If someone doesn’t value spending time with me as much as I value spending time with them, I feel rejected. Last month, I said to one of my closest friends that I would like to hang out with him more like we used to. He said that he was cool with the way things are. This hurts a lot. What can I do to make this less painful?”

When teens with ADHD struggle with rejection sensitive dysphoria, it affects their relationships — and their self-esteem. Often, they don’t know how to cope with their intense emotions and, feeling overwhelmed, they may lash out at friends and/or family members.

[Read: Why ADD Makes You Feel. So. Much.]

One of my teen clients told me: “When I come home from school, sometimes I just can’t hold it all together. I yell at my mom and then I feel bad afterward, but I know that I can’t get kicked out of my family.” Other kids will withdraw quietly into their rooms and swallow their pain. As parents, there’s a fine line between supporting your adolescent in managing their big feelings and intervening to diminish their distress.

While some ADHD non-stimulant medications or antidepressants, such as SSRIs, can reduce sensitivity and overwhelm, the following behavioral tools can be very effective to quiet the inner critic, shift perspectives, and develop self-confidence.

Sharon Saline, Psy.D., a licensed clinical psychologist, is an expert in how ADHD, learning disabilities, and mental health issues affect children, teens, and families. She is the author of What Your ADHD Child Wishes You Knew.

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His psychology professor once told him, “You’re not on the [autism] spectrum. But you’re not not on the spectrum.” In other words, my husband has ADHD, which was diagnosed late in life; he certainly does not have autism. However, his ADHD manifests many traits that some consider autistic.

Pause.

Obviously, not every person with ADHD will exhibit traits associated with autism — and while “up to a quarter of children with ADHD have low-level signs of ASD, which might include having difficulty with social skills or being very sensitive to clothing textures, for example,” sharing some traits with autism is not the same as having autism. I’ll repeat it for the people in the back: my husband does not have autism. Claiming a neurodiversity you don’t have is gross.

We can keep going now.

How Our ADHD Sometimes Looks Like Autism

Like 10 to 20 percent of people with ADHD, my husband has been diagnosed with dyscalculia, a learning difference related to math. By his own admission, he masks, or imitates other people’s social cues, facial expressions, and gestures, all the way down to handshakes. He “fixates on specific interests” (obviously, Tolkien) and, despite his ADHD, he tends toward a rigid schedule in which he vastly prefers that the same things happen at the same time every day.

[Self Test: Autism Test for Adults]

I’ve also been diagnosed with ADHD, and like my husband, I exhibit many traits associated with autism (no, I do not have autism. I would never claim to have autism. That would be gross and deeply offensive to my friends with autism or who self-identify as autistic). Like my husband, I mask. I tend toward fixations: The Magicians, which I used to live-tweet. Once, my husband made vanilla coffee in the morning. I glared over my mug and told him, “You’re going to become a podcast if you do this again.”

I also have trouble with “social emotional reciprocity,” which is a really fancy way of saying that I interrupt people a lot; I monologue; and I have trouble with peopling in general. I stim: did you know that obsessive cuticle-picking counts? I didn’t. I also have trouble with sensory overload and would happily eat my husband’s vegetarian chili every single night for the rest of my life.

The ADHD-Autism Connection

It shouldn’t come as a shock that two people with ADHD show traits associated with autism. A recent study of children with ADHD and children with autism found that “children with abnormal white matter nerve bundles are more likely to demonstrate more severe symptoms of either ADHD or ASD.” Brain scans showed that “structural abnormalities in the brains’ white matter nerve bundles were associated with more severe symptoms of both ADHD and ASD,” and these structures were related to the part of the brain related to communication.

Knowing these commonalities are normal offshoots of ADHD has helped us both tremendously. It’s that same lightbulb: “Oh, I’m not [insert negative self-talk that’s been drummed into me by years of people judging my behavior]!” Both my husband and I were diagnosed as adults, and it’s deeply reassuring, for me at least, to know that my tendency toward strange fixations is 100% normal for my neurodivergent brain.

[Read: The ADHD Brain – Neuroscience Behind Attention Deficit Disorder]

“Oh my gosh, how do you wake up every single day at 5 am and write?” people always ask me. Then their faces drop into confusion. “Wait,” they’ll say. “You mean you do it on weekends, too?” I never knew what to say, because I simply do it; I’ve done it for a decade now. If I don’t wake up and write at 5, the day feels strange and wrong. I finally understand why. My ADHD brain insists on that daily sameness—a sameness often needed, to a greater degree, by people with autism.

This knowledge has also helped me understand that my occasional meltdowns are sensory overload. There’s a solid neurological reason why my son’s incessant clicking noise might drive me over the edge, and why a brotherly shove or shout might send me fleeing. I hate loud movies; my husband thinks that films should shake the foundations. I’ve often stopped on our stairs, looked at the TV screen, and turned right around again.

Now he understands why that happens and why, when I appear, he has to turn it down.

Sometimes, it seems like childhood was one long stretch of the world shouting that I was weird, and adulthood has been a long road of realizations that wait, no, I’m not weird—and neither am I [insert negative self-talk about laziness, spaciness, time-management, messiness, a need for sameness, etc.]. Unwinding those ugly beliefs has taken a lot of time and therapy. Knowing that my ADHD can manifest traits associated with autism has handed me another piece in that puzzle.

Life makes so much more sense. I’m not the weird kid anymore. I’m a person whose ADHD shares some traits with autism. Maybe it seems small. But it points me in an important direction; it helps me to understand why I do what I do, and as a neurodivergent person, better ways to cope with a world designed for neurotypical people.

Score one for the former weird kid.

Autism Traits in Adults with ADHD: Next Steps

• Read: ADHD and Autism – Differing Symptoms of ADD and ASD
• Free Download: ADHD Brain Differences: ADD Symptoms vs. Neurotypical
• Read: Sensory Processing Disorder in Adults: SPD Symptoms & Causes

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If you answered yes to these questions, you may have the largely overlooked but hugely impactful ADHD trait called justice sensitivity. Whether it’s triggered by societal injustice or small inequities, justice sensitivity causes you to perceive unfairness and wrongdoing in the world more frequently — and to feel it more acutely — than do neurotypical peers.

Several studies have found that ADHD brains (particularly inattentive type) are significantly more justice-sensitive than are neurotypical brains. Possible reasons for this include emotional lability, intensity, and dysregulation, which are common symptoms of ADHD. But researchers also theorize that ADHD brains tend to perceive information with a less positive view; this, along with cognitive rigidity and ADHD-impacted brain networks, can lead to intense rumination. And it doesn’t stop there. Researchers found that people who have ADHD feel such a strong need to restore justice that they will take action to do so even if they hurt themselves in the long run.

