← Back
Anticancer activity of heterodinuclear ruthenium(II)–platinum(II) complexes as photochemotherapeutic agents
Clinical Psychology Review 46 (2016) 106–123
Contents lists available at ScienceDirect
Clinical Psychology Review
journal homepage: www.elsevier.com/locate/clinpsychrev
Attention-deficit hyperactivity disorder and children's emotion
dysregulation: A meta-analysis
Paulo A. Graziano ⁎, Alexis Garcia
Florida International University, United States
H I G H L I G H T S
• We examined the link between ADHD and four domains of emotion dysregulation.
• Youth with ADHD have the greatest impairment on emotion reactivity/lability.
• The ADHD & CU traits link is weakened in the presence of conduct problems.
• Conduct problems did not moderate the link between ADHD and emotion regulation.
• Cognitive functioning moderates the link between ADHD and emotion reactivity/lability.
a r t i c l e
i n f o
Article history:
Received 28 April 2015
Received in revised form 20 April 2016
Accepted 21 April 2016
Available online 27 April 2016
Keywords:
ADHD
Emotion regulation
Recognition
Lability
Empathy
Children
Meta-analysis
a b s t r a c t
While executive functioning deficits have been central to cognitive theories of Attention-Deficit Hyperactivity
Disorder (ADHD), recent work has suggested that emotion dysregulation may also play a key role in understanding the impairments suffered by youth with ADHD. However, given the multiple processes involved in emotion
dysregulation, the extent to which youth with ADHD are impaired across multiple domains of emotion dysregulation including: emotion recognition/understanding (ERU), emotion reactivity/negativity/lability (ERNL), emotion regulation (EREG), and empathy/callous–unemotional traits (ECUT) remains unclear. A meta-analysis of 77
studies (n = 32,044 youths) revealed that youth with ADHD have the greatest impairment on ERNL (weighted ES
d = .95) followed by EREG (weighted ES d = .80). Significantly smaller effects were observed for ECUT (weighted
ES d = .68) and ERU (weighted ES d = .64). Moderation analyses indicated that the association between ADHD
and ERNL was stronger among studies that had a sample containing older youth (no other demographic factors
were significant). Additionally, the association between ADHD and ECUT was significantly weaker among studies
that controlled for co-occurring conduct problems. Co-occurring conduct problems did not moderate the link between ADHD and any other emotion dysregulation domain. Lastly, the association between ADHD and ERNL was
significantly weaker when controlling for youth's cognitive functioning. Cognitive functioning did not moderate
the link between ADHD and ERU, EREG, or ECUT, respectively. Theoretical/practical implications for the study of
emotional dysregulation in youth with ADHD are discussed.
© 2016 Elsevier Ltd. All rights reserved.
Contents
1.
2.
3.
Introduction . . . . . . . . . . . . . . . . . . .
1.1.
Emotion recognition/understanding (ERU) . .
1.2.
Emotional reactivity/negativity/lability (ERNL)
1.3.
Emotion regulation (EREG) . . . . . . . . .
1.4.
Empathy/callous–unemotional traits (ECUT) .
Potential moderators . . . . . . . . . . . . . . .
2.1.
Demographic factors . . . . . . . . . . . .
2.2.
Cognitive functioning . . . . . . . . . . .
2.3.
Conduct problems . . . . . . . . . . . . .
Goals of the current meta-analysis . . . . . . . . .
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
107
107
108
108
109
109
109
109
110
110
⁎ Corresponding author at: Florida International University, Center for Children and Families, Department of Psychology, 459 Academic Health Center 4, Miami, FL 33199, United States.
E-mail address: pgrazian@fiu.edu (P.A. Graziano).
http://dx.doi.org/10.1016/j.cpr.2016.04.011
0272-7358/© 2016 Elsevier Ltd. All rights reserved.
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
4.
Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.1.
Literature review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.2.
Inclusion and exclusion criteria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3.
Coding of moderators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3.1.
Demographic variables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3.2.
Co-comorbid conduct problems (CP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.3.3.
Controlling for cognitive functioning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.4.
Computation of effect sizes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4.5.
Data analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.
Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.1.
Primary analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2.
Heterogeneity and moderation analyses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2.1.
Demographic moderators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2.2.
Measurement moderators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.2.3.
CP and cognitive functioning as moderators . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5.3.
File drawer analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
6.
Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Role of funding sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Conflict of interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Appendix A.
Coded qualities and weighted effect sizes of studies of ADHD and children's emotion dysregulation outcomes .
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1. Introduction
Attention-Deficit Hyperactivity Disorder (ADHD) is one of the most
common childhood psychiatric disorders with prevalence rates ranging
from 5 to 7% worldwide (Polanczyk, Willcutt, Salum, Kieling, & Rohde,
2014; Willcutt, 2012). The core symptoms of ADHD, consisting of inattention, hyperactivity, and impulsivity, are associated with significant
impairment across youth's social, cognitive, academic, behavioral, and
familial functioning (Loe & Feldman, 2007; Mash & Barkley, 2003)
resulting in significant societal costs (annual societal cost of $42.5 billion; Pelham, Foster, & Robb, 2007). In terms of the etiology of ADHD,
the past two decades have seen a resurgence of cognitive theories that
along with empirical data have stressed the role of executive functioning (EF) processes or cognitive control (Barkley, 1997; Harms, Martin,
& Wallace, 2010; Marsh & Blair, 2008). More recently, however,
researchers have emphasized emotion dysregulation as a core feature
of ADHD and a significant contributor to the functional impairment suffered by youth and adults with ADHD (Barkley & Fischer, 2010; Bunford,
Evans, & Wymbs, 2015; Nigg, Blaskey, Stawicki, & Sachek, 2004; Shaw,
Stringaris, Nigg, & Leibenluft, 2014).
Broadly speaking, emotion dysregulation occurs when an individual
fails to modify an emotional state so as to promote adaptive behaviors
that are necessary to accomplish his/her goals (Thompson, 1994). Within the ADHD literature, emotion dysregulation has been conceptualized
as emotional impulsiveness, difficulty in effortful regulation of induced
emotions, and/or difficulty inducing positive, more acceptable mood
states (Barkley, 2010; Bunford, Evans, & Wymbs, 2015). However, as
outlined by Gross (1998) model of emotion generation, there are several processes that occur in the modification of an emotional state prior to
the overall “dysregulation” that may be eventually observed. These processes include the individual's ability to select, attend to, and appraise/
evaluate emotionally arousing stimuli that lead to the experience of an
emotional state in both a physiological and behavioral manner. Subsequently, modulation efforts take place both unconscious or consciously
in response to such emotional state to promote an adaptive emotional
response. It is also important to acknowledge that an individual's selection into a particular situation plays a role in the emotional cues that inherently may be triggered by the situation.
Despite such recognition of the complexity and multiple processes
involved in emotion dysregulation, it remains unclear as pointed out recently by Shaw et al. (2014), which aspects of the emotion generation
process are impaired among children with ADHD. Examining which
107
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
110
110
111
111
111
111
111
111
112
112
112
112
112
112
113
113
114
116
116
116
116
119
aspects of the emotion generation process are impaired among youth
with ADHD is particularly important given that overall emotion dysregulation is found across other externalizing and internalizing disorders
(Aldao, Nolen-Hoeksema, & Schweizer, 2010; Zlomke & Hahn, 2010).
Hence, it is important to examine whether any associations between
ADHD and various emotion dysregulation domains remain after accounting for co-occurring conduct problems (CP; e.g., aggression and/
or Oppositional Defiant Disorder/Conduct Disorder) which are highly
co-morbid with ADHD. Lastly, given the important role of evaluating/
appraising emotional cues, as part of the emotion generation process,
it is not surprising that individual differences in cognitive functioning
impact an individual's capacity to regulate emotions (Zelazo &
Cunningham, 2007). Given the heterogeneity in cognitive/executive
functioning deficits exhibited by children with ADHD (Barkley, 1997;
Nigg, Blaskey, Huang-Pollock, & Rappley, 2002; Willcutt, Doyle, Nigg,
Faraone, & Pennington, 2005), an accurate understanding of which domains of emotion dysregulation are affected by ADHD needs to account
for individual differences in cognitive functioning. Modeled after Gross
(1998) emotion generation process, Fig. 1 outlines our framework for
examining the multiple levels of emotion dysregulation that may be affected in ADHD as well as moderating factors.
1.1. Emotion recognition/understanding (ERU)
While entry into a situation that contains emotional cues is recognized as the first step of Gross (1998) model of emotion generation,
the current study focuses on individual differences that occur after the
exposure to such emotional cues starting at the second and more evaluative step in terms of an individual's emotion recognition/understanding (ERU). ERU refers to youth's ability to process and infer the emotions
of others as well as one's self. Measurement of ERU entails correctly
identifying emotional states in various forms of communication including facial and/or bodily expression, gestures, and speech prosody
(Etcoff, 1986; Regenbogen et al., 2012). Various research groups have
created reliable and valid standardized tasks assessing youth's ERU
such as asking youth to name emotions presented in pictures of faces
or video vignettes (Boakes, Chapman, Houghton, & West, 2007; Da
Fonseca, Seguier, Santos, Poinso, & Deruelle, 2009; Denham, 1986;
Ekman & Friesen, 1976), or the use of a Prosody Test (Tucker, Watson,
& Heilman, 1977). From a neural mechanism perspective, the activation
of the amygdala has been shown to be a bottom-up response to emotional stimuli (Brown, Ryan, & Creswell, 2007; Deveney et al., 2013)
108
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
Fig. 1. Conceptual model of emotion dysregulation and ADHD. Note. Unidirectional arrows represent the simplest pathway although as indicated by Gross (1998) emotion generation
model these processes can occur in parallel at multiple time points. ERU = emotion recognition/understanding, ERNL = emotion reactivity/negativity/lability, EREG = emotion
regulation, ECUT = empathy/callous–unemotional traits.
while neocortical structures contribute to a top-down processing and
understanding of emotional stimuli (Borod, 1992; Ochsner et al.,
2009). Youth's ERU has been readily tied to adaptive behaviors such as
academic functioning (Izard et al., 2001), but perhaps most notably
within the social functioning domain (Denham, 1998; Izard, 1971;
Marsh & Blair, 2008; Trentacosta & Fine, 2010). For example, youth
who have greater ERU tend to exhibit greater social adjustment, engage
in more prosocial behaviors as well as empathetic responses, and are
generally more liked by their peers (Denham, Bassett, Zinsser, &
Wyatt, 2014).
Within clinical samples, significant work has shown that youth with
Autism Spectrum Disorder have difficulty with ERU (see Harms et al.,
2010 for a review). On the other hand, mixed evidence exists to whether youth with ADHD also have difficulty with ERU. For example, while
Dyck, Ferguson, and Shochet (2001) found that youth with ADHD performed more poorly on two ERU tasks compared to controls, a more recent study by Deschamps, Schutter, Kenemans, and Matthys (2014)
found no differences in youth with ADHD and controls on their ability
to recognize and share the emotions depicted in two stories.
of emotional reactivity (Cole, Michel, & Teti, 1994). Another analogous
term recently used within the ADHD literature is emotional impulsivity
which is defined as including low frustration tolerance, quickness to
anger, irritability, and emotional excitability (Barkley & Fischer, 2010).
Given our interest in ADHD, the current paper focuses on emotional reactivity or lability as it pertains to both positive and negative emotions
(with the expectation that most studies only broadly examine reactivity
across emotions) as we recognize that high reactivity or lability to positive emotions certainly have a role in other psychiatric disorders such
as bipolar disorder (see Gruber, 2011).
While some studies have shown that youth with ADHD are rated by
parents and/or teachers as having higher levels of ERNL compared to
controls (e.g., Banaschewski et al., 2012; Anastopoulos et al., 2011),
others have found only mild effects when implementing observation
based measures (e.g., Melnick & Hinshaw, 2000). Hence, it will be
important to empirically examine the magnitude of any associations between ADHD and ERNL, taking into account any potential reporter bias
(i.e., parent rating both ADHD and ERNL), as this will help determine
whether ERNL should be conceptualized as a feature of ADHD.
1.2. Emotional reactivity/negativity/lability (ERNL)
1.3. Emotion regulation (EREG)
In addition to facilitating adaptive responses, initial processing and
recognition of emotions also play a role in determining emotional response tendencies (Gross, 1998) or reactivity, which can be conceptualized as an individual's threshold, intensity, and duration of affective
arousal (Rothbart & Derryberry, 1981). Reactivity can refer to both positive and negative emotions with the term emotional negativity being
used only when describing reactivity to negative emotions. Measurement of ERNL can be captured via rating scales, such as the anger/frustration scale of the Children's Behavior Questionnaire (Rothbart,
Ahadi, Hershey, & Fisher, 2001), the emotional lability subscale of the
Conners' Parent and Teachers Rating Scales (Conners, Sitarenios,
Parker, & Epstein, 1998a, 1998b) or the lability/negativity subscale of
the Emotion Regulation Checklist (ERC; Shields & Cicchetti, 1997), as
well as observationally via coding systems (e.g., Saarni, 1984) of the
youth's intensity of emotional display during frustration/challenging
tasks. While there is mixed evidence on whether the emotional valence
of the visual stimuli (e.g., negative emotions versus positive ones) relates to greater reactivity (see Wager, Phan, Liberzon, & Taylor, 2003
for a review) the temperament literature has documented significant
individual differences, as early as infancy, in emotional reactivity to
novel and stressful events (Calkins, 2007; Fox, 1989; Rothbart &
Sheese, 2007).
Within the clinical psychology and psychiatric literature the term lability, borrowed from the biological and physical sciences, conveys the
instability and disorganization that is assumed to underlie a high degree
Following Gross (1998) emotion generation model, the next step entails modulation of the emotional response tendencies or reactivity described in the previous section. While there is no single definition for
emotion regulation (EREG), from a top-down perspective, EREG refers
to effectively responding to emotional reactivity in a flexible manner
that facilitates adaptive functioning (Bunford, Evans, & Wymbs, 2015;
Calkins, 2007; Cole et al., 1994; Gross, 2011). Hence, EREG not only refers to the reduction in the intensity of emotional arousal and/or experiences but also includes the capacity to generate and sustain emotions
when needed (Cole, Martin, & Dennis, 2004). Specifically related to
ADHD, Barkley (2010) and Bunford, Evans, & Wymbs (2015), further
note the importance of cognition/attention in down-regulating or escalating arousal that an emotion has induced as well as organizing his/her
self for a coordinated set of behaviors that lead an individual to return to
baseline functioning. Measurement of EREG can be captured via rating
scales, such as the regulation subscale of the Emotion Regulation Checklist (Shields & Cicchetti, 1997), the emotion control subscale of the Behavior Rating Inventory of Executive Function (Gioia, Isquith, Guy, &
Kenworthy, 2000) as well as observationally via coding of the youth's
effectiveness in maintaining interest in a frustrating/challenging task,
or the use of coping strategies during such task, as well as expressing
emotions appropriately (i.e., not getting overly disruptive/angry;
Saarni, 1992). While outside the scope of the current paper, Bunford,
Evans, and Wymbs (2015) provide an excellent review wherein they
outline advantages/disadvantages of various methods for measuring
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
EREG including ecological momentary assessment and pathophysiological indicators.
Across development, youth with EREG difficulties experience greater levels of behavioral, social, familial, and academic impairment (Blair,
Denham, Kochanoff, & Whipple, 2004; Cole, Zahn-Waxler, Fox, Usher, &
Welsh, 1996; Eisenberg et al., 2000; Graziano, Reavis, Keane & Calkins,
2007; John & Gross, 2004; Williford, Calkins, & Keane, 2007). It is important to acknowledge that EREG includes efforts at both at an extrinsic
and intrinsic level and can be observed behaviorally as well as via biological markers. For example, youth with greater levels of respiratory
sinus arrthymia (RSA) withdrawal, a psychophysiological marker for
emotion regulation (Calkins, 2007; Porges, Doussard‐Roosevelt,
Portales, & Greenspan, 1996), tend to have fewer externalizing and internalizing problems and better cognitive functioning (see metaanalysis by Graziano & Derefinko, 2013).
Within clinical samples or from a developmental psychopathology
perspective, EREG difficulties are prevalent across psychiatric disorders
(Aldao et al., 2010; Zlomke & Hahn, 2010). For example, within the internalizing domain, depression is often conceptualized as a disorder of
impaired EREG given that sustained negative affect and a persistent reduction in positive affect are core features of a major depressive episode
in adults (Campbell-Sills & Barlow, 2007; Joormann & Gotlib, 2010).
