Emotional dysregulation in children with attention-deficit/hyperactivity disorder

Emotional dysregulation is increasingly recognized as a core feature of attention-deficit/hyperactivity disorder (ADHD). The purpose of the present systematic literature review was to identify published data related to the neuropsychology of emotional dysregulation in children with ADHD. The literature obtained is discussed in the contexts of deficits in emotional control, impairments in executive function, the emotional components of comorbidities, neurophysiological and autonomic correlates of emotional dysregulation, and the significance of multiple neuropsychological pathways of ADHD on emotional dysregulation. These various lines of evidence are used to create a patient-oriented conceptual model framework of the pathway from stimulus to inappropriate internalized (sadness, moodiness) or externalized (anger, aggressiveness) emotional responses. The article concludes by calling for continued research into the development of reliable and universally accepted measures of emotional dysregulation in order to provide children affected with ADHD, and their caregivers, some explanation for their emotional lability and, ultimately, to be used as tools to evaluate potential treatments.     

The not-so-bitter pill: Effects of combined oral contraceptives on peripheral physiological indicators of emotional reactivity

Combined oral contraceptives (COC) are used by millions of women worldwide. Although findings are not entirely consistent, COC have been found to impact on brain function and, thus, to modulate affective processes. Here, we investigated electro-physiological responses to emotional stimuli in free cycling women in both the early follicular and late luteal phase as well as in COC users. Skin conductance response (SCR), startle reflex, corrugator and zygomaticus activity were assessed. COC users showed reduced overall startle magnitude and SCR amplitude, but heightened overall zygomaticus activity, although effect sizes were small. Thus, COC users displayed reduced physiological reactions indicating negative affect and enhanced physiological responses signifying positive affect. In free cycling women, endogenous 17β-estradiol levels were associated with fear potentiated startle in both cycle phases as well as with SCR and zygomaticus activity during the follicular phase. Testosterone was associated with corrugator and zygomaticus activity during the luteal phase, while progesterone levels correlated with corrugator activity in the follicular phase. To the contrary, in COC users, endogenous hormones were not associated with electro-physiological measures. The results further underscore the importance of considering COC use in psychophysiological studies on emotional processing.     

The physiological indices of emotional reactions in the clinical picture of local brain lesions

The psychophysiological correlates of recognition and reproduction of emotional states were studied in patients with differently localized lesions of the brain cortex. It was shown that the effect of different lesions are anisotropic. The cross and reciprocal interaction between the posteriofrontal and temporal regions of the left and right hemispheres was described. A relation was revealed between the emotion sign and different autonomic indices. A quantitative estimation of physiological reactions of healthy persons and patients with focal brain pathology was carried out.     

Hindbrain noradrenergic A2 neurons: diverse roles in autonomic, endocrine, cognitive, and behavioral functions

Central noradrenergic (NA) signaling is broadly implicated in behavioral and physiological processes related to attention, arousal, motivation, learning and memory, and homeostasis. This review focuses on the A2 cell group of NA neurons, located within the hindbrain dorsal vagal complex (DVC). The intra-DVC location of A2 neurons supports their role in vagal sensory-motor reflex arcs and visceral motor outflow. A2 neurons also are reciprocally connected with multiple brain stem, hypothalamic, and limbic forebrain regions. The extra-DVC connections of A2 neurons provide a route through which emotional and cognitive events can modulate visceral motor outflow and also a route through which interoceptive feedback from the body can impact hypothalamic functions as well as emotional and cognitive processing. This review considers some of the hallmark anatomical and chemical features of A2 neurons, followed by presentation of evidence supporting a role for A2 neurons in modulating food intake, affective behavior, behavioral and physiological stress responses, emotional learning, and drug dependence. Increased knowledge about the organization and function of the A2 cell group and the neural circuits in which A2 neurons participate should contribute to a better understanding of how the brain orchestrates adaptive responses to the various threats and opportunities of life and should further reveal the central underpinnings of stress-related physiological and emotional dysregulation.     

Attention-deficit hyperactivity disorder and cardiac vagal control: a systematic review

Attention-deficit hyperactivity disorder (ADHD) is characterized by behavioural disinhibition, deficient emotional self-regulation, inattention, and hyperactivity. The constellation of deficits found in children with ADHD implicates autonomic dysregulation characterized by deficient control of the heart by parasympathetic influences. While it is generally assumed that autonomic regulation of the heart is impaired during ADHD, the information pertaining to this dysregulation is limited. A systematic review of three databases was conducted between January and March 2012 for peer reviewed publications examining the relationship between cardiac vagal control (CVC) and ADHD without comorbid psychopathology. 19 articles were reviewed with only 6 meeting inclusion criteria. Findings were not unanimous but suggested that children with unmedicated ADHD experienced lower levels of CVC than did healthy controls. It was difficult to evaluate whether children with ADHD exhibited a different pattern of withdrawal and application of CVC than did normal controls. Findings suggested CVC reactivity depended on the task employed but children with ADHD experienced dampened CVC reactivity during tasks that involved self-regulation and emotion regulation. Finally, medication acted to correct the autonomic imbalance experienced by children with ADHD but did not bring this imbalance into normal levels. Given that so few studies were identified, no firm conclusions can be made, and there is a clear need for additional research in this area. Recommendations for future research are discussed.     

Borderline typical symptoms in adult patients with attention deficit/hyperactivity disorder

Adult attention deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) share several clinical features, e.g. emotional lability and impulsivity. This study aimed to delineate differences and similarities between ADHD and BPD with respect to borderline typical symptomatology and gender specifics. Borderline symptomatology was assessed in 60 adult patients with ADHD with the borderline symptom list (BSL) and compared to both 60 gender- and age-matched BPD patients and control subjects. The BSL is a standardized instrument including 95 items on 7 subscales (self-perception, affect regulation, self-destruction, dysphoria, loneliness, intrusions and hostility). Adult ADHD patients showed significantly higher BSL total scores and all of the seven subscales compared to healthy controls (p < 0.001) but lower scores than BPD patients (p < 0.001). With respect to the seven subscales, the largest differences between ADHD and BPD patients were found with respect to self-destruction (d = 1.12) and affect dysregulation (d = 0.90), whereas the smallest difference was found with respect to loneliness (d = 0.36). In females, the BSL subscales "loneliness" and "hostility" did not differentiate between BPD and ADHD. Borderline typical symptoms are common in adult patients with ADHD but seem to be less pronounced than in patients with BPD. Females with ADHD and BPD share more clinical features than males. However, symptoms of self-destruction and affect dysregulation appear to be more severe in BPD patients.     

The dynamics of the direct current potentials of the brain during sustained attention in 10-11-year-old children

The dynamics of direct current potentials of the brain was studied in 10-11-year-old children during sustained attention to successive presentation of series of Shulte tables. Children were examined twice: before and after the series of training to fast reading. A gradual increase in the level of direct current potentials during sustained attention was observed. The increase was more pronounced in children with excessive than in children with moderate reactions to the loading. After the series of training to fast reading, the increase in the level of direct current potentials was reduced in both groups. This aftertraining neurophysiological phenomenon was combined with a transformation of psychophysiological characteristics: a decrease in the time of viewing of Shulte tables and increase in the speed of reading. It is suggested that the shifts of direct current potentials reflects the dynamics of intensity of the cerebral energy metabolism.     

In search for neurophysiological criteria of altered consciousness

Neurophysiological approaches to brain mechanisms of consciousness are discussed. The concept of spatial synchronization of nervous processes developed by M.N. Livanov is applied to neurophysiological analysis of higher brain functions. However, the spatial synchronization of brain potentials is only a condition for information processing and does not represent it as such. This imposes restrictions on conclusions about the neural mechanisms of consciousness. It is more adequate to use the concept of spatial synchronization in views of consciousness as a psychophysiological level along with sub- and superconsciousness in three-level structure of mind according to P.V. Simonov. Forms of consciousness interaction with other levels concern the problem of altered consciousness and may be reflected in various patterns of spatial organization of brain potentials.     

The cardiosynchronous phenomena of the work of the brain: the psychophysiological aspects]

The review is devoted to the heartbeat-related components of EEG and to the heartbeat-related oscillation of performance measures and the cortical evoked potentials. The studies of these phenomena are carried out within the Laceys' hypothesis elaboration as well as in the field of the exploration of visceral self-perception. The data obtained in these studies indicate that there are elements of the time-locking with heart rate, probably unrelated to cardiovascular regulation, in functioning of the highest brain structures. The problems in the interpretation of some of heartbeat-related phenomena of brain functioning and their possible participation in the mechanisms of the psychophysiological interaction are discussed.     

