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ADHD & RSD — How to Help Children with Rejection Sensitive Dysphoria

What’s inside this article: A look at ADHD and RSD (rejection sensitive dysphoria), the connection between the two, and how to help children struggling with RSD.

Most people are sensitive to rejection to some degree. However, rejection is especially painful for people with rejection sensitive dysphoria (RSD).

RSD is a previously overlooked symptom of ADHD, due to the difficulty of measuring someone’s feelings of rejection consistently. However, a survey found that up to 99% of teens and adults with ADHD are more sensitive than usual to rejection. And nearly 1 in 3 say it’s the hardest part of having ADHD.

If your child has ADHD, you may have noticed they’re highly sensitive or struggle with emotional regulation. You may be curious to know if they have RSD as well.

Read on to learn everything you need to know about the connection between these two conditions.

What Is Rejection Sensitive Dysphoria (RSD)?

Rejection sensitive dysphoria causes an overwhelming, extreme emotional response to feeling:

  • Rejected (real or percieved)
  • Teased
  • Criticized
  • As though they have disappointed people in their lives
  • Disappointed in themselves for making mistakes or not meeting their own standards

ADHD & RSD

Most individuals with ADHD also experience RSD. But, what is the connection between these two?

People with ADHD struggle with self-regulation – their nervous system overreacts to things from the outside world. Because of this, any sense of rejection can set off their stress response, causing an emotional reaction that’s much more extreme than expected.

Did you know that by their 12th birthday, children with ADHD hear, on average, 20,000 more corrective or critical messages than neurotypical children? (Source) This has a tremendous impact on their emotions and self-esteem.

ADHD & Perception

The shame and guilt children feel from constantly being corrected, as well as from struggling to make friends, is often so strong that it negates any positive feedback they receive from parents, educators and peers.

Because of this frequent criticism, children (and adults) with ADHD may have a hard time differentiating small issues (for example, someone not laughing at their joke) from major forms of rejection (someone saying they don’t want to be friends anymore).

As a result, anything that feels even slightly like rejection can be perceived as something more severe than it is.

ADHD & Rejection

Feeling rejected generates strong feelings of shame, and children with ADHD experience negative emotions more intensely, and more frequently than others.

This emotional pain is very real, and should not be dismissed.

It’s often difficult for children to describe the feeling with words, so they might react by lashing out through angry outbursts or by withdrawing. It might seem “out of the blue” to onlookers who don’t realize what the child is feeling.

Freud referred to shame as the “master emotion” because it instantly generates a defensive reaction, and, he explained, it dominates all other emotions; due to the nature of shame, it’s hidden by the people who feel it, even from their closest friends.

Because of this, children with ADHD & RSD are highly vulnerable at any moment to misinterpreting something minor like a change in tone of voice as a berating.

Can You Have RSD Without ADHD?

According to Dr. William Dobson, who coined the term RSD, rejection sensitive dysphoria occurs exclusively with ADHD. In otherwords only individuals with ADHD can experience RSD.

William W. Dodson, MD, is a board-certified adult psychiatrist who has specialized in ADHD for the last twenty-three years.

He noted that “Early research on ADHD intentionally ignored rejection sensitivity because it was not always there, it was often hidden by the person with ADHD, and because there was no way to measure rejection.”

However – anyone can feel rejection. And, many individuals who are highly sensitive or who struggle with emotional regulation, do feel intense emotional pain to rejection, and have similar behavioral reactions to feeling rejected.

Symptoms of RSD in Children

It can sometimes be hard to differentiate rejection sensitive dysphoria symptoms from general sensitivity, especially in children. It’s also sometimes mistaken as social phobia, depression, and borderline personality disorder.

