If your child has Attention Deficit Hyperactivity Disorder (ADHD), then you need to know that there is a high prevalence of Rejection Sensitive Dysphoria (RSD). Kids with RSD experience emotional dysregulation due to actual or perceived rejection or criticism. RSD overlaps with ADHD symptoms as both can be reactive and impulsive.
Children and teens with RSD have disproportionate reactions to their actual experiences. As a result, they can go through extreme emotional sensitivity that adversely affects them, their families, and their loved ones.
Kids with RSD experience big emotional reactions to seemingly mild redirects, suggestions, or even a tone of voice that is misperceived as angry. Parents of a child with RSD are often left wondering why their child just got so upset over nothing. On the flip side, the child feels hurt and criticized. Both are at an impasse many times a day over misperceptions that lead to upset and frustration.
Because these experiences often cause friction with others, it results in disagreements. It's important to note that rejection-sensitive dysphoria is not a clinical disorder. However, it can become severe enough to prevent the person from responding to support. Therefore, it should be regarded like other mental health conditions.
Common Symptoms of RSD
RSD doesn't have a formal diagnosis as a clinical condition, but it is recognized in the mental health community. Its symptoms can affect a child's quality of life and impact how parent and child communicate and feel about each other.
When parents learn about RSD, they often feel a sense of relief that there is a condition that helps them better understand their child or teen. I recently worked with Eric, whose years of explosions left Eric feeling bad about who he was and his parents not understanding why he acted this way.
We started with deep education about ADHD and RSD and understanding the connection between Eric's brain activity and behavior with a QEEG brain map. From there, we started with calming his brain with PEMF, magnesium, and parent coaching to help his parents cultivate healthy coping skills. With parent and individual therapy, Eric learned to manage and calm his overreactions.
Some of the most common RSD symptoms are:
- Emotional outbursts when rejected or criticized
- Emotional overwhelm
- Fear of rejection and failure
- Negative self-talk
- Easily angered
- Low tolerance for frustration
- Rapid mood changes
- Social withdrawal
Helpful Ways to Cope with RSD
If your child has RSD, getting professional help is the best way to provide support. Breaking the cycle of this disorder requires calming their brain and addressing their low-stress tolerance or misperceptions at its core.
Without gaining a set of coping skills, the anger-upset cycle continues, and no pill creates a set of learned, healthy skills. A mental health professional can help kids and families deal with criticism and rejection more positively while managing the symptoms of rejection-sensitive dysphoria.
A child with RSD tends to be socially isolated and in constant conflict. It is more likely that they won't have many friends because other kids get scared or uncomfortable around them. It's one of the reasons why they feel awkward in social situations because of their history of overly emotional responses with other kids.
Some even develop social phobia due to the high anxiety surrounding unsuccessful social interactions. When parents understand their kids' issues, they can help them be more successful in managing stress and getting along with other children and family members.
RSD can be addressed through a therapeutic process of helping children regulate their emotions. However, if children and teens with RSD don't learn how to control their extreme emotional responses, they get stuck in the constant cycle of emotional activation. And on top of that, they feel shame and hopelessness too.
If your child or teen suffers from RSD, here are some coping techniques to help ease their overwhelming emotional response and provide them with healthy ways of dealing with the experiences of rejection.
#1 Recognize the triggers
RSD has triggers, and parents should know how to recognize them. Knowing what causes the problem is the first step in creating effective strategies to support the child toward treatment. Parents need to understand that their kids don't want to have too many emotional outbursts on purpose. Instead, they are having a hard time managing the pain of rejection.
Once parents recognize triggers, they learn how to react and guide their children on managing their behaviors and walking away from stressful situations. In addition, experts in neurodevelopmental disorders can help parents understand more about how these triggers affect their child's nervous system and increase their blood pressure.
#2 Start therapy
Parents should trust the therapeutic process and stick to the plan created by a licensed professional. It builds the child's problem-solving skills while also improving family communication. Cognitive behavioral therapy is one of the many treatment options that will help them overcome the feeling of rejection and help them manage difficult situations.
Focusing on learning skills is imperative for your child's lifelong mental health. Think of therapy as a way to learn how to shift your efforts to fostering healthy coping skills.
#3 Use cognitive reappraisal strategy
Cognitive reappraisal is a thought reframing technique that helps change how a person thinks about their situation to influence their emotional reaction (McRae & Gross, 2020). Because a person with RSD misperceives the situation, this process teaches a person to manage unwanted thoughts that come up and lead to overreactions.
As an antecedent-focused emotional regulation strategy, this strategy occurs in the early stages of an emotion's experience. By modulating the cognitive processes involving the re-interpretation of emotional experiences, this strategy can change emotional experiences successfully. (Gross, 1998).
Cognitive Reappraisal Involves 3 Steps:
- Step 1: Identify negative thoughts and thought patterns
- Step 2: Step back and examine the situation more objectively
- Step 3: Look for alternative and positive interpretations
When Eric came to us, we taught him and his family how to work through these three steps. At first, he needed a tremendous amount cuing in step one because he couldn't even recognize his negative thoughts. Over time and with practice and reinforcement, he not only got better at each step, his overreactive behaviors dissipated.
