Attention-Deficit-Hyperactivity-Disorder (ADHD) is a relatively common neurodevelopmental condition affecting adults, teens, and children. ADHD is often associated with impairments at work and school and difficulties with attention regulation and hyperactivity are recognized as defining symptoms of the disorder.
While this is partly accurate, it doesn't really explain why a significant majority of clients reaching out to our practice for help with anger management also have ADHD. Is there a connection between anger and ADHD? And if so, how are ADHD and anger issues related? That's what we'll explore in this article!
Brain-Based Influences
Although most people recognize that ADHD affects attention and hyperactivity, the disorder is much more complex than that. In fact, some authors have suggested that the name attention deficit hyperactivity disorder is a misnomer, leading us to think of it solely as a disorder comprised of those two symptoms. Instead, it has been suggested that ADHD would be better named Executive Functioning Deficit Disorder (EFDD) to reflect the fact that it is actually a disorder of compromised executive functioning across many areas (Barkley, 2021).
Executive function refers to our brain's high-level capabilities in managing, regulating, organizing, and controlling other brain functions and our general behaviour (CHADD, 2022). Our ability to regulate attention is an executive function as is our ability to regulate our behaviour (i.e. self-regulation) - there's the attention and hyperactivity part of things. Yet, other executive function-related capacities compromised in ADHD include working memory, planning, organization, self-motivation and self-activation, prioritization, and emotion regulation (CHADD, 2022).
Compromised executive functioning correlates with compromised functioning in life across many domains, setting people with ADHD up for - to put it lightly - a much more frustrating experience of life than those with normative executive functioning capabilities. This is something that will be explored throughout this entire article. However, even without exploring the impact of all compromised executive functions on ADHD, we have a pretty clear indicator of why people with ADHD might experience greater anger management difficulties than the average person. Two of the executive functions compromised in ADHD include emotion regulation and self-regulation. So we have a brain that is set up to get angry faster due to compromised emotion regulation capacities and also set up to have greater difficulty in inhibiting behaviour or exercising impulse control due to compromised self-regulatory capacities. That is pretty much a recipe for anger management problems!
Considering that those with ADHD are predisposed to experience greater challenges with regulating their emotions and behaviour, it makes a lot of sense that ADHD and anger often go together.
Life Experiences
It's not just direct neurobiology that predisposes individuals with ADHD to have difficulties with anger and intense emotions. The life experiences of those with ADHD similarly predispose people with ADHD to get angry more often, lose their tempers, and experience conflict. Those with ADHD are more likely than those without ADHD to experience a variety of anger-predisposing challenges including:
Being Misunderstood and Criticized
Although ADHD is a very real disability, it's not something that affects one's external appearance and presentation in any way. Those with ADHD look the same as anyone else. So it's not surprising that the people around those with ADHD tend to treat them the same as anyone else too; the same expectations, the same responsibilities, and the same interpretations of their behaviour all apply. Yet, those with ADHD are more likely to experience challenges in their ability to perform in the same way as those without ADHD - this is why ADHD is considered a disorder! Those with ADHD struggle more with everyday responsibilities and tasks. And those with ADHD are more likely to be failing to live up to expectations or standards due to fundamental neurogenetic impediments; not because they do not care. When it comes to performing the tasks and routines of everyday life, it is as if people with ADHD are walking around with hundred-pound weights attached to their ankles that they can see with frustrating clarity yet remain invisible to those around them, who rather than attempt to help the person with ADHD walk, simply tell them to run. So here we have a double whammy. The person with ADHD is likely to experience significant difficulty in completing the daily tasks they are responsible for - things like, chores, tidying up, follow-through on commitments etc. Understandably, this leads to feelings of frustration and self-criticism. They are also likely to rather than experience empathy and understanding for their difficulties, receive criticism, lectures, and chastisement from those around them. Understandably, this leads to further feelings of frustration and self-criticism, and resentment toward the people criticizing them.
Those with ADHD are more likely to be failing to live up to expectations or standards due to fundamental neurogenetic impediments; not because they do not care.
