ADHD Research Recap: Emotional dysregulation, white matter and working from home

Hi, we are the ADHD Skills Lab podcast. My name is Skye. And my name is Sarah. And we will be your hosts, chatting to you about practical ADHD strategies you can use, the research behind some of these strategies, as well as interviewing other professionals with ADHD about how they've developed skills and working through struggles in their lives. You might know us from Unconventional Organization, where we talk about this kind of stuff all day long. So we're super excited to have you along and we're going to chat through it together.

Welcome to this week's research recap. This week we have three interesting papers, all very, very different. We're gonna be looking at emotional dysregulation in adults with ADHD, but we also have a very interesting meta-analysis about white matter in the brain and how connections between parts of our brain are affected when we have ADHD or not. And then we also are gonna be talking a little bit about. benefits of working from home or not benefits from working from home during the COVID-19 pandemic. Does that mean anything for us now post pandemic? All of those kinds of things we'll be getting into as well. So really excited to chat with you, Sarah. Yeah, let's get into it. Awesome.

A Scoping Review of Factors Associated With Emotional Dysregulation in Adults With ADHD.

So the first paper that we have is from the Journal of Attention Disorders. It's a scoping review, which basically is essentially a structured literature review of the factors associated dysregulation in adults with ADHD. We've talked a lot about emotional dysregulation, the idea that with ADHD we do struggle. It's not in the DSM diagnosis, but there is increasing evidence that with ADHD often people are struggling a lot with higher emotions, stronger emotions, more struggles to maintain and manage their emotions. So this study gets into that and looks at what is emotional dysregulation among adults with ADHD and what can we figure out with regards to who may or may not be more likely to struggle with emotional dysregulation? So what did they do to get these answers, Sarah? So as Guy indicated, this is a meta-analysis. They included 35 studies. Basically, they were looking for studies that talked about ADHD, emotional dysregulation, or a dimension of emotional dysregulation, and at least one other gender in this case is a variable. Obviously also all participants were over 18 in this one. They excluded studies that were published before 2014, which is great. And they kind of used a bunch of different methods to measure emotional dysregulation. ADHD status was measured in different ways across all of the different studies, which is frustrating. But most did use self-reports. Yeah, so we'll have a look. We'll talk a little bit about that in limitations, but yeah, just to flag, because of the nature of these studies, and I think we've talked about this before, what is emotional dysregulation defined as in this paper versus that paper? What is ADHD defined as in this paper versus that paper? It was different from a lot of the studies that they took from that 35. It's really interesting that you say that because they give a definition for emotional dysregulation as their very first sentence. They're taking it from a 1994 paper, which is interesting, but I just wanted to share their defining emotional dysregulation as an inability to modify emotional states in a way that promotes adaptive goal oriented behaviors. That's interesting. That isn't actually the definition that I would have chosen. It sounds really nice. Yeah, it is. It is. It's interesting that they're talking specifically about emotional dysregulation related to goal orientated behaviors. It's not related to sort of the ability to get to a positive mental state or anything like that. It's specifically goals focused. Yeah. I mean, that's how diagnoses go in general. It doesn't become a diagnosis until it's a persistent and pervasive problem. and it's impacting your daily life. That's true. I guess that makes sense. But yeah, it is part of, I guess, the ADHD specific, which might be why they use that definition. ADHD is a lot about what is impacting your daily life, your ability to get tasks done. And so the emotional regulation associated with that, that would make sense. OK, well, what did they find? What were the factors associated with ADHD and emotional dysregulation? So they did a regression analysis, sort of looking at all of the different variables. And they found that the things that are most commonly associated with higher levels of emotional dysregulation are things like being female, eye roll, hair flips, mind wandering, using certain self-regulation strategies, having combined type ADHD, obviously comorbidities, things like that. Yeah, one of the things they actually referenced there was attachment style, insecure attachment style, which was interesting. For those of you who didn't do psychology in undergrad, it's basically the idea of psychological theory that people's relationships with their parents, particularly with their primary caregivers, when their children can affect their relationships with their partners and with other people in their lives as they get older. So that's essentially what it is. So you have secure attachment, you have insecure attachment, you have anxious and avoidant attachment, which is kind of both types of insecure attachment. So that is interesting. There must've been at least one study that looked at that specifically. The other thing they talked about was just having more severe ADHD symptoms in general. I did find the mind wandering interesting. It must've just been a study that looked at mind wandering because mind wandering is technically part of type