Study links early emotional regulation difficulties to ADHD and conduct problems

According to a new study published in Development and psychopathology. Researchers have found that these early difficulties also correlate with higher rates of conduct problems and internalizing behaviors, such as sadness and anxiety, later in childhood. The findings highlight the importance of early emotional development and could guide targeted support for children at risk.

Emotion regulation refers to a person’s ability to manage and control their emotional reactions to situations in a way that aligns with social norms and personal goals. This skill develops significantly during early childhood, as children learn to balance intense feelings such as frustration, excitement, or sadness. Effective emotion regulation allows children to respond appropriately to challenges, engage in positive social interactions, and recover from failures.

Conversely, poor emotion regulation – called emotional dysregulation – can lead to excessive emotional reactions, difficulty calming down, or impulsive behaviors that disrupt daily life. Children with persistent emotional dysregulation may have difficulties in social, academic, and home settings, making this an important area of ​​focus for understanding developmental and mental health issues.

Researchers have sought to understand how early patterns of emotional dysregulation relate to mental health problems, particularly ADHD, internalizing problems, and behavioral problems. These pathologies are often diagnosed later in childhood, making early intervention difficult.

“My interest in this topic comes from a desire to understand how differences during childhood can lead to variable outcomes with lifelong implications. I believe there is a misconception that as people we are all quite similar. For this reason, we often overlook the implications that these subtle differences may have in the long term,” said study author Francisco Antonio Calderón Alfaro, a doctoral student at the University of Oxford.

ADHD is a neurodevelopmental disorder characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with daily functioning. Children with ADHD may have difficulty focusing on tasks, staying organized, or controlling their impulses. These symptoms can affect academic performance, social relationships and self-esteem. ADHD is often diagnosed during the school years, but the first signs may appear in preschool-aged children.

Internalizing problems are characterized by inward-directed behaviors and emotions, such as excessive sadness, anxiety, or withdrawal. These problems may manifest as constant worry, low self-esteem, or physical complaints such as headaches without a clear medical cause.

On the other hand, conduct problems involve outwardly directed behaviors, including aggression, defiance, lying, and rule-breaking. These behaviors can disrupt relationships with peers and adults and lead to conflict in structured environments like school. Internalizing and behavioral problems can coexist with ADHD and other mental health problems, further complicating diagnosis and treatment.

The researchers used data from the Millennium Cohort Study, a large-scale longitudinal dataset that tracks the development of children in the UK. Their sample included more than 14,000 children, whose emotional regulation was assessed at three, five and seven years old. Parents completed questionnaires, such as the Strengths and Difficulties Questionnaire, to measure emotional dysregulation, conduct problems, and symptoms associated with ADHD.

Emotion regulation was assessed through parental observations of behaviors such as mood swings, impulsivity, and the ability to recover from upset feelings. Parents rated the frequency of these behaviors on standardized scales. The researchers then tracked how these emotional patterns changed over time, focusing on whether children showed steady improvement, developmental delay, or persistent difficulties. At age seven, researchers assessed whether these early emotional tendencies correlated with ADHD symptoms, conduct problems, or internalizing behaviors such as anxiety and sadness.

Researchers found that children who had more difficulty with emotional regulation during the preschool years tended to show more ADHD symptoms by age seven. These children were also more likely to display conduct problems and internalizing behaviors. These associations held true even after controlling for prior mental health symptoms, suggesting that the development of emotional regulation is an independent predictor of these outcomes.

Interestingly, the rate at which children improve their emotional regulation skills also matters. Children who progressed more slowly in developing emotional regulation were at greater risk for mental health problems. While most children showed general improvement in emotional regulation between the ages of three and seven, those with consistently high levels of emotional dysregulation faced the highest risks.

“Children learn to manage their emotions in different ways,” Calderón Alfaro told PsyPost. “Identifying these differences can help target early interventions and promote healthy child development.”

Gender differences were also observed. Although boys and girls are at similar risk, boys generally had higher levels of emotional dysregulation and were more likely to exhibit behavioral problems, while girls were more prone to internalizing their symptoms.

The findings highlight the importance of supporting emotional development during the preschool years. But as with any research, there are some caveats. “To put it simply, we only have three moments in our data,” Calderón Alfaro noted. “This is not the same as tracking a heartbeat in real time. As a result, the nuances of how these changes evolve over time remain unclear.

Another limitation is the observational nature of the study, which prevents definitive conclusions about causality from being drawn. Although emotional dysregulation appears to be a marker of later mental health risks, it remains unclear whether it directly causes these outcomes or is simply associated with other underlying factors. Experimental studies or intervention trials could determine whether improving emotional regulation skills can reduce the risk of mental health problems.

“I believe that more research focused on understanding developmental differences can lead to better tailored interventions,” Calderón Alfaro said. “This would help support those who may benefit less from existing programs or practices. »

The study, “Developmental Trajectories of Early Emotion Regulation and ADHD Symptoms, Internalizing, and Conduct Problems in Childhood,” was authored by Aja Louise Murray, Amanda Russell, and Francisco Antonio Calderón Alfaro.