The relationship between emotional dysregulation and impulsivity among adult attention deficit-hyperactivity disorder patients

Aim: Recent studies have focused on the role of emotional dysregulation (ED) on etiopathogenesis of attention deficit and hyperactivity disorder (ADHD). On the other hand, impulsivity is a well-known core deficit in this disorder. The aim of this study was to assess the relationship between ED and impulsivity among adult ADHD patients. We thought that assessing both behavioral aspect and emotions, might provide us much more understanding of this disorder. Method: Forty five ADHD patients diagnosed by using DSM-5 criteria and 46 healthy controls were included. ADHD self rating scales were used to determine the severity of ADHD symptoms. The patients also assesed with Hamilton Depression and Hamilton Anxiety Rating Scales to measure anxiety and depression symptoms. All participants were assesed via Difficulties in Emotion Regulation Scale (DERS) and Barrat Impulsivity Scale-11 (BIS-11). Seventeen ADHD patients diagnosed with 'predominantly inattentive' subtype (ADHD-PI) were included in a group (n=17); 27 combined typed patients (ADHD-CT) and 1 predominantly hyperactive/impulsive subtyped (ADHD-HI) patient both included in an other group we named "ADHD-Other" (n=28). Findings were compared between groups and correlation analyses were performed. Results: All subscale scores and total DERS score were similarly found to be statistically higher than the control group scores in both ADHD-PI and ADHD-Other groups. Additionally, total score and all subscale BIS-11 scores were also found to be higher in ADHD subgroups compared to healthy controls. Significant correlations were found between all subscale scores and total scores of DERS and BIS-11. Childhood symptoms of ADHD which measured by Wender Utah Rating Scale-25 (WURS-25) were found to be correlated mostly with "strategies", "impulse" and "goals" subscales of DERS. The subscale "inattention" of Adult ADHD Self Report Scale (ASRS-v1.1) also showed significant correlation with "goals". Conclusion: In our study, we found that both two subgoups of ADHD patients had much more difficulties in regulating their emotions as well as having much more impulsive behaviors compared to healthy controls. In addition to this finding, positive relation was found between ED and impulsivity. In our opinion, these findings might reflect that these two domains together may change the clinical presentation of ADHD. In general, our results were consistent with the results of previous studies. The most important feature of our study might arise from the fact that, to our knowledge, this is the first study that assessed both emotion regulation difficulties and aspect of impulsive behaviour on adult ADHD patients. To explore the similarities between two domains or distinguishing them from each other, future studies should assess emotions and impulsivity together with neurocognitive tests and neuroimaging methods. Keywords: Emotional disregulation, impulsivity