Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-11T09:43:19.416Z Has data issue: false hasContentIssue false
  • English
  • Français

Everyday emotional experience of adults with attention deficit hyperactivity disorder: evidence for reactive and endogenous emotional lability

Published online by Cambridge University Press:  15 May 2014

C. Skirrow ,
U. Ebner-Priemer ,
I. Reinhard ,
Y. Malliaris ,
J. Kuntsi  and
P. Asherson
C. Skirrow
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK Developmental Cognitive Neuroscience Unit, Institute of Child Health, University College London, UK
U. Ebner-Priemer
Affiliation:
Karlsruhe Institute of Technology (KIT), Germany Central Institute for Mental Health, Division of Biostatistics, Mannheim, Germany
I. Reinhard
Affiliation:
Central Institute for Mental Health, Division of Biostatistics, Mannheim, Germany
Y. Malliaris
Affiliation:
EDO the Hellenic Bipolar Organization and BipolarLab.com, Greece
J. Kuntsi
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
P. Asherson*
Affiliation:
MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: P. Asherson, MRCPsych., Ph.D., MRC Social, Genetic and Developmental Psychiatry Centre (SGDP), Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. (Email: Philip.asherson@kcl.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Emotional lability (EL), characterized by negative emotional traits and emotional instability, is frequently reported in children and adults with attention deficit hyperactivity disorder (ADHD). However, EL is primarily assessed using retrospective self-report, which is subject to reporting bias and does not consider the potential influence of positive and negative everyday experiences.

Method.

Ambulatory assessment was carried out in 41 men with ADHD without co-morbidity, current medication or substance abuse, and 47 healthy control participants. Reports of negative and positive emotions (irritability, frustration, anger, happiness, excitement) and the occurrence of bad and good events were completed eight times daily during a working week. Group differences in emotional intensity and instability were investigated using multilevel models, and explored in relation to bad and good events and the Affective Lability Scale – Short Form (ALS-SF), an EL questionnaire.

Results.

The ADHD group reported significantly more frequent bad events, heightened intensity and instability of irritability and frustration, and greater intensity of anger. The results for positive emotions were equivocal or negative. Bad events significantly contributed to the intensity and instability of negative emotions, and showed a stronger influence in the ADHD group. However, covariation for their effect did not eliminate group differences. Small-to-moderate correlations were seen between intensity and instability of negative emotions and the ALS-SF.

Conclusions.

Adults with ADHD report heightened intensity and instability of negative emotions in daily life. The results suggest two components of EL in ADHD: a reactive component responsive to bad events and an endogenous component, independent of negative everyday events.

