Effects of incorporating emotion dysregulation into ADHD diagnostic criteria

Emotion dysregulation (ED) is common in ADHD, and a source of greater clinical impairment. Current official diagnostic criteria for ADHD do not include ED symptoms, although some scholars have proposed revisions to address this issue. The present study examined how substituting elevated ED for elevated hyperactivity-impulsivity would change which postsecondary students meeting a combined-presentation symptom threshold. Archival data from 2,459 postsecondary students referred for a neuropsychological evaluation were analyzed. Participants completed a standard rating scale of ADHD symptoms as well as at least one ED measure. The proportions meeting the traditional and ED-inclusive symptom thresholds were similar: 22.1% met the traditional combined-presentation threshold, whereas 21.7% and 22.3% met two different ED-inclusive thresholds. Agreement between the traditional and ED-inclusive classifications was moderate (φ = .34-.37), and the ED-inclusive groups contained higher proportions of female participants (60-68%) than the traditional ADHD symptom group did (52%). Thus, substituting ED produced similarly sized but only partially overlapping symptom-threshold groups. These findings do not establish improved diagnostic accuracy or support a particular revision to ADHD criteria; rather, they demonstrate that substituting ED for traditional hyperactivity-impulsivity changes who meets the symptom threshold while leaving the overall proportion classified largely unchanged.