Here are five steps that you can start taking today to help your child stop interrupting: 

1. Have an empathetic conversation about interrupting. Children with ADHD are rarely annoying or rude on purpose, and they often lack insight into the effect that their behavior has on others. During a calm moment, talk to your child about how their ADHD causes them to interrupt others and the effect this has on their relationships. Let your child know that you realize it’s not something they are doing intentionally, but it’s something you want to work on together.
2. Begin by practicing for 30 minutes each day. Select a 30-minute block of time when your child can practice waiting patiently instead of interrupting. Be strategic about the time day that you choose. You want to aim for a time when your child tends to interrupt you or other family members often, but not a time when your child is typically cranky, hungry or tired.
3. Set clear expectations for the 30-minute period. Describe your expectations for not interrupting during the next 30 minutes. Be specific about what waiting patiently means and when and how your child should speak to others. How will they know when it’s a good time to start talking? Is there a signal you will give your child when it’s their turn? When they feel the urge to interrupt, what should they do instead? For example, you could suggest that your child write down their question so they don’t forget it, focus on what other people are saying, or wait patiently until others are finished speaking.
4. Reward your child when they go without interrupting or stop themselves after one reminder. Changing an impulsive behavior is hard, and rewards can go a long way toward helping your child stay engaged and motivated during the process. Reward your child when they go for a full 30 minutes without interrupting or stop interrupting when given just one reminder. There are many ways to build a simple and sustainable reward system that will work.
5. Encourage your child to practice at other times of the day. When you see your child making progress during their daily practice period, start encouraging them to apply their strategies for not interrupting at other times of the day. Look for times when your child waits patiently instead of interrupting, and then praise them for waiting their turn. When your child does interrupt, give them one reminder. Over time, they’ll gradually become more successful at catching themselves when they are interrupting, and they’ll stop doing so as often (even when you’re not around).

For children with ADHD, interrupting others is a difficult behavior to change. However, it can be done with a little help and support. Keep in mind that it’s unlikely that your child will stop interrupting completely. If they can begin to interrupt less throughout the day and wait patiently after only one reminder, consider this a success about which your child should feel proud.  

Here are a few tips to help get your child on track and keep them learning:

• Identify your child’s math learning style. Is your child a visual learner? Do they learn best by doing? Do they benefit from drawing or mapping out the process, or from having tangible items that can be manipulated? Do they need someone to verbally explain math logic and reasoning in a one-on-one or group setting? Once you get an idea of how your child learns, work with your child’s teacher to put strategies into place that match your child’s style.
• Have your child memorize basic math facts. Have your child “overlearn” these facts so they can recall them quickly and easily. This will help them work through math problems quickly, confidently, and with fewer errors. It’s never too late to commit math facts to memory. If your child didn’t master them in elementary school, help your child do it now.
• Help your child connect with math. Children with ADHD find it easier to stay focused and motivated when they are interested in a subject. Help make math interesting for your child! Math is essential to almost every aspect of our lives, including every sport, music, art, and technology-related interest that your child may have. Do some research with your child to learn how math is important to the things they enjoy.
• Get extra support. Some children with ADHD simply need extra support at school or outside of school from a tutor. Request an assessment of your child if you think your child would benefit from additional school support or supplemental instruction.

With help and encouragement, children with ADHD can increase their motivation and succeed at math—and they may even learn to love the subject!

While definitions of working memory can be helpful, this abstract concept is typically easier to understand through an example. So, imagine that you are verbally asked to make 1/3 of a recipe that combines 2 cups of flour with 3 tablespoons of water, 1 packet of yeast, and 1 teaspoon of salt. You would use your working memory to:

• Temporarily remember the ingredients and their quantities
• Apply your math skills to mentally calculate the revised quantities
• Draw on your existing knowledge to locate your measuring cups and spoons
• Select the correctly sized bowl
• Determine how long to mix the ingredients

If your working memory breaks down at any point in this process, you will struggle to complete the task.

People with ADHD Often Have Weaker Working Memory

Studies of children and adults with ADHD have identified weaknesses in multiple domains of working memory. On average, individuals with ADHD have a smaller working memory storage capacity than their non-ADHD peers. So, in our cooking example, they may be able to remember only three ingredients at a time vs. four or five ingredients. They also have weaknesses in their ability to manipulate the information stored in working memory (e.g., complete mental math calculations) and retrieve and apply existing knowledge to new information.

When we view working memory through this lens, it’s easy to see how these weaknesses contribute to ADHD-related difficulties like following multi-step instructions, completing assignments accurately, and sticking with tasks until they are completed. What may be a bit less obvious are the ways in which working memory contributes to problems with focus and hyperactivity.

How Individuals with ADHD Respond to Situations Involving Working Memory

To understand these connections, studies conducted in laboratory settings have used computer-based working memory tasks and automated visual and motion trackers to evaluate how individuals with and without ADHD respond to situations that place demands on working memory. From these studies, we have learned that all individuals, regardless of whether they have ADHD, naturally stop paying attention and ”zone out” when the demands of a situation are greater than what their working memory can handle. What makes individuals with ADHD unique is how easily and often the demands of a task or situation exceed their lower working memory threshold. Since their working memory is easily overwhelmed, they lose focus much more frequently than their peers without ADHD.

When it comes to hyperactivity, as working memory tasks become more demanding and begin to exceed their working memory threshold, individuals with ADHD start moving their bodies by fidgeting or getting in and out of their seats. These movements improve working memory performance in the moment for those with ADHD, which may explain in part why fidgeting and having difficulty staying seated are so common for students with ADHD in the classroom.

Poor working memory contributes to problems with focus and hyperactivity. However, there are things parents can do to help their children strengthen the working memory., Memory games, card game, active reading, and chunking information into smaller segments are a few examples of activities that can help.

Research shows that test anxiety is generally caused by factors related to fear of failure, unrealistic expectations, negative self-talk, being underprepared for the exam, and a history of poor test performance. For children with Attention Deficit Hyperactivity Disorder (ADHD), additional factors like low self-esteem, poor study habits, organizational difficulties, chronic procrastination, and poor focus during class and exams also contribute to test anxiety. Because of these additional factors, children with ADHD need extra support from parents, teachers and school counselors to manage their test anxiety. Here are a few tips that can help:

1. Build the study skills. Strong study skills lay the foundation for improved test performance, self-confidence and reduced test anxiety. Unfortunately, most children are never actually taught how to study. Many with ADHD will not develop good study strategies on their own. They need coaching on specific study skills that will enable them to be successful.
2. Teach your child relaxation exercises. Relaxation exercises can reduce anxiety before and during tests. Try techniques that are simple and don’t rely on a phone or tablet app, such as breathing slowly and evenly (and in a quiet, comfortable place if at home). Research relaxation techniques online to find a few ideas for your child.
3. Take the pressure off. Test scores are a measure of your child’s knowledge and understanding of subject matter, but your child needs to understand that their effort matters most. Help your child learn that their self-worth and self-esteem should not be based on test scores. Point out all the things in your child’s life that will continue to go well regardless of how they perform on their next exam. Share what you love about your child that has nothing to do with their grades.
4. Reduce distractions and request extended time on exams. Children with ADHD may experience more test anxiety when they are in distracting classrooms or when they are taking timed tests. Consider requesting school accommodations through an IEP or 504 plan, such as extended exam time or a quiet test-taking environment. Your child might not need these accommodations forever. Once they strengthen their study skills and know how to curb their test anxiety, they can return to taking tests in the regular classroom with the same amount of time as their peers.
5. Work with the school counselor. School counselors might be a good resource to help your child deal with test anxiety, offering relaxation techniques and strategies to tackle negative self-talk, fear of failure and procrastination. They can also teach your child how to advocate for themselves and ask for extra assistance from teachers when needed.

Test anxiety is a very real problem for many children with and without ADHD, and it’s not likely to get better on its own. Help your child reduce test anxiety by learning study skills, practicing relaxation exercises, and taking advantage of school resources or those suggested by their doctor. With the right skills and strategies, your child will be able to decrease their test anxiety and raise their test scores in the process!

This is no small task, especially since ADHD is often misunderstood (even by professionals). While you can be the one advocating for your child right now, there will come a time when they need to take on this role themselves. We now know that ADHD is not typically something that children outgrow, so your child will need to continue to advocate for themselves throughout their lives. It is never too early to start preparing your child for this transition.   

What is self-advocacy exactly? Self-advocacy can be broken down into three parts: (1) knowing yourself, (2) knowing what you need, and (3) knowing how to get what you need.  

Knowing yourself means knowing your strengths and weaknesses, understanding how your ADHD symptoms affect you, and being aware of the things that bring you the most joy and the most frustration.  

Knowing what you need means understanding the kinds of accommodations, supports, and treatments that are most helpful for managing your ADHD symptoms. It also means being able to set a goal for yourself and identify the strategies, supports, and people who can help you achieve that goal.  

Knowing how to get what you need means knowing when and who to talk to about getting the help you need, being able to clearly communicate your needs, and being able to follow through consistently on treatment and support recommendations.  

Self-advocacy skills aren’t something that children and teens learn on their own. They are skills that need to be taught and practiced over time.  Without self-advocacy skills, young adults with ADHD are at risk of delaying important milestones and, when the time comes, may struggle to live independently. This could include milestones like completing college or holding down a full-time job, establishing meaningful adult friendships and a sense of belonging, moving out of their parent’s home, and participating in activities that interest them and add meaning to their lives.  

Self-advocacy is complex, which is why all parents should start teaching these skills to their children as early as possible. It’s not feasible to tackle every aspect of self-advocacy at once. Instead, start with knowing yourself. Help your child understand how their ADHD symptoms affect them daily and the things that make their symptoms better. Also, help them discover their strengths and interests by providing opportunities for participation in a variety of activities.  

Knowing what you need and knowing how to get what you need are things that should also be learned through experience over time. In elementary school, these experiences can include having your older child attend IEP meetings or other parent-teacher meetings when appropriate, encouraging your child to take the lead on describing their symptoms and difficulties during doctor’s appointments (with parents filling in the gaps as needed), and coaching your child on how to ask their teachers for help when they are struggling.   

Learning self-advocacy skills takes time and practice. Start small and provide plenty of coaching and praise as your child practices their new skills. Over time, you’ll be helping your child grow into a confident adult with the self-advocacy skills that they need to live happily and successfully with ADHD.

1. Analyzing and Activating: Taking a big picture overview of the job that needs to be completed, organizing thoughts and materials, prioritizing tasks, and initiating work.
2. Focus: Focusing attention on the project or task, staying focused, and shifting attention back to the task in the face of distractions.  
3. Effort: Continuing to put in effort until the task is completed and working at a pace that isn’t too fast and careless or too slow and unproductive. 
4. Emotion: Managing frustration when things get tough. 
5. Memory: Remembering and recalling the steps and information that are needed to reach a goal and using “working memory” to make mental calculations along the way. 
6. Action: Monitoring progress and adjusting actions and plans as needed until the goal is reached. 

Children with ADHD benefit from the use of tools and strategies that minimize the impact of executive functioning weaknesses and strengthen executive functioning skills over time. For a comprehensive overview of the most effective strategies and tools, check out Smart but Scattered by Peg Dawson, EdD and Richard Guare, PhD. To get you started, here are three simple executive functioning tools you can start using with your child today: 

• Checklists: Checklists are a remarkably simple yet effective tool for children and adults with weak executive functioning. They can be useful for breaking down the steps of routines and complex tasks, organizing and prioritizing thoughts and materials, and serving as reminders throughout the day. Checklists are most effective when children and parents review them together. For checklists that are used repeatedly, it’s best to post them somewhere in your home so you and your child can look them over every day.  
• Timers: The use of timers, especially visual countdown timers like the Time Timer, can help children become more aware of the passage of time. They are also very useful for breaking down homework into smaller chunks and for boosting motivation and focus. If you’re using timers during homework time, choose an appropriate number of minutes (depending on your child’s age and ability) before taking a quick break. After that break, your child can jump back in for another timed stretch of work. You can also boost motivation and focus by establishing “beat the clock” challenges. For example, challenge your child to complete five math problems in five minutes (reminding them that accuracy counts), and congratulate them when they succeed.
• Physical Activity: A growing body of research shows that physical activity improves executive functioning skills in children with and without ADHD. Getting the recommended amount of exercise every day boosts executive functioning skills, and when the exercise is completed outdoors, the impact is even more significant. In addition, studies have shown that when children with ADHD exercise immediately before completing schoolwork, they demonstrate improved focus, accuracy and motivation. Look for ways to incorporate more physical activity into your child’s daily routine, and whenever possible, have your child be physically active before they sit down to complete homework or school projects. 

Consistent routines and expectations are essential for helping children with ADHD manage transitions, but they may not be enough for those who struggle the most. Here are other suggestions that might help:   

1. Start with the basics: food and sleep. Emotional or disruptive outbursts during transitions are amplified by fatigue and hunger. When a child is tired or hungry, they may be able to hold it together just enough when they are engaged in an activity they enjoy, but when they must transition to something else, it can cause a meltdown. Make sure that your child is getting the recommended amount of sleep each night based on the sleep guidelines supported by the American Academy of Pediatrics, and stick to a predictable meal and snack schedule that will fuel your child throughout the day. 
2. Look for patterns and consider hidden causes. Chances are that your child does not struggle equally with all transitions. Think about the transitions that are the most challenging. If the worst transitions always involve stopping screen time, work on new strategies for managing screen time with your child. If they always occur when your child is about to start homework, frustration related to homework may be the real problem. Sometimes meltdowns seem sporadic, but when you take a step back, you can find a common thread. For example, some children have their worst transition meltdowns when they are starting an activity that involves socializing with other children—a clear trigger for children with underlying social anxiety.  
3. Allow more time. Meltdowns are more likely to happen when you are under pressure and can’t be patient with your child. Staying patient and calm when you are pressed for time is a tall order. Couple this with the fact that children with ADHD need more time than most to get through transitions, and you have a recipe for a meltdown. Assume that your child will need twice as much time as you usually allow and give them this extra time every day for at least a week as an experiment. You may be surprised by how much this helps. 
4. Do not negotiate with your child. Many behavior challenges and meltdowns during transitions involve negotiations between parents and children. These negotiations are often a big source of conflict in families and a distraction that makes it nearly impossible for kids to move quickly. As a parent, you need to be vigilant about not letting your child deviate from their transition routine unless it’s absolutely necessary. Avoid bargaining with your child to get them to do what you’ve asked of them. If your child is trying to negotiate, don’t participate in the conversation, no matter how tempting it may be. Remember that it’s impossible for your child to negotiate with you if you simply don’t respond to their questions or demands.  
5. Pay attention to your child’s emotions. During transitions, parents are often so overwhelmed by their own emotions and their child’s behavior that they forget to think about their child’s emotions. If you are able to stay calm and allow more time for transitions, you will have the space you need to truly focus on your child’s emotions. You’ll have the capacity to be attuned to what your child needs from you emotionally at the moment. For some children, a hug before and after the transition can go a long way toward helping things go more smoothly. Empathize with your child and let them know that you recognize how hard it is for them to stop doing something fun or get ready to start doing something they aren’t looking forward to. Let them know that there are ways to make these transitions easier. Connecting with your child during the hard moments can improve your relationship overall and help stop meltdowns before they start.   

Transitions might never be easy for children with ADHD, but you can minimize stress and frustration for you and your child when you find strategies that work for your family. If you think your child’s behavior and emotions during meltdowns are tied to other difficulties like anxiety, challenges with screen time, or learning differences, seek additional help from your child’s school, pediatrician, or mental health provider.  

“My child seems to crave carbs all the time! Does sugar make ADHD worse?”  

“Does sugar calm ADHD or make it worse for my child?”  

Parents of children with ADHD ask questions like these all the time. While it may not be obvious to think that problems with attention, hyperactivity, and impulsivity could be related to food cravings, there is a connection.  

Research shows that low levels of dopamine, the chemical in the brain thought to be at least partially responsible for ADHD symptoms, is also related to cravings for sugar and other carbohydrates. Why? Sugar and other high carb foods boost dopamine levels in the brain, leading us to crave them more often when dopamine levels are low. Since children with ADHD have chronically low levels of dopamine, they are more likely than other children to crave and eat sugary or carbohydrate-heavy foods. On top of this, their impulsive tendencies make it hard for them to stop eating these foods even when they are full.  

While the consequences of eating a diet high in sugar and other carbohydrates may not be immediately obvious in kids with ADHD, the long-term effects could be significant. Research shows that ADHD is a risk factor for obesity in adulthood. Knowing that children with ADHD are at risk for developing obesity later in life, it’s important to take steps early on to help them foster a healthy relationship with food. So, what are some things parents can do to help children with ADHD eat a more balanced diet?  

• Encourage moderation. Provide a variety of food that include fruits, vegetables, lean protein, and healthy grains, but also allow for some of their favorite treats. Keep in mind the link between ADHD and low blood sugar, as low blood sugar can mimic ADHD in certain ways. Consistent meals will help minimize blood sugar ups and downs. In general, following the 80/20 rule can help teach children how to eat well without giving up their favorite foods. With the 80/20 rule, 80% of the food you eat contains healthy carbs, fats, and protein, and 20% of the food you eat are less healthy foods (the foods your children ask for all the time!).  
• Use strategies to help with impulse control. Many children with ADHD will have a hard time holding back when their favorite carb-heavy food is within reach. Many parents find these foods “disappearing” from the pantry or refrigerator just hours after they brought them home from the grocery store! Keeping these foods out of the house altogether is one way to stop your children from eating them too often. Alternatively, you can buy treats in single-serving sizes and do your best to closely monitor how often your children are helping themselves to the goodies. Lastly, having children fill up on healthy foods during meals and snacks will cut down on cravings throughout the day.  
• Use alternative strategies to boost dopamine levels. Carbohydrates are just one of many things that boost dopamine levels in the brain. Exercise, participating in fun activities, and spending time with friends all provide a natural dopamine boost. Encourage your child to participate in activities that they enjoy, sign them up for team sports or individual sports (like swimming), and schedule social activities whenever possible. 
• Consider medication for ADHD. If you remain concerned about your child’s eating habits, consider talking with your pediatrician about ADHD medication. Medications for ADHD work (in part) by boosting dopamine levels in the brain. 
• Consult with a pediatric nutritionist. Nutritionists who specialize in working with children and their families have experience with a wide range of challenging eating behaviors. They can be an excellent resource for parents of children with ADHD. Consider consulting with a nutritionist to learn strategies that are tailored to meet your child’s unique needs.  

While it’s common for children with ADHD to crave a diet that’s high in sugar and other carbohydrates, the effects of these eating habits may contribute to health problems like obesity in adulthood. Keep in mind that the sugar and ADHD myth (a direct cause and effect) is indeed unproven, but a diet high in sugar does make ADHD worse. Don’t wait for things to improve on their own. Take steps now to help your child develop healthy eating habits that will last a lifetime.  

Children with ADHD have a tendency toward a fixed mindset in part because of biological differences in the regions of the brain associated with mindset, motivation and goal setting. These children often have repeated experiences where they tried to be more organized, make fewer mistakes and get better grades, but failed because they lacked the skills and support they needed. For children with ADHD, having a fixed mindset also makes them more likely to avoid challenging tasks and try to cover up their weaknesses (rather than work to improve their skills).  

Fostering a growth mindset in your child can help to counteract some of the negative academic experiences and criticisms that they encounter because of their ADHD. It can help them find the motivation to persist in the face of challenges and work hard to achieve their academic goals.  

Fortunately, mindsets can be changed! As a parent, here are a few steps you can take to help your child shift from a fixed mindset to a growth mindset:  

1. Teach your child that they can grow their brain and improve their intelligence and academic abilities. Children grasp this concept more easily when you describe the brain as being like a muscle. Just like muscles grow stronger when we exercise our bodies, our brains grow stronger when we exercise our minds. We can do this through engaging in challenging tasks, making mistakes and correcting them, and putting effort into things even when they are hard. 
2. Help your child develop new skills and strategies. Working hard, persisting and tackling new challenges are only effective tools when your child has the skills and strategies they need to succeed. Children with ADHD often have deficits in organizational skills, academic skills and the ability to focus. Work with your child’s teachers, therapists and tutors to help your child develop and strengthen these aptitudes. 
3. Provide opportunities for positive challenges. Help break the cycle of avoidance by giving your child opportunities to engage in difficult activities where they have a high likelihood of being successful. Look for challenges where your child has the basic skills to gain small wins and where they can easily improve with a little effort and practice. Point out your child’s progress and praise them for their growth mindset approach to persist even when things became difficult.
4. Give targeted growth mindset praise. This includes praising your child when they:
   • Approach rather than avoid challenges.
   • Try out new strategies.
   • Demonstrate persistence in the face of obstacles.
   • Improve and learn from their mistakes.
5. Share in your child’s joy when they achieve their goals. Your genuine enthusiasm for your child’s success when they achieve a goal that is important to them can be hugely rewarding and motivating and will encourage your child to continue using growth mindset strategies in the future.  

Helping your child shift their fixed mindset toward a growth mindset will take effort and patience. Their mindset won’t shift overnight, but over time, you will see your child’s motivation and persistence begin to improve. They will start to internalize the message that with hard work and effort, nothing can stop them from achieving their goals.  

Check out Huntington’s webinar, Fostering a Growth Mindset in Kids with ADHD, for more ideas on how to help your child embrace challenges and recognize that they can improve their academic skills and performance with effort and hard work.  

Developmentally, children and teens with ADHD are generally 2-3 years behind their peers when it comes to social skills and executive functioning skills (the skills needed for impulse control, sustained attention, planning, organization, and time management).  

This developmental lag has been identified over and over again in research studies that have used parent and teacher rating scales, past studies that have gathered observations of children’s behavior, and neuroimaging studies that measured brain development in ADHD. So, while you may have a child with ADHD who is intelligent and talented in many ways, the foundational skills that they need in order to reach their full potential are relatively weak.  

More often than not, parents, teachers, coaches, and other important adults in a child’s life do not adjust their expectations based on the developmental level of a child with ADHD. As a result, they inadvertently set the child up for failure by holding them to an unreachable standard. As you might expect, in these situations, the child fails to meet expectations, and their self-esteem suffers. Parents will typically become increasingly frustrated with their child, but they will also try to help improve the situation.  

Sometimes this help comes in the form of “snowplow” parenting – clearing obstacles out of their child’s way whenever possible and picking up the pieces or making excuses for their child when they fail. This response may help in the short term, but long term, it does nothing to address the root of the problem: the developmental gap between expectations and skills.  

To see lasting change, a strategic, three-pronged approach is needed that addresses both the skills side and the expectations side of the problem: 

• Skill Development – When a child doesn’t have the skills needed to meet an expectation, skill development is a necessary step to close the expectations-skills gap. This could be social skills coaching, academic tutoring, organizational skills training, therapy to help children better manage their emotions, and other treatments recommended by your child’s physician to help children manage their ADHD symptoms more broadly.  
• Scaffolding – More often than not, in at least some areas, the expectation-skills gap will be so wide that skill development may only get a child part of the way to their goal. At these times, parents need to scaffold while continuing to build their child’s skills. Scaffolding is different from snowplowing. Instead of clearing obstacles out of their child’s way, parents proactively provide support and structure while their child works to meet an expectation.  

Using homework as an example, your expectation may be that your child completes all of their homework every night, but your child may not have the skills and abilities they need to work independently for 30 or 40 minutes. Rather than have an extreme response (e.g., dropping the expectation altogether or doing your child’s homework for them), try scaffolding by creating a structured homework routine designed to help them work as independently as possible every night.  That might mean 15 to 20 minutes of independent work followed by a short break and a second round of independent work time (again of 15 to 20 minutes). 

At Huntington, we practice scaffolding on all skill-based learning, so students see progress immediately and feel successful when they complete each exercise. We do this throughout our programs to build skills, confidence, and motivation. These transfer to schoolwork and homework. 

• Adjusting Expectations – There will be times when even with skill building and scaffolding, your child is still not able to meet an expectation consistently. In these cases, adjusting the expectation is appropriate. Using the homework example, requesting modified homework assignments may be necessary. A modification might mean having a child complete only every other problem on math worksheets, typing or dictating writing assignments instead of using a pencil and paper, or reducing the amount of required reading each week. The child is still required to meet the expectation of completing all of the assigned work each evening, but the amount of work assigned will be more manageable. When expectations are adjusted, they should be revisited periodically and adjusted again as your child’s skills and abilities continue to grow.  

At Huntington, we adjust expectations in a child’s program and build skills so they learn to meet the standards that are expected for schoolwork and homework. This builds the child’s confidence and self-esteem knowing that they can complete the work successfully. 

Setting clear and reasonable expectations for children with ADHD is essential to helping them reach their full potential and avoiding falling into the snowplow parenting role. Knowing where to set an expectation is hard, and not necessarily something parents should do alone. Reach out to your child’s teacher, therapist, counselor, and/or pediatrician for help.  

Initiate the first meeting. 

Teachers have 25-30 new students in their classroom at the start of the school year, and will probably not have an opportunity to reach out to each parent individually. So, take the first step by emailing or calling the teacher to schedule an initial 15-20-minute meeting at the beginning of the school year. It may seem like you will need more than 15 minutes to discuss your child’s ADHD, but longer meetings will be more difficult to schedule, and may provide more information than your child’s teacher can digest during this jam-packed time of year. Remember that this is just an initial meeting. There will be opportunities for ongoing communication throughout the school year.  

Approach the meeting with an open mind.  

Every parent walks into teacher meetings with mixed emotions at the start of the school year. If your child’s needs were not met in the past, or you had a challenging relationship with last year’s teacher, it will be tempting to carry these negative experiences forward with you into the current school year. Even if you and your child have had positive experiences previously, you may worry that this year’s teacher will not reach the high bar set by the wonderful teachers your child has had in the past. Regardless of your past experiences, try to view the new teacher and school year as an opportunity for a fresh start. Approach your child’s new teacher as a partner. You are both invested in ensuring that your child has a great school year, and you both have important roles to play in making this happen.  

Make most of your brief meeting time.  

Make the most of the time that you have scheduled by thinking through the key points that you want to discuss in advance. Make notes about these points, and bring the notes with you to the meeting. Throughout the meeting, be succinct and specific. Too much detail and too many tangential stories will make it difficult for the teacher to focus on the important information. When considering which topics to cover, aim to focus on these four important meeting goals: 

1. Share essential information about your child’s ADHD.
   • How does ADHD affect your child academically, socially, behaviorally and emotionally?
   • What was your child’s greatest struggle last year?
   • What is your child’s biggest strength?
   • What are some interventions or accommodations, including those in IEPs and 504 plans, that have previously helped your child manage their ADHD?
2. Learn about your child’s teacher’s prior experience with ADHD.
   • How many students with ADHD have they had over the course of their career?
   • What are some strategies that they have used to help students with ADHD?
   • What are their preferences when it comes to partnering with parents to help students with ADHD succeed? 
3. Learn about the teacher’s impressions of your child so far.
   • What have they noticed about your child during the first few days of school?
   • Having observed your child, and having heard the information that you’ve shared earlier in this meeting, what challenges do they anticipate for your child this school year?
4. Discuss next steps.
   • What is at least one action that you can take at home and the teacher can take in the classroom this week to help your child?
   • How will you and the teacher have regular communication going forward?
   • When should you have a follow-up meeting?  

Initiating collaborative communication with your child’s teacher at the start of the school year will lay the foundation for a positive partnership that will help your child get the support that they need throughout the year at school and at home.

Moments like these are par for the course when you have a child with ADHD, but there are things you can do to make these moments less frequent. The way that you give your child instructions can have a huge impact on their ability to follow through. And, when you pair these effective instructions with praise for a job well done, you’ll see big improvements and less frustration all around.   

Five Strategies for Giving Effective Instructions: 

1. Always get your child’s attention first. Children with ADHD often have trouble shifting their attention from one thing to the next. So, don’t assume that your child is paying attention when you speak. Make sure you are in the same room as your child, then say your child’s name, ask them to look at you, or put your hand on their shoulder. All of these steps will help ensure that they are ready to take in what you have to say. 
2. Give only one or two instructions at a time. Most children with ADHD can only absorb one or two instructions at a time, maybe three if they are a bit older. If you chain too many instructions together, you will exceed what their mind can process and will compromise their ability to follow through on anything that you’ve asked them to do. 
3. Tell your child what to do instead of what not to do. Make it easier for your child to follow through by telling them exactly what it is that you want them to do, and don’t leave it up to their interpretation. For example, if your child is running down the stairs and you tell them to stop running, they can choose to slide down the bannister and still comply with your instructions. Instead, be clear and direct and tell them to walk down the stairs. 
4. Avoid “asking” your child do to something. It feels very natural for us to ask someone to do something in the form of a question, such as, “Would you get me a cup of coffee?”  We communicate with other adults like this all the time and in many instances, it would be rude not to say it more like, “Get me a cup of coffee!” But, when you’re giving instructions to your child with ADHD, the same rules don’t necessarily apply. When you phrase an instruction as a question, your child can take you literally and simply say no. “Would you clean up your toys?” can result in this response, “No, I’m busy.” If you instead say, “Please stop playing and clean up your toys now,” you’re not asking your child for a favor. You’re telling them what you need them to do, and they will be more likely to follow though. 
5. Give your child time to react. It takes many children with ADHD a little bit longer to process information than you might think, and in general, children process information more slowly than adults. So, give your child at least 5-10 seconds to follow through before you repeat the instruction or start to feel ignored.  

When you follow these five simple steps consistently, you’ll be surprised by how much better your child follows through when you ask them to do something. In fact, they may even show up with socks and shoes on both feet the next time you ask! 

1. Optimize your child’s ADHD treatment. Your child will have the best chance at success if their ADHD treatment is working effectively. If they take ADHD medication, schedule an appointment with their prescribing doctor to make sure the medication is working as well as possible. Medication dose adjustments are often needed as children grow older, and without these adjustments it’s possible that your child’s ADHD symptoms may become undertreated over time. On the behavioral front, work on tightening up and refreshing any behavior charts or reward systems that you have in place at home. Once school starts up, work with your child’s teacher and school counselor to have an effective behavior plan in place in the classroom. Learn more about creating classroom behavior plans and home behavior charts. 
2. Schedule a meeting with your child’s teacher and school counselor as soon as possible. If it is possible to meet with your child’s new teacher before the start of the school year, schedule a meeting for yourself and your child. Otherwise aim to meet just after the school year begins. Depending on your child’s age, it can be helpful to involve them in a discussion with the teacher about the way their ADHD affects them in the classroom, what worked for them at their old school and what was difficult or did not work for them. You can also meet individually with your child’s teacher to discuss things in more detail without your child present. Have your child meet the school counselor as well and let your child know that this is someone they can go to if they are having a hard time in the classroom or with peers on the playground. 
3. Advocate for your child. Developing a strong partnership with your child’s school – including school administrators, special education coordinators, teachers, and counselors – is key for facilitating a smooth transition to a new school. If you had strained relationships with teachers and administrators at your child’s previous school (a common situation for parents of children with ADHD), look at this as an opportunity for a fresh start. Approach the situation with as much optimism as possible. If your child has an IEP or 504 plan, work with the special education coordinator to get these plans reestablished. If your child hasn’t had a special education plan in the past, you may want to consider advocating for one now (this post on qualifying for an IEP or 504 plan with ADHD will help you get started). Request copies of your child’s records from the previous school so you’ll have them on hand for your upcoming meetings with the special education team.    
4. Create opportunities for making new friends. For most children, their biggest worries are about fitting in and making new friends. While you can’t be there to support your child during the school day, there are things you can do to set them up for success outside of school. Start by enrolling your child in extracurricular activities as soon as possible. If there are non-school affiliated clubs or teams that draw children from the new school, consider signing up your child for one of these as well. Sometimes it’s easier to make friends when school social dynamics are taken out of the picture. Throughout the school year, plan to set up playdates with one or two classmates. These playdates can be brief (often a 30-minute playground meetup is all you need) and can go a long way toward building your child’s confidence and friendship skills.  
5. Talk to your child and role play scenarios. Talk to your child about how they’re feeling about starting at a new school. Let them know that they can always talk to you about things they’re worried about or difficulties they might have once the school year begins. Help them strategize about dealing with tricky social situations, like who to sit with at lunch or how to join a group of children who are playing on the playground. Role playing these scenarios ahead of time can help your child feel more confident and remember the things you discussed. If you think your child could use even more guidance around specific social situations, ask the school counselor to step in and provide in-the-moment coaching and support when your child needs it most.  

Starting at a new school can be challenging and it make take weeks or months for your child to adjust. Be as patient and supportive as possible, and if you notice significant and persistent changes in your child’s behavior or mood, don’t hesitate to reach out to a therapist for help. Over time, your child will adjust to their new teacher and new friends, and you may just find that a new school is what they needed to succeed. 

It is hard to know how to support your child when they are struggling emotionally. Here are five simple tips to help you get started: 

1. Take steps to manage your own levels of anxiety and stress. The back-to-school transition is difficult for parents too. In fact, many parents are even more worried and stressed than their children are at the start of a new school year. This is especially true of parents whose children have struggled during past school years. It is very difficult to help your child manage their emotions when your own levels of stress and anxiety are high, so take care of your own emotional health in the coming weeks. You’ll help yourself and your child in the process.  
2. Prioritize sleep for yourself and your child. Every parent knows that children (and parents) who are sleep deprived have a harder time coping with feelings of anxiety and frustration. According to the American Academy of Pediatrics, school-age children should get between 9-12 hours of sleep and teens need 8-10 hours of sleep each night. Help your child cope with the back-to-school transition by starting them on their school sleep schedule about two weeks before the first day of school. This will ensure that they are getting the sleep they need and will take some of the adjustment stress out of the first week of school. 
3. Talk to your child about how they are feeling. Hectic family schedules don’t often include time for unhurried conversations about our feelings. Start by casually checking in with your child about how they’re feeling about heading back to school. It can also help to share how you felt when you were a child who was starting a new school year. You may find that at first your child doesn’t have much to say, but if you check in regularly, they’ll likely start to open up over time.  
4. Remind your child about the non-school activities that they enjoy during the school year. It’s important for children with ADHD to remember that they are not defined by their school experience. The start of the school year also means a return to clubs, sports, and activities that they enjoy. These experiences tap into talents and interests they have that aren’t engaged during the school day, and often include friendships that aren’t burdened by the stress and pressure of school. 
5. Identify key people in your child’s support system. Your child is not alone in their return to school. They have the support of their family and friends outside of school, and there is plenty of support at school as well. Talk to your child’s school counselor, administrator or teacher to find out who your child can turn to at school when needed. Then, work with your child’s school to set a meeting up between your child and their support person the first week of school. Let your child know that you’ll check in with that person as well to find out if there are things you can do to help them at home.   

As a parent, you are your child’s number one source of emotional support, and there is a lot you can do to help them feel better as they return to school this fall. Remember that you don’t need to do it alone. If you feel overwhelmed by your child’s big emotions, reach out to a counselor or therapist for help. Not sure where to begin to find a therapist? Your child’s pediatrician is a good starting point for a referral. In the meantime, try to enjoy the last days of summer and spend some quality time with your child doing the things you both enjoy most.  

A successful start to the school year for students with ADHD requires some advance planning on the part of parents and teachers and a toolbox full of strategies that will help the student stay on task, engaged, and motivated. The greatest school success happens when parents and teachers communicate frequently and use similar strategies at school and at home. Here are five tips for helping your child or student with ADHD have a successful start to their school year.  

1. Schedule a parent-teacher meeting as soon as possible. When a student has ADHD, open communication and collaboration between parents and teachers are both essential for school success. Early in the school year (or just before the start of the school year), schedule a parent-teacher meeting to share important details about the student and discuss strategies that may be helpful at school and at home. Parents: read up on how to talk with your child’s teacher about ADHD. 
2. Create a daily schedule. During the school day, teachers and students follow a consistent schedule that provides structure and predictability in the classroom. Children with ADHD rely on this structure to help organize their thoughts and manage their behavior. Parents, you can create similar structure and consistency at home by following a before and after school schedule and evening routine. Post the schedule in a location where you can see and review it with your child every day. To make the back-to-school transition as smooth as possible, start following the morning and evening routines about two weeks before the first day of school.  
3. Break large tasks down into smaller chunks. Tasks and assignments that are long or involve multiple steps can easily overwhelm a child with ADHD. When teachers and parents help break down long assignments and tasks down into smaller chunks, children with ADHD can get started more quickly and stay on task until the work is done. 
4. Praise good behavior. Children with ADHD rely on feedback from parents and teachers to manage their behavior. When you praise a child with ADHD for doing something well, you’re making it much more likely that they will demonstrate that same behavior again the next day. So, keep an eye out for positive behavior, and give praise like, “Great job getting started right away!” as often as possible. 
5. Minimize distractions. When children with ADHD are struggling to get things done quickly and accurately, distractions are often part of the problem. Think about the most challenging times of the day for your child or student with ADHD, the activities they are doing during those times, and the distractions that may be getting in the way. In addition, have a conversation with your child or student about things that they think are distracting at that time. You may be surprised to find that it’s often not the obvious distractions that bother them the most. While it’s not possible to eliminate all distractions, keeping them to a minimum can make a big difference.    

Saying goodbye to summer is never easy, but with a bit of planning and a collaborative parent-teacher relationship, it is possible to lay the foundation for a very successful school year. 

Rewards are something your child earns for their hard work and effort. They are established ahead of time, paired with clear expectations, and given only after the child has followed through. Rewards are part of a plan that parents are ultimately in charge of managing, and lead to positive interactions that foster feelings of accomplishment. When children are rewarded after a behavior, they are more likely to repeat that same behavior again.   

Bribes, on the other hand, are typically given to a child before they follow through with a desired behavior. Often, bribes are used as a last resort, and as a result, they frequently come about during a power struggle or negotiation. They rarely lead to long-term changes in behavior. In fact, they often accidentally encourage negative behavior!  

Consider this example: A child is at a restaurant with his family. While he’s waiting for his meal, he whines and complains about being bored, and is up and out of his seat bothering the diners at the neighboring table. This is an uncomfortable, common situation for many parents, and one everyone wants to change as quickly as possible.  

If you respond by pairing a reward with clear expectations, you’ll remind your child that you agreed before dinner that first, he would stay seated for the entire meal. Then, as a reward, he would be able to order dessert. You’ll then give him an activity to keep him busy and praise his good behavior during the meal. He’ll earn his reward, feel good about his effort, and have more motivation to stay seated the next time he’s in a restaurant.  

If you respond by using a bribe, you’ll first ask your child repeatedly to stop getting out of his seat.  When he doesn’t comply, you’ll feel frustrated and worry that the family dinner will be ruined. So, you resort to a bribe by asking your child if he will sit down if you give him a piece of candy. He takes the candy, sits down for one minute and then is up out of his seat again.  

In this example, the bribe actually reinforced the child’s negative behavior. He received candy while he was out of his seat, and was not required to first meet any expectations. Once the candy was finished, he stood up again because he was bored and restless, and had nothing motivating him to stay seated. Chances are, he’ll leave the restaurant feeling bad about his behavior, and will not be motivated to behave differently next time.  

So, how can you avoid bribes and instead focus on constructive rewards? Set clear expectations ahead of time whenever possible, and share these expectations and the possible reward with your child. Using a “when-then” statement can be helpful, such as, “When you stay seated for the entire meal, then you’ll be able to order dessert.” Don’t allow your child to negotiate about the reward in the moment, and make sure to provide rewards only when they’ve been earned. This shows your child that you are in charge of the plan, and removes their ability to negotiate or engage in a power struggle.   

When rewards are used correctly, they can set your child up for success, reduce family conflicts, and teach your child that they can accomplish challenging tasks when they have the right motivation. So, rest assured that when you stick to a behavior plan that includes rewards, you’re not bribing your child. Instead, you’re using a valuable tool designed to help them manage their ADHD symptoms.  

During the summer months, students with ADHD are vulnerable to backsliding on the academic gains they have made over the past school year. Studies conducted before the pandemic found that on average, children lose up to two months of learning in math and up to one month of learning in reading over the summer, and that these losses are even greater for children with ADHD. This summer, the learning loss experienced by students with ADHD will compound their existing pandemic-related losses and further widen their achievement gap. Parents of children with ADHD should think beyond simply avoiding the summer slide this year and instead focus on ways their child can make significant academic gains that will set them up for success in the fall.   

For most parents of children with ADHD who have struggled to help their children keep up academically throughout the school year, the idea of focusing on academics during the summer months as well can feel daunting. Fortunately, summer allows for academic opportunities that are a better match to the needs of ADHD students than what is typically provided throughout the school year. This includes opportunities for individual or small group instruction, highly motivating learning activities that are matched to the child’s interests and skill level, and routines at home that include short but consistent opportunities for reading, writing and math.  

To start your child on a path to making academic gains this summer, consider these five steps: 

1. Enroll your child in a structured learning program that targets their greatest academic weaknesses. Look for programs that include small group or individualized instruction and can personalize the content to match your child’s needs and interests. The Huntington Learning Center model is an excellent match for the learning needs of students with ADHD and includes regular assessments to evaluate students’ strengths and weaknesses, as well as their progress throughout the program.  
2. Create a routine that includes a minimum of 15 minutes of reading every day. If getting your child to read is a challenge, be flexible with their reading options and allow them to choose things like comic books, books that are slightly below their reading or grade level, or magazines about videogames (or another interest area). Reward charts can also be very helpful if the rewards are provided frequently and are something your child is motivated to earn. 
3. Look for opportunities to practice math as part of your child’s everyday activities. Bring your child to the grocery store and have them add up the prices on a sheet of paper as you shop. Then celebrate if their number matches the pre-tax total at checkout. When your child is watching sports, have them keep score using scoresheets you can find online. Talk about a player’s stats with your child and learn about how these stats are calculated (there are many online resources for this as well). 
4. Have your child write every week in a summer journal. Let them choose the topic each week but require them to write a certain amount each time. The length of their writing should be matched to their age and ability level. Simple things like providing fun pens and pencils, allowing them to draw pictures alongside their writing, and showing an interest in what they’ve written can go a long way toward motivating children to keep journaling.
5. Enroll your child in an online course that will allow them to learn about something that interests them. Even if a course isn’t focused on math, reading, or writing specifically, it will no doubt tap into at least some of these skills while making learning fun for your child.  

It isn’t always easy to convince children with ADHD to participate in academic activities over the summer, but it is more essential than ever this year. The effort that you and your child invest in their academic growth will pay off when they start their school year off with confidence in the fall.

Teach friendship skills. Talk to your child about what it takes to make a new friend. Children with ADHD often need to learn social skills the same way that they need to learn skills in order to read or play a sport. Coach your child on ways to start a conversation, join a group, and be a good sport during games and activities. Role play these skills with your child, and prompt them to use these skills when you observe them playing with other children. At the end of this post there are a few simple steps to help you get started. 

Encourage playdates and get-togethers. Studies show that children who invite their peers to do fun activities are better liked than children who don’t offer invitations. So, help your child think of fun activities that they can do and help them invite their new friend along. Activities can be something as simple as going to the playground for a few minutes at the end of the day, or a bigger activity like a playdate at home or a trip to the movies.  

Get help from summer program counselors, educators and coaches. Children with ADHD often need support throughout the day to make and maintain new friendships. Talk to your child’s counselors, tutors and coaches about the skills that you’re working on with your child. Let them know that your child could use some extra support when it comes to making new friends. You’ll likely be surprised by how willing people are to help your child make new friends.  

Enroll your child in activities that allow them to shine. The demands of the school year can make it hard for a child with ADHD to feel confident academically and socially. Capitalize on summer’s flexibility by enrolling your child in the activities that they feel most confident about and enjoy the most. This confidence will naturally carry over into their interactions with new friends who share the same interests.  

Boost confidence by building academic skills. Enroll your child in group tutoring and academic programs over the summer, in addition to fun activities. They’ll meet other children like them and will have an opportunity to see that they’re not the only one who needs a little extra help to keep up at school. They’re bound to enjoy and even look up to some of these children. If your child is not struggling, summer enrichment can help they get ahead and practice some new concepts before the school year kicks off. These sessions also provide an opportunity for your child to practice conversation skills and good sportsmanship, and they can invite classmates to join them for activities outside of class. And the biggest benefit? They’ll be learning academic skills that will help them when school starts in the fall.  

Perhaps more than any other issue, parents of children with ADHD worry the most about their child making and keeping friends. Summertime can be a great chance for your child to hit the reset button and create strong friendships with children who share their same interests. Seize the opportunity, practice some of the tips included here, and you might just see your child blossom this summer. 

Keys to Good Conversations

1. Make eye contact.
2. Ask questions about something you think the other person might be interested in.
3. Give the other person a chance to talk (and try not to be a conversation hog).
4. Keep the conversation going. Share something about yourself that's on topic, or ask another on-topic question.

Keys to Good Sportsmanship

1. Be a good winner. Don't brag or boast when you sin. Say "good game" to the loser.
2. Be a good loser. Say, "That's okay; maybe I'll win next time." Then congratulate the winner.
3. Cheer on your teammates. Do this even when you're feeling frustrated!

Keys to Joining a Group

1. Make the first move. Rather than waiting for someone in the group to notice you, introduce yourself when there is a break in the conversation.
2. Follow the conversation tips above to join a conversation.
3. If the group is already engaged in an activity (like a kickball game or craft project), simply introduce yourself, and then say, "This looks fun! Can I please join you?"

Where Does Emotion Regulation Fit Within the Context of ADHD? 

Why do difficulties with emotions show up alongside problems with attention, hyperactivity, and impulsivity? Dr. Russel Barkley, an internationally recognized ADHD expert, describes two categories of emotion regulation challenges associated with ADHD: problems with emotional impulsiveness and problems with emotion self-regulation.  

• Emotional impulsiveness refers to low frustration tolerance, being easily excitable or emotionally aroused, and a quickness to anger.  

• Deficient emotion self-regulation refers to difficulty keeping strong emotions contained so they’re not expressed at inappropriate times and difficulty using self-calming activities.  

The emphasis on emotional impulsivity and poor emotional self-regulation in Dr. Barkley’s model parallels the impulsivity and self-regulation difficulties with we see in children with ADHD in areas related to regulating attention, impulsive behavior, and hyperactivity. In fact, it’s been suggested that ADHD may be a disorder that is best characterized by difficulties with self-regulation. Brain imaging studies support this and have confirmed that the brain structures and networks associated with “classic” ADHD symptoms are also associated with the expression and regulation of emotions. So, it’s not surprising that difficulties with emotion regulation would be an added challenge for children with ADHD. 

How Does Poor Emotion Regulation Impact Academic Performance? 

Problems with attention and impulsivity interfere with a child’s ability to complete their homework and schoolwork successfully, and poor emotion regulation adds another layer of difficulty. Children with ADHD who struggle with emotion regulation become frustrated more quickly when working on assignments that they perceive as being too difficult or too boring. They are easily distracted by their emotions and have a harder time keeping their minds focused on the tasks at hand. This is especially true when they are feeling down or irritable or are preoccupied by thoughts related to an emotionally charged situation that occurred earlier in the day. In addition, their ability to use self-calming strategies effectively in these situations is also compromised, making it harder for them to “reset” their emotions and redirect their attention to their schoolwork or homework. 

How Can Parents and Teachers Help? 

 
When it comes to helping a child with ADHD improve their emotion regulation, particularly when they are completing assignments at school or at home, it’s best to start with a single calming/cool-down strategy. You can prompt the child to use this before they start their work and when they begin showing signs of frustration or emotion dysregulation while they’re working. Any strategy that is brief and simple (i.e., it doesn’t require special equipment and can be done anywhere) and is one the child is open to using can be effective. Practice the technique with the child at a time when they are calm and let them know that you’ll be helping them use this cool-down strategy when they are having a hard time staying calm.  

At first, children with ADHD will need quite a bit of coaching from a parent or teacher to use the strategy, but over time, they can start using it on their own. Pairing the coaching with praise for using the cool-down strategy will help motivate children with ADHD to use these strategies and will make it more likely that they’ll start using them independently—even when a parent or teacher isn’t there to coach them.  

For children with ADHD who have more significant problems with emotion regulation and have multiple outbursts or meltdowns each week, additional interventions may be needed. Evidence-based treatments for ADHD—like behavioral parent training for children and cognitive behavioral therapy for adolescents—can also improve emotion regulation when this is a clearly identified goal in therapy.   

Mindfulness interventions can also be helpful when they are used consistently over an extended period. In addition, ADHD medication can be very helpful in reducing the more impulsive aspects of emotion dysregulation and can reduce emotional outburst in children with ADHD. So, if you are the parent of a child with ADHD who struggles with emotion regulation, talk to your child’s providers about these challenges and treatment options.

Need some help getting started with “the money talk” with your child? Break up the money talk into three smaller mini talks over the course of a few weeks. Children with ADHD learn best through hands-on activities, so here are some you can use in your conversations:    

• Mini-Money Talk #1: Where Money Comes From: In your initial conversation about money, it’s important to lay a solid foundation starting with where money comes from.  (Hint: It comes from earning an income at a job!) Talk about your job and the jobs that other people have – make sure to include a variety of professions. Share stories about your first job and how it felt to earn your first paycheck. Talk about the differences of earning potential in different professions. 
• Mini-Money Talk #2: The Difference Between a Want and a Need: Money can be spent on all kinds of things, but you can simplify this concept for your child by explaining that spending generally falls into two categories: needs and wants. Needs are essentials. So, in a family, that includes shelter (rent or a mortgage payment) food, water and electricity. Wants are the nice-to-haves like toys, jewelry, candy or fashion clothing. It's important to share that as a responsible adult, the needs come before the wants. Talk about a time when you saved up to buy something special (a want) after paying for the things you needed first. 

Wants vs. Needs Activity: On sticky notes, write down the amount of money that goes toward different needs (housing, food, gas and electric, school, etc.). Together with your child, count out the money for each category. Then count out the amount that is left to spend on wants (fun things). Ask your child how they might think about spending money in the want pile. Ask if they would spend it now or save it up for something?  

• Mini-Money Talk #3: How Credit Cards Work: Credit cards make the concept of money even harder for children to understand. Yet, it’s the number one way that children see us spending money – so it’s not a topic that we can ignore. Explain how credit cards work in simple terms:
  • People can apply for credit cards and use them to buy things without having to use cash or the money in their bank account immediately. 
  • You can buy items with a credit card, then receive a bill for all purchases once a month. 
  • When that bill comes, you can pay it all at once without getting charged any “extra,” or interest. But if you don’t pay the full bill, the credit card company will charge interest—and not just a little interest.  

Then, reinforce the concept through an activity.  

Credit Card Activity: Have your child set up a pretend store at home, with price tags on various items. Then, have your child use a credit card to “buy” some things in the store. Next, act as the credit card “bill collector” and write up a bill for the purchase. Give your child the bill, and have them count out the money (real or pretend money) to pay the bill and hand it over to you. This will help them understand how credit cards and money are connected. Next time you’re in a store, point out that you’re going to need to send the credit card company some hard-earned money for those purchases when the bill comes!  

Once you’ve had a few mini conversations about money, it will be much easier to keep talking about this topic with your child. You may even find your child asking questions the next time they see you spending money at a store or leaving a tip at a restaurant. With time and experience, they’ll begin to understand the concept as they grow into adulthood and start making money of their own!  

How does ADHD cause reading difficulties?

For students with ADHD whose reading difficulties stem primarily from motivational deficits, ADHD symptoms will be most impairing when they are reading about a topic that doesn’t interest them. While most students without ADHD can “power through” less interesting reading assignments, students with ADHD will find it nearly impossible to get their brains to focus on the text. They find these reading assignments so mentally taxing and aversive that they will do just about anything to avoid completing them, including acting out and being disruptive in class.

ADHD-related weaknesses in working memory and sustained attention lead to problems with reading accuracy and comprehension. These problems often present as a tendency to rush through reading assignments, miss key details, and skip full sentences or paragraphs while reading. Making important connections while reading and pulling out the main idea(s) are also more difficult for students with ADHD. As a result, these students may have a hard time meeting grade-level expectations in reading comprehension and other areas of learning.

Tips for helping students with ADHD improve their reading abilities:

1. Provide incentives and rewards for reading. Many students with ADHD need a motivational boost to stay focused and engaged while reading—like rewards and praise. The incentives don’t need to be large. In fact, sometimes a small privilege paired with genuine praise from their teacher can have a big impact.
2. Break larger reading assignments down into smaller chunks. Students with ADHD often struggle to complete reading assignments because they are overwhelmed by the length. Breaking longer reading assignments into smaller sections will reduce their tendency to procrastinate and give them a sense of accomplishment as they complete each sub-task.
3. Offer individualized instruction to help students overcome skills deficits and build confidence in their reading abilities. Many students with ADHD who don’t meet criteria for a specific reading disorder still have reading skills weaknesses that make it hard for them to keep up with their peers. Individualized reading instruction can have a huge impact on reading skill performance and reading confidence in students with ADHD.
4. Minimize distractions. Have a conversation with your student about distractions in the classroom. You may be surprised to find that it’s not the obvious things that distract a student the most. Sometimes it’s the sound of a dripping faucet that makes it hard to focus, or the clutter in a desk or a cubby along the wall. Helping the student find creative ways to minimize distractions can help with boosting reading productivity.
5. Tap into the student’s interests. ADHD symptoms are least impairing when students are engaged in an activity that interests them. So, whenever possible, allow the student to choose reading assignments related to topics that they find interesting. This will help the students stay focused on the text for longer periods of time, make fewer errors and retain significantly more information.

In addition to the tips above, consider having students with ADHD who are not meeting grade-level expectations evaluated for learning issues to assess whether they also have a reading disorder. In general, with extra support and reading practice at school and at home, students with ADHD can become strong and confident readers over time.

Findings from a recently published study that followed college freshmen with ADHD until their expected graduation dates four years later found that the strongest freshman-year predictors of long-term college success were 1) receiving academic services during freshman year and 2) entering college with strong study skills. One of the biggest factors that interfered with success was having higher levels of depression symptoms during freshman year. For parents and students, it’s important to pay attention to all aspects of mental health and not just ADHD symptoms.  

Successful college students with ADHD recognize that they will need extra support throughout college and work with their parents to get this support in place before they begin their freshman year. The following four steps will help students with ADHD get on the path to college success: 

1. Identify strengths and weaknesses before heading to college. Study skills, time management, organization skills, social skills and healthy sleep, eating and physical activity habits are all important for college success. Students with ADHD should work with their parents and school counselors or therapists to identify their strengths and recognize areas of weakness where they will need extra support during college. It’s also important to treat mental health symptoms related to anxiety or depression before starting college and during college. 
2. Strengthen organizational skills and study skills before going to college. Freshman-year study skills are an important predictor of long-term success in college. These skills should be taught and practiced during high school, so students can enter college with an arsenal of skills and strategies that already work for them.  
3. Look for colleges and universities that offer strong academic support programs for students with ADHD or learning disabilities. These services will help students adapt their study skills to the college context and teach new skills when they are needed. Comprehensive support programs are typically provided for an additional fee through the college’s office of disability and learning support services (see this list from Peterson’s of 20 great colleges for students with learning disabilities). 
4. Work with a therapist during freshman year. Working with a therapist during freshman year can help students quickly identify and manage symptoms of anxiety and depression. Therapists can help with the general stress that comes with adjusting to college with ADHD as well as the friendship and romantic challenges that come up during the college transition. If therapy services offered on campus are limited, students can go off campus to find therapists. Many therapists will also provide telehealth services for students who want to get started during high school.   

Attending college with ADHD can be challenging, but with planning and support, success is possible.    

Here are five strategies that parents can use to encourage independence:

1. Preview assignments together and make a list. At the start of each work period, read each assignment with your child and make sure they understand the directions. Give them a chance to ask questions and talk to you about which assignments they think they may need help with and which assignments they think they can easily do on their own. Have your child list out the assignments for the work period in order, starting with the easiest assignment first. Once your child starts working, have them cross items off the list as they go.
2. Use a timer to schedule breaks. Many younger children with ADHD can only stay on task for about 10 minutes, and some older children or teens with ADHD max out at around 20 or 30 minutes. Plan for this by building five-minute breaks into the work period. Have your child set a timer for their first stretch of work time (15 minutes, for example). Their job is to work consistently during this time. Then when the timer goes off, they get a five-minute break. Make sure they set a timer for this break and get back to work for their next 15-minute segment once their break is over.
3. Monitor your child. Children with ADHD need to be monitored when they’re completing schoolwork or homework, even when they are working independently. Without an adult close by they are much more likely to procrastinate instead of getting started right away and will lose focus more quickly. Monitoring your child doesn’t have to mean sitting next to them, but it does mean being someplace where they can see you and know that you are aware of what they are doing.
4. Only provide help during planned check-in times. An important part of children developing independence is learning to try things on their own first before asking for help. Encourage this skill by only providing help during prescheduled check-in times throughout the work period. For children who require frequent help, gradually extend the length of time between check-ins until you reach a point that seems reasonable based on your child’s age and ability level (e.g., every 10 or 15 minutes for a 4th-grade student). If your child comes across a math problem or a question they can’t complete on their own, have them circle the problem and keep working. Once they finish the work they can do independently, have them attempt the circled items again. If they are still struggling, they should ask for your help with the problem or question during a check-in time.   
5. Reward hard work and effort. “First, you work; then, you play,” is a habit that children with ADHD should learn early on. This mantra will help them learn to get their work done on time now when they are students and later when they are adults. You can use this rule to create rewards that your child can earn when they finish their homework and have met your expectations. Think about fun activities your child likes that can be used to motivate them to get their work done quickly. These can be things like playing with their favorite Legos, playing outside, getting a limited amount of screen time, building forts out of pillows and blankets, etc. If time in the evening is very limited and you feel like you won’t be able to squeeze in a fun activity, you can allow your child to earn a small reward instead. Once a week or once a month, sit down with your child and create a list of activities or rewards they can earn for getting their work done each day.

Helping children with ADHD become more independent takes time and patience, but in the long run, the effort is worthwhile. You’ll feel much less frustrated and your child will feel more confident in their knowledge and skills.

ADHD is a neurodevelopmental disorder that affects all aspects of a student’s life, including their ability to learn and perform in typical classroom settings. Students with ADHD often ‘underperform’ academically as they struggle to absorb new information and complete assignments and exams at a level that matches their intelligence. Typically, the biggest factors underlying the gap between academic performance and intelligence in students with ADHD are weak executive functioning skills.

Executive functions are the brain-based abilities that are responsible for organization, focus, planning, delayed gratification and emotion regulation. They represent the brain’s central executive, tasked with overseeing the management of our decisions, behaviors and emotions. Executive functions begin developing in infancy and continue to develop until a person is in their early 20s. Typical classroom-based learning, homework assignments and exams are all designed around the assumption that students have age-appropriate executive functioning skills. In fact, executive functioning skills predict academic success more reliably than test scores, IQ and socioeconomic status.

Research has repeatedly shown that students with ADHD lag 2-3 years behind their peers in executive functioning skill development. As a result, they are at a distinct disadvantage when it comes to school-based learning and academic performance. Dr. Thomas Brown, a leading expert on executive functioning skills and ADHD, breaks executive functions down into six separate, interconnected clusters. As you read though these clusters below, think about how weaknesses in some of these areas may be impacting your student’s ability to learn and perform academically:

1. Analyzing and Activating - Organizing thoughts and materials, prioritizing tasks and initiating work
2. Focus - Focusing attention on the project, task, or assignment, staying focused and shifting attention back to the task at hand in the face of distractions
3. Effort - Continuing to put in effort until the assignment or task is completed and working at a pace that isn’t too fast and careless or too slow and unproductive
4. Emotion - Managing feelings of frustration when an assignment feels difficult or overwhelming and persisting with the assignment or task instead of stopping before it’s completed
5. Memory - Remembering and recalling the steps and information that are needed to complete an assignment or task, remembering to bring home materials needed for homework assignments and remembering to turn in completed assignments
6. Action - Monitoring progress and adjusting actions and plans as needed until the task or assignment is completed

Executive functioning weaknesses are most impairing when the demands that are being placed on a student greatly exceed the student’s executive functioning capacity. So, for example, a bright second-grade student with weak executive functioning skills who receives very few homework assignments, has brief periods of seated classwork during the day and is in a highly structured classroom may have mild or moderate impairment and may perform well academically. In contrast, this same student may struggle significantly once they are in fifth or sixth grade, when classwork and homework become more demanding and students are required to switch classes during the day.

The goal of many behavioral and academic interventions for ADHD is to narrow the gap between the student’s lower level of executive functioning and the higher level of executive functioning need to successfully meet expectations . Interventions focused on closing the gap can take the form of skills training (like organizational skills training), behavior management plans that boost motivation and engagement by rewarding behaviors related to staying on task, completing assignments and staying organized, checklists and other tools to improve memory and break down complex tasks into smaller chunks and academic accommodations that modify assignments or exams to make them more manageable for the student.   

There are several excellent books that include interventions designed to improve or support executive functioning skills in students with ADHD. Two of the most popular and effective books are Smart but Scattered: The Revolutionary “Executive Skills” Approach to Helping Kids Reach Their Full Potential and Smart but Scattered Teens, both by Peg Dawson Ed.D. and Richard Guare, Ph.D.

Helping students improve their executive functioning skills takes time and patience, but the hard work pays off when students see a boost in their academic performance and their confidence and motivation to succeed in school. 

Students with ADHD are typically eligible for a 504 plan if their ADHD substantially limits their ability to fully participate in all academic and non-academic activities at school. When the school decides whether the student’s disability is “substantially limiting,” they must do so without taking into consideration the effect of treatments like medication or behavioral interventions that may alleviate symptoms when they are in use. 504 plans list the accommodations that will be provided for the student. However, they do not include any specific learning goals for the student and do not include regular reviews of the student’s academic progress to ensure that the accommodations and interventions included the plan are sufficient.  

IEPs are more robust than 504 plans and are typically reserved for students who are clearly unable to learn through the typical classroom curriculum that is provided via standard teaching practices. IEPs are most often provided for students with specific learning disabilities (e.g., dyslexia) or physical impairments (e.g., hearing, speech, vision) that interfere with learning. However, many students with ADHD do qualify for IEPs under the “other health impairments” category. The IEP itself is a detailed working document that describes the interventions and accommodations that will be provided for the student, as well as benchmarks for academic or behavioral success. Unlike 504 Plans, IEPs include information about the student’s current level of performance, learning goals for the student, and progress monitoring over the course of the school year.

Across all school districts, the IEP and 504 plan process begins with an evaluation that is requested by a student’s parents. This request must be submitted in writing and should be addressed to the head of special education services in your school district. School districts are required to review your request and respond within a timely manner. If your child already has an ADHD diagnosis, then the special education committee will determine whether the methods used to make the ADHD diagnosis meet their standards, or if a new evaluation will be required to confirm the diagnosis. In addition, the special education evaluation will include a review of the student’s academic records, a behavioral assessment, and classroom observations. If your evaluation request is declined or if you are not satisfied with the outcome, you can obtain a private evaluation. In some cases, the school may be required to pay for the private assessment.

If the evaluation results indicate that a student qualifies for a 504 plan or an IEP, parents should be involved in the process of identifying accommodations and establishing academic and behavior goals. There is a wide range of accommodations available for students with ADHD, and these strategies typically cluster around completing tasks and maintaining focus, staying organized, and managing impulsive and hyperactive symptoms. Here are some of the more common accommodations:

Completing Tasks and Maintaining Focus

• Shortened assignments (particularly for assignments that require repetition, like math worksheets)
• Preferential seating in the front of the classroom to reduce distraction
• Providing choices to show mastery (e.g., in writing, orally, via a hands-on project).
• Allowing frequent breaks
• Providing clear instructions and checking in with the student to ensure understanding.
• Using a computer to complete essays and other writing assignments
• Extended time on tests

Staying Organized

• Using a simple, color-coded organization system for papers
• Providing an extra set of textbooks that can be kept at home
• Checking the student’s backpack to make sure all necessary materials are packed up at the end of the day, and that homework is taken out of the backpack and handed in every morning
• Weekly desk clean-outs
• Minimizing the number of items in the desk, backpack, and cubby

Managing Impulsivity and Hyperactivity

• Encouraging frequent movement breaks
• Praising and rewarding students for raising their hand before talking
• Allowing students to move or fidget in a non-distracting manner
• Providing extra opportunities for physical activity and refraining from taking away recess as a punishment
• Providing a chair for students during circle time (or any time when students sit on the rug)

Obtaining formal interventions and accommodations for your child with ADHD can seem overwhelming when you’re a parent who is new to the process. If you think your child may benefit from formal special education services at school, schedule a meeting with the school’s special education coordinator and learn about the process. If at any time you feel like the school is not being responsive to your requests, continue to make your concerns known and enlist the help of outside professionals if necessary. Your child deserves to have the accommodations and services that they need to reach their full potential. As a parent, you are your child’s best advocate when it comes to getting them the services that they need.

What does the research say about creativity and ADHD?

For decades, researchers have tried to understand the connection between ADHD and creativity. Studies have been conducted in lab settings, where participants with ADHD and without ADHD complete behavioral tasks designed to measure the cognitive processes that might underlie creative expression. Neuroimaging (fMRI) studies have looked for brain-based connections between ADHD and creativity, and other studies have taken a more ‘real world’ approach by looking for differences in the number of creative achievements in adults with ADHD and adults without ADHD. Despite all the research that’s been done, the findings so far are mixed and inconclusive, with some of the most promising results coming from the studies that have focused on real-life creative achievements. The mixed results don’t necessarily mean that there isn’t a connection between ADHD and creativity, but they do show us how much there still is to be learned about ADHD. 

How can I help my child use their creativity to their advantage?

Children with ADHD who are creative thinkers or are passionate about creative activities like creative writing, art, and music are inherently at an advantage if they are given the opportunity to develop skills related to creative problem solving or their creative passions. If your child has a clear creative activity that they are passionate about, then provide them with as many opportunities as possible to develop their interests and talents in this area. When children with ADHD are doing something that interests them, they’ll have a much easier time staying focused, and are able to feel proud of their accomplishments. Talk to their teachers about their interests and ask for opportunities to incorporate these interests and skills into their classwork and homework. Also sign them up for creative extracurricular activities where they’ll have the opportunity to connect with children who share their interests in a  setting that is less demanding than a typical classroom environment. 

If your child generally seems like a creative kid, but they haven’t found their passion yet, provide them with opportunities to try activities that they haven’t done before. Start by talking with your child about the kinds of things they’d like to try. Consider signing your child up for a class in something that has piqued their interest. Try an online or in-person singe session class in your area. Many community and recreation centers offer classes at reasonable rates. Just avoid signing up for anything that is expensive or requires a long commitment. The goal is to encourage your child to try a few different activities so they can learn about themselves and the things they enjoy. Once they find something that truly sparks their interest, they may be ready to dive in and commit to more classes or a more formal program.

Opportunities for creative expression are important for all children, and especially for those with ADHD. Encourage your child to develop their creativity at home, at school, and through extracurricular activities. Over time you’ll see their confidence grow as they strengthen their talents and make friends with other passionate and creative children.

Here are five key strategies to help your child manage their ADHD symptoms this holiday season:  

1. Focus on reducing your own stress before trying to manage your child’s emotions and behavior. The most important thing you can do to help your child this holiday season is lowering your own level of stress. The most effective way of reducing stress during the holidays is by keeping things as simple as possible. Think about what is truly essential for you and your family when it comes to family commitments, holiday events and gifts. Set firm boundaries. To protect your own emotional health and the emotional health of your family, make decisions based on what is best for your family and not based on the expectations of others. Make sure you carve out time for yourself, even if it’s just a few minutes of alone time each day and talk to supportive friends and family whenever you have the chance. Lastly, remember that things don’t need to be perfect for your children to have a wonderful and memorable holiday season. What’s most important is that they spend quality time with the people they love the most.
2. Maintain as much of a routine as possible. Children with ADHD need routines to manage their emotions and behavior. So, during the holidays, incorporate as many elements of your typical daily routine as possible. It’s often easiest to carry routines forward when you focus on consistent wakeup and sleep times and consistent meal and snack times. Then everything else can fall into place around that schedule.
3. Keep unstructured free time to a minimum. During the holidays it’s normal to want to relax and allow your children to have more unstructured time during the day. The challenge is that when children with ADHD have too much unstructured time, their emotions and behavior become difficult to manage. So, limit unstructured time to periods of 30 minutes or less, and provide access to fun, structured activities throughout the day.
4. Avoid situations that consistently lead to meltdowns. If you know that certain situations always lead to meltdowns, like taking your child into a store, visiting friends or family in the evening when your child is tired, or attending a crowded holiday event, avoid those activities this holiday season. This may sound like common sense, but it’s often not as easy as it sounds. There may be things that you would really enjoy doing or feel like you need to do this holiday season, or activities that have become family traditions. But if something has consistently led to a meltdown in the past, the chances are high that it will be problematic again this year. Your best bet is to skip the outing altogether and reevaluate next year when stress levels may be lower, and your child may be more mature.
5. Use the ‘when-then’ rule to encourage good behavior. It can be hard to use rewards to promote good behavior during the holidays when children are already receiving so many gifts and treats. Instead, use the ‘when-then’ rule to promote good behavior. When you do the thing you need to do, then you can do the thing you want to do. For example, when you clean up your toys you can play with your new video game. Using this strategy repeatedly throughout the day will help your child follow through on instructions and will keep procrastination to a minimum.  

The holidays are stressful when you have a child with ADHD, but they are also an opportunity to make wonderful memories and connect with family and friends. Keep things as simple as possible, create as much structure for your child as you can, and take the time to appreciate the special moments as they happen all season long. 

Not all kids with ADHD experience RSD, and the cause of RSD isn’t well understood. In fact, it’s not recognized as a distinct diagnosis under the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Instead, it’s considered a cluster of symptoms that overlaps with the emotion regulation challenges associated with ADHD (and other disorders). Some of the key signs and symptoms of RSD include:

• Feeling embarrassed and anxious in a variety of social situations
• Having emotional outbursts when feeling hurt or rejected
• Setting unrealistically high standards
• Having low self-esteem
• Avoiding social situations
• Feeling like a failure in a variety of different situations including academics
• Avoiding taking on new challenges or stepping outside a comfort zone
• An excessive need to please adults and peers

As with most metal health challenges, RSD is likely caused by a combination of genetic and environmental/experience-based factors. In part because it is not well understood, RSD often isn’t identified by teachers or clinicians who work with kids who have ADHD. It may be misidentified as social anxiety or depression. While the signs and symptoms of RSD overlap with symptoms of anxiety and depression, they differ in that they tend to appear quickly in response to something happening in the moment, they are very intense, and disappear within moments or hours. In a sense, they mirror the other emotional highs and lows that many children and teens with ADHD experience throughout the day.

How can you help your child with RSD cope? Try these strategies which can help your child become mentally and emotionally stronger.

Help your child look situations differently.  If your child’s friend is playing with someone else and can’t come over, your child might see it as rejection.  Help your child understand that it could be that child called first to play.  It doesn’t always mean your child lost a friend.

Share stories about rejection and overcoming it. Michael Jordan was cut from the HS basketball team, yet went on to have one of the most successful professional sports careers. Share you own experiences of being rejected and what you did to overcome it.

Teach resilience. Help your child come up with a plan to move on. for example, if your child wasn’t chosen for basketball, find another activity to focus on. If your child’s friend cancels plan’s, call another friend to come over. Any future setbacks will be easier with a plan in place.

There is no single treatment that specifically targets RSD in kids with ADHD, but a combination of cognitive behavioral therapy, parent training and classroom behavior plans that emphasize positive feedback and minimize negative consequences can help. If you suspect that your child is struggling with RSD and it is taking its toll academically, talk with a therapist or school counselor. Treating the symptoms of RSD as early as possible can help minimize the long-term impact on your child’s mental and emotional health and their relationships with family and friends.  

While sports participation is a definite win for kids with ADHD, it can be difficult for coaches to know how to support a child with ADHD during practices and games. Unfortunately, most coach development programs provide little or no training on coaching kids with ADHD. As a result, parents often find themselves in the position of having to advocate for their child to make sure they are fully included in practices and games. Fortunately, the same behavior management strategies that work for kids at home and at school also work during practice and games. Here are five simple strategies that coaches can use to support kids with ADHD:

• Keep instructions brief and simple. Kids with ADHD can only hold one or two instructions in their mind at a time. In general, the less time kids with ADHD spend listening to instructions and the more time they spend moving and playing on the court or the field the better they will do during practice.
• Praise and reward positive behavior. Name three positive behaviors that you want to see during every practice or game. Be very specific when describing these behaviors, and have the child repeat the description back to you so you can confirm that they understand. Review these behaviors at the start of each practice or game and praise the child often when you see them meeting the expectations. You can also consider giving the child points for ‘good behavior’ throughout practice along with a reward when they reach a predetermined point goal.
• Set kids up for success. Look for things that consistently lead to higher levels of inattention or disruptive behavior and plan to intervene before the problem starts. For example, separate the child from problematic teammates, minimize the amount of time they spend playing certain positions, rotate positions often if the child loses interest or motivation, provide frequent water and snack breaks (hunger and dehydration make ADHD symptoms worse), etc.
• Provide individualized attention whenever possible. With many kids to coach on a team, it can be hard to carve out one-on-one time with a child. But even small amounts of individualized coaching can go a long way for kids with ADHD. Small doses of one-on-one coaching can help kids understand instructions more clearly, can help them feel more connected with their coach, and can help coaches develop a better understanding of the child’s needs.
• Use negative consequences sparingly. Negative consequences are only truly effective when they are used sparingly and in combination with positive consequences (like rewards and praise). So, reserve the use of negative consequences/punishment for unsafe or highly disruptive behaviors.

When coaches and parents work together, kids with ADHD can succeed during practices and games. So, when your child starts with a new team, introduce yourself to your child’s coach right away. Let them know that your child has ADHD and share the strategies that work best for them. Coaches are often happy to have this information, and if the coach doesn’t respond well then it may be a sign that they aren’t the right fit. As a parent you know your child better than anyone. When you partner with the right coach you can create a positive sports experience that will allow your child to thrive.

For children with ADHD, these activities also teach important social skills that can help strengthen their relationships with classmates and friends. When the after-school activities involve sports, they also provide an outlet for the physical activity that many children with ADHD crave and need. On top of this, for many children, scoring a goal or landing a role in a play can be the confidence boost they need—especially if they are struggling academically. So how do you support your child’s interest in extracurricular activities? Here are a few tips:

1. Create a calendar. Many children with ADHD struggle with organization, but staying organized is essential when you’re working with a tight after-school schedule and competing priorities. Be a role model for your child and begin teaching organizational skills that will help them throughout life. Start by posting a calendar at home that shows both your child’s homework assignment deadlines and after-school activities (practice, games, performances, etc.). Involve your child in updating the calendar every time a new event or deadline needs to be added.
2. Schedule homework time. Set aside designated time for homework each day.  Your child already understands the concept of blocking out scheduled time for practice and games. Extend this same concept to homework, where dedicated blocks of time are scheduled in advance throughout the week. Add these time blocks to the calendar and remind your child that they need to fit homework into these slots in order to participate in all of the fun activities they also have on the calendar.
3. Plan proactively. When your child has a full schedule, there is less room wiggle room for cramming in last-minute assignments and study sessions. If a big test is coming up at the end of the week, help your child plan ahead and break test prep down into smaller chunks of time that they can fit into the pre-scheduled homework time blocks. Planning ahead is a challenge for many children with ADHD, so your child will need your help to learn this technique. It’s a good idea to get into the habit of helping them check the classroom’s online homework assignment system regularly so they are less likely to be surprised by an upcoming project deadline or exam.
4. Enlist a tutor. Learning centers are designed to teach children study skills that will help them get their work completed more efficiently and effectively. Look for centers like Huntington, where instructors are experienced in helping children with ADHD.
5. Make participation a privilege that comes with meeting homework goals. Participation in extracurricular activities can be a powerful motivator when participation is linked to reaching homework goals. Let your child know that they can only participate if they consistently complete homework and don’t miss assignments regularly. This can go a long way toward helping children with ADHD prioritize their assignments and cut out distractions when time is short. Note that the goals should be focused on homework completion (effort) rather than homework grades (performance). Children can control whether or not they get their work done, but they can’t always control the grade they receive. This is especially true for children with ADHD whose effort isn’t always reflected in their grades.

Balancing school and extracurriculars is more art than science, but it’s worth the time to find a balance that works for your family.

If research shows that behavior charts are effective, then why does it seem like so many children with ADHD don’t respond to them? Usually it’s because the charts weren’t designed with ADHD in mind. Children with ADHD need systems in place that specifically help them overcome their difficulties with motivation, organization and completing complex tasks. As a result, special attention needs to be given to the types of behavior goals that are included in behavior charts and the way that rewards are selected and provided when a child achieves those goals. The good news is that by following a few key guidelines, you can create behavior charts that will work for your child!

Behavior Chart Guidelines

1. Write clear and positive behavior goals. Your chart should communicate to your child exactly what they need to do to achieve their goals. Always write the goals in a way that tells your child what to do rather than what not to do. For example, “Sit down at the table and start your homework at 4:15,” is a much more effective goal than, “Don’t put off doing your homework when you come home from school.” The first goal sets your child up for success not failure.
2. Focus on behaviors that happen consistently and routinely. The most successful behavior charts are those that focus on routine behaviors – things that occur at roughly the same time and in the same order every day. Why? Because these behaviors can be easily tracked and expectations around how and when they should be completed can be made clear. Eventually, these can turn into habits that don’t require a behavior chart. Morning routines, evening routines, homework routines and even mealtime routines are great targets for behavior charts. Behaviors that occur randomly outside of these routine times like whining or arguing with siblings are less appropriate targets and are less likely to improve with a behavior chart. Try other strategies for these non-routine behaviors.
3. Break complex tasks down into smaller goals. Goals like, “Finish homework” or “Get ready for school on time” might seem perfectly reasonable to parents, but for children with ADHD, these goals represent a complex series of smaller tasks. So, if you list “Get ready for school on time” on a child’s behavior chart, there’s a good chance that your child will forget to do at least two or three important things in the morning. If they do get ready for school on time, it will only be because you provided multiple reminders or completed some of the tasks for them. To set your child up for success, break complex tasks down into the smaller steps that need to be completed each day and post the list in a visible place. A typical goal for a child with ADHD should actually be listed as four or five separate goals representing each of the activities included in the typical morning routine.
4. Choose goals that are within your child’s reach. Create behavior goals that you think your child could achieve at least 80% of the time. Goals should aim to stretch your child from the point they’re at right now, while still being within your child’s reach. This might mean that you focus on intermediate behavior goals that are a step in the right direction rather than the ultimate end goals that you want your child to achieve. For example, if you want your child to wake up on their own with an alarm clock, but they have never (or rarely) done this successfully in the past, then this behavior may be out of reach right now. A more appropriate goal would be to have your child get out of bed after you wake them up and provide just one reminder. When your child has mastered this goal, you can drop the reminder. Once your child is out of bed consistently right after you wake them up, then you can adjust the goal further and expect them to wake up independently when the alarm clock goes off in the morning.
5. Include no more than five behavior goals on the chart. Most children can handle only five behavior goals on a single chart. This can be challenging for parents, especially when there are so many areas where you’d like to see your child improve. Start by focusing on the highest-priority behaviors first. You can add new goals once your child has mastered the initial list. While it’s best to start out with a single behavior chart, you can eventually create different charts for different times of the day. For example, your child can have a morning routine chart and a homework chart. This helps keep any single list from becoming too overwhelming.
6. Provide consistent and frequent rewards that your child finds motivating. In behavior charts, rewards are just as important as behavior goals – especially for kids with ADHD who often struggle with motivation. It is important to provide rewards daily, since children with ADHD struggle to maintain motivation when rewards are delayed (although some children ages 10 and up can handle larger delayed rewards). In general, the more immediate the reward, the better. Rewards also need to be provided consistently when your child meets their goal, and rewards should never be given when they have not been earned. Always involve your child in creating a list of possible rewards. This will ensure that the reward options include things that your child finds motivating. Since children’s interests change so often, you should check in with your child frequently to make sure they are still interested in the rewards they are working to earn.

