Part 2: ADHD & Emotion Regulation – Life Impact

Emotional reactivity and ADHD symptoms have been shown to get stronger with age. In fact, the percentage of individuals with ADHD who experience emotion dysregulation, increases from around 25–45% in childhood to 30–70% in young adulthood.

When our children are little, emotion dysregulation is often considered to be developmentally expected. Parents exchange stories about how small things like the wrong cup colour can trigger an emotional explosion in their child, and they commiserate about what is colloquially known as the “terrible twos”, “threenagers” and “fournados”. However, as our children grow and start school, their inability to control their emotions starts to become problematic in many aspects of their young lives.

Research is increasingly looking into how self-control skills are vital for academic performance, achieving personal goals, and having positive outcomes as kids grow up. The studies propose that kids who are good at self-control might find it easier to perform better academically, make friends, and deal with challenges that arise during the school years.

Regulating emotions doesn’t come easy to kids with ADHD, but when they struggle with emotion dysregulation, there are some extra signs to look out for, like:

  • Getting easily annoyed
  • Being impatient when things are stressful
  • Getting really angry over small problems
  • Suddenly exploding with anger
  • Having regular moments of frustration
  • Not being aware of how others feel

Emotion dysregulation and parent burnout

Your child might react strongly to everyday things, and it might feel like you have to be careful around them – like walking on eggshells. Having regular negative interactions with your child can create the conditions for parenting burnout (the same is true for carers, for simplicity I will refer to “parents” throughout this section). 

Although many parents will resonate with the feeling of burnout, parental burnout as a clinical concept is still very new. For now, there are three proposed measurements that can indicate parental burnout construct/syndrome:

  1. Feeling exhausted from parenting
  2. Feeling emotionally distant from your child
  3. Feeling that you are not a good parent and questioning how effective you are

Evidence shows that burnout affects the person in several ways including disrupted sleep, adverse physical symptoms, and addictive behaviours. There is also a strong correlation between parental burnout with co-parenting disagreement, family disorganisation, and emotional instability.

Clinicians have observed a pattern in parents who are exhausted and who care for kids with behavioural issues where they tend to step back emotionally instead of physically. This means they still take care of basic needs like feeding and bedtime, but they become less connected, less understanding, and less responsive to their children emotionally.

Your well-being is critical to your ability to effectively support your child’s emotion regulation. If you are also tired, stressed, unwell, or dysregulated, you won’t be able to effectively co-regulate with your child, and that can make situations worse. 

Emotion regulation and relationships

When a child’s dysregulation escalates to aggression it is important to seek additional help for yourself and your child.

Aggression is when anger goes up a notch and turns into actions that can immediately hurt someone. Several studies have found that more than half of pre-adolescents with ADHD combined type (inattentive/impulsive-hyperactive) score high on aggression. Impulse based aggression, i.e. acting without thinking and getting aggressive, was the most commonly observed form of aggression.

Aggressive kids might:

  • Hit
  • Grab
  • Bite
  • Kick
  • Shove
  • Pinch
  • Pull hair
  • Scratch
  • Throw things

It’s important to know that when kids get aggressive, it’s not because they’re trying to be “bad”, it’s because their emotions are too strong for them to handle at that moment. As parents, we need to find ways to help our children regulate when they have lost control and plan for future triggers. This involves in-the-moment strategies, but most importantly, it relies on implementing day-to-day support and tools that align with long-term regulation goals for your child.

In teenagers, hormones can make ADHD even more challenging, and sometimes it leads to them acting impulsively with aggression. In teens, the signs might not be physical, and might include:

  • Insulting friends
  • Yelling at family
  • Threatening to hurt themselves or others
  • Teasing or bullying
  • Lying or gossiping
  • Spreading rumours
  • Using manipulation to keep their social standing

Often, when a child has a hard time managing their emotions, it can create a back-and-forth issue with family and friends. The child’s frequent strong negative feelings can affect how they get along with their family and peers. On the flip side, if the parent has a poor relationship with their child, the child might struggle to see the parent as someone who can help them, making it harder for them to regulate. 

There is significant evidence that shows that children who have a secure relationship with their parents are better at regulating their emotions. In addition, positive maternal parenting styles are thought to be associated with changes in brain structures that are connected to cognitive and emotional functioning. This simply means that your ability to use positive parenting strategies can be a protective factor for your child’s emotional health in addition to supporting the development of their emotion regulation capabilities.

As a parent, the earlier you can start with positive parenting strategies the better it will be for your child’s future development.