Compounding things further is the fact that many people with adult ADHD aren't able to clearly articulate why they didn't do a particular task or complete something they were supposed to do. This is especially the case pre-diagnosis before the individual even understands that their challenges are ADHD-related. The individual with ADHD then is left to find some alternative explanation for the mismatch between the expectations that the task would be completed and the reality that it was not. For example:
"If I didn't do something even though you say you asked me, it's because you must not actually have asked me."
The actual ADHD explanation:
Deficits in short-term working memory capacities, predisposing the individual with ADHD to forget instructions they are told (especially when told while they are doing something else or when given multiple instructions simultaneously).
"My failure to show up on time as I promised isn't my fault, you are just such a stickler for timeliness. You need to relax!"
The actual ADHD explanation:
People with ADHD experience time myopia, or time blindness, meaning their brains fail to properly orient to and track time accurately, resulting in frequent experiences of running late and other examples of poor time management.
"I made supper tonight, it is extremely unreasonable of you to also want me to clean the dishes as well - you're so controlling, demanding, and such a nag!"
The actual ADHD explanation
People with ADHD thrive at task completion for things they are interested in - like cooking! - and struggle tremendously with completing menial and boring tasks - like washing dishes. They are also better at working towards tasks where there is a clear reward upon task completion (i.e. a delicious, impressive supper is prepared) than at tasks where there is seemingly no reward (i.e. the dishes are done, now what). Those with ADHD also are prone to feeling overwhelmed from the piling on of responsibilities without having breaks or periods to reset from tasks. Many of these issues are true for everyone but are significantly amplified and made more difficult for the person with ADHD. In this example, the individual with ADHD may be experiencing the instruction to clean the dishes as overwhelming and impossible, while it seems straightforward and not a big deal to the other person.
When the impact of ADHD is not recognized or properly incorporated into an understanding of the challenges of the individual, those around them may engage in unhelpful behaviours such as criticism or insensitivity, and the person with ADHD may engage in unhelpful behaviours such as blaming or defensiveness. Both options are routes toward conflict, priming the individual with ADHD to become reactive, angry, and emotionally dysregulated.
It is as if people with ADHD are walking around with hundred-pound weights attached to their ankles that they can see with frustrating clarity yet remain invisible to those around them, who rather than attempt to help the person with ADHD walk, simply tell them to run.
Does all of this mean that people with ADHD can do no wrong and should never be challenged, criticized, or held responsible for their actions? Of course not. People with ADHD can and do make 'bad' decisions, act self-centered, and exhibit the same personality and behavioural flaws as anyone else. The issue is that people around those with ADHD often automatically assume their challenging behaviours are a result of challenging personalities or character flaws, rather than first considering the impact of the neurodevelopmental difficulties underlying the disorder. Once you've waded through what can be attributable to ADHD, you may find that the person's 'personality flaws' seemingly disappear (and if there are personality flaws remaining not attributable to ADHD, well there you go - people with ADHD can have personality flaws too). Not everything is ADHD-related, but a great many things are. Evaluating how ADHD is affecting the individual will generally provide more appropriate attributions to their difficulties and 'flaws.' To add to this, by attributing a loved one's behaviour to their ADHD, you are more likely to be able to constructively get that behaviour addressed than if you would attribute it to their personality traits (i.e. they are just lazy, selfish, impulsive, etc.).
Feelings of Overwhelm and Intention-Action Frustration
Experiences of anger are very often intertwined with feelings of overwhelm. We often think of anger as a 0-100 phenomenon, almost as if we are completely calm and at ease and then we suddenly lose it in response to a trigger. It is more often the case that we are walking around at an 80-90 all the time, meaning that it won't take too much to push us over the edge into anger (read more on this idea here). How stressed and overwhelmed we feel plays a big role in our propensity to experience anger outbursts. This is relevant for everyone, but the problem becomes amplified in those with ADHD, given that people with ADHD are especially prone to experiences of stress and overwhelm. A computer analogy helps explain:
Every computer has a processor and RAM (and many other components too, but that's all we need for this particular analogy!). Roughly speaking, the computer processor controls how fast the computer processes can run. The faster the processor, the faster programs run. The computer's RAM is essentially the computer's working memory, and it dictates how many programs can be in operation at a given moment. When you have too many tabs open on your browser or applications open and your computer starts to operate more sluggishly, you are likely running into a RAM problem. Your computer may start to overheat. The fan may go into overdrive. Things may seem to stop working properly. Fortunately, closing down some of those programs frees up RAM and restores the system to normal functioning. Moving back to ADHD, it is as if those with ADHD have faster processors than the average person. They can start things more quickly than others and move into hyperdrive on things. Yet, they also have significantly less RAM than the average person. Meaning, whereas the average person may be able to so to speak run 4-6 programs simultaneously with no slowdown or compromised functioning, when the person with ADHD starts to run more than 2-3 programs, they start running into significant problems. The fan starts to whir tremendously. The system overheats. Shutdown is imminent. And in this scenario, it's hard to figure out what programs to close to restore functioning.
