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:

5 ways parents can help their kids with emotional stumbling blocks

5 ways parents can help their kids with emotional stumbling blocks

Parenthood is no easy task—particularly in today’s world.

Many experience occasional toddler meltdowns in the supermarket, or moody teenagers that speak in monosyllabic words. But with the rise of social media and a hyper-connected world, many parents worry about their children’s mental and emotional health—and for good reason. According to the Centers for Disease Control and Prevention, cases of depression and anxiety among children are steadily increasing.

So, with all that’s going on, what can you do to bolster your child’s emotional resilience and make your home a safer place? Here’s some advice from mental and behavioral professionals.

If you want healthier, happier children and family relationships, it starts with connection. Remember that what happens in your house is more important than what happens anywhere else. Find what works best for your family and resist the urge to compare yourself with others.

First and foremost, take time to connect with the people in your home. Put your phone down. Make eye contact. Focus only on the people and relationships that are around you at that moment. This could be 10 minutes, it could be an hour—do whatever fits in your schedule!

It’s particularly important that parents don’t let cell phones come between them and their kids. Dona Matthews, Ph.D., writes in Psychology Today that children whose mothers constantly use devices experience several negative effects. They’re less resilient, they feel unimportant, and it interferes with their social and emotional development.

“Ultimately, kids thrive when they receive consistent, dependable, focused, loving attention,” Matthews writes. “When you’re with your child, be with them.”

There are many different and simple ways to do this. Storie Stinger, a licensed clinician with Utah Behavior Health suggests going on a family walk and let the kids ride bikes or scooters. Go on a drive and get ice cream. Play a board, or card, or social game. Try to do things that will allow you to connect on their level. You could even have them pick the activity!

The most important thing is to just be present. Be right here, right now.

Now that your kids are back in school, you’ll probably have a lot to talk about at the end of the day. Instead of asking, “How was school today?” try something a little more specific. Here are a few suggestions from Stinger:

“What was your favorite part of the day?”

“What was your least favorite part of the day?”

“Tell me about a new person you met today.”

“What kind things could you do for someone tomorrow?”

Open-ended questions like these are important because they lead to more thoughtful answers. They show your child that you’re genuinely interested in what they have to say.

Focus on their strengths

It can be easy as a parent to praise your child for their talents and accomplishments. If they score a goal in their soccer game or get an A on their report card, naturally, you feel proud! But it’s also important that you point out their character strengths that aren’t based on results or performance.

Stinger suggests saying, “I love how kind you are.” Or, “I noticed you tried really hard on that thing.” And then there are the words every child needs to hear: “Thanks for being a part of our family. I love you.”

How understanding your child’s unique nature can make you a more effective parent

How understanding your child’s unique nature can make you a more effective parent

VCU professor Danielle Dick’s new book, ‘The Child Code,’ helps parents adapt their parenting strategies to fit how their child is wired.

Genetics influence every aspect of human behavior. But that biological fact is often ignored when it comes to parenting advice, which tends to perpetuate the myth that parenting techniques alone determine a child’s behavior and future.

In “The Child Code: Understanding Your Child’s Unique Nature for Happier, More Effective Parenting,” Danielle Dick, Ph.D., the Distinguished Commonwealth Professor of Psychology and Human and Molecular Genetics at Virginia Commonwealth University and an internationally recognized expert on genetic and environmental influences on human behavior, explains how each child is uniquely coded with predispositions that affect their fearfulness, impulsivity, happiness, propensity for throwing tantrums and all other aspects of their personality.

Drawing on her research in developmental behavior genetics, as well as her experience as a parent, Dick, a professor in the Department of Psychology in the College of Humanities and Sciences and the Department Human and Molecular Genetics in the School of Medicine at VCU, shows parents how they can recognize their child’s genetic predispositions and then provides practical, individualized strategies to help navigate the child’s challenges and nurture their strengths.

“The Child Code,” published by Avery, an imprint of the Penguin Publishing Group, will be released Sept. 14. Dick discussed the forthcoming book in an interview with VCU News.

The book talks about how each child is uniquely coded with predispositions that influence their behavior and personalities. What are some ways the book explains how parents can apply that knowledge?

Parents put so much pressure on themselves, especially in our culture right now. Never in human history have we spent so much time and effort parenting our children. And that creates a lot of stress on parents when kids are struggling or not being perfect little human beings. So, one of the messages that I really hope parents will take away is that they can take some of the pressure off! Our kids already contain their own instruction manuals, the so-called building blocks of life, that shape their development and behavior. We can help our kids grow and nudge them in particular directions, but it’s not all on us. So that’s one thing that I hope parents will find comforting.

The other big takeaway is that by understanding the way your child is wired, you can tailor your parenting strategies to what will work best for your child. The second half of the book covers three big temperamental dimensions that kids differ on. I call them the three E’s: extraversion, emotionality and effortful control. By understanding where your child falls on those dimensions, you can help them accentuate their strengths and overcome (or avoid!) potential challenges.

For example, kids that are high in extraversion versus kids that are low in extraversion have different environmental needs. As parents, we sometimes unwittingly put our kids in environments that are a mismatch with their nature — for example by putting kids who are low on extraversion in very active, busy, social settings, which can be overwhelming or distressing for them. And that can be a cause of temper tantrums and stress in the family, but very often we don’t even recognize the underlying cause.

