“I often feel like I am walking on eggshells.” If you’ve found yourself saying these words, then you are likely to have a child with ADHD who struggles to regulate their emotions effectively. For many families, the combination of ADHD and emotion dysregulation in their child can have a significant negative impact on stress levels and home life. It’s no surprise that in addition to looking at support for their child, parents also go on to find mental health support for themselves.

While the core symptoms of ADHD include inattention, hyperactivity, and impulsivity, there is another aspect of this neurodevelopmental difference that doesn’t get discussed, yet can be particularly challenging for families to navigate: emotion dysregulation. Dr. Russell A. Barkley, a leading expert in ADHD research, emphasises that emotional dysregulation is not simply a by-product of ADHD but a core component. 

However, there is no consensus among the medical and research community on making emotion dysregulation a core diagnostic symptom of ADHD because it is also a central aspect of other mood disorders. Three models have been proposed to explain the overlap between emotion dysregulation and ADHD: 

1. Emotion dysregulation and ADHD are related but separate different things; 
2. Emotion dysregulation is a core feature of ADHD; or,
3. The combination of ADHD and emotion dysregulation is its own entity and is distinct from just ADHD and emotional dysregulation.

Emotion regulation refers to the processes that accompany the range of emotions people feel, the intensity of each emotion, how a person experiences emotions, and how they express them. When we talk about emotional dysregulation, we are describing difficulties in managing and expressing those emotions in a manner that does not cause further stress to the individual and those around them.

In general, children with ADHD experience greater emotional distress, emotional intensity, and frequent and intense negative emotion reactivity than children without ADHD, with approximately 40% of children with ADHD having difficulty controlling their emotions.  

Our ability to control our emotions relies on two separate components, emotion regulation and emotional reactivity.  

1. Emotional reactivity – this refers to how much someone’s behaviour and body react when they feel strong emotions. 
2. Emotion regulation – this is about the strategies our brain uses to manage, control, and improve our emotional experiences and expressions. 

When kids face situations that make them feel upset, especially those causing anger and frustration, it can be harder for them to control how they react. Researchers believe that this is likely because dealing with emotions takes up a lot of mental energy, changing the dopamine response needed for a child to stay in control.

Identifying triggers for anger is crucial when you are seeking to manage your child’s emotional responses. While triggers can vary from one child to another, some common factors have been identified:

• Frustration and impatience – children with ADHD often face challenges in sustaining attention and completing tasks. When faced with obstacles, they may become frustrated and impatient, leading to anger. You can help your child by providing clear routines, talking to them about what is coming up and what to expect.
• Sensory overload – ADHD is frequently associated with sensory processing issues. Overstimulation from the environment, such as loud noises or bright lights, can contribute to heightened emotional responses, including anger. You can help your child by getting a sensory profile assessment to help you identify the support they need.
• Social difficulties – many children with ADHD experience challenges in social interactions. Rejection or difficulty making friends can be emotionally taxing, and in some instances, triggering anger as a coping mechanism. You can help by problem solving together with your child and highlighting different perspectives.

Strong negative emotional reactions can make it harder for children to get along with friends and family. 

Scientists have observed that in kids, being unable to control and handle emotions seems to be a significant factor in how often they face bullying from peers. If a child has ADHD, bullying may be worse because they struggle with managing their emotions in the moment.

As parents, it’s vital that we take the significance of social factors in understanding anger in children with ADHD. It underscores the importance of addressing not only individual triggers but also the broader social context for your child. Encouraging multiple friendship groups through school, sports and extra curricular activities is a great way to ensure your child doesn’t become reliant on one group of friends, especially when issues arise. 

Underlying brain structure and connectivity differences

Studies using brain scans of children with ADHD show that difficulties with controlling emotions, like sudden mood swings and temper outbursts, are linked to disruptions in brain circuits. In a sample of children with ADHD, it was found that those who experienced exaggerated mood swings also had altered connectivity between the amygdala and different parts of the brain, compared to kids with fewer emotional challenges. 

The amygdala, which is a part of the brain responsible for emotional memories, fear and panic responses, and decision-making, has been observed to be overactive in people with ADHD. The frontal cortex on the other hand, which is involved in inhibiting impulsive behaviors and regulating emotions, has been found to be underactive. This imbalance of neural connectivity can result in heightened emotional reactivity and impulsivity.

These findings add to a body of neuroimaging research that shows structural differences in the ADHD brain. There are still a lot of unknowns, but scientists propose that the brain differences identified impact key executive functions.

The Role of Executive Functions in Emotional Regulation

ADHD impacts self-regulation, the ability to regulate one’s own physical state, emotions, cognitions, and behaviour. The cognitive processes that support self-regulation are often referred to as executive functions, and they include:

• the ability to direct or focus attention,
• shift perspective, and adapt flexibly to changes (cognitive flexibility);
• retain information (working memory); and
• inhibit automatic or impulsive responses to achieve a goal, such as problem-solving (impulse control).

Even though our executive functions can be influenced by our experiences throughout our lifetime, there are times when they are more flexible and can be shaped by external factors. These skills appear to grow quickly when we’re very young and as we transition to adolescence. 

Mounting research suggests that executive functioning skills can be developed with practice and scaffolding. Regularly engaging the use of executive functioning skills in problem solving and at increasing levels of challenge, strengthens these skills and increases the efficiency of all related brain functions.

Recent studies suggest that a better-developed working memory predicts fewer ADHD symptoms and better emotion regulation skills than self-control or flexible thinking. There is evidence that training working memory can improve emotion regulation ability.

Understanding the underlying neurobiological factors that influence your child’s emotion regulation difficulties can help change how you see your child in moments of dysregulation – they aren’t giving you a hard time, they are having a hard time. It also puts you in a better position to select and prioritise the therapies and supports they need to manage it.