(PS3-99) Does Sex Moderate the Association between ADHD and Use of Adaptive or Maladaptive Cognitive Emotion Regulation Strategies in Early Adolescents?

Abstract Text: Although not part of the diagnostic criteria, it is recognized that emotion dysregulation is a core feature for many, if not most, youth with ADHD (Faraone et al., 2019; Sonuga-Barke et al., 2023). In addition to its high prevalence, emotion dysregulation contributes to increased functional impairment in youth with ADHD (Classi et al., 2012) and is associated with increased risk for other psychiatric disorders (Steinberg & Drabick, 2015). When examining individuals with ADHD, it is important to also consider sex differences, particularly given the underrepresentation of females in ADHD research (Hinshaw et al., 2021; Stephens et al., 2025). Preliminary evidence suggests there may be sex differences in the developmental patterns of emotion dysregulation. Specifically, both males and females with ADHD show higher levels of emotion dysregulation in childhood compared to their non-ADHD peers; however, across the transition to adolescence, males experienced improvements in their emotional symptoms whereas female dysregulation persisted, if not increased (De Ronda et al., 2024). Work in this area has primarily focused on irritability and emotional lability, leaving it unclear whether ADHD and sex-assigned at birth interact in relation to the conscious cognitive emotion regulation strategies used by individuals when experiencing negative life events. Accordingly, the current study used a large sample of adolescents, with approximately equal females and males, to examine whether sex moderated the association between ADHD and the use of cognitive emotion regulation strategies. Participants were 341 early adolescents (aged 10-12 years; 56% female; 62.2% White, 21.1% Black, 14.1% Multiracial, 2.3% Asian, 0.3% American Indian; 9.4% Latiné), with approximately half (48.7%) diagnosed with ADHD based on a semi-structured interview with the caregiver. Adolescents completed the short form of the Cognitive Emotion Regulation Questionnaire (CERQ; Garnefski & Kraaij, 2006). Items load onto two factors including adaptive strategies (e.g., putting into perspective, positive refocusing, positive reappraisal, acceptance, and planning) and maladaptive strategies (e.g., self-blame, other-blame, rumination, catastrophizing). Moderation analyses were conducted with internalizing symptoms, age, medication status, and family income included as covariates. Sex did not moderate the association between ADHD and maladaptive emotion regulation strategies. In contrast, a significant ADHD × sex interaction was found when examining ADHD in relation to total adaptive emotion regulation strategies (coefficient = -0.323, t = -2.014, p = .045), with simple slope analyses indicating that ADHD was associated with lower adaptive regulation strategies for females (t = -2.564, p = .011) but not males (t = 0.148, p = .882). In examining specific adaptive regulation subscales, the same pattern of moderation was found for the acceptance, positive appraisal, and putting into perspective subscales (all interaction ps < .08). These findings provide evidence that female adolescents with ADHD are less likely to use adaptive emotion regulation strategies and may suggest a need for sex-informed interventions for adolescents with ADHD.