Understanding Emotional Dysregulation in Children with ADHD and Empowering Parents to Foster Emotional Resilience

While emotional dysregulation isn't explicitly outlined in the diagnostic criteria for ADHD, it's frequently acknowledged as a central element of ADHD. During your child's ADHD assessment process, however, it is possible that emotional regulation was not discussed. Nonetheless, many individuals with ADHD find managing intense emotions to be one of the most challenging aspects of their neurodivergent brain. Those with ADHD can experience big and overwhelming emotions seemingly at the drop of a hat. To many, this might look like going from a 0 to a 100 with no warning.  In fact, the presence of strong symptoms of emotional dysregulation can often mimic other disorders like depression, bipolar, borderline personality, and even posttraumatic stress disorder (PTSD), which may result in misdiagnosis(1).

 

What is Emotional Dysregulation?

 

Emotional dysregulation is struggling to control your emotional response, leading to strong feelings, that are greater in intensity than others would typically feel in the given situation. 

Emotional dysregulation is characterized by:

·      Strong emotional reactions that do not seem to match the trigger

·      Sudden outbursts

·      Low resilience when it comes to frustration and annoyance

·      Feeling out of control of one’s own emotions

·      Difficulty calming down following the event

·      Perseverating on the negative emotions

What this might look like:

Your child is happily playing a boardgame with their sibling; they are laughing and having fun for most of the game. Nearing the end of the game, their sibling does something unexpected on their turn. Your child is suddenly extremely distraught; they are crying, they push the boardgame across the table and declare that they hate the game and never want to play it again. They are unable to calm their body and struggle to let go of their feelings.  Your child continues to insist they hate the game and never want to play it again despite having enjoyed playing it on numerous occasions.

 

Note:

It's crucial to remember that in such situations, children are not choosing to react this way. They are overwhelmed by their emotions; No child chooses to experience these emotional rollercoasters.

 

Before we dive into the whys of emotional dysregulation in children with ADHD let's examine the different facets of emotional regulation and their connection to ADHD. Emotional regulation comprises five dimensions:

1.      Recognizing one’s emotions

2.     Recognizing emotions in others

3.     Emotional reactivity (tolerance to triggers and response intensity)

4.    Arousal reduction (your ability to calm yourself down)

5.    Emotional generation (your ability to intentionally change your mood)

 

Research suggests that children with ADHD do not typically struggle with the first two dimensions of emotional; they can recognize emotions both in themselves and in others. In contrast, kids with ADHD struggle with emotional reactivity, arousal reduction, and emotional generation.

 

Why is Emotional Regulation Challenging for those with ADHD?

The brain regions responsible for regulating attention and impulsivity are also implicated in emotional regulation. Studies suggest that emotional dysregulation in ADHD may stem from an overactive amygdala paired with an underactive prefrontal cortex [2]. The amygdala is part of the limbic system within our brain, and it is involved in triggering emotional responses; consequently, it makes sense then that an overactive amygdala would result in more intense emotional responses. Whereas our prefrontal cortex plays a significant role in our executive functioning, which includes filtering and inhibiting our behavioural responses. You can see how these differences in ADHD brains map onto the last three dimensions of emotional regulation (i.e., reactivity, arousal reduction, and intentionally changing our mood). Children with ADHD are emotional reactive because of differences in their brain not because they are choosing to be difficult or aren’t trying hard enough to remain regulated.

 

How can we Help Build Emotional Resilience?

Knowing yourself as a parent. While it can be extremely challenging in the moment, especially if you also have ADHD, the best way to support our children through the crashing waves of their intense emotions is to remain calm. This means knowing yourself.

• Identify situations that are particularly triggering for you. Maybe this when your child is struggling in a public location (e.g., having big emotions in the middle of the grocery store because buying a toy that caught their eye is not going to happen). Or maybe this is when your child is directing their emotions at you (e.g., you may begin to spiral into your own negative self-talk “I am a horrible parent”). When you know your triggers, you can adequately plan for them. It can also help with showing yourself empathy. It is pretty much impossible to always remain calm as a parent when your child is experiencing big feelings.

