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What is the impact of ADHD on self-regulation?

Updated: Mar 14, 2023


This is a photo of a young girl walking on a bridge through a rainforest

Have you ever noticed yourself getting irritable for no apparent reason?


Do you find yourself going down a mental list...am I hungry? Tired? Do I need to get out in nature or exercise?


You might not be aware that you are utilizing practiced self-regulation skills.


Those who are neurodivergent (i.e. autism and ADHD), often have impaired executive function abilities which can cause cognitive, emotional, and behavioral dysregulation.


In this article, we will address self-regulation and its importance for individuals with ADHD, as well as practical tips and techniques for developing these skills.


Table of Contents


What is self-regulation?

Self-regulation is the ability to be in control of emotions, behavior, and thoughts.


As humans, we learn to respond to environmental and internal stressors by utilizing specific skills to regulate our thoughts and bodies.


Specific self-regulation skills have to be sharpened to be socially appropriate in adulthood:

  • Self-control (actions, emotions and impulses)

  • Self-awareness

  • Self-monitoring

There are three specific areas involved in independent regulation.


1. Cognitive self-regulation: Using attention, thoughts, and mental processes to achieve goals and manage distractions.


2. Emotional self-regulation: The ability to manage emotions in response to different situations.

3. Behavioral self-regulation: The ability to control actions and impulses based on the situation or social environment.


Self-regulation impacts all areas of life, especially mental health. It is key for all individuals to feel happy and healthy!


Through practice and support, these skills can be developed and used in everyday life.


ADHD Brain and Regulation

The brains of individuals with ADHD are wired differently from those without the disorder, which can affect their ability to regulate their behavior, emotions, and attention.


Research has shown that several regions of the brain are involved in self-regulation and that these regions may function differently in individuals with ADHD.

  • Prefrontal cortex: responsible for planning, organizing, and controlling behavior.

  • Anterior cingulate cortex: responsible for detecting and regulating emotional responses

  • The limbic system: processes and regulates emotion, memory, motivation and behavior

    • An important part of the limbic system called the amygdala is smaller in people with attention deficit hyperactivity disorder.

    • The Anterior cingulate is less active and the prefrontal cortex may be smaller than in individuals without ADHD, which can contribute to difficulties with self-regulation.

  • The dopamine system: a neurotransmitter in the brain that impacts motivation and attention

    • Those with ADHD may have lower levels of dopamine which impacts motivation and attention


Image of a brain and 3 areas that impact emotions: prefrontal cortex, cingulate cortex and amygdala.
Illustration by Menks from Frontiers for Young Minds. (https://kids.frontiersin.org/articles/10.3389/frym.2016.00016)

The anterior cingulate cortex connects to both the “emotional” limbic system involving the amygdala, and the “cognitive” prefrontal cortex. These important parts of the brain are vital for independence in regulation.


According to clinical psychologist Dr. Ellen Littman,

In ADHD brains, these regions and processes essentially compete for dominance. We want the prefrontal cortex to win as much as possible, but the limbic system often overpowers it. The result is emotional dysregulation, which, while not part of diagnostic criteria for ADHD, is increasingly considered to frequently co-occur with the condition.

Emotional and cognitive parts of the brain are interconnected and will influence one another in positive or negative ways. A person with ADHD has to use external tools to allow them to communicate properly.


How are executive function and self-regulation connected?


Executive function impacts the ability to organize, focus attention, prioritize, remember instructions, complete tasks and multi-task.


It is vital for a person to be in control of behavior, emotions and responses to environmental stressors.


Self-regulation is connected to the following cognitive processes:

  • Inhibition directly impacts a persons ability to show appropriate emotions and act in healthy ways. Self-control and monitoring must be taught to those with limited executive functioning.

  • Organizational and problem solving skills are necessary for a person to create routines/structure and respond appropriately to unexpected situations. Without these skills, dysregulation is common.

  • Emotional regulation is affected by attention, and with appropriate attention, children self regulate and learn the regulation skills necessary for independence and meeting goals.

  • Working memory allows a person to access recently learned tools or information for remaining calm and in control of different scenarios.

For more on executive function, check out: What are Executive Function Skills?



