ADHD and Emotional Regulation

When Emotional Dysregulation Creates a Barrier to Learning for Students with ADHD How to Help in the School Setting 

I was collaborating on a student who was exhibiting concerning “ behavioral” problems in the first grade classroom.  The child was frequently melting down and having atomic reactions to “not getting their way”. Ripping up the worksheet if they couldn’t have the blue marker, hysterics when it was time to clean up, refusal to participate when they couldn’t have a certain spot on the rug, and explosive during most peer interactions throughout the school day.

When I explained that the child was diagnosed with ADHD , the teacher questioned “ But that’s it?”. Confused as to what role Attention Deficit Hyperactivity Disorder would play in the serious emotional outbursts of this child. 

ADHD is globally misunderstood as a disorder that impairs a child’s ability to pay attention and causes hyperactivity.  While these visible outcomes may be true for some, they are incomplete. The emotional component of ADHD is nearly as profound as it is underestimated.

ADHD above all else is a disorder that impacts an individual’s ability to self regulate.

ADHD above all else is a neurodevelopmental disorder that impacts an individual’s ability to self regulate. Individuals with ADHD, will have substantial difficulty regulating attention, activity, emotions, verbal expression, thoughts, sensations ect.. due to differences in the development of the nervous system.

They experience emotions in a far more intense and prolonged way than other children. Inattention, impulsiveness, poor planning and episodic memory problems inherent to ADHD impact the child’s ability to develop emotional regulation skills in par with peers making them more susceptible to emotional dysregulation.  With ADHD an innate hypersensitivity magnifies the input and then deficient self regulation exaggerates the output. 

Most interventions designed to teach emotional regulation are ineffective for children with ADHD because they rely on using the executive functions to control the emotional brain. These are the students that can easily tell you or an upset friend exactly what to do to regulate their emotions.  But once that little Einstein is upset, the very strategies just mentioned a moment ago are out of reach. The child will continually fail to regulate their emotions despite their best intentions, they internalize this as personal failure, increasing emotional dysregulation and setting the stage for dangerous secondary complications. . 

What is Emotional Regulation?

There are multiple theories to about human emotion generation and emotional regulation. Emotions can be defined as a complex reaction pattern, involving experiential, behavioral, and physiological elements, by which an individual attempts to deal with a personally significant matter or event.(APA) Most theories agree that emotions are generated by our primitive instinctual brain based on sensations and past experiences to give meaning to our experiences.

The limbic system connects with the prefrontal cortex ,our thinking brain, to then manage or regulate the physiological and behavioral expression of the emotion. Emotion regulation follows a similar pattern/process to impulses, using both lower and higher brain structures.

• Situation : a subjective experience generates a feeling
• Attention: Situation has meaning to the person and they bring attention to it
• Appraisal – The person accesses the situation with cognitive processes
• Response: the emotion creates an experiential, physiological, behavioral change or expressive response.

While emotions are instinctual and automatic ,our capacity for regulating our emotions, is a learned process that requires substantial cognitive ability.

• Inhibit Responses : The ability to pause and assess the significance of the situation
• Direct Attention and , Memory , emotional vocabulary : Ability to recognize the emotional significance of perceived stimuli ( I feel disappointed) 
• Working Memory/Prioritization : Appreciate the need for regulation- (to calculate the costs of reacting outwardly or  suppressing actions not in our best interest. ( But it is important I complete my reading work.) 
• Task Initiation: Select and implement an appropriate strategy (I will use a strategy to feel better so I can do my project) 

The Process Model of Emotion Regulation, James Gross (1998), explains that emotion regulation is our capacity to strategically up-regulate and down regulate emotions depending on the person’s goal.

Gross describes the five types of strategies that humans use to regulate emotions. 

• Situation Selection: “Proactively changing our circumstances that support desired emotions.
• Situation Modification- “Proactively modifying aspects of the situation so as to alter its emotional impact
• Attention Deployment: Selecting the aspect of the situation to focus on in order to help control the emotional response. 
• Cognitive Reappraisal -Changing how we appraise the situation we are in to alter its emotional significance
• Response Modulation– After the response is generated, attempts to directly Influence the physiological, experiential, or behavioral response” to the emotion. . 