EREG difficulties have also been incorporated into theoretical adult
models of generalized anxiety disorder (Mennin, Holaway, Fresco,
Moore, & Heimberg, 2007), social anxiety disorder (Kashdan & Breen,
2008), and bipolar disorder (Gruber, 2011). Adolescents and/or adults
suffering from eating disorders and/or substance abuse also frequently
have poor EREG as the use of substances and use/restraint of food can
be conceptualized as an escape or coping strategy (Polivy & Herman,
2002; Sher & Grekin, 2007).
As it relates to the current study, some studies have found that youth
with ADHD have more difficulty controlling their emotions during challenging/frustrating/disappointment tasks compared to controls
(e.g., Melnick & Hinshaw, 2000; Walcott & Landau, 2004; Wheeler
Maedgen & Carlson, 2000). This association between ADHD and EREG
is theorized to arise partially out of shared neurocognitive/executive
functioning processes involved both in the expression of ADHD symptoms (Barkley, 1997) as well as in EREG (Bush, Luu, & Posner, 2000).
However, given the heterogeneity found in executive functioning deficits among children with ADHD (Nigg, Willcutt, Doyle, & SonugaBarke, 2005), it is important to establish the magnitude of any links between EREG and ADHD as it would provide empirical evidence on how
important EREG is in conceptualizing ADHD.
1.4. Empathy/callous–unemotional traits (ECUT)
The final aspect of the emotion generation process is engaging in an
adaptive emotional response such as empathy. The cognitive aspect of
empathy generally refers to one's ability to comprehend the affective
or cognitive status of another (Gini, Albiero, Benelli, & Altoè, 2007;
Kokkinos & Kipritsi, 2012) while the affective component, refers to the
ability to experience another's affective state and/or express concern
for another's position (Thomas, Batson, & Coke, 1981; Ze, Thoma, &
Suchan, 2014). Measurement of empathy can be captured via rating
scales such as the ‘My Child’ questionnaire (Kochanska, DeVet,
Goldman, Murray, & Putnam, 1994) which assess early conscience development. Coding systems (e.g., Strayer, 1989) are also employed during empathy eliciting tasks, often referred to as measuring theory of
mind (Premack & Woodruff, 1978), which require youth to respond to
various vignettes depicting a character's emotional state by answering
how that character was feeling as well as how they are feeling with
higher matched scores (between how the character was feeling and
themselves) indicative of greater empathy.
Within the developmental literature, there are mixed findings as to
the association between youth's empathetic responses and social
and behavioral outcomes (Eisenberg & Miller, 1987). Some studies
109
have suggested that these mixed findings are a function of the
cognitive versus affective aspect of empathy with null findings more
likely to be found within the cognitive empathy domain (Sutton,
Smith, & Swettenham, 1999). For example, youth may have high
levels of cognitive empathy in terms of understanding the emotional
state of others but simply do not emotionally care to act upon such understanding (Sutton, 2003) or use such knowledge to manipulate
the situation (Garandeau & Cillessen, 2006). Sex and age have also
been documented as important moderators for whether a link
between empathy and prosocial and adaptive behavioral functioning
is found (Rose & Rudolph, 2006; Wentzel, Filisetti, & Looney, 2007). Additionally, it is particularly pertinent to examine ECUT within the
broader concept of emotion dysregulation given evidence linking ERU
to ECUT (Dawel, O'Kearney, McKone, & Palermo, 2012; Kimonis et al.,
2008) as well as ECUT and ERNL (Willoughby, Waschbusch, Moore, &
Propper, 2011).
Within clinical psychology and psychiatry, low levels of empathy,
guilt, and caring for others have recently been categorized under the
term callous–unemotional (CU) traits (Frick, Ray, Thornton, & Kahn,
2013). Measurement of CU traits typically involves rating scales such as
the Antisocial Process Screening Device (Frick & Hare, 2001) or the Inventory of Callous–Unemotional Traits (Frick, 2003). Youth with CU traits experience deficits in both cognitive and affective aspects of empathy
(Pardini, Lochman, & Frick, 2003). Substantial research has documented
CU traits as an important characteristic for identifying the most pervasive, severe, and aggressive patterns of antisocial behavior (see Frick
et al., 2013 for a recent review). What remains unclear, as pointed out
by Stadler et al. (2011), is whether CU traits are associated with ADHD independent of CP as a recent review found mixed evidence for such a link
(e.g., Herpers, Rommelse, Bons, Buitelaar, & Scheepers, 2012).
2. Potential moderators
2.1. Demographic factors
The association between emotion dysregulation and ADHD may also
differ according to youth's sex. Developmental work has shown that
while boys and girls exhibit similar levels of ERU (Hoffmann, Kessler,
Eppel, Rukavina, & Traue, 2010), girls tend to experience greater ERNL
(Charbonneau, Mezulis, & Hyde, 2009; Sobanski et al., 2010), and engage in more empathetic behaviors (Van Tilburg, Unterberg, &
Vingerhoets, 2002) and more effective EREG (Zlomke & Hahn, 2010)
compared to boys. Within an ADHD sample, Bunford, Evans, and
Langberg (2014) found that girls exhibited significantly higher levels
of self-reported emotion dysregulation characterized, by a lack of emotional awareness and difficulty engaging in goal-directed behaviors,
compared to males. However, when compared to a community/normative sample, males with ADHD were more deviant from the norm in
terms of emotion dysregulation than females with ADHD. Given that
the emotion dysregulation factors are developmental processes that
youth improve over time with experience (Kochanska & Knaack,
2003) it is also important to examine age as a moderator. Age may be
particularly important when considering ERNL as the ADHD adult literature has noted that ERNL is present in up to 90% of adult cases (Kooij,
Aeckerlin, & Buitelaar, 2001), although comorbidity rates with anxiety,
depression, and bipolar disorder make it difficult to determine how
much of such ERNL is attributed to ADHD (Skirrow, McLoughlin,
Kuntsi, & Asherson, 2009).
2.2. Cognitive functioning
Higher order cognitive skills, generally referred to as executive functions (EF), play a key role in various aspects of self-regulation including
emotion regulation (Blair, 2002; Bush et al., 2000; Zelazo &
Cunningham, 2007). Although multiple definitions of EF have been proposed (Jurado & Rosselli, 2007), strong support exists for a model
110
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
consisting of core neuropsychological skills that include cognitive flexibility, working memory, and inhibitory control (Miyake et al., 2000). Overall
levels of intelligence and verbal abilities/fluency have also been found to
relate to EF among children with and without ADHD (Blair & Razza,
2007; Hughes, 1998; Mahone et al., 2002) and as such can impact youth's
EREG. Specifically, within the emotion generation process outlined by
Gross (1998), EF or cognitive control can play a key role in the initial evaluation of emotional cues as well as in the more regulatory or modulation
of arousal phase. Additionally, it appears that EF and EREG capabilities develop in concert during the early childhood and preschool period (Bell &
Wolfe, 2004; Carlson & Wang, 2007; Fox & Calkins, 2003) and are interconnected from a neural perspective allowing a reciprocal effect on one
another (Blair, 2002; Bush et al., 2000; Sjöwall, Roth, Lindqvist, &
Thorell, 2013). The initial evaluation of emotional cues also requires the
use of EF for cognitive understanding or perspective taking skills that
can be referred to as “theory of mind” (Denham, Zoller, & Couchoud,
1994; Nilsen & Graham, 2009). Development of EF and theory of mind
skills are dependent on one another and influence ERU (Blankson et al.,
2013). Indeed children who perform better on theory of mind tasks
tend to score higher on ERU tasks (Cutting & Dunn, 1999; Waller, Hyde,
Grabell, Alves, & Olson, 2014) and are more likely to engage in empathetic
responses and less likely to be rated as having CU traits (Waller et al.,
2014). When viewed in conjunction with the fact that there is significant
heterogeneity in terms of EF/cognitive control deficits among youth with
ADHD (Barkley, 1997; Nigg et al., 2002; Willcutt et al., 2005), it becomes
crucial for any investigation of emotion dysregulation among youth with
ADHD to account for the impact of cognitive functioning.
2.3. Conduct problems
Conduct problems (CP) is defined generally as behaviors that violate the rights of others (e.g., aggression, destruction of property)
and/or cause conflict with societal norms or authority figures
(e.g., non-compliance/oppositional behaviors, anti-social behaviors,
rule-breaking behaviors; Campbell, Shaw, & Gilliom, 2000). These
dimensions of CP can be measured both continuously in a dimensional manner or can diagnostically be captured under the categories
of oppositional defiant disorder (ODD) and conduct disorder (CD) in
the Diagnostic and Statistical Manual of Mental Disorders (DSM-5
American Psychiatric Association, 2013). The presence of cooccurring CP may impact any associations between ADHD and emotion dysregulation (Nigg et al., 2004; Sobanski et al., 2010). Youth
with CP, independent of ADHD, have been shown to have emotion
dysregulation deficits across domains. For example, youth with CP,
but not ADHD, are more likely to have CU traits (Frick, Cornell,
Barry, Bodin, & Dane, 2003; Woodworth & Waschbusch, 2008) and
have difficulty regulating their emotions (Cole, Teti, &
Zahn-Waxler, 2003; Frick & Morris, 2004). On the other hand, some
studies indicate that EREG problems are associated with ADHD
above and beyond CP (Bunford et al., 2014; Sjöwall et al., 2013).
Melnick and Hinshaw (2000) classified youth with ADHD as either
high or low in co-occurring aggression and found ERNL differences
only between youth with ADHD and high levels of aggression compared to controls. A meta-analysis by Trentacosta and Fine (2010)
also found moderate effects (r = −.26) linking overall levels of CP
and difficulty with ERU. While ADHD was not included in
Trentacosta and Fine's (2010) meta-analysis, a more recent study
suggests that poor ERU may be more strongly associated with comorbid CP rather than purely with ADHD (Factor, Rosen, & Reyes,
2013). Taken together and considering the high comorbidity rates
between ADHD and CP, ranging from 30 to 50% (Mannuzza, Klein,
Abikoff, & Moulton, 2004), it is possible that emotion dysregulation
factors theoretically attributed to ADHD may be partially or fully
accounted by the presence of CP, which is important to note may
also be partially a consequence of ADHD (Biederman et al., 2008;
Gresham, Lane, & Lambros, 2000).
3. Goals of the current meta-analysis
In summary, theoretical and recent empirical data suggest that emotion dysregulation is a core feature of ADHD. However, as outlined by
Gross (1998), there are several processes throughout the emotion generation model that may lead to dysregulation. Hence, the research literature remains unclear on the extent to which youth with ADHD show
difficulties across all emotion dysregulation processes/domains or
more focal deficits. From a developmental psychopathology perspective, it is important to understand whether for example, the EF deficits
found in some youth with ADHD, affect emotion dysregulation broadly
or relate to impairment in the more regulatory component of the emotion generation model (i.e., EREG). Understanding where in the emotion
generation model (see Fig. 1) youth with ADHD have difficulty would
help inform interventions to target such processes.
The goal of the current study was to conduct a meta-analysis to examine a) the magnitude of the associations between ADHD status and
emotion dysregulation, b) determine any differences in the magnitude
of these associations according to the domain of emotion dysregulation
(ERU, ERNL, EREG, and ECUT), and c) determine the extent to which demographic variables (i.e., sex, age), comorbid CP, and individual differences in cognitive functioning impact the association between ADHD
and emotion dysregulation. While there have been several metaanalyses conducted as it relates to ADHD and treatment (DuPaul &
Eckert, 1997; Faraone, Biederman, & Mick, 2006; Van Der Oord, Prins,
Oosterlaan, & Emmelkamp, 2008), genes (Gizer, Ficks, & Waldman,
2009; Li, Sham, Owen, & He, 2006; Nikolas & Burt, 2010), executive
functioning (Frazier, Demaree, & Youngstrom, 2004; Martinussen,
Hayden, Hogg-Johnson, & Tannock, 2005; Willcutt et al., 2005), neural
correlates (Cortese, 2012; Dickstein, Bannon, Castellanos, & Milham,
2006), we are not aware of any meta-analysis that has specifically focused on emotion dysregulation. However, there has been some theoretical and review papers on aspects of emotion dysregulation in
general psychopathology (Southam-Gerow & Kendall, 2002) and specifically to ADHD (Barkley, 2010; Bunford, Evans, & Wymbs, 2015; Shaw
et al., 2014; Skirrow et al., 2009).
Given the neurobiological overlap between emotion and cognitive
regulation (Semrud-Clikeman, Walkowiak, Wilkinson, & Butcher, 2010),
we expected the association between ADHD and EREG to be the strongest.
Given recent developmental work showing ERNL to be a strong predictor
of later psychopathology (Stringaris & Goodman, 2009) and high rates of
ERNL among adults with ADHD (Amador-Campos, Gómez-Benito, &
Ramos-Quiroga, 2014), we hypothesized a moderate association between
ADHD and ERNL. We did not expect a strong association between ADHD
and ERU given evidence that such links may be strongest for youth with
Autism Spectrum Disorder (Jones et al., 2011). Similarly, we expected a
low association between ADHD and ECUT given evidence that such
links are strongest for youth with high levels of CP (Haas, Waschbusch,
King, & Walsh, 2014). In terms of demographic predictors, given the
rapid development of self-regulation skills, including emotion regulation
and executive functioning, throughout childhood (Anderson, 2002;
Kochanska & Knaack, 2003) as well as studies documenting greater levels
of ADHD for boys (Gaub & Carlson, 1997), we expected that the link between ADHD and emotion dysregulation to be stronger for samples
with younger children and a greater proportion of males. Lastly, we expected weaker effects between ADHD and emotion dysregulation for
studies that controlled for CP as well as cognitive functioning.
4. Method
4.1. Literature review
We conducted a comprehensive search for empirical research regarding the relation between ADHD and youth's emotion dysregulation
over the last 20 years (since the early publications leading to Barkley's
(1997) influential theory), using PsychINFO (1994–2015), Science
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
Citation Index Expanded (1994–2015), Social Sciences Citation Index
(1994–2015), Arts & Humanities Citation Index (1994–2015), Google
Scholar (1994–2015), and MEDLINE (1994–2015). The terms used in
the search included ADHD, AD/HD, ADD, Attention-Deficit/Hyperactivity
Disorder, Attention-Deficit Disorder, Externalizing behavior problems, conduct problems, aggression, behavior problems, and attention problems.
These terms were crossed with terms related to children's emotion dysregulation, including emotion, emotion dysregulation, emotion regulation,
affect, affect regulation, reactivity, emotion reactivity, emotional impulsivity, negative reactivity, negativity, empathy, callous–unemotional traits,
psychopathy, problem-solving, anger, frustration, emotional labile, lability,
irritability, mood regulation, emotional control, coping, emotion recognition, emotion processing, emotional understanding, facial recognition, theory of mind, emotion knowledge, emotional intelligence, and emotional
competence. In addition to the database search, references used in identified studies and review articles were surveyed to identify other potentially relevant studies. Due to the extensive number of studies identified
through database search and study ancestry, unpublished data were not
utilized for the present analyses.
4.2. Inclusion and exclusion criteria
Eighty-three studies satisfied the inclusion criteria. Publication years
of the identified studies ranged from 1998 to 2015. Our inclusion criteria
were liberal in terms of the design of the studies as the main goal of this
meta-analysis was to determine the magnitude of any associations between ADHD and children's emotion dysregulation factors. Studies
had to report youth as having ADHD through a diagnostic process
(n = 77). Hence, some studies that examined children “at-risk” for
ADHD were excluded (e.g., Kats-Gold, Besser, & Priel, 2007) or those
who examined ADHD symptoms within normative samples
(e.g., Singh & Waldman, 2010). Studies could either compare emotion
dysregulation factors between children with ADHD and a control
group (e.g., children displaying normative levels of ADHD symptoms)
or use correlational methods to examine concurrent associations between ADHD symptom severity and emotion dysregulation outcomes.
In addition, sufficient statistical data to allow the calculation of effect
sizes had to be present (e.g., means, standard deviations, correlational
tables, regressions, test statistics such as t-test, ANOVA, etc.). Articles
written in languages other than English were excluded.
Additionally, since our focus was on four main emotion dysregulation outcomes (i.e., ERU, ERNL, EREG, ECUT), over 50 articles examining
relations between ADHD and other social–emotional outcomes
(e.g., social skills, cooperation, problem-solving, peer status) were excluded. Additionally, given that our theoretical model sought to clarify
the link between emotion dysregulation and ADHD along with other associated externalizing problems (i.e., aggression, ODD), articles which
examined ADHD and co-occurring depression and anxiety were excluded (Classi, Milton, Ward, Sarsour, & Johnston, 2012). Treatment outcome articles that only examined change in emotion dysregulation as
a function of treatment were also excluded (Herbert, Harvey, Roberts,
Wichowski, & Lugo-Candelas, 2013) unless baseline data was available
linking ADHD symptom severity to emotion dysregulation and/or provided data on emotion dysregulation for a control group. Articles that
solely examined brain regions associated with emotion dysregulation
in children with ADHD without observable or corresponding reports
were also excluded (e.g., Finger et al., 2008). Because we were interested in only youth's emotion dysregulation, any article in which the mean
and/or range of age was over 18 was excluded (e.g., Barkley & Fischer,
2010).
