Skip to main content

Advertisement

SpringerLink
Log in

Emotional Impulsivity in Children with ADHD Associated with Comorbid—Not ADHD—Symptomatology

  • Published:
Journal of Psychopathology and Behavioral Assessment Aims and scope Submit manuscript

Abstract

Children with ADHD often demonstrate sudden and intense shifts in both positive and negative affect. This study examined the role of diagnostic status on emotional impulsivity in children utilizing ecological momentary assessment (EMA). Parents of 64 8–12 year old children (15 ADHD-only; 27 ADHD-comorbid; 22 control) completed a diagnostic structured interview and then an EMA protocol, rating the child’s affect thrice daily for 28 days. Analysis of covariance (ANCOVA) suggested that children with ADHD and a comorbid disorder demonstrated significantly more EMA-derived emotional impulsivity than children with ADHD only and control children. No difference was found between children with ADHD only and control children. This study suggested that children with ADHD demonstrate significantly higher levels of emotional impulsivity than control children only in the presence of a comorbid disorder.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association Publishing.

    Google Scholar 

  • Anastopoulos, A. D., Smith, T. F., Garrett, M. E., 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(7), 583–592. doi:10.1177/1087054710370567.

    Article  PubMed  PubMed Central  Google Scholar 

  • Babb, K. A., Levine, L. J., & Arseneault, J. M. (2009). Shifting gears: coping flexibility in children with and without ADHD. International Journal of Behavioral Development, 34(1), 10–23. doi:10.1177/0165025409345070.

    Article  Google Scholar 

  • Banaschewski, T., Jennen-Steinmetz, C., Brandeis, D., Buitelaar, J. K., Kuntsi, J., Poustka, L., et al. (2012). Neuropsychological correlates of emotional lability in children with ADHD. Journal of Child Psychology and Psychiatry, 53(11), 1139–1148. doi:10.1111/j.1469-7610.2012.02596.x.

    Article  PubMed  PubMed Central  Google Scholar 

  • Barkley, R. A. (2005). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (Vol. 1). Guilford Press.

  • Barkley, R. A. (2010). Why emotional impulsiveness should be a central feature of ADHD. The ADHD Report, 18(4), 1–5.

    Article  Google Scholar 

  • Barkley, R. A., & Fischer, M. (2010). The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. Journal of the American Academy of Child and Adolescent Psychiatry, 49(5), 503–513.

    PubMed  Google Scholar 

  • Blackman, G. L., Ostrander, R., & Herman, K. C. (2005). Children with ADHD and depression: a multisource, multimethod assessment of clinical, social, and academic functioning. Journal of Attention Disorders, 8(4), 195–207. doi:10.1177/1087054705278777.

    Article  PubMed  Google Scholar 

  • Burke, J. D., Hipwell, A. E., & Loeber, R. (2010). Dimensions of oppositional defiant disorder as predictors of depression and conduct disorder in preadolescent girls. Journal of the American Academy of Child and Adolescent Psychiatry, 49(5), 484–492.

    PubMed  PubMed Central  Google Scholar 

  • Burke, J. D. (2012). An affective dimension within oppositional defiant disorder symptoms among boys: personality and psychopathology outcomes into early adulthood. Journal of Child Psychology and Psychiatry, 53(11), 1176–1183.

  • Carlson, G. A. (1998). Mania and ADHD: comorbidity or confusion. Journal of Affective Disorders, 51(2), 177–187.

    Article  PubMed  Google Scholar 

  • Crundwell, R. M. A. (2005). An initial investigation of the impact of self-regulation and emotionality on behavior problems in children with ADHD. Canadian Journal of School Psychology, 20(1–2), 62–74.

    Article  Google Scholar 

  • Drabick, D. A., & Gadow, K. D. (2012). Deconstructing oppositional defiant disorder: clinic-based evidence for an anger/irritability phenotype. Journal of the American Academy of Child and Adolescent Psychiatry, 51(4), 384–393.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ebner-Priemer, U. W., & Trull, T. J. (2009). Ecological momentary assessment of mood disorders and mood dysregulation. Psychological Assessment, 21(4), 463.

  • Factor, P. I., Rosen, P. J., & Reyes, R. A. (2013). The relation of poor emotional awareness and externalizing behavior among children with ADHD. Journal of Attention Disorders. doi:10.177/1087054713494005.

