The Dysregulation Profile Mediates Functional Impairments in School-Aged Children with ADHD: A Large Cross-Sectional Study

Abstract This large cross-sectional study investigated the prevalence of the dysregulation profile (DP) in school-aged children with attention-deficit/hyperactivity disorder (ADHD) and its mediating role in functional impairment. A total of 13,240 children with clinician-diagnosed ADHD were enrolled, and behavioral problems, emotional dysregulation, and functional impairment were assessed using parent-report scales including the Conners Parent Rating Scale, Strengths and Difficulties Questionnaire-Dysregulation Profile (SDQ-DP), Swanson Nolan and Pelham Rating Scale (Version IV), and Weiss Functional Impairment Rating Scale. Participants were categorized into DP (SDQ-DP ≥ 5, n = 1,243) and non-DP (n = 11,005) groups. The overall DP prevalence was 9.57%, with no significant differences across age or sex strata. Children with DP exhibited significantly more severe functional impairment across all domains (family, social, life skills, self-concept, school, risk-taking behaviors), with the largest effect size in the self-concept domain (Cohen’s d = 0.85). Mediation analyses showed DP accounted for 29.6% of the total effect between ADHD symptom severity and overall functional impairment, and 17.9%–22.8% of the effects linking specific behavioral problems to functional impairment. These findings indicate DP is not merely a marker of clinical severity but a key mechanistic pathway exacerbating real-world dysfunction in children with ADHD. Routine DP screening and targeted emotion-regulation interventions are warranted to improve adaptive outcomes.