Latest news with #A.D.H.D
CNA
27-04-2025
- Health
- CNA
That crushing feeling after a rejection that feels like the end of the world? There's a term for that
Imagine a nail jabbing at a shiny blue balloon. Pop! That's what rejection can feel like for someone with attention deficit hyperactivity disorder, one TikTok creator told his audience: An explosion of emotions. The clip, which has nearly 300,000 likes, is one of thousands of posts about 'rejection sensitive dysphoria,' or RSD. The term is rarely used by clinicians. You won't find it in the manual to diagnose and classify mental health conditions. But references to RSD have percolated online, especially on social media. And for some people with ADHD, the concept hits home. WHAT IS REJECTION SENSITIVE DYSPHORIA? RSD describes an intense emotional reaction to rejection, teasing, criticism or the perception that you have failed. Erin Ryder, 24, a teacher in the metro Detroit area with A.D.H.D, said that RSD gave a name to the 'extremely emotional' way she reacted to feeling dismissed. 'I just immediately go to: 'This is the end of the world,'' she said. When her boyfriend recently asked to postpone their plans after a long workweek, she said, negative thoughts flooded her brain and she obsessed over why he had canceled. Later, she realised her response was over the top. But in the moment, she said, 'I just flipped.' WHERE DID THE TERM COME FROM? Rejection sensitive dysphoria was popularised by DrBill Dodson, a psychiatrist who spent his career treating people with ADHD – but he clarified that he didn't coin the phrase. 'Believe me,' he said. 'I would not have come up with such a terrible, tongue-twisting name.' He borrowed the term from older literature on atypical depression and adapted it to describe a phenomenon that he says he has observed in thousands of his patients. Dr Dodson first publicly discussed RSD at a 2010 ADHD conference. Since then he has created 12 criteria to define RSD, chatted about the concept on podcasts and written about it extensively. Rejection sensitivity is the tendency to overreact to perceived criticism. It is most associated with mood disorders and personality disorders, said Dr Erick Messias, the chair of the department of psychiatry and behavioural neurosciences at the Saint Louis University School of Medicine. Rejection sensitivity may also surface after trauma, he added. Dr Dodson believes that RSD is distinct from rejection sensitivity, based on his decades of clinical experience, and also that it is an issue specific to patients with ADHD. With RSD, Dr Dodson says, someone isn't just sensitive to perceived criticism, they are also highly critical of themselves because they believe they have fallen short. In addition, when they are teased, criticised or rejected, their mood changes 'instantaneously,' he said, and they will suddenly feel depressed or full of rage. This is where the word 'dysphoria' comes in, meaning a state of feeling very unhappy, uneasy or dissatisfied. WHAT DO OTHER CLINICIANS THINK? Although Dr Dodson's ideas have become popular online, some mental health professionals remain skeptical. But even experts who doubt the term aren't surprised that some patients with ADHD identify with it. Dr Max Wiznitzer, a paediatric neurologist at Rainbow Babies and Children's Hospital in Cleveland, noted that people with ADHD are often diagnosed with mood disorders – and they are also prone to symptoms like outsized emotional reactions. And other clinicians, like Lindsay Blass, a psychologist in Westport, Connecticut, said they saw value in the phrase because it expressed just how gutting criticism can be for some people. 'You're not just disappointed,' Dr Blass said. 'You're devastated. And other people don't necessarily understand why it's that intense.' To avoid the hurt, Dr Dodson said his patients with RSD often become perfectionists, people pleasers or overly risk averse. 'People will arrange their entire being around preventing that pain,' he explained. WHAT CAN YOU DO TO EASE REJECTION SENSITIVITY? There is no established pharmaceutical treatment for rejection sensitivity. Dr Dodson said when his patients appeared to have RSD, he often prescribed drugs known to reduce anxiety – but that they didn't work for everyone. Therapy has been shown to help. Here are some expert-backed coping strategies for anyone who is especially troubled by rejection. Acknowledge your sensitivity: Simply reminding yourself that you tend to react strongly to perceived rejection can be a good way to gain perspective. You may see that your interpretation of a situation isn't grounded in the facts. Consider exposure therapy: If you find yourself avoiding certain experiences because of a fear of rejection, you can work with a therapist to gradually expose yourself to the things you find uncomfortable, and build your confidence along the way, said Dr David W. Goodman, an assistant professor of psychiatry at the Johns Hopkins School of Medicine. Give the benefit of the doubt: The person you're speaking with might not have negative intentions. Sometimes it can help to seek clarity. Dr Blass recommended saying something like: 'I know I have a tendency to assume the worst, but things feel a little off and I'd like to figure out what's going on.' 'It's not necessarily that they're out to get you,' she said.