one. Yeah. Inattention ADHD. Yeah. So just there was a bit of a grab bag I think of those results. So what were the limitations? Because I think we should move into that because that is there are quite a few limitations to this. Yeah. I think the first one that jumps out is that they decided to use gray literature. That just means sort of non peer reviewed studies. Is that right? Yeah, essentially. So. They had a reason for it specifically. Yeah, they were defending it basically saying that since research journals tend to only publish like certain things, that maybe there is bias among the published literature. And so to include all of the literature might give a more complete sort of finding. But that's somebody's view. Yeah, it makes sense. But then the other side of it is obviously it might be great literature because it didn't meet the rigorous requirements of you know, what gets into a be a peer-reviewed study. I completely understand it. Like I said, I've said this before, there's a lot of controversy around what is peer-reviewed, what is not peer-reviewed, what is great literature. But it does mean that we just don't know, essentially, without going through all 35 studies. We don't know if they are things that we would have included, for example, in our podcast episodes. But they are using it to make decisions or make predictions and thoughts about these topics. all correlational as well. As you would expect. Yep, yep. Lots of self-reports. Yeah, which they put down as a limitation compared to, I guess, everybody in all of these studies had a diagnosis of ADHD according to a psychiatrist. That makes sense. But it's also interesting because we've seen before studies where they did it on children. It was just teachers. does this person feel like they might have ADHD? Okay, they're part of the ADHD group, that level of diagnosis. So it depends, we've seen it before. I think the biggest one though is the inconsistency on how we measure ADHD in the studies and also how we defined emotional dysregulation in all of those different studies. And the authors did mention that was a limitation because a lot of the studies were sort of buried in how they did those things. Yeah, definitely. So in terms of like what they did find that was an interesting takeaway, given all those limitations. Sarah, what did they find? So I think the most helpful thing that they found was about the regulation strategies. They sort of go over how people with ADHD or really just struggling with emotional dysregulation tend to use suppression techniques like pushing it away, avoidance, you know, oh, I don't want to deal with this. And that's how we inherently tend to deal with our emotions. Yeah. But they were suggesting sort of like a different framework, which I think we talked about before, maybe in different words. They mentioned that we should be using more of a cognitive reappraisal, sort of attentional deployment. So basically like when you start to experience the negative emotions, redirect your attention towards something else. That might be like the five, four, three, two, one exercise or some other kind of outside of your body grounding exercise. Yeah. And then the reappraisal is, it's kind of reframing. It's kind of just like, okay, well, this is one way to look at the situation and this is a better way that is going to serve me more in how I approach this emotion. Yeah. Like for example, if you have a tick issue, say you have a document that needs to be printed and your print does not work. That kind of thing. Your cognitive brain, you can have the feeling of like, this is the worst thing that's happened to me. I'm not going to get this report in, everyone's going to. You can go down a very dark path with that. A reappraisal would be, this is a tech era, it happens to everybody, even if something is late, it's going to be fine. That would be a reappraisal. But I think what's interesting is what you do here in this conversation is you go straight into the idea that we do some kind of mindfulness. followed by reappraisal. They didn't really talk about that. They just talked about the reappraisal. And so something that we were talking about was how important it is with ADHD specifically. to do both because we're not necessarily, if you've ever been in a situation where you are emotionally dysregulated and somebody says, well, you know what you need to do? You just need to have a more positive frame of mind or reframe it. Just breathe. Yeah, it might not be taken, at least in my experience, the best way. So having some kind of grounding exercise or mindfulness that you can slip into before you reappraise. I think is such an important thing here that they didn't really talk about. It wasn't really brought up in the study, but just in general, we talk about grounding routines with ADHD as part of what we do with coaching. There's many different ways you can do it, but just giving yourself a moment to basically regulate your emotions before you engage with them cognitively is sometimes very helpful. Yeah. Putting a little bit of space in between the initial trigger and even entertaining, brainstorming, problem solving. Yes. Yeah. Sometimes physical space. Sometimes you have to leave the computer and the printer. You have to go somewhere else just to kind of get that space or something like that, listening to something else, changing your mindset. So it was interesting to see that conversation come up in this paper, but there were also some limitations. So overall, it was an interesting addition to the emotional regulation. with ADHD studies that we are now seeing.

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White matter alterations in Attention-Deficit/Hyperactivity Disorder (ADHD): a systematic review of 129 diffusion imaging studies with meta-analysis.