ADHD Emotional Dysregulation in the Classroom 

Understanding how emotions are generated and regulated , one can appreciate how a child with ADHD and undeveloped response inhibition (pause and suppress ) and working memory (calculate the costs from past and future) would have difficulty regulating emotions. Evidence suggests that individuals with ADHD are unable to effectively use the cognitive processes resulting in more frequent emotional dysregulation. Their regulators are OFFLINE. 

ADHD’s impact on emotional regulation is often characterized by emotional impulsivity, rumination, hypersensitivity and avoidance in the classroom environment.

Emotional Impulsivity: These students may struggle to inhibit behavioral responses to their emotions and moderate the intensity of their emotions.

• signs of a low frustration tolerance
• quick temper
• Intense disproportionate emotional reactions
• Difficulty calming down and moderating their emotions.
• Get easily thrown into panic mode, they get super-stressed and super excited .

Not getting the blue marker will temporarily feel like a life or death situation, because without cognitive appraisal the brain’s can’t tell the difference between a life-threatening situation and minor problems, leading to over-the-top and intense reactions to both.

Rumination: Students with ADHD often have difficulty refocusing attention from emotionally provocative events. This focus on one emotion crowds out other important information that might help regulate behavioral responses. They become flooded in one salient emotion and have problems shifting their focus to other aspects of a situation. Poor working memory results in a struggle to compare the current experience with past experiences and use typical self-soothing strategies, such as self-speech and visual imagery. 

Increased Sensitivity: Students with ADHD may appear extremely sensitive to disapproval, criticism and rejection. They might interpret a teacher’s constructive feedback as harsh criticism or insult, Red marks on their papers, grades and feedback used to improve performance can be painful. They tend to react with knee-jerk defense.

Avoidance- because of the extreme and overwhelming response to emotions some people with ADHD quickly develop avoidance behaviors. They avoid any indication of possible failure, making it hard to initiate tasks. 

Understanding the Co-Regulation Needs of Students with ADHD

Co-regulation describes the interactive process in which adult caregivers shape and support self-regulation development. As children grow into young adults, they slowly learn to self regulate and adults contribute less to balance the process.

There are three broad categories of co-regulatory support that caregivers provide to children to help them to develop and expand self-regulatory skills as they grow (Murray et al., 2015) .

• Provide a warm, responsive relationship where children feel secure and cared for.
• Structure the environment to make self-regulation manageable and buffer against excessive stress.
• Skill instruction and coaching to scaffold self-regulation enactment.

Students with ADHD may be 30% behind peers in the development of executive function and self regulation skills. They will require an increased amount of co-regulatory support from their caregivers to fill the bucket to effectively manage the situations across the school day.

Effective Interventions for Emotional Dysregulation

Interventions and support for students with ADHD in the school environment need are proactive and positive and focus on using co-regulation to support the development of emotional self regulation. By providing intervention to the “non-cognitive” parts of the process, we can empower development of strategies that work for the lifespan.

Situation Selection and Modification Interventions

Before children are able to regulate their own emotions, adults use extrinsic situation selection/ modification strategies to set up their environments. Teachers and caregivers can select and structure the situation (environment and demands) with support for emotional regulation.  It is important to understand that the situation is not limited to the physical externally observable environment. The ” situation” contains the adult’s emotional state, the perceived safety of the environment and the child’s underlying state.

Creating a “Situation” of Non-Judgmental Curious Compassionate Curiosity

Students with ADHD can be very challenging to develop relationships with. Many have had years of contingent teacher relationships and can be cautious and defensive. When caregivers are carrying the heavy load of our own stress, and feel frustrated, triggered or even threatened by student behaviors, it can be incredibly difficult reacting to disproportionate emotional responses and challenging behaviors with compassion and empathy.

Caregiver Education Parents and teachers require a complete understanding the neurodevelopmental implications of ADHD and how they impact the emotional regulation process for the individual student. These students are NOT willfully non-compliant. It is easy to misinterpret the frequent meltdowns of an intelligent mid elementary school child as a ” spoiled child” who only melts down when they do not get what they want and needs to learn to just take no for an answer.

