If your child has ADHD, she most likely has some level of ADHD Rejection Sensitive Dysphoria as well. Find out how to recognize it and how you can help.
What is ADHD Rejection Sensitive Dysphoria?
If you have a child with ADHD, he or she is likely more sensitive to rejection or perceptions of rejection than kids without ADHD. And she can experience rejection at a level of intensity that’s difficult to comprehend for people who don’t have ADHD or who aren’t particularly sensitive to rejection.
Most people are hardwired to dislike rejection. We all have the need, to some degree, of wanting acceptance and belonging. All of us want to be accepted as part of a group, whether as a leader or a follower.
The Rejection Continuum
We seek to be valued by others — families, friends, and colleagues. So, being sensitive to rejection to some extent is normal. But if you view sensitivity to rejection as a continuum – on one end, you have the person who appears to be made of Teflon. Slights, insults, or microaggressions slide right off. They make no impression. They have no meaningful effect.
At varying degrees in the middle, you have folks who are increasingly sensitive. We all know people who are highly sensitive and can easily get their feelings hurt. We may be those people.
Then, on the far side of the continuum, we reach the land of “dysphoria.” A word of Greek origin that means excessive pain too hard to bear. It is this highly intense and volatile flavor of rejection sensitivity that is commonly associated with ADHD.
Today, experts define RSD as the extreme sensitivity to perceived rejection, criticism, judgment, and/or a sense of personal failure.
While people experience this dysfunction internally, it can yield negative manifestations that are outwardly expressed. They can respond to social rejection (or the perception of rejection, whether or not factually based) that undermines the individual’s relationships. This can lead to preemptive or disproportionate hostility to the presumed rejectors. It can lead to the routine of deflecting blame. And it can also lead to physical aggression or self-harm.
What is the Connection Between RSD and ADHD?
A child growing up with ADHD often receives an abundance of criticism and negative feedback from authority figures in their lives and/or people they care about. Parents, teachers, coaches, caregivers, siblings, and extended family. They may struggle with tasks and activities that come easily to other kids.
All of these factors can lead to feeling deficient, lacking, and unworthy.
The emotional dysregulation associated with ADHD includes both the way that emotions are experienced as well as the way that they are expressed. And this holds particularly true as to rejection (or the possibility of rejection).
Is Rejection Sensitive Dysphoria Only In ADHD?
Some experts believe that RSD is almost exclusive to ADHD. But this opinion is not universally held.
But, regardless of whether RSD is exclusive to people with ADHD, ADHD experts believe that a substantial majority have it and that a substantial portion of those who have it find it plays a dominant influence in their daily lives. Indeed, some experts believe that RSD is one of the defining features of ADHD.
What Does Rejection Sensitive Dysphoria Feel Like?
People with ADHD RSD experience it as intensely painful, with an overwhelming sense of shame, hopelessness, and loneliness. Or, for some folks, it elicts extreme experiences of ragefulness and vengefulness.
Perception Is Reality
It’s important to note that an RSD episode can be triggered solely by the perception of being rejected, even if no one is intentionally trying to reject them. So, for instance, someone with ADHD RSD can easily perceive sarcastic remarks that are meant to be teasing as a rejection because it looks like the other person is mocking them and thinks badly of them.
Extreme Extended Intensity
As a result of the intense influx of negative emotions, he becomes an emotional mess, unable to function in meaningful ways when in the grips of RSD. And this can lead to dysfunctional distractions to cope with those feelings.
Depending on age and ease of access, these distractions could be the overconsumption of food, excessive indulgence in substances such as drugs, alcohol, and smoking, or immersion into experiences such as gambling or sex that can potentially generate emotional antidotes to RSD toxicity.
For some people, an RSD episode may pass relatively quickly, like a fast-moving destructive tornado. While for others, the tornado sucks them into an emotional tailspin. Stuck in an internal cycle of replaying the triggering event repeatedly and relieving the emotional experience every time. Essentially ruminating in rejection.