  • Fraire, M. G., & Ollendick, T. H. (2013). Anxiety and oppositional defiant disorder: a transdiagnostic conceptualization. Clinical Psychology Review, 33(2), 229–240. doi:10.1016/j.cpr.2012.11.004.

    Article  PubMed  Google Scholar 

  • Franco, X., Saavedra, L. M., & Silverman, W. K. (2007). External validation of comorbid patterns of anxiety disorders in children and adolescents. Journal of anxiety disorders, 21(5), 717–729.

  • Frick, P. J., Cornell, A. H., Barry, C. T., Bodin, S. D., & Dane, H. E. (2003). Callous-unemotional traits and conduct problems in the prediction of conduct problem severity, aggression, and self-report of delinquency. Journal of Abnormal Child Psychology, 31(4), 457–470.

    Article  PubMed  Google Scholar 

  • Fung, M. T., Raine, A., Loeber, R., Lynam, D. R., Steinhauer, S. R., Venables, P. H., et al. (2005). Reduced electrodermal activity in psychopathy-prone adolescents. Journal of Abnormal Psychology, 114(2), 187.

    Article  PubMed  Google Scholar 

  • Graziano, P. A., Geffken, G. R., & McNamara, J. P. (2011). Atypical behaviors and comorbid externalizing symptoms equally predict children with attention-deficit/hyperactivity disorder’s social functioning. Child Psychiatry and Human Development, 42(4), 377–389. doi:10.1007/s10578-011-0224-7.

    Article  PubMed  Google Scholar 

  • Greene, R. W., Biederman, J., Zerwas, S., Monuteaux, M. C., Goring, J. C., & Faraone, S. V. (2002). Psychiatric comorbidity, family dysfunction, and social impairment in referred youth with oppositional defiant disorder. American Journal of Psychiatry, 159(7), 1214–1224.

    Article  PubMed  Google Scholar 

  • Jensen, P. S., Martin, D., & Cantwell, D. P. (1997). Comorbidity in ADHD: Implications for Research, Practice, and DSM-V. Journal of the American Academy of Child & Adolescent Psychiatry, 36(8), 1065–1079.

  • Jensen, P. S., Hinshaw, S. P., Kraemer, H. C., Lenora, N., Newcorn, J. H., Abikoff, H. B., & Vitiello, B. (2001). ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 147–158.

  • Jensen, S. A., & Rosen, L. (2004). Emotional reactivity in children with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 8(2), 53–61.

    Article  PubMed  Google Scholar 

  • Kazdin, A. E., Siegel, T. C., & Bass, D. (1992). Cognitive problem-solving skills training and parent management training in the treatment of antisocial behavior in children. Journal of consulting and clinical psychology, 60(5), 733.

  • Kim, H.-W., Cho, S.-C., Kim, B.-N., Kim, J.-W., Shin, M.-S., & Yeo, J.-Y. (2010). Does oppositional defiant disorder have temperament and psychopathological profiles independent of attention deficit/hyperactivity disorder? Comprehensive Psychiatry, 51(4), 412–418.

    Article  PubMed  Google Scholar 

  • Kolko, D. J., & Pardini, D. A. (2010). ODD dimensions, ADHD, and callous-unemotional traits as predictors of treatment response in children with disruptive behavior disorders. Journal of Abnormal Psychology, 119(4), 713–725. doi:10.1037/a0020910.

    Article  PubMed  Google Scholar 

  • Kovacs, M., Sherrill, J., George, C. J., Pollock, M., Tumuluru, R. V., & Ho, V. (2006). Contextual emotion-regulation therapy for childhood depression: Description and pilot testing of a new intervention. Journal of the American Academy of Child & Adolescent Psychiatry, 45(8), 892–903.

  • Lilienfeld, S. O. (2003). Comorbidity between and within childhood externalizing and internalizing disorders: Reflections and directions. Journal of Abnormal Child Psychology, 31(3), 285–291.

  • Martel, M. M. (2009). Research review: a new perspective on attention-deficit/hyperactivity disorder: emotion dysregulation and trait models. Journal of Child Psychology and Psychiatry, 50(9), 1042–1051. doi:10.1111/j.1469-7610.2009.02105.x.

    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. doi:10.1007/s10802-011-9499-1.

