It’s NOT your imagination – if you have a teen with an ADHD diagnosis, those emotions are extra – why the heck didn’t anyone tell us about this?? Why weren’t we warned??

Maybe I’m all alone here but I don’t think so.

I’ve looked at websites run by The American Academy of Child & Adolescent Psychiatry, The Mayo Clinic, Johns Hopkins, McLean Hospital (of Harvard Medical School), and the CDC.

Not a single one of these websites ever mention the emotional dysregulation element of ADHD.

I even watched an hour-long video presentation from McLean hospital entitled “What You’ve Always Wanted to Know About ADHD” and the term “emotional dysregulation” was mentioned one time in passing – and never addressed further.

The websites, the psychiatrists, psychologists, pediatricians, counselors, the schools, will all tell you that ADHD symptoms revolve around inattention, hyperactivity, and impulsivity.

They all fail to mention the giant elephant in the room, the thing most experts don’t really know what to do about, the thing that’s super hard to study scientifically…the emotional element.

I knew ADHD was to blame for some of my son’s emotional issues (his intolerance for frustration, his meltdowns over homework), I knew the statistics about kids with ADHD and the trouble they could find themselves in during the teenage years, but we focused more on the academic issues with his ADHD … and for his emotional outbursts, we generally blamed his anxiety, the ADHD medications and later, his misuse of drugs

So, it really wasn’t until just this past week while doing research for this episode, reading the latest scientific research that I’ve finally gotten a clear picture of the enormity of this diagnosis…and the many ways it can impact our teens’ lives – and that’s what I want to share with you today:

how emotional dysregulation is a fundamental element of ADHD (no matter the specific type),

the other issues that tag along with ADHD that can also cause emotional dysregulation for your teen

the problems their emotional dysregulation (and other ADHD symptoms) can cause for your teen, and

what the research says you can do to help them with their emotions and the fallout from them.

And I want to go ahead and ask that you please be sure and pass this episode on to a mom with a child of any age, who’s been diagnosed with ADHD – the earlier one has this information, the better. I would have given anything to have known all this a few years ago.

You’re listening to Speaking of Teens, a weekly show to help you better understand and parent your teen or tween.

I’m Ann Coleman, and after surviving a couple of difficult years with my teenage son, I decided to make the leap from practicing law into the science of parenting teens and tweens. I want to make sure you have the skills I was sorely lacking.

The DSM-5 (American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition) only mentions 3 categories of symptoms for ADHD -  inattention, hyperactivity, and impulsivity – that’s it

So, ADHD is generally put in this box as a neurodevelopmental disorder that messes with the way the brain processes non-emotional information…a deficit of the brain’s executive functions causes all these problems with problem solving, planning ahead, focusing, working memory, being still, self-control…

When ADHD is discussed, it’s usually in relation to school and academics – we have conferences with the teachers, have IEP meetings, we’re told to stay on top of them about their homework and studying

We end up wondering why our kid has such an intense personality or is so emotional about everything…we wonder what’s wrong

And you know what? It really makes me angry that I didn’t know this – that not one of the many counselors, psychoeducational evaluators, psychiatrists, psychologists…no one ever mentioned that ADHD could cause emotional dysregulation – not ever.

That’s a big deal – because not being able to regulate your emotions can have an enormous impact on their lives and it’s crucial for parents to understand.

Knowing this enables us to have more empathy, to cut them some slack where it’s needed, to watch out for things…

There are a lot of researchers sitting around out there with all this information about how ADHD causes difficulties in processing or regulating emotions and so much of is not trickling down to us parents – or at least not to those of us with teenagers -

So, let’s get into it

Since ADHD is a neurodevelopmental issue and we’re talking about adolescents here, we need to start with the neurotypical adolescent brain…which is already causing problems for our kids’ emotions and behavior

I talked to you about the adolescent brain back in episodes 3 and 4 so if you want more, please go back and listen to those episodes,

So, here’s the very condensed and very general version of what’s happening in the adolescent brain before throwing ADHD on top:

Right before puberty the brain begins its last push to finish the last 5% of brain growth.

The neurons or brain cells begin growing all these billions of extra connections in the brain’s frontal lobe.

