OK, so yet more initials to throw at you! But I am just learning about this and thought I would share my findings.  RSD or Rejection Sensitive Dysphoria.  Heard of it?  I hadn’t.  It’s not a medical diagnosis, but more a way of describing a symptom that is closely related to ADHD.  In fact, up to 99% of individuals with ADHD have this.  Hence a blog about ADHD and RSD in children.

What is RSD?

Rejection Sensitive Dysphoria is an intense emotional sensitivity whereby the individual believes they have been rejected by a person or criticised by someone important to them.  Dysphoria comes from the Greek word meaning, ‘difficult to bear’.   This does not mean they are weak, more that they find rejection very difficult to handle.

Often criticism can simply be perceived as such by the tone, which may or may not be there.  However, it is very real to them, and they are not being ‘over-sensitive’ and should not be treated as such.  People with RSD may be easily embarrassed; jealous; have low self-esteem and feel like failures; they may have problems with relationships; have heated emotional meltdowns when they feel like someone has criticised or rejected them; feel anxious in social settings and have intense mood swings.  Even asking how something went can come across as interrogation rather than a genuine question by the tone, real or perceived.

ADHD and RSD

As we know, our children with ADHD have difficulty with their emotional regulation and really struggle with managing their emotions.  Add to this the very common comorbidity of low self-esteem and BOOM! You are dealing with a highly sensitive child. One who is likely to take comments or actions as rejection and/or criticism. 

As well as struggling with their emotional regulation, many children with ADHD also struggle with executive functioning. This is the problem solving, rational part of our brain.  So, instead of being able to rationalise a situation and move on, they will focus on it, and it becomes all-consuming.  ‘Richard didn’t play with me today so he must hate me.  What did I do?’.  They become fixated on why, when it simply may be that Richard was playing with Charlie that day and had nothing to do with them whatsoever. However, this feeling is very real to them and they often can’t see past it or any other rationale.

For example, if your child doesn’t get selected for this term’s football team, they may see that as a failure. They are never going to be picked.  Many other children didn’t get picked too but they don’t see that, they just feel their personal failure.  If our children don’t get invited to a party, it may be that there were limited numbers. They will feel like it was something they did, or that they are not liked.  Of course, many children feel like this. However, with ADHD and RSD it is extreme and takes a lot longer to recover from.  Remember, our children are hypervigilant to criticism.

And as if this wasn’t enough for our children with ADHD to deal with, they also have trouble with their working memory.  This means they can’t call on past experiences to help them manage an immediate one. So, instead of learning from something and remembering how they dealt with that particular situation, they are learning from scratch so to speak. They don’t remember the last time they weren’t picked for a team they got picked the next time.

As soon as I started researching this I thought of my daughter and how much reassurance she needs compared to her siblings.  It made me feel really sad. 

Impact of RSD on children with ADHD

Normally the impact of RSD goes two ways with our children.  They will either try to become people-pleasers, so they don’t get rejected, which is simply exhausting and impossible to maintain.  It also makes them believe that they are not liked for them, they must change to be able to have and keep friends. 

Or they may go the other way and isolate themselves, not wanting to join in with others or make friends for fear that they will be rejected.  It’s almost a form of self-sabotage in that they would rather have no friends than be rejected by them.  

Both forms can lead to anxiety and depression issues.

How to help your child with ADHD and RSD

Some of the ways to help our children are so obvious and basic, but need to be acknowledged:

Be kind – The way they are feeling is very real and they are not being overly sensitive, they are in pain from what has happened, and this should be recognised.

Give them reassurance and love – Let them know they are more than good enough, loved and wanted.

Teach resilience and flexibility –  For example tell them, ‘If this happens, we can do that’; ‘If you don’t go here, we can go there‘; show that just because something has happened doesn’t mean that door has shut forever, and meanwhile, another door has opened.  If a friend has cancelled today, they may be sick or have remembered some other commitment, they can come another day and today we can do XYZ.  Give them ways of dealing with situations and different scripts.  Cognitive Behavioural Therapy is very good at helping someone adapt their mindset to issues.  If they didn’t get selected for a team sport offer to practise with them or find another team for practice or find a sport that they are good at. Boost their self-confidence.

Tell them your experiences – everyone has been rejected at some point doing something!  I always use to pass my little ballet exams with Distinction! When I advanced and started doing ballet seriously, I failed my first exam!  I was horrified, I thought I must be rubbish and wanted to quit.  But I was able to rationalise it and went on to become a professional dancer for years.  Show them how failing and rejection can push you!  Look at JK Rowling, she was rejected for ages by publishers.  Cindy Crawford was told she’d never become a model with ‘that mole’, look who’s laughing now!

Criticise with care – Of course, you must be able to tell your child the truth, this is vital, but make sure you explain fully.  Give them time to understand what you have said and why, and time to ask questions.  Make sure your tone is in check.  And if you do have to give criticism, never do it in front of anyone else.

Seek help – if your child is consistently low and cannot see past it, even with your help, please seek professional help. 

Our children already have enough to deal with, without feeling criticised and rejected which can translate to them as unloved, unlovable, and not worthy.  As much as I dislike coming across new initials linked to ADHD, I am pleased I stumbled upon this so that I can try harder when it comes to talking to my children with ADHD.  I really do recognise this in my daughter now.  She is always looking for validation.  She calls out, ‘I love you’, x 50 a day and awaits a response.  This is lovely to a point, but it’s almost like she needs to constantly hear it back rather than just knowing?  As if she must hear it every 20 minutes to reconfirm that I do still love her? This makes me feel sad so I wonder what it does to her?

The horror that was home-schooling now makes more sense too.  I was agitated because I had three children to sort, so I would have had a ‘stressed/non-patient tone I’m sure!  Maybe she picked up on that and thought I was getting frustrated that she couldn’t get on with it?  Maybe I was, but it wasn’t intentional. Now I see that she saw this as criticism. I was, however, just exasperated that I had to get three kids sorted! 

On reflection, I now know where I went wrong.  If I had just spent a bit more ‘patient’ time with her, she wouldn’t have had a meltdown, I wouldn’t have got even more discouraged by the whole thing and it probably would have been a lot calmer!  You live and learn.  However, I do not want to test this particular theory by having another lockdown thanks! 

I now know to recognise RSD and acknowledge how awful it must make my daughter feel, and the things I can do that will hopefully help her in the immediate moment and in the future.  I hope that this has helped you too.

I have started a private support group on Facebook for parents and carers who need support with their child with ADHD. It’s a friendly place to chat with others. Please do click this link ADHDinchildren to join. And for anyone on Instagram, I’m there too ADHD Mum.

Vicki x