There are many reasons why a behavior chart may not have worked in the past, but that doesn’t mean that a behavior chart will never be a success with your child. In fact, most children with ADHD respond effectively to a well-designed behavior chart. Follow a few key principles of behavior-chart design and adjust the chart over time to match your child’s unique needs.

Accommodations are modifications to the classroom environment, instructional process, or assignments that help students with ADHD participate in school and show their understanding of class material. While the research evidence supporting the use of academic accommodations for ADHD is limited, I’ve seen many of my patients benefit when the accommodations are clearly matched to the student’s needs, are provided consistently, and are modified as needed based on how well the student responds.  

Classroom accommodations can be formally requested and implemented through the school’s special education services program, either through a 504 plan or an Individualized Education Plan (IEP). To learn more about these plans, check out my earlier post on the similarities and differences between IEPs and 504 Plans. Some teachers also provide these accommodations outside of a formal plan as part of their general teaching practices for students with ADHD. Regardless of whether the accommodations are provided formally or informally, open and consistent communication between parents and teachers is essential.

There is a wide range of accommodations available for students with ADHD, and these strategies typically cluster around completing tasks and maintaining focus, staying organized, and managing impulsive and hyperactive symptoms. Typical accommodations include:

Completing Tasks and Maintaining Focus

• Shortened assignments (particularly for assignments that require repetition, like math worksheets).
• Preferential seating in the front of the classroom to reduce distraction.
• Providing choices to show mastery (e.g., in writing, orally, via a hands-on project).
• Allowing frequent breaks.
• Providing clear instructions and checking in with the student to ensure understanding.
• Using a computer to complete essays and other writing assignments.
• Extended time on tests.

Staying Organized

• Using a simple, color-coded organization system for papers.
• Providing an extra set of textbooks that can be kept at home.
• Checking the student’s backpack to make sure all necessary materials are packed up at the end of the day and that homework is taken out of the backpack and handed in every morning.
• Weekly desk clean-outs.
• Minimizing the number of items in the desk, backpack and cubby.

Managing Impulsivity and Hyperactivity

• Encouraging frequent movement breaks.
• Praising and rewarding students for raising their hand before talking.
• Allowing students to move or fidget in a non-distracting manner.
• Providing extra opportunities for physical activity and refraining from taking away recess as a punishment.
• Providing a chair for students during circle time (or any time when students sit on the rug).

The first few weeks of the new school year are the ideal time to talk to your child’s teacher about the classroom accommodations that may benefit your child the most. Check out the CHADD website for this comprehensive list of classroom accommodations. Having the school psychologist observe your child in the classroom and recommend specific accommodations can also help identify the approaches that will benefit your child. Classroom accommodations aren’t a substitute for evidence-based interventions, but they are often a useful add-on that can help students with ADHD reach their full potential.   

The term ADD was used in the 1980s and early 1990s as a diagnostic label to describe individuals with impairing symptoms of inattention without any related hyperactivity or impulsivity. However, in 1994, the field of psychiatry dropped the ADD label and instead began using ADHD as an umbrella term that described everyone with ADHD, including those previously described as having ADD.

They also added ‘subtypes’ or ‘presentations’ to the disorder label. Today, a child with only symptoms of inattention (without significant hyperactivity or impulsivity) would receive a diagnosis of ‘ADHD – predominantly inattentive presentation.’  Relatedly, if a child has symptoms of hyperactivity and/or impulsivity with few inattention symptoms, then they would be diagnosed with ‘ADHD - predominantly hyperactive/impulsive presentation.’ And a child who is experiencing symptoms of both inattention and hyperactivity/impulsivity would receive a diagnosis of ‘ADHD – combined presentation.’  

The shift to the use of ADHD as an umbrella label for the disorder and the use of ‘presentation’ to describe the predominant symptom clusters was based on decades of research showing that ADHD symptoms often change over time. Hyperactive/impulsive symptoms may be extreme and impairing in young children, but they typically become less severe over time. By adolescence, these symptoms may appear primarily as restlessness, excessive talkativeness, and sometimes as impulsive decision-making.

Inattentive symptoms, in contrast, may not be apparent in younger children but often become more pronounced in the late elementary school, middle school, or high school grades. Therefore, the ADHD presentation that matches an individual’s symptoms in childhood may be different from the one that fits them best as an adolescent.

The shift to a single diagnostic label has also helped alter the misconception that ADHD is a disorder that only affects boys. ADHD is diagnosed more often in boys than in girls, but that doesn’t necessarily mean that girls are less likely to have ADHD. However, girls are less likely to have impairing symptoms of hyperactivity and impulsivity and are more likely to be diagnosed with the predominantly inattentive presentation than boys.

As a result, their ADHD is more likely to be overlooked or diagnosed later in adolescence or adulthood. These missed and delayed diagnoses have a negative impact on girls, who find themselves struggling to focus, stay organized, meet academic milestones, and maintain healthy friendships without access to the treatments that could help.

Evidence-based treatments for ADHD do not differ based on diagnostic presentations. Behavioral interventions delivered by parents and teachers, organizational skills and social skills programs, and medication are evidence-supported treatments for managing symptoms and impairments related to inattention, hyperactivity, and impulsivity. The intensity of treatments and the focus of the interventions may shift over time as a child’s symptoms change and as they encounter more challenging social and academic situations. With that in mind, it can be helpful to have your child’s doctor reassess their symptoms and impairments periodically to make sure that the focus of their ongoing treatments are matched to their current needs.  

1. Talk to your child about what they should expect when they return to school. It’s been a long time since your child was in a classroom full-time. Talk to them about what to expect when they head back to school by walking them through a typical school day, telling them about their teacher and classmates, talking about the kinds of activities they’ll be doing throughout the day, sharing information about what they’ll be doing after school each day, and describing COVID-19 mask and social distancing requirements.
2. Plan and practice your morning routine. Good school days begin with good mornings. Help your child start the school year off right by planning and practicing a morning routine that they can follow throughout the school year. For more information about creating a morning routine for kids with ADHD, check out my previous blog post on this topic.
3. Schedule a meeting with your child’s teacher as soon as possible. Schedule a brief meeting with your child’s teacher to discuss your child’s learning, organizational, and behavioral needs, as well as any classroom interventions and accommodations that may be available. If your child has an IEP or a 504 plan, then this meeting should be scheduled with the help of your school’s special education coordinator.
4. Consider your child’s social needs. Kids with ADHD need extra support to establish and maintain friendships with their classmates. This is particularly true this year when kids have spent so much time isolated from their peers. Enroll your child in at least one school-based extracurricular activity to create opportunities for bonding with classmates with shared interests. Also consider scheduling a playdate or two with a classmate that your child enjoys spending time with outside of school.
5. Optimize your child’s ADHD treatment plan. Check in with your child’s pediatrician, psychiatrist, and/or therapist to assess whether their current ADHD treatment plan is as effective as possible. As children mature, adjustments are often needed for medication and/or behavior management plans to maximize the impact of these treatments on ADHD symptoms.

Returning to school this fall is going to be a major transition for students, parents, and teachers. Taking steps to be proactive, plan ahead, and connect with your child’s teacher as early as possible will go a long way in helping your child have a positive start to the new school year.

Fortunately, over time, our understanding of ADHD has evolved. We now recognize that ADHD affects girls as well as boys, continues into adulthood for most individuals, and, in some cases, can present predominantly as symptoms of inattention and disorganization with little to no hyperactivity or impulsivity.

In recent years, there has been an increased focus among researchers and clinicians on the differences in the way ADHD shows up and is diagnosed in boys and girls. Being aware of these differences is important for parents and teachers who can help make sure that kids with ADHD can get the treatment they need as early as possible.

Differences in Rates and Age of Diagnosis
It is now widely acknowledged that ADHD is a disorder that affects girls as well as boys. Yet boys continue to be diagnosed with ADHD and referred for treatment at a much higher rate than girls, with estimates of the ratio of boys to girls with ADHD ranging from 2:1 to 13:1, depending on which study you consult. While these ratios suggest that ADHD shows up more often in boys, it may actually be the case that it shows up just as often in girls, but is less severe or less likely to be diagnosed in girls than in boys.

Differences in Symptom Presentation
Girls with ADHD are more likely to experience the symptoms of inattention and disorganization associated with ADHD, and are less likely to experience severe hyperactivity and impulsivity symptoms. In contrast, boys are more likely to have high levels of hyperactivity and impulsivity, as well as symptoms of inattention and disorganization. Since boys with ADHD tend to cause more disruption in the classroom because of their hyperactive and impulsive symptoms, they are referred for evaluations earlier and more often than girls with ADHD.

Differences in Rates of Co-occurring Mental Health Conditions
Disruptive behavior disorders, like Oppositional Defiant Disorder, are the most common mental health conditions diagnosed in kids with ADHD. However, these conditions are found at much higher rates in boys with ADHD than in than in girls with ADHD. In contrast, girls with ADHD are more likely to internalize their thoughts and feelings and develop anxiety and mood disorders. These internalizing disorders often go unnoticed by teachers and parents because they aren’t always accompanied by challenging or disruptive behavior.

Differences in Social Difficulties
Most kids with ADHD experience some challenges with making and maintaining healthy friendships, but the challenges often look different between boys and girls. Boys with ADHD may struggle because other kids find their hyperactivity and impulsivity too intense. Classmates and friends may actively avoid and exclude boys with ADHD from group activities. In contrast, girls with ADHD who have few hyperactive or impulsive symptoms may have difficulty initiating conversations with other kids. They may hang back and behave passively in group settings, have a hard time picking up on subtle social cues, and struggle to understand complex social interactions. As a result, they may be overlooked or ignored by their peers, and feel left out or different without understanding why. 

Differences in Efforts to Hide or Mask ADHD Symptoms
Boys with ADHD struggle in academic and social situations, but they often don’t go to great lengths to hide their symptoms. This is probably due largely to the fact that as a society, we tend to take a ‘boys will be boys’ attitude toward their behavior and academic performance. As a result, their symptoms are obvious to their teachers and parents.

In contrast, girls with ADHD also struggle in academic and social situations, but often go to great lengths to mask their symptoms. As teenagers, they may become perfectionistic to compensate for their organizational difficulties, or they may spend hours taking notes and preparing for a test just so they can perform as well as their peers who only studied for a fraction of the time. They may also work hard to fit in with their classmates by closely observing and copying their behavior. While these strategies may make it harder for others to notice a girl’s ADHD symptoms, they can contribute to the development of anxiety and depression.

While there are many differences between boys and girls with ADHD, there are similarities as well. Both struggle to pay attention, stay organized, and keep up academically and socially with their peers. Early diagnosis and treatment are extremely valuable for both boys and girls with ADHD, and effective interventions can improve their symptoms at school and at home. If you think your child is showing signs of ADHD, reach out to their pediatrician to learn about ADHD evaluation and treatment options in your area.

What do reading problems look like in kids with ADHD?
Some of the more common reading problems in kids with ADHD are related to reading fluency, including skipping over words, sentences, and punctuation, rushing through the material, and losing track of their spot on the page.

Problems related to reading comprehension include missing details in the text, having difficulty making important connections, struggling to remember what they just read, and having a hard time identifying the main idea.

How do ADHD-related reading problems differ from learning disorders like dyslexia?
Children who have a learning disorder that affects reading, like dyslexia, have reading challenges that look a bit different from what we see in ADHD. These include difficulty identifying similarities and differences between words, struggling to sound out unfamiliar words, reading very slowly, frequently failing to recognize words that should be easy and familiar, and difficulty with spelling.

It’s possible to have both ADHD and a learning disorder that affects reading. In fact, reading disorders, like dyslexia, and ADHD co-occur frequently, with 25%-40% of children with one disorder meeting criteria for the other. Kids who have both conditions require separate interventions for ADHD and their learning disorder.

Why does ADHD often lead to reading problems?

ADHD can make it harder to learn how to read, and it can also make it harder to acquire new information through reading. Here are some of the typical ways that ADHD symptoms interfere with reading:

• Poor focus or difficulty with sustained attention. When a child with ADHD reads, it can be hard for them to keep their thoughts focused on the words on the page. As a result, they lose their place, miss words or paragraphs, and have a harder time retaining information.
• Difficulty sustaining mental effort. Kids with ADHD struggle to stay motivated and mentally engaged when they are reading something that isn’t interesting to them. While everyone struggles with this to a certain extent, for kids with ADHD, this difficulty is extreme. When the content isn’t interesting, they struggle to get their brains to “click into gear.” As a result, they find reading so boring and aversive that they will do just about anything to avoid it.
• Rushing through their work. Kids who repeatedly rush through their written schoolwork are also likely to rush through their reading material. This is usually due to a combination of impulsivity and a desire to ‘escape’ a mentally boring task. When they read too quickly, they skip over words, sentences, and punctuation, miss important details, and struggle to recall what they just read.
• Poor working memory. Working memory is a cognitive function that allows us to keep track of multiple pieces of information at one time and draw connections between details. Many kids with ADHD have working memory impairments, and these can make it more difficult for them to identify the main idea in a story or paragraph, recall the details of what they just read, and connect what they are reading now with something they’ve read in the past.

Helping kids with ADHD improve their reading skills requires a two-pronged approach that includes 1) treating the underlying ADHD symptoms, and 2) providing individualized reading instruction, like the services offered through Huntington Learning Center. In addition, it is recommended that kids with ADHD who are not meeting grade-level expectations in reading receive a learning evaluation to determine whether they also have a learning disorder.

Reading problems can have a profound negative effect on a child’s ability to succeed at school. If you are concerned about your child’s reading, don’t wait to get help. With the right support, all kids with ADHD can develop the reading skills they need to succeed.

Complicated time management-oriented solutions typically aren’t designed with ADHD in mind, and as a result, they may be too complicated or detail-oriented for teens with ADHD to use daily for an extended period of time. The most successful time management solutions for teens with ADHD are those that are simple enough to use day after day all year long.

Here’s a list of 10 simple time management strategies that your teen can start using right away to help improve their time management abilities.

1. Write everything down. Many time management problems for teens with ADHD start with the fact that they simply forgot to write down important details about tests or assignments. Even if the information is supposed to be provided by their teacher online, encourage your teen to write down the information themselves during the school day to make sure they capture the important details
2. Use a calendar to record the dates of tests, assignments, and after-school activities. If your teen is using a notebook to record their assignments, then they will need to manually copy this information into a calendar. If they’re using an app or website to make their lists, then help them find one with a digital calendar integration. For example, the produivity app Trello allows you to enter a due date whenever you add an item to your list. Then it can automatically add the event details to your Google calendar.
3. Prioritize assignment lists at least once a week. A list of assignments is not very helpful if it’s not prioritized. Help your teen use a simple system to prioritize the things they ‘have to do,’ ‘want to do,’ and ‘can do later.’ Pick one day each week when you and your teen can review the list together, assign a priority to each item, and then rank the items on the list in terms of importance and urgency.
4. First do what you need to do, then do what you want to do. Teens with ADHD often have a very difficult time stopping an activity that is fun and engaging so they can start a more boring or mentally taxing task. In addition, they are more likely to suffer from mental fatigue as the day goes on, making things like homework even more difficult later in the evening. So, encourage your teen to finish the things they need to do before they start doing the things they want to do.
5. Write down the amount of time you expect each task or assignment will take to complete. Ask your teen to write down the amount of time they estimate it will take them to complete an assignment. Have them note the estimated time either when they add the assignment to the list or when they are prioritizing their list. Then have them use a timer to figure out exactly how much time they actually spent on the assignment. When they see the differences between their estimated times and their actual times, they’ll adjust their own expectations and will become more accurate in their predictions over time.
6. Break down big projects into smaller chunks. Help your teen break big projects down into smaller, more discrete tasks and add these individual tasks to their list and calendar. Projects are much less overwhelming when they are tackled one step at a time.
7. Don’t wait to get started! The longer your teen waits to start a project or assignment, the more overwhelming the task becomes and the harder it is to get started. So, encourage your teen to get started quickly and commit to spending at least ten minutes on the assignment at first. Simply making a dent in the assignment will build their confidence, and they will find it much less overwhelming when they return to finish the task.
8. Minimize Distractions. When a teen has ADHD, it’s very easy to get distracted by almost anything, especially anything with a screen. So, help your teen create a homework environment with minimal distractions. This can include installing website and app blockers on computers and phones as well as minimizing noises and activity in the homework space.
9. Take breaks. Teens with ADHD need mental breaks while they’re working to avoid losing focus and wasting time. So, help your teen use a timer and plan five-minute breaks every 20 or 30 minutes. During these five minutes, your teen should do something unrelated to their work. They can get up and stretch, get something to eat or drink, shoot hoops with a Nerf ball in their room, play with the dog, and so on. Ideally, they should do something active and avoid anything that will cause them to lose track of time (which is probably just about anything that involves a screen!).
10. Build-in rewards. Teens with ADHD need feedback and rewards to stay motivated. Unfortunately, most school assignments and exams come with very delayed gratification in the form of a (hopefully) strong grade that reflects your teen’s hard work and effort. So, help your teen stay motivated by using more immediate rewards. These can be simple things, like playing video games after they have finished their work for the day. Or it can be a larger reward that they earn by completing every item on their list for a certain number of days in a row. In most cases, it’s helpful to have parents involved in handing out the rewards since even the most earnest teens will be tempted to reward themselves even when they haven’t really earned it.

Learning to use new time management skills and strategies takes time. It’s best to start small, with just one or two strategies that address your teen’s biggest time management weaknesses. Then, once your teen has mastered those strategies, you can add some additional tools and skills that will help them be even more productive and in control of their time. With patience and practice, your teen will learn new life-long time management skills that will be helpful now and in the future.

All teens struggle at times to manage competing activities, commitments, and assignments, but many teens with ADHD have severe time management problems that go beyond what most at their age experience.

These difficulties with time management can cause significant anxiety and stress for the teen throughout the school year.

They can also contribute to conflicts with parents, who find themselves in the position of ‘nagging’ their teen or helping to pick up the pieces when they repeatedly miss assignment due dates, stay up all night to finish projects at the last minute, and forget about after-school appointments or commitments.

Fortunately, time management skills can be learned by just about anyone, including teens with ADHD. The trick to time management and ADHD is avoiding one-size-fits-all time management “solutions” and instead relying on a few simple strategies that address the biggest time management hurdles that they face every day. Before you know which strategies to use, you need to first have a clear understanding of your teen’s core time management weaknesses.

Time management skills overlap with the executive functioning skills that we rely on for planning, organizing, and executing tasks in a timely manner. Executive functioning deficits are extremely common among teens with ADHD and overlap with many ADHD symptoms. So, it’s not surprising that teens with ADHD struggle with time management.

Our ability to manage our time well is also heavily influenced by emotional factors, like anxiety, motivation, and self-confidence. It can be much harder to prioritize getting a boring or anxiety-provoking task completed when there are so many more engaging or less stressful things we could do with our time.

The main issues underlying time management problems can be different for every teen, so look at the list of common problems below and make a note about those that seem to be most relevant for your teen with ADHD:

• Difficulty keeping track of assignments and due dates or remembering what they have on their schedule after school. Forgetfulness and difficulty keeping track of things are core symptoms of ADHD and can make it very difficult to use many more complex time management strategies.
• Feeling overwhelmed by larger projects or multiple assignments. ADHD symptoms and executive functioning challenges can make it difficult for teens to break large projects or long assignment lists down into more manageable chunks. So, it’s common for teens with ADHD to regularly feel overwhelmed by a typical academic workload.
• Losing track of time, which leads to spending too much time on a single assignment without leaving enough time to finish everything else on their list. Research has shown individuals with ADHD have weaknesses when it comes to noticing or experiencing the passing of time. So, when a teen with ADHD is surprised to see that a full hour has gone by since they started working on an engaging assignment, it might be because to them, it felt as though just 10 or 15 minutes had passed.
• Difficulty estimating the amount of time it will take to complete an assignment or task. Being able to accurately estimate the amount of time it will take to complete a task is actually a sophisticated skill, and one that is difficult for many teens with ADHD to master. Since they may not feel the passing of time accurately and may not have paid attention to how long it has taken them to complete similar tasks in the past, they may underestimate the amount of time they will need for the upcoming assignments on their list.
• Difficulty stopping a fun or engaging activity on time. Many teens with ADHD have a very difficult time stopping what they’re doing at any given moment, especially if it is something they enjoy. This is true even if they need to get out of the house on time or need to get started on an important school assignment.
• Difficulty staying focused while doing their homework or studying. Difficulty with focus and concentration for long periods of time is a hallmark symptom of ADHD. It’s not surprising that high levels of distractibility make it harder to get things done on time.

Spend some time thinking about which of these challenges are the biggest source of stress for your teen. Better yet, share the list with your teen and ask them which items they identify with the most. In my next post, I’ll share some simple strategies that can help your teen solve their biggest time management challenges, leaving them less stressed and more in control of their schedule and their time.

Fortunately, it is possible for kids with ADHD to have successful virtual playdates. To make this happen, they need support and structure from their parents just as they would if they were going to have successful playdates with their friends in person. In fact, most of the strategies that help things go smoothly during typical playdates also apply to virtual playdates – with a few adjustments, of course!

Five Tips for Virtual Playdate Success:

1. Keep it short. Short playdates are often the most successful playdates for kids with ADHD. This is true for in-person playdates and virtual playdates, especially when the friend isn’t someone who they’ve had many virtual playdates with before. So, start small with a 15- or 20-minute playdate and work up to longer playdates over time if things are going well.
2. Plan an activity. Kids with ADHD need structured activities to keep them engaged and connected during virtual playdates. Activities that allow for collaboration rather than competition are ideal, like Mad Libs or ice-breaker games like Would you Rather. Competitive games can work well too, as long as they are short and relatively simple. This list of online board games includes some great options for shorter playdates.
3. Coach your child how to start and end the virtual playdate. Kids with ADHD often need to be taught specific skills for welcoming their friend to a virtual playdate and for saying goodbye at the end. Role-play the start of the playdate and the end of the playdate with your child. For example, you can say to your child, “When Mira comes on the screen, you can say, ‘Hi, I’m so glad to see you!’ Then after she responds, you can tell her about the three activities we talked about and ask her which one she’d like to do.”
4. Hit pause if you need to. One of the best things about virtual playdates is that if things aren’t going well, you can easily turn off the audio and the video for a minute while you help your child reset. For example, if the kids aren’t engaging with each other, let the friend know that your child will be back in just one minute, then pause and give your child some ideas for conversation starters or a new activity. Conversely, if things are getting out of hand, you can take a pause and help your child calm down before restarting the playdate.
5. Give positive feedback. Notice the things your child is doing well, and when the playdate is over, praise your child for their success. Ask them what they enjoyed about the playdate and what they’d like to do the same or differently next time. If something didn’t go well, you can make a mental note about this as well and use the information to make some adjustments for the next playdate. But if the playdate went reasonably well, hold off on giving any negative feedback to your child now and let the experience end on a high note!

Test anxiety is actually a form of performance anxiety. It’s similar to the anxiety that someone might experience when they’re giving a speech or performing onstage. In the case of test anxiety, the symptoms occur when someone is preparing to take a test and is worried about their ability to perform well. These worries are part of the four symptom clusters that characterize test anxiety:

• Emotional symptoms: excessive worry about performance, feeling helpless, negative self-talk
• Behavioral symptoms: difficulty sitting still, fidgeting, trouble sleeping
• Physical symptoms: increased heart rate, upset stomach, shallow or rapid breathing, muscle tension
• Cognitive symptoms: difficulty concentrating, racing thoughts, mind going blank or difficulty recalling information

There are many different factors that contribute to test anxiety. These can include catastrophic thinking (e.g. “If I fail this test, I’ll never graduate.”) or perfectionistic tendencies, poor performance on past tests, a lack of test preparation (e.g. cramming, poor study habits), and a lack of self-confidence. In the case of students with ADHD or learning differences, poor working memory is also a contributing (and often overlooked) factor.

Working memory is the ability to hold information in our mind, work with it in some way, and then recall the information when it’s needed. ADHD, some learning differences, and anxiety are all associated with lower working memory capabilities. When anxiety is at its peak, working memory abilities are even more impaired, causing a student to feel as though their mind has gone blank or like they can only recall the most basic information related to the test topic.    

Test anxiety can feel overwhelming, and it can cause students to feel powerless and hopeless. Fortunately, with the proper tools and support, test anxiety can be managed very effectively. Students with test anxiety, and especially those who also have ADHD or a learning difference, will need support from a therapist, school counselor, or learning specialist to learn new emotional, cognitive, and academic skills and strategies.

The counselor or therapist should help the student learn study skills that emphasize breaking down big tasks into smaller chunks that are spread out over time, teach strategies (drawn from cognitive behavioral therapy) for noticing and challenging self-defeating thoughts and worries, help practice relaxation and mindfulness techniques for reducing the physical symptoms of test anxiety, and encourage healthy sleep and eating habits.

Test anxiety is a very real problem for many kids and teens with ADHD or learning differences, and it’s not likely to get better on its own. If you think your child is struggling with test anxiety, reach out to a school counselor, therapist, or learning specialist for help. With the right support, your child’s test anxiety will go down over time and their test scores will go up in the process!

At school, students are navigating complex social situations, dealing with noisy and crowded hallways, following their school’s COVID-19 social distancing protocols, adjusting to their teacher’s in-person learning style, and keeping track of their supplies, assignments, and belongings in a crowded classroom. It’s not surprising that many students are experiencing anxiety when they return to school. Fortunately, there are many things parents can do to help students manage their anxiety and worries.  

• Accept and acknowledge your child’s feelings. Everyone feels anxious sometimes, and it’s normal for your child to feel some anxiety under the current circumstances. Encourage them to talk to you about their feelings. Listen to what they have to say and empathize with them. Avoid minimizing or dismissing their feelings by telling them that there’s nothing to worry about or that everything will be fine. This type of response can cause kids to shut down or make them feel like their parents don’t understand.
• Listen for clues about what is driving your child’s anxiety. Children feel anxious about school for many different reasons. Some are anxious about being separated from their parents or being away from home all day. Others are experiencing social anxiety, and some feel more general anxiety about going into a situation that feels unknown and unfamiliar. When you have a sense of the things that are driving your child’s anxiety, you’re better equipped to help them deal with it.
• Teach your child about anxiety. Anxiety is less frightening when kids can identify it and have a strategy for managing uncomfortable thoughts and feelings. Most children don’t know how to recognize the signs of anxiety, like tense muscles, “what if” thoughts, or butterflies in their stomachs. Teaching them how to recognize these signs and a brief mindfulness strategy that they can use in response, like slow breathing or visualizing a happy place, can help children feel more in control of their anxious feelings. There are many great books that teach children about anxiety, including:
  • Find Your Calm: A Mindful Approach to Relieve Anxiety and Grow Your Bravery by Gabi Garcia
  • A Little SPOT of Anxiety: A Story About Calming Your Worries by Diane Alber
  • CBT Workbook for Kids by Heather Davidson, PsyD
  • The Worry Workbook for Kids by Muniya Khanna, PhD and Deborah Ledley, PhD
• Encourage involvement in extracurricular activities at school. When students participate in activities they enjoy, they’ll have more opportunities to make friends with students who share their interests, and they’ll have something to look forward to as they head off to school each morning.
• Celebrate their success. When your child has been brave and has had a ‘good day’ at school, let them know that you’re proud of them. Consider planning a fun activity for the weekend to celebrate their success at school during the week.

While some mild or moderate school anxiety is normal, there are times when a child’s anxiety becomes more severe and requires treatment from a mental health professional. Signs that your child may need treatment for their anxiety symptoms include:

• Anxious thoughts or physical symptoms, like frequent stomachaches or headaches (without a medical cause), that cause your child to refuse to attend school or make it extremely difficult for you to get them to school each day.
• Difficulty falling asleep or staying asleep most nights.
• Difficulty participating in academic or social activities during the school day.

Your pediatrician or school counselor should be able to recommend a mental health provider in your area who treats children who are struggling with anxiety. Therapy for anxiety disorders in children is highly effective, so don’t hesitate to seek treatment if your child is struggling.

Reading skills are essential for academic success, and kids who struggle to read risk falling behind in math, science, history, and writing. Reading problems in kids with ADHD can also contribute to conflicts at home as parents struggle to determine whether their child’s reluctance to read is due to poor motivation, willful defiance, or lack of ability.

Fortunately, there are many effective strategies for improving reading skills in kids with ADHD. The first step is a learning evaluation, either conducted by the school or privately by a learning specialist or psychologist. This evaluation will assess a variety of reading-related skills, like fluency, phonemic awareness, sight word recognition, comprehension, and even spelling.

A report will be generated upon completion of the evaluation that outlines your child’s reading strengths and weaknesses. When a severe and specific pattern of weaknesses is identified, then a reading disorder diagnosis will be assigned. Typically, students with a reading disorder diagnosis qualify for an Individualized Education Plan (IEP) at school and will receive interventions matched to their learning needs.

Often, a child with ADHD will have relatively mild weaknesses in a variety of reading-related skills and won’t meet criteria for a specific reading disorder. This doesn’t mean that their reading struggles aren’t real, or that they should just “try harder.” Instead, it means that for this child, it’s the combination of reading skill weaknesses and ADHD symptoms that is interfering with their ability to meet grade-level expectations.

In these cases, reading difficulties may be more subtle, but the child’s resistance to reading may be quite high. Even when a child with ADHD is not diagnosed with a reading disorder, the results from an academic evaluation are still very important. A thorough assessment will pinpoint exactly which reading skills are weak and will explain how a child’s ADHD symptoms and difficulties with motivation are affecting their reading development.

With this knowledge in hand, parents, teachers, and specialists can identify strategies and services that are tailored to an individual child’s learning needs. Extra support through school-based instruction and after-school learning, as well as tutoring programs (like those offered at Huntington Learning Centers), can help kids with ADHD develop the specific skills they need to succeed at reading.

For parents, there are many steps that can be taken at home to encourage kids to read and reduce reading resistance.

1. Read to your child. Even kids who do not like to read enjoy having someone else read to them. Reading to your child can help improve their skills, especially when you have your child read along and ask your child to share their predictions and observations about the story.
2. Take turns reading. If your child resists reading, offer to take turns reading aloud with them. For young children, this might mean that they read one word or sentence, and then you read the next word or sentence. For older children, you can alternate paragraphs.
3. Supplement with skills practice on reading apps. Studies suggest that kids with ADHD may benefit from practicing their reading skills using computer-based reading programs. Bluster is a fun vocabulary-building app, Montessori Crosswords is great for learning phonics, and Mad Libs can be a fun way for kids 4th grade and up to practice vocabulary and reading comprehension.
4. Help your child explore websites about topics that they enjoy. Exploring interesting websites can be a great way for kids to practice reading without even realizing they are building new skills! Sit with your child and ask them to share what they are learning as they read. This will improve their comprehension, and you’ll be sure they are not skipping the text and only looking at pictures.

With support and practice, kids with ADHD can become strong readers. If reading is a struggle for your child, don’t wait to get them help.  Research shows that kids with reading difficulties do best when they receive interventions early. So, talk with your child’s teacher, enroll them in an after-school program, and/or schedule an academic evaluation as soon as possible.

As more and more schools return to in-person learning and extracurricular activities begin to resume, opportunities for spending time with other kids are increasing. While this slow return to ‘normal’ will be essential for combatting loneliness, many kids with ADHD will need extra support to truly reconnect with classmates and friends.  

The pandemic has affected everyone in unique ways, but for kids with ADHD whose social skills lag behind those of their peers, the pandemic may have further widened the skills gap, which will make it even more challenging for them to keep up as social activities return to normal. This may mean that they will have a more difficult time reading social cues, initiating conversations with other kids, or joining ongoing activities or conversations in a way that isn’t seen as either too passive or too intrusive. Kids who struggle with depression or anxiety in addition to ADHD may find that they don’t feel motivated to seek out other kids or enjoy the time they spend in social situations.

As a parent, it can be incredibly hard to see your child struggling in their friendships. Fortunately, when you are aware of your child’s struggles, you can plan ahead and provide the support, structure, and opportunities that will help them succeed.

• If your child is showing signs of anxiety or depression, get treatment as soon as possible from a therapist who provides evidence-based treatments, like cognitive behavioral therapy (CBT). Likewise, if you think your child’s ADHD is severely interfering with their ability to make or maintain friendships, then seek out a therapist who specializes in ADHD and/or social skills.
• Enroll your child in structured extracurricular activities. Kids with ADHD need structure in order to successfully navigate social situations and connect with their peers. Extracurricular activities not only provide this structure, they also provide an opportunity for kids with ADHD to develop their talents while connecting with other kids who share their passions and interests.
• Start with online options if it’s not yet safe for your child to start participating in in-person activities. These online activities might not be quite as engaging or potent as their face-to-face counterparts, but they will still provide opportunities for engaging with other kids virtually and for pursuing interests outside of school. There are many options available online.
• If your child is not receptive to a parent’s suggestions related to friends or social activities, then consider having your child work with a counselor at school or a therapist outside of school. Often, older kids are more willing to try new social activities when someone other than a parent is guiding them through the process.
• When thinking about your child’s friendships, focus on quality over quantity. Having one or two close friends is all it takes for many kids to have the social life that they need. A bigger social circle can be great too, but not at the expense of having a close friend who your child truly connects with.
• Encourage your child to schedule one-on-one activities with kids they would like to reconnect with, or kids they would like to form new friendships with. For elementary and younger middle school kids, this will likely mean that you as a parent will need to be very involved in initiating and planning the activity or play date. For older children, this will mean helping them figure out when, where, and how the activity will occur, and the steps they should take to invite their friend to join them. And if it seems like your child might not welcome your help, then this could be a good time to involve a therapist or other trusted adult in the process.

As the pandemic slowly winds down and in-person activities begin to resume, kids with ADHD will need extra support from parents and teachers to fully reengage in social activities and reconnect with friends and classmates. Fortunately, with the right support and structure in place, kids with ADHD can succeed socially and form the strong friendship bonds that they deserve.

In the videos and podcasts below, from sources like the Harvard Business Review, Understood.org, the Attention Deficit Disorder Association, and the Child Mind Institute, successful adults with ADHD talk about the challenges they faced growing up, and how as adults they have learned to use some of their ADHD traits to their advantage. All of these adults struggled at times, particularly when they were kids or teens, but they persevered and ultimately achieved success. Listening to these stories allows children and teens with ADHD and their parents to hear firsthand that the difficult times do in fact pass, and success is possible in the long run.

Podcast: Succeeding with ADHD
A military pilot, an entrepreneur, and a business professor discuss the professional struggles and strengths that come from their ADHD.

Video: Race Car Driver Dusty Davis on Growing Up with ADHD
Hear Dusty’s story (and his parents’, too) on the challenges of growing up with ADHD, the techniques they used to help him succeed, and how his ADHD continues to influence his daily life as an adult.

Video: The Journey From a Student With Dyslexia and ADHD to a Special Education Teacher
Anya, a special education teacher who was identified with dyslexia and ADHD in elementary school, talks about the support she received as a child that allowed her to become a teacher and advocate for kids with ADHD and learning disorders today.

Video: Celebrity Chef with ADHD Wants to Inspire Others
Chef Jennifer Herrera describes growing up with ADHD and her road to becoming a celebrity chef.

Video: My Younger Self Campaign
As part of the #MyYoungerSelf campaign, many prominent people have made videos sharing their personal experiences about growing up with mental health and learning disorders. The actors, athletes, and authors listed below all talk about growing up with ADHD.

• Zoe Saldana
• Mark Ruffalo
• Michael Phelps
• Katherine Ellison
• Jessica McCabe
• Ty Pennington
• Michelle Carter
• Chloe Bennet

There are plenty of strategies that parents can use to help their kids get motivated and stay engaged in school. I’ve shared many of these strategies in previous posts, and they can be real game changers when they’re used effectively. But sometimes before jumping into action, it can be important for parents to stop and consider the types of thoughts they are having about their child’s difficulties – and how these thoughts might be adding an additional layer of stress to the situation.  

When your child has ADHD, it can often feel like their behavior or academic performance at any given moment will make or break their likelihood of success in the future. It’s incredibly common for parents to have thoughts like, “My child can’t even focus on what the teacher is saying for five minutes, so how is she ever going to be able to sit through a lecture in college?” or “My child is late for everything and it doesn’t even seem to bother him. He’s never going to be able to hold down a job.” While these kinds of thoughts are perfectly normal, they aren’t helpful. They can make situations feel much more dire than they actually are and can cause you to lose sight of the big picture.

In cognitive behavioral therapy, the term catastrophizing is used to describe thoughts that take a difficult current situation and use it to predict things that may go terribly wrong in the future. Catastrophizing can make you feel hopeless and overwhelmed by everyday events. The good news is that when you change these thought patterns, you can actually improve your mood, feel more optimistic about the future, and start taking steps that will actually help improve a situation at the moment when it is happening.

So, how do you stop catastrophizing (or at least make it something that you do less often)? Start by noticing these thoughts when they happen. Many negative thought patterns are so automatic that we don’t even notice how frequently they occur. You might be surprised to realize how often you’re catastrophizing throughout the day.

Once you’ve started noticing these thoughts, the next step is to reframe them from something negative and future-oriented to something realistic and focused on the present moment. For example, if you have the thought, “My child is late for everything and it doesn’t seem to bother him. He’ll never be able to hold down a job as an adult,” you might reframe it into something more helpful like, “My child’s ADHD makes it hard for him to get places on time on his own, but with help from me and other people in his life, he is able to be on time for the things that are important. He has many years to mature and find strategies that work for him before he becomes an adult with work responsibilities.”

Reframing a negative thought doesn’t mean pretending a problem isn’t real. It just puts the problem in perspective and encourages you to focus on the present moment instead of a “worst case scenario” future.  When you work on reframing your negative thoughts consistently, you’ll find yourself catastrophizing less often over time. And, when you catastrophize less, you’ll be able to use tools and strategies more effectively to help your child manage their ADHD now and in the future.

A new survey from Nationwide Children’s Hospital shows that parents are increasingly worried about the long-term mental health effects of the pandemic. According to the survey, 66% are worried that their children’s mental health will suffer even more as the pandemic continues this winter, and 57% say they are running out of ways to keep their kids positive. Research from across the globe shows that kids with pre-existing mental health challenges, like ADHD, are among those at the highest risk for anxiety and depression during COVID-19.

While it’s not possible for parents to completely prevent pandemic-related mental health difficulties among kids with ADHD, there is a lot you can do to decrease their risk of anxiety and depression.

• Manage your own stress. Whenever we are on an airplane, we are reminded that in the event of an emergency, we should put an oxygen mask on ourselves first before we put oxygen masks on our children. This principle applies to our everyday parenting now more than ever. We all need to help ourselves first in order to be able to effectively help our children. Multiple studies have shown that when parents lower their own stress and anxiety, their child’s anxiety decreases as well. So, do whatever you can to get the support you need from friends, family members, and therapists.
• Stay connected with your kids. All parents are overwhelmed right now, and when we are busy keeping so many balls in the air, it’s easy to become emotionally disconnected from our children. Kids are craving closeness with their parents now more than ever, but they often don’t know how to ask for what they need. Instead, they act out and do things that are destructive or annoying to get our attention. Spend a few minutes each day (or every other day) talking to your child about how things are going for them. They may not open up right away, but over time, they’ll eventually start chatting. Conversation-starters, like these from #onoursleeves, can help get the conversation moving.
• Monitor ADHD symptoms and adjust treatments as needed. Your child’s ADHD treatment needs may change both in terms of medication and behavioral interventions. If your child’s ADHD symptoms seem to be worsening, or their ADHD treatments don’t seem to be as effective as they once were, don’t wait to see if things will improve on their own. Reach out to your child’s doctor quickly and request a review of your child’s treatment plan.

Watch for signs of anxiety and depression and act quickly if they show up. Monitor your child for signs of anxiety and depression. Depression is typically characterized by increased sadness or irritability, a loss of interest in things a child typically enjoys, and changes in eating or sleeping habits. Anxiety can show up as increased worries or fears, but it can also be tricky to spot in kids with ADHD. Check out my earlier post on this topic to learn more about the signs of anxiety in kids with ADHD. If you see any of these symptoms lasting a week or more, reach out to your child’s pediatrician or mental health provider to request an appointment.

Since the start of the COVID-19 pandemic, there are more support groups available online than ever before. This includes virtual support groups moderated by professionals, parent training courses taught by coaches or therapists, and moderated social networking groups. Finding the group that is the right fit for your needs might take a little legwork, but the list of resources below will give you a jumpstart and should help make the process relatively quick and painless. 

Virtual Support Groups

• Attention Deficit Disorder Association (ADDA) Virtual Support Groups: ADDA offers a collection of fantastic virtual support groups, one of which is focused specifically on parenting children with ADHD. The parenting support group includes practical strategies along with encouragement and support from other parents coping with the challenges that come with raising a child with ADHD. ADDA membership (which costs about $50 per year) is required.
• Children and Adults with ADHD (CHADD) Parenting Support Groups: CHADD offers parenting support groups through their affiliates throughout the country. Typically, these support groups are held in-person, but most are currently being held online. To locate support groups near you, use the affiliate search tool on the CHADD website.
• Telehealth Parent Training and Support Groups at Academic Medical Centers: Many of the most highly qualified ADHD experts throughout the country provide services though ADHD centers that are part of a hospital or university. Many of these centers offer ADHD parent support groups or ADHD parent training groups regularly, and historically, these groups have been held in-person. However, since the start of the pandemic, the majority of these groups have moved online. CHADD offers an ADHD Center Directory search tool on their website that can help you locate the ADHD centers in your state. While you could technically attend an online support group anywhere in the country, clinician-led groups might be limited to participants who reside in-state due to professional licensing restrictions. After locating your nearest ADHD center, call the center’s intake line to learn about their telehealth services. (Tip: don’t rely solely on their website for information.)

Facebook and other Social Networking Groups

• CHADD’s ADHD Parents Together: CHADD uses an independent social networking platform (called HealthUnlocked) to provide moderated group support to parents of children with ADHD. The ADHD Parents Together provides a Facebook-like experience and currently has over 12,000 members. The platform gives parents a space to discuss the impact of ADHD on their child and their family and receive valuable advice and support.
• ADHD Parent Support Facebook Group: ADHD Parent Support – Inspiring Understanding, is a private, moderated Facebook group with over 22,000 members. The group encourages sharing parenting successes and challenges, as well as courteous, respectful, non-judgmental responses from group members. Since this is a private group, a direct link is not available. However, the group can be found via the search function within Facebook.

Online ADHD parenting support groups are a fantastic resource, but they are not a substitute for professional mental health treatment. If you or your child are in need of mental health services, your child’s pediatrician or your primary care provider can be a great resource for referrals. If you are experiencing an immediate crisis, text the Crisis Line (text NAMI to 741-741) to be connected with a trained crisis counselor.

Under the circumstances, it might feel overwhelming to even think about strategies to boost your child’s motivation, when you are struggling to get motivated yourself. Fortunately, there are some quick and simple things you can do that can have a big impact on your child’s academic motivation. They all tap into three keys for keeping kids with ADHD motivated: novelty, physical activity, and interest.

Novelty: ADHD brains thrive on novelty. When something is new, kids with ADHD are effortlessly engaged and focused. Creating novelty when your child is stuck at home all day can seem challenging, but even simple changes can make a big difference. So, consider picking one or two days out of the week when your child can choose a different location for their schoolwork. You can set parameters around the location (e.g. not in front of the TV, not in an area with a lot of distractions, or not entirely unsupervised), but otherwise, let them choose where to work (even if it’s on the floor). You can also add novelty by letting your child pick music to listen to while they are working, mixing up the order of their daily school routine, allowing them to write with colored pens and pencils, or supplementing their school assignments with fun videos or audiobooks.

Physical Activity: All kids need physical activity to stay alert and motivated throughout the day, but it’s especially essential for kids with ADHD. When kids with ADHD don’t get enough physical activity, their ADHD symptoms become much worse and their motivation drops dramatically (check out my earlier post on the benefits of exercise for kids with ADHD – link to post 49 here). Kids naturally get a lot of movement throughout the day when they attend school in person. When they’re at home, you need to schedule time for burning off energy to compensate.

Of course, this gets harder in November when the days get shorter and the weather gets cooler. Still, whenever possible, make it a point to get your kids outside. When that’s simply not an option, get creative with their inside activities. Websites like GoNoodle and CosmicKids have great activities to get kids moving. Board games like Fitivities and video games like Just Dance for PS4 are very popular right now. And old-school favorites like obstacle courses, relay races, balloon volleyball, and Nerf basketball are still always a hit.

Interest: Kids with ADHD are naturally motivated and engaged when they are interested in the topic they are learning about. While they simply can’t be interested in every assignment, there are ways to build individualized “interest-based learning” into any curriculum. Talk to your child’s teacher about your child’s current struggle with motivation. Ask if they can modify some assignments to make them more aligned with your child’s interest areas. Ideally, your child’s teacher will have a conversation with your child about the things they are most interested in, and will be flexible enough to modify some of their assignments to fit within these topic areas.  

Staying motivated while attending school remotely is difficult for kids with ADHD, but using some of these simple strategies can help. When it comes to your own motivation as a parent, remember to take it one day at a time and celebrate the small successes that happen each day.

If you’re a parent considering telehealth treatment for your child or teen’s ADHD, you undoubtedly have questions about what to expect from virtual sessions. Here are answers to the top five questions I receive about telehealth therapy for ADHD.

Is telehealth treatment effective for ADHD?
Treatments that are effective during office visits are also effective via telehealth (check out this recent report from the Child Mind Institute for details about the research behind telehealth treatment). Conversely, treatments for ADHD that aren’t helpful (or aren’t evidence-based) when they are provided in-person will also not be effective via telehealth. So, before starting telehealth therapy, know how to identify evidence-based ADHD treatments and the therapists who use these approaches. If you’re not sure what to look for, take a look at earlier posts on this blog about the essential elements of evidence-based treatments for ADHD and finding therapists who use them (link to post 121 here).

How is therapy for ADHD different when it’s provided via telehealth rather than in an office?
Many aspects of treatment are the same whether the treatment is provided in person or virtually, but there may be a few positive differences. With some treatments, especially those that include parent coaching during sessions (like PCIT), the virtual format allows therapists to coach parents as they practice new skills while they are at home with their children. This might be even more effective than coaching during office visits, since the therapist can observe the child’s reaction in their usual surroundings. The same is true for things like organizational skills coaching for kids and teens. Therapists can now observe kids and teens in their actual homework space, for example, while they practice and fine-tune their organizational skills and strategies. 

Can kids and teens with ADHD really focus during virtual sessions?
This really depends on the individual child or teen. Some kids and teens with ADHD can focus quite well during telehealth sessions, but others struggle to stay engaged. Therapists use different strategies to keep kids with ADHD focused, like reducing the length of sessions, allowing frequent short breaks, using mini-behavior charts to reward on-task behavior during sessions, and incorporating fun, playful activities and conversations. Overall, parents should be highly involved in ADHD treatment for kids and teens, and parent involvement may need to be even higher during virtual sessions. Additionally, there are some kids with ADHD who simply really struggle to participate in virtual sessions. For these kids, attending office-based appointments whenever possible is usually the best solution.

Should I be concerned about security and privacy during virtual sessions?
Internet security and privacy is something to discuss with your therapist before starting virtual sessions. Therapists choose from a variety of video conferencing and telehealth platforms to provide virtual sessions, and each platform has its own security features. The most secure platforms are HIPAA-compliant. Your therapist should provide you with an informed consent document prior to starting telehealth treatment that provides details about the telehealth platform being used in their practice.

Can I choose to see a therapist from anywhere in the country?
One of the benefits of telehealth is that you are not limited to working with providers who are within driving distance of your home. However, in most cases, clinicians are only allowed to provide services to patients who live in the state in which they are licensed. While there are some exceptions to this rule, it’s generally best to keep your therapist search focused on providers in your home state.

Parents who suspect that their child may have ADHD can feel especially overwhelmed by the thought of seeking out an ADHD evaluation during the pandemic, when many provider offices are closed or have limited availability for in-person appointments. Fortunately, since the start of COVID-19, providers have been successfully conducting thorough ADHD evaluations remotely via telehealth. In practice, ADHD evaluations completed via telehealth sessions aren’t much different from office-based evaluations, and families usually find it easier to schedule and attend telehealth appointments. 

Which types of providers are qualified to diagnose ADHD?
Clinical psychologists (Ph.D. or Psy.D.), psychiatrists (M.D.), and pediatricians (M.D.) or primary care providers (M.D. or N.P.) are all qualified to complete ADHD assessments and assign a new ADHD diagnosis. Many other mental health providers (like social workers and counselors) and learning specialists are well qualified to treat ADHD but don’t provide diagnostic evaluations.   

Doesn’t the doctor need to see my child in their office to observe their ADHD symptoms?
Many parents are surprised to learn that clinicians don’t rely too heavily on a child’s behavior during an evaluation when making an ADHD diagnosis. Children and teens often behave much differently during office visits than they do at home or at school, especially when they are meeting a doctor for the first time. Instead, clinicians rely on rating scales and interviews to assess ADHD symptoms and behaviors.

 What’s included in a telehealth ADHD evaluation?
Thorough ADHD evaluations conducted via telehealth include the same key components as in-person ADHD evaluations. These include an assessment of the child’s medical, family, and educational history; an evaluation of past and current symptoms of ADHD and other mental health disorders (like anxiety and depression) via interviews and rating scales that are completed by parents, teachers, and the child themselves (depending on their age); a review of school records or report cards; and in some cases a continuous performance test (CPT) to assess auditory and visual attention (completed on your home computer during the session). If the clinician has concerns about a possible learning disability, they may also include psychoeducational or neuropsychological testing, some of which may need to be completed during in-person office visits.

Has the COVID-19 pandemic changed anything else about how ADHD is assessed?
One added challenge that clinicians face when assessing ADHD symptoms during the COVID-19 pandemic is differentiating between symptoms stemming from pandemic-related difficulties (e.g. remote learning, disrupted sleep habits, excessive screen time, less physical activity, stress, and anxiety) and symptoms that are a result of ADHD.

To address this, clinicians are spending extra time during the evaluation discussing what the child or teen’s symptoms looked like before the pandemic and how they have changed or stayed the same during the pandemic. Symptoms that emerged only during the pandemic are less likely to be a result of ADHD and are more likely to be related to pandemic-related factors.

How do I find a doctor who can diagnose ADHD through telehealth sessions?
The vast majority of clinical psychologists and psychiatrists are now using telehealth to conduct their evaluations. Pediatricians may also offer telehealth sessions for mental health appointments. To find a qualified provider, you have a few options:

• Start by talking with your child’s pediatrician. They may conduct evaluations themselves or refer you to a trusted specialist.
• Ask your child’s school counselor for provider recommendations or contact your insurance company for a list of in-network providers who specialize in ADHD.
• Use Psychology Today’s provider search to locate a clinical psychologist (Ph.D. or Psy.D.) or psychiatrist (M.D.) in your area who is providing remote ADHD evaluations. It’s important to note that psychologists and psychiatrists can only provide evaluations and treatment to patients in the state where they are licensed. So, limit your search to providers located in your home state.  

If your child or teen is struggling and you suspect that they may have ADHD, you don’t need to wait for the pandemic to end before you get an evaluation. Using telehealth, providers can effectively evaluate your child or teen’s symptoms and help them get the treatment and services they need now.   

Many parents are surprised to learn that kids are often bullied for weeks or months before an adult becomes aware of the problem. Kids who are bullied often don’t turn to adults for help quickly either because they feel helpless, don’t know how to ask for help, don’t understand that they are being bullied, feel ashamed, or believe that adults either can’t help or will just make the situation worse. When you talk openly with your child about bullying you are sending a clear and important message that you are someone they can turn to if they are being bullied.

Initiating conversations about bullying with your child can feel intimidating and overwhelming. It’s hard to know what to say or how to say it in a way that will resonate with your child. Fortunately, there are some fantastic books about bullying that can serve as great conversation starters. Some of these books simply tell stories that your child can relate to and others provide practical strategies and tips for kids and their parents. All of these books will be most effective if you read them with your child and talk about the tough situations the characters are facing.  

Here are my top 5 books that are great conversation starters for kids and parents:

Thank You, Mr. Falker
by Patricia Polacco

Thank you, Mr. Falker will resonate with any child who has struggled academically and has been made fun of by their peers as a result. This book is based on the author’s own experience with dyslexia as a child, and tells the story of how she learned to read with the help of an inspiring teacher who not only helped her overcome her learning differences, but also helped foster her artistic gifts.  

The Juice Box Bully
by Bob Sornson & Maria Dismondy

Great for starting conversations about why bullies act the way they do, as well conversations about how to deal with bullies, The Juice Box Bully tells the story of a new kid at school who struggles to fit in because he is bullying his classmates. It turns out that he was the victim of bullying at his old school and thought that if he was mean to kids at his new school first, he wouldn’t get picked on himself.

Stand Up for Yourself and Your Friends: Dealing with Bullies and Bossiness and Finding a Better Way (An American Girl Book)
by Patti Kelley Criswell

This book is really a guide that teaches girls how to spot bullying, how to respond, and how to ask a trusted adult for help. There are quizzes and exercises that parents and girls can do together, and plenty of great conversation starters inside.

My Secret Bully
by Trudy Ludwig

This book focuses on relational aggression among a group of girls who have been friends since kindergarten. The main character, Monica, ultimately handles the bullying successfully with the help of her mother. This book not only helps girls identify the signs of relational aggression and bullying but shows how powerful it can be when a parent steps in to help. This book also includes additional tips and discussion guides for parents.  

Loser
by Jerry Spinelli

This book is most appropriate for tweens in 5^th or 6^th grade. With humor and a very engaging writing style, the author tells the story of a boy who doesn’t fit in and deals with a lot of bullying starting in 1^st grade. The main character struggles as he makes his way through elementary school and into middle school, but with the support of his family he learns to embrace his individuality and ultimately thrives.

Teens who are prone to symptoms of anxiety or depression and those who already had tense relationships with their parents are among those struggling the most. Not surprisingly, parents of struggling teens are also struggling themselves. When a teenager is constantly irritable or frustrated, it affects the whole family – especially when the whole family is stuck at home.

While parents cannot directly change their teen’s mood or outlook on life right now, there are a few mental shifts that parents can make to help improve the situation for themselves, and hopefully for their teen as well.

1. Check your expectations. Avoid placing adult-sized expectations on your teenager, especially around their reactions to the coronavirus crisis and social distancing measures. It is completely normal for teens to lack perspective and minimize the potential impact of the coronavirus on themselves or their family and friends. It’s also normal for them to fail to comprehend the reasons why social distancing is so important or think that their world is ending when they can’t see their friends or participate in the activities that they enjoy.

Perspective is something that comes with age and experience. Most teens simply haven’t had enough life experience to grasp how our own behavior during this global crisis can affect the health and well-being of others (even many adults are struggling to understand this right now). The same applies to your expectations for their ability to self-motivate and complete the schoolwork they have been assigned, or voluntarily turn off their videos or videogames and do something active or help out around the house.

All teens, and especially teens with ADHD, are much less skilled at creating their own structure and motivation than adults. So, be patient and remember that while your teenager may look all grown up, they are in many ways still a child.   

2. Avoid falling into a ‘comparative suffering’ mindset. Comparative suffering, a concept popularized by Brené Brown, refers to our tendency to view our own difficult situation in comparison to others who may have it worse than we do. How often have you recently thought (or heard someone say) something like, “I’m so overwhelmed right now, but I shouldn’t complain. It’s the healthcare workers on the front lines and families who have lost loved ones who are really struggling.”

Comparative suffering may seem like a helpful and humble way to think about your situation, and usually it’s coming from a good place. The problem is that it causes us to bottle up our feelings (which then inevitably seep out in unhealthy ways), and as Brené Brown notes, “comparative suffering corrodes compassion and connection.”

This is particularly true when you view your teenager’s situation through a comparative suffering lens. Take this typical example, “I’m so frustrated with my teen. He’s acting out and being selfish just because I won’t let him hang out with his friends. Doesn’t he really how lucky he is, or that there are people out there struggling with serious problems right now?”  This type of comparative suffering mindset makes it extremely difficult for parents to connect with their teens and have compassion for their situation. The comparison comes much more easily when parents shift their thoughts and expectations to match their teen’s perspective, “My teen is really struggling right now. His friends are so important to him, and he had so many things he was looking forward to doing with them this spring. He doesn’t have enough experience to understand the big picture, and to him this must feel devastating.” 

3. Express empathy. Teens will respond better to everything that you say to them or ask of them if you empathize with their situation. Let them know that you realize that all of the disruptions caused by the coronavirus crisis are hard on them, and that being confined to their home is not easy. Some teens may not let you know outwardly that your empathy matters, but don’t be discouraged. Over time, it will make a difference (whether your teen admits it or not!).
4. Find time to connect. Finding ways to connect with your teen and do things together that your teen enjoys is more important than ever during a crisis. Even if your teen is pushing you away, try to find little ways to laugh or smile together. Ask them about activities they might like to do with you, and if they’re willing, have them take the lead on planning a fun (at-home) activity that you can do together.
5. Continue to set limits. No matter how difficult or frustrating your teen’s behavior is at times, it’s essential that you continue to set appropriate limits. Teenagers rely on these limits to help them regulate their mood and their behavior (especially when a teen has ADHD). So, continue to hold the line no matter how tempting it may be to give up on limit-setting when your teen pushes back.

Lastly, if your teen is struggling with anxiety or depression (or other mental health difficulties), or you feel like you need additional support to parent your teen effectively during this crisis, reach out to a mental health professional (most are offering telehealth sessions). Your pediatrician can provide referrals to a provider in your area.

Cyberbullying is similar to traditional bullying and has been defined as a person or group intentionally using digital media to threaten, harass, or intimidate someone.¹ It can occur via any social online platform, including social media, blog sites, chat groups, and video chats (Zoom, Facetime, etc.), as well as videogame platforms, texting, and traditional phone calls. Not surprisingly, concerns about cyberbullying have increased during the COVID-19 pandemic, with kids and teens spending more time online for both school and social activities.  

Studies have shown that kids and teens with learning disorders and/or ADHD are at especially high risk for all forms of bullying, including cyberbullying.^2,3 This increased risk appears to be tied to feelings of low self-esteem, loneliness, underdeveloped social skills, and difficulty reading social cues. As is the case with so many aspects of parenting a child or teen with a learning disorder or ADHD, you are your child’s best advocate and source of support when it comes to cyberbullying.

• Be on the lookout for signs of cyberbullying. Kids and teens who are victims of cyberbullying are likely to become more withdrawn, depressed, or irritable, and will sometimes have changes in their sleep or eating habits (either sleeping and eating more or sleeping and eating less than usual). If the bully is someone in their friend group, they may suddenly stop interacting with certain friends in-person or online (including social media or gaming interactions).
• Monitor your child or teen’s social media use. Every parent has their own approach to social media monitoring, with some parents closely observing their child’s social media activities and others taking a completely off-hands approach. While there isn’t a one-size-fits all approach to social media monitoring, and there are pros and cons to every strategy, every parent should at the very least know exactly how their child or teen is using their devices to interact with friends and peers.
  
  This means that even if you don’t see the content of your child’s online interactions, you know exactly which apps they are using, how these apps work, and how much time your child is spending on each app every day or every week. Every parent should also be aware of how frequently your child is texting, and ideally, who they are texting with. Sudden changes in your child’s social media app use or texting patterns may be an indicator of social withdrawal or avoidance that could be a result of cyberbullying.   
• Build up your child’s strengths and social support. Kids with strong self-esteem and social support are less likely to be bullying victims. Give your child as many opportunities as possible to develop their non-academic strengths and carve out time for them to have fun using these skills. Also help facilitate opportunities for positive social opportunities with their friends via virtual hangouts or socially distanced in person interactions. Lastly, remember that family social support is hugely important to your child and teen (even if your teen denies it!). Carve out fun family time and create new family routines and traditions that will help remind your child that even when they feel like they don’t fit in among their peers, they will always fit in at home.
• If you suspect cyberbullying, start with a calm conversation. If you suspect that your child may be experiencing cyberbullying, talk to them about it. Ask open-ended questions, try to get as many details as you can, and keep the focus on listening and information-gathering. Avoid problem-solving during the initial conversation. If your child or teen will not open up to you, then schedule an appointment with the school counselor or your child’s therapist. Whether your child talks to you or to another trusted adult, let them know that you are proud of them for talking about this difficult topic.
• Work with your child’s school. If your child is being bullied by a school peer, as is most often the case, work closely with your child’s school. Start by having a calm conversation with the school administrator and/or school counselor about the details you have learned from your child. It will take time for the school to investigate the situation, but in the meantime, they can work with you and your child to make sure your child feels safe, supported, and heard. For additional tips for talking with your child’s school, check out this brief guide from the experts at Bridgewater University’s Massachusetts Aggression Reduction Center.

No one can fully prevent a child or teen from experiencing cyberbullying, but you can help your child become more resilient by building up their strengths and social support and by intervening quickly if a bullying incident occurs. Cyberbullying is serious, and it’s not something that any parent should have to deal with alone. Turn to other parents, school professionals, and mental health professionals to get the help and support that you and your child need.    

¹Elizabeth Englander, Edward Donnerstein, Robin Kowalski, Carolyn A. Lin, Katalin Parti. (2017). Defining Cyberbullying. Pediatrics, 140 (Supplement 2), S148-S151.

²Kowalski, R., & Fedina, C. (2011). Cyber bullying in ADHD and Asperger Syndrome Populations. Research in Autism Spectrum Disorders, 5(3), 1201-1208.

³Mishna F. (2003). Learning Disabilities and Bullying: Double Jeopardy. Journal of Learning Disabilities. 2003;36(4), 336-347.

Unfortunately, adhering to new COVID-19 requirements at school will place additional demands on students’ attention, impulse control, executive functioning and organizational skills, and emotion regulation – the very domains that are most affected by ADHD. Students with ADHD will need extra support now, as they adapt to the “new normal” at school, and throughout the upcoming COVID-19 school year.

How the return to school may affect kids with ADHD:

• Behavior: You may see an uptick in oppositional behavior from your child or teen with ADHD. This may stem from frustration over dealing with demands that are greater than what their ADHD brains can handle. It may also be a natural reaction to receiving so many corrections and negative feedback throughout the school day if they are repeatedly (and often accidentally) not following the new COVID-19 rules. Oppositional behavior can also be a sign that your child is anxious or overly stressed but lacks the ability to express their feelings.
• Mood and Anxiety: Many kids with ADHD also struggle with depression and anxiety at some point during their child or teen years. Stressful situations increase the likelihood that a child or teen will develop clinical levels of anxiety or depression, and across the board, we are seeing higher rates among kids with ADHD since the start of COVID-19.
  
  Some key signs of depression in kids and teens include low mood or increased irritability, a lack of interest in things they usually enjoy, social withdrawal, and/or changes in sleep and eating habits. Signs of anxiety can include physical complaints (like headaches or stomachaches), school avoidance or refusal, a worsening of attention problems, a fear of being away from family members (separation anxiety), difficulty sleeping, and for some kids, an increase in disruptive or oppositional behavior.
• Learning: Focusing and learning throughout the school day requires far greater mental effort for students with ADHD under typical (non-COVID-19) circumstances. In practical terms, this means that the mental strain of following and coping with COVID-19 school rules will negatively affect academic learning more severely for students with ADHD.
  
  When discussing this phenomenon with parents and teachers, I often ask them to visualize a student’s mental capacity as a fuel tank that starts off full every morning and is gradually drained throughout the day. Under normal (non-COVID-19) circumstances, a child with ADHD may need to use 80-100% of their fuel to simply stay on task and absorb the basic academic details that are being taught in the classroom. This leaves very little “mental fuel” available for everything else, like navigating challenging social situations, controlling impulses, managing difficult emotions – or in today’s world, learning and following new COVID-19 rules.
  
  In contrast, under typical circumstances, a child without ADHD may only need to devote 50% of their mental fuel to learning and staying on task. As a result, they have far more fuel available for whatever comes their way, including learning and following new COVID-19 rules and schedules throughout the day. So, expect that your child or teen will have a more difficult time meeting academic demands at the start of this school year.

How to help your child manage the back-to-school transition:

• Set realistic expectations. Kids and teens with ADHD are going to have a more difficult time remembering to follow through on COVID-19 public health requirements – including social distancing, mask wearing (and simply keeping track of their mask), and hand washing. Do not expect perfection, and don’t hesitate to calmly provide reminders, pack extra masks and hand sanitizer in their backpacks, and praise them when they do follow through.
• Advocate for your child. Partner with your child’s school to ensure that your child or teen is receiving the behavioral and academic support that they need. If your child already has an IEP or a 504 Plan in place, then consider having the plan expanded to account for COVID-19-related changes in the classroom environment, the school schedule, the quantity of academic material, or the method of instruction. If your child does not currently have a special education plan, consider starting the process now.
• Follow routines. Create a sense of security for your child and minimize organizational difficulties at home by following consistent routines at key points in the day. This includes a morning routine, an after-school or homework routine, and an evening routine.
• Prioritize physical health. Your child or teen will be able to manage their ADHD symptoms and cope with stress much more effectively if they are getting enough sleep and physical activity and are eating well. When you put your child’s physical health needs first, improvement in their mental health and academic skills will follow.
• Provide additional learning support. In order for your child or teen to keep up with academic demands and avoid falling behind their peers, they will likely need additional outside learning support. As always, the Huntington Learning Center in your area is a fantastic resource for getting your child or teen with ADHD the extra support that they need.
• Adjust your child’s ADHD treatment plan as needed. As children and teens grow and demands on their attention increase, they will need adjustments to their ADHD medication and behavior management plans. Work closely with your child or teen’s doctor and therapist to optimize their ADHD treatment throughout the school year, and promptly address symptoms of anxiety or depression if they emerge.

Returning to school with ADHD during COVID-19 will be a challenge. As a parent, you are your child’s greatest source of support and advocacy. Work closely with your child’s teachers, doctors, and therapists to make sure they are getting the support they need during these unique times.

Results showed that individuals with untreated (meaning unmedicated) ADHD were 52% more likely to have tested positive for COVID-19 than individuals without ADHD. Interestingly, individuals with ADHD who were taking stimulant medication did not have a higher risk of COVID-19 infection, suggesting that actively treating ADHD symptoms reduces COVID-19 risk.

While at first glance a link between COVID-19 and ADHD may seem surprising, when we take a step back, it makes sense that ADHD symptoms would make it harder to consistently engage in social distancing or other behaviors that reduce the likelihood of being exposed to SARS-COV-2, the virus that causes COVID-19.

For example, social distancing requires us to constantly pay attention to the world around us in order to maintain a safe distance from others. When washing our hands for a full 20 seconds, we have to resist the impulse to stop because we are bored and want to move on to the next thing. Staying home and tolerating some level of boredom requires us to resist the impulse to spend time in close contact with friends and find new ways to boost our mood and regulate our emotions. Kids and teens with ADHD also have to follow directions from adults in each of these areas, even when they don’t fully comprehend why these social distancing and public health measures are in place.

Across the country and across the globe, families affected by ADHD are struggling during the pandemic. Parents are feeling stressed and burned out from conflicts with their children and teens as they try repeatedly to get them to follow important social distancing and health measures. Kids and teens with ADHD are struggling without the typical routine and structure that school and summer camps provide and are sorely missing time spent socializing with friends. The findings from this newly published study are a reminder that ADHD symptoms can make so many things in life more challenging.

As a parent of a child or teen with ADHD, it’s also important to remember that you don’t have to deal with these challenges alone. Even if your child is not attending school in person this fall, it is still important to get help from your child’s doctor, psychiatrist, and/or therapist to optimize their ADHD treatment while they are spending time at home. Support from parents dealing with similar challenges can also go a long way in managing your own stress. Reach out to your local chapter of CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder) to learn about virtual support groups in your area and across the country. With the right combination of support your stress level will decrease, and you’ll be better prepared to handle the challenges that come your way during these difficult times.

¹Merzon, E., Manor, I., Rotem, A., Schneider, T., Vinker, S., Golan Cohen, A., … Green, I. (2020). ADHD as a Risk Factor for Infection With Covid-19. Journal of Attention Disorders. https://doi.org/10.1177/1087054720943271

EndeavorRx^TM is designed to improve attention in children between the ages of 8-12 years old with primarily inattentive or combined-type ADHD, who have a demonstrated attention issue. It functions like most video games, requiring kids to move their character through different worlds and unlock new objects and challenges. The developers incorporated specialized algorithms into the video game design to increase or decrease difficulty depending on the child’s performance, with the goal of keeping children with ADHD challenged but not overloaded. The game also attempts to stimulate specific areas of the brain related to attentional control.

The FDA’s decision to approve EndeavorRx^TM as an ADHD treatment was based on five studies involving more than 600 children. In the largest trial, 348 children with ADHD between the ages of 8-12 were randomly assigned to either play EndeavorRx^TM or an unrelated word puzzle video game (the control condition) for 25 minutes per day, five days per week, for four weeks. At the end of the treatment period, researchers measured the children’s attention through rating scales (completed by the children and their parents) and computer-based measures, including the Test of Variables of Attention (T.O.V.A.).

Results showed that children in both the EndeavorRx^TM group and the control group improved on measures of attention, but the children in the EndeavorRx^TM group showed about 15% greater improvement on their T.O.V.A sustained attention scores than the control group. The EndeavorRx^TM group also had more parents, about 12% more, who rated their children as focusing better at the end of treatment than parents in the control group. However, EndeavorRx^TM did not outperform the control condition on behavioral outcomes, including ADHD symptoms related to hyperactivity and impulsivity.

The findings from these studies are definitely promising, but there are reasons to be cautious about the level of improvement you may see in your child. First, all of the studies to date have been funded by the treatment (video game) developers. This isn’t unusual for treatments newly approved by the FDA – in fact, it’s the norm for medications that receive FDA approval. However, additional independent studies would help increase confidence in the intervention’s effects. In addition, it’s unclear whether EndeavorRx^TM primarily improves focus during video game- or computer-based activities, or if these improvements translate into real-world situations, like better focus at school or during homework time.

The intervention developers emphasize that “EndeavorRx^TM should be considered for use as part of a therapeutic program that may include clinician-directed therapy, medication, and/or educational programs, which further address symptoms of the disorder.” In other words, EndeavorRx^TM is not intended to be a stand-alone treatment for ADHD and should only be used in conjunction with other treatments. The good news is that this landmark approval by the FDA will likely accelerate interest in the development of computer-based treatments for ADHD, and we may see more exciting treatment options in the future.

Many of the parents that I have worked with have concerns about using negative consequences with their child. They either feel like they are using them too often, find that negative consequences aren’t helping change their child’s behavior, or worry that the consequences are hurting their relationship with their child.

Research has shown that when negative consequences are used sparingly, they are helpful for kids with ADHD. In general, punishments and negative consequences work best when they are used only for behaviors that are unsafe or for negative behaviors that the child finds so inherently rewarding that no amount of praise or rewards will motivate them to change their behavior.

Research also tells us that punishments and negative consequences that are given too often or are too harsh aren’t helpful. In fact, they can be harmful. Excessive use of punishment and consequences can erode a child’s self-esteem and harm their relationship with their parent. On top of this, consequences don’t actually teach a child new behavior to use in place of their negative behavior. Instead, excessive negative consequences teach a child to be sneaky and avoid getting caught by their parents.

When a child is receiving too many negative consequences, I always recommend that parents take a step back and think about the specific behaviors that are driving the punishment. How many of these behaviors fall into the “unsafe” or “behaviors that are too rewarding” categories? These are the behaviors that will probably need a negative consequence or punishment, at least in the short term.

All other behaviors can probably be handled with more positive strategies – like providing support and skill-building to set the child up for success and motivating them to improve their behavior through the use of praise and rewards. For example, failing to finish homework on time, not getting through a morning routine on time, or not following directions are examples of situations that are handled much more effectively with positive strategies than with negative consequences.

When you do need to use a negative consequence, make it effective by following these guidelines:

• Never use physical punishment. Decades of research have shown that physical punishment, including spanking, is very harmful to kids in both the short-term and the long-term. It’s also not effective at changing behavior over time. Instead of physical punishment, effective negative consequences can include things like taking away access to screens (or something else that the child really enjoys) for a set period of time, having the child pay for something that they damaged, or not allowing the child to participate in a planned fun activity.
• Stay calm. When giving your child a negative consequence, stay calm. If you issue consequences when you are upset, you will be more likely to escalate the situation and/or will hand out consequences that are too harsh. So, take time to calm down and think through the consequence before talking to your child.
• Don’t give in. Do not end the punishment earlier than planned or allow your child to earn back the privilege or object that has been taken away. When you give in, you teach your child that you don’t really mean what you say. If you allow your child to earn back what they lost, then the punishment will lose its meaning. They will see it as no big deal because they know that as long as they improve their behavior for a short time, the punishment will end.
• Keep it short. Studies have shown that short punishments are just as effective as long punishments at changing behavior. So, in most cases, taking away your child’s video games for a day (or two) will be just as effective as taking them away for a week. Perhaps most importantly, it is much easier for parents to be consistent and avoid giving in when punishments are kept short.

When negative consequences are used sparingly and effectively, they can help your child improve their behavior. You’ll know that negative consequences are working when your child’s behavior improves over time. If you’re not seeing an improvement and have fallen into a repetitive cycle where your child misbehaves in the same way and receives the same punishment over and over again, then that’s a sign that you need a new strategy. If you feel stuck in a negative cycle with your child’s behavior, reach out to an experienced therapist who can help you identify the strategies that will work best with your child.

If you decide that it is time for your child to resume in-person playdates, experts recommend taking precautions, including playing outside, avoiding contact sports and games, wearing masks, and keeping kids a few feet apart while they play. These precautions will be difficult for many kids to follow. For kids with ADHD, following these precautions will be even more difficult because of their tendency to be forgetful and impulsive. Fortunately, there are things you can do to help your child follow safe playdate guidelines while they are enjoying their time with friends.

• Clearly explain the rules before the playdate begins. Write the rules down and be specific. For example, if your child needs to wear a mask, then let them know that the mask must cover their nose and mouth during the entire playdate. If you expect your child to wash their hands before and after the playdate, also include that they need to wash them for a full 20 seconds each time. Being specific will clarify your expectations and will minimize arguments and negotiations.
• Keep playdates short. Set your child up for success by keeping playdates short – at least initially. Younger kids can get a lot out of a 30-minute playdate. Older kids many need a full hour to feel like they had enough quality time with a friend.
• Plan activities that make it easy to follow social distancing rules. If you want your child to avoid getting too close to their playmate, then contact games like basketball, soccer, or tag aren’t a great fit. Instead, plan activities like bike riding, drawing with chalk on the sidewalk or driveway, water balloon or water gun games, or scavenger hunts where kids can play together but still stay a safe distance apart.
• Provide rewards and consequences. Kids with ADHD do best when there are clear rewards and consequences tied to the new rules. In this case, the easiest and most logical reward for following the rules will be the opportunity for another playdate in the future. In terms of consequences, you can choose to end the playdate early if your child isn’t following the rules. Alternatively, you can allow the playdate to finish but not allow your child to schedule another playdate for a certain period of time. Avoid banning all future playdates, since this consequence will be very difficult for you to enforce and won’t be in your child’s best interest long-term.
• Don’t require perfection. Sticking to new playdate rules will be hard for your child, and it’s going to take some practice. So, don’t expect them to follow the rules perfectly right from the start. Instead, let them know that you expect them to follow the rules with three or fewer reminders from you during the entire playdate. As they get better at following the rules, you can reduce the number of reminders during future playdates. Remind your child of the rewards and consequences before the playdate begins.
• Monitor the playdate and praise your child. Monitor your child throughout the playdate and praise them (directly or subtly) when you see them following the rules.

Debrief after the playdate. Talk to your child about how things went after the playdate. Keep things positive and emphasize the things that your child did well. If there are a few things they need to work on for next time, mention them but don’t dwell on them right now. Playdates should be fun, and your child’s experience should end on a high note!

Here are eight steps for coaching your ADHD child and their siblings through conflicts:

1. Focus on one simple conflict first. Choose one relatively straightforward conflict that happens frequently. Think about how you would ideally like your child and their sibling to respond – including their words, actions, and tone of voice. Write down exactly what you want them to say and do, making sure to keep it simple.
   
   For example, if they often get into arguments because they can’t agree on how something should be done, then ‘rock, paper, scissors’ (as simple as it may sound) can be used to resolve this problem about 90% of the time. If the issue is around bragging when they win a game or pouting when they lose, then teaching them to calmly say “good game” and walk away will help.
2. Use a simple reward system. Changing how you behave with your sibling is hard, and most kids will need an extra boost of motivation. Use a simple system that requires siblings to work together to earn rewards. I’ve found that ‘marble jar’-style reward systems tend to work best here. With a marble jar, kids add a marble (or other object, like a cotton ball) every time they use their new skills and tools. When they reach the fill line, they earn their joint reward. Check out my earlier post on this topic for tips on how to use a marble jar reward system effectively.
3. Give your kids a heads-up. During a calm moment, talk to your kids about the new tool you’ll be teaching them and the rewards they’ll be earning. You can keep things pretty high-level at this point and dive into the details later when you’re ready to get started. When you’re talking to your kids, keep it positive and avoid placing any blame for the challenges they’ve been having.
   
