Weak. Needy. Helpless. Annoying. Thanks to social conditioning and outdated gender norms and decades of hits to our self-esteem, this is how some of us think we appear when we ask for help. But research and experience tell us otherwise.
Strong self-advocacy skills — i.e., the ability to ask for and secure support when it matters — is a strong indicator of success for people with ADHD. Everything from executive dysfunction to the emotional impact of ADHD and its comorbidities are made more manageable with the right kind of help. But the same ADHD characteristics that make assistance so important also make asking for it really tough.
So we asked ADDitude readers to share their experiences with self-advocacy and offer any tips, hacks, or hints that have helped them get helpful help. Here’s what they told us:
“I see requests for help as opportunities to build relationships and connections.” —Catherine, Washington
“When I ask for help, it makes me feel like a failure. But I remind myself that I need to set an example for my kids, so I will ask my husband for help by explaining that I need to prioritize something else so can he please cook dinner?” —Kate, Australia
[Read: The Fear of Failure Is Real — and Profound]
“I’m midlife and the gig of doing it all by myself is up: I have crashed and have to ask for help now. The trick is choosing relationships in every area of life with people who have high standards of relations, reciprocity, and compassion. I choose now, rather than hoping others will get me. It changes everything!” —An ADDitude Reader
“I think having a background in addiction recovery is an asset to ADHD coping. I am already aware that in some areas, I need support outside of myself. Therefore, I am already practiced in asking for support. I know that if I try to cope on my own, it may lead to unhealthy behaviors.” —Krysta, Canada
“I have a 15-minute rule. If I am stuck for more than 15 minutes, I ask for help. I instill this in my employees as well. Asking for help tells me that they are comfortable with communication, and humble.” —John, Florida
“If I notice my RSD is preventing me from asking for support, that often indicates that I’m not getting what I need from that relationship to feel safe.” —AJ, Utah
[Read: How ADHD Ignites RSD – Meaning & Medication Solutions]
“I prefer typing out a text or email rather than orally asking for help, but if text/email is not an option, writing a script can help me prepare for a face-to-face request.” —Chandler, Pennsylvania
“Ask for something super tiny to get practice at asking for help.” —Katrina, Australia
“I have set up keywords with my husband, so when I say those words he knows I am feeling lonely and I need help.” —April, Oklahoma
“My ADHD can make me quite impatient, so I need to give people time to process my request, or take the action I’ve asked for. It helps to remember this isn’t rejection, and they don’t have to drop everything then and there in order to be willing to help.” —Trish
“To address loneliness, I have learned to say ‘I need a hug.’ Often it opens the door for me to share more about what is going on.” —Claire, Pennsylvania
“I identify a person with complementary skills, and I spontaneously contribute to our shared objective by doing the tasks they find laborious. The reciprocal task division follows naturally. Nobody has to ask, no gift debt is engendered. We are actively helping each other.” —Dettie
“I imagine that I’m giving someone good news when I’m about to ask for something I feel nervous about.” —Kelsie, Mississippi
“I have to just accept that asking feels awkward, and it probably always will.” —Sarah, Georgia
“I always express gratitude to any person who is willing to body double with me and I describe how it was helpful. For example, ‘You read your book while I was doing bills and I got sooo much more done. Thank you. Let me know when you are reading your next book.’” —An ADDitude Reader
“I offer help, often. That makes me feel better about asking for help. In my mind, I’ve kind of already paid for the help that I need by helping others, and now I’m cashing out.” —Helen, Maryland
“I practice a lot of ‘I statements,’ like, ‘I feel so overwhelmed by the number of tasks I have to do and I need extra hands.’ It’s not easy, but if you start with positive ‘I need’ statements, and practice, it’ll start feeling like second nature.” —Vanessa, Texas
“I try to set up check-ins with team members at work so it’s easier to ask for help while working on a specific project.” —Christina, Louisiana
“Give yourself 10 seconds of bravery. Start counting backwards from 10 and, before you hit one, say what you need to say to the person.” —Charlie, Australia
“Before asking for help at work, I always make sure to have a list made up of things I need help with. It shows my boss and team members that I have come prepared, with a plan.” —Melissa, Minnesota
“I have realized that I need to be very concise and direct when asking for help, instead of talking about how much I need help and giving reasons.” —An ADDitude Reader
“I use an app such as Goblin Tools to break down tasks, then I ask for specific help. I find that if I say I need help in a non-specific way, people are less ready to help, but if I say, ‘Can you declutter this one drawer please?’ then I’ll get help. The act of breaking the task down helps reduce my overwhelm, too.” —Laura, New Zealand
“One thing that helps is to talk to friends about what is going on, just to gauge what their capacity is for listening or coming up with solutions I am blind to. More eyes and brains on a problem are a good thing.” —Sarah, Germany
“With my teenager, it is mostly a choice-based, task-related ask: ‘Would you be willing to help me with Option A or Option B and at what time?’” —Kristen, Michigan
“At work, I have a personal checklist of resources to exhaust. If I can’t find the answers after doing due diligence, I reach out to an appropriate team member. Having researched on my end allows me to reach out with a more informed and confident ask for help.” —Sharon, Ohio
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Parent training didn’t prepare me for this. My husband and I stood there, quietly whispering to each other for an excruciating 20 minutes until our daughter finally calmed down. In that time, I was desperate for the screaming, the stares, and others’ well-intentioned, albeit unhelpful, suggestions (to give her a snack or a drink) to stop. This was not the highlight of my mothering career.
Eventually, all those things did (thankfully) come to a halt. My baby stood up quietly after her meltdown, looking disoriented. Then, she stumbled in my direction and finally held my hand instead of running ahead of us like we asked her to, which is what led to the whole fiasco in the first place.
Emotional dysregulation is not new — to my daughter or to any other person with ADHD. But it was an aspect of ADHD that took me a long time to fully appreciate.
The problem is that the diagnostic criteria for ADHD intentionally exclude emotion dysregulation, despite it being historically conceptualized as a crucial characteristic of the condition. Emotional dysregulation was written about as an issue related to ADHD symptoms as early as the 1700s up until 1968, when the diagnosis of hyperkinetic reaction of childhood was first introduced in the DSM-II. Around this time, emotion dysregulation started to become a forgotten part of the equation for ADHD, and public discussion of ADHD-fueled tantrums and angry outbursts all but halted.
[Get This Free Download: 9 Truths About ADHD and Intense Emotions]
This is why, despite my psychology graduate coursework and training in ADHD, my daughter’s behavior was still confounding. On the one hand, I knew that she struggled with ADHD from an early age because her symptoms were consistent with current diagnostic criteria. On the other, her obvious emotional challenges compared to other girls and children her age, were not reflected in the DSM.
Adding to my confusion was the fact that emotion dysregulation isn’t exclusive to ADHD. For example, children with disruptive mood dysregulation disorder (DMDD) display irritable mood and emotional outbursts that could be verbal or physical and that occur at least three times per week. It is a condition that goes beyond temper tantrums.