These connections are called synapses and they pass chemical messages called neurotransmitters (like serotonin, norepinephrine, oxytocin, dopamine) throughout the brain and the rest of the body over these vast networks of neuron pathways

And when puberty begins, the brain starts pruning away the synapses – these connections - that aren’t being used regularly and strengthening the ones that are being used all the time (basically, this means whatever a kid is doing more of, he or she gets better at and whatever they’re ignoring, they may lose the ability to do that) – like subjects in school, sports, musical instruments, a foreign language…OR drinking, doing drugs, vaping…both positive and negative things)

This pruning begins in the back of the frontal lobe and slowly moves towards the front – to the prefrontal cortex – so the prefrontal cortex is the last part of the brain to fully develop

The problem for adolescents is that the prefrontal cortex, while all this pruning and strengthening is going on, is not good at all at doing its main job – handling executive functions like organizing thoughts, reasoning, solving problems, planning ahead, focusing attention, delaying gratification, managing intense emotions, behaving appropriately under specific circumstances, making good decisions, using self-control

At the same time, 2 other areas of the adolescent brain are hyper sensitive – all revved up and raring to go: the amygdala and the reward system.

Generally, the amygdala is associated with automatic emotions – reactions to threatening stimuli in the environment. For example, you’re in a quiet room (you think you’re alone) and someone screams in your ear - you jump and maybe scream too – but you fairly quickly calm down when you see it’s your 6-year-old nephew!

That’s the amygdala evoking an automatic response called fight, flight  or freeze (accompanied by either fear or anger) – and in an adult, with a fully functional pre-frontal cortex to regulate your response and those emotions, you’re able to immediately calm yourself once you see it’s just a kid

But in adolescents a) the amygdala is extra jumpy and revved up and makes lots of mistakes and thinks things are threatening when they’re really not - for example, you ask your teenager to pick up their little sister from dance lessons, and they freak out and start yelling or you ask them if they’ve done their homework and they storm off and slam the bedroom door – or they totally wig out over a test they have tomorrow – that’s the adolescent amygdala making a mountain out of a mole hill

And it’s the prefrontal cortex’s responsibility to manage intense emotions and calm the amygdala down but it’s too weak during adolescence from all the pruning and strengthening going on, to do so –

…then you have a teen upset for no reason with an inability to snap out of it

Then there’s the reward system, which is responsible for motivating and reinforcing pleasurable experiences, - it’s also in hyperdrive during adolescence.

This means teens are more prone to risky behaviors like smoking, drinking, unprotected sex - despite knowing the dangers and especially if they’re around other teens

And again, it’s the prefrontal cortex that should be stepping in with self-control and good decision making and it’s just too weak to do so.

So, in general, neurotypical teens have a really hard time regulating their emotions, and controlling urges to experience new things…they’re moody, can be hot headed, argumentative and they do stupid risky things that can get them into big trouble or even get them hurt

And all of these same areas of the brain, the amygdala, the prefrontal cortex (which, remember, handles executive functions), the reward system – appear to be even more out of sync in an adolescent brain with a neurodevelopmental disorder like ADHD or autism spectrum disorder

Although scientist don’t appear to be able to pinpoint the exact mechanisms that cause it, they have definitely been able to link the symptom of emotion dysregulation to pediatric and adolescent ADHD

So, very generally speaking, you can probably take the emotional and risk-taking issues found in a neurotypical teen and multiply by some unknown number to get what you see in your neurodivergent teen – that number’s going to depend on all sorts of other factors like your kid’s temperament, genetics, possibly the type of ADHD they have, whether they have additional issues like anxiety or learning disorders, etc.)

Now, this may not be true for your kid – it’s actually around 75% of kids with ADHD (and possibly slightly more often in those with the hyperactivity diagnosis) who have major issues with their emotions

And just to be specific about what type of emotion issues we’re talking about - the latest research divides emotional functioning into these 2 components:

Emotionality (this is how easy emotions pop up and are expressed behaviorally), and

Emotion Regulation (the ability to modify your emotions and behavior to fit the situation)

I’m going to group these things together and call it emotion dysregulation - meaning they have a problem with how easily they become emotional in the first place and in how they respond behaviorally to that emotion.

So, going back to comparing a teen with ADHD to a neurotypical teen…

for example, where a typical adolescent is moody and quick to anger – an ADHD adolescent is probably 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…

You may hear them getting angry and banging around when they’re all alone, they may storm through the house aimlessly,

You may see them shift back and forth between positive and negative emotions uncontrollably at times – maybe they seem fine one minute, they go off for a minute, (perhaps look at their phone) and then they’ve totally changed moods

Their emotional reactions will seem overblown, out-of-proportion to the situation and just plain irrational…one of those situations that just leaves your head spinning…and maybe headed out the door for a walk…with some music…and a big ole’ glass of wine

And on top of this emotionality – they have a really difficult time self-soothing and calming down – the negative emotions put them out of commission for much longer – they have a really hard time springing back to baseline

I can tell you from my own personal experience with ADHD that literally until just a few years ago when I started researching emotions and emotional intelligence, I had no clue exactly what I was feeling, why I was feeling it, why I always felt so out of control and why I would get in one of these funks and just not be able to shake it.

