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Research Paper

Adult patients with ADHD differ from healthy controls in implicit, but not explicit, emotion regulation

Lukas Materna, Christian Dirk Wiesner, Anna Shushakova, Julia Trieloff, Nathalia Weber, Alva Engell, Ricarda I. Schubotz, Jochen Bauer, Anya Pedersen and Patricia Ohrmann
J Psychiatry Neurosci September 01, 2019 44 (5) 340-349; DOI: https://doi.org/10.1503/jpn.180139
Lukas Materna
From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer)
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Christian Dirk Wiesner
From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer)
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Anna Shushakova
From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer)
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Julia Trieloff
From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer)
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Nathalia Weber
From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer)
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Alva Engell
From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer)
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Ricarda I. Schubotz
From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer)
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Jochen Bauer
From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer)
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Anya Pedersen
From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer)
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Patricia Ohrmann
From the Department of Psychiatry, School of Medicine, University of Münster, Münster, Germany (Materna, Trieloff, Weber, Engell, Ohrmann); Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany (Wiesner, Shushakova, Pedersen); the Institute for Psychology, University of Münster, Münster, Germany (Schubotz); and the Institute of Clinical Radiology, Medical Faculty, University of Münster, and University Hospital Münster, Münster, Germany (Bauer)
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    Fig. 1

    Main effects of negative view and reappraisal. The displayed clusters survived correction for multiple comparisons at pCWC,FWE < 0.05, at a cluster extent threshold of k = 20 based on corrected voxels at pFWE < 0.05. The contrast maps are projected onto the normalized MRIcron template brain. CWC = cluster-wise correction; FWE = family-wise error correction.

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    Fig. 2

    Interaction effect for patients with ADHD (negative view > neutral view) > healthy controls (negative view > neutral view). The reported clusters survived correction for multiple comparisons at pCWC,FWE < 0.05, at a cluster extent threshold of k = 240 based on uncorrected voxels at p < 0.001. The contrast maps are projected onto the normalized MRIcron template brain. The bar graph depicts the eigenvariates of the first cluster in the right dorsal ACC. The bars represent activation of the cluster during all 3 conditions, but the contrast was significant only for the interaction. This figure shows that this area of the ACC was similarly activated in both groups during reappraisal. ACC = anterior cingulate cortex; ADHD = attention-deficit/hyperactivity disorder.

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    Fig. 3

    Positive correlations between self-reported habitual reappraisal (Emotion Regulation Questionnaire) and activation in the dorsal anterior cingulate cortex for ADHD (negative view > neutral view) > healthy controls (negative view > neutral view) in patients with ADHD and healthy controls, separately. The activation was extracted using the first eigenvariate of the first (largest) cluster. ADHD = attention-deficit/hyperactivity disorder; ERQ = Emotion Regulation Questionnaire.

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    Table 1

    Study sample characteristics

    CharacteristicADHD (n = 30)*Healthy controls (n = 35)*Statistical testp value
    Male/female, no.19/1119/16χ21 = 0.5450.461
    Age, yr†31.40 ± 8.2128.89 ± 7.77U = 417.500.156
    Education, yr†11.79 ±1.4012.35 ± 1.15U = 346.000.039
    WAIS-IV vocabulary score41.79 ± 9.4544.03 ± 5.89t43,11 = −1.100.279
    WAIS-IV matrix reasoning score†20.62 ± 2.8020.66 ± 3.00U = 488.000.791
    FAIR-Q score†0.91 ± 0.080.94 ± 0.04U = 371.000.092
    WURS-K score†38.59 ± 10.5611.18 ± 7.99U = 25.50< 0.001
    ADHD-SR score†32.48 ± 8.805.12 ± 3.77U = 1.50< 0.001
    BDI-II score†16.00 ± 9.942.40 ± 2.90U = 76.50< 0.001
    • ADHD = attention-deficit/hyperactivity disorder; ADHD-SR = ADHD Self Report Scale; BDI-II = Beck Depression Inventory II; FAIR-Q = Frankfurt Attention Inventory performance quality index; WAIS-IV = Wechsler Adult Intelligence Scale; WURS-K = Wender Utah Rating Scale, German short version.

    • ↵* Unless otherwise indicated, data are mean ± standard deviation.

    • ↵† Mann–Whitney–Wilcoxon test.

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    Table 2

    Interaction effect, patients with ADHD (negative view > neutral view) > healthy controls (negative view > neutral view)

    Anatomic regionsCluster*Voxel
    pcorrktpeakMNI coordinates, x, y, z
    Right anterior cingulate cortex, right medial superior frontal gyrus, right superior frontal gyrus< 0.0093894.5714, 44, 22
    Right anterior cingulate cortex, right medial orbital frontal gyrus, left anterior cingulate cortex, right medial superior frontal gyrus, left medial orbital frontal gyrus< 0.0302814.1210, 44, −4
    Left anterior cingulate cortex, left medial superior frontal gyrus< 0.0163344.10−16, 34, 20
    • ADHD = attention-deficit/hyperactivity disorder; CWC = cluster-wise correction; FWE = family-wise error correction; k = cluster size; MNI = Montreal Neurological Institute; pcorr = whole-brain-corrected cluster p values; tpeak = t values of the peak voxel of the cluster.

    • ↵* The reported clusters survived correction for multiple comparisons at pCWC,FWE < 0.05, at a cluster extent threshold of k = 240 based on uncorrected voxels at p < 0.001. Only anatomic regions overlapping at least 5% with the cluster are reported. The order of the anatomic labels reflects the amount of overlap with the activated clusters.

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    Table 3

    Correlation of habitual reappraisal (Emotion Regulation Questionnaire) with the 3 activated clusters of the interaction effect, patients with ADHD (negative view > neutral view) > healthy controls (negative view > neutral view)*

    ClusterHealthy controlsADHDDifference
    rprpzp
    Cluster 10.0790.6520.5120.005−1.8420.033
    Cluster 20.0510.7730.3890.037−1.3620.087
    Cluster 3−0.0700.6900.4520.014−2.1120.017
    • ADHD = attention-deficit/hyperactivity disorder.

    • ↵* We computed Pearson correlation coefficients for both groups and compared them using Fisher z and normal distribution. However, the same pattern of correlations arises when nonparametric Spearman coefficients that are less susceptible to distorted distributions are computed.

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Journal of Psychiatry and Neuroscience: 44 (5)
J Psychiatry Neurosci
Vol. 44, Issue 5
1 Sep 2019
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Adult patients with ADHD differ from healthy controls in implicit, but not explicit, emotion regulation
Lukas Materna, Christian Dirk Wiesner, Anna Shushakova, Julia Trieloff, Nathalia Weber, Alva Engell, Ricarda I. Schubotz, Jochen Bauer, Anya Pedersen, Patricia Ohrmann
J Psychiatry Neurosci Sep 2019, 44 (5) 340-349; DOI: 10.1503/jpn.180139

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Adult patients with ADHD differ from healthy controls in implicit, but not explicit, emotion regulation
Lukas Materna, Christian Dirk Wiesner, Anna Shushakova, Julia Trieloff, Nathalia Weber, Alva Engell, Ricarda I. Schubotz, Jochen Bauer, Anya Pedersen, Patricia Ohrmann
J Psychiatry Neurosci Sep 2019, 44 (5) 340-349; DOI: 10.1503/jpn.180139
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