International Journal of Behavioral Sciences

International Journal of Behavioral Sciences

The Mediating Role of Emotion Regulation on the Relation between ADHD Symptoms, Cognitive Disengagement Syndrome and Symptoms of Anxiety and Depression among College Students

Document Type : Original Article

Authors
Department of Psychology, Faculty of Educational Sciences and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
Abstract
Introduction: The purpose of the present study was to extend previous knowledge concerning the link between Attention-Deficit/Hyperactivity Disorder (ADHD) and cognitive disengagement syndrome with anxiety and depression by examining the mediating role of emotion dysregulation among Iranian college students.
Method: In 2022, the sample of the study consisted of 612 college students (493 females, 119 males) in the age group of 18–40 years from various universities in Iran which were selected using convenience sampling. The used measures were the Barkley Adult ADHD Rating Scale (BAARS), Gross Emotion Regulation Strategies Questionnaire (ERQ), and questions from the Beck Depression Inventory-Second Edition (BDI-II) and Beck Anxiety Inventory (BAI).
Results: The findings of the study revealed that at a significance level of 0.05, the reappraisal strategy mediates the relationship between hyperactivity and impulsivity symptoms with symptoms of anxiety and depression. Conversely, the suppression strategy mediates the relationship between impulsivity and cognitive disengagement syndrome with symptoms of depression.
Conclusion: In the treatment of ADHD, intervention in emotion regulation strategies can affect the efficiency of the treatment.
Keywords

