2025 Theses Doctoral

What Happens if Emotion Dysregulation is Incorporated into ADHD Diagnostic Criteria?

Nazmiyal, Ara

The role of emotion dysregulation (ED) in Attention-Deficit/Hyperactivity Disorder (ADHD) has been the subject of growing theoretical and empirical interest, particularly in adult populations. The current study investigates the diagnostic implications of incorporating ED into ADHD criteria, using a large clinical sample of young adults (N = 2,459) undergoing psychoeducational evaluations. Participants completed standardized self-report measures of ADHD symptoms (Conners' Adult ADHD Rating Scales–Self-Report: Long Version) emotion dysregulation (The Behavior Rating Inventory of Executive Function for Adults, Emotional Control subscale & Personality Assessment Inventory, Affective Instability subscale).

Four hypotheses were tested to assess the degree of overlap between ED and ADHD symptom domains, evaluate changes in diagnostic prevalence when ED replaced hyperactive-impulsive symptoms in combined-type ADHD criteria, and explore gender-related diagnostic shifts. Correlational analyses revealed that both inattentive and hyperactive-impulsive symptoms were similarly associated with ED, challenging the assumption that ED is more strongly tied to hyperactivity-impulsivity. Substituting ED for hyperactive-impulsive criteria yielded similar overall prevalence rates of combined-type ADHD, yet identified different individuals, with notably higher proportions of females captured under ED-inclusive criteria.

Findings suggest that ED represents a distinct and clinically meaningful dimension of ADHD symptomatology, particularly in adults. These results provide empirical support for incorporating ED as a severity specifier within diagnostic frameworks, enhancing identification accuracy and better capturing the nuanced presentations of ADHD populations. Implications for DSM revisions, gender equity in diagnosis, and targeted interventions are discussed.