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Should Emotions Be a Bigger Part of Adult ADHD?

New research argues that emotional ups and downs should get more attention in diagnosis and treatment.

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ADHD symptoms are generally divided into two types: inattentive and hyperactive. But recent research published in The Journal of Clinical Psychiatry suggests that distinction may not capture how the disorder typically presents in adults—and may leave out the critical element of emotional dysregulation, which affects many with ADHD but is absent from official psychiatric criteria.

Using multiple rating scales, symptoms were assessed for nearly 1,500 adults with ADHD. The researchers found that the classic inattentive vs. hyperactive model did not properly capture how subjects’ symptoms presented. However, they found evidence for two groupings that the majority of the subjects could fit into: inattentive presentation, with symptoms primarily related to focus and disorganization, and emotional dysregulation presentation, involving anger, mood swings, and overreactivity. Hyperactivity appeared in both groups. Although the latter group tended to display greater symptom severity, some evidence found that they respond better to treatment.

The criteria for diagnosing ADHD “needs to adjust to adults,” says study author Frederick Reimherr, a psychiatrist at the University of Utah. Adults with ADHD who present with strong emotional symptoms may be misdiagnosed with bipolar disorder and receive improper treatment, he adds. On the other hand, ADHD’s emotional symptoms tend to respond well to first-line treatments like stimulants and therapy.

Other experts suggest, however, that what the study identifies as “emotional dysregulation” may still be tied to hyperactivity. “Emotional dysregulation is not some new, different symptom factor,” argues psychiatrist Russell Barkley of Virginia Commonwealth University; rather, it’s one way that ADHD’s trademark disinhibition may manifest. While he cautions against relying too much on one “subtyping” approach, he’s “glad to see that emotional dysregulation is important in adult ADHD.”

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