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:

Six ways to help kids regain a sense of purpose

Six ways to help kids regain a sense of purpose

When the pandemic prevented a young aspiring cartoonist from attending art camp last summer, she was devastated. But when her mother told her she could go this year, the 12-year-old balked. “I’ll just stay home,” she shrugged. “They’ll probably have to shut down again.” Although some children will dive into school and activities with enthusiasm as the pandemic lets up thanks to an increase in vaccinations, others will be more guarded.

“We’re wanting a child to run, but in my view, children almost need to walk again in terms of negotiating life,” said professor emerita at Teachers College at Columbia University Suniya Luthar, and co-founder of Authentic Connections, an organisation devoted to fostering resilience. “We need to ensure they’re not unhappy, distressed or nervous about meeting friends before we can expect them to get passionate about the saxophone again.”

With time and targetted support, even the most apprehensive child can once again experience full and joyful engagement. Here are six ways parents and caregivers can ease kids back into life and help them regain a sense of purpose.

CREATE A REALISTIC PLAN FOR TRANSITIONING

Children may feel both overwhelmed and underwhelmed by the idea of resuming a more structured routine as life begins to re-open. “A certain amount of inertia can set in after being in this state of paralysis,” said psychologist and professor at the University of Arkansas Tim Cavell.

Start by determining where a child is right now, then come up with a realistic transition plan, said psychologist with the Montefiore Health System in New York Ryan DeLapp.

Ask questions such as, “What are the emotions you’re having right now?” “What are your expectations?” and “Where do you expect your comfort level to be in the next month if you just stick it out and give it your best shot?”

Once children have a plan in place, assess their progress weekly. If they continue to be anxious, avoidant, flat or discouraged, they may need support from a mental health professional. But things could go better than expected.

GIVE THEM SOMETHING TO HOLD ON TO WITH CERTAINTY

Children may resist making plans, because life has been unpredictable, and they don’t want to risk disappointment. As Editor-in-Chief of Verywell Mind and author of 13 Things Strong Kids Do: Think Big, Feel Good, Act Brave, Amy Morin said, “the rules have changed 800 times, and there’s no guarantee that anyone will be able to do something”.

Model cautious optimism, and let your child see you push yourself. “It might just be that you’re getting coffee with a friend, and say, ‘I was looking forward to this, but now that it’s here, it feels weird and I’m nervous’,” Morin said. Afterward, you can tell your child, “You know, that was more fun than I thought it would be.”

To foster hope, give children the gift of anticipation. Ask them what they’ve missed or what they look forward to doing, then design an activity around their interests. Plan something you believe can happen, then talk about it regularly to build excitement. My 13-year-old son loves baseball and wants to see the Washington Nationals play again, for example, so we bought tickets to attend a game after he’s vaccinated.

The psychological concept that may change how you process your emotions

The psychological concept that may change how you process your emotions

What if you were approached outside an insurance office by a cognitive scientist offering you $5 to answer this question: Can a beetle feel love?”

Your answer may depend on a constellation of influences.

You may think of the last time you squashed a beetle and felt bad about it. Or maybe, you think of the invasive beetle that’s infested your backyard. It may be a gut reaction: Of course beetles feel love. Of course they don’t.

Kara Weisman is part of a research team who asked people around the world this question, along with others like: Do ghosts get hungry? Are robots deserving of moral treatment?

When these answers are pooled, Weisman looks for patterns that inform similarities, and differences in our mental lives. A mental life consists of the thoughts, feelings, and intentions we attribute to others, animals, and inanimate objects. It’s a concept we employ to sort social and moral obligations.

In a study released in August in the journal Nature, Weisman and colleagues interviewed adults and children living across the United States, Ghana, Thailand, China, and the South Pacific island country of Vanuatu. The interview subjects overwhelmingly conceptualize a mind-body distinction within the framework of mental life. This is sometimes called “mind-body dualism” and it refers to thinking of cognitive abilities as different from bodily sensations.

But the research team also came across significant differences in the way people across the world categorize socio-emotional capabilities.

These differences, the scientists say, may “lead different groups of people to different conclusions about human nature, about why humans do bad things and how society should react, whether to fear or embrace artificial intelligence, and how to interact with any supernatural beings we believe to exist.”

The differences in cultural ideas also offer opportunities, Weisman tells me.

How the discovery was made — This study was part of Stanford University’s Mind and Spirit Project, an academic collaboration that combines the disciplines of anthropology and experimental psychology.