I’ll give you a quick example so, if you don’t have ADHD, maybe you can empathize a little more with your teen:

I can vividly remember over 20 years ago – my husband and I were visiting San Francisco and one night we were exploring China Town and were looking for a place to eat dinner – I can remember getting so upset and feeling so frustrated and angry about trying to make a decision about where to eat dinner. I remember not liking the choices I had…I remember being mean and rude to my husband (who was doing nothing but trying to be helpful) and I can remember walking around with my arms crossed, fuming, and spending the entire dinner that way and not being able to shake it even though I knew it was totally irrational.

It's been a few years since I was a teenager, but I do remember feeling like this ALL THE TIME – being frustrated and angry and sad…all in very big ways and not being able to pull myself out of it –

So, please know, as hard as it is for you to deal with your teen behaving, they way they do, it’s just as hard for them to feel the way they do.

Emotion and executive function plays a big role in risk-taking and decision making as well

Where a typical teen might make some really poor choices and bad decisions about missing curfew, drinking, trying drugs - you might see your teen do things that just completely defy all human logic and common sense

The difference is that the ADHD brain has an even harder time engaging the prefrontal cortex to use executive functions – like making good choices and using self-control and helping themselves to calm down

It also appears that GABA – a neurotransmitter -  is extremely low in the ADHD brain – (remember neurotransmitters are those chemical messages traveling over the synapses between the brain’s neurons – it’s how different parts of the brain communicate and how the brain communicates with the rest of the body)

This neurotransmitter, GABA, plays multiple roles in the brain – it helps keep us from getting over-excited, afraid, anxious – it inhibits certain behaviors so we don’t do things we shouldn’t

But then you add to that low GABA, the ADHD teen also have very low levels of dopamine, which is a central player in the reward system, and drives neurotypical teens to seek out new and pleasurable things no matter the risk

But because of these extremely low levels of dopamine in the ADHD brain  - it causes them to be in an almost constant state of boredom – they are bored – All.   The. Time.

Sound familiar?

Their brain needs extra stimulation for it to be satisfied - to feel pleasure or even to pay attention for that matter

So, they get this extra stimulation any way they can – engaging in the usual risky teenage stuff – reckless driving, sex, drinking, vaping, doing drugs…but with even more reckless abandon because their executive functions are even worse than a neurotypical teen

But when all that fun stuff is not an option, they get their dose of brain stimulation by arguing, fighting, and causing general drama and conflict.

This is the way they maintain their baseline – the way they ground themselves – it’s what feels normal to them – neurotypical normal feels boring to them

Oh my gosh – doesn’t that explain so much! Are you seeing your teenager a little more clearly now? I can see my son and myself!

And get this - kids and adolescents with ADHD are also much more intense when it comes to positive emotions.

They’re more excitable and can be excessive or over the top in how they express their joy or happiness – they may be a little too much in someone’s face or jump around a little too much - which can make them seem very immature and just “too much” for some of their peers

And they also have a hard time understanding other people’s emotions, empathizing, or even recognizing them correctly – this can sometimes make them seem uncaring or aloof or even mean (so they may not even realize they’ve hurt your feelings!)

As you might imagine, all these emotional dysregulation issues, and severe deficits in executive functions make it extremely difficult for a kid with ADHD to make and keep friends

It causes problems with social adaptation. Somewhere around 50 – 70% of kids with ADHD will have problems interacting with other kids at school and making and keeping friends (good news though – other research says a couple of good friends is all a kid needs to feel okay)

So – I promise I’m going to get to the part where we help them with all this but let me just get it all laid out here for you first…

Other Issues

Also recognize that having ADHD as an adolescent is just all around more stressful even without any of the regular teen issues. And because of the emotion dysregulation, they’ll have more drama in their lives than the neurotypical teen,

They’ll feel tired and sleepy a lot – even worse than typical teens - because they have a hard time turning their brain off at night – my son had issues and I’ve always had issues with this

They’re more likely to have poor self-esteem, which just adds to their emotional fluctuations - during a time when kids want more than anything to be accepted by their peers and be just like everyone else, they feel different and sadly, may not be as accepted.

So, it’s super important to check in with them often and make sure you keep your connection with them strong and if something appears off, if they appear to be struggling more than normal, talk to them about seeing a mental health professional

The reason this is SO important because what really complicates things for our ADHD kids is that at least in half of them will have other disorders or mental health issues – anxiety, depression, borderline personality disorder, disruptive behavior disorders, autism spectrum disorder, conduct disorder…

You may already know this about your child, but if not, and they seem to be struggling beyond what appears to you to be ADHD alone, please seek help and advice from a mental health provider sooner rather than later – or speak with your pediatrician for guidance.