So let's jump into the next paper, white matter alterations in ADHD. This was a systematic review of 129 different studies on brain imaging. And if you know us, if you've been following along, you'll know that we were very excited about this many studies on the brain. I guess the first thing to just talk about is a little bit about what is white matter. So basically in your brain, you have a number of different sections. You have sort of the frontal lobe, the parietal lobe. but you also have this large network of nerve fibers that is exchanging information and communicating with different areas of your brain, called white matter because it's got this white color to it. There was a period of time where we didn't really know what this did, and we were like, do we need this? Like, what is this for? But luckily we do know that now, it's very important. And if you want to imagine what it would be like, it would be like if an electrician came to your house. and opened up a panel section of your house. There was just a bunch of fibers that you didn't even know were there behind that section of your house. And they had been used for phone wires or other things. Obviously, a lot of stuff is Wi-Fi now. But those are what we're talking about in your brain. So what they wanted to look at is they wanted to see, is there a difference between how these white matter nerve fiber, different connections? And they looked at a lot of different connections. are talking to each other in an ADHD brain versus a non-ADHD brain. And they wanted to look at that en masse. They wanted to look at that in a bunch of different studies rather than just in one. So what did they find? Oh, I guess first, how did they find it, Sarah? Yeah, I mean, you said they wanted to look at a bunch of different studies, and they certainly did. So 129 studies, again, that was over 13,000 total participants. 6,700 of which had ADHD. The way that they measured ADHD is having like an actual diagnosis. They must've been looking at some early studies because they allowed as early as the DSM-3. They also made sure to include only peer-reviewed studies. I wonder if their reason they allowed so early was because they wanted so many of them. I got the impression from this paper that they were really like, let's answer this question once and for all. That was kind of the vibe that I got from it. So it sort of makes sense that they wanted to have such an early diagnosis. And also if you're going to go ahead and pick only people who've been diagnosed using the DSM or the ICD, it makes sense. You're gonna have to go pretty far back. What were the results, Sarah? What did they find overall? Well, they found significant white matter differences among ADHD and non. They found it in actually lots of different areas. They had a few areas that they particularly mentioned. So they found that the most pronounced difference was in, and I don't know if I'm going to say these words right, but the right splenium and the corpus callosum. So there were certain areas that they found were particularly different, but they were also some more sporadic differences. They found things. in terms of the interior thalamic space. But essentially what Sarah is saying is right. They looked at a lot of different, obviously with a huge study of 129 different areas, they looked at a lot of different spaces. So they were able to find a lot of differences. It was less about the specific parts of the brain that they found these differences in, and more about the fact that they found. such significant differences in how we were receiving information through these white matter pathways across the whole brain. That was really interesting. One of the areas where this white matter might have been an effect, had a big effect was with the corpus callosum, which is essentially that section in the middle of your brain, which talks to both hemispheres. If you ever heard about different brain things like cutting that space. can have a huge effect on how your brain's connecting. They said that white matter alterations in this area are associated with motor functioning deficits due to disrupting the connection, and the cognitive executive control deficits due to disrupting the connection as well. But overall, they basically found quite a huge difference between how the white matter space works if you have ADHD versus not having ADHD. They would know. major limitations and the practical implications of the study were basically that it really points to the potential for future understanding of how ADHD brains work differently using imaging rather than just using diagnosis. What do you think Sarah? They really seem to be driving home the point that we've brought all of this information together now let's go and do something different with it. Yeah, which I liked. They talked about the idea of that. This research area has reached a certain level of maturity. So this is probably one of the reasons they wanted to go all the way back. But they basically said, while currently these studies do not have direct clinical implications in the field of ADHD, our findings may help future studies to stratify individuals with ADHD according to their brain. It might guide the development of more tailored treatments. and may benefit from more different approaches of imaging to do that. That is kind of exactly what we've been talking about the last couple of weeks. So it was really great to see it. Yeah, it was really great to see it in this paper. And yeah, we agree. They should totally take this and do something interesting with it. I really hope they do. And if they do, we will be here to try and talk about it the best we can with our working knowledge of neuroscience.

Benefits of working from home during the COVID-19 pandemic for undiagnosed workers with Attention-Deficit/Hyperactivity disorder symptoms.

