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Background Emotional difficulties are common in attention-deficit/hyperactivity disorder (ADHD), but previous research lack specificity regarding how reactivity and regulation of distinct emotions relate to categorical (diagnostic) and dimensional (trait-level) ADHD, while also clarifying sex- and age-related patterns. Considering co-occurring psychiatric traits is important due to the transdiagnostic nature of emotional challenges. Method This cross-sectional study included two samples: a diagnostic cohort ( N  = 104, 10–17 years, 56.7% females) consisting of participants with an ADHD diagnosis ( n  = 56) and typically developing controls ( n  = 48), and a cohort referred to a first visit to a specialist psychiatric unit ( N  = 85, 13–18 years, 78.8% females) for which a dimensional measure of ADHD was used. Linear regressions were used to assess associations between ADHD and self- and caregiver-rated reactivity (frequency/intensity) and regulation (by oneself or with the help of others) of four different emotions (sadness, fear, anger and exuberance) using the Emotion Questionnaire. Effects of sex were explored. Adjustments were made for age and co-occurring psychiatric traits (anxiety, depression, conduct problems and autism) within the referred cohort. Findings were validated through caregiver ratings for the diagnostic cohort (N=103) and the referred cohort (N=212). Results Diagnostic and trait-level ADHD were robustly linked to reactivity and a limited ability to regulate (i.e., dysregulation) anger. Diagnostic ADHD was also related to dysregulation of exuberance and fear, and higher levels of sadness and fear reactivity. Trait-level ADHD was, in addition to anger, associated with elevated reactivity and dysregulation of exuberance, adjusting for co-occurring psychiatric symptoms. No interaction effects of sex by ADHD were identified. Conclusion Anger may be particularly relevant for ADHD. Reactivity and dysregulation of exuberance may also be important for ADHD, although further research is needed to clarify the relation between ADHD and positive emotions. Potential effects of sex and co-occurring psychiatric traits are discussed.

Background Emotion dysregulation (ED) is common in attention-deficit/hyperactivity disorder (ADHD) and often results in adverse outcomes. However, ED has been suggested as a transdiagnostic construct, why the specific association between ADHD and ED when adjusting for other mental health conditions needs further investigation. It is also important to determine the aetiological basis of the association between ADHD and ED to inform the theoretical conceptualization of ADHD. Method This study used a co-twin control design, including a sample of dizygotic (DZ) and monozygotic (MZ) twins (N = 389; 45.8% females, age = 8–31 years, MZ twin pairs 57.6%). ED was assessed using the dysregulation profile from the parent-rated Child Behaviour Checklist and its adult version. Regression analyses were used across individuals and within the pairs, while adjusting for diagnoses of autism, intellectual disability, other neurodevelopmental conditions and affective conditions. Results ADHD was significantly associated with ED, even when adjusting for age, sex, attention problems and other mental health conditions, and was the diagnosis most strongly associated with ED. Within-pair analyses revealed that twins with ADHD had higher levels of ED compared to their co-twin without ADHD. This association remained within DZ twins and was non-significant in the MZ subsample, with non-overlapping confidence intervals between the DZ and MZ estimates. Conclusion ADHD is strongly and in part independently linked to ED, stressing the importance of early detection and treatment of emotional difficulties within this group. The findings from the within-pair analyses indicate a genetic influence on the association between ADHD and ED.

Autism is frequently associated with difficulties with top-down attentional control, which impact on individuals’ mental health and quality of life. The developmental processes involved in these attentional difficulties are not well understood. Using a data-driven approach, 2 samples (N = 294 and 412) of infants at elevated and typical likelihood of autism were grouped according to profiles of parent report of attention at 10, 15 and 25 months. In contrast to the normative profile of increases in attentional control scores between infancy and toddlerhood, a minority (7–9%) showed plateauing attentional control scores between 10 and 25 months. Consistent with pre-registered hypotheses, plateaued growth of attentional control was associated with elevated autism and ADHD traits, and lower adaptive functioning at age 3 years.