And make sure that any mental health clinician evaluating your child for other conditions, understands they have an ADHD diagnosis.

It’s also important to make sure any counselor, social worker or therapist who works with your child understand their ADHD diagnosis and knows how to accommodate that issue in therapy and treatment.

For example, if they normally have a kid keep an emotions log or give them worksheets to do at home and return to the next session – they need to know that’s probably not going to work in this situation.

Also, just be aware that ADHD can look very much like other disorders – Kids with ADHD are often misdiagnosed with a mental health issue like anxiety, bi-polar disorder, or even a physical ailment of some kind when in fact, it’s ADHD –

so if you have any doubts about a diagnosis, trust your gut and by all means seek out a second opinion, do your homework, get them to the right place -  be a smart consumer of mental health services

Something else that could impact their emotions - kids and teens with ADHD are also more likely to have additional learning differences (which may or may not have been diagnosed with the ADHD, depending on how the diagnosis was determined and by whom

If a pediatrician gave them a diagnosis, they will not have evaluated for other learning issues like dyslexia, dysgraphia, dyscalculia, auditory processing disorder and on and on…

And it’s been estimated that anywhere from 20 to 60% of kids with ADHD will also have an additional learning difference – that’s major – an undiagnosed learning difference can cause all sorts of emotional distress for your teen – imagine not being able to read or write well or understand math or oral instructions and not knowing why – just feeling stupid

So, if they still struggle in school with certain issues, get some advice from people you trust and consider having a full-blown psycho-educational evaluation by a clinical psychologist or neuropsychologist – they’re generally the only professionals that can give you the full picture

Okay – lets talk about some of the specific dangers ADHD and the emotional dysregulation and other symptoms can cause for your teen

I said earlier that the reward system in the neurotypical adolescent brain is in hyperdrive – and it’s much more so in the ADHD brain – the boredom they experience, their impulsivity, can lead them to jump in to some crazy situations, which is likely exacerbated by the lack of inhibitory GABA in their brain, the especially low functioning executive skills in the prefrontal cortex and the tendency to be emotionally dysregulated.

I know.

First, let me say, I’m not trying to scare you or make you anxious – But I know from my own experience that it’s so easy to look at ADHD in a very singular – or myopic way – I did it – it was all about academics and I think I may have willfully turned a blind eye to the other issues it could cause

But ADHD symptoms – and especially the emotional dysregulation (not to mention the possible comorbid disorders) can cause so many more issues outside of academics

I believe knowing this and taking extra precautions and knowing what to keep a close eye on, is so much better than burying your head in the sand

There are tons of data showing a definitive link between ADHD and what scientists call “real life, risk-taking behavior” – that is – the kind of behavior that’s not measured with an experiment in a laboratory setting.

And before I just rattle off this list – following it, I’m going to tell you what you need to know to do everything in your power to make sure your child avoids these issues – so take a deep breath and don’t panic on me, okay?

So, this is what you need to be aware of

For example:

Childhood ADHD has been linked to adolescent nicotine use and an increased likelihood of addiction to nicotine

There’s also a link between childhood ADHD and alcohol, marijuana and cocaine use disorder in adolescence and adulthood.

The percentage of kids and adolescents with ADHD who also have conduct disorder, is quite high and in general more aggressive behavior is seen in adolescents with ADHD

And there appears to be a high correlation between ADHD and delinquent behavior among adolescents - including one study that showed there were 5 times the number of kids incarcerated in juvenile detention with ADHD than are in the un-incarcerated population

Risky sexual behavior is also associated with adolescents with ADHD (the hyperactive type) – they appear to begin having sex earlier, have more partners, more STDs, more pregnancies and parenthood

They’ve also shown a high correlation of compulsive buying and credit card misuse in college kids with ADHD

and young adults who were diagnosed with ADHD as kids (with hyperactive type) are reported to have more trouble saving money

A relationship has also been shown between childhood ADHD and unhealthy eating habits

So, what can you do about all this emotion dysregulation, the social issues and the extra risky behavior?

The science shows that ADHD stimulant medication only treats the impulsivity, the inattention, and the hyperactivity – so medication alone will not help emotion dysregulation and the issues it causes.

But the scientific evidence is that stimulant medication combined with some sort of psychosocial intervention – that is, a behavioral therapy or behavior modification program plus teaching the kids about their ADHD and how their brain works and why it causes these issues and what they can do about it.

