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:

Expert-approved tips to calm down when you're angry

Expert-approved tips to calm down when you’re angry

Anger is an important instrument for anyone’s emotional toolbox. It protects, helps discharge stress and can bring words and feelings to the surface that may need to be expressed to help relationships grow.

But the manner in which one handles feelings of anger can lead to vastly different outcomes. “There’s nothing wrong with anger, it’s what you do with it that matters,” said Dr. Joseph Shrand, an instructor of psychiatry at Harvard Medical School and author of “Outsmarting Anger: 7 Steps for Defusing Our Most Dangerous Emotion.”

Indeed, the author of “The 5 Love Languages,” Gary Chapman, has counseled countless families and couples over his career and has seen numerous instances in which mismanaged anger destroys marriages, fractures friendships and sometimes even separates parents from children. “Much of my counseling has been in helping individuals understand and process anger,” he said.

Why we get angry

It’s helpful to understand why we get angry in the first place. “In human relationships, anger is the emotion that arises when we feel that we have been wronged or in some way mistreated,” Chapman said. “It’s a call for action to right the wrong. However, when we yield to our first impulse, we usually make things worse.”

Shrand had a similar take: “We feel anger because we want something to be different. We wish someone would stop doing something or start doing something,” he said. He explained that when we’re angry, the part of the brain in charge of managing emotional responses known as the limbic system, gets ready for a fight. In such a state, “we can get impulsive, irrational and lash out without thinking,” he warned.

“Anger is part of the brain’s fight-or-flight response, so it has to do with our survival instinct,” said Stephen Dansiger, an eye movement desensitization and reprocessing clinician and author of “Mindfulness for Anger Management.” He described some of the body’s physiological responses when angry: a rising heart rate, muscle tension, sweating and heightened hearing and vision. “The body is literally preparing to deal with the perceived threat,” he said.

What to do with our anger

Problem is, such base instincts may perceive threats where no real danger exists. “When we’re angry, we see ourselves as a hammer and everyone around us as a nail,” said Dr. Laura Markham, a clinical psychologist and author of “Peaceful Parent, Happy Kids: How to Stop Yelling and Start Connecting.” That may include reacting to an insensitive comment from a spouse or to a child who just threw their plate of food on the floor. In such instances, Markham warns, “there is no real threat, but our bodies react as if there is.”

The best way to deal with anger, the experts said, is to diffuse it. That means doing whatever it takes to remind your brain there isn’t really a threat or emergency and that it’s time to calm down.

“There’s an entire body of research on how to calm down and retrain the nervous system,” Markham said. She suggested techniques like running your hands under cold water, taking deep breaths, getting some fresh air, humming, shaking your wrists, counting backwards from 100 until you start to feel calm again, or even forcing a laugh or a smile to trick your brain into switching gears. “These are all research-supported ways to calm down in the moment,” she said.

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:

Obesity is a social problem – we need to stop treating it as a personal one

Obesity is a social problem – we need to stop treating it as a personal one

I learned a lot about myself during lockdown, particularly in terms of my relationship with food. I have always had a problem with binge eating – gorging on junk food to palliate emotional lows. This destructive habit reached its nadir during the winter months of last year, when my life might as well have been one of those awful reality TV shows with titles such as “Overweight and house trapped”.

Apparently I was not alone: a study conducted last year by King’s College London found that almost half (48 per cent) of those questioned said they had put on weight during lockdown. As we shut ourselves indoors to “stop the spread” of Covid, it seems that overeating turned into one of our collective coping strategies. Notably, almost half (48 per cent) of people in the King’s College survey (the same percentage who admitted to overeating) said they were feeling more anxious and depressed than usual.

The Covid-19 mortality statistics were a constant reminder that over-indulgence was a reckless course of action – the risk of becoming seriously ill with Covid was significantly greater the more weight we piled on. Boris Johnson himself said he was “way overweight” when he was hospitalised with Covid.

Yet looking at our collective weight gain through the lens of a rational cost-benefit analysis would be to miss the point. That has always been true for me personally. I was always acutely aware that inhaling vast quantities of crisps and chocolate is bad for my health. But binge eating was an emotional coping strategy produced by my ADHD (attention deficit hyperactivity disorder). Lockdown – and the anxiety that accompanied it – simply amplified it.

I was reminded of this last week when the latest update to Henry Dimbleby’s National Food Strategy was published. The report by the co-founder of the Leon chain of restaurants and the son of David Dimbleby made several key policy recommendations, including new taxes on sugary foods and a system whereby the NHS prescribes vegetables to poorly nourished patients.

The strategy, first published in June 2020 and updated regularly, feeds into the government’s own plan to tackle what it calls Britain’s “obesity timebomb”. Ministers have already banned junk food television advertising before the 9pm watershed and calorie counts will soon be added to the menus of restaurants and cafes that employ more than 250 people.

However, the government has already rejected the proposals for new levies on salt and sugar contained in the latest report, which Boris Johnson dismissed as “extra taxes on hard-working people”.

And yet there is some evidence to suggest that food levies – of £3 per kilogram […]

Children who show a blunted neural response to errors may be at risk of psychopathology

Children who show a blunted neural response to errors may be at risk of psychopathology

A study from Brain and Behavior found that children who respond to errors with a larger error-related negativity (ERN) fared better on a range of psychological outcomes one to two years later — including anxiety, depression, and emotion regulation. The study authors say the ERN may serve as a neuromarker of resilience in children.

The error-related negativity response is an electrical brain signal that occurs after a person makes a behavioral mistake. The response stems from the anterior cingulate cortex and has been identified as an indicator of future mental health. However, the research findings are somewhat contradictory. Some studies have suggested that an enlarged ERN in childhood predicts worse mental health, while other studies have found better mental health among children with larger ERNs.

Study authors Jamie M. Lawler and her team conducted a study to explore the link between ERN activity in young children and the development of emotion regulation, cognitive control, and psychopathology one to two years later.

“About 1 in 5 kids experiences an emotional or behavioral problem but we as a field are not very good at predicting which kids that will be. Our research is one part of trying to understand how to identify children early so that we can hopefully intervene before big problems develop,” said Lawler, an assistant professor at Eastern Michigan University and director of the Self-regulation, Early Experience, and Development Lab .

Their study made use of data from a larger project and included two time points. At the baseline assessment, children were between the ages of 4 and 7 and took part in a “Go/No Go Task” — a cognitive task that requires participants to respond to certain stimuli and refrain from responding to other stimuli. The “Go/No Go” task was used to measure ERN. The children’s parents completed reports of their child’s cognitive control, negative affectivity, and internalizing and externalizing symptoms.

From the initial sample, the researchers selected a subset of children who either showed a high ERN amplitude (15 children) or a low ERN amplitude (15 children). The groups were matched by age and sex as closely as possible. At a follow-up study around one to two years later, the two groups of children completed several tests to assess cognitive control, and their parents also completed assessments of the child’s cognitive control. Both the children and their parents additionally completed measures of child emotion regulation and internalizing and externalizing symptoms.

At baseline, the group of children with a high ERN amplitude fared better according to parental reports of cognitive control, negative affectivity (e.g., anger, fear, discomfort), and externalizing symptoms (e.g., aggression, overactivity) compared to the low ERN group. Moreover, when reassessed one to two years later, the high ERN group continued to […]

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