Journal of Child Psychology and Psychiatry 50:9 (2009), pp 1042–1051 doi:10.1111/j.1469-7610.2009.02105.

Research Review: A new perspective on

attention-deficit/hyperactivity disorder: emotion
dysregulation and trait models
Michelle M. Martel
Psychology Department, University of New Orleans, USA

Attention-deficit/hyperactivity disorder (ADHD) is a common example of developmental psychopathology that

might be able to be better understood by taking an emotion regulation perspective. As discussed herein,
emotion regulation is understood to consist of two component processes, emotion (e.g., positive and negative
emotionality) and regulation (e.g., effortful and reactive forms of control), which interact with one another at
the behavioral level. Review of work to date suggests that the heterogeneous behavioral category of ADHD may
encompass two distinct kinds of inputs: inattentive ADHD symptoms may be primarily associated with
breakdowns in the regulation side, whereas hyperactivity-impulsive ADHD symptoms may be associated with
breakdowns in the emotionality side. It is argued that breakdowns in control may be a signature for ADHD
specifically, while increased negative emotionality may serve as non-specific risk factors for disruptive
behavior disorders, explaining their comorbidity. Increased understanding of the interrelations and interac-
tions of component emotion regulation processes may elucidate developmental, sex, and neural mechanisms
of ADHD and associated comorbid disruptive disorders. Keywords: Emotion, emotion regulation, ADHD,
disruptive behavior, temperament.

Attention-deficit/hyperactivity disorder (ADHD) is a
common example of developmental psychopathology
that, although typically studied through the lens of
cognitive control, might be able to be better under-
stood by taking an emotion regulation perspective.
ADHD is a behavioral disorder present by age 7,
characterized by excessive inattention-disorganization
(e.g., ‘often fails to give close attention to details’ or
‘makes careless mistakes in schoolwork, work, or
other activities’) and/or hyperactivity-impulsivity (e.g.,
‘often fidgets with hands or feet,’ ‘squirms in seat,’ or
‘often has difficulty awaiting turn’; APA, 2000). There
are currently three subtypes of the disorder: a pre-
dominantly inattentive subtype (ADHD-PI), character-
ized by six or more symptoms of inattention, a
predominantly hyperactive-impulsive subtype (ADHD-
PHI), characterized by six or more symptoms of
hyperactivity-impulsivity, and a combined subtype
(ADHD-C), characterized by six or more symptoms in
both domains (American Psychiatric Association,
2000). ADHD is commonly comorbid with other
childhood disruptive behavior disorders like opposi-
tional-defiant disorder (ODD) and conduct disorder
(CD; American Psychiatric Association, 2000). ADHD
follows a developmental trajectory with difficulties with
impulse control arising earlier in life than difficulties
with attention (Olson, 1996). Owing to its early devel-
opment, ADHD is often considered to be a trait-
like characteristic (Braaten & Rosen, 1997; Nigg,
Blaskey, Huang-Pollock, & John, 2002a). In fact,
recent research suggests that ADHD is best concep-
tualized as a dimensional trait, rather than a cate-
gorical diagnostic category (Haslam et al., 2006). Initial
Conflict of interest statement: No conflicts declared.
 2009 The Author
Journal compilation  2009 Association for Child and Adolescent Mental Health.
Published by Blackwell Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA
evidence suggests that individuals with ADHD are
often characterized by extreme affective traits like
negative emotionality (Martel & Nigg, 2006; Nigg et al.,
2002a, 2002b). Thus, increased understanding of the
role of emotion and regulation processes in ADHD may
be able to shed light on etiology and mechanisms of
this disorder.
As a starting point, the current paper will first
review definitions of emotion regulation, as well as the
complexities inherent in these definitions and associ-
ated measurement procedures. A literature review will
be conducted on studies addressing relations among
emotional regulation (including emotion- and regula-
tion-related traits), disruptive behavior disorders, and
ADHD. Sex effects on emotional regulation processes
relevant to disruptive behaviors will be discussed.
Emotion regulation models of disruptive behaviors
and ADHD will be presented. Finally, limitations of
previous work and guidelines for future work will be
discussed.