Fixated on Unfairness: Symptoms of Justice Sensitivity

How do you know if you might be prone to justice sensitivity? If you identify with the following emotions, you may have this trait:

• Frequent anger and resentment about victimization
• Fear of future victimization
• Indignation about injustice done to others
• Strong drive to restore justice
• Perceiving injustice where others do not
• Hopelessness about large-scale issues facing the world
• Feelings of worthlessness when unfairly treated
• Rumination about inequity and injustice
• Intense guilt or shame about causing injustice

[Self Test: Could You Have Emotional Hyperarousal?]

When Social Injustice Becomes All-Consuming

As anyone who’s ever stumbled down the doomscrolling rabbit hole can tell you, justice sensitivity can wreak havoc on mood, productivity, and energy levels. This is because people with ADHD are more likely to ruminate, and to feel the anger, helplessness, and despair that injustice can trigger, preventing them from moving on to other tasks and potentially affecting their mental health. In fact, research has shown that justice sensitivity, along with rejection sensitivity, largely accounts for the association between ADHD, depression, and anxiety.

But justice sensitivity doesn’t have to overwhelm you, and there’s plenty you can to do to prevent feelings of helplessness and despair. To begin, avoid being bombarded with news reports that heighten emotions by filtering your newsfeeds or turning off notifications.

Try integrating a mindfulness practice or relaxation strategies into your day by doing breathing exercises, walking in nature, or using other calming strategies that center and ground you when the world feels unbearably unjust.

Harnessing your Power: Taking Action on Social Justice Issues

If managed correctly, a healthy dose of frustration and sadness regarding inequities can be useful. After all, the world needs individuals who are committed to making a positive difference in the lives of others—so long as it doesn’t come at too great a personal cost.

[Read: Being Sensitive is One of the Gifts of ADHD]

Instead of succumbing to fury and despair, mobilize yourself to do something positive. Taking even small actions can help people feel more empowered and less despondent. Here are some suggestions:

• Feeling desperate about climate change? Take actions to reduce your daily carbon footprint.
• Heartbroken about homelessness in your city? Offer to volunteer at a local shelter.
• Eager to strengthen local crime prevention? Contact your local law enforcement authorities and ask how you can help.

Marcy Caldwell, Psy.D., is a clinical psychologist and founder of Rittenhouse Psychological Services, which specializes in adult ADHD, in Philadelphia, Pennsylvania. She also created ADDept.org.

Why Am I So Sensitive?: Next Steps

• Watch: Emotional Dysregulation with ADHD – DESR Signs, Treatments
• Self Test: Depression in Adults
• Read: What Is Rejection Sensitive Dysphoria? ADHD and Emotional Dysregulation

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ADHD may be hereditary, but emerging research suggests environmental factors and experiences can affect a child’s development and behavior in ways that may last a lifetime —or may be reversible. We know that exposure to stress, adversity, and trauma as well as many other environmental exposures, affect how genes are influenced, or expressed. We also know that these environmental factors can affect the developing brain and make learning and behavior challenges associated with ADHD worse during the early and middle years of childhood.

These findings provide clues to maximize children’s health from before birth into childhood. Among the clues: certain lifestyle changes can slow or reverse the harm caused by stress and other toxic influences — and help to restore healthy development in children with ADHD.

In this webinar, you will learn:

• How genetics influence ADHD
• About the environmental risk factors related to brain development and ADHD
• About the behavioral and learning challenges in children with ADHD that result from adverse environmental conditions
• How emerging research into environmental influences on a child’s brain development may inform prevention or new treatment
• How exercise, stress management, and lifestyle changes can benefit a child’s development and attention

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

More on Genes, the Environment, and ADHD

• Download: Unraveling the Mysteries of Your ADHD Brain
• Read: How Environment, Lifestyle, and Stress Impact ADHD
• Read: Are Everyday Toxins Causing ADHD?

Obtain a Certificate of Attendance

If you attended the live webinar on November 30, 2022, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Joel Nigg, Ph.D., is a professor in Psychiatry and Behavioral Neuroscience and Director of the Division of Psychology at Oregon Health & Science University. He is a leading researcher in the field of ADHD and the author of over 200 scientific papers related to the neuropsychological, cognitive, and temperamental correlates of childhood ADHD; to ADHD genetics; and to MRI-based research and theoretical interpretations of brain development in ADHD. He is the author of Getting Ahead of ADHD, a book for parents that addresses lifestyle and environment approaches to ADHD. (#CommissionsEarned) He also maintains a blog via Psychology Today. For more information, visit Dr. Nigg’s personal webpage here.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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It’s tempting to characterize ADHD as a collection of disparate symptoms that can be compartmentalized, strategized, and treated to mitigate their impact on school or work. Think impulsiveness, distractibility, time blindness, poor organization skills, social blunders, and so on. But ADHD is more than the sum of its parts. It is a whole-life, whole-body experience, a 24/7 companion that impacts every aspect of our being.

In honor of ADHD Awareness Month, this webinar will explore how ADHD affects our relationships, our work, our mental health, and our self-image — literally every facet of our selves.

Here, you will learn:

• How a brain-based disorder exacts constant and direct consequences on the rest of your body
• Why accepting (not rejecting) your ADHD can change your perspective and your life
• How ADHD is often invisible, misdiagnosed, or undiagnosed in women
• Why even the best ADHD strategies, tips, and tricks can fail, and what you can do to move forward
• The importance of giving your ADHD a shout out

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

More on the Impact of ADHD

• Download: Your Free Guide to All the Best Parts of ADHD
  
• Read: Sense of Self: How Being Misunderstood Impacts ADHD Brains
  
• Read: 10 Things I Wish the World Knew About ADHD
  

Obtain a Certificate of Attendance

If you attended the live webinar on October 26, 2022, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Linda Roggli, a professional certified coach, is the creator of the ADHD Palooza series, which includes ADHD women, parents, and couples. She is also an award-winning author and founder of the A-D-Diva Network for ADHD women 40 and up. She is an internationally recognized expert in midlife and senior ADHD. Linda regularly hosts workshops, organizing groups, and retreats for ADHD women.

Linda’s book, Confessions of an ADDiva: Midlife in the Non-Linear Lane (#CommissionsEarned), won first prize for women’s issues in the prestigious Next Generation Indy Book Awards competition. She is the former vice-president of ADDA and chairs its webinar series.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“Linda does a superb job of describing ADHD tendencies and giving solid information on how to manage them. I will definitely watch this a few more times.”

“Great speaker! I so easily identified with the topics and examples she shared, and it always helps to be reminded to focus on the positives.”

“Linda built a comfortable atmosphere to feel, express, cope, and accept the challenges of ADHD without judgement or feeling like a ‘classroom.’ It was like sitting in a living room talking to friends.”

