Attention deficit hyperactivity disorder (ADHD) is a condition that affects millions of US children and adults alike, including an estimated 6 million children and 8.7 million adults as of 2023. Children with ADHD are often unfairly categorized as lazy, lacking in motivation or intellect, or unruly, and both children and adults with ADHD often find themselves struggling in environments that demand sustained focus and productivity.

With a sharp increase in ADHD diagnoses over the past few years as the world around us becomes more demanding of our focus, attention, and productivity, it’s more important than ever for adults with ADHD and parents of children with ADHD to understand what ADHD is, how it affects both executive function and emotional regulation and how to treat and manage this condition.

In our latest town hall meeting, The Emotional Impacts of ADHD and How to Cope, we join Dr. Nicole McGarry, a therapist specializing in ADHD for children and adolescents in the Northern Virginia area, to take a look at what ADHD is and focus on lesser-known aspects of the condition, including the interaction between ADHD and emotions, as well as the relationship between ADHD and executive function disorders and rejection sensitive dysphoria (RSD).

An Introduction to ADHD and Executive Function

ADHD is most commonly understood as a disorder that affects executive function—your ability to control and coordinate your cognitive abilities and behaviors. Neurological differences in the prefrontal cortex and other parts of the brain affect a range of executive functions, including the ability to organize, prioritize, initiate, and focus on tasks.

One of the most often-recognized symptoms of ADHD is under-activation, the ability to organize and prioritize tasks, and the ability to become distracted not only by external stimuli but by internal and intrusive thoughts as well.

ADHD is often understood as an inability to focus or pay attention over long periods of time, but while executive dysfunction is one of its more well-known aspects, ADHD and emotional regulation are also profoundly related, and their relationship is far less widely understood.

Understanding the Interplay Between ADHD and Emotions

People with ADHD experience emotional responses that happen quicker, are stronger, and last longer than typical emotional reactions. This isn’t a result of parenting or environmental factors, as people who don’t understand ADHD might erroneously claim—rather, is inherent to the condition itself. Difficulties self-regulating their emotions, especially in children, can make navigating peer relationships and social interactions difficult.

The Effects of ADHD on Emotional Regulation

When ADHD affects various executive functions, it also affects one’s ability to regulate their own emotions. The lack of executive functioning with ADHD and emotional dysregulation are closely related. People with ADHD can be more emotionally impulsive and stubborn, more easily frustrated, or prone to moodiness. Difficulty avoiding internal and external distractions can lead to frustration and expenditures of emotional energy in sustaining effort, balancing and prioritizing tasks, or switching from a preferred task to a non-preferred task.

There is a part of our brains called the anterior cingulate cortex, or ACC, which, in simplest terms, communicates between the “thinking” and “feeling” parts of our brains. For adults and children with ADHD, the connection the ACC provides between “thinking” and “feeling” is weaker and less efficient, which makes rationally interrogating impulsive or irrational moods or behaviors more difficult. This is one of the reasons why people with ADHD can have a hard time talking themselves out of how they feel or convincing themselves to prioritize one task over another, for example.

As a result, for people with ADHD, their emotions run hotter, it’s easier to work oneself into a “meltdown” state or freeze under pressure, and it takes longer to manage emotional outbursts and return to a more stable baseline.

Understanding ADHD and Rejection Sensitive Dysphoria

One understated connection between ADHD and emotions is the prevalence of rejection sensitive dysphoria (RSD). RSD is characterized by an extreme emotional sensitivity and pain triggered by real or perceived rejection, criticism, or failure. Not all people with RSD have ADHD and not all people who have ADHD experience RSD, but it is nonetheless extremely common for people with ADHD to have strong reactions to being rejected, teased, or criticized by someone they deem important in their life, or even just perceiving that they have been rejected.

The struggles both children and adults with ADHD experience with starting tasks, staying on-task, and prioritizing tasks often lead to difficulties with schoolwork, household chores, or workplaces. When your limbic system is constantly in a state of stress in these situations, the resulting emotional stress can lead to an extreme reaction the failure to meet one’s own standards or the expectations of others.

Ways to Manage ADHD and Emotions with Brain Science

Understanding how ADHD and emotional regulation are linked is one of the most important first steps to managing your condition as an adult with ADHD or raising a child with ADHD.

Many parents of ADHD children, in particular, struggle with their children’s emotions and executive function because they don’t have the insight into ADHD to fully understand the connection between ADHD and emotional regulation—or lack thereof. Likewise, many adults with ADHD grow up without long-term healthy or effective coping methods for ADHD’s emotional effects.

Emotional regulation with ADHD is difficult, but not impossible. Some techniques adults with ADHD and parents of children with ADHD can use for more effective emotional regulation include:

• Self-Care and Mindfulness-Based Interventions that can strengthen the communication between different brain areas involved in emotional regulation
• Behavioral and Environmental Strategies such as removing stimuli that trigger emotional dysregulation, practicing self-calming techniques, and adjusting environmental factors
• Building Supportive Relationships to help individuals with ADHD navigate their challenges, through understanding, patience, and positive reinforcement

Everybody’s experience with ADHD, and which techniques to manage ADHD and emotional regulation will work best, is different. However, the fundamental basis of all these techniques is having an emotional “safe zone” where you can recover from the effects of stressors on your emotional state.

The Benefits of ADHD Medication for Adults

Medication is also an option for adults with ADHD. The most common medications for treating ADHD executive function issues are stimulants—like caffeine, but stronger. These stimulants increase dopamine levels and often perform best for managing impulsivity and attention issues.

For people with ADHD who do not respond well to stimulants or have concerns about side effects, non-stimulant medications (like SNRIs) and anti-hypertensives (which can enhance prefrontal cortex function) can also provide treatment for ADHD and emotional regulation challenges. Stimulants suppress the limbic system, which helps prevent emotional dysregulation—although an inappropriate choice of stimulant (or too high a dose) can end up suppressing a person’s emotions.

To dive deeper into how ADHD and emotions work and how to treat emotional dysregulation both through mindfulness strategies and medication, take the time to watch the recording of our town hall event in full.

Understanding ADHD and Emotions Means Understanding the Whole Person

ADHD is a complicated disorder that effects nearly everybody who has it slightly differently. The greatest benefits of ADHD medication for adults and treatment for children and adults come from a holistic, individualized approach to medication that takes into account the individual’s unique profile of ADHD symptoms, co-occurring conditions, and responses to treatment.

This sort of holistic treatment, unfortunately, is difficult to obtain in a traditional healthcare model where your doctor doesn’t have the time to fully understand your or your child’s unique health situation and needs. That’s why an alternative exists—the concierge medicine model, which offers personalized medical care from attentive care providers who value each patient as individuals.

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