Emotional dysregulation in children with ADHD

Part 1 – Why is my child so emotional?

In my opinion, the most challenging aspect of living with and parenting a child with ADHD, isn’t the frustrating inattention and distractibility, the exhaustion of constant hyperactivity, or even the potentially dangerous impulsivity.

Sure, these things are extremely difficult. However, for me, the hardest part of raising children with ADHD is having to deal with emotional dysregulation. And according to Dr. Russell Barkley (Ph.D.)1, I am not alone. He reports that emotional dysregulation is the primary reason that parents end up in the paediatrician’s office getting a diagnosis of ADHD for their child. This was true for both my children’s diagnoses.

We’d always known our son had ADHD. Many friends mentioned his activity levels and defiant behaviours, our GP confirmed it when he was 2, and a clinical psychologist further confirmed it when he was 3. At that stage, though, we could handle his inattention, hyperactivity and even risky impulsiveness. It wasn’t until he was 5, when we could no longer cope with the constant, violent outbursts, aggression and meltdowns that were taking over our life, we decided to take the step to a formal diagnosis. By this time, I felt like a complete and utter failure. I honestly believed that I must have been doing something wrong – parenting wrong. I had obviously broken this incredible miracle baby that I had been blessed with.

We often had holes in our walls, broken doors, and broken mirrors that had to be patched and replaced. We had heard horrible words come out of his mouth when we asked him to do something seemingly small. He could go from a happy, joyful child to a screaming maniac in two seconds flat, and then back again. The level of stress in our home was unbearable. No matter how much punishment we dished out, this was not getting better. In fact, it was getting consistently worse.

My daughter was at a whole other level: My husband and I were seriously concerned about her mental health prior to her getting diagnosed. She was extremely volatile, angry, irritable and moody. Her meltdowns were like she was demon possessed. She would scratch, bite, yell, scream and completely zone out. She seemed to cause conflict wherever she went. I’d had significant post-natal depression with her, so I lived with complete and utter shame and guilt that her mental health was broken because of me. She presented differently to my son, so, it took me longer to identify that she was having difficulty with emotional regulation. She wasn’t struggling with a mental illness, she was struggling with her ability to regulate her emotions.

What is Emotional dysregulation and how do we regulate it?

In extremely basic terms, emotional regulation is a human’s ability to control their emotional reactions. The current diagnostic criteria of ADHD (DSM-5), does not include any mention of emotional dysregulation, despite research indicating that all people with ADHD have difficulties with emotional regulation in differing severity. Research indicates that specific subgroups of people with ADHD (namely ADHD – Combined presentation, ADHD – Hyperactive/Impulsive presentation, and females with ADHD), have more severe deficits in emotional dysregulation2.

Humans have an amazing ability to use self-calming techniques to control their own emotions. This ability improves with age and moves from needing someone else to be responsible for soothing you (e.g. a baby needing to be cuddled and rocked when they are upset) to more self-calming or internal techniques6. Young children might move away from something that is evoking an emotion. For example, they might do a nudie run down the hallway to escape the ‘horror’ of a bath, cover their eyes so they don’t see something scary, or suck their thumb when they are feeling anxious. They still rely on their parents or carers to help control their emotions, but to a lesser extent. They have worked out some strategies for themselves.

In later childhood onwards, we can replace a negative emotion (e.g. anger/fear) with a more positive secondary emotion (e.g. happiness, joy, calm). This is us inhibiting our emotional responses to return to a liveable state, ensure our emotions are socially acceptable, and to stop escalating negative emotions. For example, if you have a fear of needles and you are waiting for a blood test, your natural primary emotion might be fear or anxiety. We can focus on the fear and anxiety, escalating to a point where we might cry, run away, or, in my case faint and vomit. So instead, we might think about something else: a special place, a loved one, a special event. It takes your mind off your primary emotion, and replaces it with a more liveable secondary emotion.

Emotional regulation in children with ADHD

A child with ADHD does not have anything wrong with their emotions. Research tells us that children with ADHD are unable to inhibit or stop their emotional responses.5 So, while they have the same emotions at the same intensity as their neurotypical peers, they are not able to inhibit them as well. This might look like impatience, quickness to anger, aggression, temper outbursts, violent reactions with negative emotions, as well as excessive excitement or extreme happiness with positive emotions.

Children with ADHD find it difficult to shift their attention away from the primary emotion they are feeling in the moment. They continue to ruminate and hyper attend to their emotion and do not inhibit their emotional response. This comes back to poor executive function abilities such as poor working memory, reduced ability to use visual imagery and difficulty manipulating and organising their thoughts. These also include problem solving, difficulty coming up with alternative thoughts or planning appropriate and more socially acceptable responses5 . When we understand this, it makes it easier to see why children with ADHD do seem more emotional than neurotypical peers. This is why we see long meltdowns, and sometimes violent, aggressive and highly emotional and volatile behaviours in children with ADHD. They often cannot inhibit these responses without support from someone else.

