Need to know: Cognitive flexibility and emotion regulation in ADHD

It’s no secret that kids with ADHD feel emotions strongly. Small incidents that most kids can easily brush off, can trigger a cascade of feelings that cause a child with ADHD to get stuck on a thought or idea. This rigidity in thinking can often be a source of arguments with family members, friends, and teachers because most people assume that the child just wants to get their way.

Cognitive flexibility is the ability to adapt one’s thinking and approach in response to changing situations and is a critical skill for success in various aspects of life.

Examples of cognitive flexibility and emotion regulation

• Multitasking – Your child’s ability to listen to their teacher and copy information off the whiteboard onto a notebook, without losing track of what they are doing, is an example of doing two concurrent tasks.
  
  
• Communication – Switching communication styles happens every school day, your child starts the morning talking to you and then switches to talking to friends at lunchtime, and then to the teacher in the classroom.
  
  
• Problem-solving – Your child needs to solve problems in structured situations like in tests, but also work through problems when they arise unexpectedly. For example, the T-shirt your child planned to wear is in the laundry, and they need to find a different top to put on instead.

Cognitive flexibility, emotion regulation, working memory, and ADHD severity

Recent research has shed light on the intricate connection between cognitive flexibility, emotion regulation, working memory, and ADHD symptoms. While the exact nature of these relationships continues to be explored, several key findings have emerged:

Neurobiological Factors

Studies using brain imaging techniques have revealed differences in the structure and function of certain brain regions in individuals with ADHD. These differences are often associated with impairments in cognitive flexibility, emotion regulation, and working memory. For instance, the prefrontal cortex, which plays a crucial role in executive functions, is frequently found to be underactive in individuals with ADHD.

Working Memory

Working memory is like your brain’s sticky notepad; it’s a mental workspace where you temporarily hold and manipulate information. It helps you remember things in the short term while you’re thinking and solving problems. For example, when you do mental calculations, follow directions, or remember a phone number long enough to dial it, you’re using your working memory. It’s an essential part of cognitive function and plays a crucial role in tasks that require active thinking and problem-solving. Children with ADHD often struggle with working memory, which can impede their capacity to adapt to new information and shift their focus between tasks.

Inhibition

Children with ADHD frequently face challenges related to inhibitory control (suppressing impulsive behaviours) and attention shifting (changing focus between tasks or stimuli). These difficulties can hinder a child’s ability to be flexible and switch strategies to meet expectations at home and school.

Emotion regulation

Emotion regulation means dealing with your feelings in a way that keeps them from getting too strong too quickly or reducing their intensity. It involves how your body reacts, what you feel, and how you act when you’re having a strong emotion. Around half of kids with ADHD struggle with controlling their emotions. This is a big deal because it makes ADHD even harder to deal with. It can lead to problems in school and with friends, more visits to the doctor, and more stress for you as a parent. 

Recent studies suggest that a better-developed working memory predicts fewer ADHD symptoms and better emotion regulation skills than self-control or flexible thinking. This means that when you are looking at different options to help your child, you might want to also consider those that develop and support working memory.

Why it’s important

For many children (and even adults) with ADHD, having a weak working memory and struggling with emotions can make it hard for them to be flexible in their thinking.

From a parent’s perspective, it’s important to recognise that cognitive flexibility is a fundamental skill that influences how your child navigates various aspects of life:

• Academic success – Children with ADHD often struggle academically due to difficulties in adapting to different learning tasks, organising their thoughts, and shifting their focus between subjects. Cognitive flexibility is essential for effective problem-solving and learning. 
  
  
• Social relationships – Our ability to think flexibly when we spend time with friends, play a team sport, do a group project, or simply chat with peers, plays a significant role in building and maintaining positive social relationships. When we interact with others we are exposed to different ideas, needs, and a myriad social cues, which we must process to adapt how we think and what we do. A child with ADHD might struggle in situations where there are competing ideas or where rules are fluid.
  
  
• Daily life – From managing daily routines to handling unexpected changes, all the while staying emotionally regulated, cognitive flexibility is crucial for navigating everyday tasks and challenges. As a parent, you can help your child at home and advocate for them at school so that they can get the support they need.

Compared to peers, children with ADHD can exhibit developmental delays in executive function by as much as 30% (a 3-5 year delay in school & early adulthood). For example, a 9-year-old child is likely to have the executive function of a 6-year-old child. This knowledge is key in ensuring you set your child up for success. Where possible, adjust your expectations to meet your children’s executive function age rather than their biological age. 

Tips & strategies

Support working memory

• Implement structured routines – Create a consistent daily schedule with designated times for different activities, such as homework, playtime, and meals. Predictable routines can help children with ADHD transition between tasks more smoothly.
  
  
• Break tasks into smaller steps –  Divide tasks into smaller, manageable steps to reduce overwhelm. Provide clear instructions and offer frequent feedback and praise for completing each step.
  
  
• Employ visual aids, timers, and music – Use visual schedules, timers, music, and reminders to help your child stay on track and transition between tasks more effectively. Not all children respond to visual cues, some prefer audio reminders and other children respond to a combination of both. Find what works best for your child.

How to develop emotional regulation skills and cognitive flexibility

• Practice mindfulness and relaxation – Teach mindfulness and relaxation techniques to help your child manage stress and improve their emotional regulation. Mindfulness exercises can enhance cognitive flexibility by promoting present-moment awareness and acceptance. This is a long-term strategy and requires regular practice as part of a multi-modal approach for treating ADHD, to reap the benefits.

• Use co-regulation – A child learns to regulate their emotions and behaviour through supportive guidance and interaction with an emotionally stable parent. When your child is feeling heightened you can help them return to a relaxed state by providing a safe environment, modeling calmness and effective coping strategies, and using verbal and non-verbal cues to guide your child’s emotional regulation. When your child is feeling regulated don’t forget to ask them to reflect on their emotions, triggers, and what strategies they can use to help them manage intense feelings.

• Identify triggers and teach reappraisal – Assist your child with identifying situations that set off negative emotions, help them understand those feelings, and work on options to manage their intensity. An evidence-based strategy for regulating emotions you can try is reappraisal. 

Reappraisal simply means changing how one thinks about or re-interprets a situation. For example, your child identifies that they get angry when they are playing a game and someone changes the rules – this is the trigger. Reappraisal would involve you guiding your child to reframe that situation in a way that would change the negative trigger, and it might sound like “the other child probably didn’t realise they were changing the rules” or “the other child forgot to check with everyone that it was ok to change the rules” or even “these new rules might be better than the old ones”.

Tips to increase cognitive flexibility

• Games and puzzles – Engage your child in activities that require problem-solving, such as puzzles, board games, and strategy games. These activities are fun for the whole family and are a great way to develop cognitive flexibility.

• Consider medication – There is evidence to support the idea that children who take stimulant ADHD medication significantly increase their neural flexibility. Scientists noted that children with lower neural flexibility were more likely to experience more severe ADHD symptoms.

• Encourage decision-making – Give your child opportunities to make choices and decisions. This allows them to practise considering different options and consequences, fostering cognitive flexibility. Teach them to look around for clues and ask questions like, “What is my goal?” and “What are my options to achieve it?”, “What are other people saying to me?” and “What if they are right?”.

• Promote physical activity – Regular medium-high intensity physical exercise has been shown to improve cognitive function, including cognitive flexibility, it can also increase neuroplasticity, and there is evidence that it decreases impulsivity and the risk of nervous system disorders. Encourage your child to engage in regular activities they enjoy, such as sports or dance.