Abstract
Unipolar depression is a common comorbidity in children with ADHD with rates ranging from 12-50%. Compared to children with ADHD alone, children with comorbid ADHD and depression require more intense interventions since they experience higher levels of stress and more psychosocial and familial problems. One mechanism hypothesized to underlie the relationship between ADHD and depression is emotion dysregulation. Cross-sectional and longitudinal research has shown that emotion dysregulation mediates the relationship between ADHD and depression. However, there are a number of limitations in the extant literature regarding emotion dysregulation as a mechanism underlying the relationship between ADHD and depression. This article aims to review those limitations and propose that by examining a specific type of emotion dysregulation, poor frustration tolerance, we may gain critical insight into the mechanisms underlying ADHD and depression. We discuss the construct of frustration, its neural basis and evidence that poor frustration tolerance is a key impairment in children with ADHD. We conclude by suggesting that poor frustration tolerance may be a key mechanism underlying the relationship between ADHD and depression, and provide recommendations for how future research can utilize affective neuroscience techniques to examine the neural, behavioral and clinical correlates of frustration tolerance in children with ADHD to more comprehensively examine this relationship.
Similar content being viewed by others
References
Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164(6):942–8. doi:10.1176/ajp.2007.164.6.942.
Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics : the journal of the American Society for Experimental NeuroTherapeutics. 2012;9(3):490–9. doi:10.1007/s13311-012-0135-8.
Bloom B, Cohen RA, Freeman G. Summary health statistics for US children: national health interview survey, 2011. Vital and health statistics, Data from the National Health Survey. 2012;10(254):1–88.
Larson K, Russ SA, Kahn RS, Halfon N. Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics. 2011;127(3):462–70. doi:10.1542/peds.2010-0165; 10.1542/peds.2010-0165.
Biederman J, Newcorn J, Sprich S. Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety and other disorders. Am J Psychiatry. 1991;148:564–77.
Jensen PS, Hinshaw SP, Kraemer HC, Lenora N, Newcorn JH, Abikoff HB, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry. 2001;40(2):147–58. doi:10.1097/00004583-200102000-00009.
Barkley RA. Attention deficit hyperactivity disorder: a handbook for diagnosis and treatment. 3rd ed. New York, NY: Guilford Press; 2006.
Wahlstedt C. Neuropsychological deficits in relation to symptoms of ADHD: independent contributions and interactions. Child neuropsychology : a journal on normal and abnormal development in childhood and adolescence. 2009;15(3):262–79. doi:10.1080/09297040802524198.
Jarrett MA, Ollendick TH. A conceptual review of the comorbidity of attention-deficit/hyperactivity disorder and anxiety: implications for future research and practice. Clin Psychol Rev. 2008;28(7):1266–80. doi:10.1016/j.cpr.2008.05.004.
Meinzer MC, Pettit JW, Viswesvaran C. The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: a meta-analytic review. Clin Psychol Rev. 2014;34(8):595–607. doi:10.1016/j.cpr.2014.10.002.
Angold A, Costello EJ, Erkanli A. Comorbidity. Journal of child psychology and psychiatry, and allied disciplines. 1999;40(1):57–87.
Chronis-Tuscano A, Molina BS, Pelham WE, Applegate B, Dahlke A, Overmyer M, et al. Very early predictors of adolescent depression and suicide attempts in children with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry. 2010;67(10):1044–51. doi:10.1001/archgenpsychiatry.2010.127.
Lahey BB, Hartung CM, Loney J, Pelham WE, Chronis AM, Lee SS. Are there sex differences in the predictive validity of DSM-IV ADHD among younger children? Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53. 2007;36(2):113–26. doi:10.1080/15374410701274066.
Elia J, Ambrosini P, Berrettini W. ADHD characteristics: I. Concurrent co-morbidity patterns in children & adolescents. Child and adolescent psychiatry and mental health. 2008;2(1):15. doi:10.1186/1753-2000-2-15.
Daviss WB. A review of co-morbid depression in pediatric ADHD: etiology, phenomenology, and treatment. Journal of child and adolescent psychopharmacology. 2008;18(6):565–71. doi:10.1089/cap.2008.032.
Biederman J, Ball SW, Monuteaux MC, Mick E, Spencer TJ, McCreary M, et al. New insights into the comorbidity between ADHD and major depression in adolescent and young adult females. J Am Acad Child Adolesc Psychiatry. 2008;47(4):426–34. doi:10.1097/CHI.0b013e31816429d3.
Blackman GL, Ostrander R, Herman KC. Children with ADHD and depression: a multisource, multimethod assessment of clinical, social, and academic functioning. J Atten Disord. 2005;8(4):195–207. doi:10.1177/1087054705278777.
Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry. 2014; doi:10.1176/appi.ajp.2013.13070966.
Thompson RA. Emotion regulation: a theme in search of definition. Monogr Soc Res Child Dev. 1994;59(2–3):25–52.
Barkley RA. Attention-deficit/hyperactivity disorder, self-regulation, and time: toward a more comprehensive theory. Journal of developmental and behavioral pediatrics : JDBP. 1997;18(4):271–9.
Martel MM. Research review: a new perspective on attention-deficit/hyperactivity disorder: emotion dysregulation and trait models. Journal of child psychology and psychiatry, and allied disciplines. 2009;50(9):1042–51. doi:10.1111/j.1469-7610.2009.02105.x.
Durbin C, Shafir D. Emotion regulation and risk for depression. In: Abela JR, Hankin BL, editors. Handbook of depression in children and adolescents. New York: Guilford; 2008. p. 149–76.
Anastopoulos AD, Smith TF, Garrett ME, Morrissey-Kane E, Schatz NK, Sommer JL, et al. Self-regulation of emotion, functional impairment, and comorbidity among childrenwith AD/HD. J Atten Disord. 2011;15(7):583–92. doi:10.1177/1087054710370567.
Seymour KE, Chronis-Tuscano A, Halldorsdottir T, Stupica B, Owens K, Sacks T. Emotion regulation mediates the relationship between ADHD and depressive symptoms in youth. J Abnorm Child Psychol. 2012;40(4):595–606. doi:10.1007/s10802-011-9593-4.
Seymour KE, Chronis-Tuscano A, Iwamoto DK, Kurdziel G, Macpherson L. Emotion regulation mediates the association between ADHD and depressive symptoms in a community sample of youth. J Abnorm Child Psychol. 2014;42(4):611–21. doi:10.1007/s10802-013-9799-8.
Leibenluft E, Blair RJ, Charney DS, Pine DS. Irritability in pediatric mania and other childhood psychopathology. Ann N Y Acad Sci. 2003;1008:201–18.
Leibenluft E, Stoddard J. The developmental psychopathology of irritability. Dev Psychopathol. 2013;25(4 Pt 2):1473–87. doi:10.1017/S0954579413000722.
Geller B, Zimerman B, Williams M, Delbello MP, Bolhofner K, Craney JL, et al. DSM-IV mania symptoms in a prepubertal and early adolescent bipolar disorder phenotype compared to attention-deficit hyperactive and normal controls. Journal of child and adolescent psychopharmacology. 2002;12(1):11–25. doi:10.1089/10445460252943533.
American Psychiatric Association. Diagnostics and statistics manual of mental disorders (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.
Melnick SM, Hinshaw SP. Emotion regulation and parenting in AD/HD and comparison boys: linkages with social behaviors and peer preference. J Abnorm Child Psychol. 2000;28(1):73–86.
Maedgen JW, Carlson CL. Social functioning and emotional regulation in the attention deficit hyperactivity disorder subtypes. Journal of clinical child psychology. 2000;29(1):30–42. doi:10.1207/S15374424jccp2901_4.
Walcott CM, Landau S. The relation between disinhibition and emotion regulation in boys with attention deficit hyperactivity disorder. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53. 2004;33(4):772–82. doi:10.1207/s15374424jccp3304_12.
Seymour KE, Macatee R, Chronis-Tuscano A. Frustration tolerance in youth with ADHD. J Atten Disord. 2016; doi:10.1177/1087054716653216.
Phillips ML, Drevets WC, Rauch SL, Lane R. Neurobiology of emotion perception I: the neural basis of normal emotion perception. Biol Psychiatry. 2003;54(5):504–14. doi:10.1016/s0006-3223(03)00168-9.
Phillips ML, Ladouceur CD, Drevets WC. A neural model of voluntary and automatic emotion regulation: implications for understanding the pathophysiology and neurodevelopment of bipolar disorder. Mol Psychiatry. 2008;13(9):829. doi:10.1038/mp.2008.65.33-57
Haber SN, Knutson B. The reward circuit: linking primate anatomy and human imaging. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 2010;35(1):4–26. doi:10.1038/npp.2009.129.
Ochsner KN, Gross JJ. The cognitive control of emotion. Trends Cogn Sci. 2005;9(5):242–9. doi:10.1016/j.tics.2005.03.010.
Ochsner KN, Ray RR, Hughes B, McRae K, Cooper JC, Weber J, et al. Bottom-up and top-down processes in emotion generation: common and distinct neural mechanisms. Psychol Sci. 2009;20(11):1322–31. doi:10.1111/j.1467-9280.2009.02459.x.