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RSD, as you know too well, causes extreme emotional pain. Whether or not the rejection has actually occurred or is strongly perceived, RSD makes it difficult to recover from criticism. Many people with ADHD look at social situations through the filter of past experiences of rejection and exclusion, which further fuels rejection sensitivity.

In part, RSD is tied to fears of embarrassment or of letting down others, and to concerns that mistakes will cause others to withdraw their love, support, or connection to you.

Many folks in your position try to discount their emotions in an attempt to overcome RSD (denial only makes them stronger though), or they avoid situations where any semblance of criticism could occur. These strategies never work because you can never please everybody all of the time. Rejection, negative feedback or judgments are inescapable parts of life. Instead of relying on avoidance or the negative expectancy that fuels anxiety, understand that your responses to rejection follow a pattern. Your goal is to create new patterns of responding, thinking and behaving to reduce both the perceptions of rejection and the reactions when it actually occurs.

Here are some tips for how to improve coping skills and manage the effect that rejection has on your ADHD brain.

[Get This Free Download: Understanding Rejection Sensitive Dysphoria and ADHD]

1. Remember the times you persevered despite discomfort. If you are reading this, there’s great news. You’ve survived everything that life has thrown at you, including all the terrifying and uncomfortable moments. RSD threatens to erase those memories of triumph and tries to convince you that the pain of rejection is unsurpassable. Make it a habit to recall moments where you persisted in the face of fear. Write some of these down in your phone or journal so you can go back and remind yourself of your courage. Over time, the unbearableness of rejection will subside.

2. Identify your strengths. Focus as much as possible on what you love to do and what you do well. You are NOT the sum of broken parts. You are MUCH, MUCH more than that. Make a list of qualities or talents you like about yourself. Write these down as well. Then transform them into affirmations for those challenging moments. “I am brave; I am creative; I take risks; I keep trying.”

3. Do a “happy and a crappy.” Each day, name a few good (happy) and not-so-good (crappy) things that transpired. This practice will teach you to de-emphasize negative thoughts and shift your attention to what’s working.

4. Be a “STAR:” Stop, Think, Act, and Recover to manage big feelings, especially during unpleasant interactions. Pausing will also help you accurately gauge a situation instead of speaking out of turn or rushing to a conclusion.

[Read: How Does RSD Really, Actually Feel?]

5. Your sensitivity is a positive. Unfortunately, (and it looks like you’ve experienced this) many people are quick to negatively label and shame sensitive individuals, which does nothing to help RSD. What does help RSD is embracing sensitivity and the good that comes with it. Say: “I am sensitive, which means I feel things deeply and connect to people in special ways.” Wear sensitivity like a badge of honor.

As you form new patterns, they may feel strange or awkward. Practice self-compassion. We have all experienced (and will continue to experience) rejection and hurt in life. When things don’t go the way you hope, take time to regroup, and treat yourself like you would a child with a skinned knee — with care and kindness.

How to Deal with Rejection Sensitive Dysphoria and ADHD: Next Steps

• Free Download: Could You Have Social Anxiety?
• Self-Test: Rejection Sensitive Dysphoria Traits
• Read: When You’re So Sensitive It Hurts
• Read: Is It Anxiety? Nervousness? Worry? What’s the Difference

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “Start with ‘Hello’: How to Reduce Social Anxiety and Foster Connections” [Video Replay and Podcast #395] with Sharon Saline, Psy.D., which was broadcast on April 6, 2022.

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Intention deficit disorder is not a real diagnosis but a term I used to describe what I believe is a central struggle of attention deficit hyperactivity disorder (ADHD): difficulty in accomplishing one’s goals.

Think of ADHD as a performance disorder. People with ADHD know what they need to do, but they struggle – greatly, at times – to transform intention into action, whether that’s preparing for a test or finalizing an important project at work. It’s an issue directly tied to the executive function difficulties inherent in ADHD. And yet, this very real challenge of ADHD is often mistaken for laziness and lack of motivation, which many breed low self-esteem and even depression.

Unpacking Intention Deficit Disorder: The ADHD Struggle to Perform

1. Executive Dysfunction Affects Behavior and Performance

The self-regulation problems inherent in ADHD stem from deficits in executive function, or the mental skills that allow us to initiate and carry out actions toward a future goal.

The executive system lives in the brain’s frontal lobe, and it is responsible for putting into action the knowledge that lives in the back of the brain. But ADHD separates these two parts of the brain like a meat cleaver.

In ADHD brains, intention and action are disconnected. This is why people with ADHD seem unlikely, unable, or unwilling to carry out behaviors that they know may be good for them. It is also why they are often unable to act effectively on what they know.

[Take This Self-Test: Executive Function Deficits]

2. Executive Dysfunction Muddles Time

Executive dysfunction also creates issues with time, timing, and timeliness of behavior. People with ADHD are often “time blind,” and they struggle to organize large, hierarchically sequenced behavior across time.

3. Intention Deficit Turns Everything Into a Crisis

As people with ADHD are nearsighted to time, they will often wait until the future is imminent to take action. That means that so long they perceive the future to be “out there,” an I-don’t-have-to-deal-with-it-yet outlook will prevail. Hence the almost universal experience of procrastination.

This far-away feeling of future events often means that people with ADHD are often only able to take action at the 11th hour, when time is all but running out. In a race to make a deadline, they may put things together in a slapdash manner. Or they may deliver high-quality work – at the cost of burnout and exhaustion.

The inability to organize and prioritize to the delayed future means that everything inevitably becomes a crisis with a too-near deadline.

[Read: 6 Secrets to Goal Setting with ADHD]

4. Intention Deficit Looks Like Laziness

Future-directed behavior is intentional behavior. When there’s often a sizable gap between intention and action, the term “intention deficit disorder” feels more accurate than “attention deficit hyperactivity disorder,” I think.

But those without ADHD often have very little patience for the short-sighted decisions of individuals with ADHD. They view these outcomes as avoidable, and attribute them to laziness, carelessness, poor time-management, lack of motivation, and moral failure instead of what it really is: executive dysfunction.

Intention Deficit Disorder: Turning Intention Into Action

Many people mistakenly believe that skill-building – in the form of time-management tips, self-motivation skills, etc. – will help people with ADHD bridge the gap between intention and action.

But in the field of neuropsychology, we know that the best way to treat a performance (i.e., executive) disorder is by targeting the point of performance, or the place and time across various settings of a person’s life where they are failing to act on what they know. Targeting the point of performance largely involves changing environments to facilitate performance. The following are key point-of-performance enhancements that work for people with ADHD:

1. Externalize time

Executive dysfunction renders internal cues unreliable, hence “time blindness” among people with ADHD. External representations of time — like calendars, white boards, visual timers (like the Time Timer), and other tools — may help guide behavior more reliably and effectively.

