DESR: Why Deficient Emotional Self-Regulation is Central to ADHD (and Largely Overlooked)

DESR: Why Deficient Emotional Self-Regulation is Central to ADHD (and Largely Overlooked)

Deficient emotional self-regulation (DESR) is a relatively new term used to describe the problem of impulsive emotion coupled with emotional self-regulation difficulties long associated with attention deficit hyperactivity disorder (ADHD or ADD). DESR may be new to the ADHD lexicon, however I argue that it is a core and commonly overlooked component of the disorder — and one that can help predict a patient’s impairments, and even improve diagnostic and treatment practices.1

Emotional dysregulation is noticeably missing from diagnostic criteria for ADHD. However, most patients and experts recognize that it is central to the disorder2. DESR, a manifestation of emotional dysregulation, specifically refers to deficiencies with these four components of emotional self-regulation3:

  • Ability to inhibit inappropriate behavior triggered by strong emotions. I argue that this emotional impulsiveness (EI) is an aspect of poor inhibition associated with ADHD that is illustrated by low frustration tolerance, impatience, being quick to anger, aggression, greater emotional excitability, and other negative reactions, all of which are related to the impulsivity dimension of the disorder
  • Ability to self-soothe and down-regulate a strong emotion to reduce its severity
  • Ability to refocus attention from emotionally provocative events
  • Ability to organize or substitute more moderate, healthier emotional responses in the service of goals and long-term welfare

To understand the role of EI and DESR in ADHD is to acknowledge the prominent role of emotional control difficulties in the disorder’s appearance and outlook, including understanding the following:

  • Why these issues are prevalent in individuals with ADHD
  • Why major comorbid disorders often develop as a result of these challenges
  • The major life impairments not adequately explained by traditional symptoms of ADHD

A wealth of compelling evidence — from ADHD’s clinical conceptualization over time to neuroanatomical and psychological research — clearly shows that EI and DESR are key components of ADHD and should be incorporated into the disorder’s diagnostic criteria and treatment practices.

EI and DESR: Evidence of Its ADHD Ties

1. EI and DESR in Historical Concepts of ADHD

Conceptualizations of ADHD have included emotional control problems for centuries. One of the earliest references to attention disorder in western medical literature4, a textbook written by German physician Melchior Adam Weikard in 1770, characterizes those who have a “lack of attention” as “unwary,” “flighty,” “careless,” mercurial,” and “bacchanal.”

EI and DESR through history4:

Alcohol use in children, and how parents can make a difference

Alcohol use in children, and how parents can make a difference

Martin was 17 when he was first introduced to alcohol.

“As a young person, there’s the world of alcohol. You go there as a way [to], I guess, get away from your problems,” he says.

“It’s a way to be social, it’s a way people perceive to have fun, you see it as something to do with your mates and if you are not doing it then … you’re different.”

But for Martin, alcohol soon became a way to cope with his anxiety.

“I think it led to experiences that weren’t necessarily the best for me,” he says.

“The decisions you make while you are under the influence essentially can increase more of that anxiety in you as a young person.”

In a culture where alcohol is prevalent, Martin says the pressure to drink can be overwhelming.

“I think just growing up in Australia in general, there’s a lot of emphasis on drinking alcohol to be social,” he says.

“At a stage of my life where I felt a bit shy or insecure, not confident in who I was, drinking alcohol was a way to cope with that social anxiety.”

Add to that research that finds people living with an anxiety disorder are 2-3 times more likely to also have an alcohol use disorder, and it becomes all the more worrying. Preventing problem drinking from the start

In a culture where alcohol is prevalent, the pressure to drink can be immense — but parents can have an impact.( Unsplash: Kelsey Chance ) It’s a familiar cause of angst for many parents — the concern that as their children grow up, they will encounter or face pressure to drink alcohol or try illicit drugs.

But while the pressure from media and peers is real, parents can make more of a difference than they think.In fact, they are more influential than peers at this stage, according to Associate Professor Nicola Newton, the Director of Prevention Research at the University of Sydney’s Matilda Centre. “The most important thing is for parents to know that they still have an influence over their children’s choices when they become adolescents,” she says. “In fact, they are the number one influence over their adolescents’ choices at this stage.”Whilst it may appear and it may seem at the time that peers are the most important influence in your life, parents still have a critical role to play in their adolescents’ health, behaviours and choices.” Dr Newton says to reduce “uptake of substances”, modelling good behaviour around alcohol is key — and that means parents need to have healthy habits themselves.”If your kids are coming home from school and you are there having a glass of […]

What to know about occupational therapy for ADHD

What to know about occupational therapy for ADHD

Occupational therapy may help individuals with ADHD in multiple ways. It can help a person identify barriers to success, develop strategies for tackling those areas, practice new skills or refine old ones, and brainstorm solutions when things do not go as planned.

