If your child has oversized reactions to minor slights, it may be Rejection Sensitive Dysphoria (RSD), often a symptom of ADHD. Here’s what parents need to know.
Medically reviewed by Emily Edlynn, PhD
If you’ve noticed that your child is exhibiting sudden emotional outbursts, crying, or even aggressive behavior when they feel rejected or criticized—often leading to social isolation—it’s possible that they are affected by Rejection Sensitive Dysphoria (RSD).
Rejection Sensitive Dsyphoria is an emotional sensitivity and emotional pain triggered by the perception—not necessarily the reality—of being rejected, teased, or criticized by important people in one’s life. It is often a symptom of ADHD, but can also present as a stand alone condition.
Are your child's meltdowns and tantrums a sign of RSD? Here’s what parents need to know.
The Symptoms of Rejection Sensitive Dysphoria
Rejection Sensitve Dysphoria is more common in kids, but, just like ADHD, it can also appear in adults as well, especially those with ADHD or autism.
“They both may hold onto and repeat unkind words or actions directed towards them for months or years. It’s as if they just can’t seem to shake off a negative comment,” says Sharon Saline, PsyD, a licensed clinical psychologist and author of What Your ADHD Child Wishes You Knew. “Both kids and adults will think they’ve fallen short and, with their exquisite sensitivity, no matter what anyone else says, they just can’t bounce back.”
However, with kids specifically, parents may see them acting out behaviors such as aggression, meltdowns or internal symptoms such as anxiety or withdrawal. “Kids may not be able to articulate why they are upset or what has triggered them. Adults who have more skills at putting their feelings into words may also respond with intense emotional upsets, anxiety or isolation,” Dr. Saline explains. “Look for heightened emotional sensitivity, intense mood shifts and feelings of shame related to any missteps or mistakes—other characteristics include social anxiety and relationship challenges.”
RSD can be present if your child is prone to exhibiting intense feelings based on a belief that they've let other people down or embarrassed themself or have difficulty letting go of past hurts and/or rejections.
ADHD and RSD Connections
Many people with ADHD struggle with emotional dysregulation, also known as emotional control. Impulse control, working memory and metacognition, all key executive functioning skills, are typically severely impacted when people live with ADHD.
“These skills typically help manage reactions and responses to emotional triggers related to social anxiety and RSD. Many people with ADHD experience a tidal wave of strong feelings and struggle to keep their heads above water during those moments,” explains Dr. Saline. “It’s harder for them to pull up effective coping strategies from previous experiences due to the way flooding affects working memory and vice versa. People with ADHD are usually wired to feel things more intensely and tend to replay unpleasant interpersonal interactions over and over.”
But as Roseann Capanna-Hodge, an integrative and children’s mental health expert explains, even when diagnosed with RSD without ADHD, RSD can still cause significant emotional distress and impairment. “It’s just not accompanied by the core symptoms of ADHD such as inattention, hyperactivity, and impulsivity.”
RSD Diagnosis and Treatment
RSD is not officially recognized in the DSM-5, and so there isn't a formal diagnostic criteria, explains Dr. Capanna-Hodge. But it’s often identified through clinical interviews and self-reporting of symptoms like extreme emotional sensitivity and emotional pain to perceived or real criticism or rejection.
Treatment options for RSD can include psychoeducation for parents on calming the brain, plus practical advice on how to challenge faulty thinking and foster coping skills. For children, cognitive-behavioral therapy (CBT) to address maladaptive thought patterns that lead to poor stress tolerance and upset is often recommended.
“It’s crucial to tailor treatment to the individual with RSD, addressing any comorbid conditions like ADHD, and incorporating family education and support," Dr. Capanna-Hodge says.
Both Dr. Saline and Dr. Capanna-Hodge concur that ADHD rarely travels alone. According to Dr. Saline, almost two-thirds of children and teens with a diagnosis of ADHD have a co-occurring diagnosis including. learning disabilities, anxiety (including social anxiety), depression, oppositional defiant disorder and autism as a secondary diagnosis.
Supporting a Child With RSD
If you have a child with RSD, Dr. Saline says your goal is teaching them how to bounce back from criticism and rejection by improving communication skills, relying on self-compassion and shifting to a growth mindset.
“By developing these tools, they will build resilience and be prepared to face challenging situations with more confidence and competence,” she explains. And, Dr. Capanna-Hodge emphasizes that it’s important for parents to “share their own calm by being as regulated as they can—meeting an emotional child with anxiety or upset will only fuel it.”
Have your toolkit ready
It’s helpful for parents to be prepared. “Pre-arranged tools such as time-aparts, relaxation techniques or other healthy self-soothing activities like going for a run, listening to music or talking with a friend are the best ways for dealing with overwhelming emotions,” recommends Dr. Saline. “Consistently nurture your child’s strengths and focus as much as possible on what they love to do and what you do well.”
Normalize your child's feelings
It’s crucial to normalize a child with RSD’s experiences and encourage self-compassion instead of reassurance. Dr. Saline suggests some simple flips to the ways you talk to your child.
For example: “Of course you’re feeling upset. Anybody would be uncomfortable in that situation” instead of “Don’t worry. Things will be alright/get better/ work out fine” because you cannot promise nor ensure that outcome.
Dr. Saline also recommends working with your child to come up with a few statements of encouragement when the noise of RSD gets too loud.
Some phrases include: "I'm stronger than I think." "My mind is uniquely wired and creative." "I can make a mistake and be a good person." Or "I can get hurt and bounce back."
Kids can fall into an overfocus loop and drop into a shame spiral, unable to forgive or stop replaying an incident. “Explain to your child that we all make mistakes and learning from them is how we grow. When things don’t go the way you’ve hoped, take the time you need to regroup,” says Dr. Saline. “Tell them to talk to and treat themselves the way they would approach a friend who skinned their knee.”
Take a beat
Help your child learn how to take a pause before responding to a question or answer. Dr. Saline says to teach responses such as "that's a good question/comment. Let me think about it,” when talking to an adult or peer.
She also suggests teaching your child to ask for some time after an unpleasant interaction by saying “I’ll get back to you about this,” so they can then better assess what's being said.
Share as needed
If your child is diagnosed with RSD, Dr. Capanna-Hodge says it’s always a good idea to let the school and teachers, because transparency helps in creating a supportive environment and ensures that caregivers are understanding and equipped to handle situations that might arise due to the child’s emotional sensitivity.
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