   Instead, let them know that it’s been harder for everyone to get along lately because the family has been spending so much time together. To help them get along better (and have more fun), you’re going to teach them a new tool to use when they feel an argument coming on. And when they use the new tool together, they’ll be able to earn rewards!
4. Role-play the conflict and the response. When you’re ready, describe the new tool (the words, behavior, and tone of voice) to your kids, and have them role-play a conflict and using the new tool.
5. Introduce the reward system. Describe the reward system to your kids. Let them know exactly how they’ll earn rewards and what the rewards will be. Ideally, involve them in choosing the rewards so they are as invested as possible and will work hard to earn them.
6. Prompt the siblings to use their new tool. It’s going to take practice to make the new tool a habit, so at first you’ll need to prompt your kids to use their new tool. You may even need to feed them their lines step by step the first few times they use the tool. After they get the hang of it, a simple reminder should be all they need.
7. Reward them consistently. Every time the siblings successfully resolve a conflict, praise and reward them. If you’re using a marble jar, have them add marbles to the jar and remind them that they are getting closer and closer to earning their reward. Make sure the reward goal is reasonable. I recommend that the bar is set so that they are able to earn a reward about once a week, or once every few days.
8. Repeat the process for more complex conflicts. Once your kids have had success with learning a new tool to resolve a simple conflict, work with them to come up with strategies for resolving more complex conflicts. The tools may look a little different, but the rest of the process will stay the same.

Remember that changing behavior is hard for kids, especially when it comes to their siblings. So, be patient and stay positive. With a little practice and a lot of praise, you’ll see improvement in your children’s relationships with each other, and your ADHD child will have learned new social skills that they can also use with their friends once schools and camps are open again.

Having ADHD makes it harder to cope with the challenges that come with close relationships. Social skills, the ability to regulate emotions and tolerate feelings of frustration and disappointment, and the ability to see things from another person’s perspective are all important when it comes to navigating sibling relationships. All kids with ADHD struggle in at least one of these areas, and the toll it takes on their relationships with their siblings is obvious.

Dealing with sibling rivalry is one of parenting’s biggest challenges. It takes patience to help kids with ADHD and their siblings develop positive relationships, but the good news is that if you stay positive and use strategies consistently, you will see progress. Many of the strategies that will lead to improved sibling relationships are the same things that will help you and your family function better overall during COVID-19 confinement.

These include taking care of yourself so you’re able to stay calm under pressure, creating structure and routines that provide your children with the security and stability they need during these uncertain times, and meeting your children’s basic needs for sleep, regular meals and snacks, and exercise. When this solid foundation is in place for your family, the following strategies focused specifically on sibling relationships will be much more effective.

1. Spend quality one-on-on time with each sibling. One of the things that makes sibling relationships so challenging is that brothers and sisters often feel like they are in competition for attention from their parents. You can’t eliminate the competition, but you can minimize it by scheduling quality one-on-one time with each sibling. Some parents find that 10 minutes of one-on-one time each day works well, while others find that longer periods of time (20 or 30 minutes) a few times a week work better for their family.
   
   During one-on-one time, remove all distractions (including cell phones) and let your child pick the activity or topic of conversation. Avoid video games and videos during one-on-one time. Screen-based activities tend to undermine one-on-one time because your child becomes so focused on the screen that they don’t even notice your attention.
2. Have a ‘family night” once a week. Family nights help siblings feel connected, bonded, and like important members of the family unit. Family nights can take the form of family game nights, movie nights, or even family walks or bike rides. Do whatever works for your family. The most important thing is that they are planned in advance, happen consistently, and are fun!  
3. Identify and prevent triggers. Be on the lookout for the situations and activities that are the biggest triggers and do your best to prevent or minimize them. Common triggers are too much unstructured time, too much “together time,” competitive games (rather than collaborative activities like Lego, crafts, bike riding, etc.), “high value” toys that both kids want to play with at the same time, meltdowns after screen time, and basic needs like hunger, fatigue, and lack of physical activity and outside time.
4. Validate your children’s feelings. Sibling relationships are hard, and kids are really struggling right now. Something what seems like a minor problem to us as adults may feel like a true injustice to your child. Let both siblings know that you understand how hard the situation is, and how unfair it might feel. This doesn’t change the outcome of their situation, but it will help them feel like they are seen and heard by their parents – which will go a long way when it comes to your relationship with your child as well as their relationship with their sibling.
5. Provide clear expectations for sibling behavior. Kids who struggle with social skills need clear expectations and directions. This means telling them exactly how you want them to respond when a conflict comes up. You can give them specific phrases to use, like “I don’t like it when you take that without asking,” and tell them when it’s appropriate to walk away from the situation and cool down or get help from an adult. Some kids need more coaching than others, and in my next post, I’ll share specific steps for effectively coaching kids with ADHD on sibling social skills.
6. Catch your children being good. If you are like most parents, you may be quick to intervene when your children are fighting but say very little when they are getting along well. This means that your children don’t get any feedback about their behavior when things are going smoothly, but get lots of feedback and attention (even if it’s negative attention) when things go south. To see more positive sibling behavior, provide feedback when things are going smoothly. Short and specific praise is best, like “I’m really impressed with how well you worked together just now.” But if that feels forced, then a simple comment that shows you’re paying attention can also work well, like “You two look like you’re having a lot of fun right now!”
7. Intervene right away if things get physical. Overall, it’s a good idea to give siblings an opportunity to work things out before jumping in (unless you’re using a specific coaching strategy). But if things get physical, don’t wait. Jump in immediately and de-escalate the situation. A punishment will probably be appropriate, and you can hand out the punishment quickly. But when it comes to discussing the situation, wait until everyone has calmed down before the conversation begins. 

Helping kids learn how to manage sibling conflicts isn’t easy, but the payoff is great – happier kids who are creating a sibling bond that will last a lifetime.

This lack of focus is causing more frequent meltdowns and greater tension between parents and kids over schoolwork. And it’s not just the kids who are struggling to stay on task; parents are struggling, too. Everyone is finding it harder to stay motivated and stick to the routines and plans that were put into place weeks ago, when we all started staying home.

With a few more weeks of school remaining, what can you do to keep your kids engaged and on task with remote learning? The most effective strategy involves only two steps: (1) breaking longer academic “periods” down into shorter chunks of time and (2) alternating these short bursts of academic work with fun and engaging activities. You could also consider requesting reduced assignments from your child’s teacher. Shorter assignments (e.g. only completing every other problem on math worksheets) and other forms of reduced work are a common accommodation for kids with ADHD who have 504 and IEP plans.

Adjusting your child’s schedule so that it includes less time spent on academics can seem counter-intuitive if you already feel like they are not getting enough learning through their school’s remote education programming. But it’s important to think about quality rather than quantity right now. For example, let’s say you have three 30-minute periods blocked out for academic time for a total of 90 minutes each day. If your child is struggling to focus and is doing anything and everything they can think of to avoid schoolwork, then they may actually only be engaged in learning for about 15 of these 90 minutes. The rest of the time is spent on procrastination, daydreaming, meltdowns, and negotiations with their parents.

If, in place of three 30-minute blocks, you adjust the schedule to include four 10-minute blocks of academic time, your child may actually spend more time learning over the course of the day. Kids with ADHD are able to focus, stay on task, and sustain motivation much more effectively when they do their work in shorter bursts. So, if they get to work and stay on task for 10 minutes four times a day, they will actually spend 40 minutes learning each day.   

To make sure your child gets the most out of each block of academic time, take the following steps:

1. Pick a realistic length of time for the academic blocks. The amount of time a child with ADHD can stay focused on schoolwork depends on a variety of factors, like age, attention span, executive functioning abilities, the amount of distraction in the room, and how interested they are in the subject. Older children or those with a longer attention span may be able to focus for 15 or 20 minutes at a time. Younger children or those who are really struggling to focus right now may only be able to stay motivated and on task for 10 minutes. Based on your experience with your child, choose a length of time that seems within their reach.
2. Use a timer. Use a timer while they are working. Visual timers like the Time Timer clock or app are best, but any timer will work as long as your child can see and hear it. For more about using timers to help kids manage their ADHD, check out my post on this topic.
3. Reward your child for staying on task. When your child stays on task during the entire academic time block, reward them. Always reward them based on whether or not they stayed on task – not based on how much work they completed (reward the effort, not the outcome). You can reward them using a When-Then plan (e.g. when you stay on task for 10 minutes, then you can join a Zoom call with your friends) or by using a classic reward chart. If you alternate academic time blocks with fun time blocks in your child’s schedule, then it can be easy to incorporate a when-then reward model into your day by using many of the fun activities that your child is already doing.
4. Supervise your child during academic time whenever possible. When kids with ADHD are really struggling the most, they get a big boost from a little bit of adult supervision. You don’t necessarily need to sit right next to your child while they are working. Simply being in the same room as your child will help them focus and will hold them accountable when it comes to staying on task. We all have very busy schedules right now, but hopefully shortening the length of academic time blocks will make it more feasible for you to be in the room when your child is working.
5. Praise your child. Staying focused and on task for any length of time is no easy feat for any of us these days. When you notice your child working and staying on task, praise them – let them know that you’re proud of their ability to stay focused and motivated.

Keeping a child with ADHD engaged in remote learning programs isn’t easy, but these simple changes to your child’s schedule will help. Shorter blocks of academic time and rewards for staying on task may be just what your child needs to stay motivated during the final weeks of the school year.   

There is truly no right or wrong answer when it comes to deciding whether or not to bring a video game console into your home. In general, parents don’t need to worry that they’ll be doing serious harm if they allow their child or teen to play video games. Research suggests that playing age-appropriate video games in moderation (about 1-2 hours a day) will not harm a child’s cognitive development.

There are also some very real social benefits to playing video games with friends, especially right now. So, letting your child get the video game console they have always wanted could be a good thing. That said, setting limits around video games is undoubtedly harder for parents of kids and teens with ADHD. While playing video games (in moderation of course) won’t harm your child, struggles around limit-setting have the potential to create substantial stress for your family.  

As you decide whether to buy a video game console for your child with ADHD, consider the following:

• Are you currently able to effectively set screen time limits with your child? Many kids with ADHD struggle with screen time limits on non-video game screens. When video games are added to the mix, setting limits can be even harder. If you are currently able to have your child follow screen time rules without too much conflict, then you will probably have the same success when it comes to video games. If screen time is a struggle now, solve this problem before you bring video games into your home. Create a screen time plan for your child and make sure they can follow it for at least two weeks (preferably four weeks) without much conflict before you consider buying a video game console.
• Does your child hyperfocus on screens? Many kids with ADHD hyperfocus when they are interacting with screens (with the exception of online schoolwork, when, unfortunately, the opposite is often true). If your child or teen really struggles to shift their attention away from a screen when they are watching videos or playing games on a tablet, then expect this challenge to be even greater when your child is playing video games with their friends.
• Does your child struggle to regulate their emotions, especially when they are transitioning off of screens? Many kids with ADHD struggle to regulate their emotions throughout the day, and the transition off of screens can be a major trigger. For kids who become dysregulated when screens are turned off, you see a major shift in behavior – they may become angry, oppositional, and sometimes even aggressive. If this happens to your child or teen now, you can expect that it will be even worse when they are transitioning off of video games.
• Are you willing to set firm video game limits and take the console away if your child or teen doesn’t follow your screen time rules? In order for most kids and teens with ADHD to stick to video game rules, they need their parents to set firm limits and use consequences consistently. This means that if your child or teen does not follow the rules you’ve laid out for them, then you need to be willing to take away their video game privileges for a period of time (and deal with your child or teen’s negative reaction).
• Are you able (and willing) to research age-appropriate video games and monitor your child’s social interactions while they are gaming? Just like you keep your kids safe online by making sure they are only accessing age-appropriate content and are safely interacting with others via social media and other sites, you’ll need to make sure your child or teen is playing age-appropriate games and is having safe and positive social interactions while gaming.
  
  Websites like theEntertainment Software Rating Board's game ratings and Common Sense Media provide the information you’ll need to determine which games are appropriate for your child, but doing the research takes time (and you may need to say ‘no’ to your child if they want a game that you don’t approve of). Monitoring your child or teen’s social gaming activity also takes time and comes with a learning curve. So, be honest with yourself about whether this is something you can reasonably take on right now.

Many kids and teens are spending a lot of time socializing via video games while we are all practicing social distancing, and allowing your child or teen to join in the fun may help reduce their feelings of social isolation. If your child or teen has ADHD, be prepared to establish firm gaming rules before the console arrives at your home and enforce these limits with the consistent use of consequences.

Fortunately, there are many things parents can do to help kids cope with anxiety, starting with helping kids recognize and name their feelings. It might seem like recognizing and labeling our feelings are things that are fairly simple to do, but it actually requires some fairly sophisticated skills that develop over time during childhood and adolescence.

Every child develops at their own pace, and kids with ADHD may develop these skills more slowly than kids without ADHD. When these skills are lagging, kids express their feelings and emotions through behaviors rather than words. Feelings manifest as behavior outbursts, argumentativeness, frequent crying, withdrawing from family and friends, poor sleep, changes in eating habits, and/or physical complaints like stomachaches or headaches. When kids are able to label their feelings and express them in healthier ways, they feel less anxious, their behavior improves as well.

Here are five strategies for teaching your child the skills they need to start recognizing and naming their feelings today.

1. Post a feelings chart. Feelings charts are used by teachers, counselors, and therapists to help kids label their emotions. They can be extremely useful for parents as well. The best charts contain about 20-25 emotions and use simple descriptive images. There are thousands of printable feelings charts available online, and most high-quality charts can be downloaded for a small fee (like this How Do You Feel emoji chart that can be downloaded for $3.00). Post the chart on the wall where you and your child can see it throughout the day.
2. Practice labeling feelings. Your child will learn to name their feelings through practice and repetition. Throughout the day, ask your child to describe how they are feeling using the feelings chart. Make sure to ask them to use the feelings chart at times when they are happy and calm as well as when they seem worried or frustrated. If they are struggling or resisting the practice when they are angry, anxious, or upset, then ask them to practice only when they are calm or excited until they get the hang of it. Over time, their resistance will decrease, and you can gradually start using the chart for feelings that are more difficult.
3. Avoid labels like ‘good’ and ‘bad’ when talking about feelings. It’s important for your child to be comfortable with a wide range of emotions. While most of us tend to think of calm and happy feelings as ‘good’ and sad, frustrated, and angry feelings as ‘bad,’ it’s important to be neutral when talking to your child about their feelings. All feelings are important and helpful, and we want to teach kids that it’s okay to experience all of them. We also want to teach kids that their parents will always accept them, regardless of how they are feeling.
4. Be a good role model by labeling your own feelings. Kids learn best when they see others model new skills. So, name your own feelings out loud as they come up throughout the day. Label a wide range of feelings so they can see that all feelings are normal. Focus on labeling emotions during simple situations that kids can understand and relate to. For example, you can mention that you’re feeling frustrated because you are struggling to open a jar of tomato sauce, are feeling disappointed because the store didn’t have what you needed in stock, or are feeling happy because it’s a warm and sunny day outside.
5. Praise your child when they name their feelings. Praise your child when they label their feelings when you have asked them to, and also praise them when they label their feelings without prompting. Let them know that you’re proud of them, and that it feels good to know what they are feeling on the inside throughout the day.

When it comes to helping your child cope with anxiety, teaching them to recognize and name their feelings is an important first step. With practice and patience, your child will develop the skills they need to express their emotions through words. Over time, you’ll find that they are relying more on words and less on behavior to express how they feel.

While it’s not surprising to hear that kids are feeling more anxious than usual right now, you may be surprised to know that it’s often harder to pick up on signs of anxiety in kids when they also have ADHD. Why? Because they often closely mimic the symptoms of ADHD themselves.

In fact, many trained professionals struggle to distinguish between anxiety and elevated ADHD symptoms or disruptive behavior in children with ADHD. On top of this, many children aren’t actually aware of their anxious thoughts and feelings, and they lack the sophisticated language needed to describe complex anxious thoughts and emotions.

So, what does anxiety look like in kids with ADHD? There’s no one-size-fits-all answer, but some of the most common symptoms include:

• Restlessness
• Trouble concentrating
• Irritability
• Defiance and oppositional behavior
• Argumentativeness
• Behavior outbursts or meltdowns
• Difficulty sleeping at night (difficulty falling asleep, refusing to sleep alone, or waking up in the middle of the night and struggling to go back to sleep)
• Stomach problems and/or headaches
• Asking questions repeatedly or talking excessively about the coronavirus
• Being “clingy” with parents or other family members

For the symptoms of anxiety that overlap with symptoms of ADHD or disruptive behavior disorders, parents should be on the lookout for a worsening of these symptoms as potential signs of anxiety. For example, if your child usually has difficulty concentrating or sitting still, but now struggles much more in these areas, then this may be a sign of anxiety.

If your child is usually argumentative a few times a week, but right now they rarely seem happy and are constantly arguing with everyone at home, then it may be more than just frustration with school closures and home confinement. It may be an expression of anxiety, especially if other signs from the list above are popping up as well.

If you think your child may be struggling with anxiety, talk to their pediatrician. They can help you find a provider who can tease apart your child’s symptoms to determine whether anxiety is in fact part of the picture. If your child takes medication for ADHD, ask their prescribing doctor if ADHD medication could be contributing to your child’s anxiety during this stressful time. For some children, ADHD medication can make anxiety worse even as it helps with ADHD symptom management.

The good news is that anxiety is highly treatable, especially in kids. While your child will continue to have at least some symptoms of anxiety during this stressful time, working with the right clinician can help you and your child learn tools that will make their anxiety much more manageable while everyone is confined at home. Long-term, you can continue to help your child use these tools so their anxiety can stay in check even when the current crisis is over and life returns to normal.

If you are a parent who is losing patience quickly or responding to your child with angry outbursts that mirror their own negative emotions and behavior, resist the urge to become frustrated or angry with yourself. Instead, consider that your short fuse may be more of a reflection of your own unmet needs than a reflection of your parenting.

For parents of kids with ADHD, there are three things that will help you manage your emotions better during the current crisis:

1. Lower your expectations. We are in a crisis and no one is able to bring their ‘best self’ to the table right now – this includes you, your partner, and your children. So, make sure your expectations aren’t as high as they would be during ‘normal’ times. Adjust them to account for the stress everyone is experiencing, and go easy on yourself when your parenting isn’t perfect.
2. Focus on getting at least some of your own needs met. Take a minute to look at the image above and reflect on the areas where you may have unmet needs. If you are like many parents, almost all of these needs are not being met as you focus instead on simply getting through each day. It is not going to be possible to meet your own needs the way that you normally would right now, but this doesn’t mean that you should neglect your own needs altogether. Neglecting your needs will leave you fully depleted and make it impossible to stay calm and connected when your child needs you. If you have unmet needs, finding creative and simple ways to get at least one or two of these needs met is the best thing you can do for your family right now.
3. Create structure. Kids with ADHD need structure in order to manage their own behavior and emotions, and parents need this structure as well. For your own emotional well-being, work on creating a routine at home that works for you and your child. You can view my latest webinar to learn how to create an ADHD-friendly routine for your family.

Staying emotionally healthy during the coronavirus crisis isn’t easy, but even small steps can help. If you are feeling overwhelmed, start by taking five minutes out of your day to do something just for yourself – even if that means simply sitting outside or listening to one of your favorite songs. If you are feeling overwhelmed by stress or anxiety, reach out to a therapist for help or contact the National Disaster Distress Helpline at 800-985-5990, or text HOME to 741741 to connect with a Crisis Counselor at Crisis Text Line (a non-profit organization).

Teens who are prone to symptoms of anxiety or depression and those who already had tense relationships with their parents are among those struggling the most. Not surprisingly, parents of struggling teens are also struggling themselves. When a teenager is constantly irritable or frustrated, it affects the whole family – especially when the whole family is stuck at home.

While parents cannot directly change their teen’s mood or outlook on life right now, there are a few mental shifts that parents can make to help improve the situation for themselves, and hopefully for their teen as well.

1. Check your expectations. Avoid placing adult-sized expectations on your teenager, especially around their reactions to the coronavirus crisis and social distancing measures. It is completely normal for teens to lack perspective and minimize the potential impact of the coronavirus on themselves or their family and friends. It’s also normal for them to fail to comprehend the reasons why social distancing is so important or think that their world is ending when they can’t see their friends or participate in the activities that they enjoy.

Perspective is something that comes with age and experience. Most teens simply haven’t had enough life experience to grasp how our own behavior during this global crisis can affect the health and well-being of others (even many adults are struggling to understand this right now). The same applies to your expectations for their ability to self-motivate and complete the schoolwork they have been assigned, or voluntarily turn off their videos or videogames and do something active or help out around the house.

All teens, and especially teens with ADHD, are much less skilled at creating their own structure and motivation than adults. So, be patient and remember that while your teenager may look all grown up, they are in many ways still a child.   

2. Avoid falling into a ‘comparative suffering’ mindset. Comparative suffering, a concept popularized by Brené Brown, refers to our tendency to view our own difficult situation in comparison to others who may have it worse than we do. How often have you recently thought (or heard someone say) something like, “I’m so overwhelmed right now, but I shouldn’t complain. It’s the healthcare workers on the front lines and families who have lost loved ones who are really struggling.”

Comparative suffering may seem like a helpful and humble way to think about your situation, and usually, it’s coming from a good place. The problem is that it causes us to bottle up our feelings (which then inevitably seep out in unhealthy ways), and as Brené Brown notes, “comparative suffering corrodes compassion and connection.”

This is particularly true when you view your teenager’s situation through a comparative suffering lens. Take this typical example, “I’m so frustrated with my teen. He’s acting out and being selfish just because I won’t let him hang out with his friends. Doesn’t he really how lucky he is, or that there are people out there struggling with serious problems right now?”  This type of comparative suffering mindset makes it extremely difficult for parents to connect with their teens and have compassion for their situation. The comparison comes much more easily when parents shift their thoughts and expectations to match their teen’s perspective, “My teen is really struggling right now. His friends are so important to him, and he had so many things he was looking forward to doing with them this spring. He doesn’t have enough experience to understand the big picture, and to him this must feel devastating.” 

3. Express empathy. Teens will respond better to everything that you say to them or ask of them if you empathize with their situation. Let them know that you realize that all of the disruptions caused by the coronavirus crisis are hard on them, and that being confined to their home is not easy. Some teens may not let you know outwardly that your empathy matters, but don’t be discouraged. Over time, it will make a difference (whether your teen admits it or not!).
4. Find time to connect. Finding ways to connect with your teen and do things together that your teen enjoys is more important than ever during a crisis. Even if your teen is pushing you away, try to find little ways to laugh or smile together. Ask them about activities they might like to do with you, and if they’re willing, have them take the lead on planning a fun (at-home) activity that you can do together.
5. Continue to set limits. No matter how difficult or frustrating your teen’s behavior is at times, it’s essential that you continue to set appropriate limits. Teenagers rely on these limits to help them regulate their mood and their behavior (especially when a teen has ADHD). So, continue to hold the line no matter how tempting it may be to give up on limit-setting when your teen pushes back.

Lastly, if your teen is struggling with anxiety or depression (or other mental health difficulties), or you feel like you need additional support to parent your teen effectively during this crisis, reach out to a mental health professional (most are offering telehealth sessions). Your pediatrician can provide referrals to a provider in your area.

Fortunately, there are outstanding online resources available. Some of these resources offer practical tools and strategies for coping during the crisis. Others allow you to connect directly with other parents who are also doing their best to manage during this difficult time. For parents of kids with ADHD, the resources below are a great starting point when searching for strategies and support online during the coronavirus crisis.   

Child Mind Institute COVID-19 Resource Center
The Child Mind Institute is a fantastic organization dedicated to providing gold standard child mental health treatment and resources for families. Their team of providers are some of the best in the nation (many were my colleagues when I was a clinician in the Child Mind Institute’s ADHD and Behavior Disorders Center), and the online resources this team is providing during the coronavirus crisis are top notch.

Facebook Live chats are scheduled twice a day with their clinical team, and Facebook Live follow-up consultations are available (costs are associated with consultations). Daily email tips for parenting during the crisis are also available, and their website is full of resources on topics related to coping with the coronavirus crisis, autism and the coronavirus, how mindfulness can help during the crisis, and more.   

PRACTICE San Francisco
PRACTICE San Francisco offers a variety of high-quality sessions and classes designed to help parents and kids practice mindfulness, develop resilience, and effectively cope with emotion. Programs are led by Dr. Nina Kaiser and an outstanding team of clinicians. Currently, many of the studio’s programs are available online where they can be accessed by families across the country.

The webinar series Parenting in Stressful Times provides practical strategies for talking to your kids about coronavirus, managing your own stress, anxiety, and frustration as parents, and surviving school closures. During the coronavirus crisis, online support groups are being offered for moms of preschool and school-age children (at 8:00 Pacific time on Mondays and Wednesdays).

ADHD Parent Support Facebook Group
While this resource isn’t specific to coping with the coronavirus crisis, the ADHD Parent Support Facebook group is a fantastic resource for parents of ADHD children who are looking to share support and ideas with other families who understand what you are going through. The support group is well moderated, and overall, members are very respectful of each other’s unique experiences. To join the group, search “ADHD Parent Support” in Facebook and submit a request to the group administrator.

CHADD: Guidance for Uncertain Times
CHADD (Children and Adults with ADHD) is the preeminent ADHD non-profit organization. The organization’s mission is to serve as a clearing house for evidence-based information on ADHD, provide support to families affected by ADHD, and serve as an advocate for appropriate public policies and public recognition in response to needs faced by families and individuals with ADHD. During the coronavirus crisis, they have compiled a set of resources for families that include many webinars and tip sheets on coronavirus-specific topics (like talking to your child about coronavirus) as well as webinars on topics related to managing behavior and ADHD symptoms, coping with emotions, staying healthy and active, and more.

As a country, we may all be practicing social distancing, but that does not mean that you go through this alone. These online resources can help you connect with others and provide practice strategies that can help you cope better during this difficult time. If you feel like you are struggling to cope and need support urgently, contact the National Disaster Distress Helpline at 800-985-5990 or text HOME to 741741 to connect with a Crisis Counselor at Crisis Text Line (a non-profit organization).

All parents have had to quickly pivot away from their routines and create some semblance of normalcy for themselves and their families. Now, after 15, 18, or 25 days of ‘super-parenting’ without a break (and with no end in sight), many parents are hitting a wall and are starting to show classic signs of burnout.

When we think about burnout, it’s usually within the context of work. We’ve all either experienced burnout ourselves or watched as one of our colleagues suddenly lost motivation and became cynical about their job. But burnout isn’t limited to work – it can actually happen in any area of our lives.

Unfortunately, parenting during the cOVID-19 crisis is a perfect storm to fuel parent burnout. Psychologists who have studied burnout have found that it follows a fairly predictable pattern. The pattern itself has been described in a variety of ways, but the six stages of burnout outlined by Katie Maycock, an anxiety specialist at Thrive Global, captures it particularly well.

When applied to parenting during today’s crisis, the stages look something like this:

Stage 1 of Burnout: Excitement!
While you might not have been excited (not even a little bit) at the start of the cOVID-19 crisis, you may have been feeling energetic and committed to making the best of a very difficult situation. You may have poured a lot of time and energy (often out of necessity) into creating a home situation that would make this time manageable for you and your family.

Stage 2 of Burnout: Let’s Work Harder!
Your initial energy is starting to wane, but you’re committed to making this work. So, you look past the cracks that are starting to show and instead continue to push even harder. Self-care continues to take a back seat, and your eating habits and sleep suffer.

Stage 3 of Burnout: Frustration
Your efforts to push harder aren’t working. You become increasingly tired, forgetful, and frustrated. You struggle to concentrate and keep up with even the most basic tasks on your list. At this stage, you may notice yourself getting increasingly irritated by your children, spouse, or other family members, and you are starting to feel hopeless.

Stage 4 of Burnout: Illness and Denial
You start to feel physically run down and possibly even ill. Your body is sending strong signals that you are headed for burnout, but you deny that anything is wrong and continue to forge ahead.

Stage 5 of Burnout: Lack of Drive and Apathy
The motivation and commitment you felt at the start of the COVID-19 crisis feels like a distant memory. Instead, feelings of apathy and withdrawal take over, sometimes accompanied by feelings of anxiety, guilt, and a lack of confidence in your parenting abilities.

Stage 6: Burnout
At this stage, you are completely exhausted – emotionally, mentally, and physically. You may feel overwhelmed and struggle to enjoy any time with your family, or the simple things that usually make you happy. Symptoms of anxiety and depression are common at this stage.

Parenting burnout will leave you feeling miserable and can take a serious toll on every member of your family. There is no magic bullet for avoiding burnout, but you can recognize the early signs and intervene before things become more severe. Right now, many parents are in the midst of Burnout Stage 2: Let’s Work Harder and Burnout Stage 3: Frustration. If you are in this group, notice the signs and take small steps to change course before burnout gets worse.

If you were experiencing burnout at your job, taking a few days off from work or delegating some tasks to a co-worker would help considerably. Unfortunately, you can’t take any days off from parenting during a crisis, and with social distancing in effect, you’re not able to bring in family members or babysitters to help. So instead, focus on the little things you can do to help reduce your stress level.

If you have a spouse or partner at home, start by having a conversation. Be honest about how you are feeling and see if there are a few tasks they can take off your plate, even just for a few days. Then, carve out time to do some things that have helped you feel recharged in the past. Chat with a friend, spend some alone time outside, take a relaxing bath, listen to your favorite music or podcast while you go for a walk. It might feel impossible to find the time to do these things, but it’s more important than ever to practice self-care right now.

Perhaps most importantly, do everything you can to get enough sleep each night and eat well throughout the day. Sleeping and eating well aren’t easy when you are stressed, so take baby steps to move your eating and sleeping habits in the right direction.

Lastly, if nothing seems to be working or if you are struggling to prioritize self-care, consider talking with a therapist. Most therapists are offering online sessions, and your primary care provider or health insurance company should be able to connect you with a professional who can help.

What this means today is that parents across the country have spent seemingly countless days juggling childcare, supervising e-learning assignments or homeschooling activities, figuring out ways to keep the kids busy while also following social distancing guidelines, and being present for their kids as they work through their feelings of anxiety, frustration, and confusion.

We are managing all of this while not being able to do many of the things we typically rely on to relieve stress – like spending time with family and friends, having kids out of the house at structured activities where we know they are occupied and safe, or even going out on a simple Target run just to get a break from things at home. And, if you are reading this post, then chances are you are also coping with the challenges that come with parenting a child with ADHD under these very difficult circumstances.

Since these closures happened quickly and with very little planning, many districts are still working through their remote education plans. In the meantime, some schools have not assigned any work, many have sent home assignment packets, and others are providing some form of online learning. For children with IEPs, their special needs may directly impact their ability to learn at home via these improvised formats.

The current situation is unprecedented, and schools are adapting as quickly as possible. Most schools, even those that have already instituted online learning programs, are still working out the kinks for all children in the general education population. Once schools are on more solid footing with their overall programming, they will likely begin focusing on adapting and tailoring these programs to meet the needs of children with IEPs.

For parents looking for information specific to the rights that children with IEPs have under the current circumstances, and the direction that school districts are being given about how to implement special education accommodations and services, the U.S. Department of Education website is your best source of information. Once programs and accommodations start rolling out, your child’s school district and your State Department of Education websites will also become key online resources.  

The U.S. Department of Education’s website can be overwhelming, so when looking for up-to-date information, focus on these three resources:

1. IDEA (Individuals with Disability Act) Coronavirus Q & A webpage. This is currently the most useful website for special education policy updates.
2. Online Education and Website Accessibility webinar. This 7-minute video created by the U.S. Department of Education’s Office of Civil Rights give an overview of online education accessibility for students with special needs.
3. Supplemental Fact Sheet: Addressing the Risk of COVID-19 in Preschool, Elementary and Secondary Schools While Serving Children with Disabilities. This fact sheet, also created by the Office of Civil Rights, summarizes the guidance being given to states and school districts specific to special education services.

There’s a lot of information embedded in these resources, but here are a few key take-away points:

• “If [a district] closes its schools to slow or stop the spread of COVID-19 and does not provide any educational services to the general student population, then [a district] would not be required to provide services to students with disabilities during that same period of time.” – IDEA Coronavirus Q & A webpage.
• If [a district] continues to provide educational opportunities to the general student population during a school closure, the school must ensure that students with disabilities also have equal access to the same opportunities, including the provision of a free appropriate public education." – IDEA Coronavirus Q & A webpage.
• “The Department [of Education] understands that there may be exceptional circumstances that could affect how a particular service is provided. If a student does not receive services after an extended period of time, the student’s IEP Team, or appropriate personnel under Section 504, must make an individualized determination whether and to what extent compensatory services are needed consistent with the respective applicable requirements, including to make up for any skills that may have been lost.” – Supplemental Fact Sheet
• “The Department [of Education] understands that, during this national emergency, schools may not be able to provide all services in the same manner they are typically provided… Many disability-related modifications and services may be effectively provided online. It is important to emphasize that federal disability law allows for flexibility in determining how to meet the individual needs of students with disabilities.” – Supplemental Fact Sheet

Responses to the COVID-19 outbreak will continue to evolve over time, with many differences from school to school and district to district. In addition to staying up to date with online resources, reach out to your child’s school if possible and discuss any concerns you may have. It will take time for schools to adjust to this unprecedented situation, so you may not get clear answers right away. But with patience and open lines of communication, you should eventually be able to work with your child’s school to develop a plan that meets your child’s unique needs.

But just because you and your kids are using screens more often doesn’t mean that your family should not have any screen time rules or limits right now. Instead, it’s time to revise your old rules and establish new limits that meet your family’s current needs. 

Even during this unique and stressful time, it is important for kids to have clear screen time rules and boundaries. Studies have shown that excessive screen use is associated with sleep problems, over-eating, lack of physical activity, and (for some children, especially those with ADHD) problems with mood, anxiety, and behavioral outbursts. 

On top of this, unmonitored internet use increases your child’s risk of exposure to content that isn’t age-appropriate. When life returns to normal and you need to set limits again, the amount of resistance you get from your child could be extreme if they have adapted to the lack of screen limits at home. 

Creating a plan for managing screen time can be done in five steps: 

1. Decide how much recreational screen time your child will be allowed each day. The American Academy of Pediatrics recommends no more than 1-2 hours of screen time per day for children over the age of 2. Since most kids are currently relying on technology for learning and socializing, focus on limiting recreational screen time – screen time that is not being used for academics or for face-to-face chats with friends (via apps like FaceTime or Zoom). I recommend allowing up to one hour of recreational screen time each day.
2. Set expectations for how your child should behave when it’s time to turn off their screens. Many kids begin arguing, negotiating, and melting down as soon they are told their screen time is over. Tell your child exactly how you expect them to react when you tell them it’s time for them to turn off their screens. For example, you expect them to turn off their screen calmly after you remind them no more than two times. You can reward them for meeting this expectation by giving them 10 minutes of extra recreational screen time the next day.
3. List the apps, videos, and video games your child is allowed to watch. You can simply say that only ‘parent-approved’ games, apps, and videos are allowed, or you can create a specific list. Also plan to monitor your child’s screen activity so you know exactly what they are doing when they are online.
4. Designate screen-free times for your family. Identify times when screens are off limits for the entire family, like meal time, family game time, and one hour before bed. This will reduce conflict, improve family relationships, and improve your child’s sleep.
5. Post your plan. Type or write up your plan and post it in a location where it can be seen by everyone in the family. Remind your family of the rules every day until they become a habit.
7. Screen use has increased for everyone. Having a strong screen time management plan for your family will help you set healthy boundaries and feel better about the time your child is spending online.

Self-advocacy skills aren’t something that kids and teens are able to learn on their own, they are skills that need to be taught and practiced over time. Unfortunately, too many young adults with ADHD have not developed these skills and are now struggling to live independently. Without self-advocacy skills, young adults with ADHD are at risk for delaying important milestones or failing to achieve them altogether. This includes things like successfully completing college or holding down a full-time job, establishing meaningful adult friendships and a sense of belonging, moving out of their parents’ homes, and participating in activities that interest them and add meaning to their lives. In fact, research has demonstrated a clear link between teaching kids self-advocacy skills and their ability to become happy, well-functioning adults.

So, what is self-advocacy exactly? Self-advocacy can be broken down into three parts: (1) knowing yourself, (2) knowing what you need, and (3) knowing how to get what you need. Knowing yourself means knowing your strengths and weaknesses, understanding how your ADHD symptoms affect you and being aware of the things that bring you the most joy and the most frustration. Knowing what you need means understanding the kinds of accommodations, supports, and treatments that are most helpful for managing your ADHD symptoms. It also means being able to set a goal for yourself and identify the strategies, supports, and people who can help you achieve that goal. Knowing how to get what you need means knowing when and who to talk to about getting the help you need, being able to clearly communicate your needs, and being able to follow through consistently on treatment and support recommendations.

Self-advocacy is a complex process, which is why all parents should start teaching these skills to their children as early as possible. It’s not feasible to tackle every aspect of self-advocacy at once. Instead, start with knowing yourself. Help your child understand how their ADHD symptoms affect them on a daily basis and the things that make their symptoms better. Also, help them discover their strengths and interests by providing opportunities for participation in a variety of activities. Knowing what you need and knowing how to get what you need are things that should also be learned through experiences over time. In elementary school these experiences can include having your child attend IEP meetings or other parent-teacher meetings when appropriate, encouraging your child to take the lead on describing their symptoms and difficulties during doctor’s appointments (with parents filling in the gaps as needed), and coaching your child on how to ask their teachers for help when they are struggling. 

Learning self-advocacy skills takes time and practice. Start small and provide plenty of coaching and praise as your child practices their new skills. Over time you’ll be helping your child grow into a confident adult with the self-advocacy skills that they need to live happily and successfully with ADHD. 

Most (if not all) of the activities that provide important structure on weekends for kids with ADHD are being cancelled. Social distancing measures will mean that typical snow day neighborhood playdates and visits to the park won’t be an option. On top of this, many parents will still have work responsibilities, either via telework or in person, on days when schools are closed.  

The coming weeks will not be easy, especially when you have a child with ADHD. Following these six tips will help things go as smoothly as possible when the kids are at home: 

1. Do not change your child’s weekday medication schedule. If your child takes ADHD medication, continue their usual school-day medication routine even when school is cancelled (unless their doctor recommends otherwise). ADHD symptom management is very important at this time, and your child will be much better equipped to cope with the disruptions brought on by COVID-19 if they have medication on board to help to keep their ADHD symptoms in check.  

1. Have consistent wake-up times and bedtimes. Even if kids are not going to school during the week, they still need enough sleep each night based on the sleep guidelines endorsed by the American Academy of Pediatrics. Kids with ADHD are more likely to have sleep problems, and poor sleep makes ADHD symptoms much worse. So, maintain a consistent sleep schedule with wake-times and bedtimes that are the same each day.  

If you choose to shift these times away from your family’s usual school-day routine by letting your child sleep later in the morning and/or go to bed later in the evening, remember that you may struggle to get them back on their regular sleep schedule when school starts up again in a few weeks. Decide if the benefit of having later wake-times and bedtimes now is worth the cost of a sleep struggle later on when they return to school.  

1. Establish and maintain a consistent schedule throughout the day. As much as possible, create a consistent routine and stick with it. Start by scheduling lunch and snacks and build the rest of the routine around these activities. Post the schedule in a place where it is visible to the whole family. 

1. Schedule learning activities for the morning. Some schools will be using virtual classrooms or e-Learning tools to keep kids engaged in school while the buildings are closed. There are many different virtual learning models available. Some are very structured, requiring kids to log in at the same time each day and complete scheduled classroom or group activities. Others are unstructured, giving kids daily assignments to complete on their own (with teachers available to help via phone calls or chats at certain times of the day). Other schools are opting out of virtual learning and are cancelling school altogether. 

Regardless of your child’s school’s plan, every student should complete some academic work every day to avoid academic backsliding. Getting kids with ADHD to stay focused and on-task when completing academic assignments at home is a challenge (I’ll share more strategies related to this in a separate post), but you can maximize your child’s ability to focus and stay on task by scheduling academic time first thing in the morning.  

1. Avoid exceeding the American Academy of Pediatrics screen time limits. The American Academy of Pediatrics recommends no more than one hour of screen time per day for children over the age of two. Since many school assignments and activities will be occurring online while schools are closed, I recommend planning for no more than one hour of screen time per day not including the time spent online for school-related activities.  

It will be very tempting to allow your child to spend more than one hour on their screens, but the negative impact of extended screen time on behavior, focus, and sleep for kids with ADHD is very real. Extended screen time every day for up to two weeks (or more) can ultimately take a toll on your child and your family. Set appropriate screen time limits on Day 1 to avoid conflicts and limit testing down the line.  

1. Make sure your child gets at least one hour of physical activity every day. One of the biggest problems with excessive screen time is that it reduces physical activity. All kids, and especially kids with ADHD, need daily physical activity to help them regulate their emotions, behavior, attention, and sleep. Make sure your child is getting at least one hour of physical activity each day – and build this into your daily routine.  

Whenever possible, encourage your child (and yourself) to be physically active outside. Schedule walks or bike rides. If you have a backyard, use it. On rainy days, kids can play Nerf basketball inside, and siblings can wrestle or have races up and down the hall. The trick is to allow them more freedom to be physically active inside by lifting some of the usual rules you may have (like no running in the house) by creating time slots when these activities are allowed and encouraged and monitoring your children to make sure they are still playing safely at these times.  

Dealing with school closures and social distancing will be a challenge for everyone, and no one has all of the answers in this unprecedented situation. Every family will have to learn what works best for them through some trial and error. Starting with these six strategies will help set your child and your family up for success and will help you make the most of your time together in the weeks to come.

Consistent routines and expectations are essential for helping kids with ADHD manage transitions, but they may not be enough for the kids who struggle the most. Try these additional tips for managing emotional and behavioral outbursts during transitions: 

1. Start with the basics: food and sleep! Emotional or disruptive outbursts during transitions are amplified by fatigue and hunger. When a child is tired or hungry they may be able to hold it together ‘just enough’ when they are engaged in an activity they enjoy, but the transition out of this activity stresses them just enough to deplete their resources and cause a meltdown. Make sure that your child is getting the recommended amount of sleep each night based on the sleep guidelines supported by the American Academy of Pediatrics, and stick to a predictable meal and snack schedule that will fuel your child throughout the day.
2. Look for patterns and consider ‘hidden’ causes. Chances are your child does not struggle equally with all transitions throughout the day. Think about the transitions that are the most challenging. What is the activity you are asking your child to transition away from and the activity you want your child to begin? If the worst transitions always involve stopping screen time, then work on new strategies for managing screen time with your child. If they always occur when your child is about to start homework, then frustration related to homework may be the real problem. Sometimes meltdowns seem sporadic, but when you take a step back you can find a common thread. For example, some kids have their worst transition meltdowns when they are heading to an activity that involves socializing with other kids - a clear trigger for children with underlying social anxiety.
3. Allow more time. Meltdowns are more likely to happen when you are under pressure and can’t be patient with your child. Staying patient and calm when you are pressed for time is a tall order. Couple this with the fact that kids with ADHD need more time than most to get through transitions and you have a recipe for a meltdown. Assume that your child will need twice as much time as you usually allow, and plan to give them this extra time every day for at least a week. You may be surprised by how much this helps! When it works you will probably be motivated to continue this change long-term.
4. Do not negotiate with your child. Many behavior challenges and meltdowns during transitions involve negotiations between parents and kids. These negotiations are often a big source of conflict in families and are a distraction that make it nearly impossible for kids to move quickly. As a parent, you need to be vigilant about not letting your child deviate from their transition routine unless it’s absolutely necessary and avoid bargaining with your child to get them to do what you’ve asked of them. If your child is trying to negotiate, don’t participate in the conversation no matter how tempting it may be. Remember that it’s impossible for your child to negotiate with you if you simply don’t respond to their questions or demands.
5. Pay attention to your child’s emotions. During transitions parents are often so overwhelmed by their own emotions and their child’s behavior that they forget to think about their child’s emotions. If you are able to stay calm and allow more time for transitions, you will have the space you need to truly focus on your child’s emotions. You’ll have the capacity to be attuned to what your child needs from you emotionally in the moment. For some kids, a hug before and after the transition can go a long way in helping things go more smoothly. Empathize with your child and let them know that you recognize how hard it is for them to stop doing something fun or get ready to start doing something they aren’t looking forward to. Let them know that you are working on making these transitions easier and that they aren’t alone in their struggle. Connecting with your child during the hard moments can be a powerful way to improve your relationship overall and stop meltdowns before they start.

Transitions will never be easy for kids with ADHD, but you can minimize stress and frustration for you and your child when you find strategies that work for your family. If you think your child’s behavior and emotions during meltdowns are tied to other difficulties like anxiety, challenges with screen time, or learning differences, seek additional help from your child’s school, pediatrician, or mental health provider.

This developmental lag has been identified over and over again in research studies that have used parent and teacher rating scales, past studies that have gathered observations of children’s behavior, and neuroimaging studies that measured brain development in ADHD. So, while you may have a child with ADHD who is intelligent and talented in many ways, the foundational skills that they need in order to reach their full potential are relatively weak.

More often than not, parents, teachers, coaches, and other important adults in a child’s life do not adjust their expectations based on the developmental level of a child with ADHD. As a result, they inadvertently set the child up for failure by holding them to an unreachable standard. As you might expect, in these situations, the child fails to meet expectations, and their self-esteem suffers. Parents will typically become increasingly frustrated with their child, but they will also try to help improve the situation.

Sometimes this help comes in the form of typical snowplow parenting – clearing obstacles out of their child’s way whenever possible and picking up the pieces or making excuses for their child when they fail. This “snowplow” response may help in the short-term, but long-term, it does nothing to address the root of the problem – the developmental gap between expectations and skills.

To see lasting change, a strategic three-pronged approach is needed that addresses both the “skills” and the “expectations” sides of the problem:

1. Skill Development. When a child doesn’t have the skills needed to meet an expectation, skill development is a necessary step in closing the expectations-skills gap. This can come in the form of social skills coaching, academic tutoring, organizational skills training, therapy to help kids better manage their emotions, and other treatments (including medication) to help kids manage their ADHD symptoms more broadly.
2. Scaffolding. More often than not, in at least some areas, the expectation-skills gap will be so great that skill development may only get a child part of the way to their goal. At these times, parents need to scaffold their child while they continue to build their skills. Scaffolding is different from snowplowing. Instead of clearing obstacles out of their child’s way, parents proactively provide support and structure while their child works to meet an expectation.

Using homework as an example, your expectation may be that your child completes all of their homework every night, but your child may not have the skills and abilities they need to work independently for 30 or 40 minutes. Rather than have an extreme response that involves either dropping the expectation altogether or doing your child’s work for them, you can “scaffold” your child by creating a structured homework routine designed to help them work as independently as possible every night (see my previous post on homework routines for more information). 

3. Adjust Expectations as Needed. There will be times when even with skill-building and scaffolding, your child is still not able to meet an expectation consistently. In these cases, adjusting the expectation is appropriate. Using the homework example, requesting modified homework assignments may be necessary. This can take the form of having a child complete only every other problem on math worksheets, typing or dictating writing assignments instead of using a pencil and paper or reducing the amount of required reading each week. The child is still required to meet the expectation of completing all of the assigned work each evening, but the amount of work assigned will be more manageable. When expectations are adjusted, they should be revisited periodically and adjusted again as your child’s skills and abilities continue to grow.

Setting clear and reasonable expectations for children with ADHD is essential to helping them reach their full potential, and for parents to avoid falling into the snowplow parenting role. Knowing where to set an expectation is hard, and not necessarily something parents should do alone. Reach out to your child’s teacher, therapist, counselor, and/or pediatrician for help.

The New York Times article that’s credited with popularizing the “snowplow parent” phrase notes that this parenting style often starts early, when parents “try to make sure their toddlers are never compelled to do anything that may frustrate them,” then escalates when school starts, with parents “running a forgotten assignment to school or calling a coach to request that their child make the team. Later, it’s writing them an excuse if they procrastinate on schoolwork, paying college counselor thousands of dollars to perfect their applications, or calling their professors to argue about a grade.”

The consequences of snowplow parenting are potentially severe. If kids rarely experience (and overcome) failure, they won’t develop resiliency. If they aren’t given the opportunity to tackle child- or teenage-sized problems, they won’t develop foundational skills that are essential for tackling adult-sized problems in the future. Long-term, kids may ultimately fail to take responsibility for their own actions and direction in life.    

What is left out of conversations about snowplow parenting are the struggles faced by parents of kids and teens with ADHD. Having ADHD makes it harder to do things independently or meet the academic, organizational, behavioral, and social expectations that might be appropriate for other kids of the same age. Kids and teens with ADHD actually need extra involvement from their parents if they are going to succeed.

But how much involvement is too much? If a parent rushes home to pick up a forgotten homework assignment that their teen with ADHD worked hard to complete the night before, are they an overly involved parent who is preventing their teen from learning a valuable life lesson about responsibility, or are they a responsible parent who is providing the extra support that their teen needs? If a parent of a child with ADHD calls the school to explain why their child was running late again this morning and requests that they not be punished, or meets with a coach to ask if their child can have one more chance to remain on the team, are they overly involved or are they reasonably accommodating the special needs that come with having ADHD?

There are no easy answers to these questions, but they highlight how articles, posts, and tweets about the perils of snowplow parenting can cause anxiety for parents who are already worried that their child’s ADHD may prevent them from developing the skills they need to succeed in life. It’s important for parents to remember that kids with ADHD do need more support than kids without ADHD. Expectations should be adjusted to accommodate their developmental level and their ADHD symptoms.

That said, this doesn’t mean that there should be no expectations at all. It just means there should be appropriate expectations. Knowing how to set expectations appropriately and how to support your child in a way that will help them grow and succeed with ADHD is a challenge. In the next series of posts, I’ll cover topics that address this challenge and offer some practical tips for striking the right balance when it comes to being an involved parent of a child or teen with ADHD.

The guidelines and recommendations focus on identifying and treating more than “typical” core ADHD symptoms (inattention, hyperactivity, and impulsivity), and focus on treatments that lead to an improvement in behavioral, social, and academic functioning and quality of life. They also recommend that evidence-based behavioral treatments are considered an essential, foundational component of any ADHD treatment plan.

Specifically, the guidelines focus on the following 5 key action statements covering both the diagnostic evaluation and the components of the treatment plan:

• Children under 19 with suspected or diagnosed complex ADHD should receive a comprehensive assessment by a clinician with specialized training or expertise, who should develop a multi-faceted treatment plan. The plan should be designed to diagnose and treat ADHD and other coexisting disorders and complicating factors including other neurodevelopmental disorders, learning disorders, mental health disorders, genetic disorders and psychosocial factors like trauma and poverty.
• The evaluation should verify previous diagnoses and assess for other conditions; it should include a psychological assessment based on a child’s functional disabilities and intellectual and developmental level.
• All children with complex ADHD should receive behavioral and educational interventions addressing behavioral, educational, and social success.
• Treatment of complex ADHD should also include coexisting conditions, such as autism spectrum disorder or substance abuse disorder, and focus on areas of impairment, not just reducing symptoms.
• Monitoring and treatment of complex ADHD should continue throughout life.

The authors of the new guidelines appropriately point out that most children and adolescents with ADHD do not receive the behavioral interventions or continuous monitoring that they need, and they hope that this can be changed in part through the issuance of the new guidelines. If your child or teen has “complex” ADHD, but isn’t receiving any treatment or support beyond medication, then discuss these new guidelines with your child’s pediatrician or your psychiatrist. Ask them to help you figure out how to get the evaluation and treatment that your child needs. You can also discuss the new guidelines with your child’s school counselor or special education coordinator, and consider requesting a 504 plan or IEP for your child if they do not already have one in place. Consider these guidelines to be another tool you can use as you continue to work with treatment providers and educators and advocate for the treatment and services that your child or teen needs.

The study, published in the Journal of Attention Disorders, examined data from the 2016 National Survey of Children’s Health. The survey was administered by the U.S. Census Bureau and the final sample included data from 34,675 households with children between the ages of 6 and 17. In the sample, 11.7% (4,057 children) had an ADHD diagnosis based on their caregiver’s report. The researchers looked at how likely children in the ADHD group were to meet the American Academy of Pediatrics’(AAP) recommendation of engaging in at least 60 minutes of physical activity each day.

Overall, children and teens with a diagnosis of ADHD were significantly less likely to meet the AAP physical activity recommendation than children and teens without ADHD. The results from this study add to recent findings from studies with smaller samples showing that children and teens with ADHD are less likely than their non-ADHD peers to engage in several health behaviors, including eating a healthy diet, regular physical activity, and participation in organized sports.

The potential positive impact of regular physical activity on ADHD symptoms is profound, with research suggesting that it can lead to improvements in impulsive behavior, focus, organization, and social relationships, as well as other factors often related to ADHD like mood, anxiety, and sleep. Unfortunately, the ADHD stereotype may be contributing to medical providers, therapists, school counselors, and even parents failing to adequately address the lower levels of physical activity seen in some kids and teens with the disorder. In fact, while many kids and teens with ADHD are indeed hyperactive and constantly on the move, more than 50% of those with an ADHD diagnosis may not experience any symptoms of hyperactivity.

On top of this, teens who may have been hyperactive as a child may have outgrown these ADHD symptoms without adding any structured physical activities to their routines to counteract the effects of the decreased activity. Symptoms of depression and sleep problems are also common, especially among teens with ADHD, and both can quickly result in decreased physical activity.

If you notice that your child or teen with ADHD isn’t getting at least 60 minutes of physical activity every day, make changing their exercise habits a priority. Adding structured activities like organized sports (either team-based on the individual) is one of the easiest ways to ensure that they will become more active. Incorporating outdoor activities or fun outings like swimming, roller skating, skateboarding, or hiking into your family’s weekend plans can also be a big help.

If you have a child or teen who is “exercise resistant,” working with them to come up with creative ideas for engaging in physical activities that map onto their interests (even the most sedentary, video game-obsessed kid can get into Pokémon GO!). And of course, don’t feel like you and your child or teen need to figure this out on your own. Talk to your pediatrician and mental health professional about your concerns. They’ll be able to draw on their experiences with countless other families in similar situations to help you find activities and solutions that match your child and your family’s unique needs.

So, how specifically can timers help? Which types of timers are best for each situation?

• Improve awareness of the passage of time. Many kids and teens with ADHD simply do not seem to experience the passage of time in the same way as other people. Parents often try to fill in this gap by calling out reminders to count down the time remaining, “10 minutes until we need to leave the house!” “Just 5 more minutes until we need to be out the door!” Unfortunately, these reminders don’t seem to help speed things along and leave everyone feeling frustrated. Visual Timers, like the Time Timer, can help. These timers include a red disk that covers the timer face. As time passes, the red disk gradually gets smaller and smaller to show the amount of time remaining before the buzzer goes off.
• Improve productivity and on-task behavior. Staying on task for long stretches of time is difficult when you have ADHD. Timers of any kind can be extremely useful for breaking longer tasks down into smaller chunks. Use a timer during homework to have kids and teens focus for anywhere between 5-20 minutes at a time (depending on their age and ability) before taking a quick break and jumping back in for another timed stretch of work. You can also increase focus by giving kids “beat the clock” challenges. For example, challenge them to complete 5 math problems in 5 minutes (remind them that accuracy counts!), and be sure to pile on the praise and enthusiasm when they succeed.
• Reduce conflict and improve independence. Parents are constantly frustrated that their child or teen is constantly running late, isn’t getting anything done, or can’t seem to do things on their own without a parent hovering over them. Kids and teens with ADHD complain that their parents keep nagging them about staying on task or getting something done on time. Frustration and anger erupt on both sides. In these situations, a timer can essentially act as a neutral party. When the timer goes off the time is up – and it is the timer that delivers the news, not the parent. It may seem simple, but this subtle shift dramatically reduces conflict for many families. On top of this, once your child or teen learns to use timers effectively, you won’t need to hover over them and call out reminders nearly as often – giving everyone the independence and breathing room they need.

If your child or teen’s struggles with time management are taking a toll, try including a timer as a tool in your ADHD parenting toolbox. Work with your child’s therapist or school counselor to help identify specific ways that you can use a timer to help manage ADHD symptoms at home.

What does Seasonal Affective Disorder look like in teens with ADHD?
Picking up on symptoms of Seasonal Affective Disorder in teens with ADHD can be tricky. The symptoms often come on gradually and it may seem at first like their ADHD symptoms are getting worse out of the blue, or like a spike in “normal” teenager behavior – things like sleeping in late or having a very hard time getting up on school days, becoming more irritable than usual, seeming tired throughout the day, and a big dip in motivation. ADHD symptoms that were pretty well managed will also worsen, like difficulty concentrating, forgetfulness, and disorganization. When these symptoms are paired with some hallmark features of depression, there is reason to suspect that your teen may be struggling with SAD. These features include increased social isolation, no longer enjoying activities that they previously looked forward to, and – in the case of SAD – a similar pattern of symptoms and behavior (sometimes less severe) during a previous winter season.  

What Can You Do to Help?
If you suspect that your teen has SAD, your first step should be a conversation with your teen about the symptoms you are seeing. Some teens will be open to this conversation and others may shut down, but simply starting the discussion will help them know that you care. Regardless of whether your teen agrees with you about their symptoms, schedule a time to talk with their pediatrician or mental health provider about what you’re seeing and why you’re concerned. Ideally your teen will participate in this discussion as well, but not all teens may have the insight or desire to be included. Many of the treatments that work for depression, like talk therapy and medication, are effective for SAD as well. Your teen’s pediatrician or mental health provider can provide or connect you with treatments that may be effective. In addition to seeking mental health treatment for your teen, there are some things you can do as a family that may be helpful. Overall, increasing physical activity and outdoor time, scheduling activities that reduce the amount of time your teen spends alone (and socially isolated), encouraging your teen to participate in activities that are fun for them and may give their mood a boost, and doing what you can to help them maintain a consistent sleep routine can all be helpful. Lastly, help your teen by also making sure you are taking care of yourself. Parenting a teen with ADHD is hard, and when SAD or depression are added to the mix it can take a toll on your ability to be patient, kind, and caring with your teen. Do your best to avoid getting run down so you can be there for your teen as they work on getting better.

When a parent has a job that comes with little or no protected vacation or sick time, the ability to get time off to attend an IEP meeting can be at the employer’s discretion. Unlike time-off for pre-planned medical appointments, which has been protected by the Family and Medical Leave Act (FMLA), attendance at IEP meetings has historically not been covered by any Federal Law. This changed in August 2019, when the US Department of Labor issued an opinion letter stating that employees are entitled to intermittent FMLA leave to attend IEP meetings (the full opinion letter can be read here FMLA2019-2-A). In the letter it is noted that while FMLA leave could be used for time off to attend doctors’ appointments related to the child’s condition, under the policy in place at the time it could not be used to attend IEP meetings related to the same condition – despite the fact that a doctor had indicated that these school services were a necessary part of the child’s treatment.

Children and teens with ADHD who qualify for IEPs do so under the “other health impaired” qualification and require ongoing interventions at school for the treatment of their chronic condition. Therefore, the precedent laid out in this opinion letter applies to ADHD as well. It’s important to note, however, that the opinion letter only covers leave for IEP meetings specifically, and not other school meetings like 504 Plan meetings or parent-teacher conferences. Fortunately, at least some states have separate laws on the books to cover parental time off for attendance at other school meetings and activities (i.e., California, Illinois, Massachusetts, Minnesota, Nevada, North Carolina, Rhode Island, Vermont and Washington, D.C).

If you are interested in using FMLA leave to attend IEP meetings, talk to your employer as far in advance of the meeting as possible. The requirements for FMLA leave qualification for the purposes of attending medical appointments will also apply to leave requested for IEP meetings. So, for example, your employer can require that you provide documentation of your child’s ADHD diagnosis and can require (with some exceptions) that the meeting is scheduled at a time that is least disruptive to the employee’s workday. While this change to FMLA access will not fully alleviate the significant burden that parents face when juggling employment and raising a child with ADHD, it is a step in the right direction and can provide at least some relief for highly stressed families.

If this sounds easier said than done your not alone. While most parents of kids with ADHD want to create an organized environment, following through and actually creating and maintaining organization at home is a challenge that can sometimes feel out of reach. In fact, staying organized when you have a child with ADHD is hard! Why? Well, many parents of kids with ADHD have at least some symptoms of ADHD themselves, and difficulty with organization may be one of those symptoms. On top of this, having a child with ADHD puts extra pressure on parents, often leaving them without the time or energy needed to maintain a complicated organization system. And keeping up with extra clutter and mess that a child with ADHD might create at home can wreak havoc on even the most organized among us.

While your home may never look like the cover of a home organization magazine, it is possible to create and maintain an “organized enough” home even when your family is affected by ADHD.

Here are 5 tips to get you started:

1. Start small and go slowly. Resist the urge to do everything at once, and view getting organized as something that will happen slowly, in chunks of time spaced out over weeks or months. Tackle one area of your home at a time – this may mean starting with one corner of a room, or one drawer in a dresser. Really, no area is too small as long as it feels manageable.
2. Assess your stuff. Resist the urge to run out and buy the bins and organizers that are tempting (or taunting) you in the stores. Instead, start by pulling everything out of the space you plan to organize and assess what you have. Group similar items together in piles and throw away anything that you don’t absolutely need.
3. Buy storage containers and organizers that are a good match for your stuff and your needs. You will probably need to purchase a few bins or drawer organizers if you want to stay organized long term. So, make sure the things you buy will actually fit the stuff you have. Focus on organizers that will help you keep the things you use every day accessible and will allow you to store the things you use rarely out of the way in labeled bins or boxes.
4. Keep the solutions simple. The best organization systems are the ones that you and your family can maintain quickly and easily. So, keep it simple and choose function over appearances. Little things can make a big difference, like storing frequently used items in open bins on a floor or bench instead of in bins with lids stacked in a closet. Why? Kids (and adults) will ADHD often struggle to follow-through on anything that requires multiple steps. Using our bins with lids example, a bin stacked in a closet represents a 5-step solution that requires your child to: (1) get the bin out of the closet, (2) take off the lid, (3) drop the item in, (4) replace the lid, and (5) put the bin back in the closet. Instead, if the frequently used item is stored in an open bin on the floor or a bench, your child will simply need to complete 1 step and drop the item in the bin. So, the lidded bin in the closet may look more organized at first, but it’s not something that will be maintained long-term.  
5. Spend a few minutes each day maintaining the solution. Even simple solutions take some time to maintain. Fortunately, most organization solutions can be maintained in just a few minutes each day. During this time replace misplaced items and make adjustments to the system if there’s room for improvement.

Getting and staying organized may feel like a challenge when your family is affected by ADHD. But if you start small, take it one step at a time, and keep it simple you will end up with a home that functions and works well for your family.

The newly published study was conducted in China, where ADHD occurs in about 6% of the population (slightly lower than what we see here in the US). In China, as in the US, children spend a great deal of their time attending school and after-school programs. In many cases, children have more of an opportunity throughout the week to use green spaces near their school than they do near their home.

In the study, researchers sought to determine whether the amount of green space around a school was associated with the rates of ADHD observed in the students. Researchers collected ADHD symptom ratings from parents of 59,754 children (ages 2-17) attending preschool, elementary school, middle school, and high school in seven provinces in Northern China. Parents rated the frequency of each of 18 ADHD symptoms during the preceding six months on a four-point scale, ranging from “never or rare” to “very often.”

To estimate the amount of green space around the schools, the researchers used measures of vegetation, referred to as vegetation indexes, derived from satellite images taken in August (the greenest month in Northern China). Values ranged from negative one to one, with higher values indicating more green space, negative values representing bodies of water, and values close to 0 indicating areas without water or vegetation.

In the study, 4.3% of the children (2,566) were classified as having ADHD based on parent ratings. The researchers found that a 0.1 unit increase in one of the vegetation indexes within 500 meters of a school or kindergarten was significantly associated with lower odds of ADHD symptoms. Given the large number of participants involved in the study and the wide range of school environments (some with no green space or very little green space, and others with large swaths of green space), the study makes an important contribution to our understanding of how the environment may impact symptoms of ADHD.

The study also highlights important gaps in our knowledge. For example, we do not know why more green space is associated with lower rates of ADHD symptoms. It could be that simply being in nature or viewing nature fosters healthy brain development and helps us regulate our emotions and behaviors. Or, it’s possible that the students with access to more green space are more physically active. Alternatively, the pollutant-lowering effects of vegetation may mean that students in greener environments are exposed to fewer pollutants (which may affect brain functioning).

Despite the unanswered research questions, parents and teachers can help kids with ADHD now by providing as many opportunities as possible for outdoor play and exploration in nature. If your child attends a school with limited green space, work on making visits to local parks part of your regular routine. We already know that kids with ADHD benefit from physical activity, and it’s possible that getting that physical activity in a green environment will give an extra boost to kids with ADHD.  

¹ Yang, B.Y. et al. (2019). “Association Between Greenness Surrounding Schools and Kindergartens and Attention-Deficit/Hyperactivity Disorder in Children in China.” JAMA Network Open. 2019;2(12):e1917862.

Plan A represents a common response to challenging behaviors. When a child doesn’t do what they have been asked, parents and teachers simply “announce” their solution to the problem without engaging the child. Teachers may announce that classwork must be done before the child can have free play. Parents may announce that the child has 20 minutes to get ready in the morning, and if they are late getting out the door, they will lose their tablet for the rest of the day. These announcements are often made in the heat of the moment, in a raised tone of voice, and with more than a little frustration. While parent- or teacher-driven solutions are often necessary for children with ADHD, they need to be planned out in advance and implemented calmly and consistently.

Plan C focuses on the adult’s expectations and actually emphasizes dropping an expectation temporarily if it consistently leads to problem behavior. While this may seem counterintuitive, dropping an expectation can be helpful when it’s done within the context of a larger plan. Kids with ADHD have many skill-expectation gap areas and it is simply not possible to address all of these areas at once. Dropping lower-priority expectations in the short term will help you make progress on high-priority expectations more quickly.  

Plan B is comprised of three basic steps that form the core of the CPS approach:

Step 1: Practice empathy. The adult is focused on hearing the child’s perspective on the problem. In this step, the adult’s only job is to hear what the child has to say, ask clarifying questions if needed, and empathize with the child.

Step 2: Define adult concerns. In this step, the adult expresses their point of view and concerns about the problem. They do this without blaming the child but may highlight ways in which the situation is negatively affecting the child, the adult, or others.

Step 3: Invite the child to discuss solutions. Here, the child is invited to participate in a brainstorming session with the adult to identify possible solutions. In most situations, the brainstorming sessions will result in at least one identified skill that the child can develop.

Other strategies will include things like simplifying routines, getting things done the night before school so mornings aren’t so hectic, keeping an extra set of school books at home if the child repeatedly forgets materials needed to complete homework assignments, and so on. This step, when done well, ultimately results in a clear, actionable plan that the child and the adult can easily follow through on. As part of this step, the child and adult agree to engage in a follow-up brainstorming session if their strategies and solutions don’t go according to plan.

The CPS model is a flexible approach that can be applied to a wide range of challenging behaviors associated with ADHD. It also teaches problem-solving skills that, if practiced repeatedly, become a tool that your child can eventually use on their own. These skills will be especially valuable as your child gains independence while navigating the challenges that come with middle school, high school, and beyond.

If you would like to learn more about how to use the CPS model with your child, check out the Lives In the Balance website, maintained by a non-profit organization founded by Dr. Green, the developer of the CPS approach.

For most kids, it will take more than one intervention to address all the areas affected by ADHD. Treatment should always include ADHD-specific, evidence-based interventions, like behavioral parent training and/or medication, but it can often be helpful to supplement with alternative models of care, like the Collaborative and Proactive Solutions (CPS) approach to addressing challenging behavior.  

Collaborative and Proactive Solutions is a model of care designed to target challenging behavior, regardless of a child’s diagnosis. The CPS model was developed by Dr. Ross Greene and is described in many of his books, including The Explosive Child, Lost at School, and Raising Humans. Schools often have counselors and social workers who are trained in the CPS model, making it a good fit for kids with ADHD who benefit from strategies that are used consistently across home and school.

Typical behavioral interventions for ADHD use positive and negative consequences to reduce challenging behaviors, like whining, hitting, and general non-compliance. In contrast, the CPS model views these behaviors as symptoms of an underlying skill deficit, which cause the child to “act out” because they simply cannot meet the expectations that have been placed on them. Rather than target the negative behaviors directly, the CPS model emphasizes identifying the specific skills that the child is lacking and the expectations that are out of reach.

The goal of CPS is to help parents, teachers, and the child change behavior without using rewards or punishments. In contrast to standard interventions for kids with ADHD, which rely almost exclusively on the caregiver and teacher to create and enforce rules and structure, the CPS approach emphasizes a collaborative partnership between the parent or teacher.

As a team, the child and adult identify strategies that will help reduce the skill-expectation gap. When the gap closes, challenging behaviors naturally decrease, and skills and confidence increase. Not surprisingly, the CPS model has been shown to reduce conflict between children and adults, improve relationships and communication, and help kids better appreciate how their own behavior affects others.  

The CPS model aims to answer three important questions before the child and adult start searching for solutions.

1. Why is the child’s behavior challenging? The CPS model assumes that a child is not being defiant or non-compliant willfully. Instead, it assumes that the child would follow through on instructions and behave appropriately if they could. So, parents and teachers are encouraged to reconsider their previous explanations, beliefs, and labels related to the child’s behavior. For example, a child’s challenging behavior may not be “attention-seeking”; rather, it may reflect the fact that the child is unable to do what is expected of them at that time. 

2. When is the child’s behavior challenging? What are the times of the day at school or at home when a child displays challenging behaviors? Is it in the morning before school when everyone is trying to get out of the door? Is it during homework time? Or on the playground during recess? What are the expectations placed on the child at those times? What are the skills they need in order to meet those expectations? 

3. What behaviors does the child exhibit when they are being challenging or disruptive? Does the child whine, hit, yell, or become increasingly stubborn? Do they get out of their seat during classwork time, take ten minutes to put on their shoes in the morning, forget to bring their homework to school? The behavior is the signal that there is a gap between the child’s skills and the adult’s expectations.  These questions lay the foundation for the CPS approach to problem-solving, which is outlined in the CPS program’s Plan A, Plan B, and Plan C. In my next post, I’ll discuss these three plans and will point you to resources designed to help parents and teachers use the CPS model at home and in the classroom.

Omega-3 fatty acids are at type of fat that our bodies need to survive, and are found in foods like fish, flaxseed oil, and other plant-based foods. Fish oil supplements are a popular source of omega-3s. There are three types of fatty acids included in the omega-3 cluster: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – found in fish, and alpha-linolenic (ALA) – found in plant oils, like flaxseed oil. Omega-3 fatty acids play an important role in the body, influencing the development and healthy functioning of cells in our eyes, brain, cardiovascular system, endocrine system, and more. When it comes to ADHD, there is a theory that omega-3 fatty acids (specifically EPA and DHA), may help reduce ADHD symptoms by boosting the level of certain neurotransmitters in the brain, minimizing oxidative stress, and/or reducing inflammation.

Recent studies have found that some individuals with ADHD have low blood and plasma levels of omega-3 fatty acids, contributing to the theory that boosting blood levels of omega-3 fatty acids may reduce ADHD symptoms. While the theory is promising, studies examining the effect of omega-3 fish oil supplements on ADHD symptoms have shown mixed results. Some studies have found decreases in ADHD symptoms following supplementation, while others have not. In studies where symptom improvement was found, symptoms were not “normalized” – meaning that while symptoms decreased, these kids and teens were still impaired relative to kids and teens without ADHD. In a placebo-controlled study published last month in the Translational Psychiatry, researchers found that supplementation with a high dose of EPA (one of the omega-3 fatty acids found in fish oil) taken daily for 12 weeks improved ADHD symptoms in children and teens who had low blood and plasma levels of EPA at the start of the study, but did not significantly affect the ADHD symptoms of children and teens whose blood and plasma levels of EPA were “normal” before supplementation.¹ This may explain some of the mixed findings observed in earlier research.

With this mixed evidence, should parents consider providing omega-3 supplements for their children and teens with ADHD? In 2018, a meeting was convened by 8 international ADHD experts to create omega-3 supplementation guidelines for health care professionals who treat children and teens with ADHD.² The panel’s consensus is that omega-3 fatty acid supplementation may lead to small behavior gains for children and teens with ADHD, and that if these supplements are used they should be used only in conjunction with other interventions, like ADHD medications and behavioral treatments, and not as a stand-alone treatment. If you are considering adding omega-3 fatty acids to your child or teen’s ADHD treatment plan, consult with your pediatrician to discuss the proper supplement dose and possible side effects.

¹Chang J.P.C., et al. (2019). “High-dose eicosapentaenoic acid (EPA) improves attention and vigilance in children and adolescents with attention deficit hyperactivity disorder (ADHD).” Translational Psychiatry, 9, Article number: 303.

²Banaschewski, T. et al. (2018). Supplementation with polyunsaturated fatty acids (PUFAs) in the management of attention deficit hyperactivity disorder (ADHD). Nutrition and Health, 24(4), 279-284.

Here are the top five TED Talks that I recommend for parents of kids with ADHD.

Failing at Normal: An ADHD Success Story
Speaker: Jessica McCabe
Jessica McCabe, host of the popular YouTube channel, How to ADHD, talks about her journey from being a bright child with a promising future to a struggling young adult unable to find her way personally or professionally. Frustrated with continually not reaching her full potential, Jessica embraced her ADHD diagnoses and carved out her own path to success.  

ADHD As a Difference in Cognition, Not a Disorder
Speaker: Stephen Tonti
When he presented this TED Talk, Stephen Tonti was a senior at Carnegie Mellon University majoring in Film Directing. He shares his personal experiences with ADHD and explains how he has come to realize that ADHD is not actually a deficit in attention, as the name would imply, but a difference in cognition. Stephen argues that once we understand these differences, they can be harnessed and used to turn passion and interest into real world success.

What Happens in Your Brain When You Pay Attention
Speaker: Mehdi Ordikhani-Seyedlar, PhD
In this talk, Dr. Ordikhani-Seyedlar, a computational neuroscientist specializing in machine learning, discusses what is happening in our brains when we pay attention. He describes in easy to understand language the complex processes our brains go through when focusing on something specific while filtering out irrelevant information. Through his research, Dr. Ordikhani-Seyedlar hopes to build computer models that can treat ADHD, and his talk may very well give you a glimpse into the future of ADHD treatment.

Inside the Mind of a Master Procrastinator
Speaker: Tim Urban
Everyone procrastinates, and individuals with ADHD procrastinate even more! In one of the most popular TED Talks available, blogger Tim Urban take us on a humorous journey through his daily struggle with procrastination. While Tim tries not to take himself too seriously, the struggle is real. He encourages viewers to think differently about why we procrastinate and how we can maintain productivity even when our minds push us to veer off course.

The Power of Introverts
Speaker: Susan Cain
Not all kids with ADHD are extremely talkative and outgoing, as the stereotype suggests. In fact, many kids with ADHD – especially those with the inattentive subtype – are more reserved and introverted. They’re frequently overlooked by teachers and peers and struggle to find their place in the world. In this highly popular TED Talk (viewed over 4 million times its first year), Susan Cain celebrates the strengths of introverts and the unique insights and abilities that they bring to the table.

Here are the top five podcasts that I recommend for parents of kids with ADHD.

Parenting Your Challenging Child
Presented by Dr. Ross Green, developer of the Collaborative and Proactive Solutions approach to parenting and author of The Explosive Child, this podcast provides practical tools based on the Collaborative and Proactive Solutions approach. Most of the episodes are from his radio talk show, where he responds to parents who call in with the challenges they are experiencing with their child. Real questions from real parents with real solutions. What could be more helpful than this?

Distraction
Looking for a podcast that will help you see the positive aspects of ADHD while also highlighting tools you can use to manage the challenges that come with the diagnosis? This podcast by ADHD expert Dr. Ned Hallowell, author of Driven to Distraction and other popular ADHD books, may be just what you are looking for.

Tilt Parenting
Deborah Reber, author of Differently Wired: Raising an Exceptional Child in a Conventional World, hosts a podcast that features interviews with parenting experts, authors, psychologists, educators, and more, on topics related to parenting differently-wired kids. While not all of the episodes focus specifically on ADHD – they also cover topics related to giftedness, learning differences, sensory processing issues, and autism – parents of kids with ADHD will find many of the episodes highly relevant to their child’s experience and symptoms.

ADDitude Magazine ADHD Experts Podcast
ADDitude Magazine is a wonderful resource for parents of kids with ADHD. In this related podcast series, ADDitude shares webinars led by experts in the field of ADHD. These webinars include question-and-answer sessions focused on topics related to ADHD symptoms, academic performance, family relationships, and treatments. These podcast episodes run longer than average, lasting about one hour each.

CHADD Podcasts
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) is the nation's leading nonprofit organization serving people affected by ADHD. This outstanding organization produces two podcasts – ADHD 365 and All Things ADHD – that address a variety of topics for anyone dealing with ADHD. If you are a parent who has ADHD (or think you may have it yourself), in addition to parenting tips, you’ll also find helpful episodes focused on managing your own adult ADHD symptoms.  

In this next series of posts, I’ll be sharing what I’ve found to be the best books, podcasts, and TEDTalks out there for parents of kids and teens with ADHD. Some of these resources will offer practical tools and strategies while others will simply improve your understanding of ADHD and how it affects your child. All of them will help you feel less alone and more connected to the millions of parents who are facing similar challenges every day.   

Here are the top five books that I recommend for parents of kids with ADHD.

• Taking Charge of ADHD: The Complete Authoritative Guide for Parents (3^rd Edition)
  By Russel Barkley, PhD
  Written by a leading clinician and academic whose career has focused almost exclusively on studying and providing treatments for ADHD, this comprehensive book provides current, science-based information about the causes of ADHD, what to look for when seeking an evaluation for ADHD, and understanding effective treatment options. It also includes practical strategies for working with your child’s school and a proven 8-step plan for improving your child’s ADHD symptoms at home.

• ADHD: What Every Parent Needs to Know (3^rd Edition)
  By the American Academy of Pediatrics
  This book should be required reading for all parents of a newly diagnosed child and can be a helpful refresher for parents of children with long-standing ADHD diagnoses. Based on the ADHD guidelines published by the American Academy of Pediatrics, this book does an outstanding job of providing an overview of almost every topic related to ADHD. It covers everything from how to get a proper ADHD diagnosis to a balanced overview of treatment options – including medication options, parenting training interventions, and other behavioral strategies, and special education services and laws that apply to kids with ADHD.

• The Everyday Parenting Toolkit
  By Alan Kazdin, PhD
  While not focused specifically on ADHD, the practical strategies included in this book are evidence-based and are the same approaches that form the core of many ADHD behavioral parent training programs. What sets this book apart is that it goes beyond these important strategies and also focuses on creating a nurturing family environment, setting appropriate screen-time limits, expanding the palates of picky eaters, and more. The author, Dr. Alan Kazdin, a leader in the field of behavioral interventions for ADHD and disruptive behavior disorders, writes in a style that is easy and enjoyable to read.

