A Deeper Dive into Emotional Dysregulation and ADHD
Even though ADHD and emotional dysregulation are deeply connected, it is not a part of the diagnostic criteria for ADHD, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5-TR). The DSM-5-TR is the reference tool that diagnostic professionals use to identify and classify mental health conditions. However, there is a lot of research which shows the presence of emotional dysregulation within ADHD. In fact, by many professionals, Emotional Dysregulation is viewed as a central part of ADHD. Children and adults with ADHD will often experience difficulties with regulating and managing their emotions. These challenges have a significant impact on the individual’s self esteem, interpersonal relationships and overall wellbeing as well - equally or even more than the typical diagnostic symptoms of inattention or hyperactivity. Even though Emotional Dysregulation may not be utilized to assess and diagnose ADHD, it is significantly analyzed, discussed and worked on in treatment.
What can emotional dysregulation look like?
Let’s explore what ADHD related emotional dysregulation can look like for an individual. Emotional Regulation challenges can result from poor executive function control. It can be seen in individuals with ADHD as they may:
- experience and display emotions more intensely, particularly during interpersonal interactions – possibly due to being overwhelmed by the emotion
- become overly excited
- focus on the more negative aspects of a task or situation
- express frustration or anger and become verbally or physically aggressive
- experience problems in social relationships including social rejection, bullying, and isolation
- experience relationship and marital problems, relationship breakup and divorce
- have difficulties achieving work or academic goals/requirements, receive a school suspension or expulsion, lose their job or fail to be promoted
- be involved in road rage and car accidents
- report increased psychological distress from their emotional experience
- develop anxiety and/or depression
- have conduct problems or be involved in crime.
The ADHD Brain and Emotional Dysregulation
The brain structures and networks implicated in ADHD are also involved in emotion. The frontal lobe, the anterior cingulate, the ventral striatum, and the amygdala are all areas of the brain involved in ADHD. Some of these structures also form the brain’s emotional circuitry — the amygdala and larger limbic system is where emotion is generated. Emotional dysregulation occurs due to differences in the nervous system and brain that also influence deficits in executive functions like working memory, organization, focus, task initiation, and time management. Emotional self-regulation is a major dimension of executive function required for daily life activities. It plays a crucial role in decision making as well.
Simply put, the brain networks which carry emotional information are lagging for people with ADHD. We process our emotions in our brain and working memory impairments (and other executive function weaknesses) present within ADHD can allow the emotions to become too strong and flood the brain intensely.
Looking Deeper into Emotional Dysregulation: Emotional Impulsivity (EI) and Rejection Sensitivity Dysphoria (RSD)
What is Emotional Impulsivity (EI)?
Emotional dysregulation in ADHD is often noticeable in behavioral patterns. Emotional Dysregulation can be observed as impulsive behaviors. Such behaviors show an inability to inhibit inappropriate behavior triggered by strong emotions. Poor emotional inhibition is an executive function deficit associated with ADHD. It is illustrated by:
- low frustration tolerance,
- impatience,
- being quick to anger,
- aggression,
- greater emotional excitability, and
- other negative reactions.
Oftentimes those with ADHD will have problems self regulating their primary response. They can experience such intense, overwhelming primary emotional reactions that they find it difficult to inhibit the expression of this emotion or to moderate the emotion and replace it with a secondary emotional reaction. An inability to refocus attention away from strong emotions can make it difficult to reduce or moderate a primary emotional response.
When exploring emotional impulsivity challenges and experiencing one’s emotions intensely, one cannot ignore the increasing acknowledgement and research into Rejection Sensitive Dysphoria and its comorbidity with ADHD.
What Is Rejection Sensitive Dysphoria?
Rejection sensitive dysphoria (RSD) is not a formal diagnosis, but rather one of the most common and disruptive manifestations of emotional dysregulation in ADHD. Dysphoria is the Greek word meaning unbearable; it signifies the severe physical and emotional pain suffered by people with RSD when they encounter real or perceived rejection, criticism, or teasing. It can also be triggered by the real or perceived withdrawal of love, approval or respect, or failure. The response or reaction of the individual is well beyond the proportion expected for the nature of the event that triggered it.
