Attention Magazine August 2020

Help Children with ADHD Learn to Regulate Their Emotions

If you have a child with ADHD, you are probably intimately aware of the fact that people with this diagnosis often have trouble managing their feelings. This difficulty is referred to as emotional dysregulation. For clarification, emotions are physical states whereas feelings are the conscious labels we put on those sensations. For many people the emotion that is most difficult to deal with is anger. It can be very hard to deal with your child’s rage, especially if it is directed at you. Anxiety is another feeling that is common among children with ADHD.

Managing feelings requires executive functions. Some experts view ADHD as a disorder of executive functions. Executive functions are so named because they direct and control the brain, just as a CEO performs in a company. The executive functions depend on the frontal lobes of the brain. For successful executive functioning, we also need to have good communication and support from within the brain. A good CEO must have the ability to stop and think, to transition, to plan and organize, and to monitor their own behavior.

Emotional regulation involves the same set of processes. They are:

• You must stop and think (inhibit your behavior) and engage in self-monitoring.
• Next you must notice physical sensations and label them with a feeling name.
• Then you must rely on your working memory to retrieve strategies you have learned or things that have worked to handle these feelings in the past, hold those strategies in your mind while you consider the current situation, think about your goal, and then choose a strategy that is likely to lead to your desired outcome.
• Then it is necessary to select a plan of action, organize your thoughts, determine the right time to act, and then initiate the action.
• Underlying all of these mental activities, you must sustain your attention during this entire process.

The skills needed to regulate emotions involve the same skills that are often areas of difficulty for kids with ADHD.

Kids often tell me they don’t always do this because their feelings go from zero to sixty like a racecar. I explain that sometimes emotions are initiated in the primitive area of the brain deep inside (the limbic system) and sometimes they are initiated by our thoughts, our thinking brain in the outer cortex. Some people refer to these as downstairs brain and upstairs brain. Downstairs brain initiates the urge to fight, run for your life, or freeze. Upstairs brain produces thoughts that can cause the downstairs brain to fire up or cool down. A thought that could cause a top down response might be “Oh no! This is a disaster!” A calming thought might be “It’s just a problem to be solved.”

In both situations the first step is to cool down the brain. When the emotional system is firing, the brain is clouded and can’t think. This means that there is no point in trying to have a discussion or reason with your child while she is in the middle of a meltdown. Lectures won’t help. In addition, meltdowns tend to be catching; when one person has one it can spread to other family members, which only makes things worse.

“Downstairs brain” initiates the urge to fight, run for your life, or freeze.
“Upstairs brain” produces thoughts that can cause the downstairs brain to fire up or cool down.

Here are some concrete ideas to teach your child to help him cool down:

1. The very first thing is to take a deep breath. Research has shown that taking a deep breath calms the part of the brain most involved in processing emotions (the amygdala). One idea is to imagine that when you inhale you are filling up a balloon in your belly and count to five. Then exhale to the count of five and imagine that you are sending out all the air until your belly button hits your back. This is called belly breathing. You can do this several times and focus on your breath or your counting while you breathe.
2. Meditation and yoga are very self-soothing activities for many people. Many kids have learned mindfulness meditation at school, which can be very helpful for regulating feelings. If not, there are apps and programs online to teach meditation. One example is Headspace, available at headspace.com/meditation/kids.
3. I highly recommend learning and practicing relaxation exercises such as progressive muscle relaxation. A lot of sports coaches are teaching their kids how to do this. Other ideas for relaxation exercises are thinking of places you have been in the past where you were relaxed or imagining relaxing scenes. There are apps available to help with relaxation as well, such as Calm, calm.com.
4. There are other apps now available to help with tracking and regulating emotions. There is an app from the Zones of Regulation curriculum that may be very helpful for educating children about their emotions and about learning to regulate them. The app is available at zonesofregulation.com/exploring-emotions-app.html.
5. I suggest that you and your child locate or create a cooling off space, a place they can go when they need to cool off. Find a place to be alone and have activities already there for your child that you and he will think will be soothing. This is very different than a time out. This is not a punishment or a kind of discipline. It is just a place to go to be calm, associated with calming things. I knew a child once who set up a tent in her room with drawing materials and music to listen to. Her mother would put small snacks in the tent as well.
6. Sometimes kids find it helpful to put out the fire with a bath or a shower.
7. Exercise can be extremely helpful. I encourage kids who are upset to go outside for a run or a walk or a bike ride. I once knew a swim coach who told his kids that they were upset to go swim forty laps. Then if they were still upset to go swim ten more laps, and ten more until they weren’t upset anymore.
8. Playing with your cat or dog or taking her for a walk can be helpful in many ways. One child I knew found petting her dog very soothing. Even cuddling a soft stuffed animal can be calming for some kids.
9. Getting out in nature can be very comforting. Go outside and go for a walk and take in some deep breaths.
10. Some kids find drawing or painting to be soothing. Drawing or writing about their thoughts and feelings can be very helpful in the moment and later for problem solving.
11. Many people find that listening to music is calming. Of course, music can be combined with any of the activities above.
12. Talking to someone is a great way to help calm down. As a parent the best thing you can do if your child wants to talk to you is to listen without interrupting. Just listen, calmly and with great interest. No need to paraphrase or offer advice.