Abler B, Walter H, Erk S. Neural correlates of frustration. Neuroreport. 2005;16(7):669–72.
Yu R, Mobbs D, Seymour B, Rowe JB, Calder AJ. The neural signature of escalating frustration in humans. Cortex. 2014;54(0):165–78. doi:10.1016/j.cortex.2014.02.013.
Siegrist J, Menrath I, Stocker T, Klein M, Kellermann T, Shah NJ, et al. Differential brain activation according to chronic social reward frustration. Neuroreport. 2005;16(17):1899–903.
Shackman AJ, Salomons TV, Slagter HA, Fox AS, Winter JJ, Davidson RJ. The integration of negative affect, pain and cognitive control in the cingulate cortex. Nat Rev Neurosci. 2011;12(3):154–67. doi:10.1038/nrn2994.
Lopez-Larson M, Michael E, Terry JE, Breeze JL, Hodge SM, Tang L, et al. Subcortical differences among youth with attention deficit hyperactivity disorder compared to those with bipolar disorder with and without attention deficit hyperactivity disorder. Journal of child and adolescent psychopharmacology. 2009;19(1):31–9.
Sasayama D, Hayashida A, Yamasue H, Harada Y, Kaneko T, Kasai K, et al. Neuroanatomical correlates of attention-deficit-hyperactivity disorder accounting for comorbid oppositional defiant disorder and conduct disorder. Psychiatry Clin Neurosci. 2010;64(4):394–402. doi:10.1111/j.1440-1819.2010.02102.x.
Seymour KE, Tang X, Crocetti D, Mostofsky SH, Miller MI, Rosch KS. Anomalous subcortical morphology in boys, but not girls, with ADHD compared to typically developing controls and correlates with emotion dysregulation. Psychiatry Res Neuroimaging. doi:10.1016/j.pscychresns.2017.01.002.
Posner J, Siciliano F, Wang Z, Liu J, Sonuga-Barke E, Greenhill L. A multimodal MRI study of the hippocampus in medication-naive children with ADHD: what connects ADHD and depression? Psychiatry Res. 2014;224(2):112–8. doi:10.1016/j.pscychresns.2014.08.006.
Campbell S, MacQueen G. An update on regional brain volume differences associated with mood disorders. Current opinion in psychiatry. 2006;19(1):25–33. doi:10.1097/01.yco.0000194371.47685.f2.
MacQueen GM, Campbell S, McEwen BS, Macdonald K, Amano S, Joffe RT, et al. Course of illness, hippocampal function, and hippocampal volume in major depression. Proc Natl Acad Sci U S A. 2003;100(3):1387–92. doi:10.1073/pnas.0337481100.
Sheline YI, Price JL, Yan Z, Mintun MA. Resting-state functional MRI in depression unmasks increased connectivity between networks via the dorsal nexus. Proc Natl Acad Sci U S A. 2010;107(24):11020–5. doi:10.1073/pnas.1000446107.
Kerestes R, Davey CG, Stephanou K, Whittle S, Harrison BJ. Functional brain imaging studies of youth depression: a systematic review. NeuroImage Clinical. 2014;4:209–31. doi:10.1016/j.nicl.2013.11.009.
Passarotti AM, Sweeney JA, Pavuluri MN. Differential engagement of cognitive and affective neural systems in pediatric bipolar disorder and attention deficit hyperactivity disorder. Journal of the International Neuropsychological Society : JINS. 2010;16(1):106–17. doi:10.1017/S1355617709991019.
Posner J, Maia TV, Fair D, Peterson BS, Sonuga-Barke EJ, Nagel BJ. The attenuation of dysfunctional emotional processing with stimulant medication: an fMRI study of adolescents with ADHD. Psychiatry Res. 2011;193(3):151–60. doi:10.1016/j.pscychresns.2011.02.005.
Acknowledgements
This work was supported by grants awarded to Dr. Seymour from the National Institute of Mental Health (NIMH) (K23 MH107734) and Dr. Miller (K23 MH090246).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
Karen E. Seymour reports speaker fees from Medgenics Inc.; consultant fees from AvaCat Consulting; and grants from the National Institute of Mental Health (NIMH) (K23 MH107734).
Leslie Miller reports a grant from the National Institute of Mental Health (K23 MH090246).
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Rights and permissions
About this article
Cite this article
Seymour, K.E., Miller, L. ADHD and Depression: the Role of Poor Frustration Tolerance. Curr Dev Disord Rep 4, 14–18 (2017). https://doi.org/10.1007/s40474-017-0105-2
Published:
Issue Date:
DOI: https://doi.org/10.1007/s40474-017-0105-2