Emotional problems in children with ADHD symptoms

The symptoms typically associated with ADHD include difficulty focusing, completing tasks, acting impulsively and high levels of activity. In addition, many show problems regulating emotions. These show up as depression, anxiety and anger outbursts.

In a recent research publication in Nature Mental Health Cambridge scientists describe how they found that as many as one in two children diagnosed with ADHD show signs of emotional dysregulation and believe that emotional problems may be a core symptom of ADHD. In addition, they found that Ritalin – the most commonly prescribed medication to control the condition – does not seem to be effective at treating this.

The number of children presenting with the symptoms of ADHD seems to be increasing and these days, more adults are being recognised as having the type of problems associated with the disorder. Including these are self-control problems, which affect their ability to regulate emotions. The study mentions that one is 50 children diagnosed with ADHD also experience mood disorders, such as depression, while more than one in four experience anxiety. Verbal or physical outbursts are common, due to their inability to control and regulate emotions.

These problems were thought to be a result of other symptoms associated with ADHD, such as problems with cognition and motivation. But this latest study shows that emotional dysregulation occurs independently of these.

Professor Sahakian, a lead researcher wrote that “Parents and teachers often say they have problems controlling children with ADHD, and it could be that when the children can’t express themselves well—when they hit emotional difficulties—they may not be able to control their emotions and have an outburst rather than communicating with the parent, teacher or the other child.”

Professor Sahakian hopes that acknowledging emotion dysregulation as a key part of ADHD will help people better understand the problems the child is experiencing. This could lead to using effective treatments for regulation of emotion, such as cognitive behavioral therapy.

The findings may also point to potential ways to help the child manage their emotions, for example by using cognitive behavioral techniques to learn to stop and think before they react and to express their feelings verbally, or use techniques such as exercise or relaxation to calm themselves or alleviate symptoms of depression and anxiety.

Identifying the problem earlier would allow for alternative, more effective interventions to help the child better manage their emotions, potentially helping the individual in adulthood.

While it is not clear exactly what causes these problems in the first place, the researchers found signs of a link to possible dysfunction of the immune system, with individuals who exhibited signs of emotion dysregulation showing higher percentages of certain types of immune cell.

Professor Sahakian added, “We already know that problems with the immune system can be linked to depression, and we’ve seen similar patterns in individuals with ADHD who experience emotion dysregulation.”

More information: Wenjie Hou et al, Emotion dysregulation and right pars orbitalis constitute a neuropsychological pathway to attention deficit hyperactivity disorder, Nature Mental Health (2024). DOI: 10.1038/s44220-024-00251-z

Journal information: Nature Mental Health

Provided by University of Cambridge

Image supplied by Freepik

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Martin Doherty, writing for The Conversation, says that at the age of about four, children reach important milestones in brain development.

One of these is a huge improvement in understanding others’ thoughts and feelings. This is the start of empathy. Another is in spatial thinking—understanding how objects are positioned and related. This is the beginning of the ability to read maps.

Martin and his colleague, Catherine Sayer, conducted a study with 175 two to five-year-olds to explore how children are able to use scale models to figure out where something is in the real world. At about four, children are able to use a scale model of a room to work out where something is. We thought that this might result from children’s understanding of how one thing can represent something else. But we actually found that four-year-olds’ ability to use scale models came from their spatial abilities.

At the same age, children start to understand that someone’s behaviour is due to what that person believes, not necessarily what is really the case. This has interesting consequences.

If you’ve played hide-and-seek with young children, you may have noticed that they aren’t always very good at it. They love the ritual of looking in all the wrong places first, but beforehand they may tell you where they are going to hide, hide in the same place every time, or not be especially hidden.

After their fourth birthday, they get much better at hide and seek. They understand that the seeker looks in the wrong places because they don’t know where the hider is.

At about three to four children also start to tell lies. They realize they can make someone believe something that isn’t true.

Understanding symbols

Martin’s earlier research with fellow psychologist Josef Perner suggests that four-year-olds don’t just start to understand how others’ minds work. Figuring this out is part of the development of an understanding of “representation”—that symbols, like thoughts, words, or pictures, can be used to stand for something else.

Children start to think about how words relate to objects. This means, for instance, knowing that “animal” can refer to something you already have a name for, such as “rabbit”. This might help children learn the new word.

Their ability to use a understand the components of pictures also improves around this age. Very young children use a lot of trial and error to complete a jigsaw, picking up random pieces to see if they fit. By the time they are about four years old, they start to use the picture as a guide, trying to connect lines and match bits of colour, while checking the guide picture on the box lid.

Developmental experiments

Another ability children develop at around four is using scale models. A classic set of developmental experiments involved a model of a regular household room. The real room had typical furniture—sofa, table, cupboard and so on—and the model had miniature versions laid out in the same way.

Children were shown where something was hidden in the model and told to find an object hidden in “the same place” in the room. Children of around four can find the object using the identical layouts. If shown a sticker under a particular chair in the model room, for example, they can go straight to the “same” chair in the other room. This is the fundamental understanding required to read maps.

Adults see scale models and maps as representations. Maps represent a town or a country. A scale model of, say, the Eiffel Tower represents the real thing. At first, Martin suspected children’s ability to use scale models is more evidence of understanding representation at this age.

He was wrong. Instead, the researchers found that this ability is based on a development in children’s spatial abilities that also occurs at about four. This is the ability to think about spaces and where objects are within them. Spatial abilities help with maths skills, and good spatial ability is linked to an interest in science, technology, engineering and mathematics.

Their experiment was simple. They compared the model room task with a test of understanding how representation works. The two abilities develop around the same age, but they found they were not related. Children who could do one task couldn’t necessarily do the other.

They also had a test of purely spatial ability. Children who passed the model room task also passed the spatial task. So it looks like the model room task relied on children‘s spatial thinking.

They don’t yet know why two important but apparently unrelated abilities arise at the same time. Perhaps it’s related to changes in the growing brain at this interesting age.

Provided by The Conversation.

Image supplied by Freepik.