4.3. Coding of moderators
Studies were coded for several demographic and methodological
features. Two judges (first and second authors) independently coded
studies. Interjudge reliability was assessed via intraclass correlation
111
coefficients (ICC) for continuous codes, and via kappas (κ) for categorical codes. When a discrepancy was found, both coders independently
reviewed the study again and decided whether they would retain
their original code or modify it. Remaining discrepancies were resolved
through discussion between coders. The reliability between coders was
excellent (all ICC values N .90 and κ values = 1.00).
4.3.1. Demographic variables
We coded studies for average age of sample, gender (% male), ethnicity (% Caucasian), time lag (time in years between ADHD symptom
and emotion dysregulation outcome), type of sample (between group
comparison of ADHD vs. control, n = 58 or within group comparison
of ADHD symptoms and emotion dysregulation among clinic/at-risk
groups, n = 19). We also coded studies for how ADHD was diagnosed.
Thirty studies used the “gold” standard of a diagnostic interview plus
a combination of parent and teacher reports. Sixteen studies used only
parent and/or teacher reports while 13 studies used a diagnostic interview with or without parent reports. Finally, 17 studies used medical
records of a previous diagnosis with or without parent report confirmation with one study solely using adolescent-self report. Most studies did
not examine subtypes of ADHD (n = 61) while almost all studies were
cross-sectional in nature (n = 76) so we were unable to examine subtype or time lag between diagnosis and emotion dysregulation as a
moderator. We also coded how emotion dysregulation was measured
(e.g., observational/laboratory measure, parent, teacher, or self-report).
4.3.2. Co-comorbid conduct problems (CP)
As noted in the introduction, there is a significant debate on whether
the link between ADHD and emotion dysregulation is due to the comorbidity between ADHD and CP (aggression and/or ODD/CD diagnoses).
Hence, we coded studies for a) whether children's CP were controlled
or co-varied in analyses of ADHD and emotion dysregulation (n = 27)
or not controlled or co-varied in analyses (n = 50) due to not measuring
conduct problems or combining conduct problems with ADHD when
examining the association with emotion dysregulation. Of note, we
contacted several authors to inquire about separating out the association between ADHD and emotion dysregulation while controlling for
conduct problems and were successful across several studies
(e.g., Dadds, Cauchi, Wimalaweera, Hawes, & Brennan, 2012; Frick
et al., 2003).
4.3.3. Controlling for cognitive functioning
As noted in the introduction and outlined by Gross (1998) emotion
generation model, youth's cognitive functioning plays a key role
throughout multiple facets of emotion dysregulation. Additionally,
given the established cognitive deficits often found in youth with
ADHD, it is important to account for cognitive functioning when examining emotion dysregulation. Hence, we coded studies for a) whether
children's cognitive functioning was measured either broadly via IQ
scores (e.g., verbal abilities, fluid reasoning) or more specific executive
functioning (EF) tasks or global measures of EF were controlled, covaried, or were stated as having no impact on the analyses of ADHD
and emotion dysregulation (n = 46) or not controlled or co-varied in
analyses (n = 31) due to not measuring cognitive functioning or simply
not providing any information.
4.4. Computation of effect sizes
For the effect size (ES) metric, Cohen's d was calculated from correlations between ADHD status and/or symptom severity and emotion
dysregulation outcomes. However, when correlations were not provided, Cohen's d was estimated from other available data sources, including
group comparisons (t-tests), analyses of variance (ANOVAs), or means
and standard deviations for extreme or tertiary groups assigned according to criterion (e.g., comparing youth with ADHD versus a control
group). All effect size estimates and all transformations from other
112
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
data sources to Cohen's d were calculated according to the formulas provided in Lipsey and Wilson (2001) using Microsoft Excel (Neyeloff,
Fuchs, & Moreira, 2012). Positive ESs in the present meta-analysis indicated positive associations between ADHD and emotion dysregulation
(e.g., ERU difficulties, difficulty engaging in empathetic responses/
higher CU traits, greater ERNL, greater EREG difficulties).
Seventy-seven studies with adequate meta-analytic information
were identified, yielding ESs for ERU (21 studies, total n = 2126),
ERNL (22 studies, total n = 21,942), EREG (20 studies, total n =
2040), and ECUT (24 studies, total n = 7,360). In studies in which
two or more pertinent dependent variables were used, such as two
different measures of emotion recognition or two different reporters,
the average effect size was used. All averaged measures used in the
current study were judged by both coders as being of approximately
equal validity. Additionally, effect sizes from studies that used the
same sample for investigating outcomes within the same domain
(e.g., Haas et al., 2011; Waschbusch, Carrey, Willoughby, King &
Andrade, 2007; Waschbusch, Craig, Pelham & King, 2007;
Woodworth & Waschbusch, 2008) were also averaged. All study references appear in the Appendix A.
4.5. Data analysis
Primary analyses were conducted using a random effects model approach (Hughes, 1998) using Microsoft Excel (Neyeloff et al., 2012). This
approach was chosen to reflect the likelihood that individual studies
would produce ESs different from other studies in the analysis. All ESs
were transformed to z-scores using Fisher's r to z transformation. After
aggregation, ESs were transformed again to d for comparison. To estimate the size of the effects, we adopted Cohen's criteria: small = .20,
medium = .50, and large = .80. As a result of the large number of studies included, we used a minimum alpha level of .01 (two-tailed tests).
Heterogeneity analyses were also conducted to determine whether
ESs were more heterogeneous than would be expected due to sampling
error alone. The measure I2 is a modification of Cochrane's Q test
(Cochran, 1954) which measures whether the ratio of variation that exceeds chance, thereby accounting for the number of studies utilized in
meta-analysis with more accuracy (Higgins & Thompson, 2002). Values
for I2 range from 0 to 1; an I2 of 0% indicates no heterogeneity, whereas
I2s of 25%, 50%, and 75% represent low, moderate, and high heterogeneity, respectively (Higgins, Thompson, Deeks, & Altman, 2003). For variables with moderate to high heterogeneity, potential moderators to the
ES were identified using weighted least squares regression procedures
(Hedges, 1994) using SPSS. Finally, weighted file drawer analyses
were conducted following Rosenberg's (2005) approach to determine
the number of studies that would be necessary to reduce the mean effect to a negligible level.
5. Results
5.1. Primary analyses
Study identification information, coded categories, and ESs
representing the relation between ADHD and youth's emotion dysregulation outcomes can be found in Table 1. The relation between ADHD
and measures of children's ERNL had a weighted ES of d = .95 (95% CI
[.91, .99], p b .001) indicating a large effect. A large effect was also
found for the association between ADHD and measures of youth's
EREG, weighted ES of d = .80 (95% CI [.70, .92], p b .001). Moderate effects were found for the associations between ADHD and ECUT (weighted ES of d = .68; 95% CI [.63, .74], p b .001) and ERU (weighted ES of d =
.64; 95% CI [.54, .74], p b .001). Fisher r-to-z comparisons indicated that
the strength of the association between ADHD and ERNL was significantly greater compared to all other ADHD and emotion dysregulation
associations (p b .001). The strength of the association between ADHD
and EREG was also significantly greater compared to the association
Table 1
Effect sizes across measures of emotion dysregulation.
Weighted mean ES
Cohen's criteria
95% CI
Number of effect sizes
Total N across studies
Range of effect sizes
t
Weighted file drawer
analysis
I2
Nature of moderation
ERU
ERNL
EREG
ECUT
.64
Moderate
.54 to .74
21
2126
−.05 to 3.27
13.97⁎⁎⁎
.95
Large
.91 to .99
22
21,942
.02 to 14.04
63.51⁎⁎⁎
.80
Moderate
.70 to .92
20
2,040
.15 to 1.94
16.84⁎⁎⁎
.68
Moderate
.63 to .74
24
7,360
−.01 to 14.04
27.75⁎⁎⁎
54.92
434.97
122.94
116.32
79%
None
99%
a, d
79%
None
95%
b, c
Note. EREG = emotion regulation, ERNL = emotion reactivity/negativity/lability, ECUT =
empathy/callous–unemotional traits, ERU = emotion recognition/understanding.
a. Age: stronger association between ADHD and emotion dysregulation among studies
which had a sample containing older children. b. Design of study: stronger association between ADHD and emotion dysregulation for between-subject studies vs. within study
studies. c. Conduct problems: weaker association between ADHD and emotion dysregulation among studies that co-varied co-occurring aggression and/or Oppositional-Defiant
Disorder/Conduct Disorder diagnosis, d. Cognitive Functioning: weaker association between ADHD and emotion dysregulation among studies that co-varied for cognitive abilities or executive functioning.
⁎⁎⁎ p b .001.
between ADHD and ERU (p b .01) as well as the association between
ADHD and ECUT (p b .01). Lastly, no significant differences were found
in the strength of the associations between ADHD and ERU and ADHD
and ECUT (p = .26).
5.2. Heterogeneity and moderation analyses
The measure I2 was used to assess whether ESs were more heterogeneous than would be expected due to sampling error alone. Values for I2
range from 0 to 1; an I2 of 0% indicates no heterogeneity, whereas I2s of
25%, 50%, and 75% represent low, moderate, and high heterogeneity, respectively (Higgins et al., 2003). Once heterogeneity was identified, potential moderators to the ES were identified using weighted least
squares regression procedures for continuous variables. Results of heterogeneity and moderator analyses are presented in Table 1.
The I2 values for the ADHD and emotional dysfunction outcomes indicated high heterogeneity for ERU, ERNL, EREG, and ECUT (79%, 99%,
79%, and 95%, respectively). Demographic moderators included average
age, gender (% male), ethnicity of sample (% Caucasian), and type of design (between subjects vs. within subjects). Co-morbid CP and cognitive
functioning were also examined as moderators.
5.2.1. Demographic moderators
As seen in Table 2, regression analyses indicated that age of sample
was significantly associated with the average strength of the relation between ADHD and ERNL (β = .81, p b .001). This indicates that the association between ADHD and ERNL was stronger among studies which had
a sample containing older youth with ADHD. Age did not have an effect
on the association between ADHD and ERU, EREG, or ECUT. The design of
studies reviewed was also a marginal predictor of the association between ADHD and ECUT (β = .41, p = .053) with between-subject studies (those comparing children with ADHD versus control/typically
developing) obtaining higher effect sizes compared to within subject
studies examining symptom severity of ADHD and outcomes. No other
significant demographic moderators were identified (e.g., percentage
of males within a sample, method of diagnosing ADHD).
5.2.2. Measurement moderators
In terms of how studies measure emotion dysregulation, regression
analyses using weighted least squares (accounting for sample size and
controlling for the previously identified significant demographic variables: age and design) revealed that studies that used parent/teacher/
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
Table 2
Moderation analyses: demographics (Model 1), conduct problems (Model 2), and cognitive control (Model 3).
Outcome
β
t-Value
Emotion recognition/understanding (ERU) (n = 21 studies)
Model 1: age
−.15
−.53
Percentage of males
.26
1.01
Design of study
.38
1.47
a
Model 2: conduct problems
−.38
−1.64
Model 3: cognitive controla
−.14
−.45
Model R2
F Change
.18
−
−
.30
.19
1.27
−
−
2.69
.206
Emotion reactivity/negativity/lability (ERNL) (n = 22 studies)
Model 1: age
.81⁎⁎⁎
5.76⁎⁎⁎
.67
Percentage of males
−.20
−1.34
−
Design of study
−.01
−.07
−
−.14
.11
.68
Model 2: conduct problemsa
−.37⁎
−2.24⁎
.75
Model 3: cognitive controla
11.32⁎⁎⁎
−
−
.626
5.02⁎
Emotion regulation (EREG) (n = 20 studies)
Model 1: age
.09
Percentage of males
−.10
Design of study
.40
Model 2: conduct problemsa
−.23
Model 3: cognitive controla
−.14
1.30
−
−
.984
.313
.40
−.48
1.74
−.99
−.56
.20
−
−
.25
.21
Empathy/callous–unemotional traits (ECUT) (n = 24 studies)
Model 1: age
.11
.49
.24
Percentage of males
−.30
−1.41
−
Design of study
.41+
2.07
−
Model 2: conduct problemsa
−.61⁎⁎
−3.14⁎⁎
.51
a
.34
1.42
.32
Model 3: cognitive control
2.02
−
−
9.88⁎⁎
2.00
Note. No multicollinearity issues were found across any of the moderation analyses.
a
Model 2 (conduct problems) and Model 3 (cognitive control) controlled for any
significant demographic variables found in Model 1.
+
p b .10.
⁎ p b .05.
⁎⁎ p b .01.
⁎⁎⁎ p b .001.
or self-reports (n = 13) reported a significantly higher effect size between ADHD and EREG F (3,16) = 5.79, β = .64, p b .01; d = .90) versus
those that used laboratory/observational/physiological regulation measures (n = 7), d = .38. Of interest, all studies that examined ADHD and
ERU utilized observational/laboratory assessments (n = 21). Thus, it remains unclear whether parents or teachers' report of ERU would yield
different results. On the other hand, studies that examined ADHD and
ECUT as well as ERNL relied almost exclusively on some combination
of parent and/or teacher reports (n = 20 and n = 19, respectively) versus laboratory/observational measures (n = 3 and n = 2, respectively)
preventing the examination of whether the effects differ depending on
the measure. Additionally, it is important to note that within the ERNL
113
domain, most studies (64%) conceptualized children's ERNL as a combination of both positive and negative emotions while 36% examined only
children's negative emotionality. Interestingly, no study solely examined youth's positive reactivity.
5.2.3. CP and cognitive functioning as moderators
To examine the influence of co-occurring CP, separate regression
using weighted least squares (accounting for sample size) was performed for each emotion dysregulation outcome (controlling for demographic variables). Co-varying CP had no effect on the strength of the
association between ADHD and EREG (β = −.23, p = .34), ERU
(β = −.38, p = .12), or ERNL (β = −.14, p = .44). However, covarying CP did have a significant effect on the strength of the association
between ADHD and ECUT (β = −.61, p = .006). As seen in Fig. 2, studies
that co-varied CP had weaker effect sizes between ADHD and ECUT
(d = .25) compared to studies that did not co-vary CP, (d = .84).
To determine whether accounting for youth's cognitive functioning
influenced the association between ADHD and emotion dysregulation
domains, separate regression using weighted least squares (accounting
for sample size) were performed for each emotion dysregulation outcome. As seen in Table 2, co-varying cognitive functioning had no effect
on the strength of the association between ADHD and EREG, ERU, or
ECUT. The null finding within the ERU domain may have been due to
the fact that only 3 studies within the ERU domain did not control for
cognitive functioning. However, co-varying cognitive functioning did
have a significant effect on the strength of the association between
ADHD and ERNL (β = −.37, p = .04). As seen in Fig. 3, studies that
co-varied cognitive functioning had weaker effect sizes between
ADHD and ERNL (d = .35) compared to studies that did not co-vary cognitive functioning, (d = .99).
5.3. File drawer analysis
According to Rosenthal (1995), if only a few studies with null results
are needed to change the significance level of a finding, then this finding
is susceptible to the “file drawer threat,” indicating that the finding is
not reliably significant. To account for the bias toward publishing or
submitting only significant findings, we conducted a weighted file
drawer analysis using Rosenberg (2005)'s fail safe number software.
This statistic examines the number of studies with null findings (assuming the addition of multiple studies; N +) that would need to exist to
bring the significant ESs of relations to less than p = .01. Results of
File Drawer analyses are provided in Table 1.
Fig. 2. Association between ADHD and emotion dysregulation domains moderated by conduct problems. Note. ** p b .01. CP = conduct problems, ERU = emotion recognition/
understanding, ERNL = emotion reactivity/negativity/lability, EREG = emotion regulation, ECUT = empathy/callous–unemotional traits.
114
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
Fig. 3. Association between ADHD and emotion dysregulation domains moderated by cognitive functioning. Note. * p b .05. ERU = emotion recognition/understanding, ERNL = emotion
reactivity/negativity/lability, EREG = emotion regulation, ECUT = empathy/callous–unemotional traits.
