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Original Research Early Career Psychiatrists October 1, 2025

Symptom Network Analysis of Attention-Deficit/Hyperactivity Disorder and Emotional Symptoms in Adults: Results From the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

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J Clin Psychiatry 2025;86(4):24m15287

Abstract

Objective: The diagnosis of attention-deficit/hyperactivity disorder (ADHD) is based on a set of symptoms and 2 main dimensions (impulsive/hyperactive and attentional). While the relationships between ADHD symptoms and emotional dysregulation (ED) have been widely studied, the interactions between individual symptoms have rarely been examined. The purpose of this study was to assess which symptoms are most influential (central) and which symptoms connect (bridge) the 2 main dimensions of ADHD and ED.

Methods: Data from wave II (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-II) were utilized, which included a large, nationally representative sample of the US population (N=33,546). Eighteen ADHD symptoms were examined based on DSM-5-TR criteria, along with 4 variables related to ED. Symptom network analyses were conducted to explore the relationships between ADHD and ED symptoms.

Results: The prevalence of ADHD was found to be 10.12% (N=3,397). Among all ADHD and ED symptoms, ED symptoms had the lowest influence (centrality) values. In terms of bridging the 2 ADHD dimensions, 2 ED symptoms were among the 4 most influential.

Conclusions: The low centrality of ED symptoms supports the traditional focus on the 2 main dimensions of ADHD. However, the significant role of ED symptoms in connecting the impulsive/ hyperactive and attentional dimensions highlights their importance within the ADHD framework. These findings have potential implications for the epidemiology, public health, research, and clinical understanding of ADHD.

J Clin Psychiatry 2025;86(4):24m15287

Author affiliations are listed at the end of this article.

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