DMDD was added to the DSM-5 because mental health professionals were over-diagnosing bipolar disorder, a condition that causes extreme changes in mood in children. DMDD was meant to account for children who didn’t quite meet criteria for bipolar disorder, and who presented with more general irritability.
Without much mention of emotion dysregulation’s connection to ADHD in my training and in what doctors told me, my daughter’s intense emotional responses made me wonder — could this be a case of DMDD, too?
[Self Test: Does My Child Have Disruptive Mood Dysregulation Disorder?]
William French, M.D., explains that the key to differentiating between DMDD and emotion dysregulation as a part of ADHD is the child’s mood between temper outbursts. Children with ADHD (and adults, too, for that matter) experience emotions intensely, but these emotions are not all negative.
Individuals with ADHD can also be incredibly excited or calm between emotional outbursts. Russell Barkley, Ph.D., says the reason the negative emotions get so much attention is because they lead to obvious social and functional challenges. While someone with ADHD experiences various emotions between periods of intense negative emotional outbursts, a person with DMDD has more persistent irritable mood between episodes.
Without a shred of doubt, I understand today – though it took lots of time and headaches to get here – that my daughter’s intense emotions are part of her ADHD.
But in my own practice, where I see neurodivergent youth, I increasingly see patients come in with an ill-fitting DMDD diagnosis. As I’ve become more and more self-educated about ADHD and emotion dysregulation, I’m convinced that many clinicians, misled by current diagnostic criteria, may be readily misattributing this central feature of ADHD to DMDD.
This is a problem, for one, because inaccurate diagnoses delay access to life-changing treatment and can cause further health complications. In addition. whether we’d like to admit it or not, certain labels carry heavier stigma than do others. Before they see me, many children with the DMDD diagnosis are turned away from other private practices, deemed too “severe” to treat. Children can also be inappropriately judged by schools when they are given labels reflecting severely dysregulated mood.
It’s important to remember that the DSM, in general, aims to simplify. But, far from simple, human beings are nuanced, and so is the way ADHD presents.
If diagnosticians took a step back and actually looked at the ADHD brain and listened to the lived experiences of individuals, maybe then they could start to understand those who are so unnecessarily misjudged, like my daughter could have been.
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Without fail, all of my female clients reply, “They are laughing at me.”
This painful thinking pattern – sensitivity to rejection – is etched into our brains, a pattern that arguably developed for an evolutionarily adaptive purpose. It’s also a pattern that appears to be much more amplified in the female ADHD brain.
According to neuropsychiatrist Louann Brizendine, M.D., author of The Female Brain (#CommissionsEarned), girls’ brains are “machines” that are “built for connection.” From infancy, girls respond more to the cries of other babies and gaze longer at faces compared to boys.
Unlike men, who are physically larger and stronger, women have historically needed other people and social connections to ensure their own safety and that of their offspring. The female brain, Brizendine posits, likely tuned into the potential for social rejection as an evolutionarily protective function.
So great is the fear of exclusion among women that it informs bullying behaviors. Peer relationship research shows us that, unlike males, who engage in more physical forms of bullying, females generally rely on more relational or reputational methods, such as excluding another girl from their social group, spreading rumors, or saying something mean directly to the victim’s face. In other words, we toy with other females’ emotions by threatening exclusion from an early age because that is really what we fear the most — being rejected and alone.
[Take the RSD Self-Test: Rejection Sensitive Dysphoria Symptoms]
The amygdala, which Brizendine describes as the brain’s “emotional gatekeeper,” is where fear and anger are initially processed. Once the amygdala detects a threat — real or perceived — that information is sent to the hypothalamus. The hypothalamus then heightens the uncomfortable fight-flight sensations (e.g., faster heartrate and breathing) we experience when we are anxious or angry. The amygdala also sounds the alarm to the prefrontal cortex (PFC), the executive functioning center of the brain, which then decides whether and how to react.
And here lies the pivotal point where the differences between girls with and without ADHD come to light. Our ADHD brains, prone to greater emotional flooding, crank up the volume on the aforementioned process. Our fear of exclusion is amplified. We interpret a situation as threatening when it likely isn’t.
Regardless, our brains get carried away with the threat. The alarm bells of “danger” ring, ring, and ring. We struggle to regulate, and, due to poor executive functioning, we struggle to respond effectively. There’s a reason psychiatrists Edward Hallowell, M.D., and John Ratey, M.D., describe the ADHD brain as a Ferrari equipped with bicycle brakes.
The way those of us with ADHD experience rejection is so unique that there’s a term for it: rejection sensitive dysphoria (RSD). Psychiatrist William Dodson, M.D., notes that some of his patients with RSD even describe feeling physical pain – as if they’ve been stabbed in the chest – as a response to rejection.
[Read: How Does RSD Really, Actually Feel?]
I can attest to this; after I got into an argument with someone very close to me, I sobbed in my husband’s arms and could only say, “It hurts.” Yes, I was hurting emotionally. But I was also in literal, physical pain. The female brain’s propensity to relay intense emotions into actual physical sensations is not lost on me. Feelings of emotional pain can register as physical pain responses for us, according to Brizendine.
As women, but especially as women with ADHD, our brains are wired to scan for rejection at every turn. Yes, this probable evolutionary adaptation – developed for protection – is turbocharged under ADHD. Yes, RSD and emotional reactivity are the excruciating result. But our sensitivity and ability to feel deeply, dare I say, has its advantages, too.
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#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.
]]>Nearly two-thirds of ADDitude readers ages 18 to 29 report feeling lonely “always” or “often,” according to a new survey of 4,170 adults with ADHD. Living or working with others made little difference; 89 percent of these young adults say they feel lonely even then. Only 19 percent say social media makes them feel more connected. In contrast, 46 percent of people ages 68 to 77—the demographic traditionally associated with social isolation — reported the same levels of loneliness.
“My ADHD makes it hard to remember to reach out or respond,” wrote one 28-year-old woman with inattentive ADHD, “but rejection sensitive dysphoria hits hard when I’m not reached out to or responded to, even though I acknowledge that hypocrisy. ADHD also makes it hard to leave the apartment (time management, overwhelm at what it takes to leave, energy to be social, executive function difficulties, etc.), so even if I’m invited, I find reasons to cancel.”
“For me, ADHD and loneliness impact one another,” wrote one survey respondent. “Now I neither want relationships nor do I have the energy to keep up the masking necessary to navigate relationships. It requires too much effort.”
The stories of social isolation shared by ADDitude readers were reflected in the findings of a recent meta-analysis of studies investigating whether young people with ADHD experienced greater loneliness than their neurotypical peers. The review of 20 studies, involving about 6,300 participants, concluded that people with ADHD who were younger than 25 had significantly elevated levels of loneliness due, in part, to mental health struggles, including anxiety and depression, and to “feeling different” because of their ADHD. Researchers called this an “important problem” of which clinicians should be aware for early identification and intervention, according to the study published in February in the Journal of Attention Disorders.1
“I feel too quirky and awkward,” wrote one survey respondent. “I’m fun at first, but quickly become too much for others. I want there to be less of me.”
[Read: “Why Don’t I Have Any Friends?”]
