Intense ADHD Emotions & Mindful Communication

IMPORTANT: This blog is not a substitute for therapy, but provides evidenced-based education for the purposes of self-help, or to compliment the therapeutic process. ​ ​This blog is non-monetized.

Episode 8 on The Christina Crowe Podcast: making the invisible VISIBLE

Despite is absence from the DSM diagnostic criteria for attention deficit hyperactivity disorder (ADHD), for anyone who lives with it, and any clinician who treats it, emotional dysregulation is a core feature of ADHD.  

The symptoms we recognize as emotional dysregulation however, can most certainly be traced to the core features of ADHD. Sudden bursts or fluctuations in emotion are linked to the impulsivity dimension of ADHD, and difficulties with emotional management in general can stem from the inattentive and executive dysfunction dimensions of ADHD. 

In our brains, various neurological processes might be either over-activated or inhibited, which on the outside looks like someone might be quite suddenly amped up, or more shut down, in response to some sort of triggering event or stimuli.

The intensity of the emotional experience, and seemingly random fluctuations throughout the day, becomes so commonplace that the person with ADHD themselves might not even realize that their emotional experiences are partly what might be making life so incredibly exhausting. It is also the core symptoms that lead to many of the comorbidities that develop over time if ADHD goes undetected and therefore untreated, like anxiety and depression or even Oppositional Defiant Disorder (ODD). 

Deficient Emotional Self-Regulation (DESR) 

Another acronym that has become more commonplace when talking about emotional regulation and ADHD is Deficient Emotional Self-Regulation (DESR). It might sound self-explanatory, but Dr. Russell Barkely, Professor of Psychiatry and Neurology from the University of Massachusetts Medical Center, described 4 core components in his writings: 

  1. Demonstrating emotional impulsiveness (EI), specifically, the inability to inhibit inappropriate behaviour, triggered by strong emotions.  It’s defined by experiences or behaviours like low frustration tolerance, impatience, being quick to anger, aggression and greater emotional excitability. 
  2. The inability to self-soothe and down-regulate a strong emotion to reduce its severity.
  3. The inability to refocus attention from emotionally provocative events.
  4. The inability to organize or substitute more moderate, healthier emotional responses in the service of goals and long-term welfare.​​

EI and DESR and the Neuroanatomy of ADHD

We already know the parts of the brain directly involved in emotional regulation: the frontal lobe, the anterior cingulate, the ventral striatum, and the amygdala – all comprise the executive circuitry that has been repeatedly shown to be involved in causing the symptoms of ADHD. 

Some of these structures also form the brain’s emotional circuitry — the amygdala and larger limbic system to which it is connected is where emotion is generated, and the prefrontal cortex and related structures are in charge of responding to these emotions as they arise. The frontal-limbic circuit — one of the four executive networks of the brain — is associated with ADHD and with symptoms of emotional dyscontrol, motivation deficits, hyperactivity-impulsivity, and aggressive tendencies. This emotional regulation network is also known as the “hot” circuit

Emotional self-regulation is a major dimension of executive functioning required for daily life activities.

​Emotional dysregulation has been shown to uniquely predict the following:

  • social rejection in children with ADHD,
  • interpersonal hostility and marital dissatisfaction in adults with ADHD,
  • greater parenting stress and family conflict in parents of children with ADHD; greater stress in parents with ADHD,
  • road rage, DUIs, and crash risks during driving,
  • job dismissals and workplace interpersonal problems,
  • dating/cohabiting relationship conflict,
  • impulse buying; poor finances.

We’ve previously written about the invisible symptoms of ADHD that make detection and diagnosis really challenging in many ways. Other every day complications of ADHD’s emotional symptoms include:

Navigating difficult conversations — while no one really loves high stakes conflict, for people with ADHD it can be even worse. Time-blindness and emotional hyperfocus steal our perspective and we get disproportionately upset, with an intensity that continues to impair our higher thinking longer than we’d like. Poor working memory leaves us forgetful, and with nothing to lock into long terms memory, its hard to even look back and see where we went wrong. 

