Does your teen get angry really easily – have emotional meltdowns over things you just don’t understand? Do they hate going to school? Do they have outbursts of extreme rage?

Maybe your child has been diagnosed with ADHD, anxiety, depression, or another mood or personality disorder.

Well today I want to talk to you about how all of these issues overlap symptomatically and tell you about a symptom of one, that I’d never even heard of until a couple of weeks ago – and it’s one that you really need to know about. Stay with me.

This is Speaking of Teens, the podcast that helps parents who are struggling to find peace and connection with their teens. My name is Ann Coleman; I’m an attorney turned parent educator and a mom who’s been there - and I want to help you build a stronger relationship and decrease the conflict with your kid so you can help them grow into the young adult they’re meant to be.

If you’ve listened to the podcast in the past you’ve likely heard me talk about how teens are in general, are more emotional because of the way their brain is changing all throughout adolescence. They’re embarrassed, self-conscious, focused on fitting in and being liked, very sensitive to being respected, feeling autonomous, being heard, and their brain is wired to view almost everything around them as an attack – a threat.

The emotional center of the brain – the amygdala is super sensitive and it interprets so many things as threatening that really are not. The amygdala is our threat detector and it’s what causes us to run when we see a snake or jump out of the way of a fastball or walk the other way when someone menacing is walking up the street.

And it certainly serves a great purpose when there are actual threats like that. But unfortunately, because civilization has advanced faster than our brains have adapted, it still thinks we’re living in the wild with deadly animals and roaming bands of cannibal tribesmen around every corner – so it looks for threats all over the place.

And because the teenage brain’s amygdala is even more sensitive, it interprets so many things that are benign as threatening. Like saying no to a sleepover or asking them how they did on a test, looking at them a certain way. Anything can set their amygdala off and cause the fight or flight response. So their brain and body is flooded with cortisol and other neurotransmitters that cause rapid heartbeat, blood rushing to the extremities, sweating, and all kinds of fun things.

And they call it the fight or flight response because that’s exactly what it causes – we fight – stand our ground or we hide, duck, run away. We do what it takes when a threat presents. So, what happens when a teen misinterprets something as threatening when it isn’t? they still have that same fight or flight response and you’re standing there thinking what in the heck just happened? Why did they just completely go off the rails because of that.

And when the brain goes into fight or flight over something, it’s sort of primed the pump for it to happen again. And the next time, primes it for the 3^rd time and so forth.

Remember what I’ve said before about those synapses in the frontal lobe? They are busy right now pruning and strengthening – they’re very plastic. The more an adolescent does something, the more their brain experiences something, the stronger those synapses for doing that thing, become. And the stronger they become the easier it is to do it the next time. That’s why addictions and dependencies are such an issue during adolescence. That’s also why anxiety can become an issue. When the amygdala goes off over and over, that’s where anxiety disorders develop.

And of course, while the prefrontal cortex is doing all this pruning and strengthening of synapses it’s connection to the other parts of the brain like the amygdala and reward system are tentative at best. And it’s the prefrontal cortex that regulates executive functions like focus, short term memory, planning ahead, organizing, making good decisions regulating impulses – self-control.

So, teens in general have a really difficult time with most of these things since both their amygdala and their reward system are super hyped up.

But when you throw in a mood disorder like anxiety or depression or ADHD, you see major issues in all these executive functions and with ADHD, your kid will be delayed from somewhere between 2 and 3 years in that area.

So, starting from the baseline of a neurotypical teen without mood disorders, you already have the weak prefrontal cortex and the hyper amygdala and reward system (which causes the risky behaviors – I’ll link to an episode about that) – so most teens have this low hum of nerves and recklessness in the background in their brain which can pop to the front at any time causing crying, yelling, getting angry or hurt over very benign things, doing things they should not do. That weak prefrontal cortex also causes issues with motivation, staying on task, planning, and organizing – school work.

But a kid who’s amygdala has been poked and poked and poked so much that they now have an anxiety disorder – they’re like a typical teen squared – their bad moods and flip outs will be much more intense. They will be super irritable, easy to anger, flip out, even become irrationally rageful. They’ll also be more likely to try drugs or substance to help ease their symptoms.

And because the prefrontal cortex is so weak, the more anxious a kid is, the less they will be able to concentrate and focus on school, on homework, on projects or reading – even on tasks like chores – all those executive functions just tank. And guess what that looks like? Yep – ADHD.

Then what about ADHD? Again, it’s like the typical teenager squared. Executive function issues? Oh yeah – lack of focus, planning, organization, motivation (except for things they’re interested in) self-control and decision making is also way off base, which is why teens with ADHD are also more prone to risky behaviors like drug use.

But neurodevelopmental disorders like ADHD (and I’ll add, Autism Spectrum Disorder - ASD) also cause issues with emotion dysregulation. Researchers don’t know the exact mechanism by which this happens but it does happen in somewhere around 75% of kids with an ADHD diagnosis (and in an even bigger percentage that also have a hyperactivity diagnosis.)

A teen with ADHD has two problems with their emotions – a) they experience negative emotions very suddenly – like drop of a hat, they can have really sudden outbursts and b) they have a hard time regulating their emotions – being able to manage them and respond appropriately.

So, a typical adolescent is moody and quick to anger – an ADHD adolescent is going to be moodier more often and longer and be really prone to anger quickly, get extremely frustrated when working on a difficult task, get really nervous about something that makes no sense to you…their reactions will seem overblown and irrational and they have a really hard time calming down and getting back down to baseline. And all of this usually is served up with a hefty dose of defiance and disrespectful behavior.

