ADHD and Emotional Regulation: Why Big Emotions Matter

ADHD and emotional regulation can go hand in hand, especially when a child has trouble calming down, controlling their reactions, or expressing difficult feelings.

A University of Cambridge study found that more than half of children in a group with high ADHD symptom scores showed signs of emotional dysregulation, suggesting that emotional difficulties may be an important part of the ADHD picture.

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What Is Emotional Dysregulation?

Emotional regulation is the ability to manage and respond to emotions.

For children, this is a skill that develops over time. But some children have a much harder time controlling their emotional reactions than others.

Emotional dysregulation can show up in different ways, including:

• Difficulty controlling behavior when upset
• Explosive emotional outbursts
• Problems expressing feelings
• Feeling extremely distressed
• Difficulty calming down after becoming upset
• Anxiety or depressive symptoms

The Cambridge researchers wanted to understand how these emotional difficulties relate to ADHD symptoms.

What Did the Study Look At?

Researchers analyzed information from the ABCD Study, a large longitudinal study following children’s brain development and mental health in the United States.

More than 6,000 children in the larger dataset had information available about ADHD symptoms.

From this group, researchers identified 350 children whose ADHD symptom scores met the clinical cutoff for ADHD. About two-thirds of this group were male.

Parents or guardians had completed questionnaires about their children’s emotional behavior, including questions about how children behaved when they were upset.

More Than Half Showed Emotional Dysregulation

One of the most striking findings was that 51.4% of the children in the high-ADHD-symptom group showed signs of emotional dysregulation.

That’s more than half.

The researchers also found that emotional dysregulation occurred independently of cognitive and motivational problems associated with ADHD.

This is important because emotional difficulties have sometimes been viewed as a consequence of other ADHD-related challenges.

The findings suggest that emotional dysregulation may be an important feature in its own right.

Emotional Regulation May Be Connected to Later ADHD Symptoms

The researchers also looked at children who had relatively low ADHD symptoms at ages 12 and 13.

Among these children, those with higher levels of emotional dysregulation at age 13 were 2.85 times more likely to have developed high ADHD symptoms by age 14 compared with children who had lower levels of emotional dysregulation.

This is an association — not proof that emotional dysregulation causes ADHD.

But it does suggest that emotional regulation may provide useful information when researchers are looking at how ADHD symptoms develop over time.

What Did Brain Imaging Show?

The researchers also examined available brain-imaging data.

They found that a particular region of the brain called the pars orbitalis was smaller among children who scored highly for both ADHD and emotional problems.

The pars orbitalis is located toward the front of the brain and is involved in processes related to emotion, communication, and inhibitory control over behavior.

The researchers suggested that differences in this brain region may help explain some of the emotional and communication difficulties observed in children with ADHD.

However, this finding doesn’t mean that the size of this brain region can be used to diagnose ADHD or emotional dysregulation.

Why Might Emotional Outbursts Happen?

Think about a child who becomes frustrated but doesn’t have the words or skills to explain what is happening.

Instead of saying, “I’m overwhelmed and I need help,” they may yell, cry, hit, argue, or completely lose control.

The researchers discussed how difficulty expressing emotions could contribute to outbursts when children are experiencing emotional challenges.

This perspective can be helpful for parents.

A major emotional reaction doesn’t necessarily mean a child is deliberately trying to be difficult.

Sometimes, the child may genuinely be struggling to manage what they are experiencing.

ADHD Isn’t Just About Attention

ADHD is commonly associated with difficulties with attention, hyperactivity, and impulsivity.

But this research adds to evidence that emotional regulation may also be an important part of the experience for some children with ADHD.

That matters because a child who has difficulty managing emotions may need support that goes beyond strategies designed solely to improve attention.

For example, a child may know what they’re supposed to do but still struggle to stop themselves from reacting emotionally when frustrated.

What Does This Mean for Parents?

If your child has ADHD and experiences intense emotions, you’re not imagining the connection.

The study found that emotional dysregulation was common among children with high ADHD symptom scores.

It also suggests that emotional regulation deserves attention when we’re thinking about the challenges some children with ADHD experience.

That doesn’t mean every child with ADHD will struggle with emotional regulation.

And emotional outbursts alone don’t mean a child has ADHD.

Instead, parents can look at emotional regulation as one part of the larger picture.

Helping Children Build Emotional Regulation Skills

The Cambridge researchers discussed approaches that may help children learn to manage their emotions, including cognitive behavioral techniques.

These approaches can teach children to pause and think before reacting and to express their feelings with words. The researchers also mentioned techniques such as exercise and relaxation for helping children calm themselves or alleviate symptoms of depression and anxiety.

At home, parents can also focus on building emotional awareness during calm moments.

Put Feelings Into Words

Help your child identify what they’re experiencing.

“You’re frustrated because that didn’t work” can give them language to describe an emotion that may otherwise come out as behavior.

Practice Before the Meltdown

It’s difficult to learn a new coping strategy while completely overwhelmed.

Practice recognizing emotions and using calming strategies when your child is already calm.

Look for the Trigger

After an emotional outburst, consider what happened immediately beforehand.

Was your child frustrated? Disappointed? Overwhelmed? Having difficulty communicating?

Understanding the trigger can help you better understand the behavior.

Teach the Pause

For some children, learning to stop for a moment before reacting can be an important skill.

The researchers specifically discussed cognitive behavioral techniques that can help children learn to stop and think before reacting.

What About ADHD Medication?

The study also looked at the relationship between ADHD treatment and emotional dysregulation.

The researchers found that Ritalin did not appear to fully treat symptoms of emotional dysregulation.

This does not mean that ADHD medication doesn’t help children with ADHD.

Rather, the finding suggests that medication may not address every aspect of a child’s difficulties, particularly emotional regulation.

Parents should talk with their child’s healthcare professional about treatment decisions rather than changing or stopping medication based on this study.

Why Early Support Could Matter

The researchers believe recognizing emotional dysregulation as an important part of ADHD could lead to earlier and more targeted support.

If emotional difficulties aren’t recognized, a child’s behavior may simply be viewed as defiance, poor self-control, or “acting out.”

But if the child is struggling to regulate emotions, they may need help developing the skills to manage those feelings.

Early support could give children more opportunities to learn how to recognize emotions, communicate what they’re experiencing, and respond differently when emotions become intense.

What This Study Doesn’t Tell Us

It’s important not to overinterpret the findings.

The study shows relationships between ADHD symptoms, emotional dysregulation, brain structure, and immune-system measures. It doesn’t establish that emotional dysregulation causes ADHD, and it doesn’t mean that every child with ADHD will experience significant emotional difficulties.

The brain-imaging findings also don’t mean that a brain scan can currently diagnose emotional dysregulation or ADHD.

More research is needed to understand exactly how these different factors fit together.

Final Thoughts

ADHD and emotional regulation deserve to be considered together when we’re trying to understand the whole child. In this study, 51.4% of children in the high-ADHD-symptom group showed signs of emotional dysregulation, and the researchers found evidence that these emotional difficulties can occur independently of cognitive and motivational problems.

For parents, perhaps the most helpful takeaway is to look beyond the behavior.

A child who is yelling, crying, shutting down, or having an explosive reaction may not simply be choosing to misbehave. They may be struggling with a skill they haven’t yet learned to manage.

Understanding that difference can change the question from “How do I stop this behavior?” to “What skill does my child need help developing?”

Materials provided by University of Cambridge.