Emotional Instability a Core Feature of ADHD

Emotional dysregulation should be considered a core aspect of ADHD because it is commonly seen in patients, including those without comorbidities, and responds to treatment, new research shows.

Presenting data from a study in adult prisoners alongside a review of the literature, Philip Asherson, MD, PhD, professor of molecular psychiatry at King's College London, in the United Kingdom, told delegates attending the 5th World Congress on Attention Deficit Hyperactivity Disorder (ADHD) that although emotional lability is not unique to ADHD, it is a unique source of impairment in these patients.

Consequently, it should always be considered in the diagnosis of patients presenting with chronic emotional or mood instability, said Dr Asherson.

Dr Asherson noted that "traditional" diagnostic criteria for ADHD included emotional lability. However, this domain, which includes mood instability and affective lability, became separated out as clinicians concentrated on hyperactivity, impulsivity, and inattention.

This may not reflect the true picture of ADHD, he continued, because the severity of emotional instability surely contributes to impairments related to home life, occupation, education, criminal activity, driving, and financial outcomes.

ADHD Is Often Mistaken for Other Conditions

A number of other health problems, such as anxiety, depression, and certain types of learning disabilities, have symptoms that are similar to those of ADHD. Other mental disorders, such as mood disorder, personality disorder, or OCD, may also be misdiagnosed as ADHD.

In some cases, children's circumstances may cause them to behave in ways that can be misinterpreted as ADHD. As a result, doctors must determine whether or not a sudden change or stressor in children's lives - such as the death of a family member or divorce - is affecting their behavior.

To determine whether emotional lability is a "third dimension" of ADHD, however, it would need to be demonstrated that treatment can have an impact on lability, that there are case-control differences in lability, that it demonstrably contributes to impairment, and that it shares genetic factors with the other dimensions.

Better Focus, Improved Mood

In an attempt to answer some of these questions, Dr Asherson launched the CIAO project, which is an open-label study of methylphenidate (multiple brands) in adult offenders with ADHD.

Of 1922 male prisoners aged 18 to 30 years, 19.3% met the DSM-5 criteria for ADHD, and 40% were treated with methylphenidate. For these patients, the dose was up-titrated during a 4-week period and was then maintained at a stable dose for 8 weeks.