An Initial Investigation of the Impact of Self-Regulation and Emotionality on Behavior Problems in Children With ADHD

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1 An Initial Investigation of the Impact of Self-Regulation and Emotionality on Behavior Problems in Children With ADHD R. Marc A. Crundwell Greater Essex County District School Board, Windsor, Ontario Canadian Journal of School Psychology Volume 20 Number 1/2 December Sage Publications / hosted at Abstract: Children with attention-deficit hyperactivity disorder (ADHD) are reported to have more difficulties with self-regulation and emotional regulation. Current ADHD models suggest a primary deficit in behavioral inhibition causes secondary deficits in executive functions, impacting on emotional regulation. This study examined the relationship of regulation and emotionality on behavior problems in children with ADHD and the relationship between ADHD symptoms and emotional regulation and emotionality. Mothers of 32 male children between the ages of 6 and 11 diagnosed as ADHD combined type or predominantly hyperactive-impulsive type completed questionnaires assessing self-control and emotionality. Results indicated that ADHD boys who showed greater emotionality in terms of anger/frustration and less self-control and inhibition were rated as having more behavioral difficulties. Children with symptoms of hyperactivity and impulsivity were rated as lower in self-control and inhibition and higher in emotionality. Results of the study are discussed with respect to current theoretical models of ADHD. Résumé: Les enfants avec désordre de l hyperactivité de l attention-déficit (ADHD) sont rapportés pour avoir plus de difficultés avec autorégulation et règlement émotif. Les modèles ADHD courants suggèrent un déficit fondamental dans inhibition behavioriste cause des déficits secondaires dans les fonctions exécutives, en enfonçant sur règlement émotif. Cette étude a examiné le rapport de règlement et emotionality sur les problèmes du comportement dans les enfants avec ADHD et le rapport entre symptômes ADHD et règlement émotif et emotionality. Mères de 32 enfants virils entre les âges de 6 et 11 diagnostiqués comme ADHD combinés le type ou type d une manière prédominante hyperactif-impulsif ont complété des questionnaires qui répartissent maîtrise de soi et emotionality. Les résultats ont indiqué que les garçons ADHD qui ont montré plus grand emotionality quant à colère/frustration et moins de maîtrise de soi et inhibition ont été estimés comme avoir des difficultés plus behavioristes. Les enfants avec symptômes d hyperactivité et impulsivity ont été estimés comme inférieur dans la maîtrise de soi et inhibition et plus haut dans l emotionality. Les résultats de l étude sont discutés en ce qui concerne modèles théoriques courants d ADHD. Author s Note: Please address correspondence to R. Marc Crundwell, Greater Essex County District School Board, 451 Park St West, P.O. Box 210, Windsor, Ontario, N9A 6K1; 62

2 Crundwell / Self-Regulation and Emotionality 63 Keywords: ADHD; emotionality; behavior problems; emotional regulation Over the past 10 years, an increasing number of children have been diagnosed with attention deficit hyperactivity disorder (ADHD), and some reports suggest that the prevalence rate of the disorder is as high as 11% (Wolraich, Hannah, Pinnock, Baumgaertel, & Brown, 1996). More conservative estimates of the disorder suggest prevalence rates in the general population of children in the United States to range from 3% to 5% (American Psychiatric Association, 1994). Core features of ADHD include impulsivity, hyperactivity, and difficulties with sustained attention (Barkley, 1996). These core symptoms are often implicated as the reason ADHD children get into more trouble at home, at school, and when interacting with their peers (Saunders & Chambers, 1996). Guevremont and Dumas (1994) suggested that half of all children with ADHD have significant problems with peer relations. The peer difficulties have been suggested to be the result of social skill and performance deficits in at least three areas: deficits in social communication, poor emotional regulation, and socialcognitive biases (Saunders & Chambers, 1996). Barkley (1997a, 1997b) recently proposed a unifying theoretical model of ADHD in which he identified behavioral inhibition as the primary or core deficit of ADHD. A key component of the model is that the deficit in inhibition leads to secondary deficits in specific executive functions that are dependent on behavioral inhibition for their own development. Specifically, the deficit in behavioral inhibition results in deficient performance in the executive functions of working memory, internalization of speech, self-regulation of affect-motivation-arousal, and reconstitution. In the model, these four executive functions are hypothesized to influence the motor system in the service of goal-directed behavior. According to Barkley (1997a, 1997b), if an individual has the power to inhibit or delay responding to an event, he or she should also have the power to delay the expression of emotional reactions that would have been elicited by the event. By delaying the immediate affective response to an event, the individual has time to reflect on the event and to modify his or her eventual response. The delay also allows an individual to determine his or her eventual emotional expression. It is the ability to countermand or counterbalance the initial charge of external events that results in the development and appropriate control of emotional self-regulation (Kopp, 1989). The core feature of behavioral inhibition discussed in Barkley s theory (1997a, 1997b) impacts directly on those skills that are necessary for appropriate social behavior and interactions. The inability to inhibit responses is associated with increased emotional reactivity, difficulties dealing with frustration, and increased difficulties selfregulating one s emotions (Friedman et al., 2003). Based on the model, Barkley (1996, 1997a) predicted that individuals with ADHD will have the following: (a) greater emotional expression in their reactions to events, (b) less objectivity in the selection of a response to an event, (c) diminished social perspective taking as emotional reactions are

