19/04/2026
When something upsetting happens, people use their thoughts to help manage how they feel. That's called "cognitive emotion regulation." Think of it as the mental moves you make AFTER a bad moment to cope with it.
Some thought patterns are usually HELPFUL (called adaptive):
- Acceptance ("okay, this happened, I can sit with it")
- Refocus on planning ("what can I do next?")
- Positive reappraisal ("maybe I'll learn something from this")
- Positive refocusing ("let me think about something nice instead")
- Putting into perspective ("this isn't the end of the world")
Other thought patterns are usually UNHELPFUL (called maladaptive):
- Self-blame ("this is all my fault")
- Other-blame ("it's their fault")
- Rumination (replaying it over and over in your head)
- Catastrophizing ("this is a disaster, and nothing will ever be okay")
Older studies said kids with ADHD use more unhelpful thoughts and fewer helpful ones. But those studies had some weak spots.
So this research team wanted a cleaner look. Their main questions:
1. Do kids/teens with ADHD really use fewer adaptive and more maladaptive thinking strategies than kids without ADHD?
2. Does that connection still hold when you account for depression, anxiety, conduct problems, and autism traits?
3. Do boys and girls differ? Do older and younger kids differ?
HOW THEY DID IT
They measured cognitive emotion regulation in two different ways, which is one of the study's strengths.
For the first method, teens answered questions about how they usually handle upset feelings. This captured what the teens THOUGHT they usually did.
For the second method, kids looked at 14 upsetting photos on a computer screen. The photos showed scary or sad things, like dangerous animals or disasters. For each photo, kids looked at it for 8 seconds, rated how upset they felt on a scale of 1 to 9, and then talked out loud about what they were thinking
Two trained researchers listened to the recordings and marked which thinking strategies each kid actually used.
This captured what the kids actually DID in the moment, not just what they think they usually do.
Parents also filled out forms about their child's depression, anxiety, autism traits, and behavior.
Then they ran statistical analyses (linear regressions and generalized linear models) to look for patterns, with TWO models: one adjusting for basic stuff like s*x, age, and SES, and a second model that also adjusted for depression, anxiety, conduct, and autism traits. They also used a Benjamini-Hochberg correction, which is a statistical method that makes the bar higher when you're testing lots of things at once, to reduce false positives.
WHAT THEY FOUND
In the initial findings before adjusting for other conditions they found:
- Kids with ADHD self-reported using FEWER adaptive (helpful) strategies
- Kids with ADHD self-reported using MORE maladaptive (unhelpful) strategies
- In the photo task, kids with ADHD used 46% fewer adaptive strategies than controls
So on the surface, the expected pattern showed up.
But interestingly, after the researchers took depression, anxiety, and other conditions into account, almost all of those differences actually DISAPPEARED.
What that suggests: the emotion dysregulation that researchers usually blame on ADHD may actually be more about CO-OCCURRING DEPRESSION than about ADHD itself.
Depressive symptoms were strongly and consistently linked to the use of maladaptive strategies, and depression often goes hand-in-hand with ADHD.
One finding stayed strong the whole way through. Kids with ADHD used acceptance much less than kids without ADHD. Acceptance means sitting with a hard feeling instead of fighting it or running from it. This pattern held up no matter what else the researchers checked, which suggests low use of acceptance may be a real, unique feature of ADHD.
A few other findings are worth knowing.
Girls used more unhelpful thoughts than boys and used less acceptance than boys.
Older teens used more unhelpful thoughts than younger teens, with self-blame and rumination going up with age.
And kids with ADHD felt just as upset by the photos as kids without ADHD. The difference was in how they handled the feelings, not how strong the feelings were.
AUTHORS CONCLUSIONS
The researchers had two main takeaways.
First, depression may matter more than we thought. When a kid with ADHD is struggling to manage emotions, depression might be the real driver underneath. That means it's worth looking for depression, not just assuming the emotion struggles come from ADHD.
Second, low use of acceptance may be a real ADHD thing. Kids with ADHD seem to have extra trouble sitting with hard feelings, separate from any depression. The researchers also noted that girls and older teens showed different patterns that future studies should look at more closely.
Why this matters
Two things stand out. First, ADHD is rarely just ADHD. When a child with ADHD is struggling emotionally, it's worth checking for depression underneath. The emotion piece may improve when the depression is addressed, not just when ADHD is the focus.
Second, acceptance is something kids with ADHD seem to have a harder time with. Knowing that could be helpful when considering what's going on for these kids when they're having a hard time, and opens up new conversations about how best to support them.
OUR THOUGHTS
Taking a neuroaffirming approach here may start by questioning the premise that unhelpful thinking patterns need to be fixed or replaced. A lot of traditional approaches treat kid's thoughts as distorted or wrong, and the job of therapy is to correct them.
That framing can feel invalidating, especially for kids whose thoughts often reflect real experiences of being misunderstood, overwhelmed, or treated as a problem.
Instead, it may be more helpful to focus on WHY certain thinking patterns show up in the first place. Rumination and self-blame in kids with ADHD often come from years of feedback that they're too much, or not enough, or lazy, or careless, or difficult. The thoughts aren't irrational. They're learned from the environment. Addressing the environment (school, family, how adults respond to the child) may matter as much or more than working on the thoughts themselves.
Language and self-understanding matter too, but offered, not imposed on them. Giving a kid words for what their brain does "sometimes brains like ours do this thing where they replay stuff, and it can feel tiring or overwhelming." Helping them notice what their brain is doing, without judgment or an expectation to change it.
Sensory and nervous system support probably belongs in the conversation too. A dysregulated body produces dysregulated thoughts. If a kid is chronically under-rested, overstimulated, or masking all day at school, their thinking patterns are downstream of that. Addressing sensory needs, rest, movement, and reducing mask load may do more for thinking patterns than any cognitive work.
Connection matters. Co-regulation with a trusted adult is probably more powerful than any self-directed thinking strategy, especially for younger kids.
Teaching adults how to BE with a dysregulated kid, rather than talking the kid OUT of their feelings, could help.
And for the acceptance piece specifically, the study's finding was that kids with ADHD use less acceptance as a thinking/coping strategy... But acceptance isn't just a skill you teach. It often grows from being accepted. Kids who've been told their whole lives that their way of being is wrong have a hard time accepting themselves or their feelings. Working on the acceptance they RECEIVE from adults around them may be foundational.
**Note: This graphic is a screenshot of recently published research. It shows the title of the study, the authors' names, and the DOI link. The caption summarizes the research and the researchers' findings and conclusions. This is shared strictly as information to our audience and is not intended as an endorsement or a claim that the research findings are definitive.**
[ Image Description: Screenshot of a research article listing from the International Journal of Clinical and Health Psychology, Volume 26, Issue 1, January to March 2026, article number 100660. The title reads "Adaptive and maladaptive cognitive emotion regulation in child- and adolescent ADHD." Authors listed are Rebecka Astenvald, Matilda A. Frick, Johan Lundin Kleberg, and Johan Isaksson. The Think Sensory logo appears at the bottom on a dark teal background.]
I provide neuro-affirming assessment (for SLD, autism, ADHD, giftedness) and therapy.