    Article  PubMed  PubMed Central  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 and Adolescent Psychiatry, 52(2), 163–171 e2. doi:10.1016/j.jaac.2012.11.009.

    Article  PubMed  Google Scholar 

  • Mychailyszyn, M. P., Méndez, J. L., & Kendall, P. C. (2010). School functioning in youth with and without anxiety disorders: comparisons by diagnosis and comorbidity. School Psychology Review, 39(1).

  • Okado, I., Mueller, C. W., & Nakamura, B. J. (2013). Positive and negative affect in clinic-referred youth with ADHD. Journal of Attention Disorders. doi:10.1177/1087054713478466.

  • Oland, A. A., & Shaw, D. S. (2005). Pure versus co-occurring externalizing and internalizing symptoms in children: the potential role of socio-developmental milestones. Clinical Child and Family Psychology Review, 8(4), 247–270.

    Article  PubMed  Google Scholar 

  • Pardini, D. A., & Fite, P. J. (2010). Symptoms of conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, and callous-unemotional traits as unique predictors of psychosocial maladjustment in boys: advancing an evidence base for DSM-V. Journal of the American Academy of Child and Adolescent Psychiatry, 49(11), 1134–1144.

    PubMed  PubMed Central  Google Scholar 

  • Pelham Jr, W. E., Wheeler, T., & Chronis, A. (1998). Empirically supported psychosocial treatments for attention deficit hyperactivity disorder. Journal of clinical child psychology, 27(2), 190–205.

  • Peyre, H., Speranza, M., Cortese, S., Wohl, M., & Purper-Ouakil, D. (2012). Do ADHD children with and without child behavior checklist-dysregulation profile have different clinical characteristics, cognitive features, and treatment outcomes? Journal of Attention Disorders. doi:10.1177/1087054712452135.

    PubMed  Google Scholar 

  • Phillips, B. M., Lonigan, C. J., Driscoll, K., & Hooe, E. S. (2002). Positive and negative affectivity in children: A multitraitmultimethod investigation. Journal of Clinical Child and Adolescent Psychology, 31(4), 465–479.

  • Porges, S. W., Doussard‐Roosevelt, J. A., & Maiti, A. K. (1994). Vagal tone and the physiological regulation of emotion. Monographs of the Society for Research in Child Development, 59(2–3), 167–186.

  • Rosen, P. J., & Factor, P. I. (2012). Emotional impulsivity and emotional and behavioral difficulties among children with ADHD: an ecological momentary assessment study. Journal of Attention Disorders. doi:10.1177/1087054712463064.

  • Rosen, P. J., Epstein, J. N., & Van Orden, G. (2013). I know it when I quantify it: ecological momentary assessment and recurrence quantification analysis of emotion dysregulation in children with ADHD. ADHD Attention Deficit and Hyperactivity Disorders, 5(3), 283–294.

  • Rosen, P. J., Walerius, D. M., Factor, P. I., & Reyes, R. A. (n.d.) Emotional Impulsivity and Internalizing/Externalizing Difficulties among Children With and Without ADHD: A Moderation Analysis. Manuscript under review.

  • Rudolph, K. D., Hammen, C., & Burge, D. (1994). Interpersonal functioning and depressive symptoms in childhood: addressing the issues of specificity and comorbidity. Journal of Abnormal Child Psychology, 22(3), 355–371.

    Article  PubMed  Google Scholar 

  • Schatz, D. B., & Rostain, A. L. (2006). ADHD with comorbid anxiety: a review of the current literature. Journal of Attention Disorders, 10(2), 141–149. doi:10.1177/1087054706286698.

    Article  PubMed  Google Scholar 

  • Scime, M., & Norvilitis, J. M. (2006). Task performance and response to frustration in children with attention deficit hyperactivity disorder. Psychology in the Schools, 43(3), 377–386. doi:10.1002/pits.20151.

    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.

  • 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(1), 28–38.

  • 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(6), 906.

  • Shrier, L. A., Shih, M. C., & Beardslee, W. R. (2005). Affect and sexual behavior in adolescents: a review of the literature and comparison of momentary sampling with diary and retrospective self-report methods of measurement. Pediatrics, 115(5), e573–e581.

  • Skirrow, C., McLoughlin, G., Kuntsi, J., & Asherson, P. (2009). Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Review of Neurotherapeutics, 9, 489–503.

