Abstract
Children with attention-deficit/hyperactivity disorder (ADHD) have difficulty with emotion regulation relative to their non-ADHD peers, including the use of distraction and reappraisal to regulate emotions. The aim of the current study was to examine emotion regulation in children and adolescents with ADHD using distraction and reappraisal strategies. A group of 20 children and adolescents with ADHD (85% male; mean age = 11.55) and 20 non-ADHD matched controls (85% male; mean age = 11.65 years) completed an experimental task in which they were instructed to react naturally or decrease negative emotion using distraction and reappraisal in response to negative emotional pictures. Participants were asked to rate their emotion after viewing each picture. A significant main effect of instruction on emotion regulation was found, indicating that the distraction and reappraisal instructions improved emotion regulation in both groups. No effect for group or group by instruction was significant. Children and adolescents with ADHD can regulate their emotions as well as non-ADHD controls when they are trained to use distraction and reappraisal. Treatment development efforts should consider the addition of training in emotion regulation strategies for children and adolescents with ADHD.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Aghaei, A., Abedi, A., & Mohammadi, E. (2011). A study of psychometric characteristics of SNAP-IV rating scale (parent form) in elementary school students in Isfahan. Researches of Cognitive and Behavioral Science, 1(1), 43–58.
Aldao, A., Gee, D. G., De Los Reyes, A., & Seager, I. (2016). Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: Current and future directions. Development and psychopathology, 28(4pt1), 927–946. https://doi.org/10.1017/S0954579416000638
Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical psychology review, 30(2), 217–237. https://doi.org/10.1016/j.cpr.2009.11.004
American Psychiatric Association. (2013). Diagnostic and statistical manual for mental disorders (5th ed.). Washington, DC: Author.
Anastopoulos, A. D., Smith, T. F., Garrett, M. E., Morrissey-Kane, E., Schatz, N. K., Sommer, J. L., Kollins, S. H., & 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. https://doi.org/10.1177/1087054710370567
Barkley, R. A. (2010). Deficient emotional self-regulation: A core component of attention-deficit/hyperactivity disorder. Journal of ADHD Related Disorders, 1, 5–37.
Bebko, G. M., Franconeri, S. L., Ochsner, K. N., & Chiao, J. Y. (2011). Look before you regulate: Differential perceptual strategies underlying expressive suppression and cognitive reappraisal. Emotion, 11(4), 732–742. https://doi.org/10.1037/a0024009
Braunstein, L. M., Gross, J. J., & Ochsner, K. N. (2017). Explicit and implicit emotion regulation: A multi-level framework. Social cognitive and affective neuroscience, 12(10), 1545–1557. https://doi.org/10.1093/scan/nsx096
Bussing, R., Fernandez, M., Harwood, M., Hou, W., Garvan, C. W., Eyberg, S. M., & Swanson, J. M. (2008). Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: Psychometric properties and normative ratings from a school district sample. Assessment, 15(3), 317–328. https://doi.org/10.1177/1073191107313888
Cedrus Corporation. (2014). SuperLab® 5 manual. San Pedro, CA: Cedrus Corporation.
Cisler, J. M., Olatunji, B. O., Feldner, M. T., & Forsyth, J. P. (2010). Emotion regulation and the anxiety Disorders: An integrative review. Journal of psychopathology and behavioral assessment, 32(1), 68–82. https://doi.org/10.1007/s10862-009-9161-1
Conners, C. K. (1999). Conners Rating Scales-Revised. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (pp. 467–495). Lawrence Erlbaum Associates Publishers.
Cordon, I. M., Melinder, A. M., Goodman, G. S., & Edelstein, R. S. (2013). Children’s and adults’ memory for emotional pictures: Examining age-related patterns using the Developmental Affective Photo System. Journal of experimental child psychology, 114(2), 339–356. https://doi.org/10.1016/j.jecp.2012.08.004
Davis, E. L., Quiñones-Camacho, L. E., & Buss, K. A. (2016). The effects of distraction and reappraisal on children’s parasympathetic regulation of sadness and fear. Journal of experimental child psychology, 142, 344–358. https://doi.org/10.1016/j.jecp.2015.09.020
Faraone, S. V., Rostain, A. L., Blader, J., Busch, B., Childress, A. C., Connor, D. F., & Newcorn, J. H. (2019). Practitioner review: Emotional dysregulation in attention-deficit/hyperactivity disorder - implications for clinical recognition and intervention. Journal of child psychology and psychiatry and allied disciplines, 60(2), 133–150. https://doi.org/10.1111/jcpp.12899
