Rejection Sensitive Dysphoria and ADHD: What Teachers And Parents Need To Know

Rejection Sensitive Dysphoria and ADHD: What Teachers And Parents Need To Know

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Have you ever heard of the term Rejection Sensitive Dysphoria (RSD)? Some pupils can find accepting criticism difficult as it can feel like a personal attack on their self-worth.

In this episode of School Behaviour Secrets, we explore what is meant by the term rejection sensitive dysphoria and how RSD relates to pupils with ADHD.

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Show notes / transcription

Emma Shackleton  0:00  

Because of the way that ADHD brains are wired, criticisms can lead the child to feel overwhelmed by sadness, anger or anxiety, so their brains exaggerate even the smallest criticism or the smallest negative or even a lack of positive is enough for an ADHD brain to register an attack, and it feels like an attack on their self worth.

Simon Currigan  0:28  

Hi there. My name is Simon Currigan and welcome to another episode of school behaviour secrets. While other educational podcasts shows are like a delicate flower, a beautiful rose that provides a delightful but subtle centrepiece to your garden. We're more like Japanese knotweed. We're relentless, we're ugly. And if you invite us in, we will destroy the value of your house. And technically we're a biohazard. I'm joined here today by my capable show host Emma Shackleton. Hi, Emma.

Emma Shackleton  1:37  

Hello, Simon. Are you comparing us to knotweed?

Simon Currigan  1:40  

You know, podcast knotweed. Anyway, moving quickly on before we get sort of lots of complaints from gardeners, I've got a quick question to ask you. According to a recent YouGov poll, how many people said they had told a hairdresser or barber that they liked their haircuts when in reality, They had not?

Emma Shackleton  1:59  

Oh, my goodness, this has got to be high. I've done this a few times. Sorry Ollie, if you're listening, I'd say about 70%.

Simon Currigan  2:09  

So that is really high, actually. So the actual number who has done this is drumroll 39%. I still think it's an awful lot of people though. 

Emma Shackleton  2:19  

Yeah, it's quite high. 

Simon Currigan  2:21  

51% said they hadn't and 10% said they didn't know which begs a question. How don't you know whether you've done it or not?

Emma Shackleton  2:28  

Yeah, I was thinking that they must have an even worse memory than I. Alright, so 39% of people out there didn't want to hurt the hairdressers feelings or were worried about causing a scene maybe. But how is this relevant to this week's episode?

Simon Currigan  2:43  

Well, it's relevant because in this week's episode, we're going to explore rejection sensitive dysphoria, which is about how you interpret criticism or negative feedback from other people. And we're going to look at, in particular, how this relates to kids with ADHD.

Emma Shackleton  3:00  

Sounds interesting. But before we get to the details, I've got a favour to ask listeners, would you be willing to share this episode with one or two colleagues that you know, so the kids in their classrooms can get the help that they need, all you have to do is open your podcast app, hit the share button and send a direct link by email messenger however you like to communicate with your friends.