    Article  PubMed  Google Scholar 

  • Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., & Faraone, S. V. (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(8), 915–923.

  • Solhan, M. B., Trull, T. J., Jahng, S., & Wood, P. K. (2009). Clinical assessment of affective instability: Comparing EMA indices, questionnaire reports, and retrospective recall. Psychological Assessment, 21(3), 425.

  • Sorensen, L., Plessen, K. J., Nicholas, J., & Lundervold, A. J. (2011). Is behavioral regulation in children with ADHD aggravated by comorbid anxiety disorder? Journal of Attention Disorders, 15(1), 56–66. doi:10.1177/1087054709356931.

    Article  PubMed  Google Scholar 

  • Stone, A. A., & Shiffman, S. (1994). Ecological momentary assessment (EMA) in behavorial medicine. Annals of Behavioral Medicine, 16, 199–202.

    Google Scholar 

  • Stringaris, A., & Goodman, R. (2009a). Longitudinal outcome of youth oppositionality: irritable, headstrong, and hurtful behaviors have distinctive predictions. Journal of the American Academy of Child and Adolescent Psychiatry, 48(4), 404–412. doi:10.1097/CHI.0b013e3181984f30.

    Article  PubMed  Google Scholar 

  • Stringaris, A., & Goodman, R. (2009b). Three dimensions of oppositionality in youth. Journal of Child Psychology and Psychiatry, 50(3), 216–223. doi:10.1111/j.1469-7610.2008.01989.x.

    Article  PubMed  Google Scholar 

  • Suveg, C., Kendall, P. C., Comer, J. S., & Robin, J. (2006). Emotion-focused cognitive-behavioral therapy for anxious youth: A multiple-baseline evaluation. Journal of Contemporary Psychotherapy, 36(2), 77–85.

  • Taylor, E. (2011). Antecedents of ADHD: a historical account of diagnostic concepts. Attention Deficit and Hyperactivity Disorders, 3(2), 69–75. doi:10.1007/s12402-010-0051-x.

    Article  PubMed  Google Scholar 

  • Thompson, E. R. (2007). Development and validation of an internationally reliable short-form of the positive and negative affect schedule (PANAS). Journal of Cross-Cultural Psychology, 38(2), 227–242.

  • Tzang, R.-F., & Chang, Y.-C. (2009). Behavior problems and subtypes of attention-deficit hyperactivity disorder with comorbidities. The Kaohsiung Journal of Medical Sciences, 25(10), 530–536.

    Article  PubMed  Google Scholar 

  • Walcott, C. M., & 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 

  • Waschbusch, D. A., Pelham, W. E., Jr., Jennings, J. R., Greiner, A. R., Tarter, R. E., & Moss, H. B. (2002). Reactive aggression in boys with disruptive behavior disorders: behavior, physiology, and affect. Journal of Abnormal Child Psychology, 30(6), 641–656.

    Article  PubMed  Google Scholar 

  • Weiss, H., Beal, D. J., Lucy, S. L., & MacDermid, S. M. (2004). Constructing EMA studies with PMAT: the purdue momentary assessment tool user’s manual. West Lafayette, Ind, Purdue University, Military Family Research Institute.

  • Wheeler Maedgen, J., & Carlson, C. L. (2000). Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child Psychology, 29(1), 30–42.

    Article  Google Scholar 

Download references

Conflict of Interest

Perry I. Factor declares that there is no conflict of interest; Rachel A. Reyes declares that there is no conflict of interest; Paul J. Rosen declares that there is no conflict of interest.

Experiment Participants

This project was approved by the Institutional Review Board at the University of Louisville. All parents provided written consent and all children provided written assent prior to beginning any study procedures.

Author information

Authors and Affiliations

  1. University of Louisville, 317 Life Sciences Building, Louisville, KY, USA, 40292

    Perry I. Factor, Rachel A. Reyes & Paul J. Rosen

Authors
  1. Perry I. Factor
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rachel A. Reyes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul J. Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Perry I. Factor.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Factor, P.I., Reyes, R.A. & Rosen, P.J. Emotional Impulsivity in Children with ADHD Associated with Comorbid—Not ADHD—Symptomatology. J Psychopathol Behav Assess 36, 530–541 (2014). https://doi.org/10.1007/s10862-014-9428-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10862-014-9428-z

Keywords

Search

Navigation