By Dr Kim White, Senior Occupational Therapy Practitioner, Osborne Park
Emotional dysregulation is strongly related to adult attention-deficit/hyperactivity disorder (AuDHD) along with paediatric ADHD, even when controlling for comorbid disorders.
While emotional dysregulation is significantly linked to other ADHD-associated neuropsychological deficits, it has been shown that when these deficits are controlled for, emotional dysregulation has an independent deleterious effect upon ADHD
Emotional dysregulation and social interaction skills can act as barriers or enablers to occupational engagement and participation.
People interact during activities of daily living, whether it be productivity, self-care or leisure occupations, and supporting occupational engagement, participation and performance is the overarching purpose of occupational therapy.
OT and emotional regulation
Emotional regulation is a series of processes through which individuals modulate their emotions, utilising different strategies toward goal-directed behaviour, for example cognitive reappraisal, emotional suppression or avoidance.
People with emotional dysregulation and AuDHD are likely to experience lower levels of functional capacity and social-emotional occupational performance than those with AuDHD and no emotional regulation difficulty.
Occupational performance in the social-emotional domain requires attention and problem-solving skills, appropriate functional cognition, and various social-emotional learning skills.
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Often there are limited opportunities available beyond elementary and secondary schooling to access programs that support social-emotional learning and development of associated skills and competencies. Patients with difficulties in this regard can be supported as adults through occupational therapy.
Comprehensively assessing emotional regulation when working with adults experiencing ADHD is important to understand specific emotional regulation difficulties and create individualised occupational therapy intervention plans.
Contemporary research in the fields of interoception and mindfulness informs the progression and development of social-emotional support and intervention in adult occupational therapy.
Multi-dimensional consideration of emotional regulation capacity will support appropriate intervention planning, and the relatively recent CERI (Comprehensive Emotion Regulation Inventory) is a good clinical choice designed for AuDHD, enabling insight into emotion regulation strategies, difficulties implementing emotion regulation strategies, effect of poor emotion regulation upon activities of daily living (ADLs), and emotional reactivity.
Social interactions
Interacting socially with other humans requires, among many things, modulation of our own cognitive processes and emotions whilst attempting to form an impression of others’ affect and emotional state.
The ability to successfully complete and differentiate this determination is essential for achieving occupational performance across the variety of social complexities that humans encounter in their environments and day-to-day lives.
The ability to distinguish between self and other, both in a physical and narrative sense is necessitated by this determination and is largely dependent upon our interoceptive and exteroceptive sensory capacity, processing and integration abilities.
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Interoception is critical for forming our realities and understanding of the world, holding subjectivity within our physical selves, that is embodiment. Interoception is emerging as a crucial determinant of mental and physiological health, and we know that interoception is closely linked to emotional awareness and emotional regulation.
Mindfulness, or self-awareness, is necessary for social-emotional health and the ability to distinguish between self-other boundaries.
Key messages
- Occupational therapy can support development of emotional regulation and social interaction skills, which are essential for successful occupational engagement and participation
- Emotional dysregulation has an independent and significant negative impact on adults with ADHD, affecting their functional capacity and social-emotional occupational performance
- Mindfulness and interoceptive intervention can support emotional regulation in AuDHD, as this can help to build self-awareness, self-other distinction, and support social-emotional health.
Occupational Therapy Practice Framework
The fourth edition of the Occupational Therapy Practice Framework specifically references social interaction skills as a subset of performance skills, which directly influence occupational engagement, performance and participation.
Utilising person-centred intervention plans that incorporate mindfulness, interoceptive awareness and attention can help occupational therapy practitioners to support social interaction, emotional regulation and development of social-emotional health and capacity in this group of patients.
In summary, occupational therapy can support social-emotional health, occupational performance and overall functional capacity through assessing and intervening appropriately for emotional dysregulation in AuADHD.
Author competing interests – nil
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