ADHD News & Research

Study: DESR a Core Component of ADHD in Children, Leading to Sleep Difficulties

A new study has revealed elevated rates of deficient emotional self-regulation (DESR) and sleep problems among children with untreated and treated ADHD, suggesting that DESR is a core feature of ADHD that should be considered in both diagnosis and treatment.

February 5, 2021

Deficient emotional self-regulation (DESR) — defined as “emotional impulsiveness, difficulties inhibiting inappropriate response, problems refocusing attention and disorganization of coordinated action in response to emotional activation, resulting in extreme responses that would be considered inappropriate for the developmental age of the person” — is more common and aggravated among children with untreated ADHD than it is among children with treated ADHD and control subjects. These higher DESR levels — and more severe symptoms of inattention and impulsivity, for example — are consequently linked to greater sleep problems in a new study published in the Journal of Attention Disorders1 that found positive correlations between DESR and ADHD, and between DESR and sleep problems with pharmacological treatment acting as a partially mitigating factor.

The study included 327 Spanish children from different studies conducted in the ADHD Unit at Hospital Sant Joan de Déu in Barcelona from 2012–2020. Participants included 80 children with ADHD who were being treated with medication, 108 children with ADHD who were receiving no pharmacological treatment, and 136 control subjects.  Anxious/depressed, attention problems and aggressive behaviors (AAA) scales from the Child Behavior Checklist (CBCL) were used to define DESR, which is not a standalone diagnosis but rather an umbrella term used to describe the emotional symptoms commonly associated with ADHD. Sleep was assessed using the Sleep Disturbance Scale for Children.

A significantly higher DESR profile was found in subjects with ADHD compared to the control group, and the highest DESR scores existed among those children with ADHD who did not undergo treatment. A positive and significant (p = .02) correlation was found between DESR and sleep, suggesting that the greater the dysregulation, the greater the likelihood of sleep disturbances. CBCL scales found higher Anxious/Depressed, Attention Problems and Aggressive Behaviors scores in participants with ADHD compared to the control group (p = .001).

Researchers conclude that these findings support evidence that DESR should be considered a basic component of ADHD, rather than a comorbid condition, and that clinicians should take into account emotional dysregulation when administering treatment.

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1Sanabra M, Gómez-Hinojosa T, Grau N, Alda JA. Deficient Emotional Self-Regulation and Sleep Problems in ADHD with and without Pharmacological Treatment. Journal of Attention Disorders. January 2021. doi:10.1177/1087054720986242