Month: <span>November 2026</span>

ADHD Anxiety By Beth Church 0 Comments

ADHD and Rejection: When Criticism Feels Crushing

Written by Sam Kroenig, BA, TLLP

When we talk about ADHD, we often hear a lot about hyperactivity and disorganization, but did you know there are important emotional components to ADHD as well? In fact, research suggests that up to 40% of children and 70% of adults with ADHD experience significant challenges with regulating emotions (Shaw et al., 2014). One topic within this discussion that is receiving growing attention is rejection sensitivity, often discussed its most intense form as rejection sensitive dysphoria (RSD) (Dodson, 2025). While rejection can hurt anyone, this blog aims to focus on the overwhelming distress many kids, teens, and adults feel in response to rejection, and how living with ADHD may contribute.

What is Meant by Rejection Sensitivity (and RSD)?

In psychology, rejection sensitivity describes a pattern of anxiously expecting rejection, reading uncertain social cues as criticism, and reacting strongly when rejection seems to occur (Downey & Feldman, 1996). In the ADHD community, you may often hear the term rejection sensitive dysphoria (RSD) used to describe the extreme, almost physical emotional pain that can happen in response to actual or perceived rejection, criticism, or a sense of having disappointed someone (Dodson, 2025; Cleveland Clinic, 2022).

This distress often involves black-and-white thinking about the source or content of the feedback, as well as sudden, intense feelings of shame, sadness, anger, or an urge to withdraw (Dodson, 2025). Rejection, whether real or perceived, can feel like a judgment of the whole person. For example, a child who is picked last in gym class might immediately assume and internalize, “I am not good enough,” while a young adult who receives routine feedback at work feels, “They’ve lost confidence in me.” 

Where Does This Sensitivity Come From?

To understand why rejection sensitivity is so common in ADHD, it helps to understand how the ADHD brain manages emotions alongside what it is like to grow up with ADHD. First, ADHD often comes with emotional dysregulation. Emotions happen fast and intensely, there is difficulty managing the intensity of feelings and how we respond to them, and it can take longer to recover after becoming upset (Rowney-Smith et al., 2026; Shaw et al., 2014). For some children, teens, and young adults with ADHD, emotions can build quickly and become difficult to settle, much like an emotional volume dial that turns up too fast and gets stuck (Cleveland Clinic, 2022; Shaw et al., 2014).

Additionally, brain wiring and past experiences can make rejection harder to shake with ADHD. Research from Babinski et al. (2019) found that youth with ADHD symptoms may overemphasize signs of peer exclusion while registering positive feedback less strongly. That is why a teen might read an unanswered text message as “They’re upset with me” and struggle to stop replaying it, even knowing their friend could simply be busy (Rowney-Smith et al., 2026; Ginapp et al., 2023). Similarly, because everyday ADHD behaviors like forgetfulness, zoning out, or speaking impulsively are often misunderstood, kids and adults face more frequent correction and exclusion (Beaton et al., 2022). Over time, they may protect themselves by hiding their feelings, over-accommodating others, or pulling away, which can offer short-term relief but at the cost of deeper connection (Rowney-Smith et al., 2026; CHADD, 2019). 

This cycle of intense emotions, more challenges with regulating, and more frequent negative feedback or exclusion can lead to a heightened sensitivity toward rejection. 

A Few Thoughts on How to Manage

  1. Acknowledge the feeling without judgment: Name the feeling with compassion. Remind yourself or your child that having a strong feeling does not mean something is wrong with you, and you can give yourself time before deciding what to do next.    
  2. Write the road map: Start tracking when these feelings come up so you can target your coping thoughts and skills. When and in what situations does rejection sensitivity tend to pop up? Do you feel rejection sensitivity more often around friends, over texts or social media, in the workplace, when with family? Tailoring our coping strategies and anticipating the feelings helps us reduce sensitivity and regulate faster. 
  3. Pause and regulate: Individuals with ADHD often need to regulate emotions with physical exertion and sensory input. A short walk, slow breathing/meditation, sensory activities like music or a shower,  and/or slowing down to write in a journal are some examples of how to calm and reset the nervous system, while also providing space to process the feelings brought up by real/perceived rejection
  4.  Reframe when you are ready: Similar to non-judgmentally approaching your feelings, once the initial hurt has eased, explore whether the experience has become a broader judgment about your worth or abilities. Additionally, try to identify any automatic/negative thoughts/phrases that play in your mind, and work to find alternative explanations. Doing this can help your brain not so easily fall into the negative thinking traps in the first place.

