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Working memory and emotion regulation in children with ADHD

Thursday, 5 September, 2019

In the United States alone, around one in fourteen children is diagnosed with attention-deficit hyperactivity disorder (ADHD). ADHD is a complex and lifelong developmental disorder, and is characterized by symptoms of inattention, impulsivity, and hyperactivity. Children with ADHD may have trouble concentrating in school, paying attention to others, thinking things through, or sitting still.

Children with ADHD are also at risk for a range of other symptoms, including mood disorders, learning disabilities, and impairments in emotion regulation.

ADHD and emotion regulation

Emotion regulation is described as the ability to produce and maintain an emotion, and to decrease an emotion’s intensity or frequency. It’s about the control you have over the emotions you feel and show to others.

Research suggests that children with ADHD have more trouble regulating emotions than their typically developing peers. This includes difficulties in recognizing and understanding emotions, heightened emotional reactivity, decreased emotion regulation, and impaired empathy.

Neurocognitive development in ADHD

Emotion regulation is closely related to the development and refinement of executive functions. Executive functions include abilities like inhibition, planning, and working memory. They are central in controlling your behavior, as well as your emotions.

For example, we learn to restrain our emotions to fit social norms, or use our working memory to interpret and react to complex emotional situations. Findings from cognitive research also show that working memory helps with understanding emotions, emotional responding, and distraction from negative moods.

Therefore, several theories suggest that emotion regulation difficulties in children with ADHD are caused by underlying neurocognitive deficits. Specifically, researchers argue that inhibition and working memory may be involved.

Studying working memory and emotion regulation

Earlier research on the relation between emotion regulation and working memory in ADHD shows inconsistent results and may have methodological limitations. For example, the tests used in these studies often target memory skills, while placing low demands on executive processes – in other words, not targeting the ‘working’ part of working memory.

Also, these studies rely mostly on rating scales of emotion regulation. These measures are vulnerable to both rater bias and errors in retrospective recall. They may also be confounded by an overlap in items targeting emotion regulation difficulties and other disorders.

Varying demands on working memory

To address these limitations, researchers Tarle and her colleagues used an observational design for their study and included a different working memory test. Observing behavior also provided them with another advantage: they could directly measure real-time changes in behavior.

By measuring real-time changes in behavior, they were able to examine neurocognitive processes described by dual process theory. Dual process theory suggests that our ‘cognitive fuel’ is limited and can become depleted when high demands are placed on our working memory. This means that after performing a difficult task, there may not be as much ‘fuel’ left to regulate emotions.

That is why the research team studied children in conditions of high and low demand on working memory, and studied their effects on emotion regulation.

They predicted that children with ADHD would not only have more difficulties in emotion regulation than their typically developing peers, but would also respond more strongly to increased demands on working memory.

Observing child behavior

Tarle and her colleagues included 36 children with ADHD and 32 typically developing children in their study. Children were assigned to these groups following a comprehensive diagnostic procedure.

Working memory was measured with a computer test in which a series of shuffled numbers and one letter were presented. Children were instructed to rearrange the numbers from low to high, followed by the letter, and to say this sequence out loud. The test was split into four blocks of varying set-sizes.

In the control condition, children could draw or paint anything they wanted for five minutes, using a computer program.

Children’s behaviors were observed and coded using The Observer XT. Specifically, the researchers were interested in behaviors that showed decreased regulation of emotions. This included self-criticism, emotion ventilation, solicitations with the examiner, positive emotion expression, and more.

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Group differences

As expected, children with ADHD showed poorer working memory performance compared to their typically developing peers. Overall, they also demonstrated poorer emotion regulation.

Specifically, they showed more frequent emotion ventilation and solicitations with the examiner, compared with children from the control group.

Children from both groups showed greater emotional expression during the working memory test, compared to the drawing condition. For example, they vented their emotions and shut down more often. These findings are in line with predictions from dual process theory.

Most interestingly, results showed significant interaction effects for self-criticism and positive emotion expression. In other words, the effects of increased working memory demands on these emotion regulation behaviors were greater for children with ADHD than for those in the control group.

These results are in line with findings from previous research, suggesting that a majority of children with ADHD show greater emotional reactivity than their typically developing peers.

Environment

Results from the current study show that the relation between working memory and emotion regulation works differently for children with ADHD. These findings have important implications for the treatment of this disorder.

For example, by understanding how emotion regulation is influenced in children with ADHD, caretakers can structure their environments more optimally. They might benefit from variations in task, activity level, and social environment, which could help prevent depletions in ‘cognitive fuel’ and the difficulties in emotion regulation that may follow.

Findings from studies like these can also help to advance the development and refinement of diagnostic criteria, and inspire new treatment possibilities.

Reference

Tarle, S.; Alderson, R.; Arrington, E.; Roberts, D. (2019). Emotion regulation and children with attention-deficit/hyperactivity disorder: the effect of varying phonological working memory demands. Journal of Attention Disorders. https://doi.org/10.1177/1087054719864636