Supporting emotion regulation in adolescents with ADHD/ADHD symptoms: Evidence-informed tips for practitioners

Supporting adolescents with ADHD symptoms to develop their emotional regulation skills can contribute to their wellbeing.  We’re outlining some key skills that evidence suggests could be most helpful.

Why is emotion regulation important for adolescents with ADHD symptoms?

ADHD symptoms refer to difficulties in attention and/or hyperactivity and impulsivity. An estimated ~5.6% of adolescents meet ADHD diagnostic criteria (Salari et al., 2023); however, many more are affected at ‘subclinical’ levels (Kirova et al., 2019).

Emotion regulation difficulties (or ‘emotion dysregulation’) are commonly associated with ADHD symptoms (Sobanski et al., 2010), manifesting as very intense, change-able (‘labile’), or persistent emotions; strong emotional reactions;  or emotionally-driven behaviours (e.g., ‘lashing out’) (Graziano & Garcia, 2016; Murray et al., 2021a). The tendency for ADHD brains to generate stronger emotions combined with difficulties in recognising and regulating them when they arise, can all contribute to these difficulties. Adolescents with ADHD symptoms  can also experience more stressors and a  greater ‘emotional burden’ due to having to operate in a neurotypical world that might not be very accommodating to the way their brains work (Brown et al., 2022; Lukito et al., 2025).

Emotion regulation difficulties are thought to contribute to the elevated rates of mental health issues associated with ADHD symptoms (Antony et al., 2022; El Archi et al., 2020), both directly and indirectly. Emotion dysregulation can, for example, increase the risk of negative peer experiences. Adolescents experiencing emotion dysregulation may be seen as ‘disruptive’ or ‘overly-exuberant’ and might have difficulties with social behaviours (e.g., waiting their turn to speak) when in a high state of emotional arousal, exposing them to a greater risk of rejection, dislike, or bullying (Murray et al. 2021b). These negative peer experiences can then adversely affect mental health and self-esteem (Murray et al., 2025a; Roy et al., 2015; Russell et al., 2025) perhaps especially for girls (Murray et al., 2026).

How can you help adolescents?

 Few studies have directly tested ways to improve emotion dysregulation in adolescents with ADHD symptoms. However, drawing on research conducted in other groups and considering how they apply to ADHD, it’s possible to identify some promising emotion regulation skills you can share with the adolescents you support (see e.g., Murray et al., 2025a):

• Acceptance refers to allowing yourself to feel your emotions without judging yourself for how you feel. Those with ADHD symptoms often receive implicit or explicit messages that their emotions are “too much”. They may internalise that messaging and learn to become ashamed of their emotions. Acceptance is included in therapeutic approaches such as acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), and mindfulness-based cognitive therapy (MBCT).
• Cognitive reappraisal is thinking differently about a situation to change its emotional impact. People who do this habitually tend to have better mental health (Schäfer et al., 2017). Evidence suggests that those with ADHD symptoms are competent in using cognitive reappraisal prompted; however,  it may not be their ‘go to’ strategy (Materna et al., 2019; Thorell et al., 2020), so reminders and encouragement to think about emotionally evocative situations from more balanced perspectives may be helpful. Cognitive reappraisal is often part of cognitive behavioural therapy (CBT) based therapies, including the Unified Protocol, which has a strong emotion regulation focus.
• Rumination is repetitive negative, emotion-focused thinking that doesn’t lead to problem solving and is associated with poorer mental health (Ehring, 2021). Our work has suggested that ADHD symptoms are linked to stronger negative cycles of rumination and feeling bad (Murray et al., 2025b). Ways to tackle rumination include: identifying and engaging in absorbing activities; identifying high risk times (e.g., in bed at night) or triggers (e.g., with particular people) for rumination and creating ‘if…then’ plans for what to do if rumination starts in order to get ‘unstuck’ in negative thought loops. For example, ‘if I start to ruminate on the way to school, then I will refocus my attention on listening to music’. Rumination-focused CBT may be helpful for those who experience difficulties with rumination.
• Grounding involves: naming 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and 1 thing can taste. This helps with reconnecting with ‘present-moment’ experiences when emotions are intense. It’s easy to remember and simple to deploy, making it potentially quite helpful for those with ADHD symptoms.
• ‘Riding the wave’ is the process of naming, accepting, and feeling emotions, using mindfulness techniques such as paying attention to the associated physical sensations. It helps increase tolerance to negative emotions, allowing you to ‘ride them out’ rather than act on them.  Impulsive, emotionally-driven behaviours can be a common and impairing aspect of ADHD (Dekkers et al., 2022) making learning to ‘ride the wave’ a potentially valuable skill for adolescents with ADHD symptoms. It’s often taught as part of DBT.
• Good sleep is linked to better emotion regulation (Fisher et al., 2022) but sleep is a common area of difficulty for adolescents with ADHD (Becker, 2020). Tips include: no naps, consistent to-bed and wake times, avoiding caffeine later in the day (e.g., energy drinks), and only using the bed to sleep (i.e., not hanging out there when not trying to sleep). Sleep is like ‘landing a plane’ rather than flicking an off switch: it is best to aim for a gradual ‘wind down’ towards bedtime focusing on relaxing, ideally ‘screen free’ activities in the  lead up to going to bed.

And finally…:

1. ADHD symptoms affect everyone differently and people may struggle with different aspects of emotion regulation (e.g., labelling emotions, emotionally-driven impulsive behaviours, emotional lability). Different emotion regulation strategies will work best for different people.

1. It is possible to leverage ADHD strengths for emotion regulation. For example, drawing on hyperfocus tendencies might be helpful for that state of absorption that helps with rumination. Distractibility  can help with redirecting attention during moments of overwhelm or rumination. Creative and optimistic thinking tendencies might be helpful for generating different, more balanced perspectives when using cognitive reappraisal.

3. Flexible and context-appropriate use of emotion regulation strategies is key, rather than thinking of strategies as always ‘bad’ or ‘good’. For example, persistently hiding feelings has been linked to poorer long-term mental health. However, temporarily suppressing emotions might stop a young person from laughing at an inappropriate moment. As such, adolescents can be encouraged to increase their repertoire of strategies and deploy the most suitable strategy for a given situation.

Summing up

Supporting emotion regulation skills in adolescents with ADHD symptoms has strong potential for improving their mental health and broader wellbeing. Emotion regulation skills can be learned  and – with consistent practise – embedded as habits. The techniques outlined above were selected because of their accessibility and promise in relation to helping alleviate emotion dysregulation associated with ADHD symptoms. There are, however, many more emotion regulation skills out there that may be helpful for emotion dysregulation and we would encourage you to keep exploring and learning to help the young people you support maximise their repertoire of effective emotion regulation skills.

Additional information

To learn more about Aja’s research and how effective emotion regulation can improve mental health outcomes, listen to Aja’s podcast with Mark Tebbs. Aja’s team are currently co-developing resources with adolescents and their parents/caregivers and we will share these through ACAMH Learn in the new year. You may also be interested in the digital health intervention from Aja’s team, which incorporates many of the strategies outlined above. Please email ppls.adhdstudy@ed.ac.uk if you would like to learn more.  Finally, please note that the techniques discussed above are not a substitute for professional mental health support.

Conflicts of interest

Aja Murray is a Professor of Developmental Psychology of Mental Health, and Amanda Russell is a Research Assistant at The University of Edinburgh.

Grant funding: This blog is part of a project that receives funding from Medical Research Foundation

Links

Russell, A., Hoxha, D., & Murray, A. (2025). Developmental relations between ADHD and self-esteem: Evaluating peer problems as a mediating mechanism. European Child & Adolescent Psychiatry, 34, 3463-3473. https://doi.org/10.1007/s00787-025-02752-3