Intense Emotions Often Misdiagnosed
It’s important to remember that all of this intense turmoil may be taking place entirely on the inside without obvious visible signs to the folks nearby.
Someone experiencing the intense emotions associated with RSD can bottle them up such that they appear to be major depression. Or, the RSD can push the intense emotions outward, and they appear as intense rage.
What ADHD Rejection Sensitive Dysphoria Might Look Like in a Child
A child who is extremely sensitive to criticism may react badly when publicly corrected by a teacher, even when that same teacher treats his classmates in the same manner. Nevertheless, this act of criticism may trigger the conclusion that this teacher hates me.
Or, a child sees a group of kids whispering. One catches her eyes but glances away. This can lead the rejection-sensitive child to conclude that the kids are actually talking bad about her. Perhaps she goes off to the bathroom to cry. Perhaps she plots revenge.
What Are Some Signs of ADHD RSD?
While in recent years, RSD has become closely associated with ADHD, it is not listed in the DSM-5. As a result, there are no official diagnostic criteria for it.
But, some commonly observed signs of ADHD Rejection Sensitive Dysphoria include:
- Intense emotional outbursts to criticism or rejection
- Disproportionate reaction to mild constructive criticism (such as overt or aggressive hostility)
- Setting excessively high standards for oneself that may be impossible to meet
- Intense rumination about past social interactions
- Frequent bouts of shame
- Low self-esteem
- Perception of self-worth entirely tied to the opinions of others
- Feelings of failure for not meeting expectations
- Easily embarrassed
A person with ADHD Rejection Sensitive Dysphoria person may see catastrophe in the smallest missteps. Stumbling over words while answering a question in class–something many people can relate to–transforms into a disaster for someone with ADHD RSD. Because, in his mind, the whole school now thinks he’s an idiot.
A person with ADHD RSD almost always expects rejection. She will easily see rejection in even minor or casual social interactions. And she will have an intensely emotional reaction to any rejection. Big or small. Real or imagined.
ADHD RSD: Contributing Factors
So why is RSD so closely associated with ADHD? There are several elements of ADHD that may contribute.
Impaired Executive Functioning
ADHD kids often have impaired executive functioning skills.
These include executive functioning skills such as flexible thinking and the ability to self-regulate. Flexible thinking means the ability to think of something in more than one way. Being able to see different sides of the same problem. Impairments in this area limit the ability to process highly emotional events in a constructive manner.
People with executive functioning issues often fixate on things. This means that, without assistance, ADHD kids may get stuck in their feelings and lack the ability to move on.
These executive functioning impairments can contribute to or exacerbate ADHD RSD.
Low Self Esteem
ADHD kids often have low self-esteem as a result of being the recipient of a constant stream of negative messages from family members, teachers, other adult figures, and peers.
Low self-esteem can reinforce the tendency to expect rejection. (Note: We have suggestions for helping boost self-esteem for your child.)
Impaired Social Skills
ADHD kids often have impaired social skills.
These impaired social skills can lead to missed social cues and other social friction. This can lead to varying levels and sources of criticism or other negative responses, which then triggers RSD.
Hyperarousal
Some ADHD kids often live in a state of hyperarousal. This means that their brains and emotions can respond to stimuli on a grander scale than one would otherwise expect. People suffering from PTSD typically have this trait as well. Where the body physically reacts to memories of a traumatic event as if it were taking place in the now.
As a result of hyperarousal, a child may magnify objectively small events into larger issues. So, an unreturned call or text can equate to being shunned, ostracized, or dumped.
“Because of this, every instance of possible rejection, even a moderately raised voice, may seem more devastating and severe.”
More Than Thin Skinned
ADHD and Actual Rejection
While perception and perceived slights alone can trigger ADHD Rejection Sensitive Dysphoria, actual rejection can trigger it as well. And the daily life of an ADHD child may often include many rejections of varying sizes.