3 64 Canadian Journal of School Psychology not delayed long enough to take into consideration the views of others and their own needs into account, and (d) diminished ability to induce drive and motivational states, especially with regard to goal-directed behavior. Barkley (1997a, 1997b) further hypothesized that the deficiencies in inhibitory control in ADHD individuals will cause problems in the following areas of self-regulation of affect: (a) decreased empathy, (b) increased emotional responsivity to provoking situations, (c) diminished ability to anticipate emotional reactions to future events, (d) decreased capacity to regulate emotional states during goal-directed behavior, and (e) greater reliance on externally based stimuli to provide the motivation and arousal needed to persist in goal-directed behaviors. Few studies have directly examined social and emotional competence or selfregulation of emotion in children and adults with ADHD. In general, research has indicated that the development of self-regulation of emotion is dependent on the development of inhibition (Garber & Dodge, 1991; Kopp, 1989). In terms of ADHD, Cole, Zahn-Waxler, and Smith (1994) reported that emotional responses of preschool children with ADHD to disappointment were poorly regulated and displayed a high frequency of disruptive behavior when compared to same-age peers. Other studies have reported that ADHD children display more negative emotions in their social communication. Pelham and Bender (1982) reported that when observed in small group interactions, children with ADHD are more likely to express negative comments or emotions when communicating with their peers. Children with ADHD have also been shown to express greater negative affect during concept formation learning tasks (Rosenbaum & Baker, 1984) and to display higher levels of negativity and frustration than non-adhd children in positive social interactions (Bonello, 1998). Douglas and Parry (1994) reported that ADHD children are more easily aroused and excitable in response to reward as well as more visibly frustrated by altered reward schedules. Shea and Fisher (1996) found that boys who scored higher on measures of impulsivity had more negative levels of affect and more variable mood. They also reported that teacher reports of behavior difficulties in ADHD girls were associated with variability in mood arousal. Braaten and Rosen (2000) examined the difference in empathy and emotional self-control in boys with and without ADHD. In general, the results were supportive of Barkley s (1997a, 1997b) theoretical model of ADHD as boys with ADHD were less empathic in comparison to control children on an empathic reasoning task. They also displayed more outward signs of sadness, anger, and guilt in comparison to the non-adhd control group. The ADHD group also differed significantly with regard to negative emotions as rated by their parents but did not differ significantly from non-adhd children in regard to positive emotions. In terms of negative emotions, ADHD children were different from their non-adhd peers in the areas of sadness, anger, and guilt. Braaten and Rosen (2000) however did not find that ADHD children displayed higher levels of emotional intensity or in their reactions to punishment and reinforcement in comparison to non-adhd controls. In adults, Rapport, Friedman, Tzelepis, and VanVoorhis (2002) found that ADHD adults reported significantly greater levels of emotional reactivity than those in the control group.