Graziano, P. A., & Garcia, A. (2016). Attention-deficit hyperactivity disorder and children’s emotion dysregulation: A meta-analysis. Clinical psychology review, 46, 106–123. https://doi.org/10.1016/j.cpr.2016.04.011
Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of personality and social psychology, 74(1), 224–237. https://doi.org/10.1037//0022-3514.74.1.224
Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39(3), 281–291. https://doi.org/10.1017/s0048577201393198
Gross, J. J. (2015). Emotion regulation: Current status and future prospects. Psychological Inquiry, 26(1), 1–26. https://doi.org/10.1080/1047840X.2014.940781
Groves, N. B., Wells, E. L., Soto, E. F., Marsh, C. L., Jaisle, E. M., Harvey, T. K., & Kofler, M. J. (2022). Executive functioning and emotion regulation in children with and without ADHD. Research on child and adolescent psychopathology, 50(6), 721–735. https://doi.org/10.1007/s10802-021-00883-0
Gualtieri, C. T., & Johnson, L. G. (2006). Efficient allocation of attentional resources in patients with ADHD: Maturational changes from age 10 to 29. Journal of attention disorders, 9(3), 534–542. https://doi.org/10.1177/1087054705283758
Gyurak, A., Gross, J. J., & Etkin, A. (2011). Explicit and implicit emotion regulation: A dual-process framework. Cognition & emotion, 25(3), 400–412. https://doi.org/10.1080/02699931.2010.544160
Hagstrøm, J., Maigaard, K., Pagsberg, A. K., Skov, L., Plessen, K. J., & Vangkilde, S. (2020). Reappraisal is an effective emotion regulation strategy in children with Tourette syndrome and ADHD. Journal of behavior therapy and experimental psychiatry, 68, 101541. https://doi.org/10.1016/j.jbtep.2019.101541
Huberty, C. J. (2002). A history of effect size indices. Educational and Psychological Measurement, 62(2), 227–240. https://doi.org/10.1177/0013164402062002002
Jackson, D. C., Malmstadt, J. R., Larson, C. L., & Davidson, R. J. (2000). Suppression and enhancement of emotional responses to unpleasant pictures. Psychophysiology, 37(4), 515–522.
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), 1301–1333. https://doi.org/10.1111/j.1467-6494.2004.00298.x
Joormann, J., & Gotlib, I. H. (2010). Emotion regulation in depression: Relation to cognitive inhibition. Cognition & emotion, 24(2), 281–298. https://doi.org/10.1080/02699930903407948
Kalokerinos, E. K., Greenaway, K. H., & Denson, T. F. (2015). Reappraisal but not suppression downregulates the experience of positive and negative emotion. Emotion, 15(3), 271–275. https://doi.org/10.1037/emo0000025
Kanske, P., Heissler, J., Schönfelder, S., Bongers, A., & Wessa, M. (2011). How to regulate emotion? Neural networks for reappraisal and distraction. Cerebral cortex, 21(6), 1379–1388. https://doi.org/10.1093/cercor/bhq216
Karalunas, S. L., Gustafsson, H. C., Dieckmann, N. F., Tipsord, J., Mitchell, S. H., & Nigg, J. T. (2017). Heterogeneity in development of aspects of working memory predicts longitudinal attention deficit hyperactivity disorder symptom change. Journal of abnormal psychology, 126(6), 774–792. https://doi.org/10.1037/abn0000292
Kiani, B., & Hadianfard, H. (2016). Psychometric properties of a Persian self-report version of Swanson, Nolan and Pelham Rating Scale (version IV) for screening attention-deficit/hyperactivity disorder in adolescents. Iranian Journal of Psychiatry and Clinical Psychology, 21(4), 317–326.
Kiani, B., Hadianfard, H., & Mitchell, J. T. (2017). The impact of mindfulness meditation training on executive functions and emotion dysregulation in an iranian sample of female adolescents with elevated attention-deficit/hyperactivity disorder symptoms. Australian Journal of Psychology, 69(4), 273–282. https://doi.org/10.1111/ajpy.12148
Kiani, B., Hadianfard, H., & Weiss, M. D. (2018). Descriptive and psychometric properties of the Persian version of the Weiss functional impairment rating scale: Parent report form in iranian children. Health and quality of life outcomes, 16(1), 225. https://doi.org/10.1186/s12955-018-1053-1
Kofler, M. J., Irwin, L. N., Soto, E. F., Groves, N. B., Harmon, S. L., & Sarver, D. E. (2019). Executive functioning heterogeneity in Pediatric ADHD. Journal of abnormal child psychology, 47(2), 273–286. https://doi.org/10.1007/s10802-018-0438-2
Lang, P. J. (1980). Behavioral treatment and bio-behavioral assessment: Computer applications. In J. B. Sidowski, J. H. Johnson, & T. A. Williams (Eds.), Technology in mental health care delivery systems (pp. 119–137). Norwood: Ablex.
Li, P., Zhu, C., Leng, Y., & Luo, W. (2020). Distraction and expressive suppression strategies in down-regulation of high- and low-intensity positive emotions. International journal of psychophysiology: official journal of the International Organization of Psychophysiology, 158, 56–61. https://doi.org/10.1016/j.ijpsycho.2020.09.010
Macnamara, A., Foti, D., & Hajcak, G. (2009). Tell me about it: Neural activity elicited by emotional pictures and preceding descriptions. Emotion (Washington D C), 9(4), 531–543. https://doi.org/10.1037/a0016251
McRae, K. (2016). Cognitive emotion regulation: A review of theory and scientific findings. Current Opinion in Behavioral Sciences, 10, 119–124. https://doi.org/10.1016/j.cobeha.2016.06.004
McRae, K., Gross, J. J., Weber, J., Robertson, E. R., Sokol-Hessner, P., Ray, R. D., Gabrieli, J. D., & Ochsner, K. N. (2012). The development of emotion regulation: An fMRI study of cognitive reappraisal in children, adolescents and young adults. Social cognitive and affective neuroscience, 7(1), 11–22. https://doi.org/10.1093/scan/nsr093
McRae, K., Hughes, B., Chopra, S., Gabrieli, J. D., Gross, J. J., & Ochsner, K. N. (2010). The neural bases of distraction and reappraisal. Journal of cognitive neuroscience, 22(2), 248–262. https://doi.org/10.1162/jocn.2009.21243
Ochsner, K. N., Bunge, S. A., Gross, J. J., & Gabrieli, J. D. (2002). Rethinking feelings: An FMRI study of the cognitive regulation of emotion. Journal of cognitive neuroscience, 14(8), 1215–1229. https://doi.org/10.1162/089892902760807212
Ochsner, K. N., & Gross, J. J. (2005). The cognitive control of emotion. Trends in cognitive sciences, 9(5), 242–249. https://doi.org/10.1016/j.tics.2005.03.010
Schmitt, K., Gold, A., & Rauch, W. A. (2012). Defizitäre adaptive emotions- regulation bei kindern mit ADHS [Deficient adaptive regulation of emotion in children with ADHD]. Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie, 40(2), 95–103. https://doi.org/10.1024/1422-4917/a000156
Shafir, R., Schwartz, N., Blechert, J., & Sheppes, G. (2015). Emotional intensity influences pre-implementation and implementation of distraction and reappraisal. Social cognitive and affective neuroscience, 10(10), 1329–1337. https://doi.org/10.1093/scan/nsv022
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. The American journal of psychiatry, 171(3), 276–293. https://doi.org/10.1176/appi.ajp.2013.13070966
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 and allied disciplines, 54(6), 619–627. https://doi.org/10.1111/jcpp.12006
Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., Holtmann, M., Krumm, B., Sergeant, J., Sonuga-Barke, E., Stringaris, A., Taylor, E., Anney, R., Ebstein, R. P., Gill, M., Miranda, A., Mulas, F., Oades, R. D., Roeyers, H., Rothenberger, A., & 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 and allied disciplines, 51(8), 915–923. https://doi.org/10.1111/j.1469-7610.2010.02217.x
Sperduti, M., Makowski, D., Arcangeli, M., Wantzen, P., Zalla, T., Lemaire, S., Dokic, J., Pelletier, J., & Piolino, P. (2017). The distinctive role of executive functions in implicit emotion regulation. Acta psychologica, 173, 13–20. https://doi.org/10.1016/j.actpsy.2016.12.001
Strine, T. W., Lesesne, C. A., Okoro, C. A., McGuire, L. C., Chapman, D. P., Balluz, L. S., & Mokdad, A. H. (2006). Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder. Preventing chronic disease, 3(2), A52.
Swanson, J. M., Schuck, S., Porter, M. M., Carlson, C., Hartman, C. A., Sergeant, J. A., Clevenger, W., Wasdell, M., McCleary, R., Lakes, K., & Wigal, T. (2012). Categorical and dimensional definitions and evaluations of symptoms of ADHD: History of the SNAP and the SWAN Rating Scales. The International journal of educational and psychological assessment, 10(1), 51–70.
Tarle, S. J., Alderson, R. M., Arrington, E. F., & Roberts, D. K. (2021). Emotion regulation and children with Attention-Deficit/Hyperactivity disorder: The Effect of varying phonological Working Memory demands. Journal of attention disorders, 25(6), 851–864. https://doi.org/10.1177/1087054719864636
Torre, J. B., & Lieberman, M. D. (2018). Putting feelings into words: Affect labeling as implicit emotion regulation. Emotion Review, 10(2), 116–124. https://doi.org/10.1177/1754073917742706
Van Cauwenberge, V., El Kaddouri, R., Hoppenbrouwers, K., & Wiersema, J. R. (2017). To make a molehill out of a mountain: An ERP-study on cognitive reappraisal of negative pictures in children with and without ADHD. Clinical Neurophysiology, 128(4), 529–537. https://doi.org/10.1016/j.clinph.2017.01.008
Weiss, M. D., McBride, N. M., Craig, S., & Jensen, P. (2018). Conceptual review of measuring functional impairment: Findings from the Weiss Functional Impairment Rating Scale. Evidence-based mental health, 21(4), 155–164. https://doi.org/10.1136/ebmental-2018-300025
Funding
No funding was received for conducting this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
The study was approved by the ethics committee for Shiraz University of Medical Sciences (Ethics ID: IR.SUMS.REC.1399.1163).
Informed consent
Informed consent from all parents and assent from all children and adolescents were obtained.
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Kiani, B., Hadianfard, H., Mitchell, J.T. et al. Examining emotion regulation using a distraction and reappraisal task in children and adolescents with and without ADHD. Curr Psychol 43, 5652–5660 (2024). https://doi.org/10.1007/s12144-023-04766-z
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12144-023-04766-z