• Smart but Scattered: The Revolutionary "Executive Skills" Approach to Helping Kids Reach Their Potential
  By Peg Dawson EdD & Richard Guare, PhD
  If you have a child who has been diagnosed with the inattentive type of ADHD and whose main struggles are related to problems with executive functioning (like getting things done on time, staying organized, or following multi-step instructions), then this book is an excellent resource. Filled with practical strategies, worksheets, and troubleshooting tools, this book is a great resource for parents who are ready and eager to try out new techniques at home.

• How to Talk So Kids Will Listen & Listen So Kids Will Talk
  By Adele Faber and Elaine Mazlish
  This book is not specifically written for parents of kids with ADHD, but it provides valuable strategies for coping with the strong emotions that kids with ADHD (and their parents!) express every day. If you want to improve communication with your child, reduce the number of conflicts at home, and improve your relationship with your child overall, then this book may be just what you’re looking for.

Changes to the ACT, coming in September 2020, may help students with ADHD better manage some of these test-taking challenges. While the content of the ACT will remain the same (with English, math, reading, science, and writing sections), students will have the option to retake individual sections of the exam without having to retake the entire test. The first time they take the ACT, all students will still be required to complete the exam in its entirety. But with section retesting, any time they retake the exam, they can choose which sections they want to complete.

This can mean completing only one section during a testing session, or two or three sections if they prefer. So, if a student scores well on the English and reading sections and poorly on the math and science sections, for example, they can be more focused in their study efforts and retake only the math and science portions of the exam.  

For students with ADHD, who tend to have less predictable test performance, this means that they will not need to worry about putting their stronger section scores (like English and reading, in our example) in jeopardy when they retake the exam. There’s no limit on how many times a student can retake sections of the exam, but there are of course fees that apply, and the cost of multiple retakes can add up.  

When reporting scores to colleges, students will have the option of selecting their highest individual section scores along with an ACT Superscore, which is a composite score that reflects the average of the four best subject scores from each of the test attempts. So, colleges will have no indication of how many times a student completed each section.

A more minor change to the test will also help students with ADHD who may need to retake a section more than once. Students who take the computer-based version of the test will receive their score within just two days. With this quick turn-around, students will know which sections to focus on during the retest and can study and retake the sections fairly quickly, leaving enough time for an additional retake if it’s needed.

Standardized testing is stressful for all students, and it is especially stressful for students with ADHD. The upcoming changes to the ACT won’t eliminate all the stress, but they will help students with ADHD overcome some of the unique challenges that come with taking college admissions exams.

On average, children and teens watch television between 1.8 and 2.8 hours a day, play video games for 40 minutes, and use a computer for 34 minutes. Almost 30% of children and teens spend more than four hours per day of their free time using screens. When you consider that kids and teens have about eight hours of time each day that’s not spent sleeping or at school, then they are spending up to half of their free time each day looking at a screen!

A recent meta-analysis study published in JAMA Pediatrics¹ analyzed the findings from 58 previous studies that looked at the connection between screen time and academic performance. Many of these prior studies showed negative associations between screen time and academic performance. For example, one found that adolescents who spent more than seven hours per day on screens were 40% less likely to achieve high academic performance.

In the current study, the researchers examined the overall connection between increases in screen time and academic performance. The findings show that as time spent watching television or playing video games increases, academic performance decreases. They also show that spending time on these activities may have a greater effect on academic performance for adolescents than children. Overall, the findings provide even more evidence of the need for limits around screen time in kids and teens.   

Of course, not all screen time is bad. Using a computer for homework or a tablet to FaceTime with friends is much different from spending hours watching YouTube videos or playing video games. But too much time watching TV (or YouTube) and playing video games does seem to take a toll.

It’s probably not the content of the video or video game that is the problem. The negative impact is likely driven in part by what kids and teens are not doing when they are their screens: they are not being physically active, reading a book, playing music, or creating art – all factors that have been positively associated with stronger academic performance.

So far, researchers have not looked specifically at the connection between screen time and academic performance in kids with ADHD. But, since children and teens with ADHD have more academic challenges in general and need more physical activity to manage their symptoms, it’s possible that the connection between increased screen time and decreased academic performance is even more striking when ADHD is part of the picture.

While researchers continue to study and explore the reasons why screens seem to be taking a toll on our kids and teens, it’s important for parents to be aware of how much time everyone in the family is spending on their devices each day. Setting screen time limits in your home will not cause any harm, but there is a very good chance that it may help kids and teens be more successful at school and in other areas of their lives.   

 ¹Adelantado-Renau et al, (2019) Association Between Screen Media Use and Academic Performance Among Children and Adolescents. JAMA Pediatrics, epub.

While these OT tools are widely used, with school districts spending millions of dollars each year on these supplies for kids with ADHD, research examining their effectiveness has not been conducted until recently. Researchers at Florida International University sought to address this gap by conducting the first controlled study examining the use of weighted vests and stability balls for kids with ADHD.¹

The study was conducted in a summer program specifically designed for children with ADHD, which included daily classroom sessions (as well as other activities throughout the day). In the study, 64 children between the ages of 7-12 were randomly assigned to receive stability balls and weighted vests at 60-minute intervals throughout the week during the classroom sessions. All of the children also received behavioral interventions (like a daily report card), and half of the children also received ADHD medication.

Researchers measured the effects of weighted vests and stability balls on academic productivity and classroom behavior. The results showed that the weighted vests and stability balls had no impact on either classroom behavior or academic productivity for kids with ADHD. In contrast (and as expected), the ADHD medication and behavioral interventions did improve both classroom behavior and academic productivity.

So, what does this mean for your child? Since this is the first study examining the effectiveness of these occupational therapy devices for kids with ADHD, and the number of participants in the study was small, more research is needed before we can draw any firm conclusions. However, the study does suggest that parents and teachers should be cautious about relying too heavily on these tools for kids with ADHD.

If you and your child’s school decide to use occupational therapy devices in the classroom, make sure that you:

1. Request that teachers complete rating scales measuring ADHD symptoms and academic productivity before the devices are introduced and again one or two weeks after the devices have been in use. If you do not see any improvement, then the child should stop using the stability ball and weighted vest. If you do see improvement, have rating scales completed one month later to make sure the improvements are long-lasting.
2. Consider the stigma that may come with using these tools in the classroom. A child using a stability ball and/or a weighted vest will stand out from their peers, and not usually in a good way. So, consider the social impact that these devices may have on your child before approving their use in the classroom. The benefits of the device need to outweigh the potentially negative social effects in order to truly be useful for your child.
3. Always use these tools in conjunction with evidence-based interventions for ADHD. Stability balls and weighted vests are not stand-alone interventions for ADHD, and they should never be used as a replacement for evidence-based strategies.

¹ Macphee et al, (2019) The Effect of Weighted Vests and Stability Balls With and Without Psychostimulant Medication on Classroom Outcomes for Children with ADHD. School Psychology Review.

It’s not surprising that teachers and parents often feel like they are at loss for how to help a child when they are struggling during the school day. Fortunately, there is a tool that is highly effective at parsing out the factors that need to be addressed in order to improve behavior and focus in the classroom: a functional behavioral assessment (FBA).

What is a Functional Behavioral Assessment (FBA)?
An FBA is a tool used by educators, psychologists, and counselors to identify the behaviors that are interfering with a child’s success, the factors that are reinforcing or maintaining these behaviors, and strategies that will help change the behaviors. Often, a functional behavioral assessment is used within the context of an individualized education plan (IEP) when a child is not meeting their IEP goals. However, an FBA can be helpful for any student who is exhibiting challenging behaviors that are not responding to typical school interventions.

How is an FBA Conducted?

Every FBA includes five steps:

Step 1: Define the Target Behavior. The target behavior is the challenging behavior that needs to be changed. For example, “Elliot is off-task 80% of the time during classwork.” The target behavior is defined through interviews with teachers, the student, and/or school administrators, as well as a review of records.

Step 2: Collect Data. Data is collected through classroom observations, a review of records or materials, and rating scales. Direct observation is often the primary method of data collection, but as in our example, samples of complete and incomplete work could be gathered for specific periods of time to identify patterns when a student is completing more work or less work.

Step 3: Develop a Hypothesis. The hypothesis is the working theory or best guess why the behavior is happening. Often, the hypothesis focuses on things that happen right before the behavior (known as antecedents) or right after the behavior (rewards or negative consequences associated with the behavior). Sometimes the hypothesis focuses on things that happened earlier in the day or at home (e.g. “Elliot completes less work on days when he arrives at school late, or on days when he had difficulty sleeping the night before”). Other times, the hypothesis includes things related to the classroom environment (e.g. “Elliot is often distracted by his talkative neighbor”).

Step 4: Plan the Intervention. A written behavior intervention plan is presented that directly targets the factors included in the hypothesis. The plan can include new skills that will be taught to the child, modifications to the classroom setting or to the instructional style used to teach certain lessons, and modifications to classwork and homework assignments. The use of specific classroom management strategies is also often included in the plan for kids with ADHD.

Step 5: Evaluate the Effectiveness of the Plan. After the plan has been in place for a fixed amount of time, the FBA team conducts a follow-up evaluation. Usually, this evaluation relies on the same methods of data collection that were used in Step 2. If the plan is working, then it will be kept in place. If the plan is not helping to change the target behavior, then the team will develop a new hypothesis and repeat the intervention and evaluation steps until the target behavior has improved.

When a child with ADHD is struggling in the classroom, and typical interventions aren’t helping, an FBA can be an excellent resource. The FBA process often results in interventions that are effective even when nothing else has worked so far, and can have a lasting impact on a child’s ability to succeed in the classroom.

Yet, despite increased awareness about the positive impact of recess on physical, emotional, and cognitive functioning, I continue to hear from parents that their child is losing recess as a punishment at school. Sometimes the punishment is related to disruptive behavior in the classroom, but more often, it is due to the child’s failure to complete their assigned classwork.

Parents frequently ask me if it’s okay for the school to take away recess as a punishment. They’re concerned because as any parent of a child with ADHD knows, kids with ADHD need physical activity. Without it, their symptoms only become worse, and their behavior inevitably becomes more difficult to manage. So, my answer to this question is unequivocal. No, it is not okay for a child with ADHD to lose recess as punishment for disruptive behavior or for incomplete work.

The reasons are two-fold. First, kids with ADHD are the kids who need recess the most. Second, taking recess away as punishment is not effective. If the goal is to have a child with ADHD complete their classwork more efficiently, taking away recess will not motivate them to work more quickly. Instead, it will cause the child to feel hopeless and defeated since they know they will probably not be able to finish their work on time. Taking away recess is also not effective at reducing disruptive behavior in the classroom. Instead, kids with ADHD will only become more disruptive once their free play and physical activity time are taken away. So, the problems that a recess punishment was meant to address simply continue even after recess is taken away.  

Then the big question is, “What should teachers do instead?” It’s not okay for a child to be disruptive in the classroom or to have incomplete work regularly. The best response is one that addresses the underlying cause of the problem. This may mean providing academic accommodations (potentially including a reduced workload) for a child who isn’t able to complete their classwork on time. It may mean using a behavior chart to help motivate a child who struggles to complete work or manage their behavior in the classroom. It might involve frequent breaks for a child who struggles to stay in their seat and therefore becomes disruptive. For many children with ADHD, it may mean taking a medication that helps effectively manages their ADHD symptoms during the school day.

There may be times when punishment is needed, but this punishment should not be related to recess unless the disruptive behavior includes something unsafe that occurred during recess time.

Recess is an essential part of the school day for all kids, and especially for kids with ADHD. If your child is losing recess as a punishment, talk with your child’s teacher, school counselor, and school administrator. Request a meeting to discuss alternatives that will support your child in meeting their daily academic and behavior goals, and when possible, have these strategies built into an IEP or 504 Plan.

Create Ground Rules. The organization Wait Until 8^th, which advocates for healthy and safe smartphone use, recommends laying out ground rules in three categories: how to use a phone 1) safely, (2) appropriately, and (3) moderately. The ground rules recommended by Wait Until 8^th are excellent but are too detailed for most kids with ADHD to keep in mind. I recommend focusing on the three rules in each category that are most important for your family.

Choosing a single rule that covers multiple topics and situations can help limit the number of rules needed.  For example, the rule “I will not text or post anything that I would not say to my grandmother/father/mother/pastor/rabbi,” covers many smaller, more specific rules that can be left off the list.

Post the Ground Rules in Your Home. Having a conversation about the ground rules is not enough for teens with ADHD. Also, post them in your house in a location that can be seen by everyone. Here they will serve as a subtle reminder for your teen and will be easy to reference if questions or conflicts come up around your teen’s smartphone use. 

Plan Consequences to Use if Rules are Broken. If your teen violates one of the ground rules, then put a consequence in place immediately. If a rule-break does not lead to unsafe behavior, then you can consider planning to give your teen one warning before issuing the consequence. Just remember to let your teen know in advance which rules will not come with a warning and will lead straight to a consequence. If your teen breaks the rule again after a warning, then be consistent about using consequences. Taking away the phone for a period of time, around one or two days, is usually an appropriate consequence.

Tell Your Teen that You Will Be Monitoring their Phone. Install parental monitoring software on your teen’s phone and let them know that you will be monitoring their phone regularly. Also, create profiles on any social media sites used by your teen, and make it a rule that your child must add you as a friend or contact on these sites so you can monitor their social media activity. This may feel like an invasion of their privacy, but in fact, it’s necessary to make sure your teen is using social media safely.

Talk about ADHD and Smartphones. Having ADHD makes it harder to use smartphones safely, appropriately, and moderately. Struggles with attention make it harder for them to put the phone down when they need to, and their impulsive tendencies may make them more likely to do or share something they will regret later. Talk to your teen about these challenges to help increase their own awareness. If you think your teen will not be receptive to having this conversation with you, then ask a school counselor, pediatrician, psychologist, or other professional to talk with your teen.

Plan a Trial Period. Institute a 30-day trial period. During this period, closely monitor their phone activity using parental monitoring apps on the phone. Make sure they are following all of the ground rules. Before the trial period starts, let your teen know specifically what would result in losing their phone privileges. For example, breaking three ground rules (or the same ground rule three times) during the trial period may result in your teen losing their phone indefinitely.

Education, consistent monitoring, and consistent consequences are essential when it comes to helping your teen use their smartphone in a healthy way. While it will take extra effort on your part, like all other aspects of parenting kids and teens with ADHD, this effort will pay off and will make life easier for everyone in the long run.

While kids and teens can be persuasive when it comes to making an argument for having a smartphone of their own, and it can be tempting to get one for your child if for no reason other than to put an end to the constant begging, getting a smartphone for your child is a big step and one that should not be taken lightly. As a general rule of thumb, experts recommend waiting until a child is 14 before giving them a smartphone. However, given the challenges that come with having ADHD, many 14-year-olds with ADHD may not be able to handle the distractions and responsibilities that come with owning a smartphone.

The organization Wait Until 8th, which is dedicated to encouraging and empowering parents to wait until 8^th grade to give their child a smartphone, provides factors for parents to consider when deciding whether or not to give their child a smartphone. Each of these factors represents an area of difficulty for most kids with ADHD:

• Does your child respect and obey rules?
• How are your child’s social skills?
• Is your child responsible for his or her belongings?
• Does your child struggle with screen limits?

If your child or teen struggles with any of these areas in their daily life without a smartphone, then the challenges will only be magnified once a smartphone is added into the picture. So, while many 14-year-olds may be ready for a smartphone, many (or most) 14-year-olds with ADHD will not be ready to handle this responsibility.

In addition to the readiness of the child or teen, parents should also consider their readiness to monitor and set limits around smartphone use. Are you ready as a parent to teach your child how to use a phone responsibly, to monitor when, where, and how they are using their phone every day, and to enforce rules and consequences consistently? Parenting a child or teen with ADHD requires more effort and energy than parenting a child without ADHD –we often say that parents of kids with ADHD are Super Parents given all that they take on in a day. With that in mind, consider whether you have the bandwidth to add smartphone management to your plate.

If you decide that your child or teen is not ready for a smartphone, what should you do? How do you avoid giving in to the pressure from your child or feeling like you are somehow hurting your child by denying them something that so many of their friends already have?

First, know that you are helping your child and not hurting them by holding out on giving them a smartphone. Many kids with ADHD need extra time to mature before they are ready for added responsibilities like having a smartphone, and it is your job as a parent to make some hard choices in order to set your child with ADHD up for success long-term.

Second, let your child or teen know that they will not be getting a smartphone any time soon, and no amount of whining, negotiating, or begging will change this. If your child or teen thinks there is even the slightest possibility that you will give in and get them a phone soon, they will continue to push and push in the hopes that you will come around. If they continue to push on the issue, consistently respond by telling them it is not open for discussion and then walk away. The briefer and more consistent you are in your response, the less time your child or teen will spend negotiating.

Lastly, if you and your teen need or want a way to stay in touch without a smartphone, purchase a simple flip phone. This will get the job done without introducing most of the risks and responsibilities that come with owning a smartphone. If you do think that your child or teen may be ready for a smartphone, then be strategic about how you introduce the phone and your rules for smartphone use

Recent studies suggest that youths with ADHD may be particularly vulnerable to the effects of concussions and may require additional monitoring and follow-up care. While these studies are preliminary and were conducted with college student-athletes, the findings are concerning for all youths with ADHD.

Recently, a study of college athletes found that those with ADHD may be slower to recover from a concussion than those without ADHD. The study included 120 participants, 40 with ADHD and 80 without ADHD. It measured concussion-related factors (like memory, processing speed, and concussion-specific symptoms) before the start of the season, two days after their concussion, and again once they were cleared to return to play.

Athletes with ADHD experienced greater decline in memory function and had more severe concussion symptoms two days after the injury compared to injured athletes without ADHD. Those with ADHD also continued to have more difficulties with some aspects of thinking and learning at the time that they were cleared to play. Concussion symptoms also lasted longer for athletes with ADHD – 10-12 days for athletes with ADHD versus four days for athletes without ADHD.

A separate study of almost 1,000 college athletes found that those with ADHD were at higher risk of experiencing anxiety and depression following a concussion than athletes without ADHD. This is particularly concerning because anxiety and depression are not regularly monitored as part of standard concussion treatment protocols.

While the findings from these studies are preliminary, they are concerning. More research is clearly needed, especially in children and teens, but in the meantime, what should parents do to protect their children with ADHD? Physical activity and participation in team sports both come with great benefits for kids and teens with ADHD, so continuing to participate in sports is important. Unfortunately, many sports, from soccer to cheerleading, come with significant concussion risks.

One of the best things parents can do is to ensure that their child is participating in a sports program that follows safe play practices to minimize concussion risk, and that responds quickly and effectively when a concussion is suspected. Parents should inform coaches and doctors that their child or teen requires additional monitoring because of their ADHD and may take longer to recover from a concussion.

In addition, children and teens with ADHD should be closely monitored for symptoms of anxiety and depression in the weeks and months following the injury. For additional helpful information on preventing, recognizing, and responding to a concussion, as well as knowing what to look for in coaches and sports programs that follow progressive concussion prevention and management guidelines, check out the CDC’s HEADS UP to Youth Sports website.

During these hours, parents feel like they are nagging their kids to get started on their work and stay on task. Even with all of this effort, parents are frustrated by the quality of the completed assignments, which they feel doesn’t reflect their child’s full potential.  Kids are frustrated, too. They think their parents are being too hard on them, and they feel like they are missing out on the fun time they should be having in the evening after a long (and often stressful) day at school.  

When it comes to getting homework done more quickly, there is one simple step that can help dramatically: having your child take breaks during homework time. Yes, adding breaks can actually shorten the amount of time your child spends on homework!

If you’re like most parents, you may be skeptical and reluctant to encourage your child to take a break from their homework, especially when it’s been such a challenge to get them started and focused in the first place. But when they’re done right, homework breaks can make it easier for your child to get started on homework and can help them stay focused longer.

Why? Sitting down to complete an evening’s worth of assignments can feel overwhelming for kids with ADHD, causing them to procrastinate and avoid getting started at all costs. In contrast, sitting down to work for 10, 15, or 20 minutes at a time can feel much more manageable. During these shorter work periods, kids with ADHD can typically stay focused. They are able to work carefully without rushing, and produce higher quality, completed assignments.  

Here are some tips for making homework breaks most effective:

• Choose work periods that match your child’s ability level. Most kids with ADHD can work for 15 minutes before needing a break. Older kids may be able to sustain their focus for 20 minutes, while some younger children may only be able to work well for 10 minutes before needing a break. Find the time that works best for your child and stick with it.
• Keep breaks short. Five minutes is enough time for kids to get the mental break that they need.
• Stay in the “homework area” during breaks. Aside from getting a glass of water or using the bathroom, kids should stay close to their “homework area.” This makes it much easier to get back on task when the break is over. There can be easy fun activities nearby for use during breaks, like a Nerf basketball hoop. Just make sure the activities aren’t something so engaging that your child will struggle to stop playing when the break is over.
• Avoid screen time during breaks. Most kids will struggle to transition between screen time and homework, making it much more difficult to get back on task when the break is over.
• Use a timer and praise your child when they get back to work after a break. Always use a timer to indicate when the break is over. Praise your child when they get back on task after the break. If needed, provide rewards for getting back to work. These rewards can be checkmarks or stickers that can be exchanged for a fun activity when all of their assignments are completed.

Homework breaks can be an excellent tool to help kids with ADHD get started on their assignments and stay focused until their work is completed. If you find that your child continues to struggle to complete work in a reasonable amount of time, even with regular breaks, talk to your child’s teacher about homework accommodations that are appropriate for kids with ADHD.

While this report focused on children enrolled in Medicaid, the follow-up care likely reflects typical care for most children who receive their medication from pediatricians or other primary care practitioners. The report did not identify the reasons why follow-up care was poor for so many children, but the findings do highlight the need for parents to advocate for their children.

As a parent, what type of follow-up care should you expect for your child after they start an ADHD medication? The American Academy of Pediatrics guidelines include four key points related to ADHD treatment:

1. When medication is prescribed, a follow-up appointment to check on medication effectiveness and side effects should occur within one month.
2. At a minimum, two additional follow-up appointments should occur within one year.
3. For optimal treatment effects, behavior therapy should be provided in addition to medication. For preschoolers, behavior therapy should be used first, and medication should only be added if necessary.
4. ADHD should be treated as a chronic condition, and providers should follow a “chronic care model” of treatment, like models used in other chronic conditions like asthma and diabetes. Therefore, treatment should continue beyond one year and medication adjustments should be made as symptoms change over time.

In addition to following these guidelines, parents should expect to complete symptom rating scales at follow-up visits. Ideally, teacher rating scales should be collected as well. The provider should review these completed rating scales at each visit and consider the responses when determining whether a medication adjustment is needed.

Follow-up care is particularly important for kids with ADHD because every child responds to ADHD medication differently. Some have a great response to the first medication they try. Others need to try two or three medications before finding one that works well. Medication dose also needs to be adjusted somewhat regularly, both when a medication is initially started and as a child grows and gains weight over time. Lastly, ADHD medications can cause side effects, many of which can be addressed with medication adjustments.

Unfortunately, as the recent federal report highlights, not all practitioners adhere to the recommended ADHD treatment guidelines. Parents should feel confident asking for regular follow-up visits and to have access to ratings scales that can be completed by parents and teachers. ADHD medication can be a very powerful treatment tool, and it’s important to work with a provider who will provide follow-up care that optimizes medication response in order to help your child reach their full potential.

Since kids – and the expectations placed on them – are constantly changing, there are times when a wait-and-see approach makes sense. For example, this can be a good method for when a child is initially adjusting to a new teacher or when there are major changes at home, like the addition of a new sibling.

In contrast, when there are persistent behavior challenges at home or at school, like difficulty following basic rules, difficulty getting along with classmates or teachers, oppositional behavior, or difficulties with focus or completing schoolwork, then a wait-and-see approach is not helpful and could even be harmful for kids who may have ADHD.

With the start of a new school year, parents are especially attuned to their child’s behavior and academic performance. So, it’s not surprising that this is the time when new or heightened concerns are often raised. It’s also a major adjustment period for kids, which means teachers and professionals may be more likely than ever to hand out wait-and-see advice.

The problem is that when kids or teens have ADHD, or suspected ADHD, waiting too long can lead to missed opportunities for social, cognitive, and academic development. The longer kids go without help, the more likely they are to experience excessive criticism, miss gaining important academic knowledge or skills, and miss opportunities to foster new friendships.

So, how long should you wait to seek professional help or an assessment for a possible ADHD diagnosis when your child or teen is struggling at the start of the school year? And what are the signs that professional help is needed? While there are no hard and fast rules to follow, here are some basic guidelines that can be helpful:

• If you are considering having your child or teen assessed for ADHD after the start of a new school year, then it is important to give a teacher 4-8 weeks to observe your child in a new classroom. This is generally enough time for your teacher to develop an understanding of how your child or teen’s behavior and academic skills compare to age- and grade-level expectations. However, it is not necessary or helpful to wait longer than two months (at most) if your child is struggling. Keep in mind that waitlists for assessments can be long, so get on a list right away and expect that it will likely be at least two months before an assessment slot becomes available.
• If homework time is a battle at the start of the school year, and nothing you do seems to improve the situation, then get additional help as soon as possible. Homework demands will only increase as the school year goes on, and it’s highly unlikely that things will get better if you take a wait-and-see approach. Talk to your child’s teacher, a school counselor, a psychologist, or a learning center, like Huntington Learning Center, about what you can do to take the stress out of homework time. 
• If you and your child are struggling to get out of the house on time in the morning, either because of behavior challenges, school refusal problems, or because your child cannot stay focused long enough to complete a basic morning routine, then get help as soon as possible. It’s much easier to establish a morning routine that works early in the school year than it is to change a routine later after bad habits have become entrenched.
• If your child is struggling socially and is having difficulty making new friends, then it may make sense to wait about a month to see if they settle into their new classroom or school. However, if your child has a long history of social difficulties, and their current social challenges are part of an ongoing pattern, then seek help as soon as possible. There may be things that you, a therapist, their teacher, or a school counselor can do early to set your child up for social success this school year.

Finding help for a child who is struggling with behavioral, social, or academic challenges can be difficult. If you suspect your child may have ADHD, then your pediatrician can be a good place to start. School counselors can also be a great resource, especially when it comes to social difficulties. Teachers and learning centers, like Huntington, can help with academic problems in the classroom and during homework time. Lastly, psychologists and therapists in your area who specialize in ADHD or behavior challenges can be very helpful.

If the first professional you talk to dismisses your concerns or tells you to wait and see if things improve, then be persistent and find someone who can provide your child with the help they need now before too much time passes by.

While CBT can be very effective for many kids with anxiety disorders, not all children respond to this treatment, and when parents aren’t involved in the therapy, they often struggle with knowing how to best support their child at home. A recent study takes a different approach to treatment, one that may be a better fit for many kids and their parents. Researchers at the Yale Child Study Center are testing a parent-focused treatment where the child doesn’t attend any therapy sessions. Instead, their parents meet with the therapist and learn strategies for helping reduce their child’s anxiety at home. For parents of kids with ADHD, this approach may sound familiar, since this is exactly what evidence-based treatments for ADHD provide (you can learn more about these treatments, like behavioral parent training, here).

The new intervention is based on strong evidence showing that the degree to which parents accommodate a child’s anxiety and avoidance behavior is directly related to the persistence of a child’s anxiety symptoms. This means the more parents rescue their child when they are anxious, the less likely it is that the child’s anxiety symptoms will improve. An example from a recent NPR article on this treatment really highlights the challenge: if you have a child who is afraid of sleeping alone, it’s natural as a parent to want to reduce their anxiety by allowing them to sleep with you or by staying in their room each night until they fall asleep. The problem is that in doing so, you’re accommodating the anxiety, and as a result, the child never learns that there is really nothing to fear. Without this learning process, their anxiety continues to creep up night after night and never goes away.

As a parent, it’s very hard to know how much to accommodate and comfort your child and how much to pull back and allow your child to experience their anxiety symptoms. This is where parent coaching comes in. The therapist discusses very specific anxiety-provoking situations that the child experiences and develops a detailed, systematic plan for gradually exposing the child to their anxiety until they have eventually mastered their fear. The therapist checks in regularly with the parents to discuss how the child is responding to the plan and to make adjustments as needed.

So far, this treatment is looking very promising and may be something that eventually moves into standard care for child anxiety disorders. In the meantime, if you think you could benefit from therapist coaching to help your child overcome their anxiety, reach out to a CBT therapist. They’ll be able to help you develop a detailed intervention plan similar to those used in the ongoing Yale study, and will coach you through the challenges that come with helping your anxious child.

For decades, there have been conflicting opinions and research findings about whether ADHD medications cause sleep problems for kids with ADHD. Some professionals have suggested that stimulant medications can ultimately improve sleep for some kids with ADHD. Others have suggested that stimulant medications don’t cause sleep problems in ADHD, but they make sleep difficulties worse in kids who already experience a secondary sleep disorder.

The most definitive answer to the question came from a large study published in Pediatrics in 2015.¹ This study pooled data from seven smaller studies in an effort to draw more definitive conclusions. Ultimately, the 2015 paper concludes that stimulant medications do result in sleep problems for some children. In their results, the exact percentage of children experiencing sleep problems was different based on the medication they were taking. As one example, about 20% of kids taking Ritalin experienced greater difficulty falling asleep. However, no single medication caused significantly worse sleep problems than the others.

There were a couple of individual factors that helped explain why some kids were experiencing sleep problems while others were not. First, kids who took ADHD medications multiple times throughout the day, rather than once in the morning, were more likely to experience sleep difficulties. This is likely because kids who took multiple doses still had stimulant medication in their system while they were trying to sleep. As a possible solution, the study authors recommend trying a single extended-release dose in the morning as an alternative to multiple doses. For kids who already take an extended-release formulation but also take a “booster dose” later in the afternoon, the researchers suggest talking with the prescribing doctor about the timing and duration of the booster medication.

A second factor that influenced sleep problems was the number of days the child had been taking the medication during the study period. Kids who had been taking ADHD medication longer experienced sleep problems that were less severe than kids who only began taking the medication recently. The authors suggest it’s possible that a child’s body adjusts to the medication over time, and sleep problems may gradually improve. In addition to these factors, it’s well known that medications affect each child differently, and while one medication may cause sleep problems, it’s possible that another stimulant medication would come with fewer side effects. So, there are many ways that your child’s pediatrician or psychiatrist may be able to help find a medication and dosing schedule that works for your child.

Stimulant medications for ADHD can be very effective for treating ADHD symptoms like inattention, hyperactivity, and impulsivity when they are used alone or in combination with behavioral interventions. They are a first-line treatment for many kids with ADHD or a second-line treatment for kids who don’t respond to behavioral interventions alone. However, medications do come with the potential for side effects, and all parents have to weigh the pros and cons when making the decision to add medication to a child’s ADHD treatment plan.

What is ODD?
ODD is characterized by a persistent angry and irritable mood, behaving in ways that are spiteful or vindictive, and argumentative and defiant behavior that often includes lashing out at others, blaming others for their own mistakes, deliberately annoying other people, and refusing to follow instructions from adults. These symptoms represent a persistent pattern of behavior in kids with ODD and aren’t something that only show up occasionally when they are tired or have had a bad day. Unlike ADHD, which causes challenges at home and at school, ODD may only be a problem in one of these settings. For example, it’s not uncommon for kids with ODD to display symptoms at home, but not at school.

How is ODD Diagnosed?
Like ADHD, ODD can only be diagnosed by a licensed clinical psychologist or medical doctor (usually a psychiatrist or a pediatrician). Making a diagnosis of ODD can be difficult in some cases, because symptoms of depression, anxiety, or trauma can lead to similar oppositional behavior in kids. So it’s important that the provider evaluate a child’s complete history and symptom profile before making a diagnosis.

How is ODD Treated?
Treatment for ODD is typically focused on behavioral interventions. Medication can be helpful if poor impulse control or other symptoms related to ADHD or a mood disorder are contributing to the oppositional behavior.  One of the most effective behavioral interventions for ODD is Parent Child Interaction Therapy (or PCIT). Typically used with kids between the ages of 3-6 years old, PCIT involves therapy sessions that include live coaching which walks parents through the use of effective behavior strategies focused both on child-directed interactions (where the child takes the lead and the parent follows) and parent-directed interactions (where the parent gives instructions and the child follows). Many parents who participate in PCIT find that it truly transforms their relationship with their child. Some practitioners have also adapted PCIT for use with children over the age of 6. In addition to PCIT, behavioral parent training, similar to the behavioral parent training used for ADHD, has been found to help with ODD and can be used with kids of all ages. Collaborative Problem Solving, where kids and parents learn specific strategies that can be applied to solving problems that come up in daily life, can also be effective.

What should you do if you suspect that your child may have ODD?
If you suspect that your child may have ODD, reach out to your child’s pediatrician or therapist as soon as possible and request a referral for a full evaluation. Like many mental health challenges, the sooner you begin treating ODD, the better the long-term prognosis for your child.

Let’s start by talking about why people suspect that playing video games leads to the development of ADHD. In general, this idea stems from the belief that video games train the brain to focus only on activities that involve a high level of stimulation. Almost every parent of a child with ADHD has observed a big difference in their child’s ability to focus when they’re playing video games versus when they’re doing just about anything else. When kids with ADHD are playing video games, they can be so focused that it almost seems like they don’t have ADHD at all. So, it’s natural to wonder if playing video games has altered their ability to focus on anything that does not involve a high level of stimulation.

But does existing research support the notion that video games cause ADHD? Overall, the answer is no. Time and time again, studies point primarily to genetic causes of ADHD, with a role for other environmental influences like prenatal factors or exposure to lead or other toxins during childhood. That said, there are numerous studies suggesting that excessive video game playing (usually defined as more than one or two hours per day) can make ADHD symptoms worse for kids who already have an ADHD diagnosis and cause higher levels of oppositional behavior.  

Why would video games make ADHD symptoms and oppositional behaviors worse? Interestingly, it’s not really the video games themselves that are to blame. It’s the difficulty that kids with ADHD, and their parents, have with monitoring and moderating the use of video games. Once kids with ADHD start playing video games, they typically become hyperfocused, so much so that they have a hard time stopping when it’s time to do something else. This means that they:

• Are more likely than kids without ADHD to play video games late into the evening, leading to insufficient sleep. Study after study shows that poor sleep makes symptoms significantly worse for kids with ADHD.
• Are more likely to have conflicts with their parents. The challenges that parents have with trying to monitor and limit their child’s video game playing often leads to serious conflicts between parents and kids with ADHD. Over time, these conflicts escalate and take a toll on family relationships. Whenever family relationships are negatively impacted, oppositional behavior increases.
• Experience greater opportunity costs. Playing video games excessively comes with what psychologists refer to as “opportunity costs.” Every minute that a child spends playing video games is a minute that they are not spending engaged in another activity. When the missed activity includes an opportunity to play with other kids offline, then they have missed a chance to improve their social skills. When the missed activity is related to academics (like reading, participating in an after-school science program, etc.), then they’ve missed an important opportunity to improve their academic skills. When the missed activity is something physically active, then they’ve missed an opportunity to get exercise that would help keep ADHD symptoms in check throughout the day. Over time, these missed opportunities accumulate and lead to ADHD symptoms and functional deficits that are worse for kids who play video games excessively than kids who don’t play video games or only play them in moderation.  

So, knowing that playing video games don’t cause ADHD, but can make ADHD symptoms worse, what should parents do? Should they keep their child from playing video games altogether? There isn’t really a one-size-fits-all answer to this question. If a child already plays video games regularly, can they play in moderation without constant arguments and negotiations with their parents? If that’s the case, then a moderate amount of video game play (for example, 30 minutes a day or limiting video games to one hour a day on the weekends) should be fine. If this is not the case, and parents find that their child is only interested in playing video games, doesn’t seem to find anything else interesting or enjoyable, or there is a high level of conflict at home around video games, then playing in moderation might not be an option – at least not right now. In these situations, I highly recommend that parents work with a mental health professional to figure out a plan for eliminating video games for a specified time (somewhere from 3-6 months) before gradually reintroducing video games with a very clear set of ground rules. It can be very challenging to make these changes successfully if your child has been playing video games excessively. If you are concerned about the impact that video games are having on your child and your family, then reach out to a mental health professional for help.

Gap year programs are becoming increasingly popular across the United States. Some colleges even encourage a gap year for their prospective students since they may give teens time to mature, gain a broader perspective on the world, and hone in on what they want to achieve once they begin college. For students with ADHD, this can sound exactly like what they need.

In general, kids and teens with ADHD have delays in skills related to attention, organization, motivation, and social interactions that place them about 2-3 years behind their peers in these areas. In fact, there is substantial research evidence showing a “maturational lag” in brain development corresponding to these delays in skill development. So, it’s possible that having an additional year to mature before college may be very helpful. However, these same skill delays also make it more challenging to ensure that the gap year is productive for teens with ADHD. After all, the year is supposed to be used for developing skills and maturity, and not for sitting on the couch playing video games or watching YouTube. If you and your teen are considering a gap year, it’s essential that structure and supervision are built into the gap year plan.

Here are some tips for making the most out of a gap year for teens with ADHD.

1. Encourage your teen to set big-picture goals for their gap year. Your teen should identify three things they want to accomplish during the year. This may involve things like the following:

• traveling to other parts of the US or internationally
• gaining skills or a certification in an area they are interested in
• gaining work experience
• making new social connections outside of their high school friend group
• taking a few college-level courses that will allow for a lighter course load during their first college semester
• taking classes in a specific interest area to help them reignite a passion for learning

2. Consider structured internship programs. There are many structured internship programs available for gap year students, some with internships in the US and some with international placements (check out com and goabroad.com for ideas). Many internships have substantial fees associated with them, so consider cost when weighing your options. Local volunteer organizations may also have internship opportunities that don’t cost a dime.
3. Pair skill development opportunities with certification programs. Most teens with ADHD do best when they are working toward achieving a specific goal. Help your gap year student stay focused by enrolling in a certification program in an area that interests them. These certificate programs can be an area of career interest (like information technology, engineering, or healthcare) or they can be more hobby-related (like scuba diving, lifeguard certification, or ski patrol). Certification programs provide structure, opportunities for learning, and access to a social network, and they also look impressive on college applications.
4. Look into a gap year program specifically designed for teens with ADHD. There is one gap year program designed specifically for teens with ADHD: the Gateway Adventure Program at SOAR. The program combines residential living on a campus in Wyoming with adventure travel in the US and internationally. The program emphasizes skill-building in the areas of independent living/life skills, social skills, personal finance management, planning, organization, and time management. Overall, it’s a fantastic program, although the fees may be high for some families.
5. Consider other accredited gap year programs. There are many accredited gap year programs available that don’t focus specifically on the needs of students with ADHD. However, they do provide structured residential living or travel opportunities, internships or community-based volunteer programs, and opportunities for making new friends and social connections. All accredited gap year programs charge fees (often related to travel and residential living expenses) and it’s important to make sure that the program you choose is accredited by the Gap Year Association.

Overall, taking a gap year after high school may provide a real boost for prospective college students with ADHD. Just make sure you and your teen work together to create a plan for a goal-oriented, productive year that will set them up for success when they are ready to start college the following fall.

University of Arizona
The University of Arizona offers a highly acclaimed program just for students with ADHD and other learning differences through its Strategic Alternative Learning Techniques (SALT) Center. The SALT Center offers individual weekly meetings with a Strategic Learning Specialist who assists with educational planning, goal-setting, time management, organization, and learning strategies. Also provided are access to assistive technology, psychological counseling, tutoring, and the option to receive additional life coaching or ADHD-specific coaching. The SALT Center charges semester-based fees ranging from $1,200 – $2,800.

Landmark College
Landmark College (Vermont) is a unique college exclusively for students with ADHD or learning disorders and offers one of the most comprehensive specialized learning programs available. At Landmark College, support services are integrated into the curriculum, and all students have access to them. These supports include small class sizes (with a student to faculty ratio of 6:1), individualized instruction designed to make classes engaging for students with ADHD, executive function coaching, tutoring, and social supports that facilitate the process of establishing a new friend group and living on a college campus.

University of Maryland College Park
The University of Maryland College Park, like most colleges, offers typical academic accommodations for students with ADHD. Through the Psychology Department on campus, students can also access the SUCCEEDS program, which is designed specifically for students with ADHD. Through the SUCCEEDS program, students receive a comprehensive assessment that identifies their areas of strengths and weaknesses, participate in weekly group meetings led by graduate students in the psychology department, and are assigned a personal coach to help them with time management, social challenges, and organizational challenges. There is a separate fee for the SUCCEEDS program ranging from $1,500 – $2,000 per semester.

Appalachian State University
Appalachian State University (North Carolina) offers a unique program for students with executive functioning challenges (including students with ADHD) through their As-U-R program. Like many of the programs on this list, they offer specialized tutoring and mentoring, specific training to address executive functioning challenges (like time management and organization), transition and adjustment assistance for incoming students, and access to assistive technology. Where this university program really raises the bar is with their commitment to accountability – all students participating in the As-U-R program are required to spend study hours in the “Study Center” each week, where they have a quiet study space and direct access to assistance from support staff. What could be better for blocking out distractions and helping students with ADHD follow-through on meeting their academic goals? Students must apply to be admitted into the As-U-R program; however, there are no additional fees for AS-U-R services.

Curry College
For students looking for a smaller college campus experience, Curry College (Massachusetts) can be an excellent option. Curry College offers the Program for Advancement of Learning (PAL), which provides credit-bearing courses to teach students with ADHD the learning strategies they need to succeed in college lecture courses. Throughout the school year, students meet with a PAL faculty member 2-3 times per week in a combination of individual and group settings to develop a better understanding of their learning styles and develop key executive functioning skills. PAL’s fees range from $1,800 - $3,500 per semester.

This list represents just a few of the many colleges that offer enhanced services for students with ADHD. For additional resources, check out the 20 Best Value Colleges for Students with ADHD or lists focused on colleges with services for students with learning differences, like College Choice’s 50 Best Disability Friendly Colleges and Universities.  

For teens with ADHD college acceptance represents a major milestone, and one that they worked very hard to achieve. Once the admissions offer has been accepted and the celebration has died down, it’s time to start thinking about how your teen’s needs will be met once college life begins. College students with ADHD need more support than their peers without ADHD in many areas. The start of college is an exciting time for incoming students, and most are eager to break away from the structure of their high school existence and start something new. It’s a time when independence is celebrated, and teens finally have a chance to really stand on their own two feet. For incoming students with ADHD, this exciting time can also be anxiety provoking, and with good reason. Teens with ADHD are more dependent than most on the structure provided by their high school and their families and breaking away from that structure while keeping ADHD symptoms in check can be a real challenge. Difficulties with organization, time management, prioritizing academic assignments and attending classes, regulating sleep schedules, etc. all become exacerbated when school structure and parental oversight are pulled away. In addition, symptoms of ADHD make attending and learning from longer lectures and dense reading assignments without individual support more challenging.

Academic accommodations in college are one tool that may help students with ADHD manage some of the ADHD-related impairments that come up during classes for students with ADHD. It’s important for students and their parents to understand in advance what types of accommodations are available to students with ADHD, how to qualify for these accommodations, and who to meet with to ensure that these accommodations are put into place. Here are some of the most frequently asked questions as they relate to college academic accommodations and ADHD.

• What documentation is needed to qualify for academic accommodations in college? Each college has its own process for determining which students qualify for accommodations (and the specific accommodations they are eligible to receive). So, it’s important to reach out to the college as soon as possible to find out about their specific requirements. In general, colleges require a recent psychoeducation or neuropsychological testing report that documents the ADHD diagnosis and/or any specific learning differences and impairments that would justify the requested accommodations. Typically, a letter from a pediatrician, psychiatrist, or psychologist will not suffice in the absence of detailed test results.
• I tried to get my teen an IEP when he was in middle school or high school, and the school said he didn’t qualify. Does this mean he won’t be able to get accommodations in college? College students can qualify for academic accommodations even if they were denied an IEP (Individualized Education Plan) earlier in their education. This is due in part to the fact that college students with ADHD are offered protections through the Americans with Disabilities Act (ADA) rather than the Individuals with Disabilities Education Act (IDEA) that covers IEPs.
• Who should we talk to at the college about the accommodation process? There are many offices and professionals who assist students with ADHD on college campuses, and knowing who to contact first can be a challenge. Your best starting point is typically the Office of Disability Support Services, or the individual listed as the 504 or American Disabilities Act (ADA) coordinator at the institution.
• When should we start talking with the college about academic accommodations? The process of obtaining accommodations can be lengthy, and I always recommend that parents and students begin talking with the college as soon as they accept the admissions offer.
• What types of accommodations are available? Perhaps not surprisingly, the accommodations and services offered on college campuses can vary widely. Some campuses offer extensive services, and others only offer more basic accommodations. However, most colleges will at least offer the following:
  • Testing accommodations (e.g. extended time, private testing room)
  • Permission to record lectures and/or have a note-taker in class to capture content the student with ADHD may have missed
  • Access to audio books
  • Reduced course-load
  • Course substitutions for typically required courses

Should I expect my teen to complete the academic accommodation qualification process on their own? I want them to become more independent, but I’m not sure they’ll follow through without my help. The process of qualifying for college accommodations can be daunting, even for adults with years of experience. While it’s important to push your teen toward independence, now is not the time to have them go it alone. That said, your teen should be involved in the process every step of the way, and even take ownership of some of the smaller steps of the process if that’s practical and feasible.

Sleep is essential for regulating emotions, staying focused, and making good decisions. So, when a child or teen has ADHD, their ADHD symptoms are much worse when they aren’t sleeping enough. Unfortunately, having ADHD can make getting a good night’s sleep a struggle. In fact, studies show that up to 70% of kids and teens with ADHD have ongoing sleep problems. One of the biggest culprits influencing sleep problems among kids with ADHD is screen time.  

There’s a great deal of research showing that using screens right before bed leads to poorer sleep in kids and teens with and without ADHD. But even more problematic for many kids with ADHD is the time they spend on screens after bedtime, when they should be sleeping instead. In a recent study of nighttime media use, researchers surveyed 81 teens with ADHD about their sleep habits and media use after 9pm.¹ Study results showed that almost all participants had a cell phone in their room, and 50% also had other devices (e.g. tablet, TV). 80% of the participants reported spending more than two hours using their devices after 9pm. Screen time after 9pm was associated with more sleep problems and more symptoms of anxiety and depression in teens with ADHD. And the majority of the teens in the study were getting far less than the recommended number of hours of sleep each night. 

What can parents do to help limit screen use after bedtime? Well, prevention is really the only effective strategy. After all, parents cannot physically monitor their child or teen’s screen time when they are asleep themselves. In practice, the most effective strategies that I’ve seen work are keeping all digital devices out of the child or teen’s room (including a television), using cell phone monitoring and control tools to restrict use after the bedtime hour, turning off household (or teen) internet access after bedtime, and using a device monitoring app to check the child’s usage and ensure that they are in fact sticking to the screen limits. 

The biggest challenge to using these strategies at home comes from the kids and teens. Most will complain (convincingly!) that they cannot fall asleep if they are not using their device in some way – they will say that they need to watch TV or videos to fall asleep, need to listen to music on their device, or need to use a white noise app on their phone or tablet. Parents need to resist giving in and look for alternative solutions to help their child or teen fall asleep. For example, a white noise machine can be purchased to replace a white noise app. A simple screen-free Mp3 player can be used to replace music on a phone or tablet. Books can be used in place of videos if they need something to quiet their mind before bed. Your child or teen isn’t going to be enthusiastic about any of these alternatives, because what they really want is to have their device back! But the bedtime limits really are in the best interest of the child or teen, and their disappointment is a small price to pay for better sleep, better ADHD symptom management, and potentially fewer symptoms of anxiety and depression. If parents are able to stick to the limits, after a while, their child or teen will adjust to their new routine, the complaints will die down, and they should be sleeping better. If sleep problems persist, consider talking to your child’s pediatrician. There are many ways to treat sleep problems, and the pediatrician will help you find the right solution. 

¹Becker, S.P. & Lienesch, J.A. (2018). Nighttime media use in adolescents with ADHD: links to sleep problems and internalizing symptoms. Sleep Medicine, 51, 171-178.

Let’s start by talking about what extended time actually entails. “Extended time” typically translates into time-and-a-half (for example, 1 ½ hours for a 1-hour test) or twice the allotted exam time. In addition to having more time to take the test, kids receiving this accommodation also take the exam in a separate room, either alone or with other students who have the same accommodation. 

Now let’s take a look at some of the pros and cons of extended time: 

1. Being pulled out of class for exams. Taking exams in a separate room can be both a positive and a negative for students with ADHD. On the positive side, if they are in a room alone or with only a few other students, they may have an easier time staying focused. They may also have less anxiety if they are bothered by seeing other students finish first. On the negative side, students (particularly older elementary students and teens) who are sensitive to the stigma that can come with being singled out from your peers may resist the extended time accommodation altogether or feel uncomfortable with the situation.
2. Addressing the underlying issue. There are many reasons why students with ADHD don’t finish exams on time. Sometimes they have poor test-taking or reading comprehension skills; other times, they struggle to stay focused and work productively on a relatively “boring” task for even 10 minutes (and extending the length of the task doesn’t improve their productivity); in other cases, anxiety is the culprit, and extended time doesn’t reduce anxiety effectively. In some cases, slow processing speed is the underlying issue, which may actually be addressed by extended time. For students who have deficits in areas related to test-taking skills or who have test anxiety, addressing the underlying issues will be more effective than an extended time accommodation.
3. Does it really improve academic performance? While only a handful of studies have looked at the effects of extended time on test grades and academic performance in students with ADHD, the findings generally show that there is no academic benefit.¹ One exception is a study that looked at test performance in students with ADHD who had poor reading comprehension skills. Those students did seem to benefit from extended time. The one caveat here is that these studies were largely done in controlled environments and not in a typical noisy classroom setting. So, the real-world academic benefits for an individual student may be different from what this limited research has shown. 

Overall, extended time on exams is an accommodation to carefully consider for your child or teen with ADHD. It may be beneficial for some students and not beneficial for others. If you decide to include extended time as part of your child’s 504 or IEP plan, monitor their progress. Are they showing academic improvement? Do they say that it’s helpful to take their exams in a separate room? Or do they find the pull-outs disruptive or stressful? When extended time is provided, it’s important to make sure that the underlying test-taking challenges are also addressed, whether that’s treating the test anxiety, teaching strategies for improving the rate of information processing, or coming up with creative ways to improve concentration during exams (e.g. wearing noise-cancelling headphones while taking exams in the classroom). As is often the case with ADHD, there is rarely a one-size-fits-all solution, and it’s up to parents and teachers to find creative and comprehensive ways to help students reach their full potential. 

¹Brown, T.E., Reichel, P.C., Quinlan, D.M. (2011). Extended time improves reading comprehension test scores for adolescents with ADHD. Open Journal Of Psychiatry, 1, 79-87 

Pariseau, M.E., Fabiano, G.A., Massetti, G.M., Hart, K.C., Pelham, W.E. (2010). Extended time on Academic Assignments: Does Increased Time Lead to Improved Performance for Kids with ADHD? School Psychology Quarterly, 25, 236-248. 

Lovett, B.J. & Leja, A.M. (2015). ADHD symptoms and Benefit from Extended Time Testing Accommodations. Journal of Attention Disorders, 19, 167-172.

Fortunately, there’s been a great deal of research examining the effects of ADHD medication on future drug addiction. Numerous studies funded by the National Institute of Mental Health and the National Institute on Drug Abuse have found that ADHD treatment with stimulant medications does not lead to drug abuse during adolescence or adulthood. In fact, 11 studies showed either no increased risk or a decreased risk for substance use problems in individuals who were treated with stimulant medication. One study showed a slightly increased risk for later substance abuse only when ADHD medication was started earlier in childhood (although there are a number of additional factors that may have contributed to this finding beyond the use of ADHD medication). 

While research suggests that taking medication to treat ADHD in childhood or adolescence may protect against substance use problems during the teen and adult years, some studies suggest that treatment response to the medication may also be an important factor. Specifically, the kids and teens who had the best medication response (meaning their ADHD symptoms were well managed by their ADHD medication) are the least likely to go on to develop substance abuse problems.  

Overall, studies suggest that ADHD medication treatment may protect against later substance abuse – especially when a child or teen’s ADHD symptoms are well managed by their medication. This finding is extremely important because teens and adults with ADHD (when compared to teens and adults without ADHD) are at higher risk for substance abuse problems overall. While the exact reasons for this risk are unknown, there are several factors that probably contribute. Specifically, the impulsivity associated with ADHD likely puts individuals at increased risk, as does higher rates of a family history of substance abuse, and the possibility that teens and adults whose mental health symptoms aren’t well managed with medication or behavioral treatment are essentially self-medicating with alcohol, marijuana, or illicit drugs at teens or adults. 

Effective treatment with ADHD medication is just one of the many routes parents can take to help protect their child from future substance use problems. Effective academic and social supports for kids with ADHD may buffer against future drug abuse, as can strong and supportive family relationships. So, if you are leery of having your child take ADHD medication, or if your child simply doesn’t respond to or tolerate ADHD medication, then it’s especially important that they receive extra behavioral supports and treatment to help minimize the impact of their ADHD symptoms on their current functioning and future development.

 When a younger child is receiving therapy for ADHD, there’s no question that parents should be highly involved in their treatment. In fact, all evidence-based treatments for ADHD require parents to learn skills and strategies to support their child at home. But when it comes to teenagers, being involved in treatment can feel like more of a gray area for parents. After all, your teenager isn’t a child anymore, and parents want to grant their teen a certain level of independence. Some parents also feel like it would be intrusive to be involved in their teenager’s therapy sessions. They want their teen to have a relationship with their therapist that represents a “safe space” where they don’t have to worry about what their parents think. 

While parent involvement in therapy for teens with ADHD isn’t as black and white as it is for children with ADHD, in almost all cases, parents should still be moderately involved in their treatment – that is, not quite as involved as they would be if their teenager were still a child, but not as hands-off as they would be if their teen were already an adult. Why? 

1. Treatment for teens with ADHD often includes strategies for creating additional structure and organization in their lives. This involves creating and sticking to routines that work at key times of the day, using tools for organizing and prioritizing their homework, strategies for organizing their possessions, and time management skills. Teens with ADHD are not typically capable of using these skills on their own – at least, not right away. They need help from their parents in order to practice these skills until they eventually become habits. 

2. Therapists only see the teen once a week for about an hour. In order to make progress, teens need to practice their skills between sessions, and the therapist needs help from parents to hold the teen accountable. 

3. Many parents of teens with ADHD are highly involved in their day-to-day lives, in an effort to help them compensate for their ADHD symptoms. Ideally, parents will be able to scale back their involvement over time as the teen improves their own skills and becomes more independent. Knowing when and how to pull back as a parent is hard. Part of a teen’s therapy involves coaching their parents on how to best support the teen as they grow and change.

 While parents should be involved in their teen’s therapy, they don’t usually need to attend every session. It’s often important for the teen to have individual sessions with the therapist when they can discuss all the complicated and messy emotions and social situations that come up during adolescence. In general, it’s common for parents to either regularly join for a few minutes toward the end of a session, or to attend occasional scheduled parent-teen sessions that occur in place of the regularly scheduled teen-only sessions.

 When it comes to concerns that the teen won’t fully open up to the therapist if they know that the therapist is also talking to their parents, more often than not, this isn’t much of a problem. Teens can have a great open and supportive relationship with their therapist even if their parents are involved in some of the sessions. Therapists who work with teens are adept at laying clear boundaries, letting the teen know that they won’t share anything with their parents without the teen’s permission (with a handful of exceptions, of course – like if they express intent to harm themselves or someone else), and as long as the therapist demonstrates that they will stick to these boundaries, then teens come to trust the therapist in return.   

When it comes to finding a therapist who is a good fit for your teen, make sure to look for someone who connects with both you and your teenager. The results you see from therapy will so much greater when you are both involved.

It’s very common for teenagers with ADHD (and teenagers without ADHD for that matter) to be resistant to the idea of working with a therapist. There isn’t usually one single factor driving the resistance, and the underlying reasons vary from teen to teen, but there are usually some similar themes. For starters, some teens are generally opposed to anything that they perceive as being their parents’ idea. They want to be in control of their own decisions, and they certainly don’t want to do something just because their parents tell them it’s in their best interest. For teens with ADHD who have a history of Oppositional Defiant Disorder, this reason alone may be why they are refusing treatment. Other teens don’t want to meet with a therapist because they have misconceptions about what therapy is, or they view therapy as a sign that there is “something wrong with them.” While this line of reasoning may not be accurate, it can be hard for parents to convince their teen to change their point of view. Lastly, there are some teens who worry that the therapist won’t be able to help them and sessions will be a waste of time, and others who fear feeling uncomfortable in sessions if they are asked to discuss things they would rather avoid.  

So, as a parent, what should you do? With any one of the scenarios above, how do you convince your teen to go to therapy? And if you succeed in getting them to see a therapist, how do you make sure that your teen will cooperate once they are in the session? There is no easy one-size-fits-all solution here, but there are a few strategies that may help.  

1. Approach the situation from the teen’s point of view. When it comes to getting your teen to go to therapy sessions, talking to them about the reasons why you think they need treatment is not going to work. Instead, look at the situation from the teenager’s point of view. Think about the things that are most important to them, and which of those things may not be going very well right now. Maybe they can’t participate in extracurricular activities because of poor grades, are struggling with friendships, are worried that they won’t get into college, or are tired of arguing with their parents all the time. Whatever it is, talk to them about how therapy can help improve these aspects of their lives.

2. Engage a respected peer or adult. Often teenagers are simply not in a mental space where they are able or willing to hear what their parents are saying to them. No matter what their parents say, they refuse to listen. To really get through to your teen, they may need to hear about the benefits of therapy from a respected peer or adult in their life. Ideally, this person will have had experience with therapy themselves and can talk about their experience. Sometimes it just takes the right messenger to get a teenager to listen.
3. Provide incentives. If all else fails, consider providing incentives or rewards for your teen if they attend therapy sessions. Remember that the primary goal at this stage is to get your teen into treatment. If incentives, either in the form of privileges (e.g. a later curfew on the weekends) or tangible rewards (e.g. gift cards or money toward a big-ticket item that they would like to buy), do the trick, then it may be a short-term solution that ultimately gets them one step closer to accepting the help that they need.

When you succeed in getting your child to attend therapy sessions, try not to worry too much about how they behave once they are actually in the room. It can be frustrating to think that your teen may be “wasting” valuable time and money by not giving 100%, but as a parent, there really isn’t much you can do to control what your teen does during therapy sessions. Fortunately, good therapists who have experience with adolescents can form close bonds with even the most resistant teens. The best thing you can do as a parent is research therapists ahead of time and find one who seems like they will be a good fit for your teen. If, after a couple of months, the therapist and teen tell you that your teen isn’t participating in sessions, then it may be time to look for a new therapist. In the meantime, do what you can to get your teenager into the therapist’s office, and then let the therapist take the lead from there.

Here are five books that I recommend for kids with ADHD who are newly diagnosed, or those who have known about their ADHD for a while but are struggling to understand their differences.

Marvin's Monster Diary: ADHD Attacks! (But I Rock It, Big Time)
by Raun Melmed, Annette Sexton, and Jeff Harvey
For 3^rd, 4^th, and 5^th grade kids who love The Diary of a Wimpy Kid series, Marvin’s Monster Diary: ADHD Attacks is sure to be a hit! Marvin is a monster who is distractible, impulsive, and energetic. He’s constantly getting into trouble at home and at school. Overall, things don’t go well for Marvin until he learns some special tricks that ultimately help him keep his ADHD symptoms in check. For a child with ADHD, this book will help validate their experiences and emotions and will get them thinking about mindfulness strategies that they can use to help make their days better. It’s not likely that a child will read this book and suddenly start using the strategies on their own, so the author has included a parent guide so parents can help their kids use the strategies at home. 

Get Ready for Jetty!: My Journal About ADHD and Me
by Jeanne Kraus
Elementary school girls with ADHD will relate to Jetty, a 4^th grader who is newly diagnosed with ADHD. Written in journal form, this book takes kids through Jetty’s journey of struggling in school and with friends, getting tested and diagnosed with ADHD, and working with her teachers, parents, and doctor to feel better. This easy to read and engaging book will be embraced by even the most reluctant readers.

All Dogs Have ADHD
by Kathy Hoopman
All Dogs Have ADHD pairs photos of energetic, distractible, funny, and adorable dogs with easy to understand descriptions of ADHD traits. The book’s simple format is great for kids with ADHD who don’t usually enjoy reading. The humor and joy conveyed in the photos help highlight the positive side of ADHD, and kids who love dogs will enjoy seeing the similarities between themselves and their favorite pets.

Shelley the Hyperactive Turtle
by Deborah Moss and Carol Schwartz
For young kids with ADHD (around ages 4-6), Shelley the Hyperactive Turtle is a great resource. It can be extremely difficult to explain the concept of hyperactivity to very young kids. Kids with ADHD will see themselves in Shelley, and the book can start some great conversations between kids and parents. If a child is taking medication for ADHD, they’ll also relate to the part of the story where Shelley goes to the doctor and gets medicine for ADHD too.

Mrs. Gorski I Think I Have the Wiggle Fidgets (The Adventures of Everyday Geniuses)
by Barbara Esham and Mike Gordon
This book does a nice job of emphasizing the inattentive symptoms of ADHD – being easily distracted. having trouble focusing, and making mistakes – as well as some of the hyperactive and impulsive symptoms. The main character, David, has a hard time staying in his seat during class and is often getting in trouble for not paying attention or for making “careless” mistakes. Kids with ADHD will relate to the feelings of embarrassment and frustration that David feels when he can’t control his ADHD symptoms. They will also experience a sense of hope and determination when they see David triumph over his ADHD and find strategies that work for him.

1. Provide a 5-minute warning. 5 minutes (or more) before the end of an activity, let the child know that the transition will be happening soon. Make sure the child heard you by making eye contact before giving the warning and asking the child to verbally repeat the number of minutes that are left in the activity.
2. Break the transition down into small manageable steps. If the transition requires the child to complete more than 2 steps (e.g., put your materials in your desk, put your completed work in the bin on the teacher’s desk, get your backpack, and line up by the door), then give the child instructions that break the instructions down into just two steps at a time. For example, “Put your materials away and then put your completed work on my desk. Nice job! Now go get your backpack and line up at the door.” If the transition is one that happens routinely, then post the steps on the wall, create a checklist, or give the child the instructions 2 at a time until the steps become a habit.
3. The fewer steps a child needs to follow during a transition time, the more smoothly things will go. Think about your most difficult transition times and consider whether there are any steps that can be removed or completed ahead of time. For example, when it comes to transitioning from play time to homework time, making sure the child’s homework station is organized, well stocked with supplies, and has his or her backpack (and daily materials) sitting nearby can actually take care of many little steps that get in the way of getting started on homework.
4. Give instructions slowly. For kids with ADHD who process information more slowly, make sure you provide the instructions with enough time (about 10 seconds) in between for the child to start following through. Often instructions are given rapid-fire during transitions because everyone is in a hurry. But, this fast pace ultimately just slows things down when a child can’t process the information quickly enough to be able to follow through.
5. Allow extra time. Most kids with ADHD cannot transition between activities quickly, and when you try to rush them they only seem to move more slowly. Instead, allow extra time either by giving the child with ADHD a head start on the transition activities, or by building in an extra few minutes for everyone during the transition time. At home this may mean allowing an extra 5 or 10 minutes in the morning to transition from finishing breakfast to getting out the door, for example.
6. Stay calm. Kids with ADHD often struggle to manage their emotions during transitions – and so do their parents and teachers who worry about being late or feel frustrated because the child is not doing what they want them to do. When a child’s emotions are escalating, help the child calm down by staying calm yourself. Practice deep breathing and/or walk away and come back in a few minutes when you’re feeling more calm and clear headed. Rather than spending too much time during the transition talking to the child about why he or she is upset, instead focus on problem solving. Is the child overwhelmed? Help him or her complete one or two tasks to provide support as he or she gets started on the new activity. Is the child frustrated because he or she didn’t want to stop playing video games? Give the child a few minutes alone to calm down before he or she starts the next activity. It can be helpful to have conversations with kids about why they are so upset or frustrated, just save these conversations for a less stressful time when they aren’t transitioning between two activities.
7. Use praise and rewards. Think about the behaviors you want to see from the child and provide specific praise to keep him or her motivated. For example, “Great job following my instructions right away.” “I like how you stayed calm even though you were disappointed that you didn’t finish the assignment before the time was up.” For kids who need extra incentives to stay on track, consider providing small rewards for successful transitions.
8. Stick to a routine whenever possible. Surprises and changes in schedules will always be a part of life but sticking to a routine as much as possible will go a long way in helping your child transition between activities smoothly. Many kids with ADHD benefit from having the routine or schedule posted on the wall, especially if they are prompted to look at it throughout the day.

Kids with ADHD will always face some challenges navigating transitions throughout the day. But with the proper support they can be successful and transition from one activity to the next smoothly most of the time.  

Transitions are so much a part of our daily lives that they aren’t something we spend much time thinking about. In general, we tend to assume that transitioning between activities is something that is easy for kids, and it should go smoothly most of the time. In reality, transitioning between activities is anything but simple, especially for kids with ADHD. Why? Transitions tap into several cognitive skills simultaneously – and these happen to be the very cognitive skills (or executive functioning skills) that are areas of weakness for kids with ADHD.

Let’s look at the different steps required for successful transitions and the cognitive skills associated with each step.

1. Stopping an activity. Before a child can transition to a new activity they first need to stop the activity they’re doing already. This may seem simple enough, especially if the activity isn’t particularly enjoyable. However, for kids with ADHD stopping or inhibiting an ongoing behavior can be very challenging. This is because the same cognitive skills that are used to “put on the breaks” and stop an impulsive behavior like calling out in class or grabbing something they want out of their friend’s hands, are the very same skills that they need to use when abruptly stopping an activity. Putting on the breaks more difficult at certain times than at others. It’s particularly challenging when a child with ADHD is hyper-focused on an activity, when the activity is something that’s particularly rewarding (like screen time), or when the upcoming activity is something they would prefer to avoid (like a writing assignment or bedtime).
2. Starting a new activity. After a child with ADHD has successfully stopped his or her previous activity, he or she is now faced with the task of initiating a new one. This can be something fairly simple, like lining up by the classroom door, or something more complicated, like starting homework. Either way, it requires the child to tap into his or her cognitive skills related to initiating a new activity. For many kids with ADHD – particularly those with the inattentive subtype - initiating a new activity can be overwhelming and exhausting. Not surprisingly, the less rewarding the new activity, the harder it is for a kid with ADHD to muster up the mental resources needed to get started on the new task.
3. Following multi-step instructions (quickly). Starting a new activity often involves following multiple steps in a specific order. If the transition isn’t routine, these steps can be a lot for a child with ADHD to process - especially if the instructions are presented verbally and very quickly. Why? Most kids with ADHD have weaknesses in either working memory (the ability to hold information in your short- term memory, and then manipulate this information in your mind) or processing speed (the ability to process information quickly). Some kids with ADHD have weaknesses in both areas. As a result, they may not have fully processed the necessary instructions making it nearly impossible for them to transition successfully.
4. Managing a chaotic environment. Transition points are often the most chaotic times of the day. Imagine 25 kids shuffling papers, chatting with their neighbors, racing to their cubbies, grabbing all their things and lining up at the door for lunch. Now imagine trying to block out this noise while you struggle to stop your activity and follow a sequence of steps that you’ve only half-processed. When you look at from this perspective it’s easier to see why kids with ADHD literally get lost in the shuffle and struggle to follow through.
5. Coping flexibly with changes in a routine. Not all transitions are planned. Things come up at school and at home that require kids to be flexible and adjust to a new routine on the fly. For kids with ADHD who struggle with cognitive flexibility, quickly wrapping their head around even small changes can be a big challenge.
6. Managing frustration and emotions. Lastly, but perhaps most importantly, dealing with transitions requires managing emotions and dealing frustration. Kids may feel upset because they don’t want to stop the fun activity that they’ve been doing. Or they may feel frustrated because they didn’t have enough time to finish everything they’d hoped to accomplish. They may feel overwhelmed by all of the noise and activity in the room or feel a sense of dread about the upcoming activity. Regulating emotions and tolerating frustration are areas of weakness for most kids with ADHD. Compared to other kids their same age, it’s not uncommon for kids with ADHD to have emotion regulation skills that are about 2 years behind. This means that at times of transition, the expectations placed on a child’s emotional capacity may exceed their actual ability level.

Understanding the underlying challenges that make it difficult for kids with ADHD to navigate transitions throughout the day is the first step in ultimately making transitions easier for the child (as well as their parents and teachers). In my next post I’ll provide concrete steps you can take to provide the support a child with ADHD needs to transition between activities successfully.

But outside of these recommended toys, what should you be thinking about when evaluating toys and gifts for your child with ADHD?  Try this simple checklist to help you make great decisions.

• Does it play to their strengths and help them feel a sense of accomplishment? Between school and homework, kids with ADHD spend a lot of time involved in activities that play to their weaknesses instead of their strengths. During their downtime, look for activities that will play to their strengths, whether it’s their artistic, musical, athletic, or social abilities, and allow them to shine. Also, look for gifts that are age appropriate and within their ability level. It’s great if a toy or activity challenges your child and stretches their skills. Just avoid gifts that are likely to be too difficult and lead to the frustration and meltdowns that can quickly derail playtime for kids with ADHD.
• Does it allow for creative play? Kids with ADHD thrive when they can play “outside the box” and create moments that fit with how they prefer to interact with their world. So toys and games that don’t “fit a mold” or have strict rules about how they are played tend to be favorites among the ADHD kid set. These toys and games allow them to express themselves through their play and bring their version of the world to life.
• Does it keep them busy and engaged? There is a reason fidget toys are so popular with all kids, but especially kids with ADHD. It keeps them busy. They help channel that nervous, hyperactive energy so kids can feel calm and have more space for creative thinking. There are many hands-on toys available that allow kids to focus and calm their mind. For kids who aren’t very active, but need an engaging activity to quiet their thoughts, detailed coloring books for kids (and adults) paired with a big set of colored pencils can make a great gift. 
• Is it active? Is it outdoors? Most kids with ADHD have more than enough energy to burn. When they don’t have any opportunity to be active, their ADHD symptoms become worse, and everyone in the family suffers. So, games that involve running, jumping, stretching, reaching (Twister anyone?)– anything active – will be a good fit for your child with ADHD. Outdoor games are also great for kids with ADHD, getting them away from screens and using up some of that energy. Just be wary of games that require a tremendous amount of of coordination or hours of practice to master. These games can frustrate some kids with ADHD and will be anything but fun. 
• Is it fast-paced? Kids with ADHD are most focused and engaged when they are participating in a faced paced activity. Fast paced, shorter games leave little space for kids’ minds to wander, setting children with ADHD up for success and fun!

With so much to choose from this holiday season, finding the right gift for a child with ADHD can feel overwhelming. But with a little thoughtfulness and consideration of your child’s strengths and their ADHD needs, you can find the perfect gift that will bring hours of fun.

While it may appear that a disorganized child with ADHD is careless or sloppy, often these students care very much about their materials and wish they could have a neat desk like their classmates. The problem is that the executive functioning skills required for organization are underdeveloped, making it almost impossible for them to maintain an organized desk and work area on their own. For kids with ADHD, getting organized and staying organized requires structure and support from their teacher and repeated practice of organizational skills and strategies.

Here is a simple 5 step process that will help the student get the support that they need:

1. Do an initial desk clean out with the child. At a time when there are no other students in the classroom, do a complete desk clean out with the student. Everything should come out of the desk, and only the absolute minimum number of items should go back in. Fewer materials in the desk means there will be less to keep track of an organize on a day-to-day basis.
2. Create an itemized checklist and tape it to the top of the desk. Make a checklist that includes every item the student needs to keep in the desk. The rule should be that if an item is not on the checklist, then it does not belong in the desk. If the student wants to put something in the desk that is not on the list, then he or she needs to ask permission and either update the list (if it’s a permanent addition) or take the item back home with at the end of the day so it doesn’t create clutter.
3. Schedule a daily desk check-in. At the end of each day, review the desk checklist with the student. Make sure only checklist items are in the desk and clear out any clutter that may have accumulated throughout the day. Over time you can have the student go through the checklist alone and call you over when he or she is ready for you to review his or her progress. Alternatively, if there is a kind, organized student in the classroom, you can have that student be a peer helper who is responsible for helping the student go through the checklist and clear out the clutter.
4. Provide praise and rewards. Remember that keeping a desk organized is an extremely challenging task for many students with ADHD. Provide a lot of praise when you complete the daily check-ins, and when the desk is looking particularly neat, snap a picture to share with the student’s parents so the student can receive praise at home as well. Some kids may need to receive rewards as well to stay motivated. You can provide rewards either by adding a daily “desk organization” goal to his or her daily report card, or by providing small stickers or incentives at the end of each day.
5. Review and update the desk checklist with the student monthly. As the curriculum changes throughout the year the student may need to add or remove items from the desk checklist. Review the checklist with the student and ask if there are items on the list that he or she is no longer using, or if there are things he or she needs regularly that aren’t in the desk or on the list. Actively engaging the student in this process will help him or her feel a sense of ownership over his or her organization and will help him or her develop valuable skills that he or she will be able to use independently in the future.

While it’s unlikely that a child with ADHD will go from being highly disorganized to the neatest student in the classroom overnight, with a few supportive strategies and daily practice the student can keep his or her materials reasonably organized and will no longer stand out as having a desk that’s the messiest one in the room.

Fortunately, there are some fairly simple strategies that help make transitions infinitely easier for students with ADHD.

1. Identify trigger points. Most students with ADHD who struggle with transitions have a few points in their day that are the most difficult for them to manage. Start by thinking of the most challenging of these times and consider the factors that may be most triggering. Is there something about the other students in the mix at that particular time - maybe someone who the student gets particularly silly and excitable around, or someone who always seems to push his or her buttons? Is there a consistent time of day when the student struggles the most with transitions? Is there something about the activity being transitioning to or from that may make the transition harder for the student? Having a clear understanding of the factors that make a transition particularly difficult for a student will help you see the situation from his or her perspective and troubleshoot more effectively. 
2. Make simple adjustments. Whenever possible, make simple adjustments to minimize triggers. For example, if a student consistently seems to have difficulty with a particular classmate at a given transition, make sure these students are not in the same group or area of the room at this time. If the difficult transition comes as lunchtime is approaching, consider whether the student is overly hungry and may need a mid-morning snack to help them make it all the way through until lunch. It may seem simple, but sometimes this is all it takes to smooth out a rough point in the day.
3. Consider medication effects. When a student with ADHD seems to handle transitions fine in the morning, but can’t manage them well in the afternoon it’s important to consider the possibility that his or her medication is not as effective as it should be throughout the entire school day. When a medication wears off too quickly, the effects are often most obvious during transitions when emotions and disruptive behaviors are at their peak. In these cases, a medication adjustment may be needed to ensure that the medication is providing the proper support all day long.
4. Announce schedule changes well in advance. Kids with ADHD rely on their daily routine to help regulate their behavior and emotions. Abrupt changes in their schedule or routine are often accompanied by abrupt change in their emotions and behaviors. Making sure the student is aware of the change well in advance will help him or her stay calm and regulated.
5. Make them a “helper.” Students with ADHD often do best during transitions when they are engaged in structured tasks. Since transitions are often a relatively chaotic time in the classroom, placing students in the role of classroom helper can add some structure and focus to this otherwise unstructured time. The tasks can be simple, like making sure all of the desk chairs are pushed in as everyone lines up, or counting the student in the line to make sure everyone is accounted for. Just remember to praise the student and thank him or her for the help, so he or she will feel confident and motivated to keep helping day after day.

Helping kids with ADHD manage transitions calmly and independently requires some initial planning and problem solving, but once a new routine is in place the student will thrive and problematic transitions will be a thing of the past!

Typical strategies for “motivating” students with ADHD to finish assignments quickly and accurately, like having them miss out on fun activities like recess or Choice Time when work is incomplete, or using a typical reward system to reinforce assignment completion, are rarely effective unless they are paired with targeted classroom accommodations. Effective accommodations help compensate for the executive functioning deficits (like slow processing speed or poor working memory) that make it difficult for students with ADHD to complete assignments at the same pace and with the same level of accuracy as their peers without ADHD.

Every student with ADHD is different, and the accommodations that will be most helpful will depend on each student’s individual profile of strengths and weaknesses.

Here are 5 of the most helpful strategies for improving work completion in the classroom, which can be tailored to meet the needs of each student:

1. Break large assignments down into smaller chunks. Students with ADHD often struggle to complete assignments simply because they find the assignment overwhelming. The executive functioning deficits that accompany ADHD can make it difficult to mentally process and organize large amounts of information and muster up the motivation needed to stay focused on a mentally painful task for an extended period of time. Helping students break assignments down into smaller chunks, either by assigning only a few questions at a time or by helping them prioritize and focus on individual components of a larger project will go a long way in helping them complete the assignment piece by piece.
2. Beat the clock.  Time limits for assignments (or a smaller portion of an assignment) that are coupled with “beat the clock” goals can motivate students with ADHD and bolster assignment completion. Setting reasonable, yet challenging “beat the clock” goals will help make assignments more fun and engaging and will help boost confidence and self-esteem.
3. Pair “Beat the clock” goals with praise and/or rewards. Some students with ADHD will find it so incredibly motivating and satisfying to meet their “beat the clock” goals that they won’t need any additional incentives. Other students with ADHD will need a bit more of a boost before you see real improvements in their classroom performance. For these students, pair verbal praise and/or rewards with the beat the clock targets. These rewards don’t need to be large, sometimes a simple sticker or a small privilege is all a student needs as long as it’s paired with genuine praise.
4. Match assignments to ability.  Many kids with ADHD have weaknesses in the areas of math and reading, even if they don’t have a diagnosable learning disorder. Sometimes the weakness is subtle, but impairing enough that when coupled with ADHD it becomes impossible for those students to complete the same amount of work as their non-ADHD peers in the time allotted. In these cases, it is often best to either have the student complete a different assignment altogether or shorten the assignment so that it’s feasible for him or her to complete it in the time allowed. When it comes to working with students who have ADHD it often takes a bit of trial and error to find that sweet spot between making sure an assignment is challenging enough but not so difficult that it is beyond their reach.
5. Minimize distractions. Distractions are a big factor underlying poor productivity among students with ADHD. Have a conversation with your student about things that he or she may find distracting in the classroom. You may be surprised to find that it’s often not the obvious distractors that bother the student the most. Sometimes it’s the sound of a dripping faucet that makes it hard to focus, or the clutter in a desk or in the cubby along the wall. Helping the student find creative ways to minimize the things that distract him or her the most can go a long way in helping the student stay focused and get his or her work done.