References

• Antony, E. M.-A., Pihlajamäki, M., Speyer, L. G., & Murray, A. L. (2022). Does emotion dysregulation mediate the association between ADHD symptoms and internalizing problems? A longitudinal within-person analysis in a large population-representative study. Journal of Child Psychology and Psychiatry. https:/doi.org/10.1111/jcpp.13624
• Becker, S. P. (2020). ADHD and Sleep: Recent Advances and Future Directions. Current Opinion in Psychology, 34, 50–56. https://doi.org/10.1016/j.copsyc.2019.09.006
• Brown, R., Speyer, L. G., Eisner, M., Ribeaud, D., & Murray, A. L. (2022). Exploring the effect of ADHD traits on the moment-to-moment interplay between provocation and aggression: Evidence from dynamic structural equation modelling. Aggressive behaviour, 49(5), 469-479, https://doi.org/10.1002/ab.22081
• Dekkers, T. J., De Water, E., & Scheres, A. (2022). Impulsive and risky decision-making in adolescents with attention-deficit/hyperactivity disorder (ADHD): The need for a developmental perspective. Current Opinion in Psychology, 44, 330–336. https://doi.org/10.1016/j.copsyc.2021.11.002
• El Archi, S., Cortese, S., Ballon, N., Réveillère, C., De Luca, A., Barrault, S., & Brunault, P. (2020). Negative affectivity and emotion dysregulation as mediators between ADHD and disordered eating: A systematic review. Nutrients, 12(11), 3292. https://doi.org/10.3390/nu12113292
• Ehring, T. (2021). Thinking too much: Rumination and psychopathology. World Psychiatry, 20(3), 441–442. https://doi.org/10.1002/wps.20910
• Fisher, R. S., Dattilo, T. M.,  Sharkey,  C. M., Traino, K. A.,  Espeleta, H. C., Krietsch, K., N.,  Chaney, J. M., Mullins, L. L., (2022). Sleep patterns related to emotion dysregulation among adolescents and young adults, Journal of Pediatric Psychology, 47, (1), 111–120. https://doi.org/10.1093/jpepsy/jsab084
• Graziano, P. A., & Garcia, A. (2016). Attention-deficit hyperactivity disorder and children’s emotion dysregulation: A meta-analysis. Clinical Psychology Review, 46, 106–123. https://doi.org/10.1016/j.cpr.2016.04.011
• Kirova, A.-M., Kelberman, C., Storch, B., DiSalvo, M., Woodworth, K. Y., Faraone, S. V., & Biederman, J. (2019). Are subsyndromal manifestations of attention deficit hyperactivity disorder morbid in children? A systematic qualitative review of the literature with meta-analysis. Psychiatry Research, 274, 75–90. https://doi.org/10.1016/j.psychres.2019.02.003
• Lukito, S., Chandler, S., Kakoulidou, M., Griffiths, K., Wyatt, A., Funnell, E., Pavlopoulou, G., Baker, S., Stahl, D., Sonuga‐Barke, E., & the RE‐STAR team. (2025). Emotional burden in school as a source of mental health problems associated with ADHD and/or autism: Development and validation of a new co‐produced self‐report measure. Journal of Child Psychology and Psychiatry, 66(10), 1577–1592. https://doi.org/10.1111/jcpp.70003
• Materna, L., Wiesner, C. D., Shushakova, A., Trieloff, J., Weber, N., Engell, A., Schubotz, R. I., Bauer, J., Pedersen, A., & Ohrmann, P. (2019). Adult patients with ADHD differ from healthy controls in implicit, but not explicit, emotion regulation. Journal of Psychiatry and Neuroscience, 44(5), 340–349. https://doi.org/10.1503/jpn.180139
• Murray, A. L., Dryburgh, K., & Sonuga-Barke, E. J. S. (2026). Identifying candidate mediators linking ADHD symptoms and internalising problems in adolescence: An exploratory longitudinal mediation analysis. Journal of Attention Disorders, 30(8), 986–998. https://doi.org/10.1177/10870547261419589
• Murray, A. L., Thye, M., Obsuth, I., Cai, S., Liu, Z., Orr, C., & Saravanan, A. (2025a). A narrative review to identify promising approaches for digital health interventions to support emotion regulation for adolescents with ADHD. JMIR Mental Health. https://doi.org/10.2196/56066
• Murray, A. L., Wong, S.-C., Obsuth, I., Rhodes, S., Eisner, M., & Ribeaud, D. (2021a). An ecological momentary assessment study of the role of emotional dysregulation in co-occurring ADHD and internalising symptoms in adulthood. Journal of Affective Disorders, 281, 708–713. https://doi.org/10.1016/j.jad.2020.11.086
• Murray, A. L., Zych, I., Ribeaud, D., & Eisner, M. (2021b). Developmental relations between ADHD symptoms and bullying perpetration and victimisation in adolescence. Aggressive Behaviour, 47(1), 58-68.  https://doi.org/10.1002/ab.21930
• Murray, A., Zhu, X., Xie, T., Hoxha, D., Melashenko, D., Eisner, M., & Ribeaud, D. (2025b). Associations between ADHD symptoms and emotion regulation strategy utilisation in daily life: A dynamic structural equation modelling analysis. Retrieved 26 October 2025, from https://osf.io/preprints/psyarxiv/2vh37
• Roy, A., Hartman, C. A., Veenstra, R., & Oldehinkel, A. J. (2015). Peer dislike and victimisation in pathways from ADHD symptoms to depression. European Child & Adolescent Psychiatry, 24(8), 887–895.
• Salari, N., Ghasemi, H., Abdoli, N., Rahmani, A., Shiri, M. H., Hashemian, A. H., Akbari, H., & Mohammadi, M. (2023). The global prevalence of ADHD in children and adolescents: A systematic review and meta-analysis. Italian Journal of Pediatrics, 49(1), 48. https://doi.org/10.1186/s13052-023-01456-1
• Schäfer, J. Ö., Naumann, E., Holmes, E. A., Tuschen-Caffier, B., & Samson, A. C. (2017). Emotion regulation strategies in depressive and anxiety symptoms in youth: A meta-analytic review. Journal of Youth and Adolescence, 46(2), 261–276. https://doi.org/10.1007/s10964-016-0585-0
• Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., Holtmann, M., Krumm, B., Sergeant, J., & Sonuga-Barke, E. (2010). Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): Clinical correlates and familial prevalence. Journal of Child Psychology and Psychiatry, 51(8), 915–923.
• Thorell, L. B., Tilling, H., & Sjöwall, D. (2020). Emotion dysregulation in adult ADHD: Introducing the Comprehensive Emotion Regulation Inventory (CERI). Journal of Clinical and Experimental Neuropsychology, 42(7), 747–758.

Author biographies

Aja is a Professor of Developmental Psychology of Mental Health at the University of Edinburgh. Her work uses ecological momentary assessment, longitudinal, and measurement burst designs to illuminate mental health across ‘daily life’ to ‘developmental’ timescales and identify and prioritise intervention targets. Her group has a particular focus on mechanisms and interventions in the links between ADHD symptoms, emotion dysregulation, and mental health.

Amanda is Research Assistant at University of Edinburgh for the Medical Research Foundation funded project: ‘changing practice in supporting the development of emotion regulation skills in adolescents with and without ADHD.’ She has a keen research interest in adolescent and child mental health in relation to ADHD, in addition to parental mental health, particularly anxiety. She began her career in public health marketing and is passionate about sharing actionable research insights to influence behaviour change to help improve health and wellbeing.