Simon Currigan  3:23  

So without any more ado, let's hop on the perch edge over to the bars and gently tap our beaks on the cuttlefish bone we call behaviour. So I suppose we should start by talking about what we actually mean by rejection sensitive dysphoria. So, rejection is obvious. That's when you perceive someone is criticising you or rejecting you. And sensitive means being sensitive to rejection. But what do we mean by dysphoria? Well, dysphoria actually means unease. It actually comes from a Greek word that means hard to bear or hard to carry. This means hard to dys and phoria comes from the root word in Greek 'to carry' but what does it look like in the classroom? Well, when we think about our children, you might think of some kids who feel very much like everyone is out to attack them, like everyone's looking down on them. They're very, very sensitive emotionally to any perceived rejection, or criticism. So you might go across and ask them to, you know, make some improvements in their work. We might say this is wrong and this needs correcting. They might completely overreact you might get an emotional outburst, you might get a URGHHH, you know, a complete rejection of that criticism, you might get someone going. That's completely wrong. That's completely unfair. A very kind of defensive or avoidant response to what's actually in the classroom is neutral criticism. It's constructive criticism. And what's dangerous is when you feel like everyone's out to get you when you constantly overreact to those threats. When you feel that real emotional sting when someone said something about your work or something you've said or about your appearance, children with RSD will start to often withdraw from social situations because they want to avoid that criticism from their peers because they feel it much more than the other children do. And then obviously, we've got other difficulties that are associated with RSD. If you're really sensitive to that external criticism, then that's going to lead to difficulties with your sense of self esteem and your sense of self worth, it's going to make you question what you're able to bring to the classroom and what other people feel about you another knock on of RSD, that's been recorded in the literature is children with RSD tend to have lots of negative self talk. So the voice in their head is telling them that this isn't good enough. Other people are going to criticise it, other people are thinking that you're not as good as them. And that's going to lead to you been constantly defensive, and always feeling under attack. And interestingly, another side effect of RSD is children with RSD will tend to ruminate on past events. So what do we mean by ruminate? Let's unpack that a little bit. It's natural for everyone to think back to their past and think back to the you know, the recent few hours and kind of review and reflect on things that have happened to them both positive and negative. And if it's negative, you might think about, you know, what happened, what could I have done better, were the other people being fair or unfair in their criticism. When we ruminate on something, what we do is, we get stuck in this pattern of just thinking back constantly to old events, it makes it difficult for us to move forwards, we can be thinking about these events, weeks, and months later, we are sort of blowing these criticisms, and these bits of negative feedback out of all proportion and getting stuck on them. And rumination is one of the characteristics associated with depression, especially in older teenagers and young adults. And also RSD will naturally result in you being easily embarrassed in social situations. And again, I think we can all, Emma,  appreciate what it feels like to be embarrassed in a social situation. But you can attach shame to that you can attach a sort of resistance to join in those social situations in future which sort of locks down risk taking both in your learning and in your sort of social interactions.

Emma Shackleton  7:16  

Yeah, it's natural to want to shy away from events that make us feel uncomfortable. And it becomes a vicious cycle, doesn't it because the more that you shy away from those situations, the less opportunity you have to be successful in those situations. And the less opportunity you've got for positive feedback. So it kind of reinforces your thinking that you're not good at this, that people don't like you that you don't fit in. And the more that you distance yourself from people, the more that confirms in your own head, you know, people don't want to be around you people don't like you that kind of thing.

Simon Currigan  7:50  

You end up in this sort of downward spiral, don't you and the more you see that evidence, because you're looking for that evidence, the more it confirms what you feel about yourself, which probably makes you more sensitive to further criticism in the future.

Emma Shackleton  8:04  

You're definitely on high alert, aren't you? Once you've picked up on something, we do this with other people too, don't we, once we notice a characteristic in somebody, especially if it's something that we don't particularly like about them, we tend to see it all the more because we're hyper vigilant of it. So it's the same here. For these children. They're on sort of high alert, and they're hyper vigilant to any slight or criticism or rejection, and they're almost waiting and watching for that to happen. And then a very small thing can be perceived much bigger to them because they're on high alert for it.

Simon Currigan  8:38  

And we've spoken about confirmation bias before in previous episodes. But for those of you that haven't heard those episodes, confirmation bias is where you're looking in the environment for any evidence that proves beliefs that you already have. So if you believe everyone's out to attack you, what you will do is you will pay lots of attention to the times in the day when people are criticising you or saying something negative, even if that's constructive criticism about your work, your brain will sort of hone in on that, and it will shine a light on it. The opposite side of confirmation bias is what you will start to do is start to discount and ignore any positive interactions. You wait those negative interactions much more heavily, because your brain is looking for them because it's trying to confirm the bias that it already has, that other people are laughing at you that they're attacking you that they're nasty and you need to be defensive. It discounts the times when that doesn't happen.

Emma Shackleton  9:31  

Also, if you haven't heard our previous podcast, why not? Do go back and listen to other episodes they often do link quite nicely together.

