Psychological Medicine

Original Articles

Deficient emotional self-regulation and pediatric attention deficit hyperactivity disorder: a family risk analysis

J. Biedermana1a2 c1, T. Spencera1a2, A. Lomedicoa1, H. Daya1, C. R. Pettya1 and S. V. Faraonea3

a1 Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Yawkey Center for Outpatient Care, Boston, MA, USA

a2 Psychiatry Department, Harvard Medical School, Cambridge, MA, USA

a3 Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA

Abstract

Background Although deficient emotional self-regulation (DESR) is associated with attention deficit hyperactivity disorder (ADHD), little research investigates this association and little is known about its etiology. Family studies provide a method of clarifying the co-occurrence of clinical features, but no family studies have yet addressed ADHD and DESR in children.

Method Subjects were 242 children with ADHD and 224 children without ADHD. DESR was operationalized using an aggregate score ≥180 and <210 in the anxious/depressed, attention and aggression scales (AAA profile) of the Child Behavior Checklist (CBCL), termed the CBCL-DESR profile. The CBCL-bipolar (CBCL-BP) profile was defined as ≥210 on the CBCL-AAA scale. We examined the familial transmission of ADHD and the CBCL-AAA scale in families selected through probands with and without these conditions.

Results We found a linear increase in the prevalence of CBCL-DESR in siblings as indexed by the Control, ADHD, ADHD+CBCL-DESR and ADHD+CBCL-BP proband groups. While the ADHD siblings were at elevated risk for both the CBCL-DESR and CBCL-BP compared with non-ADHD siblings, a significantly higher rate of CBCL-BP in the siblings of ADHD+CBCL-BP probands was found compared with siblings of the Control probands.

Conclusions ADHD shows the same degree of familial transmission in the presence or absence of DESR. CBCL-DESR and CBCL-BP are familial, but further work is needed to determine if these definitions are distinctly familial or represent a continuum of the same psychopathology.

(Received March 17 2011)

(Revised July 19 2011)

(Accepted July 25 2011)

(Online publication August 24 2011)

Correspondence

c1 Address for correspondence: J. Biederman, M.D., Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Pediatric Psychopharmacology Unit, Yawkey Center for Outpatient Care, YAW-6A-6900, 32 Fruit Street, Boston, MA 02114–3139, USA. (Email: jbiederman@partners.org)

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