Skip to main content Accessibility help
×
Home

The effects of emotional lability, mind wandering and sleep quality on ADHD symptom severity in adults with ADHD

  • Bartosz Helfer (a1), Ruth E. Cooper (a1) (a2), Natali Bozhilova (a1), Stefanos Maltezos (a1) (a3), Jonna Kuntsi (a1) and Philip Asherson (a1)...

Abstract

Mind wandering, emotional lability and sleep quality are currently mostly independently investigated but are all interlinked and play a major role is adult attention-deficit/ hyperactivity disorder (ADHD). Emotional lability is a core feature of the disorder, excessive mind wandering has recently been linked to symptoms and impairments of ADHD and poor sleep quality is experienced by a clear majority of adults with ADHD. All three phenomena lead to functional impairment in ADHD, however their relationship to each other and to ADHD symptom severity is not well understood. Here we used serial multiple mediation models to examine the influence of mind wandering, sleep quality and emotional lability on ADHD symptom severity. 81 adults diagnosed with ADHD participated in this study. We found that mind wandering and emotional lability predicted ADHD symptom severity and that mind wandering, emotional lability and sleep quality were all linked and significantly contributed to the symptomatology of adult ADHD. Mind wandering was found to lead to emotional lability which in turn lead to ADHD symptom severity; and poor sleep quality was found to exacerbate mind wandering leading to ADHD symptoms. Future research should employ objective on-task measures of mind wandering, sleepiness and emotional lability to investigate the neural basis of these impairing deficits in ADHD.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      The effects of emotional lability, mind wandering and sleep quality on ADHD symptom severity in adults with ADHD
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      The effects of emotional lability, mind wandering and sleep quality on ADHD symptom severity in adults with ADHD
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      The effects of emotional lability, mind wandering and sleep quality on ADHD symptom severity in adults with ADHD
      Available formats
      ×