Simon Currigan  9:41  

A rich library. So what has RSD or rejection sensitive dysphoria got to do with ADHD? Well, children with ADHD or Attention deficit hyperactivity disorder often suffer from RSD as well. Now it's not often diagnosed at the moment but it is actively being considered by medical practitioners as one of the diagnostic criteria for ADHD. So the diagnostic criteria at the moment are things like finding it difficult to pay attention and control your focus that's the attention deficit side. being hyperactive or impulsive. In Europe, emotional regulation is also considered a criteria. And now,  RSD, this oversensitive to criticism is also being considered one of the factors that might be considered when making a diagnosis for ADHD.

Emma Shackleton  10:30  

And because of the way that ADHD brains are wired, these criticisms can lead the child to feel overwhelmed by sadness, anger, or anxiety. So their brains exaggerate even the smallest criticism or the smallest negative or even a lack of positive is enough for an ADHD brain to register an attack. And in response to that, they might have a hugely inflated reaction. So where most neurotypical kids would just shrug off being told, for example, to go back and check their work or go and read it again, or go and make any corrections, a child with RSD and ADHD might interpret that as the teacher attacking them, and it feels like an attack on their self worth. And when people feel attacked, they often go into counter attack. And that results in really high levels of emotional pain, these mood changes have a clear trigger, are really intense, and they tend to be immediate and short lived. So often, there'll be a big blow up to what we perceive to be quite a tiny thing. But then the complaint is usually quite quick as well. So at most, you're talking about a couple of hours. So it might be a small thing that the teacher said, or a small correction or the hint of a correction. And the child with RSD has over inflated the importance of that in their brain, they've had a huge emotional reaction to it a big flare up, and then it will take a little bit of time to calm back down again.

Simon Currigan  12:13  

As we've spoken about in the past as well. What we're talking about here is an emotional reaction to events. And emotions don't have to make sense. 

Emma Shackleton  12:21  


Simon Currigan  12:21  

They don't have to make sense to the person watching. They don't have to make sense to the adult who's engaged with the child. And they don't even have to make sense to the child themselves. This is the ancient part of the brain reacting to a perceived attack. And when we think about kids with ADHD, in particular, even just putting aside that they tend to be more affected by RSD. And professionals are considering including that as part of the classification and the diagnosis. Let's think about the average ADHD child experience in the classroom as think about behaviour. To start with, let's imagine a child has got impulsivity. And they've got an idea in their head during whole class time. And they keep shouting out. Well, what's going to happen in that situation is the adults in the room are going to give the child reminders that might give them warnings and consequences for what's happening. And that's going to happen over and over and over again. Now, for most kids who aren't that sensitive to criticism, they might be able to shrug that off and make sense of it. But if you suffer with ADHD, and RSD, rejection sensitive dysphoria in your head, that is going to feel like emotional pain throughout the day. It's like being hit every time. You know, every time you shout out, and that behaviour, you know might be out of your control, then you're being slammed with this criticism that is going to affect how you feel about being in the classroom, it's going to affect how you feel about being a learner, it's going to affect whether you feel accepted by the adults in the room and the other kids in the room. It might affect the way you engage with your work with your academic performance, because you might be given a piece of work that has been perfectly differentiated by the classroom teacher to your level of ability. But you might be so worried about making mistakes and receiving that criticism that you don't take risks with your learning that you never write down an answer that you think might be incorrect. It might be that you never really push yourself out of your limits and grow in terms of your academic performance. You just stick with what you know what you're going to get right. Because you don't want that big emotional turmoil that will come when you make a mistake. So you can see how it's going to limit not just how kids with ADHD perform in terms of their behaviour in school, but also how it's going to impact on their academic performance and their social interactions, which is so important.

Emma Shackleton  14:46  

And sometimes this is where you get work refusal coming in, isn't it so again, it can be frustrating for the teacher because they have adapted the work to the right level. And maybe yesterday the child could perfectly easily complete this piece of work. But today because they are feeling differently about the work today, they might feel like it's too stressful to even attempt the work with that risk of failure or risk of negative feedback. So for them, it can be preferable to push the work away, walk away from the work, refuse the word walk out of class, refuse to engage with the work that can feel preferable to having a go with the risk that that brings of any negative feedback.

