ADHD and the Emotional Brain

 by Thomas E. Brown, Ph.D.  at

[for Orton-Gillingham tutoring in Columbus OH: 614-579-6021]

Each day for two weeks, Karen had walked to the classroom building on time, determined to go to class.

As she approached the door, her heart suddenly began to beat very rapidly; she was unable to catch her breath, and broke into a cold sweat. She felt that she was having a heart attack.

These terrifying sensations lasted about ten or fifteen minutes each time and abated only when she gave up on her intention to enter the class that day.
Karen was a patient of mine with ADHD. She had severe social anxiety—as do more than one-third of teens and adults with ADHD. Many more with ADHD struggle with other emotional issues.

I share Karen’s story and others in my book, Smart but Stuck: Emotions in Teens and Adults With ADHD. The book is about intelligent, capable young people who have gotten “stuck” because of their ADHD.

But why did they get stuck?

One of my biggest realizations from working for 35 years with people with ADHD is this: You can’t understand ADHD without understanding the role of emotion in how our brains work. Here’s how I explained this in my book:

The difficulties that people with ADHD have with emotions are similar to the problems they often have in prioritizing tasks, shifting focus, and utilizing working memory. While cleaning a room, they may get interested in some photos they pick up, soon becoming completely diverted from the job they had begun….

In a similar way, many people with ADHD tend to get quickly flooded with frustration, enthusiasm, anger, affection, worry, boredom, discouragement, or other emotions … crowding out other important feelings and thoughts.
For Karen, the main emotion that took over was anxiety. And it was the result of things happening—or not happening—in the brain:

The human brain has a mechanism that allows it to modulate the intensity of experienced anxiety, frustration, discouragement, and so on….

When the … mechanism for regulating anxiety works as it should, it allows cognitive space for a person to think about how to deal more rationally and realistically with stressors that otherwise may immobilize reasonable thought and planning….

For some people, especially many with ADHD, this top-down mechanism is often ineffective; it does not prevent an intense cascade of emotion that floods the person so completely that he is unable to think clearly about his response. Quickly he is overwhelmed by panic or anger or hopelessness that may be quite disproportionate to the actual situation.

So what can you do as a parent of a child with ADHD?

First, try to recognize that your child’s puzzling behavior may be due to difficult emotions he’s unable to understand. Second, keep in mind that your family is not alone.

Many kids with ADHD can get “stuck” with emotional difficulties. If this happens repeatedly to your child, there are three important steps to consider:

  • Get an evaluation and a thorough explanation of your child’s issues.
  • Consider options for treatment and accommodations.
  • Find supportive counseling or psychotherapy.

Thomas E. Brown, Ph.D., is a clinical psychologist and associate director of the Yale Clinic for Attention and Related Disorders in the department of psychiatry at Yale School of Medicine.


Orton-Gillingham tutoring in Columbus OH: Adrienne Edwards 614-579-6021 or email


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