Children with ADHD have an approximate 30% delay in their executive functioning skills compared to their neurotypical peers5. This is the same in terms of emotional regulation. Children with ADHD are going to appear less mature in their ability to inhibit their emotions than other children of their age.

This means that a 5-year-old child with ADHD will have the inhibition ability of approximately a 3-year-old neurotypical child. What happens when a 3-year-old child takes a toy from another 3-year-old? Chances are the toy-taker will be met with tears, yelling, and maybe even a good punch or bite. This neurotypical 3-year-old child finds it extremely difficult to inhibit their anger or sadness, and this is typical. More than likely they will still need support from their parent to regulate their emotions and settle down.

Let’s contrast this by thinking about a neurotypical 5-year-old. They might have just started school and our expectations are that this child should be able to handle the same anger and sadness, without hitting or biting their peer. We might expect them to inhibit their emotions long enough to find a teacher to tell.

But what happens when a child with ADHD is 5 years old and a child takes their toy to school? They do not have a typical capacity to inhibit their emotions, so the parent of the ADHD child gets a phone call from the school, informing them that they have punched a child, broken a window, sworn at the teacher or a combination of all three. This child wasn’t choosing to be naughty or difficult, they were unable to inhibit their emotion long enough to problem solve and go and get the teacher, or ask the child for their toy back or replace their anger and sadness with a different emotion. And of course, we punish the child for their reaction without understanding why they have acted this way.  

I am not saying there shouldn’t be consequences for breaking windows and punching children – I believe there should be! But, now we can understand why they do it, and we are positioned to work with our children to assist them in learning emotional regulation and giving appropriate consequences.

What can be done?

There are many different ways and methods of teaching your child emotional regulation. One of my favourites is emotion coaching6! This method for training emotional regulation, has worked wonders in my family. When we introduced emotion coaching into our parenting toolbox, we saw a massive shift in our family stress levels and our children with ADHD’s emotional regulation abilities.

In my next blog we will discuss this method and I’ll share with you how it helped my family! If you are interested in emotion coaching, I can’t recommend this book highly enough – Raising an emotionally Healthy Child. It’s a game changer.

Final thoughts

My final thought and challenge for you this week – Emotional dysregulation is extremely hard to live with. Nothing increases my emotional dysregulation, like an emotionally dysregulated child. I struggle with my own ability to regulate emotions constantly! Particularly after a long day or week, or after another meltdown from my children or argument over cleaning up after themselves! With some children with ADHD, it is almost a full-time job to assist them in regulating emotions. That takes a toll on even the most patient, loving and kind parent.

However, I challenge you to think of a time where your emotional dysregulation, supported and modelled appropriate emotional control to your child. Yelling at our children not to yell or getting angry at them for being angry, while telling them not to feel angry! Not being able to pick ourselves up and dust ourselves off after disappointment, isn’t going to help our children to learn to regulate their own emotions. Trust me! I tried this for years.

We are all human. It is natural to be out of control at times. However, if this is something you feel you are struggling with consistently, please seek professional help. I have been to psychology many times in my life, to work through situations that have had a significant effect on me being able to regulate my own emotions. There is no shame in seeking help. Actually it is one of the bravest things you will do.

If we are unable to regulate our emotions, how can we effectively teach our children? Learn to regulate yourself and your family will thank you for it. I promise.

Check out part 2 of our emotion series where we look into emotion coaching! And what can we do after the meltdowns? Let’s get ADHD Done Differently.

Additional information/resources

  1. https://www.youtube.com/watch?v=V8nY3YtiU_E Long video! But worth the watch.
  2. Hirsch, O., Chavanon, M.L. & Christiansen, H. Emotional dysregulation subgroups in patients with adult Attention-Deficit/Hyperactivity Disorder (ADHD): a cluster analytic approach. Sci Rep 9, 5639 (2019). https://doi.org/10.1038/s41598-019-42018-y
  3. Deberdt, W., Thome, J., Lebrec, J. et al. Prevalence of ADHD in nonpsychotic adult psychiatric care (ADPSYC): A multinational cross-sectional study in Europe. BMC Psychiatry 15, 242 (2015). https://doi.org/10.1186/s12888-015-0624-5
  4. Theule, Jennifer & Wiener, Judith & Rogers, Maria & Marton, Imola. (2011). Predicting Parenting Stress in Families of Children with ADHD: Parent and Contextual Factors. Journal of Child and Family Studies. 20. 640-647. 10.1007/s10826-010-9439-7.
  5. https ://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018741/
  6. https://www.gottman.com/blog/an-introduction-to-emotion-coaching/

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