Given the neurobiological changes associated with ADHD, people with ADHD are predisposed to have a harder time with stress and overwhelm. The 'overactive processor' places the ADHD individual at greater risk of stress. The person with ADHD is more likely to load up more 'programs' and load them up more quickly. The person with ADHD is likely to take on more responsibilities than they can handle, say yes in many situations in which they should say no, and be juggling more things in their minds while doing other things than someone without ADHD. The 'underactive RAM' makes it harder for them to manage stress. The person with ADHD is more likely to be doing more things at the same time but is also less able to do so effectively and sustainably. Compromised working memory interferes with how many things they can juggle in their minds and behaviours simultaneously. Compromised emotion regulation limits their ability to tolerate the frustration that comes along with this. Compromised prioritization makes it more likely that they will overload their minds, time, and space, with low-value, high-urgency tasks and miss out on important opportunities for rest, relaxation, restoration, and engagement in valued activities - all of which could potentially have a tremendous impact on their ability to effectively manage their emotions and wellbeing. Let's look at how this plays out using the 0-100 anger concept comparing how a neurotypical individual and someone with ADHD might fare in a similar scenario:
Neurotypical Example
The neurotypical individual sits down in front of their computer to engage in the task of going through their email inbox. 0. They start replying to some emails and see an email that reminds them of an unfinished task they have yet to get to. 10. They make a mental note of that or write down a reminder to follow up with that task and carry on with the task at hand. 0. Their phone buzzes a few times with notifications, but they know they'll get to that on their next break and carry on with their intended work. 0. They finish up their day and get home. They try to get their kids to do their homework and chores before bed. The kids pay no attention and completely ignore the instructions. 15. They re-issue the instructions using more effective prompts and appropriate consequencing strategies. The kids groan a bit but they eventually comply and everyone goes onwards with their evening.
ADHD Example
The person with ADHD sits down in front of their computer to engage in the task of going through their email inbox. 0. They start replying to some emails and see an email that reminds them of an unfinished task they have yet to get to. 10. They shift over to tackling the unfinished task while trying to keep in mind the last email they were replying to. 20. The task takes them longer than anticipated. Meanwhile, they get distracted by notifications on their phone that pull them away from their work and add more things to their task list for the day. 40. They move back to their inbox and try to go back to what they were last working on, but they get sidetracked because they notice they just got some new emails to reply to. 50. They spend the next thirty minutes dealing with those new emails, then realize they are way off base from their initial plans and have so far not accomplished the essential things they needed to accomplish. 75. Feeling guilty for having wasted their time, they work late to make up for their 'failure.' 85. They start heading home and their spouse calls them upset that they are not home since they were supposed to be there forty-five minutes ago. 95. They get home and try to get their kids to do their homework and chores before bed. The kids pay no attention and completely ignore the instructions. 100. They lose it, yell at the kids, throw out an array of heavy-duty but ineffective consequences and punishments for non-compliance and the rest of the evening devolves into further chaos.
The experience of going through the day with an overactive processor and underactive RAM primes the person with ADHD to absolutely lose it in response to a 'minor' trigger once they get home. The neurotypical person encounters the same trigger but without a whole build-up of stress is able to keep their cool and handle the situation more effectively. This is not to say that people without ADHD do not experience problematic stress. Of course they do, all the time! It is simply that having ADHD provides someone with many more ways to get stressed and more difficulty in managing this stress too.
