12), e36.

    Article  PubMed  Google Scholar 

  • Barkley, R. A. (2010). Deficient emotional self-regulation: a core component of attention-deficit/hyperactivity disorder. Journal of ADHD and Related Disorders, 1, 5–37.

    Google Scholar 

  • Becker, S. P., Langberg, J. M., Evans, S. W., Girio-Herrera, E., & Vaughn, A. J. (2014). Differentiating anxiety and depression in relation to the social functioning of young adolescents with ADHD. Journal of Clinical Child and Adolescent Psychology. doi:10.1080/15374416.2014.930689.

    Google Scholar 

  • Biederman, J., Newcorn, J., & Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry, 148, 564–577.

    Article  PubMed  Google Scholar 

  • Biederman, J., Faraone, S.V., Keenan. K., Benjamin, J., Krifcher, B., Moore, C., … & Tsuang, M, T. (1992). Further evidence for family-genetic risk factors in attention deficit hyperactivity disorder: patterns of comorbidity in probands and relatives in psychiatrically and pediatrically referred samples. Archives of General Psychiatry, 49, 728738.

  • Biederman, J., Faraone, S. V., & Monuteaux, M. C. (2002). Differential effect of environmental adversity by gender: Rutter’s index of adversity in a group of boys and girls with and without ADHD. American Journal of Psychiatry, 159, 1556–1562.

    Article  PubMed  Google Scholar 

  • Bunford, N., Evans, S. W., & Langberg, J. M. (2014). Emotion dysregulation is associated with social impairment among young adolescents with ADHD. Journal of Attention Disorders, 1087054714527793.

  • Chronis-Tuscano, A., Molina, B. S., Pelham, W. E., Applegate, B., Dahlke, A., Overmyer, M., & Lahey, B. B. (2010). Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Archives of general psychiatry, 67(10), 1044.

    Article  PubMed Central  PubMed  Google Scholar 

  • Cunningham, C. E., & Barkley, R. A. (1979). The interactions of normal and hyperactive children with their mothers during free play and structured tasks. Child Development, 50, 217–224.

    Article  PubMed  Google Scholar 

  • Daviss, W. (2008). A review of co-morbid depression in pediatric ADHD: etiologies, phenomenology, and treatment. Journal of Child and Adolescent Psychopharmacology, 18(6), 565–571.

    Article  PubMed Central  PubMed  Google Scholar 

  • Daviss, W., Diler, R., & Birmaher, B. (2009). Associations of lifetime depression with trauma exposure, other environmental adversities, and impairment in adolescents with ADHD. Journal of Abnormal Child Psychology: An official publication of the International Society for Research in Child and Adolescent Psychopathology, 37(6), 857–871.

    Article  Google Scholar 

  • Durbin, C., & Shafir, D. (2008). Emotion regulation and risk for depression. In J. R. Z. Abela & H. L. Hankin (Eds.), Handbook of depression in children and adolescents (pp. 149–176). New York: Guilford.

    Google Scholar 

  • Elia, J., Ambrosini, P., & Berrettini, W. (2008). ADHD characteristics: I. Concurrent co-morbidity patterns in children & adolescents. Child and Adolescent Psychiatry and Mental Health, 2, 5.

    Article  Google Scholar 

  • Elliott, S. N., & Gresham, F. M. (2008). SSIS-RS intervention guide. Minneapolis: NCS Pearson.

    Google Scholar 

  • Fabiano, G. A., Pelham, W. E., Waschbusch, D. A., Gnagy, E. M., Lahey, B. B., Chronis, A. M., et al. (2006). A practical measure of impairment: psychometric properties of the impairment rating scale in samples of children with attention deficit hyperactivity disorder and two school-based samples. Journal of Clinical Child and Adolescent Psychology, 35, 369–385.

    Article  PubMed  Google Scholar 

  • Feng, X., Keenan, K., Hipwell, A., Henneberger, A., Rischall, M., Butch, J., et al. (2009). Longitudinal associations between emotion regulation and depression in preadolescent girls: moderation by the caregiving environment. Developmental Psychology, 45(3), 798–808.

    Article  PubMed Central  PubMed  Google Scholar 

  • Fristad, M. A., Teare, M., Weller, E. B., Weller, R. A., & Salmon, P. (1998). Study III: development and concurrent validity of the Children’s Interview for Psychiatric Syndromes—parent version (P-ChIPS). Journal of Child and Adolescent Psychopharmacology, 8(4), 221–226.