Emotion regulation
Empirical study of emotion and emotion regulation is,
in some senses, the Holy Grail of psychological study
(LeDoux, 1996). Although most laypeople recognize the
important role of emotion in daily life, historically,
researchers have been reluctant to delve into this illusive
and seemingly irrational psychological process. How-
ever, two influential books written in the 1990s empha-
sized the importance of emotions in rational thought
processes (Damasio, 1994) and set about describing
the neurobiological basis of emotion and emotion regu-
lation (LeDoux, 1996). Although Damasio examined
human patient neuropsychological performance on the

Gambling Task following brain injury, and LeDoux
studied rat performance on fear conditioning tasks
following well-defined experimental lesions, these two
researchers came to strikingly similar and complemen-
tary conclusions: emotion and its regulation are distinct
and yet often intertwined during day-to-day life (e.g.,
Adolphs et al., 1999; Bechara, Damasio, Damasio, & Lee,
1999; Phillips & LeDoux, 1992; Wilensky, Schafe,
Kristensen, & LeDoux, 2006). Since this research was
conducted, there has been much interest in emotion
regulation, but definitions of this construct remain
unclear, despite consensus that definitional clarity is
needed.
The role of emotion in emotion regulation complicates
definition (Campos, Frankel, & Camras, 2004). Most
developmental work on emotion and emotion regulation
has been based on careful observation and interval
coding of child emotion, emotion expressiveness, and
emotion regulation, as well as related parent–child
interactions, measured during laboratory tasks meant
to emulate real-life situations and/or experimentally
induce natural mood states (e.g., a competitive game, a
task that requires the child to wait for the mother to
complete work before he/she can open a gift; Chaplin,
Cole, & Zahn-Waxler, 2005; Cole, Teti, & Zahn-Waxler,
2003; Cole, Zahn-Waxler, Fox, Usher, & Welsh, 1996;
Eisenberg et al., 1996; Eisenberg, Fabes, Guthrie, &
Reiser, 2000a). Based on this work, a recent definition
of emotion refers to it as ‘appraisal-action readiness
stances’ (Cole, Martin, & Dennis, 2004; p. 320) which
connotes both an evaluating and an action-readiness
component of emotion. A second, somewhat overlap-
ping, definition emphasizes functionality and defines
emotion as the process of registering the significance of
an event, with magnitude and urgency stressed as two
important components of emotional responses (Campos
et al., 2004).
Emotions have at least two potential roles; they reg-
ulate and are regulated (Cole et al., 2004; Cole, Michel,
& Teti, 1994). Regulatory emotion refers to changes that
come about because of emotion (e.g., a child’s anger
leading to conflict with peers) while regulated emotion
refers to changes in valence of emotion (Cole et al.,
2004; e.g., a child soothes him/herself or makes a sad
playmate smile). Individual differences in regulated
emotion have been linked to later behavior problems
(Cole et al., 1996; Cole, Zahn-Waxler, & Smith, 1994).
An alternative, yet somewhat overlapping, definition of
emotional regulation is the act of modifying any process
that generates emotion or any behavioral manifesta-
tions of emotion (Campos et al., 2004; e.g., use of self-
soothing strategies). Seeing these definitions as overly
broad, Eisenberg and colleagues argued for a definition
of emotion-related self-regulation as ‘the process of
initiating, avoiding, inhibiting, maintaining, or modu-
lating the occurrence, form, intensity, or duration of
internal feeling states, emotion-related physiological,
attentional processes, motivational states, and/or the
behavioral concomitants of emotion in the service of
accomplishing affect-related biological or social adap-
tation or achieving individual goals’ (Eisenberg &
Spinrad, 2004, p. 338).
 2009 The Author
Journal compilation  2009 Association for Child and Adolescent Mental Health.
Emotion, regulation, and ADHD 1043
Eisenberg’s notion of emotion-related behavioral
regulation, alternatively called behavioral regulation or
reactive control, is frequently found to interact with the
trait of negative emotionality (i.e., the culmination of a
diverse set of negative emotions including anger, sad-
ness, and worry) in predicting behavioral outcomes
such as social functioning and problem behavior
(Eisenberg et al., 2000b). Specifically, negative emo-
tionality moderates the relationship between emotional-
related behavioral regulation and both positive and
negative outcomes (e.g., social competence; externaliz-
ing behavior) with stronger relationships found for
those higher in negative emotionality (Eisenberg et al.,
1996, 2000b). Based on this definition, emotion-based
behavioral regulation is likely only one component of
the broader concept of emotional regulation. The defi-
nition of emotion regulation used in the current paper is
most in line with this perspective in that emotion- and
regulation-related temperament/personality traits (e.g.,
negative/positive emotionality, effortful control) are
seen as one way to gain purchase on the broader, more
complex concept of emotion regulation. Emotion- and
regulation-related temperament/personality traits may
provide one means by which to understand specific
components of emotion regulation. Since emotion reg-
ulation and temperament theorists claim much of the
same domain, discussion of the similarities and differ-
ences between emotion regulation and traits may
facilitate development of alternative conceptualizations
and description, as well as enrich measurement strat-
egies.