Ask yourself “Do my child and I have a good relationship?” If you said no or believe that it has been eroded over time, repairing that relationship is an essential part of addressing your child’s emotion regulation difficulties. And although you might not feel like connecting with your child because of past interactions where you’ve been hurt, this is probably the most important time to prioritise repair and connection. Try the 7 day connection challenge to get you started.

Early intervention for better long-term outcomes

Investigating and addressing emotion control during childhood, when the brain’s plasticity is at its highest, will have the most positive impact on your child. Emotional reactivity and ADHD symptoms have been shown to get stronger with age; this finding is consistent with published reports acknowledging that emotion dysregulation persists over the lifespan. In fact, the percentage of individuals with ADHD who experience emotion dysregulation increases from around 25–45% in childhood to 30–70% in young adulthood.

The combination of ADHD symptoms and emotion regulation is associated with significant reductions in quality of life. In a study that looked at 2076 kids over 14 years, evidence linked problems with controlling emotions in childhood to having more anxiety, mood issues, behaviour problems, and substance abuse as grown-ups.

These types of longitudinal studies highlight the importance of early identification of emotion control problems in kids with ADHD, and the importance of managing them.

Science and research only give us some pieces of the puzzle. Your child’s natural temperament and personality also influence their capacity for self-regulation, in addition to their sensory and neurodevelopmental differences. This is why it is so important to know your child and understand their needs beyond a diagnosis.

References

  1. Working memory training improves emotion regulation ability: Evidence from HRV – ScienceDirect
  2. The neurodevelopment of executive function skills: Implications for academic achievement gaps.
  3. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review – PMC
  4. Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis – PMC
  5. Practitioner Review: Emotional dysregulation in attention-deficit/hyperactivity disorder – implications for clinical recognition and intervention
  6. Managing Frustration for Children (MFC) Group Intervention for ADHD: An Open Trial of a Novel Group Intervention for Deficient Emotion Regulation – ScienceDirect
  7. Childhood attention-deficit hyperactivity disorder: Family therapy from an attachment based perspective – ScienceDirect
  8. Altered Intrinsic Functional Connectivity of the Cingulate Cortex in Children with Severe Temper Outbursts – PMC
  9. Abnormal Amygdala Functional Connectivity Associated With Emotional Lability in Children With Attention-Deficit/Hyperactivity Disorder – PMC
  10. Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation
  11. Performance of children with attention deficit hyperactivity disorder (ADHD) on a test battery of impulsiveness
  12. Emotion regulation accounts for the relation between ADHD and peer victimization | SpringerLink
  13. Indirect effect of ADHD on parenting stress through increased child anxiety and decreased emotional regulatory coping | SpringerLink
  14. Efficacy of psychosocial interventions for children with ADHD and emotion dysregulation: a systematic review – ScienceDirect
  15. Adult Outcomes of Childhood Dysregulation: A 14-year Follow-up Study – PMC
  16. Examining the influence of irritability and ADHD on domains of parenting stress | SpringerLink
  17. Effectiveness of group psychodrama on aggression and social anxiety of children with attention-deficit/hyperactivity disorder: A randomized clinical trial – ScienceDirect
  18. The effectiveness of parent-child interaction training on behavioral problems and aggression of children with ADHD symptoms
  19. Preliminary data on the development of emotion vocabulary in typically developing children (5-13 years) using an experimental psycholinguistic measure
  20. Does central executive training and/or inhibitory control training improve emotion regulation for children with attention-deficit/hyperactivity disorder? A randomized controlled trial – PMC
  21. Evidence of emotion dysregulation as a core symptom of adult ADHD: A systematic review – PMC
  22. Regulation of sadness via acceptance or suppression in adult Attention Deficit Hyperactivity Disorder (ADHD)
  23. ORIGINAL ARTICLE An Examination of Emotion Regulation and Associated Factors in Attention Deficit-Hyperactivity Disorder Dikkat
  24. Preschool Intervention Can Promote Sustained Growth in the Executive-Function Skills of Children Exhibiting Early Deficits – PMC
  25. Evidence review for universal curriculum approaches – NCBI Bookshelf
  26. Self-regulation facets differentially predict internalizing symptom trajectories from middle childhood to early adolescence: a longitudinal multimethod study – PMC
  27. Effectiveness of Universal Self-regulation–Based Interventions in Children and Adolescents – PMC
  28. A Step Forward in the Conceptualization and Measurement of Parental Burnout: The Parental Burnout Assessment (PBA) – PMC
  29. Exhausted Parents: Development and Preliminary Validation of the Parental Burnout Inventory – PMC
  30. A Review of Associations between Parental Emotion Socialization Behaviors and the Neural Substrates of Emotional Reactivity and Regulation in Youth – PMC

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