Practice Makes… Effective

Shifting gears when you are feeling the intense distress of rejection sensitivity can be really difficult and take a lot of practice. Oftentimes being guided by a professional to learn and practice these strategies is the most effective way to stop the rejection sensitivity cycle. Additionally, guiding a loved one or child through these strategies can be very challenging.  Be sure to reach out to the experts at Monarch Behavioral Health for more support if needed.

https://www.mbh-mi.com/make-an-appointment/ 

 

References

Babinski, D. E., Kujawa, A., Kessel, E. M., Arfer, K. B., & Klein, D. N. (2019). Sensitivity to Peer Feedback in Young Adolescents with Symptoms of ADHD: Examination of Neurophysiological and Self-Report Measures. Journal of Abnormal Child Psychology, 47(4), 605–617. https://doi.org/10.1007/s10802-018-0470-2

Beaton, D. M., Sirois, F., & Milne, E. (2022). Experiences of criticism in adults with ADHD: A qualitative study. PLOS ONE, 17(2), e0263366. https://doi.org/10.1371/journal.pone.0263366

Children and Adults with Attention-Deficit/Hyperactivity Disorder. (2019, April 4). Rejection can be more painful with ADHD. ADHD Weekly. https://chadd.org/adhd-weekly/rejection-can-more-painful-with-adhd/

Cleveland Clinic. (2022, August 30). Rejection sensitive dysphoria (RSD): Symptoms & treatment. https://my.clevelandclinic.org/health/diseases/24099-rejection-sensitive-dysphoria-rsd

Dodson, W. W. (2025, May 9). New insights into rejection sensitive dysphoria. ADDitude. [https://www.additudemag.com/rejection-sensitive-dysphoria-adhd-emotional-dysregulation/]

Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70(6), 1327–1343. https://doi.org/10.1037/0022-3514.70.6.1327

Ginapp, C. M., Greenberg, N. R., MacDonald-Gagnon, G., Angarita, G. A., Bold, K. W., & Potenza, M. N. (2023). “Dysregulated not deficit”: A qualitative study on symptomatology of ADHD in young adults. PLOS ONE, 18(10), e0292721. https://doi.org/10.1371/journal.pone.0292721

Rowney-Smith, A., Sutton, B., Quadt, L., & Eccles, J. A. (2026). The lived experience of rejection sensitivity in ADHD – A qualitative exploration. PLOS One, 21(1), e0314669. https://doi.org/10.1371/journal.pone.0314669

ADHD Child Wellness Women's Health By Beth Church 0 Comments

Girl ADHD: Why do girls often get diagnosed later or not at all?

Written By: Julie Braciszewski, PhD, LP

When most people think of ADHD, the stereotype of a boy bouncing off the walls often pops into their mind. But this stereotype gets in the way of girls obtaining timely and full diagnoses. In fact, girls are half as likely to get an accurate diagnosis in childhood, and if they are diagnosed, they receive a diagnosis, on average, 7 years later than boys. The amount of growth and change that is missed during that window is mind boggling! So, let’s get to the tricky questions; why is girl ADHD overlooked so often and what can we do about it? 

Why ADHD Symptoms in Girls Are Often Overlooked

The squeaky wheel gets the… diagnosis. Kids and teens who exhibit more of the disruptive behavioral and emotional patterns associated with ADHD – like impulsive behaviors, hyperactivity, intense difficulty following directions and completing tasks, and emotional reactivity – are more likely to be diagnosed with ADHD earlier in childhood. Honestly, this is because they are more likely to be causing frustration and ire among the adults in their lives. Kids and teens who have a more inattentive profile; who might have intense difficulties with regulating attention but look more ‘zoned out’, can’t keep track of tasks, dates and materials, and are turning intense emotional reactions inward are overlooked, often because they are not disruptive.

