An Examination of Relations Among Working Memory, ADHD Symptoms, and Emotion Regulation

Abstract

Emotion regulation difficulties are present in many, if not most, children with attention-deficit/ hyperactivity disorder (ADHD) and confer risk for a host of adverse outcomes. Little is known, however, regarding the neurocognitive and behavioral mechanisms that underlie these difficulties. A well-characterized, clinically evaluated sample of 145 children ages 8-13 years (M=10.33, SD=1.47; 55 girls; 69% White/non-Hispanic) were administered multiple, counterbalanced working memory tests and assessed for emotion dysregulation and ADHD symptoms via multipleinformant reports. Bias-corrected, bootstrapped conditional effects modeling indicated that underdeveloped working memory exerted significant direct effects on emotion regulation in all tested models as well as indirect effects on emotion regulation via parent-reported hyperactive/ impulsive symptoms (95% CIs excluded zero). Interestingly, hyperactive/impulsive symptoms also predicted emotion dysregulation when controlling for the influence of working memory. Inattention failed to predict emotion regulation difficulties in all tested models (all 95% CIs included zero). This pattern of results replicated across parent and teacher models and were robust to control for mono-informant bias, age, and gender. These findings suggest that emotion dysregulation in ADHD reflects, in part, both a direct outcome of underdeveloped working memory and an affective outcome of hyperactive and/or impulsive symptomatology, both attributable to and independent of the role of underlying working memory deficits.

Emotional Dysregulation in Children and Adolescents With Psychiatric Disorders. A Narrative Review

“…An underdeveloped working memory ( 18 ) and problems of impulse inhibition may contribute to ED. Thereby emotional impulsiveness and problems of impulse inhibition are associated with greater emotional and behavioral dysregulation ( 42 , 43 ).…”

“…At the age of 3 years, children already understand their emotions (16). Various processes, such as the development of executive functions and language influence the development of ER (17)(18)(19). Next to the encoding of internal emotional cues, ER involves accessing of coping resources, using a broad range of regulation strategies (20).…”

Association of treatment procedures and resilience to symptom load three-years later in a clinical sample of adolescent psychiatric patients

“…Disorder specific features were also observed in that those with anxiety and mood disorders at T 1 had received the highest number of psychotherapy sessions, whereas ADHD and other disorders had the highest rate of medication, both indicating a high disease burden at T 1 . The different treatment methods could furthermore depend on disorder specific features, for example verbal deficits and problems with emotion processing often present with ADHD [ 60 , 61 ]. Moreover, medication has been long established as an effective treatment for ADHD.…”

Targeting working memory to modify emotional reactivity in adult attention deficit hyperactivity disorder: a functional magnetic resonance imaging study

“…Whether this affects (the neural mechanisms underlying) emotional processing remains to be determined. Indeed, an underdeveloped working memory (WM) system may underlie impaired ER in ADHD (Groves et al, 2020). More specifically, ADHD participants perform worse (Marx et al, 2011) and show reduced WM-related PFC activation in WM-tasks (Cortese et al, 2012;Burgess et al, 2010;Ko et al, 2013).…”