Deficient Emotional Self-regulation Research Articles

Alexithymia and binge eating: Maladaptive emotion regulation strategy or deficient interoception?

Alexithymia has been linked to various excessive behaviors as a likely risk factor, including binge eating. Such relationships are often attributed to deficient emotional self-regulation in alexithymia, ostensibly leading to the use of maladaptive, externalized behaviors as strategies for coping with distress. An alternative view is that alexithymia reflects a fundamental deficit of interoceptive awareness that, in the case of binge eating, would suggest that internal satiety cues are poorly recognized, promoting overconsumption. The present study assessed the relationship between alexithymia and binge eating in the context of these competing hypotheses. A large online sample of young adults (n = 532) completed validated measures of alexithymia, emotion regulation, interoception, binge eating, emotional eating motivation, and sensitivity to reward and punishment. Correlations were as expected except for interoception, which showed minimal association with alexithymia or binge eating. In a hierarchical regression controlling for age, gender, education level and student status as covariates, binge eating was predicted by emotional eating motivation, emotion regulation (a negative predictor), alexithymia, and reward sensitivity, with the final model explaining 53% of variance in binge eating. Bootstrapped path analyses controlling for all other variables indicated that the relationship between alexithymia and binge eating was mediated by deficient emotion regulation but not deficient interoception, and that the relationships of both alexithymia and emotion regulation with binge eating were mediated by emotional eating motivation. Results are consistent with the notion that the association of alexithymia with binge eating reflects deficient emotion regulation in alexithymia, which can lead to adoption of maladaptive, externalized behaviors such as binge eating for coping with distress.

Alexithymia and Psychopathological Manifestations Centered on the Body: Somatization and Self-Harm.

The present study aimed to investigate alexithymia and psychopathological manifestations centered on the body in a sample of adolescents with somatizing and/or self-harming issues to analyze the phenomenon of NSSI linked to Somatic Symptom Disorders (SSD). A sample of 184 adolescents between 12 and 19 years of age, was divided into three groups, one with NSSI (n = 49) and the second group with SSD (n = 57), comparing them with a third group of adolescents with SSD and NSSI (n = 78) to investigate their differences and similarities in psychopathological correlates and to analyze the mediation role of alexithymia and emotional dysregulation in NSSI and SSD related to internalizing problems. The battery of tests included the Toronto Alexithymia Scale (TAS-20) and the Youth Self-Report 11–18 (YSR). The NSSI + SSD group scored higher than the other two groups on all the YSR scales. The affective syndromes were the only clinical condition that discriminated between the three groups. On all the other syndrome scales, the NSSI + SSD group differed from the other two groups, while there were no differences between the NSSI group and the SSD group. The NSSI + SSD group revealed a more severely deficient emotional self-regulation. Difficulty identifying feelings was a trait shared by adolescents with SSD and those engaging in NSSI, a more complex overall alexithymia profile was associated with the combination of self-harming behavior and somatization. Alexithymia and emotional dysregulation played a mediating role in the relationship between internalizing problems and somatization. We did not find a mediating role in alexithymia and emotional dysregulation in the relationship between internalizing problems and self-injurious behavior. The combination of NSSI and SSD gave rise to more severe psychopathological correlates, clinical levels of alexithymia, and more severe deficient emotional self-regulation. Results of mediation role indicated a link between alexithymia, emotional dysregulation, and somatization.

