ADHD and Anger: How Are They Connected?
Children and young adults with attention deficit hyperactivity disorder (ADHD) often have issues with emotional regulation. This article focuses on anger and explores the relationship between ADHD and the common experience of those living with ADHD of having a difficult time controlling emotions.
While most people familiar with ADHD understand the diagnosis as one that primarily affects a person’s ability to pay attention or to complete tasks, ADHD’s effect on a person’s ability to manage an emotional outburst - especially when it comes to anger - is often overlooked. Research, however, shows that 70% of adults with ADHD report problems managing their emotions or with anger management. For children, the prevalence rises to 80%.
This startling statistic raises the question, what is the relationship between ADHD and anger?
The link between ADHD and anger
At the center of the relationship between ADHD and anger is an individual’s difficulty in managing their emotions, which is known as emotional dysregulation. While emotional dysregulation is not unique to ADHD, and is common in many other mental health disorders, it is important to highlight this connection because, as mentioned above, most people focus primarily on the hyperarousal and inattentiveness that comes with an ADHD diagnosis, and overlook the emotional instability aspect of the disorder.
It is also important to consider the frustration that can arise from living with the untreated symptoms of ADHD. It is easy to understand how having difficulty in completing daily tasks, struggling to pay attention to information that may be important, or not being able to stay focused while in conversation with others can create a situation in which a person is constantly fighting against the odds, causing intense anger and vexation.
What is ADHD?
According to the CDC, ADHD is one of the most common mental health disorders, occurring in approximately 8.4% of children and 2.5% of adults. ADHD affects a person’s ability to pay attention, control impulsive behaviors, and cause a person to be overly active. While it is normal for children and young adults to find it difficult to complete a task they do not want to do, act out from time to time, and occasionally become overly excited, when these types of behaviors persist over an extended period of time, and negatively affect their ability to function at work, school, or in their relationships, it is possible that an ADHD diagnosis is present.
There are three types of ways ADHD presents itself, and these types are differentiated by which symptoms of the disorder present themselves most strongly:
Predominantly inattentive presentation
It is hard for the individual to organize or finish a task, pay attention to details, or follow instructions or conversations. The person is easily distracted or forgets details of daily routines.
Predominantly hyperactive-impulsive presentation
The person fidgets and talks a lot. It is hard for them to sit still for long. Smaller children may run, jump, or climb constantly. The individual feels restless and has trouble with impulsivity. This may cause them to interrupt others, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions.
Symptoms of the above are equally present in the person.
It is imperative that if you or someone you love identify with any of the symptoms above, you reach out to a mental health professional. Dealing with uncontrolled ADHD symptoms can cause life to be incredibly difficult. According to the American Psychiatric Association, ADHD can lead to poor self-esteem and social function in children when not appropriately treated, and adults may experience poor self-worth, sensitivity towards criticism, and increased self-criticism, possibly stemming from higher levels of criticism throughout their life. It is important to note that adult ADHD may present differently than childhood ADHD.
For many people, ADHD occurs alongside other mental health disorders. In fact, the CDC reports that approximately half of children with ADHD also have a behavior or conduct problem, which makes it even more difficult for them to manage negative emotions such as anger and aggression.
What can trigger anger in people with ADHD?
Unfortunately, events that seem minuscule or insignificant to some people may cause an intense emotional response in someone with ADHD. For example, a child may drop their ice cream and break into an hour-long temper tantrum, or a young adult may misplace their car keys and suddenly explode into a screaming bout at no one in particular.
For their peers without ADHD, these events will cause negative emotional reactions. Obviously, no one likes dropping their ice cream or losing their car keys. But, the difference between a person that has ADHD and a person that does not is that for a person with ADHD, their emotional reaction to the negative event can be incongruous with the event itself.
People that do not suffer from emotional dysregulation related to ADHD tend to be able to employ their coping skills and reasoning to conclude that a small setback or challenge does not justify an overblown, extreme reaction. The question is, what is the cause of emotional dysregulation in individuals with ADHD?
ADHD and the brain
Different regions in the brain function to regulate specific emotions and behaviors. The amygdala region of the brain is where we receive signals related to emotional reactions. When we are confronted with a difficult situation, one that causes frustration, fear, or anger, the amygdala communicates with another region of the brain known as the cerebral cortex. This region’s function is to help inhibit and manage emotional responses so that we can think through a situation and respond appropriately.
In people with ADHD, the brain’s ability to communicate between these two regions is weak. According to Joel Nigg Ph.D., an expert on ADHD management, this weak connection may cause:
- Emotional reactions that seem out of sync with their cause
- Difficulties calming down once an intense emotion has taken hold
- Seeming insensitive to, or unaware of, the emotions of others
Based on the information above, it is clear to see how living with ADHD, and having this weakened connection between two of the most important regions of the brain that are meant to regulate heightened emotions, can cause extreme difficulties in managing anger and in functioning day-to-day.