Omega-3 fatty acids are related to abnormal emotion processing in adolescent boys with attention deficit hyperactivity disorder

BackgroundIn addition to the core symptoms, attention deficit hyperactivity disorder (ADHD) is associated with poor emotion regulation. There is some evidence that children and young adults with ADHD have lower omega-3 levels and that supplementation with omega-3 can improve both ADHD and affective symptoms. We therefore investigated differences between ADHD and non-ADHD children in omega-3/6 fatty acid plasma levels and the relationship between those indices and emotion-elicited event-related potentials (ERPs).MethodsChildren/adolescents with (n=31) and without ADHD (n=32) were compared in their plasma omega-3/6 indices and corresponding ERPs during an emotion processing task.ResultsChildren with ADHD had lower mean omega-3/6 and ERP abnormalities in emotion processing, independent of emotional valence relative to control children. ERP abnormalities were significantly associated with lower omega-3 levels in the ADHD group.ConclusionsThe findings reveal for the first time that lower omega-3 fatty acids are associated with impaired emotion processing in ADHD children.     

Intrinsic Affective Network Is Impaired in Children with Attention-Deficit/Hyperactivity Disorder

Deficits in impulsivity and affect dysregulation are key features of attention-deficit/hyperactivity disorder (ADHD) besides impairing levels of hyperactivity and/or inattention. However, the neural substrates underlying these traits are relatively under-investigated. In this study, we use resting-state functional magnetic resonance imaging to test the hypothesis of diminished functional integration within the affective/limbic network (which includes the amygdala, hippocampus, subgenual cingulate cortex, orbitofrontal cortex and nucleus accumbens) of children with ADHD, which is associated with their behavioral measures of emotional control deficits. Resting state-fMRI data were obtained from 12 healthy control subjects and 15 children with ADHD, all who had a minimum one-month washout period for medications and supplements. Children with ADHD demonstrated less integrated affective network, evidenced by increased bilateral amygdalar and decreased left orbitofrontal connectivity within the affective network compared to healthy controls. The hyper-connectivity at the left amygdalar within the affective network was associated with increased aggressiveness and conduct problems, as well as decline in functioning in children with ADHD. Similar findings in affective network dysconnectivity were replicated in a subset of children with ADHD three months later. Our findings of divergent changes in amygdala and orbitofrontal intrinsic connectivity support the hypothesis of an impaired functional integration within the affective network in childhood ADHD. Larger prospective studies of the intrinsic affective network in ADHD are required, which may provide further insight on the biological mechanisms of emotional control deficits observed in ADHD.     

Cerebral Correlates of Abnormal Emotion Conflict Processing in Euthymic Bipolar Patients: A Functional MRI Study

Background

Patients with bipolar disorder experience cognitive and emotional impairment that may persist even during the euthymic state of the disease. These persistent symptoms in bipolar patients (BP) may be characterized by disturbances of emotion regulation and related fronto-limbic brain circuitry. The present study aims to investigate the modulation of fronto-limbic activity and connectivity in BP by the processing of emotional conflict.

Methods

Fourteen euthymic BP and 13 matched healthy subjects (HS) underwent functional magnetic resonance imaging (fMRI) while performing a word-face emotional Stroop task designed to dissociate the monitoring/generation of emotional conflict from its resolution. Functional connectivity was determined by means of psychophysiological interaction (PPI) approach.

Results

Relative to HS, BP were slower to process incongruent stimuli, reflecting higher amount of behavioral interference during emotional Stroop. Furthermore, BP showed decreased activation of the right dorsolateral prefrontal cortex (DLPFC) during the monitoring and a lack of bilateral amygdala deactivation during the resolution of the emotional conflict. In addition, during conflict monitoring, BP showed abnormal positive connectivity between the right DLPFC and several regions of the default mode network.

Conclusions

Overall, our results highlighted dysfunctional processing of the emotion conflict in euthymic BP that may be subtended by abnormal activity and connectivity of the DLPFC during the conflict monitoring, which, in turn, leads to failure of amygdala deactivation during the resolution of the conflict. Emotional dysregulation in BP may be underpinned by a lack of top-down cognitive control and a difficulty to focus on the task due to persistent self-oriented attention.     

Psychophysiological correlates of aggression and violence: an integrative review

This paper reviews existing psychophysiological studies of aggression and violent behaviour including research employing autonomic, electrocortical and neuroimaging measures. Robust physiological correlates of persistent aggressive behaviour evident in this literature include low baseline heart rate, enhanced autonomic reactivity to stressful or aversive stimuli, enhanced EEG slow wave activity, reduced P300 brain potential response and indications from structural and functional neuroimaging studies of dysfunction in frontocortical and limbic brain regions that mediate emotional processing and regulation. The findings are interpreted within a conceptual framework that draws on two integrative models in the literature. The first is a recently developed hierarchical model of impulse control (externalizing) problems, in which various disinhibitory syndromes including aggressive and addictive behaviours of different kinds are seen as arising from common as well as distinctive aetiologic factors. This model represents an approach to organizing these various interrelated phenotypes and investigating their common and distinctive aetiologic substrates. The other is a neurobiological model that posits impairments in affective regulatory circuits in the brain as a key mechanism for impulsive aggressive behaviour. This model provides a perspective for integrating findings from studies employing different measures that have implicated varying brain structures and physiological systems in violent and aggressive behaviour.     