    Article  PubMed  Google Scholar 

  • Goldstein, T. R., Axelson, D. A., Birmaher, B., & Brent, D. A. (2007). Dialectical behavior therapy for adolescents with bipolar disorder: a 1-year open trial. American Academy of Child and Adolescent Psychiatry, 46, 820–830.

    Article  Google Scholar 

  • Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26(1), 41–54.

    Article  Google Scholar 

  • Gresham, F. M., Elliott, S. N., Vance, M. J., & Cook, C. R. (2011). Comparability of the social skills rating system to the Social Skills Improvement System: content and psychometric comparisons across elementary and secondary age levels. School Psychology Quarterly, 26, 27–44.

    Article  Google Scholar 

  • Guevremont, D. C., & Dumas, M. C. (1994). Peer relationship problems and disruptive behavior disorders. Journal of Emotional and Behavior Disorders, 2, 164–172.

    Article  Google Scholar 

  • Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis. New York: Guilford Press.

    Google Scholar 

  • Henker, B., & Whalen, C. K. (1989). Hyperactivity and attention deficits. American Psychologist, 44, 216–223.

    Article  PubMed  Google Scholar 

  • Hesslinger, B., Tebartz van Elst, L., Nyberg, E., Dykierek, P., Richter, H., Berner, M., & Ebert, D. (2002). Psychotherapy of attention deficit hyperactivity disorder in adults: a pilot study using a structured skills training program. European Archives of Psychiatry and Clinical Neuroscience, 252, 177–184.

    Article  PubMed  Google Scholar 

  • Hoza, B. (2007). Peer functioning in children with ADHD. Ambulatory Pediatrics, 7(1 Suppl.), 101–106.

    Article  PubMed Central  PubMed  Google Scholar 

  • Hoza, B., Mrug, S., Gerdes, A.C., Hinshaw, S.P., Bukowski, W.M., Gold, J.A., … & Arnold, L.E. (2005). What aspects of peer relationships are impaired in children with attention-deficit/hyperactivity disorder? Journal of Consulting and Clinical Psychology, 73(3), 411–423.

  • Hoza, B., Murray-Close, D., Arnold, L. E., Hinshaw, S. P., Hechtman, L., & MTA Cooperative Group. (2010). Time-dependent changes in positively biased self-perceptions of children with ADHD: a developmental psychopathology perspective. Development and Psychopathology, 22(2), 375.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kats-Gold, I., Besser, A., & Priel, B. (2007). The role of simple emotion recognition skills among school aged boys at risk of ADHD. Journal of Abnormal Child Psychology, 35(3), 363–378.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., & Nock, M. K. (2003). Delineating mechanisms of change in child and adolescent therapy: methodological issues and research recommendations. Journal Of Child Psychology And Psychiatry, 44, 1116–1129.

    Article  PubMed  Google Scholar 

  • Landau, S., & Moore, L. A. (1991). Social skill deficits in children with attention-deficit hyperactivity disorder. School Psychology Review, 20, 235–251.

    Google Scholar 

  • Linehan, M. M., Bohus, M., & Lynch, T. R. (2007). Dialectical behavior therapy for pervasive emotion dysregulation: Theoretical and practical underpinnings. In J. J. Gross (Ed.), Handbook of emotion regulation. New York: Guilford Press.

    Google Scholar 

  • MacDermott, S. T., Gullone, E., Allen, J. S., King, N. J., & Tonge, B. (2010). The emotion regulation index for children and adolescents (ERICA): a psychometric investigation. Journal of Psychopathology and Behavioral Assessment, 32(3), 301–314.

    Article  Google Scholar 

  • Maedgen, J. W., & Carlson, C. L. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29, 30–42.

    Article  PubMed  Google Scholar 

  • Martel, M. M., & Nigg, J. T. (2006). Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality. The Journal of Child Psychology and Psychiatry, 47, 1175–1183.

    Article  Google Scholar 

  • McQuade, J. D., Hoza, B., Waschbusch, D. A., Murray-Close, D., & Owens, J. S. (2011). Changes in self-perceptions in children with ADHD: a longitudinal study of depressive symptoms and attributional style. Behavior Therapy, 42(2), 170–182.