Alexithymia, attachment security and negative mood

ABSTRACT Objective Alexithymia, a trait dimension defined by difficulties identifying and describing feelings and an externally oriented thinking style, is often associated with negative moods such as depression, anxiety and stress as well as an insecure adult attachment style. The present study evaluated the hypothesis that the link between alexithymia and negative moods is mediated by insecure attachment, which implies a lack of social resources for coping with distress. Method A nonclinical online community sample of 206 male and female young adults recruited from throughout Australia completed validated measures of alexithymia, attachment security and negative moods. Results In a hierarchical regression model with demographic variables and socially desirable responding at step 1, alexithymia at step 2 and insecure attachment at step 3, the final model accounted for 62.4% of variance in negative moods, with alexithymia and insecure attachment as significant predictors. Bootstrapped mediation modelling, controlling for demographic variables and socially desirable responding, indicated partial mediation of the association between alexithymia and negative moods by insecure attachment. Conclusions Results point to the role of insecure attachment in the negative moods often associated with alexithymia, presumably in addition to the deficient emotional self-regulation associated with alexithymia. KEY POINTS What is already known about this topic: Alexithymia is associated with negative moods and maladaptive coping. Alexithymia is associated with insecure adult attachment styles. Alexithymia is associated with loneliness and interpersonal difficulties.What this topic adds: Insecure attachment mediated the association of alexithymia with negative moods. This suggests the role of insecure attachment in negative moods associated with alexithymia. Therapy for alexithymic clients may thus benefit from targeting insecure attachment, but replication is needed in clinical samples.

Verbal working memory and processing speed: Correlations with the severity of attention deficit and emotional dysregulation in adult ADHD.

ObjectivesThe Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5), emphasizes symptoms severity with regard to the diagnosis of attention deficit hyperactivity disorder (ADHD). Many clinicians use neuropsychological test results as objective measures of cognitive functions as part of the diagnostic work‐up. The aim of this study was to investigate whether the psychometric test results regarding verbal working memory and processing speed are useful as indicators of the severity of attention deficits and emotional dysregulation in adults with ADHD.MethodsThis observational cross‐sectional clinical study included 418 adults diagnosed with ADHD according to the DSM‐5. Attention deficit severity was defined based on the inattentive subscale of the Adult ADHD Self‐Report Scale. Emotional dysregulation was assessed with the Deficient Emotional Self‐Regulation scale. Verbal working memory was measured with the Working Memory Index (WMI), and processing speed was measured with the Processing Speed Index (PSI) from the Wechsler Adult Intelligence Scale, third edition.ResultsThe full‐scale intelligence quotients of the participants were in the normal range, with expected reductions in verbal working memory and processing speed. Only processing speed was associated with attention deficits (β = −.056, p = .003). The association between the psychometric test result for verbal working memory and processing speed and that between the severity of attention deficits and emotional dysregulation were weak (R2 < .1) and mostly non‐significant.ConclusionThe psychometric index scores for verbal working memory (WMI) and processing speed (PSI) seem to have limited utility as indicators of the severity of attention deficits and emotional dysregulation in adult ADHD patients.

Deficient Emotional Self-Regulation and Sleep Problems in ADHD with and without Pharmacological Treatment

Objective: The purpose of this study is to analyse DESR and its influence on sleep parameters in three different groups of children and adolescents: a group newly diagnosed with ADHD naïve, a group with ADHD under pharmacological treatment and a control group. Method: Subjects were a total of 327 children and adolescents. Two groups diagnosed with ADHD: 108 medication-naïve and 80 under pharmacological treatment; and one group with 136 healthy subjects. DESR was defined using anxious/depressed, attention problems and aggressive behaviors (AAA) scales from the Child Behavior Checklist (CBCL), and sleep through the Sleep Disturbance Scale for Children. Results: Significant differences were found comparing the three groups (p = .001), with a significantly higher profile on DESR in ADHD subjects, especially those who did not undergo treatment, and a positive correlation between DESR and sleep. Conclusion: Children and adolescents with ADHD without treatment present higher DESR than healthy controls and consequently higher sleep problems.

Toward operationalizing deficient emotional self-regulation in newly referred adults with ADHD: A receiver operator characteristic curve analysis

