Adult patients with ADHD differ from healthy controls in implicit, but not explicit, emotion regulation

Abstract

Background: There is increasing evidence that people with attention-deficit/hyperactivity disorder (ADHD) are impaired in emotion regulation, but psychophysiological and functional MRI data on emotion processing in adult patients with ADHD are scarce. We investigated the neural correlates of reappraisal as one of the most efficient emotion-regulation strategies.

Methods: We included 30 adult patients with ADHD and 35 healthy controls in our study. We applied a well-established reappraisal paradigm in functional MRI and assessed behavioural emotion-regulation strategies with standardized questionnaires. We hypothesized that patients with ADHD would demonstrate impaired reappraisal related to reduced activations in the frontoparietal cognitive control network.

Results: Despite our hypothesis, we found no significant activation differences in the neural reappraisal network between patients with ADHD and controls. As well, both groups revealed similar reappraisal success on the immediate behavioural ratings in the scanner. Interestingly, patients with ADHD revealed significantly increased activations in the dorsal and ventral anterior cingulate cortex (ACC) compared to controls when viewing negative > neutral pictures. These ACC activations were significantly correlated with the prevalence of habitual use of reappraisal in patients with ADHD only.

Limitations: Patients withdrew medication only 24 hours before the experiment; we investigated negative, but not positive, emotion processing and regulation.

Conclusion: Although emotion dysregulation is regarded as a core symptom of ADHD, explicit reappraisal does not seem to be impaired in adult patients. However, increased activation of the ACC implies stronger implicit emotion regulation induced by negative stimuli. This might be explained by emotional hyperresponsivity in patients with ADHD compared with controls.

Conflict of interest statement

None declared.

© 2019 Joule Inc. or its licensors

Figures

Fig. 1

Main effects of negative view and reappraisal. The displayed clusters survived correction for multiple comparisons at pCWC,FWE < 0.05, at a cluster extent threshold of k = 20 based on corrected voxels at pFWE < 0.05. The contrast maps are projected onto the normalized MRIcron template brain. CWC = cluster-wise correction; FWE = family-wise error correction.

Fig. 2

Interaction effect for patients with ADHD (negative view > neutral view) > healthy controls (negative view > neutral view). The reported clusters survived correction for multiple comparisons at pCWC,FWE < 0.05, at a cluster extent threshold of k = 240 based on uncorrected voxels at p < 0.001. The contrast maps are projected onto the normalized MRIcron template brain. The bar graph depicts the eigenvariates of the first cluster in the right dorsal ACC. The bars represent activation of the cluster during all 3 conditions, but the contrast was significant only for the interaction. This figure shows that this area of the ACC was similarly activated in both groups during reappraisal. ACC = anterior cingulate cortex; ADHD = attention-deficit/hyperactivity disorder.

Fig. 3

Positive correlations between self-reported habitual reappraisal (Emotion Regulation Questionnaire) and activation in the dorsal anterior cingulate cortex for ADHD (negative view > neutral view) > healthy controls (negative view > neutral view) in patients with ADHD and healthy controls, separately. The activation was extracted using the first eigenvariate of the first (largest) cluster. ADHD = attention-deficit/hyperactivity disorder; ERQ = Emotion Regulation Questionnaire.