For more than three-quarters of ADDitude survey respondents, feelings of loneliness are tied directly to ADHD symptoms, manifestations, and repercussions. According to the survey, the most common ADHD-related roots of loneliness include:
Loneliness correlates to mental health problems for 78 percent of adults with ADHD, who also report high levels of anxiety (65%) and depression (61%), among other comorbid conditions. For two-thirds of survey respondents, loneliness has led to toxic relationships, substance abuse, self-harm, binge eating, excessive spending, and porn addiction.
Among ADDitude readers who say they “always” or “often” feel lonely, only 26 percent live alone. Retirement, lonely marriages, physically limiting health conditions, and strenuous caregiving responsibilities were often cited by older survey respondents, who say that late ADHD diagnoses contributed to their loneliness as well.
“Grieving the loss of what I perceived as a ‘good’ life after my ADHD diagnosis made me feel like a failure,” wrote one older adult. “I cannot undo the damage or ill feelings caused by my past actions, and this recognition has caused me even more pain.”
[Read: The Science of Loneliness]
“When I feel lonely,” said one survey respondent, “I want to reach out, but I usually don’t because:
More than half of the adults surveyed say they have trouble making and keeping friends for the following reasons:
“It’s a cruel loop,” one survey respondent said. “I feel safe when alone, so, much of the time, it’s a relief. But then, the loneliness is crushing.”
A spate of startups like the United Kingdom’s Timeleft and Friender are joining the veteran app Meetup in efforts to facilitate online connections that lead to real-life interactions. Some apps invite groups of strangers to meet for dinner at a specific time and place. Others work more like platonic dating apps where users scroll profiles before making plans. And some draw people together over common interests.
More than two-thirds of people say they feel less lonely when they reach out and connect with others in person, or via text or phone call. They also successfully alleviate loneliness through the following:
More than half of adults surveyed say they relate better to, and feel less lonely around, other neurodivergent adults.
“Being with other neurodivergent folks validates my experience of living with ADHD,” wrote one survey respondent. “There’s less judgment.”
Said another adult with ADHD: “In a neurodivergent group, I don’t feel weird, and I can let my mask slip. It is less taxing and there is less of a chance of me freaking out later over social mistakes I might have made.”
1Jong A, Odoi CM, Lau J, J Hollocks M. Loneliness in Young People with ADHD: A Systematic Review and Meta-Analysis. J Atten Disord. 2024 May;28(7):1063-1081. doi: 10.1177/10870547241229096. Epub 2024 Feb 23. PMID: 38400533; PMCID: PMC11016212.
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]]>“Social interactions rely on a complex orchestration of brain functions, from understanding another person’s point of view, recognizing their emotional state, feeling their emotional pain, and so on. Difficulties with any of these can affect our ability to connect to others,” says Ellen Lee, M.D., associate professor of psychiatry at the University of California San Diego. “The emotional pain and stress of loneliness can also take a toll on our brains.”
Lee was the corresponding author of a systemic review of 41 studies, involving 16,771 adult participants, examining the neurobiology of loneliness. Researchers in those studies used brain imaging and other scans to identify the differences in the brain structure and function of lonely people. The findings showed that some people were hard-wired for loneliness in the same way that some are hard-wired for anxiety.
Loneliness is defined as the emotional discomfort one feels when their need for intimacy and social connection goes unmet.
In the lonely participants, abnormal structure and/or activity was discovered in the prefrontal cortex, which mediates emotional regulation and inhibitory control; the insula, which plays a role in emotional pain and self-awareness; and in other parts of the brain. The review was published in the journal Neuropsychopharmacology in 2021.1
[Test Yourself: How Severe Is Your Loneliness? Take This Quiz]
Lee says it’s possible that brain changes associated with ADHD, depression, and anxiety can lead to feelings of prolonged loneliness because people tend to withdraw from social interactions when they have low mood or other symptoms.
“Researchers are starting to study these links to understand if improving loneliness could be a way to improve these symptoms,” she says.
In a study published in the journal Psychological Science in 2023, researchers discovered that lonely people viewed the world differently from each other and from nonlonely people. Using fMRI scans to examine neural responses to stimuli (videos) and other methods, the researchers also administered a loneliness scale and survey to evaluate the 66 study participants.2
They found that loneliness was associated with structural and functional differences in regions of the brain, and the researchers said their results remained significant even after controlling for individuals’ reported numbers of friends.
“Lonely people process the world idiosyncratically, which may contribute to the reduced sense of being understood that often accompanies loneliness,” the researchers said in the study. “In other words, we found that nonlonely individuals were very similar to each other in their neural responses, whereas lonely individuals were remarkably dissimilar to each other and to their nonlonely peers.”
The researchers said the findings “raise the possibility that being surrounded predominantly by people who view the world differently from oneself may be a risk factor for loneliness (even if one socializes regularly with them).”
Those findings echo the lived experience of many adults with ADHD who report feeling a sense of isolation due to their perceived difference. “I mostly feel like a dolphin in a sea of stingrays,” an ADDitude reader says. “I never meet people with whom I have anything significant in common, and with whom I can forge solid, lasting friendships.”
[Read: How to Make Friends As an Adult With ADHD]
Stephanie Cacioppo, Ph.D., a behavioral neuroscientist whose research seeks to understand how people experience different emotions, says evolution has sculpted the human brain to respond to biological mechanisms like hunger and thirst. Hunger, she says, is triggered by low blood sugar and motivates us to eat. Thirst helps us find water before we become dehydrated. Pain encourages us to take care of our body.
“Loneliness alerts us to potential threats, and damage to our social body, and in doing so, increases our motivation to bond with others,” says Cacioppo, author of Wired for Love. “It’s the brain’s way of telling you: You’re in social danger, you’re on the periphery of the group, you feel left out, misunderstood, you need protection, inclusion, support, and love. One of the most important things that love can do, it turns out, is shield us from the ravages of chronic loneliness.”
Cacioppo says it’s not uncommon for people to mask in the company of others when they don’t feel a sense of connection.
“Masking is totally understandable from a neuroscientific perspective,” she says. “The best solution is to stay authentic. Authenticity is the key to connectivity. Building connections with people while staying true to yourself can be a buffer against loneliness.”
Cacioppo offers several strategies to address chronic loneliness, encapsulated by the acronym G.R.A.C.E.:
Gratitude: Every day, write down five things you truly appreciate. Science shows that expressing gratitude improves emotional wellbeing.
Reciprocity: If you know someone who feels lonely, ask them for help or for advice. Showing respect can give a lonely person a sense of worth and belonging that decreases feelings of isolation.
Altruism: Helping others, and sharing your knowledge, will give you a feeling of self-expansion that is similar to what people experience when they are in a love relationship.
Choice: The tricky thing about loneliness is that, to some extent, it’s self-fulfilling. The more you think you are lonely, the more you are. To break the spiral, shift your mindset and choose to be curious about how you can make meaningful connections.
Enjoy: Smiling and sharing good times (or good news) with people helps reduce loneliness and increase happiness.