A growing body of research suggests that deficient emotional self-regulation (DESR) is common and morbid among attention-deficit/hyperactivity disorder (ADHD) patients. The main aim of the present study was to assess whether high and low levels of DESR in adult ADHD patients can be operationalized and whether they are clinically useful. A total of 441 newly referred 18- to 55-year-old adults of both sexes with Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition (DSM-5) ADHD completed self-reported rating scales. We operationalized DESR using items from the Barkley Current Behavior Scale. We used receiver operator characteristic (ROC) curves to identify the optimal cut-off on the Barkley Emotional Dysregulation (ED) Scale to categorize patients as having high- versus low-level DESR and compared demographic and clinical characteristics between the groups. We averaged the optimal Barkley ED Scale cut-points from the ROC curve analyses across all subscales and categorized ADHD patients as having high- (N = 191) or low-level (N = 250) DESR (total Barkley ED Scale score ≥8 or <8, respectively). Those with high-level DESR had significantly more severe symptoms of ADHD, executive dysfunction, autistic traits, levels of psychopathology, and worse quality of life compared with those with low-level DESR. There were no major differences in outcomes among medicated and unmedicated patients. High levels of DESR are common in adults with ADHD and when present represent a burdensome source of added morbidity and disability worthy of further clinical and scientific attention.

Deficient Emotional Self-Regulation in Children with Attention Deficit Hyperactivity Disorder: Mindfulness as a Useful Treatment Modality

The aim of this study was to investigate the efficacy of a structured mindfulness group intervention program targeting deficient emotional self-regulation (DESR) in a sample of children with attention deficit hyperactivity disorder (ADHD). Seventy-two children aged 7 to 12 years with ADHD were randomized into 2 groups (mindfulness and control). The dysregulation profile was measured using the Child Behavior Checklist (CBCL) Attention/Anxiety-Depression/Aggression scales. Children with ADHD who received mindfulness-based group therapy showed lower levels of DESR after treatment, with a reduction in CBCL dysregulation profile (F (1,63) = 4.81; p = 0.032). All ADHD symptoms showed a moderately significant positive correlation with DESR (p < 0.01). Children with combined-type showed higher levels of DESR than children with inattentive-type (p = 0.018); however, no statistically significant changes were observed in the combined-type after mindfulness treatment. This study suggests that mindfulness in the form of structured group therapy might be clinically relevant in treating children with ADHD and thus make an impact on the overall clinical outcome, regardless of the ADHD subtype.

Is Increased Response Time Variability Related to Deficient Emotional Self-Regulation in Children With ADHD?

Objective: Elevated response time intrasubject variability (RT-ISV) characterizes ADHD. Deficient emotional self-regulation (DESR), defined by summating Child Behavior Checklist Anxious/Depressed, Aggressive, and Attention subscale scores, has been associated with worse outcome in ADHD. To determine if DESR is differentially associated with elevated RT-ISV, we examined RT-ISV in children with ADHD with and without DESR and in typically developing children (TDC). Method: We contrasted RT-ISV during a 6-min Eriksen Flanker Task in 31 children with ADHD without DESR, 34 with ADHD with DESR, and 65 TDC. Results: Regardless of DESR, children with ADHD showed significantly greater RT-ISV than TDC (p < .001). The ADHD subgroups, defined by presence or absence of DESR, did not differ from each other. Conclusion: Increased RT-ISV characterizes ADHD regardless of comorbid DESR. Alongside similar findings in children and adults with ADHD, these results suggest that RT-ISV is related to cognitive rather than emotional dysregulation in ADHD.

T67. Is Increased Response Time Variability Related to Deficient Emotional Self-Regulation in Children With ADHD?

T67. Is Increased Response Time Variability Related to Deficient Emotional Self-Regulation in Children With ADHD?

Practitioner Review: Emotional dysregulation in attention‐deficit/hyperactivity disorder – implications for clinical recognition and intervention