6. Discussion
Given emerging research suggesting that emotion dysregulation is a
core aspect of ADHD (Bunford et al., 2015; Martel, 2009; Shaw et al.,
2014), the current study sought to determine the extent to which
ADHD is associated with multiple facets of emotion dysregulation as
outlined in Gross (1998)’s emotion generation model. Central to determining the role of emotion dysregulation in ADHD was examining the
extent to which the presence of co-occurring CP as well as cognitive
functioning impact the proposed association between ADHD and emotion dysregulation. Our research questions were examined via a metaanalysis of 77 studies, the first to our knowledge that has focused on
ADHD and emotion dysregulation in children and adolescents. Additionally, understanding which aspects of emotion dysregulation are impaired in youth with ADHD holds significant clinical implications in
terms of informing both behavioral and pharmacological interventions.
Starting with the more basic process, impairment in emotion recognition/processing has long been conceptualized as a core feature of Autism Spectrum Disorder in children (Hall, Szechtman, & Nahmias, 2003;
Wong, Beidel, Sarver, & Sims, 2012). On the other hand, mixed evidence
exists to whether youth with ADHD also have difficulty with ERU
(Deschamps et al., 2014; Dyck et al., 2001), with some suggestions
that they may be due to co-occurring CP (Dodge, 1993), or more specifically attributed to deficits in cognitive functioning/understanding skills
(Blankson et al., 2013). Given the well-documented social deficits
among youth with ADHD (Bagwell, Molina, Pelham, & Hoza, 2001;
Barkley & Fischer, 2010), it was important to examine these mixed findings. Our meta-analysis documents a moderate effect size (d = .64)
showing that ERU is also compromised in youth with ADHD. This finding suggests that youth with ADHD, at a more basic level, have some difficulty encoding and processing emotional information. While the social
deficits documented in youth with ADHD are sometimes attributed to
co-occurring CP and/or difficulties controlling their emotions (Frankel
& Feinberg, 2002), they can also occur independently (Bunford et al.,
2015; McQuade & Hoza, 2008). Hence, there may be quite a bit more
to the story regarding the underlying reasons for why youth with
ADHD experience social impairment. The empirical data summarized
here appear to support the possibility that children with ADHD suffer
from basic ERU deficits, independent of co-occurring CP or cognitive
functioning, which may contribute to their difficulties in social interactions. More longitudinal work is needed examining ERU changes across
development for youth with ADHD and whether changes in such ERU
relates to changes in social functioning. It is also important to acknowledge the possibility that the ERU deficits found in the current study may
be at least part of a more general encoding and processing deficit. Therefore, more studies are needed comparing processing skills across both
emotional and non-emotional situations among youth with ADHD.
Perhaps the most complex dimension of emotion dysregulation
reviewed is emotion reactivity. Part of the complexity is the multiple
terms that are used across different disciplines (developmental psychology, neuropsychology, clinical psychology, psychiatry) ranging from
terms like emotionality, reactivity, lability, emotional impulsivity. Regardless of the term and slight differences in how one conceptualizes
an individual's strength of response to an emotional experience, there
is consensus that high emotional reactivity tend to be associated with
poor outcomes across domains (Campbell-Sills, Barlow, Brown, &
Hofmann, 2006; Shapero & Steinberg, 2013; Silk, Steinberg, & Morris,
2003). Our findings document a significant and strong link between
ADHD and emotional reactivity such that youth with ADHD are more
likely to experience intense negative and positive emotions and are reported as more reactive to stressful and/or frustrating situations (d =
.95). Perhaps just as noteworthy, is the fact that this association was
not moderated by co-occurring CP. On the other hand, individual differences in cognitive functioning did moderate the link between ADHD
and ERNL such that studies that controlled for cognitive functioning reported significantly lower effect sizes (more than half the magnitude)
compared to studies that did not control for cognitive functioning. Developmental research has provided convincing evidence showing that
cognitive and emotion control processes develop in parallel and provide
bidirectional/reciprocal effects on one another (Bell & Wolfe, 2004;
Blair, 2002; Bush et al., 2000; Carlson & Wang, 2007; Fox & Calkins,
2003; Sjöwall et al., 2013). Our finding further highlights the importance of understanding the heterogeneity of cognitive functioning
among youth with ADHD given its impact on the experience of
emotions.
It is also important to note that almost all studies relied exclusively
on parent/teacher or self-report. While it certainly appears that ERNL
has a significant and central role in the conceptualization of ADHD, it
will be crucial for future studies to examine objective/observational
measures of ERNL. Additionally, most studies reviewed conceptualized
youth's ERNL as a combination of both positive and negative emotions
with no study solely examining children's positive reactivity. Given
that reactivity to positive events can on their own contribute to
children's functioning (Catalino & Fredrickson, 2011), it will be important for future work within the ADHD child literature to examine differences in positive reactivity. Within the negative emotionality domain,
almost no studies compared the reactivity of different negative emotions (e.g., anger vs. sadness) which will be important to do given that
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
some theoretical work has focused on anger as the primary emotion involved in emotional impulsivity (Barkley & Fischer, 2010). Lastly, it is
important to note the high degree of overlap between emotional lability
and emotional reactivity measures. This is an important point as these
constructs are not synonymous as lability constitutes more of the back
and forth of the emotional reactivity process. Hence, more measurement work is needed to create an assessment and/or questionnaire
that can accurately differentiate emotional reactivity from lability. A
more precise differentiation of these constructs will allow us to determine whether youth with ADHD simply have strong emotional reactions that subside and/or if they actually have a more up and down
experience of emotions (i.e., lability).
Since Barkley's (1997) influential behavioral inhibition theory of
ADHD, deficits in EREG has been posited as a correlate of ADHD with
this correlate gaining more importance over the last decade (Barkley,
2010; Bunford, Evans & Wymbs, 2015; Shaw et al., 2014). Part of the increased interest in EREG in youth with ADHD is due to recent observations that such EREG difficulties contribute to significant impairments
for children with ADHD, above and beyond severity of symptoms
(Bunford et al., 2014; Sjöwall et al., 2013). However, similar to work
on executive functioning (EF) showing the heterogeneity of the disorder in that most youth with ADHD do not have significant impairments
in EF (Nigg, 2013), it was crucial to empirically examine the potential
link between deficits in the control or regulation aspect of emotion dysregulation and ADHD. Our meta-analysis found that indeed youth with
ADHD do have significant difficulties with EREG (d = .80) as observed
in the laboratory and/or reported by parents and teachers. Perhaps
just as important, this association was independent of co-occurring CP,
which was previously theorized as being the primary culprit for emotion dysregulation findings (Nigg, 2005).
It is important to note that the magnitude of the relation between
ADHD and EREG difficulties is larger than that of effect sizes of executive
dysfunction reported in the literature (Willcutt et al., 2005), and that
the magnitude of the link between ADHD and EREG did not vary as a
function of whether the study controlled for youth's cognitive functioning. Perhaps it is not too surprising that the level of EREG difficulties
found in youth with ADHD is similar in nature to that of EF difficulties.
From a physiological perspective there is a significant overlap in the
brain structures (e.g., ACC and orbitofrontal cortex) that facilitate the
regulation of both emotions and higher order cognitive processes
(Semrud-Clikeman et al., 2010). A recent meta-analysis has indeed
found a small association between a biological marker of emotion regulation (i.e., RSA withdrawal) and cognitive outcomes including EF
(Graziano & Derefinko, 2013), although that same study pointed to
the lack of studies linking biological markers of emotion regulation to
cognitive outcomes. To more accurately capture the heterogeneity of
ADHD, it will be important for future work to examine the link between
EF and emotion dysregulation across different levels analyses ranging
from biological markers to neural networks measured during cognitive,
emotion induction, and frustration tasks.
When examining the link between ADHD and empathy, it is important to acknowledge that recent research within clinical psychology has
focused on callous–unemotional (CU) traits as a proxy for referring to
low levels of guilt, empathy, and caring for others (Frick et al., 2013).
CU traits have mainly been examined within the context of CP as children displaying high levels of CU traits tend to experience more aggressive, pervasive, and disruptive behaviors across age groups (Enebrink,
Andershed, & Långström, 2005; Hawes & Dadds, 2005; Lynam, Miller,
Vachon, Loeber, & Stouthamer-Loeber, 2009). The results of our metaanalysis provides clear support that the association between ADHD status and ECUT is largely explained by co-occurring CP but was unaffected
by accounting for children's cognitive functioning. However, it is important to note that even after accounting for CP, a small association between ADHD and ECUT exists (d = .25). The mechanisms linking
ADHD and CU traits may differ from those of youth displaying more
severe CP. Specifically, given the aforementioned ERU deficits
115
documented in this paper, it is possible that youth with ADHD do not
engage in as many empathetic responses simply due to initially not recognizing the emotional state of others. On the other hand, youth with
severe CP may simply not care enough to engage in any empathetic responses. It will be important for future work to compare these subgroups of youth with disruptive behavior disorders across various
emotion dysregulation tasks to further understand the mechanisms
linking ADHD and CU traits.
Other moderation analyses indicated a significant association between youth age and ERNL (but not with any other emotion dysregulation outcome) with the magnitude of the association being stronger
with samples that included older children. This finding is consistent
with the developmental trajectories of mood disorders such that more
occurrences of lability (i.e., less stability) start to emerge in adolescence
and across young adulthood (Carstensen et al., 2011). However, given
that almost all studies we reviewed were cross-sectional in nature, we
cannot preclude the possibility that such ERNL may be at least partially
a consequence of the various functional impairments a child with ADHD
may suffer from early childhood to adolescence. For example, a constant
pattern of peer rejection and academic difficulties may influence a
child's stress reactivity system such that it creates an overload in
which future incidents may instigate a quicker emotional response
(Dodge et al., 2003). More longitudinal work, particularly measuring
ERNL in the toddlerhood and preschool period, is needed to determine
whether early signs of ERNL predict later ADHD status. It is also important to acknowledge that the link between age and ERNL may also be a
function of common method variance as almost all studies that we
reviewed that measured ERNL did so using rating scales which
implicitly make age based comparisons. Additionally, teachers tend to
judge youth's behavioral and social–emotional functioning relative to
their peers. Hence, high levels of ERNL may be viewed by raters as
more typical of younger children which would result in less of a reported difference when compared to young children with ADHD.
Of note, no other demographic factors including sex, moderated the
associations between ADHD and youth's emotion dysregulation factors.
The null finding as it relates to sex is noteworthy as a handful of studies
have suggested that boys may be more likely to have EREG difficulties
(Weinberg, Tronick, Cohn, & Olson, 1999), ERU (Kothari, Skuse,
Wakefield, & Micali, 2013), and ECUT (Essau, Sasagawa, & Frick, 2006)
while girls may have more instances of ERNL (Labouvie-Vief, Lumley,
Jain, & Heinze, 2003). Hence, despite higher rates of ADHD among
boys as well as in the diagnosis of Autism Spectrum Disorder (Jang
et al., 2013), which may influence ERU findings, the current metaanalysis found that the link between ADHD and emotion dysregulation
is similar in strength for boys and girls, alike.
In terms of limitations, it is important to acknowledge that almost all
studies we reviewed were cross-sectional in nature thus precluding us
from determining the directionality of the link between ADHD and
emotion dysregulation. For example, it is conceivable that the social difficulties and peer rejection experienced early in life among some children with ADHD would affect children's stress responses overtime and
perhaps contribute to greater levels of ERNL in adolescence. Within
the EREG domain and given the overlap in brain regions associated
with cognitive control and EREG, it is likely that EREG difficulties have
a bi-directional link with ADHD as self-regulation processes involved
in emotion, behavior, and attention develop rapidly in an intertwined
manner across the toddlerhood period, prior to any formal identification of ADHD (Cole et al., 2004). It will be important for future longitudinal studies to measure emotion dysregulation across domains in
toddlerhood and carefully track the development of ADHD symptoms
to more accurately model the bidirectional or developmental cascade
that may occur due to early difficulties with emotion dysregulation. It
is important to note that while the method of diagnosing youth's
ADHD was not a significant moderator in the analyses, a small percentage of included studies used non-evidence based methods such as relying solely on past medical records while one study relied primarily on
116
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
adolescent self-report to arrive at a diagnosis. We were also not able to
examine whether subtype of ADHD moderated any link between ADHD
status and emotion dysregulation as most studies did not examine these
subtypes separately or did not have enough children in certain subtypes. Of note, Bunford et al. (2014) reported that emotion dysregulation did not differ as a function of adolescents' ADHD subtype. On the
other hand, it is possible that the link between ADHD and emotion dysregulation is stronger for youth with the combined subtype presentation (indicative of both inattention and hyperactivity/impulsivity
difficulties) whereas youth with a predominantly inattentive type presentation (indicative of only attention problems) may have more subtle
emotion dysregulation impairments (Barkley, 2010; Wheeler Maedgen
& Carlson, 2000). Lastly, given that the current study's framework
sought to clarify the link between emotion dysregulation and ADHD
along with other associated externalizing problems (i.e., aggression,
ODD), comorbid affective disorders (i.e., anxiety and depression) were
excluded. However, it is important to acknowledge that affective disorders are marked by both EREG and ERNL difficulties and as such may be
implicated in the comorbidity with ADHD (see Meinzer, Pettit, &
Viswesvaran, 2014 for a review).
In summary, this study marks the first meta-analysis to examine the
role of emotion dysregulation across domains in youth with ADHD. We
found evidence to suggest that youth with ADHD display the strongest
deficits within the ERNL domain followed by EREG and ERU, and that
such deficits are independent of co-occurring CP. It is important to
note that youth's cognitive functioning only had a significant impact
on the link between ADHD and ERNL. Hence, it is possible that deficits
in cognitive/EF skills among youth with ADHD are more readily responsible for the initial experience and quick reactivity to emotional states
but may not affect the modulation or more effortful regulatory component that takes place after the emotional experience. From a clinical intervention perspective, perhaps it would be more fruitful if we can help
teach youth with ADHD to not only “calm down” (i.e., regulatory component) but also how to evaluate and more proactively think about
how to handle challenging situations prior to them initiating an emotional reaction.
Notably, the strength of the association between ADHD and ECUT
was moderated by co-occurring CP with a smaller yet significant independent association remaining after accounting for co-occurring CP.
Given the developmental trajectory of early ADHD and ODD toward
later CD (Biederman et al., 2008; Gresham et al., 2000; Van Lier, Der
Ende, Koot, & Verhulst, 2007), the current study points to the importance of remaining vigilant that youth with only ADHD may still display
CU traits. More work is needed examining whether the CU traits present
in young children with ADHD (in the absence of ODD) differ from those
with a more comorbid presentation (ADHD + ODD) and how CU traits
in the absence of CP impact children's developmental course. From a
theoretical perspective, our findings highlight the importance of conceptualizing ADHD not only as a disorder with deficits in top-down cognitive processes but also one that experiences emotional difficulties
from a bottoms-up perspective ranging from difficulty just recognizing
others' emotions to experiencing negative emotions intensely. When
combined with poor emotion regulation, it is evident how these
bottoms-up emotional processes can have significant implications for
engaging in appropriate social behaviors. It will be important for neuroscience research to examine the neural correlates and specific brain
regions involved in these emotion dysregulation processes among children with ADHD as this may aid in the early identification of children atrisk for emotion dysregulation. Lastly, while both stimulant medication
and behavioral parent training are considered evidence-based treatments for ADHD (Chronis, Jones, & Raggi, 2006; Pelham & Fabiano,
2008), they have both failed to successfully improve the social functioning of youth with ADHD (Evans, Langberg, Raggi, Allen, & Buvinger,
2005). It will be important for future clinical interventions, both
behaviorally and pharmacologically, to measure changes in youth's
emotion dysregulation across domains and if necessary develop
ancillary interventions that more directly targets emotion regulation
as well as emotion recognition/understanding as these emotional
processes may be key improving the social functioning of youth with
ADHD.
Role of funding sources
None.
Contributors
Paulo Graziano designed, analyzed, and wrote the study. Alexis
Garcia conducted literature searches and coded articles for analyses as
well as provided editorial comments on the manuscript. Both authors
contributed to and have approved the final version of the manuscript.
Conflict of interest
All authors declare that they have no conflict of interest.
Appendix A. Coded qualities and weighted effect sizes of studies of ADHD and children's emotion dysregulation outcomes.
Study
1
2
3
4
5
6
7
8
9
10
Anastopoulos et al.
(2011)
Aspan et al. (2014)
Babb, Levine, and
Arseneault (2010)
Banaschewski et al.
(2012)
Berlin, Bohlin, Nyberg,
and Janols (2004)
Blader et al. (2013)
Blaskey, Harris, and
Nigg (2008)
Boakes et al. (2007)
Braaten and Rosen
(2000)
Brammer and Lee
(2012)
Demographic variables
Emotion dysregulation factors
Effect
Size
(d)
N
Mean
age in
years
% of
sample
male
% of
sample
Caucasian
Design
(between vs.
within subject)
How was ADHD
diagnosed?
