Category: ADHD - Child
Introduction: ADHD is characterized by deficits in cognitive control (e.g., executive functioning; EF; Barkley, 1997). Yet, these deficits are heterogeneous, only accounting for 10% of symptom variability (Willcutt, 2015). Recent empirical evidence supports emotion dysregulation (ED) as an additional core symptom domain (Graziano & Garcia, 2016). Accordingly, ADHD has been contemporarily described as a disorder of deficient overall self-regulation, encompassing both cognitive and emotional control domains (Shaw et al., 2014). Attention, a mechanism underlying self-regulation development (Kaplan & Berman, 2010), may play a prominent role in ED in ADHD. Basic emotion regulation strategies utilized during childhood (e.g., distraction; Gross, 1998), rely upon both selective and sustained attention. These mechanisms are deficient in ADHD (Tsal et al., 2005) though significant heterogeneity exists. We seek to explore the relationship between selective and sustained attention deficits and ED in children with ADHD.
Methods: Fifty children, ages 7-9 years, with symptoms of ADHD (CBCL ADHD problems DSM-oriented subscale T>60), are being recruited. Data collection is ongoing with the aim of completion by the fall. Diagnoses are determined using a semi-structured parent interview (KSADS-PL; Kaufman, 2013). To test study hypotheses, children complete a battery of four measures: 1) Sustained Attention: Continuous Performance Task (CPT; Jongman et al., 2016), 2) Selective Attention: Visual Discrimination Task (Tsal et al., 2005), 3) ED: Mirror Tracing Persistence Task (MTPT; Seymour et al., 2016), and 4) EF: Trail Making Test (TMT; Reitan & Wolfson, 1985).
Results: To date, complete data are available for 14 children. Twelve met criteria for ADHD (5 ADHD-C, 2 ADHD-I, 1 ADHD-H) and 2 were diagnosed with ADHD-unspecified. Five children also presented with comorbid ODD. Initial analyses revealed a significant relationship between sustained attention (measured using d’ block change) and emotion regulation (measured using persistence time): r(14) = -0.54, p < 0.05. This finding remained a trend when controlling for age and EF (measured using standard score): r(14) = -0.53, p < 0.07. Neither sustained attention nor ED correlated with change in self-reported frustration before and after the MTPT. Once data collection is completed, we plan to utilize hierarchical multiple regression analyses to further explore these relationships.
Conclusion: Here, among a small group of children with ADHD, poorer sustained attention related to greater emotion dysregulation. Our initial findings are a first step towards gaining a deeper understanding of the complex interplay between cognitive and emotional control deficits in ADHD. Ideally, clarity of this within-group heterogeneity will lead to increased treatment specificity.