Because emotional symptoms are common in attention-deficit/hyperactivity disorder (ADHD) patients and associate with much morbidity, some consider it to be a core feature rather than an associated trait. Others argue that emotional symptoms are too nonspecific for use as diagnostic criteria. This debate has been difficult to resolve due, in part, to the many terms used to describe emotional symptoms in ADHD and to concerns about overlap with mood disorders. We sought to clarify the nature of emotional symptoms in ADHD by reviewing conceptual and measurement issues and by examining the evidence base regarding specificity of such symptoms for ADHD. We reviewed the various terms used to define emotional symptoms in ADHD, clarify how these symptoms are demarcated from mood disorders, and assess the possibility that symptoms of emotional impulsivity and deficient emotional self-regulation should be considered as core symptoms. We addressed psychiatric comorbidities, the effects of ADHD treatments on associated emotional dysregulation, and the utility of current rating scales to assess emotional symptoms associated with ADHD. Emotional symptoms are common and persistent in youth and adults with ADHD. Although emotional symptoms are common in other psychiatric disorders, emotional impulsivity (EI), and deficient emotional self-regulation (DESR) may be sufficiently specific for ADHD to function as diagnostic criteria. Emotional symptoms in ADHD cause clinically significant impairments. Although there is a solid theoretical rationale for considering EI and DESR to be core symptoms of ADHD, there is no consensus about how to define these constructs sin a manner that would be specific to the disorder. An instrument to measure EI and DESR which demarcates them from irritability and other emotional symptoms could improve the accuracy of diagnostic criteria for ADHD.

Effect of Methylphenidate on Emotional Dysregulation in Children With Attention-Deficit/Hyperactivity Disorder + Oppositional Defiant Disorder/Conduct Disorder.

Emotional dysregulation (ED) is a frequent feature of attention-deficit/hyperactivity disorder (ADHD). It can be observed as a dysregulation profile or a deficient emotional self-regulation (DESR) profile. Oppositional defiant disorder/conduct disorder (ODD/CD) comorbidity is prevalent in ADHD and known to be related with ED. The first-line treatment of ADHD includes psychostimulants, but their effects on ED are not well studied. This study aimed to evaluate the outcomes of methylphenidate (MPH) treatment on ED in ADHD + ODD/CD cases. A total of 118 ADHD + ODD/CD patients with a mean age of 9.0 ± 1.9 years were treated with MPH for 1 year. Also, parents of cases were recruited for a parent-training program, which initiated after first month of MPH treatment. Symptom severity was assessed at baseline and 12th month by Turgay Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parent Form, Children Depression Inventory, Child Behavior Checklist 4-18 years, and Parental Acceptance and Rejection Questionnaire-Mother Form. Emotional dysregulation (DESR + DP) was present in 85.6% of cases. Conduct disorder was significantly higher in patients with DP, whereas ODD was significantly higher in the DESR and non-ED groups (P < 0.0001). Symptoms of ADHD and ED were significantly improved with 1-year of MPH treatment (P < 0.05). The improvement in ED was independent of improvement in ADHD symptoms and parent training (P < 0.05). Emotional dysregulation is highly prevalent in disruptive behavioral disorders as ODD and CD, which are comorbid with ADHD. The MPH treatment is effective on ED independently from other clinical determinants.

Pilot study on nutritional and eating disorders in children and mood disorders: comorbidity or prodromal traits?

Both children affected by nutritional and eating disorders (ED) and adults with bipolar disorder (BD) display symptoms of deficient emotional self-regulation, which can present in different forms. If we observe the clinical and developmental histories of individuals affected by EDs and BD, based on a cognitive systemic post-rationalist approach, we can hypothesise a continuum between the two disorders. The aim of this pilot study is to support the hypothesis - from an explanatory rather than a non-descriptive approach - that EDs and BD are the possible result of issues tied to biological and psychological self-regulation. When such an issue manifests during an individual's early stages through an eating disorder, it is more likely to result in an actual affective disorder, such as BD, during an individual's adult years. The study examined a total of 51 patients affected by an ED between the ages of 8 and 18. At least one of the parents had been diagnosed with a mental disorder. All of the subjects completed the Child Behavior Checklist (CBCL) and the Eating Disorders Inventory (EDI) II. Each of the patients underwent a pediatric assessment using their BMI to establish the type of ED. The parents were divided into two groups: subjects with BD and subjects affected by other psychopathologies. Although the comparison between patients with EDs and parents with or without BD did not demonstrate a significant difference in any scale, it highlighted specific common characteristics between the disorder presented by the parent and the cognitive-emotional expressions of his or her child. In fact, the results indicate that the CBCL "problems of thought" scale explains much of the Impulsivity variance obtained by the EDI and that the CBCL "high withdrawal/depression" dependent factor highlighted a statistical significance for the EDI's "low interoceptive awareness" scale. The study presented limitations, especially with respect to the sample size examined, but it suggests a field that can be further explored to understand the reasons for a significance in the aspects related to contrasting emotional adjustments, impulsivity and depression/withdrawal, highlighting a connection with the parents' distinctive relational model.

