Abstract
The goal of the present study was to examine whether young children with attention-deficit/hyperactivity disorder (ADHD) symptoms experience difficulties with emotional understanding, reactivity, and regulation. Participants were 64 children, 4 to 7 years of age (43 boys, 20 girls), 29 with ADHD symptoms and 34 typically developing children. Children completed an emotion matching task and parents reported on child lability and emotional regulation. Children also completed a frustrating computer task. Facial expressions of emotions were coded and children self reported affect during the task. Parent reports indicated heightened lability and impaired emotional regulation abilities in children with ADHD symptoms. Compared to typically developing children, children with ADHD symptoms demonstrated emotional understanding impairments in matching similar expressions and matching expressions to situations, but not in producing expression labels or matching expression labels to images. Self-reports of negative affect during the frustration task indicated that children with ADHD symptoms experienced more difficulty with emotional regulation than typically developing children. Behavioral observations during the frustration task indicated that the two groups demonstrated a similar increase in expressed negative affect during frustration; however, children with ADHD symptoms showed higher levels of negative affect across all four conditions of the task. This study suggests that the deficits documented in older children with ADHD are already evident during the preschool years, and distinct from the developmentally appropriate emotional dysregulation seen in typically developing preschoolers.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Notes
Parents reported that two children were prescribed Guanfacine, two were prescribed Adderall, and one was taking 5 HTP, an over-the-counter supplement. All group differences remained when these participants were excluded.
References
Anastopoulos, A. D., Smith, T. F., Garrett, T. M., Morrissey-Kane, E., Schatz, N. K., Sommer, J. L., et al. (2011). Self-regulation of emotion, functional impairment, and comorbidity among children with AD/HD. Journal of Attention Disorders, 15, 583–592. doi:10.1177/1087054710370567.
Applegate, B., Lahey, B. B., Hart, E. L., Biederman, J., Hynd, G. W., Barkley, R. A., et al. (1997). Validity of the age-of-onset criterion for ADHD: a report from the DSM-IV field trials. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 1211–1221. doi:10.1097/00004583-199709000-00013.
Bar-Haim, Y., Bar-Av, G., & Sadeh, A. (2011). Measuring children’s regulation of emotion-expressive behavior. Emotion, 11, 215–223. doi:10.1037/a0022602.
Becker, S. P., & Langberg, J. M. (2013). Sluggish cognitive tempo among young adolescents with ADHD: relations to mental health, academic, and social functioning. Journal of Attention Disorders, 17, 681–689. doi:10.1177/1087054711435411.
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society. Series B (Methodological), 57, 289–300. doi:10.1214/aos/1013699998.
Berlin, L., Bohlin, G., Nyberg, L., & Janols, L. (2004). How well do measures of inhibition and other executive functions discriminate between children with ADHD and controls? Child Neuropsychology, 10, 1–13. doi:10.1076/chin.10.1.1.26243.
Blandon, A. Y., Calkins, S. D., & Keane, S. P. (2010). Predicting emotional and social competence during early childhood from toddler risk and maternal behavior. Development and Psychopathology, 22, 119–132. doi:10.1017/S0954579409990307.
Bloom, B., Cohen, R. A., & Freeman, G. (2009). Summary health statistics for U.S. children: National Health Interview Survey, 2008. Vital and Health Statistics, 10(244), 1–81.
Boakes, J., Chapman, E., Houghton, S., & West, J. (2008). Facial affect interpretation in boys with attention deficit/hyperactivity disorder. Child Neuropsychology, 14, 82–96. doi:10.1080/09297040701503327.
Braaten, E. B., & Rosén, L. A. (2000). Self-regulation of affect in attention deficit-hyperactivity disorder (ADHD) and non-ADHD boys: differences in empathic responding. Journal of Consulting and Clinical Psychology, 68, 313–321. doi:10.1037/0022-006X.68.2.313.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Earlbaum Associates.
Cole, P. M., Dennis, T. A., Smith-Simon, K. E., & Cohen, L. H. (2009). Preschoolers’ emotion regulation strategy understanding: relations with emotion socialization and child self-regulation. Social Development, 18, 324–352. doi:10.1111/j.1467-9507.2008.00503.x.
Da Fonseca, D., Seguier, V., Santos, A., Poinso, F., & Deruelle, C. (2009). Emotion understanding in children with ADHD. Child Psychiatry and Human Development, 40, 111–121. doi:10.1007/s10578-008-0114-9.
Davis, T. L. (1995). Gender differences in masking negative emotions: ability or motivation? Developmental Psychology, 31, 660–667. doi:10.1037/0012-1649.31.4.660.
Denham, S. A., Bassett, H. H., & Wyatt, T. (2007). The socialization of emotional competence. In J. E. Grusec, & P. D. Hastings, J. E. (Eds.) Handbook of socialization: Theory and research (pp. 614–637). New York: Guilford Press.
Denham, S., Bassett, H., Way, E., Mincic, M., Zinsser, K., & Graling, K. (2012). Preschoolers’ emotion knowledge: self-regulatory foundations, and predictions of early school success. Cognition and Emotion, 26, 667–679. doi:10.1080/02699931.2011.602049.
Dickstein, D. P., & Castellanos, F. X. (2012). Face processing in attention deficit/hyperactivity disorder. In C. Stanford & R. Tannock (Eds.), Behavioral neuroscience of attention deficit hyperactivity disorder and its treatment (pp. 219–237). New York: Springer-Verlag Berlin Heidelberg. doi:10.1007/7854_2011_157.
Douglas, V. I., & Parry, P. A. (1994). Effects of reward and nonreward on frustration and attention in attention deficit disorder. Journal of Abnormal Child Psychology, 22, 281–302. doi:10.1007/BF02168075.
Durbin, C. E. (2010). Validity of young children’s self-reports of their emotion in response to structured laboratory tasks. Emotion, 10, 519–535. doi:10.1037/a0019008.
Eisenberg, N., Valiente, C., & Eggum, N. D. (2010). Self-regulation and school readiness. Early Education and Development, 21, 681–698. doi:10.1080/10409289.2010.497451.
Gomez, R., & Corr, P. J. (2010). Attention-deficit/hyperactivity disorder symptoms: associations with Gray’s and Tellegen’s models of personality. Personality and Individual Differences, 49, 902–906. doi:10.1016/j.paid.2010.06.033.
Graziano, P. A., & Garcia, A. (2016). Attention-deficit hyperactivity disorder and children’s emotion dysregulation: a meta-analysis. Clinical Psychology Review, 46, 106–123. doi:10.1016/j.cpr.2016.04.011.
Gross, J. J. (1998). The emerging field of emotion regulation: an integrative review. Review of General Psychology, 2, 271–299. doi:10.1037/1089-2680.2.3.271.
Healey, D. M., Marks, D. J., & Halperin, J. M. (2011). Examining the interplay among negative emotionality, cognitive functioning, and attention deficit/hyperactivity disorder symptom severity. Journal of the International Neuropsychological Society, 17, 502–510. doi:10.1017/S1355617711000294.
Hoza, B., Waschbusch, D. A., Owens, J., Pelham, W. E., & Kipp, H. (2001). Academic task persistence of normally achieving ADHD and control boys: self-evaluations, and attributions. Journal of Consulting and Clinical Psychology, 69, 271–283. doi:10.1037/0022-006X.69.2.271.
Izard, C. E., Haskins, F. W., Schultz, D., Trentacosta, C. J., & King, K. A. (2003). Emotion matching task. Newark: University of Delaware.
Karrass, J., Walden, T. A., Conture, E. G., Graham, C. G., Arnold, H. S., Hartfield, K. N., & Schwenk, K. A. (2006). Relation of emotional reactivity and regulation to childhood stuttering. Journal of Communication Disorders, 39, 402–423. doi:10.1016/j.jcomdis.2005.12.004.
Kats-Gold, I., & Priel, B. (2009). Emotion, understanding, and social skills among boys at risk of attention deficit hyperactivity disorder. Psychology in the Schools, 46, 658–678. doi:10.1002/pits.20406.
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, 363–378. doi:10.1007/s10802-006-9096-x.
Knaus, W. J. (2006). Frustration tolerance training for children. In A. Ellis & M. E. Bernard (Eds.), Rational emotive behavioral approaches to childhood disorders: theory, practice and research (pp. 133–155). New York: Springer. doi:10.1007/0-387-26375-6_4.
Lahey, B. B., Pelham, W. E., Loney, J., Lee, S. S., & Willcutt, E. (2005). Instability of the DSM-IV subtypes of ADHD from preschool through elementary school. Archives of General Psychiatry, 62, 896–902. doi:10.1001/archpsyc.62.8.896.
Lavigne, J. V., LeBailly, S. A., Hopkins, J., Gouze, K. R., & Binns, H. J. (2009). The prevalence of ADHD, ODD, depression, and anxiety in a community sample of 4-year-olds. Journal of Clinical Child and Adolescent Psychology, 38, 315–328. doi:10.1080/15374451382.
