The relationship between emotion regulation, emotion recognition skills and treatment of children with attention deficit hyperactivity disorder

Objective: It is known that people diagnosed with Attention Deficit and Hyperactivity Disorder experience varying degrees of inadequacy in emotion recognition and emotion regulation skills. Although there are studies on emotion recognition and emotion regulation difficulties in the diagnosis of ADHD, studies examining the effect of treatment on these skills are limited, and there is no study examining the effect of drug holiday. The aim of the study is to determine the difficulties experienced in emotion recognition and emotion regulation skills in children with ADHD and to examine the changes in the difficulties experienced with treatment and druh holiday. Materials and Methods: The study is a longitudinal follow-up study. The study was carried out in Bolu İzzet Baysal Training and Research Hospital Child and Adolescent Psychiatry Outpatient Clinics between January 2022 and November 2022. 56 cases aged between 8-12 years, who applied to the outpatient clinic within the specified date range, were diagnosed with ADHD and met the inclusion criteria, participated in the study. First, the participants were presented with the Affective Disorders and Schizophrenia Interview Schedule for School-Age Children - Now and Lifetime Version, The Reading the Mind in the Eyes Test, Faces test and Clinical Global Impression Scale (CGI) were administered before treatment, after treatment, and after medication vacation. Before the treatment, the DSM-IV-Based Screening and Evaluation Scale for Conduct Disorders in Children and Adolescents was given to parents and teachers in order to determine the severity of the disease. Affective Reactivity Index-Parent Form (ARI-P), Weiss Impairment Functioning Scale-Parent Form (WIFS-P), DSM -5 Level 2 Irritability Scale Parent Form (L2IS-P), DSM-5 Level 2 Anger Scale Parent Form (L2AS-P); Affective Reactivity Index-Child Form (ARI-C) and Cognitive Emotion Regulation Strategies Scale for Children (CERSS) were given to children. In addition, the Sociodemographic Data form was used to evaluate sociodemographic characteristics. Results: 56 children with ADHD were included in the study. Of the children and adolescents included in the study, 42 were boys (75.0%) and 14 were girls (25.0%). The mean age of the cases was 118.6 ± 19.7 months. In general, sociodemographic findings were found to be compatible with the literature. The mean severity of impairment, as assessed by the CGI, was determined as 4.8 (SD= 0.8) at the beginning of the study, and the cases were evaluated as "significantly ill". The mean ARI scores of parents and children at the beginning of the study were 3.9 (SD= 3.4) and 4.2 (SD= 3.1), respectively. It was found that the treatment tended to affect the emotional reactivity reported by the children, but the emotional reactivity levels reported by the parents were not significantly affected by the treatment. According to the CERSS scores, it was observed that the participants mostly used the strategies of positive refocusing, positive reappraisal and refocusing on the plan in their initial evaluations, and there was an increase in the use of self-blame and plan refocusing strategies with treatment. According to the mean WIFS-P scores, it is seen that the patients with ADHD have impaired functionality especially in the field of school-learning (mean > 1.5). It was determined that there was a significant improvement in functionality in the fields of school-learning and family with treatment. At the beginning of the study, the mean L2IS-P score was 3.8 (SD= 3.3), and the L2AS-P score was 9.9 (SD= 4.7). There was no statistically significant difference in the scores of both scales with treatment. In the first evaluation, the mean total score of The Reading the Mind in the Eyes Test was 14.6 (SD= 5.6), and the average score of the faces test was 14.3 (SD= 2.7). A statistically significant increase was found in recognizing positive and neutral emotions in the mind reading test with the treatment. No significant difference was found in the results of the faces test. It has been observed that the effects seen with the treatment tend to continue, although they decrease after the drug holiday. Conclusion: According to the findings of the study, children with ADHD have emotional reactivity, difficulty in regulating their emotions, inadequacy in recognizing emotions from the face and eyes, and their functionality decreases especially at school. It was determined that there was an increase in the use of adaptive cognitive strategies and a decrease in the use of maladaptive cognitive strategies. It has been observed that the effect seen with drug holiday tends to persist, although partially diminished. Although the effect tends to persist in part, the decision to take medication should be made by the clinician only when necessary. Longer-term studies with larger samples and wider age range are needed. Key Words: Attention Deficit Hyperactivity Disorders, drug holiday, emotion recognition, emotion regulation, Methylphenidate, stimulant