Attention Magazine August 2020

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Everyone EXPERIENCES A MIXTURE of positive and negative emotions daily. For some people, these emotions—particularly negative emotions like anger, frustration, sadness, and guilt—can be overwhelming. Emotion regulation is a term generally used to describe a person’s ability to manage and respond to an emotional experience in an adaptive way. Emotion regulation is essential for social and emotional well-being.

Managing emotions is particularly challenging for adolescents, who often experience high levels of conflict with parents and peers. This is especially true for adolescents with ADHD, who Russell Barkley describes as having a “low frustration tolerance, impatience, [and] quickness to anger.”

Although teens with ADHD have significant difficulty managing negative emotions, many also have difficulty managing positive emotions. Specifically, when happy or excited, adolescents with ADHD often display age-inappropriate levels of enthusiasm or exuberance. They may yell, jump up and down, and invade others’ personal space when they find out good news. As a result, parents, teachers, and peers often view these teenagers as immature and rambunctious.

Growing recognition of emotion regulation difficulties in ADHD

Relative to adolescents who do not have ADHD, adolescents with ADHD have significant difficulty managing positive and negative emotions. In particular, adolescents with ADHD exhibit intense displays of negative and positive emotions, stronger reactions to frustration or stress, and more rapid and drastic changes between emotions.

Recent evidence suggests that the extreme changes from day to day in positive and negative emotions among adolescents with ADHD is linked to less peer acceptance, more internalizing symptoms (anxiety, depression), and more externalizing symptoms (ADHD, oppositionality, defiance, conduct problems). Overall, poor emotion regulation may contribute to many of the negative outcomes they experience, such as engagement in risky behaviors including substance use, verbal and physical aggression, peer rejection, romantic difficulties, and family conflict.

Strategies for parents to increase adolescent emotion regulation

Parents play an important role in adolescent emotion development through their use of emotion socialization practices. Parent emotion socialization is an umbrella term used to describe emotion-focused parenting behaviors. It includes modeling of emotions and regulating emotions, discussing emotions, and responding to emotional displays in others, particularly their children.

When parents model helpful ways of dealing with negative emotions, such as talking to someone or taking space to calm down, and respond to their child’s negative emotions by validating, coaching problem solving, and providing comfort, adolescents show better emotion regulation, more prosocial behaviors, and lower levels of anxiety, depression, and aggression. In contrast, when parents model anger; engage in arguments or violence; and punish, minimize, or escalate their teen’s negative emotions, it may further exacerbate emotion regulation difficulties.

Managing emotions is particularly challenging for adolescents, who often experience high levels of conflict with parents and peers.
This is especially true for adolescents with ADHD.

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Parents can use these four strategies to help improve adolescent emotion regulation:

1. Encourage your adolescent (and yourself) to develop a list of coping skills.
   Coping skills are any behavior that help you feel better and are not harmful to yourself or someone else. Some common coping skills include talking to a friend or parent, exercising, listening to music, drawing or writing in a journal, taking a shower or bath, taking time (such as going to your room to calm down), taking deep breaths, or practicing mindfulness. Not all coping skills can be used in every situation. It is important for your adolescent to think of skills that can be used at home, at school, and in public situations when big emotions and stressful or frustrating situations arise.

It is equally important that you support and acknowledge when your adolescent is using a coping skill. This can be challenging at times. For example, if you and your adolescent are having a conversation and they become upset and ask to go to their room to calm down before finishing the conversation. This is a great display of emotion regulation and should be encouraged. However, it sometimes is mistakenly interpreted as the adolescent being disrespectful or avoiding the parent or conversation.

2. Listen, empathize, and validate your adolescent’s emotional experiences.
   It is critical that parents help provide a supportive environment where adolescents feel safe sharing their thoughts and emotions. Many times what we say as parents is less important than showing that we are listening and care. In fact, at times asking direct questions might not be as effective as simply sitting back and listening. Adolescents are more likely to be open with their parents if they don’t feel pressured to share information.
   

Many well-intentioned parents try to solve problems for their children, or downplay their disappointments. However, it is important to empathize and validate your adolescent’s feelings. You do not need to agree with or understand your adolescent’s emotion to listen, express empathy for their experience, and validate the emotion they are experiencing. For example, try saying “I can tell this was really upsetting for you, I would be angry as well if my friend said something like that to me.” Emotions are often not rational, especially for children and adolescents. Just because an emotion is irrational does not make it any less real and does not make it wrong. Believing that you are wrong for feeling a certain way can make you feel worse.

