Challenges with impulsivity and emotional regulation may present as aggression in children with ADHD. These behaviors can be challenging, but a mental health professional can help create an effective plan to support you and your child.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder. People often recieve the initial diagnosis during their childhood. It features a wide range of behaviors related to inattention, impulsivity, and hyperactivity.

Challenges with aggressive behaviors are common in children with ADHD, and these outbursts and physical displays may be disruptive and harmful to these children or those around them.

Understanding why aggression may occur in children with ADHD can help you find ways to manage their behavior if you have a child with ADHD and help them modify it effectively.

Aggressive behaviors in children with ADHD can vary, but mental health professionals generally categorize them as reactive/impulsive or proactive/instrumental. Here is more information about these categories:

Reactive/Impulsive

These behaviors happen as an unplanned response in retaliation for real or perceived provocation.

Examples of reactive/impulsive aggressive behaviors can include:

  • verbal outbursts when frustrated or upset
  • physical retaliation like pushing, shoving, or hitting
  • slamming or breaking objects when upset, angry, or frustrated
  • self-harm when upset, angry, or frustrated

According to an older literature review from 2016, more than 50% of young children with ADHD display clinically significant aggressive behaviors, with reactive/impulsive aggression being the most common.

Proactive/Instrumental

These behaviors are preplanned, goal-oriented, and generally done for personal benefit.

Examples of proactive/instrumental aggressive behaviors can include:

  • bullying (physically or verbally)
  • manipulating
  • sabotaging
  • threatening

Aggression in children with ADHD can occur for a variety of reasons.

Lisa Anderson, a licensed clinical social worker and Clinical Director of Brooks Healing Center, Normandy, Tennessee, explains impulsivity, a core symptom of ADHD, often leads to difficulties with emotional regulation, making it hard for some children to manage their reactions to frustration.

”When a child feels overwhelmed or struggles to communicate their needs, they might resort to aggressive behavior,“ she said. “The environment also plays a role — stress, inconsistent discipline, or even poor sleep can exacerbate aggression.”

The way a child with ADHD’s brain works may, in part, explain why aggressive behaviors are so common among children with ADHD.

A 2022 study may help explain aggressive behavior in adults with ADHD. The study shows that people with ADHD have specific patterns of brain activation. These patterns promote reactive and impulsive aggression. Researchers believe that these neural pathways may cause problems in emotional regulation and reduced impulse control.

Disruptive behavior disorders (DBD), also referred to as disruptive, impulse control, and conduct disorders, are a group of conditions featuring similar patterns of aggression, impulsivity, and disruptive behaviors.

Destroying property, defiance, lying, fighting, and rule-breaking are all challenges seen in DBDs.

Conditions included under the banner of DBDs include:

Managing aggression in children with ADHD is a part of treating ADHD as a whole.

Medications, behavioral therapies, and appropriate environmental support are the basis of ADHD treatment. They may help with symptoms of inattention, impulsivity, and hyperactivity.

When it comes to aggression in children with ADHD, according to Anderson, a multi-faceted approach is necessary.

“Behavioral therapy, especially parent management training (PMT), is effective in helping parents set consistent limits and reinforce positive behavior,” she explained. “Cognitive behavioral therapy (CBT) can also help children learn to manage their emotions better and develop coping strategies for dealing with frustration.”

Sometimes, adjusting medication can help if their current treatment causes aggression​ Anderson said.

“Parent-child interaction therapy (PCIT) is also an effective approach for helping parents manage aggression in their children,” added Amy Braun, a licensed clinical professional counselor from Yorkville, Illinois.

Similar in concept to PMT, PCIT focuses on building more positive parent-child interactions and addressing effective discipline strategies.

Understanding the contributing factors in aggression is important to help children with ADHD. Situational changes such as ensuring children with ADHD have the correct support in place, or if they are bullied or are under stress, removing them from those circumstances can help manage aggression.

DBDs occur frequently alongside ADHD. According to a 2020 review, between 27% and 55% of children diagnosed with ADHD also live with ODD or CD.

If you’re a parent or caregiver of a child with ADHD and aggressive behaviors, Braun recommends the following tips:

  • Set clear and consistent rules to create a sense of security and predictability.
  • Reward positive behavior to encourage more of it using things like praise, small rewards, or a point system.
  • Teach them healthy strategies to manage frustration, like deep breathing or counting to ten.
  • Model the behavior that you want to see from your child.
  • Maintain a structured routine to minimize stress.
  • Make sure they get enough sleep, eat well, and have plenty of time for physical activity, as all these affect their emotional health.
  • Be patient with the process. Managing aggression in children with ADHD takes time and persistence.
  • Use social stories to help children understand and manage social interactions and emotions better.
  • Advocate for accommodations like extra time for assignments or tests, a quiet space for work, or the ability to take breaks.
  • Work with your child to recognize situations or emotions that trigger aggressive behavior.

Aggressive behaviors in children with ADHD can improve with appropriate treatment and support.

Research suggests that stimulant medications alone, a first-line therapy in treating children with ADHD, are effective for approximately 70% of people. Overall, as many as 50% of children experience a gradual relief in ADHD symptoms as they grow into adulthood.

How do you help a child with ADHD aggression?

You can respond to aggression from a child with ADHD by including tips like:

  • remaining calm
  • removing others from harm, and ensuring safety in the environment
  • using firm, straightforward language to explain why their behavior is unwelcome. (Ex: “It is not OK to push others. Pushing can hurt someone.”)
  • validating their feelings, for example, “I can see you’re frustrated, and it’s OK to be upset, but it doesn’t make it OK to push others.”
  • enforcing expected disciplinary measures, for example, “Pushing is wrong. If you push someone, you have to sit in time-out for 15 minutes.”
  • encouraging and rewarding a positive alternative behavior choice like drawing

Can it be more challenging to parent children with ADHD?

Having ADHD can pose unique challenges during childhood. Following certain tips and getting professional help can make parenting less challenging. With appropriate skill development and education about ADHD, parenting a child with ADHD can be similar to parenting a child who doesn’t have it.

Can ADHD cause rage in kids?

Many children with ADHD experience challenges with aggression. Aggressive behaviors may include angry outbursts and acts of physical violence that one may consider rage. Frequent episodes of intense rage, however, may indicate a co-existing condition like IED.

Aggression in children with ADHD is a common experience and may stem from challenges with emotional regulation and impulse control.

Standard treatment of ADHD and focusing on specific interventions like PMT, PCIT, and CBT can help reduce episodes of aggressive behavior.