Controlled Controlled for
for CP?
cognitive
functioning?
Emotion
dysregulation
domain measured
8.70
61
N/A
Between
No
No
ERNL (P)
.95
358
14.70
9.56
100
63
N/A
64
Between
Between
No
Yes
Yes
Yes
ECUT (M)
EREG (O)
1.15
1.50
44
80
11.60
69
100
Between
No
Yes
ERNL (M)
1.85
988
8.35
100
N/A
Between
No
Yes
EREG (P)
1.46
63
9.31
10.06
79
67
69
80
Between
Between
Yes
Yes
No
Yes
ECUT (T)
ERU (O)
.49
.14
160
134
10.21
8.05
100
100
N/A
81
Between
Between
No
No
Yes
Yes
50
49
Between
No
Yes
ERU (O)
ERNL (P)
ECUT (O)
ECUT (P)
.63
1.22
1.07
1.22
48
43
7.40
Parent & teacher report,
diagnostic interview
Previous records
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Parent & teacher report
Parent & teacher report,
diagnostic interview
Parent report
Parent & teacher report,
diagnostic interview
Diagnostic report
106
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
117
Appendix
A (continued)
(continued)
Study
Demographic variables
Emotion dysregulation factors
Mean
age in
years
% of
sample
male
% of
sample
Caucasian
Design
(between vs.
within subject)
How was ADHD
diagnosed?
Controlled Controlled for
for CP?
cognitive
functioning?
Emotion
dysregulation
domain measured
13.80
7.79
62
54
N/A
N/A
Between
Within
Diagnostic interview
Parent report
No
Yes
Yes
Yes
ERU (O)
EREG (B)
.10
.24
55
63
13.5
76
77
Within
Yes
Yes
EREG (S)
.30
180
9.23
77
N/A
Between
Yes
Yes
ERU (O)
.65
200
8.75
80
67
Between
Parent & teacher report,
diagnostic interview
Parent & teacher
interviews
Previous records
Yes
No
ERNL (P)
ECUT (O)
1.28
.43
238
10.16
9.79
83
64
N/A
N/A
Between
Between
Previous records
Parent report
No
No
No
Yes
ERNL (S)
ERU (O)
.39
1.19
70
74
8.47
100
78
Within
No
No
ERNL (P)
.95
32
14.49
47
98
Between
Yes
No
ERNL (S)
2.49
2876
20
Cukrowicz, Taylor,
Schatschneider, and
Iacono (2006)
Dadds et al. (2012)
Parent & teacher report,
diagnostic interview
Diagnostic interview
10.52
76
N/A
Within
Yes
No
Da Fonseca et al. (2009)
10.17
78
100
Between
No
Yes
ERU (O)
ECUT (M)
ERU (O)
.06
−.02
.77
195
21
22
Demurie, De Corel, and
Roeyers (2011)
13.97
86
N/A
Between
Yes
Yes
ECUT (O)
.41
44
23
Deschamps et al. (2014)
7.00
61
N/A
Between
No
Yes
ERU (O)
ECUT (M)
.08
.65
131
24
De Pauw and Mervielde
(2011)
10.40
83
100
Between
No
No
ERNL (P)
1.04
519
25
9.60
Dittmann,
Banaschewski, Schacht,
and Wehmeier (2014)
Downs and Smith (2004)
8.30
Dyck et al. (2001)
12.09
Factor, Reyes, and
9.83
Rosen (2014)
Falk and Lee (2012)
7.4
73
N/A
Within
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Previously diagnosed,
confirmation with
parent report
Previously diagnosed,
confirmation with
parent report
Previously diagnosed,
confirmation with
parent report
Previous records
No
Yes
ERNL (P)
.18
504
100
74
64
N/A
N/A
61
Between
Between
Between
Previous records
Previous records
Diagnostic interview
Yes
No
Yes
Yes
Yes
No
ERU (O)
ERU (O)
ERNL (P)
1.22
1.09
.02
36
71
64
71
56
Between
No
No
ECUT (P)
.39
208
Yes
No
ECUT (S)
.22
156
Yes
No
No
Yes
ECUT (M)
ERNL (P)
.41
1.28
98
80
11
12
13
14
15
16
17
18
19
26
27
28
29
Brotman et al. (2010)
Bubier and Drabick
(2008)
Bunford et al. (2014)
Cadesky, Mota, and
Schachar (2000)
Cordier, Bundy,
Hocking, and Einfeld
(2010)
Carroll et al. (2006)
Corbett and Glidden
(2000)
Crundwell (2005)
Effect
Size
(d)
N
54
30* Fowler et al. (2009)
14.50
91
N/A
Within
31
32
12.36
10.75
52
78
N/A
71
Between
Within
9.10
66
N/A
Between
Previous records
No
Yes
ERU (O)
.98
64
34
Frick et al. (2003)
Graziano, McNamara,
Geffken, and Reid
(2011)
Greenbaum, Stevens,
Nash, Koren, and Rovet
(2009)
Haas et al. (2014)
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Parent report
Parent report
9.72
76
82
Between
No
Yes
ECUT (P)
1.91
72
35
Haas et al. (2015)
9.7
76
82
Between
No
Yes
ECUT (P)(T)
3.1
72
36
15.10
54
2
Between
No
No
ECUT (P)
.52
168
11.80
69
78
Between
No
Yes
EREG (P)
1.12
68
38
39
Hogue, Dauber, Lichvar,
and Spiewak (2012)
Jarratt, Riccio, and
Siekierski (2005)
Jensen and Rosen (2004)
Katic et al. (2013)
9.25
9.10
75
71
75
71
Between
Within
No
No
No
Yes
ERNL (P)
EREG (P)
.93
.68
67
316
40
Kolko and Pardini (2010)
8.80
85
45
Within
No
No
ECUT (T)
.26
177
41
Linder, Kroyzer, Maeir,
Wertman-Elad, and
Pollak (2010)
Ludlow, Garrood,
Lawrence, and Gutierrez
(2014)
Martel and Nigg (2006)
12.50
59
N/A
Between
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Parent report, diagnostic
interview
Parent & teacher report,
diagnostic interview
Previous records
Previously diagnosed,
confirmation with
parent report
Parent & teacher report,
diagnostic interview
Informal interview
based on DSM-IV
No
No
EREG (P)
1.09
158
13.86
81
N/A
Between
Parent report
No
Yes
ERU (O)
.77
48
9.45
63
72
Between
Parent & teacher report,
diagnostic interview
No
Yes
ERNL (P)
1.32
179
33
37
42
43
(continued on next page)
118
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
Appendix
A (continued)
(continued)
Study
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
74
75
76
77
Emotion dysregulation factors
% of
sample
male
% of
sample
Caucasian
Design
(between vs.
within subject)
How was ADHD
diagnosed?
Controlled Controlled for
for CP?
cognitive
functioning?
Emotion
dysregulation
domain measured
Effect
Size
(d)
N
12.46
61
75
Between
No
No
ERNL (P)
1.04
363
10.14
100
N/A
Between
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Yes
Yes
ECUT (P)
.12
92
8.24
70
94
Between
Parent & teacher report
No
No
EREG (P)(T)
.65
70
7.86
N/A
55
Between
Yes
Yes
ECUT (M)
.70
221
13.42
58
54
Within
Parent & teacher report,
diagnostic interview
Diagnostic interview
No
No
ECUT (P)
.56
754
9.11
100
55
Between
Yes
Yes
47
67.84
Between
No
Yes
EREG (O)
ERNL (O)
EREG (B)
.52
.22
.47
79
8.02
66
Musser, Galloway-Long,
7.60
Frick, and Nigg (2013)
Norvilitis, Casey,
10.27
Brooklier, and Bonello
(2000)
Pardini and Fite (2010) 10.70
Pelc, Kornreich, Foisy,
8.1
and Dan (2006)
Posner et al. (2011)
13.45
57
88
Between
Yes
Yes
EREG (B)
.16
150
64
69
Between
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Previous records
No
Yes
ERU (O)
.48
80
100
77
44.8
N/A
Within
Between
Diagnostic interview
Previous records
Yes
No
No
No
ECUT (P)
ERU (O)
.12
1.25
1517
60
N/A
N/A
Between
No
Yes
ERNL (O)
.98
30
9.29
9.65
70
58
59
87
Within
Between
Parent ratings,
diagnostic interview
Diagnostic interview
Previous records
No
No
No
Yes
60
78
Between
No
No
96
11.66
57
54
Between
No
Yes
EREG (M)
.82
69
11.00
56
49
Within
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Parent report
.80
.82
.49
1.12
27
64
10.25
EREG (P)
EREG (S)
ERNL (S)
EREG (P)
No
No
ERNL (P)
1.58
277
8.6
12.75
68
85
32
N/A
Within
Between
Previous records
Diagnostic interview
No
No
No
Yes
ERU (O)
ERU (O)
.58
.45
50
59
10
45
N/A
Between
Yes
Yes
65
N/A
Between
Yes
Yes
EREG (P)
ERU (O)
EREG (P)
1.35
.52
.70
204
5.6
104
10.6
65
N/A
Between
Yes
Yes
ERNL (P)
.10
3013
13.60
52
N/A
Between
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Parent & teacher report,
diagnostic interview
Diagnostic interview
No
No
ERNL (M)
1.15
4911
3.17
51
N/A
Between
No
ERNL (P)
.12
7140
9.66
78
85
Between
Parent report, diagnostic Yes
interview
Parent & teacher report, Yes
diagnostic interview
Yes
ERU (O)
ECUT (M)
−.04
.45
183
9.17
100
94
Between
Parent report
No
No
EREG (O)
.80
49
6.67
3.45
45
51
N/A
86
Between
Within
Parent & teacher report
Parent & teacher report
No
Yes
Yes
Yes
52
50
N/A
N/A
Within
Within
Parent & teacher report
Teacher report
Yes
No
No
No
1.12
.24
.43
.08
1.67
87
240
Waschbusch et al., (2004)
8.13
Waschbusch and
8.38
Willoughby (2008)
8.14
Waschbusch, Graziano,
Willoughby, and
Pelham (2014)
Wheeler Maedgen and
10.2
Carlson (2000)
Williams et al. (2008)
13.44
Yuill and Lyon (2007)
8.92
EREG (P)
ERU (O)
ECUT (P)
ECUT (P)(T)
ECUT (T)
1579
214
54
N/A
Within
Teacher Report
Yes
No
ECUT (T)
.58
648
70
79
Between
No
Yes
N/A
N/A
Between
Between
No
No
Yes
Yes
EREG (O)
ERNL (O)
ERU (O)
ERU (O)
.63
.63
.63
1.91
47
100
100
Parent & teacher report,
diagnostic interview
Parent report
Previous records
Martel, Nigg, and Von
Eye (2009)
Marton, Wiener,
Rogers, Moore, and
Tannock (2009)
McCandless and
O'Laughlin (2007)
McKenzie and Lee
(2014)
McMahon, Witkiewitz,
and Kotler (2010)
Melnick and Hinshaw
(2000)
Musser et al. (2011)
Rosen and Factor (2012)
Scime and Norvilitis
(2006)
Semrud-Clikeman et al.
(2010)
Seymour et al. (2012)
Seymour,
Chronis-Tuscano,
Iwamoto, Kurdziel, and
MacPherson (2014)
Singh et al. (1998)
Sinzig, Morsch, and
Lehmkuhl (2008)
Sjöwall et al. (2013)
Sjöwall, Backman, &
Thorell (2015)
Sobanski et al. (2010)
Stringaris and
Goodman (2009)
67 Stringaris, Maughan,
and Goodman (2010)
68* a) Haas et al. (2011)
b) Woodworth and
Waschbusch (2008)
c) Waschbusch, Carrey,
et al. (2007)
d) Waschbusch, Craig,
et al. (2007)
69 Walcott and Landau
(2004)
70 Wåhlstedt et al. (2008)
71 Waller et al. (2014)
72
73
Demographic variables
Mean
age in
years
102
38
Note. *One effect size derived from multiple studies using overlapping sample, N/A = not available in article, (P) = parent report, (T) = teacher report, (S) = self-report, (M) = multiple
reporters combined, (0) = observational, (B) = biological marker of emotion regulation: RSA withdrawal during a challenging task.
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
References
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies
across psychopathology: A meta-analytic review. Clinical Psychology Review, 30(2),
217–237.
Amador-Campos, J. A., Gómez-Benito, J., & Ramos-Quiroga, J. A. (2014). The Conners'
Adult ADHD Rating Scales—Short self-report and observer forms: Psychometric properties of the Catalan version. Journal of Attention Disorders, 18(8), 671–679.
Anastopoulos, A. D., Smith, T. F., Garrett, M. E., Morrissey-Kane, E., Schatz, N. K., Sommer, J.
L., ... Ashley-Koch, A. (2011). Self-regulation of emotion, functional impairment, and
comorbidity among children with AD/HD. Journal of Attention Disorders, 15(7),
583–592.
Anderson, P. (2002). Assessment and development of executive function (EF) during
childhood. Child Neuropsychology, 8(2), 71–82.
Aspan, N., Bozsik, C., Gadoros, J., Nagy, P., Inantsy-Pap, J., Vida, P., & Halasz, J. (2014). Emotion recognition pattern in adolescent boys with attention-deficit/hyperactivity disorder. BioMed Research International, 2014.
Babb, K. A., Levine, L. J., & Arseneault, J. M. (2010). Shifting gears: Coping flexibility in children with and without ADHD. International Journal of Behavioral Development, 34(1),
10–23.
Bagwell, C. L., Molina, B. S. G., Pelham, W. E., & Hoza, B. (2001). Attention-deficit hyperactivity disorder and problems in peer relations: Predictions from childhood to adolescence. Journal of the American Academy of Child and Adolescent Psychiatry, 40(11),
1285–1292.
Banaschewski, T., Jennen‐Steinmetz, C., Brandeis, D., Buitelaar, J. K., Kuntsi, J., Poustka, L., ...
Asherson, P. (2012). Neuropsychological correlates of emotional lability in children
with ADHD. Journal of Child Psychology and Psychiatry, 53(11), 1139–1148.
Barkley, R. A. (1997). Behavioral inhibition, sustained attention, and executive functions:
Constructing a unifying theory of ADHD. Psychological Bulletin, 121(1), 65.
Barkley, R. A. (2010). Deficient emotional self-regulation: A core component of attentiondeficit/hyperactivity disorder. Journal of ADHD & Related Disorders, 1(2), 5–37.
Barkley, R. A., & Fischer, M. (2010). The unique contribution of emotional impulsiveness
to impairment in major life activities in hyperactive children as adults. Journal of
the American Academy of Child and Adolescent Psychiatry, 49(5), 503–513.
Bell, M. A., & Wolfe, C. D. (2004). Emotion and cognition: An intricately bound developmental process. Child Development, 75(2), 366–370.
Berlin, L., Bohlin, G., Nyberg, L., & Janols, L. (2004). OHow well do measures of inhibition
and other executive functions discriminate between children with ADHD and controls? Child Neuropsychology, 10(1), 1–13.
Biederman, J., Petty, C. R., Dolan, C., Hughes, S., Mick, E., Monuteaux, M. C., & Faraone, S. V.
(2008). The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: Findings from a controlled 10-year prospective longitudinal follow-up study. Psychological Medicine, 38(07), 1027–1036.
Blader, J. C., Pliszka, S. R., Kafantaris, V., Foley, C. A., Crowell, J. A., Carlson, G. A., ... Daviss,
W. B. (2013). Callous–unemotional traits, proactive aggression, and treatment outcomes of aggressive children with attention-deficit/hyperactivity disorder. Journal
of the American Academy of Child and Adolescent Psychiatry, 52(12), 1281–1293.
Blair, C. (2002). School readiness: Integrating cognition and emotion in a neurobiological
conceptualization of children's functioning at school entry. American Psychologist,
57(2), 111.
Blair, C., & Razza, R. P. (2007). Relating effortful control, executive function, and false belief understanding to emerging math and literacy ability in kindergarten. Child
Development, 78(2), 647–663.
Blair, K. A., Denham, S. A., Kochanoff, A., & Whipple, B. (2004). Playing it cool: Temperament, emotion regulation, and social behavior in preschoolers. Journal of School
Psychology, 42(6), 419–443.
Blankson, A. N., O'Brien, M., Leerkes, E. M., Marcovitch, S., Calkins, S. D., & Weaver, J. M.
(2013). Developmental dynamics of emotion and cognition processes in preschoolers. Child Development, 84(1), 346–360.