Okay, let's jump on to the last paper. The benefits of working from home during the COVID-19 pandemic for people who have undiagnosed ADHD symptoms versus people who don't, which was interesting. And that paper was based in Japan specifically. It was an interesting paper. They looked at the association between whether undiagnosed ADHD individuals were he remotely struggled with. Depressive symptoms, work productivity and quality of life during the COVID-19 pandemic. So Sarah, can you take us through a little bit about how they did the study? It was really interesting. It seems like they sent out two different surveys. One at the end of 2019, which they never mention again in the paper. We couldn't find it. We spent a while looking for it before we did this podcast. Yeah. But then they sent out a second survey sort of in March of 2021. And that is the one that they did all of the statistical analyses on. They had a pretty large sample, 904 ADHD types and 900 neurotypicals. They judged the ADHD status based on self-report scales. They did a different number of statistical tests. I don't know these by name, but maybe you will know the ANOVA. the Tukey Kramer, Poisson. Yeah, these are pretty common statistical analysis. Yeah. I think it's possible. Yeah, that sounds very right. Obviously, this was all a survey, so it was all self-report scales. Yeah, it was 100% a survey. And in terms of what they found, they found some of what you would expect and some things that were slightly different. So they found that, you know, Working from home during COVID-19, we'll talk about that a little bit more, but it's important. Working from home during COVID-19 was associated, if you had ADHD, with lower productivity and lower overall quality of life, but it was interesting what they found with the depressive symptoms. So Sarah, do you want to take us through what they found there? Yeah, so working from home during the COVID-19 pandemic also was associated with lower depressive symptoms for ADHD types. but higher depressive symptoms for non ADHD types, which caused a bit of confusion on our part. Yeah, we were looking at that, trying to figure out how that made sense. But essentially what they found in this one study of self-reports was that potentially if you had, you know, if you were struggling with depression or you had ADHD, working from home might've actually been beneficial for you. And we can kind of see how that might come about. if you were in a position where you could support yourself, maybe you could take better care of your sleep or do something else, maybe you were with family. But at the same time, it was interesting because the study, and I think that we will see more of these studies into COVID. So this is something that we're going to probably have a conversation about more and more. It didn't really factor or control for whether you were in. a very small room with three people who are driving you insane or whether you were in a really nice large house or all of those kinds of different factors that would have affected you working from home and working from home during a pandemic where you're not allowed to leave your house is a very different thing. It's interesting because we looked at another study a few weeks ago about how, you know, not having those social interactions during the COVID times sort of. decreased our quality of life and sort of increased our depressive symptoms. But working from home and working from home during COVID with limited access to things. Yeah, absolutely. It's a totally different conversation. And they sort of alluded to it in a couple of different ways. You know, they did look at income here and they found that higher income was associated with less depression and like higher quality of life. And I was just like, yeah. Very surprising. Yeah. So it's, it is interesting. Yeah. I think it's worth mentioning because I think a lot more studies are going to come out just in general that look at COVID and equate it with working from home. But obviously those two things are not the same. So it is worth just mentioning that because I wouldn't be surprised if we find ourselves having this conversation again. It was very interesting. And overall like three very interesting studies this week in terms of. our emotional regulation, the idea that maybe with ADHD specifically, we can focus on that grounding and then that reappraising as a supportive factor if we struggle with emotional regulation, which a lot of us do. The idea that not only is our brain functionally different, but also the white matter in our brain. Structurally different as well. It's coming through and it's making those differences, and we're seeing them in huge meta-analysis studies. Once again, our brains are different and it is great to see people calling for more studies in that. And yeah, working from home, is it good, is it bad? Still kind of unclear. One of the things that they said, which was interesting, was they mentioned that both workers with and without ADHD engaging for work from home may benefit from prior preparation and practices to address issues such as communicating with colleagues, workstation settings, physical exercise, all of the things essentially that we do in coaching, which is build structures to support you with ADHD, regardless of whether you want to work from home or not, or work from the hybrid way. Because it does kind of depend on the person and the environment. Yeah, and just more on that. A suitable workspace for one person is not going to be a suitable workspace for another person. I think that this study did a good job of really supporting the idea that like, having conditions that work for you are going to increase your productivity and your mental well-being. And that doesn't look the same for everyone. Yeah, and it doesn't because we often work on this as part of coaching. We work with so many different people and at no point have I ever said, oh hey, you're going to work from home now. This is what your life is like or vice versa. It's always, I mean, gosh, even the times of day you work can be different for different people. Yeah, definitely more of a conversation starter than a real focused decision. Awesome. Well, that is everything from us this week. Thank you so much for joining us. We'll see you again in two weeks for another research recap. 

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