New York Times
17-04-2025
- Health
- New York Times
When a Small Rejection Feels Like ‘the End of the World'
Imagine a nail jabbing at a shiny blue balloon. Pop! That's what rejection can feel like for someone with attention deficit hyperactivity disorder, one TikTok creator told his audience: an explosion of emotions. The clip, which has nearly 300,000 likes, is one of thousands of posts about 'rejection sensitive dysphoria,' or R.S.D. The term is rarely used by clinicians. You won't find it in the manual to diagnose and classify mental health conditions. But references to R.S.D. have percolated online, especially on social media. And for some people with A.D.H.D., the concept hits home. What is rejection sensitive dysphoria? R.S.D. describes an intense emotional reaction to rejection, teasing, criticism or the perception that you have failed. Erin Ryder, 24, a teacher in the metro Detroit area with A.D.H.D, said that R.S.D. gave a name to the 'extremely emotional' way she reacted to feeling dismissed. 'I just immediately go to: 'This is the end of the world,'' she said. When her boyfriend recently asked to postpone their plans after a long workweek, she said, negative thoughts flooded her brain and she obsessed over why he had canceled. Later, she realized her response was over the top. But in the moment, she said, 'I just flipped.' Where did the term come from? Rejection sensitive dysphoria was popularized by Dr. Bill Dodson, a psychiatrist who spent his career treating people with A.D.H.D — but he clarified that he didn't coin the phrase. 'Believe me,' he said. 'I would not have come up with such a terrible, tongue-twisting name.' He borrowed the term from older literature on atypical depression and adapted it to describe a phenomenon that he says he has observed in thousands of his patients. Dr. Dodson first publicly discussed R.S.D. at a 2010 A.D.H.D. conference. Since then he has created 12 criteria to define R.S.D., chatted about the concept on podcasts and written about it extensively. What's the difference between R.S.D. and rejection sensitivity? Rejection sensitivity is the tendency to overreact to perceived criticism. It is most associated with mood disorders and personality disorders, said Dr. Erick Messias, the chair of the department of psychiatry and behavioral neurosciences at the Saint Louis University School of Medicine. Rejection sensitivity may also surface after trauma, he added. Dr. Dodson believes that R.S.D. is distinct from rejection sensitivity, based on his decades of clinical experience, and also that it is an issue specific to patients with A.D.H.D. With R.S.D., Dr. Dodson says, someone isn't just sensitive to perceived criticism, they are also highly critical of themselves because they believe they have fallen short. In addition, when they are teased, criticized or rejected, their mood changes 'instantaneously,' he said, and they will suddenly feel depressed or full of rage. This is where the word 'dysphoria' comes in, meaning a state of feeling very unhappy, uneasy or dissatisfied. What do other clinicians think? Although Dr. Dodson's ideas have become popular online, some mental health professionals remain skeptical. But even experts who doubt the term aren't surprised that some patients with A.D.H.D. identify with it. Dr. Max Wiznitzer, a pediatric neurologist at Rainbow Babies and Children's Hospital in Cleveland, noted that people with A.D.H.D. are often diagnosed with mood disorders — and they are also prone to symptoms like outsized emotional reactions. And other clinicians, like Lindsay Blass, a psychologist in Westport, Conn., said they saw value in the phrase because it expressed just how gutting criticism can be for some people. 'You're not just disappointed,' Dr. Blass said. 'You're devastated. And other people don't necessarily understand why it's that intense.' To avoid the hurt, Dr. Dodson said his patients with R.S.D. often become perfectionists, people pleasers or overly risk averse. 