Some ADHD behaviors do indeed lead to actual avoidance or rejection whether it’s the child who constantly interrupts conversations. Or the teen who often misses commitments or fails to follow through on obligations. This can lead to some level of pushing away, and this relatively low-level rejection can fuel the fire of RSD.
Similarly, impulsivity may exacerbate the effects of ADHD Rejection Sensitive Dysphoria. It can lead to someone taking what appears to be an extreme reaction in response to some perceived criticism or failure. Such as stomping off the playground in a grand display. Or impetuously quitting the school play or the soccer team.
Negative effects of ADHD Rejection Sensitive Dysphoria
According to expert Dr. William Dodson, ADHD folks with RSD tend to cope with it by developing dysfunctional ways of interacting (or not) with the world around them. But parents should be aware that the “earlier you can intervene, the less fixed these ways of approaching the world are.”
Left unchecked or unremitted, RSD can have negative consequences throughout life. These typically track the following patterns:
The Extreme People Pleaser
Out of an intense need to avoid rejection and the toxic feelings it generates, someone may seek to please those around them at all costs. This can lead to subverting one’s own goals and ambitions to the perception of others’ wants and expectations. Or inappropriate acts of self-sacrifice.
There can be multiple layers of issues here. Suppressing one’s own goals and desires is itself a problem. But, an erroneous perception of what others may want compounds the problem.
In other words, someone could be making sacrifices for targets that don’t actually exist. Like spending dozens of hours baking the perfect cake when the person you’re baking for actually prefers cookies or, perhaps, even hates cake.
Dysfunctional Avoidance
Alternatively, some people may fall into avoiding any opportunity for rejection entirely. They avoid social situations and meaningful relationships.
Or, they may avoid seeking help and assistance when the situation definitely requires help or intervention. So, not going to see a teacher after class or during office hours because of fear of creating a bad impression.
Pathological Perfectionism
Sometimes kids experience ADHD Rejection Sensitive Dysphoria as intense feelings of personal failure. This can lead to an unhealthy orientation towards perfectionism. This can lead to setting unrealistically high and unobtainable standards.
Or, viewing episodes of success as failures because their performance fell short of perfection. Getting the A- instead of the A+. And regardless of whether the standards are attainable, the constant striving for perfection can be extremely stressful and not compatible with actually enjoying life.
Rejection As Self-Fulfilling Prophecy
Because a kid with ADHD RSD expects rejection, efforts to avoid it or compensate for it can lead to the very rejection that they don’t want.
For instance, research has shown that rejection-sensitive kids may behave more aggressively — angrily, expecting rejection. And, of course, interacting with someone who is starting off angry and aggressive is not appealing to most folks, which reinforces the cycle of rejection.
RSD and Social Anxiety
Some of the descriptions of RSD sound very much like social anxiety in children.
They are similar in that they both turn on a fear of rejection or responses to perceived rejection. One key difference, however, is in timing. Social anxiety typically precedes an event. The dread of going to the party or addressing a group. That all occurs before the event takes place and may prevent the event from happening at all.
For RSD, it typically occurs as a reaction to perceived criticism or rejection.
Social Anxiety and RSD also differ as to who falls within the potential zone of triggers. For social anxiety, it can basically be the whole world. The amorphous, unknown public at large. Complete strangers.
For RSD, the focal point is people that are actually known and have some importance in the person’s life.
What Parents Need to Know About ADHD Rejection Sensitive Dysphoria
There are no short-term fixes to this issue, and treatment options are limited. But one thing to focus on is to work toward avoiding certain dysfunctional ways of thinking and interacting with the world to become a pattern or a settled mindset. These are tasks easier to undertake with children than with adults.
Treatment Options for ADHD Rejection Sensitive Dysphoria
Behavioral
Behavioral therapy can be a treatment for RSD to some degree. It won’t necessarily help someone avoid having those feelings and reactions because they spring up in ways not easily anticipated. But, it can be effective in helping people cope with the feelings that do arise and manage them in a less dysfunctional way.
