Neurobiological research supports the model that includes emotional and motivational problems in the development of ADHD. Increased knowledge of such problems can in the long run lead to better treatment of patients through the development of more individually adapted forms of therapy.

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This emerges from a review article written by Høvik and Plessen and published in the Norwegian Journal for the Association of General Practitioners (Tidsskrift for Norsk Legeforening).

 

ADHD: Not just a disorder of cognitive control functions

ADHD has a prevalence of 5,3% in the child and adolescent population worldwide and is thus one of the most common psychiatric disorders in children. The main symptoms are attention problems, hyperactivity and impulsivity.

The authors of the article write:





Failure of cognitive control functions has long been seen as the main problem in the development of attention deficit / hyperactivity disorder (ADHD). In a newer model, however, the importance of emotional and motivational problems in people with ADHD is emphasized.  

The authors wanted to investigate the background of this model - which also includes emotion regulation and motivation as part of the causes of the development of ADHD. They believed that such an extended model could have an impact on how children and young people with ADHD problems are met in clinical practice.

 





Difficulties with emotional regulation and motivation

Høvik and Plessen conducted a non-systematic literature search in PubMed and selected articles based on their own experience in the field. After reading these articles and their research findings, the authors concluded:

Few studies have been done in this area, which is now devoted to increasing research activity. People with ADHD react differently than controls to tasks that include rewards or stress the ability to regulate emotions. Deviating signals on examination with electroencephalography (EEG) and anatomical and functional magnetic resonance imaging (fMR) reflect problems with emotion regulation in patients with ADHD.

Prevention and treatment of ADHD

It is written in the article in the section on prevention and treatment of ADHD:

If the parents have ADHD, there is a genetic predisposition in the child to develop the disease. In addition, inconsistent, impulsive and disorganized parenting may increase the likelihood of the child developing ADHD symptoms. Consistent and organized upbringing, on the other hand, can act as a protective factor against developing the disease and promoting the child's ability to regulate his emotions. 

They add that research on general sample of children has shown that early interaction with caregivers is important for the development of safe attachment, which in turn forms the basis for adequate emotion regulation, but that little research has been done on relationships between early interaction, attachment, and ADHD. .

With regard to drug treatment, the authors write:

It is well documented that stimulant medications reduce the main symptoms of ADHD, but the direct effect on emotion regulation in children has not been studied). Nevertheless, a general improvement in self-regulation as a result of such medication is likely to help with this type of problem as well.

 

Neurobiological research supports an expanded understanding of ADHD

The review article interprets the findings as follows:

Recent theories and studies highlight the importance of emotional / motivational factors for the development of ADHD. Emotional dysregulation seems to be a widespread and disabling aspect of the disease. A hypofunctional dopamine system, which causes motivational difficulties and altered response to reward, can be an important causal factor in the development of ADHD.

They point out that there is a need for more research in this field, and believe that we in particular have too little knowledge about the development of emotional and motivational problems among people with ADHD in a lifetime perspective. With better knowledge, it will be possible to offer better and more specialized forms of therapy, the authors of the overview study believe.

 

Sources:

  • Emotion regulation and motivation in children with ADHD
  • Sonuga-Barke EJ. The dual pathway model of ADHD: an elaboration of neuro-developmental characteristics. Neurosci Biobehav Rev 2003; 27: 593 - 604.
  • Polanczyk G, de Lima MS, Horta BL et al. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007; 164: 942 - 8.
  • American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV. 4th ed. Washington, DC: American Psychiatric Association, 1994.
  • Sagvolden T, Johansen EB, Aase H et al. A dynamic developmental theory of attention-deficit / hyperactivity disorder (ADHD) predominantly hyperactive / impulsive and combined subtypes. Behav Brain Sci 2005; 28: 397 - 419.
  • Williams LM, Hermens DF, Palmer D et al. Misinterpreting emotional expressions in attention-deficit / hyperactivity disorder: evidence for a neural marker and stimulant effects. Biol Psychiatry 2008; 63: 917 - 26.