Once all is calm, problem-solving can begin

Once your child’s brain is calm, it is time to use access her thinking brain and do some advance problem-solving. I encourage you to try some of the activities I listed with your child to see what is most helpful, then make a list and post it. During an upset we are likely to forget what we have learned to, so it is important to have a visual reminder.

During problem-solving time, we can talk about the fact that what we think affects how we feel and how we act. So, if we can change how we think, we can change how we feel. This takes some practice. Understanding a situation from another person’s perspective can really help change how you feel, especially if you can also have some empathy for that person.

If your child is able to write down all his thoughts and feelings from his upset, perhaps later when he is calm you can help him see the situation from a different perspective. Are there other ways of thinking about the situation that might change how she feels? Can she see things from another person’s point of view? This is very important because changing how she feels may change how she acts and may change the impact of her behavior on other people.

For solving the problem, it is important to learn what triggers upsets or anxiety. Are there steps that your child can take to avoid having a meltdown? I suggest thinking back to the last time they felt calm. Then we talk about the events that led up to an upset such as a meltdown or anxiety attack. I have always found that there was a series of events that led the feelings to escalate.

I draw a ladder. At the bottom rung is #1, and that is where she is calm. At the top of the ladder is a #10, and it is where the feeling is out of control. When did she last remember being calm? What happened next? We write down the events at each step up the ladder. When she gets to 3 it is time to start taking some action like belly breathing to calm her brain and try to prevent the feeling from escalating. By the time she gets to 7, she must take action—like going to her cooling-off place. If she is not at home, she needs to try alternative ways to cool to cool down. She may need help with this. By the time she gets to 8 it is harder and harder to avoid losing control. We think this all out and practice what to do and write it down to take home.

As a parent, you can help your children learn these skills by learning and practicing with them. Children learn by what they see their parents do. So, start by taking one of these ideas and put it into practice right now. Learn meditation with your child. Practice belly breathing at night before bedtime. Try some other relaxation ideas as well. Talk about happy memories. Make a cooling-off place for each family member and practice using it before you need it.

Have a family meeting and discuss what is relaxing for each family member. Write these ideas down and post them. Then next time you can feel your feeling temperature rising you will have a reminder of how to cool it down and stay cool. So will your child.

Judith M. Glasser, PhD, is a clinical psychologist who specializes in the treatment of children, adolescents, and their families. A graduate of Oberlin College and the Catholic University of America, Dr. Glasser completed an externship at the Georgetown University Child Development Center. She has worked in private practice in the Washington, DC, metro area for 36 years. Over the course of her career, Dr. Glasser developed special expertise in the diagnosis and treatment of ADHD and related issues and diagnoses. Dr. Glasser is the coauthor, with Kathleen Nadeau, PhD, of Learning to Feel Good and Stay Cool: Emotional Regulation Tools for Kids with ADHD (Magination Press, 2014) and Learning to Be Kind and Understand Differences: Empathy Skills for Kids with ADHD (Magination Press, 2015).