Keywords

Ambulatory monitoringattention deficit hyperactivity disorder (ADHD)co-morbidityemotional labilitymood instability
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 16 , December 2014 , pp. 3571 - 3583
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anastopoulos, AD, Smith, TF, Garrett, ME, Morrissey-Kane, E, Schatz, NK, Sommer, JL, Kollins, SH, Ashley-Koch, A (2011). Self-regulation of emotion, functional impairment, and comorbidity among children with AD/HD. Journal of Attention Disorders 15, 583–592.CrossRefGoogle ScholarPubMed
Anestis, MD, Selby, EA, Crosby, RD, Wonderlich, SA, Engel, SG, Joiner, TE (2010). A comparison of retrospective self-report versus ecological momentary assessment measures of affective lability in the examination of its relationship with bulimic symptomatology. Behaviour Research and Therapy 48, 607–613.CrossRefGoogle ScholarPubMed
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). American Psychiatric Association: Washington, DC.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association: Washington, DC.Google Scholar
Asherson, P (2005). Clinical assessment and treatment of attention deficit hyperactivity disorder in adults. Expert Review of Neurotherapeutics 5, 525–539.CrossRefGoogle ScholarPubMed
Asherson, P, Chen, W, Craddock, B, Taylor, E (2007). Adult attention-deficit hyperactivity disorder: recognition and treatment in general adult psychiatry. British Journal of Psychiatry 190, 4–5.CrossRefGoogle ScholarPubMed
Barkley, RA (1998). A Clinical Workbook: Attention-Deficit Hyperactivity Disorder. Guilford Press: New York.Google Scholar
Barkley, RA, Fischer, M (2010). The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. Journal of the American Academy of Child and Adolescent Psychiatry 49, 503–513.Google ScholarPubMed
Barkley, RA, Murphy, KR (2010). Deficient emotional self-regulation in adults with attention-deficit/hyperactivity disorder (ADHD): the relative contributions of emotional impulsiveness and ADHD symptoms to adaptive impairments in major life activities. Journal of ADHD and Related Disorders 1, 5–28.Google Scholar
Bauer, M, Glenn, T, Grof, P, Pfennig, A, Rasgon, NL, Marsh, W, Munoz, RA, Sagduyu, K, Alda, M, Quiroz, D, Sasse, J, Whybrow, PC (2007). Self-reported data from patients with bipolar disorder: frequency of brief depression. Journal of Affective Disorders 101, 227–233.CrossRefGoogle ScholarPubMed
Biederman, J, Faraone, SV, Monuteaux, MC (2002). Differential effect of environmental adversity by gender: Rutter's index of adversity in a group of boys and girls with and without ADHD. American Journal of Psychiatry 159, 1556–1562.CrossRefGoogle Scholar
Biederman, J, Mick, E, Faraone, SV, Spencer, T, Wilens, TE, Wozniak, J (2000). Pediatric mania: a developmental subtype of bipolar disorder? Biological Psychiatry 48, 458–466.CrossRefGoogle Scholar
Biederman, J, Milberger, S, Faraone, SV, Kiely, K, Guite, J, Mick, E, Ablon, JS, Warburton, R, Reed, E, Davis, SG (1995). Impact of adversity on functioning and comorbidity in children with attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry 34, 1495–1503.CrossRefGoogle ScholarPubMed
Biederman, J, Spencer, T, Lomedico, A, Day, H, Petty, CR, Faraone, SV (2012). Deficient emotional self-regulation and pediatric attention deficit hyperactivity disorder: a family risk analysis. Psychological Medicine 42, 639–646.CrossRefGoogle ScholarPubMed
Bolger, N, Davis, A, Rafaeli, E (2003). Diary methods: capturing life as it is lived. Annual Review of Psychology 54, 579–616.CrossRefGoogle ScholarPubMed
Bower, GH (1981). Mood and memory. American Psychologist 36, 129–148.CrossRefGoogle ScholarPubMed
Chepenik, LG, Ten Have, T, Oslin, D, Datto, C, Zubritsky, C, Katz, IR (2006). A daily diary study of late-life depression. American Journal of Geriatric Psychiatry 14, 270–279.CrossRefGoogle ScholarPubMed
Conners, CK, Epstein, J, Johnson, D (2001). Conners' Adult ADHD Diagnostic Interview for Adults. Multihealth Systems: North Tonawanda, NY.Google Scholar
Delespaul, P, deVries, M, van Os, J (2002). Determinants of occurrence and recovery from hallucinations in daily life. Social Psychiatry and Psychiatric Epidemiology 37, 97–104.CrossRefGoogle ScholarPubMed
Ebner-Priemer, UW, Kuo, J, Kleindienst, N, Welch, SS, Reisch, T, Reinhard, I, Lieb, K, Linehan, MM, Bohus, M (2007). State affective instability in borderline personality disorder assessed by ambulatory monitoring. Psychological Medicine 37, 961–970.CrossRefGoogle ScholarPubMed