2. Bring the future to the present

If people with ADHD tend to wait until the future is imminent to act, then pushing the future back a few notches can help spur action. Dividing long-term goals into smaller, contiguous steps is one way to ensure constant action on an overall goal.

3. Ensure motivation along the way

Along with breaking up tasks into manageable chunks, people with ADHD will benefit from what I call motivational prostheses to sustain action toward a goal. The following are a few ideas:

• short breaks in between longer bursts of work
• body doubles, or accountability partners
• visualizing rewards and positive outcomes

Intention Deficit Disorder and ADHD: Next Steps

• Read: The Mystery of ADHD Motivation, Solved
• Read: ‘Procrastivity’ — Why the ADHD Brain Chooses the Less Important Task
• Read: Do You Shine Under Pressure? How to Manufacture a Sense of Urgency
• Listen: How to Turn Intentions Into Action

The content for this article was derived with permission from Dr. Russell Barkley’s lecture, “The Neuroanatomy of ADHD” delivered during the Centre for ADHD Awareness, Canada’s (CADDAC) annual ADHD Conference (2009).

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Social anxiety is a debilitating fear of judgment, humiliation, or rejection by others in social situations. Socially anxious adults carry distorted, negative self-perceptions driven by a core belief of deficiency. This restricts their participation in activities, relationships, and other areas of life.

We know that anxiety and ADHD frequently co-occur. Experiences common to ADHD, like rejection sensitive dysphoria, shame, and emotional dysregulation, may exacerbate social anxiety. ADHD symptoms, like hyperactivity and inattention, may also undermine social skills and cause difficulties. Social anxiety treatment often involves behavioral interventions and working to improve social skills.

Signs of Social Anxiety

Intense fear of negative judgment from others is a common marker of social anxiety disorder. Other signs include:

• Discomfort interacting with people outside the immediate family
• Difficulty making or keeping friends
• Excessive worry in the days or weeks leading up to an event
• Fear of being observed (e.g., when eating and drinking)
• Fear of performing in front of others
• Avoiding places or events that involve socializing
• Nausea, shaking, or excessive perspiration in social environments

Fear, anxiety, or avoidance of social situations must cause clinically significant impairment and persist for at least six months to merit a diagnosis.

[Self-Test: Does My Child Have Generalized Anxiety Disorder?]

Social Anxiety Treatment: Behavioral Interventions

Cognitive behavioral interventions effectively target the distorted thoughts that fuel social anxiety. Medication for anxiety may help, but as with ADHD, pills don’t teach skills. To cope with social anxiety, find ways to reduce your worries.

1. Shift your thinking. Identify limiting core beliefs and notice negative self-talk. What social situations trigger those thoughts and worries?
2. Recall positive social experiences. Anxiety erases memories of courage and success. Think back to times when you rose to a challenge despite your fears. What steps did you take?
3. Stay in the moment. Show curiosity about others and practice reflective listening, such as nodding. Notice your surroundings. Take deep breaths to quell physical symptoms.
4. Build up tolerance. Gradually expose yourself to low-risk, uncomfortable social situations. Join a hiking group, for example, and smile at a few new faces. On the second hike, talk to a few people. You might feel awkward and nervous, but you’ll see that you’ve survived.
5. Foster connection. Pay attention to body language that signals interest (like a relaxed posture) versus discomfort (looking away). Ask open-ended questions to encourage conversation and let others know that you’re listening.

[Download: Social Anxiety Facts and Falsehoods]

Improve Social Skills with an APPLE

To navigate social situations:

• Ask to join in a conversation.
• Physical proximity and volume. Are you too close? Too loud?
• Participate with curiosity. Use reflective statements and ask open-ended questions.
• Listen and lay off the self-criticism.
• Enjoy connection. Share what’s special and fun about you.

Social Anxiety in Children: Next Steps

• Download: Get a Grip on Tough Emotions
• Watch: Anxiety in Children: Overlooked Signs and Effective Supports
• Read: How Can I Help My Son Overcome Social Anxiety?

Sharon Saline, Psy.D., a licensed clinical psychologist, is an expert in how ADHD, learning disabilities, and mental health issues affect children, teens, and families. She is the author of What Your ADHD Child Wishes You Knew.

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My first thought was to try to sand and oil the deck to get the stains out. It took multiple trips to the shop – first because I hadn’t paid attention to the grade of sandpaper, and then because I bought the wrong decking oil – before I got to work. But after hours of inexpert, inefficient work, my results were underwhelming.

It was obviously time to buy a pressure washer. Though I had never used one, I was sure it was exactly what I needed to get the job done.

Testing the Waters

The green, compact pressure washing machine came to life with a groan. My first tentative squeeze of her trigger released a satisfying, powerful jet of water that made me feel like a ghostbuster. This was going to be a lot more fun than sanding.

I stopped after a few minutes of spraying to assess the hose’s effect. Bright, uneven stripes covered parts of the deck where the nozzle had dipped closer to the boards. I panicked, thinking that I now had a stripey deck to deal with on top of the planter box rectangles. (It’s what I get for skipping over the owner’s manual.) I crouched closer to the boards to investigate. Those weren’t bad stripes. They were stripes of pure clean! It worked! This was the thing I needed.

[Read: The Good, the Bad, and the Ugly of Hyperfocus]

I retraced my steps and positioned the nozzle closer to the boards to get an even clean. Each wave of the wand stripped away layers of grey, age, and grime. It was like reverse painting, only instead of adding color I was removing age and revealing timber. It was so quick! So satisfying! So easy! I was in a trance.

How had I lived so long without knowing the glory of pressure hosing? There was nowhere I would rather be and nothing I would rather do. The blessings of the world were mine. I was a woman with a powerful hose, and I was complete.

I eventually reached the end of the deck. Then, I looked around. Why had I never noticed just how dirty those concrete steps were? Spray. Spray. Spray. And what about the outdoor table? I couldn’t put that back on the deck like that. Spray. Spray. Spray.

Then I spied our cedar hot tub. I had previously sanded and oiled it but had never fully succeeded in removing the ingrained dirt. Surely the hose would work with that, too? I gave it a blast. Where once there was dirt now remained only unstained splendor. I had the power of purest clean in my hands, and there was nothing that I could not make cleaner!

[Read: When Hobbies Turn Into Obsessions — Diaries of ADHD Hyperfocus]

The Hyperfixation Pipeline

I started to film my adventures on day three of hosing. I wanted to capture the bliss of the “after” following an impossibly soiled “before.” Surely everyone would be into high-pressure hosing like I was if only they knew about it? I sent videos to my husband and my friends. Look! Look at this! Dirty… clean! Ugly… beautiful! This actually may be the greatest thing in the history of the world!

One night I was waxing lyrical about the beauty of the hose with my husband and a friend (and long-time hose admirer) and we came up with the idea of guerilla hosing. Instead of spray paint, we would go to old, dirty buildings and draw beautiful pictures on them using the power of water. We started talking logistics of pumps on trucks and whether guerrilla hosing might result in arrest.

