• ADHD: Bitesize

Emotion — Our First Executive Function

Welcome to the ADHD: Bitesize Guide to our Six Executive Functions!



I have written about each of the six executive functions, which are impaired in those of us with ADHD, explaining how and why each of them affects us, and showing you some powerful solutions we can try that may help alleviate their impact on our lives.



This time we're looking at Emotion—the first of our six executive functions.


ADHD brains experience more powerful emotions, and often have a harder time coping with them.

Almost a third of us with ADHD rate a lack of emotional control as our most troubling symptom, yet the diagnostic criteria makes no mention of it.



So why are we so often troubled by feelings of rejection, oversensitivity, frustration and anger? Why don't these hugely significant symptoms even appear in any of the diagnostic definitions of ADHD? And, most importantly, what can we do to feel calm and controlled in times of stress?



The Trouble With Our Emotions


Emotions for ADHDers can be big. Really big. We can experience incredible highs and crushing lows, sometimes within moments of each other.



We're prone to sudden emotional outbursts, tend to have a low tolerance for frustration, and we can often be over-sensitive and overreact. Those of us with ADHD often feel as though our emotions are in control of us, rather than us of them.



Yet, emotional instability is the ADHD elephant in the room.



A huge subsection of ADHD symptoms relate to the inability to regulate emotions, and emotional disruption is often one of the most impairing aspects of ADHD. But neither the DSM-5 nor the ICD-11, the two globally major diagnostic health manuals, make any reference to it.



So why are these important characteristics of ADHD so often overlooked, even in the diagnostic literature?


It's very hard to measure emotions in a scientific way.

One significant reason is the obvious preference of diagnostic health manuals for specific, measurable symptoms which can be observed objectively, rather than messy, subjective emotions which often rely on user-reported information.



Thankfully, much recent research has focused on this important yet overlooked area, demonstrating that those of us with ADHD have significantly more difficulty with:

  • low frustration tolerance

  • impatience

  • hot temper

  • excitability



Why Do We Have Emotional Difficulties?


Our difficulty with emotion stems from the way our brains function relative to neurotypical brains, most notably in the regions known as the prefrontal cortex (PFC) and the anterior cingulate cortex (ACC). Here comes the science bit!


The prefrontal cortex, shown here in red, regulates behaviour and thought analysis.

The PFC

The PFC (prefrontal cortex) is a region of the brain responsible for regulating behaviour and analysing thoughts. The PFC can be thought of as a big intersection where a whole bunch of different roads meet, with thoughts and feelings racing through it like cars.



In a neurotypical brain, the intersection has a complicated set of traffic lights controlling the flow of cars—or thoughts—through it. The most important ones get a green light and are allowed through, whereas lesser thoughts and feelings are held back until the vital ones are safely clear of the intersection.


A neurotypical brain has a well-organised system for its thoughts, like traffic lights at an intersection.

The ADHD brain has no such lights, and the "thought-cars" end up racing through the intersection all over the place. Rather than the most important ones taking priority, it might be the fastest or most colourful thought-cars that grab our attention and hold it.



Sometimes there are too many cars in the intersection and the whole thing becomes clogged, like a giant traffic jam of thoughts and emotions all at once, making it impossible to think of anything clearly.



Other times there's a single, giant thought or emotion blocking the entire intersection, causing us to hyperfocus on that one thing to the exclusion of all others—and it may not even be that important!


Impairments in our PFC can make our thoughts a bit like a traffic jam.

The ACC

Connected to the PFC, the ACC (anterior cingulate cortex) is a region of the brain responsible for regulating our emotions and modulating our physical and emotional reactions to them.



In neurotypical brains, the ACC activates whenever an emotional/social conflict occurs, holding us back from making any rash decisions or reacting without thinking first.



It holds back the flood of powerful emotions, buying us valuable time for other areas of the brain to contribute important information, which helps us make a rational decision on how to react rather than an emotional one.



In the ADHD brain, however, studies have shown that the ACC does... well, basically nothing. When we experience an emotional/social conflict, we don't have much of an ability to stem the tide of powerful emotions or effectively modulate our reactions to them.



The other areas of our brains may well have important, rational reasons why we shouldn't break down and cry, yell and scream, or punch a wall. but without the ACC to hold us back, we've already reacted—long before those reasons get any airtime.

Without your ACC, disproportionate reactions in inappropriate situations are much more likely.