Blaskey, L. G., Harris, L. J., & Nigg, J. T. (2008). Are sensation seeking and emotion processing related to or distinct from cognitive control in children with ADHD? Child
Neuropsychology, 14(4), 353–371.
Boakes, J., Chapman, E., Houghton, S., & West, J. (2007). Facial affect interpretation in boys
with attention deficit/hyperactivity disorder. Child Neuropsychology: A Journal on Normal and Abnormal Development in Childhood and Adolescence, 14(1), 82–96.
Borod, J. C. (1992). Interhemispheric and intrahemispheric control of emotion: a focus on
unilateral brain damage. Journal of Consulting and Clinical Psychology, 60(3), 339.
Braaten, E. B., & Rosen, L. A. (2000). Self-regulation of affect in attention deficithyperactivity disorder (ADHD) and non-ADHD boys: Differences in empathic
responding. Journal of Consulting and Clinical Psychology, 68(2), 313.
Brammer, W. A., & Lee, S. S. (2012). Impairment in children with and without ADHD contributions from oppositional defiant disorder and callous–unemotional traits. Journal
of Attention Disorders, 16(7), 535–543.
Brotman, M. A., Rich, B. A., Guyer, A. E., Lunsford, J. R., Horsey, S. E., Reising, M. M., ...
Leibenluft, E. (2010). Amygdala activation during emotion processing of neutral
faces in children with severe mood dysregulation versus ADHD or bipolar disorder.
American Journal of Psychiatry, 167(1), 61–69.
Brown, K. W., Ryan, R. M., & Creswell, J. D. (2007). Mindfulness: Theoretical foundations
and evidence for its salutary effects. Psychological Inquiry, 18(4), 211–237.
Bubier, J. L., & Drabick, D. A. (2008). Affective decision-making and externalizing behaviors:
The role of autonomic activity. Journal of Abnormal Child Psychology, 36(6), 941–953.
Bunford, N., Evans, S. W., & Langberg, J. M. (2014). Emotion dysregulation is associated
with social impairment among young adolescents with ADHD. Journal of Attention
Disorders (1087054714527793).
Bunford, N., Evans, S. W., & Wymbs, F. (2015a). ADHD and emotion dysregulation among
children and adolescents. Clinical Child and Family Psychology Review, 18(3), 185–217.
119
Bunford, N., Brandt, N. E., Golden, C., Dykstra, J. B., Suhr, J. A., & Owens, J. S. (2015b).
Attention-deficit/hyperactivity disorder symptoms mediate the association between
deficits in executive functioning and social impairment in children. Journal of
Abnormal Child Psychology, 43(1), 133–147.
Bush, G., Luu, P., & Posner, M. I. (2000). Cognitive and emotional influences in anterior
cingulate cortex. Trends in Cognitive Sciences, 4(6), 215–222.
Cadesky, E. B., Mota, V. L., & Schachar, R. J. (2000). Beyond words: How do children with
ADHD and/or conduct problems process nonverbal information about affect? Journal
of the American Academy of Child and Adolescent Psychiatry, 39(9), 1160–1167.
Calkins, S. D. (2007). The emergence of self-regulation: Biological and behavioral control
mechanisms supporting toddler competencies. Socioemotional development in the
toddler years: Transitions and transformations (pp. 261–284).
Campbell, S. B., Shaw, D. S., & Gilliom, M. (2000). Early externalizing behavior problems:
Toddlers and preschoolers at risk for later maladjustment. Development and
Psychopathology, 12(03), 467–488.
Campbell-Sills, L., & Barlow, D. H. (2007). Incorporating emotion regulation into conceptualizations and treatments of anxiety and mood disorders.
Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Acceptability and
suppression of negative emotion in anxiety and mood disorders. Emotion, 6(4),
587–595.
Carlson, S. M., & Wang, T. S. (2007). Inhibitory control and emotion regulation in preschool children. Cognitive Development, 22(4), 489–510.
Carroll, A., Houghton, S., Taylor, M., Hemingway, F., List‐Kerz, M., Cordin, R., & Douglas, G.
(2006). Responding to interpersonal and physically provoking situations in classrooms: Emotional intensity in children with attention deficit hyperactivity disorder.
International Journal of Disability, Development and Education, 53(2), 209–227.
Carstensen, L. L., Turan, B., Scheibe, S., Ram, N., Ersner-Hershfield, H., Samanez-Larkin, G.
R., ... Nesselroade, J. R. (2011). Emotional experience improves with age: Evidence
based on over 10 years of experience sampling. Psychology and Aging, 26(1), 21–33.
Catalino, L. I., & Fredrickson, B. L. (2011). A Tuesday in the life of a flourisher: The role of
positive emotional reactivity in optimal mental health. Emotion, 11(4), 938–950.
Charbonneau, A., Mezulis, A., & Hyde, J. (2009). Stress and emotional reactivity as explanations for gender differences in adolescents' depressive symptoms. Journal of Youth
and Adolescence, 38(8), 1050–1058.
Chronis, A. M., Jones, H. A., & Raggi, V. L. (2006). Evidence-based psychosocial treatments
for children and adolescents with attention-deficit/hyperactivity disorder. Clinical
Psychology Review, 26(4), 486–502.
Classi, P., Milton, D., Ward, S., Sarsour, K., & Johnston, J. (2012). Social and emotional difficulties in children with ADHD and the impact on school attendance and healthcare
utilization. Child and Adolescent Psychiatry and Mental Health, 6.
Cochran, W. G. (1954). Some methods for strengthening the common χ2 tests. Biometrics,
10, 417–451.
Cole, P. M., Michel, M. K., & Teti, L. O. (1994). The development of emotion regulation and
dysregulation: A clinical perspective. Monographs of the Society for Research in Child
Development, 59(2–3), 73–102.
Cole, P. M., Zahn-Waxler, C., Fox, N. A., Usher, B. A., & Welsh, J. D. (1996). Individual differences in emotion regulation and behavior problems in preschool children.
Journal of Abnormal Psychology, 105(4), 518.
Cole, P. M., Teti, L. O., & Zahn-Waxler, C. (2003). Mutual emotion regulation and the stability of conduct problems between preschool and early school age. Development and
Psychopathology, 15(01), 1–18.
Cole, P. M., Martin, S. E., & Dennis, T. A. (2004). Emotion regulation as a scientific construct:
Methodological challenges and directions for child development research.
Conners, C. K., Sitarenios, G., Parker, J. D., & Epstein, J. N. (1998a). The revised Conners'
Parent Rating Scale (CPRSR): Factor structure, reliability, and criterion validity.
Journal of Abnormal Child Psychology, 26(4), 257–268.
Conners, C. K., Sitarenios, G., Parker, J. D., & Epstein, J. N. (1998b). Revision and
restandardization of the Conners Teacher Rating Scale (CTRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26(4), 279–291.
Corbett, B., & Glidden, H. (2000). Processing affective stimuli in children with attentiondeficit hyperactivity disorder. Child Neuropsychology, 6(2), 144–155.
Cordier, R., Bundy, A., Hocking, C., & Einfeld, S. (2010). Empathy in the play of children
with attention deficit hyperactivity disorder. OTJR: Occupation, Participation and
Health, 30, 122–132.
Cortese, S. (2012). The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): What every clinician should know. European Journal of Paediatric Neurology, 16(5), 422–433.
Crundwell, R. M. A. (2005). An initial investigation of the impact of self-regulation and
emotionality on behavior problems in children with ADHD. Canadian Journal of
School Psychology, 20(1–2), 62–74.
Cukrowicz, K. C., Taylor, J., Schatschneider, C., & Iacono, W. G. (2006). Personality differences in children and adolescents with attention‐deficit/hyperactivity disorder, conduct disorder, and controls. Journal of Child Psychology and Psychiatry, 47(2), 151–159.
Cutting, A. L., & Dunn, J. (1999). Theory of mind, emotion understanding, language, and
family background: Individual differences and interrelations. Child Development,
853–865.
Da Fonseca, D., Seguier, V., Santos, A., Poinso, F., & Deruelle, C. (2009). Emotion understanding in children with ADHD. Child Psychiatry and Human Development, 40(1),
111–121.
Dadds, M. R., Cauchi, A. J., Wimalaweera, S., Hawes, D. J., & Brennan, J. (2012). Outcomes,
moderators, and mediators of empathic-emotion recognition training for complex
conduct problems in childhood. Psychiatry Research, 199(3), 201–207.
Dawel, A., O'Kearney, R., McKone, E., & Palermo, R. (2012). Not just fear and sadness:
Meta-analytic evidence of pervasive emotion recognition deficits for facial and
vocal expressions in psychopathy. Neuroscience & Biobehavioral Reviews, 36(10),
2288–2304.
120
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
De Pauw, S. S., & Mervielde, I. (2011). The role of temperament and personality in problem behaviors of children with ADHD. Journal of Abnormal Child Psychology, 39(2),
277–291.
Demurie, E., De Corel, M., & Roeyers, H. (2011). Empathic accuracy in adolescents with autism spectrum disorders and adolescents with attention-deficit/hyperactivity disorder. Research in Autism Spectrum Disorders, 5(1), 126–134.
Denham, S. A. (1986). Social cognition, prosocial behavior, and emotion in preschoolers:
Contextual validation. Child Development, 194–201.
Denham, S. A. (1998). Emotional development in young children. Guilford Press.
Denham, S. A., Zoller, D., & Couchoud, E. A. (1994). Socialization of preschoolers' emotion
understanding. Developmental Psychology, 30(6), 928.
Denham, S. A., Bassett, H. H., Zinsser, K., & Wyatt, T. M. (2014). How preschoolers' social–
emotional learning predicts their early school success: Developing theory‐promoting,
competency‐based assessments. Infant and Child Development, 23(4), 426–454.
Deschamps, P. K. H., Schutter, D. J. L. G., Kenemans, J. L., & Matthys, W. (2014). Empathy
and prosocial behavior in response to sadness and distress in 6-to 7-year olds diagnosed with disruptive behavior disorder and attention-deficit hyperactivity disorder.
European Child & Adolescent Psychiatry, 1–9.
Deveney, C. M., Connolly, M. E., Haring, C. T., Bones, B. L., Reynolds, R. C., Kim, P., ...
Leibenluft, E. (2013). Neural mechanisms of frustration in chronically irritable children. American Journal of Psychiatry, 170(10), 1186–1194.
Dickstein, S. G., Bannon, K., Castellanos, X. F., & Milham, M. P. (2006). The neural correlates of attention deficit hyperactivity disorder: An ALE meta‐analysis. Journal of
Child Psychology and Psychiatry, 47(10), 1051–1062.
Dittmann, R. W., Banaschewski, T., Schacht, A., & Wehmeier, P. M. (2014). Findings from
the observational COMPLY study in children and adolescents with ADHD: Core symptoms, ADHD-related difficulties, and patients' emotional expression during
psychostimulant or nonstimulant ADHD treatment. ADHD Attention Deficit and
Hyperactivity Disorders, 1–12.
Dodge, K. A. (1993). Social–cognitive mechanisms in the development of conduct disorder and depression. Annual Review of Psychology, 44(1), 559–584.
Dodge, K. A., Lansford, J. E., Burks, V. S., Bates, J. E., Pettit, G. S., Fontaine, R., & Price, J. M.
(2003). Peer rejection and social information-processing factors in the development
of aggressive behavior problems in children. Child Development, 74(2), 374–393.
Downs, A., & Smith, T. (2004). Emotional understanding, cooperation, and social behavior
in high-functioning children with autism. Journal of Autism and Developmental
Disorders, 34(6), 625–635.
DSM-5 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington: American Psychiatric Publishing.
DuPaul, G. J., & Eckert, T. L. (1997). The effects of school-based interventions for Attention
Deficit Hyperactivity Disorder: A meta-analysis. School Psychology Review.
Dyck, M. J., Ferguson, K., & Shochet, I. M. (2001). Do autism spectrum disorders differ from
each other and from non-spectrum disorders on emotion recognition tests? European
Child & Adolescent Psychiatry, 10(2), 105–116.
Eisenberg, N., & Miller, P. A. (1987). The relation of empathy to prosocial and related behaviors. Psychological Bulletin, 101(1), 91.
Eisenberg, N., Guthrie, I. K., Fabes, R. A., Shepard, S., Losoya, S., Murphy, B., ... Reiser, M.
(2000). Prediction of elementary school children's externalizing problem behaviors
from attentional and behavioral regulation and negative emotionality. Child
Development, 71(5), 1367–1382.
Ekman, P., & Friesen, W. V. (1976). Pictures of facial affect. Palo Alto, CA: Consulting Psychologists Press.
Enebrink, P., Andershed, H., & Långström, N. (2005). Callousunemotional traits are associated with clinical severity in referred boys with conduct problems. Nordic Journal of
Psychiatry, 59, 431–440.
Essau, C. A., Sasagawa, S., & Frick, P. J. (2006). Callous–unemotional traits in a community
sample of adolescents. Assessment, 13(4), 454–469.
Etcoff, N. L. (1986). The neuropsychology of emotional expression. Springer.
Evans, S. W., Langberg, J., Raggi, V., Allen, J., & Buvinger, E. C. (2005). Development of a
school-based treatment program for middle school youth with ADHD. Journal of
Attention Disorders, 9(1), 343–353.
Factor, P. I., Rosen, P. J., & Reyes, R. A. (2013). The relation of poor emotional awareness
and externalizing behavior among children with ADHD. Journal of Attention Disorders.
Factor, P. I., Reyes, R. A., & Rosen, P. J. (2014). Emotional impulsivity in children with
ADHD associated with comorbid – not ADHD – symptomatology. Journal of
Psychopathology and Behavioral Assessment, 1–12.
Falk, A. E., & Lee, S. S. (2012). Parenting behavior and conduct problems in children with
and without Attention-Deficit/Hyperactivity Disorder (ADHD): Moderation by callous–unemotional traits. Journal of Psychopathology and Behavioral Assessment,
34(2), 172–181.
Faraone, S. V., Biederman, J., & Mick, E. (2006). The age-dependent decline of attention
deficit hyperactivity disorder: A meta-analysis of follow-up studies. Psychological
Medicine, 36(02), 159–165.
Finger, E. C., Marsh, A. A., Mitchell, D. G., Reid, M. E., Sims, C., Budhani, S., ... Blair, J. R.
(2008). Abnormal ventromedial prefrontal cortex function in children with psychopathic traits during reversal learning. Archives of General Psychiatry, 65(5), 586–594.
Fowler, T., Langley, K., Rice, F., Whittinger, N., Ross, K., van Goozen, S., & Thapar, A. (2009).
Psychopathy traits in adolescents with childhood attention-deficit hyperactivity disorder. The British Journal of Psychiatry, 194(1), 62–67.
Fox, N. A. (1989). Psychophysiological correlates of emotional reactivity during the first
year of life. Developmental Psychology, 25(3), 364.
Fox, N. A., & Calkins, S. D. (2003). The development of self-control of emotion: Intrinsic
and extrinsic influences. Motivation and Emotion, 27(1), 7–26.
Frankel, F., & Feinberg, D. (2002). Social problems associated with ADHD vs. ODD in children referred for friendship problems. Child Psychiatry and Human Development,
33(2), 125–146.
Frazier, T. W., Demaree, H. A., & Youngstrom, E. A. (2004). Meta-analysis of intellectual
and neuropsychological test performance in attention-deficit/hyperactivity disorder.
Neuropsychology, 18(3), 543.
Frick, P. J. (2003). The inventory of callous–unemotional traits. Unpublished rating scale,
University of New Orleans.
Frick, P. J., & Hare, R. D. (2001). Antisocial processes screening device: Technical manual.
Toronto: Multi-Health Systems.
Frick, P. J., & Morris, A. S. (2004). Temperament and developmental pathways to conduct
problems. Journal of Clinical Child & Adolescent Psychology, 33(1), 54–68.
Frick, P., Cornell, A., Barry, C., Bodin, S. D., & Dane, H. (2003). Callous–unemotional traits
and conduct problems in the prediction of conduct problem severity, aggression,
and self-report of delinquency. Journal of Abnormal Child Psychology, 31(4), 457–470.
Frick, P. J., Ray, J. V., Thornton, L. C., & Kahn, R. E. (2013). Can callous–unemotional traits
enhance the understanding, diagnosis, and treatment of serious conduct problems in children and adolescents? A comprehensive review.
Garandeau, C. F., & Cillessen, A. H. (2006). From indirect aggression to invisible aggression: A conceptual view on bullying and peer group manipulation. Aggression and
Violent Behavior, 11(6), 612–625.
Gaub, M., & Carlson, C. L. (1997). Gender differences in ADHD: A meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 36(8),
1036–1045.
Gini, G., Albiero, P., Benelli, B., & Altoè, G. (2007). Does empathy predict adolescents' bullying and defending behavior? Aggressive Behavior, 33(5), 467–476.
