Individuals with ADHD often experience emotion dysregulation, including heightened irritability, which can lead to significant challenges in various aspects of life.
Emotion dysregulation in ADHD may manifest as difficulty managing and appropriately expressing emotions, especially in response to frustrating or stressful situations. This can result in impulsive emotional reactions, such as anger outbursts or emotional meltdowns.
Irritability, a common feature of emotion dysregulation in ADHD, is characterized by a low threshold for frustration and a tendency to react with anger or aggression.
These emotional difficulties can have negative consequences for individuals with ADHD, including strained relationships with family and peers, academic and occupational challenges, and an increased risk for comorbid mental health problems.
Johns-Mead, R., Vijayakumar, N., Mulraney, M., Melvin, G., Anderson, V. A., Efron, D., & Silk, T. J. (2024). The longitudinal relationship between socioemotional difficulties and irritability in ADHD. Journal of Affective Disorders, 350, 573–581. https://doi.org/10.1016/j.jad.2024.01.151
Key Points
- This longitudinal study investigated the relationship between irritability and socioemotional difficulties (peer and emotional problems) in children with and without ADHD.
- Children with ADHD had higher levels of irritability, emotional difficulties, and peer difficulties compared to controls, and these differences persisted over time.
- Change in irritability corresponded with change in both emotional and peer difficulties for both groups. However, baseline irritability did not predict future emotional or peer difficulties for either group.
- Baseline peer difficulties predicted change in irritability for both groups, while baseline emotional difficulties predicted change in irritability only for the ADHD group, suggesting socioemotional difficulties drive irritability over time.
- ADHD exacerbated certain aspects of the relationship between socioemotional difficulties and irritability, but more research is needed to clarify group differences.
- The findings emphasize the importance of developing effective interventions targeting peer and emotional problems in ADHD.
Rationale
Children with ADHD often experience higher levels of irritability and difficulties in socioemotional development compared to typically developing peers (Stringaris et al., 2018).
While these factors are known to be associated, their developmental trajectories and potential changes in their relationship over time, especially in the context of ADHD, remain unclear (Dougherty et al., 2015; Evans et al., 2020; Lengua, 2003).
Most studies have focused on irritability as a predictor of later socioemotional problems. However, some evidence suggests peer difficulties and emotional problems may exacerbate or contribute to the development of irritability (Barker & Salekin, 2012; Mulraney et al., 2017).
This study aimed to clarify the longitudinal relationship between irritability and socioemotional difficulties in children with and without ADHD during the transition from late childhood to early adolescence.
Method
Longitudinal study using latent change score models to examine irritability and socioemotional difficulties at two time points (baseline and 18-month follow-up).
Procedure
Community-based sample recruited through schools, screened for ADHD. Irritability and socioemotional difficulties assessed at baseline (mean age 10.5 years) and 18-month follow-up using parent-report measures.
Sample
336 children (45% ADHD, 61.9% male). ADHD status was confirmed using a DISC-IV diagnostic interview.
Measures
- Affective Reactivity Index (ARI): measures irritable feelings and behaviors, as well as associated impairment, using parent-reported ratings on a 3-point Likert scale.
- Strengths and Difficulties Questionnaire (SDQ): a behavioral screening tool that assesses emotional symptoms, peer problems, conduct problems, hyperactivity-inattention, and prosocial behavior using parent-reported ratings on a 3-point Likert scale.
- DISC-IV: a structured diagnostic interview that assesses for the presence of various mental disorders, including ADHD, anxiety disorders, and disruptive behavior disorders, based on DSM-IV criteria.
Statistical Analysis
Latent change score models examined baseline correlations, cross-coupling (baseline levels of one variable predicting change in the other), and covariance between latent change scores. Group differences tested using Wald test.
Results
- ADHD group had higher baseline irritability, emotional difficulties, and peer difficulties than controls.
- Change in irritability correlated with change in emotional and peer difficulties for both groups.
- Baseline peer difficulties predicted change in irritability for both groups. Baseline emotional difficulties predicted change in irritability only for ADHD group.
- Baseline irritability did not predict change in emotional or peer difficulties for either group.