Common Signs of ADHD in Girls

One of the ways we can all do better in supporting neurodivergent girls is to amplify the girl ADHD profile. Although there are certainly ADHD girls who do present as hyperactive, it is less common. Additionally, hyperactive symptoms in girls look a bit different from boys; boys often exhibit physical hyperactivity while girls are more likely to be hyperverbal, or very talkative, rather than physically dysregulated. The ADHD girl tends to experience more inattentive symptoms, like ‘day dreaming’ or ‘zoning out’. They are having trouble sustaining attention and concentration, and this is often impacting learning, hearing directions and completing tasks, but doesn’t result in the outward hyperactive or disruptive behaviors. Instead ADHD girls are often quietly disorganized, forgetful, easily derailed or distracted from tasks or during conversations, they may hop from activity to activity, have trouble remembering steps in routines, and experience internal restlessness. Girls also tend to use their strengths to hide symptoms or compensate for the difficulties ADHD causes. This results in misdiagnosis and under-diagnosis.

The Long-Term Impact of Undiagnosed ADHD in Girls

Learning to mask and compensate for neurodevelopmental differences is exhausting and stressful! Resultantly, girls with ADHD are more likely to experience anxiety and mood troubles. Unfortunately, these anxiety and mood troubles are often seen as the primary issue, leaving ADHD unrecognized and untreated. 

What is especially tricky is that inattentive symptoms don’t really get better with age without intervention, so ADHD girls tend to struggle for a long time, often being told they just aren’t trying hard enough. The longer term impact of underdiagnosis is substantial; girls and women with ADHD may be at higher risk for additional negative outcomes such as anxiety, depression, eating disorder, suicidal thoughts, suicidal attempts, and even shorter life expectancy, compared to boys and men with ADHD. The long-term consequences of undiagnosed ADHD are well established and highlight why correct diagnosis and treatment are so important. 

How to Get an ADHD Evaluation for Yourself or Daughter

The first stop on the path to a correct diagnosis is often your primary provider or pediatrician. However, pediatricians and primary care providers report varying levels of confidence in diagnosing and managing ADHD. Their hands are often tied by the pressure to move through office visits quickly, and they do not have the means to test for ADHD beyond questionnaires. There is no one biological test for ADHD. Their reluctance to throw a diagnosis on neurodivergent symptoms is completely understandable; primary care physicians and pediatricians’ expertise covers such a wide range of knowledge and they refer out to specialists for many specific health and development related issues. In fact, many pediatricians report feeling that their training offered very limited training in developmental-behavioral pediatrics and psychiatry and readily refer out to psychologists for testing and treatment. So, while your first stop may be to discuss concerns with your primary care doctor or pediatrician, they will likely refer you to a specialist for evaluation and treatment. As you move through an evaluation for ADHD, it’s good to know what a complete diagnostic evaluation should include. For more information on full neurodiagnostic testing click here.

What to Expect From a Comprehensive ADHD Assessment

Because symptoms of ADHD overlap with anxiety, mood troubles, and other neurodivergent learning profiles and disorders, a full assessment is often warranted. It’s important that co-occurring differences or disorders are identified and treated alongside ADHD when present. This typically includes an hour long intake, review of medical and academic records, standardized measures of brain functioning across many areas of functioning as well as several types of standardized questionnaires. Testing should take several hours (4-6 hours, sometimes more) and should result in a lengthy report that explains all of the evaluation data as well as a clear path of recommendations.  

A word of caution; general screening measures are an ok place to start, but are often not a good measure of ADHD and co-occurring conditions and disorders. Gender differences among symptoms of ADHD is part of the reason general screenings and short questionnaires often just don’t cut it when it comes to getting an accurate diagnosis. 

No matter where you are in your or your loved one’s journey of diagnosis, we are here to help. We provide comprehensive evaluations that set individuals and families on the path of success with accurate diagnoses, as well as clear, evidence-based recommendations and follow up treatment.

For more information on neuropsychological testing at Monarch Behavioral health click the link here: https://www.mbh-mi.com/testing/general-information/

If you or a loved one are seeking general services, click the link to make an appointment:

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