Copyright

Corresponding author

*Corresponding author. E-mail address: bartosz.helfer@kcl.ac.uk

References

Hide All
[1]Fayyad, JDe Graaf, RKessler, RAlonso, JAngermeyer, MDemyttenaere, KDe Girolamo, GHaro, JMKaram, EGLara, CLepine, JPOrmel, JPosada-Villa, JZaslavsky, AMJin, RCross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 2007; 190:402–9.
[2]Polanczyk, Gde Lima, MSHorta, BLBiederman, JRohde, LAThe worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007;164(6):942–8.
[3]Faraone, SVAsherson, PBanaschewski, TBiederman, JBuitelaar, JKRamos-Quiroga, JARohde, LASonuga-Barke, EJTannock, RFranke, BAttentiondeficit/hyperactivity disorder. Nat Rev Dis Primers 2015; 1:15020.
[4]APA, Diagnostic and statistical manual of mental disorders (DSM-5®) 2013, American Psychiatric Pub.
[5]Kessler, RCAdler, LBarkley, RBiederman, JConners, CKDemler, OFaraone, SVGreenhill, LLHowes, MJSecnik, KThe prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006;163(4):716–23.
[6]Moukhtarian, TRMintah, RSMoran, PAsherson, PEmotion dysregulation in attention-deficit/hyperactivity disorder and borderline personality disorder. Borderline Personality Disorder and Emotion Dysregulation 2018;5(1):9.
[7]Asherson, PBuitelaar, JFaraone, SVRohde, LAAdult attention-deficit hyperactivity disorder: key conceptual issues. Lancet Psychiatry 2016;3(6):568–78.
[8]Skirrow, CAsherson, PEmotional lability, comorbidity and impairment in adults with attention-deficit hyperactivity disorder. J Affect Disord 147(1-3)2013; 80–6.
[9]Skirrow, CMcLoughlin, GKuntsi, JAsherson, PBehavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Rev Neurother 2009;9(4):489503.
[10]Moukhtarian, TCooper, RVassos, EMoran, PAsherson, PEffects of stimulants and atomoxetine on emotional lability in adults: a systematic review and meta-analysis. Eur Psychiatry 2017; 44:198207.
[11]Barkley, RAFischer, MThe unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. J Am Acad Child Adolesc Psychiatry 2010;49(5):503–13.
[12]Merwood, AChen, WRijsdijk, FSkirrow, CLarsson, HThapar, AKuntsi, JAsherson, PGenetic associations between the symptoms of attention-deficit/hyperactivity disorder and emotional lability in child and adolescent twins. J Am Acad Child Adolesc Psychiatry 2014;53(2):209–20e204.
[13]Stawarczyk, DMajerus, SMaquet, PD’Argembeau, ANeural correlates of ongoing conscious experience: both task-unrelatedness and stimulus-independence are related to default network activity. PLoS One 2011;6(2): e16997.
[14]Smallwood, JSchooler, JWThe science of mind wandering: empirically navigating the stream of consciousness. Annu Rev Psychol 2015; 66:487518.
[15]Kane, MJBrown, LHMcVay, JCSilvia, PJMyin-Germeys, IKwapil, TRFor whom the mind wanders, and when: an experience-sampling study of working memory and executive control in daily life. Psychol Sci 2007;18(7):614–21.
[16]Killingsworth, MAGilbert, DTA wandering mind is an unhappy mind. Science 2010;330(6006):932.
[17]Seli, PRisko, EFSmilek, DOn the necessity of distinguishing between unintentional and intentional mind wandering. Psychol Sci 2016;27(5):685–91.
[18]Seli, PSmallwood, JCheyne, JASmilek, DOn the relation of mind wandering and ADHD symptomatology. Psychon Bull Rev 2015;22(3):629–36.
[19]Mowlem, FDSkirrow, CReid, PMaltezos, SNijjar, SKMerwood, ABarker, ECooper, RKuntsi, JAsherson, PValidation of the mind excessively wandering scale and the relationship of mind wandering to impairment in adult ADHD. J Atten Disord 2016 1087054716651927.
[20]Franklin, MSMrazek, MDAnderson, CLJohnston, CSmallwood, JKingstone, A et al. Tracking distraction. J Atten Disord 2017;21(6):475–86.
[21]Bozhilova, NMichelini, GKuntsi, JAsherson, PMind wandering perspective on ADHD. Neurosci Biobehav Rev 2018.
[22]McKiernan, KAD’Angelo, BRKaufman, JNBinder, JRInterrupting the "stream of consciousness": an fMRI investigation. Neuroimage 2006;29(4):1185–91.
[23]Mason, MFNorton, MIVan Horn, JDWegner, DMGrafton, STMacrae, CNWandering minds: the default network and stimulus-independent thought. Science 2007;315(5810):393–5.
[24]Fox, KCSpreng, RNEllamil, MAndrews-Hanna, JRChristoff, KThe wandering brain: meta-analysis of functional neuroimaging studies of mind-wandering and related spontaneous thought processes. Neuroimage 2015; 111:611–21.
[25]Shaw, GAGiambra, LTask-unrelated thoughts of college-students diagnosed as hyperactive in childhood. Dev Neuropsychol 1993;9(1):1730.
[26]Jonkman, LMMarkus, CRFranklin, MSvan Dalfsen, JHMind wandering during attention performance: effects of ADHD-inattention symptomatology, negative mood, ruminative response style and working memory capacity. PLoS One 2017;12(7): e0181213.
[27]Krause, AJSimon, EBMander, BAGreer, SMSaletin, JMGoldstein-Piekarski, AN et al. The sleep-deprived human brain. Nat Rev Neurosci 2017;18(7):404–18.
[28]Pilcher, JJHuffcutt, AIEffects of sleep deprivation on performance: a metaanalysis. Sleep 1996;19(4):318–26.