4 Crundwell / Self-Regulation and Emotionality 65 Research conducted with non-adhd populations has indicated that individual differences in emotional reactivity and emotional regulation are related to the quality of an individual s socioemotional functioning (Eisenberg & Fabes, 1992). Eisenberg, Fabes, and Losoya (1997) and Eisenberg and Fabes (1992) presented a heuristic model for characterizing the additive and interactive contributions of individual differences in general emotional intensity (i.e., the tendency to respond intensely when one experiences emotion) and regular capabilities to a variety of aspects of social functioning. The model predicts that externalizing behavior problems are associated with low levels of both behavioral and emotional regulation. This association is especially true for those individuals who tend to exhibit their negative emotions intensely. To assess their model, Eisenberg et al. (1996) examined the relationship of regulation and emotionality to problem behaviors in elementary school children. Results supported the model as the frequency of conduct problems was associated with low regulation. Problem behaviors were associated with low attentional control and low regulation. Children who were viewed as high in negative emotionality were rated as having a relatively high frequency of behavior problems. This was also true for children rated as high in general emotional intensity. The purpose of this study was to examine the impact of self-regulation and emotionality on behavior problems in boys with ADHD. It was predicted that there would be a linear relationship between regulation and emotionality to behavior problems in children with ADHD whereby as the severity of regulation deficits and emotional intensity increased in ADHD children, so would the intensity and severity of problem behaviors. It was predicted that there would be a linear relationship between the severity of ADHD symptoms in ADHD children to regulation and emotionality whereby as the severity of ADHD symptoms increased, regulation would decrease and emotionality would increase. Participants Method The sample consisted of the mothers of 32 children diagnosed with ADHD. Their children were assessed and provided services at one of two mental health centers: a regional children s mental health center located in a large Canadian metropolitan center and a private mental health clinic located in a large U.S. metropolitan center. These centers were located approximately 30 minutes from each other. The mothers of the 32 children (20 Canadian, 12 U.S.) ranged from age 26 to 65 years of age, with a mean age of (SD = 9.35). The ethnicity of the mothers included European American/ White (n = 25) and African American (n = 7). All 32 children met the criteria for a Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric

5 66 Canadian Journal of School Psychology Association, 1994) diagnosis of ADHD combined or predominantly hyperactiveimpulsive type. The boys ranged from 6 to 11 years of age (M = 8.47, SD = 1.80). Of the children, 31 were being educated in regular classrooms, and 1 was receiving halfday support in a self-contained class for behavioral exceptionalities. Assessment An expert clinical diagnosis of ADHD was established through not only DSM-IV diagnostic criteria but also the judgment of two clinicians. The diagnosis was determined through a multistep process at the time of the intake assessment. First, a clinical interview with parents was completed. Second, parents completed the Disruptive Behavior Rating Scale (DBRS). Third, a clinical interview and behavioral observation of the child were undertaken. Finally, the parents were requested to have the child s classroom teacher complete the Disruptive Behavior Rating Scale (Teacher Version) and return it to the clinician. Measures of regulation. Two measures of regulation were used: the Children s Behavior Questionnaire (CBQ) and the Self-Control Rating Scale (SCRS). The Children s Behavior Questionnaire (Rothbart, Ahadi, Hershey, & Fisher, 1998) is a 195-item paper-pencil questionnaire in which parents are required to rate statements of behavior on a 7-point Likert scale ranging from extremely untrue to extremely true. The CBQ assesses individual differences in reactivity and self-regulation. Composite scores for the following scales were calculated: (a) impulsivity and (b) inhibitory control. The CBQ has been shown to have good psychometric properties (Rothbart, Ahadi, & Evans, 2000; Rothbart et al., 1998) and has been used in a number of studies of emotion in children (Eisenberg et al., 1996, 2003). The Self-Control Rating Scale (Kendall & Wilcox, 1979) is a 33-item scale developed to assess self-control as well as the ability to inhibit negative behavior in children. The SCRS was developed according to a cognitive-behavioral definition of selfcontrol. Parents rated each item on a 7-point Likert-type scale ranging from 1 to 7, with two opposite verbal descriptions at each end to provide the parent assistance in responding. The responses vary, with some positive responses rated as 1 and others rated as 7. Using the author protocol for scoring, the negative items were reversed scored prior to obtaining a composite score for the scale. Higher composite scores indicated lower self-control and difficulties inhibiting negative behavior. The SCRS has been shown to have good psychometric properties (Kendall & Wilcox, 1979; Kendall, Zupan, & Braswell, 1981) and has been correlated with other measures of regulation in other research (Eisenberg et al., 1995). Measures of emotionality. Mothers were asked to complete two measures of emotionality: (a) the Affect Intensity Scale (AIS) and (b) the Children s Behavior Questionnaire. The AIS (Larsen & Diener, 1987) is a 19-item scale that asks parents to rate how their child reacts to events on a 7-point Likert scale ranging from never