    Article  PubMed Central  PubMed  Google Scholar 

  • Melnick, S. M., & Hinshaw, S. P. (2000). Emotion regulation and parenting in AD/HD and comparison boys: linkages with social behaviors and peer preference. Journal of Abnormal Child Psychology, 28, 73–86.

    Article  PubMed  Google Scholar 

  • Musser, E. D., Backs, R. W., Schmitt, C. F., Ablow, J. C., Measelle, J. R., & Nigg, J. T. (2011). Emotion regulation via the autonomic nervous system in children with attention deficit/hyperactivity disorder (ADHD). Journal of Abnormal Child Psychology, 39(6), 841–852.

    Article  PubMed Central  PubMed  Google Scholar 

  • Musser, E. D., Galloway-Long, H. S., Frick, P. J., & Nigg, J. T. (2013). Emotion regulation and heterogeneity in attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(2), 163–171.

    Article  Google Scholar 

  • Nigg, J. T., Goldsmith, H. H., & Sachek, J. (2004). Temperament and attention-deficit/hyperactivity disorder: the development of a multiple pathway model. Journal of Clinical Child and Adolescent Psychology, 33, 42–53.

    Article  PubMed  Google Scholar 

  • Owens, J.S., Sadler, J.M., Bunford, N., Vaughn, A., Schultz, B., Evans, S. W., & Langberg, J. (2011). Self-perceptions of competence in adolescents with ADHD. Symposium presented at the annual meeting of the Association for behavioral and cognitive therapies, Toronto, Canada.

  • Pelham, W. E., Gnagy, E. M., Greenslade, K. E., & Milich, R. (1992). Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 31(2), 210–218.

    Article  Google Scholar 

  • Reynolds, W. M. (2002). Reynolds adolescent depression scale (2nd ed.). Inc: Wiley.

    Google Scholar 

  • Scime, M., & Norvilitis, J. (2006). Task performance and response to frustration in children with attention deficit hyperactivity disorder. Psychology in the Schools, 43(3), 377–386.

    Article  Google Scholar 

  • Seymour, K. E., Chronis-Tuscano, A., Halldorsdottir, T., Stupica, B., Owens, K., & Sacks, T. (2012). Emotion regulation mediates the relationship between ADHD and depressive symptoms in youth. Journal of Abnormal Child Psychology, 40(4), 595–606.

    Article  PubMed  Google Scholar 

  • Seymour, K. E., Chronis-Tuscano, A., Iwamoto, D. K., Kurdziel, G., & MacPherson, L. (2014). Emotion regulation mediates the association between ADHD and depressive symptoms in a community sample of youth. Journal of Abnormal Psychology, 42(4), 611–621.

    Article  Google Scholar 

  • Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Boston: Houghton Mifflin and Company.

    Google Scholar 

  • Silk, J. S., Steinberg, L., & Morris, A. S. (2003). Adolescents’ emotion regulation in daily life: links to depressive symptoms and problem behavior. Child Development, 74, 1869–1880.

    Article  PubMed  Google Scholar 

  • Singh, S. D., Ellis, C. R., Winton, A. S., Singh, N. N., Leung, J. P., & Oswald, D. P. (1998). Recognition of facial expressions of emotion by children with attention-deficit hyperactivity disorder. Behavior Modification, 22(2), 128–142.

    Article  PubMed  Google Scholar 

  • Sjöwall, D., Roth, L., Lindqvist, S., & Thorell, L.B. (2013). Multiple deficits in ADHD: executive dysfunction, delay aversion, reaction time variability, and emotional deficits. Journal of Child Psychology and Psychiatry, 54(6), 619–627.

  • Steinberg, L. (2005). Cognitive and affective development in adolescence. Trends in Cognitive Science, 9, 69–74.

    Article  Google Scholar 

  • Teasdale, J. D., Segal, Z. V., & Williams, M. G. (1995). How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness training) help? Behaviour Research and Therapy, 33, 25–39.

    Article  PubMed  Google Scholar 

  • Tortella-Feliu, M., Balle, M., & Sesé, A. (2010). Relationships between negative affectivity, emotion regulation, anxiety, and depressive symptoms in adolescents as examined through structural equation modeling. Journal of Anxiety Disorders, 24(7), 686–693.

    Article  PubMed  Google Scholar 

  • United States Census Bureau (2011). State & County QuickFacts. Retrieved from http://quickfacts.census.gov/qfd/states/39000.html.

