Emotional dysregulation or an inability to manage the intensity, duration and recovery of one’s emotional response to a stimulus. It can be in response to any real or perceived stimuli but is more likely related to a negative emotion such as criticism, rejection, fear, shame, sadness or anger.
Children and adolescents who struggle with emotional dysregulation often overreact to minor challenges and can need a lot of parent coaching to recover from emotional upset. It can impact the ability of these kids to manage small frustration or big emotions. When a parent has a child who is prone to emotional dysregulation, parents often report having to “walk on eggshells” to avoid an extended emotional meltdown.
Treating ADHD emotional symptoms is paramount not only for the child or teen but restoring calm at home. ADHD symptoms such as impulsivity, hyperactivity and inattentiveness all factor into emotional lability.
For some children, the same medication that helps them focus, increases their emotional symptoms. For others, ADHD medication can help reduce those emotional responses at least initially before other medication side effects appear.
What is Emotional Lability?
Emotional Lability is the tendency to experience frequent mood swings, and switch between different emotional states with little control. Unlike general ‘moodiness,’ people with emotional lability experience dramatic emotional fluctuations that aren't often triggered by something specific.
Having high emotional lability can overall be linked to underdeveloped executive functioning, a major component of Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD) (Childress, 2015). Emotional lability is also seen in mood disorders such as bipolar disorder, disruptive mood disorder, depression, as well as borderline personality disorder.
Signs and Symptoms of Emotional Dysregulation
When a child or teen frequently dysregulates both emotionally and behaviorally, that means day-to-day life is filled with inner and sometimes outer turmoil. When the brain is in a constant state of flight, fight or freeze, stuck behaviors dominate.
These kids can be resistant to treatment because “nothing works” and they may be the case only in that they haven’t received the right treatment. Calming the brain first before any type of cognitive behavioral therapy is attempted is essential. Without a regulated brain, dysregulated children can’t process what they have learned and utilize coping skills to tolerate life’s stressors.
- Fluctuation of mood
- Mood swings
- Labile mood
- Persistent negative thinking
- Easily angered
- Self-harm behaviors
- Conflictual interpersonal relationships
- Disordered eating
- Substance use
- High-risk behaviors
- Suicidal thoughts or attempts
Why Do Children and Teens With ADHD Have Mood Swings?
Mood swings are a common temporary issue for all kids. They become a problem when they are persistent and get in the way of their school, home, and peer relationships. Sometimes anger and rage rule their lives and that gets them into trouble and causes peer rejection.
There are many reasons why children and teens have mood swings. Children and adults with ADHD experience heightened emotions, leading to high feelings of happiness but also intense bursts of anger or sadness and thus are more prone to mood swings or emotional lability. Feelings of shame, sensitivity to criticism, and fear of rejection are factors too.
ADHD symptoms also include relative impulsivity and low self-control, and therefore these strong emotions may be difficult to keep at bay in certain situations. Their low frustration tolerance and lack of coping skills is a factor in how they manage stress. When actively working to concentrate on a difficult task, any type of distraction, both internal and external, may trigger frustration and mood swings.
Because of this, many parents are quick to call the doctor hoping for a simple solution to their child’s distress. However, these medications will only push you and your child even further from your goal of maintaining a healthy mind, and are likely to result in even more irritability and frustration in the long run.
Rejection-Sensitive Dysphoria (RSD) and Emotional Lability
Rejection-sensitive dysphoria (RSD) is a condition that affects a large percentage of those with ADHD and overlaps with ADHD symptoms. Children and teens with RSD are prone to emotional dysregulation with criticism or rejection that can be real or perceived.
For those with RSD they experience emotional pain that is hard to recover from and can be upset for extended periods of time. Their frequent strong emotional reactions can be quite disruptive for a child’s and their family’s life. Frequent friction and upset with others is the norm because of their intense sensitivity.
Can ADHD Medication Cause Mood Swings?
Even though stimulants are frequently used as a treatment to reduce mood swings (Posner, Kass, & Hulvershorn, 2014), stimulant ADHD medications can actually lead to increased mood swings on their own.
I recently worked with a teen who had been prescribed ADHD stimulants to address their ADHD and anxiety. With each medication trial, Amanda became moodier and more emotional. By the time she came to me, she was highly distressed and she also was dealing with self-harm behaviors and food restriction. In our BrainBehaviorReset™ Program, we worked to help calm her brain with CALM PEMF™ and neurofeedback and used nutrition and supplements to support detoxification and CNS restoration. After a few weeks, the medication side effects disappeared and then we worked on her original ADHD symptoms and behaviors. Thankfully, her parents trusted their gut and looked for more holistic remedies.
One of the most common side effects of ADHD medication is irritability. A metastudy confirmed through an observation of 92 trials that amphetamine-derivative drugs (Adderall) are associated with increased irritability in patients (Stuckelman, 2017).
Mood swings are par for the course when one is irritable and this is especially true when stimulant medications wear off in the late afternoons or early evenings. This is called a medication rebound effect. Many use extended release medications to combat this but this then interferes with appetite. Many with ADHD on stimulants simply don’t get enough nutrients as a result and that negatively impacts the brain and behavior.