  1. Baker BH, Lugo-Candelas C, Wu H, Laue HE, Boivin A, Gillet V, et al. Association of prenatal acetaminophen exposure measured in meconium with risk of attention-deficit/hyperactivity disorder mediated by frontoparietal network brain connectivity. JAMA pediatrics. 2020;174(11):1073-81. doi:10.1001/jamapediatrics.2020.3080
  2. Franke B, Michelini G, Asherson P, Banaschewski T, Bilbow A, Buitelaar JK, et al. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. European Neuropsychopharmacology. 2018;28(10):1059-88. https://doi.org/10.1016/j.euroneuro. 2018.08.001.
  3. Anbarasan D, Kitchin M, Adler LA. Screening for adult ADHD. Current psychiatry reports. 2020;22:1-5. https://doi.org/10.1007/s11920-020-01194-9
  4. Banaschewski T, Coghill D, Zuddas A. Oxford textbook of attention deficit hyperactivity disorder: Oxford University Press; 2018.
  5. Murray AL, Wong S-C, Obsuth I, Rhodes S, Eisner M, Ribeaud D. An ecological momentary assessment study of the role of emotional dysregulation in co-occurring ADHD and internalising symptoms in adulthood. Journal of Affective Disorders. 2021;281:708-13. https://doi.org/10.1016/j.jad.2020.11.086
  6. Halldorsdottir T, Ollendick TH, Ginsburg G, Sherrill J, Kendall PC, Walkup J, et al. Treatment outcomes in anxious youth with and without comorbid ADHD in the CAMS. Journal of Clinical Child & Adolescent Psychology. 2015;44(6):985-91. https://doi.org/10.1080/15374416.2014.952008
  7. Braaten EB, Beiderman J, Monuteaux MC, Mick E, Calhoun E, Cattan G, Faraone SV. Revisiting the association between attention-deficit/hyperactivity disorder and anxiety disorders: a familial risk analysis. Biological psychiatry. 2003;53(1):93-9. https://doi.org/10.1016/S0006-3223(02)01434-8
  8. Solberg BS, Halmøy A, Engeland A, Igland J, Haavik J, Klungsøyr K. Gender differences in psychiatric comorbidity: a population‐based study of 40 000 adults with attention deficit hyperactivity disorder. Acta Psychiatrica Scandinavica. 2018;137(3):176-86. https://doi.org/10.1111/acps.12845
  9. Chen Q, Hartman CA, Haavik J, Harro J, Klungsøyr K, Hegvik T-A, et al. Common psychiatric and metabolic comorbidity of adult attention-deficit/hyperactivity disorder: A population-based cross-sectional study. PloS one. 2018;13(9):e0204516. https://doi.org/10.1371/journal.pone.0204516
  10. Libutzki B, Ludwig S, May M, Jacobsen RH, Reif A, Hartman CA. Direct medical costs of ADHD and its comorbid conditions on basis of a claims data analysis. European Psychiatry. 2019;58:38-44. https://doi.org/10.1016/j.eurpsy.2019.01.019
  11. Mayer JS, Bernhard A, Fann N, Boxhoorn S, Hartman CA, Reif A, Freitag CM. Cognitive mechanisms underlying depressive disorders in ADHD: A systematic review. Neuroscience & Biobehavioral Reviews. 2021;121:307-45. https://doi.org/10.1016/j.neubiorev .2020.12.018
  12. Barkley RA. Emotional dysregulation is a core component of ADHD. 2015.
  13. Reimherr FW, Marchant BK, Gift TE, Steans TA. ADHD and anxiety: clinical significance and treatment implications. Current psychiatry reports. 2017;19:1-10. https://doi.org/10.1007/s11920-017-0859-6
  14. Gross JJ. Emotion regulation: Current status and future prospects. Psychological inquiry. 2015;26(1):1-26. https://doi.org/10.1080/1047840X.2014.940781
  15. 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. https://doi.org/10.1371/journal.pone.0280131
  16. Beheshti A, Chavanon M-L, Christiansen H. Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC psychiatry. 2020;20(1):1-11. https://doi.org/10.1186/s12888-020-2442-7
  17. Hirsch O, Chavanon ML, Christiansen H. Emotional dysregulation subgroups in patients with adult Attention-Deficit/Hyperactivity Disorder (ADHD): a cluster analytic approach. Scientific Reports. 2019;9(1):5639. https://doi.org/10.1038/s41598-019-42018-y
  18. Becker SP, Willcutt EG, Leopold DR, Fredrick JW, Smith ZR, Jacobson LA, et al. Report of a work group on sluggish cognitive tempo: Key research directions and a consensus change in terminology to cognitive disengagement syndrome. Journal of the American Academy of Child & Adolescent Psychiatry. 2023;62(6):629-45. https://doi.org/10.1016/j.jaac.2022.07.821
  19. Leikauf JE, Solanto MV. Sluggish cognitive tempo, internalizing symptoms, and executive function in adults with ADHD. Journal of Attention Disorders. 2017;21(8):701-11. https://doi.org/10.1177/1087054716682337
  20. Lunsford-Avery J R KSH, Mitchell J T. Cognitive disengagement syndrome in Adults Referred for an ADHD Evaluation: A Psychometric Analysis of Self- and Collateral Report. Journal of Attention Disorders. Journal of Attention Disorders. 2018;0(00):1-10.
  21. Flannery AJ, Becker SP, Luebbe AM. Does emotion dysregulation mediate the association between sluggish cognitive tempo and college students’ social impairment? Journal of attention disorders. 2016;20(9):802-12. https://doi.org/10.1177/1087054714527794
  22. Shushakova A, Ohrmann P, Pedersen A. Exploring deficient emotion regulation in adult ADHD: electrophysiological evidence. European archives of psychiatry and clinical neuroscience. 2018;268(4):359-71. https://doi.org/10.1007/s00406-017-0826-6
  23. Materna L, Wiesner CD, Shushakova A, Trieloff J, Weber N, Engell A, et al. Adult patients with ADHD differ from healthy controls in implicit, but not explicit, emotion regulation. Journal of Psychiatry and Neuroscience. 2019;44(5):340-9. https://doi.org/10.1503/jpn.180139
  24. Thorell LB, Tilling H, Sjöwall D. Emotion dysregulation in adult ADHD: Introducing the comprehensive emotion regulation inventory (CERI). Journal of Clinical and Experimental Neuropsychology. 2020;42(7):747-58. https://doi.org/10.1080/13803395.2020.1800595
  25. Howell D. Statistical Methods for Psychology, 6th Edn Belmont. CA: Wadsworth. 1997;293.
  26. Lindeman RH, Merenda PF, Gold RZ. Introduction to bivariate and multivariate analysis. (No Title). 1980.
  27. Kerlinger FN. Multiple regression in behavioral research. 1973.
  28. Barkley RA. Barkley Adult ADHD Rating Scale-IV (BAARS-IV): Guilford Press; 2011.
  29. Mashhadi A, Mirdoraghi F, Hasani J, Yaghoobi H, Hamzeloo M, Maleki ZH. The prevalence of attention deficit/hyperactivity disorder symptoms and its association with Sluggish Cognitive Tempo in Students. Journal of Research in Behavioural Sciences. 2014;12(1):103-11.
  30. Beck A, Steer R. Manual of the Beck Anxiety Inventory. San Antonio, TX: The Psychology Corporation. Harcourt, Brace; 1990.
  31. A FA. Psychological tests: evaluation of personality and mental health. Tehran: Besat2012.
  32. Beck AT SR, Brown GK. Beck depression inventory. New York: Harcourt Brace Jovanovich1987.
  33. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. Journal of personality and social psychology. 2003;85(2):348. https://psycnet.apa.org/doi/10.1037/0022-3514.85.2.348
  34. Taherifar Z FS, Mutabi F, Mazaheri M, Fati L. The mediating role of failure of emotion regulation strategies in the relationship between negative emotion intensity and safety motivation with generalized anxiety symptoms. Contemporary psychology Biannual Journal of the Iranian Psychological Association. 2016;10(2):51-66.
  35. Chou C-P, Bentler PM. Estimates and tests in structural equation modeling. 1995.
  36. Kline RB. Principles and practice of structural equation modeling: Guilford publications; 2023.
  37. Schermelleh-Engel K MH, Müller H. Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Method Psychol Res. 2003;8:23–74.
  38. Zhang S-Y, Qiu S-W, Pan M-R, Zhao M-J, Zhao R-J, Liu L, et al. Adult ADHD, executive function, depressive/anxiety symptoms, and quality of life: A serial two-mediator model. Journal of affective disorders. 2021;293:97-108. https://doi.org/10.1016/j.jad. 2021.06.020
  39. Haugan A-LJ, Sund AM, Thomsen PH, Lydersen S, Nøvik TS. Executive functions mediate the association between ADHD symptoms and anxiety in a clinical adolescent population. Frontiers in psychiatry. 2022;13:834356. https://doi.org/10.3389/fpsyt.2022.834356
  40. Sevincok D, Ozbay HC, Ozbek MM, Tunagur MT, Aksu H. ADHD symptoms in relation to internalizing and externalizing symptoms in children: The mediating role of sluggish cognitive tempo. Nordic journal of psychiatry. 2020;74(4):265-72. https://doi.org/10.1080/08039488. 2019.1697746
  41. Başay Ö, Çiftçi E, Becker SP, Burns GL. Validity of sluggish cognitive tempo in Turkish children and adolescents. Child Psychiatry & Human Development. 2021;52:191-9. https://doi.org/10.1007/s10578-020-01110-5