  • Vasilev, C. A., Crowell, S. E., Beauchaine, T. P., Mead, H. K., & Gatzke-Kopp, L. M. (2009). Correspondence between physiological and self-report measures of emotion dysregulation: a longitudinal investigation of youth with and without psychopathology. Journal of Child Psychology and Psychiatry, 50, 1357–1364.

    Article  PubMed  Google Scholar 

  • Walcott, C., & Landau, S. (2004). The relation between disinhibition and emotion regulation in boys with attention deficit hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology, 33(4), 772–782.

    Article  PubMed  Google Scholar 

  • Walden, T. A., Harris, V. S., & Catron, T. F. (2003). How I feel: a self-report measure of emotional arousal and regulation for children. Psychological Assessment, 15(3), 399–412.

    Article  PubMed  Google Scholar 

  • Wang, Y., Zhang, W., Peng, J., Mo, B., & Xiong, S. (2009). The relations of attachment, self-concept, and deliberate self-harm in college students. Psychological Exploration, 5, 56–61.

    Google Scholar 

  • Wechsler, D. (2003). Wechsler intelligence scale for children–fourth edition (WISC-IV). San Antonio: The Psychological Corporation.

    Google Scholar 

  • Weinberg, A., & Klonsky, E. D. (2009). Measurement of emotion dysregulation in adolescents. Psychological Assessment, 21, 616–621.

    Article  PubMed  Google Scholar 

  • Weller, E. B., Weller, R. A., Rooney, M. T., & Fristad, M. A. (1999). Parent form - children’s interview for psychiatric syndromes (P-ChIPS). Arlington: American Psychiatric Press, Inc.

    Google Scholar 

  • Weller, E. B., Weller, R. A., Fristad, M. A., Rooney, M. T., & Schecter, J. (2000). Children’s interview for psychiatric syndromes (ChIPS). Journal of the American Academy of Child and Adolescent Psychiatry, 39, 76–84.

    Article  PubMed  Google Scholar 

  • Wilens, E., Biederman, J., Brown, S., Tanguay, S., Monuteaux, M., Blake, C., & Spencer, T. (2002). Psychiatric comorbidity and functioning in clinically referred preschool children and schoolage youths with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 262–268.

    Article  PubMed  Google Scholar 

  • Wolraich, M.L., Wibbelsman, C.J., Brown, T.E., Evans, S.W., Gotlieb, E.M., Knight, J.R., … & Wilens, T. (2005). Attention-deficit/hyperactivity disorder among adolescents: a review of the diagnosis, treatment, and clinical implications. Pediatrics, 115(6), 1734–1746.

  • Zeman, J., Cassano, M., Perry-Parrish, C., & Sheri, S. (2006). Emotion regulation in children and adolescents. Journal of Developmental and Behavioral Pediatrics, 27, 155–168.

    Article  PubMed  Google Scholar 

  • Zylowska, L., Ackerman, D. L., Yang, M. H., Futrell, J. L., Horton, N. L., Hale, T. S., Pataki, C., & Smalley, S. L. (2008). Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study. Journal of Attention Disorders, 11, 737–746.

    Article  PubMed  Google Scholar 

Download references

Author Notes and Disclosures

During the preparation of this article, the first author was supported in parts by the Elizabeth Munsterberg Koppitz Dissertation Fellowship, awarded by the American Psychological Foundation. The second and fourth authors were supported in parts by a grant from the National Institute of Mental Health (5ROIMH082864) and the second author by grants from the Department of Education, Institute of Educational Sciences (R324C08006; R324A120272). The contents of this article do not necessarily represent the views of the American Psychological Foundation, National Institutes of Health or Institute for Education Sciences and do not imply endorsement by the federal government.

We wish to thank Andrew F. Hayes and Eric A. Youngstrom for their valuable assistance and feedback during the preparation of this manuscript.

Conflict of Interest

The authors declare that they have no conflict of interest

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nora Bunford.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 26 kb)

ESM Table 5

(DOCX 25 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bunford, N., Evans, S.W., Becker, S.P. et al. Attention-Deficit/Hyperactivity Disorder and Social Skills in Youth: A Moderated Mediation Model of Emotion Dysregulation and Depression. J Abnorm Child Psychol 43, 283–296 (2015). https://doi.org/10.1007/s10802-014-9909-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-014-9909-2

Keywords

Navigation