Amphetamine-derived psychostimulants can also have dose dependent effects on brain neurochemicals like dopamine, norepinephrine, and serotonin, all of which have strong relationships to irritability.
So even though ADHD medications are quickly offered to parents as a safe treatment for ADHD, there are double blind placebo controlled studies that document a long list of medication side effects. These controlled trials with randomized double blind participants most often document the most common ADHD medication side effects of irritability, sleep problems, and anorexia or food restrictions, which can easily be found with a systematic review of the literature.
How Can Parents Help Their Behavioral and Moody Children WIth ADHD?
There are many ways to gain significant improvement in ADHD symptom reduction and in
mental health and the research shows us how. ADHD can be overcome without medication and that means we focus on teaching skills such as executive functioning.
When we focus on executive functioning skills, then children and teens have assets that they can use in daily life. They have the foundational skills to plan and prioritize for a future event. Even when a brain is focused, they need to know what to do and that can only come from direct skills teaching.
Kids who struggle with emotional and behavioral regulation need to calm their brain first before we introduce new learning strategies. Moody teens are already irritable, so finding a therapy that works for them without causing more issues is important for their overall wellbeing. They need to understand how to better interact with others and manage their emotions.
Rather than using medication that can increase moodiness and cause additional irritability, there are many reasons why other holistic treatments are much more beneficial. Meeting with a psychologist equipped with skills to evaluate your child’s specific needs, and receiving the proper treatment and care, outweighs the effects of a one-size-fits-all drug that will only cause further distress to your child’s mind.
Natural supplements and a good diet can also help restore balance to a moody kid, helping to restore a positive emotional state without the use of medication. And brain tools such as PEMF and neurofeedback are effective and natural ways to calm the brain and reduce mood swings. The best part is they are safe and you don’t have to worry about the many side effects of ADHD medications.
Our team in Ridgefield, CT, can help you and your child get to the bottom of their mental health struggles, and provide you with assistance and tools to improve all types of symptoms. Using the BrainBehaviorReset Program gives your family the opportunity to meet with specialized psychologists, custom therapies and protocols to meet each child’s specific needs, and a whole team of supportive professionals working to ensure that your child improves.
How Can Neurofeedback Help Moody and Cranky Kids
Neurofeedback helps calm your child’s mind, relieving stress from their own life as well as in your home. It is an effective treatment that works to reduce brain dysregulation by reinforcing brainwaves to stay in a healthy rhythm. And when the brain is in a regulated state, one can think, pay attention, and not react so strongly to stimuli.
After a QEEG brain map, I create a custom care plan catered to exactly what your brain needs to thrive. Myself and the whole team will work to provide you and your child with the guidance you need to turn around behavior and bring some calm to home too.
Baweja, R., Waschbusch, D. A., Pelham, W. E., 3rd, Pelham, W. E., Jr, & Waxmonsky, J. G. (2021). The Impact of Persistent Irritability on the Medication Treatment of Paediatric Attention Deficit Hyperactivity Disorder. Frontiers in psychiatry, 12, 699687. https://doi.org/10.3389/fpsyt.2021.699687
Childress, A. C., & Sallee, F. R. (2015). Emotional Lability in Patients with Attention-Deficit/Hyperactivity Disorder: Impact of Pharmacotherapy. CNS drugs, 29(8), 683–693. https://doi.org/10.1007/s40263-015-0264-9
Cortese, S., Panei, P., Arcieri, R. et al. Safety of Methylphenidate and Atomoxetine in Children with Attention-Deficit/Hyperactivity Disorder (ADHD): Data from the Italian National ADHD Registry. CNS Drugs 29, 865–877 (2015). https://doi.org/10.1007/s40263-015-0266-7
Fotopoulos, N. H., Devenyi, G. A., Guay, S., Sengupta, S. M., Chakravarty, M. M., Grizenko, N., Karama, S., & Joober, R. (2021). Cumulative exposure to ADHD medication is inversely related to hippocampus subregional volume in children. NeuroImage. Clinical, 31, 102695. https://doi.org/10.1016/j.nicl.2021.102695
Krinzinger, H., Hall, C. L., Groom, M. J., Ansari, M. T., Banaschewski, T., Buitelaar, J. K., . . . Liddle, E. B. (2019). Neurological and psychiatric adverse effects of long-term methylphenidate treatment in ADHD: A map of the current evidence. Neuroscience & Biobehavioral Reviews, 107, 945-968. doi:https://doi.org/10.1016/j.neubiorev.2019.09.023
Voveli, P. (2009). Shire reports analysis examining emotional lability in children with ADHD taking Vyvanse. https://www.eurekalert.org/news-releases/923389
Posner, J., Kass, E., & Hulvershorn, L. (2014). Using stimulants to treat ADHD-related emotional lability. Current psychiatry reports, 16(10), 478. https://doi.org/10.1007/s11920-014-0478-4
Stuckelman, Z. D., Mulqueen, J. M., Ferracioli-Oda, E., Cohen, S. C., Coughlin, C. G., Leckman, J. F., & Bloch, M. H. (2017). Risk of Irritability With Psychostimulant Treatment in Children With ADHD: A Meta-Analysis. The Journal of clinical psychiatry, 78(6), e648–e655. https://doi.org/10.4088/JCP.15r10601
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