Why is it difficult for a person with ADHD to self regulate?


It is often challenging for individuals with ADHD to self-regulate because the disorder affects the brain's executive function skills.


Key skills impaired by ADHD:

  • Inhibition

  • Working memory

  • Attention

Acting without considering the consequences, or lack of inhibitory control, is a common hallmark of ADHD.


Working memory is needed to utilize previous information to make appropriate decisions. Remembering instructions or following multi-step tasks is needed to self-regulate effectively.


Neuroscientists Shields, Sazma and Yonelinas found that stress also impaired working memory and cognitive flexibility.


ADHD can affect a person's ability to sustain attention and shift attention from one task to another, which can make it challenging to stay focused on tasks that require self-regulation.


Those with ADHD self regulate best with specific strategies that address these executive functions.


How to support the development of self-regulation in children


Self-regulation skills are not present at birth. Repetition and practice is needed, even from a very young age.


Strong emotions are normal while children grow. As a parent, it is important to stay calm, model and directly teach children these skills. Individuals with ADHD may require more focused direction in order for them to develop these skills.


Some specific strategies for younger children that can be done as a whole family are listed below:

  1. Model self-regulation: talk to your children about your need to take deep breaths, take a break, or talk about your feelings. Showing them how you cope with stress will help them with their own regulation.

  2. Predictable routines: Daily schedules are beneficial for children and adults alike! When children know what's ahead, they feel more in control, and their anxiety is minimized. You can begin teaching them to create their own schedules with their daily tasks and activities.

  3. Teach emotion recognition: Students need to identify and express their feelings, this can be helped by adults labeling them.

  4. Exercise: Research continues to show that emotional dysregulation can be reduced through physical activity.

  5. Provide choices: All children enjoy control, and individuals with ADHD can increase regulation when given options for decision making.

  6. Use positive reinforcement: We all need a pat on the back sometimes. Students with ADHD need this positive reinforcement more than most. Acknowledging appropriate or expected behaviors in self-regulation tasks will encourage continued use.

  7. Practice mindfulness and meditation together (Specific ideas below)

  8. Create a quiet/calm down area to refocus:

    • This provides children with a safe space to recognize and regulate emotions. As adults we can model this by taking a break in a bedroom or a cozy chair for breathing and calming. To create this space you can use a corner of a room, a swing or and add a tent with cozy beanbags and quiet toys, books and stuffed animals.

Teaching children these strategies will help to develop independence in coping strategies and increase appropriate emotional response to their changing environment.


Self-regulation strategies for students with ADHD

Pre-teens and teens, may experience stronger symptoms of emotional dysregulation than young children. Academic challenges may be an additional source of stress.


As a parent, it is important to provide compassion and support as they develop the tools needed. Celebrate the small successes!


Dr. Ellen Littman lists out common changes that increase dysregulation during this time:

* Hormonal changes contribute to mood fluctuations and increased emotionality. During puberty, monthly drops in estrogen levels exacerbate ADHD symptoms in girls.
* Bodily changes and sexual development are often sources of embarrassment and confusion.
* Increased academic demands, often accompanied by decreased parental scaffolding, cause stress.
* A desire for independence, questions around identity, and an expanding social life (and desperation for sensitivity to peer acceptance) all characterize adolescence.

While all teens have to deal with these challenges, individuals with ADHD have increased symptoms due to their syndrome.


As mentioned, self-regulation skills can be sorted into three categories: cognitive, emotional and behavioral.


There are various techniques that have shown successful outcomes for individuals who are neurodiverse.


Specific strategies for each area are listed below:


Cognitive strategies


Goal-setting

  • Self-regulation motivates us to achieve worthy goals. The process of goal setting, monitoring, adjusting, and achievement is a learned process that must be directly taught and supported.

  • Ask your student, "think about your "intentions"... is your current behavior helping you get there?" If not- help them adjust actions to focus on their goals.

Self-talk

  • Positive self-talk: Encouraging and supportive self-talk can help individuals build resilience and cope with challenges. It's a great tool to help students remind themselves they are loved, can learn from mistakes, and able to achieve their goals.