[29]Dinges, DFPack, FWilliams, KGillen, KAPowell, JWOtt, GEAptowicz, CPack, AICumulative sleepiness, mood disturbance, and psychomotor vigilance performance decrements during a week of sleep restricted to 4-5 hours per night. Sleep 1997;20(4):267–77.
[30]Durmer, JSDinges, DFNeurocognitive consequences of sleep deprivation. Semin Neurol 2005;25(1):117–29.
[31]Lund, HGReider, BDWhiting, ABPrichard, JRSleep patterns and predictors of disturbed sleep in a large population of college students. J Adolesc Health 2010;46(2):124–32.
[32]Cortese, SFaraone, SVKonofal, ELecendreux, MSleep in children with attentiondeficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry 2009;48(9):894908.
[33]Hvolby, AAssociations of sleep disturbance with ADHD: implications for treatment. Attent Deficit Hyperactiv Disorders 2015;7(1):118.
[34]Bjorvatn, BBrevik, EJLundervold, AJHalmoy, APosserud, MBInstanes, JT et al. Adults with attention deficit hyperactivity disorder report high symptom levels of troubled sleep, restless legs, and cataplexy. Front Psychol 2017; 8:1621.
[35]Konofal, ELecendreux, MCortese, SSleep and ADHD. Sleep Med 2010;11(7):652–8.
[36]Yoon, SYJain, UShapiro, CSleep in attention-deficit/hyperactivity disorder in children and adults: past, present, and future. Sleep Med Rev 2012;16(4):371–88.
[37]Kooij, JSBijlenga, DThe circadian rhythm in adult attention-deficit/hyperactivity disorder: current state of affairs. Expert Rev Neurother 2013;13(10):1107–16.
[38]Boonstra, AMKooij, JJOosterlaan, JSergeant, JABuitelaar, JKVan Someren, EJHyperactive night and day? Actigraphy studies in adult ADHD: a baseline comparison and the effect of methylphenidate. Sleep 2007;30(4):433–42.
[39]Schredl, MAlm, BSobanski, ESleep quality in adult patients with attention deficit hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 2007;257(3):164–8.
[40]Sobanski, ESchredl, MKettler, NAlm, BSleep in adults with attention deficit hyperactivity disorder (ADHD) before and during treatment with methylphenidate: a controlled polysomnographic study. Sleep 2008;31(3):375–81.
[41]Surman, CBAdamson, JJPetty, CBiederman, JKenealy, DCLevine, MMick, EFaraone, SVAssociation between attention-deficit/hyperactivity disorder and sleep impairment in adulthood: evidence from a large controlled study. J Clin Psychiatry 2009;70(11):1523–9.
[42]Um, YHHong, SCJeong, JHSleep problems as predictors in attention-deficit hyperactivity disorder: causal mechanisms, consequences and treatment. Clin Psychopharmacol Neurosci 2017;15(1):918.
[43]Oosterloo, MLammers, GJOvereem, Sde Noord, IKooij, JJPossible confusion between primary hypersomnia and adult attention-deficit/hyperactivity disorder. Psychiatry Res 143(2-3)2006; 293–7.
[44]Bioulac, SMicoulaud-Franchi, JAPhilip, PExcessive daytime sleepiness in patients with ADHD--diagnostic and management strategies. Curr Psychiatry Rep 2015;17(8):608.
[45]Ottaviani, CCouyoumdjian, APros and cons of a wandering mind: a prospective study. Front Psychol 2013; 4:524.
[46]Gruber, RCassoff, JThe interplay between sleep and emotion regulation: conceptual framework empirical evidence and future directions. Curr Psychiatry Rep 2014;16(11):500.
[47]Gobin, CMBanks, JBFins, AITartar, JLPoor sleep quality is associated with a negative cognitive bias and decreased sustained attention. J Sleep Res 2015;24(5):535–42.
[48]Palmer, CAAlfano, CASleep and emotion regulation: an organizing, integrative review. Sleep Med Rev 2017; 31:616.
[49]Buckner, RLAndrews-Hanna, JRSchacter, DLThe brain’s default network: anatomy, function, and relevance to disease. Ann N Y Acad Sci 2008; 1124:138.
[50]Christakou, AMurphy, CMChantiluke, KCubillo, AISmith, ABGiampietro, VDaly, EEcker, CRobertson, DMurphy, DGRubia, KDisorder-specific functional abnormalities during sustained attention in youth with attention deficit hyperactivity disorder (ADHD) and with autism. Mol Psychiatry 2013;18(2):236–44.
[51]Horovitz, SGBraun, ARCarr, WSPicchioni, DBalkin, TJFukunaga, M et al. Decoupling of the brain’s default mode network during deep sleep. Proc Natl Acad Sci U S A 2009;106(27):11376–81.
[52]Gujar, NYoo, SSHu, PWalker, MPThe unrested resting brain: sleep deprivation alters activity within the default-mode network. J Cogn Neurosci 2010;22(8):1637–48.
[53]De Havas, JAParimal, SSoon, CSChee, MWSleep deprivation reduces default mode network connectivity and anti-correlation during rest and task performance. Neuroimage 2012;59(2):1745–51.
[54]Dai, XJLiu, CLZhou, RLGong, HHWu, BGao, L et al. Long-term total sleep deprivation decreases the default spontaneous activity and connectivity pattern in healthy male subjects: a resting-state fMRI study. Neuropsychiatr Dis Treat 2015; 11:761–72.
[55]Andrews-Hanna, JRThe brain’s default network and its adaptive role in internal mentation. The Neuroscientist 2012;18(3):251–70.
[56]Andrews-Hanna, JRSmallwood, JSpreng, RNThe default network and selfgenerated thought: component processes, dynamic control, and clinical relevance. Ann NY Acad Sci 2014;1316(1):2952.
