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Background <p>Emotional dysregulation (ED) is increasingly recognized as a clinically significant and functionally impairing dimension of Attention-Deficit/Hyperactivity Disorder (ADHD), particularly in individuals with the combined presentation and in females (Beheshti et al., BMC Pscyhiatry 20:120,2020, Shaw et al., Am J Psychiat 171:276-293, 2014, Karalunas et al., J Child Psychol Psychiatry 64:55-65,2023). Despite this recognition, pharmacological strategies specifically targeting ED remain underexplored (Caye et al., Lancet Psychiatry 8:7956-810,2021, Krieger et al., J Child Adolesc Psychopharmacol 29:186-194,2019).</p> Objective <p>To synthesize and evaluate the efficacy of pharmacological treatments for emotional dysregulation in ADHD, with stratification by sex and ADHD subtype.</p> Methods <p>This meta-analysis included 20 peer-reviewed studies published between 2010 and 2025 that utilized validated instruments to assess ED (e.g., CBCL-DP&#xa0;(Grizenko et al., J Am Acad Child Adolesc Psychiatry 56:984-992,2017), DERS&#xa0;(Beheshti et al., BMC Pscyhiatry 20:120,2020), BRIEF(Mahone et al., J Atten Disord 20:673-684,2016, Musser et al., J Abnorm Child Psychol 48:L683-695,2020)). The studies evaluated the effects of both stimulant medications (e.g., methylphenidate, lisdexamfetamine) and non-stimulant agents (e.g., atomoxetine, guanfacine)&#xa0;(Krieger et al., J Child Adolesc Psychopharmacol 29:186-194,2019, Grizenko et al., J Am Acad Child Adolesc Psychiatry 56:984-992,2017, Waltereit et al., Front Child Adolesc Psychiatry 2:1547672,2025). Data were extracted on age, medication class, stratification variables, and pre-/post-treatment ED outcomes.</p> Results <p>Most stimulant treatments were associated with significant reductions in ED, particularly among individuals with the combined ADHD subtype&#xa0;(Caye et al., Lancet Psychiatry 8:7956-810,2021, Grizenko et al., J Am Acad Child Adolesc Psychiatry 56:984-992,2017, Posner et al., Biol Psychiatry: Cogn Neurosci Neuroimaging 6:142-151,2021). Guanfacine and atomoxetine demonstrated moderate efficacy, especially in individuals with the inattentive subtype and in females&#xa0;(Krieger et al., J Child Adolesc Psychopharmacol 29:186-194,2019, Waltereit et al., Front Child Adolesc Psychiatry 2:1547672,2025, Schmid et al., J Child Psychol Psychiatry 66:512-523,2025). Several studies reported sex differences in both baseline ED severity and treatment response&#xa0;(Beheshti et al., BMC Pscyhiatry 20:120,2020, Karalunas et al., J Child Psychol Psychiatry 64:55-65,2023, Reinhardt et al., BMC Psychiatry 24:153,2024, Wigal et al., J Atten Disord 29:706-723,2025).</p> Conclusion <p>Pharmacological treatment significantly reduces emotional dysregulation in ADHD, with central stimulants demonstrating the strongest efficacy. Clinicians should incorporate sex and ADHD subtype-specific stratifications to optimize personalized pharmacological strategies and improve patient outcomes&#xa0;(Beheshti et al., BMC Pscyhiatry 20:120,2020, Caye et al., Lancet Psychiatry 8:7956-810,2021, Karalunas et al., J Child Psychol Psychiatry 64:55-65,2023).</p> <p>This review was conducted and reported in accordance with the PRISMA 2020 guidelines for systematic reviews and meta-analyses.</p>

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Pharmacological interventions for emotional dysregulation in ADHD: a meta-analysis stratified by sex and ADHD subtypes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月23日

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  • Davoud Amiri,
  • Lamberto Briziarelli,
  • Enrico Tempesta,
  • Hadi Rahimi Danesh,
  • Amir Hossein Jalali Nadoushan,
  • Barry Karlsson

摘要

Background

Emotional dysregulation (ED) is increasingly recognized as a clinically significant and functionally impairing dimension of Attention-Deficit/Hyperactivity Disorder (ADHD), particularly in individuals with the combined presentation and in females (Beheshti et al., BMC Pscyhiatry 20:120,2020, Shaw et al., Am J Psychiat 171:276-293, 2014, Karalunas et al., J Child Psychol Psychiatry 64:55-65,2023). Despite this recognition, pharmacological strategies specifically targeting ED remain underexplored (Caye et al., Lancet Psychiatry 8:7956-810,2021, Krieger et al., J Child Adolesc Psychopharmacol 29:186-194,2019).

Objective

To synthesize and evaluate the efficacy of pharmacological treatments for emotional dysregulation in ADHD, with stratification by sex and ADHD subtype.

Methods

This meta-analysis included 20 peer-reviewed studies published between 2010 and 2025 that utilized validated instruments to assess ED (e.g., CBCL-DP (Grizenko et al., J Am Acad Child Adolesc Psychiatry 56:984-992,2017), DERS (Beheshti et al., BMC Pscyhiatry 20:120,2020), BRIEF(Mahone et al., J Atten Disord 20:673-684,2016, Musser et al., J Abnorm Child Psychol 48:L683-695,2020)). The studies evaluated the effects of both stimulant medications (e.g., methylphenidate, lisdexamfetamine) and non-stimulant agents (e.g., atomoxetine, guanfacine) (Krieger et al., J Child Adolesc Psychopharmacol 29:186-194,2019, Grizenko et al., J Am Acad Child Adolesc Psychiatry 56:984-992,2017, Waltereit et al., Front Child Adolesc Psychiatry 2:1547672,2025). Data were extracted on age, medication class, stratification variables, and pre-/post-treatment ED outcomes.

Results

Most stimulant treatments were associated with significant reductions in ED, particularly among individuals with the combined ADHD subtype (Caye et al., Lancet Psychiatry 8:7956-810,2021, Grizenko et al., J Am Acad Child Adolesc Psychiatry 56:984-992,2017, Posner et al., Biol Psychiatry: Cogn Neurosci Neuroimaging 6:142-151,2021). Guanfacine and atomoxetine demonstrated moderate efficacy, especially in individuals with the inattentive subtype and in females (Krieger et al., J Child Adolesc Psychopharmacol 29:186-194,2019, Waltereit et al., Front Child Adolesc Psychiatry 2:1547672,2025, Schmid et al., J Child Psychol Psychiatry 66:512-523,2025). Several studies reported sex differences in both baseline ED severity and treatment response (Beheshti et al., BMC Pscyhiatry 20:120,2020, Karalunas et al., J Child Psychol Psychiatry 64:55-65,2023, Reinhardt et al., BMC Psychiatry 24:153,2024, Wigal et al., J Atten Disord 29:706-723,2025).

Conclusion

Pharmacological treatment significantly reduces emotional dysregulation in ADHD, with central stimulants demonstrating the strongest efficacy. Clinicians should incorporate sex and ADHD subtype-specific stratifications to optimize personalized pharmacological strategies and improve patient outcomes (Beheshti et al., BMC Pscyhiatry 20:120,2020, Caye et al., Lancet Psychiatry 8:7956-810,2021, Karalunas et al., J Child Psychol Psychiatry 64:55-65,2023).

This review was conducted and reported in accordance with the PRISMA 2020 guidelines for systematic reviews and meta-analyses.