Ebner-Priemer, UW, Kuo, J, Welch, SS, Thielgen, T, Witte, S, Bohus, M, Linehan, MM (2006). A valence-dependent group-specific recall bias of retrospective self-reports: a study of borderline personality disorder in everyday life. Journal of Nervous and Mental Disease 194, 774–779.CrossRefGoogle ScholarPubMed
Ebner-Priemer, UW, Trull, TJ (2011). Investigating temporal instablity in psychological variables. In Handbook of Research Methods for Studying Daily Life (ed. Mehl, M. R. and Conner, T. S.), pp. 423–439. Guilford Press: New York.Google Scholar
Eid, M, Diener, E (1999). Intraindividual variability in affect: reliability, validity, and personality correlates. Journal of Personality and Social Psychology 76, 662–676.CrossRefGoogle Scholar
Fredrickson, BL (2000). Extracting meaning from past affective experiences: the importance of peaks, ends, and specific emotions. Cognition and Emotion 65, 577–606.CrossRefGoogle Scholar
Fredrickson, BL, Kahneman, D (1993). Duration neglect in retrospective evaluations of affective episodes. Journal of Personality and Social Psychology 65, 45–55.CrossRefGoogle ScholarPubMed
Granholm, E, Loh, C, Swendsen, J (2008). Feasibility and validity of computerized ecological momentary assessment in schizophrenia. Schizophrenia Bulletin 34, 507–514.CrossRefGoogle ScholarPubMed
Gueorguieva, R, Krystal, JH (2004). Move over ANOVA: progress in analyzing repeated-measures data and its reflection in papers published in the Archives of General Psychiatry. Archives of General Psychiatry 61, 310–317.CrossRefGoogle ScholarPubMed
Hedeker, D, Mermelstein, RJ, Berbaum, ML, Campbell, RT (2009). Modeling mood variation associated with smoking: an application of a heterogeneous mixed-effects model for analysis of ecological momentary assessment (EMA) data. Addiction 104, 297–307.CrossRefGoogle ScholarPubMed
Hedges, SM, Jandorf, L, Stone, AA (1985). Meaning of daily mood assessments. Journal of Personality and Social Psychology 48, 428–434.CrossRefGoogle Scholar
Jahng, S, Wood, PK, Trull, TJ (2008). Analysis of affective instability in ecological momentary assessment: indices using successive difference and group comparison via multilevel modeling. Psychological Methods 13, 354–375.CrossRefGoogle ScholarPubMed
Kihlstrom, JF, Eich, E, Sandbrand, D, Tobias, BA (2000). Emotion and memory: implications for self-report. In Science of Self-Report: Implications for Research and Practice (ed. Stone, A. A. and Turkkan, J. S.), pp. 81–99. Erlbaum: Mahwah, NJ.Google Scholar
Lewis, G, Pelosi, AJ, Araya, R, Dunn, G (1992). Measuring psychiatric-disorder in the community – a standardized assessment for use by lay interviewers. Psychological Medicine 22, 465–486.CrossRefGoogle ScholarPubMed
Links, PS, Heisel, MJ, Garland, A (2003). Affective instability in personality disorders. American Journal of Psychiatry 160, 394–395; author reply 395.CrossRefGoogle ScholarPubMed
Malliaris, Y (2010). MyiMonitor.com v.1: a user-friendly mobile electronic diary for bipolar patients. Annals of General Psychiatry 9, S12.CrossRefGoogle Scholar
Mayer, JD, Mccormick, LJ, Strong, SE (1995). Mood-congruent memory and natural mood – new evidence. Personality and Social Psychology Bulletin 21, 736–746.CrossRefGoogle Scholar
Merwood, A, Chen, W, Rijsdijk, F, Skirrow, C, Larsson, H, Thapar, A, Kuntsi, J, Asherson, P (2014). Genetic associations between the symptoms of attention-deficit/hyperactivity disorder and emotional lability in child and adolescent twins. Journal of the American Academy of Child and Adolescent Psychiatry 53, 209–220.CrossRefGoogle ScholarPubMed
Muller, DJ, Mandelli, L, Serretti, A, DeYoung, CG, De Luca, V, Sicard, T, Tharmalingam, S, Gallinat, J, Muglia, P, De Ronchi, D, Jain, U, Kennedy, JL (2008). Serotonin transporter gene and adverse life events in adult ADHD. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics 147B, 1461–1469.CrossRefGoogle ScholarPubMed
Oliver, MNI, Simons, JS (2004). The affective lability scales: development of a short form measure. Personality and Individual Differences 37, 1279–1288.CrossRefGoogle Scholar
Psychological Corporation (1999). Wechsler Abbreviated Scale of Intelligence (WASI) Manual. Harcourt Assessment: San Antonio, TX.Google Scholar
