Emotion Regulation and Attention Deficit Hyperactivity Disorder

Chapter 6 describes emotion dysregulation features which are associated with children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD). In ADHD adaptive emotion regulation processes are impaired; this negatively impacts the individual’s ability to flexibly select, attend, and appraise emotionally evocative stimuli. This is identified as emotion dysregulation, which occurs when individuals fail to alter emotional states that affect behaviours necessary for achieving one’s goals. This review also examines the relationship between executive functions and emotion dysregulation in ADHD. Successful modulation of emotion occurs as a result of intact executive functions; however, ADHD is characterized by poor executive functions as a result of deficits in the prefrontal cortical networks. Along with describing neural mechanisms associated with ADHD, this review also focuses on the development of emotion dysregulation, clinical implications and current interventions.

Children’s and Adolescents’ Emotion Regulation in the Context of Parental Incarceration

This chapter discusses children’s emotion regulation and adjustment in relation to parental incarceration. Parental incarceration may contribute to psychological maladjustment by disrupting the attachment bond between the parent and child and by influencing the development and deployment of maladaptive emotion regulation competencies. A nascent body of research indicates children of incarcerated parents are at risk for negative socio-emotional, psychological, educational, and health outcomes. Limited studies have investigated the impact incarceration has on emotion regulation; preliminary findings demonstrate children who manifest stronger emotion regulation skills have fewer negative psychological outcomes. Thus, a more comprehensive investigation of emotion regulation competencies fostering resilience is warranted. Additionally, future research investigating the impact of modeling and emotion coaching by key socializing figures is warranted. Training children and caregivers to manage affect during emotionally-provocative situations during the incarceration period (e.g., visitations, family reunification) may promote healthy adjustment.

Emotion Regulation in Autism Spectrum Disorder

Chapter 12 discusses childhood and adolescent autism spectrum disorder (ASD), a pervasive neurodevelopmental disorder characterized by deficits in social communication, and by restricted, repetitive patterns of behavior, interests, or activities. Emotion regulation difficulty, particularly understanding emotion, is common in ASD, as is the use of maladaptive regulatory strategies (i.e., avoidance, expressive suppression). In terms of treatment, robust empirical evidence supports using mindfulness and cognitive behavioral approaches in treating anxiety, a frequent outcome of emotion dysregulation in youth ASD. In addition, two psychopharmacologic medications, risperidone and ariprazole, have well-established evidence supporting their utility in this population. Understanding the underlying dynamics of emotion regulation through ASD from a developmental perspective, whilst considering the stressors unique to this population, is imperative in order to improve treatment outcomes and optimize individualized skill development. The chapter concludes with a description of a novel intervention designed to specifically address emotion regulation difficulties in children with ASD.

Emotion Regulation and Substance Use Disorders in Adolescents

Chapter 11 evaluates how emotion dysregulation enhances vulnerability to substance use disorders in adolescents. In late adolescence (15–18 years of age), recurrent substance users are prone to develop substance use disorder in adulthood. Substance use disorder may be broadly characterized as the inability to regulate substance consumption, deleteriously impacting social functioning, whilst accumulating a myriad of negative consequences and recurring risk to the self. Research suggests emotion dysregulation may be a predisposing factor that presents prior to onset of disorder. Moreover, dysregulation in cognitive, emotional and behavioral domains may be interconnected processes; substance abuse presenting as a product of overall dysregulation. Although theoretical efforts have outlined conceptual models delineating the relationship between emotion regulation and substance abuse, limited evidence has been garnered in adolescent samples. From a treatment perspective, school-based interventions centered on fostering adaptive emotion regulation skills have demonstrated efficacy, and maintained positive findings at long-term follow-up.

Emotion Regulation and Eating Disorders

Chapter 10 discusses the prevalence and manifestation of childhood and adolescent eating disorders focusing on Anorexia Nervosa (AN), due to its prevalence. Implementation of maladaptive emotion regulation strategies, with a reduced ability to label and describe emotions leads to the development and propagation of AN. Family based treatments have been widely recognized, as the leading intervention for adolescents with AN, with efficacy rates from 20% to 60%. However, this chapter focuses on a novel approach to AN treatment, centered on emotion regulation in its management, as this may improve treatment outcomes. Programs include: Maudsley Model of Anorexia Nervosa Treatment for Adults and Emotion Acceptance Behavior Therapy, in addition to the modification or adaption of existing, evidence based treatments, such as Radically-Open DBT, although many programs require empirical validation in adolescent samples.

