Elsevier

Biological Psychiatry

Volume 58, Issue 2, 15 July 2005, Pages 125-131
Biological Psychiatry

Original article
Emotional Dysregulation in Adult ADHD and Response to Atomoxetine

https://doi.org/10.1016/j.biopsych.2005.04.040Get rights and content

Background

Before 1980, attention-deficit/hyperactivity disorder (ADHD) was called minimal brain dysfunction and included emotional symptoms now listed as “associated features” in DSM-IV. Data from two multicenter, placebo-controlled studies with 536 patients were reexamined to assess: 1) the pervasiveness of these symptoms in samples of adults with ADHD; 2) the response of these symptoms to atomoxetine; and 3) their association with depressive/anxiety symptoms.

Methods

The Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) was used to assess temper, affective lability, and emotional overreactivity, thus identifying patients exhibiting “emotional dysregulation.” Other DSM-IV Axis I diagnoses were exclusionary. Outcome measures were the Conners’ Adult ADHD Rating Scale (CAARS) and the WRAADDS.

Results

Thirty-two percent of the sample met post hoc criteria for emotional dysregulation and had higher baseline scores on ADHD measures, a lower response to placebo, and greater response to atomoxetine (p = .048). Symptoms of emotional dysregulation had a treatment effect (p < .001) at least as large as the CAARS (p = .002) and the total WRAADDS (p = .001). Emotional dysregulation was present in the absence of anxiety or depressive diagnosis.

Conclusions

Symptoms of emotional dysregulation were present in many patients with ADHD and showed a treatment response similar to other ADHD symptoms.

Section snippets

Methods and Materials

The impact of emotional dysregulation was evaluated using data from two identical studies conducted concurrently at 31 outpatient sites in the United States and Canada. There were no differences in the patient population or outcome between the two studies. Consequently, the data from the two studies have been combined and will be presented as one data set in this re-examination (Michelson et al 2003). The studies were conducted to assess the efficacy of atomoxetine in adults with ADHD.

Statistical Methods

Results were analyzed by a last observation carried forward approach using a repeated measures analysis of variance (ANOVA). The primary analysis in this re-examination was the improvement in the total CAARS as a function of treatment (atomoxetine or placebo) and using emotional dysregulation (the sum of the three emotional dysregulation items in the WRAADDS) as a continuous covariate. Within the secondary analyses, outcome measures included the total CAARS, as well as the CAARS inattentive and

Results

In the original study, 536 patients were randomized. Of these, 529 were evaluated with the WRAADDS in the screening period and could be assessed for emotional dysregulation. Outcome data were obtained from 510 patients on the CAARS and 444 patients on the WRAADDS (last visit carried forward). The CAARS was done at every clinic visit, while the WRAADDS was done only at screening and at study termination. The missing WRAADDS scores are a result of patients not returning for their termination

Discussion

One third of patients in this study averaged at least moderate impairment on the three WRAADDS symptoms of emotional dysregulation (temper, affective lability, and emotional overreactivity) and met our post hoc criteria for emotional dysregulation. Although using a very different sample (children meeting DSM-IV criteria for ADHD combined type, with a wide range of comorbid conditions and demographic characteristics), the MTA Cooperative Group (1999) study of ADHD children reported findings

References (29)

  • S. Clements

    Minimal Brain Dysfunction in ChildrenTerminology and Identification

    (1966)
  • C.K. Conners et al.

    Conners’ Adult ADHD Rating Scales (CAARS)

    (1999)
  • M.B. First et al.

    Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version

    (2000)
  • D. Hedges et al.

    An open trial of venlafaxine in adult patients with attention deficit hyperactivity disorder

    Psychopharmacol Bull

    (1995)
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