Incomplete assignments are a frustrating problem for teachers, students, and their parents. Fortunately, with a combination of tailored classroom accommodations and praise or rewards, students with ADHD are capable of completing more work than they (or their teacher!) ever thought was possible during the school day.

1. The Daily Report Card. A well-structured daily report card or personalized positive behavior system is the backbone of any successful classroom behavior management program for kids with ADHD. Impulsive behaviors like talking out of turn or rushing through work can (and should) be included as behavior goals on a daily report card. Daily report cards only work well when they are designed and used correctly. For tips on creating effective daily report cards for kids with ADHD see my previous posts on the topic (insert links to posts here).
2. Hold that thought! Most kids with ADHD struggle with resisting the impulse to shout out answers to questions before they have been called on by the teacher.  Help students with ADHD resist calling out by encouraging them to “hold their thoughts” in a notebook where they can write them down instead of shouting them out. While students might not be able to capture every thought in writing, this exercise provides an opportunity to resist the urge to call out every time. In addition, adding a daily report card behavior goal of, “raise a quiet hand and wait to be called on,” puts a reward system in place that will encourage impulse control.
3. Waiting is not easy. Impulsive students often feel like they need to be first at everything – first in line, the first to make it to the rug for circle time, the first to try a new activity, etc. Ask your students with ADHD to count to 5 before jumping into an activity. Initially, you may have to help by counting along with them either out loud or silently with your hands. Eventually students will remember to count independently, and will continue to do it on their own if they are praised or rewarded for the behavior often.
4. Faster isn’t always better. Getting started on classwork and staying on task are challenges for all students with ADHD. On top of this, many students with ADHD rush through their work and make careless mistakes. Reduce this impulsive behavior by reminding the student that the goal isn’t to simply finish the assignment, it’s to finish the assignment accurately. Praise students for behaviors that reflect patience and thoughtfulness, like careful handwriting, answering questions in the correct order, and double checking answers before turning in assignments. Check in with the student while they are working and praise their effort. Kids with ADHD will work more methodically and accurately when they know an adult is monitoring them.
5. Higher engagement = lower impulsivity. Students with ADHD struggle with downtime in the classroom. As soon as boredom sets in, impulsive behaviors increase dramatically. Consider giving your students access to an engaging filler activity if they finish assignments and quizzes early (after double checking their work of course!), to reduce impulsive behaviors while they are waiting for their classmates to finish.

Impulsivity can be one of the more challenging aspects of ADHD to manage in the classroom. When impulsivity interferes with a student’s performance and peer relationships, then the student needs classroom accommodations and supports to help him or her change his or her behavior. Creativity and consistency are the keys to implementing successful behavioral strategies and reducing impulsivity in the classroom.

What is Neurofeedback?
Neurofeedback is based on the premise that the brain emits different patterns of brain-waves depending on whether a person is in a focused state or a distracted state. The goal of neurofeedback is to train the brain to produce and sustain more brain-waves associated with focus and concentration and fewer brain-waves associated with distraction or daydreaming. Neurofeedback treatment begins with brain mapping. The patient wears a cap lined with electrodes and is instructed to perform cognitive tasks (like simple math or reading). During these tasks a computer program reads the signals transmitted by the electrodes and identifies areas where the brain appears to be underactive or overactive. These areas of brain-wave underactivity or overactivity become the targets of the tailored neurofeedback treatment plan. During weekly treatment sessions the patient wears an electrode cap while playing a video game filled with challenging cognitive tasks. Brain-wave activity is measured, and if the electrode signals indicate that a child or teen has lost focus then the game stops. The game resumes when “focused” brain-wave activity picks up again. The patients goal is to keep the game running without interruption by staying engaged and encouraging sustained “focused” brain-wave activity.

What the Research Says

Unbiased research published by scientists without affiliations with the neurofeedback programs themselves provides the most reliable source of information about the treatment’s effectiveness. Locating results from these studies can be challenging, since the findings are published in academic journals and aren’t always described on the neurofeedback websites that appear in a Google search.  A number of randomized controlled trials comparing neurofeedback to ADHD medication treatment and/or a control condition have been published. Some of these studies show that neurofeedback leads to changes in brain-wave patterns and improved performance on computer tasks. However, in studies where medication was included as a comparison treatment, the medication group always outperformed the neurofeedback group. When these studies examined the impact of neurofeedback on the child “real-world” ADHD symptoms at school or at home (rated by teachers and parents), there were no effects or very limited effects on symptoms. In addition, clinical scientists are concerned that there may be a placebo effect. In a recently published meta-analysis researchers combined and analyzed the data from 13 randomized controlled studies of neurofeedback. The results showed that when studies compared neurofeedback to a “sham” or placebo neurofeedback condition, there were no differences in computer task performance or ADHD symptoms between the placebo group and the actual neurofeedback group.¹

Being an Educated Consumer

The current research suggests that parents should be cautious about enrolling their children in neurofeedback for ADHD. Of course, there are children who have received neurofeedback whose parents report an improvement in ADHD symptoms, and there are also many children whose parents say they saw no change in symptoms. It is possible that some children do in fact see some benefit. If ADHD medication is not effective or if symptoms that persist even after other evidence-based treatments have been tried, then neurofeedback may be an alternative treatment to explore for your child.

If you choose to seek out neurofeedback treatment, remember that the goal of treatment should be to see “real world” improvement in ADHD symptoms at school and at home and not only improvement on a handful of computer tasks or a change in brain-wave patterns. Ask the neurofeedback practitioner how they will monitor real world symptom improvement. Will they be obtaining rating scales from parents and teachers at regular intervals? Also ask how soon should you expect to see improvement, and at what point should you stop the treatment if there is no observable change in ADHD symptoms or behavior.

Neurofeedback requires a significant investment of time and money. Before enrolling, make sure you have explored evidence-based behavioral treatments and medication options first. Also, consider your child’s specific challenges and look for interventions with proven track records that target the areas where your child needs help the most. These can be academic interventions, social interventions, programs that help kids learn to manage their emotions, or behavioral treatments that target ADHD symptoms specifically. Targeted interventions with a history of proven outcomes are most likely to lead to real-world results for your child or teen with ADHD.

¹ Cortese, S., Ferrin, M., Brandeis, D., Holtmann, M., Aggensteiner, P., Daley, D., Santosh, P., Simonoff, E., Stevenson, J., Stringaris, A., Sonuga-Barke, E., on behalf of the European ADHD Guidelines Group (EAGG) (2016). Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes from Randomized Controlled Trials. J Am Acad Child Adolesc Psychiatry, 55(6), 444-455.

While old school flashcards on paper or index cards can work well, online flashcards take things to the next level with features like definition libraries, pictures and images, “flexible scoring,” and premade card stacks for popular topics. As a bonus, all of the information is stored online, making it possible for you to study from anywhere as long as you have a phone or tablet with you.

There are many online flashcard programs available, each with different features. Here’s my take on some of the most popular feature-rich programs to choose from.

Cram.  Creating flashcards in Cram is straightforward: you have a front, a back and a hint section that you can choose fill in. You can add photos or create text-only cards. As a bonus, you can choose from two study modes: “Memorization” and “Cram.” In Memorization mode you go through each flashcard in your set at your own pace and get a performance report at the end. In Cram mode you go through the same set of cards, but you can’t move on from a card until you get it correct. This can force you to look up information if you’re not sure of the answer or stay focused on a card until you’ve really processed the concept. https://www.cram.com/

Quizlet. Quizlet is full of features for visual and auditory learners. With Quizlet you start by creating a “study set” of all the terms and definitions that you need to master. Your definitions can be text, images, or even audio recordings. Next you publish your study set to your account, where you can save multiple study sets saved for multiple classes. You can quiz yourself from either the website or the app, and tailor the scoring method to meet your preferences. For example, if you want to focus on progress rather than perfection, you can enable “flexible scoring” which gives you credit for multiple answers or partial answers. Similar to Cram, Quizlet offers multiple study modes, with Flashcard mode (one at a time), Learn mode where you need to provide a correct answer before you’re able to move on to the next card, and Match mode where you can work on improving your response time. Quizlet also offers a library of flashcards that other users (some of whom are teachers) have published for sharing. http://www.quizlet.com

StudyStack. StudyStack takes a more game-like approach to studying, which can help tremendously with motivation! You can create basic flashcards, or use your stack to create crossword puzzles, matching games, word searches and more. A quick note: StudyStack’s free version does contain advertising, but an ad-free version is available for a small fee.  http://www.studystack.com

Adobe Spark.  Adobe Spark is a tool that’s great for visual learners. It was originally designed as storyboarding program, so they really do take the visual components to the next level. You start by picking the size and shape of the cards, then you select a theme, add images and text, and download your completed cards. While this tool might not be great for studying math concepts, it really stands out when it comes to more visual subjects like geography, art, and even history. https://spark.adobe.com/make/card-maker/flashcards/

Brainscape. Brainscape was developed by a team of cognitive researchers who wanted take findings from academic research and put them into practice where they could help people learn more effectively. An enormous library of premade flashcards is included in the app, which draws on sophisticated research to implement patterns of repetition, color, social interactions, breaks, sounds, humor, animations, achievements, and rewards! All in an effort to improve learning!  The tool started out in the cognitive science lab at Columbia University before it was rolled out to the public, and it now includes components for high school students as well as college students (and adults studying for professional certification exams!). There are many features within Brainscape that are free, and a subscription model can be purchased to unlock even more features. http://www.brainscape.com

With so many online flashcard programs to choose from, you are bound to find one that is the right fit for your learning style. If you start with one app and find your motivation lagging over time, mix it up by trying a new app with different features. Sometimes it just takes a small change to get your motivation and focus back on track.

Unfortunately, there is no simple way for parents and other consumers to know in advance whether a therapist provides evidence-based treatments. Occasionally, a therapist will have participated in a specific evidence-based treatment certification program and this certification will be listed on their website. While this makes it much easier for parents to have confidence in the therapist’s use of evidence-based treatments, many highly qualified, highly trained therapists who provide evidence-based treatments have not received these certifications. So, relying on a certification alone isn’t a great option. Overall, finding a good evidence-based therapist requires interviewing the therapist and asking key questions to determine whether evidence-based approaches will be incorporated into your child’s treatment.

Questions to Ask Prospective Therapists
When interviewing potential therapists for your child, ask the following questions. You should expect to hear answers that are consistent with the description of evidence-based treatments that I provided in my previous post.

1. Training and Credentials
   Have you received training in any evidence-based treatments?
   Which treatments or approaches have you been trained in specifically?
   Where did you receive this training?
   Do you have any certifications?
   How much experience do you have treating children or teens with ADHD (and/or other conditions or challenges that may apply to your child)?
2. Measuring symptoms and treatment progress
   What type of assessments do you conduct at the start of treatment?
   Do you use rating scales or measures and clinical interviews?
   Will I be expected to complete measures about my child’s symptoms and behavior?
   Will you collect measures from my child’s teacher as well?
   How do you measure treatment progress (i.e., how will you know if my child is improving)?
   What will you do if my child’s symptoms aren’t improving?
3. Treatment and Treatment plan
   Do you create a treatment plan after you complete the initial assessment?
   Do you consult with parents when creating the treatment plan?
   Which treatments or treatment approaches do you use for ADHD (and/or other conditions or challenges that may apply to your child)?
   Do you recommend any websites or have any materials to share that will help me learn more about these treatments and approaches?
4. Session content
   Do your sessions typically involve working on new skills or strategies?
   Do you expect your clients to practice new skills and strategies at home in between therapy sessions?
5. Parent involvement
   What is the role of parents in the child’s treatment?
   How often will I (and my co-parent) be expected to attend treatment sessions?
   Will I be expected to help my child practice new skills and strategies at home?
6. Treatment length
   After you complete the initial assessment, will you provide an estimate of how many therapy sessions you think my child will need?
   Do your clients usually remain in treatment for a few months or a few years?
   Do you encourage booster or maintenance sessions after treatment ends?

As a parent it is ultimately up to you to decide which therapist and treatment approach is the best fit for your child. Choosing a therapist is like choosing any other professional who delivers a service, and finding the right fit requires some research and legwork upfront. Fortunately, this effort will pay off when your child is able to work with a therapist who is trained in evidence-based treatments that can be tailored to meet your child’s individual needs.

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*Note that before meeting with any therapist, you should always confirm that they are licensed in your state. To verify a therapist license, first find out whether they are a psychologist, a social worker, counselor, or a marriage and family therapist, and then search for “verify license” on one of the following organization’s websites:   

Psychologist (Ph.D. or Psy.D.): The Association of State and Provincial Psychology Boards

Social Worker: Association of Social Work Boards

Mental Health Counselor: American Counseling Association

Marriage and Family Therapist: American Association for Marriage and Family Therapy

There are many specific evidence-based treatments available for a variety of child and adolescent mental health problems (you can find articles and videos about specific treatments here https://effectivechildtherapy.org/therapies/), and all of these treatments for children and teens share five essential ingredients that contribute to their effectiveness.

1. Measurement of symptoms and improvement over time. All evidence-based treatments require therapists to collect initial measures of symptoms and functional impairment. These measures should be completed by the child (if they are old enough) or the teen, as well as by parents and teachers (when appropriate). Measures are administered at the start of treatment and repeated regularly to measure treatment progress.
2. Teaching new skills. All evidence-based treatments focus on learning new skills and strategies, and the emphasis on using these skills starts early. Therapists may spend only a couple of sessions getting to know the child or teen and his or her family before quickly diving in to teaching and rehearsing new skills. As the child or teen learns and practices these skills, the relationship with the therapist continues to grow and before long the child or teen is seeing improvement in symptoms and developing a strong bond with the therapist.
3. Practicing skills in-between sessions. All evidence-based treatments require the child or teen and the parents to use the new skills and strategies at home in-between sessions. Changing thoughts and behaviors takes time and practice, making between session “homework” and practice an essential component of all evidence-based treatments.
4. Parent involvement. All evidence-based treatments for children and teens require at least some degree of parent participation (more when kids are younger and a bit less as kids get older and grow into teenagers). When it comes to ADHD treatment for younger children, research has shown that parent-focused interventions (like behavioral parent training) are the most effective treatments. They can work so well that sometimes the child never needs to attend a single therapy session! For older children and adolescents with ADHD, evidence-based approaches that combine child or teen-focused sessions with sessions that target parenting skills and the parent-child relationship are typically most effective. When it comes to treatments for other disorders, like anxiety or depression, evidence-based treatments often include more child or teen-focused sessions and fewer parent-focused sessions, however parents still spend at least some time with the therapist, so they can learn about the skills and strategies that their child or teen will be using at home.
5. Improvement in a relatively short period of time. Many evidence-based treatment programs last for only 10-20 sessions, with many children and teens experiencing significant improvement after a couple of months. Since ADHD is a chronic disorder, it always requires parents and children or teens to continue to use the skills they learned in therapy even after they’ve stopped working closely with their therapist. Many kids and teens also require ongoing medication to manage their symptoms, and most require ongoing booster or maintenance therapy sessions to keep their skills current.

If your child or teen’s therapist is not providing evidence-based treatment and their ADHD symptoms at home and at school are not improving, then it’s probably time to find a new therapist. In next week’s post I’ll share a list of questions to ask a prospective therapist that will help you learn about his or her approach to treatment before you and your child start to work with him or her. Not sure where to begin your search for a new therapist? One of the following therapist directories can be a good starting point:

Society of Child and Adolescent Psychology

Association for Behavioral and Cognitive Therapies

American Psychological Association

Psychology Today

With more and more children and teens being diagnosed with ADHD, it’s more important than ever for parents to insist that their child receive a rigorous diagnostic assessment. A thorough assessment is the only way to minimize the risk of a misdiagnosis and ensure that ADHD is the most appropriate explanation for a child or teen’s symptoms and behavior. Often, ADHD diagnoses are made in the pediatrician’s office after a single visit. If these office visits are too brief and rating scales completed by parents and teachers aren’t included in the assessment process, then the likelihood of a misdiagnosis goes up dramatically. Some pediatricians have a practice that can support the demands of an ADHD diagnostic assessment and have a great deal of experience in this area, but often the most thorough evaluations are conducted by a mental health specialty provider or a developmental pediatrician. When evaluating whether the assessment your child or teen is receiving is as rigorous as it needs to be, look for the following components:

Detailed Interview with Parents
The foundation of a solid ADHD evaluation is a detailed parent interview that assesses the child’s medical history, and social history, as well as his or her history of symptoms of ADHD and other conditions like anxiety and depression. Overall, the goal of this interview is to establish a timeline for the development of ADHD symptoms and behaviors as well as other disorders or situational factors that may also explain a child’s symptoms. At a minimum this interview should take 30-60 minutes.

Detailed Interview with the Child or Adolescent
Older children and adolescents should also be interviewed. Children and teens with ADHD may not have much insight into their ADHD symptoms, but they often have an awareness of anxiety or depression symptoms that may not be as obvious to parents or others around them.

Symptom Rating Scales Completed by Parents and Children or Teens
In addition to diagnostic interviews, rating scales completed by parents and the child (ages 8 and older) or adolescent themselves are a key component of a thorough diagnostic assessment. Rating scales should include questions related to ADHD symptoms as well as symptoms of other disorders. These measures often include normative scales which allow the provider to compare ratings for the child or teen undergoing the evaluation against a large database of scores to see how the child or teen compares to peers of a similar age and gender. This can help determine whether a child’s behavior and symptoms are typical of someone their age or if they have relative weaknesses in certain areas.

Symptom Rating Scales Completed by Teachers
In order to meet diagnostic criteria for ADHD, children and teens must experience impairment at school as well as at home, making teacher reports an essential component of an ADHD assessment. Like the rating scales completed by parents, these measures should include questions about symptoms of anxiety and depression as well as ADHD and should include normative scales that allow for comparisons with same age peers. A measure of academic performance and skills should also be included to help determine whether a learning disorder evaluation is also needed. Ratings should be completed by teachers who have had the child in the classroom for at least 1 month at the time of the evaluation. If a child or teen has multiple teachers, then ideally each teacher should provide ratings, so the evaluator can determine whether a child’s symptoms present differently across classroom subjects and settings.

Report Cards
Past and current year report cards can be extremely helpful in an ADHD evaluation. Report cards include valuable information about a child’s behavior and focus in the classroom over time and can be used to identify the need for a learning disorder evaluation.  

Learning Disorder Evaluation in Kids and Teens with Learning Concerns
In some cases, learning disorder symptoms can look a lot like symptoms of ADHD. When kids and teens struggle to learn new concepts despite having average or above average intelligence, they may have difficulty focusing in class or may act-out behaviorally. If report cards and teacher ratings suggest a history of poor performance in some subject areas but not others (for example, a child or teen receives below average grades in math but receives average or above average grades in other subjects), then a learning disorder evaluation should be completed by the school or by an educational specialist or psychologist.

The process of diagnosing ADHD is complex and participating in the evaluation process can take a great deal of time and effort – but the effort is worth it in the long run when you receive an accurate diagnosis that can be used to identify the best treatments for your child or teen.

 ¹ Xu G, Strathearn L, Liu B, Yang B, Bao W. Twenty-Year Trends in Diagnosed Attention Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Network Open. 2018;1(4):e181471. doi:10.1001/jamanetworkopen.2018.1471

For kids with ADHD who are auditory learners, Podcasts are a highly accessible and often underutilized resource when it comes to alternative methods of learning new information. Before I share some of my favorite podcasts, here’s a little more information about what makes them so great for supplementing learning for kids with ADHD (and kids without ADHD!):

• Enhanced learning. Engaging hosts, dynamic storytelling, fascinating topics, and connecting big concepts with everyday life are just some of the reasons that the podcast format connects so well with kids and helps them focus and retain detailed information. On top of this, podcasts are often short. They pack a lot of information and entertainment into a snack size format that is just the right length for a child who struggles to pay attention for long periods of time.
• Reduced screen time. Parents are often encouraged to limit their kids screen time (I’ve written a few posts about why this is so important for kids with ADHD. But the inevitable question from parents is: if I remove screen time, what’s the alternative? Well, audio podcasts are a great alternative! They offer an engaging experience without a screen.
• They can go anywhere. Have player, will travel. You can play podcasts in the car, on the bus, on your phone – any place that you have an audio player (and some headphones).
• They cost nothing. Unlike audiobooks, podcasts are often free and sometimes they are even more interesting to kids than an audiobook.

Today there is a growing catalog of kid-focused podcasts available, with something that every child with find interesting. Figuring out which podcasts are best can take some time, so here’s a list of some of my favorites to get you started:

• But Why? A Podcast for Curious Kids tackles questions like “Why do leaves change color?” or “Who invented words?” Topics are submitted by kids (using the voice feature on your phone), making the podcast responsive and engaging. Try asking the “Buy Why?” team about challenging topics in science and math to help your child grasp abstract or confusing topics. http://butwhykids.org

• The Past and The Curious. Comedic performances help make history come alive in this highly entertaining podcast. In addition to the terrific storytelling, the producers are working on a companion graphic book that should be fun for kids. http://thepastandthecurious.com/

• Tumble: Science Podcast for Kids. In each episode, science is brought to life through extremely engaging storytelling.  The producers have a strong belief that science is not something that is simply something that you do or memorize, but instead is a process that is comprised of mistakes, false starts, failed experiments and learning and that builds on itself over time. This process is what drives the storytelling and educational material in this podcast, making the underlying message highly compelling to kids -  especially those who have struggled and failed and need encouragement to keep trying. http://www.sciencepodcastforkids.com/

• Brains On! A different science lesson is tackled in each episode, allowing you to find at least one that fits your child’s interests. To the delight of many children, there are also some non-classroom science topics (ahem…The History of Boogers and Farts!). Just the kind of highly entertaining, yet educational, material that will get even the most skeptical child hooked on science podcasts. https://www.brainson.org/

• Stuff You Should Know. Sometimes better for teens than younger children, this podcast explains the ins-and-outs of historical moments or key concepts in math and science.  You’ll find topics like, “What is an invasive species?”, “The Gettysburg Address: Short and Sweet” or “The Great Wall of China,” to name a few.  https://www.stuffyoushouldknow.com/

• The Radio Adventures of Dr. Floyd. At first you might think this podcast is all fun, as Dr. Floyd tries to overcome a wide cast of nemesis.  But in order to win, Dr. Floyd has to learn about history – and so too will your child.  Super hero meets history in this podcast! http://www.doctorfloyd.com/

• Wow in The World. Produced by NPR, this show is all about fascinating facts from around the world and is focused on space, science and technology.  https://www.npr.org/podcasts/510321/wow-in-the-world

“People who are mildly dehydrated really don’t do as well on tasks that require complex processing or on tasks that require a lot of their attention,” according to study author Mindy Millard-Stafford.  Mildly dehydrated. That’s just 1.5 – 2% dehydrated, according to the researchers – a level so mild that we wouldn’t even feel thirsty yet.

What does this mean for a child with ADHD? While researchers haven’t specifically studied the impact of hydration on the ability to focus or complete complex cognitive tasks in kids with ADHD, the fact ADHD causes weaknesses in these specific areas of cognitive functioning suggests that staying hydrated could be even more important when a child has ADHD. In addition, for kids with ADHD who are already struggling to keep up with their peers academically, a 12% drop in performance from mild dehydration could mean the difference between passing and failing or grasping a new concept quickly or falling behind the rest of the class.

So, as the new school year begins, commit to helping your child stay hydrated to help fuel his or her mental performance.  When it comes to drinking water, kids with ADHD are likely to fall into two categories at any time throughout the day. First, when they are at school or doing homework, kids with ADHD may ask for a drink of water repeatedly as a procrastination strategy, a reason to “escape” a boring activity, or an excuse to get out of their seat and move around. In this situation, parents and teachers are quick to deny that trip to the faucet or drinking fountain. Alternatively, if they are engaged in activity they enjoy, they may be so busy or hyperfocused that they forget to drink any water for hours on end. As a result, getting a child with ADHD to drink water consistently throughout the day can be a challenge.

Here are 8 ideas to get you started:

1. Start your day with water. Help your child get in the habit of reaching for a glass of water first thing in the morning.
2. Water with every meal. Serve water (or another hydrating beverage) with every meal, even if your child says they are not thirsty.
3. Make water accessible. Kids will drink water when they see it. Make sure they can easily access cups and the water dispenser or faucet at home. At school, work with your child’s teacher to build water breaks into your child’s schedule. This will help ensure that your child gets the water he or she needs even if the teacher is in the habit of denying the trips to the water fountain that he or she has repeatedly asked for.
4. Water on the go. Make sure to bring water bottles in the car and have them on hand when your son or daughter is at after school extracurricular and tutoring activities.
5. Make water fun. Start off with a water bottle of your child’s choice (get a new one to kick off the school year) and consider things to “brighten up” water like frozen berries in ice cubes or fresh-fruit infused water. Don’t forget: fruits and veggies are great sources of water.  Load up lunches and snacks with things like watermelon, strawberries, celery, cucumbers and other watery snacks.
6. Water is especially fun when it’s frozen! A great snack or treat can be a homemade or no-sugar-added fruit popsicle.
7. Make it a game or a family competition. You’ve likely seen first-hand the power of sticker charts and rewards with your child. Build in fun incentives and rewards for your child or the whole family. You can use a “Marble Jar” where everyone adds a marble whenever they drink a glass of water. When the jar is full, the family earns a fun reward (a trip to the water park?!). Or you can have a family competition using sticker boards to see who can drink the most water (within reason!) in a week!
8. End your child’s day with water. At bedtime, have a glass (or water bottle) of water on the nightstand by your child’s bed and encourage your child to have a drink after they brush their teeth or right before bed.

It takes a few weeks to develop new habits but following just a few of these tips will help your child get off to a great start!

The good news is that despite the complexity of the problem there are some fairly simple things parents can do to help make homework time easier. The first, which I talked about in my last post, is to create a homework station designed specifically for a child with ADHD. The second is to create a simple homework routine that lays out the steps your child needs to complete each day and rewards him or her for his or her effort. When both the homework station and homework routine are used consistently, homework time becomes infinitely easier for kids with ADHD.

Steps for creating a homework routine:

1. Time of day. Have your child do homework as soon as possible after he or she gets home from school or after-school activities. The later it gets the more fatigued kids become, and the harder it is for them to stay focused and on task during homework time. And as much as possible, have your child do his or her homework at the same time each day. If after-school schedules make this difficult, then aim to create as much consistency as possible – for example, on Tuesdays and Thursdays homework time is 4:30 and on Mondays and Wednesdays homework time is 6:00.
2. Use a timer to build in homework breaks. Many younger kids with ADHD can only stay on task for about 10 minutes, and some older kids or teens with ADHD max out at around 20 or 30 minutes. Plan for this by building 5-minute breaks into the homework routine. Have your child set a timer for the first stretch of work time (15 minutes, for example). Your child’s job is to work consistently during this time. Then when the timer goes off he or she gets a 5-minute break. Make sure your child sets a timer for this break period and gets back to work for the next 15-minute segment once the break is over. Some parents worry that if their child takes a break he or she will never get back to work, but as long as you build this into your homework plan and reward your child for getting back to work quickly when the break is over, you should see that he or she actually gets more work done with breaks than he or she would with no breaks at all.
3. Clear expectations. Provide your child with clear expectations around the behaviors you want to see during homework time. Really think through the small steps that you want him or her to take, regardless of what his or her specific homework assignments might be. Focus on things like getting started right way, continuing to work until the timer goes off, and getting back to work right away when the break is over. Try to keep your expectations limited to just 5 steps. For example:
   • Get started on your homework right away at your homework station (with only 1 reminder from an adult).
   • Use a timer for homework time (10 minutes) and break times (5 minutes).
   • Get back to work right away when a break is over.
   • Try to answer each question or problem at least once before asking for help.
   • Keep working until your timer goes off or your homework is finished.
4. Build in rewards. “First you work then you play” is a good rule of thumb for everyone to learn and follow, and this is especially true for kids with ADHD. When it comes to doing homework, you can use this rule to create natural rewards that your child can earn when he or she finishes his or her work and has met your clear expectations. Think about fun activities your child likes to do that be used to motivate him or her to get homework done quickly. These can be things like playing with favorite Legos, playing outside, getting a limited amount of screen time, building forts out of pillows and blankets, etc. If time in the evening is very limited and you feel like you won’t be able to squeeze in a fun activity on some nights, then you can allow your child to earn a small reward instead (check out my post on quick and easy reward ideas for families). Sit down with your child and create a list of activities or tangible rewards they can earn for meeting homework expectations.
5. Make a When-Then plan. Use the list of homework expectations and the list of possible rewards to create a When-Then plan. “When you complete your homework and meet the expectations, Then you can choose one activity or reward from the list.” Print your When-Then plan and post it on a wall near your child’s homework station so he or she can see it while he or she works. If your child starts to get off track, remind him or her about the plan and give your child an opportunity to refocus on work.

SAMPLE HOMEWORK WHEN-THEN PLAN

Following these 5 steps to create a homework routine for your child will go a long way in helping to make homework time less stressful for you and your child. Your child will have an easier time getting started on his or her work and staying focused until homework is finished. Plus, your child will be finishing homework more quickly, leaving more time for the fun activities and family time that everyone enjoys!

Location
Kids who don’t have ADHD may be able to sit down in any corner of the house or bedroom and get their homework completed without any problem. But, when a child has ADHD, it’s a different story. Where he or she does homework can have a big impact on how quickly and accurately he or she gets it done.

• Monitoring: Kids with ADHD need to be monitored during homework time. Without supervision, they are much more likely to procrastinate instead of getting started right away, and once they do get started they will lose focus more quickly. Monitoring and supervising your child doesn’t mean sitting next to him or her during homework time, but it does mean being someplace where your child can see you and where you can check-in while he or she is working.
• Consistency: Every child’s homework station is different, and kids with ADHD may have some unique preferences – some may prefer to stand while they work, others may be most comfortable working on the floor instead of sitting at a desk. But all kids with ADHD should do their work in the exact same spot every day. They will quickly come to associate this “homework spot” with homework time, making it easier for them to transition quickly from play time to work time. Having a consistent “homework spot” also eliminates nightly time-wasting arguments or negotiations with kids about where they will be doing their homework.

Supplies
Making sure that every homework supply your child needs is readily available at his or her homework station is important for kids with ADHD. Why? Searching for supplies and sharpening pencils are two of the most popular (and most effective!) homework procrastination strategies! Wondering which supplies to include? Here’s a list to get you started:

• Sharpened pencils (at least 5 well sharpened pencils)
• Pencil sharpener
• Eraser (one that works well)
• Colored pencils or crayons
• Paper (printer paper & lined loose-leaf paper)
• Scissors
• Glue stick
• Ruler
• Timer (setting time limits and time goals will be an important part of the homework routine)
• Clock
• A place to hang their backpack near their homework station
• Access to a computer nearby
• A large hard surface as a work area
• A comfortable chair (based on your child’s preferences)

Clutter-Free Organization
Clutter is a huge distraction for kids with ADHD, especially when they are doing homework. Maintaining a clutter-free homework area will help your child get started on homework quickly and stay on task. It will also make it much easier to notice when he or she is running low on supplies or has managed to misplace or break all his or her pencils (again!).  

   
via Simple Made Pretty                                          via Apartment Therapy

• Create an organized supply system: All kids would benefit from an organized supply system, but for kids with ADHD organization is practically essential. Instead of using a single shoebox, supply bin, or drawer to store their supplies, use individual cups, bins or a divided tray. Label each compartment with the supplies that should be included. If your child doesn’t have a dedicated desk and will be working at the kitchen table or on the floor with a lap desk, then use a supply caddy with labeled compartments that he or she can move to and from the homework location each day. Just remember to place only one type of supply in each compartment and use labels liberally.
• Create a clutter-clean up routine: The best way to manage clutter is to prevent it from building up in the first place. As part of your child’s homework routine, have him or her put all his or her supplies away, throw out loose papers, and sharpen the pencils as soon as his or her homework is finished. This way the workspace will be well stocked and clutter-free the next time your child sits down to do homework.

Having your child’s homework station set up and ready to go by the start of the school year will help him or her transition more smoothly into a daily homework routine. Having clear expectations around homework and putting a homework “when-then” plan into place are also essential for homework success. In my next post I’ll be talking about strategies for simple and effective homework plans you can start using right away.

1. Recognize that kids and teens with ADHD may need more video game limits than kids without ADHD. When parents try to set limits on anything fun (including video games), kids and teens will inevitably point out that all of their friends get to do it, so they should be allowed to as well. It’s important to realize that kids with ADHD need firmer limits and structure around certain activities than kids without ADHD – and video games fall into this category. Just as children who are at high risk for developing Type 2 diabetes need more structure and support around healthy eating, kids with ADHD who may be at high risk for developing problematic video game use need more structure and support around their gaming time. So, don’t give in to the “everyone else is doing it” argument when it comes to video games.
2. Keep screens out of the bedrooms. Perhaps the number one most effective strategy for preventing excessive video game use is to keep all screens (tablets, phones, televisions, and computers) out of a child or teen’s bedroom. When screens are in kids’ bedrooms their screen time is much less likely to be monitored, and they are much more likely to be playing video games when they should be sleeping instead. If you have a teenager who is used to having phones and tablets in his or her room, have him or her put the devices on a charging station that is in the kitchen, the parents’ bedroom, or even in a cabinet that is locked by his or her parents before bed. The change will be hard for your child at first but will get easier over time.
3. Fill their time with other activities. If your child or teen is busy with activities that are not screen-related, he or she will simply have less time to play video games. If you have a child who loves playing video games more than he or she enjoys doing anything else, then that is a sign that the child needs your help (or the help of a therapist or school counselor) to find other activities that he or she will find rewarding. Some kids with ADHD don’t enjoy group activities like sports or drama club, and that’s okay. There are other activities out there! Try individual sports (swimming, gymnastics, karate, etc.), art or craftsman classes, or clubs where kids can share in their love of robots, rockets or even frogs! Not all of the activities in a child or teen’s day need to be extracurricular. Teens can work at a part-time job (paid or volunteer), and homework and academic support need to be part of the mix. The main thing is to limit the amount of time that he or she can spend sitting in front of a screen, while also making sure that he or she has at least some fun and social activities in the day.
4. Set limits and be consistent. The American Academy of Pediatrics recommends that elementary school children have no more than one hour of screen time each day, and that middle and high school kids have no more than two hours of screen time daily. This includes time spent in front of screens doing research for academic projects or playing educational games. Make a plan with your child or teen for the amount of video game time that will be allowed each day during the week and on weekends. Remind your child of these limits and have him or her set a timer whenever he or she starts gaming.
5. Reward your child or teen for sticking to the limits. Changing behavior is hard and it helps to have some extra incentives when we’re working on establishing new habits. Talk with your child or teen about rewards they can earn for sticking to the new video game plan. Make sure the rewards are something your child will be motivated to earn and are things he or she can earn quickly (on a weekly basis at the very least). Kids with ADHD struggle with delayed rewards, and even if they think they will be able to work toward earning something over the course of a month or longer, they will quickly lose motivation when they feel like the reward is too far out of reach.

Helping kids and teens develop healthy video game habits isn’t easy. Sometimes, it’s harder on parents than it is on the kids! However, for kids with ADHD, limits around video gaming are important and worth the effort. If you are struggling to set limits with your child or teen, seek out help from a therapist who specializes in problematic videogaming or behavioral interventions for kids and teens with ADHD.

¹https://www.digitaltrends.com/computing/91-percent-of-kids-play-video-games-says-study/

So, what are the signs of video game addiction?
There are currently no formal diagnostic criteria available for video game addiction; however, the most recent edition of the DSM (the diagnostic tool used the US for categorizing mental health disorders and addictions) does include Internet Gaming Disorder in the appendix as a tentative diagnostic category.

The DSM-5¹ suggests that Internet Gaming Disorder (which can include playing video games off-line as well as on-line), may be identified when an individual has displayed at least 5 of the following 9 symptoms in the past 12 months:

1. Preoccupation with games: The individual thinks about previous gaming activity or anticipates playing the next game; gaming becomes the dominant activity in daily life
2. Withdrawal symptoms when gaming is taken away: These symptoms are typically described as irritability, anxiety, or sadness
3. Tolerance: The need to spend increasing amounts of time engaged in games
4. Unsuccessful attempts to control or reduce participation in games
5. Loss of interest in real-life relationships, previous hobbies, and other entertainment as a result of, and with the exception of, games
6. Continued excessive use of games despite knowledge of psychosocial problems;
7. Has deceived family members, therapists, or others regarding the amount of gaming;
8. Use of games to escape or relieve a negative mood (like feelings of helplessness, guilt, or anxiety); and
9. Has jeopardized or lost a significant relationship, job, or educational or career opportunity because of participation in games.

Why might kids and adults with ADHD be at higher risk?
Researchers are not entirely sure why individuals with ADHD are at higher risk for video game addiction, but they have some theories that are being studied. Some factors being considered include:

• Impulsivity and difficulty stopping an activity that is highly reinforcing or engaging
• Difficulty with time management and other executive functions
• Avoiding stressful social interactions or academic/work-related activities
• Self-medicating untreated symptoms of anxiety or depression (which occur at higher rates in individuals with ADHD)
• A biological predisposition to addiction: Many activities (including video gaming), foods, and drugs can become addictive because they trigger the release of dopamine in the brain. Kids and adults with ADHD naturally have lower levels of dopamine in the brain, and as a result they are more likely to have an additive response to anything that triggers a dopamine rush.  

Knowing that kids and teens with ADHD may be at higher risk for problematic video game use is important, but when it comes to helping a child change his or her behavior it can be hard for parents to know where to start. In my next post I’ll talk about 5 steps parents can take to help their kids and teens develop healthy video game habits.

¹Diagnostic and Statistical Manual of Mental Disorders – 5^th edition (DSM-5) https://www.psychiatry.org/psychiatrists/practice/dsm

Use these 5 quick tips in the 30 days leading up to the start of school to help your child with a smooth transition:

1. Get back on a schedule & set a routine. It’s hard to abruptly transition from the lax routine of summer to early morning wake-ups and routines, especially for kids with ADHD who are prone to having difficulties falling asleep at night and waking up on time in the morning.  So, phase in the school-year schedule gradually.  Begin by inching back their wake-up time in 15-minute increments in the weeks leading up to the start of school, and make sure you’ve reached the school wake-up time at least one week before the first day of school. The same goes for bedtime, where later summer bedtimes should be inched back in 15-minute increments until you reach school-appropriate bedtimes at least one week before school begins.
   
2. Build excitement, not dread. Instead of dreading the end of summer, work on building excitement for the year ahead!  Yes, school is stressful for kids with ADHD, but there are many things that kids enjoy about school as well. Engage your child in activities that remind him or her about the fun parts of learning, like museum outings focused on science topics for the upcoming year, or popular and engaging movies about famous inventors or historical time periods. Read bedtime stories that focus on your child’s favorite part of school (even if that’s recess!).

3. Form strong relationships with the teachers. Strong relationships among parents, teachers, and students are essential when a child has ADHD, and it’s practically never too early to start laying the foundation for good relationships here. If your school offers an open house, take advantage – even if this isn’t your child’s first year in this school. Meet the teachers, counselors and support staff who will be assisting your child and agree to create a plan together for your child’s success. Talk positively to your child about his or her new teacher. Coach your child on how to introduce himself or herself and invite your child to a meeting that both of you attend, when he or she can start to advocate for himself or herself and come up with strategies for getting extra help when needed. If your child has a 504 Plan or an IEP, get a meeting scheduled as early in the school year as possible, and have your child attend the meeting if this is appropriate in your school setting.
4. School supply shopping with organization in mind. You know your child needs notebooks and pens but use school supply shopping as the time to set-up a homework organization plan. I’ve written several blogs with recommendations about what your child’s homework plan and space should look like and those may be a helpful reference here. The key thing is to get as many pieces of the homework puzzle in place before the first day of school, so your child can start building good homework habits right away.
   
5. Start building academic skills before the school year begins. Huntington Learning Centers offer summer tutoring programs designed for kids of all ages. For elementary students, summer tutoring can help identify areas of weakness, and work toward developing core skills in reading, writing, and math that are at or above grade level. Your child’s instructors can also help set up study skill plans that your child can use from Day 1.

Being proactive and planning for the start of the new school year ahead of time can help prevent problems before they start and help your child transition into a new classroom as smoothly as possible.  

What happens when a 2e child has ADHD?

When ADHD is part of the picture, a 2e child may be gifted in his or her ability to grasp complex concepts, engage in critical thinking, and communicate his or her knowledge and understanding verbally, but the child’s test scores reflect only average (or even below-average) performance. Without a clear understanding of the impact of ADHD symptoms on factors like motivation, attention to detail, persistence, and organization, parents and teachers become frustrated by what they perceive as willful underperformance. They complain that the child is being lazy or simply doesn’t care about the quality of his or her work. In reality, the 2e child may be working very hard to compensate for his or her weaknesses, but without proper support the efforts rarely translate into lasting improvements. Unfortunately, the messages that these kids hear about laziness and carelessness take a toll over time and their self-esteem suffers. To make matters worse, their sub-par academic performance prevents them from getting one of the things 2e children need the most at school: recognition of their strengths and access to classes and activities that challenge and engage their exceptional intellect.

All 2e kids are at risk for being excluded from the advanced classes that they need to reach their full potential. 2e kids with ADHD are also at risk for having their ADHD go undetected and undiagnosed. Why? With their high intelligence, 2e kids can often perform in the average range academically despite their ADHD symptoms. While they are underperforming relative to their true abilities, they are not necessarily underperforming relative to their classmates. As a result, the school doesn’t identify them as needing an evaluation or extra support. Parents may be frustrated that their child isn’t achieving at the level they believe he or she is capable of, but they also aren’t seeing some of the typical red flags that would normally trigger an ADHD assessment.

What can parents do to help?

1. Obtain an evaluation. Twice exceptional kids are complex, and a full psychoeducational assessment or neuropsychological assessment (which includes cognitive and achievement testing) can help parents, teachers, and the child develop a clear picture of their strengths and weaknesses. In some cases, schools will provide a psychoeducational assessment as part of their special education services. In other cases, parents need to seek out these evaluations privately through a psychologist, neuropsychologist, or learning specialist.
2. Seek out special education services and academic support. Many 2e children qualify for special education services – services that address their weaknesses and their gifts. An Individualized Education Plan (IEP) will outline the educational goals, accommodations, and services that your child needs. His or her access to these services and progress toward individual goals will be tracked and reviewed regularly in team meetings that parents (and often the child) attend. If your child has areas of academic weakness, consider supplementing his or her school-based services with individualized academic support from a private learning center or learning specialist.
3. Advocate for your child. 2e kids need access to advanced classes just as much as any other gifted child. With the proper support and accommodations, 2e children can thrive in an accelerated academic environment. Without a high level of intellectual stimulation, 2e kids with ADHD are at high risk of becoming bored at school, which will exacerbate their ADHD symptoms and ultimately lead to even greater academic underachievement (see my previous post on this topic [link to “Understanding Boredom and ADHD]).
4. Provide emotional support. Talk to your child about his or her strengths and weakness, and his or her unique gifts. Help your child process feelings about being different from other kids, and frustration over his or her ADHD symptoms getting in the way. Many 2e kids will feel like “there is something wrong with them,” and unconditional love and support from parents can go a long way in counteracting these feelings. Getting to know other 2e kids can also help. If you don’t know of other families of 2e kids in your area, check out one of the many Facebook groups for parents to 2e kids to get connected.
5. Treat the ADHD symptoms. 2e kids can reach their full potential when their ADHD symptoms are well managed. Work with mental health providers to obtain evidence-based treatments for your child and consider including medication in your child’s symptom management plan.

What is Auditory Processing Disorder?

Kids with APD have difficulty processing information that is presented to them orally. They don’t have difficulty with hearing, although it may seem like they do at times. Instead, the problem lies in their brain’s ability to decipher and translate words and sentences into meaningful information. Kids with APD struggle to filter out background noise, focus on conversations (especially in noisy environments), remember the details of conversations, recall the order of instructions that are presented to them, correctly process sequences of numbers (e.g., 108 vs. 801), discriminate between similar sounding words (dig vs. big), and struggle to learn proper sentence structure and syntax. Since many aspects of language processing overlap in the brain, many kids with APD also struggle with components of reading and writing.

How is Auditory Processing Disorder Different from ADHD?

Many symptoms of APD overlap with symptoms of ADHD but there are significant differences between the two disorders as well. Kids with ADHD will have difficulty focusing or staying on task even when there are few distractions around them, and they will have difficulties in areas that are not related to attention and information processing (such as organizational skills, impulsivity, and/or hyperactivity). Kids with APD may be so sensitive to noisy environments that they have trouble tolerating them at all. They may even complain that the sound is “hurting their ears,” and become increasingly upset if they aren’t able to go to a quieter place. In contrast, many kids with ADHD enjoy noisy places. And while they may start having some behavior challenges if they become overstimulated, they usually aren’t distressed by the noise. When a child has ADHD as well as APD, their problems with focus and concentration become severely impairing in loud environments, and they are hypersensitive to sound.

How is Auditory Processing Disorder Diagnosed?

Unlike ADHD which can be diagnosed by a psychologist, psychiatrist, or pediatrician, APD can only be diagnosed by an audiologist. The audiologist administers a series of tests primarily designed to test a child’s ability to process information within the context of increasing levels of background noise. The child’s scores on the test are compared against the scores obtained from large samples of children without APD. If a child’s score falls well outside of the average range of the comparison sample’s scores, the audiologist will likely make an APD diagnosis.

How is Auditory Processing Disorder Treated?

There is very limited research on treatments for APD, so it is difficult to know what will be most effective for any one child. Generally, interventions are provided by speech and language pathologists who help a child improve their ability to discriminate between similar sounds and remember the details and the sequences of information that they hear. In addition, to speech and language interventions, many children benefit from accommodations that minimize the impairments related to APD. This may include preferential classroom seating, taking exams in quiet rooms, having teachers and parents ask the child to repeat information back to them to check for understanding, and having information and key concepts presented in multiple formats (e.g., orally, written, video, etc.). While there is no cure for APD, many children do see large improvements in their auditory processing abilities as their brain matures over time.

If you suspect that your child may have APD, talk to your child’s teacher or special education coordinator, or request an audiology referral from your pediatrician.

This year-round pressure is just one of many factors that researchers and clinicians think may be driving the rise in anxiety among teenagers. A recently published article in the Journal of Developmental Pediatrics found that in the U.S. rates of anxiety disorder diagnoses increased 20% between 2007-2012.¹ Many clinicians suspect that rates have increased even more rapidly between 2012 and 2018. In fact, according to the National Institute of Mental Health, about one-third of today’s adolescents will experience an anxiety disorder during their lifetime. Teens with ADHD are at even higher risk, with up to 50% experiencing significant anxiety.

While some of the factors driving up teen anxiety are pervasive and can’t be changed in a single summer, there are still many things parents can do to help their teens keep anxiety in check.

1. Help your teen focus on experiences that are meaningful and personalized. It’s smart to start thinking about college and career paths early on, and to use time away from school to build skills and experiences that bolster college and career success. But for teens with ADHD who have struggled to succeed in school, and whose self-confidence has eroded over time, focusing first and foremost on finding activities and internships that build confidence and self-esteem is important. Encourage your teen to think about the big picture and seek out experiences that tap into his or her strengths and minimize weaknesses. Ideally these experiences should be in areas that your teen is passionate about, where he or she can feel confident in his or her knowledge and abilities and be an equal or a leader among his or her peers.
2. Encourage your teen to devote some time working on academic skills. A complete break from academics during the summer months can make it difficult for teens with ADHD to start the new school year off with confidence. So, while your teen’s activities and internships should play to his or her strengths, that doesn’t mean your teen shouldn’t spend any time building up weaker academic skills. The trick is to set your teen up for success by providing him or her with academic experiences that build confidence as well as skills. Working with learning professionals who provide personalized instruction tailored to your teen’s learning style and strengths is the most surefire path to academic confidence and success.
3. Quality family time is important. It’s normal and healthy for teens to prefer to spend time with friends rather than family. But, that doesn’t mean that family time isn’t important. In fact, family time can provide a healthy break from social pressure, and the anxiety that comes with it for many teens with ADHD. Schedule family activities that include a break from technology when teens (and their parents) don’t check their social media accounts for extended stretches of time. The focus of this time should be on blocking outside distractions and spending quality time with each other. Activities that are naturally less compatible with cell phone use (like hiking, swimming, amusement parks, paintball, horseback riding, trampoline parks) will help make the technology breaks a little easier.
4. Work with a therapist if your teen seems highly anxious or unmotivated. Finding time for therapy appointments can be hard during the school year. If you are worried about your teen’s level of anxiety, or if he or she seems to be constantly irritable or unmotivated, use the summer months to find a therapist who can meet with you and your teen to assess his or her mood and anxiety. Even a few appointments with a good therapist can make a big difference when it comes to treating anxiety and having a go-to therapist your teen can meet with if anxiety spikes in the fall can mean getting treatment more quickly when your teen needs it the most.

What are sensory processing problems?
“Sensory processing” is a broad term that is used to describe a person's ability to absorb sensory information (sights, sounds, tastes, textures, smells), regulate the intensity of a sensation, and respond appropriately. Kids with sensory processing problems can be under responsive and respond to signals in the environment slowly, lethargically, or passively, or they can be over responsive and have an exaggerated response to signals (e.g., be hyperaware of background noise, feeling highly irritated by a texture or sound, melting down in overly stimulating situations).

What causes sensory processing problems?
While the exact cause of sensory processing problems is not known, there appears to be a strong genetic or biological influence. Sensory processing difficulties are more common among kids with autism spectrum disorders or those who display some autism traits, and boys are more like to experience sensory processing problems than girls.

How do sensory processing problems affect a child's functioning?
Depending on the severity of the symptoms, sensory processing problems can impact every aspect of a child’s life. Socially, they can interfere with a child's ability to attend or enjoy events that are noisy or crowded, focus on conversations in busy settings, or play comfortably in places that other kids often gravitate toward (e.g., sandboxes, grassy lawns, noisy indoor play spaces, etc.). Extreme reactions to situations, sounds, and textures that are difficult to tolerate can seem strange to other children and can have a negative impact on their relationships with peers. These extreme reactions can also cause behavior that seems oppositional or difficult to parents, leading to stress and strain for the entire family. Academically, difficulty blocking out or tolerating background noise can make it difficult for kids to focus throughout the school day and can interfere with learning.

How are sensory processing problems treated?
Unlike disorders that are classified in the DSM, there are currently no evidence-based treatments for sensory processing problems or sensory processing disorder. Identification and diagnosis of these problems is often done via an assessment with an occupational therapist. Treatments are typically tailored to the individual needs of each child and can involve a variety of movement and sensory-based interventions designed to improve sensory modulation capabilities. Treatment can also include changes to the child's environment at home or at school that minimize exposure to aversive sensory triggers. However, the true effectiveness of these interventions is unknown due to limited research in this area.

Do kids outgrow the problem?
It is difficult to predict whether a child’s sensory processing problems will improve over time. For many kids, particularly those with more mild symptoms, there may be improvement even with no intervention. For others, there may be only modest changes in their symptoms over time. However, even if a child's sensory processing problems do improve in the long term, the short-term impact can be long lasting if they interfere with a child’s ability to develop essential academic or social skills.

If you suspect that your child may be struggling with sensory processing problems, reach out to your pediatrician or school counselor and request an evaluation by an occupational therapist or other provider who specializes in sensory evaluations.

Parents of kids with ADHD are constantly faced with an array of treatment options including medication, various behavioral interventions, and dietary recommendations. In recent years there has been a lot of buzz about the use of a gluten-free diet to treat a wide range of physical and cognitive problems, including ADHD. In posts and comments online, some parents describe huge improvements in their child's ADHD symptoms after eliminating gluten from their diet. And some pediatricians and nutritionists recommend a gluten free diet as part of a child’s ADHD treatment plan. For a chronic condition like ADHD, the thought that a dietary change could eliminate symptoms altogether is highly appealing. However, removing gluten from a child’s diet is a substantial undertaking, and one that can be stressful and exhausting for both parents and kids. Before making any major changes to your child’s diet, it's important to know what research findings tell us about the likelihood that a gluten-free diet will be an effective ADHD treatment option.

What is Gluten?
Gluten is a protein found in wheat, rye, and barley and is present in bread and pasta, as well as many rice products and processed foods present in the typical American diet. For individuals with celiac disease (about 1% of American's¹) eating gluten causes severe health problems including malnutrition, gastro-intestinal symptoms, and abdominal pain.

Where did the idea of a Gluten – ADHD connection come from?
In addition to malnutrition, abdominal pain, and gastro-intestinal symptoms, untreated Celiac disease is also associated with attention problems and behavioral issues. So, children with either undiagnosed or poorly managed Celiac disease may display ADHD-like symptoms. Some may even initially receive an incorrect diagnosis of ADHD. For these children, once the underlying problem is appropriately treated, and gluten is completely removed from a child's diet, attention and behavior problems improve dramatically and may even remit completely.

In recent years, some doctors and nutritionists have suggested that a substantial minority of the population experiences non-celiac gluten sensitivity. It is thought that people in this group don't experience the severe gluten reaction found in celiac disease, but experience a milder reaction that contributes to weight gain, fatigue, difficulty concentrating, and memory problems (among other symptoms). Most often, when doctors, nutritionists, and parents of kids with ADHD talk about gluten, they are usually focused on underlying gluten sensitivity rather than Celiac disease.

What does the research say?
A number of research studies have examined the impact of a gluten-free diet on ADHD symptoms in individuals who had confirmed ADHD diagnoses. Across the board, removing gluten from a child's diet had no clinically significant impact on ADHD symptoms. In other studies of children with gluten sensitivity or celiac disease, attention and behavior issues did improve when gluten was eliminated from the child’s diet. However, these children did not have ADHD, they had attention and behavior problems secondary to their medical condition.

The Bottom Line:
Many parents are willing to go through the very difficult process of systematically eliminating gluten from their child's diet in the hope that it will lead to big improvements in the child's ADHD symptoms. If a child has celiac disease or a gluten sensitivity (which is typically associated with some physical discomfort such as bloating, stomach pain, headaches, excessive fatigue, etc.), then the ADHD symptoms may be caused by the medical condition and eliminating gluten from the child’s diet will have a significant impact. If a child does not have celiac disease or gluten sensitivity, then switching to a gluten-free diet will not lead to a significant improvement in ADHD symptoms. If you would like to try a gluten-free diet with your child, talk to your child’s pediatrician and/or a nutritionist about strategies for making the dietary changes as simple and stress-free as possible.

¹Fasano et. al. (2003). A multi-center study on the sero-prevalence of celiac disease in the United States among both at risk and not at-risk groups. Archives of Internal Medicine, 163, 283-92.

Identifying and treating anxiety in kids with ADHD is an important part of an effective intervention plan. While it might seem like spotting anxiety in a child with ADHD would be simple – you might expect that he or she would be telling an adult that he or she is nervous, worried, or has butterflies in his or her stomach – in reality, the signs of anxiety are often mislabeled by parents, teachers, and pediatricians as worsening ADHD symptoms. This happens in part because kids don’t always express their anxiety in the same way as adults. They may not be aware of the anxious thoughts or feelings they are having, and they may lack the more sophisticated language needed to describe complex emotions. On top of this, many of the signs and symptoms of anxiety in kids overlap directly with symptoms of ADHD.

Here are some of the key symptoms of anxiety in children:

• Restlessnes
• Trouble concentrating
• Irritability
• Difficulty sleeping at night
• Complaints about stomach problems or headaches
• Excessive worry on most days (that they may or may not talk about with adults)
• Avoiding certain activities or social situations

Many of these symptoms will seem very familiar to any parent or teacher of an ADHD child! Since kids with ADHD often experience restlessness, difficulty sleeping, difficulty concentrating, and even irritability, how can you tell when anxiety might be part of the picture? Here are a few clues that suggest a more thorough anxiety assessment is warranted:

1. Increased difficulty concentrating or increased restlessness. Have you noticed a worsening in your child’s concentration problems or restlessness/hyperactivity? This change may be due to a worsening of his or her ADHD symptoms or a decrease in his or her ADHD medication’s effectiveness. But it could also be a sign that your child has developed anxiety that is interfering with his or her ability to concentrate or sit still.
2. Increased irritability or oppositional behavior. Many kids with ADHD are prone to irritability or oppositional behavior. However, if a child has typically been easy going and this has suddenly changed, or if a child who was previously irritable occasionally is now irritable most of the time, then anxiety may be contributing to the problem.
3. A change in sleep patterns. Many kids with ADHD struggle to fall asleep or stay asleep throughout the night. However, if your child's sleep challenges change (e.g., he or she has always had a hard time falling asleep, but now he or she is also waking up throughout the night), then anxiety may be playing a role.
4. Frequent complaints of stomach aches or headaches. Kids with ADHD don't typically experience stomach aches or headaches more often than kids without ADHD (unless they are experiencing medication side effects). If these complaints persist and their pediatrician can’t find a medical cause, then they may be signs of anxiety.
5. Avoiding specific situations, places, or people. Kids with anxiety will try to do just about anything to avoid whatever it is that is triggering their anxiety. For example, if a child is anxious about school he or she may become very oppositional when it’s time to get out of the house in the morning or he or she may drag his or her feet and get ready as slowly as possible. Some kids might complain that they don’t feel well as an avoidance strategy, hoping that they will be able to stay home sick from school.

If you think your child may be showing some signs of anxiety, talk to his or her pediatrician. The pediatrician can help you find a provider who can help tease apart your child’s symptoms and clarify whether anxiety is in fact part of the picture. The good news is that anxiety is highly treatable, especially in kids. Working with a clinician who can identify anxiety-related problems and provide evidence-based treatments can quickly lead to lasting improvements in your child’s symptoms.

Dealing with the ups and downs of ADHD is frustrating for parents, teachers, and kids. When kids with ADHD have good days sometimes it’s easy to think they could have good days all the time if they would just try harder. However, there are many factors that go into making any day a “good day” for kids with ADHD, and only one of these factors is how much effort a child puts into staying focused and in control of his or her impulsive behavior. As a result, a child can feel like he or she is trying as hard as he or she can to pay attention, or complete work quickly and carefully, and still not be able to meet the standards that teachers and parents have set for him or her.

If you have a child with ADHD whose focus, organizational skills, work completion, and/or impulsive behavior varies greatly from day to day or activity to activity, it can be helpful to take a step back and look at the bigger picture. Shift your own focus away from thinking about your child’s intentions or effort and instead think about other factors that may consistently interference with your child’s ability to pay attention and get things done. If you focus on changing these factors, you’ll be setting your child up for success and soon they’ll be having more good days than bad.  

There are many factors that impact a child’s ADHD symptoms. Here are a few to get you started:

1. Nutrition and Sleep. Good nutrition, consistent meal and snack times, and a full night’s sleep all impact ADHD symptoms. If your child is hungry or tired, then his or her ADHD symptoms will be much harder to control, and he or she will be much more likely to have a difficult day at school.
2. Physical activity. More and more research studies are pointing to the importance of physical activity for managing ADHD symptoms. If your child is engaged in regular high intensity exercise (i.e., running around and working up a sweat rather than simply going for a walk) for about 45 minutes a day, his or her ADHD symptoms will be easier to manage. If your child spends most of the day sitting (at school, during homework time, watching videos or playing video games), then he or she will be more likely to have difficulty keeping his or her ADHD in check.
3. Distractions in the classroom. It may seem obvious that distractions in the classroom can make it hard to stay focused and productive. What is not always obvious is knowing which things are distracting to an individual child. Some kids with ADHD are highly sensitive to certain noises (e.g., a printer warming up, a heating fan) or movement (e.g., kids walking by quietly in the hallway) that are not even noticeable to other kids in the room. So, even in a classroom that may seem to have very few distractions, there may be things that are making it hard for your child to focus.
4. The subject matter. If your child consistently does much better in some subjects than in others (e.g., much better at writing than at math), then it’s possible that he or she may have an underlying learning difficulty or simply needs some additional support to be successful in the weaker subject areas. You can request an assessment from the school and seek out additional tutoring and learning support services from a private learning center.
5. Medication routine. If your child takes ADHD medication, then it’s important for him or her to take it at the same time every day as prescribed. If your child is consistently taking medication, but it’s not working as well as it used to then talk to your child’s doctor. Medication doses often need to be adjusted as a child grows and sometimes a new medication is needed to replace one that is no longer effective.

The daily ups and downs of ADHD can be frustrating, but there are things you can do to support your child. Sometimes a few relatively minor changes can make a big difference and go a long way in helping your child have more good days at school and at home.  

1. Set the rules in advance. Choose up to 3 rules that you would like your child to follow while he or she is at the playground. These can be things related to staying in the playground area, following your instructions the first time you ask, being respectful of other kids and the equipment, politely inviting another child to play, taking turns or sharing equipment, and playing safely. Make sure your child clearly understands each of the rules ahead of time and can repeat them back to you.
2. Be strategic. Think back to playground visits that did not go well. What were the problems that came up? Is your child more likely to have problems at one playground than another? Do conflicts happen more often when he or she brings toys or sports equipment from home? Set your child up for success by thinking ahead and being strategic about your playground visits. For example, avoid playgrounds where problems often occur, pack snacks to avoid hunger meltdowns, don’t bring any toys or sports equipment from home, invite a friend for your child to play with, etc.
3. Monitor or play with your child. Often parents use time at the playground to relax and chat with other parents or spend time on their phones. While this seems like a win-win - you get some downtime while your child gets to play, it is usually not a recipe for success. If a child is playing alone and feeling ignored, he or she will probably try to get your attention by doing something that is either risky or annoying. If he or she is playing with others, it’s harder to catch problems before they escalate if you aren’t watching. So, keep an eye on your child the entire time. If he or she is playing with other kids, monitor from a distance. If he or she is playing alone then join in and play with your child!
4. Praise your child for following the rules. Help your child stay on track by giving him or her attention when he or she is doing something right, rather than only calling out to him or her when he or she is doing something wrong. Giving positive attention, either with a subtle thumbs-up from a distance or a few words of praise when he or she pauses for a water break, can help your child stay motivated to follow the rules.
5. Give one warning when a rule is broken. If your child breaks one of the rules, give him or her one warning. If he or she continues to break the rules after the warning, then time at the playground should be finished for the day. As calmly as possible, let your child know that it’s time to leave. Be consistent and avoid negotiating with your child. The rules will only be effective if your child knows that you will consistently leave the playground when he or she breaks a rule after a warning. When you are consistent, and your child knows that you mean what you say, soon he or she will start responding to your warnings and eventually you won’t need to leave the playground early at all!

Autism Spectrum Disorder, commonly known as autism, is not a singular disorder but rather a spectrum of symptoms and impairments. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the diagnostic guidebook published by the American Psychiatric Association, autism spectrum disorders are characterized by difficulties with communication and interactions with other people, as well as restricted interests and repetitive behaviors. These problems are severe enough that they interfere with an individual’s ability to function at school, work, or in other areas of their life (a comprehensive list of autism symptoms can be found here: https://www.nimh.nih.gov/health/publications/autism-spectrum-disorder/index.shtml). Kids with more severe forms of autism are highly impaired and may develop little (if any) language and interact only minimally with those around them. Kids on the higher functioning end of the autism spectrum may have fully developed language abilities and can communicate with others, but overall, they struggle in their interpersonal relationships. 

There is a certain degree of overlap between ADHD symptoms and autism symptoms, including social difficulties and challenges related to executive functioning. However, there are some key differences as well.

• Communication Skills. Many kids with ADHD struggle with their communication skills. They may talk too much or say the wrong thing at the wrong time, and they may even have difficulty picking up on subtle social cues. Children with autism have these same challenges but experience them to an even greater degree. In addition to missing subtler social cues, they often fail to notice obvious changes in facial expression, body language, or tone of voice.
  
• Theory of Mind. Every parent at some point finds themselves asking their child, “How do you think that other boy or girl feels about what just happened?” When a child responds to this question he or she is engaging a unique cognitive skill referred to as Theory of Mind. This skill provides the ability to put ourselves in another person’s shoes and see the world from their perspective. Often kids with ADHD need a bit more prompting or guidance to engage in Theory of Mind thinking. When it comes to kids with autism, their Theory of Mind abilities are often so impaired that even with assistance they are not able to truly think about things from another person’s perspective. As a result, they have trouble understanding why people do the things they do and fail to understand the intentions and feelings of others. This can lead to feelings of confusion and frustration on the part of the child with autism, and the perception by others that he or she is insensitive or rigid in his or her thinking.  
• Social reciprocity. Interactions with family members and friends involve a natural give and take. Someone asks you a question, you respond, and maybe ask a question back or mention something that you think the other person might find interesting. Social interactions also involve inviting others into our world by sharing things we are interested in, or in the case of children, showing others a favorite toy or object. Kids with ADHD may struggle with some of the back and forth aspects of social interactions, but overall, they are interested in sharing their world with others. Kids with autism display very limited social reciprocity. They struggle to make eye contact, rarely point out interesting things that they want to show to the people around them, rarely share, and often don’t respond when asked to engage.

Distinguishing between autism spectrum disorders and ADHD isn’t always straight forward. If you are wondering if some of your child’s social challenges may be due to more than ADHD, then reach out to your child’s pediatrician. They can help you locate a specialist in your area who can clarify your child’s diagnostic picture and recommend targeted interventions that can help.

Here are six quick tips for troubleshooting your child’s sleep issues:

1. Empathize with your child. It can be frustrating for you as a parent when your child doesn’t fall asleep, but it’s important to remember that it’s frustrating for your child as well. Start off by letting your child know that you realize falling asleep isn’t easy for him or her. Ask what it feels like when he or she can’t fall asleep and explain that you’re going to be trying some new strategies to help him or her sleep better.
   
2. Get Enough Exercise. It’s tough to sleep if you’re feeling mentally or physically restless from not having had enough stimulation and engagement during the day.  Begin by making sure your child is getting enough exercise, fresh air, and all around social, emotional, physical and mental stimulation throughout the day. Your grandmother was right: a kid who plays all day, sleeps all night!
   
3. Nix the Caffeine. You know for yourself that a cup of coffee late in the day may keep you up at night. Same is true for your child.  But his or her caffeine may be coming from soda, chocolate, protein bars, ice cream and water products like Vitamin Water. Read the labels and work hard to eliminate any caffeine at least 4 hours before bedtime.
   
4. Have a Consistent Bed Time and Wake Time. Children sleep better when they have a consistent sleep schedule. It may be tempting to let your child stay up later on Friday nights or sleep in on the weekends, but ultimately that makes it harder to fall asleep and wake up on other days of the week. 
   
5. Have A Wind Down Period. Thirty minutes before bedtime, have a wind down period where videogames, tablets, and the TV are turned off, the lights are dimmed, and the volume on any music is turned down. This will help your child mentally prepare for bed.
   
6. Consider Relaxation Techniques. Many kids are starting to learn about mindfulness in school, and there are some great tools out there to help kids learn meditation, relaxation and breathing/calming techniques that they can use at home. Building one or more of these into your child’s bedroom routine may help him or her fall asleep faster and more consistently. PBS provides some helpful instructions on calming breathing exercises (http://www.pbs.org/parents/adventures-in-learning/2015/09/calming-breathing-exercise-for-kids/). For teens, AnxietyBC has a “How to Chill” webpage with a variety of relaxation exercises that can be used anytime and anywhere (http://youth.anxietybc.com/relaxation).
   
7. Make sure the bedroom is set up for sleep success. Check the temperature: researchers believe the ideal sleep temperature is between 60 and 67 degrees. Check the noise level: can your child hear the street, the TV from downstairs, or his or her sister’s radio next door?  Consider a white noise machine if you can’t effectively quiet the space.  Check the light. Make sure the room is as dark as possible, and cover up any small lights on electronic devices that may be distracting.

Each of these tips can go a long way in helping your child get better sleep. If you continue to try different strategies, and the sleep challenges continue, talk to your child’s pediatrician or seek the help of a pediatric sleep specialist.

1. Create a calendar. Many kids with ADHD struggle with organization, but staying organized is essential when you’re working with a tight after school schedule and competing priorities. Be a role model for your child and begin teaching organizational skills that will help him or her throughout life. Start by posting a calendar at home that shows both your child’s homework assignment deadlines and afterschool activities (practice, games, performances, etc.). Involve your child in updating the calendar every time a new event or deadline needs to be added.
   
2. Schedule homework time. Set aside designated time for homework each day.  Your child already understands the concept of blocking out scheduled time for practice and games. Extend this same concept to homework, where dedicated blocks of time are scheduled in advance throughout the week. Add these time blocks to your calendar and remind your child that he or she needs to fit homework into these slots in order to participate in all of the fun activities he or she also has on the calendar.
   
3. Plan proactively. When your child has a full schedule, there is less room wiggle room for cramming in last minute assignments and study sessions. If a big test is coming up at the end of the week, help your child plan ahead and break test prep down into smaller chucks that he or she can fit into the pre-scheduled homework time blocks. Planning ahead is a challenge for many kids with ADHD, so your child will need your help to learn this technique. It can be a good idea to get into the habit of helping him or her check the classroom’s online homework assignment system regularly so he or she is less likely to be surprised by an upcoming project deadline or exam.
   
4. Enlist A Tutor. Learning centers are designed to help teach children study skills that will help them get their work completed more efficiently and effectively.  Look for centers, like Huntington Learning Centers, where instructors are experienced in helping kids with ADHD.
5. Make participation a privilege that comes with meeting homework goals. Participation in extracurricular activities can be a powerful motivator when participation is linked to reaching homework goals. Let your child know that he or she can only participate if he or she consistently completes homework, and don’t have missed assignments regularly. This can go a long way in helping kids with ADHD prioritize their assignments and cut out distractions when time is short. Note that the goals should be focused on homework completion (effort) rather than homework grades (performance), since kids can generally control whether or not they get their work done, but they can’t always control the grade they receive – and this is especially true for kids with ADHD whose effort isn’t always reflected in their grades.

Balancing school and extracurriculars is more art than science, but it’s worth the time to find a balance that works for your family.

For busy families whose weekdays are jam packed with school, after-school activities, homework, appointments, tutoring, dinner, and hopefully a few minutes of family time, finding ways to consistently provide daily rewards is a challenge. Small trinkets or grab-bag style rewards are only motivating for a little while, and often end up creating clutter at home. Screen-time can be very motivating for many kids and it’s inexpensive, but it’s often problematic, especially if you have a child who gets upset when his or her screen time is over, or if parents are too busy in the evenings to effectively monitor time limits and media content.

Ask kids an open-ended question about what they want to earn, and you’ll probably get a list of activities that are too time consuming or expensive to do regularly or tangible items that are expensive and would take much longer than one day to earn. Presenting your child with a list of daily rewards that he or she might enjoy can help him or her think outside of the box and focus his or her attention on coming up with rewards that are both feasible and motivating. From this list he or she can select top choices, or add additional options, and then use his or her selections to create a smaller “reward menu.” Every day when your child achieves his or her daily behavior goals, he or she can choose one item from the personalized reward menu.  

The list of quick and easy reward ideas below can be a good starting point. You may want to create your own refined list from this larger selection, based on what you think will be the best fit for your family. Just remember that kids’ preferences and interests change quickly, and you might be surprised to learn that something your child couldn’t get enough of last week isn’t even on his or her radar today! So, always involve your child in the final reward selection process.

20 Quick and Easy Reward Ideas

• Offer a later bedtime (5-10 minutes later)
• Read an extra book with a parent
• Make a 5-minute video of singing, dancing, telling jokes, etc.
• Hold a 5 or 10-minute phone call or video chat with a grandparent, other relative, or friend
• Choose the radio station in the car
• Offer a coupon to get out of doing a chore
• Choose a special treat for school lunch or snack
• Invite a friend to join a weekend activity or get together
• Offer a coupon for fun one-on-one time with a parent
• Let the dog or cat sleep in the bedroom
• Help plan or prepare favorite snack or meal
• Build a pillow fort in the living room
• Have a picnic-style dinner on a blanket in the living room or outside when the weather is nice
• Choose individual arts & craft supplies (e.g., a tube of paint, one tub of Play-Doh, a sheet of stickers, a role of mini patterned Duck Tape®, etc.)
• Download one song or short video
• Pick out a special outfit to wear to school
• Create funny hairstyles with hair gel or mouse for 5 minutes before a bath or shower
• Add a fizzy or bubbly colorful bath bomb or bubble bath to an evening bath
• Color pictures that can be used as placements during dinner
• Get to school 10 minutes early to play on the play structure (or stay 10 minutes after pick-up)

In my previous post I discussed guidelines for creating effective behavior charts at home for kids with ADHD. Many of these guidelines apply to classroom behavior charts as well, but there are important additional details to attend to when charts are used at school. The good news is that just like home behavior charts, when you follow these guidelines you’re setting a child up for success and are likely to see improvements in his or her ADHD symptoms and behaviors.

Classroom Behavior Chart Guidelines

1. Write clear and positive behavior goals. Your chart should communicate to your student exactly what it is that he or she needs to do to succeed. Always write the goals in a way that tells your student what to do rather than what not to do. For example, “Raise a quiet hand and wait to be called on before you speak,” is a much more effective goal than, “Don’t shout out answers before you’ve been called on.” The first example communicates to your student exactly what it is you expect of him or her. Not only do you want him or her to stop shouting out answers before he or she has been called on, but you want him or her to sit quietly and raise his or her hand. It leaves very little room for misinterpretation!
2. Focus on behaviors that occur frequently across activities and situations. The most successful behavior charts are those that focus on a few key problematic ADHD-related behaviors that occur throughout the day across many different classroom activities and situations. For example, “Keep your hands and feet to yourself,” is an effective goal that can be used all day in almost any situation. In contrast, “Don’t grab pencils from your neighbor during Writer’s Workshop,” only targets a behavior during one activity.
3. Choose goals that are within reach. Create behavior goals that your student can achieve at least 80% of the time. Goals should aim to stretch your student beyond the point he or she is at right now, while still being within reach. This might mean that you focus on intermediate behavior goals that are a step in the right direction, rather than ultimate end goals. Using “reminders” can be an easy way to create intermediate goals. For example, if you add a goal called, “Get started right away,” when your student has never (or only rarely) ever done this in the past, then he or she will probably not be successful. Instead, you can set an intermediate goal of, “Get started right away with only 1 reminder.” You can drop the reminder once they have mastered this goal.
4. Include no more than 4 behavior goals on the chart. Most kids with ADHD can handle only 3 or 4 behavior goals on a classroom behavior chart. If more goals are included, students and teachers quickly lose track of them. The easiest way to keep the number of goals small, is to follow guideline #2 above: Focus on behaviors that occur frequently throughout the day. In addition, start with the highest priority behaviors. Then, over time, once those behavior goals have been mastered, you can replace them with new targets.
5. Provide feedback and ratings consistently at multiple time points throughout the day. The least effective classroom behavior charts are those that are rated by teachers only at the end of the school day. Students with ADHD need constant feedback about their behavior, in the form of verbal praise and physical ratings on their behavior charts. Behavior chart check-in times should occur at least twice a day, and ideally three times a day. To be consistent, link check-in times to regularly occurring daily activities, like “before lunch” or “after morning recess.” Always share the ratings with your student at each check-in period. Between check-ins, praise your student when you see him or her behaving in a way that is consistent with his or her goals. Some older students with milder ADHD symptoms can switch to a single check-in at the end of the day after they have had their behavior chart in place for at least a few weeks. In these cases, continue to provide praise throughout the day and switch back to a 3-times per day schedule if your student starts to slip on his or her behavior goals.
6. Use a positive points-based rating system. All classroom behavior charts should include a point goal that the student should aim for each day. These types of systems reward the child with points when he or she does something well and move him or her closer to his or her goal. In contrast, negative points-based systems punish a child when he or she doesn’t do something well and move him or her further away from his or her daily goal. For example, if a child starts off the day with 10 points, and then loses a point every time they violate a classroom rule, then they are being punished rather than rewarded. Negative systems are less motivating and less effective for all kids, and especially kids with ADHD. systems should also be avoided because the sad faces act like a punishment and can be highly demotivating.
7. Set daily point goal targets that don’t require perfection. When kids are learning new behaviors or improving behaviors that are difficult for them, they will make mistakes. If daily point goal targets require kids to achieve each of their behavior goals 100% of the time, then they will rarely reach their daily target and will quickly lose interest in their behavior chart. Instead, set daily point targets that are between 70% - 80% of the total number of possible points that the student could earn in a day.
8. Provide consistent daily rewards at school or at home. Kids with ADHD need frequent rewards to stay motivated. Rewards should be provided every day that the daily point goal is achieved. School-based rewards can work well, but in cases where strong parent-teacher communication is feasible, rewards provided at home by parents who have reviewed the classroom chart are even more effective. For kids who prefer larger rewards, weekly rewards can be used in addition to daily rewards. What’s most important is that the rewards are highly motivating for the student. If you notice that the student has stopped putting effort into his or her behavior goals, then revisit the reward options and find out if the student is still motivated to earn them.

Classroom behavior charts that are designed specifically for students with ADHD can be highly effective when they are used consistently. Focus on setting clear, achievable goals and point targets, providing regular check-ins and feedback throughout the day, and providing rewards that your student is excited to earn. Your effort will pay off when you see big improvements in your student’s behavior!

If research shows that behavior charts are effective, then why does it seem like so many kids with ADHD don’t respond to them? Usually it’s because the charts weren’t designed with ADHD in mind. Kids with ADHD need systems in place that specifically help them overcome their difficulties with motivation, organization, and completing complex tasks. As a result, special attention needs to be given to the types of behavior goals that are included in behavior charts and the way that rewards are selected and provided when a child achieves his or her goals. The good news is that by following a few key guidelines, you can create behavior charts that will work for your child!

