E L ADULTO COLÉRICO

Emotion regulation refers to the processes in which “individuals influence which emotions they have, when they have them, and how they experience and express

them” (Gross, 1998, p. 271). Such processes may either be automatic or controlled, and conscious or unconscious. Gross (1998) postulated that emotion regulation can

be regulated at five stages along an emotion generative process: (1) the selection of

the situation, (2) the modification of the situation, (3), the deployment of attention,

(4) change of cognitions, and (5) the modulation of responses.

Healthy functioning relies upon effective emotion regulation. When emotion

regulation is impaired, emotional dysregulation is the result and this can be

characterised by rapid and poorly controlled shifts in emotion, emotional expressions

or experiences which are out of proportion for the context, or are against social

norms, and the irregular allocation of attention to emotional stimuli (Shaw,

Stringaris, Nigg, & Leibenluft, 2014). Emotional dysregulation is thought to be

central to initiating and maintaining the symptoms of psychopathology (Cole,

Michel, & Teti, 1994). Indeed, emotion regulation problems are implicated in over

half of DSM-IV Axis I, and all of Axis II disorders (Gross & Levenson, 1997).

33 emotion regulation have been found in both ADHD and CD in separate studies.

Indeed, emotion dysregulation is thought to be particularly important in ADHD. A

recent meta-analysis (Shaw et al, 2014) found prevalence estimates of emotion

dysregulation of between 24% and 50% in clinic based studies. It is thought that

adolescents with ADHD show problems in emotion regulation due to their reduced

capacity for inhibition resulting in difficulties withholding a response for long

enough to gather the information necessary to understand emotionally charged

situations (Barkley, 1997). In addition, emotion dysregulation has also been used to

explain the antisocial behaviour displayed in those with CD (Cole, Michel, & Teti,

1994). Neurobiological circuits (including the orbitofrontal cortex (OFC),

ventromedial prefrontal cortex (vmPFC), dorsolateral prefrontal cortex (DLPFC),

amygdala, and anterior cingulate cortex (ACC)) are thought to be dysfunctional in

those with CD, and it is these areas that are involved in both top-down regulation of

(negative) emotions and the bottom-up processing of environmental cues that

ordinarily produce emotional restraint (Davidson, Putnam, & Larson, 2000). In

support of emotion regulation being deficient in CD, numerous studies have found

impairments in emotion regulation in adolescents with CD compared to controls

(Calkins & Dedmon, 2000; Deborde, Maury, & Aitel, 2015; Kostiuk & Fouts, 2002;

McLaughlin, Hatzenbuehler, Mennin, & Nolen-Hoeksema, 2011). Therefore further

research is required that considers both ADHD and CD together to explore the extent

to which emotion regulation difficulties are driven by individual or both disorders.

A problem with research into emotion regulation is that it to a large extent

(although see Northover, Thapar, Langley, & van Goozen, 2015a) relies on self- or

informant report (Anastopoulos et al., 2012; Sobanski et al., 2010; Strine et al.,

34 (Nisbett & Wilson, 1977), especially in judgements that are made retrospectively

(Robinson & Clore, 2002). As mentioned above, some studies have begun to explore

other measures of emotion regulation, specifically by making use of the ultimatum

game (UG; Northover et al., 2015a; Schoorl, Van Rijn, De Wied, Van Gooen, &

Swaab, 2016). In this task participants have to choose to accept or reject offers made

to them. Some offers are clearly fair (e.g. an equal share of a reward), while others

are clearly unfair (a very biased share of the reward in favour of the proposer of the

offer), and still others are ambiguous (offers 70/30 and 60/40 splits). It is argued that

it is rational to accept all offers made because accepting offers results in both the

participant and the responder receiving the reward proposed in the offer, while

rejecting offers result in the reward being withheld from both parties. As a result,

rejected offers, particularly the rejection of ambiguous offers, is taken as evidence of

a failure to regulate emotions. When utilising this paradigm, Northover et al.,

(2015a) found that participants with ADHD and comorbid CD rejected a

significantly higher amount of ambiguous offers than ADHD alone. However, there

are problems with this paradigm. Emotion regulation as determined by the UG is

based on the assumption that the acceptance of unfair offers is a rational decision

because from an economic perspective, the rejection of offers is irrational because it

results in personal loss. However, from a social perspective, rejection of unfair offers

can be seen as a rational, altruistic action to preserve social norms. Rather than

maximising self-interest, the participant chooses to punish the socially inappropriate

action, therefore a decision to reject an offer is not necessarily a result of a failure in

regulation (Fehr & Fischbacher, 2003; Knoch, Pascual-Leone, Meyer, Treyer, &

Fehr, 2006). Indeed, similar rejection rates are found in a modified version of the UG

35 themselves (Civai, Corradi-Dell’Acqua, Gamer, & Rumiati, 2010). In addition, it is

assumed that the production of unfair offers results in an emotional response (anger

in particular), but as physiological responses are usually not measured, it remains

unclear whether an emotional response was evoked. Therefore, it is clear from the

above, that the emotion regulation literature, especially in relation to ADHD and CD,

would benefit from an objective measure of emotion regulation that clearly involves

some aspect of emotional processing.