Physiological Emotion Regulation in Children with ADHD with and without Comorbid Internalizing Disorders: a Preliminary Study
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Children with Attention-Deficit/Hyperactivity Disorder (ADHD) experience deficits in emotion regulation that can be measured physiologically under environmental stress conditions by examining respiratory sinus arrhythmia (RSA), a marker of parasympathetic nervous system (PNS) withdrawal. The current pilot study examined the impact of comorbid internalizing disorders and comorbid Oppositional Defiant Disorder (ODD) on emotion regulation in children with ADHD by measuring RSA as an indicator of dysregulated emotional reactivity. Twenty-four 7–10 year old children with ADHD participated in the current study. Children completed a 5-min resting attending baseline while electrocardiogram data (ECG) were recorded to examine baseline RSA. Children then completed a stress inducing, blocked goal, Card Sorting Task to measure RSA reactivity to stress. Results revealed a significant effect of internalizing disorder status on RSA difference score, F (1, 18) = 5.83, p = .03, η2 = .25. Children in the comorbid internalizing disorder group had a significantly greater decrease in RSA from the baseline time period to the card sorting task. There was no significant effect of ODD diagnostic status on RSA difference score, p > .05. The results of this preliminary study suggest that among children with ADHD, the presence of a comorbid internalizing disorder predicts greater withdrawal of the PNS. These findings represent an important step in understanding autonomic functioning of children with ADHD and comorbid disorders.
KeywordsPhysiological emotion regulation Attention-deficit/hyperactivity disorder Internalizing disorders Stress reactivity
All authors contributed significantly to the revision of this manuscript.
The authors received no financial support for the research, authorship, and/or publication of this article.
Compliance with Ethical Standards
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.
This article does not contain any studies with animals performed by any of the authors.
Conflict of Interest
Kirsten D. Leaberry, Paul J. Rosen, Nicholas D. Fogleman, Danielle M. Walerius, and Kelly E. Slaughter declare that they have no conflict of interest.
This article contains studies with human participants. Experimental participants provided informed consent for study participation.
Informed consent was obtained from all individual participants included in the study.
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association.Google Scholar
- Anastopoulos, A. D., Smith, T. F., Garrett, M. E., Morrissey-Kane, E., Schatz, N. K., Sommer, J. L.,... Ashley-Koch, A. (2011). Self regulation of emotion, functional impairment, and comorbidity among children with ADHD. Journal of Attention Disorders, 15, 583–592. https://doi.org/10.1177/1087054710370567.
- Barkley, R. A. (Ed.). (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. New York: The Guilford Press.Google Scholar
- Berntson, G. G., Lozano, D. L., Chen, Y., & Cacioppo, J. T. (2004). Where to Q in PEP. Psychophysiology, 41, 333–337. https://doi.org/10.1111/j.1469-8986.2004.00156.x.
- Berntson, G. G., Bigger, J. T., Eckberg, D. L., Grossman, P., Kaufmann, P. G., Malik, M.,...Van der Molen, M. W. (1997). Heart rate variability: Origins, methods, and interpretive caveats. Psychophysiology, 34, 623–648. https://doi.org/10.1111/j.1469-8986.1997.tb02140.x.
- Biederman, J., Spencer, T. J., Petty, C., Hyder, L. L., O'Connor, K. B., Surman, C. B., & Faraone, S. V. (2012). Longitudinal course of deficient emotional self-regulation CBCL profile in youth with ADHD: Prospective controlled study. Neuropsychiatric Disease and Treatment, 8, 267–276. https://doi.org/10.2147/NDT.S29670.
- Calkins, S. D., Graziano, P. A., & Keane, S. P. (2007). Cardiac vagal regulation differentiates among children at risk for behavioral problems. Biological Psychology, 74, 144–153. https://doi.org/10.1016/j.biopsycho.2006.09.005.
- Crowell, S. E., Beauchaine, T. P., Gatske-Kopp, L., Sylvers, P., Mead, H., & Chipman-Chacon, J. (2006). Autonomic correlates of attention-deficit/hyperactivity disorder and oppositional defiant disorder in preschool children. Journal of Abnormal Psychology, 115, 174–178. https://doi.org/10.1037/0021-843X.115.1.174.CrossRefPubMedGoogle Scholar
- El-Sheikh, M., Hinnant, J. B., & Erath, S. (2011). Developmental trajectories of delinquency symptoms in childhood: The role of marital conflict and autonomic nervous system activity. Journal of Abnormal Psychology, 120, 16–32. https://doi.org/10.1037/a0020626.CrossRefPubMedPubMedCentralGoogle Scholar
- Gentzler, A. L., Santucci, A. K., & Fox, N. A. (2009). Respiratory sinus arrhythmia predicts emotion regulation and depressive symptoms in at-risk and control children. Biological Psychology, 82, 156–163. https://doi.org/10.1016/j.biopsycho.2009.07.002.
- Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review. Review of General Psychology, 2, 271–299. https://doi.org/10.1037/1089-26126.96.36.1991.
- Herpertz, S. C., Wenning, B., Mueller, B., Qunaibi, M., Sass, H., & Herpertz-Dahlmann, M. (2001). Psychophysiological responses in ADHD boys with and without conduct disorder: Implications for adult antisocial behavior. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 1220–1230.CrossRefGoogle Scholar
- Keenan, K. (2000). Emotion dysregulation as a risk factor for child psychopathology. Clinical Psychology: Science and Practice, 7, 418–434. https://doi.org/10.1093/clipsy.7.4.418.
- van Lang, D. J. N., Tulen, J. H. M., Kallen, V. L., Rosbergen, B., Dieleman, G., & Ferdinand, R. F. (2007) Autonomic reactivity in clinically referred children attention-deficit/hyperactivity disorder versus anxiety disorder. European Child & Adolescent Psychiatry, 16, 71–78. https://doi.org/10.1007/s00787-006-0575-y.
- Martel, M. M., & Nigg, J. T. (2006). Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality. Journal of Child Psychology and Psychiatry and Allied Disciplines, 47, 1175–1183. https://doi.org/10.1111/j.1469-7610.2006.01629.x.CrossRefGoogle Scholar
- Maughan, B., Rowe, R., Messer, J., Goodman, R., & Meltzer, H. (2004). Conduct disorder and oppositional defiant disorder in a national sample: Developmental epidemiology. Journal of Child Psychology and Psychiatry, 45, 609–621. https://doi.org/10.1111/j.1469-7610.2004.00250.x.
- Mauss, I. B., Bunge, S. A., & Gross, J. J. (2007). Automatic emotion regulation. Social and Personality Psychology Compass, 1, 1–22. https://doi.org/10.1111/j.1751-9004.2007.00005.x.
- Musser, E. D., Backs, R. W., Schmitt, C. F., Ablow, J. C., Measelle, J. R., & Nigg, J. (2011). Emotion regulation via the autonomic nervous system in children with attention- deficit/hyperactivity disorder (ADHD). Journal of Abnormal Child Psychology, 39, 841–852. https://doi.org/10.1007/s10802-011-9499-1.CrossRefPubMedPubMedCentralGoogle Scholar
- Okado, I., Mueller, C. W., & Nakamura, B. J. (2013). Positive negative affect in clinic-referred youth with ADHD. Journal of Attention Disorders. https://doi.org/10.1177/1087054713478466.
- Richards, J. E. (1995). Reliability of respiratory sinus arrhythmia in R-R intervals, in 14-, 20-, and 26-week-old infants. Infant Behavior and Development, 18, 155-161. Retrieved from: https://doi.org/10.1016/0163-6383(95)90045-4.
- 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 & Adolescent Psychiatry, 39, 28–38.CrossRefGoogle Scholar
- 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 and Allied Disciplines, 51, 915–923. https://doi.org/10.1111/j.1469-7610.2010.02217.x.CrossRefGoogle Scholar
- Stringaris, A., & Goodman, R. (2009b). Longitudinal outcome of youth oppositionality: Irritable, headstrong, and hurtful behaviors have distinctive predictions. Journal of the American Academy of Child & Adolescent Psychiatry, 48, 404-412. Retrieved from: https://doi.org/10.1097/CHI.0b013e3181984f30.
- 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 and Adolescent Psychiatry, 50, 1357–1364. https://doi.org/10.1111/j.1469-7610.2009.02172.x.Google Scholar
- Vitiello, B. (2008). Understanding the risk of using medications for attention deficit hyperactivity disorder with respect to physical growth and cardiovascular function. Child and Adolescent Psychiatric Clinics of North America, 17, 459–474. https://doi.org/10.1016/j.chc.2007.11.010.CrossRefPubMedPubMedCentralGoogle Scholar
- Waxmonsky, J. G., Wymbs, F. A., Pariseau, M. E., Belin, P. J., Waschbusch, D. A., Babocsai, L., … Pelham, W. E. (2013). A novel group therapy for children with ADHD and severe mood dysregulation. Journal of Attention Disorders, 17, 527–541. https://doi.org/10.1177/1087054711433423.
- Whelan, Y. M., Stringaris, A., Maughan, B., & Barker, E. D. (2013). Developmental continuity of oppositional defiant disorder subdimensions at age 8, 10, and 13 years and their distinct psychiatric outcomes at age 16 years. Journal of the American Academy of Child & Adolescent Psychiatry, 52, 961–969.CrossRefGoogle Scholar
- Wolraich, M. L., Lambert, W., Doffing, M. A., Bickman, L., Simmons, T., & Worley, K. (2003). Psychometric properties of the Vanderbilt ADHD Diagnostic Parent Rating Scale in a referred population. Journal of Pediatric Psychology, 28, 559–568. https://doi.org/10.1093/jpepsy/jsg046.CrossRefPubMedGoogle Scholar