Having ADHD provides someone with more ways to get stressed and more difficulty in managing this stress too.
General Life Challenges and Comorbidities
Having ADHD predisposes those with the disorder to experience greater challenges in every part of their lives. People with ADHD tend to experience more challenges in school, work, and occupational functioning. They have greater rates of marital discord and interpersonal conflict. They are more prone to financial difficulties, underemployment, and unemployment. They are also more likely to have one or more additional mental health diagnoses. Comorbidity - more than one diagnosis - is the rule rather than the exception when it comes to ADHD. People with ADHD often simultaneously have an anxiety disorder and/or mood disorder or other mental health challenges. Some of these challenges are neurodevelopmentally linked to ADHD (i.e. Tourette's Syndrome, tic disorders, and learning disabilities). Others are a predictable result of a life filled with the challenges that come along with ADHD such as Generalized Anxiety Disorder (GAD) and Major Depressive Disorder (MDD). Life is harder for people with ADHD. Anger, frustration, resentment, and irritability are predictable consequences that follow.
Compromised Health Behaviours
Not only are people with ADHD more stress-prone, but they are also less likely to be doing things that could help them manage stress. Self-care behaviours are often highly compromised in ADHD. Things like eating right, exercising, getting to bed on time, and sleeping well are all less likely when it comes to ADHD. Never mind meditation, yoga, or other well-known coping strategies; the basic health behaviours of the individual with ADHD are significantly compromised. The executive function difficulties that affect ADHD across every area of life affect their ability to activate, organize, sustain, and manage every health behaviour too. More stress combined with reduced coping behaviours is a recipe for emotion dysregulation, predisposing individuals with ADHD to experience anger more frequently and manage it less effectively.
More stress combined with reduced coping behaviours is a recipe for emotion dysregulation, predisposing individuals with ADHD to experience anger more frequently and manage it less effectively.
Solutions
Maintain Accountability
Understanding that the cards are stacked against people with ADHD when it comes to anger is essential. It provides a new way to understand and contextualize their behaviour, allowing for new ways to communicate and address the behaviour. Importantly, addressing it remains necessary. Angry behaviour still causes harm, still hurts relationships, and still has an impact, regardless of how much we understand where it is coming from. For the person with ADHD, it remains essential that they learn interventions and strategies or seek out help to get their anger behaviour under control. For those living with an individual with ADHD, it remains essential that they maintain healthy boundaries regarding acceptable behaviour and hold the individual with ADHD responsible for improving their behaviour. Doing so from a place of support and understanding for the role ADHD plays in all this will foster greater connection and communication in relationships and provide motivation for the person to address their behaviour. We understand and we maintain accountability. The two ideas are not at odds with one another. A very useful line from Compassion-Focused Therapy comes to mind: it's not your fault, but it is your responsibility. The person with ADHD didn't choose to have such a tricky brain or to be set-up to have difficult life experiences. The person with ADHD didn't choose to be anger-prone. Yet, these are the cards that have been dealt. This is the reality that is being lived. We may not be able to choose our realities, but it remains our responsibility to choose our next steps within the reality that we are living in. When we do this with compassion, understanding, and support we have a much greater power to improve the situations we find ourselves in.
Angry behaviour still causes harm, still hurts relationships, and still has an impact, regardless of how much we understand where it is coming from.
Treat ADHD
This might seem a tad obvious, but if many aspects of someone's anger are related to their ADHD, then treating ADHD can also alleviate some anger problems. As outlined earlier in this article, there are many pathways by which ADHD influences anger. Depending on the specific pathway, primary ADHD treatment can reduce some anger problems. Many of my clients have told me that they've experienced less reactivity and problems with anger after getting started on medication. Most ADHD medications target impulse control among other issues and some specific medications are noted to also improve aspects of emotion regulation so this makes sense!* Even beyond medication, ADHD interventions such as skills training, mindfulness for ADHD, CBT for ADHD, and simply learning more about how the disorder influences and affects everyday life can have a tremendous effect on emotion regulation and behavioural inhibition. Part of this is due to ADHD being better managed. Less ADHD-related difficulties provides less fuel for stress, overwhelm, and anger reactions. Part of this is due to having a new understanding for ADHD behaviour, from the perspective of both the person with ADHD and those around them. Integrating an understanding of yourself as a person with ADHD can better enable you to respond to yourself more compassionately and with greater understanding (although this is not guaranteed; self-compassion is tricky business). The people around you also may be more sensitive to your struggles and recognize the influence of your neurogenetic make-up ("Oh it's his ADHD, it's not that he doesn't care!"). This also is not guaranteed; the people around you may not be understanding of how ADHD affects your life, believe that you do indeed have ADHD, or in many cases - unfortunately - assert that ADHD doesn't exist or is not a serious disorder and that you should just stop making excuses for your character flaws. Sigh. Notwithstanding these limitations, treating ADHD will generally have a positive impact on problematic anger.
