Emotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder

Background: Adults with attention-deficit hyperactivity disorder (ADHD) frequently report emotional lability (EL). However, it is not known whether EL may be accounted for by comorbid psychiatric conditions or symptoms. This study evaluates the influence of comorbid clinical symptoms on EL, and investigates the relationship between EL and impairment. Methods: Over 500 consecutive male adult referrals at the ADHD Clinic for adults at the South London and Maudsley Hospital (U.K) were screened. 41 individuals with ADHD without comorbidity, current medication or frequent substance were identified, and compared with 47 matched healthy male control participants. Measures included IQ, clinical interview and self-reported ADHD symptoms, EL, impairment and antisocial behaviour. Results: ADHD participants reported elevated EL, showing good case-control differentiation in receiver operating curve analysis. EL was most strongly predicted by hyperactivity-impulsivity rather than subsyndromal comorbid symptoms, and contributed independently to impairment in daily life. Limitations: Results may not generalise to children with ADHD, or many adults with ADHD, who are frequently affected by comorbid psychiatric conditions and substance use disorders. Conclusions: EL in adults with ADHD appears to be primarily associated with ADHD itself rather than comorbid conditions, and helps to explain some of the impairments not accounted for by classical features of the disorder. Results indicate that adults presenting with long-term problems with EL should routinely be screened for the presence of ADHD.