6 Crundwell / Self-Regulation and Emotionality 67 (1) to always (7). The scale was designed to emphasize distinctions between the frequency of emotional states and the intensity of experienced emotions, with items to measure the intensity dimension. Larsen and Diener (1987) viewed emotional intensity as a temperamental or personality dimension that is relatively stable over time. The AIS is viewed as a measure of general tendencies to respond emotionally. It is not a measure of how one responds in an individual situation but the general intensity of an individual s emotional reaction. A composite score for the scale is obtained, with higher scores indicating a higher magnitude or intensity of emotional expression. The validity of the AIS has been assessed in three separate studies relevant to parental report of emotional response intensity (Larsen & Diener, 1987). Eisenberg et al. (1995, 1996), in using this measure, reported good psychometric properties. Selected subtests from the CBQ were used to assess emotionality. The Anger/ Frustration Scale is reported to assess the amount of negative affect related to interruption of ongoing tasks or goal blocking. The Sadness Scale measures the amount of negative affect and lowered mood and energy related to exposure to suffering, disappointments, and object loss. Measure of child behavior. The Eyberg Child Behavior Inventory (ECBI) is a 36- item parent rating of compliance and conduct problems for children between the ages of 2 and 17. The scale was designed to be a behavior-specific instrument to assess parental reports of behavior problems in children (Eyberg & Ross, 1978). ECBI items reflect only situations in which parents can directly observe their child (e.g., home) and not situations in which parents do not observe their children (e.g., school). Parents are required to rate how often each behavior occurs using a 7-point frequency of occurrence scale ranging from 1 for never to 7 for always. Parents are also asked to indicate whether the behavior is a problem for them on a yes-no problem identification scale. Factor analysis of the ECBI has revealed that it is a unidimensional measure of conductproblem behaviors during the age span for which it is relevant (Boggs, Eyberg, & Reynolds, 1990; Eyberg & Robinson, 1983; Eyberg & Ross, 1978). Scores on the ECBO have been found to relate significantly to direct observational measures of parent-child interactions, activity level, and temperament, providing evidence of convergent validity (Robinson & Eyberg, 1981; Webster-Stratton & Eyberg, 1982). ADHD measures. The Disruptive Behavior Rating Scale (Barkley & Murphy, 1998) is comprised of home and school versions that reflect ADHD symptoms as described in the DSM-IV. The DBRS requires parents to rate items using a 4-point Likert-type scale ranging from 0 to 3 to measure frequency of occurrence of disruptive behaviors. A 0 score indicates that the behavior never or rarely happens, whereas a rating of 3 indicates the behavior occurs very often. The DBRS produces scores for hyperactivity-impulsivity, inattention, and a total scale score. It also has a scale to assess for oppositional defiant disorder. Factor analysis of the DBRS has identified a two-dimensional clustering of behavior (DuPaul et al., 1997). Research

7 68 Canadian Journal of School Psychology has also supported the reliability and validity of the DBRS for assessing symptoms of inattention and hyperactivity-impulsivity; the DBRS is also successful in predicting group membership in the different subtypes of ADHD (DuPaul et al., 1997). Procedure Mothers of children with ADHD were recruited at the time of their child s assessment at one of the two centers. Two psychologists assessed all of the children, with one completing all of the U.S. sample and the other completing the entire Canadian sample. Current diagnostic criteria from the DSM-IV were used to make a diagnosis of ADHD. The psychologists met to review data obtained on each child and ensure consistency of diagnosis between the U.S. and Canadian sites. Once the assessment was completed and the diagnosis of ADHD was given, the mother was provided with an information sheet that described the study, and the psychologist discussed participation with her. If the mother agreed to participate, she was provided a survey package that included the research questionnaires. The mother was asked to complete the questionnaires and return them in a postage-paid preaddressed envelope. Results Regulation, Emotional Intensity, and Behavior Problems Stepwise multiple regression analyses were performed to test the hypothesis that low levels of regulation and high levels of emotionality would be related to high numbers of behavior problems (see Table 1). Self-control and impulsivity entered the stepwise multiple linear regression equation and accounted for a significant portion of the variance (F 1,30 = , p <.001). The positive relationship between the two variables indicates that children who had more self-control were less likely to exhibit behavior problems. A second stepwise multiple linear regression analysis was completed to examine the relationship between emotionality and problem behaviors. The selected predictor variables of anger/frustration, affect intensity, fear, sadness, falling reactivity and whether they were consolable, and discomfort entered the stepwise multiple linear equation, accounting for a significant portion of the variance (F 2,29 = , p <.001). The positive relationship between the variables indicated that higher levels of anger/frustration and fear were associated with more problem behaviors. Severity of ADHD Symptoms and Regulation and Emotionality Stepwise multiple regression analyses were performed to determine if there was a linear relationship between the severity of ADHD symptoms in children to regulation