Caregivers must understand that a child will not learn how to self regulate just by being told to “calm down“. They will not stop experiencing intense flooding levels of disappointment because an adult says that “it’s not that big of a deal, it’s just a blue marker.” And they will only learn not to trust their feelings when told  “ You get what you get and you don’t get upset“.

These all too common messages, that I myself am guilty of, further dysregulate the child and reinforce a cycle of shame and low self esteem in which a child does not possess the ability to self correct. 

Reframe Behaviors : Co-regulatory strategies will develop self regulation skills rather than just manage the behavioral responses. We can strive to reframe and understand challenging behaviors as expressions of poor self regulation. When we recognize and respond to behavior cues as signals of unmet skill development we can provide the needed support in times of stress.

Regulate Yourself First: A dysregulated adult can NOT calm a dysregulated child: Regulate yourself first. Before interacting with the dysregulated student, the caregiver must get to a calm state or you will escalate the situation. This is much easier said than done. Walk away, take deep breathes and wait until you are calm.

Use Reflective Language: Use reflective language to validate the students experience and emotions . We need to recognize that all problems are equally valid to the nervous system regardless of our reality. The blue marker is a life or death situation to that child right now ( meaning it needs the life or death coping tools).

• Name and validate students’ experiences/ emotions no matter how disproportionate.
• Separate how you address students’ emotions from how you address their actions.
• Be mindful of perceived criticism when providing feedback.
• Provide a 4:1 positive to corrective feedback ratio to reduce defensiveness.

Check Physical Presence: Our physical presence, including body language, proximity and eye contact impacts students perceived safety and regulatory state.

• Keep an open, non-threatening body posture .
• Use a quiet or moderate volume with a serious, calm, steady tone v to model calm when a situation is escalating.
• Use a compassionately curious posture and tone of voice to frame questions.
• Getting on or below a students’ eye level to balance power.
• Using proximity as a signal for support but avoid standing over/rushing toward a child.

Environmental Structuring for Self Regulation

Students with ADHD function best in a calm, safe and structured environment with clear and consistent externally represented expectations. Environments that have low demands on impulse control, working memory and cognitive flexibility will support the child’s cognitive state for improved emotional regulation. 

Increase Predictability: Predictability creates emotional safety. Clear and consistent, predictable routines and expectations promote a sense of security by providing clear goals for behavior regulation.

• Create visual reminders of what will be happening each day.  
• Follow a Consistent Routine
• Have Daily and Weekly Visual Schedules
• Provide Visual Expectations of Routines and Procedures

Reduce extraneous environmental stimulation: The ADHD brain has significant difficulty with regulating input, all input. Due to difficulty with prioritization, input can appear to be all at the same importance level. For example, the buzzing of the AC is processed at the same volume as the teacher’s voice.  Reduce extraneous cognitive load present in the learning environment.

• Minimize extraneous distractions
• Adjusting the lighting
• Provide alternative seating options
• Create a “reset and return ”space where students can go to calm down  

Create a Safe Reset and Return Space :  An effective “Reset and Return” space provides a place to go and reset before you return to the classroom demands.  Reset and Return areas provide a space to downregulate big emotions before they get out of hand. They house helpful tools that externalize the cognitive processes that the student has trouble accessing. 

They are safe spaces are for the whole classroom use (including teacher), never to be used as a consequence and need to be trialed by every student to reduce novelty. 

R&R spaces typically contain:

• Visuals of emotion charts
• Visuals of the regulation strategy choices
• A bean bag chair or soft comfortable seating
• Fidget toys or stuffed animals
• Sensory blocking tools like soundproof headphones or a weighted blanket.

Check on TPT and the Whole Hearted Counseling linked below for Free Resources.

Scaffolding Emotional Self-Regulation Skills

Therapist and teachers can support the development of emotional self regulation skills through modeling, instruction, point of performance practice with prompts for skill enactment. Therapists and teachers can provide externalized scaffolding for attentional deployment and cognitive reappraisal.

