Emotion dysregulation in children and adolescents with externalizing disorders: a systematic review and meta-analysis

Externalizing disorders (Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD)) are frequent among children and adolescents referred to mental health services. Despite numerous studies linking emotion dysregulation to both severity and symptoms of externalizing disorders, the strength of the relationship is unclear. The purpose of this systematic review and meta-analysis was to evaluate the correlation between emotion dysregulation (deficits in emotion regulation and emotional lability) and symptoms of externalizing disorders. Embase OVID, Ovid MEDLINE and PsycINFO were systematically searched for eligible studies published up to June 2025. In total 75 studies involving 11,913 participants were included, with 63 studies on ADHD, 9 on ODD, 2 on ODD/CD, and 1 on ADHD/ODD/CD. Results showed a moderate correlation between emotion dysregulation and symptoms of externalizing disorders (r=0.35), with a higher correlation for emotional lability (r=0.47) than for emotion regulation (r=0.24). No significant moderating effects were found for age, gender, continent, informant, ADHD subtype, comorbidity or medication status. The findings indicate that emotion dysregulation, especially emotional lability, has a significant relation to symptoms of externalizing disorders. PROSPERO [CRD420251061853].