Emotion and regulation: one process or two?
The fundamental question regarding emotion and reg-
ulation concerns whether we conceive them as one or
two processes. Although most definitions of emotion
regulation conceptualize emotion and regulation as
dissociable from one another, this idea is being
increasingly critiqued. One-factor models of emotion
regulation may, in fact, be better supported (Campos et
al., 2004), despite the fact that it is possible to break
down one-factor models into their component processes
(e.g., emotions, regulation processes). The structure of
emotion regulation may, in fact, depend critically on the
level of analysis examined. While emotion and regula-
tion may be inseparable when examined at the behav-
ioral level, they may be distinguishable at the neural
level (Goldsmith & Davidson, 2004). One complicating
factor is that temporal relations between emotion and
regulation are almost certainly bidirectional (Bridges
Denham, & Ganiban, 2004; Cole et al., 2004).
Study of the neurobiology of emotion and regulation
may shed some light on the distinctiveness of these
processes. The neurobiology of emotions has been
extensively studied. Negative emotion (i.e., avoidance)
and positive emotion (i.e., approach) have received most
emphasis in regard to neurobiological underpinnings,
in part due to their important evolutionary functions
(Gray, 1981; Nigg, 2006). Negative and positive emo-
tionality are also believed to be the first emotionally
1044 Michelle M. Martel
driven reaction of human infants (Rothbart & Posner,
2006). Negative emotionality, such as fear and anger,
appears to rely on a neural circuit involving the
amygdala, hippocampus, anterior cingulate cortex,
and right prefrontal cortex with particular reliance on
serotonin neurotransmission. Positive emotionality,
such as extraversion and positive affect, rely on the
amygdala, the nucleus accumbens, the anterior cin-
gulate cortex, and the left prefrontal cortex with par-
ticular reliance on dopaminergic neurotransmission
(Depue & Lenzenweger, 2006; Derryberry & Tucker,
2006; Fox, 1994; Rothbart & Posner, 2006; Whittle
et al., 2006).
Although negative and positive emotionality are evi-
dent during infancy, control processes develop later
during childhood (Casey, Tottenham, Liston, & Durston,
2005). Control processes, alternatively conceptualized
as constraint, effortful control, conscientiousness, or
cognitive control (Nigg, 2000), rely heavily on the pre-
frontal cortex, especially the dorsolateral, orbitofrontal,
and anterior cingulate cortex (Derryberry & Tucker,
2006; Rothbart & Posner, 2006; Whittle et al., 2006).
Further, a variety of neurotransmitters are associated
with integrity in control processes, including acetylcho-
line, norepinephrine, dopamine, and serotonin (Depue &
Lenzenweger, 2006; Rothbart & Posner, 2006; Whittle
et al., 2006).
Recent work suggests that the prefrontal cortex,
particularly the anterior cingulate (with dopaminergic
and serotoninergic neurotransmission involvement),
likely functions to integrate emotion and cognitive
control processes (Holroyd & Coles, 2002). In this way,
emotion and regulation (or cognitive control) appear to
have some ‘crosstalk’ and may be able to work together
to achieve some goals, such as evaluation of informa-
tion and execution of action (Bell & Wolfe, 2004). This
may explain why these processes are sometimes so
difficult to dissociate at a behavioral level. However,
differences in the timing of the development of these
processes also suggest important distinctions between
emotion and its regulation.
Measurement of emotion regulation
In the scientific literature, emotion regulation is most
commonly examined during frustration-eliciting para-
digms, and emotion regulation is commonly charac-
terized using affective and behavior coding. One
frustration-eliciting paradigm consists of giving an
undesirable prize as a reward (Cole, 1986; Saarni,
1984). Another frustration-eliciting paradigm consists
of asking children to construct a model or puzzle that
is missing several critical pieces (e.g., Melnick &
Hinshaw, 2000). Affective coding frequently involves
the coding of negative facial expressions, such as
anger, sadness, and worry. Behavioral coding generally
focuses on emotion regulation strategies such as
problem-solving, help-seeking, emotion expression,
and disruptive behavior (e.g., Cole, Zahn-Waxler, and
Smith, 1994b; Melnick & Hinshaw, 2000). The mea-
surement of emotional regulation differs dramatically
between studies.
