Beneath the volcano: ADHD and emotional outbursts
Right now Georgie White is seeing at least five youth who have ADHD, Attention Deficit Hyperactivity Disorder, and has noticed an increasing number of referrals.
Georgie is one of our clinicians at RISE and working with children and youth with ADHD is not new to her. She moved here last year from Canada where she worked at several schools supporting children with ADHD from the age of five to late teens. A growing client base of youth with ADHD makes sense when you know that ADHD is one of the most common neurodevelopmental disorders.
But Georgie isn’t seeing kids for their ADHD. “At RISE we usually begin working with ADHD clients after an episode that involved anger,” she says.
“A child or youth with ADHD has outbursts of many emotions – joy, excitement, sadness, and anger. Their outbursts run the spectrum. Having ADHD makes a person impulsive, disorganised, and uninhibited with their emotions. It’s understandable that people would be concerned about an angry outburst, which turns into a referral to RISE. Anger and violence are not the same thing but sometimes there are also violent behaviours at home. That is where I can help, supporting new skills for people with big emotions.”
If you are not familiar with ADHD, you might think it means people living with it are spacey or messy. In Georgie’s experience, it’s much, much more.
“It can have a massive impact on kids’ lives. They often struggle to do what is expected of them. Over time, children can absorb a message that they are lazy, bad, or dumb and the effects can be devastating as they get older, often leading to low self-esteem and social isolation.”
Youth who have their diagnosis in their teens have told Georgie that they have learned to believe something is wrong with them. They struggle to maintain friendships because others become less interested in tolerating their different behaviours.
“By the time I see these kids, they have tried over and over again to do well. They tell me they feel like they are failing in life. They are desperate to do the right thing, and yet they just can’t. And they don’t know that it’s because their brain is wired differently.”
Georgie says that if you don’t know you have ADHD, you don’t understand what’s going on in your brain.
“I can tell you with certainty that youth with ADHD are not lacking the will to do well, they lack the wiring. Reframing challenging behaviour from ‘won’t’ to ‘can’t’ can profoundly change how youth are supported. The youth I see with ADHD are awesome, genuine, and authentic, just like other youth. I’ve never met a ‘bad egg’ in my entire career.”
Treating the ADHD and treating the effects of the ADHD are often connected. ADHD is a lifelong disorder and, when properly diagnosed, has good outcomes with medication. It also requires re-education about how the brain works and using new tools and strategies for everyday life.
“I talk to the kids and their parents about how the brain works and what is going on in a brain that has ADHD,” she says. “I reframe the child’s behaviour in the context of capacity. In other words, many of the behaviours they have exhibited are not intentional. Once they understand what is happening to them, we can start to deal with the resulting emotional issues.
“The more parents and kids know about ADHD, the more we can help, the sooner they can be supported, and the better everyone will feel for the rest of their lives.”
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The National Institute of Mental Health (NIMH) says people with ADHD experience an ongoing pattern of the following types of symptoms:
Inattention - difficulty staying on task, sustaining focus, and staying organised that isn’t caused by defiance or lack of comprehension.
Hyperactivity - seeming to move about constantly, including in situations when it is not appropriate; excessively fidgets, taps, or talks. In adults, hyperactivity may be internalised and mean extreme restlessness or talking too much.
Impulsivity - acting without thinking or difficulty with self-control. Could also include a desire for immediate rewards or the inability to delay gratification. An impulsive person may interrupt others or make important decisions without considering long-term consequences.
There is a lot of literature on Attention Deficit Hyperactivity Disorder and Georgie recommends looking at a seminal video from Dr Russell Barkley, now a retired professor of psychiatry at several universities in the United States. He completed many research projects for the NIMH. A clinical scientist, educator, and practitioner, Dr Barkley is a Diplomate (board certified) in three specialties, Clinical Psychology (ABPP), Clinical Child and Adolescent Psychology, and Clinical Neuropsychology (ABCN, ABPP). He is also a Fellow in the American Psychological Association. Watch his 30 Essential Ideas You Should Know About ADHD.