Revisiting stimulant use for emotional dysregulation in attention-deficit/hyperactivity disorder (ADHD)

ABSTRACT

Introduction

Emotional dysregulation (ED) symptoms are present in a considerable portion of patients with attention-deficit/hyperactivity disorder (ADHD). In recent years, an increasing number of studies investigated the effects of stimulant medications on ED in patients with ADHD.

Areas covered

A narrative review of the literature on stimulant treatment for ED is provided, including controlled and observational clinical studies conducted on pediatric and adult samples and neurobiological investigations. Positive effects of stimulants on irritability have been demonstrated in children. Comorbidity with disruptive behavior disorders (DBD) and disruptive mood dysregulation disorder does not prevent stimulant effectiveness. Methylphenidate has also been found to reduce temper problems, affective instability, and emotional over-reactivity in adults with ADHD, although with variable effect sizes. A variety of adverse emotional effects have been reported, especially at high doses and in special populations. However, several possible confounders of treatment-emergent ED have been highlighted. Finally, according to neuroimaging studies, stimulants may mitigate emotional processing anomalies associated with ADHD.

Expert opinion

The findings are consistent with models including ED within the core features of ADHD. Stimulant treatment should be prioritized over antipsychotics in ADHD-DBD. It remains to be elucidated whether other medications may be more effective in specific populations with ADHD and/or ED.

KEYWORDS:

• Attention-deficit/hyperactivity disorder
• emotional dysregulation
• irritability
• disruptive behavior disorders
• disruptive mood dysregulation disorder
• stimulant
• methylphenidate
• amphetamines

Article highlights

• Stimulants effectively treat irritability and anger-related behaviors in children with ADHD

• No randomized, controlled trials on stimulants for ED were conducted in adolescents

• MPH effectively treats different ED facets in adults with ADHD

• Treatment-emergent ED symptoms are more common at higher doses, lower ages, and in patients with intellectual disability and autism

• Stimulants may attenuate abnormal orientation toward emotional stimuli

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.