You might have heard about how ADHD renders us time-blind. Our brains struggle to perceive time outside the present moment, or its pretty distorted. (Not all people with ADHD have issues with time or time management, but it’s probably safe to say, most do). We can’t even imagine ourselves feeling anything else.  While an argument with a spouse may naturally upset a neurotypical person, they have a broader perspective and can leverage it for a faster recovery.  A person with ADHD only feels this moment. We only feel the pain we’ve caused the other person, or vice versa.

Then comes the bane of many relationships – defensiveness. When you’ve spent a lifetime feeling like no matter what you do, you cant get it right, or can’t catch a break, of course the minute someone you love seems disappointed, your defences will spring into action. Nothing shuts progress down like defensiveness (well by definition, that makes sense, right?) but if we can’t get past this automatic reaction, our relationships can really suffer. 

Poor working memory can be strained even further by both the ADHD-zone-out, or by the sudden activation of our fight or flight protective responses. Remember, our higher thinking shuts down when we feel threatened (because we aren’t supposed to negotiate with the sober toothed tiger, are we?).  Several minutes into an argument, we forget what we were even fighting about, but still feel like crap. 

Some hot tips for moments like these?  

  1. Excuse yourself if overwhelmed – but say when you’re coming back to resolve the issue (if it’s possible). 
  2. Take notes. Seriously. 
  3. What time of day is it? Did you take your meds today? Food? Water? Having tough conversation’s on empty stomachs or when there are no meds still in our systems might not be the best timing. 

Therapeutic approaches:
 
Which ever type of therapy your therapist works from, any psychotherapeutic approach should be adapted for the nuances of an ADHD brain. For a gold star, your therapist can further adapt their approach based on whether or not one takes ADHD medication (therapy is much more successful if a person with ADHD is actually taking 1st line ADHD medication), and which unmanaged symptoms are the ones in fact driving these troubling experiences.
 
Family therapy and treatment: Parental ADHD could contribute to emotional dysregulation in children with ADHD, not just genetically through inheritance, but through modeling of poor emotional control and by engaging in emotionally provocative encounters with the child. Clinicians should screen parents for ADHD and recommend treatment for their symptoms as well.

Mindful Communication

Listening more deeply to others helps to develop greater clarity and confidence about how to respond. Bringing mindfulness to your communication style isn’t some hokey-pokey exercise.  It could very well be a major factor in improving the quality of your relationships, which is inextricably tied to the quality of your life. 

Engaging in a mindfulness practice around how you communicate aims to: 

  • identifying your communication patterns and habits,
  • uncover any hidden fears that might be sabotaging your communications,
  • learning to stay open during tough conversations so you can respond thoughtfully and skillfully,
  • and learn how a mindful communication practice can help you become more truthful, compassionate, and flexible in your relationships.


Essentially, we want to learn to notice whether communication with someone is closed, open, or somewhere in-between, kind of like a traffic light. 
 
In the Five Keys to Mindful Communication, author Susan Gillis Chapman uses this traffic light metaphor to teach these concepts:

  • When the channel of communication closes down, we imagine the light has turned red.
  • When communications feels open again, we say the light has turned green.
  • When communication feels in-between, or on the verge of closing down, we say the light has turned yellow.

The changing-traffic-light imagery helps us identify our own styles of communication, and to recognize the consequences of each.

The green light symbolizes openness, when the two-way traffic is flowing in a conversation.
 
The yellow light describes the period in between the green and red light, the gap of groundlessness that occurs just before communication shuts down. We’ve been caught off guard and we feel embarrassed, irritated, or disappointed by an unexpected event. Below the surface of these reactions, deeper fears and self-doubts are exposed. How many of us hit the gas instead of the brakes when the light turns yellow? 
 
