Emotional Dysregulation and ADHD: The Overlooked Connection

ADHD is a disorder that affects about ten percent of children and four percent of adults. Most people think of ADHD as a condition that means children have trouble sitting still or concentrating, but that is just one side of ADHD.

According to recent studies, ADHD has an emotional side that affects half or more of children diagnosed with ADHD. These children typically suffer from poor impulse control which may make it harder for these children to regulate their emotions.

Studies on ADHD and Emotions

In previous decades, one of the biggest criteria for diagnosing ADHD was poor emotional control. However, in the 1980s and 1990s, the emotional criterion was dropped from the ADHD official diagnostic list because many health practitioners recognized signs of attention problems or concentration problems in children who did not have emotional dysregulation. It was thought that emotion control and the hyperactivity/attention issues that children with ADHD have been two separate issues.

However, recent studies have suggested that ignoring the emotional side of ADHD may have been a mistake. A study from 2011 published in the American Journal of Psychiatry found that half of the children diagnosed with ADHD have poor emotion regulation, called deficient emotional self-regulation (DESR).

These children have frequent bursts of anger, frustration, excitability, or impatience. Every emotion the child has is extreme. In the 2011 study, researchers examined 83 people, who either had ADHD and DESR, ADHD alone, or no diagnosed condition. 128 siblings of these children were also enrolled in the study. The study authors observed the children for symptoms.

The study authors found that half of the individuals with ADHD had DESR and ADHD was more common in siblings of individuals with diagnosed ADHD. The study authors found that even when other mental issues were not present, such as depression or bipolar disorder, the study participants still reported trouble with emotional control.

“We found you can individually remove any of the major mental health conditions that we inventoried and people still are reporting these kinds of irritable, emotional overreactions,” the study authors stated.

In 2014, a follow-up study published in the American Journal of Psychiatry studied the potential causes and treatments for the emotional side of ADHD. The study authors examined multiple studies on how emotion control works in individuals with ADHD and proposed two theories for why individuals with ADHD tend to have poor emotional control.

Bottom-up theory

The researchers found that individuals with ADHD have trouble learning the right emotional response from a young age. Adults with ADHD have more child-like responses to emotional stimuli and have not learned to regulate emotions. Both children and adults with ADHD also tend to have trouble reading emotions as well as individuals without ADHD, which could add to the confusion.

Top-down theory

The 2014 study authors stated that in a healthy person, "autonomic nervous system function tracks the valence of emotional stimuli and task demands, with greater top-down regulatory activity when stimuli are negative rather than positive."

However, individuals with ADHD cannot adjust their top-down regulation as well as children who do not have ADHD. This suggests that the attention problems associated with ADHD could have an emotional effect as a person must pay attention to emotional signals to produce the correct response. When the brain has trouble focusing attention, it could result in poor emotional control during periods of stress because the brain cannot process the correct response as quickly as it should.

The study authors found that children with ADHD were far more likely to fall apart under pressure than individuals without ADHD.

The Symptoms of ADHD

ADHD symptoms can be ambiguous and some medical professionals may diagnose ADHD when it is not present. Just because a child is active or does not want to focus on school does not mean that she or he has ADHD. The difficulty in full identification of ADHD has caused some individuals to believe that ADHD doesn't exist and is simply the result of poor parenting or a broken school system.

However, parents who have children with true ADHD, particularly children who also suffer the emotional side effects of the disorder, know that ADHD is real. Only a qualified psychologist or medically-trained individual can diagnose ADHD, but parents usually have a good idea that their child has ADHD before the official diagnostic test.

Currently, the DSM-5 criteria for suspected ADHD include three separate types of ADHD. Impulsive/hyperactive, inattentive, or a mix of the two. A child must have symptoms before the age of 12, have symptoms present in multiple settings, have symptoms severe enough to interfere with normal functioning, symptoms must have been present for six or more months, and the symptoms are not better explained by another mental disorder.

Controlling the Emotional Side of ADHD

Studies suggest that over half of children and adults with ADHD have problems regulating their emotions. This makes it harder for them to get along with siblings, co-workers, friends, family, and significant others. Poor emotion control can have huge disadvantages in professional and personal life, which can trigger low self-esteem and lead to trouble with the law and poor decision making.

When treating ADHD, it is vital to consider the emotional side of ADHD. The Center for Disease Control reports that children and adults with ADHD report lower self-esteem, a higher risk for depression, a higher risk for breaking the law and engaging in risky behavior, and additional trouble keeping relationships and jobs. However, the outlook is not entirely bleak.

Studies show that treatment can be effective in helping both the impulsive and inattentive sides of ADHD as well as the emotional side. A study from 2010 published in The Journal of the American Medical Association found that two-thirds of patients with ADHD who received at least 12 sessions of cognitive-behavioral sessions had a 30 percent reduction in symptoms over individuals who received medication alone.

The current recommendation for ADHD treatment is a combination of medication and therapy, although not all insurance companies will cover both treatments.

Emotional Dysregulation: The Forgotten Side of ADHD

If you or a loved one suffers from the emotional side effects of ADHD, there are treatments available even if you do not want to turn to traditional ADHD medications. Behavioral therapy combined with a boost in vitamin and nutrient intake can provide a balance that will help not only control the attention problems associated with ADHD but also help control mood and help make it easier to regulate emotions.