Abstract
Youth with attention-deficit/hyperactivity disorder (ADHD) are at increased risk to develop co-morbid depression. Identifying factors that contribute to depression risk may allow early intervention and prevention. Poor emotion regulation, which is common in adolescents, is a candidate risk factor. Impaired cognitive emotion regulation is a fundamental characteristic of depression and depression risk in the general population. However, little is known about cognitive emotion regulation in youth with ADHD and its link to depression and depression risk. Using explicit and implicit measures, this study assessed cognitive emotion regulation in youth with ADHD (N = 40) compared to demographically matched healthy controls (N = 40) and determined the association with depressive symptomatology. As explicit measure, we assessed the use of cognitive emotion regulation strategies via self-report. As implicit measure, performance in an ambiguous cue-conditioning task was assessed as indicator of affective bias in the processing of information. Compared to controls, patients reported more frequent use of maladaptive (i.e., self-blame, catastrophizing, and rumination) and less frequent use of adaptive (i.e., positive reappraisal) emotion regulation strategies. This pattern was associated with the severity of current depressive symptoms in patients. In the implicit measure of cognitive bias, there was no significant difference in response of patients and controls and no association with depression. Our findings point to depression-related alterations in the use of cognitive emotion regulation strategies in youth with ADHD. The study suggests those alterations as a candidate risk factor for ADHD-depression comorbidity that may be used for risk assessment and prevention strategies.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition defined by a persistent and cross-situational pattern of age-inappropriate inattention and/or hyperactivity-impulsivity that leads to functional impairment [1]
Our findings provide new insights into impairments in cognitive emotion regulation in youth with ADHD and their role in the development of co-morbid depression
With respect to the explicit measure of cognitive emotion regulation, youth with ADHD who are at increased risk for co-morbid depression reported more frequent use of maladaptive and less frequent use of adaptive cognitive emotion regulation strategies
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition defined by a persistent and cross-situational pattern of age-inappropriate inattention and/or hyperactivity-impulsivity that leads to functional impairment [1]. Being a prevalent neurodevelopmental disorder with childhood onset, ADHD is often the entry point into a trajectory defined by a high risk for co-morbid psychiatric disorders [2,3,4,5]. Mood disorders such as Major Depressive Disorder are among the most common comorbidities in adulthood [6,7,8] with prevalence rates considerably increasing when patients transition from childhood into adulthood [2,3,4,5, 9, 10]. A better understanding of the factors [13, 17] that contribute to the increased risk for depression among patients with ADHD during the particular sensitive phase of adolescence and young adulthood is needed and would provide new opportunities in the development of early intervention and prevention strategies
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