Journal compilation  2009 Association for Child and Adolescent Mental Health.
Emotional regulation and disruptive behavior
disorders
Emotion dysregulation can be viewed as critically
important in the development and clinical expression
of disruptive behavior disorders and ADHD, although
this is a relatively under-examined perspective.
Although deficits in cognitive control are most fre-
quently studied in relation to ADHD in school-age
children, examination of emotion dysregulation may
be particularly useful in younger children, due to the
earlier emergence of emotionality systems (vs. control
systems). Study of emotion regulation deficits in
young children may elucidate early longitudinal
pathways to these disorders, as well as sex differences
in these pathways.
One study addressed part of this question by
examining the relation of preschoolers’ expressive
control of emotion with risk for developing general
disruptive behavior disorders (Cole et al., 1994). Cole
and colleagues (1994) gave preschoolers an undesir-
able prize and coded subsequent negative affect
(i.e., anger, sadness, worry, and disgust) and behavior
(i.e., active self-regulation, passive tolerance, and
disruptive behavior) in the examiner’s presence and
absence. Sex differences were found in children’s
reactions to the undesirable prize. Boys at high risk for
disruptive behavior disorders showed more negative
emotion in the examiner’s presence than boys at low
risk, although boys at low risk had comparable levels
of negative emotion as boys at high risk in the exam-
iner’s absence. For the at-risk boys, anger predicted
subsequent oppositionality. In contrast, at-risk girls
exhibited less negative affect in the examiner’s absence
than low-risk girls. Thus, sex differences were evident
in affective response and emotion regulation for
children at high risk for the development of disruptive
behavior disorders. Decreased emotional regulation of
anger predicted increased disruptive behavior symp-
toms for males, and increased ‘minimization of nega-
tive emotion’ predicted disruptive behavior symptoms
for females.
Emotion regulation and ADHD
An additional question concerns whether emotion reg-
ulation deficits are specific to ADHD or other disruptive
behavior disorders or whether they explain the comor-
bidity among these disorders. Only one study has
examined the role of emotion regulation in ADHD spe-
cifically. Melnick and Hinshaw (2000) examined emo-
tion regulation strategies in 45 school-aged boys with
ADHD with and without comorbid aggression as com-
pared to 34 boys without problem behaviors. Each child
participated in a frustration-eliciting task with one
parent during which they were asked to solve a puzzle
that was missing two pieces; a behavioral coding system
was used to code child behavior during the task. A
subgroup of the children with ADHD, the subgroup with
ADHD and comorbid aggression, had more maladaptive
emotion regulation compared to the other children.
 2009 The Author

Specifically, children with ADHD with high levels of
aggression focused more on the negative aspects of the
task, engaged in less accommodation (i.e., cognitive
reframing), and exhibited more intense emotional
expression (e.g., slamming fist, sighing; Melnick &
Hinshaw, 2000).
Walcott and Landau (2004) also found that boys with
ADHD exhibited more ineffective emotion regulation
than boys without ADHD, although they did not
examine or control for comorbid aggression. In this
study, cognitive disinhibition and emotion regulation
was examined in a sample of 49 boys aged 6 to 11 with
and without ADHD. Cognitive disinhibition was mea-
sured via Stop Signal Reaction Time (i.e., a measure of
how much time is needed to successfully inhibit a mo-
tor response) from the Stop Task (Walcott & Landau,
2004). Emotion regulation was examined with a com-
petitive version of the task used by Melnick and Hin-
shaw (2000; described above). In this task, children
were asked to solve a puzzle in which two pieces were
missing, and they were asked to do it faster than a
confederate competitor. In addition, half of the children
were asked to mask their frustration from the confed-
erate competitor. Behavioral coding was used to assess
emotional reaction and emotion regulation. Boys with
ADHD exhibited more ineffective emotion regulation
than boys without ADHD, exhibited by more negative
responses and immobilized behavior. They also had
more difficulty trying to regulate their emotional display
when instructed. Precompetition cognitive disinhibition
predicted a small, but statistically significant, amount
of emotion dysregulation during the competitive peer
task.