[57]Pan, JZhan, LHu, CYang, JWang, CGu, LZhong, SHuang, YWu, QXie, XChen, QZhou, HHuang, MWu, XEmotion regulation and complex brain networks: association between expressive suppression and efficiency in the fronto-parietal network and default-mode network. Front Hum Neurosci 2018;12(70):.
[58]Sheline, YIBarch, DMPrice, JLRundle, MMVaishnavi, SNSnyder, AZMintun, MAWang, SCoalson, RSRaichle, METhe default mode network and selfreferential processes in depression. Proc Natl Acad Sci 2009;106(6):1942–7.
[59]Lyznicki, JMDoege, TCDavis, RMWilliams, MAA. Am Med, Sleepiness, driving, and motor vehicle crashes. Jama-J Am Med Assoc 1998;279(23):1908–13.
[60]Connor, JNorton, RAmeratunga, SRobinson, ECivil, IDunn, RBailey, JJackson, RDriver sleepiness and risk of serious injury to car occupants: population based case control study. Br Med J 2002;324(7346):112528A.
[61]Cowley, JAOff task thinking types and performance decrements during simulated automobile driving. Proc Hum Factors Ergonom Soc Annu Meet 2013;57(1):1214–8.
[62]Yanko, MRSpalek, TMDriving with the wandering mind: the effect that mindwandering has on driving performance. Hum Factors 2014;56(2):260–9.
[63]Doi, YMinowa, MTango, TImpact and correlates of poor sleep quality in Japanese white-collar employees. Sleep 2003;26(4):467–71.
[64]Dewald, JFMeijer, AMOort, FJKerkhof, GABogels, SMThe influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: a meta-analytic review. Sleep Med Rev 2010;14(3):179–89.
[65]Carciofo, RDu, FSong, NZhang, KMind wandering, sleep quality, affect and chronotype: an exploratory study. PLoS One 2014;9(3): e91285.
[66]Poh, J-HChong, PLChee, MWSleepless night, restless mind: effects of sleep deprivation on mind wandering. J Exp Psychol Gen 2016;145(10):1312.
[68]Conners, CKErhardt, DSparrow, EPConners’ adult ADHD rating scales (CAARS). North Tonawanda, multi-health systems 1999.
[69]Oliver, MNISimons, JSThe affective lability scales: development of a short-form measure. Personal Individ Diff 2004;37(6):1279–88.
[70]Buysse, DJReynolds, C.F. 3rd, Monk, THBerman, SRKupfer, DJThe Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28(2):193213.
[71]Carpenter, JSAndrykowski, MAPsychometric evaluation of the Pittsburgh sleep quality index. J Psychosom Res 1998;45(1):513.
[72]Mollayeva, TThurairajah, PBurton, KMollayeva, SShapiro, CMColantonio, AThe Pittsburgh sleep quality index as a screening tool for sleep dysfunction in clinical and non-clinical samples: a systematic review and meta-analysis. Sleep Med Rev 2016; 25:5273.
[73]Mulraney, MSciberras, ELecendreux, MADHD and sleep Oxford textbook of attention deficit hyperactivity disorder 2018 280.
[74]Hayes, AIntroduction to mediation, moderation, and conditional process analysis: a regression-based approach 2013, Guilford Press New York.
[75]Winer, ESCervone, DBryant, JMcKinney, CLiu, RTNadorff, MRDistinguishing mediational models and analyses in clinical psychology: atemporal associations Do not imply causation. J Clin Psychol 2016;72(9):947–55.
[76]Axelrod, VRees, GLavidor, MBar, MIncreasing propensity to mind-wander with transcranial direct current stimulation. Proc Natl Acad Sci U S A 2015;112(11):3314–9.
[77]Gallo, EFPosner, JMoving towards causality in attention-deficit hyperactivity disorder: overview of neural and genetic mechanisms. Lancet Psychiatry 2016;3(6):555–67.
[78]Smallwood, JFitzgerald, AMiles, LKPhillips, LHShifting moods, wandering minds: negative moods lead the mind to wander. Emotion 2009;9(2):271.
[79]Shaw, PStringaris, ANigg, JLeibenluft, EEmotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry 2014;171(3):276–93.
[80]Cairncross, MMiller, CJThe effectiveness of mindfulness-based therapies for ADHD: a meta-analytic review. J Atten Disord 2016 1087054715625301.
[81]Mitchell, JTZylowska, LKollins, SHMindfulness meditation training for attentiondeficit/hyperactivity disorder in adulthood: current empirical support, treatment overview, and future directions. Cognit Behav Pract 2015;22(2):172–91.
[82]Braboszcz, CDelorme, ALost in thoughts: neural markers of low alertness during mind wandering. Neuroimage 2011;54(4):3040–7.
[83]McVay, JCKane, MJKwapil, TRTracking the train of thought from the laboratory into everyday life: an experience-sampling study of mind wandering across controlled and ecological contexts. Psychonom Bull Rev 2009;16(5):857–63.

Keywords

Related content

Powered by UNSILO

The effects of emotional lability, mind wandering and sleep quality on ADHD symptom severity in adults with ADHD

  • Bartosz Helfer (a1), Ruth E. Cooper (a1) (a2), Natali Bozhilova (a1), Stefanos Maltezos (a1) (a3), Jonna Kuntsi (a1) and Philip Asherson (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.

The effects of emotional lability, mind wandering and sleep quality on ADHD symptom severity in adults with ADHD

  • Bartosz Helfer (a1), Ruth E. Cooper (a1) (a2), Natali Bozhilova (a1), Stefanos Maltezos (a1) (a3), Jonna Kuntsi (a1) and Philip Asherson (a1)...
Submit a response

Comments

No Comments have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *