Emotion regulation is a deep and complex topic, so if you haven’t read Part 1 and Part 2 of this article series I urge you to do so because as brief as they are, the content is important in understanding and supporting your child.

In part 1, we talk about the neurobiology of emotion regulation and the role our body and brain play in how we control our emotions. For children with ADHD, brain connectivity differences and executive function difficulties can underlie emotion dysregulation.

Part 2 of the series focuses on the impact of emotion dysregulation. We outline the signs of dysregulation in childhood and adolescence, and the impact on relationships. Parent burnout is often not discussed, but it’s an important factor in how you provide long-term support for your child.

To conclude the series, we’ve reviewed research on the therapies and interventions that have been used to improve emotion regulation and added a lived experience perspective.

Tips & strategies

What you can do to support emotion regulation

Don’t burn out – parenting isn’t easy at the best of times, but raising a child who has difficulties with emotion dysregulation adds another level of complexity to life. There is no medal for pushing yourself beyond your limits. To avoid burnout consider the following:

• Don’t wait until you have nothing left to give. You shouldn’t feel guilty about regularly putting aside time to do things that make you happy and help you feel rested and regulated. When you become a parent you don’t stop being human.

   

• Lower expectations for yourself and everyone in the family. You might think this is an impossible task because you’ve deemed everything to be essential, but when you are feeling overwhelmed or your child is constantly stuck in the fight mode, it’s time to just do the basics. Where possible outsource help, delay chores, and say no to events and things that require physical and emotional energy. 

Prioritise your relationship – Choose a few golden rules that you’ll always enforce and be flexible the rest of the time. If you engage in daily conflicts you’ll end up answering every offence with criticism or punishment. Acknowledge all the positive gestures, the effort your child makes and their honest attempts to do the right thing. 

Listen with empathy – Feeling ignored can trigger anger in your child, but being heard can have the opposite effect and help them calm down. It’s important to acknowledge anger as a normal emotion, rather than ask them to suppress it because implicitly this can make things worse.  

A study discovered that when adults with ADHD try to hold back their emotions, it takes them longer to get back to feeling calm compared to when they accept their emotions. Suppressing emotions can lead to using other not-so-helpful strategies to cope, like overthinking or imagining the worst, creating a cycle of feeling out of control. However, it also suggests that practising better ways to handle emotions could help improve emotional responses. This tells us that teaching children with ADHD to accept and manage emotions, empowers them with tools they can use every day and throughout their life. 

Be the emotion coach and link to internal body cues – Dismissing, minimising, or punishing children for their emotional experiences has been found to have a direct impact on how a child expresses emotions in the future. Emotion coaching strategies, however, where you acknowledge a child’s feelings as valid and guide them to feeling calm, have shown to be an important factor for developing self-regulation. 

Vocabulary of emotion is integral to emotional development and emotional intelligence is associated with improved mental health outcomes. Some children benefit from help naming their emotions and connecting them to accompanying physical sensations (interoception). For example, you might talk about anxiety and the sensation of having butterflies in your stomach or anger as heat travels through your body. 

Note: some children may have a condition called Alexithymia, which affects their ability to recognise and describe the emotions they feel.

Find the triggers – Anger is a primary emotion (immediate and instinctual), but often it can also be a secondary emotion (influenced by thoughts/beliefs/experiences) and used to protect ourselves or cover up emotions. Understanding your child’s triggers can help you avoid them when necessary or plan for them. Talk to your child about situations or things that cause them to feel negative emotions, and work through options on how to identify and deal with them. Involving your child in problem-solving during these circumstances develops multiple skills, including self-awareness and self-advocacy.

Empower your child with options: Work with your child to develop coping strategies for managing frustration and anger. There are many different ways to regulate our feelings, and they can include deep-breathing exercises, counting to ten, reappraisal of a situation, or taking a short break to cool down. Jumping on a trampoline or squeezing a stress ball, can give kids a way to direct and release their anger without hurting anyone. Depending on the situation and their triggers, your child should feel like they always have options for regulating.

Try role-playing: Playing out scenarios that have previously been an issue for your child can give them a safe way to practise self-advocating. Practicing breathing exercises and problem-solving when they are calm is a great to increase your child’s confidence. This preemptive approach is especially helpful as they start to navigate complex social situations.