One of my friends got caught up in my enthusiasm and bought herself the same pressure hose model I had. And she totally got into it. Of course. Because it is all the good things! Painting without the mess. Stripping away grime. Getting slippery stuff off rocks. Everything is cleaner and brighter with a high-power hose!

Each day, for a week, I woke up early, charged with an inexhaustible urge to use my hose. It is amazing how many things you can find to clean. But eventually, like all my hyperfixations, my obsession with high-power hosing faded as the anxiety of work, emails, and deadlines I had been ignoring took over.

I am not saying that this high-pressure hosing hyperfixation is finished forever. (I would still totally be up for starting a hose-based art movement). But I know, after a lifetime of so many fleeting enthusiasms, that there always will be more. And I will love them just as fiercely and passionately as I did this one, for however long they last. I heart my ADHD hyperfixations.

ADHD Hyperfixations: Next Steps

• Free Download: Focus Your ADHD Brain With 5 Helpful Hacks
• Read: Flow State vs. Hyperfocus – On Channeling Your Unsteady ADHD Attention
• Read: After the Thrill — Avoiding a Hyperfocus Hangover

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Emotional dysregulation is a core facet of ADHD. Though it’s not included in the DSM diagnostic criteria for ADHD, deficient emotional self-regulation is an almost-universal problem that looks like this:

• Inappropriate or exaggerated responses triggered by strong emotions
• An inability to self-soothe or reduce the severity of a strong emotion
• An inability to refocus attention away from emotionally provocative events or people
• A struggle to adopt healthier responses to stressful situations

In males, emotional dysregulation is more likely to manifest as aggression or hostility. In females, it may look like anxiety or a mood disorder. In both genders, it is exacerbated by elevated stress and by trauma — both of which our children and teens have experienced in spades during the pandemic and amid news of recent school shootings.

When emotional dysregulation spirals out of control, caregivers and educators often feel helpless and trapped. Here, learn how to de-escalate an explosive situation with a dysregulated child or student while protecting everyone’s safety.

In this conversation with ADHD expert William Dodson, M.D., you will learn the following:

• How to recognize the emotional, behavioral, and cognitive signs of agitation
• How to safely approach and respond to a person’s anger, aggression, and/or agitation
• Age-appropriate de-escalation techniques including active listening, reflections, and emotion-less responses
• Self-calming strategies to teach children and teens
• Suggested language to use when flooded with emotion during an outburst

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More on Emotional Dysregulation and ADHD

• Download: Rein In Intense ADHD Emotions
• Read: Why Your Child’s ADHD Outbursts Are So Explosive — and Isolating
• Read: How ADHD Ignites Rejection Sensitive Dysphoria

Meet the Expert Speaker:

Dr. Dodson is a board-certified adult psychiatrist who has specialized in adults with ADHD for the last 26 years. He has written on how the basic research on ADHD can be applied to everyday clinical practice.

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Brain development may be disrupted and delayed by trauma, anxiety, fear, and stress. This can lead to a host of problems, including difficulty with attention and focus, working memory problems, delays in language development, and disrupted sleep in children and teens. Understandably, academic performance may suffer, emotional control may falter, and impulsivity may flare in times of stress. In addition, constant exposure to trauma, anxiety, and stress can cause chronic health conditions in children.

In this special “Mental Health Out Loud” conversation, you will learn the following from ADHD expert Cheryl Chase, Ph.D.:

• How trauma, stress, anxiety, and fear affect brain function in younger and older children, and how these factors adversely impact children through adolescence and into adulthood
• The telltale signs of anxiety, stress, fear, and trauma in children and teens, and signs that a child might need intervention
• What caregivers can do at home to help a child move forward
• How to support our kids’ mental health at a time of unabated school shootings and gun violence in communities

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay” to watch the Q&A recording and access related resources.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

More on Trauma, Stress, and ADHD

• Free Download: Emotional Control Strategies for Chlidren with ADHD
• Read: The Science of Fear —Probing the Brain Circuits That Link ADHD and PTSD
• Read: Does Trauma Cause ADHD? And Vice Versa?
• Read: How to Teach Resilience to Children

Meet the Expert Speaker:

Cheryl Chase, Ph.D., is a licensed clinical psychologist in private practice in Independence, a suburb of Cleveland, Ohio. She specializes in the diagnostic and neuropsychological assessment of various conditions impacting children, adolescents, and young adults including ADHD, Pervasive Developmental Disorders, Learning Disorders, and emotional concerns. In addition to her clinical practice, Dr. Chase is also an accomplished speaker at the local and national levels, leading workshops on such timely topics as executive functioning, differentiated instruction, and creative ways to support those who struggle in school. Finally, Dr. Chase serves as an adjunct instructor at several colleges in the Cleveland area.

Dr. Chase is an active member of the American Psychological Association, the International Dyslexia Association, and the Learning Disabilities Association of America.

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The self-determination theory (SDT), a motivational framework, may help broaden and inform research on the role and source of motivation in relation to attention deficit hyperactivity disorder (ADHD or ADD), according to a new study published in the Journal of Attention Disorders.¹

The study finds that considering the mediating role of internal motives in relation to environmental factors and behavior, as described in the SDT, could help researchers generate and interpret new studies on the interplay between motivation and ADHD.

ADHD is characterized, in part, by motivational deficits that can contribute to challenges in various domains. The authors note that commonly accepted theories on this relationship focus on dopamine deficiencies, which impact reward centers, and the role of reinforcement and external triggers on behavior. Researchers have paid little attention, they write, to other parts of motivation, like internal motives.

Internal motives comprise needs, perceptions, and emotions, all of which can serve as mediators between external triggers and behavior or action. For example, when a child is sent to do homework, the command is the external trigger, but internal motives (the child’s belief that homework is useful or pointless, their emotions related to homework, etc.) ultimately drive the child’s behavior in this framework. External triggers merely influence conditions and indirectly drive behavior.

Internal motives are central to the SDT, which defines motivation as a natural, internal tendency toward growth, ideally through autonomous, voluntary choices. To reach this point, however, basic psychological needs such as competence, autonomy, and relatedness must be met first. Otherwise, the tendency toward growth (motivation) is hampered. (Example: If doing homework makes a child feel competent, the child is more likely to experience voluntary motivation. Escaping punishment for not completing homework is not as strong a motivator.)

Further, the authors believe the SDT framework may even inform clinical interventions for individuals with ADHD, as in the case of existing SDT-based intervention programs focused on autonomy support.

