Departments of Psychiatry, Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
Departments of Psychiatry and Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
J Child Psychol Psychiatry. 2019 Feb;60(2):133-150. doi: 10.1111/jcpp.12899. Epub 2018 Apr 6.
Because emotional symptoms are common in attention-deficit/hyperactivity disorder (ADHD) patients and associate with much morbidity, some consider it to be a core feature rather than an associated trait. Others argue that emotional symptoms are too nonspecific for use as diagnostic criteria. This debate has been difficult to resolve due, in part, to the many terms used to describe emotional symptoms in ADHD and to concerns about overlap with mood disorders.
We sought to clarify the nature of emotional symptoms in ADHD by reviewing conceptual and measurement issues and by examining the evidence base regarding specificity of such symptoms for ADHD. We reviewed the various terms used to define emotional symptoms in ADHD, clarify how these symptoms are demarcated from mood disorders, and assess the possibility that symptoms of emotional impulsivity and deficient emotional self-regulation should be considered as core symptoms. We addressed psychiatric comorbidities, the effects of ADHD treatments on associated emotional dysregulation, and the utility of current rating scales to assess emotional symptoms associated with ADHD.
Emotional symptoms are common and persistent in youth and adults with ADHD. Although emotional symptoms are common in other psychiatric disorders, emotional impulsivity (EI), and deficient emotional self-regulation (DESR) may be sufficiently specific for ADHD to function as diagnostic criteria.
Emotional symptoms in ADHD cause clinically significant impairments. Although there is a solid theoretical rationale for considering EI and DESR to be core symptoms of ADHD, there is no consensus about how to define these constructs sin a manner that would be specific to the disorder. An instrument to measure EI and DESR which demarcates them from irritability and other emotional symptoms could improve the accuracy of diagnostic criteria for ADHD.
由于情绪症状在注意缺陷多动障碍（ADHD）患者中很常见，且与许多发病率有关，因此一些人认为它是核心特征，而不是相关特征。另一些人则认为，情绪症状过于非特异性，不能作为诊断标准。由于部分原因，这个争议一直难以解决，因为在 ADHD 中用于描述情绪症状的术语很多，而且人们还担心与情绪障碍的重叠问题。
我们通过回顾概念和测量问题，并检查有关此类症状对 ADHD 的特异性的证据基础，旨在阐明 ADHD 中情绪症状的性质。我们审查了用于定义 ADHD 中情绪症状的各种术语，阐明了这些症状与情绪障碍的区别，并评估了将情绪冲动和情绪自我调节不足的症状视为核心症状的可能性。我们还讨论了精神病共病、ADHD 治疗对相关情绪失调的影响，以及当前评估量表用于评估与 ADHD 相关的情绪症状的实用性。
情绪症状在患有 ADHD 的青少年和成年人中很常见且持续存在。尽管情绪症状在其他精神疾病中很常见，但情绪冲动（EI）和情绪自我调节不足（DESR）可能对 ADHD 具有足够的特异性，可以作为诊断标准。
ADHD 中的情绪症状会导致明显的临床损害。尽管从理论上有充分的理由认为 EI 和 DESR 是 ADHD 的核心症状，但尚未就如何以特定于该疾病的方式定义这些结构达成共识。一种用于测量 EI 和 DESR 的工具，可以将它们与易激惹和其他情绪症状区分开来，这可能会提高 ADHD 诊断标准的准确性。