Maedgen and Carlson (2000) found that children with
ADHD-C had less effective emotion regulation than
children with ADHD-PI and children without ADHD,
although comorbid aggression was not examined.
Emotion regulation and emotion expression was as-
sessed in 16 children with ADHD-C, 14 children with
ADHD-PI, and 17 non-ADHD comparison children
during a prize paradigm (Maedgen & Carlson, 2000). In
this prize paradigm, children were asked to rank order a
list of prizes. Then, they were presented with a desirable
prize following one task and an undesirable prize fol-
lowing a second task. Behavioral coding was used to
assess positive behavior (e.g., smiling), negative
behavior (e.g., frowning) and emotional regulation
(measured in the same way as by Melnick and Hinshaw
(2000; above). In this study, children with ADHD-C
expressed more negative behavior during the disap-
pointing condition of the task and more positive
behavior overall. Children with ADHD-C were also
judged to be more intense, more interested, and less
effective in their emotional regulation than other chil-
dren. Other research suggests that children with ADHD
differ from other children in other emotion-related
abilities, including emotion appraisal skills, recognition
of facial expressions of emotion, and subjective experi-
ence of emotion (Norvilitis et al., 2000; Scime & Norvi-
litis, 2006; Singh et al., 1998; Wigal et al., 1998). Again,
however, most studies did not control for comorbid
aggression.
 2009 The Author
Journal compilation  2009 Association for Child and Adolescent Mental Health.
Emotion, regulation, and ADHD 1045
Emotion- and regulation-related traits and
ADHD
In addition to research on emotion regulation, some
research has addressed the relations among childhood
disruptive behavior disorders, ADHD, and emotion-re-
lated traits like negative emotionality, neuroticism, and
extraversion (i.e., outward directed sociability, related
to positive emotionality). Since there is considerable
controversy about whether childhood traits are best
captured by temperament and personality constructs,
findings from both domains will be presented herein. It
should be noted that recent theory suggests that tem-
perament and personality can and possibly should be
integrated in children due to similarities between the
two domains (Shiner, 2005). Negative emotionality has
been linked to neuroticism; surgency and high-inten-
sity pleasure has been linked to extraversion, and
effortful control has been linked to conscientiousness
(reviewed by Shiner & Caspi, 2003). Evidence also
supports the trait of agreeableness in children, al-
though the trait of openness to experience has been
found less consistently in this age range (reviewed by
Shiner & Caspi, 2003). Further, temperament and
personality traits are thought to be hierarchically or-
ganized with higher-order factor structures (e.g., three-
factor models) believed to subsume lower-order factor
structures (e.g., five-factor models), thus allowing for
both three- and five-factor models to explain phenom-
enon at different levels of abstraction (Digman, 1997;
Markon, Krueger, & Watson, 2005).
Overall, children with disruptive behavior disorders
are characterized by increased negative emotionality
(especially anger and frustration) and neuroticism, in-
creased high-intensity pleasure and extraversion, and
low agreeableness (Eisenberg et al., 2001; Huey & We-
isz, 1997; Lynam et al., 2005; Oldehinkel et al., 2004;
Sanson & Prior, 1999). Children with ADHD have been
likewise characterized by high negative emotionality
and neuroticism, positive emotionality and sometimes
extraversion, as well as low agreeableness compared to
children without ADHD (Parker, Majeski, & Collin,
2004; White, 1999). Further, there is substantial evi-
dence that disruptive behavior disorders and ADHD in
particular are associated with poor regulation, whether
conceptualized as effortful control or conscientiousness
(e.g., Eisenberg et al., 2001; Olson et al., 2005; Parker
et al., 2004). Despite the utility of mapping these
associations, these studies are less informative about
specificity of relations between traits and disruptive
behaviors because they did not examine these disrup-
tive behaviors in isolation.