Gioia, G. A., Isquith, P. K., Guy, K., & Kenworthy, L. (2000). Behavior rating inventory of executive function. Lutz, FL: Psychological Assessment Resources, Inc.
Gizer, I. R., Ficks, C., & Waldman, I. D. (2009). Candidate gene studies of ADHD: A metaanalytic review. Human Genetics, 126(1), 51–90.
Graziano, P., & Derefinko, K. (2013). Cardiac vagal control and children's adaptive functioning: A meta-analysis. Biological Psychology, 94(1), 22–37.
Graziano, P. A., Reavis, R. D., Keane, S. P., & Calkins, S. D. (2007). The role of emotion regulation in children's early academic success. Journal of School Psychology, 45(1), 3–19.
Graziano, P. A., McNamara, J. P., Geffken, G. R., & Reid, A. (2011). Severity of children's
ADHD symptoms and parenting stress: A multiple mediation model of selfregulation. Journal of Abnormal Child Psychology, 39(7), 1073–1083.
Greenbaum, R. L., Stevens, S. A., Nash, K., Koren, G., & Rovet, J. (2009). Social cognitive and
emotion processing abilities of children with fetal alcohol spectrum disorders: A
comparison with attention deficit hyperactivity disorder. Alcoholism: Clinical and
Experimental Research, 33(10), 1656–1670.
Gresham, F. M., Lane, K. L., & Lambros, K. M. (2000). Comorbidity of conduct problems and
ADHD identification of “fledgling psychopaths”. Journal of Emotional and Behavioral
Disorders, 8(2), 83–93.
Gross, J. J. (1998). The emerging field of emotion regulation: An integrative review.
Review of General Psychology, 2(3), 271.
Gross, J. J. (Ed.). (2011). Handbook of emotion regulation. Guilford Press.
Gruber, J. (2011). Can feeling too good be bad? Positive emotion persistence (PEP) in bipolar disorder. Current Directions in Psychological Science, 20(4), 217–221.
Haas, S. M., Waschbusch, D. A., Pelham, W. E., Jr., King, S., Andrade, B. F., & Carrey, N. J.
(2011). Treatment response in CP/ADHD children with callous/unemotional traits.
Journal of Abnormal Child Psychology, 39(4), 541–552.
Haas, S. M., Waschbusch, D. A., King, S., & Walsh, T. M. (2014). Examining the role of callous–unemotional traits in the attributional styles and self competence evaluations of
children with conduct problems and ADHD. Journal of Psychopathology and Behavioral
Assessment.
Haas, S. M., Waschbusch, D. A., King, S., & Walsh, T. M. (2015). Examining the Role of Callous-Unemotional Traits in the Attributional Styles and Self Competence Evaluations
of Children with Conduct Problems and ADHD. Journal of Psychopathology and
Behavioral Assessment, 37(2), 196–206.
Hall, G. B. C., Szechtman, H., & Nahmias, C. (2003). Enhanced salience and emotion recognition in autism: A PET study. The American Journal of Psychiatry, 160(8), 1439–1441.
Harms, M. B., Martin, A., & Wallace, G. L. (2010). Facial emotion recognition in autism
spectrum disorders: a review of behavioral and neuroimaging studies.
Neuropsychology Review, 20(3), 290–322.
Hawes, D. J., & Dadds, M. R. (2005). The treatment of conduct problems in children with
callous–unemotional traits. Journal of Consulting and Clinical Psychology, 73(4), 737.
Hedges, L. V. (1994). Fixed effects models. The handbook of research synthesis
(pp. 285–299).
Herbert, S. D., Harvey, E. A., Roberts, J. L., Wichowski, K., & Lugo-Candelas, C. I. (2013). A
randomized controlled trial of a parent training and emotion socialization program
for families of hyperactive preschool-aged children. Behavior Therapy, 44(2),
302–316.
Herpers, P. C., Rommelse, N. N., Bons, D. M., Buitelaar, J. K., & Scheepers, F. E. (2012).
Callous–unemotional traits as a cross-disorders construct. Social Psychiatry and
Psychiatric Epidemiology, 47(12), 2045–2064.
Higgins, J. P. T., & Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis.
Statistics in Medicine, 21(11), 1539–1558.
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. British Medical Journal, 327(7414), 557–560.
Hoffmann, H., Kessler, H., Eppel, T., Rukavina, S., & Traue, H. C. (2010). Expression intensity, gender and facial emotion recognition: Women recognize only subtle facial emotions better than men. Acta Psychologica, 135(3), 278–283.
Hogue, A., Dauber, S., Lichvar, E., & Spiewak, G. (2012). Adolescent and caregiver reports
of ADHD symptoms among inner-city youth: Agreement, perceived need for treatment, and behavioral correlates. Journal of Attention Disorders (1087054712443160).
Hughes, C. (1998). Executive function in preschoolers: Links with theory of mind and verbal ability. The British Journal of Developmental Psychology, 16, 233.
Izard, C. E. (1971). The face of emotion. New York: Appleton-Century-Crofts.
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
Izard, C., Fine, S., Schultz, D., Mostow, A., Ackerman, B., & Youngstrom, E. (2001). Emotion
knowledge as a predictor of social behavior and academic competence in children at
risk. Psychological Science, 12(1), 18–23.
Jang, J., Matson, J. L., Williams, L. W., Tureck, K., Goldin, R. L., & Cervantes, P. E. (2013).
Rates of comorbid symptoms in children with ASD, ADHD, and comorbid ASD and
ADHD. Research in Developmental Disabilities, 34(8), 2369–2378.
Jarratt, K. P., Riccio, C. A., & Siekierski, B. M. (2005). Assessment of attention deficit hyperactivity disorder (ADHD) using the BASC and BRIEF. Applied Neuropsychology, 12(2),
83–93.
Jensen, S. A., & Rosen, L. A. (2004). Emotional reactivity in children with attention-deficit/
hyperactivity disorder. Journal of Attention Disorders, 8(2), 53–61.
John, O. P., & Gross, J. J. (2004). Healthy and unhealthy emotion regulation: Personality
processes, individual differences, and life span development. Journal of Personality,
72(6), 1301–1334.
Jones, C. R. G., Pickles, A., Falcaro, M., Marsden, A. J. S., Happé, F., Scott, S. K., ... Charman, T.
(2011). A multimodal approach to emotion recognition ability in autism spectrum
disorders. Journal of Child Psychology & Psychiatry, 52(3), 275–285.
Joormann, J., & Gotlib, I. H. (2010). Emotion regulation in depression: relation to cognitive
inhibition. Cognition and Emotion, 24(2), 281–298.
Jurado, M. B., & Rosselli, M. (2007). The elusive nature of executive functions: A review of
our current understanding. Neuropsychology Review, 17(3), 213–233.
Kashdan, T. B., & Breen, W. E. (2008). Social anxiety and positive emotions: A prospective
examination of a self-regulatory model with tendencies to suppress or express emotions as a moderating variable. Behavior Therapy, 39(1), 1–12.
Katic, A., Dirks, B., Babcock, T., Scheckner, B., Adeyi, B., Richards, C., & Findling, R. L. (2013).
Treatment outcomes with lisdexamfetamine dimesylate in children who have
Attention-Deficit/Hyperactivity Disorder with emotional control impairments.
Journal of Child and Adolescent Psychopharmacology, 23(6), 386–393.
Kats-Gold, I., Besser, A., & Priel, B. (2007). The role of simple emotion recognition skills
among school aged boys at risk of ADHD. Journal of Abnormal Child Psychology,
35(3), 363–378.
Kimonis, E. R., Frick, P. J., Skeem, J. L., Marsee, M. A., Cruise, K., Munoz, L. C., ... Morris, A. S.
(2008). Assessing callous–unemotional traits in adolescent offenders: Validation of
the Inventory of Callous–Unemotional Traits. International Journal of Law and
Psychiatry, 31(3), 241–252.
Kochanska, G., & Knaack, A. (2003). Effortful control as a personality characteristic of
young children: Antecedents, correlates, and consequences. Journal of Personality,
71(6), 1087–1112.
Kochanska, G., DeVet, K., Goldman, M., Murray, K., & Putnam, S. P. (1994). Maternal reports of conscience development and temperament in young children. Child
Development, 65(3), 852–868.
Kokkinos, C. M., & Kipritsi, E. (2012). The relationship between bullying, victimization,
trait emotional intelligence, self-efficacy and empathy among preadolescents. Social
Psychology of Education: An International Journal, 15(1), 41–58.
Kolko, D. J., & Pardini, D. A. (2010). ODD dimensions, ADHD, and callous–unemotional
traits as predictors of treatment response in children with disruptive behavior disorders. Journal of Abnormal Psychology, 119(4), 713.
Kooij, J. J., Aeckerlin, L. P., & Buitelaar, J. K. (2001). Functioning, comorbidity and treatment of
141 adults with attention deficit hyperactivity disorder (ADHD) at a psychiatric outpatient department. Nederlands Tijdschrift voor Geneeskunde, 145(31), 1498–1501.
Kothari, R., Skuse, D., Wakefield, J., & Micali, N. (2013). Gender differences in the relationship between social communication and emotion recognition. Journal of the American
Academy of Child and Adolescent Psychiatry, 52(11), 1148–1157.
Labouvie-Vief, G., Lumley, M. A., Jain, E., & Heinze, H. (2003). Age and gender differences
in cardiac reactivity and subjective emotion responses to emotional autobiographical
memories. Emotion, 3(2), 115–126.
Li, D., Sham, P. C., Owen, M. J., & He, L. (2006). Meta-analysis shows significant association
between dopamine system genes and attention deficit hyperactivity disorder
(ADHD). Human Molecular Genetics, 15(14), 2276–2284.
Linder, N., Kroyzer, N., Maeir, A., Wertman-Elad, R., & Pollak, Y. (2010). Do ADHD and executive dysfunctions, measured by the Hebrew version of Behavioral Rating Inventory of
Executive Functions (BRIEF), completely overlap? Child Neuropsychology, 16(5),
494–502.
Lipsey, M. W., & Wilson, D. B. (2001). The way in which intervention studies have “personality” and why it is important to meta-analysis. Evaluation & the Health
Professions, 24(3), 236–254.
Loe, I. M., & Feldman, H. M. (2007). Academic and educational outcomes of children with
ADHD. Journal of Pediatric Psychology, 32(6), 643–654.
Ludlow, A. K., Garrood, A., Lawrence, K., & Gutierrez, R. (2014). Emotion recognition from
dynamic emotional displays in children with ADHD. Journal of Social and Clinical
Psychology, 33(5), 413–427.
Lynam, D. R., Miller, D. J., Vachon, D., Loeber, R., & Stouthamer-Loeber, M. (2009). Psychopathy in adolescence predicts official reports of offending in adulthood. Youth
Violence and Juvenile Justice, 7(3), 189–207.
Mahone, E. M., Hagelthorn, K. M., Cutting, L. E., Schuerholz, L. J., Pelletier, S. F., Rawlins, C.,
... Denckla, M. B. (2002). Effects of IQ on executive function measures in children with
ADHD. Child Neuropsychology, 8(1), 52–65.
Mannuzza, S., Klein, R. G., Abikoff, H., & Moulton, J. L., III (2004). Significance of childhood
conduct problems to later development of conduct cisorder among children with
ADHD: A prospective follow-up study. Journal of Abnormal Child Psychology, 32(5),
565–573.
Marsh, A. A., & Blair, R. J. R. (2008). Deficits in facial affect recognition among antisocial populations: A meta-analysis. Neuroscience and Biobehavioral Reviews, 32(3), 454–465.
Martel, M. M. (2009). Research review: A new perspective on attention-deficit/
hyperactivity disorder: Emotion dysregulation and trait models. Journal of Child
Psychology and Psychiatry, 50(9), 1042–1051.
121
Martel, M. M., & Nigg, J. T. (2006). Child ADHD and personality/temperament traits of reactive and effortful control, resiliency, and emotionality. Journal of Child Psychology
and Psychiatry, 47(11), 1175–1183.
Martel, M. M., Nigg, J. T., & Von Eye, A. (2009). How do trait dimensions map onto ADHD
symptom domains? Journal of Abnormal Child Psychology, 37(3), 337–348.
Martinussen, R., Hayden, J., Hogg-Johnson, S., & Tannock, R. (2005). A meta-analysis of
working memory impairments in children with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44(4),
377–384.
Marton, I., Wiener, J., Rogers, M., Moore, C., & Tannock, R. (2009). Empathy and social perspective taking in children with attention-deficit/hyperactivity disorder. Journal of
Abnormal Child Psychology, 37(1), 107–118.
Mash, E. J., & Barkley, R. A. (2003). Child psychopathology. Guilford Press.
McCandless, S., & O'Laughlin, L. (2007). The clinical utility of the Behavior Rating Inventory of Executive Function (BRIEF) in the diagnosis of ADHD. Journal of Attention
Disorders, 10(4), 381–389.
McKenzie, M. E., & Lee, S. S. (2014). Cognitive ability and psychopathic traits: Independent
and interactive associations with youth conduct problems. Journal of Abnormal Child
Psychology, 1–11.
McMahon, R. J., Witkiewitz, K., & Kotler, J. S. (2010). Predictive validity of callous–
unemotional traits measured in early adolescence with respect to multiple antisocial
outcomes. Journal of Abnormal Psychology, 119(4), 752.
McQuade, J. D., & Hoza, B. (2008). Peer problems in attention deficit hyperactivity disorder: Current status and future directions. Developmental Disabilities Research Reviews,
14(4), 320–324.
Meinzer, M. C., Pettit, J. W., & Viswesvaran, C. (2014). The co-occurrence of attentiondeficit/hyperactivity disorder and unipolar depression in children and adolescents:
a meta-analytic review. Clinical Psychology Review, 34(8), 595–607.
Melnick, S. M., & Hinshaw, S. P. (2000). Emotion regulation and parenting in AD/HD and
comparison boys: Linkages with social behaviors and peer preference. Journal of
Abnormal Child Psychology, 28(1), 73–86.
Mennin, D. S., Holaway, R. M., Fresco, D. M., Moore, M. T., & Heimberg, R. G. (2007). Delineating components of emotion and its dysregulation in anxiety and mood psychopathology. Behavior Therapy, 38(3), 284–302.
Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D.
(2000). The unity and diversity of executive functions and their contributions to
complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41(1),
49–100.
Musser, E. D., Backs, R. W., Schmitt, C. F., Ablow, J. C., Measelle, J. R., & Nigg, J. T. (2011).
Emotion regulation via the autonomic nervous system in children with attentiondeficit/hyperactivity disorder (ADHD). Journal of Abnormal Child Psychology, 39(6),
841–852.
Musser, E. D., Galloway-Long, H. S., Frick, P. J., & Nigg, J. T. (2013). Emotion regulation and
heterogeneity in attention-deficit/hyperactivity disorder. Journal of the American
Academy of Child and Adolescent Psychiatry, 52(2), 163–171.
Neyeloff, J. L., Fuchs, S. C., & Moreira, L. B. (2012). Meta-analyses and Forest plots using a
microsoft excel spreadsheet: step-by-step guide focusing on descriptive data analysis. BMC Research Notes, 5(1), 52.
Nigg, J. (2005). Reinforcement gradient, response inhibition, genetic versus experiential
effects, and multiple pathways to ADHD. Behavioral and Brain Sciences, 28(3),
437–438.
Nigg, J. T. (2013). Attention deficits and hyperactivity–impulsivity: What have we
learned, what next? Development and Psychopathology, 25(4pt2), 1489–1503.
Nigg, J. T., Blaskey, L. G., Huang-Pollock, C. L., & Rappley, M. D. (2002). Neuropsychological
executive functions and DSM-IV ADHD subtypes. Journal of the American Academy of
Child and Adolescent Psychiatry, 41(1), 59–66.
Nigg, J. T., Blaskey, L. G., Stawicki, J. A., & Sachek, J. (2004). Evaluating the endophenotype
model of ADHD neuropsychological deficit: Results for parents and siblings of children with ADHD combined and inattentive subtypes. Journal of Abnormal
Psychology, 113(4), 614.
Nigg, J. T., Willcutt, E. G., Doyle, A. E., & Sonuga-Barke, E. J. S. (2005). Causal heterogeneity
in Attention-Deficit/Hyperactivity Disorder: Do we need neuropsychologically impaired subtypes? Biological Psychiatry, 57(11), 1224–1230.
Nikolas, M. A., & Burt, S. A. (2010). Genetic and environmental influences on ADHD symptom dimensions of inattention and hyperactivity: A meta-analysis. Journal of
Abnormal Psychology, 119(1), 1.