¹Morsink, S., Van der Oord, S., Antrop, I., Danckaerts, M., & Scheres, A. (2021). Studying Motivation in ADHD: The Role of Internal Motives and the Relevance of Self Determination Theory. Journal of Attention Disorders. https://doi.org/10.1177/10870547211050948

Deficient emotional self-regulation (DESR) is a relatively new term used to describe the problem of impulsive emotion coupled with emotional self-regulation difficulties — issues long associated with attention deficit hyperactivity disorder (ADHD or ADD). DESR may be new to the ADHD lexicon, however I argue that it is a core and commonly overlooked component of the disorder — and one that can help predict a patient’s impairments, and even improve diagnostic and treatment practices.¹

Emotional dysregulation is noticeably missing from diagnostic criteria for ADHD. However, most patients and experts recognize that it is central to the disorder². DESR, a manifestation of emotional dysregulation, specifically refers to deficiencies with these four components of emotional self-regulation³:

• Ability to inhibit inappropriate behavior triggered by strong emotions. I argue that this emotional impulsiveness (EI) is an aspect of poor inhibition associated with ADHD that is illustrated by low frustration tolerance, impatience, being quick to anger, aggression, greater emotional excitability, and other negative reactions, all of which are related to the impulsivity dimension of the disorder
• Ability to self-soothe and down-regulate a strong emotion to reduce its severity
• Ability to refocus attention from emotionally provocative events
• Ability to organize or substitute more moderate, healthier emotional responses in the service of goals and long-term welfare

To understand the role of EI and DESR in ADHD is to acknowledge the prominent role of emotional control difficulties in the disorder’s appearance and outlook, including understanding the following:

• Why these issues are prevalent in individuals with ADHD
• Why major comorbid disorders often develop as a result of these challenges
• The major life impairments not adequately explained by traditional symptoms of ADHD

A wealth of compelling evidence — from ADHD’s clinical conceptualization over time to neuroanatomical and psychological research — clearly shows that EI and DESR are key components of ADHD and should be incorporated into the disorder’s diagnostic criteria and treatment practices.

[Free Download: 15 Ways to Disarm (and Understand) Explosive ADHD Emotions]

EI and DESR: Evidence of Its ADHD Ties

1. EI and DESR in Historical Concepts of ADHD

Conceptualizations of ADHD have included emotional control problems for centuries. One of the earliest references to attention disorder in western medical literature⁴, a textbook written by German physician Melchior Adam Weikard in 1770, characterizes those who have a “lack of attention” as “unwary,” “flighty,” “careless,” mercurial,” and “bacchanal.”

EI and DESR through history⁴:

• 1798: Alexander Crichton, a Scottish-born physician, includes emotional frustration in his description of disorders of attention, especially problems with persistent attention
• 1902: George Still, a British physician widely considered to be the “founder” of ADHD, includes emotional impulsiveness and poor regulation of emotions in his conceptualization of “defective moral control of behavior” (the precursor to ADHD)
• 1960s-1970s: Major clinical researchers at the time — including Mark Stewart, Dennis Cantwell, and Paul Wender — include emotion as a core feature in their concepts of “hyperactive child syndrome (now ADHD).”

So why isn’t emotion considered in the diagnostic criteria for ADHD today?

• 1968: DSM-II references ADHD for the first time (as hyperkinetic impulse disorder) but fails to list EI or DESR as a feature of the disorder. It is excluded from all future DSMs, for unknown reasons, despite continuing research linking emotion to ADHD.

2. EI and DESR and the Neuroanatomy of ADHD

The brain structures and networks implicated in ADHD are also involved in emotion and would thus logically be expected to give rise to EI and DESR and be part of the disorder.
The frontal lobe, the anterior cingulate, the ventral striatum, and the amygdala all comprise the executive circuitry that has been repeatedly shown to be involved in causing ADHD². Some of these structures also form the brain’s emotional circuitry — the amygdala and larger limbic system to which it is connected is where emotion is generated, and the prefrontal cortex and related structures attend to these generated emotions. Thus, how we feel also influences how we think, and the dorsolateral PFC is where some thinking occurs, as well as working memory (or what we are holding in mind).

[The ADHD-Anger Connection: New Insights into Emotional Dysregulation]

3. EI and DESR in Neuropsychological Theories of ADHD

The frontal-limbic circuit — one of the four executive networks of the brain — is associated with ADHD and with symptoms of emotional dyscontrol, motivation deficits, hyperactivity-impulsivity, and aggressive tendencies. This emotional regulation network is also known as the “hot” circuit. I also refer to it as the “why” circuit, because it’s absolutely crucial in decision making.

This network is also connected to the other executive networks that we know are implicated in ADHD. ADHD, of course, would be expected to disrupt this emotional regulation network substantially.

4. EI and DESR in ADHD Psychological Research

Emotional self-regulation is a major dimension of executive functioning required for daily life activities. It is also one of the most impaired dimensions in children and adults with ADHD^{5 6}. Ample evidence from an abundance of psychological research shows that children and adults with ADHD are highly likely to manifest EI-DESR² including low frustration tolerance⁷, anger, poor inhibition of emotion, and emotional excitability^{8 9}.

Additional research on EI-DESR and ADHD:

• Meta-analysis: Emotional dysregulation is a core feature of ADHD’s psychopathology in adults¹⁰
• Developmental studies on preschool children find that negative temperament, irritability, and poor emotional regulation are strong predictors for ADHD later in life^{11 12}
• Studies on family genetics and ADHD show that the genes implicated in ADHD are also responsible for associated emotional problems¹³

5. EI and DESR Underpinning ADHD Comorbidities

Putting impulsive emotion and emotional self-regulation problems back into the realm of ADHD also helps us understand the basis for several of the comorbid conditions commonly associated with ADHD, especially that of oppositional defiant disorder (ODD)¹⁴.

ODD is two-dimensional, comprising aspects of social conflict and emotion dysregulation. These two dimensions significantly contribute to the risk for later disorders. The emotional dimension, for example, in children contributes to the later risk for anxiety and mood disorders in teens.

Given ADHD’s prevalence in ODD, we can assume that the emotional component of ODD arises biologically from ADHD. That is, ADHD likely creates one of the two dimensions involved in ODD. Indeed, the longer ADHD goes untreated and emotions remain dysregulated, the greater the odds that comorbid conditions, particularly anxiety disorders, will develop¹⁵. This framework helps us understand why emotion and ODD are managed so well by ADHD medication, but only if ADHD is also present¹⁶.

Meanwhile, the social component of ODD predicts later conduct disorder and antisocial behavior. This component of ODD, contrary to the biological aspect of emotionality, is likely learned, most often within family interactions.

6. EI and DESR and Impairment in Major Life Activities

Centering the role of emotion in ADHD predicts a variety of impairments that are not similarly associated with the traditional symptoms of ADHD: hyperactivity, inattention, and/or impulsivity.

Emotional dysregulation has been shown to uniquely predict the following⁶

• social rejection in children with ADHD
• interpersonal hostility and marital dissatisfaction in adults with ADHD
• greater parenting stress and family conflict in parents of children with ADHD; greater stress in parents with ADHD
• road rage, DUIs, and crash risks during driving
• job dismissals and workplace interpersonal problems
• dating/cohabiting relationship conflict
• impulse buying; poor finances

EI and DESR: Diagnostic Implications

Elevating EI-DESR’s place in ADHD would greatly assist with differential diagnosis of the disorder from mood disorders and other conditions involving emotional dysregulation. In other words, it would reduce the odds of misdiagnosis for patients who are simply experiencing what is central to ADHD itself. (Individuals with ADHD are commonly misdiagnosed with mood disorders.¹⁷)

Mood disorders, however, are common in individuals with ADHD, so comorbidity must be considered¹⁸. Duration could be a guiding diagnostic principle used to distinguish a legitimate mood disorder from the emotional dysregulation associated with ADHD. Emotions, unlike moods, are of short duration, setting-specific, provoked, and easily traced to the source. EI-DESR is a “top-down” deficit in regulating rational emotional responses to events; its impact is typically shorter in duration than that of a mood disorder.

Mood disorders are generally “bottom-up” excessive expressions of emotions likely attributed to underlying amygdala-limbic system activities. Moods are of long duration — lasting hours, days, or weeks. Moods are cross situational, and irrational in the case of mood disorders (it is often not clearly understood, for example, what triggers a patient with bi polar disorder to become manic, or the opposite).

EI and DESR: Treatment Considerations

Re-centering ADHD on emotions also helps us understand treatment outcomes. It’s why we often observe that ADHD medications impact core EI and DESR problems in patients with ADHD, albeit in different ways¹⁹. Stimulants appear to quell and even dampen the limbic system, sometimes leading to complaints from patients about having robot-like, bland emotions. Non-stimulants like atomoxetine, on the other hand, act on a different part of the brain. They help to up-regulate the executive brain, giving patients more self-control of emotion. Prescribers sometimes utilize different drug combinations to allow patients more control over ADHD, including emotional problems.

Other treatment implications:

• Secondary impairments from EI-DESR on major life activities may also be improved by ADHD medication.
• Cognitive behavioral therapy (CBT) programs that target EF deficits, along with mindfulness-based approaches, might help with emotional regulation in adults with ADHD, especially if they are taking ADHD medication.
• In children, emotional dysregulation is better handled through medication and then, to some extent, through behavioral parent training programs that focus on restructuring situations and interactions so as not to trigger strong impulsive emotions.
• Parental ADHD could contribute to emotional dysregulation in children with ADHD, not just genetically through inheritance, but through modeling of poor emotional control and by engaging in emotionally provocative encounters with the child. Clinicians should screen parents for ADHD and treat their symptoms as well.

EI and DESR: Conclusions

Impulsive emotion and emotional dysregulation are core facets of ADHD. Impulsive emotion is linked to the impulsivity dimension of ADHD, and difficulties with emotional control is part of the large inattentive/executive dimension of ADHD. Historical concepts of ADHD include EI-DESR, and research in the fields of neuroanatomy, neuropsychology, and psychology also link ADHD to EI and DESR. This core relationship may help to explain, at least in part, why the disorder poses high risk for ODD and mood disorders, as well as the unique impairments some patients experience.

By recognizing that EI and DESR are involved in ADHD, we can significantly improve diagnostic and treatment practices.

DESR and EI with ADHD: Next Steps

• Essential Reading: New Insights Into Rejection Sensitive Dysphoria
• Free Download: 9 Truths About ADHD and Intense Emotions
• Read: Why We Feel So Much — and Ways to Overcome It
• Read: Learning to Cope with Intense ADHD Feelings

The Clinicians’ Guide to Differential Diagnosis of ADHD from Medscape and ADDitude

• How can I better understand ADHD, its causes, and its manifestations?
• What do I need to understand about ADHD that is not fully represented in the DSM?
  • How does ADHD impair the areas of the brain responsible for executive function?
  • Why does ADHD impact a patient’s sleep?
  • What is complex ADHD?
  • Is rejection sensitive dysphoria a symptom of ADHD?
  • What do I need to know about the latest research on ADHD and emotional dysregulation?
  • How can clinicians address the stigma around ADHD in Black communities to ensure better healthcare?
  • Free Webinar: Deficient Emotional Self-Regulation (DESR) and ADHD?
  • Free Webinar: Understanding Complex ADHD
  • Free Webinar: How ADHD Shapes Your Perceptions, Emotions & Motivation
• How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
• How can I best consider psychiatric comorbidities when evaluating a patient for ADHD?
• How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
• How can I best consider trauma and personality disorders through the lens of ADHD?
• What diagnostic criteria and tests are recommended for performing a differential diagnosis of ADHD?

The content for this article was derived from the ADDitude Expert Webinar Deficient Emotional Self-Regulation: The Overlooked ADHD Symptom That Impacts Everything [Video Replay & Podcast #369] with Russell Barkley, Ph.D., which was broadcast live on August 26, 2021.

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹Barkley, R. A. (2015). Emotional dysregulation is a core component of ADHD. In R. A. Barkley (Ed.), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment (pp. 81–115). The Guilford Press.

²Shaw, 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

³Koole, S. et.al. (2011). The self-regulation of emotion. In Vohs, K., Baumeister, R. (Eds).Handbook of self-regulation, second edition: research, theory, and applications.(pp 22-40). Guilford Press.

⁴Barkley, R. A., & Peters, H. (2012). The earliest reference to ADHD in the medical literature? Melchior Adam Weikard’s description in 1775 of “attention deficit” (Mangel der Aufmerksamkeit, Attentio Volubilis). Journal of attention disorders, 16(8), 623–630. https://doi.org/10.1177/1087054711432309

⁵Barkley, R. A. (2012). The Barkley Deficits in Executive Functioning Scale: Children and Adolescents.New York: Guilford Press.

⁶Barkley RA, Fischer M. The unique contribution of emotional impulsiveness to impairment in major life activities in hyperactive children as adults. Journal of the American Academy of Child & Adolescent Psychiatry. 2010;49(5):503–513.

⁷Seymour, K. E., Macatee, R., & Chronis-Tuscano, A. (2019). Frustration Tolerance in Youth With ADHD. Journal of attention disorders, 23(11), 1229–1239. https://doi.org/10.1177/1087054716653216

⁸Jensen, S. A., & Rosén, L. A. (2004). Emotional reactivity in children with attention-deficit/hyperactivity disorder. Journal of attention disorders, 8(2), 53–61. https://doi.org/10.1177/10870547040080020.

