Emotional dysregulation in adult ADHD and response to atomoxetine

ABSTRACT Objective: Agreement on the symptoms of adult ADHD remains problematic. The Wender- Reimherr Adult Attention Deficit Disorder Scale (WRAADDS) contains three items which could be considered signs of emotional dysregulation: temper, affective lability and emotional over-reactivity. Previously published data were reexamined to assess: 1) the pervasiveness of these symptoms; 2) if their presence predicted a favorable response to atomoxetine; and 3) was their response to atomoxetine similar to other ADHD symptoms. Method: This placebo-controlled, double-blind study was conducted concurrently at 31 outpatient sites. Patients met DSM-IV criteria for ADHD, confirmed using the Conners' Adult ADHD Diagnostic Interview. Outcome was assessed using the Conners' Adult ADHD Rating Scale (CAARS) and the WRAADDS. Emotional dysregulation was operationally defined as scores of 7 or more on the three scales. Results: Emotional dysregulation affected 31% of the population. There was a significant interaction between treatment and emotional dysregulation on improvement of the CAARS (p=.031). These emotional factors displayed a treatment effect (p<.001) similar to the CAARS. Conclusions: Patient outcome was related to emotional dysregulation as defined using the WRAADDS. These emotional symptoms showed treatment effects that were statistically significant and similar in size to the traditional signs of hyperactivity/impulsivity and inattention. In the past, ADHD was known as MBD and included emotional and personality dimensions. It is uncertain whether these dimensions should be viewed as part of an ADHD spectrum or independent comorbid diagnoses. Recent studies with atomoxetine in adults were carefully designed to exclude other comorbid adult psychiatric diagnoses and used both the CAARS and WRAADDS to assess outcome. Three factors on the WRAADDS appear to measure emotional dysregulation while the other four factors measure DSM-IV criteria. These factors were used to assess the frequency of emotional dysregulation in adult ADHD. We then examined the attributes of these patients and effects of atomoxetine in these patients both on emotional dysregulation and DSM-IV criteria symptoms of ADHD.