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Attention-Deficit/Hyperactivity Disorder (ADHD), characterized by inattention and/or impulsivity/hyperactivity, can include emotional dysregulation (such as affect lability), especially when symptoms persist into adulthood. Some individuals with ADHD have trouble with modulating attention in the context of goal-directed behavior. They may perform significantly worse on cognitive tasks, relative to those without ADHD, particularly when these tasks involve resisting interference from emotionally salient distracting stimuli. This could contribute to emotion dysregulation in individuals with ADHD.

Questions remain regarding the neural correlates of emotion regulation in adults with heterogenous ADHD symptom persistence. Investigators including Amar Ojha (Center for Neuroscience at the University of Pittsburgh graduate student); Neil Jones, PhD (Assistant Professor of Psychiatry and Psychology); Amelia Versace, MD (Associate Professor of Psychiatry); Heather Joseph, DO (Assistant Professor of Psychiatry and Pediatrics); Brooke Molina, PhD (Professor of Psychiatry, Psychology and Pediatrics); and Cecile Ladouceur, PhD (Professor of Psychiatry and Psychology), from the University of Pittsburgh, examined patterns of brain activation in adults with childhood ADHD diagnoses (and either persisting or desisting symptoms) and adults without ADHD histories. Study participants underwent functional magnetic resonance imaging (fMRI) scans during an Emotional Faces N-Back task, which involves performing a visual working memory task while ignoring emotional facial expressions presented simultaneously with the information they were instructed to hold in working memory. This task has been used to examine emotion regulation subprocesses (attentional control) across psychiatric disorders.

Findings from the study, recently published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, showed that reduced activations in the dorsolateral prefrontal cortex and ventral lateral prefrontal cortex during high cognitive load with emotional distractors were associated with more severe affect lability for adults with persisting ADHD symptoms. This association remained significant even after accounting for variability in inattention and impulsivity/hyperactivity symptoms within the ADHD symptom persistent group.

“Despite evidence that many individuals with ADHD struggle with regulating their emotions, the neural underpinnings of emotion regulation associated with emotional symptoms (e.g., anger outbursts) remain unclear. Findings from this study suggest that heightened emotionality in individuals with persisting symptoms of ADHD are associated with alterations in the functioning of prefrontal cortical brain structures involved in emotion regulation, which could contribute to heightened risk for comorbid conditions such as anxiety and depression,” said Dr. Ladouceur, the study’s co-senior and corresponding author.

“The patterns of alterations in emotion regulation brain function found in this study could also have implications in day-to-day life, such as successfully executing daily functions that are often impaired for individuals with ADHD and especially for those who tend to react emotionally (e.g., quick or intense frustration).  For example, holding in mind a series of tasks to complete is easily derailed for people with ADHD particularly when the information in emotionally charged; these findings show which parts of the brain may be responsible for such difficulties and can help focus research on future treatment targets,” said Dr. Molina, the study’s co-senior author. 

Altered Lateral Prefrontal Cortex Functioning during Emotional Interference Resistance is Associated with Affect Lability in Adults with Persisting Symptoms of ADHD from Childhood
Ojha A, Jones NP, Teague H, Versace A, Gnagy EM, Joseph HM, Molina BSG, Ladouceur CD.
Biological Psychiatry: Cognitive Neuroscience and Neuroimaging (2024), doi: https://doi.org/10.1016/j.bpsc.2024.02.003.