MOVED TO POSTER SESSION II, 348A, ECPN STUDENT POSTER CONTESTANT: Further Investigation of Emotion Dysregulation in Adolescents with ADHD

Emotion dysregulation (ED) is a transdiagnostic characteristic that is associated with several psychiatric disorders (see Bunford et al., 2015, for a review). Importantly, ED manifests in a variety of ways across these disorders. In a recent meta-analysis, Graziano and Garcia (2016) reported that of the various aspects of ED, youth with ADHD experienced the most impairment related to intensity and duration of affective arousal – a characteristic reminiscent of what Bunford and colleagues (2015) defined as ED. Accordingly, the goal of this study was to begin evaluating the validity of defining ED, in association with ADHD, as (1) an individual’s inability to moderate the speed and degree to which the expression of emotion escalates; (2) the intensity of the expression of emotion; and (3) the speed and degree to which the expression of emotion de-escalates (Bunford et al., 2015). Using a sample of N = 210 adolescents (78% male; 41.1% ninth grade; 37.6% 10th grade; 21.3% 11th grade) demonstrating ADHD symptoms, we combined 20 items from three measures designed to assess ED and conducted an exploratory factor analysis (EFA). We expected to find three factors, in alignment with those described above. We also examined the discriminant validity of the factors by assessing their relations with impulsivity, depression, and anxiety using exploratory structural equation modeling. Our EFA results suggest a 2-factor solution to ED with factor one characterized as speed of escalation and intensity of emotional response. Factor two was best characterized as speed of de-escalation. ADHD impulsivity symptoms as described in the Diagnostic and Statistical Manual (DSM-5) were positively related to escalation/intensity, but not de-escalation. Cognitive and behavioral impulsivity, as measured by a trait-based assessment of impulsivity, were not related to either factor. Finally, anxiety and depression were positively related to de-escalation, but not related to factor escalation/intensity. These results help discern which aspects of ED are most important for ADHD, with clear implications for prevention and treatment development. First, the child who becomes upset quickly and expresses behavior intensely may most benefit from emotional awareness and regulation treatment designed to modify self-destructive behavior (Linehan, 2015). However, the processes underlying factor 2 – return to baseline – may be similar to the cognitive processes that contribute to ED in internalizing disorders (Aldao et al., 2010). This suggests that the speed of de-escalation component of ED may best be treated by strategies that are considered most effective for youth with internalizing disorders (e.g., cognitive-behavioral therapy; Higa-McMillan et al., 2016; Weersing et al., 2017).