The Neurobiology of Emotional Hyper-Reactivity in ADHD: Understanding Rejection Sensitive Dysphoria

Attention Deficit Hyperactivity Disorder (ADHD) is frequently mischaracterized as a disorder of attention. While challenges with sustained focus are the most visible symptoms, they are secondary to a more fundamental neurobiological reality: ADHD is a disorder of regulation. The ADHD brain struggles to consistently modulate a wide array of processes, including attention, emotion, arousal, sensory input, motivation, and even the perception of time. These domains do not operate in isolation; they share neural pathways, neurotransmitters, and networks responsible for interpreting, prioritizing, and responding to environmental and internal stimuli. Emotional regulation cannot be extricated from attentional control because both depend on the dynamic functioning of fronto-limbic circuits, dopaminergic pathways, and prefrontal cortical systems that inhibit, contextualize, and soothe.