This is a visual with 10 positive talk phrases
thepathway2success.com

Cognitive restructuring

  • Cognitive-behavioral therapy (CBT): CBT is a type of therapy that can help individuals learn to identify and modify unhelpful thoughts and behaviors.

Time management

  • Tools such as calendars, timers, and to-do lists can help with planning and prioritization.


Emotional strategies

Some individuals with ADHD may experience emotional shut down in response to stress. The may need time & support to articulate what they are feeling until they can move on.


Emotion identification & regulation tools

This is an Infograph with primary colors showing pictures of names of emotions as Zones of Regulation

Mindfulness


Useful calming strategies that increase awareness


Breathing exercises

When dysregulated, keeping breathing has been shown to calm the body and mind. A few specific techniques are listed below.


This is an Infograph showing 3 breathing techniques for anxiety

Guided meditation

When students can identify feelings and observe body responses without judgment, it helps to reduce stress and increase regulation.


This is an image showing the 5-4-3-2-1 grounding technique
https://goodthoughtsgoodlives.com/tag/grounding-technique-for-mind-rest/


Behavioral strategies


Self-monitoring

  • Social stories: Social stories can be used to help individuals understand themselves and others, and prepare for social situations that may be challenging or overwhelming.

  • Use this process for self-reflection

    • Step 1: The issue that is going on is (Describe it in the way your are feeling - blame overtly)

    • Step 2: Physically step into a place that represents taking responsibility Repeat the answers here until you experience breakthrough:

      • From the past this reminds me of...

      • I keep this situation going by...

      • What I get from keeping this situation going is...

      • The lifelong pattern I am noticing is...

      • I can demonstrate 100% responsibility concerning this issue by...

Start this process over if you don’t experience breakthrough.

Self-reflection

Environmental modifications (discussed in depth below)


Physical/tactile Tools


Exercise

Regular exercise can help reduce stress and anxiety, and improve mood and cognitive function. Movement breaks in the classroom or in between studying can greatly improve emotional regulation.

This is a series of images showing exercises for your brain.
Brain Gym exercises

This is a program of physical movements and exercises that help to engage your brain. It can help to reduce stress and improve the ability to learn.


Tapping acupoints teaches the brain to respond to stress in a neutral way: Video to practice with your child.


Visual supports

Visual supports such as pictures, diagrams, or written instructions, color-coding or highlighters to help prioritize tasks and make them more visually appealing.


Yoga

Sensory regulation

Sensory input such as weighted blankets, headphones, bumpy textured fabrics, calming scents, stimulating/calming music, fidgets or earplugs can help regulate the senses.

  • If your child is experiencing significant dysregulation from sensory input, consultation with a trained occupational therapist may help determine whether sensory integration therapy could help.

  • Teen sensory strategies may include focus on social thinking, activities based on areas of interest and other age appropriate strategies for children with ADHD or autism.

  • In the classroom, wall push ups, jumping jacks, and drink breaks can even be helpful between lessons.

Art & Creativity

Draw or write to self-regulate emotions



This is an image of a girl painting a picture

Environmental modifications

Environmental modifications often help individuals with ADHD to self-regulate because of heightened response to stimulation. Optimal Stimulation is a theory that people with ADHD cannot persist through non-preferred tasks when they are either overstimulated or understimulated.


A few examples of helpful environmental modifications are:

  1. Minimize distractions

  2. Provide a quiet study area

  3. Organize and simplify the environment

  4. Create a predictable routine

  5. Use visual aids

  6. Provide regular breaks (encourage physical activity during breaks)

  7. Incorporate sensory input

  8. Take a break from the environment

By implementing these modifications, individuals with ADHD can feel more in control of their environment and better able to manage their emotions, behavior, and attention.


Technology & screen time

The world has become increasingly dependent on technology. We use it as a helpful tool and as a way to be entertained.


Schools have found that technology also increases learning and engagement due to the high-interest factor. Kids with ADHD are drawn to these visual programs and often utilize technology at a higher rate than their peers.


According to the American Academy of Pediatrics & Adolescent Psychiatry:

Children ages 8-12 in the United States spend 4-6 hours a day watching or using screens, and teens spend up to 9 hours. Children aged 2 to 5 years should have no more than one hour of screen time per day, and children aged 6 years and older should have consistent limits on the amount of time spent using media, including digital devices.