3. Encourage your adolescent to engage in healthy habits.
   Snickers was on to something when they developed their “You’re not you when you’re hungry” commercial series. Being “hangry”—that is, angry because you are hungry, is a very real experience for adolescents and adults alike.

Making sure your adolescent has eaten, received an adequate amount of sleep, and is engaging in regular physical activity all can help with managing emotions. Recommendations for these healthy habits include:

• • Healthy eating. Adolescents are encouraged to eat three meals a day with healthy snacks in between, and to drink at least eight glasses of water. It is hard to think, manage stress, and respond appropriately when you are hungry.
  • Sleep. Adolescents are recommended to get eight to ten hours of sleep a night. Sleep schedules should be consistent, that is going to bed and waking up within a one-hour window each day of the week (for example, 7 AM on weekdays and 8 AM on weekends). Adolescents should avoid caffeine in the four to six hours before bed and technology use within at least thirty minutes before bed.
  • Exercise. Adolescents are recommended to get sixty minutes or more of physical activity each day. Regular exercise has been linked to better attention and mood and less anxiety. Exercise can also help adolescents burn off steam and feel more relaxed.

4. Recognize your emotions and stress levels.
   Your emotional health is a priority, too! Think of the air mask analogy on airplanes—you need to take care of your own emotional health first in order to take care of your adolescent’s emotional health. Ensuring that you are in a good emotional state makes it more likely that you will respond in supportive and helpful ways when your adolescent experiences a negative emotion. Utilize your coping skills, make sure you have some “me” time each day, and make sure you have adequate social support to manage the many stressors you experience in daily life.

Interventions targeting emotion regulation in adolescents with ADHD

Despite the overwhelming evidence for the presence and impact of emotion regulation difficulties among teenagers with ADHD, interventions are just beginning to target these specific difficulties.

The RELAX (Regulating Emotions Like An eXpert) Intervention was developed to address the high levels of emotion regulation difficulties and family conflict experienced by adolescents with ADHD and their families. RELAX is in an eight-week group-based intervention. Parents and teens meet separately for the first sixty minutes on skill-building activities and meet together for the last thirty minutes for a discussion activity, and to problem-solve skill use for their family over the coming week. RELAX seeks to equip adolescents with coping, communication, and conflict management skills. RELAX also helps parents learn how to support their adolescents in using these skills and to utilize helpful emotion socialization practices.

RELAX is unique in its structure of teaching skills to parents the week prior to adolescents in order to facilitate parental reflection and utilization of skills in their own lives. This helps parents model these skills for adolescents and facilitates parents supporting their adolescents’ skill use in the following weeks. This structure is critical given the importance of emotion socialization for emotional development, and the fact that parents of teenagers with ADHD often experience emotion regulation difficulties and high levels of stress themselves.

In addition to this group-based intervention for adolescents with ADHD and their parents, several existing evidence-based interventions like cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) have been increasingly used with adolescents and adults with ADHD to address emotion dysregulation. Check out the additional readings and resources for some RELAX, CBT, and DBT resources to help your teen with ADHD improve their emotion regulation.

ADDITIONAL READING AND RESOURCES

Bunford, N. (2019). Emotion Regulation in Adolescents with ADHD. In S. P. Becker (Ed.) ADHD in Adolescents: Development, Assessment, and Treatment (pp. 77-100): The Guilford Press.
Halloran, J. (2020). Coping Skills for Teens Workbook: 60 Helpful Ways to Deal with Stress, Anxiety and Anger: Encourage Play, LLC.
Honos-Webb, L. (2010). The ADHD Workbook for Teens: Activities to Help You Gain Motivation and Confidence: Instant Help Books, A Division of New Harbinger Publications, Inc.
RELAX Intervention Handouts: https://www.calmerlab.com/the-relax-intervention
Van Dijk, S. (2011). Don’t Let Your Emotions Run Your Life for Teens: Dialectical Behavior Therapy Skills for Helping You Manage Mood Swings, Control Angry Outbursts, and Get Along with Others: Instant Help Books, A Division of New Harbinger Publications, Inc.

Rosanna Breaux, PhD, LCP, is an assistant professor of psychology at Virginia Polytechnic Institute and State University in Blacksburg, Virginia. She is the assistant director of the Virginia Tech Child Study Center, a specialty research, service, and training facility devoted to the comprehensive assessment, treatment, prevention, and understanding of problems of childhood and adolescence. Dr. Breaux’s research focuses on the emotional and social functioning of children and adolescents with ADHD, with a focus on emotion regulation. Additionally, Dr. Breaux is working to evaluate and disseminate the RELAX intervention for adolescents with ADHD, which targets emotion dysregulation and interpersonal conflict.