Moreover, people often have feelings of shame and hopelessness surrounding ADHD Rejection Sensitive Dysphoria. These collateral feelings can be a stumbling block for actually seeking out and responding to therapy.
Medical
There are no medicines that are particularly designed for the treatment of ADHD Rejection Sensitive Dysphoria. But some people respond well to medical options typically used to treat depression and anxiety, particularly Monoamine oxidase inhibitors.
Other medical treatment options consist of clonidine and guanfacine, medications typically prescribed for high blood pressure but now also have an approved indication for ADHD.
Helping Kids Cope With Rejection
Parents can help their kids with ADHD Rejection Sensitive Dysphoria to some extent by helping them cope with rejection or perceived rejection, whether or not factually grounded.
Some possible approaches:
* It’s not about you.
The reason for rejection may not have anything to do with you personally. If we assume that it had nothing to do with you, what could some other explanations be?
Perhaps space constraints limited the guest list. Someone had a conflicting appointment. Allergies prevented certain activities. Whatever. You can likely reframe the situation in several different ways.
* Wait for the next chapter.
Today’s events may be disappointing, but the story isn’t over yet. There are many different examples of people being rejected repeatedly and ultimately finding success. For Harry Potter fans, JK Rowling is a great example. Her initial manuscript was rejected by many publishers before the right connection was made.
Or, for someone who is fixated on perceived personal failure, Thomas Edison could be a great example. He often had large numbers of experiments that did not work out before finding one that did. And he’s known as one of the greatest inventors of the 20th Century.
Other examples of extremely successful people who initially encountered failure:
- Oprah Winfrey — fired from her first job because she was deemed “unfit for television.”
- Steven Spielberg — rejected from film school multiple times.
- Michael Jordan — cut from his high school basketball team.
- Abraham Lincoln — defeated in dozens of political campaigns.
You can find examples in almost any field. (Perhaps even in your own life.) Find one that resonates with your child.
* What can we do instead?
You can also help your child focus on problem-solving skills. What actions within his control can help bring about a different account? Would more studying help with better test scores? Or, focusing on editing and proofreading, or practicing throwing the ball, address an underlying issue and lead to a better result.
Or do other attractive alternatives exist? Did Johnny turn down a playdate? What about other friends or classmates? Not selected for student council? What other interesting clubs and activities are still open?
* Examine the actual facts.
Person X was looking at me funny in the cafeteria.
Were they really? Could it be they were reacting to the way you were looking at them?
* Seek professional help when necessary.
Some situations are beyond everyday parenting skills and require professional intervention. Don’t hesitate to seek professional help for your child when needed.
What NOT to do When Facing ADHD Rejection Sensitive Dysphoria
- Dismissing it, ignoring it, or otherwise giving it the back-of-the-hand treatment.
- Assuming you have a drama queen. The emotions experienced are real, even if they are baffling.
- Avoid teasing, even if “well intentioned.” This will most likely add to feelings of shame.
Beware of these Pitfalls With ADHD Rejection Sensitive Dysphoria
- Peer Pressure on Steroids. The propensity for extreme people-pleasing can magnify the effects of peer pressure. Insecurities about their social standing can lead kids to feel compelled to do the wrong things to fit in. And this can make them more vulnerable to being bullied or taken advantage of.
- Unnecessary & Avoidable Failures. In some circumstances, ADHD RSD can create substantial obstacles to seeking help because of misplaced fear or anxiety about creating a poor impression.
Key Takeaway for Parents
ADHD kids experience a constant stream of negative input that can erode self-esteem over time. Creating a foundation of shame that colors every aspect of life. One of the best things that you can do for your child is be a supportive cheerleader. Making it clear to your child that he or she is always loved. Even on bad days when everything seems to go wrong.