*It's important to note that there are also various reports and some studies finding that medication had a negative effect on emotion regulation. Working closely with your prescriber to assess, monitor, and evaluate the effects of various medication options can help maximize the potential benefits while reducing the potential side effects.
ADHD-Informed Anger Management
Also unsurprising is that anger management training and skills building will be very helpful in addressing anger challenges. Anger management can help people learn new ways for managing intense emotions, problem-solve, and communicate with others in more helpful ways during challenging situations. Anger management - ideally! - will be more than just lectures from a therapist telling you about all the harm that anger causes and why you should stop getting angry (surprisingly that doesn't work too well...) A trained anger management therapist can help you get better at recognizing your triggers and at developing new ways to respond in triggering moments, while also facilitating reductions in general levels of stress, tension, and anxiety. While any form of cognitive-behaviourally focused anger management is likely to be helpful, there are reasons to consider working with a therapist who is trained and knowledgeable in both ADHD and anger and who can provide you with ADHD-Informed Anger Management. For one, they are more likely to understand the context for your anger and how ADHD contributes to the problems you are experiencing. They can also simultaneously provide strategies to help with the ADHD side of things fueling the anger. Perhaps, most importantly they are more likely to be able to provide an approach that not only teaches you useful conceptual ideas but also facilitates your implementation of the ideas. After all, one of the most disabling aspects of ADHD is that it interferes with our ability to take what we intend to do and actually do it. In a psychotherapy session, you might discuss some fantastic anger management ideas. They might make perfect sense and you can see how using the skill or idea would really help in the situation you're struggling with. And then you might proceed from one session to the next without having implemented the tool a single time. When working with an anger management specialist who also understands ADHD, the skills and strategies can be adapted to an ADHD brain so that they are more likely to be implemented by someone with ADHD. Additional strategies and methods can be brought in to remind you, prompt you, and reward you for the use of skills, meaning that you are more likely to use helpful emotion regulation strategies and keep using these strategies (after all, consistency is also usually compromised in ADHD!). ADHD affects every area of a person's life; understandably it can affect the course of psychotherapy progress too. When possible, work with someone who understands ADHD and anger.
One of the most disabling aspects of ADHD is that it interferes with our ability to take what we intend to do and actually do it.
Taking back Emotional Control
In this article, we set out to explore how ADHD and anger are related. The relationship seems quite clear! There are many paths leading someone with ADHD to experience difficulties with anger management. From simple brain-based influences to the life experiences that often go along with ADHD, anger is likely to be a frequent companion of those experiencing challenges with ADHD. The good news is that even when anger is related to ADHD, it remains highly addressable. There are many strategies, skills, and ideas that can help individuals with ADHD change their relationship to difficult thoughts, feelings, and experiences, leading to profound changes and improvements in their personal, occupational, and interpersonal well-being. At our Toronto-based therapy clinic, we provide a number of services to help people struggling with both ADHD and anger. We provide psychotherapy and skills training tailored to ADHD. Our stress reduction counselling can help people with ADHD reduce general stress and frustration contributing to anger blow-ups. We provide ADHD-informed couples counselling which can be extremely helpful in managing the relationship distress that often comes along with ADHD and anger. We also provide ADHD-informed anger management counselling. We offer in-person services at our Toronto locations and remote and online sessions throughout Ontario, Canada. If you're looking for support in managing ADHD and anger, reach out below. We work with and understand ADHD from the inside out; we would be happy to help you on your own ADHD journey.