Since starting the Main Line ADHD Clinic, I have had the most incredible, eye-opening talks with women recently diagnosed with ADHD. Some struggled in college until their anxiety or depression was properly diagnosed. Others were moms who recognized how ADHD affected their lives after their kids were diagnosed.

Almost every conversation lands on the same note: Why don’t we talk about the emotional side of ADHD?

First, let’s clarify a couple of things:

What is ADHD versus ADD?

There are three types of ADHD in the diagnostic manual: 

• • Hyperactive/Impulsive presentation
  • Inattentive (distracted) presentation
  • Combined type

Many people say they have “ADD” to show they are not hyperactive or impulsive. The official term is Attention-Deficit/Hyperactivity Disorder (ADHD). You can have ADHD that is inattentive. It doesn’t mean you have to drop the “H.”

Here is what ISN’T in the diagnostic manual

One reason women and girls often go undiagnosed is the hidden fourth type of ADHD: emotional dysregulation.

Who decides how something like ADHD is defined? Believe it or not, these decisions are made by committee. And that means politics. So not everyone is happy with the outcome. When the muckety-mucks came up with the criteria for impulsive and inattentive ADHD, a third group was shut out of the conversation.

My clients struggle to manage their emotions, just like they work hard to regulate their behavior and their cognitive skills.

The common story about ADHD is that boys get diagnosed when they misbehave in school. Their acting out disrupts their own learning and that of others. Girls, on the other hand, have historically flown under the radar, having trouble maintaining focus and fighting distraction. Only after psychologists began to notice how ADHD extended beyond hyperactive boys did we start talking about “inattentive” ADHD.

Before we noticed how girls also struggled with inattention, we picked up their anxiety and depression. This sometimes led to observations of “somatization,” where their complaints of headaches and stomach pain reflected deeper emotional problems.

What frustrates me to this day is how we have never really acknowledged the difficulty that many women and girls with ADHD have in regulating their emotions.

Why do I keep using the word “regulating”?

Everyone wakes up every day with a full tank of “regulation energy.” We need that energy to control our behavior and emotions. It also helps with metacognitive skills, like finishing tasks and using working memory to keep everything in mind at once.

My clients wonder why other people don’t have to work as hard as they do. One reason is that it is harder to do things that need more regulating later in the day, especially if your tank is empty. On the other hand, adding more structure to your day and learning executive function techniques can reduce the amount of regulation energy you have to use.

People with ADHD need to use more of this kind of energy to get through an average day. Tasks that require a lot of executive functions, like planning or organizing, can quickly drain your tank. Or you might drain your regulation energy when resisting impulses. This is a form of behavior regulation. At other times, you may have trouble staying on task (metacognitive regulation).

It may be out of character for you to get so upset, or feel super anxious, or break down emotionally. Other evaluators and therapists often miss the fact that ADHD makes it harder to control your emotions.

If you have difficulty regulating your emotions, you can learn more about how ADHD may be impacting you with our thorough and quick ADHD evaluation. I have designed an evaluation process that strips away the unnecessary complexity while maintaining professional thoroughness. If you want to learn more, schedule a consultation call here.