This review looked at 22 studies of adults over 18 with an ADHD diagnosis. Each study measured emotion regulation, which is how well a person manages their feelings. Most of the adults came from clinics. The studies differed a lot in size, gender mix, ADHD type, other conditions and medicine use.
Ten studies compared adults with and without ADHD. In all ten, the ADHD groups had lower emotion regulation scores, with gaps from medium to very large. Some studies found that adults with ADHD more often held back their feelings and less often rethought a situation to change how they felt.
Emotional trouble was linked to impulsivity, executive function problems, trouble in daily life, substance use and criminal convictions. Brain activity also differed between adults with and without ADHD.
In treatment studies, atomoxetine and a form of methylphenidate each eased emotional trouble more than a placebo. A mindfulness program also helped compared with a waiting list.
Studies found no clear difference in emotional trouble between ADHD and autism. So the authors concluded that it is present in ADHD but not shown to be a core symptom. The studies were few and very mixed. Gender and other conditions could make the gap look bigger, while ADHD medicine could hide it. The authors suggest that medicine and behavioral therapies such as mindfulness could help adults with ADHD with emotional difficulties, though the evidence is preliminary and medicine decisions belong with a clinician.
The numbers Stats and what the terms mean
The statistics behind the plain-language claims above.
- Reviewed studies (cited in Soler-Gutiérrez, 2023): how much lower adults with ADHD scored on emotion regulation than controls across ten studies, d’ = 0.31 to 2.27.
- Materna et al. (cited in Soler-Gutiérrez, 2023): adults with ADHD scored lower than controls on rethinking a situation (reappraisal), t = 2.40, p = 0.020.
- Materna et al. (cited in Soler-Gutiérrez, 2023): adults with ADHD scored higher than controls on holding back feelings (suppression), t = −3.28, p = 0.002.
- One included study (cited in Soler-Gutiérrez, 2023): atomoxetine versus placebo on emotional trouble, F = 15.10, p = 0.001, d’ = 0.66.
- One included study (cited in Soler-Gutiérrez, 2023): OROS methylphenidate versus placebo on emotional trouble, F = 10.476, p = 0.002, d’ = 0.70.
- One included study (cited in Soler-Gutiérrez, 2023): mindfulness versus waiting list on impulse control difficulties, p = 0.002, d = 1.60.
- One included study (cited in Soler-Gutiérrez, 2023): mindfulness versus waiting list on limited access to emotion regulation strategies, p = 0.007, d = 1.38. What the terms mean:
- d and d’ show how big a difference is between groups. Roughly, 0.2 is small, 0.5 is moderate and 0.8 is large. A minus sign shows the direction of the change, not its size.
- t and F are test scores used to check whether a difference between groups is real. A minus sign shows the direction of the difference.
- p is the chance of seeing a result this strong if there were no real difference. Below 0.05 is usually read as unlikely to be down to chance.
Source: Soler-Gutiérrez A, Pérez-González J, Mayas J. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review. PLOS ONE (2023). doi:10.1371/journal.pone.0280131