1 Lam JA, Murray ER, Yu KE, Ramsey M, Nguyen TT, Mishra J, Martis B, Thomas ML, Lee EE. Neurobiology of loneliness: a systematic review. Neuropsychopharmacology. 2021 Oct;46(11):1873-1887. doi: 10.1038/s41386-021-01058-7. Epub 2021 Jul 6. PMID: 34230607; PMCID: PMC8258736.
2 Baek, E. C., Hyon, R., López, K., Du, M., Porter, M. A., & Parkinson, C. (2023). Lonely Individuals Process the World in Idiosyncratic Ways. Psychological Science, 34(6), 683-695. https://doi.org/10.1177/09567976221145316
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The lives of girls and women with ADHD are jeopardized by exponentially higher rates of self-harm, suicidality, and intimate partner violence, as compared with their neurotypical counterparts or with neurodivergent boys and men.
“ADHD in girls portends continuing problems through early adulthood that are of substantial magnitude across multiple domains of symptomatology and functional impairment,” write the authors of the Berkeley Girls ADHD Longitudinal Study (BGALS) follow-up study.1 “The sheer range of negative outcomes is noteworthy; the most striking include the high occurrences of suicide attempts and self-injury in the ADHD sample, confined to the childhood-diagnosed combined type.”
This is an arresting statistic, particularly considering how self-harm and suicidality have spiked in adolescent girls in general. The most recent CDC Youth Risk Behavior Survey (YRBS) report found that 1 in 10 girls has attempted suicide, and 1 in 3 of girls seriously considered suicide during the past year, which is an increase of nearly 60% from a decade ago.
Research suggests that neurodivergent girls face a significantly higher risk for self-harm than do neurodivergent boys, or neurotypical people of any gender. A 2020 study in European Child & Adolescent Psychiatry found that the rate of self-harm was four times greater in females than it was in males (8.7% vs 2.2%).2 A 2022 ADDitude survey found reports of self-harm among 18% of girls with ADHD versus 9% of boys with ADHD.
The correlation between teen girls with ADHD and self-harm is so strong that a 2021 study published in Child and Adolescent Mental Health proposed that all teen girls treated for self-harming behavior should be screened for ADHD:3 A full 83% of teen patients admitted to the hospital for self-harm were girls, the study found.
Indeed, early diagnosis and treatment of ADHD is critical to mitigating the risk of self-harm. “Girls and women with untreated ADHD are at double the risk for engaging in self-harm and significantly more likely to attempt suicide,” says Julia Schechter, Ph.D., of the Duke Center for Girls and Women with ADHD.
Low self-esteem, high rejection sensitive dysphoria (RSD), and social skill deficits put women and girls with ADHD at heightened risk for intimate partner violence (IPV). A study published in the Journal of Abnormal Child Psychology found that: 4
“Findings indicate that in young women, childhood ADHD is a specific and important predictor of physically violent victimization in their intimate relationships,” write the authors of the study. “Given the devastating impact of intimate partner violence, additional research on how to empower females with ADHD in their social and romantic relationships is greatly needed.”
The connection between SUD and ADHD has been well-established through research. We know that:
Among the general population, we know that teen girls are more likely to use substances than are teen boys. According to the CDC’s YRBS:
That said, studies on the prevalence of SUD among girls and women with ADHD have resulted in mixed findings. An elevated risk of substance use was found in a large-scale study led by Joseph Biederman, M.D.,8 however no such association was found in the BGALS follow-up.
Most recently, researched at the University of Minnesota conducted a study investigating how ADHD symptoms may influence substance use in women and men, and it found a stronger association between alcohol use and ADHD for young adult women than for young adult men.9
“The current study confirms that ADHD-associated risk for adult substance problems is consistently greater in magnitude for women,” the authors of the study write. “The presence of adult ADHD increases risk for substance problems in women more than men.”
No research exists on the relative efficacy of interventions that may reduce the risks for self-harm, suicidality, intimate partner violence, and substance use among girls and women with ADHD. Without fully understanding where these threats begin and how they escalate, we cannot devise and adjust solutions.
The BGALS follow-up study found elevated risks of self-harm and suicidality only among girls with combined-type ADHD, and not among those with inattentive symptoms alone, which leads researchers to speculate that impulsivity is associated with higher risk. Researchers also posit that psychosocial factors, such as the teen’s environment, contribute to the likelihood of self-harm. Longitudinal research is needed, however, to confirm this.
“What are the transition points — psychologically, family or school-related, community-wide — that predict impairment vs. resilience for girls with ADHD as they transition through adolescence to adulthood?” asks Hinshaw. “What are the strategies and supports that teen girls and women with ADHD find most helpful in self-advocacy and thriving?”
In the British Journal of Psychiatry,10 Hinshaw and doctoral student Sinclaire O’Grady call for longitudinal research on long-term correlated outcomes, such as the development of borderline personality disorder, as well as research into the intergenerational transmission of risk for negative outcomes in the children of women with ADHD.
Further research is needed to answer the following questions:
Researching suicidality, self-harm, intimate partner violence, and substance abuse among women with ADHD will, quite literally, save lives.
A study led by Russell Barkley, Ph.D., published in the Journal of Attention Disorders, found that life expectancy was 13 years lower for patients with combined-type ADHD diagnosed in childhood and with persistent symptoms, relative to control children.11
However, because of the severely limited number of females in the study, the findings are largely not relevant. No major study has investigated the impact of ADHD on life expectancy specifically in women.
With dramatically higher rates of self-harm and suicidality, as well as intimate partner violence, this research is desperately needed to protect women from bodily harm, as well as devastating emotional consequences.
Feelings of loneliness, RSD, emotional dysregulation, anxiety, and low self-worth exert a crushing emotional burden — and prompt some readers to harm themselves, to abuse substances, and to maintain toxic relationships.
“I made poor choices that led to abuse,” says Debs, an ADDitude reader in the United Kingdom. “I’ve taken substances to make the pain less, and I have self-harmed to try to take away the pain.”
“The inner turmoil just seems to get louder and louder and more difficult to turn down, which leads to unhealthy ways of coping like self-harm to help manage the stress,” shares Laura, an ADDitude reader in Texas.
“I abuse cannabis,” explains ADDitude reader Elizabeth, in the United Kingdom.
“Sometimes I feel worthless and want to self-harm because of RSD, assuming I’m not loved by my loved ones.”
“I get myself in relationships that aren’t good for me as I’m just happy that somebody finally loves me despite my flaws,” explains ADDitude reader Annika in Germany. “Self-harm comes into play when I feel like a failure because the relationship is rocky, and I get invalidated or criticized.”
“I constantly feel like I’m failing, which makes the thoughts about self-harm pop up often, although I haven’t given in to those for a while now,” says Lizzy in the Netherlands.
“I drink a lot right now,” says Nicole, an ADDitude reader in Washington. “I know it is unhealthy, but it is the only way for me to cope.”
“I have a history of self-harm, which was sometimes brought on my intense feelings of worthlessness and loneliness,” shares an anonymous ADDitude reader.
The long-term ravages of underdiagnosed and undertreated ADHD in women are dire — a matter of life and death in some cases. To develop effective interventions, research is essential.