Attention deficit hyperactivity disorder (ADHD) is a chronic mental health condition that affects a person’s ability to pay attention and manage impulses.

Experts estimate that 5–7% of school-aged children worldwide have ADHD, and around 63 million children and adolescents live with the condition worldwide. In the United States, about 6.1 million children have an ADHD diagnosis. Although ADHD symptoms evolve, it typically persists into adulthood, affecting about 366 million adults worldwide.

People living with ADHD may have challenges with time management, organization, focusing, and multitasking. Because ADHD symptoms are highly individualized, occupational therapy aims to help people plan and prioritize by using various techniques tailored to the situation.

Keep reading to learn more about occupational therapy for ADHD, including how it works, and why it may be effective.

At its core, occupational therapy involves helping people of all ages participate in whatever they want or need to do.

Occupational therapy encourages people to overcome the barriers that prevent them from doing important activities, and increases their independence and satisfaction in life.

It addresses the importance of people’s psychological and emotional well-being, and focuses on improving these by using everyday activities in a therapeutic manner. For people with ADHD, who may report low self-esteem and self-efficacy, this is also a focus for the therapy.

Overall, the main goal of occupational therapy is to adapt the environment to fit the individual. It follows the thinking that no two people are the same, so the surroundings should adapt to serve everyone best and allow them to be their most productive.

The basis of this reasoning is especially beneficial for those living with ADHD. Occupational therapy helps these individuals participate fully in social situations. For children with ADHD, it can also help them with school, work ethic, and performance.

While occupational therapy is beneficial when applied to other mental health conditions, limited evidence of its application with ADHD exists.

ADHD typically affects an individual’s educational functioning, management of interpersonal conflict, relationships, and ability to provide emotional support. The symptoms of ADHD include inattention and hyperactivity or impulsivity. These qualities can lead to difficulties in time management, emotional regulation, motivation, and executive function, which are needed for completing tasks.

In a small 2018 study, 38 children aged 9–15 either were randomly placed to work with an occupational therapist for 12 weeks or be in a control group. After this time, those in the occupational therapy group showed a significant improvement in their ability to manage their time effectively and their general awareness of time.

Another 2020 study involved 23 female participants, divided into either a 7-week occupational therapy intervention group or a control group. Researchers found that the 11 participants in the therapy group demonstrated reduced stress and ADHD symptoms, with enhanced task performance and satisfaction.

Ease Your Child’s Mental Burden During These Difficult Times

Ease Your Child’s Mental Burden During These Difficult Times

The COVID-19 outbreak and consequent lockdowns have changed the way we function in the world and brought us face-to-face with a lot of uncertainty and fear. Children could possibly be the silent sufferers of the pandemic as they are too young to understand or process their thoughts and emotions, something that even adults have been struggling to navigate through in the past year. Toddlers and young children particularly need dedicated attention and care as the brain is still in the process of formation, and high stress and social isolation can lead to unwanted deep-seated issues later in life. Dr Neeraj Raj B, Consultant Psychiatrist, Aster RV Hospital, explains how the pandemic has impacted the little ones and how to ease their mental burden…

Impact Of The Pandemic On Little Ones

In one of the earliest studies conducted during the ongoing pandemic, it was found that younger children (three to six years old) were more likely than older children to exhibit symptoms of clinginess and feel dread about family members getting infected. Older youngsters ( six to 18 years old), on the other hand, were more prone to inattention. Sleep problems, nightmares, poor eating, irritability, inattention and separation anxiety have been commonly observed among children during the pandemic.

Guidelines For Parents To Ease Their Children’s Mental Burden

Toddlers and younger children demand and require more attention from their parents and it is a key part of their early development. Parents must set aside time to provide their undivided attention and reassurance to their kids. They need their parents’ physical presence and must be encouraged to engage in more indoor activities.

• Parents can explain the pandemic in an age-appropriate way, using simple terminology. Children can learn about safety precautions and their role in avoiding the spread of the virus. Role-playing, gentle reminders of COVID safety behaviour in a soothing and loving tone, fun cue cards and audiovisual material can be used. This will help the child feel more in control of the situation and ease stress.

• Good behaviour can be rewarded with positive reinforcement such as praise and loving statements. Avoid using material reinforcement.

• Negative reinforcement/punishment for bad behaviour must be avoided as far as possible. In such cases, simply ignore the child and do not give them any attention.

• Set a good example: Children look up to their parents and when parents are able to cope with stress better, that sets the child up for better emotional regulation in the future.

• Avoid heated discussion or debates, particularly about the COVID pandemic while at home. Children are silent absorbers and can easily be affected by such discussions even if they don’t openly express […]

5 Reasons Your Kid Might Be Performing Poorly in School

5 Reasons Your Kid Might Be Performing Poorly in School

If your child’s grades are slipping, there are a few things that could be going on. Here’s what you should know.

