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Attention Deficit Hyperactivity Disorder (ADHD) is a condition that affects children and adults throughout their lifespan in similar and unique ways. For some people with ADHD, these symptoms may be very internal with “zoning out” or daydreaming behaviors being the most prominent ones affecting school performance, work, or relationships.
Other people with ADHD, including both adults and children, may display more externalizing behaviors such as behavioral or emotional outbursts. With children with ADHD, the triggers to these outbursts may be more apparent, such as sensory overload, fatigue, or frustration, and other times it may be less so.
In this article, you will learn later on how ADHD and Rejection Sensitive Dysphoria overlaps in certain symptoms and behaviors.
Rejection-sensitive dysphoria (RSD) is a condition that affects a large percentage of those with ADHD and overlaps with ADHD symptoms. People with RSD are prone to emotional dysregulation with real or perceived criticism or rejection. They experience emotional pain that is hard to bounce back from as a result. The strong emotional reactions can disrupt a child's and their family's life and adults too, as it often leads to friction and upset with others.
Ben was a little boy who already had been in multiple therapies and on multiple medications for his emotional dysregulation for years. His parents came to me exhausted, deflated, and with their blood pressure raising by the minute. They felt like they had tried everything to curb his explosive behaviors and meltdowns but nothing helped. The other kids were afraid to play with him and so were his siblings.
Ben came in with a diagnosis of ADHD and Oppositional Defiant Disorder (ODD), which meant he was impulsive and also combative when asked to do something. His parents tried to be loving and supportive but Ben was quick to lash out and always felt persecuted and criticized. It was that constant battle over being criticized that drove his outbursts. That is RSD. Don't worry we helped Ben love himself and his brain. Read to the end to find out how.
So let's dive into what exactly rejection-sensitive dysphoria is and why haven't you heard of this condition that might explain the behaviors you see in your child or teen.
What is Rejection Sensitive Dysphoria?
Rejection sensitive dysphoria (RSD) is when a person experiences emotional pain after real or perceived criticism or rejection. Individuals who experience RSD react very strongly and in a manner that is disproportionate to the experience.
Although not a clinical disorder, rejection-sensitive dysphoria can be severe enough to disrupt a child's or an adult's life. Their emotional responses are often out of proportion to the actual event trigger and they can be too dysregulated to respond to support. Family members often describe having to “walk on eggshells” around them to avoid their emotional or explosive episodes.
Emotional Regulation and Rejection Sensitive Dysphoria
How one responds to upset, criticism, unexpected changes, and one's stress tolerance are all factors that determine how a person regulates their emotions. For some kids, teens, and adults, managing emotional and behavioral responses are easy because they are cool under pressure.
For others, when minor things happen or plans change, they have big emotions and reactions. They embody, “Making a mountain out of a molehill.” This happens because they feel things so strongly and lack frontal lobe regulatory control to put the breaks on.
Emotional Dysregulation and The Brain
When I see the QEEG Brain Maps of individuals with emotional dysregulation, a clear pattern emerges. They have over-reactivity in the emotional centers of their brain (limbic system), poor frontal lobe control, and low activity in the occipital region. This triple whammy means that their brain feels things more strongly and lacks the ability to both put the brakes on and recover when upset.
The inability to pull back from an emotional upset causes one to get caught in a behavioral loop of over-reactivity to seemingly minor everyday stressors. The problem with emotionally reactive behaviors is that the more it happens, the more likely the subconscious brain is to repeat the pattern.
That is why interventions that we use on our our program that focus on both calming the brain so it reacts less and behavioral support to teach coping skills are imperative. You must reduce the brain's over-sensitivity and at the same time show a child, teen, or adult a healthy way to respond to stress or change.
How Does Rejection Sensitive Dysphoria Relate to Those With ADHD?
Rejection sensitive dysphoria (RSD) is comorbid with ADHD, which means that it occurs at a high rate in individuals with a diagnosis of ADHD.
The brains of individuals with ADHD are more prone to dysregulation and thus their behavior can reflect that. With emotional dysregulation, behaviors such as excitability, rapid, exaggerated mood changes, easily upset or tearfulness, rage, or being quick to anger. A lack of impulse control, cognitive flexibility, and behavioral inhibition are all common to ADHD and manifest in many ways including sensitivity to criticism.
In the case of RSD, a person with ADHD not only lacks behavioral control but may perceive the slightest suggestion as a direct character attack and become emotional as a result. Their impulsive sensitivity can be a barrier in relationships.
Is Rejection Sensitive Dysphoria Only in ADHD?
With the rise in neurodevelopmental disorders and clinical mental health conditions in children in teens, RSD behaviors are also on the rise.
In one 2013 study (Surman et. al) that looked at the emotional regulation in adults with ADHD, they found that difficulties with emotional regulation were more common among those with ADHD compared with non-ADHD adults. The study results noted that 55% of adults with ADHD reported extreme difficulties with emotional regulation.
Poor emotional self-regulation behaviors such as low frustration tolerance, temper outbursts, emotional impulsivity, and mood lability are commonly associated with ADHD.
Is Rejection Sensitive Dysphoria a Symptom of ADHD?
Is it the chicken or the egg is the question most ask when it comes to emotional regulation with those with ADHD and RSD. Is it the lack of impulse control that feeds difficulties with low frustration tolerance and emotional regulation or do RSD symptoms impede one's ability to focus? There isn't an easy answer and each child or adult has a unique set of brain wave patterns and history.
