How to Recognize ‘Rejection Sensitive Dysphoria’ in Your Child

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A term gaining traction in the neurodivergent community is Rejection Sensitive Dysphoria (RSD), which means someone feels pain when they’re criticized or feel like they’re being put down or rejected in any way. Kids with ADHD often have RSD, which is often mislabeled as being a “bad sport,” “too sensitive,” or a “crybaby.” Here we outline the signs of RSD and speak to some experts on how to help your child cope with it.

What does RSD “look” like?

If you’re a visual person, check out this TikTok from Dr. Ned Hallowell, a psychiatrist who both has and specializes in ADHD, where he outlines some of the qualities of someone with both ADHD and RSD. They include:

  • Over sensitivity
  • Is easily hurt, emotionally
  • [Heightened] empathy
  • Perceiving rejection often, including when it’s not really there or intended
  • Self-criticism or negative self-talk, which can include self-harm
  • Emotional outbursts
  • Social withdrawal
  • Low self-esteem

People with RSD often describe the feeling of rejection as an actual, physical pain, more severe than the emotional pain neurotypical people feel when faced with criticism. That can obviously make it difficult to cope with interpersonal relationships, school situations, and eventual employment. RSD is not its own clinical diagnosis, though, and is not in the DSM, the official document that lists mental health conditions.

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Why does RSD go with ADHD?

One reason kids with ADHD might have a higher prevalence of RSD can be due to the amount of rejection they may face from their hyperactive, impulsive, or inattentive behaviors. “Because of these symptoms, they tend to receive more directives and negative feedback from adults than their same-aged peers,” says Dr. Fatima Watt, PhD, a psychologist with Francscan Children’s. Kids with ADHD are told, “stop,” “pay attention,” and “no” more often than others.

Continued negative feedback can have behavioral results. “Frequently being told to stop doing something that’s hard for you to stop doing often leads to feeling sensitive to the feedback of others,” says Dr. Emily King, a child psychologist specializing in raising and teaching neurodivergent children and teens. Research shows children with ADHD receive a disproportionate amount of criticism compared to peers.

Dr. Watt adds, “the central nervous system plays a role in the development of RSD. Because of differences in the frontal lobe, children with ADHD have a nervous system that tends to be more reactive to the outside world. Actual or perceived rejection can cause a stress reaction, similar to those who have experienced trauma, that appears more extreme than is warranted by outside observers.” Experts don’t think RSD is caused by trauma, but rather that ADHD can often mimic trauma in the brain.

How to help your child feel better about themselves

If your child is struggling with rejection and you think it might be RSD, there are several ways you can help them manage these uncomfortable feelings, starting by talking with them about it. Knowing “the challenges that may accompany the condition can help them feel less isolated and alone.” Demystifying the diagnosis can help your child build community.

Overall, you want to try to focus on your child’s positive attributes as well. “Be sure to provide positive feedback to your child on a regular basis, while avoiding unnecessarily harsh criticism,” says Dr. Watt. It’s hard sometimes to notice the positive, so you may need to give yourself reminders to point out even little things. For example, when your child has a setback and they don’t blow up, make sure to notice that they regulated their response and used their skills, even though if it had happened to you, what they had done would have been a “normal” way to react. For your child, it may have been a big win.

Give your child lots of opportunities to succeed. “Nurture confidence in all areas of strength so there is a buffer to the more frequent feedback children with ADHD might get about their behavior. Help build a growth mindset where mistakes are normalized as part of learning to increase problem solving skills,” says Dr. King. Practice saying “yet” at the end of sentences. “I don’t know how to do this…yet.” This makes “failure” feel less like failure and more like “not yet.”

Share a strategy with teachers

When it comes to problem solving both at school and at home, Dr. King suggests you “Approach feedback as a problem-solving team where you are brainstorming together what was hard. Remember, it’s you and the child against the problem, not viewing the child as the problem.” The best teachers are ones that say your child had a hard day, not that they had a hard day with your child.

Make sure you talk to all teachers, coaches, and other caregivers about what works well for your child. “Any strategy a parent has found helpful, such as problem solving as a team, should be shared with others so they also have that strategy in their tool kit when teaching and coaching your child,” says Dr. King.

Inevitably, something will go wrong, they’ll be rejected, or they’ll have someone treat them poorly, “and teaching your child coping skills to manage their feelings associated with rejection and criticism can be particularly helpful as they grow and develop,” says Dr. Watt. Different things may work better for different kids. Mindfulness, breathing techniques, and other “reset” techniques might work well.

No kid can be completely rejection-proof, but your child can learn resilience skills now to set themselves up for the lifetime of rejection, acceptance, highs, and lows that await them as they grow up.

 

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