After we’ve spent some time observing our patterns of opening up and closing down, we can zero in on this most important area, the stage in between

Mindfulness teaches us how to hold steady when we feel hurt or disappointed. It gives us the power to refrain from making matters worse during those episodes when negative reactions rise up because things aren’t going as we planned. I have always maintained that people with ADHD are already halfway there with becoming mindfulness masters – we are all already in the moment, now we are adding intentionality and removing judgement. 

When we are in red light territory, our defences are activated and our backs are up. We perceive we are being criticized, and we either instinctively fight back or shut right down. It’s important to note thought, that when we’ve put up that defensive barrier, we have closed ourselves off from the world. In our mind, we justify our defensiveness by holding on to unexamined opinions. We tell ourselves that relationships are not that important. We undervalue other people and put our self-interest first. In short, our values shift to “me-first.” Closed communication patterns are controlling and mistrustful.

Author Susan Chapman provides a framework for understanding that shifting into a “we-first” perspective can be a really valuable skill we can all strengthen. Mindful communication training and self-learning is a great example of a psychosocial intervention that can be a powerful intervention in working with an ADHD brain of any age. Parents can read this book (library, book, audiobook!) and start to model this behaviour at home around and with their kids. 

The role of medication

There is no doubt that one of the most debilitating parts of unmanaged ADHD in adulthood is emotional dysregulation, stemming from the impulsivity domain of ADHD. Re-centering ADHD on emotion also helps us understand treatment outcomes more clearly. 

Specifically, stimulants (the only medicines indicated to medically treat ADHD) appear to settle and even dampen the limbic system. If you feel too calm on your stimulant, you might be dosed too high and should talk to your doctor about the symptoms you are targeting, versus the things you don’t need addressed. (But this is rarely what we see – we notice much more that people are under-dosed and still experiencing symptoms that are easily controlled on the right dose for that individual brain). 

Non-stimulants for ADHD, like atomoxetine, act on a different part of the brain. They help to up-regulate the executive brain, potentially giving patients more self-control of emotion. 
In summary, if you are still struggling with the every day runaway ‘light switch’ emotionality of ADHD, the great news is, it can all be addressed.  Medication can be optimized and interventions like mindful communication practice can really amp up your relational skills.

Resources

​Learn more about mindfulness medication on our YouTube playlist HERE

​If you prefer one on one support, check out the therapists on the team with current availability. 

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Original music, courtesy of Tim Crowe
Produced by Jenell Riesner
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References

Barkley, R. A. & Murphy, K. R. (2011). Deficient emotional self‐regulation in adults with ADHD: The relative contributions of emotional impulsiveness and ADHD symptoms to adaptive impairments in major life activities. Journal of ADHD and Related Disorders, 1(4), 5‐28.

Chapman, Susan Gillis. The Five Keys to Mindful Communication: Using Deep Listening and Mindful Speech to Strengthen Relationships, Heal Conflicts, and Accomplish Your GoalsShambhala, Boston. 2012.

Shaw, P., Stringaris, A., Nigg, J., & Leibenluft, E. (2014). Emotion dysregulation in attention deficit hyperactivity disorder. The American journal of psychiatry171(3), 276–293. https://doi.org/10.1176/appi.ajp.2013.13070966

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Picture of ​Christina Crowe, H.BSc. MACP, RP, (S-Cert) OAMHP (she, her)

​Christina Crowe, H.BSc. MACP, RP, (S-Cert) OAMHP (she, her)

Registered Psychotherapist, Validated Clinical Supervisor, ADHD Therapist & Coach Podcast Host The Christina Crowe Podcast Christina is a Canadian Registered Psychotherapist, a member of CADDRA's Advocacy Committee and relentless mental health advocate. Christina believes great mental health information should be available to everyone, loves creating content that makes invisible things VISIBLE and finding new ways to bring healing experiences to as many people as possible.

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