“There is a critical need for studies into how increasing degrees of isolation, shame, and despair lead to self-harm and earlier mortality, exploring the relationships to early chronic trauma, impulsivity, poor self-care,” says Ellen Littman, Ph.D. “Research must respond to outcomes signaling such a significant public health crisis.”
“Too little is known about later-adult outcomes of females with ADHD,” write Hinshaw and O’Grady. “Overall, we contend that the extraordinarily high risk for self-harm incurred by girls with ADHD as they mature requires a shift in clinical perspective.”
“Girls and women with untreated or undertreated ADHD — or those who have been misdiagnosed with other conditions — have been put at higher risk for an array of negative outcomes including higher rates of depression and anxiety, intimate partner victimization, and risky sexual behaviors resulting in teen and unplanned pregnancies,” says Schechter. “Research specifically devoted to girls and women with ADHD is not only an issue of equity but a life-or-death issue for some girls and women.”
Related Reading
Intro: Top 10 Research Priorities
1 SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012 Dec;80(6):1041-1051. doi: 10.1037/a0029451. Epub 2012 Aug 13. PMID: 22889337; PMCID: PMC3543865.
2 Ohlis, A., Bjureberg, J., Lichtenstein, P. et al. Comparison of suicide risk and other outcomes among boys and girls who self-harm. Eur Child Adolesc Psychiatry 29, 1741–1746 (2020). https://doi.org/10.1007/s00787-020-01490-y
3 Ward JH, Curran S. Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health. 2021 Nov;26(4):303-309. doi: 10.1111/camh.12471. Epub 2021 May 3. PMID: 33939246.
4 Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.
5 Wilens T. E. (2004). Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. The Psychiatric clinics of North America, 27(2), 283–301. https://doi.org/10.1016/S0193-953X(03)00113-8
6 Charach, A., Yeung, E., Climans, T., & Lillie, E. (2011). Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 9–21. https://doi.org/10.1016/j.jaac.2010.09.019
7 Wilens, T. E., & Morrison, N. R. (2011). The intersection of attention-deficit/hyperactivity disorder and substance abuse. Current opinion in psychiatry, 24(4), 280–285. https://doi.org/10.1097/YCO.0b013e328345c956
8 Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Klein KL, Price JE, Faraone SV. Psychopathology in females with attention-deficit/hyperactivity disorder: a controlled, five-year prospective study. Biol Psychiatry. 2006 Nov 15;60(10):1098-105. doi: 10.1016/j.biopsych.2006.02.031. Epub 2006 May 19. PMID: 16712802.
9 Elkins IJ, Saunders GRB, Malone SM, Wilson S, McGue M, Iacono WG. Differential implications of persistent, remitted, and late-onset ADHD symptoms for substance abuse in women and men: A twin study from ages 11 to 24. Drug Alcohol Depend. 2020 Jul 1;212:107947. doi: 10.1016/j.drugalcdep.2020.107947. Epub 2020 Feb 27. PMID: 32444170; PMCID: PMC7293951.
10 O’Grady SM, Hinshaw SP. Long-term outcomes of females with attention-deficit hyperactivity disorder: increased risk for self-harm. Br J Psychiatry. 2021 Jan;218(1):4-6. doi: 10.1192/bjp.2020.153. PMID: 33019955; PMCID: PMC7867565.
11 Barkley, R. A., & Fischer, M. (2019). Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors. Journal of Attention Disorders, 23(9), 907-923. https://doi.org/10.1177/1087054718816164
]]>But if you’ve tried some of these ADHD interventions with limited success and ended up feeling like you “failed” at treatment, rest assured that you did not -— and you’re not alone in feeling this way.
In ADDitude’s recent treatment survey, we asked 11,000 readers about their experiences with 10 different kinds of treatments for ADHD, from medication to meditation. Readers shared what worked and what didn’t, plus stories of how painful the process of finding effective treatment can be, especially for those with rejection sensitive dysphoria (RSD), perfectionism, or feelings of shame.
“I felt as though I flunked mindfulness because I couldn’t pay attention for that long!” said one ADDitude reader. Another shared: “I felt like I was failing in talk therapy when I couldn’t talk in straight lines or remember what I had just said.”
Robyn, an ADDitude reader in Canada, simply said, “I always feel like I’m failing.”
[Read: ADHD and the Epidemic of Shame]
Many people are quick to blame themselves when supplemental therapies don’t work as rapidly or as well as they’d hoped. This instinct has everything to do with the wiring of the ADHD brain, explains Tamar Rosier, Ph.D., in the ADDitude article, “Silence Your Harshest Critic — Yourself.”
“Neurotypical people have prefrontal cortexes that act like a butler. ‘Sir,’ the butler calmly says, ‘your keys are on the table.’ Or ‘Madam, you must leave now if you want to be on time,’” Rosier explains. “Instead of a tranquil butler, individuals with ADHD have an angry neighbor threatening them with his shoe. ‘If you lose your keys again,’ he yells, ‘I’ll throw this at you!’”
Zak, an ADDitude reader in Florida has experienced this first-hand: “My doctor is still working with me to get the meds correct and I feel at times it’s my fault; that I am the one whose body is not adjusting.”
[Download: 2024 Scorecard of ADHD Treatments]
For many, these feelings of falling short or failing to meet expectations are amplified by RSD, which triggers intense emotional sensitivity and pain, explains William Dodson, M.D., LF-APA in “How ADHD Ignites Rejection Sensitive Dysphoria.” “For people with RSD, these universal life experiences are much more severe than for neurotypical individuals. They are unbearable, restricting, and highly impairing.”
This description resonates with ADDitude reader Calvin in Florida. “When I have tried things like mindfulness, exercise, or therapy, I have not had success and I just felt awful,” Calvin says. “I thought mindfulness might help to end the snow-piercer-like train that lives in my head, but instead I felt like a child unable to do a simple concept.”
In addition to the neuroscientific factors that play a role in triggering feelings of failure, a long history of negative experiences exerts a powerful force, says J. Russell Ramsay, Ph.D., ABPP, clinical psychologist.
“Adults with ADHD are often more susceptible to feelings of failure and defeatism when undertaking new endeavors,” Ramsay explains. “This is likely due to past experiences with setbacks, which often result in criticisms. This, in turn, makes adults with ADHD sensitive to the first signs that something seems to not be going well.”
Clinical psychologist Sharon Saline, Psy.D., agrees, adding: “These past struggles resemble a thousand paper cuts per day and accumulate over time into larger wounds which leave sensitive scars. Feelings of shame and not measuring up haunt folks and make it tougher to try new things.”
Experts agree that to optimize treatment for ADHD, trial-and-error is essential. The “error” part of that process can be demoralizing, but it is critical. To discover interventions that work, you’ll have to try ones that don’t — and knowing that from the get-go can be helpful.
“It is important to normalize setbacks as a part of the process of establishing new habits. It is rarely, if ever, a straight line,” Ramsay says. “Reframing a new habit as a challenge or as an experiment is important, as is setting up realistic expectations.”
