- The Brown Clinic
"There is no single profile of emotions common to all individuals with ADHD."
An 11 year old who went “on strike” when asked to write
Eleven-year-old Sandy was the best goalie on her travel soccer team. She was well-liked by her teammates and often praised by her coaches for her skills and consistent effort. Yet she hated school. She got along alright with her classmates and usually got passing grades, but was seen by her teachers as stubborn and temperamental. Now in 6th grade she had been having increasingly frequent incidents of what the teachers called “going on strike.” When the class was asked to write paragraphs or brief essays, Sandy often wrote nothing. When the teacher asked what was wrong, Sandy just stared ahead and did not respond. When the class was given a timed challenge test for math problems, Sandy often started with the others and then suddenly stopped, tore up her paper, refused to talk, and began repetitively kicking the desk in front of her until the teacher sent her out to the principal who told Sandy to complete the work at home and return with a better attitude. Sandy’s parents reported that it often took them 5 or 10 minutes to explain the writing assignment to Sandy and help her get started, but she then was able to complete the task, producing results that the teacher said were fully satisfactory.
When I first met with Sandy and her parents, she was initially unwilling to answer any of my questions, but as I continued to talk with her parents, she gradually warmed up and began to respond, first with just facial expressions and nods or head-shaking, then gradually with words. Her mother told me that Sandy had been slow to speak as a young child, producing no words until she was 3 years old, but at that point she began suddenly to speak in sentences. I also learned that both Sandy and her mother had been diagnosed with ADHD several years earlier and that both were taking stimulant medication that they found helpful.
Over a series of conversations together, I found that Sandy readily spoke with me about how her soccer team was doing, yet she was unwilling to discuss any incidents in school where the teacher had complained to her parents about her behavior. When her parents told me how teachers were complaining about her being angry, stubborn, and going on strike, Sandy kept her head down and stared at the floor as her eyes began to fill up with tears.
Gradually it became clear that Sandy’s teachers were mistaken when they interpreted her “on strike” behavior as anger and stubbornness. That behavior was covering intense feelings of shame and fear. Sandy had very high standards for herself, especially for expository writing and for math. She also had ADHD-related problems with working memory and processing speed. Her working memory problems often caused her to get confused about oral directions given for writing assignments so she did not understand and remember what she was being asked to do. Her slow processing speed made it very difficult for her to keep up with her classmates in doing tightly timed math challenges. When she saw her classmates working much faster on the timed math quizzes, she felt embarrassed and gave up. When she felt confused about how to start her writing assignments, she froze in shame and was unable to respond to the teacher’s offers of help. What appeared as oppositional behavior was, in fact, a diversionary maneuver that served to distract her, her classmates and her teacher from what Sandy saw as humiliating failure.
I asked Sandy’s pediatrician to add an SSRI to the stimulant medication Sandy had been taking for her ADHD; gradually that helped to reduce her chronic anxiety. I also tried to help Sandy and her parents to understand the puzzling intensity of her reactions to confusion and perceived failure. Her mother then reported that both her sister, Sandy’s aunt, and also Sandy’s maternal grandmother, had longstanding reputations in their family for quickly getting angry and then pulling into their shell when they felt anxious, especially when stress was in a social situation.
We had a meeting with Sandy’s team of teachers who readily agreed to give written directions for writing assignments and to provide extra help for Sandy to learn how to get herself started on writing assignments. Her pediatrician, her parents and I also arranged to make some adjustments in Sandy’s ADHD medications so she could have more support for her problems with working memory and processing speed.
There is no single profile of emotions common to all individuals with ADHD. There is much diversity due to differences in age, temperament, personality style, family life, cultural background, and many other variables. Yet there are some ADHD characteristics and some situations often experienced by many with ADHD (and those involved with them) that cause particular patterns of emotional dynamics to emerge more frequently among these people. These case studies describe some emotional dynamics often reported by children, adolescents or adults with ADHD and those who interact with them.
The palette of human emotions is rich and variegated. It includes happiness, enthusiasm, interest, disinterest, boredom, delight, worry, fearfulness, panic, terror, frustration, annoyance, anger, rage, pride, envy, embarrassment, shame, guilt, jealousy, disappointment, discouragement, grief, hopelessness, sadness, depression, longing, trust, optimism, expectancy, determination, affection, passion, love, hope, and many others.
Emotions are dynamic in that they often change and interact, sometimes in an instant, sometimes over hours, weeks or years. Often they change in response to specific circumstances of a situation, what someone else says or does and how individuals perceive and react to one another in given moments and over time. Sometimes emotions are quite transient, a flash of anger or a moment of jealousy, pride or affection that may quickly be modified or replaced by other emotions which may be quite contradictory. Emotions also may be persistent over much of a lifetime, absorbed into the fabric of one’s personality across differing settings.
Emotions vary not only in type, but also in intensity. Sometimes emotions arise with fierce or crushing intensity; at other times that same emotion may be scarcely noticeable. Emotions also vary in level of consciousness. Sometimes a person is fully aware of a particular emotion in a given moment, yet at another time that person may be totally unaware of an emotion that others readily recognize and respond to.
In all persons, emotions tend to arise in multiple mixes and blends. Sometimes the blend is subtle and convergent—affection and longing, pride and hope. In other instances, emotions strongly conflict with one another— interest and fear, pleasure and guilt, pride and resentment, love and hate. Sometimes the conflict is immediate; in other instances, one emotion may be followed quickly or gradually with another, or a person may experience rapid alternation between one emotion and another. Examples described in this case study may be experienced by various individuals in many different ways, only some of which are included here.
Brown, T. E. (2017). Emotional Dynamics in Individuals, Couples, and Families Coping with ADHD. In Outside the Box; Rethinking ADD/ADHD in Children and Adults (pp. 151–170). Arlington, VA: American Psychiatric Association Publishing.