ADHD and Attachment Trauma | 5 Tips to Address Rejection Sensitivity

Hey there, everybody, and welcome to this video on ADHD, rejection sensitivity and attachment trauma. I'm your host, Dr. Donnelly Snipes. In this video, we're going to review ADHD symptoms, explore the function of secure attachment, describe attachment trauma, discuss how attachment trauma is related to rejection sensitivity, and identify five interventions to begin addressing rejection sensitivity. So let's start out by talking about ADHD symptoms, because in order to understand how we get to rejection sensitivity, we need to understand what's going on with the child. Now we're going to start out by talking about the observable symptoms. And I have here oppositional. And I am not saying that the child is oppositional. What I'm saying is a lot of times they are perceived by teachers, by caregivers as being oppositional. They're not trying to be. But the, the behaviors that are seen with ADHD often appear that way. It's important to note. It's just a side note. You can have ADHD and oppositional defiant disorder or conduct disorder, co occurring. However, you know, that's, that's for a different video. What I want to talk about today is rejection sensitivity. So you have this child who, and we'll say toddler at this point, who has difficulty sitting still. They have difficulty paying attention. They may start to watch Elmo and three or four minutes later they're wandering off to do something else, or you're trying to get them to sit still at the dinner table and they just can't pay attention to what's going on. They make careless mistakes in their chores, in their homework and the things that they're doing. They may have difficulty following through or completing tasks. They may be disorganized, tardy. They may blurt in a conversation instead of waiting their turn. They may be more impulsive, have low frustration tolerance and, and have aggressive behavior and negative emotionality. So let's think about how this all kind of fits together. Remember, children with ADHD have difficulty processing the stimuli that are coming in, difficulty figuring out what's important to pay attention attention to and what's not. So they're constantly being bombarded by visual stimuli and auditory stimuli and tactile stimuli know what they're feeling. And so it's really, really hard to concentrate on what's going on, which makes it more difficult to sit still and pay attention. And when you're not paying attention, you're going to make careless mistakes. When you're being bombarded by all that, it makes sense that you may be a little edgier and have difficulty with Trying to persevere on something when it's causing you problems, when it's causing you frustration, and that may cause you to feel stressed, it may trigger that fight or flight response which we know is anger or anxiety. And for children, they don't have a lot of skills to identify those feelings or modulate those feelings. So it can result in aggressive behavior, it can result in throwing things or temper tantrums and negative emotionality. Other hidden symptoms of adhd, and I mentioned this a minute ago, sensory gating abnormalities. This is when a child or a person has difficulty filtering out the important stuff from the unimportant stuff. So they're constantly being inundated and bombarded and it's just exhausting. They also may have hyper or hyposensitivity to stimuli. And research has been somewhat unclear. It depends on the person. But some of the research indicates that people with ADHD are especially sensitive to touch, sights and sounds. Those can be a lot more attention getting or distracting than smells, for example. So it's important to recognize that because a child that's in an environment that is extremely visually stimulating and there's lots of noise and stuff going on, and there may be even, you know, different tactile sensations that can be very distracting for them. So when the air conditioner kicks on, you know, that may distract them if it's blowing right on them. So we need to be sensitive about this because a child's behavior and their ability to focus and their hyperactivity and fidgetiness may differ based on some of these sensory issues. If they're in an environment in that is sensory overload, they are probably going to react differently than if they're an invite in an environment that is conducive to their sensory preferences. Children, infants, toddlers, even elementary school children are often unable to articulate that. So to parents, it may seem like, or caregivers, it may seem like they are behaving in one situation and then being willfully oppositional in other situations. I would encourage you to get curious when they're being oppositional. When they are exhibiting ADHD behaviors, it may be an indication that their stress response system has been activated or hyperactivated. So you want to say what's different about this situation that may be contributing to this acting out or this behavior? Likewise, some situations are under stimulating to the child with adhd. So we need to recognize that too much quiet, too much still, too much of anything can also be problematic and bring out some of those behaviors. So again, getting curious about the