Effects of a multi-modal management model incorporating executive function-targeted intervention for pediatric attention-deficit/hyperactivity disorder with comorbid emotional dysregulation

Abstract

BACKGROUND

In pediatric populations, attention-deficit/hyperactivity disorder (ADHD) is among the most frequently diagnosed neurodevelopmental disorders. Emotional dysregulation is not only integral to its core symptomatology but also crucial in determining clinical prognosis.

AIM

To investigate the efficacy of a multimodal management model incorporating executive function-targeted intervention for children with ADHD and comorbid emotional dysregulation, and to provide empirical evidence for clinical management innovation by evaluating changes in executive function, emotion regulation, core ADHD symptoms, and social function.

METHODS

A total of 112 children aged 6-12 years with ADHD and comorbid emotional dysregulation between March 2024 and January 2025 were included in this study and divided into a conventional group (58 cases receiving methylphenidate hydrochloride prolonged-release tablets + basic behavior log feedback) and an observation group (54 cases managed with a multimodal management model in addition to routine treatment). The main assessment tools included Behavior Rating Inventory of Executive Function-2^nd Edition (BRIEF-2) for executive function, Child Behavior Checklist (CBCL)/Multidimensional Anxiety Scale for Children (MASC) for emotional disorders, Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV) for ADHD symptoms, Social Skills Rating System (SSRS) for social function, and Emotion Regulation Questionnaire (ERQ) for emotional regulation strategy). All children underwent dynamic follow-up assessments at 1, 3, and 6 months postintervention.

RESULTS

After 6 months of follow-up, the observation group showed significantly lower BRIEF-2 total score (P < 0.001), CBCL Emotional Problems factor score (P = 0.023), MASC total score (P = 0.018), and SNAP-IV total score (P < 0.001), as well as higher SSRS total score (P < 0.001) and ERQ cognitive reappraisal score (P = 0.009) than in the conventional group (all P < 0.05). No significant between-group differences were observed in medication compliance (81.03% vs 88.89%) or adverse reaction incidence (15.52% vs 11.11%; P > 0.05).

CONCLUSION

The multimodal management model incorporating executive function-targeted intervention systematically addresses the cognitive, emotional, and behavioral challenges of children with ADHD and comorbid emotional dysregulation, demonstrating sustained intervention effects.

Keywords: Attention-deficit/hyperactivity disorder; Emotional dysregulation; Executive function; Multimodal intervention; Cognitive-behavioral-ecological approach

Core Tip: This retrospective cohort study explored the efficacy of a multimodal management model centered on executive function-targeted intervention for children aged 6-12 years with attention-deficit/hyperactivity disorder (ADHD) and comorbid emotional dysregulation. The model integrates medication, behavioral therapy, and family-school ecological support. It significantly improved executive function, emotional regulation ability, core ADHD symptoms, and social function while maintaining safety and medication compliance comparable to routine intervention. This cognitive-behavioral-ecological intervention paradigm provides an evidence-based foundation for transforming ADHD management from symptom control to functional rehabilitation and warrants clinical promotion with personalized stratification.