The combination of our PFC intersection with no traffic lights and our largely inactive ACC failing to hold back our emotions means that, for many of us with ADHD, we have little to no gap between a stressful sensory input and our physical and emotional reaction to it.



Psychiatrist Edward Hallowell describes it as having a "Ferrari engine, but bicycle brakes."



What Can We Do About It?


Now we know why we have a harder time regulating our emotions, what can we do to help make our brakes stronger? Here are 5 great places to start creating a space between your thoughts and your reactions:



Meditation

No, wait! Meditation probably isn't what you think it is, nor as difficult as it seems. It's often assumed that meditation means sitting perfectly still and clearing all thoughts from your head. Well, even neurotypical people would find that almost impossible. Meditation is actually about allowing yourself to have thoughts without reacting to them.


Observing your thoughts and emotions like clouds floating past is a good way to practice meditation.

Many practitioners liken meditation to observing your thoughts as they enter your mind like clouds floating across a calm, blue sky. You acknowledge them, then allow them to float peacefully away. If the idea of sitting still feels difficult or strange, there are many forms of meditation involving movement or motion, such as thumbing beads on a string or walking.



Meditation for ADHD brains is, effectively, the act of practicing how to delay, defer, or separate thoughts and feelings from actions, and is done whilst you're calm and relaxed. The more you practice, the easier it will become under stressful or emotional conditions.



Mindfulness

Mindfulness can be described as the act of bringing your attention to the present moment, becoming more aware of where you are and what you’re doing, without becoming overly reactive or overwhelmed by what’s going on around you. Meditation can be considered a form of mindfulness, but it takes many other forms, too.


Bringing your attention to the present moment without judgment or reaction is the essence of mindfulness practice.

Simply focusing on your breathing for a few minutes is considered a mindfulness practice, but mindfulness can be incorporated into almost anything; eating, yoga, or even doing the washing up! Being aware of each of your actions as you perform them, whatever they may be, can be considered mindfulness.



Cognitive Behavioural Therapy

Cognitive Behavioural Therapy, or CBT, is a form of psychotherapy which changes negative patterns of thinking by addressing automatic, "cognitive" thoughts.


Cognitive Behavioural Therapy can help us learn to manage our big emotions.

Cognitive thoughts are spontaneous interpretations of events and often come loaded with distortions—unfounded assumptions about self or others, a particular situation, or the future.



Often, these assumptions are built up over many years of feeling like we've disappointed people or failed.



CBT challenges and addresses these assumptions, thereby changing the way in which we process these automatic, spontaneous thoughts in the present moment, allowing us to deal with them more rationally and without the huge emotional strain of assumptions.



Exercise

Exercise is a great way to help everyone stay healthy, not just those of us with ADHD. However, there are some specific benefits of exercise that particularly help us ADHDers.


Yoga is a form of mind-body exercise, which is especially good for emotional regulation.

Exercise causes the brain to release neurotransmitters, including dopamine, which is naturally lacking in those of us with ADHD. Boosting neurotransmitter production is the main way stimulant medications help treat ADHD.



Studies have shown that aerobic exercise—something that really gets your heart pumping—is the best form of exercise to help alleviate overall ADHD symptoms.



Mind-body exercise specifically—such as yoga, archery, or martial arts—is the best for improving emotional self-regulation.



Medication

DISCLAIMER: I am not a doctor! It's important to consult with a qualified medical doctor to discuss anything relating to medication usage, including but not limited to starting, stopping, or changing (either dosage or type of) medication.


Medication can be very beneficial for our emotional wellbeing.

Medication can be very beneficial to many of us with ADHD, as it can boost the production and/or uptake of the neurotransmitters we naturally lack in our brains, allowing different areas of the brain to communicate more effectively with each other. I often compare it to lubricating the gears in a machine, allowing it to run more smoothly.



If you have reservations about starting medication to treat your ADHD, discuss your concerns with your doctor.



Good medical professionals will "trial" medications with you, starting with a low dose and very gradually increasing until you reach the lowest effective dose to treat your symptoms effectively with minimal side-effects.



Finally...


It's important to remember that everyone experiences strong, powerful emotions. This might not be a surprise to some, but to many—including me—this realisation is revelatory.



Knowing that we aren't just being over-emotional or hyper-sensitive can help us to understand that it isn't our feelings that are a problem, it's only our responses that need a bit of work.



Next Time


Join us next time when we take a look at Action—our Second Executive Function. Learn why we often have trouble regulating our actions appropriately, the ways that affects us, and powerful solutions to help. See you there!

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