The ADHD-Anger Connection

Joel Nigg, Ph.D.

Irritability, anger issues, and emotional dysregulation in general contribute significantly to the psychosocial burden of ADHD in children and adults. The latest research suggests that these problems are inherent to ADHD and may require specific treatment.

Anger issues stemming from emotional dysregulation – while noticeably missing from diagnostic criteria for attention deficit hyperactivity disorder (ADHD or ADD) – are a fundamental part of the ADHD experience for a significant number of children and adults. Even when controlling for related comorbid conditions, individuals with ADHD experience disproportionate problems with anger, irritability, and managing other emotions. These problems walk in lock step with the general difficulties in self-regulation that characterize ADHD. Recent findings, however, suggest that problems with emotional regulation, including anger and negative emotions, are genetically linked to ADHD, too.

Ultimately, emotional dysregulation is one major reason that ADHD is subjectively difficult to manage, and why it also poses such a high risk for other problems like depression, anxiety, or negative self-medication. Scientific and clinical attention are now increasingly turning to correct the past neglect of this integral aspect of ADHD.

Anger problems and emotional dysregulation in individuals with ADHD are sometimes explained by co-occurring mood disorders, such as anxiety or depression. However, these associated disorders do not explain the near universal anger and emotional issues that ADHD individuals experience.

A critical aspect to consider, then, is ADHD’s nature as a disorder of self-regulation across behavior, attention, and emotion. In other words, any difficulties in regulating our thoughts, emotions, and actions – as is common with ADHD – may explain the irritability, tantrums, and anger regulation issues these individuals experience. And the majority do.

About 70 percent of adults with ADHD report problems with emotional dysregulation, going up to 80 percent in children with ADHD. In clinical terms, these problem areas include:

• Irritability: issues with anger dysregulation – “tantrum” episodesas well as chronic or generally negative feelings in between episodes.
• Lability: frequent, reactive mood changes during the day. .
• Recognition: the ability to accurately recognize other people’s feelings. Individuals with ADHD may tend to not notice other people’s emotions until pointed out.
• Affective intensity: felt intensity – how strongly an emotion is experienced. People with ADHD tend to feel emotions very intensely.
• Emotional dysregulation: global difficulty adapting emotional intensity or state to situation.

Some of the different options used to help manage the symptoms are:

• Cognitive Behavioral Therapy (CBT): Some children with anger issues have a tendency to over-perceive threat – they over-react to an unclear or ambiguous situation (someone accidentally bumps you in line) when no threat is actually present. For these children, CBT can help the child with understanding that something ambiguous isn’t necessarily threatening.
• Counseling: Anger problems can also be caused by difficulties with tolerating frustration. Counseling can help children learn how to tolerate normal frustrations and develop better coping mechanisms.
• Parent Counseling: Parents have a role in how a child’s anger manifests. A parent’s angry reaction can lead to negative and mutual escalation, such that parents and kids both start to lose their balance. This can form a negative loop. With counseling, parents can learn to react differently to their child’s tantrums, which can help reduce them over time.

Problems with emotional dysregulation, in particular with anger reactivity, are very common in people with ADHD. You are not alone in struggling in this area. Anger may indicate an associated mood problem but often is just part of the ADHD. Either way, changes in traditional ADHD treatment can be very helpful.