Here are some common symptoms of RSD in children:

  • Extreme anxiety triggered by small changes
  • Difficulty forming words or expressing oneself when feeling hurt
  • Hyper-focusing on “negative” traits for which they’ve been criticized, or percieve they’ve been criticized for.
  • Feeling so afraid of disappointing someone else (a teacher, parent, etc.) that they overwork themselves and stress over tiny details
  • Avoiding social situations due to fear of criticism or embarrassment
  • People-pleasing
  • Struggling to make or maintain friendships
  • Refusing or avoiding trying new things, stemming from a fear of failure leading to intense rejection
ADHD & RSD, list of symptoms of rejection sensitive dysphoria

Treatment Options

If a parent is concerned that their child has RSD, they should consult a qualified mental health professional to discuss their concerns and learn about potential treatments.

The current medical treatments for RSD typically involve a combination of therapy and medication. Common medications prescribed for RSD include:

  • Guanfacine (or Intuniv) and clonidine (or Kapvay), drugs that lower blood pressure
  • Tranylcypromine (or Parnate) and other monoamine oxidase inhibitors, which help to treat symptoms of ADHD like inattention, impulsivity, and hypersensitivity

These medications are often used to treat ADHD. You can see a full list of medications for ADHD here.

Therapy can also help with some of the symptoms associated with RSD. For example, a therapist can help children learn how to handle their emotions and respond to feelings of rejection in healthier ways.

Dialectical behavior therapy  is a therapeutic technique initially developed for Borderline Personality Disorder, but is now used to treat a range of other conditions.

It is a form of cognitive-behavioral therapy (CBT) that incorporates mindfulness meditation, interpersonal effectiveness, emotional regulation, and distress tolerance skills. 

How to Help Children Manage Rejection Sensitivity?

There are many strategies parents and caregivers can implement to help children manage rejection sensitivity, including the following:

Positive Affirmations

Positive affirmations are specific, simple statements that you repeat to yourself (often) to provide yourself with encouragement or motivation.

They’re spoken in the present tense, directed toward yourself, and use positive words. For example: “I can…” or “I am…”

Research shows that positive affirmations also boost self-esteem and help your child develop a positive mental attitude, helping them develop a growth mindset and a positive outlook on life. Using positive affirmations can also help you overcome negative thinking patterns.

You can learn more about positive affirmations and download a free printable list of affirmations, worksheet, and coloring page here.

Healthy Coping Strategies

It can also be helpful for children with RSD to have a list of healthy coping strategies they can turn to when they feel rejected.

One idea is to create a script, code word, or a hand signal your child can use when they’re feeling too emotionally overwhelmed to communicate.

It’s important to choose coping strategies that are developmentally appropriate, and that your child can use when they actually need them, such as at school.

This list can help you brainstorm some ideas.

Choosing Words Carefully

For parents and caregivers, choose words carefully when giving criticism or feedback. Try to focus more on the child’s strengths than their weaknesses.

Be specific, too.

Asking a child with ADHD and RSD why they didn’t complete a task or do something a certain way is often fruitless. Instead, it helps to ask specific, relevant questions like “did you get stuck on this step?”

Teaching Resilience

Children need to know that it’s normal and perfectly okay for them to make mistakes.

They need to know that it’s not the end of the world if they receive constructive criticism or don’t do something correctly the first time, and that they can try again and improve.

This is known as a growth mindset.

Validating Emotions

Children with ADHD and RSD don’t need to be told that they’re being too sensitive or that they’re being irrational when they are struggling with feelings of rejection. These kinds of messages will just make them feel worse.

What is helpful is letting them know their feelings are valid, while also helping them to reframe their thoughts. Acknowledge how they’re feeling in that moment, then work with them to look at the situation from a different angle.

A great method of validating emotions is through a method known as emotion coaching. This is a strategy used in Emotion Focused Family Therapy (EFFT) and you can learn how to use emotion coaching here.

emotion coaching steps

The combination of ADHD and RSD is often very frustrating and overwhelming for children and can negatively impact their quality of life.

The sooner they get access to treatment and learn healthy coping skills, though, the better off they’ll be. Having a parent who understands their pain is real and not just an overreaction is critical.

Parents and caregivers should keep this information in mind so they can identify potential warning signs and partner with a mental health professional to give their children the tools they need to succeed now and in the future.

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