Externalize Attentional Deployment

Attention deployment is where the individual selects the aspect of the situation to focus on in order to help control the emotional response. We can help students develop a mindful awareness of their emotional states by using frequent check ins and body scans.

Frequent “Systems” Checks – Students with ADHD very often have difficulty noticing and responding to their internal sensations (interoceptive cues). Explicit teaching of interoceptive awareness will improve emotional regulation skills. The Interoceptive Curriculum is highly recommended.

Helping students develop improved interoception allows them to detect a trigger and calm an emotional storm on the horizon. They may need frequent check ins that bring awareness to their feelings, emotions and sensations.

Systems Check /Body Scan:

• Check my surroundings
• How is my breathing?
• Body Scan?
• Am I hungry?, Am I thirsty?Am I tired?
• Do I need the bathroom?
• Temperature: Am I hot or cold or just right ?
• Do I have any pain?
• Emotions? Scale of the feeling.

Empty the Stress Bucket Regularly: Reduce emotional vulnerability by providing regularly scheduled movement and whole class stress relief. Movement breaks, brain breaks, one minute mindfulness and breathing exercises will increase a student’s underlying stress tolerance. Offer variability to help a student find what works best for them.

Externalize Cognitive Appraisal to the Environment

Because students with ADHD have difficulty accessing the prefrontal cortex to think about their emotions before expressing it, we can externalize this process through development of Emotional Plans of Action, practicing gratitude and providing visual choices of down regulation strategies .

Emotional POA: . To scaffold poor episodic or working memory, we can consider upcoming events and how students might feel in them .We can list concerns and develop a plan of action to cope, on paper. This gives kids the chance to think about their emotions when calm and regulated in advance of an event, and plan how to proactively manage those emotions. Remind students of available supports or strategies, when they might not be at their best. How did you handle the assembly last time? What worked for you?  (In the moment , “Check your POA”)

Gratitude/Glimmers Habit – “What wires together fires together”. Evidence supports that practicing gratitude on a regular basis will lay more positive neural networks to build up the underlying defense. Incorporate finding three things that you are grateful for or three things that went well today into the class routine to build a reparative habit.

Key TakeAways

Children with ADHD have a developmental difference or delay in their ability to learn how to self-regulate their emotions. ADHD’s impact on emotional regulation is often characterized by emotional impulsivity, rumination, hypersensitivity and avoidance in the classroom environment.  Emotional dysregulation impacts capacities to think clearly, increases cognitive load demands and stresses working memory capacities. Emotional dysregulation can be a formidable barrier to learning.

These students will not learn how to effectively self regulate without increased co-regulatory support from an adult. The typical self regulation strategies that students learn throughout childhood will not salient without explicit practice and co-regulatory support.

Teachers, parents, coaches, mentors can help the child develop self regulation skills by modeling and scaffolding the five type of strategies humans use to regulate our emotions,

We can co-regulate to fill their individualized regulation bucket to match the expectations of the classroom environment by:

The key is not to totally avoid situations that are difficult for kids to handle, but to coach kids through them and provide a safe , non judgmental supportive framework that will work for them long after they leave our classrooms. We can systematically scaffold emotional self regulation,   ❤️

Tools for School

Emotional Regulation Strategies and Visual Supports: Includes a copy of this article and 21 pages of caregiver education and student visual supports.

Interoceptive Curriculum– I use this prior to any emotional language. Becoming a detective of our own body cues is essential.

Whole Hearted Counselors – I own many of her resources in digital and print format.

The three titles linked below are a must read . Dr. Ross Greene, Dr. Lori Desautels and Dr. Mona Delahooke brilliantly illustrate co-regulation and its powerful impact on behavior.

References

Gross, J.J., Sheppes, G. and Urry, H.L., 2011. Emotion generation and emotion regulation: A distinction we should make (carefully). Cognition and emotion (Print), 25(5), pp.765-781.

Van Stralen J. Emotional dysregulation in children with attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord. 2016 Dec;8(4):175-187. doi: 10.1007/s12402-016-0199-0. Epub 2016 Jun 14. PMID: 27299358; PMCID: PMC5110580.