ADHD and Behavior Problems
The concurrence of ADHD with other mental health disorders poses an even greater challenge for the individual's ability to manage negative emotions such as anger. According to the CDC, some mental health issues that are commonly found in tandem with ADHD are behavior problems, learning disorders, peer problems, anxiety, and depression.
Children and young adults with ADHD that persistently act angry or defiant around adults or become aggressive regularly may be suffering from a behavior disorder as well. Children with ADHD are more likely than their peers to be diagnosed with behavior disorders such as Oppositional Defiant Disorder, Conduct Disorder, and Disruptive Mood Dysregulation Disorder.
Oppositional Defiant Disorder (ODD)
ODD occurs when a child acts out often and when this repeated behavior causes serious problems at home, in school, or with peers. Examples of ODD behavior are arguing with adults or refusing to comply with rules or requests, frequent anger outbursts, feeling resentful or wanting to hurt someone who they feel has hurt them or caused problems for them, deliberately annoying others, or becoming annoyed easily by others, and consistently blaming others for their own mistakes or misbehaviors.
Conduct Disorder (CD)
CD can be present when a child shows persistent patterns of aggression towards others and consistently violates rules at home, school, or within social settings. These behaviors not only put the child at risk of being socially isolated from their peer group but can also lead to trouble with the law. Examples of CD behavior are breaking serious rules, such as running away, staying out at night when told not to, skipping school, and being aggressive in a way that causes harm, such as bullying, fighting, being cruel to animals, lying, stealing, and damaging other people's property on purpose.
Disruptive Mood Dysregulation Disorder (DMDD)
The DMDD diagnosis was added to the DSM5 in 2013 in order to differentiate a set of symptoms that presented similarly to bipolar disorder but were unique, not fully meeting the criteria to be considered bipolar disorder. DMDD is characterized by intense temper tantrums that occur at least three times a week, along with a constant angry mood. Studies have found that 20% of those with ADHD qualify for a diagnosis of DMDD. Examples of DMDD behavior include persistent irritability, anger, outbursts disproportionate to the situation, fits of rage with little to no provocation, and physical aggression.
To summarize, ODD, CD, DMDD, and ADHD can all lead to irritability and anger issues. The different diagnoses are meant to help better capture the severity and frequency of irritability, anger, and aggression. While it is not necessarily the case that if you have ADHD that you will also have a secondary behavior disorder, it is not uncommon for the two disorders to exist together.
Due to the weak communication between the amygdala and the cerebral cortex found in an ADHD brain, learning to better manage negative emotion such as anger is central to leading a more full and meaningful life with ADHD. Through ADHD treatment, improvements can be made in one’s ability to work through the emotional dysregulation that comes with ADHD.
Managing anger caused by ADHD
While many of the treatments for ADHD help improve attentiveness and can help dampen the intensity of the emotional symptoms, professionals note these treatments tend to be less effective in managing emotional dysregulation than they are in addressing the traditional symptoms of ADHD listed in the DSM5.
According to CHADD, the nation's leading nonprofit organization serving people affected by ADHD, treatment for ADHD requires a comprehensive approach that should be specifically tailored to the individual. For this reason, collaborating with a mental health clinician, like the professionals at Charlie Health, can give you a better chance at improving your quality of life. Treatment options that have been found to be effective in reducing symptoms include:
- parent training
- skills training
- behavioral therapy, including cognitive behavioral therapy (CBT)
- educational support
- education regarding ADHD
According to Nigg, “Counseling is the most well-proven intervention for addressing the emotional dysregulation tied to ADHD, as well as anger problems and extreme irritability (compared to medication). Professional counselors help patients identify coping skills and put them into practice so they actually work.” Through collaboration with a mental health counselor, you can obtain effective tools that can be employed when you are faced with situations that cause frustration and anger. With practice, managing anger caused by ADHD can become easier.
How Charlie Heath can help
While emotional dysregulation and anger issues are not considered formal symptoms of ADHD, due to the fact that almost everyone dealing with an ADHD diagnosis struggles with managing emotions, finding a therapist that will work with you to manage this aspect of life with ADHD is paramount. Additionally, as mentioned above, the coexistence of other mental health issues alongside ADHD can complicate the matter even further. The professionals at Charlie Healthcan work with you to create a plan of care that focuses on what is important to you and help you better employ tools and strategies to better manage your anger caused by ADHD. Click here to get started today.
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