Insights
This study highlights the dynamic relationship between irritability and socioemotional difficulties, suggesting that these factors influence each other over time.
Notably, socioemotional difficulties appear to drive later irritability, rather than the reverse. ADHD may exacerbate certain aspects of this relationship.
The findings underscore the importance of addressing peer and emotional problems in ADHD interventions.
Future research should investigate specific mechanisms underlying these relationships and how they can be targeted in clinical settings.
Strengths
This study had several methodological strengths, including:
- Large, community-based sample with demographically similar controls
- Longitudinal design capturing developmental transition period
- Novel application of latent change score models to compare ADHD and control groups
Limitations
Despite strengths, this study also came with several limitations, including:
- Only two time points captured; multiple assessments across a broader age range could provide further insights
- Specific ADHD presentation and symptom severity not investigated; may reveal additional nuances
- Brief screening measures used; more comprehensive assessments could support deeper understanding
Implications
The findings emphasize the need for effective interventions targeting peer and emotional difficulties in ADHD, as these factors appear to drive irritability over time.
Clinicians should consider subthreshold emotional symptoms even in the absence of comorbid diagnoses.
The study also highlights the importance of investigating specific mechanisms underlying the relationship between socioemotional difficulties and irritability to inform targeted interventions.
Methodologically, the use of latent change score models provides a valuable approach for examining developmental relationships between variables without assumptions of causality.
References
Barker, E. D., & Salekin, R. T. (2012). Irritable oppositional defiance and callous unemotional traits: is the association partially explained by peer victimization?. Journal of Child Psychology and Psychiatry, 53(11), 1167-1175. https://doi.org/10.1111/j.1469-7610.2012.02579.x
Dougherty, L. R., Smith, V. C., Bufferd, S. J., Kessel, E., Carlson, G. A., & Klein, D. N. (2015). Preschool irritability predicts child psychopathology, functional impairment, and service use at age nine. Journal of Child Psychology and Psychiatry, 56(9), 999-1007. https://doi.org/10.1111/jcpp.12403
Evans, S. C., Cooley, J. L., Blossom, J. B., Pederson, C. A., Tampke, E. C., & Fite, P. J. (2020). Examining ODD/ADHD symptom dimensions as predictors of social, emotional, and academic trajectories in middle childhood. Journal of Clinical Child & Adolescent Psychology, 49(6), 912-929. https://doi.org/10.1080/15374416.2019.1644645
Lengua, L. J. (2003). Associations among emotionality, self-regulation, adjustment problems, and positive adjustment in middle childhood. Journal of applied developmental psychology, 24(5), 595-618. https://doi.org/10.1016/j.appdev.2003.08.002
Mulraney, M., Zendarski, N., Mensah, F., Hiscock, H., & Sciberras, E. (2017). Do early internalizing and externalizing problems predict later irritability in adolescents with attention-deficit/hyperactivity disorder?. Australian & New Zealand Journal of Psychiatry, 51(4), 393-402. https://doi.org/10.1177/0004867416659365
Stringaris, A., Vidal‐Ribas, P., Brotman, M. A., & Leibenluft, E. (2018). Practitioner review: definition, recognition, and treatment challenges of irritability in young people. Journal of Child Psychology and Psychiatry, 59(7), 721-739. https://doi.org/10.1111/jcpp.12823
Keep Learning
Here are some reflective questions related to this study that could prompt further discussion:
- How might the relationship between irritability and socioemotional difficulties differ across development? What factors could influence changes in this relationship over time?
- Given the findings that socioemotional difficulties predict later irritability, what specific intervention targets and strategies might be most effective for reducing irritability in children with ADHD?
- How could future research build upon these findings to further elucidate the mechanisms underlying the relationship between irritability and socioemotional difficulties in ADHD? What additional variables or methodological approaches could provide valuable insights?
- Considering the limitations of this study, how might researchers design future investigations to address these limitations and strengthen our understanding of the topic?
- What are the potential implications of these findings for clinical practice, educational settings, and family interactions? How can this knowledge be effectively translated into real-world applications?
