What Happens After the Upset?

If you're raising, teaching, or supporting an autistic and/or ADHD young person, you already know school can be a minefield of small (and not-so-small) upsets. What you might not have language for is what happens in the moments after — the bit that so often gets labelled "emotional dysregulation" and left at that, as though it's simply a fault in the child rather than a response to something that happened to them.

A new study, co-produced with neurodivergent young people themselves, has taken a proper look at exactly this. It's the kind of research I find genuinely exciting — not because it tells autistic and ADHD families something we didn't already sense, but because it finally gives that lived knowledge a robust evidence base.

What did the researchers actually do?

The team built a new questionnaire called the MERSI (My Emotional Responses in School Inventory). Crucially, it wasn't designed by clinicians guessing what neurodivergent distress looks like — it was co-produced with autistic and ADHD young people, based on their own accounts of what they actually do when something upsetting happens at school.

It was given to 732 secondary school students aged 11–16: 100 with ADHD, 100 autistic, 79 with both, and 453 non-neurodivergent peers as a comparison group. Alongside it, students completed measures of depression, anxiety, emotion regulation, and how much "emotional burden" school events had placed on them.

That's the question at the heart of the whole scale. And how a young person answers it, the researchers found, tells us a huge amount about their risk of depression and anxiety — often more than the upsetting events themselves.

Three ways young people respond

The questionnaire settled into three clear patterns of response:

All three neurodivergent groups showed more outward and more inward distress than their non-neurodivergent peers — but the pattern differed depending on the group, and this is where it gets genuinely interesting.

ADHD: not just "acting out"

Both ADHD groups (with and without autism) showed high outward distress — the arguing, the storming off, the visible stuff that schools are quick to notice and quick to sanction. But here's the part that challenges the standard narrative: they also showed strongly elevated inward distress, including "hide your feelings" and "not be able to get it out of your mind" ranking among their very top responses.

ADHD emotional responding is so often framed purely as a lack of control — impulsive, externalising, loud. This study suggests that's an incomplete picture. There's a hidden internal layer that schools rarely see, because it doesn't disrupt a lesson or need managing in the moment.

Autism: quietly carrying it

For autistic-only students, the picture looked different again. Their top five responses were all inward distress expressions. Masking, withdrawal, shutting everything out, and rumination weren't just present — they dominated. And solution-focused responses were roughly on a par with their non-neurodivergent peers, which the researchers were careful to point out: autistic students aren't lacking in coping strategies, they're just carrying a heavier internal load alongside them.

This lines up with what so many parents describe as the "coming home and falling apart" phenomenon — a child who's held it together, masked, and internalised all day at school, only to release everything once they're somewhere safe. This research gives that pattern a name and a mechanism.

Why this matters more than you'd think

Here's the finding I think schools most need to hear: when the researchers looked at what actually predicted depression and anxiety, inward distress expressions came out as the strongest predictor — stronger than outward behaviour, and comparable in strength to the overall emotional burden a student was carrying from upsetting school events.

What this means for schools, and for us

I don't think this study is telling us to police masking or withdrawal as though they're the problem to be corrected. The researchers are explicit about this too: these responses may well be adaptive — a way of staying safe in an environment built around neurotypical expectations. Masking can be a survival strategy. Outward expression can be overwhelm rather than "bad regulation." Reducing distress expressions shouldn't be the whole aim.

What it does tell us is where our attention is misplaced. Schools are set up to respond to what's visible and disruptive. This research suggests the quieter, harder-to-spot responses deserve at least as much attention — arguably more, given they're the stronger predictor of a young person's longer-term mental health.

What this looks like from the therapy chair

When I'm sitting with a young person, or sitting in a pastoral meeting about one, this research gives me language for something I've long held instinctively: the absence of visible distress is not the same as the absence of distress. A school's system of concern is built to respond to what disrupts a room. It was never built to notice a child who has gone quiet, who's got very good at looking fine, or whose "I'm okay" has become so practised it's stopped sounding like a question.

In individual work, this shapes how I listen. I'm not just asking a young person what happened at school today — I'm holding space for the fact that their answer might be shaped by months (or years) of learning that the honest answer isn't safe, wanted, or even accessible to them in the moment. Rumination, "hiding your feelings," the sense of not being able to get something out of your mind — these aren't add-ons to the presenting issue. This research suggests they may be the clinical picture, sitting underneath whatever brought the referral in the first place.

In pastoral and multi-agency meetings

This is where I think the findings do some of their most important work. Pastoral meetings are, by necessity, built around what's observable — attendance, incidents, behaviour logs. A student who isn't shouting, storming off, or refusing rarely makes it onto the agenda, and yet this study tells us that student may be carrying the greater long-term risk. As a therapist in the room, I see part of my role as translating the quiet into something a meeting can act on: naming the invisible as evidenced data rather than speculation; reframing "coping well" for ADHD students who may be carrying significant inward distress; protecting masking as a strategy rather than a target; and advocating for solution-focused scaffolding, particularly for ADHD students, who showed the least reliance on these strategies and the most to gain from them.

What could actually help

Reference: Lukito, S., Chandler, S., Kakoulidou, M., Griffiths, K., Funnell, E., Wyatt, A., Baker, S., Stahl, D., Pavlopoulou, G., & Sonuga-Barke, E. J. S. (2026). Autistic and ADHD adolescents respond differently to upset in school: evidence from a new questionnaire co-designed from the neurodivergent point of view. European Child & Adolescent Psychiatry. Open access, CC BY 4.0. Read the full study here.