New Study: Adult ADHD Diagnosis Criteria Should Include Emotional Symptoms

April 21, 2020

Classifying attention deficit hyperactivity disorder (ADHD or ADD) into two subtypes based on levels of emotional dysregulation offers a more clinically relevant approach for diagnosing ADHD in adults than does the current DSM-5 criteria, according to the conclusion of a replication analysis published in the Journal of Clinical Psychiatry.¹

The replication analysis revisited a 2015 study that divided adult ADHD into two presentations: ADHD inattentive presentation and ADHD emotional dysregulation presentation, using the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). Researchers found that defining and assessing subjects according to these two subtypes revealed cases of adult ADHD that might otherwise have been mistaken for another condition like mood disorder or bipolar disorder.

“Many cases of ADHD in adults are not being accurately assessed,” said Frederick W. Reimherr, M.D., adjunct professor emeritus in the department of psychiatry at University of Utah School of Medicine in an interview with Healio Psychiatry.² “The lack of criteria for this diagnosis reflecting emotionality has contributed to this problem. Given the many reports of adults with ADHD experiencing comorbid depression, anxiety, or bipolar disorder, this system will help lead to more appropriate treatment of patients with and without comorbid disorders.”

In developing this system, researchers used eight double-blind adult ADHD clinical trials encompassing 1,490 participants who had been assessed with the WRAADDS, an alternative ADHD measure, and the Clinical Global Impressions-Severity of Illness Scale (CGI-S). Confirmatory analyses of the data were conducted as well as comparisons of ADHD presentations, including treatment response.

ADHD inattentive presentation was defined as having high levels of attention difficulties, disorganization, and lower levels of emotional symptoms. ADHD emotional dysregulation presentation was defined as having high levels of emotional dysregulation (temper control problems, affective lability and emotional over-reactivity), combined with inattentive symptoms.

774 participants demonstrated ADHD inattentive presentation and 620 demonstrated ADHD emotional dysregulation presentation. The presentation of ADHD emotional dysregulation ranged from 25% to 73% of participants across the eight studies. Researchers found associations between this presentation and a greater severity of symptoms as measured by the CGI-S as well as more common manifestations of childhood ADHD, as measured by Wender Utah Rating Scale. Additionally, patients with emotional dysregulation symptoms showed significant response to both methylphenidate and atomoxetine.

“The improvement in these emotional dysregulation symptoms with medications shown to be effective in treating ADHD supports the inclusion of these symptoms in the diagnostic criteria,” Reimherr said.

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