8 Crundwell / Self-Regulation and Emotionality 69 Table 1 Summary of All Stepwise Regression Analyses Stepwise Regression Analysis for Regulation Variables Predicting Behavior Problems (N = 32) Variable B SE B ß Self-control R F for change in R ** Stepwise Regression for Analysis for Emotionality Variables Predicting Behavior Problems (N = 32) Model 1 Model 2 Variable B SE B ß B SE B ß Anger/frustration Fear R F for change in R ** ** Stepwise Regression Analysis for Severity of ADHD Symptoms Predicting Regulation (N = 32) Variable B SE B ß Disruptive Behavior Rating Scale (DBRS) hyperactivity-impulsivity R F change in R ** Stepwise Regression Analysis for Severity of ADHD Symptoms Predicting Emotionality (N = 32) Variable B SE B ß DBRS hyperactivity-impulsivity R F change in R * *p <.012. **p <.001. and emotionality. In terms of the relationship between severity of ADHD symptoms and regulation, three predictor variables, the total score of the disruptive behavior scale, the hyperactive-impulsivity score, and the oppositional defiant disorder scale, were entered into the stepwise multiple linear regression equation, with the self-control rating scale serving as the dependent variable. The resulting regression model accounted for a significant portion of the variance (F 1,30 = , p <.001). The positive relationship between the variables indicated that as the severity of hyperactiveimpulsive behavior increased in ADHD children, their self-regulation decreased.

9 70 Canadian Journal of School Psychology The same predictor variables, total score on the disruptive behavior scale, the score on the hyperactive-impulsivity scale of the DBRS, and total score on the oppositional defiant disorder scale, were used in a stepwise multiple linear regression analyses to explore the relationship between severity of ADHD symptoms and emotionality, with the Affect Intensity Scale serving as the dependent variable. Only the hyperactive-impulsivity score from the DBRS entered the stepwise multiple regression equation, accounting for a significant portion of the variance (F 1,30 = 7.162, p <.01). The positive relationship between the variables indicated that higher scores on the DBRS hyperactive-impulsivity scale were associated with higher levels of emotionality. Discussion The purpose of this study was to examine the impact of self-regulation and emotionality on behavior problems in boys with ADHD. Furthermore, this study examined the relationship of symptom level to self-regulation and emotionality in boys with ADHD. The pattern of results was supportive of the hypotheses under investigation. In terms of the relationship between self-regulation and behavior problems, the results indicated that children who were rated by their mothers as displaying less selfcontrol were also rated to have a higher frequency of behavioral problems. Similarly, children with ADHD who were rated as higher in emotionality in terms of anger/ frustration were also rated as having more behavioral problems. The results are important, as when taken together, they indicate that ADHD children who show greater negative emotionality in terms of anger/frustration and less self-regulation are at increased risk for behavioral difficulties. As the degree of their emotional states of anger/frustration and their self-regulation difficulties increase and become more pronounced, their level of behavioral difficulties increases substantially. For children with ADHD who are already more likely to have behavioral difficulties as a result of the underlying deficits of the disorder, poor self-regulation and negative emotionality appear to intensify their behavior difficulties. The findings are consistent with previous research that indicated that children with ADHD were more visibly frustrated by altered reward schedules (Douglas & Parry, 1994) and with research that has indicated that children with ADHD, in comparison to control peers, show higher levels of anger (Braaten & Rosen, 2000). The results are also consistent with Eisenberg et al. (1996) who in a nonclinical population found that the frequency of problem behaviors was associated with low regulation and negative emotional intensity. In children with ADHD, the current results suggest that negative emotionality, such as anger/frustration and poor selfcontrol, is predictive of behavior problems and poor social functioning. Children with ADHD who present with poor self-control and inhibition of negative emotions

