Suppose a child or adult with attention deficit hyperactivity disorder lashes out to a friend, family member or teacher on a regular basis. Perhaps he or she abruptly tosses homework to the floor then stomps off, or maybe someone uses foul language in response to a bothersome situation. Could it be that the person with ADHD who regularly behaves in such a manner struggles to keep aggression under control? Is there a link between the two?

Indeed, there is a “high rate of aggression in ADHD,” says Dr. L. Eugene Arnold, professor emeritus of psychiatry and behavioral health at the Nisonger Center at Ohio State University’s Wexner Medical Center and author of the book, “A Family’s Guide to Attention-Deficit/Hyperactivity Disorder.” He says that about half of children with ADHD will have “oppositional defiance disorder or a conduct disorder which will involve aggression,” adding that it’s most commonly demonstrated among two of the three ADHD types: hyperactive-impulsive (having to move frequently and having challenges managing impulse control) or the combined type (an inability to pay attention and feeling the need to constantly move). The third ADHD type involves inattention, where there are difficulties sustaining focus.

In the case of people experiencing aggressive tendencies, however, Arnold explains that being thrown off and easily frustrated by the little things is common and has a lot to do with poor control over emotional regulation. For example, he says that a child lacking the ability to manage emotions may become irritated and instead of asking for help, may cry, whine or perhaps throw something to convey frustration.

[See: 8 Things You Didn’t Know About Counseling.]

Acting in the Moment

Such emotional reactions are understandable, says Ellen Braaten, expert at Understood.org (a free online resource and community supporting parents of the 1 in 5 kids with learning and attention issues) and director of the Learning and Emotional Assessment Program at Massachusetts General Hospital. She explains that children with ADHD “have more things to be frustrated about.” Between simply not always being able to exhibit self-control and often hearing from others that they’re not doing things right, it’s easy for their frustrations to mount. She adds that especially in hyperactive-impulsive children with ADHD, they’re more inclined to act on something with immediacy and a degree of intensity the moment the urge strikes.

It’s this very point about acting in the moment that is worth noting, says Thomas E. Brown, author of “Smart but Stuck: Emotions in Teens and Adults with ADHD,” Understood.org expert and director of the Brown Clinic for Attention and Related Disorders in Manhattan Beach, California. “It’s really important to make clear that this is a subset of people with ADHD who have more difficulties with impulsive behaviors and problems related to emotional flooding,” he says. “They feel the same emotions everybody else does, but sometimes what happens is that the emotions of the moment will hit them hard.”

None of this is to say that having ADHD is a guarantee that a person will exhibit aggressive behaviors. While these experts say co-occurring conditions such as oppositional defiance or being hyperactive-impulsive can certainly play a role, there may be other factors worth considering.

[See: 10 Concerns Parents Have About Their Kids’ Health.]

Not About Willful Intent to Hurt Others

For example, Braaten says that a person’s perception and understanding of ADHD is important. A child with ADHD who acts a certain way may be interpreted as being more aggressive, when the behavior is really a manifestation of an inability to keep irritability or anxiety in check. Outbursts, she explains, may be deemed aggressive to someone else who doesn’t fully understand the reason behind the action. “A lot of times people think of aggression as willful intent, but sometimes these kids can’t stop their impulses,” she says. “That impulse isn’t about an intent to harm somebody, but about the inability to stop themselves before they act.”

Verbal and Physical Aggression

As for harming others, Brown makes the point this is “more often about verbal aggression and not physical aggression,” especially among adults with ADHD. He says that there may be instances when a young child who becomes frustrated with an older sibling may hit, spit or tear up their homework assignment. “They may be very impulsive, but again, we’re talking about dealing with emotional flooding and reacting in the moment,” he explains.

As for adults, Braaten says that they “tend to be less impulsive and hyperactive overall, so aggression may be different or less likely.” Compared to a child, an adult might yell at his or her spouse instead of lashing out physically.

It’s also important not to not lump everyone with ADHD in one category, according to Brown. He says that just as everyone with ADHD isn’t only the hyperactive-impulsive type, not everyone who is hyperactive-impulsive is aggressive. The word itself — aggression — is something he says should be given careful consideration, emphasizing that it’s often about challenges with managing emotions. “Aggression is closely tied to modulation of emotion, particularly frustration,” he says. “Managing frustrations or irritability is an important issue.”

[See: Hoarding, ADHD, Narcissism: Inside the Minds of History’s Great Personalities.]

Tips to Help Manage Aggression

To help manage aggression, Arnold suggests that parents act as a model by demonstrating control over their own impulses. It’s also beneficial to “sit down with children and figure out a way to handle a situation and work it out together,” he says. Braaten suggests parents be more cognizant of situations or triggers that may cause a kid to act aggressively, which may even involve considering whether a teacher is truly an ideal match for a child. “If it’s not a good match, the teacher may not understand the child, which can make a child feel bad,” she says. “And when that happens, kids with ADHD are more likely to act aggressively.” She says that children placed in the correct environment with the right people can obtain a sense of worth that may help reduce frustrations and any related aggressive tendencies.

For other people, medication may prove to be helpful. Braaten says ADHD stimulants “can often be helpful in managing impulsive behaviors” but adds that at the same time, some of these medications can actually increase irritability that can lead to aggression in children. Arnold is well aware of this fact too, noting that studies are underway to determine if another medication (which he says won’t be a stimulant) — in addition to current ADHD treatments including interventions such as parent training — may address this issue.

Ultimately, Brown reminds people that just as there are individuals with ADHD who may be aggressive, there are instances where “just the opposite of aggression may surface.” Some may have a hard time standing up for themselves, be shy or have difficulties dealing with others, he explains. ” ADHD is not a cookie-cutter thing,” he says. “It’s important for people to see that.”

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Is There a Link Between ADHD and Aggression? originally appeared on usnews.com