It was an effort to “think about how people understand their minds and how that affects their spiritual and religious experiences,” Weisman explains.

It’s also an extension of the work Weisman was doing for her dissertation at the time. She’s interested in folk philosophy — how people process, explain, and predict the behavior of others.

“I was kind of steeped in these sorts of classical questions and trying to figure out ways to understand how ordinary people, non-philosophers, think about the deep things,” she says.

While conducting preliminary research in the United States, Weisman realized seemingly simple, and purposefully child-like questions (“do chickens ever feel sad?”) allowed her to probe the heavy topics without having to ask intimidating questions about the relationship between the mind and body.

“We can use those kinds of lightweight, easy-breezy answers to infer these deeper philosophical ideas that I’m interested in,” she says of her method.

This work informed the “bottom-up approach” the team took to the study. When interviewing U.S. adults, the responses were grouped into three categories:

How to react when your kid’s having a tantrum & the one thing you can do to stop it

How to react when your kid’s having a tantrum & the one thing you can do to stop it

FROM the terrible twos to the troublesome threes and ferocious fours, tantrums evolve over time but they’re all equally unpleasant.

Whether you’re dealing with a child who screams and cries, lashes out physically or gets nasty with words, there are foolproof strategies to put tantrums to bed.  Parenting expert Sophie Giles shares the best way to deal with inevitable tantrums as your child grows up. Fabulous spoke to Sophie Giles, parenting and behavioural consultant and founder of the Gentle Start Family Consultancy, who says the worst thing you can do is fear them.

She says: “Children have tantrums, it’s a natural part of child development.

“They don’t have a way to express everything and they’re trying to work out how to manipulate the world and get what they want.

“So you have to help them to see that having a meltdown isn’t the way to do that.”

To know how best to react, it can be helpful to identify the type of tantrum your child is having.

There are three basic types:

Emotional outburst

Sophie says: “This is when a child has no other way of dealing with their emotions, it all gets a bit too intense and they just have a meltdown.”

Behavioural tantrum

“This is a manipulative kind of tantrum,” explains Sophie.

“The kind of tantrum where they’re threatening, ‘I will scream and yell until you give me what I want’.” Sensory overload Similar in cause to an emotional outburst, but with a slightly different solution, is the sensory overload.Sophie says: “This is when things are too loud, or too bright or there are too many people.”  So what should you do next? With a sensory overload, Sophie says the child may need attention and calming and for you to give them a deep pressure hug (provided they’re not flailing around and trying to hurt you). With an emotional outburst, it’s important to give them space to work through it.“ They need to get it out of their system,” says Sophie.   “If there’s a really shrill screaming going on, that’s telling you, ‘Get out of my face now, I’ve had enough of you’, in which case leave them to it – but you have to make sure they’re safe, obviously.

She also advises limiting your words as much as possible.  “A child under the age of five can’t really process language and heightened emotion at the same time,” Sophie explains.  “Try to use five words or less – that’s pretty much all they can compute.  ”The language you use is also very important with behavioural tantrums and you should think hard about what you’re going to say before you speak.  Sophie says: “The more words you use, the more angry they may get, or […]

How To Teach Kids The Importance Of Accountability

How To Teach Kids The Importance Of Accountability

We’re living in a time and place in which it often seems the people in charge have no sense of accountability ― whether it’s governors rejecting mask mandates and other public health measures aimed at keeping people safe, or leaders failing to own up to their role in big and small failures.

On an everyday level, many adults don’t understand the consequences of their actions and refuse to acknowledge when they’ve made mistakes. And as always, our children are watching. So perhaps now, more than ever, is the time for parents to focus on teaching kids about accountability.

“Accountability is a way to take responsibility for actions you’re in charge of,” Priya Tahim, a licensed professional counselor and founder of Kaur Counseling, told HuffPost. “By teaching kids personal accountability, you’re teaching them that mistakes happen and when those mistakes happen, it’s important to learn to fix or grow from them.”

“It helps instill moral values of right and wrong, even when there is no one watching,” she added. “It also allows kids to see that it’s OK to make mistakes, and there are ways to move forward from those mistakes.”

So how can parents create a culture of accountability in their homes? Below, Tahim and other experts share their advice.

Start small.