There is no doubt that there is a crossover between the two and they co-occur together. Managing impulsive and dysregulated behaviors can be extremely hard on a person and their family. There is a lot of shame behind this up-and-down behavioral cycle, which only serves to add fuel to the fire.
How Is Rejection Sensitive Dysphoria Different From ADHD?
Top Parent Tips for Managing Emotional Dysregulation in Children and Teens
- Calm the brain
- Teach coping skills
- Preview expected and unexpected behaviors
- Role play alternative solutions
- Break negative self-talk and rumination behaviors
- Use emotional language that connects to body sensations
- Reinforce desired behaviors
- Find ways to connect with your child
- Educate your child and yourself
- Have patience and be consistent
Remember Ben? The little boy whom no one would play with because of his emotional and behavioral outbursts and whose parents felt like they had exhausted all options to help him? Well, Ben is a thriving adult now because we calmed his brain with neurofeedback and taught Ben (and his parents) how to cope with frustration and unexpected changes, and stop his negative self-talk.
His brain was too on fire to take a different action and instead, he was caught in a behavioral loop that he couldn't get off until his brain was calm. Only then could Ben use the coping skills that he learned in therapy. It didn't happen overnight but Ben learned to understand his brain and more importantly love himself. When that happened, he was able to connect with other children, and his siblings and have a loving, non-friction, relationship with his parents. And that is why I do what I do… so we can have happy families!
Just remember even if you feel frustrated and hopeless because you have tried a lot with your child or teen, it is all about calming the brain and teaching new skills (even if they have both Rejection Sensitive Dysphoria and ADHD). Have patience and stick with it and you both will be better for it today and for the days to come.
Parent Action Steps
☐ Observe your child for possible symptoms, such as emotional dysregulation, impulsivity, and inattention.
☐ Consult a mental health professional for a comprehensive evaluation and guidance.
☐ Seek support and education to discover effective strategies for managing your child's condition.
☐ Explore treatment options, such as therapy or neurofeedback, tailored to your child's needs.
☐ Help your child develop coping skills, including cognitive reappraisal, to manage emotions and frustration.
☐ Be patient and consistent in implementing coping strategies and reinforcing desired behaviors.
☐ Stay informed about the latest research and developments to make informed decisions in supporting your child with RSD and ADHD.
☐ Take this ADHD Quiz to know if your child has ADHD or something else.
☐ Try our Solutions Matcher to get personalized treatment for your child.
Citations
Bennett, Shannon & Albano, Anne. (2020). Using exposure with adolescents and youth adults. 10.1016/B978-0-12-815915-6.00013-5.
McRae, K., & Gross, J. J. (2020). Emotion regulation. Emotion (Washington, D.C.), 20(1), 1–9. https://doi.org/10.1037/emo0000703
Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. The American journal of psychiatry, 171(3), 276–293. https://doi.org/10.1176/appi.ajp.2013.13070966
Surman, C. B., Biederman, J., Spencer, T., Miller, C. A., McDermott, K. M., & Faraone, S. V. (2013). Understanding deficient emotional self-regulation in adults with attention deficit hyperactivity disorder: a controlled study. Attention deficit and hyperactivity disorders, 5(3), 273–281. https://doi.org/10.1007/s12402-012-0100-8
Dr. Roseann Capanna-Hodge is an expert in ADHD and RSD and frquently featured in the media.
- Parents Magazine: Are Your Kid's Meltdowns a Sign of Rejection Sensitive Dysphoria
- Healthline Understanding Self-Regulation Skills
- She Knows 11 Products Moms of Kids With ADHD Swear By to Maintain Order in the Chaos
- The Healthy 12 Silent Signs of Adult ADHD You Might Be Ignoring
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Dr. Roseann is a Children’s Mental Health Expert and Licensed Therapist who has been featured in/on hundreds of media outlets including The Mel Robbins Show, CBS, NBC, PIX11 NYC, Today, FORBES, CNN, The New York Times, The Washington Post, Business Insider, Women’s Day, Healthline, CNET, Parade Magazine and PARENTS. FORBES called her, “A thought leader in children’s mental health.”
She coined the terms, “Re-entry panic syndrome” and “eco-anxiety” and is a frequent contributor to media on mental health.
Dr. Roseann Capanna-Hodge has three decades of experience in working with children, teens and their families with attention-deficit hyperactivity disorder (ADHD), autism, concussion, dyslexia and learning disability, anxiety, Obsessive Compulsive Disorder (OCD), depression and mood disorder, Lyme Disease, and PANS/PANDAS using science-backed natural mental health solutions such as supplements, magnesium, nutrition, QEEG Brain maps, neurofeedback, PEMF, psychotherapy and other non-medication approaches.
She is the author of three bestselling books, It’s Gonna Be OK!: Proven Ways to Improve Your Child's Mental Health, The Teletherapy Toolkit, and Brain Under Attack. Dr. Roseann is known for offering a message of hope through science-endorsed methods that promote a calm brain.
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She is the founder and director of The Global Institute of Children’s Mental Health, Neurotastic™Brain Formulas and Dr. Roseann Capanna-Hodge, LLC. Dr. Roseann is a Board Certified Neurofeedback (BCN) Practitioner, a Board Member of the Northeast Region Biofeedback Society (NRBS), Certified Integrative Mental Health Professional (CIMHP) 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).
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