10 Crundwell / Self-Regulation and Emotionality 71 are far more likely to engage in less prosocial behavior. As a result, research suggests that children with ADHD are more actively rejected by peers and experience more behavioral difficulties across social settings (Barkley, 1996). Although not directly exploring Barkley s (1997a, 1997b) current theoretical model of ADHD, the results are at least suggestive of a pattern of difficulties in self-regulation, behavioral inhibition, and higher levels of negative emotionality in children with ADHD, which are associated with increased behavioral difficulties in social settings. This is consistent with Friedman et al. (2003) who found that the inability to inhibit responses is associated with increased emotional reactivity and difficulties dealing with frustration. The model proposed by Barkley will require more extensive research in this area as some studies have found general support for the predictions regarding self-regulation and emotionality (Crundwell, 2001), whereas others have found no group differences in emotionality or emotional expression in children with ADHD (Braaten & Rosen, 2000). The results of this study also found a linear relationship between the severity of the symptoms of hyperactivity-impulsivity in children with ADHD and regulation and emotionality. Children with ADHD rated by their mothers as displaying more symptoms of hyperactivity-impulsivity were rated as lower in regulation and selfcontrol and higher in emotionality. The results suggest that as the number of symptoms of hyperactivity and impulsivity increase, there is a corresponding increase in difficulties with both self-regulation and emotionality in children with ADHD. As ADHD is reported to range on a continuum from very mild to severe, the results represent one reason why there might be increased social and behavioral difficulties in those children presenting with more severe and pronounced symptoms of the disorder. In both self-regulation and emotionality, it was the number and severity of the hyperactivity and impulsivity symptoms that were most important in explaining the relationship. Hence, the results suggest that the greater the mother s rating of symptoms of hyperactivity and impulsivity, the greater the perceived severity of the deficits in self-regulation and emotionality. The results provide at least some initial support for the suggestion that the greater the deficit in inhibition in ADHD children, the larger the deficit in executive functions and hence the greater the deficit in selfregulation of emotions and emotionality. The linear relationship found in this study is also consistent with the theoretical model of ADHD proposed by Barkley (1997a, 1997b) and suggests that as children with ADHD display more symptoms of hyperactivity-impulsivity, indicating more severe levels of the disorder, that the difficulties with both the regulation of their behavior and emotionality become more pronounced. As a result, they are likely to experience substantive difficulties in school settings and have greater difficulties with peers and more conflicts with parents (Barkley, 1996). Limitations of the present study were the male-only sample, the reliance on mothers for the collection of information about the child, age of the sample, and the total

11 72 Canadian Journal of School Psychology sample size. The use of only male participants, although consistent with previous research studies, does limit the ability to generalize the findings to all children diagnosed with ADHD. Further research will need to include female participants to determine if the relationships found in the present study also apply to female children with ADHD. The age range of the current study also limits the generalizability of this study as the participants ranged only between the ages of 6 and 11. As a result, these results cannot be applied to younger or older ADHD populations. Also limiting the study was the reliance on mothers for the collection of information about the child. Supplemental ratings incorporating perspectives from multiple sources would provide additional useful information and help confirm the pervasiveness of the difficulties reported by the mothers. Of the limitations, the small sample size likely had the greatest impact on the results. In this regard, Green (1991) explored the number of participants necessary to complete a regression analysis with reasonable chance of rejecting the null hypothesis. Green indicated that some authors suggest a simple rule of thumb of having at least five times more cases than IVs, which this study does meet in many of the analyses. However, Green did specify that such rules of thumb often result in studies that have insufficient power and have a high probability of not yielding significance unless the effect size is extremely large. Hence, he suggested that a more complex rule of thumb is required that directly incorporates effect size or uses power analyses. As a result, future research should address the limitations of sample size as well as identify other variables that may also impact on the abnormal development of self-regulation and emotional regulation and intensity. Overall, these results indicate that ADHD children who display better skills in regulation and lower levels of emotionality are rated as having fewer behavioral problems. However, as difficulties in regulation increase and the level of emotionality increases, ADHD children are rated as having more behavior problems. The association between emotional regulation and problem behaviors was high, as was the association between emotionality and problem behaviors. Results are consistent with previous research by Eisenberg et al. (1996), who stated, One might reasonably expect the relations of regulation and emotionality to be considerably higher in samples with more variation in problem behaviors and more individuals with clinical levels of problem behavior (p. 160). Those children with ADHD appear to be representative of this group. Finally, the severity of the ADHD disorder as assessed in terms of frequency and severity of symptoms was related to self-regulation and emotionality. As the number and severity of hyperactive-impulsivity symptoms increased, ADHD children were found to have increased difficulties with self-regulation and to present with higher levels of emotionality. Taken together, the findings indicate that the social and behavior problems of ADHD children are likely, in part, related to issues of self-regulation of emotions and their level of emotionality, which place them at significant risk for ongoing behavior and social difficulties.

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