“Parents are unsure sometimes about when to actually start asking their kids to be accountable,” Sheryl Ziegler, a psychologist and the author of “Mommy Burnout,” told HuffPost. “I feel like it starts when they’re toddlers, and it’s as simple as, ‘We can play with the puzzle but when we’re all done, we need to clean it up.’”

She noted that kids may wander off to play with something else or get a snack when the puzzle is finished, and too often parents resort to just cleaning it up themselves because it’s faster and easier that way. But it’s better to provide opportunities for kids to take ownership of their own little responsibilities.

“If you start early, you start setting the foundation that it’s important to be accountable: ‘Sure we can play with that now, as long as we clean this up,’” Ziegler said. “You can make it fun and have cute cleanup songs like they do in preschool, but bring it into the home to reinforce that this is how the world works.”

Give more responsibilities.

As kids get older, you can give them more things to be responsible for. The key is to make sure the tasks are developmentally appropriate, such as asking toddlers to pick up their toys and books at the end of the day.

“For kids that might be a little bit older, it could look like packing your own lunch, packing your own backpack, making your bed, or putting all of your dirty clothes in the hamper,” clinical psychologist and author Jenny Yip said. “Kids begin to understand that they do have responsibilities, and the choices they make ultimately have consequences. It also teaches them free will and how to be responsible citizens of society ― it’s ‘I do have a part in what happens in the world.’”

Five Ways to Celebrate Your Students’ Cultures

Five Ways to Celebrate Your Students’ Cultures

Effective teachers cultivate positive relationships with students every day, no matter if the classroom is physical or virtual. They foster emotional connections among students, and help them to feel a sense of belonging and purpose.

This is not a small task. In fact, it is possibly one of the most difficult but important things an educator can do. According to the latest research in developmental science, relationships between and among children and adults are “a primary process through which biological and contextual factors influence and mutually reinforce each other.”

This means that when children experience positive relationships, they are not only creating the pathways for lifelong learning, adaptation, and integration of social, emotional, and cognitive skills, but also making qualitative changes to their genetic makeup. In other words, children’s brains change in response to their life experiences, relationships, and the environments they encounter from birth into adulthood.

Positive relationships also foster resilience, and reduce the impact that negative factors—such as adverse childhood experiences (ACE)—may have on children’s healthy development. Researchers from the Center on the Developing Child at Harvard University suggest that these positive experiences, along with support from adults and the development of adaptive skills, can counterbalance the lifelong consequences of adversity.

Unfortunately, differences in social and cultural backgrounds can make it harder for students to trust teachers. For instance, Black, Indigenous, and People of Color (BIPOC) students and their families may have a hard time trusting their white teachers, given America’s history and current reality of institutionalized racism. At the same time, white teachers may not be inclined to trust their BIPOC students due to their own bias and learned beliefs. This trust gap may hinder their ability to establish meaningful relationships, and can affect students’ academic success.

While an increasing number of schools are adopting social-emotional learning (SEL) programs and practices to create positive learning environments, many fail to incorporate cultural competence as an essential building block to foster these trusting relationships. However, educators still need to gain awareness of their own cultural identity, consider their biases, and how they use their power and privilege with students. Cultural competence also means that educators develop their ability to learn about and build on the varying cultural and community assets of students and their families.

In my new book, Teaching with the HEART in Mind: A Complete Educator’s Guide to Social Emotional Learning, I discuss why educators need to build their cultural competence in order to nurture positive relationships—and how they can ensure that students feel respected, seen, and affirmed. At the root of developing a culturally responsive classroom lies the belief that students’ diverse cultural practices and ethnic backgrounds are assets in the learning process, that should be celebrated and incorporated into academic content and pedagogy. “Culture is central to student learning,” writes education consultant Zaretta Hammond. “Cultural practices shape students’ thinking processes, which serve as tools for learning in and outside of school.” Therefore, students’ languages, cultures, and life experiences should be acknowledged as meaningful sources for learning and understanding.

1. Develop an awareness of your own racial and cultural identity

This entails identifying the historical roots of your identity, as well as beliefs, values, the way culture has influenced your life, and the things that motivate and matter to you. It also involves considering implicit biases, and the privileges and disadvantages afforded to you based on your race or ethnicity. This process is especially important for white educators, since research suggests people of color will commonly begin developing their racial identity before white people. According to author and University of Georgia professor Dr. Anneliese Singh, developing a positive racial identity entails cultivating nonjudgmental curiosity—questioning old ideas and remaining open to new ones.