Emotion Regulation and Conduct Disorder

The present chapter examines several developmental pathways towards a diagnosis of conduct disorder (CD) in childhood and adolescence. In particular, we discuss the evidence for considering how children with CD manage their emotions since subgroups of children with CD may show a different developmental trajectory based on their emotion regulation abilities. The chapter reviews the prevalence and life-course of CD, the development of emotion regulation, temperament and emotionality, and the development of reactive and proactive aggression. It discusses the biopsychosocial distinction of CD with callous-unemotional (CU) traits and CD with severe anger dysregulation. It also reviews the most recent evidence on effective interventions and treatment for children and adolescents with CD and CU traits. The chapter closes with a discussion of the implications for clinical practice of CD based on the heterogeneity within the disorder.

Cultural and Social Aspects of Emotion Regulation

Chapter 4 investigates how emotion regulation is a socially constructed, culturally influenced phenomenon. Investigating emotion regulation through a cultural lens provides a viable framework to differentiate social norms according to a larger social context. In Western cultures fostering autonomy and cultivating a positive personal self-concept is important for emotion regulation. In contrast, in non-Western cultures achieving harmony among relationships is the primary goal of emotion regulation. Cross-cultural research has determined both similarities and differences. Accordingly, empirical findings suggest emotion expression is common in Western cultures, whereas, suppression is common among Asian cultures. Relatedly, the same regulatory strategies have divergent effects in different cultures. Research has demonstrated the association between suppression and psychopathology in Western cultures; however, emotional suppression has been associated with positive health outcomes in East Asian cultures. Yet, cultures are often heterogeneous in nature, supporting both autonomy and harmony; thus, future research should consider intra-cultural differences more closely.

Adolescents who Engage in Nonsuicidal Self-Injury (NSSI)

Nonsuicidal self-injury (NSSI) refers to intentional damage to the body without fatal intent. While distal factors such as genetic predisposition, emotional sensitivity, emotional reactivity and invalidating childhood environments may serve as risk factors, NSSI is primarily maintained by alleviation of intense negative emotional states, in the absence of alternative emotion regulation strategies. Currently, no specific NSSI intervention for adolescents exists; however, extant self-harm interventions have demonstrated promising, preliminary findings. Of note, the salient role of emotion regulation in the initiation and maintenance of NSSI suggests this may be a viable treatment target. While empirical evidence supports this in adult samples, replication in large-scale, randomized controlled trials with adolescent samples is required to inform best practice in treating NSSI among adolescents.

Emotion Regulation and Anxiety

Chapter 8 reviews anxiety disorders of childhood and adolescence, investigating the role of emotion regulation in onset, maintenance and propagation. Based on DSM-5 criteria anxiety disorders have the following core features: Excessive, persisting anxious arousal and clinically significant symptoms causing distress or dysfunction in social, academic or other domains of functioning. Currently, CBT interventions have been created for school-aged children with anxiety including the Coping Cat and the Cool Kids programs. Despite relatively high success rates, children remaining symptomatic after treatment may benefit from emotion-focused approaches, such as Emotion-Focused Cognitive-Behavioral Therapy and the Unified Protocol for the Treatment of Emotional Disorders in Youth. In addition, novel therapies have been devised targeting parents and their emotion regulation deficits like the Supportive Parenting for Anxious Childhood Emotions (SPACE) program. Future research should employ randomized control trials comparing the novel treatment approaches, treatment as usual, and standard CBT determining best practice protocols.

The Relation of Self-Regulation to Children’s Externalizing and Internalizing Problems

Chapter 2 investigates the relation between self-regulation and both internalizing and externalizing problems in children and adolescents. Although the association between children’s self-regulation and externalizing and internalizing symptoms has been established, research on co-morbidity is scarce; moreover, causal models delineating underlying regulatory mechanisms involved in the development and propagation of psychopathology via self-regulatory processes are lacking. Thus, further research is needed to explore potential mediating and moderating variables impacting this association. Intervention research indicates multi-level system-based approaches targeting various aspects of the child’s ecosystem (child-, parent-, peer, and/or school-level elements) elicit tangible changes in emotion regulation competencies and adjustment. Moreover, culture may play a crucial role in the degree to which self-regulation is valued and the extent to which internalizing or externalizing symptoms are viewed as problematic, which in turn, impacts the relation between self-regulation and maladaptive behavior.