Several studies examined specific relations among
traits and disruptive behavior symptoms. In a study of
adults, inattentive ADHD symptoms were significantly
related to higher neuroticism, lower openness, and
lower conscientiousness, while hyperactive-impulsive
ADHD symptoms were linked to higher neuroticism,
higher extraversion, lower agreeableness, and lower
conscientiousness (Parker et al., 2004). At least two
studies have attempted to examine specific relations
between disruptive behaviors and traits by isolating
1046 Michelle M. Martel
disruptive symptom domains from one another. A
study that examined the Big Five Factors in an adult
sample found that inattentive ADHD symptoms
were specifically related to low conscientiousness,
whereas hyperactive-impulsive ADHD symptoms and
oppositional-defiant symptoms were related to low
agreeableness (Nigg et al., 2002b). A study that exam-
ined temperament traits in a clinical child sample found
that inattention was related to effortful control, hyper-
activity-impulsivity was related to reactive control, and
opposition-defiance was related to negative emotional-
ity (Martel & Nigg, 2006). Thus, children with ADHD
appear to be characterized by high levels of negative
emotionality and low levels of control as a group, but
more specific associations can be seen at the symptom
level.
Further, relations between traits and clinical symp-
toms may exhibit developmental changes or interactive
effects. While childhood remitting or persisting ADHD is
related to low levels of control or conscientiousness,
ADHD that persists into adolescence is also character-
ized by increased neuroticism and decreased agree-
ableness (Miller et al., 2008), although it should be
noted that comorbidity was not examined in this study.
Finally, some research has found that control processes
interact with emotion-related traits like negative emo-
tionality in relation to disruptive behavior disorders and
ADHD (Eisenberg et al., 2000b; Martel & Nigg, 2006).
Sex differences in emotion- and
regulation-related traits relevant to
disruptive behavior disorders
Although sex differences in emotion regulation pro-
cesses are underexplored, sex differences in emotion-
and regulation-related traits are well established.
Similar to the sex-biased prevalence rate observed in
childhood psychopathology, early childhood traits also
show substantial sex differences, and these traits are
related to preschool psychopathology (Lavigne et al.,
1996). A meta-analysis on gender differences in tem-
perament in children between the ages of 3 months
and 13 years indicates that girls typically exhibit
higher levels of effortful control, while boys exhibit
higher levels of positive affect (Else-Quest et al., 2006).
In regard to the development of sex differences in
traits, data are limited. Some data suggests that boys
exhibit higher levels of negative emotionality (e.g.,
irritability) in toddlerhood and that girls develop higher
levels of trait control during early childhood with the
advent of language development (Sanson & Prior,
1999). However, sex differences in traits appear early
and map onto early-appearing sex differences in the
prevalence rates of common forms of psychopathology
like ADHD.
Emotion regulation models of disruptive
behavior disorders and ADHD
Maladaptive emotion and regulation processes may
exhibit specific linkages with psychopathological symp-
Journal compilation  2009 Association for Child and Adolescent Mental Health.
tom domains, and mapping such linkages may enable
more accurate prediction of risk for developmental
psychopathology (Lynam & Widiger, 2007; Widiger &
Trull, 2007). It may be possible to link emotion regula-
tion processes with specific disruptive behavior symp-
tom domains in such a way as to shed light on the high
levels of comorbidity evidenced among the disruptive
behavior disorders. As shown in Figure 1, high negative
emotionality may increase risk for all disruptive behavior
disorders. More specific linkages, however, may be seen
between (dis)agreeableness and conduct disorder,
between high reactive control/negative emotionality and
oppositional-defiant disorder, between low control and
ADHD inattention, and between high positive emotion-
ality and ADHD hyperactivity-impulsivity. Thus, the
ADHD symptom domain of inattention may be more
specifically related to control, while the ADHD symptom
domain of hyperactivity-impulsivity may be more related
to affectively driven forms of control, sharing some
overlap with oppositional-defiance through this trait
linkage. Such shared relations among traits may lead to
the comorbid conditions and symptomatology frequently
seen in children.
Several possible models of emotion regulation
process associations with ADHD and other childhood
disruptive behavior disorders could be proposed. Three-
and five-factor models will be emphasized in the current
paper. These models are meant to be illustrative of a
general logic that can guide work going forward.
Because little work has examined specific relations
between symptom domains and emotion regulation
processes, these models must be considered pre-
liminary and subject to refutation.
