Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence
Open accessAbstract
Background: The goal of this study was to investigate the occurrence, severity and clinical correlates of emotional lability (EL) in children with attention deficit/hyperactivity disorder (ADHD), and to examine factors contributing to EL and familiality of EL in youth with ADHD. Methods: One thousand, one hundred and eighty‐six children with ADHD combined type and 1827 siblings (aged 6–18 years) were assessed for symptoms of EL, ADHD, associated psychopathology and comorbid psychiatric disorders with a structured diagnostic interview (PACS) as well as parent and teacher ratings of psychopathology (SDQ; CPRS‐R:L; CTRS‐R:L). Analyses of variance, regression analyses, χ 2 ‐tests or loglinear models were applied. Results: Mean age and gender‐standardized ratings of EL in children with ADHD were >1.5 SD above the mean in normative samples. Severe EL (>75th percentile) was associated with more severe ADHD core symptoms, primarily hyperactive‐impulsive symptoms, and more comorbid oppositional defiant, affective and substance use disorders. Age, hyperactive‐impulsive, oppositional, and emotional symptoms accounted for 30% of EL variance; hyperactive‐impulsive symptoms did not account for EL variance when coexisting oppositional and emotional problems were taken into account, but oppositional symptoms explained 12% of EL variance specifically. Severity of EL in probands increased the severity of EL in siblings, but not the prevalence rates of ADHD or ODD. EL and ADHD does not co‐segregate within families. Conclusion: EL is a frequent clinical problem in children with ADHD. It is associated with increased severity of ADHD core symptoms, particularly hyperactivity‐impulsivity, and more symptoms of comorbid psychopathology, primarily symptoms of oppositional defiant disorder (ODD), but also affective symptoms, and substance abuse. EL in ADHD seems to be more closely related to ODD than to ADHD core symptoms, and is only partly explainable by the severity of ADHD core symptoms and associated psychopathology. Although EL symptoms are transmitted within families, EL in children with ADHD does not increase the risk of ADHD and ODD in their siblings.
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One group found that siblings of probands with both ADHD and emotion dysregulation also had significantly elevated rates of this combination, although this has not been replicated.
“In support, one group found that the siblings of probands with both ADHD and emotion dysregulation also had significantly elevated rates of this combination, although this has not been replicated (52, 110, 111).”
From Emotion Dysregulation in Attention Deficit Hyperactivity Disorder (2014) · cites this paper as [52]
The ‘Familial prevalence of EL, ADHD and ODD’ section reports that siblings’ rates of ADHD plus high emotional lability did not differ significantly by proband emotional-lability severity. The Discussion likewise states that there was no evidence of co-segregation of emotional lability with ADHD. This paper therefore does not report the attributed significantly elevated rate of the combination. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredMost epidemiological research in children finds a strong association between ADHD and emotion dysregulation.
“Most epidemiological research has focused on children and finds a strong association between ADHD and emotion dysregulation (35, 51-56)(Table 1).”
From Emotion Dysregulation in Attention Deficit Hyperactivity Disorder (2014) · cites this paper as [52]
The Abstract and Distribution and severity of emotional lability section report substantially elevated emotional-lability ratings in children with ADHD, supporting an association. The paper does not establish that most epidemiological research focuses on children; its Discussion mentions one epidemiological study, while its own findings concern children with ADHD and their siblings. Page numbers were not available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSobanski and colleagues found that in a clinical sample of 1,186 children with ADHD, 25% had severe levels of emotional lability and an additional 50% had moderate levels.
“Based on the emotional lability subscale of the Parent and Teacher Conners’ ADHD rating scale, Sobanski and colleagues [2] found that in a clinical sample of 1186 children with ADHD, 25% had severe levels of emotional lability and an additional 50% had moderate levels.”
From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [2]
The “Distribution and severity of emotional lability” section reports 296 of 1,186 probands (25%) in the severe group and 594 (50%) in the mild/moderate group. The citing sentence calls that entire 50% “moderate,” omitting the paper’s “mild” qualification. Page numbers are not available in the supplied copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe severity of emotional and behavioral changes positively correlates with ADHD symptom severity, particularly in individuals with hyperactive-impulsive subtype, impacting social, daily living, and adaptive skills.
“the severity of these emotional and behavioral changes has been observed to positively correlate with ADHD symptom severity, particularly in individuals who exhibit the hyperactive-impulsive sub-type of ADHD, impacting social, daily living, and adaptive skills (Anastopoulos et al., 2011; Sobanski et al., 2010).”
From A Post-Hoc Analysis of Emotional Lability With Delayed-Release/Extended-Release Methylphenidate in Children Aged 6 to 12 Years of Age Participating in Two Phase 3 Clinical Trials (2024) · cites this paper as Sobanski et al., 2010
The ‘Association of emotional lability with demographic and clinical characteristics’ section reports that ADHD symptom severity rises with emotional lability, more markedly for hyperactive-impulsive than inattentive symptoms; its table also reports greater social/peer problems. But the study concerns children with ADHD combined type, not specifically the hyperactive-impulsive subtype, and the cited passages do not establish effects on daily living or adaptive skills. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredCore symptoms of ADHD, especially hyperactivity/impulsivity symptoms, are more pronounced with increasing severity of emotional lability.
