Emotional Profiles in Adolescents With ADHD: A Person-Centered Analysis of Emotion Regulation, Resilience, and...

Emotion dysregulation and internalizing symptoms are increasingly recognized as central features of attention-deficit/hyperactivity disorder (ADHD), yet substantial emotional heterogeneity exists among affected adolescents. This study aimed to identify distinct emotional profiles in adolescents with ADHD by integrating emotion regulation difficulties, resilience, and internalizing symptoms using a person-centered, data-driven approach.

This multicenter, cross-sectional study included 109 clinically referred adolescents aged 11-18 years with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis of ADHD. Adolescents completed self-report measures of emotion regulation difficulties (Difficulties in Emotion Regulation Scale-16; DERS-16), resilience (Connor-Davidson Resilience Scale; CD-RISC-25), and internalizing symptoms (Revised Child Anxiety and Depression Scale; RCADS). Parents completed parent-report measures of their child's ADHD symptom severity (Swanson, Nolan, and Pelham Rating Scale; SNAP-IV) and perceived competence, as well as self-report measures of their own emotion regulation difficulties and resilience. Clinicians rated global severity using the Clinical Global Impression-Severity scale (CGI-S). K-means clustering was applied to standardized adolescent emotional variables to identify distinct profiles, which were evaluated using internal validation indices and clinical correlates. Between-cluster comparisons were conducted across demographic, clinical, and psychosocial variables. Correlation and mediation analyses were performed to examine associations among resilience, emotion regulation difficulties, and internalizing symptoms.

Four distinct emotional profiles were identified: (1) Low Emotion Dysregulation / High Resilience / Low Internalizing, (2) Moderate Emotion Dysregulation / Moderate Resilience / Moderate Internalizing, (3) Low-to-Moderate Emotion Dysregulation / Low Resilience / Low-to-Moderate Internalizing (descriptively labeled as "Low-resilience silent" profile), and (4) High Emotion Dysregulation / Low Resilience / High Internalizing. Emotional profiles differed significantly in emotion regulation difficulties, resilience, and internalizing symptom severity (all p < 0.001), but not in parent-reported ADHD symptom dimensions or clinician-rated severity. Perceived social competence, gender distribution, internalizing comorbidity, and medication patterns varied across profiles, whereas parental emotion regulation difficulties and resilience did not. Emotion regulation difficulties showed a significant indirect effect in the association between resilience and internalizing symptoms, such that lower resilience was associated with greater emotion regulation difficulties, which in turn were associated with higher internalizing symptom severity.

Adolescents with ADHD exhibit clinically meaningful emotional profiles that are largely independent of core ADHD symptom severity. Emotion regulation difficulties represent a key mechanism linking resilience and internalizing symptoms. Profile-informed assessment incorporating brief measures of emotion regulation, resilience, and internalizing symptoms may enhance clinical formulation and help identify adolescents with silent emotional vulnerability who may otherwise be overlooked in routine care.