Exploratory Symptom Profiles and Clinical Correlates in Adults with Attention-Deficit/Hyperactivity Disorder: A Retrospective Study Using the Wender-Reimherr Adult Attention Deficit Disorder Scale

Background: Emotional dysregulation (ED) is a clinically relevant feature of adult attention-deficit/hyperactivity disorder (ADHD), but its relationship to clinical burden remains incompletely characterized. We aimed to describe latent symptom profiles and compare clinical and sociodemographic characteristics of adults assigned to classes with elevated probabilities in emotion-related domains with those assigned to the remaining classes. Methods: This retrospective cross-sectional study included 749 adults with ADHD from a specialized outpatient clinic. Latent class analysis was performed on 28 items of the clinician-rated Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). Classes with elevated probabilities in temper, affective lability, and emotional overreactivity were grouped post hoc as an exploratory ADHD+ED group; the remaining classes formed the ADHD group. These labels do not denote clinical diagnoses. Sensitivity analyses examined alternative groupings and adjustment for core ADHD symptom severity. Results: A six-class solution was retained. Under the primary grouping, 60.9% of participants were assigned to ED-related classes (24.6%-77.0% across alternative groupings). The ADHD+ED group showed greater psychological distress, depressive symptoms, and functional impairment; these differences persisted after adjustment for core symptom severity. Differences on several subscales of the Conners Adult ADHD Rating Scales (CAARS) also remained, whereas differences in broader ADHD self-report scores and the number of comorbid diagnoses did not. The small difference in drug-use screening scores was not robust in sensitivity analyses; alcohol-use screening scores and sociodemographic characteristics did not differ significantly. Conclusions: Assignment to the exploratory ED-related group was associated with greater psychological distress, depressive symptoms, and functional impairment. The proportion assigned depended on the grouping and should not be interpreted as an ED prevalence estimate. The cross-sectional design limits causal inference; the single-center sample and exclusion of severe psychiatric comorbidities limit generalizability; and the shared WRAADDS basis limits independent interpretation of WRAADDS-derived group differences. Future research should use independent, dimensional measures of ED and longitudinal designs, and should evaluate interventions targeting emotion regulation in adults with ADHD.