 And the most recent research strongly suggests (and to me this is a no-brainer)

that parents, teaching social and emotional skills at home, are a major factor in how well the child does in all environments (school, socially and at home)

Using an emotion coaching style of parenting ----- this will help improve many of the issues for your teen, including the risky behavior, and your relationship with them

I said this is a no-brainer because it’s what all the research has told us to do with our neurotypical adolescents – it’s what I did with my son after learning about it when he was 18…it’s part of the reason he’s doing so well today and it’s what I preach…so, of course, this is where the experts say to start.

If you’ve listened to previous podcasts (like 1, 6, 8 and 10), you’ve heard me talk about this before (don’t worry, I’ll link to everything in the show notes)

This latest research confirms what common sense would tell us:

Kids with ADHD who have parents who use emotion coaching or emotion socialization type behaviors, are more emotionally regulated and have fewer negative emotional issues than kids whose parents were not using proper emotion socialization techniques with them.

This emotion coaching, emotion socialization, social and emotional skills training…or whatever you want to call it – even positive discipline (it goes by many names) – what it does is it teaches your teen emotional intelligence.

That is - it teaches them to become more aware of their emotions, and how to regulate them and by doing this it also helps them begin to recognize emotion in others, empathize better, and helps them get along better with you and other people and even make better choices regarding risky behaviors.

It’s the best way to parent all kids - it falls into the category of an authoritative parenting style – firm but kind – which is the recommended parenting style.

But the prerequisite to being able to “coach” your kid is that you also have to be emotionally aware and emotionally regulated.

Here’s how it goes, in a nutshell:

You’re aware of your own emotions and are able to regulate those emotions even when their kids are dysregulated

you listen to your teen when they’re emotional,

you empathize and try to see things from where your kid is right now, with their brain in their shoes

you get curious and ask questions to see what’s really behind the emotion they’re expressing

you acknowledge their feelings by helping them put a label on how they feel - you give them an emotion word to use for that feeling,

you encourage them to solve their own problems by teaching problem-solving skills,

you have rules and boundaries and stick to natural and logical consequences and discuss all of this after your teen is calm

What you don’t do is

Jump in when your teen is dysregulated with your own dysregulated behavior

you don’t punish emotionally dysregulated kids – start taking things away, ground them, send them to their room

you don’t dismiss their emotions (“it’s no big deal” “stop being so dramatic” “just calm down”)

you don’t tell them how to fix their problems or fix mistakes for them

You don’t do all the things that I did with my son! I made every single one of the mistakes many times – I made things worse. I nagged, punished, cried, begged, I did ALL the things you shouldn’t do…until I learned better. And that’s what I want for you – I want you to learn better.

And as a person with anxiety and ADHD myself, with a son who was hugely dysregulated, if I can learn how to do this and bring calm back to my family…I’m telling you that you CERTAINLY can.

And it’s not too late. That’s also been shown in the research – and I proved it in real life when my own son was 18 years old - so stay with me here and I’ll tell you what I have for you in just a minute

So, I hope I’ve shed some light on the emotional dysregulation that is likely a part of your teen’s neurodevelopmental disorder,

and that you understand there could be some mental health problems or learning differences you may not have uncovered yet that could be adding to emotional distress

You’ve listened to the list of risky behaviors that teens with ADHD may fall into because of their emotional dysregulation (and other ADHD symptoms)

BUT, you also know that the research says medication plus your own emotion coaching type parenting can do wonders to help them with their emotions and the potential fallout from them.

And here’s what I’ve done for you to help you with that parenting – I’ve combined 4 of my current free downloadable guides (one that teaches you about the adolescent brain, one that teaches you how to be more emotionally aware and regulated, one that takes you through the basics of this social-emotional parenting style, and one that teaches you how to communicate with your teen to get them to cooperate more)

On top of that, I’ve scoured the internet searching for every tip I can find from experts in the field of adolescent ADHD for how to handle emotions with your ADHD teen and I’ve summarized, paraphrased and added these tips at the beginning of this giant PDF for you.

I did this so you don’t have to fill in your name and go to your email and download each guide separately – that’s a pain in the rear!

So, you’ll essentially have a book on how to best parent your ADHD teen (or really any teen for that matter!)

So, after you finish the episode just go to neurogility.com/13 and click on the link to download the “Giant book of parenting ADHD Teens” – I guess that’s what I’ll call it!

You’ll also find the sources for this episode, links to other resources on this topic, and the transcript

So…Speaking of Teens is the official podcast of neurogility.com, an organization I started to educate other moms and adolescents about emotional intelligence.

Please don’t forget to share this with friends who have kids and teens with ADHD – they’ll appreciate it.

See you right here next week! Take care (and start reading!)