'People will arrange their entire being around preventing that pain,' he explained. What can you do to ease rejection sensitivity? There is no established pharmaceutical treatment for rejection sensitivity. Dr. Dodson said when his patients appeared to have R.S.D., he often prescribed drugs known to reduce anxiety — but that they didn't work for everyone. Therapy has been shown to help. Here are some expert-backed coping strategies for anyone who is especially troubled by rejection. Acknowledge your sensitivity: Simply reminding yourself that you tend to react strongly to perceived rejection can be a good way to gain perspective. You may see that your interpretation of a situation isn't grounded in the facts. Consider exposure therapy: If you find yourself avoiding certain experiences because of a fear of rejection, you can work with a therapist to gradually expose yourself to the things you find uncomfortable, and build your confidence along the way, said Dr. David W. Goodman, an assistant professor of psychiatry at the Johns Hopkins School of Medicine. Give the benefit of the doubt: The person you're speaking with might not have negative intentions. Sometimes it can help to seek clarity. Dr. Blass recommended saying something like: 'I know I have a tendency to assume the worst, but things feel a little off and I'd like to figure out what's going on.' 'It's not necessarily that they're out to get you,' she said.
New York Times
13-04-2025
- Health
- New York Times
5 Takeaways From New Research About A.D.H.D.
As diagnoses of A.D.H.D. and prescriptions for medications hit new record highs, scientists who study the condition are wrestling with some fundamental questions about the way we define and treat it. More than 15 percent of American adolescents have been diagnosed with A.D.H.D., according to the Centers for Disease Control and Prevention, including 23 percent of 17-year-old boys. A total of seven million American children have received a diagnosis. Normally, when a diagnosis booms like this, it's because of some novel scientific breakthrough — a newly discovered treatment or a fresh understanding of what causes the underlying symptoms. I spent the last year interviewing A.D.H.D. scientists around the world for my magazine article, and what I heard from them was, in fact, the opposite: In many ways, we now understand A.D.H.D. less well than we thought we did a couple of decades ago. Recent studies have shaken some of the field's previous assumptions about A.D.H.D. At the same time, scientists have made important discoveries, including some that are leading to a new understanding of the role of a child's environment in the progression of his symptoms. At a moment of national concern about our shrinking attention spans, this science suggests that there may be some new and more effective ways to help the millions of young people who are struggling to focus. Below are the key findings from the new research. A.D.H.D. is hard to define — and recent science has made it harder, not easier. A.D.H.D. has always been a tricky condition to diagnose. One patient's behavior may look quite different from another's, and certain A.D.H.D. symptoms can also be signs of other problems, from anxiety and depression to childhood trauma and autism spectrum disorder. Twenty years ago, researchers thought they were on the verge of ending that controversy by finding a distinct 'biomarker' for A.D.H.D. — a single gene that would reliably predict the disorder, or a physical difference in the brain that you could spot on an M.R.I. But today scientists acknowledge that the search for a biomarker has mostly come up empty, which means the diagnosis remains fluid and somewhat subjective. Adding to the confusion, a study published last October found that only about one in nine children diagnosed with A.D.H.D. experiences consistent symptoms all the way through childhood. More often, the researchers found, symptoms come and go, sometimes disappearing for a few years, sometimes returning. Together with other research, this study has led some in the field to conclude that our traditional conception of A.D.H.D. as an inherent biological fact — something you simply have or don't have, something wired deep in your brain — is both inaccurate and unhelpful. A new model considers A.D.H.D. differently: not as a disorder you always have in some essential way, but as a condition you experience, sometimes temporarily. Medications like Adderall and Ritalin can have a positive effect on children's behavior – but the results often don't last. The biggest long-term study of A.D.H.D. treatments found that after 14 months of treatment, a daily dose of Ritalin did a better job of reducing children's symptoms than nondrug interventions