environment, about the time of day about what's going on. Why does Johnny behave this way in this situation? And why did they. Why did he behave differently in this situation when I asked him to do the same thing or when it seems pretty similar? So maybe in Mrs. Johnson's class, Johnny has no problem and is able to sit still and continue to do things. But over in Mr. Smith's class, Johnny has problems sitting still and not blurting and whatever else. So we want to get curious in those situations about what's different between Ms. Johnson's classroom and Mr. Smith's classroom. It could be the way they conduct the activity. It could be a variety of different things. It could be who the child is sitting next to. Maybe they're sitting next to somebody who's a little bit more disruptive in Mr. Smith's class. But we need to get curious about what the differences are. They also may have what we call low sensory registration, and this is an interesting concept. They may be sensitive to a particular stimulus, but it takes a while for it to register in their brain. So think about putting your hand on a hot stove. If you put your hand on a hot stove, generally you notice it's hot really fast and you pull your hand off and you're like, ow. But low sensory registration, you know it's hot or it's going to be hot, you put your hand on it. But it takes longer for your brain to register, oh, that's hot. Take your hand off of it. They find that children with ADHD and adults with ADHD may have delayed reaction times as a result of the low sensory registration, which is another issue that can become problematic when the person with ADHD starts trying to learn how to do something like drive. I've mentioned in other videos that people with ADHD have what we call habituation deficits. Instead of getting used to a particular noise, like a dog barking, every time that happens is like the first time it happened. And the startle response or the stress response is equally as strong every time. Which means that that HPA axis is just being taxed every single time instead of starting to get used to it. All of these things often add up in infancy and early childhood to HPA axis dysregulation. They've actually found that children that are diagnosed with ADHD by the time they are in preschool and early elementary school, they often have symptoms and signs of HPA axis dysregulation and changes in their the way their body responds to cortisol as a result of excessive exposure to glucocorticoids. Cortisol in fetal and early postnatal periods. Now, we've talked about this situation in other videos on trauma. How when the HPA axis, the stress response is regularly activated, eventually the body says, I can't get this stressed out this much of the time anymore. So it turns down its sensitivity to the stressors in the environment. So the cortisol response is, is blunted, if you will, most of the time. But when the cortisol response, when the stress response actually does kick off, when there's enough to actually trigger that HPA axis response, it's a tsunami of stress hormones. And, and that is what we call emotional dysregulation. Going from flat, you know, I just, I'm just not gonna notice much of anything to frantic or furious. Other related symptoms that might also cause consternation for caregivers include food fussiness. The child with adhd, because of the tactile sensitivities, may not like the texture of certain foods. And it can be really frustrating for the caregiver. They may think, well, the child's just being intentionally difficult and not wanting to eat their vegetables or only wanting to eat chicken nuggets or hot dogs or whatever it is. And it very well could be that their tactile sensations of those different texture foods may be problematic for them, maybe repulsive to them. So forcing them to eat those may be contributing to distress in the child. So you have the food fussiness, and it's obviously something to talk over with the pediatrician and maybe even work with a occupational therapist in order to address those tactile sensitivities. Children with ADHD often have developmental delays. We know that when that HPA axis is regularly activated, when people are in fight or flight mode, or fight flight, freeze mode, they have difficulty learning. The brain is not in learning mode, it is in survival mode. The child with ADHD is often in survival mode, which makes it more difficult for them to learn. So the skills that their peers are picking up, they're not getting quite as easily. Now, you do have children with ADHD who are very gifted, and so they may learn certain things, especially academic things, really well. Children with ADHD don't necessarily have a lower IQ than those without adhd. What a lot of what they miss picking up on are social skills and communication skills and emotion modulation and those sorts of things. Because of their adhd, they may also have difficulty learning particular skills. Learning particular subjects like math can be particularly difficult for some people with ADHD because there are so many nuances, so many Things you've got to remember. And it's easy to make small, quote, careless mistakes as opposed to history, which is more sort of more broad strokes. It's important to explore what is working