Can Emotion Regulation Difficulties Explain the Link Between ADHD Symptoms and Depression/Anxiety in Children?

What you need to know

• Children with ADHD symptoms often struggle with regulating their emotions and are at higher risk for developing anxiety and depression.
• This study found that difficulties with emotion regulation help explain the link between ADHD symptoms and later anxiety/depression in children.
• Helping children with ADHD improve their emotion regulation skills may be an important way to prevent the development of anxiety and depression.

Background on ADHD and Associated Challenges

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition that affects approximately 5% of children. The core symptoms of ADHD include difficulties with attention, hyperactivity, and impulsivity. However, many children with ADHD also struggle with regulating their emotions. This can involve having intense emotional reactions, difficulty calming down when upset, or trouble controlling emotional expressions.

In addition to emotion regulation difficulties, children with ADHD symptoms are at higher risk for developing other mental health issues as they grow up. In particular, children with ADHD are more likely to experience anxiety and depression (referred to as “internalizing problems” by researchers). It’s estimated that 15-75% of youth with ADHD meet criteria for depression at some point, and about 25% meet criteria for an anxiety disorder.

Researchers have been interested in understanding why ADHD symptoms are linked to higher rates of anxiety and depression. One theory is that the difficulties with emotion regulation act as a bridge between ADHD symptoms and internalizing problems. The idea is that ADHD symptoms lead to challenges with regulating emotions, which in turn increases risk for anxiety and depression over time.

Examining the Links Between ADHD, Emotion Regulation, and Internalizing Problems

Previous studies have provided some evidence supporting the idea that emotion regulation difficulties help explain the connection between ADHD and internalizing problems. However, most research to date has had some key limitations:

1. Many studies only looked at a single point in time, rather than tracking children over several years.

2. Studies often couldn’t distinguish between differences between individuals (e.g. children with more ADHD symptoms tend to have more emotion regulation difficulties) and changes within individuals over time (e.g. when a child’s ADHD symptoms increase, their emotion regulation gets worse).

3. Most research has relied on relatively small samples of children diagnosed with ADHD, rather than looking at ADHD symptoms in the general population.

The current study aimed to address these limitations by using data from the Millennium Cohort Study, a large study that has followed over 19,000 children in the UK since birth. The researchers focused on data collected when the children were 3, 5, and 7 years old.

At each time point, parents completed questionnaires about their child’s:

• ADHD symptoms (e.g. difficulty paying attention, being overly active)
• Emotion regulation difficulties (e.g. getting overly excited, having strong reactions)
• Internalizing problems (anxiety and depression symptoms)

The researchers used advanced statistical techniques to look at how changes in a child’s ADHD symptoms related to changes in their emotion regulation and internalizing problems over time. Importantly, they were able to separate out differences between children from changes within individual children across the years.

Key Findings on the Role of Emotion Regulation

The main findings from the study were:

1. There was a significant indirect effect of ADHD symptoms on internalizing problems through emotion regulation difficulties. In other words, increases in a child’s ADHD symptoms predicted increases in their emotion regulation difficulties, which in turn predicted increases in anxiety/depression symptoms.

2. This pattern held true for both boys and girls.

3. The indirect effect through emotion regulation difficulties accounted for most of the relationship between ADHD symptoms and internalizing problems. There was little evidence for a direct effect of ADHD symptoms on internalizing problems once emotion regulation was accounted for.

4. The effects, while statistically significant, were relatively small in size. This suggests emotion regulation is an important factor, but not the only pathway linking ADHD symptoms to anxiety and depression.

These results provide strong support for the idea that difficulties with regulating emotions help explain why children with ADHD symptoms are at higher risk for developing anxiety and depression. The longitudinal design tracking children over time and the large, representative sample make this some of the most robust evidence to date on this topic.

Implications for Supporting Children with ADHD Symptoms

The findings have a number of potential implications for how we understand and support children with ADHD symptoms:

1. Assessing emotion regulation: The results highlight the importance of evaluating a child’s emotion regulation abilities along with their core ADHD symptoms. This could help identify children who may be at higher risk for developing anxiety or depression.

2. Intervention targets: Improving emotion regulation skills may be a key way to prevent the development of anxiety and depression in children with ADHD. While medications and behavioral strategies for ADHD can help with emotion regulation to some degree, the authors suggest that targeted emotion regulation interventions may be beneficial.

3. Early intervention: The study looked at young children (ages 3-7), suggesting that emotion regulation difficulties emerge early. This points to the potential value of early intervention to improve emotion regulation skills.

4. Transdiagnostic focus: Emotion regulation has been linked to many mental health issues beyond just ADHD and internalizing problems. Interventions targeting emotion regulation in children with ADHD may have broad benefits for their overall mental health and well-being.

Conclusions

• Difficulties with emotion regulation appear to be an important mechanism linking ADHD symptoms to the development of anxiety and depression in children.
• Assessing and targeting emotion regulation skills may be a promising way to reduce the risk of internalizing problems in children with ADHD symptoms.
• More research is still needed on the most effective ways to improve emotion regulation abilities in children with ADHD symptoms.