“I have a hard time planning and sticking to a good regular habit, like exercise and mindfulness meditation. I used to get so aggravated with myself, and feel helpless,” says an ADDitude reader. “My therapist has taught me to not make a big deal of it and simply get back on track.”
Fine-tuning the therapies, lifestyle changes, and medications that best address your particular constellation of symptoms — and dealing with the emotional fallout of that process — is hard work, make no mistake. You can make that hard work a little easier by being kind to yourself, says Saline.
“Treat yourself with compassion, understanding that change usually involves forward motion along with some backsliding,” Saline urges. “Stumbling, regrouping and trying again is part of living for everybody—ADHD or not.”
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Teenage girls who often ruminate exhibit patterns of brain activity different from their non-ruminative peers after encountering social rejection, according to new research published in Developmental Cognitive Neuroscience.1 Increased activity was seen in the parts of the brain involved in developing self-concept, which researchers say suggests that ruminative teens internalize social rejection and integrate it into their view of themselves.
“Everyone experiences rejection, but not everyone experiences it in the same way,” explained Amanda Guyer, Ph.D., one of the study’s authors and associate director of the Center for Mind and Brain at the University of California at Davis. “Our results suggest that girls who tend to ruminate are experiencing more than just momentary sadness after rejection. They are deeply internalizing this negative feedback into their self-concept.”
The study, conducted by researchers at the UC Davis Center for Mind and Brain, involved 116 female participants, aged 16 to 19, who were asked to self-report their tendency to ruminate, defined by the study’s authors as engaging in repetitive, negative thought patterns. The participants were also asked to perform two tasks related to social selection. In their initial visit, participants viewed photos of 60 teens, and were prompted to select 30 they’d like to talk to online. At the follow-up visit, the teens were informed of which of those selected teens had chosen them, and which teens had not. While receiving this information, the teens received functional MRIs to measure blood flow and electrical activity in different areas of the brain.
The study showed that, among girls who ruminate, there was increased activity in the parts of the brain associated with developing one’s sense of identity and interpreting the intentions of others. This led researchers to conclude that ruminative teen girls tend to deeply reflect on the negative feedback of social rejection, incorporating it into their self-concept.
This type of emotional distress is frequently experienced by people with ADHD, among whom rejection sensitivity is common, and painful. “The emotional intensity of rejection sensitive dysphoria (RSD) is described by my patients as a wound.” explains William Dodson, M.D., in his ADDitude article “New Insights Into Rejection Sensitive Dysphoria.” “One-third of my adult patients report that RSD was the most impairing aspect of their personal experience of ADHD.”
The pattern of brain activity revealed in the study also helps explain why teen girls who ruminate are compelled to analyze peers’ behavior, particularly social rejection, which researchers say “aligns with high ruminators’ need to understand a situation and their propensity to ask ‘why’-type questions.”
The study also found that rumination caused increased activity in the parts of the brain associated with working memory. Researchers believe that because ruminative teen girls are using much of their working memory to revisit negative social feedback, it may be harder for them to perform cognitive tasks that demand working memory.
For individuals with ADHD, who frequently struggle with deficits in working memory, this may cause additional strain on already limited resources.
By demonstrating the neurobiological basis of rumination and its relationship to rejection sensitivity, the study reveals the importance of equipping teen girls with strategies to decrease rumination.
Left unaddressed, rumination, which is more common among girls than boys, is associated with a higher incidence of many mental and behavioral health challenges. Previous research has demonstrated that rumination is a risk factor for:
To avoid these negative outcomes, the study’s researchers stress the benefit of interventions that break the rumination cycle.
“Our study suggests that it can make a difference to reframe their [teens’] negative experiences in a way that makes them feel better afterward instead of worse,” said Guyer.
These strategies may be particularly important for individuals with ADHD, among whom patterns of negative thinking are common.
“Obsessing and ruminating are often part of living with ADHD,” explains ADHD coach Beth Main in her ADDitude article, “ADHD and Obsessive Thoughts: How to Stop the Endless Analysis.” “No matter how hard you try to ignore them, those negative thoughts just keep coming back, replaying themselves in an infinite loop.”
Rather than attempting to ignore ruminative thoughts, Main suggests the following strategies:
1 Yoon L, Keenan KE, Hipwell AE, Forbes EE, Guyer AE. Hooked on a thought: Associations between rumination and neural responses to social rejection in adolescent girls. Dev Cogn Neurosci. 2023 Dec;64:101320. doi: 10.1016/j.dcn.2023.101320. Epub 2023 Oct 30. PMID: 37922608; PMCID: PMC10641579.
2K.A. McLaughlin, S. Nolen-Hoeksema, Rumination as a transdiagnostic factor in depression and anxiety, Behav. Res. Ther., 49 (3) (2011), pp. 186-193.
3A. Grierson, I. Hickie, S. Naismith, J. Scott. The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models.
4J. Ying, J. You, S. Liu, R. Wu. The relations between childhood experience of negative parenting practices and nonsuicidal self-injury in Chinese adolescents: The mediating roles of maladaptive perfectionism and rumination
Child Abus. Negl., 115 (2021), Article 104992.
5L.M. Hilt, C.A. Roberto, S. Nolen-Hoeksema. Rumination mediates the relationship between peer alienation and eating pathology in young adolescent girls. Eat. Weight Disord. -Stud. Anorex., Bulim. Obes., 18 (3) (2013), pp. 263-267.
6Y. Li, S. Gu, Z. Wang, H. Li, X. Xu, H. Zhu, et al. Relationship between stressful life events and sleep quality: rumination as a mediator and resilience as a moderator. Front. Psychiatry, 10 (2019), Article 348.
7K.A. McLaughlin, S. Nolen-Hoeksema, Interpersonal stress generation as a mechanism linking rumination to internalizing symptoms in early adolescents, J. Clin. Child Adolesc. Psychol., 41 (5) (2012), pp. 584-597.
As someone who also feels emotions intensely (growing up, my parents called me Super Sensitive Sharon), I understand completely where you’re coming from when you question the validity of your feelings. When I have big feelings, I truly think that something is the matter with me. The typical thoughts in my head are, “What is wrong with me that I’m getting this upset? No one else seems to be reacting this way.” But as I’ve learned, and as I hope you’ll come to learn, there is nothing wrong with being sensitive. (It’s really helped me in my career as a psychologist.)
Your feelings are valid — RSD or not, neurotypical or not. You are entitled to have your emotions however you would like to have them. Is it true that your ADHD brain is wired to feel emotions more intensely? Yes. And we can’t talk about ADHD without bringing up emotional dysregulation, which also affects how you process emotions. It’s also the case that RSD makes it difficult to perceive responses neutrally; you may perceive injury or threat where there is none.
[Get This Free Download: Understanding Rejection Sensitive Dysphoria]
But penalizing yourself for feeling how you’re feeling is counterproductive. It’s much more helpful to normalize your feelings. More importantly, you can acknowledge your emotional reactions and still investigate them.