Longitudinal effects of prenatal exposure to air pollutants on self-regulatory capacities and social competence.

We evaluated the influence of prenatal exposure to widespread urban air pollutants on the development of self-regulation and social competence in a longitudinal prospective cohort of children born to nonsmoking minority women in New York City. Air pollutant exposure was estimated categorically by level of polycyclic aromatic hydrocarbon (PAH)-DNA adducts in maternal blood collected at delivery, providing a biomarker of maternal exposure to PAH over a 2- to 3-month period. Deficient emotional self-regulation (DESR) was defined as moderate elevations on three specific scales of the child behavior checklist (anxious/depressed, aggressive behavior, and attention problems). We used generalized estimating equations to assess the influence of prenatal exposure to PAH on DESR in children at 3-5, 7, 9, and 11years of age, adjusted for gender and race/ethnicity. Next, we assessed the association of prenatal exposure to PAH with social competence, as measured by the social responsiveness scale (SRS), the association of impaired self-regulation with social competence, and whether impairment in self-regulation mediated the association of prenatal exposure to PAH with social competence. We detected a significant interaction (at p=.05) of exposure with time, in which the developmental trajectory of self-regulatory capacity was delayed in the exposed children. Multiple linear regression revealed a positive association between presence of PAH-DNA adducts and problems with social competence (p<.04), level of dysregulation and problems with social competence (p<.0001), and evidence that self-regulation mediates the association of prenatal exposure to PAH with social competence (p<.0007). These data suggest that prenatal exposure to PAH produces long-lasting effects on self-regulatory capacities across early and middle childhood, and that these deficits point to emerging social problems with real-world consequences for high-risk adolescent behaviors in this minority urban cohort.

Neuroanatomical basis of emotional dysregulation in children and adults with ADHD

Introduction Since the advent of DSM III, emotional dysregulation has been relegated to associated features of ADHD. However, research has shown that 25% to 40% of children and 30% to 70% of adults with ADHD have emotional dysregulation. Deficient emotional dysregulation is an important cause of disability, and poor clinical course. Objectives At the end of this presentation, the participants will be able to: – discuss the prevalence, disability and clinical/behavioral manifestations of emotional dysregulation in ADHD as a dimensional trait; – discuss the major brain functions of the hypothalamus, amygdala, ventral striatum, cingulate gyrus, anterior insula and orbitofrontal cortex, and how these may explain emotional dysregulation in ADHD. Aims The aim of this presentation is to elucidate the relationship between clinical manifestations of deficient emotional self-regulation in ADHD and the neuroanatomical structures and neurocircuitry involved in emotional regulation. Methods This presentation will selectively review specific research findings of functional imaging ADHD studies and analyze them in the context of emotional regulation exerted by the interrelationships between the amygdala, ventral striatum, medial prefrontal cortex, orbitofrontal cortex and anterior insula. Results Bottom-up neuroanatomical mechanisms involve the detection of hypothalamic and amygdalar firing, signaling higher cortical structures that control is needed. Top-down regulatory processes in ADHD subjects fail in the allocation of attention to emotional stimuli and reward valuation necessary to maintain focus on a goal. Conclusions Further research is needed to continue elucidating the anatomical structures and functional connectivity underlying deficient emotional self-regulation in ADHD.