for the child, what is clicking with the child and what they may need a little bit more assistance in learning because it's just not clicking with them or it's not registering in some way. And a lot of children with adhd, even from a very, very young age, experience social rejection. They try to blurt in conversations and whether it's in preschool or in, even at home, they may experience a lot of rejection where people are telling them to be quiet, to mind their manners, to sit still, still. So they're constantly getting corrective feedback and rejection and feeling like what they have to say is not important or people don't want to spend time with them. So let's look at what's important in creating secure attachment and let's talk about what may happen with the child with adhd. Now, in an ideal world, the caregiver creates a secure attachment with the child. The caregiver is consistently mindful of the child's needs. This helps the child learn to be mindful of their own needs. If the caregiver is consistently mindful, then you're going along. Throughout the day, the caregiver may say, hey, you seem to be getting tired right now. Are you tired? And the child checks in with themself. They say, yeah, I'm tired or no, I'm not. And then they can proceed appropriately. But the caregiver models regular self mindfulness for the, for the child, the caregiver models checking in and encourages the child to check in with themselves. This is such an important skill. Insecure attachment. It doesn't stop with just noticing, hey Johnny, you seem like you're getting tired. Good luck. The caregiver is actually responsive and says, okay, you're tired. So you've identified that as what, how you're feeling right now. Let's talk about what you can do about it. Do you need to go lay down? Do you need to take a time out? Do you need to, what is it that you need to do right now? So the caregiver responds, you know, the caregiver notices how the child's doing and the response responds by helping them develop the vocabulary to describe what's going on with them emotionally or physically and helps them develop the skills and tools to tolerate the distress and then figure out how to address it and, and make it better. Insecure attachment. Caregivers also provide Just what I call attention, proactive attention. Hey, I want to spend time with you. Listen, let's go to the playground or let's play this game or let's even make dinner together. I enjoy spending time with you. I like you as a person and that is really important. Especially maybe for the child with ADHD who re receives a lot of criticism and correction. Having a caregiver go, you know what? Yeah, you had to have some correction today and I want to spend time with you. That's so important to developing the child's self esteem to help them recognize that they are lovable and value as an individual even though they may make mistakes, even though they may have some hyperactivity or attention problems. Validation is another part of secure attachment. When the caregiver validates how the child's feeling or what what's going on with the child, you feel really overwhelmed right now or it seems like you're really tired. This teaches the child about other awareness. The caregiver may not feel that way, but they recognize they're noticing, hey, I see that you're feeling this way or they're noticing, hey, I'm really upset right now and I notice that it's making you upset. So noticing you, your impact on other people. And it also teaches boundaries. When the caregiver validates how the child's feeling, they're not saying, hey, I feel that way too. I'm with you, I'm terrified. They're saying, I see that you're terrified it's going to be okay or I, I, I know that it's going to be okay, but I can see how this would be terrifying to you. So teaching the child how to be aware of being their feelings but also respect the boundaries of others and acknowledge their feelings and acknowledge the feelings of others without correcting them or stomping all over their boundaries. Encouragement helps the child develop frustration tolerance. When they are small children and they're trying to learn how to put the, the blocks into the little cutouts or whatever sitting with the child and when they start doing it and they hit a problem and they start getting frustrated, in a good secure attachment, the caregiver is going to be consistently aware of what's going on with the child. They're going to see the child starting to get frustrated and then they're going to respond and we call this sensitivity. They respond to help the child figure out how do I solve this problem? How do I meet this need? And that helps the child develop frustration tolerance. Instead of saying, well, why don't you just put the toy away. The caregiver encourages the child and says, okay, well, it doesn't seem to fit here. What if we try it and they take the child's hand with the toy and move it over to the correct cutout? What if we try it here and the child see, see, sees it works. And they're like, oh, okay. And that helps the child learn what to do, but it also helps the child feel safe because they recognize that their caregiver is going to help them if they get stuck. And safety, safety is really important for the child