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Child Development

How Does Rejection-Sensitive Dysphoria Affect Your Child with ADHD?

January 9, 2023
Table of Contents

    While it's not formally considered a symptom of ADHD in the United States, rejection-sensitive dysphoria affects almost everyone with attention deficit hyperactivity disorder (ADHD). 

    It's safe to say that no one enjoys feeling rejected, but rejection-sensitive dysphoria is beyond what most people experience. rejection-sensitive dysphoria (RSD) is far more severe than typical feelings of rejection. It's a type of emotional dysregulation that could be responsible for some of the negative emotions, distress, and other reactions you notice in a child with ADHD.

    So, what exactly is rejection-sensitive dysphoria? How does RSD present in children, and what can parents do to help a child cope with RSD symptoms? In this article, we'll define rejection-sensitive dysphoria, discuss the effects of ADHD RSD on children, and go over how to help children cope with rejection. Then, we'll talk about what else parents can do for RSD in children with ADHD and how Joon can help.

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    What Is Rejection-Sensitive Dysphoria (RSD)?

    The word "dysphoria" refers to a state of unease or unhappiness. Rejection-sensitive dysphoria refers specifically to intense emotional pain experienced as a result of real or perceived rejection. In the context of ADHD RSD, rejection can refer to criticism, bullying, being left out, feeling less-than, or virtually anything else that leads to that I’m-not-good-enough feeling.

    How does rejection-sensitive dysphoria feel? Many people with ADHD RSD describe rejection sensitivity as all-consuming: It can shatter a person's self-worth, enjoyment, and mood all at once. The emotions, feelings of failure, humiliation, and sadness are overwhelming with ADHD RSD. In other words, RSD heightens typical or expected reactions to rejection severely.

    Rejection-sensitive dysphoria vs. mood disorders

    At times, rejection-sensitive dysphoria is misdiagnosed as a personality disorder like borderline personality disorder or a mood disorder like depression or bipolar disorder. During a time of social rejection, the symptoms a person experiences could mirror symptoms of mood disorders. While it is possible to have both in some cases, RSD and mood disorders aren’t the same. Medical professionals and clients should both be aware of the signs to avoid misdiagnosis.

    The primary difference between RSD and a mood disorder is that rejection-sensitive dysphoria is an intense, short-lived episode that occurs due to real or perceived criticism, rejection, or teasing. During this episode, individuals with RSD experience extreme sadness and other intense feelings. On the other hand, mood disorders are persistent with episodes lasting two weeks or more. Mood disorders persist regardless of what's going on in a person's life, whereas rejection-sensitive dysphoria is a direct response.

    This doesn't mean that rejection-sensitive dysphoria doesn't have a lasting effect on mental health. In fact, it most certainly can.

    How Does Rejection Affect Children With ADHD? 

    Rejection-sensitive dysphoria is linked to various mental health conditions and other effects on mental health. Research shows that people with ADHD RSD are more likely to experience mental health issues such as:

    • Low self-esteem
    • Depression
    • Social anxiety disorder (also called social phobia)
    • Generalized anxiety disorder
    • Suicidal thoughts

    Other mental health conditions and self-harm can occur alongside, too. Even physical health concerns like high blood pressure and trouble sleeping are linked to feelings of rejection, and since people with ADHD RSD feel rejected more often, it's critical to learn to cope with an ADHD RSD episode in order to support overall wellness. Teaching children to manage rejection sensitivity is a way to support a child's mental health and better manage emotional responses and painful feelings associated with rejection sensitivity.

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    Teaching Your Child How to Manage Rejection Sensitivity

    It is true that rejection sensitivity makes people feel rejection disproportionately. Just because emotions are disproportionate does not mean that the feeling isn’t real. For some people with ADHD, RSD is the most difficult part of the condition. One of the best things parents can do for children with ADHD RSD is to teach them how to manage rejection sensitivity. Kids with ADHD might not be able to avoid the emotional experience of rejection sensitivity, but it is possible for children to learn how to navigate it more effectively. Here are some tips parents to try. 

    Combine empathy and resilience

    If your child is highly sensitive, their feelings will seem bigger or more intense than the emotions of other kids. Many children with ADHD RSD get branded as a "drama queen" or are told to get over it. Some parents might even relate to this experience. Be empathetic toward your child and validate that they are in pain first. Then, teach your child how to be resilient when feeling rejected.

    Thought reframe is a valuable tool for those with RSD. Often, emotional dysregulation pairs with unrealistic cynical thoughts, like "I'm a failure," or "no one likes me." Validate the emotion itself by saying something akin to “that is painful.” Then, walk your child through the reality (e.g, "We’re all learning. Getting the answer wrong doesn't make you a failure.") Positive affirmations can be similarly valuable for teaching resilience.

    Talk about overcoming rejection

    People with rejection-sensitive dysphoria often attempt to avoid rejection at all costs, whether that is actual rejection or perceived rejection. Even the possibility of rejection might make someone with ADHD RSD avoid social situations and other instances that could lead to the intense emotional pain caused by sensitivity to rejection. However, as we know, it isn't possible to avoid rejection entirely.

    Talk with your child about how rejection is a normal part of life and is not reflective of their self-worth. You can discuss times you've overcome rejection in your own life or give other examples. For example, a parent may tell their child about how some of the world's most famous basketball players didn't make their high school basketball team.

    Work on identifying and verbalizing emotions

    Teach children how to identify and express emotions. Together, explore what rejection, sadness, anger, or feeling left out is like. Ask your child about the physical and emotional signs they notice when they experience those emotions. Then, talk about how to come to other people about their feelings. For example, "I feel sad because..."

    Have this conversation at a calm time or after an episode rather than during. In the thick of an RSD episode, emotions tend to run too high and can be overwhelming. The goal in that moment is to use coping skills to get to a less heightened place.

    Help your child explore healthy coping strategies

    Rejection-sensitive dysphoria or not, healthy coping strategies are crucial for everyone. Show children coping strategies they can turn to when emotions are high. Soothing activities such as reading, taking a bath, art, and grounding exercises can all be helpful alongside thought reframe in coping with the stress of RSD. Physical activity, taking deep breaths, and asking to talk to someone about how they feel are other strategies to teach kids.

    Identify your child's strengths

    Parents can promote self-esteem in children by helping kids acknowledge their strengths and giving them positive feedback. Similarly, be careful with word choice when you discipline or redirect your child. Discipline can be firm and clear, yet gentle. Many kids with ADHD RSD feel like they experience frequent criticism even if they don't, though it's also true that people with ADHD tend to face a higher level of criticism than others. 

    How Parents Can Help

    In addition to helping children cope with rejection and the emotional pain that comes with it, parents can support children with RSD in other ways. Here are some additional tips for parents who believe their child is or might be facing rejection sensitivity.

    Understand the signs

    If you're not sure whether your child experiences emotional dysregulation in the form of RSD, look out for the signs. Common symptoms of rejection-sensitive dysphoria in children include:

    • People pleasing behavior
    • Feelings of embarrassment or anxiety in social situations
    • Emotional outbursts connected directly to feelings of rejection
    • Avoidance of social situations
    • Feeling like a failure, perfectionism, or being excessively hard on oneself
    • Avoidance of new situations where one could experience failure
    • Low self-esteem

    Seek professional support

    How is rejection-sensitive dysphoria treated? Therapy and medication can help treat symptoms of rejection-sensitive dysphoria. Common medications such as monoamine oxidase inhibitors (MAOIs) may be prescribed for some people who experience rejection sensitivity.

    Stimulant medications like Ritalin that are used to treat ADHD are also said to aid emotional regulation in ADHD RSD. Working with a therapist doesn't make rejection sensitivity "go away," but it can help children discover coping strategies.

    Working with a therapist can also be of value if a child has other disorders or needs to discuss other matters that affect their life and mental health, like difficulties at school or with peers.


    rejection-sensitive dysphoria (RSD) affects most kids and adults with attention deficit hyperactivity disorder. Especially if left unaddressed, RSD is connected to a range of negative consequences.

    Negative consequences associated with RSD include but aren't limited to increased risk of anxiety and other disorders, self-harm, and suicidal thoughts. Teaching children coping strategies for rejection can support emotional health and help kids work through feelings of rejection.

    Alongside parental support, treatment options such as medication and therapy can help those with ADHD RSD.

    How Joon Can Help Your Child With ADHD

    Symptoms of ADHD and RSD can interfere with a child's self-esteem and ability to complete daily tasks. Joon is a new app designed for children with ADHD ages 6-12 and their parents. 

    Parents sign up first and build a custom task list for their child. When children complete assigned tasks, they get rewards that allow your ADHD child to care for a pet virtually. 90% of children who use Joon finish all their tasks.

    Joon promotes self-esteem, motivation, and independence in children with ADHD. The app acts as a reward system, and many parents say that Joon has improved their parent-child relationship.

    Click here to download the app. 


    Dr. Brittany Ferri, PhD

    Brittany is a registered and licensed occupational therapist who holds a PhD in Integrative Mental Health. She is the owner of a writing and consulting company called Simplicity of Health. She has direct experience in program development, behavioral health, pediatrics, and telehealth. She has published five books, lectured at 20+ OT/OTA programs, and has been quoted as a health expert by NBC News, WebMD, CNN, and other outlets.


    Dr. Brittany Ferri, PhD

    Brittany is a registered and licensed occupational therapist who holds a PhD in Integrative Mental Health. She is the owner of a writing and consulting company called Simplicity of Health. She has direct experience in program development, behavioral health, pediatrics, and telehealth. She has published five books, lectured at 20+ OT/OTA programs, and has been quoted as a health expert by NBC News, WebMD, CNN, and other outlets.