Emotion regulation strategy and its relationship with emotional dysregulation in children with attention-deficit/hyperactivity disorder: behavioral and brain findings.

Important associations between emotional dysregulation (ED) and ADHD have been identified in adults, with a key manifestation of this being differential use of emotion regulation strategies: reduced use of cognitive reappraisal (CR), but elevated expressive suppression (ES). These associations have been observed at both behavioral and neuroimaging levels. The present study aims to explore the use of CR and ES in children with ADHD, and their relationship to ED. 148 children with ADHD and 265 healthy controls (age 9-16 years) were recruited and evaluated and correlated their ED, CR, and ES. Resting-state fMRI functional connectivity, with 6 amygdala subregions as regions-of-interest, were analyzed in a subsample to identify potential neural correlates. Children with ADHD showed significant higher ED, and lower use of both CR and ES. A significant negative correlation was found between CR and ED. Mediation analysis indicated that CR has an indirect influence on the relationship between ADHD diagnosis and ED. In the neuroimaging analyses, the functional connectivity between the right superficial amygdala and left middle occipital gyrus showed a significant group-by-ES interaction, highlighting potential neural correlates for elevated ED in children with ADHD. Children with ADHD expressed elevated levels of ED, and used less CR and ES compared to healthy controls. The lower use of ES may relate to abnormal amygdala connectivity in children with ADHD. This finding suggested that brain immaturity in children may preclude effective deployment of ES in emotion regulation processes.