The first model, shown in Figure 2, is a three-factor
trait model of ADHD. As suggested by previous work
(e.g., Martel & Nigg, 2006), low effortful control may be
most specifically related to increased inattentive symp-
toms of ADHD. In contrast, high positive and negative
emotionality may be more specifically related to high
hyperactive-impulsive ADHD symptoms. These emo-
tion-related traits may also be related to oppositional-
defiance and conduct problems in a developmental
progression, shown in Figure 3. While negative emo-
tionality may be a risk factor for hyperactive-impulsive
ADHD symptoms, it may also be directly related to
ADHD
Effortful Inattention
Control/ Negative
Conscientio Emotion/
usness ADHD Neuroticism
Hyperactivity-
Impulsivity
Reactive
Control
ODD
Positive
Emotion/
Agreeable- Extraversion
ness CD
Figure 1 Emotion and regulation process model of
disruptive behavior disorders and comorbidity
 2009 The Author

Control
ADHD
Inattention
Positive
Emotion
ADHD
Hyperactivity-
Impulsivity
Negative
Emotion
Figure 2 Three-factor trait model of ADHD
ADHD
Inattention
Control
Positive ADHD
Emotion Oppositionality/
Hyperactivity-
Defiance
Impulsivity
Negative
Emotion
Figure 3 Three-factor developmental trait model of
ADHD and other disruptive behavior disorders
oppositional-defiance. However, positive emotionality
may be a risk factor only for hyperactivity-impulsivity
and influence oppositional-defiance only indirectly.
Then, oppositional-defiance may increase risk for later
conduct problems through the aforementioned trait
characteristics.
A five-factor model framework can also be con-
ceived, shown in Figure 4. Based on work by Nigg
(2006) et al. (2002b) and Lynam et al. (2005), con-
scientiousness appears to be related to inattention,
while high neuroticism, low agreeableness, and high
extraversion are related to hyperactivity-impulsivity.
High neuroticism and low agreeableness may directly
increase risk for oppositional-defiance, as well as
having indirect effects through hyperactivity-impul-
sivity. High neuroticism, disagreeableness, and/or low
conscientiousness may also lead to conduct problems
(Nigg, 2006). Thus, trait models can be proposed that
appear to account for established patterns of comor-
bidity among childhood psychopathology, as well as
specific relations among traits and psychopathology.
Whether these models are feasible or helpful in terms
of predicting later behavior problems or explaining
diagnostic symptoms and criteria remains to be
tested.
 2009 The Author
Journal compilation  2009 Association for Child and Adolescent Mental Health.
Emotion, regulation, and ADHD 1047
ADHD
Inattention
Conscien
tiousness
Conduct
Problems
Neuro-
ticism ADHD Oppositionality-
Hyperactivity- Defiance
Impulsivity
Agree-
ableness
Extraver-
sion
Open-
ness
Figure 4 Five-factor trait model of ADHD and other
disruptive behavior disorders
Conduct
Problems
Limitations of previous work
Work to date on emotion regulation and ADHD has
notable limitations. Little research has examined
specific relations between ADHD and emotion regula-
tion. Most prior studies have examined relations
between emotion regulation and childhood disruptive
behavior disorders with little attention to the extensive
comorbidity among disorders. Research on emotion
regulation in children with ADHD has often not
attended to the comorbid aggression seen in many of
these children (for exceptions, see Martel & Nigg, 2006;
Melnick & Hinshaw, 2000). For this reason, it is difficult
to know which aspects of emotion dysregulation are
specifically related to ADHD.
Longitudinal changes in emotion regulation are not
well mapped. Little research has attended to sex dif-
ferences in emotion regulation as they are related to the
sex-biased prevalence rates of childhood psychopa-
thology. Finally, the pervasiveness of emotion dysre-
gulation and extreme emotion-related traits in children
with developmental psychopathology has not been
studied at the individual level (using person-centered
data analytic strategies), although it clearly has impli-
cations for mapping pathways to developmental psy-
chopathology.
The relations among emotions, emotion-related
traits, emotional regulation, and cognitive control are
not well mapped. Distinctions between these domains
may be useful for componential analysis, but – at the
behavioral level – these distinctions may be more
semantic than real. The borders between emotional
and control processes may be more fluid than has
previously been acknowledged. Yet, developmental
changes in theses processes’ manifestations and
interaction may be related to age-related changes in
rates of developmental psychopathology.
1048 Michelle M. Martel
One methodological issue that must be carefully
considered in the study of relations among emotion
regulation, cognitive control, and psychopathology is
item and rater overlap. A handful of studies have
examined item overlap between temperament and psy-
chopathology and determined that relations typically
hold even controlling for this overlap (e.g., Lemery, Es-
sex, & Smider, 2002; Lengua, West, & Sandler, 1998;
Martel & Nigg, 2006). However, item overlap between
temperament traits and symptoms must continue to be
diligently evaluated within specific research studies. A
related issue is overlap among raters completing tem-
perament and symptom ratings. Overlap among raters
may artificially inflate relations among temperament
traits and symptoms and should be avoided, if at all
possible.