to feel like they've, they're understood, they're accepted, they're loved, they're safe. And in their environment. Unconditional positive regard is the notion of making sure the child knows that they are loved for who they are and they can make mistakes and they're still going to be loved. That is so important for all children and the, the person with ADHD who often received more criticism than children without adhd. It can be really, really important to help sort of balance out the tide of criticism and love, to help them separate the difference and recognize behavior today wasn't so good. Still lovable, though. When a child fails to develop a secure attachment with a caregiver because the caregiver is unresponsive, um, and, and they may be dealing with their own depression, they may be overwhelmed by the child, they may be insensitive, they don't know how to meet the child's needs, or they're harsh, they just get frustrated and angry. Then the child starts to feel unsafe and insecure, and often they don't know how to fix things so they can feel safe, which means their HPA axis, their threat response system system is constantly on. So you've got this child who is constantly fearing rejection, constantly fearing punishment and criticism and not feeling lovable, how awful, how scary must that be for that child in that environment where they don't have a, a safe place where they can go, where they can feel loved and accepted? Eric Erickson proposed stages of psychosocial development. And I, I put these here just as a brief review. But when children are infants, when they have a need and the caregiver is consistently responsive and sensitive to their needs and meets their needs, then they develop trust in their caregiver. They believe that they are safe. Well, for the child with adhd, the infant with adhd, this may not happen. The caregiver may not understand how to effectively respond. They perceive the child as, quote, overly fussy or quote, high needs. And so they have difficulty responding because they can't understand why the child responds, is calm one moment and is frantic the next moment. So the child from infancy may experience trauma and not feel safe, not be able to trust that the caregivers will actually meet their needs. When they get a little bit older, they're starting to toilet train, they're starting to try to dress themselves. They develop, hopefully, autonomy, this feeling that, okay, I can choose my clothes and hey, I can go to the bathroom by myself. How awesome is that? If the child receives too much criticism during this period, then they start feeling inadequate. And so if they make mistakes then, and which children do, then it can be more difficult. And at this age, they're toddlers, caregivers may be starting to give them instructions and expecting them to do things that they just cannot do yet. And it's important to recognize the child with adhd. If you give them complex instructions like go into the kitchen and get, get your sippy cup out of the refrigerator and bring me something back with you or something I don't know, that may be too much for a three year old to handle. It's important. Or even a five or a six year old with adhd, you may need to give them one task at a time and be considerate of or consider how much additional stress they're under. What else is going on that might be pulling their attention? The more distractors there are, the harder it is going to be for them to follow through with instructions. Even one thing, they may say, okay, I'm going to go do that. And then 20 minutes later, they still haven't done it because they got sidetracked. And that can be true even in teenage or adult years. So it's important to recognize that in initiative, this is the preschool years, you know, four or five, the child is starting to initiate games and trying to develop relationships. Well, this is a child who has difficulty waiting their turn, who blurts in, may become aggressive, has low frustration tolerance. So they may have difficulty forming relationships with their peers because they have had difficulty in mastering those social skills that their peers have already mastered. So they start to feel this sense of isolation even as early as preschool. When you are dealing with a child with adhd, it can be exhausting, it can be overwhelming, especially if you don't know what's going on. So let's talk about how attachment may get disrupted and result in a traumatic experience for the child. Consistency. Well, the caregiver, well, we're going to do consistency and responsiveness together. The caregiver with a Child with ADHD may just get overwhelmed with what's going on with Junior because they are so freaking energetic. The child may be restless. The child may have bouts of irritability and low frustration tolerance, which can be overwhelming for caregivers who don't understand what's going on. They're like, okay, you don't want to do this. Maybe you're tired, so let me put you in your bed. And that's not what the child wanted. And. And then the child feels rejected. So the caregiver is getting overwhelmed. They don't know how to respond. And so they're responding what we call insensitively to the child's needs and where the caregiver may be trying to be consistently