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Current Psychiatry Reports
Published in: Current Psychiatry Reports 10/2014

01-10-2014 | Attention-Deficit Disorder (A Rostain, Section Editor)

Using Stimulants to Treat ADHD-Related Emotional Lability

Authors: Jonathan Posner, Erica Kass, Leslie Hulvershorn

Published in: Current Psychiatry Reports | Issue 10/2014

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Abstract

Emotional lability, or sudden strong shifts in emotion, commonly occurs in youth with attention-deficit/hyperactivity disorder. Although these symptoms are impairing and disruptive, relatively little research has addressed their treatment, likely due to the difficulty of reliable and valid assessment. Promising signals for symptom improvement have come from recent studies using stimulants in adults, children and adolescents. Similarly, neuroimaging studies have begun to identify neurobiological mechanisms underlying stimulants’ impact on emotion regulation capacities. Here, we review these recent clinical and neuroimaging findings, as well as neurocognitive models for emotional lability in ADHD, issues of relevance to prescribers and the important role of psychiatric comorbidity with treatment choices.
Literature
1.
Barkley R. Attention-deficit hyperactivity disorder: a handbook for diagnosis and treatment. 3rd ed. New York: Guilford Press; 2005.
2.•
Sobanski E et al. Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence. J Child Psychol Psychiatry. 2010;51(8):915–23. This was one of the first papers to estimate the prevalence of emotional lability. It also related ratings of emotional lability to clinical features.
3.
4.••
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. This paper highlighted the impact of emotional impairments in ADHD on children and adolescents’ quality of life.
5.
Rydell A-M, Berlin L, Bohlin G. Emotionality, emotion regulation, and adaptation among 5-to 8-year-old children. Emotion. 2003;3(1):30.PubMedCrossRef
6.
Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013.
7.
Leibenluft E et al. Defining clinical phenotypes of juvenile mania. Am J Psychiatr. 2003;160(3):430.PubMedCrossRef
8.
Copeland WE et al. Prevalence, comorbidity, and correlates of DSM-5 proposed disruptive mood dysregulation disorder. Am J Psychiatr. 2013;170(2):173–9.PubMedCrossRefPubMedCentral
9.
10.
Becker A et al. Psychopathological screening of children with ADHD: strengths and difficulties questionnaire in a pan-European study. Eur Child Adolesc Psychiatry. 2006;15(1):i56–62.PubMedCrossRef
11.
Strine TW, et al. Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder. Preventing chronic disease, 2006; 3(2).
12.
Barkley R, 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
13.
Spencer T et al. Toward defining deficient emotional self-regulation in children with attention-deficit/hyperactivity disorder using the Child Behavior Checklist: a controlled study. Postgrad Med. 2011;123(5):50.PubMedCrossRefPubMedCentral
14.
Barkley R. Deficient emotional self-regulation: a core component of attention-deficit/hyperactivity disorder. J ADHD Relat Disord. 2010;1:5–37.
15.
Hinshaw SP. Impulsivity, emotion regulation, and developmental psychopathology: specificity versus generality of linkages. Ann N Y Acad Sci. 2003;1008(1):149–59.PubMedCrossRef
16.
Sonuga-Barke EJ. Psychological heterogeneity in AD/HD—a dual pathway model of behaviour and cognition. Behav Brain Res. 2002;130(1–2):29–36.PubMedCrossRef
17.
Barkley R. ADHD and the nature of self-control. New York: Guilford Press; 1997.
18.
Barkley R. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull. 1997;121(1):65–94.PubMedCrossRef
19.
Barkley RA et al. Executive functioning, temporal discounting, and sense of time in adolescents with attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). J Abnorm Child Psychol. 2001;29(6):541–56.PubMedCrossRef
20.
Nigg JT et al. Causal heterogeneity in attention-deficit/hyperactivity disorder: do we need neuropsychologically impaired subtypes? Biol Psychiatry. 2005;57(11):1224–30.PubMedCrossRef
21.
22.
Brotman M et al. Amygdala activation during emotion processing of neutral faces in children with severe mood dysregulation versus ADHD or bipolar disorder. Am J Psychiatr. 2010;167(1):61.PubMedCrossRefPubMedCentral
23.
24.
Sonuga-Barke EJ et al. Hyperactivity and delay aversion–I. The effect of delay on choice. J Child Psychol Psychiatry. 1992;33(2):387–98.PubMedCrossRef
25.
Sonuga-Barke E, Bitsakou P, Thompson M. Beyond the dual pathway model: evidence for the dissociation of timing, inhibitory, and delay-related impairments in attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2010;49(4):345–55.PubMed
26.••
Posner J et al. Abnormal amygdalar activation and connectivity in adolescents with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2011;50(8):828–37. e3. This neuroimaging-phacmacolgical study suggests that stimulant treatment may normalize hyperactivation of the amygdala in youth with ADHD seen in response to the subliminal presenation of fearful faces.
27.
