Effect of Emotion Regulation on Anxiety/Depression Symptoms in Children With Attention-Deficit/Hyperactivity Disorder: The Mediating Role of Social Problems and the Moderating Role of Family Functioning
Abstract
Objective To investigate the mediating effect of social problems in the effect pathway of emotional dysregulation influencing anxiety/depression emotions in children with attention-deficit/hyperactivity disorder (ADHD) and to explore the potential moderating effect of family functionality.
Methods A total of 235 children diagnosed with ADHD were enrolled in the study. The paticipants' age ranged from 6 to 12. Emotion Regulation Checklist, Achenbach's Child Behavior Checklist (CBCL) Social Problems Subscale, CBCL Anxious/Depressed Subscale, and Family Assessment Device were used to evaluate the emotional regulation, social problems, anxiety/depression emotions, and family functionality of the participants. A moderated mediation model was employed to analyze whether social problems and family functionality mediate and moderate the relationship between emotional regulation and anxiety/depression emotions.
Results Social problems partially mediated the impact of emotional dysregulation on anxiety/depression emotions in ADHD children, with the direct effect being 0.26 (95% confidence interval [CI]: [0.17, 0.36], P<0.001), the indirect effect being 0.13 (95% CI: [0.07, 0.19], P<0.001), and the mediating effect accounting for 33% of the total effect. Family functionality exhibited a positive moderating effect on the relationship between social problems and anxiety/depression emotions.
Conclusion This study contributes to the understanding of complex factors influencing anxiety/depression in children with ADHD, providing reference for the further development of targeted interventions for children with ADHD and the improvement of prognosis.
Keywords: Attention deficit, Hyperactivity disorder, Anxiety, Depression, Emotion regulation, Social problems, Family function
Full Text:
PDFReferences
FARAONE S V， BANASCHEWSKI T， COGHILL D， et al. The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev，2021，128: 789–818. doi: 10.1016/j.neubiorev.2021.01.022.
QUENNEVILLE A F， KALOGEROPOULOU E， NICASTRO R， et al. Anxiety disorders in adult ADHD: a frequent comorbidity and a risk factor for externalizing problems. Psychiatry Res，2022，310: 114423. doi: 10.1016/j.psychres.2022.114423.
BABINSKI D E， NEELY K A， BA D M， et al. Depression and suicidal behavior in young adult men and women with ADHD: evidence from claims data. J Clin Psychiatry，2020，81(6): 19m13130. doi: 10.4088/JCP. 19m13130.
BUNFORD N， EVANS S W， WYMBS F. ADHD and emotion dysregulation among children and adolescents. Clin Child Fam Psychol Rev，2015，18(3): 185–217. doi: 10.1007/s10567-015-0187-5.
BARKLEY R A. Recent longitudinal studies of childhood attention-deficit/hyperactivity disorder: Important themes and questions for further research. J Abnorm Psychol，2016，125(2): 248–255. doi: 10.1037/abn0000125.
SHAW P， STRINGARIS A， NIGG J， et al. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry，2014，171(3): 276–293. doi: 10.1176/appi.ajp.2013.13070966.
SOBANSKI E， BANASCHEWSKI T， ASHERSON P， et al. Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence. J Child Psychol Psychiatry，2010，51(8): 915–923. doi: 10.1111/j.1469-7610.2010. 02217.x.
MARTZ E， WEINER L， WEIBEL S. Identifying different patterns of emotion dysregulation in adult ADHD. Borderline Personal Disord Emot Dysregul，2023，10(1): 28. doi: 10.1186/s40479-023-00235-y.
SOLER-GUTIÉRREZ A M， PÉREZ-GONZÁLEZ J C， MAYAS J. Evidence of emotion dysregulation as a core symptom of adult ADHD: a systematic review. PLoS One，2023，18(1): e0280131. doi: 10.1371/journal. pone.0280131.
DALSGAARD S， MORTENSEN P B， FRYDENBERG M， et al. ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood--a naturalistic long-term follow-up study. Addict Behav，2014， 39(1): 325–328. doi: 10.1016/j.addbeh.2013.09.002.
