Emotional Dysregulation in Adult ADHD and Response to Atomoxetine

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.

[1]  G. Glaser,et al.  The syndrome of "minimal brain damage" in childhood. , 1966, New England Journal of Medicine.

[2]  J M Swanson,et al.  Anxiety as a Predictor and Outcome Variable in the Multimodal Treatment Study of Children with ADHD (MTA) , 2000, Journal of abnormal child psychology.

[3]  M. Drenth.  San Juan, Puerto Rico , 2001 .

[4]  E. Denhoff,et al.  Hyperkinetic behavior syndrome in children. , 1957, The Journal of pediatrics.

[5]  A. Abrantes,et al.  Controlled trial of high doses of pemoline for adults with attention-deficit/hyperactivity disorder. , 1999, Journal of clinical psychopharmacology.

[6]  P. Wender.  Attention-deficit hyperactivity disorder in adults. , 1995, The Psychiatric clinics of North America.

[7]  Russell A. Barkley,et al.  ADHD and The Nature of Self-Control , 1997, Journal of Cognitive Psychotherapy.

[8]  H. Kraemer,et al.  ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[9]  Robert E. Strong,et al.  An open trial of venlafaxine in adult patients with attention deficit hyperactivity disorder. , 1995, Psychopharmacology bulletin.

[10]  S. Faraone,et al.  Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. , 1993, The American journal of psychiatry.

[11]  G. Still.  Some Abnormal Psychical Conditions in Children , 2006, Journal of attention disorders.

[12]  H. Kraemer,et al.  Impairment and deportment responses to different methylphenidate doses in children with ADHD: the MTA titration trial. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[13]  S. West,et al.  Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies , 2003, Biological Psychiatry.

[14]  P. Wender,et al.  Attention deficit disorder ('minimal brain dysfunction') in adults. A replication study of diagnosis and drug treatment. , 1981, Archives of general psychiatry.

[15]  S. Faraone,et al.  Attention-deficit/hyperactivity disorder in adults: an overview , 2000, Biological Psychiatry.

[16]  C. Bradley.  THE BEHAVIOR OF CHILDREN RECEIVING BENZEDRINE , 1937 .

[17]  C. Conners.  The syndrome of minimal brain dysfunction: psychological aspects. , 1967, Pediatric clinics of North America.

[18]  K. Macey.  Conners' Adult ADHD Rating Scales (CAARS). , 2003 .

[19]  P. Wender,et al.  A controlled study of Methylphenidate in the treatment of Attention Deficit Disorder, Residual Type, in Adults , 1985, The American journal of psychiatry.

[20]  M. Monuteaux,et al.  A controlled clinical trial of bupropion for attention deficit hyperactivity disorder in adults. , 2001, The American journal of psychiatry.

[21]  P. Wender,et al.  Bupropion treatment of attention-deficit hyperactivity disorder in adults. , 1990, The American journal of psychiatry.

[22]  P. Wender,et al.  Diagnosis and treatment of minimal brain dysfunction in adults: a preliminary report. , 1976, Archives of general psychiatry.

[23]  J. Elashoff,et al.  Multiple Regression in Behavioral Research. , 1975 .

[24]  P. Wender.  Minimal brain dysfunction in children , 1971 .

[25]  Stephen P. Hinshaw,et al.  A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. , 1999, Archives of general psychiatry.