• Identify coping mechanisms that will help you to remain calm. What are tools and strategies that help you stay calm when your sympathetic nervous system (stress response) is activated?

  • Try taking deep breaths.

  • Try picturing yourself in a loving and kind moment with your child (e.g., a happy memory such as holding them as a baby in your arms).

  • Try taking a moment to yourself; walking away from a distraught child momentarily to collect yourself will likely be more effective than engaging in behaviours that will only escalate the situation because you are also dysregulated.

Validating their Emotions. Remember your child is not choosing to experience these intense emotions; their brain is reacting to a situation that is perceived to them as extremely stressful. Instead of focusing on changing their emotions or behaviours in the escalated moment, validate your child’s feelings:

• You are sad that you can’t get the game that you wanted. You REALLY want that game, and it is hard not getting what you want.

• You are angry that you have to stop playing video games. It was so fun to play and now you have to do something else. It is hard to stop doing something that you really like.

• You are very upset about what happened during the boardgame. I can see you are having a really hard time.

Teaching Emotional Literacy. Teaching children about various different emotions and how it feels in their body can help a child “name it to tame it”. It is best to teach emotions and associated body sensations when a child is not in as escalated situation; when a child is overwhelmed by their emotions, their brain is unavailable for learning. You may want to use an emotion wheel to show them that there are many different types of emotions. https://lindsaybraman.com/emotion-sensation-feeling-wheel/  

Help your child identify triggers and coping strategies.  Just as you need to know your triggers and your calming strategies, your child also needs to learn what is hard for them and what helps them. Many children may not be able to identify their own triggers or calming strategies; you can help them with this.

• Talk to your child about your triggers and calming strategies. It can be helpful for your child to hear that they are not alone. All people, children and adults alike can struggle to keep their emotions under control. Try to be consciousness of using developmentally appropriate language when discussing your own emotions.

  • “I can feel really sad when I see people I love crying. Sometimes it helps me to close my eyes and imagine a beautiful garden.”

  • “I can get really frustrated when I burn dinner. It makes me feel really angry because I feel like I messed up. I find it helpful to stop and take a deep breath and remind myself that making mistakes is ok.”

• Explore your child’s triggers . While talking to your child about their emotions, be careful not to use words that may be interpreted as negative. Let them know that all emotions are ok, we just have to learn safe ways to express them. After your child has heard about your own triggers you may want to start a conversation about their triggers using the sentence starter “I noticed”.

  • “I noticed that you feel really upset when I ask you to stop playing video games to come to eat dinner. Have you noticed that?”

  •  “I noticed that losing boardgames makes you feel really sad sometimes. Maybe losing board games is hard for you?”

• Identify calming strategies and practice them. Some children need space, others need tight hugs. Calming strategies that will work will depend on your child. Remember these strategies should be practiced and practiced and practiced when the child is calm; they should become almost automatic. Some calming strategies might include:

  • Sensory input: hugs, jumping, hitting a pillow, music, etc.

  • Deep breathing: square breathing and belly breathing

  • Visualization: picturing a safe place, remember a happy memory, imagining the emotions slowly drifting away

  • Muscle relaxation: actively flexing and then relaxing the muscles

  • Positive self-talk: these feelings will pass, it’s ok that I am sad, I am loveable, mistakes are ok, etc.

Ride out the wave. Even with all of these strategies in place, there will always be moments that your child will struggle to remain regulated. In highly escalated moments, your child is unable to think rationally; the only thing you can do is ride out the wave of emotions with them. Remind yourself that the emotions will pass.  

References

1.      Kring, A. M., & Sloan, D. M. (Eds.). (2010). Emotion regulation and psychopathology: A transdiagnostic approach to etiology and treatment. The Guilford Press.

2.     Shaw P, Stringaris A, Nigg J, Leibenluft E. Emotion dysregulation in attention deficit hyperactivity disorder. AJP. 2014;171(3):276-293. doi:10.1176/appi.ajp.2013.13070966

3.     Graziano PA, Garcia A. Attention-deficit hyperactivity disorder and children’s emotion dysregulation: A meta-analysis. Clinical Psychology Review. 2016;46:106-123. doi:10.1016/j.cpr.2016.04.011