Checking in with a friend, partner, coach, therapist, or anyone who understands the type of brain that you have is a good, safe way to gauge your interpretation of a situation. Say, “This thing happened, and I’m not sure if I’m overreacting. What do you think in this situation? How would you feel if someone said this to you?” These conversations can help you reframe the situation. You may find that the remark someone directed at you was simply a thoughtless comment that bears no reflection on who you are. Or maybe the situation was that unfortunate; if that’s the case, focus on the fact that you survived it, and think about what you’ve learned from it.
Regardless of whether RSD is in the picture, I’d like to leave you with a parting thought by Maya Angelou: “You may not control all the events that happen to you, but you can decide not to be reduced by them.”
The content for this article was derived from the ADDitude ADHD Experts webinar titled, “RSD Toolkit: Strategies for Managing Your Sensitivities in Real Time” [Video Replay & Podcast #476] with Sharon Saline, Psy.D. which was broadcast on October 19, 2023.
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Apparently not. “Only 27 likes?” my brain scoffed. My mother-in-law’s voice rang in my ears: “Your expectations are your worst enemy.” I hate it when she’s right.
The truth is that she’s going to be right as long as I have ADHD, which, unfortunately (but, also fortunately), will be always. Rejection sensitive dysphoria (RSD) exists, and learning about it for the first time as a clinical psychologist allowed me to better understand my patients and finally name one of the most perplexing aspects of my own ADHD. I understood why I couldn’t handle rejection in all forms, including the rejection that is baked into social media use.
I’ll admit that the time I spent off social media was incredible. The world looked and felt brighter and clearer when I finally put down the phone and took a look around. But after seven years, social media has called me back – a desire that has caused equal parts confusion and intrigue.
I’m not back for the likes or validation. I returned because, as a psychologist who specializes in working with children, teens, and young adults, I have something to say to youth struggling with mental health challenges today. I want to be there for them, and I cannot be heard or reach youth, I fear, without using social media.
[Read: Compare & Despair – Social Media & Mental Health Concerns in Teens with ADHD]
Since re-entering the social media sphere and navigating the sensory overload that is YouTube and TikTok (I’m @drgillykahn on both platforms) I’m taking note of the healthy social media habits that are keeping me balanced – habits that may help you use social media in a healthy way, too.
1. Ask yourself why you’re using social media. You’re more likely to have positive experiences with social media if you tie its uses to a concrete purpose or value – like staying in touch with people you care about. Notice how you feel as you visit platforms and consider if the benefits outweigh the costs. It may be time to limit your use or get off certain platforms completely if social media is encouraging compare and despair, keeping you up at night, and anxiously attaching you to your phone.
2. Stick it to The Man. Think of social media breaks as a way to stick it tor the corporate giants who use you as pawns for consumerism and data collection. That’s another reason to use social media with intention, not passively. In other words, use social media in the same way that it uses you. Joke’s on you, social media!
3. Don’t be afraid to create physical distance from your phone. I remember the good old days when we had a landline and had to sprint across the house to answer the phone. Nowadays, it’s like our phones are fused to our hands. Unless you have a valid reason for keeping your phone near you, keep it in your bag, in another room, or out of sight somehow. If you must, build up to keeping your device away in 30-minute increments. Take it a step further by disabling notifications.
[Read: “My Phone Was My Drug”]
4. Remind yourself that social media is not real life. If you catch yourself in an RSD or comparison spiral after spending time on social media, ride out the wave of your emotions and then remind yourself that a lot of what you see on these platforms is simply not representative of reality. There aren’t beauty filters to activate on the fly in real life, for one, and most people only post the good part of their days, not the boring or negative stuff. Also remember that the relative anonymity of the Internet often emboldens users to post mean comments; don’t let this skew your perception of how interactions actually work in the real world. Your emotional responses to negative experiences online are valid, but keep in mind that platforms are designed to raise the volume on entertainment and drama while often muting sensitivity to, well, rejection sensitivity.
5. Let RSD inspire your posts. Shake things up by showing the world that being vulnerable is acceptable and admirable. Our heightened sensitivities should be nothing to be ashamed of. Allow yourself to be yourself on social media and consider sharing your emotional experiences in the moment. Who knows, maybe you will help someone recognize RSD in themselves and encourage others to spread support and acceptance of big emotions as a pertinent and underrecognized aspect of ADHD.
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Healthy friendships help people feel supported, provide a sense of belonging, and stave off loneliness. But for many neurodivergent adults, making and keeping friends is a lifelong challenge. They might overshare, struggle to fully listen, and experience social anxiety, all of which can lead to feelings of rejection. To try and avoid these feelings, many adults adopt people-pleasing behaviors or wall themselves off from others.
In this webinar, Caroline Maguire, M.Ed., will explain strategies to help adults with ADHD and co-existing conditions feel empowered, raise their levels of confidence, and understand the friendship strengths they have to offer. Learning how to stand up for yourself, set healthy boundaries, and speak from the heart are important skills in developing and maintaining friendships that are valued and healthy.
In this webinar, you will learn:
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.
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; Audacy; Spotify; Amazon Music; iHeartRADIO.
If you attended the live webinar on November 2, 2023, 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 »
Caroline Maguire, M.Ed, ACCG, PCC, earned a master’s degree at Lesley University with a specialization in social emotional learning (SEL). She is the author of the award-winning book, Why Will No One Play with Me? written to coach emotional regulation, social and self-awareness, and responsible decision-making skills. She founded The Fundamentals of ADHD Coaching for Families training program at the ADD Coach Academy which is accredited by ICF. Visit her website, CarolineMaguireAuthor.com, follow her @AuthorCarolineM and download her free video, How to Tell a Tighter Story.
“This webinar was incredibly helpful, and I love how both relatable and insightful Caroline Maguire was.”
“Thank you for putting normalcy around this!”
“Wow, I learned so much about myself. This webinar brought to light some of the barriers I face that I didn’t even know were connected to ADHD! Thank you!”
“Loved this! I really needed to hear about the topic of friendship. I just turned 60 and have never been diagnosed but know without a doubt. I appreciate the speaker’s honesty and knowledge.”
The sponsor of this ADDitude webinar is…
Brain Balance is an integrative cognitive development program designed to help kids, teens and adults with ADHD, Learning Differences, Anxiety & beyond. An exploratory study with Harvard’s McLean Hospital found the Brain Balance Program to be as effective as low-dose stimulant medication in alleviating ADHD symptoms in children. Visit brainbalance.com to learn more about Brain Balance today.
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Do you ever feel so devastated by criticism or ‘constructive’ feedback that you shut down and recovery seems impossible? Is it overwhelmingly tough to rebound after feeling left out or saying something you regret? Rejection sensitivity dysphoria (RSD) is almost ubiquitous with ADHD, though it’s not included in the condition’s formal diagnostic criteria.
RSD refers to unbearable feelings of pain following an actual or perceived rejection. These intense feelings, directly related to emotional dysregulation, lead to an expectation that others will pull back their support, love, or respect. In this webinar, award-winning author, international speaker, and consultant Dr. Sharon Saline will show you how to manage the heightened emotional sensitivity that often accompanies ADHD. She will explore various treatment options and practical techniques for managing RSD in real time based on cognitive behavior therapy, positive psychology, and mindfulness.