Hulvershorn, L. The impact of methylphenidate on frontal activation in youth with disruptive mood dysregulation disorder, in 60th Annual Meeting of the American Academy of Child and Adolescent Psychiatry 2013; Orlando, FL.
28.
Bradley C, Bowen M. Amphetamine (Benzedrine) therapy of children's behavior disorders. Am J Orthopsychiatry. 1941;11(1):92–103.CrossRef
29.
Kaplan SL. Your child does not have bipolar disorder. Santa Barbara: ABC-CLIO, LLC; 2011.
30.
Network UAA. Handbook for attention deficit hyperactivity disorder in adults. Heidelberg: Springer; 2013.
31.
Group MC. A 14-month randmonized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999;56(12):1073–86.CrossRef
32.
Greenhill L et al. Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD. J Am Acad Child Adolesc Psychiatry. 2006;45(11):1284–93.PubMedCrossRef
33.•
Reimherr FW et al. 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. Using a crossover, placebo-controlled design in a sample of 47 adults with ADHD, the authors report large improvements (effect size: 0.7) in emotional dysregulation following treatment with osmotic release oral system methylphenidate.
34.
Rosler M et al. Twenty-four-week treatment with extended release methylphenidate improves emotional symptoms in adult ADHD. World J Biol Psychiatry Off J World Fed Soc Biol Psychiatry. 2010;11(5):709–18.CrossRef
35.
Marchant BK et al. Methylphenidate transdermal system in adult ADHD and impact on emotional and oppositional symptoms. J Atten Disord. 2011;15(4):295–304.PubMedCrossRef
36.••
Childress AC et al. The effects of lisdexamfetamine dimesylate on emotional lability in children 6 to 12 years of age with ADHD in a double-blind placebo-controlled trial. J Atten Disord. 2012. doi:10.​1177/​1087054712448252​. This is the largest study of stimulant effects on emotional lablity in youth with ADHD and the findings suggest that lisdexamfetamine attenuates this symptom in highly emotional labile youth with ADHD.PubMed
37.
Coghill DR, Rhodes SM, Matthews K. The neuropsychological effects of chronic methylphenidate on drug-naive boys with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2007;62(9):954–62.PubMedCrossRef
38.
Marchant BK et al. Psychometric properties of the Wender-Reimherr adult attention deficit disorder scale. Psychol Assess. 2013;25(3):942–50.PubMedCrossRef
39.
Schachter HM et al. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. Can Med Assoc J. 2001;165(11):1475–88.
40.
Kavale K. The efficacy of stimulant drug treatment for hyperactivity a meta-analysis. J Learn Disabil. 1982;15(5):280–9.PubMedCrossRef
41.
Biederman J et al. Efficacy and tolerability of lisdexamfetamine dimesylate (NRP-104) in children with attention-deficit/hyperactivity disorder: a phase III, multicenter, randomized, double-blind, forced-dose, parallel-group study. Clin Ther. 2007;29(3):450–63.PubMedCrossRef
42.
Pliszka SR et al. A double-blind, placebo-controlled study of Adderall and methylphenidate in the treatment of attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2000;39(5):619–26.PubMedCrossRef
43.
44.
Biederman J, Newcorn J, Sprich S. Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. Am J Psychiatr. 1991;148(5):564–77.PubMed
45.
Jensen PS et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry. 2001;40(2):147–58.PubMedCrossRef
46.
Schatz DB, Rostain AL. ADHD with comorbid anxiety a review of the current literature. J Atten Disord. 2006;10(2):141–9.PubMedCrossRef
47.
Pliszka SR. Effect of anxiety on cognition, behavior, and stimulant response in ADHD. J Am Acad Child Adolesc Psychiatry. 1989;28(6):882–7.PubMedCrossRef
48.
Wolraich ML et al. Stimulant medication use by primary care physicians in the treatment of attention deficit hyperactivity disorder. Pediatrics. 1990;86(1):95–101.PubMed
49.
Martinussen R et al. A meta-analysis of working memory impairments in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2005;44(4):377–84.PubMedCrossRef
50.
Tannock R, Ickowicz A, Schachar R. Differential effects of methylphenidate on working memory in ADHD children with and without comorbid anxiety. J Am Acad Child Adolesc Psychiatry. 1995;34(7):886–96.PubMedCrossRef
51.
Bedard A-C, Tannock R. Anxiety, methylphenidate response, and working memory in children with ADHD. J Atten Disord. 2008;11(5):546–57.PubMedCrossRef
52.
Diamond IR, Tannock R, Schachar RJ. Response to methylphenidate in children with ADHD and comorbid anxiety. J Am Acad Child Adolesc Psychiatry. 1999;38(4):402–9.PubMedCrossRef
53.
Wolraich M et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007–22.PubMedCrossRef
54.
Pliszka SR et al. The Texas Children's Medication Algorithm Project: revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2006;45(6):642–57.PubMedCrossRef
Metadata
Title
Using Stimulants to Treat ADHD-Related Emotional Lability
Authors
Jonathan Posner
Erica Kass
Leslie Hulvershorn
Publication date
01-10-2014
Publisher
Springer US
Published in
Current Psychiatry Reports / Issue 10/2014
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-014-0478-4

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