Rejection Sensitivity in Kids with ADHD

By Dr. Mary Rooney, Ph.D.

If you have a child with ADHD or if you have students with ADHD in your classroom, then you are very familiar with classic symptoms related to difficulty staying focused, problems with organization, impulsive behavior, and hyperactivity. In addition to these classic symptoms there is a less discussed cluster of symptoms associated with ADHD, Rejection Sensitive Dysphoria (RSD), that can also cause a great deal of distress and impairment. As the name implies, individuals affected by RSD become overly distressed and overwhelmed when they feel like they have failed to meet expectations or have been criticized. As a result, they develop strategies to minimize negative judgement or failure (either real or perceived) by actively avoiding certain social situations, opting out of challenging academics or extracurricular opportunities, and/or developing perfectionistic and people-pleasing tendencies.

Not all kids with ADHD experience RSD, and the cause of RSD isn’t well understood. In fact, it’s not recognized as a distinct diagnosis under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Instead, it’s considered a cluster of symptoms that overlaps with the emotion regulation challenges associated with ADHD (and other disorders). Some of the key signs and symptoms of RSD include:

  • Feeling embarrassed and anxious in a variety of social situations
  • Having emotional outbursts when feeling hurt or rejected
  • Setting unrealistically high standards
  • Having low self-esteem
  • Avoiding social situations
  • Feeling like a failure in a variety of different situations including academics
  • Avoiding taking on new challenges or stepping outside a comfort zone
  • An excessive need to please adults and peers

As with most metal health challenges, RSD is likely caused by a combination of genetic and environmental/experience-based factors. In part because it is not well understood, RSD often isn’t identified by teachers or clinicians who work with kids who have ADHD. It may be misidentified as social anxiety or depression. While the signs and symptoms of RSD overlap with symptoms of anxiety and depression, they differ in that they tend to appear quickly in response to something happening in the moment, they are very intense, and disappear within moments or hours. In a sense, they mirror the other emotional highs and lows that many children and teens with ADHD experience throughout the day.

How can you help your child with RSD cope? Try these strategies which can help your child become mentally and emotionally stronger.

Help your child look situations differently.  If your child’s friend is playing with someone else and can’t come over, your child might see it as rejection.  Help your child understand that it could be that child called first to play.  It doesn’t always mean your child lost a friend.

Share stories about rejection and overcoming it. Michael Jordan was cut from the HS basketball team, yet went on to have one of the most successful professional sports careers. Share you own experiences of being rejected and what you did to overcome it.

Teach resilience. Help your child come up with a plan to move on. for example, if your child wasn’t chosen for basketball, find another activity to focus on. If your child’s friend cancels plan’s, call another friend to come over. Any future setbacks will be easier with a plan in place.

There is no single treatment that specifically targets RSD in kids with ADHD, but a combination of cognitive behavioral therapy, parent training and classroom behavior plans that emphasize positive feedback and minimize negative consequences can help. If you suspect that your child is struggling with RSD and it is taking its toll academically, talk with a therapist or school counselor. Treating the symptoms of RSD as early as possible can help minimize the long-term impact on your child’s mental and emotional health and their relationships with family and friends.  


Mary Rooney, Ph.D., is a licensed clinical psychologist in the Department of Psychiatry at the University of California San Francisco. Dr Rooney is a researcher and clinician specializing in the evaluation and treatment of ADHD and co-occurring behavioral, anxiety, and mood disorders. A strong advocate for those with attention and behavior problems, Dr. Rooney is committed to developing and providing comprehensive, cutting edge treatments tailored to meet the unique needs of each child and adolescent. Dr. Rooney's clinical interventions and research avenues emphasize working closely with parents and teachers to create supportive, structured home and school environments that enable children and adolescents to reach their full potential. In addition, Dr. Rooney serves as a consultant and ADHD expert to Huntington Learning Centers.


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