8 Ways You Can Help a Child With ADHD-Related Rejection Sensitive Dysphoria

Many children with ADHD have a sense that they’re somehow different from their peers, even if they don’t have a diagnosis. These children are right; they are different — and that can be both a great thing and a source of challenges. And some children have a harder time bouncing back from failures, criticism and rejections than others. 

Children with rejection sensitive dysphoria (RSD) may start to fear that others are harboring resentment for them or just plain dislike them. These children need some extra support and positive reinforcement to develop emotional resilience and a positive self-image.

In this blog post, we’ll be providing a definition of rejection-sensitive dysphoria. It also outlines eight ways to support a child with this ADHD characteristic.

What is rejection-sensitive dysphoria? 

Rejection-sensitive dysphoria is severe emotional pain caused by perceived failures or the feeling of rejection. A lot of people with ADHD experience it, and researchers suspect it may happen because of differences in their brain structure. People with RSD have a harder time regulating rejection-related emotions and behaviors. This only makes these feelings feel more intense.

RSD goes beyond typical rejection sensitivity in a few significant ways. People with RSD may develop anxiety or feel other negative emotions while anticipating a rejection. If an encounter is neutral or vague, they’re likely to see it as a rejection and react accordingly. People with RSD struggle to regulate their emotions in situations when they expect they might fail. This can look like overreacting, taking things personally, perfectionism, people pleasing or extreme negative feelings.

While RSD is a symptom in itself, it breaks down into smaller traits and behaviors. Children with RSD may show their pain in the following ways:

• Getting embarrassed or self-conscious easily
• Showing low self-esteem
• Having extreme emotional reactions to perceived rejection
• Internalizing emotional reactions, which can look like mood swings
• People pleasing
• Procrastinating or avoiding situations that could lead to perceived failure
• Perfectionism or intense anxiety

8 ways to help a child with ADHD-related rejection-sensitive dysphoria

By the age of 12, children with ADHD hear up to 20,000 more corrective messages than their peers. To a child with rejection-sensitive dysphoria, being told to stop fidgeting, be quiet or calm down can sound like criticism or scolding. The combination of near-constant correction and RSD creates a negative mindset where conditions like low self-esteem and depression can fester. 

Parents, teachers, and mentors can help children with RSD learn healthy coping skills to regulate their emotions. They can also support them in developing the social skills and resilience to engage with others in ways that aren’t so painful.

The following are our top eight tips for helping a child with rejection-sensitive dysphoria:

• Be kind — This point may sound simplistic, but children with RSD are likely to encounter others who don’t have the patience or consideration to meet their intense feelings with kindness. This includes both peers and adults in their lives. Speak to them with an even and gentle tone, and if you’ve said something harsh, apologize. Recognize that these children are more vulnerable to feeling embarrassed or ashamed. “Tough love” isn’t going to work for children with RSD.
• Help them learn self-compassion — Some children internalize negative messages they hear about themselves because of RSD. This can lead to a poor self-image or low self-esteem and perfectionism. You can model self-compassion by admitting your mistakes. When you hear the child use negative self-talk, encourage them to give themselves some grace. Talk about the important function of self-compassion in a positive relationship with oneself. You can set up this conversation by asking what they would say to a friend in a similar situation.
• Help them learn emotion regulation skills — We all need emotion regulation skills to get through the day. Children with RSD may need more help noticing when their emotions are running high and redirecting them to a healthy outlet. Practice things like deep breathing and self-soothing with comforting sensations when the child is feeling good. That way, these skills will be accessible when intense emotions come up. 
• Give them reassurance — Children with RSD may start to feel that their value is attached to their performance or their productivity. Remind them often that they’re worthy of love just the way they are. Tell them they deserve things like breaks and they’re allowed to make mistakes. Children with RSD are likely to hold themselves to very high standards, with a low tolerance for missteps.
• Help them accept their feelings — Having intense emotional reactions can make regular daily interactions very difficult. Even more so if one is around people who aren’t supportive or comfortable with their own vulnerability. By acknowledging intense feelings and talking about them, you can start to normalize them and decrease any feelings of shame. When these reactions happen, help the child name their emotions. Treat intense emotions like neutral, temporary states that will pass rather than negative experiences or weaknesses. Encourage the child to search their emotions for helpful information and either find a way to process them or let them go.
• Help them come up with positive affirmations — Affirmations are another proactive tool that can help build defenses against negative self-talk. You can help the child take some of the negative things they’ve said about themselves and flip them to create positive affirmations. For example, “Nobody likes me because I’m always crying” could turn into, “My emotions are powerful messages and I have good friends who don’t judge me.”
• Help them focus on what’s true — In moments when RSD is causing a lot of anxiety, gently challenging and reframing negative thoughts can help a child curb their worries. After all, worrying about things we can’t control drains energy we could be using in more interesting and positive ways. When a child expresses that they’re expecting negative feedback, ask how they know that will be the outcome. Getting consistent negative feedback from someone might say more about the person giving feedback than the person receiving it. This can be very hard to understand at a young age.
• Discreetly let their teachers know — If you’ve spoken to your child’s pediatrician or a specialist about rejection-sensitive dysphoria, it could be helpful to share that information with their teachers, mentors or coaches. Let them know how you’re helping your child learn to regulate their emotions. Then they can give your child time and space to do so. They could be helpful allies in normalizing your child’s intense emotions and helping them feel less shame around them. A parent-teacher conference would be an appropriate time to do this. 

Free resource: ADHD Success Kit

Does rejection-sensitive dysphoria come with other risks?

There are some mental health risks that come along with the Executive Function challenges of ADHD and RSD in particular. As mentioned earlier, low self-esteem and depression can stem from rejection-sensitive dysphoria. Ruminating on past and future rejections can lead to generalized anxiety or anxiety around specific activities or situations. 

Having underdeveloped social skills may make your child a target for bullying or abuse. Also, teenagers with ADHD are more likely to develop substance use disorders. Put another way, RSD can intensify the social and emotional challenges most children with ADHD experience.

Find a Beyond BookSmart coach to help you manage ADHD symptoms 

The skills for managing the intense emotions that come with rejection-sensitive dysphoria are within your child’s reach. Many young people with RSD have learned to manage their emotions and relationships effectively with the support of the adults in their lives. For some people, the effects are less noticeable in adulthood. Others must practice mindfulness and self-care to proactively maintain their emotional resilience. 

Emotion regulation is just one aspect of Executive Function that Beyond BookSmart coaches can help with. 

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