Lugo-Candelas, C., Flegenheimer, C., Harvey, E., & McDermott, J. M. (2016). Neural correlates of emotion reactivity and regulation in young children with ADHD symptoms. Manuscript submitted for publication.
Maedgen, J., & Carlson, C. L. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29, 30–42. doi:10.1207/S15374424jccp2901_4.
Matthies, S., Philipsen, A., Lackner, H. K., Sadohara, C., & Svaldi, J. (2014). Regulation of sadness via acceptance or suppression in adult attention deficit hyperactivity disorder (ADHD). Psychiatry Research, 220, 461–467. doi:10.1016/j.psychres.2014.07.017.
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. doi:10.1023/A:1005174102794.
Milich, R., & Okazaki, M. (1991). An examination of learned helplessness among attention-deficit hyperactivity disordered boys. Journal of Abnormal Child Psychology, 19, 607–623. doi:10.1007/BF00925823.
Milich, R., Balentine, A. C., & Lynam, D. R. (2001). ADHD combined type and ADHD predominantly inattentive type are distinct and unrelated disorders. Clinical Psychology: Science and Practice, 8, 463–488. doi:10.1093/clipsy/8.4.463.
Morgan, J. K., Izard, C. E., & King, K. A. (2010). Construct validity of the emotion matching task: preliminary evidence for convergent and criterion validity of a new emotion knowledge measure for young children. Social Development, 19, 52–70. doi:10.1111/j.1467-9507.2008.00529.x.
Murphy, B. C., Eisenberg, N., Fabes, R. A., Shepard, S., & Guthrie, I. K. (1999). Consistency and change in children’s emotionality and regulation: a longitudinal study. Merrill-Palmer Quarterly, 45, 413–444.
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, 841–852. doi:10.1007/s10802-011-9499-1.
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, 163–171. doi:10.1016/j.jaac.2012.11.009.
Norvilitis, J. M., Casey, R. J., Brooklier, K. M., & Bonello, P. J. (2000). Emotion appraisal in children with attention-deficit/hyperactivity disorder and their parents. Journal of Attention Disorders, 4, 15–26. doi:10.1177/108705470000400102.
O’Brien, M., Weaver, J. M., Nelson, J. A., Calkins, S. D., Leerkes, E. M., & Marcovitch, S. (2011). Longitudinal associations between children’s understanding of emotions and theory of mind. Cognition and Emotion, 25, 1074–1086. doi:10.1080/02699931.2010.518417.
Owens, J. S., Goldfine, M. E., Evangelista, N. M., Hoza, B., & Kaiser, N. M. (2007). A critical review of self-perceptions and the positive illusory bias in children with ADHD. Clinical Child and Family Psychology Review, 10, 335–351. doi:10.1007/s10567-007-0027-3.
Pelc, K., Kornreich, C., Foisy, M. L., & Dan, B. (2006). Recognition of emotional facial expressions in attention-deficit hyperactivity disorder. Pediatric Neurology, 35, 93–97. doi:10.1016/j.pediatrneurol.2006.01.014.
Pérez-Edgar, K., & Fox, N. A. (2005). A behavioral and electrophysiological study of children’s selective attention under neutral and affective conditions. Journal of Cognition and Development, 6, 89–118. doi:10.1207/s15327647jcd0601_6.
Pérez-Edgar, K., Fox, N. A., Cohn, J. F., & Kovacs, M. (2006). Behavioral and electrophysiological markers of selective attention in children of parents with a history of depression. Biological Psychiatry, 60, 1131–1138. doi:10.1016/j.biopsych.2006.0.
Rich, B. A., Schmajuk, M., Perez-Edgar, K., Fox, N. A., Pine, D. S., & Leibenluft, E. (2007). Different psychophysiological and behavioral responses elicited by frustration in pediatric bipolar disorder and severe mood dysregulation. The American Journal of Psychiatry, 164, 309–317. doi:10.1176/appi.ajp.164.2.309.
Rolon-Arroyo, B., Arnold, D. H., Harvey, E. A., & Marshall, N. (2016). Assessing attention and disruptive behavior symptoms in preschool-age children: the utility of the diagnostic interview schedule for children. Journal of Child and Family Studies, 25, 65–76. doi:10.1007/s10826-015-0203-x.
Rosch, K. S., & Hawk, L. J. (2013). The effects of performance-based rewards on neurophysiological correlates of stimulus, error, and feedback processing in children with ADHD. Psychophysiology, 50, 1157–1173. doi:10.1111/psyp.12127.
Saarni, C. (1999). The development of emotional competence. New York: Guilford Press.
