“Emotional sunburn”, “an allergy to rejection”, “a physical blow to the gut”, or an “emotional third-degree burn”. These statements are often used to describe an intense, sudden and overwhelming wave of emotional pain triggered by perceived rejection, criticism, or failure—better known as Rejection Sensitive Dysphoria (RSD). RSD is not reflected in the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) but it is widely recognized by clinicians and research, most often as a core and debilitating feature of ADHD and neurodivergence. Research indicates that approximately 98%-99% of adolescents and adults with ADHD experience some degree of RSD.

What Causes RSD in individual with ADHD?

While experts aren’t exactly sure why RSD happens, we do know that it’s brain-based and the combination of neurological differences in emotional regulation and a history of frequent negative feedback can contribute to it. By the age of 12, children with ADHD receive approximately 20,000 more negative, critical, or corrective messages than their peers. This negativity can result in lower self-esteem, chronic anxiety, and the development of RSD. Keep in mind, RSD is not a trauma-based disorder, but it can exacerbate it. It often develops in people with ADHD due to the differences in how the brain processes emotion with a heightened intensity and slower regulation. Think of it like this, the prefrontal cortex of the brain which is the “brakes” of the brain is bypassed by an overactive amygdala which is the primary processing center of emotions in the brain. When the “brakes” don’t kick in, stimuli are processed as an immediate crisis which leads to intense and disproportionate reactions—hence RSD.

How Might RSD present itself in children with ADHD?

Have you ever told your neurodivergent or ADHD child in a neutral tone “no”, “stop”, asked them to do something, or corrected them, and it was met with an involuntary rapid response of rage, uncontrollable anger, crying, shame, or sadness that was disproportionate to the situation? Does this happen repeatedly? If so, it’s important for parents to know that this is not “just” disobedience, it’s a feeling of overwhelming rejection that triggers the extreme response. Emotional pain feels like physical pain. The intensity of the pain causes individuals to feel as though someone is angry, rejecting, or “yelling” at them, even when the interaction was calm or neutral. I know this is eye-opening for parents unaware of RSD!

Some other symptoms include social avoidance, perfectionism, low self-esteem, negative self-talk, people pleasing, and difficulty with feedback.

Parenting tips for ADHD children with RSD

Regulate your own emotions: When your child becomes dysregulated, it’s extremely important to be a calm support. Parental response directly influences a child’s ability to de-escalate. Dysregulated children don’t respond to logic during a full-blown meltdown-this is not the time to teach a lesson. Learning and understanding the ADHD brain and RSD can help you to go for compassion over tough love. ADHD children often don’t respond to tough love because their behavior stems from brain-based executive function delays, not defiance. If you change the lens you view their behavior through, it can help you better self-regulate.

Also, take a moment to regulate yourself if needed. Doing so models healthy coping for the child – they are watching!

Validate their feelings: “I see that you feel very hurt by what I said.” Validate their feelings to help them feel understood.

Saying things like “Why are you screaming” or “I didn’t even say anything to warrant this behavior” is only going to make them feel more rejected.

Once dysregulated, give space: As mentioned above, once dysregulated, they just need to go through it. Let them know you’re there when they are ready.

Normalize feelings: Talk about feelings and normalize them to reduce the shame attached to them. Work on identifying and noticing emotions. They will come and they will pass.

Give them lots of love: With all the negative and/or corrective messages these kids receive, they need that much more love and positive messages. Let them know how loved they are regardless of the mistakes made along the way.

Consider professional help: Reading tips can generally be helpful, but sometimes a family needs more support, and that’s okay.

If you’ve read this far, maybe you recognize RSD in yourself or your child with ADHD. I applaud you for having an open mind to learn and reflect on your own experience. Each day provides a new opportunity for self-growth and positive changes. The parental mistakes of yesterday can be improved today. While you can’t take away the “emotional sunburn” from RSD, you can bring your compassion and sit with them in the shade while they heal. 😊