In this webinar, you will learn:
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.
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; Audacy; Spotify; Amazon Music; iHeartRADIO.
If you attended the live webinar on October 19, 2023, 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 »
Sharon Saline, Psy.D., clinical psychologist and author of the award-winning book, What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life and The ADHD Solution Deck. (#CommissionsEarned) She specializes in working with children, teens, emerging adults and families living with ADHD, anxiety, learning disabilities, autism, twice exceptionality and mental health issues. Her unique perspective, as a sibling in an ADHD home, combined with decades of experience as a clinical psychologist and educator/clinician consultant, assists her in guiding families and adults towards effective communication and closer connections. She lectures and facilitates workshops internationally on topics such as understanding ADHD, executive functioning, anxiety, motivation, different kinds of learners and the teen brain.
#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.
“Fantastic seminar. Will be watching it again with my whole family.”
“This felt like someone scooped out my brain and put it in a slide deck. So insightful.”
“Thank you all for talking about RSD. It’s so validating to hear that I’m not alone and to get more information and knowledge surrounding this debilitating symptom.”
“I don’t miss any presentation Dr. Sharon provides; she is a huge asset to the ADDitude community. ”
The sponsor of this ADDitude webinar is….
Inflow is the #1 app to help you manage your ADHD. Developed by leading clinicians, Inflow is a science-based self-help program based on the principles of cognitive behavioral therapy. Join Inflow today to better understand & manage your ADHD.
ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.
Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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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.
Remind them of situations that contradict those beliefs. Help them to recall times when they felt uncomfortable and did something anyway.
[Self-Test: Could You Have Rejection Sensitive Dysphoria?]
Name and reinforce their strengths. Pay attention to what is going well. Give examples of their successes.
Help them combat the negative messages they tell themselves by prompting them to create positive self-talk phrases. Practice these so they will be familiar and handy when they are needed most.
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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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.
Intense fear of negative judgment from others is a common marker of social anxiety disorder. Other signs include:
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?]
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.
[Download: Social Anxiety Facts and Falsehoods]
To navigate social situations:
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.
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.
Though it’s not included in the condition’s DSM-5 criteria, DESR and emotional impulsivity are fundamental components of ADHD that shape an individual’s experiences and challenges throughout their lifetime.
Because DESR is a novel concept to many, questions abound. Below, I answer several posed during my recent ADDitude webinar titled “Deficient Emotional Self-Regulation: The Overlooked ADHD Symptom That Impacts Everything.”
Emotional dysregulation does change and it can improve, but it depends on the individual and the factors involved. For instance, emotional self-regulation is rarely elevated as an issue in toddlers. We don’t expect 4-year-olds to manage their emotions very well. Parents are typically more concerned with the impulsive aspect of emotion at this stage.
But by the time we get into late adolescence, and especially adulthood, we do expect individuals to have developed that second stage of emotional control: top-down executive management (or moderating emotional reactions to evocative events). However, DESR impairs just that —processes related to emotional self-regulation. And that leads to more disparaging moral judgment about adults with ADHD than it would in much younger individuals.
It’s almost like the two components of this emotion problem in ADHD — emotional impulsivity (EI) and DESR — trade places as individuals age. The former is more problematic in children, while the latter becomes a more compelling deficit for the adult individual.
[Get This Free Download: 5 Emotional Control Strategies for Kids with ADHD]
We also know that ADHD symptoms fluctuate over time for many individuals, which may mean that issues like emotional dysregulation also change in severity or degree of impairment. And keep in mind that ADHD mostly persists to some degree from childhood to adulthood for 90% of people.
But can emotional regulation be “trained?” In children, the chances of that are quite slim because they haven’t yet developed the appropriate self-regulation skills that such training would require. Interventions like medication, parent training, and controlling for environmental triggers may be most helpful for this stage. Adults, however, may benefit from cognitive behavioral therapy (CBT) and mindfulness-based programs especially reformulated for adult ADHD in recent books, both of which help the individual deal with many aspects of emotional dysregulation.
Generally, we know that males are more prone to exhibit aggression and hostility, which are associated with externalizing disorders, while females are more prone to anxiety and mood disorders. Both, however, do struggle with impatience and frustration, and the emotional dysregulation component in ADHD will only exacerbate that.
DESR usually appears between ages 3 and 5, though it may be quite obvious in a younger child who is significantly hyperactive and impulsive. Still, many families write off this behavior, believing it to be developmentally normal (i.e. the terrible twos), only realizing later on that the child is quite hot-headed and emotional compared to peers. Some of these children will go on to develop oppositional defiant disorder (ODD). If we accept DESR as a core feature of ADHD, we can see why the disorder poses such a significant risk for ODD and related disorders.
[Read: Why Is My Child So Angry and Defiant? An Overview of Oppositional Defiant Disorder]
It will be very, very difficult to do so. With ADHD in children, we’re looking at a dysregulated brain with a highly variable, immature executive circuitry — part of which includes this problem with emotional expression and regulation. To expect to try to find some other social or psychological intervention that can change that underlying neural network problem is asking for too much of psychotherapy. It may be best to work with the aforementioned interventions as parents await the greater maturity of these neurological systems that comes with further development.
Yes — sometimes medications can create their own problems. Stimulants, for example, may create emotional blunting, which is the absence of natural emotion in some children or adults. As stimulants wear off, it’s not uncommon for the emotional brain to go through a rebound. In some cases, that may look like irritability, a proneness to weepiness or crying, and sadness.
These experiences with stimulants are not universal, but remember that you’ve been suppressing an emotional brain and, as medication wears off, that could come to the fore. We don’t see this issue with non-stimulants so much because they’re not suppressing the emotional circuitry of the brain. Ultimately, each drug works on the brain a little differently, and therefore works on emotion a little differently. It’s why some clinicians sometimes opt to combine these medications to get much broader coverage over patient symptoms than any single drug could do alone.
Let’s say a child is engaging in some defiant, oppositional behavior. A parent with ADHD may experience a much stronger reaction to that compared to a typical parent. They might exhibit a more impulsive reaction of anger or hostility toward the child, or they may arrive at that level of emotional upset faster than would a parent without ADHD.
When a parent exhibits these behaviors, they are, in effect, modeling these reactions to their child. They are also provoking the child, who has their own emotional regulation problems. What you have, I think, is an emotional tornado in the family — each person is triggering the other to higher levels of conflict.
It’s bi-directional. Research suggests that ADHD, because of the emotional dysregulation factor, especially, puts children at a higher risk for exposure to trauma. And once trauma has occurred in a child with ADHD, it’s more likely to progress to a PTSD reaction. This is why ADHD is one of the strongest predictors of who will develop PTSD if exposed to trauma. Once PTSD develops, it will only worsen existing emotional regulation problems.
Absolutely not. It is never too late to get help for ADHD and its symptoms, even if emotional dysregulation has been an impairing factor for a long time. Multiple studies show that a diagnosis in late life and subsequent treatment only benefits the individual.
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