Now let’s look at a teen with depression. In addition to other symptoms (you can listen to episodes 51 and 53 on depression) - teens with depression can be extremely irritable, angry, even rage-filled, and seemingly unhinged. They are often very defiant, lash out at parents, authority figures, use drugs and other substances.

Of course, other mood disorders like bi-polar disorder and even personality disorders like borderline also impact mood or emotional regulation.

So with all of the overlap here, it’s confusing to say the least! Then when you throw medications on top, many of which cause side effects like anxiety or irritability, or your kid’s self-medicating with who knows what – it can be even more convoluted and hard to pinpoint exactly what’s going on. Oh and wait – there’s the sleep deprivation that all teens suffer – executive function suffers and it makes anxiety worse.

But hang on – I’m about to throw something new in the mix, that I’d not even heard of until very recently. It’s something that is most often associated with ADHD and it muddles up the picture even more because it also causes emotional dysregulation. I mentioned it in the newsletter on Tuesday and posted an article about it I think a few weeks ago in the Facebook group.

It’s called rejection sensitivity – or the more pronounced version of it is called Rejection Sensitive Dysphoria.

Now stick with me for this – it’s important.

According to the Cleveland Clinic, rejection sensitivity can make someone feel severely anxious, or angry even by just thinking that someone may criticize, judge or disapprove of them – much less a real rejection of some kind.

It can make it really hard for them to interpret neutral or vague reactions from someone as anything but a rejection.

And it can cause someone to act out towards a real or perceived rejection with huge overreactions of anger, rage or anxiety or major sadness.

So that’s rejection sensitivity but if you have what they call RSD or rejection sensitive dysphoria – it’s even worse. People with RSD don’t just misinterpret, overreact, or feel angry, rageful, anxious or sad…they feel intense or overwhelming emotional pain like nothing else describable. They often don’t even have the words to describe it – they just say it’s intense, horrible, awful.

In teens with RSD, when they feel they’ve failed somehow or are being criticized, or someone’s showing disapproval – all of this is like a rejection – and it’s almost impossible for them to control the anger or rage or the intense sadness or nervousness – so it’s an enormous lashing out or falling apart.

And so, these kids are often misdiagnosed with a sudden onset of severe depression or even bipolar disorder or borderline personality disorder. It’s also misdiagnosed as social phobia because people with RSD are terrified of being embarrassed in public, of people thinking bad of them.

There’s just not a ton of research available on RSD but it does appear to happen most often in people with ADHD. Dr. William Dodson who writes for ADDitude magazine says that people with ADHD typically learn to deal with RSD in a couple of different ways – maybe both.

1. They just become a people pleaser – they get so wrapped up in avoiding rejection that they basically mold themselves into whatever anyone else likes, and/or
2. They just avoid doing anything that they fear they won’t look good doing, a fear of failure – if it’s risky, they avoid it. That could be anything from going out for a sports team to applying for a certain college.

So rejection sensitivity or RSD may explain a lot for you if you’ve seen this type of behavior in your ADHD teen.

On the other hand, because all of these issues have so much overlap and you and I may not know the line between typical teen behavior and a teen with a mood disorder, ADHD, ADHD with RSD on top, a personality disorder, sleep deprivation, or substance abuse - these issues should be deeply researched, and multiple professionals should be involved if at all possible. And when I say researched, I mean do your own research as well as take them to professionals. You know your child better than anyone else. Learn what you can, journal your kid’s behavior, their moods, their thoughts if they share them, their sleep patterns, and let the professionals know.

Honestly, looking back, I would not ever take the first opinion as truth. As you can see just from listening to this podcast, neurodevelopmental disorders and mental health disorders should not be diagnosed in a half-hour visit to the pediatrician’s office. An improper diagnosis can do a lot of damage. Not only because the real issue is overlooked and not addressed but because the treatment for the issue someone doesn’t have, can be really damaging.

Don’t stop seeking until you’re 100% sure. Listen to the episode I did on the trouble with a mental health diagnosis (episode 29) and the one on getting a higher level of care for your teen (episode 7). If I had taken a psychiatrists word for it when my son was in residential treatment, he would still be on medication for bipolar disorder despite not having it. I took him to UCLA and had a world-renowned expert in adolescent bipolar disorder evaluate him to be sure that diagnosis was right – and it was not. And guess what – he took insurance just like many other doctors.

Be careful out there. Know that emotional dysregulation is normal for neurotypical teens and that kids with any other disorder, it’s going to be majorly ramped up. Some more than others. Don’t assume it’s drugs. That may play a role - but it could be so many things. Find the right experts, do your own research, get second opinions. The information is out there, you just have to look. And above all, understand that neurotypical, neurodivergent or mental health disorder, if they could control their emotions they would. You have the adult brain, you can learn to regulate your emotions much easier than they can. Study emotion coaching, download my guides, listen to the podcasts. Learn to deal with their emotional dysregulation and help them through it, no matter what it stems from. I’ll have lots of links for you in the show notes.

Okay, that’s it for Speaking of Teens today. Thank you so much for listening and sharing the podcast, and for your kind remarks on social and your reviews – it means the world to me just to know I help you even a little bit.

If you’d like to talk more about your teen, come on into the Facebook group – the link is at the very bottom of the episode description in your app.

Until next time, remember, a little change goes a long way.