Guidelines for future work
There are a number of directions for future work. Con-
tinued clarification of the concept of emotion regulation
is needed. The development of standardized paradigms
for the measurement of emotion regulation would be
enormously helpful in clarifying relations between
emotion regulation and psychopathology. Distinctions
between related constructs like emotion, regulation,
emotion- and regulation-related temperament/person-
ality traits, and cognitive control need better definition.
Integration of ideas/constructs across fields of related
research, such as social/personality and clinical
psychology, are imperative to allowing work to move
forward under a unified front.
Increased attention to relations between emotion
regulation and specific forms of psychopathology
would be illustrative, especially as these relations
develop over time. For example, is effortful control
specifically related to inattention or is it a broader
risk factor for disruptive behaviors? The elucidation
of longitudinal relations among emotion regulation
and specific forms of psychopathology will be impor-
tant. For example, is the relation between reactive
control and oppositional-defiance mediated by hyper-
activity-impulsivity? Mediational analyses conducted
within a longitudinal sample would help clarify these
issues.
Examination of relations between psychopathology
and emotion regulation at the group and individual
level would also be helpful. Sex and age differences
may be important to consider. Further, patterns of
emotion regulation problems may be useful in identi-
fying more homogeneous subgroups of children with
ADHD. For example, are all children with ADHD
characterized by maladaptive emotion regulation? Are
there subgroups of children with ADHD who are
characterized by certain patterns and combinations of
Journal compilation  2009 Association for Child and Adolescent Mental Health.
extreme traits and/or poor cognitive control? Person-
centered data analysis would aid in the examination of
these kinds of questions.
Finally, increased study of relations among tem-
perament, cognitive control, and psychopathology
would be helpful in order to clarify associations
among these domains. In these studies, item and
rater overlap should be avoided, if possible, or at least
carefully considered, if not. Increased utilization of
behavioral observation and/or cognitive assessment
would be useful in this regard to lessen item and
rater overlap.
Conclusion
Study of emotion regulation processes may improve
understanding of the development and structure of
disruptive behavior disorders and ADHD. Emotion
regulation can be understood as two related and
potentially interactive developmental processes: emo-
tion and regulation. These processes have been asso-
ciated with disruptive behavior disorders in general and
ADHD in particular, although little work has examined
specificity between emotional regulation processes and
disruptive behavior symptom domains. The current
paper proposed several models of emotion- and regu-
lation-related process associations with disruptive
behavior disorders with the intent of elucidating
mechanisms of single and comorbid disorder develop-
ment. While high negative and positive emotionality
may be associated with disruptive behavior disorders in
general, explaining their comorbidity, deficient control
processes may be specifically associated with ADHD,
and low agreeableness may be specifically associated
with oppositional-defiant and conduct problems. Of
course, these models require empirical test. In this vein,
limitations of previous work on emotion regulation and
ADHD were discussed, and directions for future work
were advanced.
Acknowledgements
The author wishes to acknowledge Drs. Joel Nigg, Paul
Frick, and Elizabeth Shirtcliff for invaluable discussion
and comments on the draft.
Correspondence to
Michelle M. Martel, University of New Orleans, Psy-
chology Department, 2005 Geology & Psychology
Building, 2000 Lakeshore Drive, New Orleans, LA
70148, USA; Tel: 504-280-6776; Fax: 504-280-6049;
Email: mmartel@uno.edu
 2009 The Author
 Emotion, regulation, and ADHD 1049

Key points

• Study of emotion regulation may improve understanding of development of disruptive behavior disorders
and ADHD.
• Emotion regulation can be understood as two related and potentially interactive developmental processes:
emotion and regulation.
• The current paper proposed several models of emotion- and regulation-related process associations with
disruptive behavior disorders.
• While high negative emotionality may be associated with disruptive behavior disorders in general,
explaining their comorbidity, deficient control processes may be specifically associated with ADHD inat-
tention, and low agreeableness may be specifically associated with oppositional-defiant and conduct
problems.
• Use of these models may guide future work on developmental, sex, and neural mechanisms of ADHD and
associated comorbid disruptive behavior disorders.

between preschool and early school age. Development

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