Can neuroimaging help in diagnosing RSD in ADHD patients?Â
Brain imaging has transformed our understanding of ADHD and emotional regulation, revealing how differences in brain networks shape attention, motivation, and mood. However, while neuroimaging helps researchers study Rejection Sensitive Dysphoria (RSD), it is not currently used to diagnose RSD or ADHD in clinical practice.
What brain imaging shows about RSD and ADHD
Studies using fMRI and PET scans have shown that RSD-like emotional responses in ADHD are linked to reduced regulation between the prefrontal cortex and the amygdala, the brain regions responsible for emotional control and threat processing. Research published in Frontiers in Psychiatry (2022) found that when individuals with ADHD experienced rejection or criticism, brain activity patterns showed heightened amygdala activation and weaker prefrontal inhibition, explaining the emotional intensity of RSD (Frontiers in Psychiatry, 2022).
Other studies also highlight the role of dopamine dysregulation across the frontostriatal pathways, supporting the link between ADHD’s attentional control systems and emotional hypersensitivity.
Why neuroimaging is not used for diagnosis
According to the NICE guideline NG87 (2025), ADHD should be diagnosed based on clinical assessment, not imaging. Although research has identified consistent patterns in brain connectivity, these findings are not specific enough to confirm individual cases. The NHS England ADHD Taskforce Report (2025) similarly advises against using brain scans for diagnostic purposes, noting that emotional dysregulation, including RSD, is best assessed through clinical history, behaviour, and emotional context.
How clinicians currently assess RSD
Clinicians explore RSD-like symptoms through detailed clinical interviews and emotional regulation questionnaires during ADHD assessment. These methods provide richer insight into emotional experience and triggers than neuroimaging currently can.
Getting help and support
If emotional pain or sensitivity to rejection is affecting daily life, professional assessment can help clarify whether ADHD-related emotional dysregulation is contributing. Alongside NHS services, private options such as ADHD Certify provide structured ADHD assessments and post-diagnostic reviews with qualified clinicians in the UK.
Takeaway
Neuroimaging has helped explain the brain mechanisms behind RSD, but it is not used to diagnose it. Emotional dysregulation in ADHD is best identified through thorough clinical evaluation, helping individuals receive the right support and treatment for both attention and emotional regulation.