aware of what's going on. For a lot of children with adhd, their behavior often seems very unpredictable. Sometimes they behave and sometimes they don't. And a lot of times this is because their needs vary depending on the situation. Are they in an environment that is triggering more stress or less stress? Are they an environment that is under stimulating? And so some of their behaviors are for self stimulation. What is different in this situation? What is triggering these behaviors? But parents are not taught to ask these questions. So in terms of the child, what the child sees is an inconsistent, insensitive, unresponsive parent. In terms of attention, many caregivers get frustrated at the inattention or just exhausted by the physical activity. So doing things with the child may kind of fall by the wayside. The caregiver may, typically, with their other children or whatever, want to sit down and play a game. Well, a child with ADHD may not be able to focus for an entire game. So then the caregiver gets frustrated. It's like, well, every time we start playing a game, we get halfway through and then you quit playing or they start doing something and the child gets frustrated and gets up and walks off. That can be frustrating to the caregivers. But it's important. Instead of getting angry and going, well, I guess, you know, go do whatever you're going to do if you don't want to spend time with me, it's important to get curious and say, okay, maybe this game was too intense or too long for the child. What else could we do that might work within this child's attention span at this point in time? Public activities can also be a challenge due to impulsivity and blurting. And I've got stories. Oh my gosh, I have stories. Bless his heart of going to places like museums with my son. And he would get so excited. Even as like a five year old, he would get so excited about things. But we would go on tours and he would just constantly be bombarding the tour guide with questions and we'd have to pull him back and go, okay, sweetie, you know, let's let other people have a chance to ask questions. And he didn't really understand why that was important. And maybe we didn't do a good job explaining it to him, but it is important to recognize that children with ADHD may have difficulty holding, holding their tongue. As he got older, we developed a system where he could ask questions when we were, you know, at the museum or at the zoo or whatever. But then when it was time for him to stop asking questions and give other people a chance, his father or I would put our hand on his shoulder. And, and when we put our hand on his shoulder, he knew it was time for him to let somebody else have a turn. So he started learning how to manage that. But it took a while. As he got older. Validation can also be difficult for the caregiver. They may have a lack of awareness of what's going on with the child. They don't understand about the child feeling constantly bombarded or being overstimulated or understimulated. So they have difficulty empathizing. They see that the child does their math homework right on Tuesday, but then on Thursday they make all these careless mistakes, and then they get angry at the child's behavior. But oftentimes that comes out as angry at the child. Why are you being so careless today? You did fine on Thursday. The caregiver may not recognize the difference. And, and again, I know you'll get tired of me hearing me say this, but get curious. What's different today that when the child is having more, making more careless mistakes than Tuesday, when they made fewer careless mistakes. And we also have what I call ADHD deniers. There are people out there who really don't even believe ADHD exists. And, and I'm not talking about clinicians, I'm talking about the general public who may say, oh, they're just being a, a little kid. Well, there is a spectrum. There is a continuum. And we know that there are neurological differences in children with adhd. We know that it actually exists, but we also know that it's. Most of the behaviors that we're seeing are more intense, more frequent versions of what a non ADHD child does. I mean, every child occasionally makes careless mistakes or gets disorganized or those sorts of things. They can learn how to manage those things very effectively. The the person with ADHD has difficulty learning to manage those, especially as a child. So we see the same things over and over again and we see the child getting more frustrated despite their best efforts. So it's important for us to recognize that if a child is having difficulty improving on some of these skills that we now call symptoms of adhd, then it's important to have them evaluated because they may be doing their gosh darn very best. Encouragement is often lacking from caregivers of children with adhd. Their responses to the child are often harsh and rejecting because they start getting so frustrated. Why is it that I have to continuously remind you to do these things? Why is it that you keep making these same careless mistakes? Etc. The caregiver is having difficulty empathizing and providing encouragement for the child based on the child skills to the caregiver. Basic addition, for example, seems like, you know, it's