Let’s be honest: Parents often worry just as much or more than their kids about a bad report card.

If your child has repeatedly received lower grades in school, chances are you’re probably worried about the next report card almost as much as they are. It’s easy to worry about what poor grades could mean.

There are many reasons why your child may be having difficulty at school. Sometimes, it’s just a temporary issue, explains Amy Marschall, a licensed psychologist who works primarily with children and teenagers.

“There is a huge range of ‘typical’ development, so often a child will be a bit behind but then catch up without intervention,” says Marschall. “I was the last kid in my kindergarten class to be able to read. I just was not getting it, and within 2 years, I was reading at a 7th-grade level.”

However, there are things parents and caregivers can do to help, and early intervention can have major benefits.

“A lot of parents will tell me they had a gut feeling when the child was very young,” Marschall says. So, if you’re worried, a good first step may be to figure out why your child is having difficulty academically.

“If there has been a sudden change in your child’s performance; if they were doing well and suddenly began [having difficulty], look into stressors or changes in their life that might be affecting them,” suggests Marschall.

Stressors that might influence your child’s performance in school could include:

  • changes at home, such as the arrival of a new sibling or the separation of parents
  • a demanding schedule
  • puberty

Stressors rarely occur in a vacuum or without warning. For example, if your child is being bullied, you might notice that they seem particularly distressed or sad about going to school — in addition to getting poor grades. They might even try to fake being sick just to stay home.If they’re experiencing troubles at home, you might notice that they no longer seem to be reaching their academic potential. They may also lash out more at home, throwing tantrums or behaving defiantly toward family members. The good news is, intervention or treatment can help improve your child’s mood and school performance. For some kids, the problem with school isn’t academics. Instead, they have difficulties with social situations or controlling their emotions.

Emotional dysregulation

Some children take longer to learn how to control their emotions or resist impulsive behavior. This can lead to temper tantrums and outbursts.

Of course, it’s normal for young children to experience temper tantrums or meltdowns when they’re toddlers — they don’t call them the “terrible 2s” for nothing. But most children learn to regulate their emotions by the time they enter kindergarten.

There are many reasons why your child may be having difficulty at school. Sometimes, it’s just a temporary issue, explains Amy Marschall, a licensed psychologist who works primarily with children and teenagers.

The key to a happy teen? Listen and support — and resist solving problems for them.

In a new book, two experts advise parents on how to talk to their teenagers in ways that foster closeness and help them cope with adversity on their own.

You’ve probably heard that to raise a successful person, you need to allow your child, especially adolescents, to have autonomy. That if you micromanage everything, they won’t learn how to do it themselves and thus won’t thrive later in life.

You’ve probably heard that to raise a successful person, you need to allow your child, especially adolescents, to have autonomy. That if you micromanage everything, they won’t learn how to do it themselves and thus won’t thrive later in life.

But how do you actually do that? William Stixrud, a clinical neuropsychologist, and Ned Johnson, founder of test-preparation company PrepMatters, have a new book out that aims to answer all of that. “What Do You Say? How to Talk With Kids to Build Motivation, Stress Tolerance and a Happy Home,” builds on their last bestseller, “The Self-Driven Child.” They break down how each parent can be a non-anxious parent-consultant, rather than a parent-boss, and ways to help kids be truly happy as they grow and head into the world.

Stixrud says that one of the wisest things he has heard about adolescents is that “Every day, when they come home from school, you can see who they’re deciding to be.” Here, they give advice on helping your child to become who they really are. (This interview has been edited for length and clarity.)

How has the pandemic affected kids’ motivation and stress tolerance, and how should parents pivot to deal with their teens?

WS: The kids who are introverted, hated getting up for the bus — for a lot of kids it’s been a pretty good thing for them and for their families. Nationally, you see a significant increase in depression and anxiety, but these were increasing dramatically before the pandemic.

NJ: We know that kids from wealthy families are at an even greater risk than those stretched thin, in part because of an intense pressure to excel. And these kids don’t feel as close to their parents. It’s really helpful if parents take the long view and recognize that the emotional resilience we so want for our kids [can be achieved by] adversity with support. We’ve had so much adversity; let’s do everything we can to support our kids — not to get the highest GPA, but to be able to cope.

You write about the importance of making our home the place where our kids can feel that connection with us. How?

WS: Parents need to validate [kids’] feelings, treat them respectfully, and not try to solve their problems for them. The practice of listening more than talking: “I’m trying to understand you, and here’s what I’m hearing.” Home should be a safe base where after a stressful day, they know you don’t criticize them, that you understand them. We don’t want our kids to say: “I got a C, but don’t tell my parents!” We want them to feel safe enough to bring their problems to us.