Behavior Chart Guidelines

1. Write clear and positive behavior goals. Your chart should communicate to your child exactly what it is that he or she needs to do to achieve his or her goals. Always write the goals in a way that tells your child what to do rather than what not to do. For example, “Sit down at the table and start your homework at 4:15,” is a much more effective goal than, “Don’t put off doing your homework when you come home from school.” The first goal sets your child up for success by telling him or her what to do and when to do it.
2. Focus on behaviors that happen consistently and routinely. The most successful behavior charts are those that focus on routine behaviors – things that occur at roughly the same time and in the same order every day. Why? Because these behaviors can be easily tracked, expectations around how and when they should be completed are clear, and they can eventually turn into habits that don’t require a behavior chart at all. Morning routines, evening routines, homework routines, and even mealtime routines are great targets for behavior charts. Behaviors that occur randomly outside of these routine times, like whining or arguing with siblings, are less appropriate targets and are less likely to improve with a behavior chart. Choose other strategies for these non-routine behaviors.
3. Break complex tasks down into smaller goals. Very often I see behavior charts that include goals like “Finish Homework” or “Get Ready for School on Time.” As an adult we may look at these goals and think they are perfectly reasonable. After all, they describe exactly what you want your child to do! The problem is that for kids with ADHD, each of these goals actually represents a complex series of smaller tasks. So, if you list “Get Ready for School on Time” on your child’s behavior chart, there is a good chance that you will find your child forgetting to do at least two or three important things in the morning, and if he or she is ready for school on time it will only be because you provided multiple reminders or completed some of the tasks for him or her. To set your child up for success, break complex tasks down into the smaller steps that need to be completed each day and post the list in a place where it is visible to your child. A typical “Get Ready for School on Time” goal for a child with ADHD should be listed as 4 or 5 separate behavior goals representing each of the activities included in his or her typical morning routine. 
4. Choose goals that are within your child’s reach. Create behavior goals that you think your child could achieve at least 80% of the time. Goals should aim to stretch your child from the point he or she is at right now, while still being within your child’s reach. This might mean that you focus on intermediate behavior goals that are a step in the right direction, rather than the ultimate end goals that you want your child to achieve. For example, if you want your child to wake up on his or her own with an alarm clock, but he or she has never (or rarely) done this successfully in the past, then this behavior may be out of reach right now. A more appropriate goal would be to have your child get out of bed after you wake them up and provide just one reminder. When your child has mastered this goal, you can drop the reminder. Once your child is out of bed consistently right after you wake him or her up, then you can adjust the goal further and expect him or her to wake up independently when the alarm clock goes off in the morning.
5. Include no more than 5 behavior goals on the chart. Most kids can handle only 5 behavior goals on a single chart. This can be challenging for parents, especially when there are so many areas where you’d like to see your child improve. Start by focusing on the highest priority behaviors first. You can add new goals once your child has mastered the initial list. While it’s best to start out with a single behavior chart, you can eventually create different charts for different times of the day. For example, your child can have a morning routine chart and a homework chart. This helps keep any single list from becoming too overwhelming.
6. Provide consistent and frequent rewards that your child finds motivating. In behavior charts, rewards are just as important as behavior goals – especially for kids with ADHD who often struggle with motivation. It is important to provide rewards daily, since kids with ADHD struggle to maintain motivation when rewards are delayed (although some kids ages 10 and up can handle larger delayed rewards). In general, the more immediate the reward the better. Rewards also need to be provided consistently when your child meets his or her goal, and rewards should never be given when they have not been earned. Always involve your child in creating a list of possible rewards ahead of time. This will ensure that the reward options include things that your child truly finds motivating. Since kids’ interests change so often, you should check in with your child frequently to make sure he or she is still interested in the rewards they are working to earn.

There are many reasons why a behavior chart may not have worked in the past, but that doesn’t mean that a behavior chart will never be a success with your child. In fact, I have yet to work with a child who has ADHD and did not respond to a well-designed behavior chart! It’s all about following a few key principles of behavior chart design and adjusting the chart over time to match your child’s unique needs.

Why are kids with ADHD at increased risk for becoming overweight or obese in their lifetime? At this point, researchers aren’t sure, but they do have some theories. Preliminary studies suggest that dysregulated eating patterns, decreased physical activity, sleep problems, genetics, and the executive functioning deficits associated with ADHD may be some of the factors driving the connection. Studies also suggest that treatment of ADHD symptoms with stimulant medication significantly reduces obesity risk.

While there is little specific guidance currently available for parents of kids with ADHD around obesity prevention, targeting factors that may underlie the connection between ADHD and obesity is a good place to start.  Helping your child learn to regulate his or her appetite and eating habits, develop healthy sleep patterns, and become physically active will make it much easier for him or her to engage in a healthy lifestyle as adults. For kids who respond well to stimulant medications, including medication in their ADHD treatment plan may also be an effective preventative measure. 

Making lifestyle changes to support your child’s eating, sleeping, and physical activity habits can be challenging, and it can be hard to know where to start. In general, it’s best to start small and target one or two areas at a time. Here are a few ideas to get you started:

1. Help your child regulate his or her appetite and eating habits. Help your child regulate his or her appetite by providing meals and snacks on a consistent schedule (on both weekdays and weekends). This will help ensure that your child is hungry when mealtimes come around. Your child will eat more of the healthy foods on his or her plate and will develop an improved awareness of his or her body’s hunger cues. Avoid letting your child graze on food throughout the day or engage in “mindless eating” while watching TV or playing videogames.
2. Encourage your child to eat (and enjoy) a range of foods. Kids will be more likely to be on board with broadening their meal options if they are involved in choosing which foods they will eat, and in preparing their meals. If your goal is to have your child eat more vegetables, allow to choose from 2 or more veggie options, and/or a selection of relatively healthy sauces that he or she can add to enhance the flavor. Involve your child in meal prep activities when time allows, and plan some fun cooking and healthy baking activities during weekends and school breaks.
3. Encourage physical activity through participation in sports. Kids, teens, and adults are more likely to be physically active if they are participating in athletic activities that they enjoy. Help your child find a sport that he or she loves and provide him or her with the opportunity to participate regularly. It doesn’t really matter if it’s a team sport or an individual sport, as long as it’s something he or she looks forward to doing. Your child will be building skills that he or she can apply to other athletic pursuits as he or she grows, and he or she will develop a positive association with exercise that will stay with him or her as he or she grows into adults.
4. Prioritize sleep. Sleep can be a real struggle for many kids with ADHD. With busy schedules, it can be easy to allow kids to stay up late and get less sleep than they really need. But the cost of insufficient sleep is high for kids with ADHD – it makes their symptoms of inattention, impulsivity, and hyperactivity worse in the short term, and can interfere with their ability to regulate their emotions and appetite now and in the future. So, make your child’s sleep a priority by creating a sleep schedule and sticking to it.
5. Be a good role model. Kids will have the most success with regulating their eating habits, activity levels, and sleep patterns if they see their parents engaging in these healthy behaviors too!

If making any of these changes feels overwhelming, or your child shows persistent difficulties with eating, sleeping, or engaging in physical activity, reach out to your pediatrician and ask for extra support. Even small steps that you take now will go a long way in helping your child develop healthy lifestyle habits that will benefit him or her throughout his or her lifetime.

For a summary of the latest research on the link between ADHD and Obesity, check out the following article:

Cortese, S. & Tessari, L. (2017). Attention-Deficit/Hyperactivity Disorder (ADHD) and Obesity: Update 2016. Current Psychiatry Reports, 19, ePub. https://doi.org/10.1007/s11920-017-0754-1

If you are the parent of a child with ADHD, this may sound strikingly familiar. Many of the parents I have worked with describe their child as someone who can hyperfocus on a few high-interest activities, but seem to be unable to focus on less enjoyable tasks, like homework. While the targets of hyperfocused attention vary from child to child (e.g., Legos, video games, books, etc.), across the board parents are bewildered by their child’s ability to focus so well on some things and not at all on others. Parents often say that they feel frustrated by their child’s seemingly willful choice to focus well only when he or she is engaged in an activity that he or she enjoys.

For frustrated, perplexed parents, it’s often helpful to start by shifting the way we talk about and conceptualize the ability to focus within the context of ADHD. We often talk about a child, teen, or adult with ADHD as completely lacking the ability to pay attention. In reality, most people with ADHD can focus very well at times, and many can in fact hyperfocus on some activities – directing 100% of their attention toward the task at hand and blocking out everything else in the room. The core difficulty in ADHD may not be the inability to pay attention, but instead be difficulty in regulating attention. The struggle lies in turning on focused attention at the necessary and appropriate times, adjusting the focus intensity to match the demands of the activity, and “turning off” focused attention when it’s time to shift to another task or activity. In fact, some would argue that across the board ADHD should be conceptualized primarily as a disorder of regulation, including difficulties with regulating emotion, activity level, and behavior, as well as attention.

When we think about ADHD as a disorder that causes problems with regulating attention, it becomes easier to understand why kids with ADHD experience so much variability in their level of attention from one day to the next, and why they hyperfocus on some activities and focus so little on others. There are many factors that influence our ability to regulate attention, including fatigue, hunger, how interesting an activity is to us, the length and complexity of a task, the immediate payoff we get for completing an activity, etc. As parents, there are things you can do to help your child regulate his or her attention and even make the most of his or her ability to hyperfocus.

1. First, make sure your child’s basic needs around sleep, nutrition, and exercise are adequately met. If your child is hungry, sleep deprived, has a great deal of pent up energy, or is feeling lethargic from sitting around too much, then address these issues first. You’ll be laying a solid foundation for better regulation of attention – as well as emotion, behavior, and activity level.
2. Second, be on the lookout for factors that tend to push your child into hyperfocused mode. There will of course be certain high interest activities that pull his or her attention into a hyperfocused state, but there may be other factors as well, like having to complete an assignment just before a deadline, being asked to “beat the clock” by completing a certain number of problems or worksheets before a timer goes off, being challenged to do something better than he or she has ever done it before, or having to finish an assignment or task to earn a reward or privilege. Hyperfocus triggers will be specific to your child, but once they’ve been identified, you can use them to help your child focus when it’s necessary.
3. Lastly, always have your child complete his or her hyperfocused activities last. Once your child goes into hyperfocus mode, it may be hard for him or her to stop what he or she is doing and shift to another activity. On top of this, it takes more mental energy for your child to regulate his or her attention during less engaging activities than it does when he or she is hyperfocused. So, have your child do less interesting activities first, before he or she is mentally fatigued.  

Helping your child use strategies to regulate their attention, and make the most of his or her hyperfocus abilities, will go a long way in improving the ability to focus during those activities that he or she doesn’t typically enjoy.

While we will need to wait for research to be conducted and new parental controls to be released, there are things that parents of kids with ADHD can do now to gain more control over digital device use in their home.  

1. Create Technology House Rules. In general, kids (and especially kids with ADHD) are not capable of setting their own reasonable limits around screen time. Just like you wouldn’t let your child be fully in charge of deciding how often and how much cake, candy, and cookies he or she can eat, you cannot expect your child to make healthy decisions about how often and how much he or she uses digital devices without parental guidance and limit setting. The best place to start with limit setting is by creating house rules that are discussed and posted at home. This lets everyone know what the rules are in advance, so it doesn’t come as a surprise when they are enforced.

Deciding on what the rules should outline can be challenging, so set aside some time to really think this through. Consider: (1) how often can your child use devices, (2) how long can your child use devices at any given time, (3) what is your child allowed to do with the device, (4) how will you monitor his or her activity, and (5) what will happen if he or she violates a technology rule?

While there aren’t any hard and fast rules around how much screen time kids should be getting in a day, I generally recommend that parents keep it to no more than 30 minutes - excluding homework-related activities or FaceTime with family members. So, that’s 30 minutes to spend watching YouTube videos or playing games each day. Most parents make exceptions for snow days, sick days, or the occasional Saturday or Sunday, but otherwise, it’s important to be consistent. If 30 minutes seems like far too little time, resist the urge to simply bump it up to 1 hour or more. First, consider alternative activities for your child, whether these are scheduled activities, or things they can do at home. Is there a way to shift the focus of his or her time from devices to non-screen activities? Most of the time, making the shift isn’t hard if the activities are things that your child really enjoys.

Once you’ve outlined your technology rules, have a family meeting. Talk about some of the challenges your family has been having with screen time (arguments, less quality time, lack of interest or time for other activities, etc.). Let your kids know that scientists are learning that too much time spent using phones, tablets, and videogames can make kids and adults unhealthy, just like eating too many sweets can take a toll on your health over time. Give your kids an opportunity to talk about some of the things they’ve noticed are a problem with digital device use at home. Don’t be surprised if they call out your own smartphone use as a problem! Be willing to make some compromises with your own device use, to be a good role model for your kids. In fact, I’d recommend reading this recent Washington Post article on this very topic before your family meeting so you’re fully prepared for the conversation. 

2. Create a Digital Use Contract. It may seem like an unnecessary or formal step, but research shows that when kids (and adults) sign off on something, they are more likely to stick to their commitments. Contracts should include specific guidelines for each child and age group, each device (phones, computers, tablets, etc.), each platform/technology (example: social media, web browsing, etc.) and each situation (example: dinner time, bed time, friends over, etc.). Common Sense Media has some excellent sample contracts on their website. Good contracts also require discussion, compromise and negotiations.  Give your child the space to share his or her point of view, and if he or she has reasonable requests, then you should honor them. If your child has some say in the rules, he or she will be even more likely to hold up his or her end of the bargain.  
3. Use Parental Controls. Setting restrictions on the devices to protect your child from inappropriate content or off-limit apps and websites is important. While the parental controls that are currently available aren’t perfect, they do include basic functions that control at least some of what your child does on his or her device. Smartphones and tablets all include built-in features that allow you to lock everything from the Internet browser, FaceTime or Skype, iTunes, app purchases, app access, etc. There are also third-party apps available with some advanced features. Videogame consoles also include parental control functions that allow you to block games by age range or rating and disable in-game purchases. Some videogame consoles even allow you to limit the amount of time your child spends playing in a day – once that daily limit has been reached, the console turns off automatically!

Managing a child’s digital device use is one of the biggest challenges faced by many parents of kids with ADHD (often it’s second only to dealing with homework time!). Your guidelines, strategies, and rules will need to evolve and adapt as your child grows and technology changes. Fortunately, there are great resources available online that can help you make smart decisions, and set the technology limits that your child needs.

Additional Online Resources:

Family Online Safety Institute https://www.fosi.org/

Common Sense Media https://www.commonsensemedia.org/

The Social Institute https://thesocialinstitute.com/

All teens struggle to keep up sometimes, but most teens intuitively adopt strategies that help them manage their day-to-day lives relatively effectively. Teens with ADHD, on the other hand, typically feel like they simply can’t keep up, and lack the required executive functioning skills that are needed to intuitively manage their daily influx of assignments and responsibilities. As a result, teens with ADHD become anxious and avoidant when they think about tackling their growing to-do list, and they continue to fall behind. To overcome their executive functioning challenges, and break out of an anxiety and avoidance cycle, teens with ADHD need to learn specific strategies and systems for recording assignments, ideas, and tasks, and seeing them through to completion.

Getting Things Done® is a system designed to turn the ideas and tasks floating around in our heads (and causing anxiety) into actionable items that can be completed efficiently. In fact, the Getting Things Done® slogan is, “Your mind is for having ideas, not holding them.” Getting Things Done® is based on 5 key steps that can easily be adapted to meet the needs of almost any teen with ADHD, especially when it comes to getting homework done!  

The Five Key Steps to Getting Homework Done:

Capture
Record everything that you need to get done.

Every teen with ADHD has hundreds of thoughts, ideas, and “to do” items bouncing around in his or her head. It is simply not possible to rely on memory alone without forgetting items or missing due dates. It’s essential that every single assignment, upcoming test, or task (like getting a permission slip signed, or bringing supplies to school) be written down. In addition, each of these items needs to be recorded in the same place. Too often some assignments are captured as reminders in text messages or emails (sent to yourself), while others are noted in a Word document, or in the school’s online homework system (like Blackboard), or on random sheets of paper in notebooks or stuffed in the bottom of a bag. Pick one location and stick with it – whether it’s a Word or Evernote document, a paper notebook, or a notes section of the school’s homework assignment system. If it’s not captured in writing, it’s probably not going to be done well and on time.

Clarify
Turn assignments into action items and next steps.

Simply recording your assignments in one place is an accomplishment when you have ADHD! Mastering this first step is essential, and will help you stay in control of your assignment list. But, to finish your assignments quickly and on time, there are a few more steps you’ll consistently need to take. Clarifying exactly what you need to do in order to complete each assignment is the next essential step. Creating a checklist of assignment action items provides you with a roadmap for your work and breaks bigger projects down into smaller manageable chunks. For some assignments, the checklist list will be short. For example, “Complete Math Worksheet” may have only two items on the checklist, (1) complete worksheet, (2) doublecheck for errors. More complex assignments, like “Write Spanish Essay” will require longer action item checklists: (1) develop topic, (2) create outline, (3) write thesis statement, (4) write the body, (5) write the introduction, (6) write the conclusion, (7) revise, (8) proof read.

Organize and Prioritize
Group your action items together into meaningful categories.

Using a homework whiteboard, a Word or Evernote document, or an online project management tool, like Trello, organize and prioritize your action items. Getting Things Done® recommends using only three categories: “Now” “Tomorrow” and “Later.” For assignments with a “Later” due date, make sure you enter a reminder into your calendar. Then, look at the action items for the project, and see if there are any steps you should be starting today or tomorrow, and add them to the appropriate list.

Review and Reflect
Do a weekly review of your lists to clean-up, update, and clear your mind.

With your assignments displayed visually, you are now able to easily scan your categories and see if there is anything that needs to be moved from “Later” into “Now” or “Tomorrow.” I recommend scanning this list once a day to make sure you’re not missing anything, and so that you have a very clear sense of how much you’ll have on your plate in the coming days and weeks.

Engage

Simply Do.  Use your system to take appropriate actions with confidence.

Now that you have very clear action items on your list, and a knowledge of what needs to be done when, you can dive in and get started. For many of the kids and teens that I have worked with, simply completing the first step of a project (no matter how small that step is) makes it much easier to overcome procrastination as the project due date approaches. The project feels less overwhelming because it’s already been started! For smaller assignments, like completing a math worksheet, the act of quickly completing the task and crossing it off your list will give you a great sense of accomplishment and will help you feel motivated to tackle the next action item.

Incorporating a structured system like Getting Things Done® into a homework plan will help all teens with ADHD get assignments completed efficiently and on time. This is a huge benefit, but just as importantly, it can help teens with ADHD develop a sense of competence and control over their academic life. Anxiety will decrease, and time with friends and family becomes more relaxed and fun!

To learn more about Getting Things Done®, visit David Allen’s website at https://gettingthingsdone.com.

Many of the parents I have worked with tell me that homework is the most stressful part of their day because of the frequent arguments and conflicts that come up during this time. Most tell me that they feel like arguments around homework are having a serious negative impact on their relationship with their child. While you can’t eliminate homework from your child’s life, there are things you and your child or teen can do to help make homework more manageable.

• Schedule dedicated homework time. The National PTA and the National Education Association suggest that kids should be doing about 10 minutes of homework per grade level, and many public schools aim for these targets. So, your 6^th grader should have at least an hour of homework to do. Your sophomore in high school should have about an hour and 40 minutes (100 total minutes). You and your child may believe this is longer than he or she should be spending on homework each night, but if this is the reality of what is being assigned, then it’s best to be prepared for it. Help your child or teen figure out how to set aside the specified amount of time in his or her daily schedule. Any less dedicated time than this, and your child will probably find himself or herself with too much to do and too little time, even if he or she is efficient. In fact, if your child has ADHD, he or she may need about 50% more time than kids without ADHD to complete work. If your child or teen is regularly taking much longer than expected to complete assignments (e.g., a 6^th grader regularly takes 1 hour and 30 minutes or longer), then talk to your child’s teacher. Often teachers don’t realize how long homework is taking, and are open to making adjustments to your child’s assignments to accommodate his or her ADHD.
• Create an action plan. Kids with ADHD often have a hard time starting on their homework, but do pretty well once they’re going. Parents can help by sitting down with their child at the beginning of homework time to create an action plan. Have your child make a list of each assignment, the due date, the tasks necessary to complete the work, and the materials he or she needs to get the job done. Then, decide which assignment should be completed first, and sit with him or her for a minute or two while he or she gets started.
• Try a homework club. Many schools and public libraries have started Homework Clubs after school to help kids get homework done. Homework clubs provide great spaces for kids to stay focused (no bedroom toys or everyday family life to distract them) and may provide more supportive adults (teachers, aides, librarians) and homework tools (supervised computer access, protractors for geometry assignments, etc.), and less distracting environments than typical afterschool programs. The best part about these programs is that they occur right after school, before your child becomes fatigued at the end of the day. They also minimize parent-child conflicts, since other adults are providing the supervision.
• Work with a tutoring center. If your child is struggling with homework completion, and a homework club and he or she needs more individualized help than a typical homework club or afterschool program can provide, then private tutoring or learning centers can help. They offer more flexible hours and small group or one-on-one support that can benefit kids with ADHD. They are also staffed with educational professionals who are focused on helping kids not only complete their assignments, but also truly understand and master the concepts. If you’re searching your area for a center, search for one that has extensive experience working with kids who have ADHD. 
• Fuel your child’s performance. Kids need the right amount of sleep, nutrition, and physical activity to complete their work effectively – this is true for all kids, but it is especially true for kids with ADHD. When any of these factors is out of balance, your child’s homework will suffer.  So, take a holistic approach to your child’s homework time, and help him or her get the sleep, nutrition, and physical activity that he or she needs.  

Homework is challenging for all kids, and it is especially challenging for kids and teens with ADHD. By taking a solution-focus approach to helping your child get his or her assignments completed, you can alleviate stress for your child and your family.  

In my next post, I’ll talk more about creating effective Action Plans by applying a Getting Things Done approach to homework!

Across the board, kids attribute human thoughts, feelings, and intentions to inanimate objects. It’s completely normal for them to think that their stuffed bear may feel lonely if he is left alone all day, or that their dump truck is mad because it’s wheel got stuck in the sand. As kids get older this tendency gradually decreases, but for some, it still pops up well into adulthood (think of people you know who talk about their beloved car as though it is a person!).

Technology like Alexa taps into this tendency to attribute human qualities to objects. And, depending on your child’s developmental level, the line between person and technology may still be quite blurry. So, as you bark out commands to your digital assistant -- “Alexa, turn on the lights,” or “Alexa, play my favorite radio station,” or worse, as you keep trying to get it to work, saying more sternly each time, “Alexa. Alexa!  ALEXA!” -- your kids are hearing and absorbing your tone and phrasing. Without intending to, you’re providing a model of communication that they may generalize to their interactions with friends and family.  

Fortunately, with three simple steps (and ongoing mindfulness on your part) you can keep this behavior to a minimum:

1. Rename Alexa. Did you know that you don’t actually need to refer to Alexa as “Alexa”? “Alexa” is simply a word programed into your digital assistant to “wake it up” and get it ready to receive a command.  It’s called the “Wake Word” and you can change it to anything that you would like to use. You can de-personalize your digital assistant and make it clear that you are taking to a machine and not a person by changing the device’s Wake Word to “Computer” or another technology-related name.
2. Say “Please.” Start talking to your digital assistant the way you would talk to a friend or colleague when you’re asking them to do something for you. Start each request or command with “Alexa, please…” (or the new name for your device in place of “Alexa”). After the task is completed, end the conversation with “Alexa, thank you.” Your device will always respond by saying something like, “You bet!” or “Anytime!”, providing a great model for your child.
3. Remember that you can turn off Alexa. It’s easy to forget that you are in charge of your technology, and not the other way around. If you’re concerned about how your child is interacting with Alexa, or your child isn’t practicing his or her “please and thank you” with the device, then it might be time for a break. Let your child know that when he or she doesn’t use “please” or “thank you,” the device will stop responding. Then, unplug Alexa. It’s as simple as that. After a break, plug Alexa back in and let your child give it another try.

As digital assistants continue to evolve I’m optimistic that new family-friendly features and parental controls will be added to their functionality. In the meantime, be mindful of the way you and your child interact with Alexa, and be on the lookout for unintended consequences that may pop up as you integrate this technology into your daily life.

Kids with ADHD are typically slow to gain independence in their daily activities, like getting ready in the morning, completing their homework, and getting ready for bed in the evening. Parents often find themselves “micromanaging” their child’s day, making sure that things get done well and on time, even when their child is of an age when they “should” be managing these activities independently. The need for constant reminders and double-checking frustrates parents, and on the flip side, kids often complain that their parents spend too much time “nagging” them. This is where Alexa can be helpful. Alexa can essentially serve as an independent third party that provides reminders, alarms, and lists. Kids can easily learn to use these features in Alexa, building independence and confidence, and reducing conflict and negotiations with parents. After all, when a parent says, “You’re going to need to leave for soccer practice in 10 minutes,” it can feel like nagging to a child, but when Alexa says the same thing, it’s not emotionally loaded or the source of immediate conflict.

There are many ways to incorporate Alexa into your child’s daily routine. Here are a few ideas to get you started.

1. Alarm clock. Help your child set an alarm with Alexa, and customize the alarm with his or her favorite song. For example, “Alexa, please wake me up at 7am every weekday with ‘Let it Go’ from Frozen.” If your child is generally slow to wake up, then let him or her know that he or she will need to be out of bed by the time the wake-up song ends. By having your child tell Alexa when to wake him or her up and which song to play, he or she is taking responsibility for his or her morning alarm and gaining independence.

2. Getting out the door on time. Alexa’s scheduling functions can also help your child keep track of time in the morning. In the Alerts & Alarms section of your Alexa app, create custom reminders that are scheduled to repeat at the same time every morning or afternoon. For example, you can create a reminder called “Ten Minute Warning” and then program Alexa to remind your child at 7:50am every day that it’s almost time to leave the house, “Dylan, I just wanted you to know the bus is coming in 10 minutes.” Again, by leveraging Alexa to provide the reminder, you’re helping to break the cycle of conflict that may be dominating your mornings.
   
3. Homework Time. You can also use Alexa’s scheduling and alarm systems to help manage homework time, either by using the Timer Feature, “Alexa, please set a homework timer for one hour” or the Alarm Feature, “Alexa, please set an alarm for 4pm when homework time is over.” Your child can also ask, “Alexa, please tell me how much time is left on my homework timer,” without involving his or her parents in the discussion.

4. To-Do Lists. To-Do lists may seem like an organization strategy that is geared toward adults, but they can also be very helpful for kids with ADHD. For example, if your child mentions that he or she needs to return a permission slip to school by Thursday and attend a Science Fair on Friday he or she can easily add these items to his or her to-do list. “Alexa, please add permission slip to our to-do list for Wednesday” or “Alexa, please remind me about my science project on Thursday afternoon at 3pm.”

As Alexa and similar technologies begin to play a more central role in our daily lives, kids with ADHD will gain access tools that can help them gain independence, manage their ADHD symptoms more effectively, and reduce conflict at home. And one of the best features: Alexa is screen-free! These digital tools are all available without a distracting tablet or phone that can derail any child’s best intentions. So, help your child get started with Alexa, and see what this technology can do for your family.   

While the first few weeks in January will never be without their difficulties, there are things you can do to help them go as smoothly as possible for you and your child.

1. Adjust Your Expectations. Your child is going to have more difficulty getting out of the house in the morning, will probably forget things that he or she needs to bring home from school, will have a hard time getting started on homework, and will have a more difficult time falling asleep at night. This is normal and to be expected! Provide your child with extra support if he or she needs it, and be patient when things don’t go as planned. Just because your child is struggling this week doesn’t mean that things will always be this way. This is a temporary situation and your child will be back on track soon.
2. Minimize Your Own Tasks and Commitments. This adjustment period will go more smoothly if you keep your own responsibilities and commitments to a minimum. While you can’t stop doing all of the things that keep your home and life running smoothly, there are things that you can do to reduce the burden. Plan meals that require little prep work or clean up, put off any non-essential errands, and ask for help from other parents, friends, and family with things like school or activity pick-ups and drop-offs.
3. Schedule fun family activities for the weeks ahead. For most kids, the holidays are followed by a long stretch of winter that doesn’t include many planned fun activities at home or at school. This can take a serious toll on a child’s mood and motivation, especially when a child has ADHD. Schedule fun activities that your child and your family can look forward to. Friday family movie nights, ice skating or sledding, a visit to an indoor waterpark or activity center, and a trip to your family’s favorite museum are all fun ways to spend time on winter weekends. Schedule these activities in advance, and post them somewhere at home where your child can see the list every day. When your child is feeling down, remind him or her of all of the exciting days ahead. 

The return to school after the winter break isn’t easy for kids with ADHD or their families. A little planning, patience, and understanding can go a long way in making this time as enjoyable as possible for you and your child.

Kids with ADHD identify more situations as being “unfair” than kids without ADHD, and they struggle to move on and let go. Why? In general, kids with ADHD are prone to black-and-white thinking, and struggle to see the gray areas in situations. They also tend to have difficulty looking at things from the perspective of another person, and think that their view of a situation is the only perspective that exists. In addition, when they are frustrated, they have a hard time managing their feelings, and when they feel frustrated they are more likely to think negatively about the things that are happening around them.

It’s challenging to know how to respond when your child complains about fairness. You want to help him or her understand why something is fair despite how it may seem, or learn to be okay with the fact that things in life won’t always be fair. But the life-lesson conversations about fairness that you’ve had with your child in the past don’t really seem to be having an impact.

1. Plan a brief response that you can use consistently. Think about a brief response that you can use whenever your child complains about fairness. First, acknowledge your child’s feelings of frustration. Let him or her know that you can see why things might feel unfair and that you know this can be upsetting. Then, let him or her know that even though it’s frustrating, “fair doesn’t always mean equal, and equal doesn’t always mean fair.” It can help to give an example, like - if your friend (or sibling) is sick and needs to stay home and miss a party and then I tell you that you also need to stay home because that would make things equal, that would not be fair. If you think your child would benefit from longer, more detailed discussions about being flexible, or understanding the gray areas in situations, then have these talks at another time – when both of you are calm and more open-minded.
2. Stick to your decision and do not give in. When you give in to your child after they complain that something is not fair, then you are sending the message that complaining is an effective strategy. Essentially, you are rewarding their behavior and inadvertently making it more likely that they will complain about things being unfair again in the future.
3. Catch your child being good – praise them when they don’t complain. It’s easy to notice the times when your child complains about a situation, but it’s important to look for times when he or she doesn’t complain! Be on the lookout for situations when things didn’t go the way your child had hoped, but he or she didn’t complain about things being unfair. Instead, he or she rolled with the situation and didn’t get caught up in the perceived unfairness. You may need to start by praising “little victories.” If your child complained, but then moved on quickly, then let him or her know that you appreciate the fact that even though he or she wasn’t happy with the situation, he or she was able to bounce back quickly. Praise is a type of reward, and it will help your child become more likely to move on quickly again in the future.

If you follow this three-step approach consistently, you’ll start hearing fewer and fewer complaints from your child about fairness. At the same time, your child will learn that he or she can tolerate feelings of frustration, and that it can feel good to let go and move on from difficult situations.

While having a break from school gives your child an opportunity to recharge and spend quality time with family, it presents a real challenge for families of kids with ADHD. Fortunately, there are things you can do to avoid backsliding completely over the holidays: 

1. Modify Your Routine. Start by creating a modified routine that is custom tailored for the holiday break. Set a bedtime and morning wake-up schedule that is realistic for this time of year, and stick to it. Avoid deviating too far from regular sleep and wake times, since this will make it much harder to get back on track when the holidays are over. As always, be as consistent as possible. Consistency helps your child regulate their sleep, appetite, attention, energy level, and mood – all of which contribute to making the holiday season enjoyable for you and your child!
2. Schedule Fun Activities. While it may seem like the winter break should simply be fun by default, too much downtime can lead to meltdowns and the post-holiday blues. On top of this, the busyness of the season tends to detract from the quality family time that your child craves this time of year. So, plan a fun, special activity each day with your child. These don’t have to be elaborate activities. In fact, it’s often the simple things that go a long way over winter break (e.g., watching a special movie together, driving around town to see holiday lights, going out for hot chocolate, baking cookies, going out for a pancake breakfast, etc.). Take a few minutes to sit down with your child and brainstorm activities that you’d like to do together. Then schedule them at specific days and times during the break. Let your child decorate the list, and then post it someplace where you can see it each day.
3. Keep Learning. Let your child know that breaks from school don’t have to mean a break from learning. Kids with ADHD who struggle in school start to feel like learning is a chore, and something is they suffer through each day until they become adults. In reality, kids love to learn, they just don’t like doing routine schoolwork or sitting too much during the day. So, help your child remember that learning can be fun. When you’re planning activities for your child, or looking for ways to keep him or her busy while you get things done around thing house, aim for projects that combine learning and fun. There are some terrific websites out there with countless ideas to get you started: com, Coolmath.com or PBS.org.
4. Limit Screen Time. Too much screen time over the holidays will make it harder for your child to adjust once school starts back up again, and can lead to meltdowns and arguments. Set a clear plan for screen time, and stick to it. If your child argues or melts down when screen time is over, then don’t allow screen time the next day. Remember, iPads, phones, computers, and television are all privileges, and these privileges can be taken away if your child isn’t able to handle them.

Take care of yourself. It’s easy to get caught up in the stress of the holidays, and as a parent of a child with ADHD, you have even more to manage than most families. At some point, you’ll find yourself wishing the holidays were over already and your child was back in school just so you can have a break. Try to find at least a few minutes each day when you can do something for yourself, even if it’s simply sitting and enjoying a good cup of coffee or taking a relaxing bath after the kids go to bed. These small activities can go a long way in giving you the energy and patience you need to enjoy your child and the holiday season.

First let’s start with the numbers. The increase in ADHD diagnoses is a real phenomenon. The most recent data published by the CDC shows that during 2013-2015 the percentage of kids (ages 4-17) who had ever received a diagnosis of ADHD in their lifetime was 10.4%. Compare this to just 10 years prior (2003) when only 7.9% had received a diagnosis. Such a substantial change over such a short period of time often points to big picture factors that have an impact on a national level. Factors like increased public awareness, changes in public education, and the availability of long-acting stimulant medications to treat ADHD.

Increased Awareness

Public awareness about ADHD has increased dramatically over the past 30 years, and particularly in the past 15 years with the proliferation of online medical and mental health information. Pharmaceutical companies, advocacy groups, and the media have all taken an interest in sharing stories and information about ADHD symptoms and treatments. Often this information is provided in bite-sized snippets that only briefly describe a handful of ADHD symptoms. And, since so many children have at least a few of these symptoms, like difficulty focusing or sitting still for long periods of time, it’s understandable why many parents and teachers may start to wonder if their struggling child or student has ADHD. Before long, the number of children referred to medical doctors and psychologists goes up, as do the rates of children receiving actual ADHD diagnoses. In many cases, an ADHD diagnosis may be very appropriate, and the increased awareness led to a real benefit for that child. In some cases however, the child’s difficulties are due to other challenges, like anxiety, learning difficulties, sleep problems, slightly delayed social or academic skills, or even simply being a few months younger than most of the children in his or her classroom. If a thorough diagnostic assessment isn’t completed, then an ADHD diagnosis may be assigned incorrectly.

Changes in Public Education

With the introduction of legislation like No Child Left Behind in 2001, which tied school funding to student test scores, there was a dramatic shift in US public education. Teachers and schools suddenly became much more focused on ensuring that their students performed well on national exams. Underperforming students were being identified more often, and solutions for poor test performance were sought out quickly. Referrals for ADHD evaluations increased, as did rates of diagnosis. A series of studies (published in The ADHD Explosion by Drs. Hinshaw and Scheffler) shows a strong correlation between states with the highest rates of ADHD diagnoses and state laws that penalize schools for poor student performance.

Availability of Long-Acting Stimulant Medication

Stimulant medication remains one of the most common treatments for ADHD, and for many children it is very effective. Early formulations of stimulant medication, like Ritalin, required multiple doses to be taken throughout the day. Kids had to visit their school nurse at lunchtime to take their medication, which led to very real concerns about stigma and skipped doses. In addition, the side effects from these first-generation medications were problematic for many kids. Throughout the 2000s, multiple improved versions of stimulant medications became available. These medications last for 8 hours or longer, have fewer side effects, and some are even available in a skin patch for kids who are not able or willing to swallow pills. With more tolerable, effective treatments available, and increased awareness of these medication options, parents and teachers became increasingly receptive to the idea of an ADHD diagnosis.

While rates of ADHD continue to rise, and our understanding of ADHD continues to grow, so does the controversy surrounding the validity of the diagnosis itself and the use of medication as a first line treatment. Decades of research have shown that ADHD is a very real disorder, and studies suggest that the percentage of elementary school-age kids (in the US and worldwide) who truly have ADHD is around 5-7%. The goal of treatment providers, educators, and parents, should be to limit rates of ADHD misdiagnosis, by insisting on thorough evaluations that consider a range of factors (including, but not limited to, ADHD) that may be contributing to a child’s difficulties.

1. Classroom-based lectures are not an optimal strategy for teaching students with ADHD. Didactic instruction via lectures is rarely an effective teaching style for students with ADHD. Many students with ADHD struggle to focus and process verbal information quickly during lectures, and have poor note taking skills. They often leave class having missed key points from the lecture and have sparse, ineffective notes to refer to when completing assignments or studying for exams independently.

2. Homework is a struggle for students with ADHD. As any parent or teacher of a child or teen with ADHD knows, homework is an ongoing struggle for these students. Even under the best of circumstances kids and teens with ADHD have difficulty completing their homework efficiently and consistently. This is due in part to the time of day when homework is completed (in the evening when fatigue is setting in and ADHD symptoms are worsening and when ADHD medication has worn off) and the lack of support from peers and teachers during homework time.

Flipped classrooms at least partially address both of these problems for students with ADHD. When lectures are provided in video format, students can watch them at their own pace. They can rewind if their attention drifts and they can listen again to catch key points that they may have missed. Taking notes becomes easier when they are able to slow down the pace of the lecture, and notetaking may become less essential if teachers and classmates can serve as resources when assignments are completed during the class period. When assignments are completed in class instead of at home, students with ADHD may be less fatigued, will have the advantage of their ADHD medication still being in effect, can receive individualized instruction from the teacher as needed, will have the social and intellectual support of their classmates, and ideally, the assignments will be more interactive and less tedious than in traditional homework.

Even with these clear benefits, optimizing flipped classrooms for students with ADHD requires special considerations:

“Homework” will continue to be a challenge for students with ADHD.
In flipped classrooms, homework does not altogether disappear, it is simply replaced by video lectures. Students with ADHD will still struggle to focus on the videos, they will still procrastinate, and they will still miss key points during the lectures. Optimize the use of video lectures by incorporating elements that are known to increase engagement and compliance for students with ADHD:

• Keep the videos as brief as possible. Small, digestible chunks of information will be absorbed more readily than lengthy presentations.
• Incorporate interactive features. Insert pop-up questions and activities throughout the lectures and grade students on their responses. Provide immediate feedback to students about the accuracy of their responses.
• Set due-dates and measure progress. Set clear due dates for lecture viewing, and monitor progress. If a student skips a video, follow-up and brainstorm strategies for getting back on track.
• Reward students for meeting deadlines. Give students points for watching videos, and tie these points to meaningful rewards. Allow students to track their progress toward earning rewards, and incorporate game-like features whenever possible. Remember that praise is also very rewarding! When you notice that a student is consistently watching videos and meeting deadlines, let them know that you’re impressed and encourage them to keep up the good work.
• Encourage the development of notetaking skills. Notetaking remains an essential skill for students throughout high school and college. Since students with ADHD struggle to take effective notes, provide specific instruction on notetaking, and require students to take notes during video lectures. Review the notes and provide feedback about things the student has done well and areas where he or she can improve.

Flipped classroom assignments present unique challenges for students with ADHD.
Students with ADHD who struggle to complete assignments at home will also have challenges with classroom assignments.

• Provide individualized instruction whenever possible. One of the benefits of flipped classrooms is increased opportunity for individualized instruction. Students with ADHD don’t always stand out as needing individualized attention, particularly when they are bright students who can compensate relatively well for their weaknesses, and when they are more inattentive than they are impulsive or disruptive. Seek out these students and aim to give them a boost in areas where they may not be reaching their full potential.
• Encourage effective teamwork and collaboration skills. Group-based assignments are more common in flipped classrooms. While there are many benefits to group-based learning, students with ADHD are more likely than their peers to have difficulty participating effectively in these learning activities. Students with ADHD often lack confidence in their knowledge and abilities. As a result, they may hang back from the group and fade into the background. Conversely, their insecurities may drive them to act out and become disruptive. Focus on teaching strategies that will help them become confident, engaged members of their team, and participate in ways that enhance the group as well as their own learning process.

Flipped classrooms have the potential to be far more engaging for students with ADHD than traditional instructional models. Tailoring flipped classrooms to meet the needs to students with ADHD can have a positive impact on their ability to learn and their motivation to participate in the learning process.

The cognitive skills involved in driving a car are the very skills that are impaired in kids, teens, and adults with ADHD. ADHD is associated with deficits in the executive functioning skills responsible for staying focused, planning ahead, managing emotions and impulses, and reacting quickly to changes in the surrounding environment – all of which come into play while driving. With this in mind, it’s not surprising that the rates of car accidents, speeding tickets, and other traffic citations are even higher among teens with ADHD than teens without ADHD.⁴ Recent studies using driving simulators have found that teens with ADHD had difficulty staying in their lane and driving at a consistent speed. In simulator tasks that included texting, both the teens with ADHD and the teens without ADHD drove more poorly – but the texting-related impairment in teens with ADHD was significantly worse than in the teens without ADHD.⁴

Knowing that driving risks are higher for teens with ADHD, parents are encouraged to take extra steps to help their adolescents develop safe driving skills.

1. Effective treatment with ADHD medication improves teen driving. ADHD medication has been shown to improve teen driving skills during driving simulator tasks. If your teen takes medication for ADHD, require them to take their medication consistently once they start driving.

2. Teach your teen about the risks of driving with ADHD. Feeling invincible is a hallmark of the teenage years, and many teens with ADHD underestimate the negative effects that their ADHD symptoms have on every day activities – including driving. Make sure your teen is aware of the increased risks that come with having ADHD, and the reasons why his or her driving will become even more impaired if he or she texts or faces other distractions while driving.

3. Lack of sleep will impair driving abilities. The effects of sleep deprivation on driving performance are profound, and under extreme conditions can be as impairing as alcohol. Poor sleep also negatively impacts ADHD – worsening the symptoms of inattention and impulsivity, and slowing down reaction times. Mix poor sleep, ADHD, and driving in teenagers and the result is a very risky combination. Encourage your teen to get at least 8 hours of sleep each night, and when he or she can’t, consider not allowing him or her to drive that day.

4. Develop your own house rules around driving. Many states limit the time of day when teens can drive and the number of passengers allowed in the car. While these limits are protective, teens with ADHD may need even more stringent rules. If you think that your teen’s ADHD symptoms are interfering with his or her driving ability or he or she is not demonstrating the level of maturity needed for safe driving, then create your own driving rules. Consider requiring more practice driving hours than what is mandated by state law, not allowing friends in the car even after the state-based limits have been lifted, limiting driving to short distances and only on weekdays during daylight hours, and having your teen use an app that reduces cell phone distractions while driving.

5. Create a driving contract. Work with your teen to draw up a driving contract that outlines driving rules that you can both agree to. Whenever possible involve your teen writing the actual contract. Your teen will be more invested and respectful of the contract if his or her input was valued when it was created.

ADHD symptoms pose a serious risk for teen drivers, but there are steps that parents can take. Encouraging your teen to take his or her ADHD medication daily, get good sleep, and work collaboratively to develop driving rules and a driving contract, can help keep your teen safe on the road.

¹ Insurance Institute for Highway Safety (IIHS). Fatality facts: teenagers 2015. Arlington (VA): The Institute; http://www.iihs.org/iihs/topics/t/teenagers/fatalityfacts/teenagers

² National Highway Traffic Safety Administration (2017). Traffic Safety Facts: Summary of Statistical Findings. Washington D.C.: NHTSA’s National Center for Statistics and Analysis; https://www.nhtsa.gov/sites/nhtsa.dot.gov/files/documents/812_381_distracteddriving2015.pdf

³ Olsen, Shults, Eaton (2013). Texting while driving and other risky motor vehicle behaviors among US high school students. Pediatrics, 131, e1708-e1715,

⁴ Narad et al. (2013). Impact of distraction on driving performance of adolescents with and without ADHD. JAMA Pediatrics; 167, 933-938.

While spelling struggles may be a lifelong challenge for many kids with ADHD, there are strategies that can help.

1. Commit words to memory using creative strategies. Making spelling an automatic process whenever possible won’t eliminate spelling problems, but it will help cut down on errors. Basic, repetitive memorization strategies are often not very effective for kids with ADHD. Instead, try incorporating tactile activities. Allow your child to use magnetic letters to spell words or “write” words with his or her fingers in a tray of sand or on a cutting board covered in baking flour. If you have more time, allow your child to use clay to form letter shapes and spell out words.

2. Encourage your child to read. In general, the more kids read the better they will become at spelling. If your child is a reluctant reader, supplement required reading assignments with fun reading activities. These can be things like reading comic books, having someone read aloud while he or she follows along, or visiting websites with articles on his or her favorite topics.
3. Allow your child to type words instead of handwriting them. Spelling is a complex process, and some kids with ADHD have difficulty with the physical process of handwriting letters to form word lists and at least some of his or her assignments. Consider talking to your child’s teacher about getting an accommodation that will allow your child to turn in homework assignments that were completed on a computer.

4. Use Text to Speech readers and spell checkers as proofreading tools. Basic proofreading is a challenge for kids with ADHD, but technology can help. Spell checkers will catch many spelling errors, and Text to Speech readers will identify even more spelling mistakes and grammatical errors. Text to Speech programs will read aloud the words that your child has typed onto the page. Your child will be able to hear when a word sounds incorrect, or is used is the wrong context. There are many free Text to Speech readers, like NaturalReader, available online.

5. Consider testing for learning problems. If your child’s spelling challenges are severe and/or are accompanied by reading delays and other writing problems, then consider requesting a learning evaluation from your child’s school, an educational therapist, or a psychologist. It’s possible that a reading or writing disorder is driving the problem, and targeted interventions can help.

Spelling struggles can be frustrating for kids with ADHD, but with patience, practice, and a little help from technology, your child’s spelling can improve over time.

5 Key Strategies for Reducing Boredom and Increasing Engagement

1. Make Activities Meaningful

When an activity is meaningful to a child, either because it is helping him or her to improve skills in an area that is important or because it is tied to a topic that he or she enjoys, his or her interest and enthusiasm will increase dramatically. For example, many kids with ADHD complain that math is boring, but when a child learns to use his or her skills to predict the scoring potential of a favorite athlete, math suddenly becomes much more interesting. Or when a child learns that getting through homework quickly (and accurately) means that he or she will finish sooner and have more time to play a favorite game, he or she becomes much more engaged and less distracted during homework time.

2. Incorporate Physical Activity

Physical activity provides essential mental stimulation for kids with ADHD, and can make typically “boring” activities much more engaging. Physical activity can come in the form of a hands-on project, an opportunity to complete assignments while standing and fidgeting rather than sitting still, or frequent pre-planned activity breaks. In an ideal scenario, active games can be used to teach new skills, routines, and habits. Whenever activities are fun and game-like boredom quickly disappears!

3. Keep it Short

Kids with ADHD become bored with almost any lengthy task. For very young children, even a 10-minute activity can induce boredom. Older children may have a 20-minute limit before the boredom sets in. In general, helping kids with ADHD learn new skills and complete everyday tasks through short bursts of activity will reduce boredom and increase engagement. Try reducing the length of repetitive academic assignments, and breaking down longer activities, like cleaning up a very messy play area, into smaller chunks.

4. Set Short-Term Goals

Most kids with ADHD find activities boring when they lack a clear purpose or have a very delayed outcome. Build small goals into activities to bump up engagement. For example, rather than having a child passively listen to a book report presentation in class, have him or her complete a worksheet that requires him or her to listen for very specific details during the presentation. Challenge the child to have an answer written down for each question before the presenter has finished the report.

5. Reward Progress

Providing immediate rewards can make almost any activity more engaging for kids with ADHD. In general, rewards should be immediate, they should be something that the child wants to earn, and they should be used sparingly. Rewards are powerful tools for kids with ADHD, but when they are used too frequently they can be difficult to sustain. In addition, they may undermine a child’s internal motivation when they are paired with activities that the child perceives as easy or inherently interesting. So, build in rewards when they are needed, but use them only after you’ve tried one or more of the four strategies listed above.  

Anytime an otherwise boring activity can be made engaging for a child with ADHD he or she will receive a boost in his or her ability to focus, be productive, and feel proud of his or her efforts. It’s not possible to escape boredom altogether, but with a few tips and tricks most activities can be made interesting for kids with ADHD.

Much of the boredom and difficulty focusing that kids with ADHD experience has to do with individual differences in the amount of mental stimulation that they require before their brain will “click into gear” and become engaged. Everyone has an optimal level of mental stimulation that they need in order to focus and learn. If something is too mentally stimulating, it will hard to stay engaged for very long. If something is not mentally stimulating enough, then it will be hard to focus right from the start. For kids (and adults) without ADHD, the amount of mental stimulation that they need for optimal focus and engagement would fall somewhere in the average range (about a 5 on a scale from 1-10). For individuals with ADHD, their brains work a bit differently. In order for their brains to click into gear, and focus without a great deal of effort, an activity or task needs to be more interesting than average. It may need to fall around a 7 or an 8 on our scale.

Take a look at the graphic above. The student in this picture is presenting a pretty interesting book report -  it’s about a 6 on our scale. Most kids in the room aren’t having a problem staying engaged, and the teacher isn’t expecting anyone to find the presentation boring. Unfortunately, for the typical students with ADHD, this presentation is just not interesting enough. Their brains aren’t clicking into gear and they aren’t naturally engaged like most of the other students. They find the presentation “boring” and may find it very uncomfortable to stay seated and listen. Research has shown that many kids with ADHD use physical movement as a strategy for increasing mental engagement, since movement actually stimulates the brain. So, the students with ADHD will probably start fidgeting, and some may even try to find an excuse to stand up and get out of their chair.

If the presentation was just a bit more interesting, either because of the topic area or because it included pictures or interactive activities, then it would cross the engagement threshold for the kids without ADHD and the kids with ADHD. If you observed the students listening to this more engaging presentation, you might not be able to guess which kids in the room had ADHD. They would not seem bored, they would probably be sitting pretty still, and they would be listening attentively.                                      

These differences in the level of mental stimulation required for kids with ADHD lead to the perception that they can focus “when they want to” or “when something is interesting to them.” It confuses parents and teachers who struggle to understand why a child with ADHD can focus so well on videogames but can’t stay engaged when he or she is completing school assignments. Even outside of academics, it frustrates everyone when a child with ADHD complains that he or she is bored when everyone else seems to be having a good time. It’s important to remember that kids with ADHD don’t choose to be bored. There are very real brain-based differences that make many everyday situations actually feel very boring for kids with ADHD. While the world cannot change to accommodate the mental engagement needs of all kids with ADHD, there are some strategies that parents, teachers, and kids can do to help their brains click into gear more often. I’ll be talking about those strategies in my next post, so stay tuned!  

Intelligence, as it has been traditionally defined, is a reflection of skills measured on standardized IQ tests, including verbal and spatial reasoning, information processing, and memory skills. These are essentially the skills that are most highly correlated with academic success. Traditional IQ tests however, are limited in their ability to capture an individual’s full range of abilities and potential. Fortunately, multifaceted models of intelligence have been proposed to address this problem. Dr. Howard Gardner’s Theory of Multiple Intelligences is one IQ model that encompasses nine different types of intelligence:

• Spatial: visualizing objects in 3D, mentally and physically manipulating objects with a specific goal in mind
• Naturalist: Understanding living things, reading nature, connecting with nature
• Musical: discerning the pitch, tone, rhythm, and timbre of sounds
• Logical/Mathematical: quantifying things, engaging in scientific thinking and reasoning
• Intrapersonal: understanding your own feelings and needs
• Linguistic: verbal and written expression
• Interpersonal: sensing other people’s feelings and motives
• Bodily-kinesthetic: coordinating your mind with your body
• Existential: grappling with the questions of why we live and why we die

For kids and teens with ADHD who do not fit into the traditional model of intelligence, a Multiple Intelligences framework provides an opportunity for tailoring and personalizing the way that they are taught in the classroom. For example, for children who learn best in a more physical way or a more musical way, teaching math through physical activity or music could have a significant impact on a child’s ability to learn. In addition, allowing kids to demonstrate their knowledge in ways that capitalize on their strengths (e.g., through project-based learning) could greatly enhance their academic performance and motivation.

Parents and teachers have the opportunity to reflect on a child’s abilities and consider which of the 9 intelligences represent areas of strength. Providing opportunities for a child to develop these strengths through extracurricular activities will build self-confidence, and help buffer against the feelings of self-doubt that come with having ADHD. With a Multiple Intelligences framework, parents and teachers can start to change the dialog around what it means to “be smart,” and empower kids with ADHD to see their true potential - well beyond the grades that they receive at school.

Teens with ADHD often feel like they are different from their friends but don’t know why. They have a tendency to make impulsive decisions that lead to bad outcomes, or talk too much and tend to say the wrong thing at the wrong time, and they almost always have difficulty navigating the high school social scene – both in-person and online. In addition to dealing with ADHD, they are also coping with the typical challenges of adolescence – developing their identity, struggling for independence, dating, riding emotional rollercoasters, handling increased academic pressure, facing tough choices about alcohol and drugs, and feeling the pressure to prepare for life after high school. When you think about it this way, it seems like a lot to manage, right?  

Adolescence is one of the most challenging times in our lives. During childhood, the structure and support provided by parents and teachers, coupled with relatively low social and academic demands, help make ADHD manageable. Once a child becomes a teen, the social and academic demands increase dramatically, and the high level of support and structure present during elementary school falls away. Teenagers who are cognitively and emotionally equipped to handle these changes ultimately develop healthy coping skills and strategies that allow them to become more independent over time. Unfortunately, most, if not all, teens with ADHD do not have the cognitive or emotional resources to manage increased demands and expectations without additional support.

The difference between the cognitive and emotional abilities of a teen with ADHD and the expectations placed by parents and teachers at this age creates a virtual gap. On a day-to-day basis, this gap shows up in arguments between teens and parents about lack of motivation and effort, poor social choices, and failure to keep track of important items. Left to their own devices, teens with ADHD use ineffective coping strategies in an attempt to fill the gap between their abilities and the expectations they face. Not surprisingly, these ineffective strategies do nothing to build independence and only serve to widen the gap over time. Fortunately, with the help and support from therapists, teachers, and parents, as well as ongoing treatment of underlying ADHD symptoms, teens with ADHD can develop the skills and coping strategies that they need to succeed. 

As a parent, how to you start helping your teen close the gap between their current abilities and real-world expectations?

1. Take a few minutes to reflect on the number of times you find yourself thinking or saying, “My teen should be doing ___ by now, but instead he or she still need help with this.” Make a list of these things that you think he or she should be doing. Chances are they are going to be things like getting homework done each day, getting out of bed or out of the house each morning, staying organized, keeping track of his or her phone or other belongings, planning ahead for projects or events, helping out around the house, joining activities at school, or making new friends.
2. Think about your expectations for each of the items on your list. Are the expectations what you would reasonably expect for an average teenager? If you’re not sure, then ask for input from a counselor or teacher at your teen’s school, or someone who has experience working with a wide range of teenagers.
3. For each item on your list, the space between the realistic expectation and your teen’s current behavior represent the gaps that your teen needs help closing. Helping your teen close these gaps doesn’t mean continuing to do things for him or her, and it also doesn’t mean lowering the bar. What is does mean is making sure that your teen:
   • Understands why he or she is struggling
   • Receives treatment for his or her ADHD symptoms and learns the necessary skills and healthy coping strategies for building up areas of weakness
   • Receives academic assistance that will help him or her learn the material that he or she has struggled to grasp and develop the academic skills needed for success.

Adolescence is a challenging time for all teens with ADHD, and none of them should have to cope with the challenges alone. As a parent, you can help by identifying the gap areas where your teen needs help the most, and providing the support and resources that will help close the gaps and succeed over time.

Fortunately, most sleep problems in ADHD can be treated successfully. Developing a clear understanding of your child’s sleep problems is the first step determining which intervention will be most helpful.

• Inconsistent or prolonged bedtime routines. Kids with ADHD often struggle to get to bed on time, and at the same time, each night. For many kids, especially those who struggle with inattention, following a bedtime routine is a challenge. They start their bedtime tasks late, and take a long time to get everything finished, leading to a much later bedtime. Other kids with ADHD who are also oppositional may resist going to bed. They tend to have outbursts and refuse to do things like brush their teeth or turn off their electronics. These nightly battles delay bedtimes, and make it hard for them to settle down once they are in bed.
• Many kids and teens with ADHD also struggle with anxiety. Anxiety and ADHD can both make it difficult for kids and teens to “turn off their thoughts” when it’s time to go to sleep, leading to insomnia. Anxiety can also make it harder to fall back asleep for kids who wake up in the middle of the night.
• Stimulant medication side effects. Difficulty falling asleep is a common side effect of stimulant medications. When a child or teen starts a new stimulant medication, increases a medication dose, or takes medication too late in the day, he or she is especially susceptible to having his or her sleep disrupted.
• Screen time. Research has shown that kids with ADHD spend more time watching screens (television, videogames, tablets, phones) than kids without ADHD. Screen time throughout the day and especially in the evening, around 1 or 2 hours before bedtime, is associated with greater sleep problems.
• Secondary Sleep Disorder. For some kids, a secondary sleep disorder, like sleep apnea or periodic limb movement disorder (similar to restless leg syndrome in adults), may be a driving factor. Studies have consistently shown that sleep disorders occur more often in kids with ADHD than in kids without ADHD, and can exacerbate problems with attention, impulsivity, and hyperactivity. Kids with these secondary sleep disorders often get the recommended amount of sleep, but are not well rested in the morning and feel very sleepy throughout the day.
• Delayed Sleep-Wake Phase. Kids, and especially teens with ADHD, are also more likely to have delayed sleep-wake phase cycles. In these cases, a child or teen’s natural sleep cycle is delayed, so his or her body doesn’t prepare to fall asleep until late into the night or and isn’t cued to wake up until late the next morning. Kids and teens with a delayed sleep-wake phase have significant difficulty falling asleep and getting up on time in the morning. They also find it difficult to be alert in the morning, and are often much more focused and engaged in the afternoon.

If your child or teen has ongoing sleep problems that make it difficult for him or her to fall asleep, wake up in the morning, or stay alert throughout the day, then talk to your child’s pediatrician. A thorough sleep assessment will help uncover the cause of the sleep problems, and will help determine which intervention is best for your child.

Hearing these messages is especially difficult for parents of kids with ADHD. Parents face the challenge of not only having to cope with their child’s ADHD, but also having to defend their parenting choices and the very existence of the ADHD symptoms. For many parents, dismissive comments from friends and family also plant seeds of doubt, leading them to quietly wonder whether their parenting is in fact the problem, or if they did actually cause their child’s ADHD by allowing them to play too many videogames. In addition, these comments perpetuate the stigma that too often surrounds ADHD, and ultimately discourages people from seeking help for themselves or their child.     

While public opinion about ADHD varies widely, the science behind ADHD is actually quite specific: ADHD is a real, brain-based disorder that manifests as difficulty with concentration, organization, impulse control, and hyperactivity. Through brain imaging studies scientists are now able to identify parts of the brain that develop and function differently in individuals with ADHD (see my previous post on brain differences in with ADHD).

What causes ADHD?

Researchers are continually developing a more sophisticated understanding of why some people develop ADHD and others do not. The science shows us that the number one factor contributing to the development of ADHD is not watching too much TV or playing too many videogames, or parenting style or the food someone eats. It’s genetics. A person’s genes make up about 80% of their risk for developing ADHD. The other 20% likely comes from other “environmental” or health-related factors, like exposure to nicotine in utero, being born prematurely, being exposed to lead, etc. While factors like screen time, parenting style, teaching style, and diet don’t cause ADHD, research show that they can affect the severity of ADHD symptoms. So, growing up in a structured home environment, attending high quality schools, spending limited amounts of time playing videogames and watching TV, and eating a healthy diet can all help with the management of ADHD symptoms. These protective factors may even change the way the brain develops over time, leading to a less severe course of ADHD overall.

With so much evidence showing that ADHD is real, why do people question the diagnosis?
For starters, ADHD symptoms exist on a spectrum, and everyone as moments or days when they are less focused than they’d like to be or find themselves struggling to sit still. So, on an individual level, people without ADHD don’t fully understand that their periodic symptoms are far less severe than the chronic symptoms experienced by those with ADHD. As a result, they struggle to comprehend why it is that a person with ADHD can’t simply “make themselves” focus or stop fidgeting. On a societal level, we believe that parents and teachers should be able to control a child’s behavior. And, we fundamentally believe that all children and adults can be focused and organized when they choose to apply themselves. Individual weaknesses in these areas are rarely discussed or accepted as valid challenges faced by people with ADHD.

There may be times when it seems like everyone has a different opinion about whether or not ADHD really exists – but the scientific evidence doesn’t waiver. ADHD is a brain-based disorder that has a very real impact on the lives of children and adults, as well as their families. Parenting and teaching styles, screen time, and diet don’t cause ADHD to develop, but intervening in these areas can have a positive impact on symptoms and the trajectory of ADHD over time.

While it’s undeniably important for all kids to develop their strengths and talents, it would be hard to overstate just how important this is for the emotional health and well-being of kids with ADHD. Even in the most supportive school environments, kids with ADHD receive more negative feedback than kids without ADHD. Every day they are told that they need to be more focused, be more organized, or be less active. They repeatedly receive the message that they aren’t reaching their full potential because their ADHD symptoms are getting in the way. When these same kids are given the opportunity to engage in activities that capitalize on their strengths, they receive the opposite message. The pendulum shifts and they are suddenly the child in the room who is being called out for their positive qualities rather than their impairments. They stand out because they are doing so well, not because they are falling behind. Over time, these experiences build confidence and resilience, and help counteract the negative effects that ADHD can have on their self-esteem. A child’s inner dialogue can shift from, “I’m not as good as other kids.” to “School might be harder for me than it is for other kids, but when it comes to (sports or art or music) I’m really talented. That’s where I really shine!”

For many parents and teachers, finding the time to help a child develop his or her strengths can feel like a challenge. Fortunately, when a child is more engaged in activities that play to his or her strengths, managing ADHD symptoms will become easier and less draining for everyone involved.

1. Start by pointing out your child’s strengths on a daily basis. Every day there is at least one thing that your child does well. He or she may sound great when singing along with the radio, or run really fast when playing with friends, or do an excellent job teaching a younger child a new skill. Pointing out these little things to your child reminds him or her that there are many things that he or she is doing well.

2. Reflect on your child’s positive qualities. Block out 5 minutes of time to sit and reflect on your child. What are the things that you enjoy about him or her the most? What are your child’s best qualities? If your child could be on summer vacation all year long, what athletic, creative, musical, technical, or artistic activities do you think he or she would enjoy the most? Are there things your child has expressed an interest in, but has not had an opportunity to try?

3. Have a conversation with your child. Next spend a few minutes talking with your child. Ask him or her to imagine an endless summer vacation. What kinds of activities would he or she like to spend time doing? You can help him or her brainstorm by doing some research online with your child. A good place to start is by looking at activities that are available at some summer camps, since these are naturally geared toward a variety of interests (check out a list of activities at http://www.ourkids.net/camp/types-of-camps.php).

4. Talk to your child’s teacher and other staff at your child’s school. Meet with your child’s teacher, and with other supportive staff at the school, to talk about your child’s strengths and learn about relevant programs or activities that your child may be able to participate in during the school day or in an afterschool program.

5. Look for outside resources and at-home activities. Be creative and look for activities your child can do at home or through programs in your community. When your child participates in these activities he or she may even be motivated to do his or her schoolwork quickly and do it well – since once school work is done he or she will have more time to spend on other activities that he or she will enjoy!

Kids with ADHD thrive when they receive treatments and accommodations for their symptoms and are surrounded by people who help them recognize and develop their strengths. As kids grow into adults, this whole-person approach will guide them toward selecting work, activities, and social groups that capitalize on their strengths and minimize the impact of ADHD symptoms on their daily life.

ADHD and Screen Addiction

Research shows that kids with ADHD are at high risk for developing screen addiction. In fact, it’s estimated that up to 25% of kids and teens with ADHD suffer from some form of screen addiction. Why are kids with ADHD at increased risk? The constant simulation and reinforcement that comes from fast paced video games, videos, and even social media sites triggers a release of dopamine in the brain – the same reward chemical that is implicated in other addictions (food, drugs, gambling, etc.). The brains of kids and adults with ADHD are especially sensitive to this dopamine release, and as a result, have a harder time disengaging from triggering activities than individuals without ADHD.

What are the Signs of Screen Addiction?

How can you tell if your child is actually addicted to screens, or just really enjoys spending time on his or her iPad or playing video games? Start by thinking back to times when you have tried to set screen time limits. How has your child reacted when you put the limits in place? Most kids will be disappointed and upset, but kids with a screen problem will quickly escalate verbally and sometimes physically. They will act as though their world has just been crushed, and will try just about any tactic to their screen time back. They will often become very sneaky in their efforts to get back in front of a screen, and will typically lie when confronted about their behavior. Children with a screen addiction prefer playing videogames or going online much more than any other activity. In fact, they may seem to no longer truly enjoy any activity that isn’t screen-related. As a result, their relationships with friends and family and their grades at school begin to suffer.

How Do You Help Your Child Break the Addiction?

There isn’t a one-size-fits-all approach to screen addiction. However, there are four basic principles that apply to everyone:

1. Limit the number of screens in your home. Keep televisions out of your child’s bedroom and do not allow any tablets or smartphones in his or her room overnight. Have one central charging station in the house where everyone leaves their devices at the end of the day and during mealtimes.
2. Limit internet access. Set up website blockers for all of your child’s most addictive sites and apps. Also, work with your internet provider to disable your child’s internet access at a set time each day.
3. Be a good role model. Set limits around your own screen time. Pay attention to the amount of time you spend on your phone or tablet. If your child sees that you are constantly in front of a screen, then you are sending the message that excessive screen time isn’t a problem.

With these two steps in place, your path forward will depend on the age of your child and his or her level of screen addiction. If you have a younger child with a relatively mild problem, then putting firm limits into place (e.g., 30 minutes of iPad time a day) and sticking to them despite the behavior outbursts, will help dramatically. In addition, if your child has not started playing videogames yet, then do not let him or her start now. In my experience, the most severe cases of screen addiction among kids and teens with ADHD all involved videogames. With any type of addiction, the best strategy is prevention.

If you have an older child or teen with a moderate or severe screen problem, then intervening is more difficult. Kids and teens who are addicted to screens rarely have any insight into their problem, so talking to them about their behavior and encouraging change is very challenging. It’s best to work with a child and adolescent cognitive behavioral (CBT) therapist who has experience treating screen addictions. A good therapist will work closely with both you and your child to set limits on screen use at home, and help your child learn to enjoy activities that don’t involve their phone, tablet, or gaming console. 

Screen addiction is a very real problem for many children with ADHD, and it’s not something that will simply get better on its own. Look out for the signs of screen addiction and get help if you think your child is struggling to manage healthy limits around screen time. 

What the Research Says

Unbiased research published by scientists who are unaffiliated with the cognitive training programs themselves provides the most reliable source of information about the programs’ effectiveness. Results from these studies aren’t always easily found in online searches, so many parents may not realize that currently in the United States and internationally there is a sizable investment in research on ADHD and computer-based cognitive training programs. Recently, a number of researchers have combined and analyzed the data from many studies so they could draw more accurate conclusions about the effectiveness of computer programs for kids with ADHD. Results from these studies have consistently indicated that children with ADHD do not show any improvement in ADHD symptoms, academic performance, behavior, or memory at school or at home after completing computer-based programs. When improvements were observed, they were limited to gains on the computer tasks that the children had spent hours practicing through the program. Unfortunately, improvements on computer tasks did not translate into real-world gains. Basically, computer-based programs help kids get better at completing the programs they are using, but they do not lead to observable improvements in ADHD symptoms or functioning.^1,2,3

Being an Educated Consumer

The current research suggests that parents should be cautious about enrolling their children in computer-based cognitive training programs for ADHD. For parents who are considering one of the many cognitive training programs currently available, ask the following questions as part of your pre-enrollment evaluation:

• How many research studies have been conducted with this particular cognitive training program? Who funded the research, an independent agency or the private company that owns the computer program?
• Was real-world improvement seen in ADHD symptoms and functioning at home and at school?
• How will you know if the program is effective and your child is actually improving?

Remember- you will see results at home or at school with any effective treatment. 

Also, ask yourself and your child the following question:

What activities will your child need to give up in order to find the time needed to complete the computer-based program? Every hour spent alone in front of a computer represents time that is not spent socializing or engaging in physical activity – both of which are especially important for kids with ADHD.

Computer-based cognitive training programs require a significant investment of time and money. Before enrolling, think about your child’s specific challenges and consider alternative targeted interventions with proven track records in the areas where your child needs help the most. These can be academic interventions, social interventions, programs that help kids learn to manage their emotions, or behavioral treatments that target ADHD symptoms specifically. Targeted interventions with a history of proven outcomes are most likely to lead to real-world results for your child with ADHD.

¹Rapport, M.D., Orban, S.A., Kofler, M.J., & Friedman, L.M. (2013). Do programs designed to train working memory, other executive functions, and attention benefit children with ADHD? A meta-analytic review of cognitive, academic, and behavioral outcomes. Clinical Psychology Review, 33(8), 1237-52.

²Sonuga-Barke, E., Brandeis, D., Holtmann, M., Cortese, S. (2014). Computer-based cognitive training for ADHD: a review of current evidence. Child and Adolescent Psychiatry Clinics of North America, 23(4), 807-24.

³Cortese, S. et al., (2015). Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child and Adolescent Psychiatry, 54(3), 164-174

Initiate the first meeting.

Teachers have 25-30 new students in their classroom at the start of the school year, and will probably not have an opportunity to reach out to each parent individually. So, take the first step by emailing or calling the teacher to schedule an initial 15-20-minute meeting at the beginning of the school year. It may seem like you will need more than 15 minutes to discuss your child’s ADHD, but longer meetings will be more difficult to schedule, and may provide more information than your child’s teacher can digest during this jam-packed time of year. Remember that this is just an initial meeting. There will be opportunities for ongoing communication throughout the school year.

Approach the meeting with an open mind.

Every parent walks into teacher meetings with mixed emotions at the start of the school year. If you have struggled to get your child’s needs met in the past, or had a challenging relationship with last year’s teacher, then it will be tempting to carry these negative experiences forward with you into the current school year. Even if you and your child have had positive experiences previously, you may worry that this year’s teacher will not live up to the high bar set by the wonderful teachers your child has had in the past. Regardless of your past experiences, try to view the new teacher and school year as an opportunity for a fresh start. Approach your child’s new teacher as a collaborator and partner. You are both invested in ensuring that your child has a great school year, and you both have important roles to play in making this happen.

Make most of your brief meeting time.

Make the most of the time that you have scheduled by thinking through the key points that you want to discuss in advance. Make notes about these points, and bring the notes with you to the meeting. Throughout the meeting, communicate in a manner that is brief and specific. Too much detail and too many tangential stories will make it difficult for the teacher to focus on the important information that you are sharing. When considering which topics to cover, aim to focus on these 4 important meeting goals:

1. Share essential information about your child’s ADHD.
   • How does ADHD affect your child academically, socially, behaviorally, and emotionally?
   • What was your child’s greatest struggle last year?
   • What is your child’s biggest strength?
   • What are some interventions or accommodations, including those in IEPs and 504 plans, that have previously helped your child manage his or her ADHD?
2. Learn about your child’s teacher’s prior experience with ADHD.
   • How many students with ADHD have they had over the course of their career?
   • What are some strategies that they have used to help students with ADHD?
   • What are their preferences when it comes to partnering with parents to help students with ADHD succeed?
3. Learn about the teacher’s impressions of your child so far.
   • What have they noticed about your child during the first few days of school?
   • Having observed your child, and having heard the information that you’ve shared earlier in this meeting, what do they anticipate some of the greatest challenges may be for your child during this school year?
4. Discuss next steps.
   • What is at least one action that you can take at home and the teacher can take in the classroom this week to help your child?
   • How will you and the teacher have regular communication going forward?
   • When should a follow-up meeting be held?

Initiating collaborative communication with your child’s teacher at the start of the school year will lay the foundation for a positive partnership that will help your child get the support that he or she needs throughout the year at school and at home. 

Help your child know what to expect.  Anxiety often stems from not knowing what to expect when we’re doing something new for the first time. While you can’t predict everything that will happen on the first day of school, there are things you can do to make the day feel more familiar and predictable for your child.

• Visit the school ahead of time and walk with your child to his or her new classroom. Allow your child to have some fun playing on the play structure or shooting hoops on the basketball court.
• Talk to your child about his or her new teacher. Share some of the good things that you’ve heard from other parents and kids. If it’s possible, have your child meet the new teacher ahead of time or create an opportunity for him or her to talk to a former student who enjoyed having that teacher in the past.
• Make sure your child is introduced to at least one classmate before the first day of school. If you’re new to the area, talk to neighbors or someone at your child’s new school to get tips on reaching out to some of your child’s peers ahead of time.
• Create a back-to-school morning routine and start practicing in the week leading up to the start of school https://huntingtonhelps.com/resources/adhd-blog/back-to-school-routines-for-kids-with-adhd. 

Encourage your child to share their feelings.  Some of our greatest fears can lose their power when we share them out loud. Not all kids are eager to talk about their anxiety, so some gentle encouragement may be needed.

• Ask your child questions about how he or she is feeling. Avoid emotionally loaded questions like, “Are you nervous about starting school this year?” Instead, ask neutral questions that allow your child to set the tone of the conversation. For example, “What do you think the first day of school will be like this year?” If he or she doesn’t respond to your direct questions, avoid pushing your child to talk. Instead, be on the lookout for times when your child casually mentions how they are feeling about the upcoming school year. Use those moments as an opportunity to listen and respond with empathy and encouragement.
• Empathize when he or she expresses feelings of anxiety, or when he or she shuts down and seems walled off. Let your child know that you understand that it can be hard to go back to school, and that he or she might wish that summer could go on forever. Normalize his or her feelings by sharing some of your own personal experiences with back to school jitters.
• Create space to focus on the positives. Anxiety causes us to naturally focus on the negative aspects of a situation. Remind your child about the things he or she enjoyed at school last year – even if he or she says that recess and art class were school’s only two redeeming qualities! It’s important for your child to have something to genuinely look forward to when he or she heads through the school doors on the first day.

Help your child feel in control of some aspects of his or her day. When kids return to school they have very little control over how their day will go. They are more or less told what to do and when to do it from the moment they wake up in the morning until school ends for the day. You can help you child feel more in control by allowing him or her to make choices and decisions about small things that will impact his or her day. Here are a few ways that you can build in some choices:

• Allow your child to pick out the snack that will be included in his or her lunch.
• Ask your child if he or she would like to get to school early to play on the play structure for a few minutes, or if he or she would prefer to arrive right on time and head straight into the classroom.
• Let them pick out his or her first day of school outfit.
• Ask if he or she would like to choose the radio station in the car. If you walk your child to school, ask if he or she would like to choose the route that you take.
• Engage in conversations about choices that your child will be able to make throughout the school year. For example, he or she may be able to choose a musical instrument to play, a sports team to join, or sign up for a special afterschool activity.

As a parent you can’t take away all of your child’s back-to-school anxiety. In fact, some anxiety is normal for everyone in the family at this time of year. But you can help your child cope with his or her anxiety by helping him or her feel more in control, creating space for him or her to share his or her feelings, and helping him or her know what to expect on the first day back at school.

While kids with ADHD do much better when they follow routines, they actually struggle to create and manage these routines on their own. Planning out a series of steps and sticking to the same order each time requires executive functioning skills that they are often lacking. In addition, without support from parents, kids with ADHD typically do not have the motivation required to initiate and follow a new routine. While ADHD definitely makes starting a new routine more challenging, as a parent there are steps you can take to get a back-to-school routine up and running successfully. Here 5 key components to creating a successful back-to-school routine for your child:

1. Start the first day of school bedtime and wake time at least one week in advance. Kids with ADHD are prone to sleep problems and often have a difficult time adapting to changes in their sleep schedule. Transition to an earlier bedtime gradually by moving the time up by 15 minutes each night during the week before school starts. On average kids need about 10-11 hours of sleep each night. So, bedtime should be no later than 8:30 or 9:00 if your child has a 7:00 wake-up time.
2. Design a morning checklist together with your child. Create a checklist of the steps your child needs to take every morning. Keep the list limited to no more than 6 or 7 items. Help your child become invested in the routine by involving him or her in the process of coming up with the checklist steps. Make the process fun by allowing your child to decorate the checklist once it’s been printed.
3. Create excitement. Kids with ADHD are most engaged when they are excited about what they are doing. Have a rehearsal where your child runs through all of the steps in the routine while you playfully use a timer to see how fast he or she can go. You can repeat the activity and challenge your child to beat his or her fastest time. Also, allow your child to earn a small reward on mornings when he or she completes the routine successfully.
4. Avoid screen time. Tablets, phones, and TVs can derail even the most well-planned morning routine, especially for kids with ADHD. Kids sit down in front of the screen intending to watch for only a minute, but then quickly lose track of time. So, don’t allow any screen time until after all of the morning routine steps have been completed. If your child struggles to turn off the screen when it’s time to leave the house, then it’s best not to allow any morning screen time at all.
5. Supervise your child during his or her routine. The ultimate goal with any routine is to have your child complete all of the steps independently. While every child can reach this goal eventually, many will need some assistance and prompting when they are starting off. So, check-in regularly with your child, and provide as much help and supervision he or she needs. Over time, the routine will become a habit your child will be able to go through all of the steps without any help or prompting.

Creating a strong back-to-school routine will go a long way in helping your child’s school year get off to a great start. Before you know it your child be following his or her routine every morning, and will be well on his or her way to developing an autopilot mode that will help him or her all year long!

1. Design a shopping plan with your child’s limits in mind. While you may be tempted to embark on a back-to-school shopping marathon so that you can finish everything in one day, chances are good that your child is not up to this monumental task. Instead, break the shopping trip up into chunks either by store or by category (clothes, school supplies, shoes, etc.). Plan to spend only as much time in each store as you think your child can reasonably handle. Remember that unlike typical shopping outings where you pick up some groceries or a few household items, back-to-school shopping requires your child to help make decisions about things you’ll be buying. Decision fatigue, and the irritability and frustration that accompany it, will inevitably creep in if you shop for too long.
2. Make a list and let your child check it off. Creating a list for each shopping trip will help you and your child stay focused on the things that you really need to buy. Empower your child by assigning him or her the task of checking off items as you go. Better yet, have your child write down the price of each item as it is purchased, so that he or she can track the amount of money being spent. When children pay more attention to cost, they may be more understanding when they ask for something extra and are told “No.”
3. Set clear expectations. Your child will feel more calm and patient while shopping if he or she knows what to expect before you leave the house. Let your child know which stores you’ll be visiting, how long you’ll be shopping, and what you’ll be buying (only items on the shopping list!).
4. Be prepared to help your child deal with temptations. When a store is filled with temptations, your child is going to see many things that he or she would like to buy that aren’t on the list. It hard for kids to be surrounded by so many things that they cannot have, and this is especially true for more impulsive kids who have ADHD. You can’t remove the temptations, but you can help your child cope with his or her impulsive feelings and the “need” to have so many things that he or she sees:
   • Create opportunities for choices. Empower your child by allowing him or her to make choices about the things that he or she is able to have. Let your child pick out his or her favorite notebooks, pencils, erasers, backpack, etc. If having too many options is overwhelming for your child, then point out two or three items that are a good fit for your child’s needs and your family’s budget, and allow your child to choose from this smaller selection.
   • Add extra items to a birthday, holiday, or future rewards list. Spending time shopping with your child actually provides an excellent opportunity for you to learn about things that he or she may want to earn as rewards for meeting behavior goals, or receive as gifts on his or her next birthday or holiday. So, if your child sees something that he or she wants, let him or her know that he or she can’t have it now, but he or she can add it to the reward or gift list. Some kids like to create the list as they shop, and others like to write out the full list from memory when they get home.
5. Praise your child. When you’re busy and stressed it can be easy to focus on all of the things that your child is “doing wrong” and forget to focus on everything that he or she is doing right. So, make a conscious effort to notice the times when your child calmly puts something back after he or she was told that he or she couldn’t have it or when he or she stayed by your side instead of wandering off. Praise your child and let your child know that you appreciate the way that he or she is behaving. Also acknowledge that it’s not always easy to follow the rules and accept tough decisions on school shopping days. The more positive attention your child receives from you, the more likely he or she will be to meet your expectations and enjoy the experience.