Excessive screen time may exacerbate ADHD symptoms and impair healthy development.

  • Sleep problems

  • Lower work completion

  • Reading fewer books

  • Less time with family and friends

  • Limited physical activity

  • Weight problems

  • Increased emotional dysregulation

  • Depression and increased insecurity of self

Here are some guidelines for managing technology and screen time for kids with ADHD:


1. Set limits on screen time: While challenging to implement, boundaries are necessary.

  • Use parental controls

  • No phones during meals or during outdoor activities

  • Keep TVs and screens outside of the bedroom

  • Turn off screens 30-60 minutes before bedtime

  • Do not use it as a primary tool for decompression

  • Allow child to use technology for short amounts of time in between completion of school and home tasks

2. Choose age-appropriate, educational content: Use technology as a tool for your child to learn. These are great resources to increase engagement, especially for those with ADHD. However, violent or overly stimulating contentwill have a negative effect.


3. Use screen time as a reward: Children find screen time motivating, take advantage of this! You can help positively motivate your child with ADHD by allowing them to use their phone, game console or computer after completing tasks or acting appropriately.


4. Monitor screen time closely: Observe your child's behavior and sleep around their technology use. Make adjustments if you feel it is increasing dysregulation.

Managing technology with your child will help to support healthy development for kids with ADHD.


Is ADHD medication helpful for self-regulation?

Medical research through a variety of clinical trials has shown that medication may provide positive results for adults dealing with emotional dysregulation. Some helpful medications mentioned:

  • methylphenidate

  • atomoxetine

  • lisdexamfetamine

It was also noted that behavioral interventions, specifically CBT and mindfulness also increased regulation skills when medication was not present.


Using medication is a personal decision between an individual and their doctor, who should work together to make sure dosage is appropriate and effective to treat symptoms.


Final Thoughts

Children with ADHD can improve their self-regulation skills through a combination of structure, self-monitoring, mindfulness, movement, positive reinforcement and collaboration.


Executive function specialists are specially trained to support students with dysregulation and can also help individuals choose self-regulation techniques that work for them.


To learn more about how executive function coaching can support the development of your child's self-regulation skills, visit our website: https://www.efspecialists.com.


Sources


Broadway, C. (2022). Study: Emotional Dysregulation Improved with ADHD Medication Use: Stimulant and non-stimulant medications for ADHD may also help adults regulate unwanted emotional expression, according to a recent study. Retrieved from: https://www.additudemag.com/adhd-medication-emotional-dysregulation-study/


Harvard University (2023). Center for the Developing Child. Executive Function & Self-Regulation. Retrieved from: https://developingchild.harvard.edu/science/key-concepts/executive-function/


Littman, Ellen. (2022). How Dysregulated Emotions Hijack the Teen ADHD Brain. Retrieved from: https://www.additudemag.com/dysregulated-adhd-teens-relationships-social-media-support/


Shields G.S., Sazma M.A., Yonelinas AP. (2016). The effects of acute stress on core executive functions: A meta-analysis and comparison with cortisol. Neurosci Biobehav Rev. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5003767/


Stevens, F.; Hurley, R; Taber, K.; Hurley, R.; Hayman, A.; and Taber, K. (2011). Anterior Cingulate Cortex: Unique Role in Cognition and Emotion. The Journal of Neuropsychiatry Vol. 23 (2). Retrieved from: https://neuro.psychiatryonline.org/doi/10.1176/jnp.23.2.jnp121


The American Academy of Child and Adolescent Psychiatry (2020) Screen Time and Children. No. 54. Retrieved from: https://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/FFF-Guide/Children-And-Watching-TV-054.aspx


About the Author

Kelsey Sinclair is an executive function specialist with EFS. She was a special educator for over 10 years in public school settings. She completed her masters degree in Education with an emphasis on educational therapy to support students with executive functioning deficits. She specializes in social/emotional skill development and provides interventions to those with learning disabilities such as dyslexia, dyspraxia and dyscalculia. Kelsey utilizes a strengths-based approach to coaching, supporting her students toward independence and a positive self-concept.

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