Redelmeier, DA, Kahneman, D (1996). Patients’ memories of painful medical treatments: real-time and retrospective evaluations of two minimally invasive procedures. Pain 66, 3–8.CrossRefGoogle ScholarPubMed
Reimherr, FW, Marchant, BK, Olsen, JL, Halls, C, Kondo, DG, Williams, ED, Robinson, RJ (2010). Emotional dysregulation as a core feature of adult ADHD: its relationship with clinical variables and treatment response in two methylphenidate trials. Journal of ADHD and Related Disorders 1, 53–64.Google Scholar
Reimherr, FW, Marchant, BK, Strong, RE, Hedges, DW, Adler, L, Spencer, TJ, West, SA, Soni, P (2005). Emotional dysregulation in adult ADHD and response to atomoxetine. Biological Psychiatry 58, 125–131.CrossRefGoogle ScholarPubMed
Rosen, PJ, Epstein, JN (2010). A pilot study of ecological momentary assessment of emotion dysregulation in children. Journal of ADHD and Related Disorders 1, 13.Google Scholar
Rosen, PJ, Epstein, JN, Van Orden, G (2013). I know it when I quantify it: ecological momentary assessment and recurrence quantification analysis of emotion dysregulation in children with ADHD. Attention Deficit and Hyperactivity Disorders 5, 283–294.CrossRefGoogle ScholarPubMed
Russell, JJ, Moskowitz, DS, Zuroff, DC, Sookman, D, Paris, J (2007). Stability and variability of affective experience and interpersonal behavior in borderline personality disorder. Journal of Abnormal Psychology 116, 578–588.CrossRefGoogle ScholarPubMed
Simons, CJP, Wichers, M, Derom, C, Thiery, E, Myin-Germeys, I, Krabbendam, L, van Os, J (2009). Subtle gene-environment interactions driving paranoia in daily life. Genes, Brain, and Behavior 8, 5–12.CrossRefGoogle ScholarPubMed
Skirrow, C, Asherson, P (2013). Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. Journal of Affective Disorders 147, 80–86.CrossRefGoogle ScholarPubMed
Skirrow, C, Hosang, GM, Farmer, AE, Asherson, P (2012). An update on the debated association between ADHD and bipolar disorder across the lifespan. Journal of Affective Disorders 141, 143–159.CrossRefGoogle ScholarPubMed
Solhan, MB, Trull, TJ, Jahng, S, Wood, PK (2009). Clinical assessment of affective instability: comparing EMA indices, questionnaire reports, and retrospective recall. Psychological Assessment 21, 425–436.CrossRefGoogle ScholarPubMed
Stone, AA, Broderick, JE, Kaell, AT, DelesPaul, PA, Porter, LE (2000). Does the peak-end phenomenon observed in laboratory pain studies apply to real-world pain in rheumatoid arthritics? Journal of Pain 1, 212–217.CrossRefGoogle ScholarPubMed
Surman, CB, Biederman, J, Spencer, T, Yorks, D, Miller, CA, Petty, CR, Faraone, SV (2011). Deficient emotional self-regulation and adult attention deficit hyperactivity disorder: a family risk analysis. American Journal of Psychiatry 168, 617–623.CrossRefGoogle ScholarPubMed
Taylor, SE, Brown, JD (1988). Illusion and well-being: a social psychological perspective on mental health. Psychological Bulletin 103, 193–210.CrossRefGoogle ScholarPubMed
Trull, TJ, Solhan, MB, Tragesser, SL, Jahng, S, Wood, PK, Piasecki, TM, Watson, D (2008). Affective instability: measuring a core feature of borderline personality disorder with ecological momentary assessment. Journal of Abnormal Psychology 117, 647–661.CrossRefGoogle ScholarPubMed
Wender, PH, Reimherr, FW, Wood, D, Ward, M (1985). A controlled study of methylphenidate in the treatment of attention deficit disorder, residual type, in adults. American Journal of Psychiatry 142, 547–552.Google ScholarPubMed
Whalen, CK, Henker, B, Ishikawa, SS, Jamner, LD, Floro, JN, Johnston, JA, Swindle, R (2006 a). An electronic diary study of contextual triggers and ADHD: get ready, get set, get mad. Journal of the American Academy of Child and Adolescent Psychiatry 45, 166–174.CrossRefGoogle ScholarPubMed
Whalen, CK, Henker, B, Jamner, LD, Ishikawa, SS, Floro, JN, Swindle, R, Perwien, AR, Johnston, JA (2006 b). Toward mapping daily challenges of living with ADHD: maternal and child perspectives using electronic diaries. Journal of Abnormal Child Psychology 34, 115–130.CrossRefGoogle ScholarPubMed
Wozniak, J, Biederman, J, Kiely, K, Ablon, JS, Faraone, SV, Mundy, E, Mennin, D (1995). Mania-like symptoms suggestive of childhood-onset bipolar disorder in clinically referred children. Journal of the American Academy of Child and Adolescent Psychiatry 34, 867–876.CrossRefGoogle ScholarPubMed
Supplementary material: File

Skirrow Supplementary Material

Table S1

Download Skirrow Supplementary Material(File)
File 51.2 KB