Back-to-school shopping isn’t easy for kids with ADHD or their parents. But when you’re prepared with a few key strategies and solid shopping plan you’ll be able to get your child everything that he or she needs and may even enjoy each other’s company along the way.

Fortunately, it doesn’t have to be this way. Using a few simple organization strategies before and during your trip will empower your children to keep their things organized. Kids with ADHD will learn that even though they may struggle to stay organized, there is a lot that they can do to keep track of their own things.

1. Plan and create an activity bag for each child. Before your trip, work with your kids to make a list of the games and activities that they will keep in the car. Provide each child with a reasonably sized bag and let him or her know that everything he or she brings needs to fit inside. Travel cosmetics caddies can be the best car activity bags. They can hang from a car headrest, they can easily fold up and be carried into restaurants and hotel rooms, and they have clear pockets for keeping things organized. Label each of the pockets with the items that should go inside, and your kids will easily know where their things should be stored. They can also check the pockets before they leave the car, restaurant, or hotel to make sure they haven’t left anything behind.

2. Clean out the backseat every time you stop for gas. Avoid letting wrappers, food, and other trash build up in the backseat by cleaning out the car every time you stop to refuel. Keep a trash bag in the car to make the cleanup easier. You can put your kids in charge of the clean-outs either by rotating the person responsible for the entire car, or by making each kid responsible for his or her own area. Make the task more fun by playfully scoring his or her clean-out efforts. Your kids will be aiming for 10s in no time!

3. Wet-wipes are your friend. Deal with spills and messes before they get sticky by keeping wet-wipes and paper towels in the back seat. Your kids can do most of the spill clean-up on their own, but double check when you stop to make sure there isn’t too much sticky goo left behind.

4. Pack only what you need. One of the best strategies for staying organized on the road is to bring fewer things with you on your trip. It’s always tempting to over pack, but it’s especially tempting with road trips because you’re not restricted by airline luggage limits. Resist the urge to bring everything but the kitchen sink, and pack only what your kids will really need. When it comes to packing kids clothes, try packing each day’s outfit in its own gallon-size ZipLock® bag. Put one complete outfit, including the shirt, shorts, socks, and underwear in a bag labeled with the day of the week and your child’s name. Do this for every day of the trip, and your child will easily be able to find what he or she needs. As an added bonus, you’ll have only packed the clothes that are necessary and nothing more.
5. Use a pop-up hamper. Dirty clothes can pile up quickly, and before long they can take over a hotel room. Keep the laundry under control by bringing along a pop-up hamper. These collapsible hampers take up very little space in a suitcase, and make it easy for kids (and adults) to see where their dirty clothes should go at the end of each day.

With a little planning and a few good strategies you can help your kids stay organized while they’re on the road, even when they have ADHD. Everyone will feel more relaxed, and your kids will feel proud of how well they were able to keep track of their belongings independently.

In 1980, the term Attention Deficit Disorder (ADD) was included in the DSM for the first time. Two types of ADD were described: ADD with hyperactivity and ADD without hyperactivity. Overtime, healthcare professions became concerned that the term “ADD” didn’t place enough emphasis on hyperactive and impulsive symptoms that so many people with the disorder experience. So, in 1987 the name was changed to Attention Deficit Hyperactivity Disorder (ADHD) and has stayed the same ever since. Today ADHD is described in the DSM-5 as having 3 possible presentations (or subtypes):

Predominantly Inattentive Presentation: This presentation is assigned to children and adults who experience challenges that are solely related to inattention symptoms. These symptoms reflect difficulty sustaining attention, persisting at tasks or play activities, following through on instructions, giving close attention to details, organizing tasks and activities, and keeping track of belongings.

Predominantly Hyperactive Impulsive Presentation: This presentation is assigned to children, and occasionally to adults, who experience challenges solely related to the hyperactive/impulsive symptoms. These symptoms reflect excessive movement, including difficulty remaining seated, often fidgeting, and constantly being on-the-go as if “driven by a motor,” as well as excessive talkativeness, and impulsive behavior such as blurting out answers, difficulty waiting, and frequently interrupting others.

Combined Presentation: This presentation is assigned to children and adults who experience symptoms in both the inattentive and hyperactive/impulsive clusters. It’s the most common presentation diagnosed in children and adolescents.

Often, when someone has received a diagnosis of the Predominantly Inattentive Presentation of ADHD, they will refer to themselves as having ADD rather than ADHD. It’s an easy way to describe the fact that they struggle with focus and concentration, but aren’t necessarily hyperactive or impulsive. It is much easier to day “ADD” than it is to say “ADHD-Predominantly Inattentive Presentation” whenever you’re talking about your diagnosis! And these patients aren’t alone. There is discussion among many clinicians and researchers about whether the term ADHD should be changed to better reflect the symptoms and challenges that come with the disorder. For example, the majority of children and adults with ADHD struggle with organization, time management and following multi-step instructions. None of these challenges are clearly captured by the ADHD label. In addition, for children and adults who have the inattentive presentation of ADHD, it doesn’t necessarily make sense to have the term “hyperactivity” included the diagnosis. Some psychologists have suggested that Executive Function Deficit Disorder may be a better term for ADHD, especially for the inattentive presentation.

Over the next decade, as scientists learn more about ADHD and the biological underpinnings of the disorder, we can expect to see changes in the way healthcare professionals think about and label the disorder. With so many possible presentations and combinations of ADHD symptoms, clear descriptions and labels will make it easier for people with ADHD to communicate about their experiences and will create pathways for the development of more targeted and personalized treatments.

Here are 5 creative activities that will help get your child learning while having fun this summer.

1. Family Game Nights. Almost all board games involve some elements of reading, writing, math, planning, or strategic thinking. When kids are immersed in their favorite games they don’t realize that they are actually practicing their academic skills. Great games for practicing math skills are Phase 10, a rummy-style game that combines math and strategy and Sumoku, a crossword-style numbers game that helps kids practice foundational math concepts. To encourage reading, try Apples to Apples, which requires reading on every card, and Bananagrams, a Scrabble-like game that’s allows kids to create words without the rules and limitations that come with using the Scrabble board.
2. Write a Blog. Blogging provides kids with an excellent opportunity for self-expression while they are practicing writing and communication skills. Blogging is one writing activity that most kids are excited to try because they can choose topics that they find interesting, and they can share their interests with family and friends. Positive feedback from blog readers helps build confidence and encourages more posts (and more writing!). Choose a blogging site that allows you to password protect blog posts, so they can only be viewed by readers with the password. And always review your child’s blogs before they are posted. Teach your child about online safety by discussing ground rules for blog topics and blog content. Edublogs (edublogs.com) is a great blogging platform created just for students. It allows for password protected posts, and is free for student users.
3. Expert for a Day. Sometimes the best way to learn something is to teach it. When we teach others we are more attentive to details and we think more critically and deeply about a topic. Encourage your child to teach you and other members of the family by making them an “Expert for a Day” this summer. With the help of your child find a local historical site or educational attraction (the zoo, a marina, a nature preserve) that you and your family can visit this summer. Have your child learn about the site or attraction through research online and at the library. Allow your child to take the lead on your family outing and play the role of tour guide for the attraction. Encourage your child to take notes while he or she researches so he or she can remember the important details when you are all at the site. Your child will love taking the lead and the whole family will learn from the experience.
4. Cooking and baking are simple, every day activities that provide excellent learning opportunities. Kids use their math and reading skills, practice following multi-step instructions, and even learn about science! The Exploratorium’s Science of Cooking website (https://www.exploratorium.edu/cooking/index.html) includes recipes and activities that teach kids about the science of cooking in a way that is engaging and interactive. Their Bread Science 101 page (http://www.exploratorium.edu/cooking/bread/bread_science.html) teaches about the chemical reactions that occur when dough ingredients are mixed together and yeast is added to help the bread rise. Combine this website with a simple “bread in a bag” recipe (http://allrecipes.com/recipe/85114/bread-in-a-bag/) and you have a learning experience that every kid will enjoy.
5. EarthCaching. Everyone loves to go on a scavenger hunt! Geocaching has taken the hunt to a new level with hidden containers (caches) all over US (and the world) that can be discovered using a simple smartphone GPS tool. To make Geocaching more educational, focus your family’s search on EarthCache sites. EarthCaching is a scavenger hunt for geographical and geological caches. EarthCache sites are listed on geocaching.com and in the Geocaching app. When you search for a Geocache on the site or app, check the “EarthCache” box under “Geocache types” to find these unique sites!

Finding creative ways to engage your child in learning over the summer will go a long way in helping him or her start the new school year off with confidence. Your child will enjoy learning and will be excited to “grow his or her brains” while having fun!

Decades of research have in fact established that genes play a significant role in the development of ADHD. For parents of kids with ADHD, it’s probably not surprising to hear that ADHD often runs in families. Most children with ADHD have at least one close relative with the disorder, and one-third of fathers with ADHD have a child who has ADHD themselves. The strongest evidence for the role of genes in the development of ADHD comes from studies of identical twins. Researchers have found that if one twin has ADHD there is a 90% chance that the other twin will have ADHD as well. This is compared to a 25% chance among non-identical siblings. Overall, scientists estimate that ADHD has a heritability factor of .76, meaning that genes are responsible for about 76% of the differences that contribute to the development of ADHD. For comparisons sake, genes are responsible for about 70% of individual differences in IQ, with the remaining 30% being determined by non-genetic factors, like access to high quality early education.  As with IQ, whether or not an individual develops ADHD is largely influenced by genetics. However, environmental, or non-genetic, factors also play a role. These factors include exposure to toxins, maternal smoking during pregnancy, and premature birth (among others). If a child is exposed to one or more of these environmental factors, then he or she is at risk for developing ADHD. If a child is exposed to these environmental factors and he or she also carries genes that predispose him or her to ADHD, then his or her likelihood of developing the disorder increases significantly.

If we know that genes play an important role in the development of ADHD, is a genetic test available? Many parents ask this question, and why not given that genetic testing exists for many medical disorders and even for ancestry DNA profiles? While scientists can confidently establish a genetic basis for ADHD from twin and family studies, identifying specific genes associated with the disorder is a much more challenging task. ADHD affects multiple parts of the brain and impacts a wide range of cognitive functions. No single gene or chromosomal region is responsible for all ADHD symptoms. Instead, multiple genes make small contributions to the development of the disorder. Researchers have identified a few of these genes already, but they have a long way to go before they have a clear genetic picture of ADHD. So, currently no genetic test for ADHD is available.

Despite not yet having a clear understanding of every piece of the ADHD genetic puzzle, researchers are optimistic about where this line of research is headed. In the future, scientists may be able to conduct genetic testing that will measure ADHD susceptibility, even in very young children. This testing would open the door for prevention and early intervention opportunities that could greatly improve the lives of children and families who are at risk. Equally as exciting is the possibility of using precision medicine, which optimizes treatment based on an individual’s genetic profile, to tailor ADHD medications and behavioral interventions for each child. This could greatly reduce the amount of trial and error involved in finding the “right” ADHD medication or the most effective behavioral and cognitive interventions.

Understanding that ADHD is strongly influenced by genetics should help parents recognize that they are not “to blame” for a child’s symptoms. There is, however, a great deal that parents can do to help their child manage their ADHD and reach their full potential.  In the future, with access to a clear picture of each child’s unique ADHD genetic profile, parents, teachers, and healthcare professionals will have the ability to be even more effective with the interventions they use to support children with ADHD.

So, what should parents do? If your child struggles with regulating his or her attention and transitions around screen time, then keeping videogames and movies off limits during the trip is your best option. If this doesn’t feel manageable or realistic, then follow these three guidelines to keeping screen-related disruptions to a minimum:

1. Limit screen sessions to 30 minutes. Keeping your child’s screen sessions relatively short, with longer screen-free breaks in between, will help your child regulate his or her attention. He or she will have an easier time transitioning off the screens, and he or she should have fewer “screen time” cravings after the trip.
2. Create a screen schedule and stick to it. Plan out times when screens will be allowed and share this schedule with your child ahead of time. Keep track of screen session time by using the timer on your phone (it’s very easy to lose track and accidentally allow your child a much longer session then was planned). Do the same for the time between screen sessions. This way, when your child asks you when he or she can have the device back you can simply tell him or her to check the timer.
3. Reward your child. If your child is not used to having limits around screen time, then adjusting to a schedule may be challenging. Acknowledge this when you discuss the schedule and your expectations with him or her ahead of time. Let your child know that he or she will earn a reward at the end of the trip if he or she keeps a positive attitude while sticking to the schedule. Make sure to praise him or her along the way and let him or her know that he or she is well on the way to earning a reward.

Wondering what you should do to keep your child entertained in between screen sessions? The best activities are those that your child is able to look forward to and feel excited about. So, start by asking him or her to come up with some ideas. Bring some of your own ideas to the table too. Look for special activities that your child doesn’t typically have an opportunity to do every day, to keep the novelty and interest high. Here are a few ideas to get you started:

1. No Mess Creative Toys. No mess creative toys and art supplies, like molding and sculpting Wikki Sticks (wikkistix.com), Travel Spirograph (www.originalspirograph.com/), and dot art created with inexpensive school supply stickers (https://tinyurl.com/yb9f276d), can keep kids entertained for hours.
2. Mad Libs. Mad Libs (http://www.madlibs.com/) “fill in the blank” stories will have everyone laughing, and will help the time fly by.
3. Comic Books and Graphic Novels. If your child is a resistant reader, then reading a chapter book during a long car or plan ride isn’t going to seem like an appealing activity. Instead, substitute with graphic novels or comic books. Many kids wish they could choose graphic novels or comic books as their “assigned” reading during school year, so having the opportunity to pick them as their vacation reads will feel like a treat.

This family vacation, keep screen time to a minimum and fill the time with fun activities that your kids will enjoy.  With a little planning and creativity, your vacation will be off to a great start this year!

Are you considering a summer ADHD medication holiday for your child? Start by talking with your child’s doctor.  Having answers to the following questions will allow you make an informed decision, and will help you create an effective plan for getting the most out of a summer medication break. 

1. How will we evaluate changes in my child’s ADHD symptoms? Ask your doctor about rating scales you can complete before and after your child discontinues his or her medication. It can be helpful to also have camp counselors or summer instructors complete rating scales. Make sure you or an instructor is able to observe your child during some academic activities over the summer so that your child’s ability to stay focused can be assessed.
2. How will the break affect my child during summer activities? For some children, ADHD medication primarily serves as a tool for managing symptoms during activities that place a high demand on attention, like sitting in a classroom, reading a book, or doing homework. For other children medication also significantly helps manage attention, impulse control, and hyperactivity when they are playing sports, interacting with friends, participating in less structured games and activities, and traveling on family vacations. Share your child’s summer plans with the doctor and ask how a summer medication break may affect your child during his or her activities.
3. Are there any safety concerns around taking a medication break? If your child is very impulsive and required intense supervision before starting an ADHD medication, discuss whether a summer medication holiday is compatible with your current childcare and vacation plans.
4. What will we do if we need to reintroduce a modified ADHD medication schedule that can accommodate summer academic activities? If you would like to take a summer medication break but are concerned about the impact it will have on your child’s summer learning activities, talk to your doctor about a modified summer medication plan. Can the frequency of his or her medication be reduced by taking it only on days when academic activities are scheduled? Or, if he or she is attending a summer program that only has academic enrichment activities in the morning, is a short-acting medication that wears off by the afternoon an option?
5. If medication needs to be restarted this summer, what steps should be taken? Have a plan in place for restarting medication in the event that your child’s ADHD symptoms begin to interfere with his or her daily activities this summer. Will you be able to quickly schedule an appointment with your child’s doctor? Or will they be able to provide a simple phone consultation? If you need to restart your child on a lower dose of his or her medication and gradually work back up to the current dose, how long will that process take?

Summer ADHD medication holidays can be beneficial for some children with ADHD. By creating a plan and working closely with your child’s doctor the medication break can go as smoothly as possible. You’ll be setting your child up for success so that he or she can enjoy the summer and make the most of his or her time off from school!

Make the most of these activities and strategies by reviewing your practice test results. Identify key areas where you need the most improvement, and choose the activities that tap into those areas. Also, consider using motivators. For example, commit to studying your test prep materials for 1 hour, and then reward yourself for time spent on one of the following activities.

• Play Word Games. Word games can make the task of building your vocabulary less tedious. While there are many websites available that provide vocabulary building games and exercises, maximize your study time by using a tool that is specifically designed for the SAT. Word Dynamo is an excellent app (for iOS and Android) created by Dictionary.com. They have specific SAT prep games, with word matching, crossword puzzles, and digital flashcards. You can track your progress and earn points and badges to help you stay motivated.
• Memorize Math Concepts with Pinterest. If you are a visual learner, then pictures and images will go a long way in helping you grasp and memorize math concepts. You’ll find thousands of helpful math-related graphics on Pinterest. Print them off, or better yet, copy them by hand into your own sketchpad. In the process of recreating the diagram or image you’ll encode important details into your memory. Just make sure to give yourself a time limit for each diagram so you don’t spend hours focused on only one math concept!
• Read the New York Times. Students have been told to read the New York Times to improve their vocabulary for just about as along as the SAT has been in existence. While you may be tempted to tune out as soon as you hear “New York Times,” do yourself a favor and check out the 182 Questions to Write or Talk About section designed specifically for high school students. (https://learning.blogs.nytimes.com/2013/06/13/182-questions-to-write-or-talk-about/ ). It contains interesting student opinion questions, like “Is cheating getting worse?” “Do you think a healthier lunch program is a lost cause?” and “Is school designed more for girls than boys?” with responses and opinions from students across the country. Each question is linked to a relevant New York Times article or opinion piece. When the article you are reading is an opinion piece, make notes about the argument the author is building and the techniques they use to strengthen their logic to help yourself prepare for the SAT writing section. You can also add your own responses to the online dialogue as a way to practice your writing skills.    
• Play SAT Jeopardy. Jeopardy Labs (www.jeopardylabs.com) was created by an undergraduate student at Washington State as a platform to help students and teachers create their own online Jeopardy games. The site contains games created by previous users, like New SAT Math (https://jeopardylabs.com/play/new-sat-math) and SAT writing (https://jeopardylabs.com/play/sat-writing-jeopardy-3). You can play as a single player or you can play with friends for some friendly competition. Since one of the best ways to learn new information is to create materials yourself, consider creating your own Jeopardy games on this site based on practice test questions that you’ve found challenging.
• Read for Pleasure. Reading is one of the best things you can do to prepare for the SAT. The test itself entails reading long, dense passages that require extended focus and concentration. So, the more reading practice you have the better. In addition, many of the vocabulary words on the SAT can be found in moderately challenging non-fiction books. Pick a non-fiction book on a topic that you find interesting and dive in! As you come across unfamiliar words, look up their meaning online and make an effort to understand how they are used in context.
• Watch Educational Videos. Give yourself a break from reading by watching educational videos. Review your practice test results and identify a few areas where you need to improve your knowledge. Focus your video search on these topics. Most people will easily be distracted by fun, non-educational videos when they search on YouTube, so stay on task by searching on www.Hippocampus.org instead. This site contains links to an impressive collection of educational videos that cover almost every topic on the SAT.

• Study with Friends. If you’re an extrovert and find it hard to stay motivated when you study alone, organize a study group with some of your most motivated friends. Use your study group time to play competitive games, like Jeopardy, or practice exercising and reviewing your writing skills. Quiz your friends on vocabulary and math facts using flashcards that you create yourself or find online. Just remember to carve out independent study time as well, especially for information that you need to rehearse and commit to memory.

Preparing for the SAT takes time and commitment, but parts of the process can be fun! Do yourself a favor and don’t wait until you are a couple of months away from the SAT to start some of these activities. Building your SAT reading, writing, and math skills over time will give you a big advantage in the long run.

1. Start with clear expectations. Let your child know that summer represents a break from school, but not a break from learning. Describe the summer backslide and explain that by reading and doing math problems over the summer he or she can help his or her brain grow stronger so that school will be easier when he or she returns in the fall. Develop a summer learning schedule and share the plan with your child in advance. It may be helpful to also highlight the amount of time he or she will spend on fun activities, like attending camp or going to the pool, so he or she can clearly see that the entire summer isn’t being consumed by academic tasks.
2. Set goals and track your child’s progress. Even with the best of intentions, very few kids will be satisfied with learning for learning’s sake over the summer. Set clear goals for daily academic activities and give your child the opportunity to track his or her progress. Seek out summer learning programs that focus on building specific academic skills and monitoring growth and progress over time.
3. Be a role model for your child. Set your own summer learning goals and share them with your child. Your goals can be simple, like reading for a few minutes every day or spending time each week learning something new about an interest you would like to explore. Set goals for yourself and share them with your child. You can both track your progress together.
4. Set your child up for success. Much of the stress that kids with ADHD feel during the school year comes from struggling to keep up with their peers and hold their own in classroom settings that aren’t designed for their learning style. Counteract these negative experiences by providing your child with the opportunity to experience academic success in the summer. Set initial goals that are easily achievable, like completing math worksheets that are quite simple, or reading books that are well within his or her current ability level. Then gradually make the goals and academic material more challenging. Aim for targets that are just ahead of where your child is at currently, but are still within his or her reach.
5. Praise and reward effort. Spending time on math and reading over the summer, and working to achieve academic goals will be challenging for most kids with ADHD. Let your child know that you recognize his or her hard work and praise his or her effort. If your child needs extra motivation, then consider offering activities or privileges that can be earned for achieving his or her goals.

Encouraging kids with ADHD to participate in reading and math over the summer isn’t always easy. So, make a solid plan, set clear expectations, be a good role model, and praise and reward their effort. The payoff will be great when their school year gets off to a great start in the fall.

1. Use an Online Mneumonic Generator

A mneumonic device is a technique for remembering facts using a series of common words that are strung together in a memorable way. For example, a common mneumonic device for remembering the order of mathematical operations (Parentheses, Exponents, Multiply, Divide, Add, Subtract) is “Please Excuse My Dear Aunt Sally.” The first letter of each word in the sentence maps to the first letter of each of the mathematical operations. The trick is to come up with a sentence that is more memorable than the series of facts you’re trying to memorize. An online mneumonic generator, like the one provided by Spacefem, can provide excellent inspiration when you’re looking to create your own mneumonic devices quickly and easily.

2. Create Flashcards and Test Your Knowledge

There is a reason why flashcards have been around since what seems like the beginning of time – they work! Flashcards are one of the most effective study methods available because they prompt you to actively recall information from memory based on only a few details displayed on the front of the card. This active learning process is far more effective at encoding information in your memory bank than more passive processes, like reviewing your notes or re-reading a book chapter. Flashcards also help you maximize your study time by helping you sort information you have already learned from fact you haven’t yet memorized. While flashcards are effective, historically they haven’t been the most exciting and engaging tool. Fortunately, online flashcard tools, like Quizlet, are more fun and more effective. Quizlet allows you to create your own online flashcards or choose from decks of cards that have already been created. You can add pictures and audio to your cards to make them more interesting, and you can track your progress as you memorize new information. If you really want to keep yourself focused and engaged, try one of Quizlet’s study games and compete against the clock or against other users.
www.quizlet.com

3. View Video Presentations

Repetition is necessary when you’re studying, but it can get boring! Using multimedia presentations to review a subject can help keep things interesting. If you’re struggling to clearly understand a particular concept from your notes, watching the same information presented in a slightly different manner can help bring clarity. Unfortunately, combing through all of the videos available online to find those that are accurate and high quality can be tricky and time consuming. You also run the risk of getting distracted the minute you start looking at any videos on YouTube! To avoid these pitfalls, keep your search focused and productive by going to Hippocampus.org. Hippocampus has an extensive collection of online learning videos that cover just about any topic you might be studying, and the quality of the content is generally excellent.   
www.hippocampus.org

Taking advantage of these online tools will help keep you focused and engaged next time you’re studying. You’ll be more prepared than ever for your big exam, and you’ll have the grades to prove it!     

Music has many positive benefits including enhancing our mood, providing a distraction from negative thoughts, and even boosting feelings of self-empowerment – all of which are directly related to academic performance. Research has shown that listening to calming music before an exam can reduce anxiety, and listening to upbeat and empowering music before a challenging task can improve your mood and your self-confidence. Elite athletes incorporate music into their pre-game routines in order to mentally prepare themselves for competition. In fact, there’s some scientific evidence that shows that pre-game music does positively impact their performance. In a study of basketball players who were struggling at the free throw line, researchers found that listening to upbeat music before hitting the court improved the players’ free throw percentage. The players in the study told the researchers that listening to the music helped them control their mood and their negative thoughts about shooting. These same principles apply to academic performance!

When it comes to picking your own pre-exam music, think about the emotional state you want to achieve and find songs that will stir up those emotions. If you tend to feel down and discouraged before an exam, look for music will inspire you to feel positive, energized, and hopeful, like gold medalist Michael Phelps who blasts “Levels” by Avicii to get himself pumped up before a big race. If you tend to feel nervous and anxious, look for music that is reassuring, like Olympic soccer player Megan Rapinoe, who shakes off her pregame nerves with “Shake it Off” by Florence + the Machine. If your self-confidence often wanes before a big test, look for empowering music. According to a study conducted at Northwestern University, songs with a heavy bass, like Queen’s “We Will Rock You,” have the power to increase confidence and make you feel more in control. 

When you’re listening to music before an exam, use that time to give yourself an even greater mental boost by visualizing your best possible performance. Imagine yourself confidently tackling the test questions, and easily recalling answers from all of the material that you have studied. Remind yourself that you’ve worked hard to prepare for the exam and that all of your hard work and effort will pay off. Think back to a time when you aced an exam and how that made you feel. Imagine yourself feeling that same way when you’ve completed this final exam.

Music can be a powerful tool for boosting your mood and self-confidence going into your final exams. Just as music has inspired elite athletes to perform at their peak under pressure, when paired with a smart study plan it can help inspire you to reach your full potential on your exams this year.

Our thoughts, feelings, and behaviors are all dependent on each other. If we want to change the way we behave or act, and the way we feel about the things that we have to do, then we can start by changing the way that we think. So, if you want to develop study habits that will allow you to put your best foot forward, then challenge the negative thoughts that might be getting in your way.

There are common negative thought patterns that everyone experiences sometimes. These thoughts are more likely to come up when we’re faced with something that makes us nervous, stressed, or overwhelmed – like studying for a big exam!

All or Nothing Thoughts. With these types of thoughts, you’re either great at something or terrible at something. You need to do things perfectly, or not at all. When it comes to studying, this kind of thinking can cause you to set an impossibly high standard for yourself. If you think that you need to study perfectly and get a top score on the exam, then you’ll quickly become overwhelmed and anxious when you think about all of the work you need to do. On top of that, the possibility of failure seems very high since anything less than a perfect grade will be a disappointment.

All or Nothing Reframe: Remind yourself that you won’t get a top score on every test, and that is okay. No single test is going to make or break your final grade. If you study and prepare for the test then you’ll have worked hard in order to do your personal best.

Turning Small Problems into Catastrophes (Catastrophizing). When people catastrophize they take one small incident and allow it to grow larger and larger in their mind until it’s been built up to be a complete disaster. For example, if you get one bad grade on a math quiz, you think that this just proves that you’re terrible at math. You’ll probably fail every quiz and test for the rest of this year. This will show up on your college applications and now there is no way you’ll ever get into your first-choice school!

Catastrophizing Reframe: Remind yourself that this is just one small problem, and that you don’t know what it means for the future. You’re not a fortune teller! Try to put the problem out of your mind. Learn from any mistakes that were made, and start fresh today.

“Should” Thoughts. When you have a long list of rigid rules about things you “should do” in order to study effectively, you set yourself up for guilt and regret when you’re not able to follow through. This is especially true when you’re lists of “shoulds” is impossibly long, impossibly challenging, or simply not a good fit for your personality or study style. So, if you thought that you “should have” started studying on Monday, but you didn’t start until Thursday, then you’ll feel very guilty and defeated before you even sit down to study.

“Should” Reframe: Try not to think about what you “should have done” and instead think about where you are at right now. Make a plan based on the amount of time that you have available and do your best right now. Then, when you’re getting ready to study for another test in the future, think about the lists of rigid “shoulds” that you have in your mind. Ask yourself:  Are they are realistic? Are they a good fit for you?  Are they helping you move forward or just making you feel guilty and holding you back? Talk to a teacher or tutor about finding new strategies that will work for you.

Challenging these three common negative thought patterns will go a long way in helping you change your study mindset. You’ll feel less stressed when it’s time to start studying, and you’ll tackle your study plan more effectively. You’ll shift from avoidance mode to action mode, and before you know it you’ll be well on your way to achieving your best on that test!  You’ve got this!!

So, what do kids want to talk about with their doctor? What are the questions that are on their mind? The kids in this study were presented with a list of questions related to ADHD or ADHD medication and were asked to choose the questions that they would like to ask. On average, kids selected 8 questions. The number one question, chosen by 75% of the kids, was Will I outgrow my ADHD?  Other top questions included: Do a lot of people have ADHD?  Are there other things I can do at home to help my ADHD? Should I take my ADHD medication every day?

The results from this study suggest that opportunities are being missed that would otherwise allow kids with ADHD to feel heard and to participate in their treatment from an early age. ADHD is a chronic disorder, and one that requires a high level of parent involvement throughout childhood and adolescence. However, parent involvement doesn’t need to be at the exclusion of child participation in appointments, treatment planning, and day-to-day management. In fact, gradually encouraging your child to take a more active role in managing his or her ADHD can be empowering.

If your child is accustomed to sitting in the background while the adults in the room discuss ADHD, then it will probably take some encouragement on your part to get him or her involved in his or her own care. The following tips will help you prepare your child to talk to his or her doctor at the next appointment.

1. Start the conversation at home. A few weeks (or more) before your child’s next appointment, start having conversations about questions he or she might like to have answered by his or her doctor. Many kids feel embarrassed about having ADHD, and may hold back during these conversations with their parents. That’s okay. Take it slow, and help your child feel more comfortable by sharing some things that you’ve been curious about when it comes to ADHD.
2. Follow your child’s lead. You want to encourage your child to talk to his or her doctor if he or she has questions, but you also don’t want to force the issue. If your child seems overwhelmed in conversations with you at home, ask them to privately write down one or two questions he or she might like to have answered about his or her ADHD. Tell him or her to share the questions with you or keep them private, it’s his or her choice. The goal is to get your child thinking about his or her ADHD and things he or she might like to ask the doctor, even if he or she is not ready to talk about them right now.
3. The day before your child’s next appointment ask him or her if he or she would like to have the opportunity to ask the doctor some of the questions you had discussed (or that he or she had written down). If he or she hasn’t done so already, encourage your child to write these questions down ahead of time so he or she can recall them easily during the appointment.

4. During the appointment, create space for your child to speak by letting the doctor know that your child has some questions. Then turn the floor over to your child.

5. Teens and tweens may prefer to talk to their doctor privately about their ADHD concerns. While parents should always be involved in appointments that include a discussion of ADHD symptoms and medication side effects, the doctor can set aside a few minutes for an individual discussion with your child. Encourage your teen to ask the doctor if they can have a few minutes to discuss ADHD one-on-one.

By creating opportunities for your child to actively participate in their ADHD treatment you are providing an opportunity for your child to learn skills that will serve him or her well for a lifetime. The more empowered and the more involved he or she is in his or her treatment, the more your child will feel in charge of his or her ADHD.  

For additional study information: Betsy Sleath et al. (2017). Youth Views on Communication about ADHD and Medication Adherence. Community Mental Health Journal, 53: 438-444.  
DOI: 10.1007/s10597-016-0078-3

With these benefits, it can seem like a no brainer to take the SAT in August instead of during the school year, especially when you have ADHD. But before you jump online to register, consider some unique challenges that come with taking the test over the summer when ADHD is in the mix:

• There is such a thing as too much free time! The biggest challenge is that the same free time that makes it more feasible to study for the SAT over the summer also makes it more difficult to stick to a study plan. Children, teens, and adults with ADHD thrive on structure. So, without the structure of school and extracurricular activities, it can be hard to start tasks and get things completed efficiently and effectively when you have ADHD.
• Studying during the summer? Getting motivated to study is hard enough during the school year when you have ADHD. Over the summer, when free time has typically been spent relaxing and recharging, mustering up the motivation to study is especially hard.

Even with these challenges, most students with ADHD will benefit from taking the SAT over the summer rather than during the school year. The trick is anticipating the challenges and creating a plan that will help you to be successful right from the start. So, what are some steps you can take to make the August SAT work for you?

1. Create structure. Create and commit to a structured test prep plan. SAT test prep programs provided by tutoring centers provide built-in structure and accountability, and are a great fit when you have ADHD. With any test prep plan, whether it’s one that you create, or one provided by a tutoring center, there will be an at-home study component. Schedule study time blocks in advance, and set mini goals for each study session. Write these goals down and check off your progress along the way.
2. Strengthen your motivation. Help yourself stay motivated on a day-to-day basis by coming up with activities that you can “earn” by sticking with your study plan. It can be simple things, like committing to going to the pool or hanging out with friends only after you’ve first met study goals for the day. Or it can be something bigger, buying tickets to a concert once you’ve met your study goals for two weeks in a row.
3. Plan ahead and create consistency. In order to reach your full potential and get your highest possible score on the SAT you will need consistency in your summer schedule. This means avoiding long breaks (more than a few days) from studying, especially in August. Talk to your family about scheduling vacations earlier in the summer rather than closer to your SAT test date. If you have a summer job, talk to your employer about creating a relatively consistent schedule each week and working fewer hours the week prior to the SAT.
4. Don’t go it alone. Everyone needs support when they are working toward a long term goal like studying for the SAT. This is especially true when you have ADHD. Ask for help from a tutor, sibling, parent, or friend who can help you stay accountable and stick to your plan. Check in with this person every week and review the progress you’re making toward your goals.

The August SAT presents a real opportunity to get a jump start on taking the SAT before the demands of the school year become overwhelming. With a little planning and support you can make the summer SAT work for you!

According to the American Academy of Pediatrics, ADHD can be reliably diagnosed in children as young as 4-years-old. Although it’s important to note that not all kids with ADHD can be identified this early. Kids who receive diagnoses at this young age are more likely to be boys than girls, and their symptoms will cluster more around hyperactivity and impulsivity than difficulty paying attention. Why? During the preschool years the demands placed on kids’ attention are generally fairly light. At school or day care, activities are brief, they change frequently, and they are designed to be engaging and active. They are exactly the type of activities that kids do well with when they have short attention spans! As a result, attention challenges may not be obvious at this age.

If you’re the parent or teacher of preschool age children, or have spent any time around preschoolers, then you know that in general kids at this age are very active, and most behave pretty impulsively – they act first and think later. So, how can you tell the preschoolers with ADHD from the preschoolers without ADHD? The kids with ADHD are much more hyperactive and impulsive than their peers. They rarely sit still, although some may sit for longer stretches of time if they’re watching TV or playing videogames. They run and climb on things excessively, to such an extent that their parents and teachers worry about their safety. Some of these kids may have already had trips to the ER because of falls and other accidents. Their high activity levels and impulsive behavior also cause serious challenges at school or day care. Their parents receive calls from school at least once a week, and sometimes kids with these ADHD symptoms are asked to leave their day care or preschool program altogether. At home, mealtimes are a challenge because of difficulties with staying seated at the table, even for a few minutes. Going to a restaurant, church, or participating in any activity that requires sitting feels next to impossible, even when parents provide activities to keep their kids entertained. More active family outings may feel difficult too, because it’s hard to keep the child from running off or having a meltdown if he or she doesn’t get their way.

When it comes to diagnosing ADHD in preschool children, higher levels of activity and impulsive behavior alone aren’t enough. Diagnosing ADHD at any age can be challenge, but in young children it is especially difficult. Kids who are anxious, have learning differences, a history of trauma, social challenges, or other mental health concerns can behave in ways that mimic ADHD symptoms. A thorough assessment by a medical doctor or psychologist to rule out other causes is essential. This assessment should include gathering detailed information from parents, teachers, and the child to determine whether or not ADHD is present.

When a preschool child is diagnosed with ADHD, behavioral interventions, especially those that are put into place by parents and teachers under the guidance of a trained therapist, are the first line treatment according to the American Academy of Pediatrics. Kids who don’t improve with intensive behavioral interventions can be treated with medication, in addition to ongoing behavior therapy. ADHD medications have been shown to be effective with kids as young as 4-years-old, although they may not work quite as well as they do for older children and may be accompanied by greater side effects. One treatment to avoid is one-on-one therapy, where the child talks directly to the therapist week after week without parent involvement in the sessions. At this age especially, it is essential that parents are involved in sessions and are learning new skills that they can use at home to help their child.

If you suspect that your preschooler may have ADHD, talk to your pediatrician. Let them know about your concerns and request a thorough assessment. If ADHD is the source of the problem, then start treatment as soon as possible. Getting help for your child’s ADHD now will set him or her up for success in elementary school and beyond.

Television: Your child may find homework less painful when he or she is watching television, but chances are his or her work performance is suffering. In a study conducted at a renowned ADHD center, scientists examined the effects of television on schoolwork completion and focus in kids with ADHD.¹ When the television was on in the classroom, kids with ADHD, on average, completed significantly less schoolwork than when the television was turned off. They were also off-task more frequently and had to be reminded more often by the teacher to get back to work.

Music: Like television, music can help make boring tasks less painful. For example, studies have shown that people will stay on a treadmill longer and find that time goes by faster when they’re listing to music. But is music too much of a distraction for kids with ADHD who need to focus on schoolwork? In the television study described above, the researchers also studied the effects of music and found it to be much less distracting than television. For most of the kids with ADHD, background music didn’t have any effect on their performance, and 12% of the kids actually completed more work when they were listening to music! Additional studies of kids with attention problems have demonstrated improved performance on memory tasks when music without a vocal track is played in the background.

White Noise: While your child may not be specifically asking to have white noise on in the background while he or she works, research shows that it may actually be helpful for kids with ADHD. A recent study compared the effect of white noise on the cognitive performance of three groups of kids: those with exceptionally high levels of attention, those with average levels of attention, those with low levels of attention². For the least attentive kids, white noise (at a medium to high volume) significantly improved their cognitive performance. Interestingly, for the kids in the high attention group, white noise worsened their performance. It had no effect on kids with average levels of attention. A handful of additional studies have produced similar results for kids with attention challenges.  

Bottom Line: Skip the television. If your child wants to listen to music or white noise, then test it out. Does he or she make more careless mistakes on his or her homework, does he or she take longer to complete it? Or, if there’s no change in his or her work, but your child seems happier, more calm and content, then that would count as an improvement. Let your child know ahead of time that you’ll be monitoring his or her progress. Maybe that will even motivate him or her to work better, so he or she can keep the music or background noise around!

¹Pelham, W.E., Waschbush, D.A., Hoza, B., Gnagy, E.M., Greiner, A.R., Sams, S.E….Carter, R.L. (2011).  Music and Video as Distractors for Boys with ADHD in the Classroom: Comparison with Controls, Individual Differences, and Medication Effects. Journal of Abnormal Child Psychology, 39(8), 1085–1098. https://doi.org/10.1007/s10802-011-9529-z

²Helps, S. K., Bamford, S., Sonuga-Barke, E. J. S., & Söderlund, G. B. W. (2014). Different Effects of Adding White Noise on Cognitive Performance of Sub-, Normal and Super-Attentive School Children. PLOS ONE, 9(11), e112768.

 Choose a strategic location. Have your child play where you can see them. Simply having an adult present in your child’s line of sight helps kids with ADHD stay safe and engaged. So, avoid sending your child off to his or her bedroom or playroom alone. Instead, have your child bring a few toys and activities to a common room in the house. Just make sure you leave time for clean-up when free play is over!

Have creative play toys and activities available that your child finds interesting. Kids with ADHD often need a high level of stimulation in order to stay engaged. Every kid is different when it comes to the toys and activities that they find interesting, so work with your child to find creative options that will hold his or her attention for at least 10 minutes, if not longer. Make sure these activities are largely mess free (steer clear of paint and glue!), and can be done independently without close adult supervision.

Limit the options. This may seem counterintuitive, but giving kids with ADHD fewer options during free play will actually help them be more engaged. Many kids with ADHD will become overwhelmed if they are presented with too many choices, and some will even meltdown. So, present a few free play options, about 3 at a time, and change them out regularly to keep things interesting.

Use a Timer. Some of the biggest free play conflicts happen when it’s time to transition to the next activity. It’s natural for kids to want to continue to play when they’re having a good time, so use a timer to make the transition easier on everyone. Have the child set the timer at the start of free play. Give a warning when there are 5 minutes left, and let your child know that free play ends when the time goes off. By having your child set the timer, you’re helping him or her take ownership of the process, so that the narrative can change from “My parents are making me stop playing! to “My timer went off so free play time is over.”  

Post a list of Free Play Rules. Having basic ground rules for free play provides necessary structure for your child without interfering with his or her creativity and imaginative play. Create a list of just 3 or 4 basic rules and post them someplace where they are visible to your child. At the start of free play, read through this list with your child and let him or her know that free play will need to end early if he or she needs to be reminded to follow the rules more than three times (the number of reminders can be tailored to your child’s level). The best rules are those that cover a wide variety of behaviors and tell kids what to do rather than what not to do. For example, rules like, “start cleaning up when the free play timer rings,” “stay in your play area,” “show good sportsmanship when playing with others,” and “use your inside voice,” encourage a wide range of positive behaviors.

Catch Your Child Being Good! When your child shows positive behaviors during free play, make sure to let him or her know that you have noticed! Praise the good behaviors as they happen, or at the end of free play if you want to avoid interrupting his or her play. Your child will feel proud of the fact that he or she was able to play well independently, and will be more likely to demonstrate these positive behaviors again.

Free play is important for all kids, so help your child carve out time each day to play creatively outside the structure of typical extracurricular activities. Shorter free play times may work better for many kids with ADHD, so start small. With a little structure and planning your child can be engaged, content, and creative during free play time.

When you look closely at the research you’ll find that involvement in extracurricular activities actually comes with many positive benefits, even at an early age. A recent study funded by the National Institutes of Health found that when infants (9-18 months) who were overly motivated by food were enrolled in music classes with their parents, they began to find more pleasure and motivation in activities other than eating.¹ The researchers propose that this may help prevent obesity later in life. For adolescents, most research studies have found that participation in after school activities is associated with improved well-being and school engagement. Even with the positive study findings, when it comes to the number of activities kids participate in, there does seem to be a tipping point. Enroll them in too many extracurricular activities, especially those that are performance or achievement-based, and kids and teens can end up stressed and anxious. How many activities are too many? That really depends on the child. Some kids with ADHD need more downtime in order to recharge. Others thrive on back-to-back activities each day. But even for kids who thrive on a busy schedule, some free time is important for their development. Like participation in extracurricular activities, research shows that free time and free play come with many benefits. Kids and teens do in fact need this time to help develop their creativity and imagination, as well as the ability to think for themselves without been told what to do by adults. However, they likely do not need large daily swaths of free time to reap these benefits. As parents of kids with ADHD the trick is finding enriching, motivating afterschool activities, and balancing these activities with at least a few weekly opportunities for safe and enjoyable unstructured time. 

What are some signs that your child or teen’s extracurricular activities or schedule may not be meeting their needs?

• Your child asks to skip activities, or regularly complains of headaches or stomach aches when it’s time to attend.
• Your child seems less motivated at school, during afterschool activities, or at home.
• Your child’s grades are falling and they don’t have time to get the extra academic support that he or she needs.
• Your child is regularly going to bed late in an effort to fit in school, extracurricular activities, and homework.
• Your child’s activities are all performance or achievement-based, leaving little time to explore new activities without the pressure of having to meet the expectations of adults.
• Your child is showing symptoms of unhealthy levels of stress (see my previous post for more details on signs of stress in teens with ADHD).

If your child or teen is displaying one or more of these signs, it may be time to take a step back and reconsider his or her schedule and activities. Talk with your child or teen about how he or she is feeling about his or her extracurricular activities. Are there activities that he or she enjoys more than others? Do they think that he or she needs more downtime? Kids and teens will often have difficulty noticing when they are overscheduled and may be reluctant to cut back on their activities. As a parent you have an opportunity to help them problem solve, streamline their schedule, and build in necessary downtime (I’ll talk about strategies for creating manageable downtime for kids with ADHD in my next post). With your help your child will reap more joy and enrichment from his or her activities, and will build motivation and academic skills along the way.  

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¹ Kong, K. L., Eiden, R. D., Feda, D. M., Stier, C. L., Fletcher, K. D., Woodworth, E. M., … Epstein, L. H. (2016). Reducing relative food reinforcement in infants by an enriched music experience. Obesity, 24(4), 917–923.

Parents can usually identify unhealthy levels of stress before teenagers are able to do so themselves. Parents can also see the bigger picture, focus on long-term goals, and access help in ways that teenagers with ADHD often cannot. However, as a parent spotting signs of stress in a teenager with ADHD can be tricky. Many of the signs of teenage stress overlap with symptoms that typically accompany ADHD or are known side effects from ADHD medications:

• Poor concentration
• Sleep problems
• Anger outbursts
• Anxiety
• Poor appetite
• Headaches or stomach complaints
• Social withdrawal
• Taking longer to complete schoolwork and/or missing deadlines

So, when your teenager seems highly irritable, his or her grades are lower than you think they should be, he or she is complaining that he or she never has enough time to finish homework, and talks about not being able to focus in class, is that stress or is it ADHD? Every teen is different, but there are some signs that will indicate that unhealthy levels of stress may be part of the picture:

• Differences in personality during school breaks vs. when school is in session. Many teens will be less irritable, angry, or frustrated when school isn’t in session. However, if the change is dramatic, to the point where during breaks or summer vacation you find yourself thinking things like, “I’m so glad to see my child finally starting to act like her usual self again,” then that is a sign that your teen may be experiencing unhealthy stress during the school year.
• Loss of interest and enthusiasm. If your previously energetic, enthusiastic, and curious teen has started to seem uninterested in things, especially things that he or she usually enjoys, then that may be a sign of stress. It’s typical for teens to shift their interests and become less enthusiastic about things that they may have enjoyed when they were younger; but they should still be interested in something, even if it’s a new activity or subject in school.
• Hinting at being overwhelmed. Some teens will actually tell you that they are stressed out or overwhelmed, but many don’t think about themselves in these terms. Instead you may start hearing them say negative things about their ability to get things done, or their life in general. Things like: “I can’t do it.” “I’ll never get everything finished!” “It’s too much.” “I hate school!” When you try to help or problem-solve they may simply shutdown and refuse to try, not because they don’t care but because they are overwhelmed.

If you think your teen may be overly stressed, then start by having a conversation. Pick a low-key moment with your teen and start off by simply acknowledging that you’ve noticed that he or she has a lot on the plate right now. Ask what it feels like to have so much going on, and if he or she ever has moments where it feels like too much. Many teens will open up and will talk about themselves, but don’t feel pressured to get them to talk about everything in a single conversation. It’s okay to simply use the first conversation as an icebreaker on the topic. Sometimes shorter conversations with parents are all teens can handle when the subject matter is intense or serious. Therapists in your area or at your child’s school can also help you figure out if stress is having a negative effect on your teen. So, don’t hesitate to reach out and ask for help if you’re worried. You’ll be getting the support that you need, and you’ll be serving as a great role model for your teen by showing that it’s okay to ask for help when you need it.

A team of researchers had a different idea. What if the fidgeting and constant movement actually serves a purpose? What if moving actually helps kids with ADHD focus on their work, think more clearly, and stay alert and engaged when they are doing something that is not particularly interesting to them? To test this theory Dr. Rapport and his students developed a series of studies that precisely measured the movements of elementary school-aged boys with ADHD in two different scenarios. In the first scenario, the boys sat and watched a movie, which is an activity that most people can focus on fairly effortlessly. In the second scenario, the boys completed computer-based tasks that required them to concentrate and use their “working memory” – working memory is what allows us to store information in our mind for short periods of time and use the stored information to do things like calculate math problems in our head. During the movie there was very little movement from the boys with ADHD, but as soon as they switched gears and started their working memory computer tasks the amount of movement increased dramatically. The boys without ADHD moved a bit more during the working memory tasks than they did during the movie, but not nearly as much as their ADHD counterparts. In a follow-up study, the researchers looked more closely at how movement impacted the boys’ level of accuracy on the working memory tasks. Sure enough, for most of the boys with ADHD, the more they moved the more accurately they performed! The opposite was true for the boys without ADHD. Their accuracy actually decreased the more that they moved.

Why does movement helps kids with ADHD perform better? It’s probably tied to the fact that the brains of kids with ADHD need more stimulation in order to “click into gear” and focus than the brains of kids without ADHD. So, when an activity isn’t very interesting or stimulating, kids with ADHD need an extra push to get their brains working, and moving their bodies gives their brains the push that they need. Everyone actually experiences this sometimes. Next time you’re in a boring meeting or are really feeling like you need another cup of coffee, pay attention to your body. You’ll probably find yourself fidgeting or moving around in an effort to stay alert and engaged. The difference for kids with ADHD is that they feel like this on a daily basis.

So, does this mean that we should stop telling kids with ADHD to stay in their seat and sit still? If a child is in a situation where their movement isn’t distracting to other kids around them, and they’re staying on task and getting their work done, then I would recommend allowing them to keep moving. If the child is in a classroom and other kids are getting distracted, or the child’s desk has to be moved away from his peers because of his movement, then the answer isn’t as straightforward. In classroom situations it can be helpful to find tools that allow kids to move or fidget without disrupting the group. Different tools work for different kids, so finding the right option might take some trial and error. In general I recommend fidget tools that can be attached to desks or chairs rather than loose fidget objects that can be lost or turn into distracting toys. Bouncy Bands attach to chairs and desk legs and can help facilitate quiet feet and leg movement (http://bouncybands.com/). Or, if a standing desk is an option at your child’s school, many come with a fidget bar already installed that is similar to a swinging footrest. For kids who fidget with their hands a simple strip of Velcro attached to the bottom of the desk can be a good sensory fidget tool.

Next time you see your child fidgeting or moving during homework time, spend some time observing him before you decide whether or not you should tell him to sit still. The movement might just be helping him build up the brain power he needs in order to concentrate and do his work well.

From a scientific standpoint, studies like these help advance our understanding of ADHD and will hopefully one day lead to more targeted treatments and more specific diagnoses. For example, previous studies hadn’t identified the amygdala, which helps us regulate our emotions, as a region of the brain that is smaller in kids with ADHD. Now, with this new information, ADHD researchers will likely invest more time and money into developing behavioral treatments and medications that target emotion regulation. From an everyday, real-world standpoint, these results also serve another purpose - one that may be equally as important. For parents and teachers who too often hear that ADHD is caused by poor parenting or poor teaching, and for children with ADHD who are too often told that they should just “try harder” and “apply themselves,” these results provide reassurance that ADHD is a real brain-based problem and that no one should be blamed for the fact that the symptoms exist.

While parents very often find this research helpful when it comes to understanding ADHD overall, it also brings up important questions about what this research means for their children specifically:  

Can I ask our pediatrician to order a brain scan so I can confirm that my child has ADHD?
Currently there is no brain scan methodology available to doctors that will help them diagnose ADHD. In research studies the reported differences in brain volume are actually very small. So small in fact that these differences are only observable and meaningful when you are able to combine brain scan data from multiple people into a single study. With the limited technology and information that we have available today, we can’t reliably identify these differences in a single child with ADHD. Hopefully one day in the future this will be possible!

If the differences were not found in adults, then does this mean that my child’s brain will eventually catch up and they won’t have ADHD anymore?
Remember that this study compared brain regions in people with ADHD and people without ADHD. To qualify for the “ADHD” group, adults were required to have a current ADHD diagnosis. So, even without smaller brain volume, adults in this study were experiencing ADHD symptoms. This means that it’s not just differences in brain volume that causes ADHD symptoms, its other aspects of brain functioning as well. However, these study results do show us how the brain changes over time, and they may help explain why many ADHD symptoms look different in adults than they do in kids.

If my child’s brain is different, is there anything we can really do to help him get over his ADHD?
Knowing that ADHD is a brain-based disorder doesn’t change the fact that there are many effective behavioral, educational, and medication-based treatments that work for kids with ADHD. These treatments all help compensate for the brain differences that we see in these research studies. On top of this, many factors that have been shown to improve “brain health” and promote brain growth and development may help kids with ADHD if they are used long-term. This includes things like regular physical activity, healthy food and nutrition, getting enough sleep, close family relationships and friendships, and participating in a wide-range of academically and mentally challenging activities.

Scientists are just starting to learn about differences in the ADHD brain, and their findings will eventually lead to new treatment options. In the meantime, we can use this information to help ourselves improve our understanding of ADHD and expand our thinking about ADHD treatments to include healthy lifestyle choices that promote long term brain growth and development.    

 Read the full study here: http://www.sciencedirect.com/science/article/pii/S2215036617300494

Scientists aren’t sure why exercise leads to improvement in ADHD symptoms and other areas of weakness for kids with ADHD, but they have some theories. During exercise the brain releases several chemicals – serotonin, dopamine, norepinephrine  - which are all important for attention and emotional control. In fact, many of the stimulant medications used to treat ADHD target these same chemicals. So, it may be this exercise “brain boost” that drives improvements in ADHD symptoms, mood, social skills, and motor control. Exercise also improves blood flow in the brain and promotes the development of new brain cells, two factors that may also lead to improvements in ADHD symptoms.  We’ll learn more about how exercise and ADHD symptoms are related as additional research is done.

In the meantime, take advantage of what we already know and help your child get active! It’s easier to get some kids moving than others. If you have a naturally active child, then finding time and an activity for him or her to do regularly may be your main challenge. If your child is more of a couch potato, then you’ll need to be a bit more strategic about how you get them moving!

• You’ll have the most success long-term if you find activities that can fit into your child’s regular routine. Simple things like getting to school 15 minutes early so your child can spend time on the play structure, taking time a couple of evenings a week to supervise your child while he or she rides their bike outside or plays in the backyard, or talking to your child’s afterschool program about the availability of activities that require kids to be physically active.
• If your child is spending most of his or her time indoors these days, look into apps and websites that encourage physical activity. I’m a big fan of GoNoodle, an app that allows kids to choose from guided activities like dance- and sing-alongs, Zumba® for kids, track and field activities, and more.
• Get physically active with your kids. Outdoor activities like swimming, hiking, and skating are great, but simple activities can be good too. Invite your child to come with you when you walk the dog or work in the yard. You can turn every day activities like these into special one-on-one or family bonding time. If you’re stuck indoors, try to get creative. Kids always love a spontaneous family dance party!

We’ve always known that exercise is great for physical health, and promising new research is showing that it may help with ADHD symptoms too. While it’s not a cure for ADHD, exercise is a great supplement to any ADHD management program. So, give your child the boost he or she may need by helping him or her be more physically active every day

When he was in college, entrepreneur and author Francesco Cirillo realized that he could accomplish much more work in short spurts of time than in longer study sessions. He used a timer shaped like a tomato to track his time, and ultimately created a system called The Pomodoro Technique to help him get his work done efficiently (“pomodoro” means tomato in Italian). The Pomodoro Technique is simple. It emphasizes short bursts of work time, and it allows you to build in rewards for your hard work and effort – all features that make it an excellent fit for anyone with ADHD. So, how does it work?

1. Break your homework down into 25 minute segments. Start by listing all of the assignments that you need to complete. For longer assignments, create a list of smaller chunks that can be completed in 25 minutes or less.
2. Prioritize your assignments. Select the assignment, or portion of the assignment, that you would like to complete first.
3. Set your timer for 25 minutes and get to work. Commit to working on the assignment until the timer goes off. You’ll be surprised to see how quickly 25 minutes goes by!
4. When the timer goes off, review your work. When the timer rings look over the work you’ve done. Did you meet your goal?
5. Take a 5-minute break. At this point your brain will need a break. Take 5 minutes to do something unrelated to homework. Get up and stretch, get something to eat or drink, shoot hoops with a Nerf ball in your room, play with your dog. Do something active and try to avoid anything that will cause you to lose track of time (which is probably just about anything on your phone or computer!).
6. After 5 minutes, repeat the cycle. Work for another 25 minutes, followed by a 5-minute break.
7. Reward yourself. After 4 successful 25-minute work cycles, reward yourself with a longer 20- or 30-minute break. Do something fun during this break! Just remember to keep track of time (set your timer!) and get back to work after 20 or 30 minutes have passed.

When you break your homework down into 25-minute segments you’ll find yourself more focused and more relaxed. You may even find that you finish your work faster, so you spend less time on homework and more time on the things you enjoy!

1. Start small. Combat feelings of being overwhelmed by starting assignments quickly and starting small. The number one thing that I have seen help teens (and adults) with ADHD who procrastinate is starting on a project, essay, or study plan shortly after it has been assigned. The longer you wait the harder it is to get started. Getting started can just mean spending as little as 5 or 10 minutes working - just enough to make a dent in the assignment or task. Getting started builds your confidence and makes the task much easier to begin again when you’re ready to work for a longer stretch of time.
2. Create checklists. Many assignments and study plans will seem overwhelming when you think about them as a whole. But, when you break them down into smaller parts they’ll start to seem much more doable. Break each assignment or study plan down into a checklist of manageable steps, and cross items off your list as you complete them. Not sure how to break an assignment down into smaller pieces? Start by thinking about the very first thing you need to do. Maybe it is reading a chapter and taking notes. Then think about the next step - review the notes and identify an essay theme; and then the next step – create an essay outline, etc. Before you know it you’ll have a full list. If you’re still not sure how to break an assignment down, ask for help from a teacher or friend. You might need some guidance before you’re ready to do it on your own.   
3. Feed the need for instant gratification. Assignments, projects, and tests will always come with delayed rewards. Keep yourself motivated by giving yourself rewards along the way. Rewards can be things you like to do or things you want to buy. If there’s a show that you really like to watch or a videogame that you love to play, consider only allowing yourself to watch it or play it whenever you finish an assignment. Other times, keep it off limits. If there is something you would really like to buy, ask your parents if they’ll help by contributing money toward the item every time you complete an assignment or study for a test in advance. Sometimes having someone else in charge of handing out your rewards can be helpful, especially if you think you’ll be tempted to reward yourself even when you haven’t really earned it.
4. Avoid procrastination triggers. What’s the number one thing you do when you procrastinate? Are you on your phone? Playing a videogame? Hanging out with friends? Whatever it is, it will continue to trigger procrastination as long as it’s around when you should be working. In many ways procrastination is a habit, and triggers make all habits harder to break. So, put your phone in another room even if it’s only for 30 minutes, don’t allow yourself to play the videogame until you’ve finished your work, or go to a quiet place away from friends until you’ve accomplished what you need to get done. If websites are your trigger and you need to use your computer to do your work, then consider using a temporary website blocking app that you control. I’ll review my favorite apps in my next post.

Get help when you need it. Reaching your full potential with ADHD means having to rely on other people to help you accomplish some of your goals. When it comes to long-term projects or subjects that are a struggle, ask for help if you’re not making progress on your own. If you have been planning to start studying for the SATs for months but haven’t even looked at a single vocabulary word, then chances are you’re going to need someone to help you create and stick with a study plan. If you feel like you’re falling behind in a subject and this is making it harder than ever to finish assignments on time, then talk to your teacher or find a tutor. Everyone does better when they have someone to help them get started, stay on task, and catch up on material they may have missed or don’t understand. With ADHD having someone to help is even more important, so don’t go it alone. Sometimes something as simple as asking a friend to call and remind you to get to work can go a long way.

Everyone procrastinates sometimes. It’s human nature. But when you procrastinate so often that it prevents you from reaching your full potential and adds stress and anxiety to your life, then it’s a problem. You’re not alone. Most people with ADHD (and many people without ADHD) struggle with procrastination. The good news is that you can break the procrastination cycle with two steps: first identify the ADHD tendencies that cause you to procrastinate and then make some relatively simple changes that will help you overcome these challenges.

Common ADHD tendencies that lead to procrastination are listed below. Think about which of these apply to you - for some people it may be all five and for others it may be just one or two.

• Seeking Instant Gratification. With ADHD comes a tendency to prioritize things that are fun in the moment over things that are less enjoyable now but come with a delayed reward. Working on assignments and studying for tests are both activities with delayed payoffs. Sometimes the delay is very long, like when you study for months to prepare for the SAT. Other times it can be relatively short, like when you start working on an essay a few days before it’s due. In many cases the delayed payoff for your effort can be big – like excellent scores on the SAT! But when you have ADHD it’s hard to be motivated by a delayed reward even with big payoffs. So, instead of getting started on things you logically know you need to get done, you’re likely to do something immediately fun and rewarding instead - like playing videogames or chatting with friends.
• Feeling overwhelmed. When you have ADHD you can easily feel overwhelmed by longer assignments and exams that require a lot of preparation. It can be hard to know where to start or how to break the assignments or study plans down into smaller manageable chunks. No one wants to feel overwhelmed, and when you procrastinate you’re able to avoid this feeling – at least for a short time. Unfortunately, when you procrastinate you ultimately feel more overwhelmed in the long run.
• Time management. Estimating the amount of time it will take to complete an assignment or study for a test can be difficult when you have ADHD. You’re more likely to underestimate the amount of time you will need, and you may have trouble paying attention to the amount of time that has passed once you start working. Both of these ADHD tendencies make it difficult to get started early on projects and manage your time well so you’ll finish by the deadline. 
• Self-confidence. When you’re not confident in your ability to write a strong essay or get a good grade on a test, then it can be very difficult to get started. Self-defeating thoughts start to creep in, your anxiety goes up, and an already challenging task becomes even more unappealing. Many people with ADHD struggle with self-confidence, especially when it comes to school, so it’s not surprising that this might be causing some difficulties now.
• With ADHD it’s very easy to get distracted by almost anything, especially anything with a screen. Before you know it you’ve been sucked into your phone for an hour and genuinely have no idea how much time has passed! Once you’re distracted by your phone or computer it can be even harder to switch gears and get started on the work you’ve been avoiding.

Did you see yourself in any of these tendencies? Pay attention to your thoughts and feelings over the next few days as you get started on assignments or procrastinate instead of getting work done. See if you notice any other tendencies popping up. Once you’ve identified your own patterns you’ll be ready to take action and make some changes.  In my next post I discuss some simple steps that will help you stop procrastinating so you can turn in assignments on time, with less stress, and earn better grades!

Research shows that test anxiety is generally caused by factors related to fear of failure, unrealistic expectations, negative self-talk, being underprepared for the exam, and a history of poor test performance. For kids with ADHD, additional factors like low self-esteem, poor study habits, organizational difficulties, problems with chronic procrastination, and difficulty staying focused during class and during exams also contribute to test anxiety. Because of these additional factors, kids and teens with ADHD will need extra support from parents, teachers, and school counselors to overcome their test anxiety. Here are a few tips to help your child or teen get started:

1. Study Skills. Strong study skills will lay the foundation for improved test performance, self-confidence, and reduced test anxiety. Unfortunately most kids are never actually taught how to study! Most kids without ADHD will not pick up good study strategies on their own. Instead they will need coaching on specific study skills that will enable them to be successful. Enroll your child in a study skills program at his or her school or in an afterschool program at a local learning center. You can also check out some home-based study skills programs. Personally, I like SOAR Study Skills by Susan Kruger.
2. Relaxation Exercises. Your child will benefit from learning at least one relaxation exercise that he or she can use before and during tests to reduce anxiety. The relaxation techniques should be simple things that your child can do without having to rely on a phone or tablet app. For younger kids, PBS provides some helpful instructions on calming breathing exercises (http://www.pbs.org/parents/adventures-in-learning/2015/09/calming-breathing-exercise-for-kids/). For teens, AnxietyBC has a "How to Chill" webpage with a variety of relaxation exercises that can be used anytime and anywhere (http://youth.anxietybc.com/relaxation).
3. Take the pressure off. Help your child or teen learn that his or her self-worth and self-esteem are not based on test scores. Point out all of the things in your child's life that will continue to go well regardless of how he or she performs on his or her next exam. Share all of the things that you love about your child that have nothing to do at all with his or her grades or test scores!
4. Reduce distractions and request extended time on exams. Kids with ADHD may experience more test anxiety when they are in distracting classrooms or when they are taking timed tests. Consider requesting school accommodations that will allow your child to take tests in a quiet space and with extended time. Once your child has learned new study skills and has a better handle on his or her test anxiety, he or she may no longer need these accommodations and can return to taking tests in the regular classroom.
5. Work with the school counselor. School counselors typically have a great deal of experience with helping kids overcome test anxiety. They can help your child learn strategies of tackling negative self-talk, fear of failure, procrastination, and can teach relaxation techniques. They can also help your child learn to advocate for himself or herself and learn to ask for extra help from teachers when needed.

Test anxiety is a very real problem for many kids and teens with ADHD, and it's not likely to get better on its own. Help your child master test anxiety by learning study skills, practicing relaxation exercises, and taking advantage of helpful resources at school. With the right skills and strategies your child's anxiety will go down and his or her test scores will go up in the process!

In more mild cases, handwriting difficulties may be due to factors directly associated with ADHD, like weaknesses in executive functioning or fine motor control. In more severe cases, a written expression learning disorder (dysgraphia) or a motor control disorder (developmental coordination disorder) may be an underlying issue. So, if your child or teen with ADHD struggles with handwriting, he or she is probably not being careless or failing to take pride in his or her work. In fact, he or she may care very much and want to have neat handwriting but face challenges that make it difficult for him or her to achieve this goal. Fortunately, as a parent you can help your child improve his or her handwriting and compensate for their challenges.

1. Empathize with your child. If your child or teen has had persistent problems with handwriting - so much so that he or she can only write neatly if he or she works at a painfully slow pace or her or she seems unable to write neatly or efficiently at all, then writing is probably much harder for them than it is for most other kids his or her age. Chances are that over the years he or she received a great deal of negative feedback and criticism from adults and classmates about his or her handwriting. On the flip side, he or she probably also received very little praise when he or she did put effort into writing well. Let your child know that you recognize that writing is difficult for him or her, and acknowledge his or her effort even when his or her written work doesn't look as neat as you'd hoped it would. This validation will go a long way in helping your child follow through when you try to help him or her improve his or her handwriting, and will help lower his or her anxiety and stress overall.
2. Get an evaluation. Persistent handwriting difficulties require an evaluation to determine the underlying cause of the problem. The evaluation should include an assessment of learning disorders and coordination problems, and should provide recommendations for programs and services to address the handwriting issues, as well as school accommodations (e.g., being allowed to use a keyboard, modified homework assignments, etc.). A psychologist or educational therapist will be qualified to complete this evaluation.
3. Get your child involved in a handwriting program. For children with ADHD who do not also have a learning disorder, a targeted handwriting program may be all they need to see improvement. An experienced occupational therapist at your child's school should be able to help your child get started with a program. Most programs are specific to kids in elementary school and take either a multisensory approach or a cognitive approach to teaching handwriting. Multisensory approaches engage touch, sound, sight, and other senses and use multi-media, while cognitive approaches focus more on imitation, practice, and self-evaluation. Some kids will respond better to one approach over the other, but it can be difficult to predict which will work best for your child. Research does tell us however, that regardless of the approach it is essential that the handwriting program include regular practice sessions – at least 20 hours of practice over the course of a few weeks or months. The program should also include regular evaluations to determine whether or not handwriting is improving. If you don’t see improvement with regular practice over the course of a few months then it's time to try a different approach. If you'd like to try a program at home, Handwriting Without Tears is an evidence-based multisensory program that includes many opportunities for practice through workbooks and an iPad app.
4. Teach keyboarding early. Keyboarding isn't a replacement for handwriting, but it is an essential tool for kids and teens with handwriting challenges. Help your child learn to type as early as possible, and request that your child be allowed to type his or her homework assignments. If you have a teen, encourage him or her to take an online keyboarding course that will help him or her become faster and more efficient at typing.
5. Provide an incentive. Kids with ADHD struggle with motivation, especially for tasks that are hard or painful for them – like handwriting. So, even if your child or teen wants to improve his or her handwriting in the long term, chances are that he or she will go out of his or her way to avoid any handwriting task or practice exercise in the short-term. Help him or her overcome this resistance by providing an incentive for working hard on his or her handwriting. Allow him or her to earn points, privileges, or tangible rewards each time he or she practices without whining or complaining.

Dealing with handwriting problems can be challenging for kids with ADHD as well as their parents and teachers. But improvement is possible with a proper assessment, solid instruction, practice, and some very motivating rewards for all of your child's hard work.

5 Strategies for Giving Effective Instructions:

1. Always get your child's attention first. Kids with ADHD often have trouble shifting their attention from one thing to the next. So, don't assume that your child is paying attention when you speak. Make sure you are in the same room as your child, then say your child's name, ask him or her to look at you, or put your hand on his or her shoulder. All of these steps will help ensure that he or she is ready to take in what you have to say.
2. Give only one or two instructions at a time. Most children with ADHD can only absorb one or two instructions at a time, maybe three if they are a bit older. If you chain too many instructions together you will exceed what their mind can process and will compromise their ability to follow through on anything that you've asked them to do.
3. Tell your child what to do instead of what not to do. Make it easier for your child to follow through by telling him or her exactly what it is that you want them to do, and don't leave it up to their interpretation. For example, if your child is running down the stairs and you tell him or her to "stop running" he or she can choose to slide down the bannister and still comply with your instruction. Instead, be clear and direct and tell him or her to, "Please walk down the stairs."
4. Avoid "asking" your child do to something. It feels very natural for us to ask someone do something in the form of a question, "Would you get me a cup of coffee?" We communicate with other adults like this all the time and in many instances it would be rude not to - "Get me a cup of coffee now!" But, when you're giving instructions to your child, especially your child with ADHD, the same rules don’t necessarily apply. When you phrase an instruction as a question your child can take you quite literally and simply say no. "Would you clean up your toys?" can result in this response, "Um, not now, I'm busy." Well, you asked and they answered! If you instead say, "Please stop playing and clean up your toys now," you're not asking your child for a favor. You're telling him or her what you need him or her to do, and he or she will be more likely to follow though.
5. Give your child time to react. It takes many kids with ADHD a little bit longer to process information than you might think, and in general kids process information more slowly than adults. So, give your child at least 5 -10 seconds to follow through before you repeat the instruction or start to feel ignored.

When you follow these 5 simple steps consistently you'll be surprised by how much better your child follows through when you ask him or her to do something. In fact, he or she may even show up with socks and shoes on both feet the next time you ask!

Executive functions are brain-based abilities responsible for helping us with organization, focus, planning, delayed gratification, and emotion regulation. They represent the brain's central executive, responsible for overseeing the management of our decisions, behaviors, and emotions - especially when we are planning and working toward achieving a specific goal. Executive functioning skills exist on a continuum. Some people having very strong executive functioning abilities (these are people who are planners and seem to always be on top of everything in their busy lives!) and others have weaker executive functioning skills. As you might have guessed, research has shown that kids and adults with ADHD generally have weaknesses in executive functioning skills.

Dr. Thomas Brown, a leading expert on executive functioning skills and ADHD, breaks executive functions down into six separate interconnected clusters. As you read though the summary of these clusters below, think about your child and his or her specific strengths and weaknesses in these six areas. It might be helpful to consider these clusters within the context of an everyday activity like completing homework or getting ready for school in the morning:

1. Analyzing and Activating: Taking a big picture overview of the job that needs to be completed, organizing thoughts and materials, prioritizing tasks, and initiating work.
2. Focus: Focusing attention on the project or task, staying focused, and shifting attention back to the task in the fact of distractions.
3. Effort: Continuing to put in effort until the task is completed, and working at a pace that isn't too fast and careless or too slow and unproductive.
4. Emotion: Managing frustration when things get tough.
5. Memory: Remembering and recalling the steps and information that is needed in order to reach a goal, and using "working memory" to make mental calculations along the way.
6. Action: Monitoring progress and adjusting actions and plans as needed until the goal is reached.

All children develop executive functioning skills gradually as they age. A five-year-old child has limited executive functioning abilities, and will struggle to work consistently toward a goal or complete a multi-step task. As they age their executive functioning skills will gradually develop and by adolescence they will see significant gains in their ability to achieve long term goals and complete complex tasks. However, when a child has ADHD these executive functioning skills develop more slowly. In fact, it's not uncommon for a child, adolescent, or young adult with ADHD to have executive functioning skills that are developmentally about two years behind their peers. This is one of the reasons why a very bright student with ADHD might struggle to stay organized or complete and turn in simple homework assignments. Many aspects of the student's intelligence are highly developed and possibly even advanced, but the executive functioning skills that would allow them to reach their full academic potential are delayed.

As parents, if you can identify which executive functioning skills are weak areas for your child, then you can focus on teaching him or her these skills and providing supports that will help your child compensate until his or her skills are more developed. There are a number of excellent books available that you can use as a guide. My favorites are Smart but Scattered: The Revolutionary "Executive Skills" Approach to Helping Kids Reach Their Full Potential and Smart but Scattered Teens, both by Peg Dawson Ed.D. and Richard Guare, Ph.D. As you read and learn more about executive functioning you may just find that a targeted executive functioning skills-based approach is just what your child needs to move closer to reaching his or her full potential.

If your child has ADHD and cannot seem to keep his or her room at least somewhat clean and organized, then there is a good chance that it’s not simple defiance or lack of caring on your child's part. He or she might have a real weakness in skills related to organization. These kids get overwhelmed when asked to clean up a mess, they struggle to consistently put things away where they belong, or create a logical plan for organizing a space. While it can be tempting to ignore your child's messy room - and there is definitely merit in choosing to pick your battles – your child will benefit in the long run if you help him or her learn the skills he or she needed to create and maintain a clean and organized room.

1. Keep it simple. Avoid creating a complicated organization plan where multiple steps are needed to put away a single item. For example, avoid boxes with lids that stack on top of each other. Stacking boxes may seem like a simple solution, but in reality they require your child to complete multiple steps including taking down a number of boxes, lifting and replacing lids and replacing boxes in a neat stack (phew!). So, instead aim for clearly labeled, unstacked, lid-free bins that your child can toss things into with one step.
2. Reduce the clutter. The fewer things your child needs to keep organized the more likely he or she is to keep his or her room clean. See my previous post for tips on helping your child get rid of stuff that they no longer need.
3. Create a clean room checklist. While the phrase "clean your room" seems like a very clear statement to most adults, many kids don't actually know what this means! To them cleaning their room may literally mean just picking up a few items off of the floor, or shoving their clothes into their closet or tucking them away under their bed. Clearly define the meaning of "clean your room" by creating a clean room checklist. This checklist should be specific. For example: (1) all items are picked up off the floor, (2) clean clothes are on hangers or folded in drawers, (3) dirty clothes are in the hamper, (4) toys and books are in their spots on the shelves, (5) trash is in the trash can.
4. Tackle only one section or checklist item at a time. The overall task of cleaning a room is overwhelming for most kids with ADHD. So, break it down into smaller chunks by asking your child to clean just one spot in his or her room (e.g., put away all of the toys that are in front of the bookshelf) or to complete one item on the checklist. Then, when they complete that task have them tackle another.
5. Do it together. If your child hasn't been able to clean his or her room on his or her own so far, then he or she might need you to help him or her with the process until it becomes routine. Helping your child clean and organize can also help you identify and correct pitfalls in the organization plan that might otherwise derail your child.
6. Take pictures. Take pictures of the organized space and attach them to your checklist. This will give your child a visual reminder of what a clean room should look like when he or she is finished. You can take before and after photos too so your child can see the progress he or she has made!
7. Don't aim for perfection. Avoid setting the cleaning bar so high that it’s out of reach for your child. Think about what your child's room looks like now and his or her current ability to keep things organized. What would you consider to be a reasonable, modest improvement from the current situation? That's where you should set the bar. Then once he or she has achieved that goal, consider aiming for a higher level of organization.
8. Pile on the praise. Remember that the task of cleaning a room is hard for your child. Praise his or her hard work and his or her effort. Let them know how proud you are! The more you acknowledge his or her effort the more likely he or she is to clean his or her room again.

Helping your child learn the skills he or she needs to keep his or her room clean and organized will definitely take some effort and planning at the start. But over time both you and your child will have fewer arguments and less frustration, and your child will learn skills that he or she will use for a lifetime.

It's very common for kids with ADHD to want to hold on to more stuff than they can manage simply because the process of sorting through and getting rid of things feels mentally and emotionally overwhelming. So, how can you help your child learn to let things go and get rid of the stuff that he or she doesn't really need or enjoy?

1. Help your child understand why it's important to get organized. Talk to him or her about things that aren't really working for him or her right now, and why you need to make some changes together. Sit with your child and look at pictures online of kids' bedrooms or playrooms and talk to him or her about what their dream room would look like. Does the room he or she has now look like that? Could it ever look like his or her dream room if he or she kept all of the stuff he or she has now?
2. Donate to a charity. Let your child know that there are kids out there who don't have enough clothes or toys, and that they would really use the things that your child has outgrown and doesn't need anymore. So instead of sitting unused in a pile of clutter in your home, these toys and clothes could be used every day by someone who needs them. Find at least two charities in your area that accept donations, and let your child pick the charity that he or she would like to donate to. If it's possible, have your child go with you when you drop off the items so he or she can see the impact that he or she is making.
3. Earn points. Motivate your child by having him or her earn points for each item that he or she gives away. Then, allow him or her to turn in these points for a special activity. Make sure the activity is something that he or she will really enjoy and is not something he or she gets to do every day. Maybe it's going ice skating, a trip to the pool, a round of mini golf, or building a fort in the living room. Whatever it is, let him or her pick the activity and remind him or her of the reward that is waiting for him or her after his or her hard work is done.
4. Consider starting small. If your child is very resistant to getting rid of things then start with only a few items. Have your child pick out the items on his or her own. Then, one or two weeks later, talk to your child about how it feels to have given away the items. Does he or she miss them or even remember what he or she got rid of? For most kids they will find that they don't even miss their donated items after a little time has passed. Then take the next step by getting rid of a few more things, gradually increasing the amount until real progress is being made.
5. Try a step down approach. For some kids the idea of getting rid of something permanently feels overwhelming at first. So, put items into a box that you can store away temporarily. After a few weeks, ask your child if he or she needs any of the things that were put in the storage box. Does he or she even remember what was put in there? Then remind him or her of steps 1, 2, and 3 above, and help him or her donate the items. This 'step down' approach can take some of the emotional sting out of the process, and eventually your child will be more open to getting rid of things right away.
6. Take pictures. Offer to take pictures of special items before they are given away. Sometimes the hardest part of getting rid of something is dealing with the fear that you will lose all of the memories that you made when you were playing with or wearing the item. Having a picture makes letting go a little less scary.
7. Be a good role model. Show your child that everyone needs to get rid of clutter in order to stay organized. Model good organization techniques by getting rid of things that you no longer need or enjoy. Talk to your child about the things you are getting rid of and what the process feels like for you. If it's hard, let him or her know. But also share with him or her how much better you feel when you have less clutter in your room too.

