Xiaolan Cao,1,2 Zhaomin Wu,1,2 Juan Liu,1,2 Ying Li,1,2 Linlin Zhang,1,2 Yufeng Wang,3 Binrang Yang1,2 

1Children’s Healthcare and Mental Health Center, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China; 2Children’s Healthcare and Mental Health Center, Affiliated Shenzhen Children’s Hospital of Shantou University Medical College, Shenzhen, Guangdong, People’s Republic of China; 3NHC Key Laboratory of Mental Health (Peking University), Peking University Sixth Hospital, Institute of Mental Health, Beijing, People’s Republic of China

Correspondence: Binrang Yang, Children’s Healthcare and Mental Health Center, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China, Tel +86 18938691619, Email ybinrang@126.com

Background: Emotional lability (EL), characterized by excessive emotional fluctuations and intense outbursts, frequently co-occurs with attention deficit hyperactivity disorder (ADHD) and may exacerbate functional impairments. This study aimed to explore the disparities in ADHD-related symptoms and functional impairments in children with ADHD who exhibited EL and those without it and to examine the unique contribution of EL to functional impairments.
Methods: A total of 427 children with ADHD, aged 6– 14 years, were recruited from Shenzhen Children’s Hospital. EL was assessed using the Conners’Parent Rating Scale, while ADHD-related symptoms were measured using the ADHD Rating Scale (ADHD-RS) and Child Behavior Checklist (CBCL). Functional impairment was assessed using the Weiss Functional Impairment Scale-Parent Form (WFIRS-P). Group comparisons were conducted between ADHD with EL and ADHD without EL, and correlations and multiple linear regressions were performed to explore the associations between EL, ADHD-related symptoms, and functional impairment.
Results: EL prevalence in the study sample was 33.96%. Children with ADHD and EL exhibited significantly higher scores for inattention (P< 0.001), hyperactivity/impulsivity (P< 0.001), CBCL factors (P< 0.001), and all domains of functional impairment (P< 0.05) than those without EL. The two groups differed substantially in their distribution of ADHD subtypes (P=0.012). Moderate correlations were found between EL and functional impairment (r=0.40– 0.45, P< 0.001). After adjusting for ADHD-related symptoms, EL independently predicted impairments in family (P=0.001), life skills (P=0.001), self-concept domains (P=0.001), and total functional impairment (P=0.002). EL, along with attention scores, social problems, and delinquent behaviors, significantly predicted the overall functional impairment.
Conclusion: EL is a significant contributor to functional impairment in children with ADHD, exerting its influence independently of the core symptoms of ADHD. Our findings highlight the need for targeted interventions to address emotional regulation in ADHD and mitigate long-term functional impairments.

Keywords: attention deficit/hyperactivity disorder, emotional lability, functional impairment