like therapy or parent coaching. But then the effect started to fade, and by 36 months, the relative benefit of the drug treatment had disappeared altogether. The symptoms of the children in the medication treatment group were no better than those of the ones assigned to behavioral interventions — and no better than a comparison group that was given no intervention at all. The medications can improve students' behavior in the classroom — but they don't seem to help them learn. Medications like Ritalin and Adderall reliably improve students' behavior — at least in the short term — but they don't seem to do much to improve academic achievement. Research suggests that on medication, children are working harder and faster but not more effectively. So when it comes time to take a test, they haven't actually learned anything more. Still, it's a puzzle: If A.D.H.D. medications don't improve academic performance, why do so many students and their parents think they do? Researchers investigating this question have found that drugs like Ritalin and Adderall mostly work on your emotions, not your cognition. They don't make you smarter, in other words — but they make you believe you're smarter by increasing your emotional connection to the work you're supposed to be doing. There's some history to this. Today's leading A.D.H.D. medications are all versions or derivatives of amphetamine, and ever since World War II, a main attraction of amphetamine pills is that they make boring activities (watching for German planes, doing endless loads of laundry, driving a truck across the country) seem more interesting. Today Ritalin and Adderall may be having the same effect for high school students — making boring school work seem temporarily fascinating. There is no clear dividing line between those who have A.D.H.D. and those who don't. Rather than conceiving of A.D.H.D. as a black-or-white, yes-or-no diagnosis, many researchers now believe that it's more accurate to consider A.D.H.D. symptoms as existing on a continuum. As the British researcher Edmund Sonuga-Barke said to me: 'There literally is no natural cutting point where you could say: 'This person has got it, and this person hasn't got it.' Those decisions are to some extent arbitrary.' On one end of the continuum are children who could probably get an A.D.H.D. diagnosis — but also might be fine without one. On the other extreme are cases that are much more serious. Joel Nigg, a researcher in Oregon, has identified one group of children — about a third of the diagnosed total — whose A.D.H.D. symptoms are accompanied by intense anger. They are at much higher risk of future problems, including school dropout, criminal behavior and early death. We should put our treatment focus on those children, he says, and consider other approaches for those with less serious cases. Changing a child's environment can change his or her symptoms. A.D.H.D. is usually portrayed primarily as a medical condition — a neurodevelopmental disorder with a genetic cause — which is why we often look first to medication to treat it. But researchers are now discovering that A.D.H.D. symptoms can be highly responsive to the environment as well. When the surroundings of a person with an A.D.H.D. diagnosis improve — a more engaging classroom, a more stimulating job, a more congenial home life — his symptoms often improve as well. These findings are leading some researchers away from the traditional 'medical model' of A.D.H.D., which sees the brains of people with A.D.H.D. symptoms as biologically deficient, and toward a new model that considers A.D.H.D. primarily as a mismatch between a child's unique brain and his environment. Medication can still be useful in helping to resolve those mismatches, but changing the environment can sometimes work just as well. When A.D.H.D. is bad, it's bad. And when it's bad, medication can help. But many children and parents have been led to think of A.D.H.D. as a permanent malfunction, when in fact it might be better thought of as a temporary misalignment, brought on by external forces as well as internal ones. Finding a solution for that misalignment is important, especially for a family in crisis. But identifying the right solution starts with having a more accurate understanding of A.D.H.D.
New York Times
13-04-2025
- Health
- New York Times
Understanding A.D.H.D.
