Attention-deficit hyperactivity disorder and children's emotion dysregulation: A meta-analysis

While executive functioning deficits have been central to cognitive theories of Attention-Deficit Hyperactivity Disorder (ADHD), recent work has suggested that emotion dysregulation may also play a key role in understanding the impairments suffered by youth with ADHD. However, given the multiple processes involved in emotion dysregulation, the extent to which youth with ADHD are impaired across multiple domains of emotion dysregulation including: emotion recognition/understanding (ERU), emotion reactivity/negativity/lability (ERNL), emotion regulation (EREG), and empathy/callous-unemotional traits (ECUT) remains unclear. A meta-analysis of 77 studies (n=32,044 youths) revealed that youth with ADHD have the greatest impairment on ERNL (weighted ES d=.95) followed by EREG (weighted ES d=.80). Significantly smaller effects were observed for ECUT (weighted ES d=.68) and ERU (weighted ES d=.64). Moderation analyses indicated that the association between ADHD and ERNL was stronger among studies that had a sample containing older youth (no other demographic factors were significant). Additionally, the association between ADHD and ECUT was significantly weaker among studies that controlled for co-occurring conduct problems. Co-occurring conduct problems did not moderate the link between ADHD and any other emotion dysregulation domain. Lastly, the association between ADHD and ERNL was significantly weaker when controlling for youth's cognitive functioning. Cognitive functioning did not moderate the link between ADHD and ERU, EREG, or ECUT, respectively. Theoretical/practical implications for the study of emotional dysregulation in youth with ADHD are discussed.