Nilsen, E. S., & Graham, S. A. (2009). The relations between children's communicative
perspective-taking and executive functioning. Cognitive Psychology, 58(2),
220–249.
Norvilitis, J. M., Casey, R. J., Brooklier, K. M., & Bonello, P. J. (2000). Emotion appraisal in
children with attention-deficit/hyperactivity disorder and their parents. Journal of
Attention Disorders, 4(1), 15–26.
Ochsner, K. N., Ray, R. R., Hughes, B., McRae, K., Cooper, J. C., Weber, J., ... Gross, J. J. (2009).
Bottom-up and top-down processes in emotion generation common and distinct
neural mechanisms. Psychological Science, 20(11), 1322–1331.
Pardini, D. A., & Fite, P. J. (2010). Symptoms of conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder, and callous–unemotional traits as
unique predictors of psychosocial maladjustment in boys: Advancing an evidence
base for DSM-V. Journal of the American Academy of Child and Adolescent Psychiatry,
49(11), 1134–1144.
Pelc, K., Kornreich, C., Foisy, M. L., & Dan, B. (2006). Recognition of emotional facial expressions in attention-deficit hyperactivity disorder. Pediatric Neurology, 35(2),
93–97.
Pelham, W. E., & Fabiano, G. A. (2008). Evidence-based psychosocial treatments for
Attention-Deficit/Hyperactivity Disorder. Journal of Clinical Child & Adolescent
Psychology, 37(1), 184–214.
122
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
Pelham, W. E., Foster, E. M., & Robb, J. A. (2007). The economic impact of attention-deficit/
hyperactivity disorder in children and adolescents. Ambulatory Pediatrics, 7(1),
121–131.
Polanczyk, G. V., Willcutt, E. G., Salum, G. A., Kieling, C., & Rohde, L. A. (2014). ADHD prevalence estimates across three decades: An updated systematic review and metaregression analysis. International Journal of Epidemiology, 43(2), 434–442.
Polivy, J., & Herman, C. P. (2002). Causes of eating disorders. Annual Review of Psychology,
53(1), 187–213.
Porges, S. W., Doussard‐Roosevelt, J. A., Portales, A. L., & Greenspan, S. I. (1996). Infant regulation of the vagal “brake” predicts child behavior problems: A psychobiological
model of social behavior. Developmental Psychobiology, 29(8), 697–712.
Posner, J., Maia, T. V., Fair, D., Peterson, B. S., Sonuga-Barke, E. J., & Nagel, B. J. (2011). The
attenuation of dysfunctional emotional processing with stimulant medication: An
fMRI study of adolescents with ADHD. Psychiatry Research: Neuroimaging, 193(3),
151–160.
Premack, D., & Woodruff, G. (1978). Does the chimpanzee have a theory of mind?
Behavioral and Brain Sciences, 1(04), 515–526.
Regenbogen, C., Schneider, D. A., Gur, R. E., Schneider, F., Habel, U., & Kellermann, T.
(2012). Multimodal human communication—Targeting facial expressions, speech
content and prosody. NeuroImage, 60(4), 2346–2356.
Rose, A. J., & Rudolph, K. D. (2006). A review of sex differences in peer relationship processes: Potential trade-offs for the emotional and behavioral development of girls
and boys. Psychological Bulletin, 132(1), 98.
Rosen, P. J., & Factor, P. I. (2012). Emotional impulsivity and emotional and behavioral difficulties among children with ADHD: An ecological momentary assessment study.
Journal of Attention Disorders.
Rosenberg, M. S. (2005). The file‐drawer problem revisited: A general weighted method
for calculating fail‐safe numbers in meta‐analysis. Evolution, 59(2), 464–468.
Rosenthal, R. (1995). Writing meta-analytic reviews. Psychological Bulletin, 118, 183–192.
Rothbart, M. K., & Derryberry, D. (1981). Development of individual differences in temperament. Advances in Developmental Psychology.
Rothbart, M. K., & Sheese, B. E. (2007). Temperament and Emotion Regulation.
Rothbart, M. K., Ahadi, S. A., Hershey, K. L., & Fisher, P. (2001). Investigations of temperament at three to seven years: The Children's Behavior Questionnaire. Child
Development, 72(5), 1394–1408.
Saarni, C. (1984). An observational study of children's attempts to monitor their expressive behavior. Child Development, 55, 1504–1513.
Saarni, C. (1992). Children's emotional–expressive behaviors as regulators of others'
happy and sad emotional states. In N. Eisenberg, & R. Fabes (Eds.), Emotion and its regulation in early development: New directions in child development. Vol. 55. (pp.
91–106). San Francisco, CA: Jossey-Bass.
Scime, M., & Norvilitis, J. M. (2006). Task performance and response to frustration in children with attention deficit hyperactivity disorder. Psychology in the Schools, 43(3),
377–386.
Semrud-Clikeman, M., Walkowiak, J., Wilkinson, A., & Butcher, B. (2010). Executive functioning in children with Asperger syndrome, ADHD-combined type, ADHDpredominately inattentive type, and controls. Journal of Autism and Developmental
Disorders, 40(8), 1017–1027.
Seymour, K. E., Chronis-Tuscano, A., Halldorsdottir, T., Stupica, B., Owens, K., & Sacks, T.
(2012). Emotion regulation mediates the relationship between ADHD and depressive
symptoms in youth. Journal of Abnormal Child Psychology, 40(4), 595–606.
Seymour, K. E., Chronis-Tuscano, A., Iwamoto, D. K., Kurdziel, G., & MacPherson, L. (2014).
Emotion regulation mediates the association between ADHD and depressive symptoms in a community sample of youth. Journal of Abnormal Child Psychology, 42(4),
611–621.
Shapero, B. G., & Steinberg, L. (2013). Emotional reactivity and exposure to household
stress in childhood predict psychological problems in adolescence. Journal of Youth
and Adolescence, 42(10), 1573–1582.
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in Attention
Deficit Hyperactivity Disorder. American Journal of Psychiatry, 171(3), 276–293.
Sher, K. J., & Grekin, E. R. (2007). Alcohol and affect regulation.
Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-age children: The development and validation of a new criterion Q-sort scale. Developmental Psychology,
33(6), 906–916.
Silk, J. S., Steinberg, L., & Morris, A. S. (2003). Adolescents' emotion regulation in daily life:
Links to depressive symptoms and problem behavior. Child Development, 74(6),
1869–1880.
Singh, A. L., & Waldman, I. D. (2010). The etiology of associations between negative emotionality and childhood externalizing disorders. Journal of Abnormal Psychology, 119(2), 376.
Singh, S. D., Ellis, C. R., Winton, A. S., Singh, N. N., Leung, J. P., & Oswald, D. P. (1998). Recognition of facial expressions of emotion by children with attention-deficit hyperactivity disorder. Behavior Modification, 22(2), 128–142.
Sinzig, J., Morsch, D., & Lehmkuhl, G. (2008). Do hyperactivity, impulsivity and inattention
have an impact on the ability of facial affect recognition in children with autism and
ADHD? European Child & Adolescent Psychiatry, 17(2), 63–72.
Sjöwall, D., Roth, L., Lindqvist, S., & Thorell, L. B. (2013). Multiple deficits in ADHD: Executive dysfunction, delay aversion, reaction time variability, and emotional deficits.
Journal of Child Psychology and Psychiatry, 54(6), 619–627.
Sjöwall, D., Backman, A., & Thorell, L. B. (2015). Neuropsychological heterogeneity in preschool ADHD: Investigating the interplay between cognitive, affective and motivation-based forms of regulation. Journal of Abnormal Child Psychology, 43(4), 669–680.
Skirrow, C., McLoughlin, G., Kuntsi, J., & Asherson, P. (2009). Behavioral, neurocognitive
and treatment overlap between attention-deficit/hyperactivity disorder and mood
instability. Expert Review of Neurotherapeutics, 9(4), 489–503.
Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., ... Faraone, S.
V. (2010). Emotional lability in children and adolescents with attention deficit/
hyperactivity disorder (ADHD): Clinical correlates and familial prevalence. Journal
of Child Psychology and Psychiatry, 51(8), 915–923.
Southam-Gerow, M. A., & Kendall, P. C. (2002). Emotion regulation and understanding:
Implications for child psychopathology and therapy. Clinical Psychology Review,
22(2), 189–222.
Stadler, C., Kroeger, A., Weyers, P., Grasmann, D., Horschinek, M., Freitag, C., & Clement, H.
W. (2011). Cortisol reactivity in boys with attention-deficit/hyperactivity disorder
and disruptive behavior problems: the impact of callous unemotional traits.
Psychiatry Research, 187(1), 204–209.
Strayer, J. (1989). What children know and feel in response to witnessing affective events.
In C. Saarni, & P. L. Harris (Eds.), Children's understanding of emotions (pp. 259–289).
Cambridge, England: Cambridge University Press.
Stringaris, A., & Goodman, R. (2009). Mood lability and psychopathology in youth.
Psychological Medicine, 39(8), 1237–1245.
Stringaris, A., Maughan, B., & Goodman, R. (2010). What's in a disruptive disorder? Temperamental antecedents of oppositional defiant disorder: Findings from the Avon
longitudinal study. Journal of the American Academy of Child and Adolescent Psychiatry,
49(5), 474–483.
Sutton, J. (2003). ToM goes to school: Social cognition and social values in bullying. In B.
Repacholi, & V. Slaughter (Eds.), Individual differences in theory of mind: Implications
for typical and atypical development (pp. 99–120). New York: Psychology Press.
Sutton, J., Smith, P. K., & Swettenham, J. (1999). Social cognition and bullying: Social inadequacy or skilled manipulation? British Journal of Developmental Psychology, 17(3),
435–450.
Thomas, G. C., Batson, C. D., & Coke, J. S. (1981). Do good samaritans discourage helpfulness? Self-perceived altruism after exposure to highly helpful others. Journal of
Personality and Social Psychology, 40(1), 194–200.
Thompson, R. A. (1994). Emotion regulation: A theme in search of definition. Monographs
of the Society for Research in Child Development, 59(2–3), 25–52.
Trentacosta, C. J., & Fine, S. E. (2010). Emotion knowledge, social competence, and behavior problems in childhood and adolescence: A meta‐analytic review. Social
Development, 19(1), 1–29.
Tucker, D. M., Watson, R. T., & Heilman, K. M. (1977). Discrimination and evocation of affectively intoned speech in patients with right parietal disease. Neurology, 27,
947–950.
Van der Oord, S., Prins, P. J., Oosterlaan, J., & Emmelkamp, P. M. (2008). Efficacy of methylphenidate, psychosocial treatments and their combination in school-aged children
with ADHD: A meta-analysis. Clinical Psychology Review, 28(5), 783–800.
Van Lier, P. A., Der Ende, J. V., Koot, H. M., & Verhulst, F. C. (2007). Which better predicts
conduct problems? The relationship of trajectories of conduct problems with ODD
and ADHD symptoms from childhood into adolescence. Journal of Child Psychology
and Psychiatry, 48(6), 601–608.
Van Tilburg, M. A. L., Unterberg, M. L., & Vingerhoets, A. J. J. M. (2002). Crying during adolescence: The role of gender, menarche, and empathy. British Journal of
Developmental Psychology, 20(1), 77–87.
Wager, T. D., Phan, K. L., Liberzon, I., & Taylor, S. F. (2003). Valence, gender, and lateralization of functional brain anatomy in emotion: A meta-analysis of findings from neuroimaging. NeuroImage, 19(3), 513–531.
Wåhlstedt, C., Thorell, L. B., & Bohlin, G. (2008). ADHD symptoms and executive function
impairment: Early predictors of later behavioral problems. Developmental
Neuropsychology, 33(2), 160–178.
Walcott, C. M., & Landau, S. (2004). The relation between disinhibition and emotion regulation in boys with attention deficit hyperactivity disorder. Journal of Clinical Child
and Adolescent Psychology, 33(4), 772–782.
Waller, R., Hyde, L. W., Grabell, A. S., Alves, M. L., & Olson, S. L. (2014). Differential associations of early callous–unemotional, oppositional, and ADHD behaviors: Multiple domains within early‐starting conduct problems? Journal of Child Psychology and
Psychiatry.
Waschbusch, D. A., & Willoughby, M. T. (2008). Attention‐deficit/hyperactivity disorder
and callous‐unemotional traits as moderators of conduct problems when examining
impairment and aggression in elementary school children. Aggressive Behavior, 34(2),
139–153.
Waschbusch, D. A., Porter, S., Carrey, N., Kazmi, S. O., Roach, K. A., & D'Amico, D. A. (2004).
Investigation of the heterogeneity of disruptive behaviour in elementary-age children. Canadian Journal of Behavioural Science/Revue canadienne des sciences du
comportement, 36(2), 97.
Waschbusch, D. A., Carrey, N. J., Willoughby, M. T., King, S., & Andrade, B. F. (2007a). Effects of methylphenidate and behavior modification on the social and academic behavior of children with disruptive behavior disorders: The moderating role of
callous/unemotional traits. Journal of Clinical Child and Adolescent Psychology, 36(4),
629–644.
Waschbusch, D. A., Craig, R., Pelham, W. E., Jr., & King, S. (2007b). Self-handicapping prior
to academic-oriented tasks in children with attention deficit/hyperactivity disorder
(ADHD): Medication effects and comparisons with controls. Journal of Abnormal
Child Psychology, 35(2), 275–286.
Waschbusch, D. A., Graziano, P., Willoughby, M. T., & Pelham, W. E. (2014). Classroom rule
violations in elementary school students with callous–unemotional traits. Journal of
Emotional and Behavioral Disorders (1063426614552903).
Weinberg, M. K., Tronick, E. Z., Cohn, J. F., & Olson, K. L. (1999). Gender differences in emotional expressivity and self-regulation during early infancy. Developmental
Psychology, 35(1), 175–188.
Wentzel, K. R., Filisetti, L., & Looney, L. (2007). Adolescent prosocial behavior: The role of
self‐processes and contextual cues. Child Development, 78(3), 895–910.
Wheeler Maedgen, J., & Carlson, C. L. (2000). Social functioning and emotional regulation
in the attention deficit hyperactivity disorder subtypes. Journal of Clinical Child
Psychology, 29(1), 30–42.
P.A. Graziano, A. Garcia / Clinical Psychology Review 46 (2016) 106–123
Willcutt, E. G. (2012). The prevalence of DSM-IV attention-deficit/hyperactivity disorder:
A meta-analytic review. Neurotherapeutics, 9(3), 490–499.
Willcutt, E. G., Doyle, A. E., Nigg, J. T., Faraone, S. V., & Pennington, B. F. (2005). Validity of
the executive function theory of Attention-Deficit/Hyperactivity Disorder: A metaanalytic review. Biological Psychiatry, 57(11), 1336–1346.
Williams, L. M., Hermens, D. F., Palmer, D., Kohn, M., Clarke, S., Keage, H., ... Gordon, E.
(2008). Misinterpreting emotional expressions in attention-deficit/hyperactivity disorder: Evidence for a neural marker and stimulant effects. Biological Psychiatry,
63(10), 917–926.
Williford, A. P., Calkins, S. D., & Keane, S. P. (2007). Predicting change in parenting stress
across early childhood: Child and maternal factors. Journal of Abnormal Child
Psychology, 35(2), 251–263.
Willoughby, M. T., Waschbusch, D. A., Moore, G. A., & Propper, C. B. (2011). Using the
ASEBA to screen for callous unemotional traits in early childhood: Factor structure,
temporal stability, and utility. Journal of Psychopathology and Behavioral Assessment,
33(1), 19–30.
123
Wong, N., Beidel, D. C., Sarver, D. E., & Sims, V. (2012). Facial emotion recognition in children with high functioning autism and children with social phobia. Child Psychiatry
and Human Development, 43(5), 775–794.
Woodworth, M., & Waschbusch, D. (2008). Emotional processing in children with conduct problems and callous/unemotional traits. Child: Care, Health and Development,
34(2), 234–244.
Yuill, N., & Lyon, J. (2007). Selective difficulty in recognising facial expressions of emotion
in boys with ADHD. European Child & Adolescent Psychiatry, 16(6), 398–404.
Ze, O., Thoma, P., & Suchan, B. (2014). Cognitive and affective empathy in younger and
older individuals. Aging & Mental Health, 18(7), 929–935.
Zelazo, D., & Cunningham, W. (2007). Executive function: Mechanisms underlying emotion regulation. In James J. Gross (Ed.), Handbook of emotion regulation (pp. 135–158).
New York, NY, US: Guilford Press.
Zlomke, K. R., & Hahn, K. S. (2010). Cognitive emotion regulation strategies: Gender differences and associations to worry. Personality and Individual Differences, 48(4), 408–413.