BERNARDI S， FARAONE S V， CORTESE S， et al. The lifetime impact of attention deficit hyperactivity disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Psychol Med，2012，42(4): 875–887. doi: 10.1017/S003329171100153X.
BROWN T E， FLOOD E， SAROCCO P， et al. Persisting psychosocial impairments in adults being treated with medication for attention deficit/hyperactivity disorder. Psychopharmacol Bull，2017，47(4): 8–17.
GARCIA C R， BAU C H， SILVA K L， et al. The burdened life of adults with ADHD: impairment beyond comorbidity. Eur Psychiatry，2012， 27(5): 309–313. doi: 10.1016/j.eurpsy.2010.08.002.
BRONFENBRENNER U. Ecological systems theory. Six theories of child development: revised formulations and current issues. London， England: Jessica Kingsley Publishers， 1992: 187–249.
MURRAY A L， WONG S C， OBSUTH I， et al. An ecological momentary assessment study of the role of emotional dysregulation in co-occurring ADHD and internalising symptoms in adulthood. J Affect Disord，2021，281: 708–713. doi: 10.1016/j.jad.2020.11.086.
ANTONY E M， PIHLAJAMÄKI M， SPEYER L G， et al. Does emotion dysregulation mediate the association between ADHD symptoms and internalizing problems? A longitudinal within-person analysis in a large population-representative study. J Child Psychol Psychiatry，2022，63(12): 1583–1590. doi: 10.1111/jcpp.13624.
BECKER S P， MEHARI K R， LANGBERG J M， et al. Rates of peer victimization in young adolescents with ADHD and associations with internalizing symptoms and self-esteem. Eur Child Adolesc Psychiatry， 2017，26(2): 201–214. doi: 10.1007/s00787-016-0881-y.
MPHAHLELE R M， PILLAY B， MEYER A. Internalising comorbidities in primary school children with attention-deficit hyperactivity disorder (ADHD): sex and age differences. J Child Adolesc Ment Health，2020， 32(2/3): 119–129. doi: 10.2989/17280583.2020.1848851.
SHAO R， HE P， LING B， et al. Prevalence of depression and anxiety and correlations between depression, anxiety, family functioning, social support and coping styles among Chinese medical students. BMC Psychol，2020，8(1): 38. doi: 10.1186/s40359-020-00402-8.
KAUFMAN J， BIRMAHER B， BRENT D， et al. Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry，1997，36(7): 980–988. doi: 10.1097/00004583-199707000-00021.
GONG Y X， CAI T S. The Wechsler Intelligence Scale for chidren revisd in China (C-WISC). Chin J Clin Psychol，1994，2(1): 1–6. doi: 10.16128/j. cnki.1005-3611.1994.01.001.
SWANSON J M， KRAEMER H C， HINSHAW S P， et al. Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment. J Am Acad Child Adolesc Psychiatry，2001，40(2): 168–179. doi: 10.1097/ 00004583-200102000-00011.
SHIELDS A， CICCHETTI D. Emotion regulation among school-age children: the development and validation of a new criterion Q-sort scale. Dev Psychol，1997，33(6): 906–916. doi: 10.1037//0012-1649.33.6.906.
ACHENBACH T M， RUFFLE T M. The Child Behavior Checklist and related forms for assessing behavioral/emotional problems and competencies. Pediatr Rev，2000，21(8): 265–271. doi: 10.1542/pir.21-8-265.
SPENCER T J， FARAONE S V， SURMAN C B， et al. Toward defining deficient emotional self-regulation in children with attention-deficit/hyperactivity disorder using the Child Behavior Checklist: a controlled study. Postgrad Med，2011，123(5): 50–59. doi: 10.3810/pgm. 2011.09.2459.
.
LIU P Y， HE M T. Family Assessment Device (FAD)//Handbook of Mental Health Assessment Scales（revised edition). Beijing: Chinese Mental Health Journal Publisher， 1999: 149–151.
LEABERRY K D， ROSEN P J， FOGLEMAN N D， et al. Comorbid internalizing and externalizing disorders predict lability of negative emotions among children with ADHD. J Atten Disord，2020，24(14): 1989–2001. doi: 10.1177/1087054717734647.
Refbacks
- There are currently no refbacks.