The alexithymic brain: the neural pathways linking alexithymia to physical disorders

Alexithymia is a personality trait characterized by difficulties in identifying and describing feelings and is associated with psychiatric and psychosomatic disorders. The mechanisms underlying the link between emotional dysregulation and psychosomatic disorders are unclear. Recent progress in neuroimaging has provided important information regarding emotional experience in alexithymia. We have conducted three brain imaging studies on alexithymia, which we describe herein. This article considers the role of emotion in the development of physical symptoms and discusses a possible pathway that we have identified in our neuroimaging studies linking alexithymia with psychosomatic disorders. In terms of socio-affective processing, alexithymics demonstrate lower reactivity in brain regions associated with emotion. Many studies have reported reduced activation in limbic areas (e.g., cingulate cortex, anterior insula, amygdala) and the prefrontal cortex when alexithymics attempt to feel other people’s feelings or retrieve their own emotional episodes, compared to nonalexithymics. With respect to primitive emotional reactions such as the response to pain, alexithymics show amplified activity in areas considered to be involved in physical sensation. In addition to greater hormonal arousal responses in alexithymics during visceral pain, increased activity has been reported in the insula, anterior cingulate cortex, and midbrain. Moreover, in complex social situations, alexithymics may not be able to use feelings to guide their behavior appropriately. The Iowa gambling task (IGT) was developed to assess decision-making processes based on emotion-guided evaluation. When alexithymics perform the IGT, they fail to learn an advantageous decision-making strategy and show reduced activity in the medial prefrontal cortex, a key area for successful performance of the IGT, and increased activity in the caudate, a region associated with impulsive choice. The neural machinery in alexithymia is therefore activated more on the physiologic, motor-expressive level and less in the cognitive-experiential domains of the emotional response system. Affects may play an important role in alleviating intrinsic physiologic reactions and adapting to the environment. Deficient development of emotional neural structures may lead to hypersensitivity to bodily sensations and unhealthy behaviors, a possible mechanism linking alexithymia to psychosomatic disorders.     

Laminar Thickness Alterations in the Fronto-Parietal Cortical Mantle of Patients with Attention-Deficit/Hyperactivity Disorder

Although Attention-Deficit/Hyperactivity Disorder (ADHD) was initially regarded as a disorder exclusive to childhood, nowadays its prevalence in adulthood is well established. The development of novel techniques for quantifying the thickness of the cerebral mantle allows the further exploration of the neuroanatomical profiles underlying the child and adult form of the disorder. To examine the cortical mantle in children and adults with ADHD, we applied a vertex-wise analysis of cortical thickness to anatomical brain MRI scans acquired from children with (n = 43) and without ADHD (n = 41), as well as a group of adult neurotypical individuals (n = 31), adult patients with a history of stimulant treatment (n = 31) and medication-naïve adults with ADHD (n = 24). We observed several clusters of reduced laminar cortical thickness in ADHD patients in comparison to neurotypical individuals. These differences were primarily located in the dorsal attention network, including the bilateral inferior and superior parietal cortex and a section of the frontal cortex (centered on the superior frontal and precentral gyrus bilaterally). Further laminar thickness deficits were observed in the bilateral orbitofrontal cortex and medial occipital cortex. The deficits in the cortical surface were especially pronounced in the child sample, while adult patients showed a more typical laminar thickness across the cerebral mantle. These findings show that the neuroanatomical profile of ADHD, especially the childhood form of the disorder, involves robust alterations in the cortical mantle, which are most prominent in brain regions subserving attentional processing.     

Psychophysiological indexes of recognition of emotions in speech

A review of experimental and theoretical works upon perception of emotions in speech is introduced. The main approaches to experimental study and different types of stimulation are considered. Clinical research and experiments upon healthy subjects investigate the brain organization of emotional speech recognition. In the works by Rusalova, Kislova integral psychophysiological preconditions for the successfulness of the recognition of speech emotional expression were studied. As a result of the investigation, extreme groups of persons were identified: with high indices of "emotional hearing" and with low level of recognition of emotions. Analysis of EEG included comparison of different EEG parameters between two groups: values of EEG power, the dominating frequencies, percentage of different EEG-bands in the summary EEG power, coherence, values of EEG inter- and intra-hemispheric asymmetry, etc. The subjects with low identification rates showed a higher brain activation and reactivity both during the emotion identification task and at rest as compared to the subjects with high identification rates. The data obtained reveal specific activation within the left frontal regions, as well as the right posterior temporal cortex during nonverbal recognition of emotions.     

Subconscious components of psychophysiological responses in the participants of a 105-day experiment in an isolated environment

Six participants of a 105-day experiment in an isolated environment were studied in order to identify subconscious mechanisms of their psychophysiological changes during the experiment. We used the method of neurocognitive diagnostics based on the analysis of the evoked electrocardiographic (EEG) potentials caused by stimuli that were below the conscious threshold. The technique included separation of evoked responses to each stimulus, cross-correlation and wavelet analyses, estimations using neural network algorithms, and an overall evaluation for all stimuli for each derivation and each period of stimulation. Comparison of the reactions to meaningful and meaningless groups of words elicited the extent of involvement of different brain areas in semantic information processing. Our results give grounds to indicate a number of changes in the psychological state of the subjects due to their participation in the experiment. These are list below:

1. An increase in subconscious tension between some of the crew members, such as representatives of different cultures.
2. An increase in psychological defense stress, primarily caused by basic fears of death and worries about health, as well as private family relations.
3. The appearance of addictive trends manifested in the changes in the subconscious attitude to alcohol and an increase in the role that alcohol plays in the emotional state.

These findings on the changes in the major mechanisms of unconscious responses are useful in defining the strategy for working out the methods of autonomous psychological support for crews and computer-assisted psychological correction.     

Effects of unexpected chords and of performer's expression on brain responses and electrodermal activity

Background

There is lack of neuroscientific studies investigating music processing with naturalistic stimuli, and brain responses to real music are, thus, largely unknown.

Methodology/Principal Findings

This study investigates event-related brain potentials (ERPs), skin conductance responses (SCRs) and heart rate (HR) elicited by unexpected chords of piano sonatas as they were originally arranged by composers, and as they were played by professional pianists. From the musical excerpts played by the pianists (with emotional expression), we also created versions without variations in tempo and loudness (without musical expression) to investigate effects of musical expression on ERPs and SCRs. Compared to expected chords, unexpected chords elicited an early right anterior negativity (ERAN, reflecting music-syntactic processing) and an N5 (reflecting processing of meaning information) in the ERPs, as well as clear changes in the SCRs (reflecting that unexpected chords also elicited emotional responses). The ERAN was not influenced by emotional expression, whereas N5 potentials elicited by chords in general (regardless of their chord function) differed between the expressive and the non-expressive condition.

Conclusions/Significance

These results show that the neural mechanisms of music-syntactic processing operate independently of the emotional qualities of a stimulus, justifying the use of stimuli without emotional expression to investigate the cognitive processing of musical structure. Moreover, the data indicate that musical expression affects the neural mechanisms underlying the processing of musical meaning. Our data are the first to reveal influences of musical performance on ERPs and SCRs, and to show physiological responses to unexpected chords in naturalistic music.     

Functional connectivity of pain-mediated affect regulation in Borderline Personality Disorder

Affective instability and self-injurious behavior are important features of Borderline Personality Disorder. Whereas affective instability may be caused by a pattern of limbic hyperreactivity paired with dysfunctional prefrontal regulation mechanisms, painful stimulation was found to reduce affective arousal at the neural level, possibly underlying the soothing effect of pain in BPD.We used psychophysiological interactions to analyze functional connectivity of (para-) limbic brain structures (i.e. amygdala, insula, anterior cingulate cortex) in Borderline Personality Disorder in response to painful stimulation. Therefore, we re-analyzed a dataset from 20 patients with Borderline Personality Disorder and 23 healthy controls who took part in an fMRI-task inducing negative (versus neutral) affect and subsequently applying heat pain (versus warmth perception).Results suggest an enhanced negative coupling between limbic as well as paralimbic regions and prefrontal regions, specifically with the medial and dorsolateral prefrontal cortex, when patients experienced pain in addition to emotional arousing pictures. When neutral pictures were combined with painful heat sensation, we found positive connectivity in Borderline Personality Disorder between (para-)limbic brain areas and parts of the basal ganglia (lentiform nucleus, putamen), as well areas involved in self-referential processing (precuneus and posterior cingulate).We found further evidence for alterations in the emotion regulation process in Borderline Personality Disorder, in the way that pain improves the inhibition of limbic activity by prefrontal areas. This study provides new insights in pain processing in BPD, including enhanced coupling of limbic structures and basal ganglia.