This morning, my colleagues at The Times Magazine published a remarkable cover story by Paul Tough about a surge of A.D.H.D. cases in the United States — and the way we treat them. Today, 23 percent of 17-year-old boys have received a diagnosis of attention deficit hyperactivity disorder. The number of prescriptions rose nearly 60 percent in a decade. You almost certainly know people who take these stimulants. Why is this happening? One thing I love about Paul's story is that it's partly a tale about how science is made and changed. Researchers in the 1930s saw immediate benefits when they treated jumpy kids with amphetamines. Eventually, doctors crafted a diagnosis that could explain distracted and excitable personalities, and a consensus formed about how to treat them. Paul's story describes how a few scientists have come to challenge that consensus — and some of the fundamental ideas behind A.D.H.D. For today's newsletter, I spoke to Paul about his reporting. What got you interested in this story? I've been writing for decades about education and children, and I now have two boys of my own. A few years ago, I began to notice how many families I met were struggling with their kids' attention issues. Attention was something I worried about in my own children — and in myself, too. But I didn't know much about the science behind attention. So I started talking to scientists. When I did, I discovered they had a lot of big unresolved questions. What is A.D.H.D., and why is it so tricky to define? There is no biological test for A.D.H.D. So it has to be diagnosed by its symptoms, and those symptoms are sometimes hard to pin down. One patient's behavior can look quite different from another's, and certain A.D.H.D. symptoms can also be signs of other things — depression or childhood trauma or autism. Take a child who is constantly distracted by her anxiety. Does she have A.D.H.D., an anxiety disorder or both? So A.D.H.D. may not be a clear, distinct medical disorder with defined boundaries — something you either have or don't have? Increasingly, the science shows that the condition exists on a continuum, and there is no clear dividing line between people who have A.D.H.D. and people who don't. For many kids, A.D.H.D. symptoms fluctuate over time — worse one year, better the next — and those fluctuations may depend on their external environment as much as their internal wiring. Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times. Thank you for your patience while we verify access. Already a subscriber? Log in. Want all of The Times? Subscribe.
New York Times
13-04-2025
- Health
- New York Times
Have We Been Thinking About A.D.H.D. All Wrong?
Even as prescriptions rise to a record high, some experts have begun to question our assumptions about the condition — and how to treat it. Supported by In the early 1990s, James Swanson was working as a research psychologist at the University of California, Irvine, where he specialized in the study of attention disorders. It was a touchy time for the field. The Church of Scientology had organized a nationwide protest campaign against the psychiatric profession, and Ritalin, then the leading medication prescribed to children diagnosed with attention deficit hyperactivity disorder, was one of its main targets. Whenever Swanson and his colleagues gathered for a scientific conference, they were met by chanting protesters waving signs and airplanes overhead pulling banners that read, 'Psychs, Stop Drugging Our Kids.' It was true that prescription rates for Ritalin were on the rise. The number of American children diagnosed with A.D.H.D. more than doubled in the early 1990s, from fewer than a million patients in 1990 to more than two million in 1993, almost two-thirds of whom were prescribed Ritalin. To Swanson, at the time, that increase seemed entirely appropriate. Those two million children represented about 3 percent of the nation's child population, and 3 percent was the rate that he and many other scientists believed was an accurate measure of A.D.H.D. among children. Still, you didn't have to be a Scientologist to acknowledge that there were some legitimate questions about A.D.H.D. Despite Ritalin's rapid growth, no one knew exactly how the medication worked or whether it really was the best way to treat children's attention issues. Anecdotally, doctors and parents would observe that when many children began taking stimulant medications like Ritalin, their behavior would improve almost overnight, but no one had measured in a careful, large-scale scientific study how common that positive response was or, for that matter, what the effects were on a child of taking Ritalin over the long term. And so Swanson and a team of researchers, with funding from the National Institute of Mental Health, began a vast, multisite randomized controlled trial comparing stimulant treatment for A.D.H.D. with nonpharmaceutical approaches like parent training and behavioral coaching. Swanson was in charge of the site in Orange County, Calif. He recruited and selected about 100 children with A.D.H.D. symptoms, all from 7 to 9 years old. They were divided into treatment groups — some were given regular doses of Ritalin, some were given high-quality behavioral training, some were given a combination and the remainder, a comparison group, were left alone to figure out their own treatment. The same thing happened at five other sites across the continent. Known as the Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study, or M.T.A., it was one of the largest studies ever undertaken of the long-term effects of any psychiatric medication. 'We have a clinical definition of A.D.H.D. that is increasingly unanchored from what we're finding in our science.' Want all of The Times? Subscribe.
