Emotion Regulation: The Secret ADHD Struggle

ADHD is often defined by the American Psychiatric Association as a condition with symptoms of inattention, hyperactivity, or both. But one aspect that doesn’t get as much attention is the difficulty people with ADHD have in managing emotions. What's even more interesting is how emotional regulation can differ between males and females with ADHD, a reality we hear very little about. In this blog post, we’ll dive into research that highlights the connection between ADHD and emotional regulation struggles and illuminates what differences might exist between males and females with ADHD. 

About ADHD

ADHD affects about 5% of school-aged kids, which is when most diagnoses happen. Boys are diagnosed more often than girls, with a ratio of 6:1. However, this difference could be due to referral bias or societal factors that make ADHD symptoms harder to spot in girls. ADHD is typically recognized by difficulties with attention, activity levels, and impulsivity. These challenges can lead to significant life problems in adulthood, including lower income, struggles with work or school, unemployment, legal issues, relationship difficulties, safety concerns, substance abuse, and even antisocial behavior.

Defining Emotion Regulation

The research reviewed has a hard time agreeing on a clear definition of emotion regulation. In fact, Hirsch and colleagues pointed out that there isn’t a standard definition for emotion regulation. It can involve things like lack of self-control, extreme emotions (both positive and negative), and the inability to engage in self-regulation. In 2019, Hirsch and his team proposed a self-regulation model, explaining that you first need to identify your emotions, choose a regulation strategy, and then apply that strategy in a flexible and effective way.

Similarly, instead of providing a single definition, Welkie and colleagues describe emotion regulation as involving emotional awareness and how you respond to emotions through your behavior. De Ronda and her team, on the other hand, offer a more specific definition. They define emotion regulation as the ability to adjust your emotional state to help with achieving goals and adapting to situations. They also describe emotional dysregulation as when emotions are too extreme for social norms, when emotional shifts are poorly controlled, and when there's an unusual focus on emotional triggers. Likewise, Groves and colleagues also define emotion regulation in terms of how we physically, mentally, and behaviorally express emotions, and our ability to control how fast or intensely those emotions rise and fall. Overall, there is consistency in the fact that emotion regulation is related to our level of reactivity and control over our reactions. 

Emotion Regulation and ADHD

Emotional regulation issues are common in adults with ADHD, affecting around 34-70% of them. In fact, both kids and adults with ADHD often experience mood swings, irritability, and emotional dysregulation. Hirsch and colleagues' research backs the idea that emotional regulation problems are a distinct symptom of ADHD in adults. Groves and her team also highlight that emotional dysregulation is a major issue in ADHD, one that doesn’t respond well to typical ADHD treatments. A separate study even found that people with ADHD, regardless of how their symptoms show up, experience more negative emotions compared to those without ADHD.

Researchers generally agree on the link between ADHD and emotion regulation struggles and explain how this can lead to negative outcomes. Groves and her team explain that these emotional difficulties can carry into adulthood and lead to academic struggles, higher healthcare use, and increased daily parenting stress—often more so than other core ADHD symptoms like hyperactivity or impulsivity. Other studies, like those by Barkley and Murphy, argue that emotional regulation problems can affect social functioning, leading to things like risky driving, poorer parenting, and relationship issues. Overall, most of the research agrees that the connection between ADHD and emotional regulation deficits causes significant challenges for adults with ADHD.

A lot of the reviewed literature also discusses why this connection exists. Many researchers believe that the core ADHD symptoms—like inattention, hyperactivity, and impulsivity—are rooted in emotional regulation deficits. Several studies point to the idea that people with ADHD struggle to mentally process and recall past experiences or emotions, which makes it harder to control their emotions in certain situations. Essentially, when someone with ADHD faces a stressful situation, they may not remember how they previously turned negative emotions into positive ones. Kearns and colleagues explain that people with ADHD are less likely to think through and reframe their emotional responses. Groves agrees, suggesting that this is due to the well-documented working memory problems in people with ADHD.

Emotion Regulation Differences by Sex

There isn’t a lot of research on how emotion regulation issues impact adult men and women with ADHD differently. Some studies don’t focus on gender differences at all, and those that do usually look at adolescents. De Ronda and colleagues found that among children with ADHD, girls showed much more emotional instability than boys. Girls also felt the effects of emotional lability (mood swings) on anxiety and inattention more strongly than boys. Interestingly, their research showed that as boys with ADHD got older, their emotional regulation issues seemed to improve, while girls continued to experience high levels of negative emotional symptoms over time.

In studies of young adults with ADHD, Welkie and her team found that although women reported using more emotion regulation strategies, they were still more likely to fall back on unhealthy coping mechanisms like rumination (overthinking). 

Hirsch and colleagues also supported the idea that women tend to experience more negative effects from emotional regulation problems. In their research, they identified a group with more women than men who had the highest levels of emotional lability and the lowest emotion regulation skills.

Kearns and colleagues took this further by suggesting that emotional symptoms related to ADHD might be worsened by the social and physiological pressures females face. They pointed out that women are often expected to be nurturers and supporters, which means they don’t always get the support they need for their own challenges. These emotional triggers, combined with a lack of support, can make women with ADHD feel less in control and lead to more anxiety or emotional outbursts.

Overall, there’s not much research exploring how men and women experience emotional regulation problems due to ADHD, and more studies are needed to better understand these differences.

Final Takeaways

The connection between ADHD and emotion regulation difficulties are real. If you have ADHD and struggle with this, you are not a hopeless cause cursed to be uncontrollably reactive for the rest of your life. It just means this is an area worth paying attention to and working with your therapist with on better understanding and developing coping skills for.