#4 Reinforce strengths
Focus on what your child wants and does well. If needed, list all their talents, qualities, and strengths. Then, use them to make affirmations that your child can repeat daily or when overwhelmed with negative emotions and dealing with an actual rejection.
Children with rejection sensitivity dysphoria aren't incapable or weak. They just feel things intensely, replaying unpleasant interpersonal interactions over and over. Social anxiety and insecurity are factors that contribute to RSD. But the good news is that children can be taught new skills that will help them address not just RSD or ADHD but also other mental health disorders.
Children with RSD will feel more confident when their work and effort are acknowledged. Rewarding them for a job well done helps a lot as well. Also, it can help them shift from negative self-talk about rejection and see things from a new perspective. It can also encourage them to approach future situations with courage.
#5 Think positively
Children with RSD are often negatively labeled and shamed because of their big emotional and often behavioral reactions, which do nothing to help them. Helping kids embrace their emotional sensitivity in healthy ways and all the good that goes with it helps them address and improve their mental health.
It's not easy to train a child with RSD and ADHD brain to think differently, but it is achievable with effort and patience. They will have to learn new thinking patterns, which could initially feel awkward or strange. Things won't always go their way. Let your child realize that everyone experiences hurt and go through the fear of rejection. If things don't go your child's way, teach them to regroup and think positively.
#6 Practice self-reflection
Teens and older children can be taught self-reflection. Mindfulness-based activities have been shown to reduce stress and increase self-awareness. They also increase attention and executive functioning, which are needed for supporting impulse control.
Self-reflection involves allowing them to spend time alone in a comfortable and quiet place to write down all their emotions. Let your child reflect on their intense pain and negative experiences and try to understand why the situation triggers them.
#7 Create affirmations
By creating affirmations or mantras, the noise of negative thoughts accompanying RSD can be reduced. Brainstorm positive words your child or teen can tell to the negative voice in their heads.
“I can do it,” “I am the boss of my mind,” or “Focus on the solution.” Then, they can return to these affirmations whenever they need a boost. Doing this can help them in different ways and even lead them to more good days than bad days.
Before bed or in the morning, say these affirmations together. It helps to start the day with a positive thought when feelings of doubt creep in. Doing those affirmations will also calm them before bedtime. Affirmations positively affect a person's life for a long time.
#8 Connect with family members
Kids with RSD need to connect with family members. Participating in fun and memorable activities can reduce emotional pain related to non-acceptance. Doing so will let your kids rediscover the joy of being with family and prevent them from perpetuating those feelings of rejection and low self-esteem.
A lot can be said about the positive effects of laughter and connecting with your child. Building these connections in micro-moments is even more important when you have a child who is upset easily.
Home is also a safe place to practice new coping skills and learn social cues. Remember that for kids with ADHD and RSD, learning to cope with painful social experiences is the key. In addition, they learn to cope better if they experience their parents' consistent, loving presence. Family members are the most important people who can provide RSD kids with the social support they need in any given situation.
Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74(1), 224–237. https://doi.org/10.1037//0022-35126.96.36.199
McRae, K., & Gross, J. J. (2020). Emotion regulation. Emotion, 20(1), 1–9. https://doi.org/10.1037/emo0000703
Always remember… “Calm Brain, Happy Family™”
Are you looking for SOLUTIONS for your struggling child or teen?
Dr. Roseann and her team are all about solutions, so you are in the right place!
There are 3 ways to work with Dr. Roseann:
You can get her books for parents and professionals, including: It’s Gonna Be OK™: Proven Ways to Improve Your Child’s Mental Health, Teletherapy Toolkit™ and Brain Under Attack: A Resource For Parents and Caregivers of Children With PANS, PANDAS, and Autoimmune Encephalopathy.
If you are a business or organization that needs proactive guidance to support employee mental health or an organization looking for a brand representative, check out Dr. Roseann’s media page and professional speaking page to see how we can work together.
Dr. Roseann is a Children’s Mental Health Expert and Therapist who has been featured in/on hundreds of media outlets including, CBS, NBC, FOX News, PIX11 NYC, The New York Times, The Washington Post,, Business Insider, USA Today, CNET, Marth Stewart, and PARENTS. FORBES called her, “A thought leader in children’s mental health.”
She is the founder and director of The Global Institute of Children's Mental Health and Dr. Roseann Capanna-Hodge. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Medicine Mental Health Provider (CMHIMP) and an Amen Clinic Certified Brain Health Coach. She is also a member of The International Lyme Disease and Associated Disease Society (ILADS), The American Psychological Association (APA), Anxiety and Depression Association of America (ADAA) National Association of School Psychologists (NASP), International OCD Foundation (IOCDF) International Society for Neurofeedback and Research (ISNR) and The Association of Applied Psychophysiology and Biofeedback (AAPB).
© Roseann-Capanna-Hodge, LLC 2023
Disclaimer: This article is not intended to give health advice and it is recommended to consult with a physician before beginning any new wellness regime. *The effectiveness of diagnosis and treatment vary by patient and condition. Dr. Roseann Capanna-Hodge, LLC does not guarantee certain results.