adhd, anxiety, and emotion regulation in children: unraveling mechanisms through sem study

Background: this study aimed to examine the mediating role of emotion regulation strategies in the relationship between attention-deficit/hyperactivity disorder (adhd) symptoms and anxiety symptoms in children.methods: this applied research employed a descriptive, cross-sectional design for data collection and analysis. the statistical population included all elementary school students in neyshabur, iran, in 2024 (n > 35,000). a sample of 450 participants was selected via clustered random sampling with stratified randomization by gender and grade. measurement tools included the spence children’s anxiety scale (scas), the swanson, nolan, and pelham (snap-iv) adhd rating scale, and the emotion regulation questionnaire (erq), all culturally adapted for the iranian population. structural equation modeling (sem) was used to analyze relationships.results: the path coefficient for the relationship between adhd symptoms and anxiety symptoms was positive and significant (β = 0.45, p < 0.01). the path coefficient between adhd symptoms and emotion regulation was negative and significant (β= -0.38, p<0.01), indicating an inverse relationship. emotion regulation showed a negative, significant correlation with anxiety symptoms (β = -0.32, p < 0.01). the indirect effect of adhd symptoms on anxiety symptoms through emotion regulation was significant (β = 0.12, p < 0.01), confirming mediation. sem fit indices (cfi = 0.92, tli = 0.90, rmsea = 0.06) indicated good model fit.conclusions: emotion regulation strategies significantly mediate the relationship between adhd symptoms and anxiety symptoms in children. enhancing emotion regulation can reduce both adhd and anxiety symptoms, improving emotional adjustment.