Do Treatments for Adult ADHD Improve Emotional Behavior? A Systematic Review and Analysis
Abstract
Objective Dysregulated emotional behavior occurs often in adults with ADHD. Analysis of clinical trials may guide clinical intervention and future research. Method Controlled trials of adult ADHD measuring emotional behavior were included if another study offered a comparable analysis of the same treatment method. Standardized Mean Difference (SMD) of effects were calculated, and the size of effects for emotional and non-emotional ADHD behavior were compared. Results 13 out of 14 studies of methylphenidate, atomoxetine, and lisdexamfetamine demonstrated significant improvement in emotional behavior measures, with small to high SMDs. The proportional effect on emotional versus non-emotional behavior ranged from 46% to 110% for methylphenidate, 56% to 129% for atomoxetine, and 36% to 96% for lisdexamfetamine. Conclusion Psychopharmacological treatments for ADHD are likely to improve emotional behavior, and available scales are sensitive to these effects. Studies dedicated to treatment of this domain of function can further refine clinical approaches.
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Several meta-analyses and reviews of clinical trials for stimulant and non-stimulant treatments have demonstrated improvements in EL.
“These reports have been further demonstrated by several meta-analyses and reviews of clinical trials for stimulant and non-stimulant treatments (Lenzi et al., 2017; Moukhtarian et al., 2017; C. B. H. Surman & Walsh, 2022).”
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 C. B. H. Surman & Walsh, 2022
Several meta-analyses and reviews assessing double-blind randomized control trials describe positive emotional outcomes for treatments such as atomoxetine, lisdexamfetamine, methylphenidate transdermal system, and OROS-MPH versus placebo in adults with ADHD.
“several meta-analyses and reviews assessing the results of double-blind randomized control trials describe positive emotional outcomes for treatments such as atomoxetine, lisdexamfetamine, methylphenidate transdermal system, and OROS-MPH versus placebo in adults with ADHD (Lenzi et al., 2017; Moukhtarian et al., 2017; C. B. H. Surman & Walsh, 2022)”
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 C. B. H. Surman & Walsh, 2022
Cites
Barkley, R. A. (1997) · Psychological Bulletin · doi:10.1037//0033-2909.121.1.65 · Cited by 580 · cited 1× · see citing works
“This evidence includes a line of studies that explored correlates of high levels of emotional dysregulation items from the Barkley’s Current Behavior Scale (Barkley, 1997).”
BackgroundCognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms
Safren, S. A., Otto, M. W., Sprich, S., Winett, C. L., Wilens, T. E., & Biederman, J. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.07.001 · Cited by 519 · cited 1× · see citing works
“The CBT in this study was based on a method from a validated method (Safren et al., 2005).”
MethodMedori, R., Ramos-Quiroga, J. A., Casas, M., Kooij, J. J. S., Niemelä, A., Trott, G.-E., Lee, E., & Buitelaar, J. K. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2007.11.008 · Cited by 186 · see citing works
Surman, C. B. H., Biederman, J., Spencer, T., Miller, C. A., McDermott, K. M., & Faraone, S. V. (2013) · ADHD Attention Deficit and Hyperactivity Disorders · doi:10.1007/s12402-012-0100-8 · Cited by 155 · see citing works
Self-citationSurman, C. B. H., Biederman, J., Spencer, T., Yorks, D., Miller, C. A., Petty, C. R., & Faraone, S. V. (2011) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2010.10081172 · Cited by 135 · cited 3× · see citing works
“Studies suggest that maladaptive patterns of emotional expression may be common in adults with ADHD (Reimherr et al., 2005; Surman et al., 2011).”
BackgroundSelf-citationRösler, M., Retz, W., Fischer, R., Ose, C., Alm, B., Deckert, J., Philipsen, A., Herpertz, S., & Ammer, R. (2010) · The World Journal of Biological Psychiatry · doi:10.3109/15622971003624197 · Cited by 131 · see citing works
Hepark, S., Janssen, L., de Vries, A., Schoenberg, P. L. A., Donders, R., Kan, C. C., & Speckens, A. E. M. (2019) · Journal of Attention Disorders · doi:10.1177/1087054715613587 · Cited by 84 · see citing works
Bachmann, K., Lam, A. P., Sörös, P., Kanat, M., Hoxhaj, E., Matthies, S., Feige, B., Müller, H., Özyurt, J., Thiel, C. M., et al. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.05.002 · Cited by 73 · see citing works
Adler, L. A., Dirks, B., Deas, P. F., Raychaudhuri, A., Dauphin, M. R., Lasser, R. A., & Weisler, R. H. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12m08144 · Cited by 62 · cited 4× · see citing works
“The other study (Weisler et al., 2017) found that lisdexamfetamine treatment led to significantly improved scores on the observer CAARS: I/E subscale.”
MethodInfluentialEffect of Atomoxetine on Executive Function Impairments in Adults With ADHD
Brown, T. E., Holdnack, J., Saylor, K., Adler, L., Spencer, T., Williams, D. W., Padival, A. K., Schuh, K., Trzepacz, P. T., & Kelsey, D. (2011) · Journal of Attention Disorders · doi:10.1177/1087054709356165 · Cited by 59 · see citing works
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Arnold, V. K., López, F. A., Childress, A. C., Po, M. D., Uchida, C. L., Cuthbertson, L., Sallee, F. R., & Incledon, B. (2024) · Journal of Attention Disorders · doi:10.1177/10870547241243155 · Cited by 1 · see citing works
“These reports have been further demonstrated by several meta-analyses and reviews of clinical trials for stimulant and non-stimulant treatments (Lenzi et al., 2017; Moukhtarian et al., 2017; C. B. H. Surman & Walsh, 2022).”
BackgroundResult
- Authors
- Surman, C. B. H., & Walsh, D. M.
- Affiliations
- Harvard University (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Surman, Craig B. H.
- ORCID
- Surman, Craig B. H.
- Venue
- Journal of Attention Disorders
- Publisher
- SAGE Publications
- Published
- 2022-07-13
- Volume
- 26
- Issue
- 14
- Pages
- 1822-1832
- ISSN
- 1087-0547 (ISSN-L)
- 1557-1246
- OpenAlex
- W4285392517
- Cited by
- 6
- References
- 10
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 1
- FWCI
- 0.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Attention Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- adult ADHD, emotional behavior, emotional dysregulation, methylphenidate, atomoxetine, lisdexamfetamine, psychopharmacological treatment, standardized mean difference
- MeSH terms
- Atomoxetine Hydrochloride, Lisdexamfetamine Dimesylate, Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Humans, Methylphenidate, Treatment Outcome
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