Boost positivity – Working on amplifying positive emotions and creating daily opportunities for experiencing moments that calm the nervous system, is just as important as helping kids manage negative feelings. Two easy and effective strategies include:

• Gratitude reflection – there is something powerful about taking the time to think about what makes you grateful. Incorporate a regular ritual, where everyone in the family can reflect and share what things they are grateful for.

   

• Finding glimmers – The word “glimmers” is used to describe a small moment that has a regulating effect on our nervous system. Think of tiny cues from the external environment or your own body, that make you feel safe and calm or bring you joy. Encourage your child to increase their awareness of those positive moments throughout their day.

Seek support  – Depending on the severity of your child’s emotion regulation difficulties, it might be worth exploring other underlying issues or conditions. Your child’s psychologist and paediatrician can advise on how to proceed. To help clinicians, keep note of all your observations in the Keywell app so you can confidently discuss the frequency and intensity of your concerns.

Treatment options for emotional dysregulation 

Over the last few years, there have been several studies to test and understand what interventions provide the most significant improvements in self-regulation for children and young people with ADHD. Scientists have found that it is very difficult to design robust studies that measure emotion regulation in a standardised and consistent manner and that meet feasibility, efficacy, and acceptability criteria. 

We’ve summarised some of the established and emerging therapy options that can help with emotion dysregulation. You’ll need to talk to your medical care team to determine whether you want to explore these options further. Depending on your child’s unique neurology they may respond better to one or a combination of therapies.

Medication – ADHD medication has been proven to be a good treatment option for emotional dysregulation as it can help regulate neurotransmitters in the brain, improving attention, focus, and impulse control, which in turn, contribute to better emotional regulation. If emotion dysregulation is a symptom of an underlying and independent condition like anxiety, your child’s paediatrician might suggest a combination of medications to treat different symptoms.

Cognitive behavioural therapy (CBT) – CBT for ADHD is an effective option for emotional dysregulation as it helps children learn to identify situations that cause anger and frustration, and develop techniques to manage negative emotions. In some CBT programs, children learn how to recognise the anger cues from their body, triggering situations, behaviours, and how their thinking changes when they are angry. Children also learn strategies to reduce angry outbursts, reduce their intensity (e.g. through relaxation, activity practice, thinking about something else, cognitive reappraisal), and develop a set of solutions for problem-solving. They learn to understand social situations better and the role of thoughts in causing and keeping anger. Additionally, children may practice ways to peacefully resolve conflicts in situations where they are provoked such as being teased by peers or reprimanded by adults.

Parent–Child Interaction Therapy (PCIT-ED) – there are decades of research supporting the use of PCIT to reduce disruptive behaviours and improve the relationship between a parent and child. PCIT has since been modified to support children with an ADHD diagnosis. There are a few variations of the original program that target anxiety, including PCIT-ED for emotional development, PCIT-Eco for emotion coaching, and PCIT CALM designed to coach approach behaviour and leading by modelling. If you are considering a type of PCIT, please talk to your clinician about whether the program they deliver is neuro-affirming.

Digital interventions: Emerging research on digital solutions is still insufficient to support the effectiveness of apps for children, preadolescents, and adolescents with mental health concerns. That said, you can speak to your psychologist about trialing them.

• Virtual or augmented reality – In a recent study, individual exposure to immersive virtual reality emotion and social skill practice was linked to improvements in emotion regulation in a sample of autistic kids with low support needs.

   

• Digital games – The strongest evidence from digital games is in the reduction of negative emotional experiences (anxiety). This suggests that digital games can be efficacious for training emotion regulation in children and early adolescents.

Neurofeedback: Neuroplasticity is the concept that parts of our brain can be developed and shaped over time. Neurofeedback (NF) is believed to support the brain networks underlying emotion regulation like the prefrontal cortex and amygdala, by changing the frequency and intensity of brainwave activity. Scientists believe that Neurofeedback may be particularly effective when the brain is undergoing substantial development like during adolescence.

This emerging therapy can use real-time fMRI (functional magnetic resonance imaging) or EEG data (electrical activity of the brain recorded via electrodes affixed to the scalp) to help an individual train their brain to improve ADHD symptoms like emotion regulation, impulsivity, and focus. 

Although there are concerns about the validity of the methodology and design of studies on neurofeedback, the results suggest a positive link to emotion regulation improvements, especially when coupled with a digital game. The combination of both interventions may be more effective because they target the emotion regulation framework where top-down and bottom-up regulation strategies are used together.