Scime, M., & Norvilitis, J. M. (2006). Task performance and response to frustration in children with attention deficit hyperactivity disorder. Psychology in the Schools, 43, 377–386. doi:10.1002/pits.20151.
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, 595–606. doi:10.1007/s10802-011-9593-4.
Seymour, K. E., Pescosolido, M. F., Reidy, B. L., Galvan, T., Kim, K. L., Young, M., & Dickstein, D. P. (2013). Emotional face identification in youths with primary bipolar disorder or primary attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 537–546. doi:10.1016/j.jaac.2013.03.011.
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 Child Psychology, 42, 611–621. doi:10.1007/s10802-013-9799-8.
Seymour, K. E., Kim, K. L., Cushman, G. K., Puzia, M. E., Weissman, A. B., Galvan, T., & Dickstein, D. P. (2015). Affective processing bias in youth with primary bipolar disorder or primary attention-deficit/hyperactivity disorder. European Child and Adolescent Psychiatry. doi:10.1007/s00787-015-0686-4.
Shaffer, D., Fisher, P., Lucas, C. P., Dulcan, M. K., & Schwab-Stone, M. E. (2000). NIMH diagnostic interview schedule for children version IV (NIMH DISC-IV): description, differences from previous versions, and reliability of some common diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 28–38. doi:10.1097/00004583-200001000-00014.
Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-age children: the development and validation of a new criterion Q-sort scale. Developmental Psychology, 33, 906–916. doi:10.1037/0012-1649.33.6.906.
Shin, D., Lee, S. J., Kim, B.-J., Park, Y., & Lim, S. (2008). Visual attention deficits contribute to impaired facial emotion recognition in boys with attention-deficit/hyperactivity disorder. Neuropediatrics, 39, 323–327. doi:10.1055/s-0029-1202286.
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, 619–627. doi:10.1111/jcpp.12006.
Sjöwall, D., Backman, A., & Thorell, L. B. (2015). Neuropsychological heterogeneity in preschool ADHD: investigating the interplay between cognitive, affective and motivation-based forms of regulation. Journal of Abnormal Child Psychology, 43, 669–680. doi:10.1007/s10802-014-9942-1.
Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., et al. (2010). Emotional lability in children and adolescents with attention deficit hyperactivity disorder (ADHD): clinical correlates and familial prevalence. Journal of Child Psychology and Psychiatry, 51, 915–923. doi:10.1111/j.14697610.2010.02217.x.
Steinberg, E. A., & Drabick, D. G. (2015). A developmental psychopathology perspective on ADHD and comorbid conditions: the role of emotion regulation. Child Psychiatry and Human Development, 46, 951–966. doi:10.1007/s10578-015-0534-2.
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, 772–782. doi:10.1207/s15374424jccp3304_12.
Weintraub, S., Dikmen, S. S., Heaton, R. K., Tulsky, D. S., Zelazo, P. D., Bauer, P. J., et al. (2013). Cognition assessment using the NIH Toolbox. Neurology, 80, S54–S64. doi:10.1212/WNL.0b013e3182872ded.
Wigal, T., Swanson, J. M., Douglas, V. I., Wigal, S. B., Wippler, C. M., & Cavoto, K. (1998). Effect of reinforcement on facial responsivity and persistence in children with attention-deficit hyperactivity disorder. Behavior Modification, 22, 143–166. doi:10.1177/01454455980222003.
Wongpakaran, N., Wongpakaran, T., Wedding, D., & Gwet, K. L. (2013). A comparison of Cohen’s kappa and Gwet’s AC1 when calculating inter-rater reliability coefficients: a study conducted with personality disorder samples. BMC Medical Research Methodology, 13, 2–7. doi:10.1186/1471-2288-13-61.
Yuill, N., & Lyon, J. (2007). Selective difficulty in recognizing facial expressions of emotion in boys with ADHD: general performance impairments or specific problems in social cognition? European Child and Adolescent Psychiatry, 16, 398–404. doi:10.1007/s00787-007-0612-5.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Funding
This study was funded by a University of Massachusetts Amherst Center for Research on Families’ Dissertation Fellowship Award, a University of Massachusetts Amherst Dissertation Research Grant, and University of Massachusetts Amherst Graduate School Diversity Dissertation Fellowship awarded to the first author.
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
Rights and permissions
About this article
Cite this article
Lugo-Candelas, C., Flegenheimer, C., McDermott, J.M. et al. Emotional Understanding, Reactivity, and Regulation in Young Children with ADHD Symptoms. J Abnorm Child Psychol 45, 1297–1310 (2017). https://doi.org/10.1007/s10802-016-0244-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-016-0244-7