March 16, 2019

The Problem of Emotions in ADHD

By Mihai Simionescu MD By MS
Complexity rating Intermediate
Evidence Well Known
Read time 7 minutes

The Problem of Emotions in ADHD

 

Emotional problems are common and persistent in children, youth and adults with ADHD. Actually, much of the difficulties they have in their moment-to-moment interactions have to do with regulating emotions. They are not included in the diagnostic criteria but they can be seen, at least for now, as the downstream consequence of the same set of basic brain dysfunction that is also responsible for inattention or impulsivity.

 

When an emotion bubbles up we do not just feel something but we feel like doing something. The emotions are a call-to-action, they push us in a certain direction and, often, that particular thing is not the best response for the situation. 

 

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Emotion regulation is the capacity to adjust the level of the emotion we have to match the current situation. We often feel angry, but only in very limited circumstances it is adaptive to strike. We feel afraid, or anxious, in many situations, but  running is not always the proper response. Seeing somebody tripping and falling may be, in a way, amusing, but it is rarely OK to laugh.

 

Emotion regulation, when it works well, allows us to diminish, increase or maintain an emotion in order to match the situation. If something goes well, the emotion is positive, and everybody is enjoying the situation you do not want to get distracted, bored and sink into a funk. You want to maintain the positive feeling. But a depressed individual will likely drift away from it. If somebody is bullied, and feels the need to stand up against it but is rather shy and sinks into accepting it, should try to enhance the feeling of righteousness. But he might not.

 

The child with ADHD will have a hard time diminishing the emotion of anger or, on the positive side the excitement or joy. Yes, even excitement and joy need to be adjusted. Many problems will start from too much enjoyment that gets out of hand: things get too loud, or the milk gets spilled or the brother gets hit. The parent tries to temper that enthusiasm and joy becomes irritation, then overt anger. 

 

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Children with ADHD have a hard time regulating their level of excitement (modulating arousal levels) to deal with the current situation. 

 

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Emotions get activated more intensely and they will have the wheels rolling (behavior) in the direction of the emotion whether that is a good thing or not. It is the same ‘touchy gas pedal loose brake pedal’ problem we saw previously. We call this emotional lability or, if you want, excessively slipping emotions.

 

Emotional lability is the frequent display of high intensity negative emotions (like anger or anxiety) in response to everyday situations. For the child with ADHD, frequently is anger in response to frustrations. Frustrations are everywhere and cannot really be avoided. A sibling wants what he wants, the parent is asking to stop playing and come to dinner, the lego pieces don’t want to come together and the list of frustrations is endless. 

 

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“Just stop!” says Johnny’s mother for the hundredth time hoping to get him to slow down. 

 

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Let us summarize up to this point:

  1. emotions push us to do things
  2. sometimes doing those things makes the situation worse, not better 
  3. in those cases we need to regulate the emotion and DO DIFFERENT than we feel
  4. this is hard to do in ADHD (easy to say, hard to do)

 

Now, where is this capacity to regulate coming from? Some from inside, some from outside. Some is self-control or self-regulation, it is an internal capacity and some is the capacity to respond positively to the efforts that people, like parents, put forth to assist their children. 

 

The child with ADHD will have a hard time to self-regulate but will also respond poorly to other people’s attempts to externally-regulate or help tune down his emotions. As a result he spends a fair amount of time, depending of the severity of the problem, in a dysregulated state. Dysregulated moods lead to dysregulated behaviors and dysregulated behaviors lead to dysregulated moods. They take longer to calm down and they do not respond easily to other people’s interventions to assist them.

 

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ADHD is not the only condition that affects the emotion regulation. A substantial number of patients with ADHD will have other disorders as well. In some studies, up to 80% of the children with ADHD will have an additional diagnosis and up to 60% of them two additional diagnoses. Some of the most common are Oppositional Defiant Disorder (ODD), Anxiety and Mood Disorders, all of which will make the task of emotion regulation even more difficult.

 

For this reason, while it is natural to ask a child who lost control to ‘get a grip’, it is CRITICAL for the parent to keep in mind that a) he (currently) does not have working brakes and b) he might not take kindly your generous offer for help. It is critical because if we offer assistance to somebody and they do not or cannot take it we start ourselves feeling powerless, hopeless, frustrated and ….angry. Our sympathy or compassion for the child in need diminishes and we start seeing the problem as being just lack of trying on his part.

 

Things can go down pretty fast from here with two frustrated, angry and hopeless people in the room.

 

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If you read this far you probably have more questions than answers at this point. I do understand this. My goal in this website is to break-down complicated problems in manageable steps. Please continue to read the posts from the ‘emotion regulation’ series.

 

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