Abstract / Summary
Abstract Background This study aimed to identify which domains of emotional dysregulation (ED) characterize Chinese children with attention-deficit/hyperactivity disorder (ADHD) and to determine their specificity to the predominantly inattentive (ADHD-I) and combined (ADHD-C) subtypes using the multidimensional framework proposed by Graziano and Garcia. Methods A cross-sectional study was conducted with 44 children with ADHD (ADHD-I: n = 18; ADHD-C: n = 26) and 49 typically developing (TD) controls aged 7–12 years. Four ED domains—emotion recognition/understanding (ERU), emotional reactivity/negativity/lability (ERNL), emotion regulation strategies, and empathy—were evaluated through standardized tasks and parental reports. Data were analyzed using independent t-tests, multivariate analysis of covariance, and binary logistic regressions, controlling for sex and intelligence quotient (IQ). Results Compared to TD peers, children with ADHD exhibited significantly lower ERU accuracy ( p < 0.001, d = 0.76), higher ERNL ( p < 0.001, d = -1.02), reduced cognitive reappraisal ( p = 0.005, d = 0.59), and lower cognitive empathy ( p < 0.001, d = 0.86). Binary logistic regression indicated that ERNL was the sole ED dimension robustly differentiating the overall ADHD group from the TD group ( OR = 1.24, 95% CI: 1.07–1.44, p = 0.004). Subtype analyses revealed that ERNL significantly distinguished the ADHD-C subtype from TD controls ( OR = 1.46, 95% CI: 1.16–1.85, p = 0.002), but did not significantly distinguish the ADHD-I subtype ( p = 0.171). Furthermore, ERNL approached significance in differentiating ADHD-C from ADHD-I ( OR = 1.22, 95% CI: 1.00-1.49, p = 0.051). Conclusion The Graziano & Garcia multidimensional model demonstrates strong applicability for clinical assessment within a Chinese cultural context. The pronounced ERNL observed in the ADHD-C subtype highlights the critical need for subtype-specific behavior management strategies. Incorporating targeted cognitive behavioral therapy (CBT) modules focused on emotion regulation, alongside structured parenting skills training, may directly address these specific behavioral challenges and significantly improve treatment outcomes for children with ADHD-C.