Common behaviors observed in children and adults with RSD can include:
- Sudden emotional outbursts following real or perceived criticism or rejection
- Withdrawal from social situations
- Negative self-talk and thoughts of self-harm
- Avoidance of social settings in which they might fail or be criticized
- Low self-esteem and poor self-perception
- Constant harsh self judgment and negative self-talk that leads them to become “their own worst enemy”
- Rumination and perseveration
- Relationship problems, especially feeling constantly attacked and responding defensively.
How can we help develop emotional regulation in children?
When discussing emotional dysregulation and its prevalence within ADHD, it is important to explore helpful techniques and strategies to help children and young adults learn skills to be able to manage their emotions in healthy ways.
Label the emotions
Improving emotional regulation starts with becoming aware of emotions and labeling them. This would involve slowing down, becoming aware of the emotions and what caused them in the first place, and specifically labeling the emotions.
This can start by getting the individual to describe the bodily symptoms like what they feel in their body. It is important to consider that an ‘emotionally dysregulated’ individual might not be aware they are even anxious or worried about something, but could be aware of the bodily symptoms (e.g., their head or stomach hurts). Labeling these body symptoms and relating them to the concrete emotions could make it easier to understand, which prepares them for the next step: creating distance between feelings and responses. This is when we utilize reflection, problem solving and helpful insight to improve the individual’s ability to understand and create increasingly healthy responses to their emotions.
It can be helpful to utilize emotion wheels to label emotions and incorporate body diagrams to let the child reflect on how the emotion may show up in their body. From there, they can work on effective language to use when expressing how they feel and what they may need to aid them in the situation (we have attached supplementary resources at the bottom).
Explore mindfulness
Research suggests that mindfulness-based interventions help to regulate emotions through the process of observing, followed by describing, and then acting with awareness. Mindfulness is a powerful tool in emotional regulation for both adults and children. Practicing mindfulness together will help both parents and children increase regulation of difficult emotions. We have attached supplementary recommendations on mindfulness and ways in which you can implement and explore mindfulness with your child.
Work from a Holistic Approach
A unified approach to emotional regulation starts with healthy routines, including getting adequate sleep, following a healthy diet, and getting regular exercise. Pay close attention to these daily routines and assess for any areas of improvement. Making small changes over time could eventually lead to easier emotional management.
Co-regulate with children: Children can benefit from calm support from caregivers, as well as learned coping strategies. It is important to use a warm and supportive approach to help children engage in coping strategies when dysregulated, such as deep breathing and helping them to identify and label their emotions. One of the most important tools parents can use is remaining calm and responding in a calm manner, promoting co-regulation. This is because children respond to the emotions being mirrored to them. Working with a therapist or psychologist to create a plan in advance on how to help a child cope with difficult emotions or situations can also help to prevent or resolve intense emotional responses.
Medication
Psychostimulant treatment of the core symptoms of ADHD is often linked to a beneficial effect on emotion dysregulation and should be considered the first line of treatment. Research has shown that these first-line treatments for ADHD are effective in improving, and in many cases remitting, emotion-related disturbances in adolescents who had significant problems with aggressive behavior and emotion dysregulation.
The Takeaway Message
There is ample individual experiences and increasing research stating the strong connection between ADHD and emotional dysregulation. Although it’s important to remember that this isn’t always the case - a person with ADHD can have typical levels of emotional regulation. However, if you live with ADHD and experience emotional dysregulation, or know someone who does, there are many people who share your experience. There are effective strategies to use to promote emotional awareness and regulation. Working with an experienced professional who can utilize researched and proven interventions can also be an effective approach to improving emotional regulation and can aid in building healthy skills and appropriate responses to difficult emotions.
Helpful Articles:
Ways to expand emotional literacy in children - labeling and expressing difficult emotions:
- http://deepikamittra.com/blog/2021/5/1/all-the-feels
- https://veryspecialtales.com/i-statements-examples-worksheets/
Mindfulness activities and support for parents:
- https://www.weareteachers.com/mindfulness-activities-for-kids/
- https://www.gottman.com/blog/mindful-parenting-how-to-respond-instead-of-react/
- https://kumarahyoga.com/how-to-make-a-mindfulness-glitter-calm-down-jar/
AttitudeMag is a great resource for families, with many short, easy-to-read articles and even some videos. A few related to Emotional Dysregulation and ADHD include: