Adult patients with ADHD differ from healthy controls in implicit, but not explicit, emotion regulation

Adult patients with ADHD differ from healthy controls in implicit, but not explicit, emotion regulation

J Psychiatry Neurosci 2019;44(5):340-349 | PDF | Appendix

Lukas Materna, MD; Christian Dirk Wiesner, PhD; Anna Shushakova, PhD; Julia Trieloff, MD; Nathalia Weber, PhD; Alva Engell, PhD; Ricarda I. Schubotz, PhD; Jochen Bauer, PhD; Anya Pedersen, PhD; Patricia Ohrmann, MD

Background: There is increasing evidence that people with attention-deficit/hyperactivity disorder (ADHD) are impaired in emotion regulation, but psychophysiological and functional MRI data on emotion processing in adult patients with ADHD are scarce. We investigated the neural correlates of reappraisal as one of the most efficient emotion-regulation strategies.

Methods: We included 30 adult patients with ADHD and 35 healthy controls in our study. We applied a well-established reappraisal paradigm in functional MRI and assessed behavioural emotion-regulation strategies with standardized questionnaires. We hypothesized that patients with ADHD would demonstrate impaired reappraisal related to reduced activations in the frontoparietal cognitive control network.

Results: Despite our hypothesis, we found no significant activation differences in the neural reappraisal network between patients with ADHD and controls. As well, both groups revealed similar reappraisal success on the immediate behavioural ratings in the scanner. Interestingly, patients with ADHD revealed significantly increased activations in the dorsal and ventral anterior cingulate cortex (ACC) compared with controls when viewing negative > neutral pictures. These ACC activations were significantly correlated with the prevalence of habitual use of reappraisal in patients with ADHD only.

Limitations: Patients withdrew medication only 24 hours before the experiment; we investigated negative, but not positive, emotion processing and regulation.

Conclusion: Although emotion dysregulation is regarded as a core symptom of ADHD, explicit reappraisal does not seem to be impaired in adult patients. However, increased activation of the ACC implies stronger implicit emotion regulation induced by negative stimuli. This might be explained by emotional hyperresponsivity in patients with ADHD compared with controls.


Submitted Aug. 13, 2018; Revised Dec. 5, 2018; Accepted Jan. 14, 2019; Published online on Apr. 26, 2019

Affiliations: From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer).

Competing interests: None declared.

Funding: This work was supported by the Deutsche Forschungsgemeinschaft (DFG, PE 1882/2-1). We acknowledge support from the Open Access Publication Fund of the University of Münster.

Contributors: L. Materna, J. Trieloff, J. Bauer, A. Pedersen and P. Ohrmann designed the study. L. Materna, A. Shushakova, J. Trieloff, J. Bauer, A. Pedersen and P. Ohrmann acquired the data, which L. Materna, C. Wiesner, A. Shushakova, N. Weber, A. Engell, R. Schubotz, J. Bauer, A. Pedersen and P. Ohrmann analyzed. L. Materna, C. Wiesner, A. Engell, J. Bauer, A. Pedersen and P. Ohrmann wrote the article, which all authors reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.

DOI: 10.1503/cjs.180139

Correspondence to: P. Ohrmann, Department of Psychiatry, School of Medicine, University of Münster, Albert-Schweitzer-Campus 1, 48149 Münster, Germany; ohrmann@uni-muenster.de