⁹Barkley, R. A. & Murphy, K. R. (2011). Deficient emotional self‐regulation in adults with ADHD: The relative contributions of emotional impulsiveness and ADHD symptoms to adaptive impairments in major life activities. Journal of ADHD and Related Disorders, 1(4), 5‐28.

¹⁰Beheshti, A., Chavanon, M. L., & Christiansen, H. (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC psychiatry, 20(1), 120. https://doi.org/10.1186/s12888-020-2442-7

¹¹Dougherty, L. R., Smith, V. C., Bufferd, S. J., Kessel, E., Carlson, G. A., & Klein, D. N. (2015). Preschool irritability predicts child psychopathology, functional impairment, and service use at age nine. Journal of child psychology and psychiatry, and allied disciplines, 56(9), 999–1007. https://doi.org/10.1111/jcpp.12403

¹²Vogel, A. C., Jackson, J. J., Barch, D. M., Tillman, R., & Luby, J. L. (2019). Excitability and irritability in preschoolers predicts later psychopathology: The importance of positive and negative emotion dysregulation. Development and psychopathology, 31(3), 1067–1083. https://doi.org/10.1017/S0954579419000609

¹³Merwood, A., Chen, W., Rijsdijk, F., Skirrow, C., Larsson, H., Thapar, A., Kuntsi, J., & Asherson, P. (2013). Genetic association between the symptoms of attention‐deficit/hyperactivity disorder and emotional lability in child and adolescent twins. Journal of the American Academy of Child and Adolescent Psychiatry, 53(2), 209‐220.

¹⁴Connor, D. Steeber, J. et.al.(2010) A review of attention-deficit/hyperactivity disorder complicated by symptoms of oppositional defiant disorder or conduct disorder. Journal of Developmental & Behavioral Pediatrics, 31(5), 427-440. doi: 10.1097/DBP.0b013e3181e121bd

¹⁵Geffen, J., & Forster, K. (2018). Treatment of adult ADHD: a clinical perspective. Therapeutic advances in psychopharmacology, 8(1), 25–32. https://doi.org/10.1177/2045125317734977

¹⁶Newcorn, J. H., Spencer, T. J., Biederman, J., Milton, D. R., & Michelson, D. (2005). Atomoxetine treatment in children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 44(3), 240–248. https://doi.org/10.1097/00004583-200503000-00008

¹⁷Ginsberg, Y., Quintero, J., Anand, E., Casillas, M., & Upadhyaya, H. P. (2014). Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. The primary care companion for CNS disorders, 16(3), PCC.13r01600. https://doi.org/10.4088/PCC.13r01600

¹⁸Katzman, M. A., Bilkey, T. S., Chokka, P. R., Fallu, A., & Klassen, L. J. (2017). Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC psychiatry, 17(1), 302. https://doi.org/10.1186/s12888-017-1463-3

¹⁹Schulz, K. P., Fan, J., Bédard, A. C., Clerkin, S. M., Ivanov, I., Tang, C. Y., Halperin, J. M., & Newcorn, J. H. (2012). Common and unique therapeutic mechanisms of stimulant and nonstimulant treatments for attention-deficit/hyperactivity disorder. Archives of general psychiatry, 69(9), 952–961. https://doi.org/10.1001/archgenpsychiatry.2011.2053

To better understand impulsivity in adulthood, we asked ADDitude readers, “Does your ADHD have a strong impulsivity component? If so, how has this affected your life? Share a story of a time when you acted on impulse, and the negative (or positive!) result.” Below, find relatable responses from other adults with ADHD; share your experiences in the Comments section below.

ADHD Impulsivity in Adults

“Impulsivity has been a deciding factor in my life many times, seldom for the best. Upon finding out I was pregnant when I was supposed to be physically unable to bear children, I quit my job and relocated to another country to start a family with the father, a man I had met online and had only spent 3 weeks with in real life. I went from being a television producer in Vegas to a farmer’s wife in Australia. He and I were like water and oil, but we stuck it out for 8 years because of our child, who is now 21 years old. I never got rich and famous, but it has certainly been an adventure.” – Tony

“My impulsivity has dangerously impacted my driving. I get impatient in traffic and fail to be aware of cars behind me or in the lane into which I intend to merge. Consequently, I have had numerous car accidents and ‘near misses’ with death.” – Anonymous

“After I was diagnosed with ADHD in my 40s, I realized the pattern of my impulsivity throughout my life; I could never stick with a hobby as a child, then in college I would instantly drop out of a course if I was bored or confused by the material. A few years ago, I changed jobs 8 times in under 2 years. It has taken me 35 years to slow down and ask for help when overwhelmed.” – Karen

[Download This Free Guide to ADHD in Adults]

“I impulsively spend money to buy countless organizing products into which I cram stuff, causing even more clutter. I don’t have the budget to buy them, but that doesn’t stop me. I hate how this makes me feel. I know how I want my home to look and feel – why do I feel like the purchases will fix things?” – Val

“In the few months leading up to my diagnosis, which was a period of tremendous upheaval and overwhelming symptoms, I got 8 new piercings in 3 months! All entirely spontaneous…” – Anonymous

“Online shopping, the occasional sugar binge, a handful of impulsive tattoos, and interrupting are how my impulsivity manifests. Impulsive speaking causes me the most problems; I blurt out inappropriate things and have been called ‘rude’ because of it.” – Kelly

“My impulsivity depends on how overwhelmed I am feeling by my own emotions. Once, after a period of depression, I wrote an entire book!” – Anonymous

[Read This Next: How to Hit Pause on ADHD Impulsivity]

“My impulsivity led me to fall for someone I shouldn’t have. I missed every single red flag that was glaringly obvious to everyone else. When the relationship ended, rejection sensitive dysphoria compounded my shame and shock at having thrown away my inhibitions so easily.” – Anonymous

“I have a bad online shopping habit where I look only at ‘for sale’ items, and when I see how affordable they are, I add more items to the cart. It, of course, adds up but I don’t think about it until I look at my bank account. I’m trying really hard to break this habit.” – Anonymous

“When my friend got married, I was so overcome with happiness right after the ceremony, that I jumped up to hug her and cut off her mother. It was so embarrassing. My impulsiveness is always putting me in these awkward situations.” – Anonymous

“My impulsivity has been my demise, primarily in work. I speak to colleagues and managers impulsively; I’m a reactor instead of an actor.” – Patty

“My girlfriend has ADHD and impulsively buys things we don’t need – it is very stressful and on the verge of hoarding. She is an ‘emotional shopper’ and only buys things when she is upset or stressed.” – Anonymous

ADHD Impulsivity in Real Life: Next Steps

• Self-Test: Do I Have Adult Hyperactive and Impulsive ADHD?
• Free Download: Unraveling the Mysteries of Your ADHD Brain
• Real-World Strategies: “How I Stop Being So Impulsive”

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.