Deficient Emotional Self-Regulation in Preschoolers With ADHD: Identification, Comorbidity, and Interpersonal Functioning

Objective: This study aims to develop an age-adjusted Child Behavior Checklist- (CBCL) and Teacher Report Form (TRF)-based method for the detection of deficient emotional self-regulation (DESR) in preschoolers with ADHD and to assess its incidence, comorbidities, and consequences on interpersonal functioning. Method: Eighty-six ADHD preschoolers and 104 controls were assessed using CBCL, TRF/1½ to 5, Psychiatric Interview With Preschool Age Psychiatric Assessment, Leiter-R, and ADHD rating scales. Results: Greatest sensitivity and specificity were obtained applying slightly lower threshold scores compared with school-age children (CBCL: Anxiety/Depression [A/D] ≥ 59, Attention Problems [AP] ≥ 60, Aggression Behaviors [AB] ≥ 58; TRF: A/D ≥ 59, AP ≥ 60, AB ≥ 60). DESR was detected in 33/86 (38.4%) and in 16/54 (29.6%) ADHD preschoolers versus 2/104 (1.9%) controls using CBCL and TRF, respectively. DESR is associated with significantly greater comorbidity and impairment in interpersonal functioning. Conclusion: Among ADHD preschoolers, DESR (a) requires lower CBCL and TRF threshold scores for detection, compared with school-age children, (b) displays similar incidence rates, and (c) is associated with enhanced psychiatric comorbidity and interpersonal difficulties.

Attention Deficit Hyperactivity Disorder in the Light of the Epigenetic Paradigm.

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder characterized by a definite behavioral pattern that might lead to performance problems in the social, educational, or work environments. In the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, the symptoms of ADHD were restricted to those associated with cognitive (attention deficit) and behavioral (hyperactivity/impulsivity) deficits, while deficient emotional self-regulation, a relevant source of morbidity, was left out. The etiology of it is complex, as its exact causes have not yet been fully elucidated. ADHD seems to arise from a combination of various genetic and environmental factors that alter the developing brain, resulting in structural and functional abnormalities. The aim of this paper was to review epigenetics and ADHD focused on how multidimensional mechanisms influence the behavioral phenotype.

Increasing Early Awareness of Hazard of Children with ADHD’s ODD and Aggression by Structural Equation Modeling (SEM)

Background: The hazard of children with Attention Deficit Hyperactivity Disorder (ADHD) occurring Oppositional Defiant Disorder (ODD) (shorten as ADHD’s ODD) and aggression is not well understood. This study employs structural equation modeling (SEM) to operationalize aggression as joined symptoms on children with ADHD’s ODD by analyzing how aggression symptom transact the symptom severity of ADHD’s ODD. Methods: ADHD children and adolescents received clinical diagnosis and inattention (ADHD-I), hyperactivity/impulsivity (ADHD-H/I), and ODD subscale of Swanson, Nolan, and Pelham, version IV scale (SNAP-IV-C) and child behaviour check list (CBCL). SEM was applied to associate ADHD-I, ADHD-H/I, and ODD subscale toaggression. Results: Significantly aggressive symptom on CBCL interact with symptom of ADHD, ODD on SNAP; the standardized direct effect of ADHD symptom by SNAP on behavior symptom by CBCL is 0.57 and the standardized total (direct and indirect) effect of ODD symptom on behavior symptom is 0.34. Children with ADHD’s ODD symptom share similar characteristic symptom as symptom of ADHD children with deficient emotional self-regulation (DESR). The aggression is highly correlated with ODD (0.607). Conclusions: On ADHD symptom, the likelihood of symptom severity is predicted by the symptom of ADHD-I, ADHD-H/I, and ODD. On ODD symptom, ODD is associated with aggression and anxiety/depression symptom. There is a need to regard child with symptom of ADHD’s ODD and aggression as a child with heavy genetic loading and predictor of disruptive behavior disorder.

