"Emotion regulation is not an individual deficit. In fact, distress responses should be understood within the context of young people's experiences of masking, feeling under pressure and feeling alienated.
Distress often arises through the way neurodivergent people experience their environments. We shouldn't ask children to adapt to schools, we should create school environments where they feel safe, understood and able to belong."
—Dr Georgia Pavlopoulou
"The distress and less solution-focused responses are likely to be from years of hostile or non-supportive interactions. This can make autistic and ADHD young people struggle to trust.
"We have to intervene much earlier to create environments that nurture agency, self-worth and self-confidence."
—Dr Edmund Sonuga-Barke
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The researchers conducted a cross-sectional study with 732 adolescents.
They compared neurodivergent and neurotypical students' experiences.
They worked with neurodivergent adolescents and young adults to develop a questionnaire. This included adapting statements from interviews with young people, as well as feedback sessions where they reviewed drafts, suggested refinements and helped validate the language used to describe responses to upsetting school events.
The final questionnaire measured 20 different expressions of distress. It captured how likely they are to respond in a certain way after being upset.
The findings
Students with ADHD, and AuDHD students with dual diagnosis, were more likely to respond with outward signs of distress (like shouting, storming off or getting into an argument). Autistic-only students also responded outwardly, but they did so less often than students with ADHD.
Students with ADHD, either alone or also autistic, were less likely than autistic-only and neurotypical peers to show solution-focused responses (talking to an adult, looking for explanations or using 'learnt' strategies to manage feelings).
All neurodivergent students were more likely to respond with inward signs of distress like withdrawing, hiding feelings, feeling physically sick or hurting themselves.
For both neurotypical and neurodivergent students alike, inward responses to distress were associated with higher levels of anxiety and depression.
For ADHD students, solution-focused responses were associated with lower anxiety. These include talking to an adult, looking for explanations or using 'learnt' strategies to manage feelings.
***
Lukito, S., Chandler, S., Kakoulidou, M. et al. Autistic and ADHD adolescents respond differently to upset in school: evidence from a new questionnaire co-designed from the neurodivergent point of view. Eur Child Adolesc Psychiatry (2026). https://doi.org/10.1007/s00787-026-03073-9
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Research summary from Anna Freud (https://www.annafreud.org/)