“Sobanski and colleagues reported that the core symptoms of ADHD, especially hyperactivity/impulsivity symptoms, were more pronounced with increasing severity of emotional lability (Sobanski et al. 2010).”
From Treatment Outcomes with Lisdexamfetamine Dimesylate in Children Who Have Attention-Deficit/Hyperactivity Disorder with Emotional Control Impairments (2013) · cites this paper as Sobanski et al. 2010
Children with high levels of emotional lability tolerate frustration poorly, have high levels of irritability, and demonstrate frequent crying spells or tantrums.
“Children with high levels of emotional lability have been shown to tolerate frustration poorly, have high levels of irritability and demonstrate frequent crying spells or tantrums [2].”
From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [2]
Emotional lability commonly occurs in youth with attention-deficit/hyperactivity disorder.
“Emotional lability, or sudden strong shifts in emotion, commonly occurs in youth with attention-deficit/hyperactivity disorder.”
From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [2]
The presence of emotional lability in hyperactive children is associated with more severe ADHD symptoms, more frequent comorbid disorders, and higher rates of substance use disorders.
“Studies have also shown that the presence of emotional lability in hyperactive children is associated with more severe ADHD symptoms, more frequent comorbid disorders, and higher rates of substance use disorders [2, 14, 15].”
From Using Stimulants to Treat ADHD-Related Emotional Lability (2014) · cites this paper as [2]
ADHD combined with severe EL increases the likelihood of certain comorbidities, such as oppositional defiant, affective, and substance use disorders.
“Additionally, ADHD combined with severe EL increases the likelihood of certain comorbidities, such as oppositional defiant, affective, and substance use disorders, which make identifying an appropriate treatment regime more challenging due to varying symptom profiles and complex medication regimens (Jensen et al., 2001; Sobanski et al., 2010).”
From A Post-Hoc Analysis of Emotional Lability With Delayed-Release/Extended-Release Methylphenidate in Children Aged 6 to 12 Years of Age Participating in Two Phase 3 Clinical Trials (2024) · cites this paper as Sobanski et al., 2010
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“…of these emotional and behavioral changes has been observed to positively correlate with ADHD symptom severity, particularly in individuals who exhibit the hyperactive-impulsive sub-type of ADHD, impacting social, daily living, and adaptive skills (Anastopoulos et al., 2011; Sobanski et al., 2010).”
Background
- Authors
- Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., Holtmann, M., Krumm, B., Sergeant, J., Sonuga‐Barke, E., Stringaris, A., Taylor, E., Anney, R., Ebstein, R. P., Gill, M., Miranda, A., Mulas, F., Oades, R. D., Roeyers, H., Rothenberger, A., Steinhausen, H., & Faraone, S. V.
- Affiliations
- Central Institute of Mental Health (DE)
- Radboud University Nijmegen (NL)
- University of Southampton (GB)
- Vrije Universiteit Amsterdam (NL)
- St. James's Hospital (IE)
- Herzog Hospital (IL)
- Universitat de València (ES)
- Ghent University (BE)
- University of Göttingen (DE)
- University of Zurich (CH)
- SUNY Upstate Medical University (US)
- Corresponding author
- Banaschewski, Tobias
- ORCID
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2010-07-09
- Volume
- 51
- Issue
- 8
- Pages
- 915-923
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- OpenAlex
- W1780507086
- Cited by
- 365
- References
- 13
- Citations by year
- 2026: 12 · 2025: 15 · 2024: 24 · 2023: 16 · 2022: 21 · 2021: 17 · 2020: 29 · 2019: 23 · 2018: 24 · 2017: 26 · 2016: 28 · 2015: 35 · 2014: 30 · 2013: 21 · 2012: 18
- FWCI
- 13.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Universitätsbibliographie, Universität Duisburg-Essen (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- DuEPublico (University of Duisburg-Essen) (submittedVersion)
- ePrints Soton (University of Southampton) (submittedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Research Portal (King's College London) (submittedVersion)
- GRO (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Funders
- National Institutes of Health
- National Institute of Mental Health (R01 MH 62873, R01MH062873)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- emotional lability, attention deficit hyperactivity disorder, children and adolescents, hyperactivity/impulsivity, oppositional defiant disorder, comorbid psychopathology, affective symptoms, substance use disorders, family transmission, siblings, combined type ADHD
- MeSH terms
- Adolescent, Affective Symptoms, Attention Deficit Disorder with Hyperactivity, Child, Cross-Sectional Studies, Female, Humans, Inhibition, Psychological, Internal-External Control, Male, Models, Psychological, Personality Assessment, Phenotype, Psychometrics, Psychopathology, Social Adjustment, Statistics as Topic, Comorbidity, Linear Models, Conduct Disorder, Attention Deficit and Disruptive Behavior Disorders, Substance-Related Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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