Lenard Adler, MD ADHD in AdultsThis article reviews the phenomenology of emotional dysregulation in adult ADHD. The article discusses whether symptoms of emotional dysregulation (ED) are co-traveling symptoms that travel with symptoms of adult ADHD or whether they are part of the core symptoms of the condition.

Symptoms of ED include rapidly shifting affect, changeable mood, mood lability, impulsivity and emotional overactivity. Barkley et al. (7 from article) have posited that ED symptoms are part of a set of executive function deficits which are critical to the core of ADHD symptomtology (8).

In contrast, Wender (13) and co-workers have posited that ED symptoms should be part of the diagnostic criteria of adult ADHD and are included in the Utah criteria they defined and the Wender-Reimherr Adult Attention-Deficit Disorder Scale (WRAADS). Work from Adler and Kessler and co-workers (21) found that ED symptoms tracked separately from symptoms of inattention, hyper-activity impulsivity and executive function and were more likely to load on the Combined presentation of ADHD and be present in sub-threshold cases. The article also reviews a number of scales which have been used to assess ED, including the WRAADS, the expanded Adult ADHD Clinician Diagnostic Scale (ACDS) v.1.2, expanded Adult ADHD Self-Report Scale (ASRS) v1.1 Symptom Checklists and the Brown Adult ADD Scale (BAADS).

This article is important to clinicians because: 1) it defines and highlights the importance of recognizing symptoms of ED, 2) describes assessment methods and 3) notes the lower efficacy of standard adult ADHD pharmacotherapies of stimulants and atomoxetine than on core ADHD symptoms and 4) highlights the potential utility of cognitive behavioral therapy in treating ED symptoms in adults with ADHD.

REFERENCES
https://www.healio.com/psychiatry/journals/psycann/2018-7-48-7/%7Bd9674afc-698a-4cd9-9a24-81e3e4d4d944%7D/emotional-dysregulation-in-adult-adhd

Lenard A. Adler, MD

About Lenard A. Adler, MD

Dr. Adler is Professor, Department of Psychiatry, and Department of Child and Adolescent Psychiatry, as well as the Director of the Adult ADHD Program at NYU Langone Medical Center in Manhattan, New York. He is a member of APSARD, the American Professional Society of ADHD and Related Disorders, and is on the Advisory Board of ADHD in Adults.com