Simon Currigan  15:29  

And when you look at researchers who have gone into classrooms and have gone into homes, interestingly, and observed how adults interact with kids with ADHD, they do see that kids with ADHD do receive much more negative feedback from the adults from teachers from parents. And that's not really the fault of the teachers or parents or the child with ADHD, what they're seeing is negative behaviour, impulsive behaviour, hyperactive behaviour, and the adults are trying to support the child with that, but it's how you receive the criticism, in this case that matters. And if you've got rejected sensitive dysphoria, you're receiving that criticism more like a hammer blow than a piece of friendly advice.

Emma Shackleton  16:08  

And I think if you have got the hyperactivity aspect of ADHD, then you stand out, those behaviours are often big, they're loud, they're distracting. And as the teacher, it's really, really difficult to tune those behaviours out, you can't help noticing them. And that the unfortunate trap is the adults then get sucked into commenting or correcting or even supporting, but the child feels like they are constantly getting noticed, or getting drawn attention to or getting pulled up for behaviours, which as you said, earlier Simon,  might even be out of that child's control. And many people with ADHD report that being sensitive to rejection is the hardest part of living with the condition, they can feel like a failure, because they perceive that they've let people down that they haven't lived up to other people's expectations, and that hurts that really gets to them. And also, if you throw in the fact that many children with ADHD do experience a lot of negative feedback and a lot of negative interactions from adults and their peers, due to that impulsivity or the hyperactive behaviour, you can see then how this adds up. And over time, that's going to be very disheartening and very wearing. So on the one hand, they're getting negative feedback more frequently, because they're standing out and they might be interrupting the learning more frequently. And on the other hand, the feedback that they get impacts them more greatly than everybody else. So as you say, it's like a double blow.

Simon Currigan  17:49  

So what can we do to help kids who have ADHD and RSD or maybe just even RSD by itself? Although I don't know about you, Emma? I've never come across a child who just has a diagnosis of rejection sensitive dysphoria by itself? 

Emma Shackleton  18:02  

No, not yet. 

Simon Currigan  18:03  

So what can we do to support them in the classroom? Well, or if you're a parent listening to this, well, some medications have been shown to help improve RSD. Now, we are not doctors, we've never worked in the medical profession. So you don't want to take medical advice from us, we do know that those medications can help. And we also know that those medications have side effects. So if you have a child who is being overwhelmed by criticism, if it's limiting their choices and opportunities, then it may be worth talking to a paediatrician or a doctor about possible support that they can give your child

Emma Shackleton  18:38  

Yeah, and because the impact is so immediate, and the reaction can be so overwhelming. Skill Building isn't really so helpful on this one. But what does help is reducing how much stress the child experiences in the classroom. Because the more stress chemicals you've got in your body, the more sensitive you are to feel under attack. If you think about it, everyone's kind of the metaphor is that they've all got their own cup that can hold the amount of stress that they can take. And everyone's cup will vary. Some people will have a great big cup that can hold lots of stress, and other people will have a smaller cup that will be able to carry less stress. And this of course can vary from person to person, but can also vary for the same person from day to day. And that will depend on other factors. So whatever else they've got going on in their life right now, for students with ADHD, their cup can already be kind of full due to the daily demands of being in school. So being expected to sit still to not call out to interact appropriately with others to remember instructions to keep track of their equipment, all of that kind of thing that can be impaired and can be difficult for children with ADHD. So for them, what we might perceive to be a small criticism or a small correction, say the teacher says, Ada stop rocking on your chair, for the child that can feel huge and might just be the very last drop in that stress cup that fills it to the brim, and tips the cup over. In many cases, children report back that the teacher has shouted at them. But actually, in reality, the adult might just have used a slightly firmer tone or a slightly louder voice, they weren't actually shouting. But for that child, it feels like they've been shouted at. So strategies for teachers to support and accommodate students with RSD in the classroom include creating a positive and supportive learning environment. And guess what that benefits everybody, you're not just doing something special there for that one child. Of course, that would be the ideal for everybody. It's things like setting very clear expectations, and providing those accommodations and being flexible, as needed, doing whatever we can to build self esteem and self worth, and really taking the time to think carefully before we speak. So being really mindful of the way that we phrase instructions, or suggestions, trying to keep it positive. So this is how we can make this better. For example, rather than you need to change that part of your work, or that part is wrong, or that part needs doing. Again, it's the same outcome. But it's the way that we phrase this means that that information can be received more palatable by that child who's hypersensitive, and subtle communications that make the child feel included really simple things, but just taking the time to remember to smile, and be warm towards those children. That goes a long way. Children always learn better from adults who they believe like them and care about them.