something that's very easy to the child. It's very overwhelming. And there's a disconnect in the empathy which results in the caregiver saying, I don't understand why you don't get this. What is wrong with you? And I don't understand why you don't get this. There's not a problem with that. That's the caregiver saying, I don't understand it is the what is wrong with you that is devastating to the child. Additionally, expectations may be excessive for the child's skill level. Even as teenagers, people with ADHD have difficulty with organization and time management and social interaction sometimes. And expecting the person with ADHD to be able to exhibit those skills as easy, easily as something. Somebody without ADHD is probably foolhardy. And that sets the child up for rejection and criticism. And finally, safety. Because the caregiver does not have an awareness of the child's needs or does not understand how to respond sensitively. The child never feels safe. Insecure attachment and a history of criticism and rejection produces hypervigilance. So the child is constantly on guard now because it's really uncomfortable and unpleasant to get this frequent criticism and rejection. So now they're just, they're waiting for it, they're on guard for it, they're scanning for it. Signs of rejection or anticipation of rejection or criticism triggers the flat to furious or frantic. It triggers that HPA axis and the emotional dysregulation. It's interesting to note that people with ADHD often have alterations in their glucocorticoid receptors. Again, that's a different video. But recognizing that People with ADHD respond differently to cortisol and the question is why is that? If these videos are helpful for you, help us continue our mission of making practical tools available to everyone by donating@docsnipes.com donate, become a paid member of the YouTube channel@docsnipes.com YouTube or purchase a super thanks on videos that are particularly helpful so we've been talking about how lack of a secure attachment can develop as a result of the caregiver being unaware of the symptoms and the causes of ADHD and and how to respond to it effectively. Because of that, the child does not learn the necessary skills in order to function in a non ADHD environment and may experience a lot of rejection and isolation. This leads them to be hyper vigilant, hyper aware, constantly on edge, expecting rejection, expecting criticism. And that's that rejection sensitivity. They are primed for it and so they notice things that may not even actually be rejection, but they are so attuned or so used to getting rejection that they make assumptions based on prior experiences. So what can you do to start addressing rejection sensitivity? Acknowledge your inner child. That person with the ADHD has to acknowledge their inner child and that child's experiences and feelings, acknowledging how they experienced rejection and experienced trauma and did the best they could and just could never seem to get a pat on the back. It's important to acknowledge that and say, you know what? As your adult caregiver now I am sorry for that and connect with that child and empathize with them. Feel pity for them or compassion for them. Instead of disdain, instead of anger at what happened in the past, connect with that child and go, wow, that was really awful. I'm here for you now. You didn't have it then, but I'm here for you now. Use fact and context based processing as an adult. When you start feeling rejection, when that rejection sensitivity gets triggered, recognize that's that inner child going, ah, here we go again. It's important for you as the adult to stop and say, okay, what are the facts in this situation? In this context, am I I being rejected? Is this an example of rejection? And going along with that? Separating rejection or dislike of a behavior or an idea from rejection of you. People may not like everything you do or every idea you have, or they may not behave in the way you want them to, but it are they rejecting you or are they rejecting an idea or behavior or a edict from you? Increase your awareness of your rejection triggers. Think about what things happen that trigger your sense of rejection, that trigger your sense of anger at other people when you feel like they're not being effectively responsive. Those are your rejection triggers. The more you're aware of those, the more you can buffer against them and communicate with others about rejection sensitivity, what it is and how they can be more sensitive. If somebody that you're in a relationship with regularly does something that's one of your rejection triggers, let them know. Let them know about that and how. What could they do differently that might be more helpful to you? Undiagnosed ADHD in infancy and toddlerhood often contributes to attachment trauma and developmental delays. Lack of a secure attachment and being different from peers causes the child to feel unsafe and unlovable and become hypervigilant to rejection. These perceptions and related behaviors continue into adult life if not addressed. Other related videos that might be of interest to you include the other videos I have on ADHD. You can find those@docsnipes.com ADHD list or on attachment@docsnipes.com attachment.