A new clinical review published in the New England Journal of Medicine (15 October 2026) highlights that emotional dysregulation is present in most adults with ADHD, despite not being included in the formal diagnostic criteria. ADHD is a lifelong neurodevelopmental condition, and difficulties with emotional regulation can persist well into adulthood.
This raises important questions about how schools approach ADHD support.
Self-regulation and self-advocacy are frequently central goals in Individual Education Plans (IEPs). But if emotional dysregulation remains common in adulthood, should schools be measuring children’s success primarily by their ability to independently control their emotional responses?
It’s unlikely that most adults with ADHD simply missed out on being taught how to regulate their emotions as children. The review doesn’t investigate their childhood education, but its findings challenge the assumption that emotional dysregulation is simply a skills deficit that can be taught away.
Knowing how to regulate and being able to regulate in the moment are not the same thing. Someone can have excellent emotional awareness, understand their triggers, and know effective strategies, yet still experience overwhelming reactions.
Environmental modification may be the equivalent of a wheelchair ramp for a student with ADHD: changing conditions that repeatedly provoke distress, rather than treating the child as the problem that needs fixing.
Rather than concentrating on eliminating dysregulation, schools should be helping students develop skills and relationships that support them throughout their lives. This includes:
- Environmental accommodations: Identifying and reducing predictable triggers, modifying demands and environments that repeatedly cause distress, and maintaining access to learning.
- Trusted relationships and co-regulation: Making it an adult responsibility to build safe, dependable relationships with teachers and education assistants, so students feel comfortable seeking support before distress escalates.
- Recognising early warning signs: Helping students identify their own triggers and bodily signals, such as tension, restlessness, or butterflies in their stomach, while teaching adults to recognise signs that support may be needed.
- Accessing breaks and support: Establishing predictable, non-punitive ways for students to request a break, connect with a trusted adult, or change their environment, without having to reach a crisis before support becomes available.
- Self-understanding and advocacy: Supporting students to understand their needs and communicate what helps, without making their ability to independently advocate a prerequisite for accommodation.
- Relational repair: Explicitly teaching and modelling how to acknowledge harm, offer meaningful apologies, rebuild trust, and reconnect after conflict.
Repair deserves particular attention. Children need to learn that an emotional reaction can be understandable or unintentional while still affecting other people. They also need adults who model accountability and repair when they make mistakes.
The goal shouldn’t be to produce children who never become dysregulated. It should be to equip them to navigate their emotions, maintain relationships, and participate meaningfully in their communities, with support when they need it.
Self-regulation is a useful skill to develop. But needing ongoing support with regulation is not evidence that a child has failed to learn.