Simon Currigan  22:12  

So that's our guide to rejection sensitive dysphoria. It's when a child hears criticism or some negative feedback, and then kind of amplifies and explodes the size of that in their mind, and has a big, emotional reaction to that on the inside that's outside of their control. One thing that can support as well before we move on, by the way, is self knowledge, understanding the condition that you have. So if you're working with older children, who are, you know, kind of old enough to have some self awareness and self knowledge, they might be old enough to understand that they have ADHD, and you can talk to them about what RSD means. You can say that when people say negative things to you, it really stings on the inside, you know, you get this big emotional whoomph!, that big emotional pain when you hear those things, understanding the why can be powerful in how you process what's happening to you. So it's not going to take away that pain, it's not going to take away that hurt when you hand in your book and you get ten crosses on it and three ticks, it's still going to hurt that actually in terms of understanding your own self worth. And in terms of your own kind of metacognition and understanding your own emotions, you might be able to process that more positively more constructively, in the long term.

Emma Shackleton  23:27  

And I like what you said there about the child being old enough. And of course, we don't mean the number on their birthday card, we mean emotionally old enough. So the ones who've got a level of awareness and you feel that they're ready now to enhance that understanding in those skills. I think it's important that we are transparent and we teach children, as you say, to analyse their thoughts and check check if they are, real check if they are in proportion, and that can help them then to meet their response to them. Self knowledge is power certainly is. And by the way, if you work with children whose behaviour can be challenging, and you're stuck, you don't understand why you're seeing those behaviours, we've got a download that just might help. It's called the SEND handbook. And what that does is help you link behaviours that you see before you in your classroom with possible causes, such as trauma, autism and ADHD.

Simon Currigan  24:25  

The idea here isn't for teachers to make a diagnosis because as educators, we're not qualified to do that. But if we can link classroom behaviours to possible causes quickly, it means we can get the right help to the right children get early intervention strategies in place, which results in better outcomes for the child.

Emma Shackleton  24:43  

The new version of the handbook now contains fact sheets on conditions like PDA, ODD, DLD, foetal alcohol, and more. Plus, there's a specific section on trauma and ACE's. It's a free download, so head over to our website., click on Free Resources near the top. And we'll also put a link in the episode description.

Simon Currigan  25:08  

And if you found today's episode interesting or helpful, make sure you don't miss the next open up your podcast app now and hit the subscribe button and that will tell your podcast app to download every episode as it's released. So you never miss a thing. It's like tapping series length on your TV, and to celebrate subscribing. Why not whisper affirmation phrases into the year of a pensioner as they sleep things like you can do it. And if you believe you can achieve and you've got this when the pensioner awakes, they'll feel full of positivity and optimism. They're not quite able to explain why. And the best part, you'll be like a Santa for OAP's delivering sackfuls of sweet self confidence, and they'll never even know you're in their bedroom.

Emma Shackleton  25:55  

Okay, so that's wrong on so many levels. Please don't do that. But do remember to catch school behaviour secrets next time. Have a brilliant week, and we look forward to seeing you on the next day. Bye for now

Simon Currigan  26:07  

Youve got this!

(This automated transcript may not be 100% accurate.)