Child behaviour checklist emotional dysregulation profiles in youth with disruptive behaviour disorders: Clinical correlates and treatment implications

Two Child Behaviour Checklist (CBCL) profiles were correlated to poor self-regulation, Deficient Emotional Self-Regulation (DESR) (elevation between 1 and 2 Standard Deviations (SD) in Anxiety/Depression, Aggression, Attention subscales), and Dysregulation Profile (DP) (elevation of 2 Standard Deviations or more). We explored youths with Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) whether these profiles are associated with specific clinical features. The sample included 57 patients with DESR profile and 41 with DP profile, ages 9 to 15 years, all assigned to a non-pharmacological Multimodal Treatment Program. No differences resulted between groups in demographic features, diagnosis ratio, and comorbidities with Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder (BD), and Anxiety Disorder. The DP group was associated with higher scores in Withdrawn, Social Problem, Thought, Rule Breaking, and Somatic CBCL subscales, and higher scores in Narcissism and Impulsivity (but not Callous–Unemotional (CU)), according to the Antisocial Process Screening Device (APSD). After treatment, patients with DESR improved their personality traits (Narcissistic and Callous–Unemotional, but not Impulsivity), while changes in CBCL scales were modest. Patients with DP improved scales of Attention, Aggression, Anxiety–Depression, Rule Breaking, Withdrawal, Social Problem and Thought, while personality features did not change. These results suggest diagnostic implications of CBCL profiles, and indications for targeted treatment strategies.

EPA-1746 – The role of family structure and of tryptophan hydroxylase 2 (TPH2) on the stability of deficient emotional self-regulation symptoms throughout adolescence

Deficient emotional self-regulation (DESR) have been found to be a very heritable trait that increases susceptibility for later psychopathology, including severe mood problems and aggressive behaviour. A common single nucleotide polymorphism (SNP G-703T, rs 4570625) in the transcriptional control region of TPH2 has been reported to modulate amygdala responsiveness to affective stimuli and has been found to be associated with emotional dysregulation. we have investigated the moderating role of a TPH2 polymorphism on genesis and stability/instability of DESR during the transition from early to late adolescence, taking also into account the possible interaction with family structure. This is a five year follow-up study of the genetic section of the PrISMA project (Progetto Italiano Salute Mentale Adolescenti) The final study population included 287 subjects (50.9% boys, 49.1% girls, aged 15-19). To test for hypothesized influences and moderation effect of TPH2 genotype we performed a path analysis using Mplus 6.11 and the bootstrapping procedure describe by Preacher et al. (2007) The effect of family structure on early-adolescence DESR is moderated by TPH2 genotype: subjects living in monoparental families which are also homozygous for G-allele show higher scores on DESR index. Otherwise, the effect of family structure on late-adolescence DESR is mediated by the same symptoms in early-adolescence and this mediation is moderated by TPH2 G-703T polymorphism Future models of the developmental link between environmental adversities and dysregulation problems therefore need to consider that a more ‘dynamic’ G×E perspective.

Re-examining the risk for switch from unipolar to bipolar major depressive disorder in youth with ADHD: A long term prospective longitudinal controlled study

BackgroundRecent studies have identified subthreshold forms of bipolar (BP)-I disorder and deficits in emotional regulation as risk factors for bipolar disorder in youth. The primary aim of this study was to investigate whether emotional dysregulation and subthreshold forms of BP-I disorder increase the risk for BP switches in ADHD youth with non-bipolar MDD. MethodsWe used data from two large controlled longitudinal family studies of boys and girls with and without ADHD. Subjects (N=522) were followed prospectively and blindly over an average follow up period of 11.4 years. Comparisons were made between ADHD youth with unipolar major depression (MDD) who did (N=24) and did not (N=79) switch to BP-I disorder at follow-up. ResultsThe rate of conversion to BP-I disorder at follow up was higher in MDD subjects with subthreshold BP-I disorder at baseline compared to those without (57% vs. 21%; OR=9.57, 95% CI=1.62−56.56, p=0.013) and in MDD subjects with deficient emotional self-regulation (OR=3.54, 95% CI=1.08−11.60, p=0.037). LimitationsThe sample was largely Caucasian, so these results may not generalize to minority groups. The sample of youth with SED was small, which limited the statistical power for some analyses. ConclusionsSwitches from unipolar MDD to BP-I disorder in children with ADHD and MDD were predicted by baseline subthreshold BP-I disorder symptoms and baseline deficits in emotional regulation. More work is needed to assess whether these risk factors are operant outside the context of ADHD.