Decoding emotion regulation in adults with ADHD: Subphenotypes, neural correlates, clinical features, and treatment...

Adults with ADHD frequently exhibit significant emotion dysregulation (ED), including emotion impulsivity and impaired emotion regulation abilities. However, ED in ADHD is heterogeneous, and the underlying causes remain unclear. Therefore, this study aims to investigate and validate the presence of emotion regulation profiles in adults with ADHD, and further compare behavioral and neuroimaging differences across profiles.

A total of 497 adults with ADHD were recruited. Eight dimensions from Emotion Regulation Questionnaire and Difficulties in Emotion Regulation Scale were used for the latent profile (LP) analysis. Support vector machine classification was performed to verify the model. The internal validity was examined based on differences in emotion regulation, executive function, and brain functional connectivity (FC) of the amygdala. Treatment responses across different LPs were also analyzed.

We identified three profiles: Well-Adapted (LP1; 29.4%), Moderately Dysregulated (LP2; 49.7%), and Severely Dysregulated (LP3; 20.9%). SVM validation achieved 97.8% accuracy. LP3 exhibited the highest symptom severity and the greatest executive function impairments. In hierarchical regression, only ED symptoms predicted membership in LP2, while comorbidity status, ADHD severity and ED predicted membership in LP3. In addition to significantly improving executive functions (particularly inhibition, shifting, and initiation) in LP3, Cognitive Behavioral Therapy (CBT) also led to marked improvements in emotion regulation strategy use. LP2 displayed weaker postcentral gyrus-amygdala connectivity compared with LP1 and LP3, which may be specific to ED in ADHD.

Our findings suggest the presence of emotion regulation subphenotypes in adults with ADHD, each with distinct neural correlates, which may help deepen the understanding of the clinical characteristics of different regulatory abilities. Therefore, these emotion regulation subphenotypes may serve as key identifiers for tailoring CBT in adults with ADHD, optimizing improvements in both cognitive and emotional domains.