Similarly, some kids are just more highly emotional than others. They are just more naturally predisposed to be easily frustrated or fearful. A lot of parents who have kids like that wonder, “What am I doing wrong?” Or “What’s wrong with my child?” They’re trying reward charts and consequences, and it’s not helping the behavior. There are actually different parenting strategies that can work better for these highly emotional kids.

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:

Shh … How a little silence can go a long way for kids’ mental health

Shh … How a little silence can go a long way for kids’ mental health

Amy Carson’s four-year-old daughter is ignoring her—and she doesn’t mind one bit. Pushing Isa in her pram, Carson is opting for a walk instead of a drive after a playdate to give them both a break from the thrum of life. The 15-minute soundless sojourns make a big difference.

“This silent time is really helpful for Isa after an outing,” Carson says. “She’s calmer watching the world go by while resting her head against the stroller than after a car ride, where we typically talk or listen to music.”

Any parent will tell you that that silence is golden in the orchestra that is family life. But it can also be good for a child’s mental health.

Silence works like a buffer between external stimuli and emotional processing. In other words, the lack of noisy distraction can help kids’ brains better understand the world around them. And in fact, multiple studies have shown that silence might boost feel-good oxytocin levels and therefore decrease stress, help focus and streamline thoughts, and promote a general calmness that allows their brains to learn to regulate their emotions.

“Children need an opportunity to strategically and safely disengage from a complex social world, step back, assimilate, and build a story of who they are,” says Mary Helen Immordino-Yang, professor of education, psychology, and neuroscience at the University of Southern California.

Of course, children and silence don’t exactly go together. One study published by a team of researchers at the University of Virginia and Harvard University showed that college students would rather administer a minor electric shock to themselves than sit in utter silence for 15 minutes.

“Life, especially with kids, is full of sensations and motion,” says Meghan Fitzgerald, co-founder and chief learning officer at Tinkergarten, an early education program focused on outdoor learning. “Anyone who has worked with children knows that asking for total stillness or silence is futile at best.”

Luckily, you don’t need to force kids to sit mutely in a corner to get the benefits of silence. Experts say quiet time—fusing soundlessness with calming activities like puzzles or painting—works just as well. Likewise, daydreaming can act like a staycation for children’s thoughts. Even focusing on calming sounds, like nature or hums, can centre children.

Basically, adding a daily dose of silence into a child’s life by creating pockets of low-volume space is like giving them a mental health multivitamin. Here’s how to get started.

The science behind the silence

For kids, silence is more than a mental time out. “A child needs silence to stay sound,” says Eric Pfeifer, professor for aesthetics and communication at the Catholic University of Applied Sciences in Freiburg, Germany. “It’s highly important to a child‘s development. Just imagine an orchestra and all its musicians playing non-stop without a pause. It would be an unbearable cacophony.”

Basically, silence minimises distractions, which helps children relax. And relaxation helps activate the brain’s hippocampus, which is important for building memories that support life skills like decision-making and empathy. As a result, during silent moments kids can streamline their thoughts, make sense of their emotions, and rewire their stress response.

What to Do When Your Kid Thinks You're Playing Favorites

What to Do When Your Kid Thinks You’re Playing Favorites

I wasn’t exactly surprised when, in the midst of a recent disagreement, my 11-year-old son expressed how upset he was by telling me that he believed I love his younger sister more than him. That’s a pretty common go-to move that most parents hear at some point, and I certainly remember breaking it out on at least a couple of occasions when I wasn’t getting the attention I wanted from my mom.

But after the obligatory, “Oh, that’s ridiculous!” that most parents probably reflexively reply with when faced with that familiar scenario, I thought about it again later. Is he right? Do I play favorites?

I obviously don’t love one of my children more than the other. But his sister and I do have more similar temperaments and senses of humor. Is it possible that I unknowingly send a message to him that I have a favorite child? And, if so, what can I do to fix it?

“Most of the time, when children say those things, almost always it is about attention, whether it’s emotional attention or physical attention,” says Loretta Rudd, project director, clinical associate professor, and program coordinator for child development and family studies at the University of Memphis.

The ramifications for not taking claims of favoritism seriously can cause a negative impact for kids later in life. Psychology Today points out that “disfavored children” can be at greater risk for depression, substance abuse, greater aggressiveness, or poor academic performance, among other things. Healthline also notes that the favoritism doesn’t necessarily even have to be real—simply perceiving that they are the least-favored child can lead to similar negative consequences later in life.

The good news is that, most of the time, parents can simply use healthy communication habits to help make favoritism accusations into teachable moments.

Explain how difference in age mean differences in responsibilities

One easy way differences in rules for siblings can start to manifest in accusations of favoritism is when an older child starts to get more privileges. Older kids may stay up later, have more freedom to talk with or see friends, get to watch shows or games with more mature themes, or get to do other activities with less stringent parental oversight.

When younger siblings take notice and believe parental bias or favoritism is the cause, it is important to explain the added responsibilities that typically go with those privileges.

“There are social norms, maybe, that the older child gets to first,” Rudd says. “So, they’re getting something the younger child isn’t. But if you can explain to them that, as they get there [developmentally], they’ll have the opportunity. You can’t promise them they’re going to get it, but just explaining that with privileges comes responsibility, and being really clear and up front [is best].”

Since younger kids are attention-driven, lessons about responsibility can be reinforced with them when they ask to do things. For example, saying that we can play a game or go for a bike ride after the kitchen is clean is a way to subtly teach them that sometimes fun or privileges require less fun tasks being handled first.