Getting rid of stuff is hard for everyone, but it's an important first step in helping your child stay organized. For kids with ADHD who struggle with organization, learning to reduce clutter is a skill that they will use throughout their lives. So, the effort you and your child put into this now will continue pay off for years to come!

1. Keep it short. Research shows that shorter punishments are just as effective for children as longer punishments. So, if you're going to take away videogame time, for example, consider taking it away for only one day rather than for a week or longer.
2. Don't give in. Negative consequences will only work if your child knows that you won't give in by taking away the punishment early or skipping the punishment altogether. When you give in, your child learns that you don't really mean what you say, and he or she will eventually stop taking you seriously. Following step #1 and giving out shorter punishments will make it easier for you to avoid giving in.
3. Be consistent. It's important to put a negative consequence in place every time the problem behavior occurs. If you let things slide sometimes, then your child will know that he or she might be able to "get away" with the behavior.
4. Give your child a warning. When you consistently give your child a warning before he or she receives a negative consequence, the warning alone should eventually be enough to stop the negative behavior. But, this will only work if you consistently follow through with the negative consequence whenever your child does not stop the behavior after he or she has been warned. Remember, your child needs to learn that you mean what you say!
5. Always make an effort to teach new behaviors. Negative consequences only teach children what not to do - for example, do not pick on your sister. They do not teacher children what to do – this is how you and your sister can have fun playing a game together. So, when you find yourself repeatedly using negative consequences for the same behavior, carve out time in your week to teach your child the skills he or she needs in order to be successful. Then praise and reward these new skills. When you do this often you'll find yourself relying on negative consequences less and less over time.

Having to hand out punishments and negative consequences to your child is not something that any parent wants to do. So, it's important to know that the negative consequences that you do use are actually having an impact on your child's behavior. How can you tell if you are being effective? Look for a change in behavior over time – not just a change in the moment. Does your child fight less often with his sister now than he did last week or last month? If the answer is yes, then your strategies are working. But if you aren't seeing a change in the behavior over time, then it's time to try something else. Think strategically about other things that you can do to make the negative behavior less likely to happen. Are there skills your children need to learn? Do they need more sleep so they are less irritable during the day? Do they need more one-on-one time with a parent so they don't feel the need to seek out negative attention? Are there certain games or toys that often lead to conflict and should be limited?

Taking a step back and looking at the bigger picture will help you problem solve more effectively rather than just doing the same thing over and over again. When in doubt, get help from a professional who specializes in ADHD or child behavior challenges.

Overusing negative consequences can really take a toll on your relationship with your child and your child’s self-esteem. Kids who lose privileges, have toys taken away, or get sent to time out too often may start to avoid the adults who are handing out these punishments. This is especially true when those same adults don’t balance out the negative consequences for bad behavior with lots of praise and attention for good behavior. Kids also start to internalize the frequent negative feedback that they are receiving, and begin to feel like they "can't do anything right."

In addition, negative consequences generally only tell children what not to do. They don't help them learn what to do instead. Think about this typical scenario: a brother is constantly picking fights with his sister and they rarely play together without the playtime ending in tears. His parents want more than anything for him to get along with his sister, and they take way videogames whenever he starts picking a fight. He gets upset about losing his videogames and leaves his sister alone for a little while after he receives his punishment. So, taking away videogames stops the fighting in the moment, but does it teach him how to positively interact with is sister next time? Does he learn any new skills that might help him avoid future punishments? Nope. Only coaching or modeling a new behavior and pairing praise or rewards with new skills will help kids with ADHD learn and practice new ways of interacting with their world.

So, while negative consequences aren't ideal, there are some times when you simply need to use them:

1. When your child is demonstrating a negative behavior that is so rewarding or interesting to him or her that no amount of praise or rewards will motivate him or her to change his or her behavior. This is often the case with something like stopping a videogame the first (or second) a child has been asked to do so.
2. When your child is engaging in an impulsive or unsafe behavior that you need to stop immediately.

When should you avoid using negative consequences regularly with your child?

1. When your child needs to learn a new skill in order to meet goals or expectations. For example, if your child is always late for school because he or she can't get ready on time, punishing your child for being late probably won't help change the situation. Your child likely needs help learning a new routine, and might need some support from you in order to get everything done on time in the morning. Providing support along with praise and rewards will teach new behaviors in a way that negative consequences cannot.
2. When you've been using negative consequences repeatedly for the same problem, but the behavior has not improved over time. This means that negative consequences aren't working and it's time to try something else.

For those times when you do need to use negative consequences, there are things you can do to make these consequences more effective and less frequent. In my next post I'll talk about these specific strategies, and will give you some tips on how to maintain a positive relationship with your child.

Section 504 Plan
Section 504 is a civil rights law that prohibits discrimination against individuals with disabilities. It is intended to ensure that students with disabilities are provided with an equal opportunity to succeed at school. With 504 plans students receive instruction through the same regular education curriculum that is provided to all students in the classroom. To help students with disabilities access this curriculum and participate in activities, Section 504 allows for specific accommodations and evidence-based services tailored to each student’s individual needs. For children with ADHD, these accommodations may be things like a quiet place to take exams, reduced homework assignments, or positive behavior plans in the classroom that help them stay on task. Typically 504 accommodations and services can be implemented by the child’s classroom teacher without assistance from additional school staff and professionals.

Students with ADHD are eligible for a 504 Plan if their disability substantially limits their ability to fully participate in all academic and non-academic activities at school. When the school makes a determination about whether or not the disability is "substantially limiting" they must do so without taking into consideration the effect of treatments like medication or behavioral interventions that may alleviate symptoms when they are in use. 504 Plans list the accommodations that will be provided for the student, but they do not include a review of the student's academic performance or any specific learning goals.

504 Plans are typically used for students with ADHD who have less severe impairments, or who do not qualify for services under the Individuals with Disabilities Education Act.

Individualized Education Plan (IEP)
The Individuals with Disabilities Education Act is a detailed law that ensures students with disabilities are provided with schooling that clearly provides educational benefit– meaning that there is clear evidence that the child is able to learn and make academic gains in response to the instruction that they are receiving. For students with disabilities who are not able to learn through a standard educational curriculum, instruction must be tailored to meet their individual needs in the Least Restrictive Environment possible. This means that the educators should aim to have the student in a typical classroom environment to the greatest extent feasible. An Individualized Education Plan (IEP) is the detailed working document created for each eligible child, and serves as the cornerstone of his or her educational program and services. An IEP may contain the same accommodations as a 504 Plan, but may also include additional special education services like speech therapy, social skills groups, or occupational therapy. Often (but not always) these individualized services are provided by educational professionals and staff other than the main classroom teacher.

It is more difficult to qualify for an IEP than a 504 Plan. Formalized testing is required to determine eligibility for an IEP. This testing is provided by the school when a student is referred for an evaluation (by a parent, teacher, doctor, therapist, etc.) due to poor school performance. The evaluation assesses cognitive factors, emotional factors, academic achievement, and behavioral functioning. In addition to determining IEP eligibility, results are also used to make decisions about the student’s individualized accommodations and services and their learning goals.

IEPs are also much more detailed than 504 Plans. They include information about the student’s current level of performance, learning goals for the student, and progress monitoring over the course of the school year. Parents are involved in reviewing the student’s current level of performance, identifying learning goals and reviewing progress toward those goals.

Even when you are armed with knowledge and information, determining which plan is right for your child can be difficult and will require input from teachers, school administrators, special education staff, and possibly outside professionals like child psychologists and special education advocates. If you think your child may benefit from extra services at school, schedule a meeting with the school’s special education coordinator and learn about the process. If at any time you feel like the school is not being responsive to your requests, continue to make your concerns known and enlist the help of outside professionals if necessary. Your child deserves to have the accommodations and services that he or she needs in order to reach his or her full potential with ADHD. As a parent you are your child’s best advocate when it comes to getting him or her the services that he or she needs.

Making an effort to notice your child’s positive behavior, and praise him or her when he or she is doing something right can help break this cycle. When you “catch your child being good” you set them up for success. You start to lay the foundation for positive family interactions, you build his or her self-esteem, and you increase the chance of seeing more positive behavior in the future. In order for praise to be most effective, and actually lead to a change in family dynamics and your child’s behavior, you’ll need to be strategic about how and when you deliver the praise. The following guidelines will help you get off to a good start:

1. Be Specific. Let your child know exactly what he or she did well. For example, “You did a great job helping your sister find her toy.” rather than “Good job!” When you’re specific your child knows exactly what it is that he or she did well, and will be more likely to do it again in the future.
2. Be genuine. Kids respond well to praise when it’s heartfelt and genuine, and when your level of enthusiasm matches their behavior. For example, let’s say that your child does something that isn’t very hard for him or her, like tying his or her shoes, for example. You respond with over the top enthusiasm, “Wow! You tied your shoes, amazing!” You’re child isn’t going to find you very believable, and might even think that you’re acting strange. But, if you say something more genuine, like, “I noticed that you tied your shoes the first time I asked. Thank you.” Then he or she will be much more likely to accept your praise.
3. Praise effort. Studies show that kids who are praised for their hard work and effort, rather than for their intelligence or abilities, are more likely to approach new challenges with a positive attitude and have the motivation to keep trying even when things are hard. So, if your child gets a good grade on a math assignment, rather than saying, “Nice job! You’re so smart at math!” focus on the things that he or she did in order to earn the grade, like, “You worked really hard on that assignment and double checked all of your answers before your turned it in. Your hard work really paid off! Nicely done!”
4. Remember 5:1: It takes quite a few positive statements to offset the effects of negative feedback and criticism. So as a rule of thumb, aim for 5 positive comments for every negative statement. If this seems like a tall order, start with a smaller ratio, like 3:1 and work your way up.

Shift the balance in your home, from only commenting on the negative to really praising the positive. Noticing your child’s good behavior, and following these praise guidelines will go a long way in helping things go more smoothly this holiday season and throughout the year. Over time you’ll see even more good behavior and improved family relationships as your child continues to seek and receive more positive attention from you.

Despite current research evidence, the belief that children will outgrow their ADHD has persisted in our culture. As parents you may have relatives, friends, and even teachers tell you not to worry because your child’s symptoms will simply go away as he or she gets older. People usually mean well when they say this, but it can be frustrating if it makes you feel like your child’s current challenges are not being taken seriously.

So why has this belief persisted, even when we now know that many teenagers and adults do in fact have ADHD? One reason may lie in the child-centered way that ADHD has been defined and categorized. When ADHD was first included in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the authoritative guide to the diagnosis of mental health disorders in the US, the symptoms and impairments were based solely on the presentation of ADHD in children. While there have been some minor adjustments to the symptoms and diagnostic criteria in the DSM over time to better account for the disorder’s presentation in adolescents and adults, the overall child-centered focus of the criteria has remained. As a result, some symptoms, like “often runs and climbs on things excessively,” or “often leaves seat in situations where staying seated is expected,” are in fact only seen in children. If we were to see an adult “climbing on things excessively,” for example, we would suspect that there is much more going on than ADHD!

So, in a sense, children do outgrow some symptoms of ADHD – at least on the outside. What many people without ADHD don’t realize is that the underlying ADHD feelings and impulses often stick around into adolescence and adulthood. A child who struggled to stay in his or her seat during class may have learned to stay seated as he or she got older, but he or she has continued to experience strong underlying feelings of restlessness. Another child who would “often blurt out answers” or “interrupt others” may develop greater awareness of these symptoms over time. He or she still experiences the urge to blurt out or interrupt during conversations, but now he or she works hard to hold his or her thoughts and not speak out of turn. Sometimes he or she may have a hard time focusing on conversations or staying in the moment because he or she is so distracted by the urge to jump in and speak. So, in other words, many of these childhood ADHD symptoms don’t go away over time. They just become less visible to other people.

As a parent there are many things you can do now that will help your child manage his or her symptoms well into adolescence and adulthood. The skills you teach them as children, especially social skills, organizational skills, strategies for doing things independently, will last a lifetime. Being open to having conversations with your child about his or her ADHD symptoms can create a safe space where your child can learn to accept his or her ADHD rather than judge and hide his or her symptoms. And if behavioral strategies alone are not enough, helping your child find a medication that will work for him or her can make a tremendous difference in his or her symptom management now and in the future. So, while your child may not ultimately outgrow his or her ADHD symptoms, he or she can improve over time with the right treatment and support from family and friends.

When it comes to making sure your child has access to strategies and tools that work for him or her, I recommend setting up a meeting with your child’s teacher. Find out which areas they think your child needs to improve in the most, and what suggestions they have for accelerating this improvement. If your child’s teacher suggests that your child receive additional help outside the classroom, then seek out additional learning services at school or in an after-school learning or tutoring program. Also, ask for suggestions about what you can do at home each week to help your child improve.

When your child is trying out new strategies and working on things that are hard for him or her, encourage a Growth Mindset by taking the following steps:

1. Remind your child that when he or she works hard they are growing their brain. When we lift weights our muscles grow stronger. We know they are stronger because over time it becomes easier to lift heavier weights. Remind your child that when we challenge our brains by working on things that are hard for us, our brains get stronger too. We know they’re getting stronger because math problems, books, and writing assignments that were hard for us become easier over time. And we get more answers correct the first time around.
2. Praise Growth Mindset goals. When your child is working hard, tie your praise to our Growth Mindset goals. Praise your child for stepping up to a challenge, trying out new strategies, working hard, and improving. Overall, you’ll be most successful at fostering a Growth Mindset when you focus your praise on your child’s process rather than on your child’s grades and achievement.
3. Counter Fixed Mindset thoughts with Growth Mindset alternatives. When kids are frustrated they are likely to have a whole host of Fixed Mindset thoughts that get in the way. When they voice these thoughts, try to come up with Growth Mindset alternatives that can help your child think differently about his or her situation. Your child may not seem too receptive in the moment, especially if he or she is feeling very frustrated. But over time, your child will hear you and will start to come up with these Growth Mindset alternatives on his or her own. Here are some examples to help you get started:

Fixed Mindset: I always make mistakes!
Growth Mindset: When we correct our mistakes, we grow our brains.

Fixed Mindset: I can’t…
Growth Mindset: You haven’t done it … yet!

Fixed Mindset: This stuff is easy for other kids.
Growth Mindset: With new strategies and practice it will become easier for you too.

Helping your child develop a Growth Mindset will take time. After all, your child has probably been living with a Fixed Mindset for years. Be persistent and look for small, gradual improvements. Mindsets are fluid, so don’t be surprised if sometimes your child is able to maintain Growth Mindset and other times he or she is firmly stuck in a Fixed Mindset. The goal is to help your child spend more time in a Growth Mindset framework than he or she was able to in the past. Over time, his or her motivation and self-esteem will improve, and you’ll notice that he or she is more willing to take risks and step up to challenges at school and in life.

Unfortunately kids with ADHD may be more likely to have a Fixed Mindset. Their struggles with motivation and academics may have lead them down the path of believing that their hard work doesn’t really pay off, and there is nothing they can do to become smarter or better at the things that are challenging for them. And with this set of beliefs, mustering up the motivation to work hard at school or tackle challenging homework problems is extremely difficult. Fortunately, research has shown that mindsets can be changed – and that includes your child with ADHD. Parents and teachers can foster Growth Mindsets in their children and have a big impact on their motivation and achievement.

So, how do you go about encouraging a Growth Mindset? It takes two phases. First, teach your child a few core Growth Mindset principles. Then on a daily basis, emphasize Growth Mindset thoughts and actions to cement the new Growth Mindset lessons and encourage increased motivation over time.

So let’s start with Phase I: teaching three core Growth Mindset principles.

1. We can grow our brains. Explain to your child that the brain is like a muscle. When we lift weights our muscles get stronger and they grow. The same thing happens when we “exercise our brain.” The more we challenge our brain the more it grows, and the more we grow our brain the better we become at things like math, reading, writing, and even fun things like videogames and sports. (Videogames may make the most sense to some kids: ‘Remember when you got that new game and didn’t know how to get past Level I, but then you kept playing and learning and you were able to not only get past Level I but get all the way to Level 4. And now you’re still playing and learning and soon you’ll be at Level 5? That’s because you were exercising your brain and challenging it to grow.”) There are some excellent videos online that teach kids about how they can grow their brain. For younger kids I recommend the Class Dojo Growth Mindset series https://www.youtube.com/watch?v=2zrtHt3bBmQ and for older kids I recommend the Khan Academy “Growing your Mind” video https://www.youtube.com/watch?v=WtKJrB5rOKs.
2. How our brains grow. In order to straighten our muscles, we challenge them through exercise. If we keep lifting the same light weight over and over again, then our muscles won’t really get stronger. We need to challenge them by gradually adding heavier weights. With our brains, we exercise them by doing challenging work. By trying things that may seem hard, and by making and correcting mistakes. Mistakes can actually be good things, because when we correct our mistakes our brain gets stronger! (Let’s go back to our videogame example: “When you first started Level 2, you struggled to defeat the monster. He won a lot of the time. But you kept hitting the reset button and challenging yourself to find a way to get around the monster. Each time you failed to beat him, you learned a little bit more about what might work next time.”)
3. We need good tools and strategies. Your child has certainly tried to do challenging work in the past. But if your child has ADHD, there’s a good chance that there have been quite a few times when he or she were not able to succeed at the level that was expected of him or her. These failures may have made your child hesitant to take on new challenges, even if he or she knows that challenging work is good for him or her. So, make sure to let your child know that in addition to challenging work, they need strategies that will help them succeed. Tell your child that you recognize that he or she may not have had the tools and strategies that he or she needed in the past. But you’re going to do everything you can to help him or her learn different strategies and tools so that he or she can succeed now. And with your child’s hard work, combined with new strategies and tools, the sky is the limit! (And one last time we’ll revisit the videogame example: “And then when you reached Level 4, you really struggled with the dragon. But it was your babysitter Mark who gave you a great idea for a strategy to try – and it worked! Sometimes we need some coaching and help just to give us a little help in what direction to go in or what we might want to try. Mark didn’t give you the answers, but he gave you a strategy. And having that strategy helped you beat that Level. Sometimes life is like the videogame where we just need someone to give us a new strategy or a tool to help us do our work and then we can see the way forward.”)

In addition to teaching your child these key Growth Mindset principles, get started on figuring out ways to help your child learn new strategies for the things that are hard for him or her. Talk to your child’s teacher about subjects that are difficult. Find out which learning tools are currently working for your child and which tools are not. Kids with ADHD may need different learning strategies, so ask about alternate tools and strategies that they can try. Consider getting extra help for your child through their school or through a learning center or tutoring program (see my previous post on choosing a good tutoring center for your child). Remember that your child’s hard work will only lead to improvement when he or she is putting their effort into using the tools and strategies that work for him or her.

My next post, the last in this Growth Mindset series, I’ll talk about Phase II -- the things you can do every day to encourage a Growth Mindset in your child. You’re well on your way to instilling a Growth Mindset, and soon you’ll start to think about all of the ways that your child – and you – can rethink challenges and have a Growth Mindset approach to life.

But when you have a child with ADHD, what can you do as a parent that will really make an impact on your child’s motivation for schoolwork? There are several behavior management strategies that help to improve motivation on a moment to moment basis. I’ve talked about some of them here in this blog – including setting up routines, using rewards to motivate kids to try new behaviors, and strategies for helping your child engage with reading. These strategies are essential components of effective ADHD treatment plans, and can go a long way in helping to set your child up for success.

However, these behavior plans do little to address underlying motivational challenges. To truly address motivation and particularly motivation as it relates to academics and school, you need to also consider your child’s mindset – or the way that he or she thinks about his or her abilities and potential to improve. I’m a big fan of Carol Dweck’s seminal work, The Growth Mindset and how it helps all kids – including kids with ADHD – rethink success and failure and how they think about their own learning and intelligence.

Individuals with a Growth Mindset believe that the have the ability to improve their intelligence and abilities through hard work and the use of good learning strategies. This belief is backed by decades of science showing that we do in fact have the ability to “grow our brain” and improve our intelligence. When children are armed with this knowledge, they are motivated to work hard and tackle challenges because they believe that they can improve and overcome obstacles with effort. In contrast, individuals with a Fixed Mindset believe that their intelligence and abilities cannot be changed. When faced with a difficult task in a subject that they are “not good” at, they will shy away from the challenge and instead put their efforts into hiding their weaknesses and avoiding the task at all cost. Sound familiar?

Kids with ADHD may be more likely to get stuck in a Fixed Mindset than kids without ADHD. After all, they’ve had years of experience with their ADHD symptoms getting in the way and preventing typical learning strategies from working for them. So, they’ve inadvertently collected a great deal of evidence supporting the notion that nothing they do will help them improve in the areas that are hard for them. In addition, neuroimaging studies have shown that the part of the brain that controls ADHD symptoms (the prefrontal cortex), is also responsible for motivation and mindset. In other words, they may be biologically predisposed to fall into a Fixed Mindset more quickly.

Kids are smart about playing their parents off of each other to get what they want. And while your candy bar strategy as a kid might not have been a big deal, when parents of kids with ADHD are not on the same page the consequences can be significant. This is especially true when it comes to the “negotiating” that kids with ADHD are prone to do in order to get their way. While their negotiating tactics can be clever and downright impressive at times (“My kid could be a lawyer!”), they ultimately create stress for the whole family and can become increasingly problematic as children grow into adolescents. Limiting your child’s negotiating behavior can reduce stress and improve your relationship with your child. To minimize negotiations, you and your co-parent need to be as consistent as possible with the things that your child pushes limits on throughout the day (treats, screen time, chores, bedtime, etc.).

Now, you may be thinking: easier said than done! It’s sometimes difficult to get on the same page about what you’re going to be having for dinner, let alone all of these smaller things throughout the day. But actually, a few basic “rules of road” for the two of you can help you get on the same page and become a consistent parenting team.

Rule 1: Start small. Make a list of the things your child negotiates about regularly. Then pick on one thing on the list to focus on first. Set yourself up for success by starting with the easiest item on the list.

Rule 2. Give your child a heads-up. At a time when you, your co-parent, and your child are calm, have a group talk about the problem and how things are going to change. Keep it simple, positive, and brief. For example, “I know you’ve been wanting to go to bed later, and we’ve been arguing about that almost every night. We’ve both talked about it, and we’ve decided that since you’re getting a bit older, on Saturday nights you’ll be able to go to bed 10 minutes later than your usual bedtime. But every other night of the week, your bedtime doesn’t change. If you ask us to go to bed later we’re both going to tell you no. We might even walk away if you keep asking about it - not because we’re upset, but because we don’t want to argue."

Rule 3. Support each other. When you first try out your new plan you may have a hard time not giving in to your child. After all, sometimes it does seem easier to just give in right away. So, look to your co-parent for reassurance and support to help build up your confidence as you learn to stick to your plan.

Rule 4. Praise your child. If your child accepts your answer and doesn’t negotiate, whine, or meltdown, then let your child know that you’ve noticed the good behavior. “You did a great job going with the flow tonight when I told you that you couldn’t stay up late. I know that’s not always easy, but I’m really impressed with how well you handled it!” Kids get so much attention from their parents when they whine or negotiate, so make sure they get positive attention when they accept no for an answer!

Rule 5: Expand your plan. Once you’ve managed to be consistent with the first item on your list, expand your plan to include a second behavior. Follow the same rules above, and gradually address more items until you’ve covered most of your child’s “negotiation triggers” throughout the day.

Rule 6: Ask for help if you need it. Parenting is hard, and even harder when your child has ADHD. Don’t be afraid to turn to a professional to get some coaching on how to be consistent and co-parent successfully. Even a little coaching can go a long way, and everyone in your family will benefit.

Presenting a united front will make parenting easier and ultimately more enjoyable. It’s nice to know that someone else understands your frustrations, shares your concerns, and has your back. So, try out these basic rules. They’ll go a long way toward creating a less stressful household that will benefit everyone in your family.

The vibe. Your child’s tutoring experience starts with how he or she will feel about the space and the staff. Is the space warm and inviting? Does it look like a place that your child would be drawn to? How’s the rapport between the staff and students? What does the energy in the room feel like? Trust your instincts: if something doesn’t feel right it’s time to look elsewhere.

Strong staff engagement with your child. It may seem like a no-brainer, but every child in the room should be engaged with a staff member. Some students may be doing individual work, but staff should be overseeing these students and checking in on their progress. You should get the feeling that the staff genuinely care about their students and the work that they are doing. And that the students feel comfortable looking to the staff and teachers for help when they need it.

Challenging activities. Tutoring should not be about a teacher doing work for a student. Instead it should include structured learning activities that are adapted to your child’s specific academic level. These activities should start at a fairly low level of difficulty to help your child get his or her feet wet and build confidence, and then gradually become more challenging as your child develops new skills, strategies, and knowledge. Instructions should always be clear and concise, and even challenging work should be within the child’s reach. The work should never be so challenging that your child is constantly struggling, feeling defeated, or disengaged.

Self-directed work time. No matter the curriculum or teaching strategies that are in place, tutoring should always include some independent work time. During these time-limited periods your child will have the opportunity to complete assignments on his or her own but can also ask for assistance when needed. This helps kids gain confidence, and learn strategies that will carry over to independent work time at school and at home.

Space! Are there individual work areas as well as small group spaces? A solid desk and comfortable chair? Good lighting? Does it feel overcrowded or just right? The space should be clean, well-organized, well-lit and have designated space for activities. There should be a sense of shared care for the space, from the owner all the way down to staff and students.

Specific ADHD training. While there are great tutoring choices out there, you’re looking for one that specifically has the training, knowledge and experience of working with kids with ADHD. While many centers may say they work with students who have ADHD, ask about specific ADHD training that has been provided to the staff and teachers. Learn about the specific strategies that they use for dealing with typical ADHD-related challenges, like having difficulty staying seated, talking too much, or being easily distracted. Look for a combination of positive reinforcement (praise), clear instructions, engaging, structured activities, frequent breaks and a limited use of negative consequences.

Choosing a tutor or a tutoring center can be tough – and time consuming. But ensuring a good fit between you, your child, and the center is the key to success. Tutors with experience and training in working with students who have ADHD can provide the additional support that your child will need in order to reach his or her full academic potential.

Begin by getting your child involved in an activity that interests him or her. It may sound simple, a structured setting and an interesting activity will provide your child with the foundation that he or she needs to start building his or her tribe. Involve your child in choosing the activity, and make sure to put your own preferences and interests aside! If you push your child into signing up for something that he or she doesn’t enjoy, you run the risk of having him or her feel alienated and different from the other kids who have enrolled because they are excited and interested.

Watch and observe your child during the activity. Is he or she connecting with another child? Does it seem like both kids are having fun? If so, seek out the parent of the other child and suggest a follow-up play date. “I noticed our sons really enjoyed today’s planetarium workshop. My son loves space but doesn’t have too many buddies who also share his interest. Would you and your son like to meet up at the museum sometime this month for a planetarium show together? The boys might enjoy connecting again over their love of space.” Give your child the chance to reconnect with his or her new friend within the context of their shared interest before venturing into open-play opportunities.

In addition to new activities, think about current activities that your child participates in. If your child attends a tutoring center, religious ed. class, or music lesson then he or she is meeting kids every day outside of school who have the potential to become good friends. Ask your child if there’s anyone from his or her afterschool activities who he or she would like to hang out with. Help him or her come up with a plan for talking with this child about a shared interest, and then inviting them to get together outside of school – preferably to do something related to something that they both enjoy.

And lastly, during a get-together, provide your child with some subtle social skills coaching. Talk to him or her ahead of time about what it means to be a good host or a good guest. Remind your child to take turns, and to look out for his or her new friend to make sure they are having a good time. If your child isn’t picking up on social cues, discretely pull him or her aside and give him or her some strategies to try out. If a conflict comes up, rock-paper-scissors is always a great tool to fall back on - it works just about every time!  

Helping your child find his or her tribe can build self-confidence and help your child feel more comfortable in his or her own skin. A little support from parents can go a long way in helping kids with ADHD make valuable connections that may just turn into the close childhood friendships that they have been missing.

My own research has focused on alcohol and drug use in college students with ADHD. So I wanted to take a moment to share with you what the research today shows on ADHD and addition, and what steps you can take to help your teen and young adult avoid falling into some of these patterns. Research on ADHD and addiction does indeed show that both males and females with ADHD are at increased risk for alcohol and drug-related problems and addiction. My own research shows that while college students may report using the same amount of alcohol or marijuana as their peers without ADHD, they experience greater negative consequences and impairment as a result of their use. Across multiple studies by a variety of researchers, adolescents with ADHD are more likely to start using alcohol or drugs earlier than adolescents without ADHD. And, early initiation of alcohol or drug use, even in small amounts at first, is associated with increased risk for alcohol or drug problems later in life. The individuals with ADHD who are at the greatest risk for addiction are those who have a history of alcohol or drug addiction in their family. In fact, researchers have even identified a shared genetic link between ADHD and alcohol use disorders that may contribute to this risk.

As parents there are things that you can do now to help protect your child or teen from developing alcohol or drug-related problems. I recommend focusing on four areas:

1. Seek effective ADHD treatment. Children and adolescents whose ADHD symptoms are well controlled through behavioral interventions or medication management may be less likely to self-medicate or impulsively seek-out alcohol and drugs. Some parents are concerned that ADHD treatment with stimulant medications may increase the risk for drug addiction later in life. But in fact, research shows no increased risk and some studies suggest that early treatment with stimulant medication may actually protect against the development of alcohol and drug addiction later in life.
2. Teach coping strategies. Poor coping and stress management skills are a consistent predictor of alcohol and drug related problems among college students and adults. Teaching your child or teen to effectively manage his or her stress and respond in a healthy way to life’s ups and downs can help protect him or her against addiction. Help your child get involved in stress-relieving extra-curricular activities that he or she can turn to again and again throughout their life. Also encourage him or her to learn mindfulness strategies that have been proven to reduce stress in teens and adults. I recommend The Stress Reduction Workbook for Teens: Mindfulness Skills to Help you Deal with Stress, by Gina Biegel as a starting point.
3. Monitor your child or teen. Monitoring how your child or teen is spending his or her time and knowing who your child’s friends are will help you intervene early if you think he or she is experimenting with alcohol or drugs. Make sure your child is participating in structured activities afterschool (the time when kids are most likely to be unsupervised), and don’t let your child spend time at the homes of friends whose parents allow alcohol or marijuana use in their house.
4. Talk to your teen about the risks. Let your teen (or preteen) know that his or her ADHD puts him or her at increased risk for alcohol or drug addiction. If there is a history of alcohol or drug addiction in your family, share this with your child. He or she may not want to hear it from you, and may seem very dismissive during these conversations, but talking to your child can still make a difference. If you drink alcohol, model responsible drinking for your child or teen. The things you do are just as powerful as the things you say when it comes to influencing your child.

A diagnosis of ADHD does not mean your child is destined for a life of addiction. What it does mean is that ADHD doesn’t usually go away. ADHD is usually a lifetime diagnosis that requires constant vigilance. Throughout your child’s life, beginning with diagnosis and all through adulthood, he or she will be confronted with situations that challenge him or her differently than his or her peers because of his or her ADHD. But the key to success, now and in the future, is acknowledgement and awareness, together with a set of tools and strategies to overcome those situations and thrive!

But wait, you know your child, and you know their ADHD gets worse when they eat sugar. You’ve seen it! Well, your child may simply be more sensitive to sugar or food dyes than many of the kids in these studies. Or, maybe there are alternative explainations that published research findings have not yet addressed. For starters, kids with ADHD are often more emotional than kids without ADHD, and when they get excited they are bursting with energy and enthusiasm. So, on holidays like Halloween they may get caught up in the excitement and their hyperactivity may shoot through the roof regardless of what they eat. Alternatively, when any child (or adult) eats way too much sugar in one sitting – far more sugar than has been examined in any studies – they become more hyperactive, inattentive, and irritable. Impulsive kids with ADHD are less likely to have an “off” switch when it comes to eating candy, and in fact some researchers have shown the kids with ADHD eat more sugar than kids without ADHD on a regular basis. In practice this means that they will continue to eat more candy long after many other children have stopped, especially when presented with a nearly bottomless bag of Halloween treats. And since they have eaten so much more sugar, it wouldn’t be surprising if they experienced greater side effects than kids without ADHD.

If Halloween candy causes problems for your child, either because they eat too much or because they are very sensitive to the effects of sugar and food additives, then there are things that you can do to limit how much candy they eat without taking the fun out of Trick-or-Treating. The Switch Witch^TM www.switch-witch.com is a great option that kids love. The night of Halloween, kids leave a pile of candy next to an adorable stuffed witch, who magically trades it out for special non-sugary gifts while they sleep. Kids still get treats, like small toys or healthier fun foods like popcorn, which helps them feel okay about giving up their candy. As an alternative, some parents simply allow their kids to trade their candy for money, 10 cents for each piece or a dollar per pound, which usually goes over pretty well too! Not sure what you would do with all of the candy that your child won’t be eating? Consider donating to a local soup kitchen or to troops stationed overseas through a candy buy-back program at a local dentist’s office www.halloweencandybuyback.com or through Operation Gratitude www.operationgraditude.com.

Sugar can be “tricky”, not wanting to deny your kids the fun and connections to friends that happen around birthday cakes, ice cream and Halloween candy. But moderating the sugar intake of all kids – and especially those with ADHD and sugar sensitivities – can actually help keep your child’s energy and emotions in balance so they can connect with friends and enjoy the parties and holiday that they look forward to all year long.

Understanding how to help a child with ADHD improve his or her reading skills can be challenging. I usually recommend starting with an academic assessment. Results from a thorough evaluation will let you and your child’s teacher know exactly which reading skills are weak, will identify whether or not your child has a specific reading disorder that needs to be addressed, and will explain how your child’s ADHD symptoms and difficulties with motivation are impacting his or her reading development. All of this information will help you and your child’s teachers identify strategies and services that are tailored to meet your child’s needs. Extra instructional support at school and through afterschool learning and tutoring programs can help your child learn basic and complex reading skills that he or she may have missed during regular classroom instruction.

Many kids with ADHD are “reluctant” to read and go out of their way to avoid of reading. When they do read they choose books that are too easy for them or are very short. Unfortunately, this reluctance limits their opportunities to practice reading and gain essential skills. As a parent, there are many things you can do to help your child get the reading practice that is needed, without engaging in stressful arguments or negotiations. Here are some suggestions to get you started:

1. Read to your child. Even kids who do not like to read enjoy having someone else read to them. Reading to your child can help improve his or her skills, especially when you have your child read along and ask your child to share his or her predictions and observations about the story.
2. Take turns reading. If your child resists reading, offer to alternate reading aloud with him or her. For young children this might mean that they read one word or sentence and then you read the next word or sentence. For older children you can alternate paragraphs. Keep going and before you know it, you’re child will have read half of a book!
3. Supplement with skills practice on reading apps. Studies suggest that kids with ADHD may benefit from practicing their reading skills using computer-based reading programs. Bluster is a fun vocabulary building app, Montessori Crosswords is great for learning phonics, and Mad Libs can be a fun way for kids 4^th grade and up to practice vocabulary and reading comprehension.
4. Help your child explore websites on topics that they enjoy. Exploring interesting websites can be a great way for kids to practice reading without even realizing they are building new skills! Sit with your child and ask him or her to share what he or she is learning as he or she reads. This will improve his or her comprehension, and you’ll be sure that he or she is not skipping the text and only looking at pictures.

With support and practice kids with ADHD can develop into strong readers. If you suspect that your child’s reading skills are not as strong as they should be, don’t wait. Talk to your child’s teacher right away so you can get started with a plan to get your child the help that he or she needs.

Simone Biles is a shining example of how when you own your ADHD you can not only succeed, but succeed at the highest levels. So, what does it mean to own your ADHD? It means acknowledging and accepting that ADHD is a part of who you are, taking action to treat your symptoms, and advocating for yourself so that you can receive the help that you need. But how can kids learn to own their ADHD, especially in a world that isn’t always supportive? It’s a process and a journey that parents can help guide and champion.

• Acknowledge and Accept. Coming to terms with an ADHD diagnosis can be challenging. Feelings of denial, anger and depression are not unusual. But to be honest, these feeling are far more common among parents of children with ADHD than among the kids themselves. Kids are often relieved to learn that there is a reason why they have been struggling, feeling out of place, or thinking that they are different. As parents you can help your child accept his or her ADHD diagnosis by teaching him or her that ADHD is not something to be ashamed of. It is not a personal weakness or failure. Instead, it’s something that people are usually born with. It’s something that they have inherited just like other characteristics, like their height. Having ADHD just means that they have some specific challenges, and these challenges can be managed and overcome with treatment and support. Share Simone Biles’ tweet with your child. Talk about how she didn’t let ADHD get in her way, and how when she publicly acknowledged her ADHD diagnosis she received 50,000 likes from people who support her!

• Take Action. Once you and your child acknowledge and accept his or her ADHD, create an action plan and share it with your child. Let your child know that doctors, scientists, and educators have been studying ADHD for decades, and there are treatments that work. When you make a plan, remember that it doesn’t need to be perfect. At the beginning, it may only include one or two action items, and that’s okay! For your child, simply knowing that you have a plan will help put him or her at ease. It clearly shows your child that taking action is what you need to do if you want to succeed with ADHD. Also talk to your child about the actions that he or she will need to take to help himself or herself, like attending appointments and committing to trying out new strategies at school and at home.
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• Advocate. People with ADHD need a network of support in order to thrive. They need this as kids, and they will continue to need this as adults. So, talk to your child about the people you will be reaching out to for help. Your child’s support team can include doctors who will provide medication and/or behavioral treatments, teachers who will provide extra support in the classroom, yourself as a parent who will learn strategies to support your child at home, relatives who you will call on for extra help, coaches and mentors who will teach your child skills through sports or the arts, and tutors who will help your child succeed in school. When you feel your child is ready and when it is appropriate, include your child in meetings at school when ADHD-related accommodations or the need for additional services are being discussed. Allow your child to participate by sharing what it is that he or she needs help with, and include your child in conversations about possible solutions.

At 19 years old Simone Biles is able to own her ADHD because the adults in her life taught her how to accept her diagnosis, take action to get treatment, and advocate for herself to receive support from teachers, coaches, teammates, and friends. As parents, the steps you take now to help your child own his or her ADHD will enable your child to strive to reach his or her full potential without letting ADHD get in the way.

The honesty and vulnerability reflected in the students’ responses has tugged at the heartstrings of teachers and parents across the country. They remind us that kids intuitively know what our educational system too often seems forget - that their social and emotional lives define who they are as students and affect their ability to learn.

(Source: http://iwishmyteacherknewbook.com/)

Perhaps more than any other students, kids and teens with ADHD are misunderstood. Their outward behavior and performance often doesn’t reflect their internal world. Their ADHD symptoms make it hard for them to meet the expectations of teachers and classmates, and they get worn down by the daily struggle to fit into classrooms that weren’t designed with their brains in mind.

Students with ADHD wish their teachers knew that:

• They are frustrated and discouraged before they even get to class because their ADHD makes it so hard to get ready for school every morning and out the door on time.
• They don’t choose to only focus on things that are really interesting to them. It’s just that no matter how hard they try they can’t seem to get their brains to click into gear when something is dull.
• They can’t stand that they disappoint people.
• They feel embarrassed when their teacher criticizes them in front of the class, even if they don’t let their feelings show.
• They get discouraged when teachers tell them to try harder. They’re already trying hard, but it’s difficult to see because their ADHD keeps getting in the way.
• They feel like they don’t fit in and they don’t know why.
• They wish they had more friends, but nothing that they do seems to get kids to like them more.
• They need help. And they know it. But they don’t always know how to ask for it.

There is so much that kids and teens with ADHD want their teachers to know about them, and this list is only the tip of the iceberg. Maybe one of the most important generalized insights is that students with ADHD don’t always understand why things are hard for them but they desperately wish they could ‘fit in’ and meet the expectations of their teachers, fellow students, and parents. Every student with ADHD struggles, but how that struggle plays out is different for each individual. I would encourage teachers to spend some extra time getting to know their students with ADHD. Ask them to write down something they wish you knew about them. Talk to them about the things that are hard. Then work together on strategies that will help them reach their full potential.

Register on Time

If you have a teenager with ADHD you know by now that completing tedious, multi-step tasks and meeting deadlines are not their forte. While it’s important for all teens to gain independence during high school, resist using the SAT or ACT sign-up process to teach a life lesson. Take some of the burden off of your teen by learning about the deadlines and taking the lead in the sign-up process. This will reduce stress and will allow your teen to focus their energy on studying for the exam.

Request Accommodations
Students with ADHD are often eligible to receive testing accommodations on standardized tests. These accommodations are intended to help students demonstrate their knowledge to the best of their ability while minimizing the problems caused by their ADHD symptoms. This may mean receiving extended time on exams to account for the slower pace at which students with ADHD complete academic work, taking the exam in a private room to minimize distractions, or using a calculator to help offset a propensity to make careless mistakes.

The SAT and ACT have stringent criteria for the documentation required to qualify for accommodations. These requirements typically include a thorough psychoeducational evaluation that was completed within the last 5 years. Getting a psychoeducational evaluation scheduled and completed takes time – usually a few months – so plan ahead. Once you have the documentation that you need, it takes at least a few weeks for SAT and ACT representatives to review your accommodations request. So, submit your documentation early. For more information about the specific documentation requirements, see the College Board (SAT and PSAT) and ACT, Inc. websites. Your teen’s school guidance counselor or special education coordinator can also be an excellent resource. They should have a great deal of experience helping students submit documentation and request accommodations.

Enroll Your Teen in a Test Prep Program
Studying for the SAT and ACT involves doing just the type of tedious academic work teens with ADHD often struggle with the most. A test prep program that provides structure, social support from teachers and peers, and accountability will go a long way in helping your teen stay on track with a study plan. Look for a test prep program with teachers who have experience working with ADHD students. Help your teen stay motivated by planning out rewards that they can earn as they study. Tie the rewards to the things they can truly control, like the amount of time they spend studying and the number of test prep study sections they complete. Avoid tying rewards to scores on practice tests or the actual exam. Help your teen identify a reward they can earn at least once a week, or if necessary, more immediate rewards that they can earn after each study session. This will help them stay motivated in the moment as they work toward their long-term goal.

By being a partner in the SAT and ACT prep process you’ll help your teen reach their full potential on these exams. Just remember to start the planning process early, request accommodations if you think they will be helpful, and find a test prep program with teachers who know how to work with students who have ADHD. The investment you make now will help set your teen up for success on their college applications.

1. Work with a professional who you like and respect. If you respect and enjoy the psychologist or educator who is conducting the evaluation, then there’s a good chance that you child will too! Kids and adolescents pick up on social cues from their parents, and if you seem to be at ease with the process your child will feel much more relaxed themselves.
2. Discuss your concerns with the professional. Share your concerns with the professional who is conducting the evaluation. Ask them what types of strategies they use to help kids like yours have a positive evaluation experience. If you have suggestions for what might help your child, let the professional know. They might be able to use some of these same strategies during their testing sessions.
3. Create positive expectations for your child. Have your child start off on the right foot by letting them know that you’ve met with the doctor (or educator), and you really enjoyed meeting with them. Tell your child that you think they’ll like the doctor/educator too, and that you think they’ll have fun during the appointments.
4. Focus on learning styles. When talking to your child about the evaluation it can be very helpful to describe it as a process that will help you and your child figure out how they learn best. Let them know that everyone learns differently. For example, some kids learn best by watching a demonstration of how something is done, other kids learn best by reading about things, while others learn best in a hands-on way – by doing things. In addition, let your child know that it will help everyone understand which subjects are harder and easier for your child, and how they can help your child be successful in the areas that are more challenging.
5. Even resistant kids can enjoy the process. If you have a child who is resistant to going to an evaluation appointment, try not to worry too much. Just because your child might not want to go doesn’t mean that they’ll have a bad experience once they’re there. I’ve had plenty of kids and teens come into my office feeling reluctant or even upset about having to attend the appointment (especially when it’s on a Saturday). But once things get started and we get to know each other, the kids settle in and forget that they didn’t want to come in the first place. Usually they are even happy to come back for a follow-up appointment. After all, it’s not often that kids get so much uninterrupted time from an adult who is so interested in what they have to say!

Assessments can be powerful tools for learning about your child’s strengths and weaknesses, and the things you can do to help them succeed academically. Proactive and positive communication before and after the assessment are key to helping your child feel comfortable so you can both get the most out of the evaluation process.

In most cases, it’s best to talk to your child about ADHD sooner rather than later. Here’s why: Most kids with ADHD already feel like they are somehow different from other kids. They notice that their friends and classmates don’t seem to struggle to focus the way that they do, or don’t forget or lose things as often, or have such a messy desk. But they don’t know why. Telling your child that he or she has ADHD lets him or her know why he or she feels different from other kids. It validates your child’s feelings, and helps him or her understand that it’s not his or her fault if things don’t come easily to him or her. In addition, you’re going to need to make some changes to how you’ve been doing things at home in order to help your child manage their ADHD. If your child knows about their diagnosis, you can clearly explain the reasons for these changes and how they are going to help make things better. If your child understands why things are changing, then they’ll be more likely to go with the flow.

So how do you talk to your child about ADHD?

• Pick a good time and place for the conversation. Don’t do it when you or your child are tired, hungry, or have just had an argument. Choose someplace quiet for the conversation, someplace private where your child won’t be distracted.
• Talk about the doctor. Refer to the appointment your child had with the doctor who provided the diagnosis for your child (as long as it was a good experience). Say something like, “Remember when we met with Dr. …” It provides context for the conversation, and helps kids understand where this is coming from.
• Talk in terms of strengths and weaknesses. Explain to your child that everyone has things that they’re really good at and come pretty easily to them. Point out what one of these things is for your child. Then let him or her know that everyone also has things that are harder for them, and share one thing that is harder for your child (e.g., remembering to write down homework assignment, staying focused at school). Then let your child know that he or she is not the only one who has a hard time with this. In fact, it’s so common, that we even have a name for it! It’s called ADHD. Then end on a positive by pointing out one of your child’s strengths that will help him or her tackle their ADHD.
• Be relatable.As you talk about strengths and weaknesses, be relatable to your child by talking about your own strengths and weaknesses and the way that your strengths have helped you deal with some of your weaknesses.
• Share that it’s good to know about ADHD.Let your child know that it’s a really good thing that we know about ADHD, because now you’ll be able to help your child with the things that are hard for him or her.  You’ll be able to help him or her improve, one step at a time.
• Check-in with your child. Finish by asking your child how he or she is feeling, and if he or she has any questions.  Don’t be surprised if your child doesn’t have any questions – yet.  All children process information differently and sometimes even get shy when conversations focus on tough topics. Check-in again a few days later in a casual one-on-one situation, and you might be surprised to hear what your child has been thinking.

While you might be concerned or apprehensive about talking with your child about their diagnosis, being open and honest can get you started off on the right foot.

Planning a teacher meeting early in the school year will also provide an opportunity for you to learn about the academic expectations in your child’s new classroom – and in particular, homework expectations. I have worked with so many families whose children struggle with homework, expending two, three, or even four times more effort on homework than other children in their class. But since these kids ultimately turn in their assignments on time, their teachers never realize that homework is such a challenge for them. Once they understand what is happening, many teachers will recommend modifications to reduce the burden. For example, they may recommend that your child complete only one page of practice math problems instead of two, or break large projects down into small components with individual due dates. In addition, if your child struggles in a particular subject area and you have already enrolled him or her in a learning center or are working individually with your child at home, then share this information with your child’s teacher. They’ll appreciate your extra effort.

Lastly, if your child’s teacher recommends a daily behavior chart in the classroom, offer to check the chart every day. Provide praise, and maybe even rewards, when your child meets the teacher’s daily point or sticker goal. This will allow you to monitor your child’s progress every day. It will also help your child feel motivated to do his or her best, knowing that his or her parents will be proud.

So don’t hesitate to reach out to your child’s teacher at the start of this new school year. Opening up the lines of communication early will help get things off to a good start, and will set your child up for success all year long.

Start by sharing how much you appreciate the relationship the grandparent has with your child. Express your genuine gratitude for all of the help the grandparent already provides, and let them know that you need their help with managing your child’s ADHD as well. Talk with them about ADHD. Find out what they know about the disorder, and how they think it affects your child. Try to gently fill in the gaps, and ask if they’d be willing to learn more about ADHD and the treatment strategies that you’re using at home. Consider sharing books and videos that you’ve found helpful, or a book especially for grandparents, like Help! My Grandchild Has ADHD: What These Children and Their Parents Wish You Knew, by Judy Kirzner.

Then have a follow-up conversation about the specific strategies that you use to manage your child’s ADHD. Talk about your behavior plan, the clear expectations that you have put into place, and the rewards that are tied to these expectations. Explain why it is so important for your child to have structure in their day, and why they can only receive rewards when they have actually been earned. Grandparents love nothing more than to see their grandchildren happy, so be sure to share the positive effects that these plans have had on your child! Let the grandparent know how much happier, calmer, and more motivated their grandchild is when you’re sticking with the plan. Then ask the grandparent if they’d be willing to help by also following the plan. Support the grandparent’s efforts by posting a visual reminder of the routines, expectations, and rewards at home where it can be seen by everyone.

The next two steps are key: praise and patience! When your child’s grandparent follows through, show your appreciation and let them know how much it means to have them on board. When grandparents receive positive feedback they’ll be more likely to continue to stick to the plan. But remember, grandparents are human and they are bound to make mistakes. So try to be patient. Rather than waiting for them to do everything perfectly, notice and praise the little things you catch them doing right each day. When you need to address something that hasn’t gone well, strive to provide constructive feedback in a neutral tone of voice.

Lastly, help your child’s grandparent continue to do what they do best – occasionally spoil your child! Encourage them to schedule fun one-on-one time when they can indulge their grandchild and take a break from the daily routine. This will allow them to meet their own needs as a grandparent, and will strengthen their bond with their grandchild.

With effective communication and patience, you can help the grandparents in your child’s life become parenting allies and provide your child with the support they need to thrive with ADHD.

Rewards are something your child earns for their hard work and effort. They are established ahead of time, paired with clear expectations, and given only after the child has followed through. Rewards are part of a plan that parents are ultimately in charge of managing, and lead to positive interactions that foster feelings of accomplishment. When children are rewarded after a behavior they are more likely to repeat that same behavior again. Bribes, on the other hand are typically given to a child before they follow through desired behavior. Often they are used as a last resort, and as a result they frequently come about during a power struggle or negotiation. They rarely lead to long term changes in behavior. In fact, they often accidentally encourage negative behavior!

Consider this example: A child is at a restaurant with his family. While he’s waiting for his meal, he whines and complains about being bored, and is up and out of his seat bothering the diners at the neighboring table. This is an uncomfortable, common situation for many parents, and one everyone wants to change as quickly as possible.

If you respond by pairing a reward with clear expectations you’ll remind your child that you agreed before dinner that first he would stay seated for the entire meal, and then as a reward he would be able to order dessert. You’ll then give him an activity to keep him busy and praise his good behavior during the meal. He’ll earn his reward, feel good about his effort, and have more motivation to stay seated the next time he’s in a restaurant.

If you respond by using a bribe, you’ll first ask your child repeatedly to stop getting out of his seat. When he doesn’t comply you’ll feel frustrated and maybe even worry that the family dinner will be ruined. So, you resort to a bribe by asking your child if he will sit down if you give him a piece of candy. He takes the candy, sits down for one minute and then is up out of his seat again.

In this case the bribe actually reinforced the child’s negative behavior. He received candy while he was out of his seat, and was not required to first meet any expectations. Once the candy was finished, he stood up again because he was bored and restless, and had nothing motivating him to stay seated. Chances are he’ll leave the restaurant feeling bad about his behavior, and will not be motivated to behave differently next time.

So, how can you avoid bribes and instead focus on constructive rewards? Set clear expectations ahead of time whenever possible, and share these expectations and the possible reward with your child. Using a “When-Then” statement can be helpful, “When you stay seated for the entire meal, then you’ll be able to order dessert.” Don’t allow your child to negotiate about the reward in the moment, and make sure to provide rewards only when they’ve been earned. This shows your child that you are in charge of the plan, and removes their ability to negotiate or engage in a power struggle.

When rewards are used correctly, they can set your child up for success, reduce family conflicts, and teach your child that they can accomplish challenging tasks when they have the right motivation. So, rest assured that when you stick to a behavior plan that includes rewards, you’re not bribing your child. Instead, you’re using a valuable tool designed to help them manage their ADHD symptoms.

It may only be July, but back-to-school shopping commercials and sales are already under way! As you create the list of school supplies and backpacks that your family will need for the next school year, remember that teens with ADHD also need extra programs and support to succeed academically. By planning for extra support now, you will ensure that your teen has everything that he/she needs to succeed right from the start. I recommend having a plan in place that targets the three areas below. Involve your teen in the planning as much as possible, so you’ll both feel confident and prepared heading into the school year.

• To be effective in school, kids need to be organized. Where do books go? Where do you take notes? Where do you write down assignments that need to be completed? Where do you keep handouts and worksheets? And what should you do with notices from school? Teens with ADHD have weak “executive functioning skills” which makes it hard for them to stay organized. Start off the school year right by helping them create systems. Color-coded notebooks by subject, simple folder systems for storing worksheets and assignments, assigning places for everything from school supplies to school notices, and visual calendars.

• Goal Setting. One of my favorite tools that a high school English teacher used with his students was the Grade Contract. At the beginning of the semester, he asked each student to decide on the grade they wanted to achieve in the class, and then shared the work they would need to do to achieve to reach that grade. The Grade Contract helped each student set specific goals and promoted a keen understanding the milestones they would need to meet along the way. In a less formal sense, parents can have discussions with their kids about course goals the academic year. You can help your teen break down each goal into the necessary milestones, and provide them with the support they need to achieve their goals. Having a roadmap for your child makes the end goal less daunting and helps your child stay focused and on-task. Since kids with ADHD struggle to sustain motivation for long term goals, attach rewards and motivators to each milestone and check-in regularly.
• Time Management. Staying on task and completing an assignment means understanding how to manage the time at hand. It’s helpful to coach your child through the steps of the first few assignments of the school year. Ask your child to articulate the assignment that needs to be completed, then write out the plan of attack together -- “First this, then that, next this, and after that…” Have your child check-off each of the steps as he/she goes. After your teen announces he/she has completed the assignment, review the checklist. Praise hard work and effort! If he/she has missed a step, have him/her make corrections before turning in the assignment. Eventually, you can try pulling back on your support and have your teen create his/her own plan of attack. If it goes well, you can supervise from a distance. If your teen is still struggling, then don’t hesitate to stay involved or get him/her extra time management support and skills training.

If your child needs more support than what you can provide at home, learning centers like Huntington Learning Center offer great programs like the Advanced Study Skills Program that help kids improve their organization and executive functioning skills and give them practical tools and tips for improving their goal setting, time management, memorization and recall, and study guide use.

• Youth sports provide a unique, life lessons classroom. There are very few places where kids learn teamwork, where it’s okay (and in fact encouraged!) to make mistakes and learn from them, where you learn to control your emotions, and where you learn how to set and achieve goals. Kids also learn good sportsmanship – winning with class, and losing with dignity. You’d be hard pressed to find another place where you child could learn so much!
• Kids learn the benefits of routine. It’s sometimes hard to convince your child that their morning routine actually sets hin/her up for success. But that lesson becomes a bit clearer to kids in sports. They start to understand the benefits of ‘practice’ before games, they start to understand the importance of following steps or plays to achieve a goal, and they start to see how following that routine leads to success (goals scored!). The ability to learn the importance of a routine and adhering to that routine then rubs off in other non-sports areas.
• Kids learn teamwork. Relating to other kids can sometimes be a challenge for kids with ADHD, especially in a classroom environment. In sports, success comes when kids work together and early-on kids start to see the benefits of teamwork. They understand that in order to score points, they need the other players to communicate and understand each other. And oftentimes kids with ADHD who otherwise struggle to connect with other kids can find quick common ground on the need to pass, to call for a ball, or to look ahead for a teammate. When kids can master that teamwork in the sports environment, they oftentimes can parlay those lessons into life outside of sports.
• Mistakes are okay. Kids with ADHD are often down on themselves, always being disciplined or scolded for their out-of-bounds behavior. They feel like they are always making mistakes. But in sports, mistakes are okay – actually, they are encouraged. Coaches remind kids that in order to learn how to do it right, they need to do it wrong and learn from those mistakes. And even more importantly, that past mistakes don’t matter – that you “brush it off” and “move to the next play”. Learning that type of thinking allows kids with ADHD to recognize that, for example, they might make a mistake in the classroom, but that doesn’t mean they will keep making those mistakes or will forever be the “bad kid, but instead that they can learn from their mistake and do it differently next time.
• Staying positive. Along those same lines, sports help teach kids how to stay positive. Do you remember the McDonald’s commercial where the coach takes the losing team to McDonald’s after the game, while the winning team just gets a trophy? Somehow losing was actually a more positive outcome! Kids learn in sports that there are positives to be had even in loses and that sports is about having fun, spending time with your friends, learning new skills, and trying something new. And for kids with ADHD who may feel down on themselves about school or are not looking forward to another challenging academic year, sports can be a bright spot – something for them to look forward to, to get excited about, and to be engaged with you and their friends.
• Focus on effort, not outcomes. In sports, kids learn that they can’t control the outcome – they can’t control whether they win or lose, because that really depends on the other side. What they can control is the effort they put forth. They learn to “control the controllables” – their effort, their commitment to learning, and their willingness to take risks and make mistakes to get better. That lesson, too, can translate to their life outside of sports and help them be far more resilient as they work to improve, say, their math skills.
• Exercise! Last but not least, the research is clear: kids with attention-issues benefit from exercise. Think about it: you’d find it hard to concentrate and get your work done if you weren’t allow to step away from your desk and clear your head. That’s even more true for growing kids. They need a break! They need time to run around, use their muscles, get some fresh air, and release some of that pent up energy. Running the length of a soccer field multiple times in practice and games is great for them! And when it’s over, they can then sit down at the kitchen table to tackle homework.

So go ahead! Register for a fall sport this season. One last piece of advice: introduce yourself to your child’s coach right away. Let them know that your son or daughter has ADHD, and share the strategies that work best for your child. More often than not coaches respond positively to having this information upfront. It helps them plan ahead and strategize about which ADHD management activities may work best. If your child’s coach doesn’t respond well, it may be a sign that this coach isn’t the right fit. You know your child and their ADHD better than anyone. When you partner with your child’s coach, you’ll help create an ideal environment for your child to learn and grow.

• Academic Accommodations: Think about the academic supports that your teen has accessed during high school. Did they have a 504 Plan, an individualized education plan (IEP), or an informal plan that allowed them to have things like extended time on tests or the ability to take exams in a separate room with no distractions? These accommodations and others are available to college students with ADHD who need them. In order to qualify, colleges require documented evidence of an ADHD diagnosis. At most schools, this means recent results from an evaluation that includes cognitive and achievement testing, as well as an assessment of ADHD symptoms and impairments. Often a signed letter from a pediatrician or psychiatrist is not sufficient. Contact the college’s learning support center to find out about their requirements. Also find out about other academic supports on campus, like tutoring services and writing centers. Encourage your teen to sign up for services when school starts – rather than waiting until they are struggling. It’s all about preventing academic problems before they happen.
• Medication management: If your teen takes medication to manage their ADHD, find out if the psychiatrists on-campus provide ADHD medication management services. Some colleges and universities require students to see doctors and psychiatrists off campus to have their ADHD medication prescriptions filled. Others require a diagnosis from an off-campus physician before they will begin prescribing medications. The campus medical center will be able to answer questions about the services provided on-campus, and will give referrals for off-campus providers if one is needed.
• Social Success. All college students, and especially those with ADHD, have more success socially when they join clubs and participate in extracurricular activities. Have casual conversations with your teen about the activities they’d like to participate in on campus. Encourage them to learn about the clubs and sports available at their school. Just don’t take over and do the research for them unless they ask for your help (and even then, do the online research together)! They’ll be more likely to join if they feel like participating was their own idea and not something their mom or dad told them to do.
• Talk about Alcohol. My own research and that of my colleague’s has shown that college students with ADHD are more likely to experience problems with alcohol on campus than students without ADHD. Even if students with ADHD drink the same amount of alcohol as their peers without ADHD, they are likely to experience greater negative consequences. Plus, if school is already difficult to manage with ADHD, adding alcohol to the mix is only going to make it harder. Make sure your teen knows the risks, and that their risks are greater because of their ADHD. If your teen isn’t going to be receptive to this information coming from you, have them talk with another trusted family member who they look up to, or an older friend, or a therapist or teacher who they respect.
• Counseling services. If you think your child may have difficulty with the transition to college, help them preemptively schedule a few sessions at the school’s counseling center. Counseling center therapists are experts when it comes to the college transition. If your child needs ongoing support, they’ll be able to provide referrals to off-campus providers who specialize in ADHD.

With proactive supports in place, your child can begin their college career on the right foot and help ensure four years of success.

For starters, there’s no evidence to say that videogames cause ADHD. There are some studies showing that kids with ADHD spend more time playing videogames than kids without ADHD, but the relationship isn’t necessarily causal. It might be the case that kids with ADHD choose to spend more time playing because they crave activities that are highly engaging and provide immediate rewards. Parents of kids with ADHD may also allow more videogame time. It can be so challenging to get some children with ADHD to turn off videogames, that parents can understandably get worn down by all of the battles and negotiations.

While videogames may not cause ADHD, growing evidence suggests that playing videogames regularly may in fact make ADHD symptoms worse. This may be because of the way that videogames interact with the ADHD brain as well as the documented negative impact of regular gaming on sleep, academic skills, social skills, and physical activity. Time spent playing videogames is time devoid of social interactions that teach kids with ADHD important social skills that don’t come naturally. It’s sedentary time with an absence of the important physical activity needed to help keep ADHD symptoms in check. And it’s highly stimulating time in the evening which makes it harder for kids with ADHD to fall asleep and stay asleep throughout the night. Equally concerning is evidence showing that kids and teens with ADHD are in fact at increased risk for developing problems with videogame and Internet overuse or addiction.

If as a parent you are concerned about how much time your child spends playing videogames, or the way they react when they aren’t allowed to play, then I would encourage you to trust your instincts and take action. You can start by setting firm limits around the amount of videogame time you allow. The American Academy of Pediatrics recommends that kids over the age of two spend no more than 2 hours watching screens each day. Since videogames represent a fraction of a child’s daily screen time, I recommend limiting videogames to no more than 30 minutes per day. If your child refuses to turn off videogames after 30 minutes, then you may need to eliminate videogames altogether for a few weeks. Then reintroduce them with a firm 30 minute rule in place. If the struggle continues, then you will need to take the videogames away again until your child learns that you mean it when you say, “It’s 30 minutes or nothing.” Without a doubt your child is going to complain that “other kids get to play videogames all the time!” Just remember those “other kids” may not have ADHD or parents who are as informed and diligent as you are about setting the limits that their children need.

While videogames themselves are not to blame for their ADHD, videogames unfortunately exacerbate ADHD conditions and prevent kids with ADHD from pursuing activities needed to help manage their systems and build skills to overcome their symptoms. Prioritizing activities that build social skills, as well as activities that include physical activity, will help kids with ADHD manage their condition. And setting firm limits now on your child’s screen time – videogames included – will pay off immediately and in the long run.

Following Routines. Kids with ADHD need extra help turning everyday tasks and activities into routines and habits that they can do consistently. Brili Routines allows parents to create routines that can be followed anytime and anywhere. Kids view the routines in a game-like format with a picture for each task. The game challenges them to complete each task, stay on time, and earn points along the way.

Habit Tracker for Teens and Parents. Teens and parents with ADHD also need help scheduling routines will eventually develop into good habits. The Productive Habit Tracker allows you or your teen to schedule activities and tasks that repeat on a daily basis, or occur only on select days of the week. This tracker uses a colorful interface with visual prompts, and allows you to track your progress. Progress can be paired with rewards for extra motivation.

Activity Breaks. Research shows that brief activity breaks during homework time helps kids recharge and stay focused while they are working. Brief structured activities that are under 5 minutes work best for kids with ADHD. GoNoodle is a program that was originally designed for teachers who needed classroom activity breaks. But parents can also use it at home. Kids chose from dance- and sing-alongs, Zumba® for kids, track and field activities, and more. Most activities are under 5 minutes!

Social Skills. Learning and practicing good social skills can be hard for kids and teens with ADHD. There are quite a few social skills apps and programs out there, but my personal favorites are The Social Express® for elementary school kids and Middle School Confidential™ for pre-teens and teens. The Social Express® contains 81 webisodes that teach conversation skills, attentive listening, conflict resolution, and self-management. The Social Express® was originally designed for use in schools, but as parents you can access the curriculum and one-on-one activities to use at home. The Social Express® can be accessed through any web browser or an iPad app. Middle School Confidential™ is a graphic novel series about common social challenges faced by pre-teens and teens. The first three books are available as apps and focus on being confident, making real friends, and dealing with family conflicts. The engaging graphic novel format resonates with teens, and keeps them interested and engaged.

Staying Calm. ADHD can make it hard for kids and teens to calm down when they feel anxious or frustrated. As a parent, you’ve probably noticed that simply telling your child or teen to calm down rarely helps, and may even make the situation worse. Providing strategies and tools to help kids regulate their emotions can help. For kids I recommend Breathing Bubbles and Calm Counter. For teens I recommend the Take a Chill. Breathing Bubbles is a colorful calming app that helps kids identify their worries and stress, place their worries inside of virtual bubbles and take deep breaths while they float away. Calm Counter includes social stories designed to teach kids that we all get angry sometimes, and “I need a break” exercise that help kids identify their emotions and cool down. Take a Chill is a wonderful app designed especially for teens. It contains calming exercises, progress trackers, reminders, and assessments that help kids identify their stress and work through it in a healthy way.

These any many other mobile apps and websites provide great support for the lessons that you and your child’s teachers, social workers, and after school tutors are working hard to teach and reinforce. The engaging nature of this technology is sometimes just the thing to really bring that lesson home in a fun, memorable way. And it creates ‘positive screen time’ for kids with ADHD, fostering a more healthy relationship between your child and technology.

Have a favorite app or program you’d like to share? Comment here – I’d love to hear from you. I’m always interested to hear about new apps and websites and to check them out!

Teach friendship skills. Talk to your child about what it takes to make a new friend. Kids with ADHD often need to learn social skills, the same way that they need to learn skills in order to read or play a sport. Coach your child on ways to start a conversation, join a group, and be a good sport during games and activities. Role play these skills with your child, and prompt them to use these skills when you observe them playing with other kids. At the end of this post I’ve included a few simple steps to help you get started.

Encourage playdates and get-togethers. Studies show that kids who invite their peers to do fun activities are better liked than kids who don’t offer invitations. So, help your child think of fun activities that they can do and help them invite their new friend along. Activities can be something as simple as going to the playground for a few minutes at the end of the day, or a bigger activity like a playdate at home or a trip to the movies.

Get help from summer program counselors, educators, and coaches. Kids with ADHD often need support throughout the day to make and maintain new friendships. Talk to your child’s counselors, tutors, and coaches about the skills that you’re working on with your child. Let them know that your child could use some extra support when it comes to making new friends. You can even ask one or two summer staff members if they’d be willing to try out the coaching tips included in this blog. You’ll likely be surprised by how willing people are to help your child make new friends.

Enroll your child in activities that allow them to shine. The demands of the school year can make it hard for a child with ADHD to feel confident academically and socially. Capitalize on summer’s flexibility by enrolling your child in the activities that he or she feels most confident about and enjoys the most. This confidence will naturally carry over into their interactions with new friends who share the same interests.

Boost confidence by building academic skills. Enroll your child in group tutoring and academic programs over the summer, in addition to fun activities. They’ll meet other kids like them and will have an opportunity to see that they’re not the only one who needs a little extra help to keep up at school. They’re bound to enjoy and even look-up to some of these kids, and will learn that even cool kids struggle sometimes. These sessions also provide an opportunity for your child to practice conversation and good sportsmanship skills, and they can invite classmates to join them for activities outside of class. And the biggest benefit? They’ll be learning academic skills that will put them ahead when school starts in the fall. How’s that for a confidence booster!

Perhaps more than any other issue, parents of kids with ADHD worry the most about their child making and keeping friends. Summertime can be a great chance for your child to hit the reset button and create strong friendships with kids who share their same interests. Seize the opportunity, practice some of the tips included here, and you might just see your child blossom this summer.

PARENT COACHING TIPS
Keys to Good Conversations

1. Make eye contact.
2. Ask questions about something you think the other person might be interested in.
3. Give the other person a chance to talk (try not to be a conversation hog!).
4. Keep the conversation going. Share something about yourself that’s on-topic, or ask another on-topic question.

Have realistic expectations. Family vacations do not need to be perfect in order to be great. Often the pressure to make special memories and enjoy every moment of a hard-earned vacation makes families less tolerant of irritable moods and disruptive behavior. Remember that kids (and parents!) will have bad moments during vacation just like they do during the rest of the year. Try to remember that these moments will pass and will not derail the rest of your vacation. If bad moments are becoming too frequent, try to identify the underlying cause. It may be that your child is hungry, tired, or overscheduled. Small changes to any of these areas may make a big difference.  

Involve your child in the planning. Kids with ADHD tend to do best when they are engaged in activities that they find highly interesting. Encourage your child to select one or more activities that will be geared especially toward them. Make sure each sibling has an opportunity to choose at least one activity. If your vacation involves visits to historical sites, let your child act as the “family expert” for their favorite site. This will encourage them to learn about the history before you travel, and they’ll have fun sharing their knowledge during the trip.            

Create space for “alone” time. When tensions run high during family vacations, it is often due in part to the fact that everyone has had a little too much “together” time. Everyone needs some alone time to decompress and recharge, but how much alone time is needed will vary greatly from person to person. Think about your own family. Are there members who need more alone time than others? Create alone time breaks by allowing children to listen to music on headphones, read a book independently, or watch a video by themselves. After their break, they’ll be recharged and ready for the next family activity.

Allow for one-on-one parent-child time to reduce sibling conflict. During family vacations, it’s not uncommon for siblings to compete for their parents’ attention. Add into the mix the fact that kids with ADHD often require more attention to keep their behavior in check, and attention-seeking conflicts will inevitably pop up. Keep these conflicts to a minimum by scheduling one-on-one parent-child time with each of your children. These one-on-one breaks can be as short as 15 minutes, or longer if there are special activities that you would like to do individually with each of your children.

Set small goals and reward good behavior. Kids with ADHD thrive with structure and external motivators like praise and rewards. Build structure into your vacation by setting mini-behavior goals for your child, and by providing praise and rewards when they meet these goals. For example, if your child struggles to stay seated during meal times, set the goal of only getting out of their seat 2 times during the meal. If they meet their goal, then they can get a special treat when the meal is over.

Family vacations aren't without any stress, but with a few of these tips in place, you might just find that the stress level will stay down, the enjoyment will be up, and fond memories will be created.  Travel safely, and have a great vacation!

Create a summer educational plan for your child now, before summer begins. This way you’ll be ready to start as soon as the school year ends. Taking even a short break from academics when summer starts will make it harder for your child to get back into academic gear. So, as tempting as it may be to take a break, make things easier on yourself and your child by starting your child’s summer education plan right away.

• Include one or two hours of academic activities in your child’s daily schedule. Summer provides an opportunity for kids to develop all kinds of skills – social, athletic, creative, and academic. So, don’t overload them with academics. But do consistently carve out one or two hours every weekday for educational skills.
• Work with a learning center. If it is at all feasible, I highly recommend working with a learning center to get your child the academic support that he or she needs. Reputable learning centers, like Huntington Learning Centers, will conduct an academic assessment with your child at the start of their tailored academic program. This is essential, because it allows your child to work on the areas where he or she needs help the most.
• Avoid control battles. If homework time has been a struggle all year long, then you may dread having this same battle around summer academics. Minimize control battles by setting clear expectations, empathizing with your child about how hard academics can be, and rewarding your child for his or her hard work.

• Schedule family reading time. Over the summer your child should be reading every day. Make this a habit for your whole family by scheduling 30-minutes of family reading time every day. Turn off the electronics and minimize distractions. Your child will be much more receptive to reading when everyone is doing it together. If it doesn’t seem feasible for parents and kids to read at the same time, then block out 30-minutes each day when all of your kids read together.
• Make reading fun. Many kids with ADHD would rather eat a giant bowl of broccoli than read a book. Take extra steps to make reading fun. Go to the library and let your child pick out his or her own books. If your child prefers to read books that are below his or her grade level, then compromise. Allow your child to read the easier book on Tuesdays and Thursdays. Make Mondays, Wednesdays, and Fridays the challenging book days.

Creating an educational plan for your child will not only help avoid backsliding over the summer. It will allow your child to strengthen his or her academic skills and start the new school year off with confidence.

Need some help getting started with “The Money Talk” with your preschool or elementary school child? I like breaking up the Money Talk into three smaller ‘mini-talks’ over the course of a few weeks. Kids with ADHD learn best through hands on activities. So I’ve also included some activities that you can use during your conversations.

• Mini-Money Talk #1: Where Money Comes From. In your initial conversation about money, it’s important to lay a solid foundation starting with where money comes from. (Hint: It comes from working!). Talk about your job, and the jobs that other people have – make sure to include a variety of professions. Share stories about your first job, and how it felt to earn your first paycheck!

• Mini-Money Talk #2: The Difference Between a Want and a Need. In this second conversation, let you child know that the money you earn at a job can be spent on all kinds of things. But ultimately things fall into two categories: wants and needs. Needs are things our family has to have: food for dinner, water for the shower, and electricity for the lights. But wants are “extras” – things that we don’t need to have, but it might be nice to have. And we can’t buy “wants” until we have met our “needs.” Share a personal story about something special that you wanted, but had to save up to buy so that you could pay for the things you needed first.

Wants & Needs Activity: On Post-It notes, write down the amount of money that goes toward different “needs” (housing, food, gas & electric, school, etc.). Together with your child, count out the money for each category. Then count out the amount that is left to spend on fun things – the things that you want. Ask your child how he or she thinks they should spend the money in the “want” pile. Would he or she spend it now, or save it up for something special?

• Mini-Money Talk #3: How Credit Cards Work. Credit cards make the concept of money even harder for kids to understand. Yet, it’s the number one way that kids see us spending money – so it’s not a topic that we can ignore. I recommend explaining how credit cards work through an activity rather than a conversation.

Credit Card Activity: Have your child set up a pretend store at home, with price tags on the items. Then have your child use a credit card to “buy” some things in the store. Next, act as the credit card “bill collector” and write up a bill for the purchase. Give your child the bill, and have them count out the money (real or pretend money) to pay the bill and hand it over to you. This will help them understand how credit cards and money are connected. Next time you’re in a store, point out that you’re going to need to send the credit card company some hard earned cash for those purchases when you get home!

Once you’ve opened the door with your first mini-conversations about money, it will be much easier to keep talking about this topic with your child. You may even find your child asking questions the next time he or she sees you spending money at a store or leaving a tip at a restaurant. This curiosity is great, and will encourage you to keep the lessons coming! I’ll be following up with a post about how to use an allowance to teach kids with ADHD about money. By then you’ll have already had your money conversations and will be more than ready for this next step!

1. Provide clear expectations. Tell your child exactly what is expected of him or her during dinner. Focus on very specific behaviors, like “stay in your seat,” “talk without interrupting,” “no electronics at the table.”
2. Be realistic. If your child really struggles with a behavior, then make sure your expectations not beyond your child’s reach. For example, if your child currently gets up from his or her seat four times during dinner, then he or she will likely find it very difficult to sit for the entire meal. A more reasonable expectation may be to allow him or her to get up only once or twice during dinner. Once he or she has mastered this, then you can expect him or her to work on staying seated for the entire meal.
3. Try using a talking stick. If family members struggle to have good conversations during dinner, then try using a talking stick. The person holding the talking stick speaks while others listen and ask questions. Then the stick gets passed to the next person at the table. You may need to set some ground rules around topics that can be discussed – especially if things have a tendency to become way too silly, or too tense.
4. Pay attention to good behavior. It can be easy to accidentally give your child less attention when he or she is quiet and following the rules and more attention when he or she is misbehaving – and demanding your negative attention. You’ll see better behavior at the dinner table if you give your child the most attention when he or she is behaving well. He or she will be much less likely to engage in attention-seeking behavior if he or she is included in conversations and feels seen and heard at the table.
5. Reward good behavior. When your children meet your mealtime expectations, provide them with a reward. Some of my favorite rewards include: healthy desserts, the privilege of listening to music during dinner, playing a quick game as a family at the end of the meal, or points toward a larger reward at the end of the week. Just make sure the reward is something that your child really wants, and let him or her know about the reward ahead of time. During dinner, point out good behavior and tie it to the reward, “You’re doing a great job staying in your seat. If you keep this up then we’ll be able to listen to music during dinner again tomorrow!”

• Pick the reward before you start. Make sure the reward is something the whole family is motivated to earn. Ideally, it will be a special activity that doubles as quality family time.
• Be consistent. The marble jar only works when your kids actually earn marbles! Aim to catch your children following the rules at least once a day. It can actually be harder to notice good behavior than it is to notice bad behavior. So you’ll need to make it a point to keep your eyes and ears open for marble-worthy actions.
• Pair the marbles with praise. Be enthusiastic when your children earn a marble. Be specific with your praise by telling them exactly what they did well. “Wow, you were so patient at dinner, waiting your turn to speak. You just earned another marble!”
• Adults can earn marbles too! Model the family rules for your kids by noticing when other adults in the house follow the rules too. If your rule is, “We put things back where we found them,” and your partner puts the TV remote back in the remote basket instead of leaving it buried in the cushions, then go ahead and add a marble to the jar!
• Try not to go more than two weeks between rewards. Kids with ADHD often struggle with delayed rewards. If you go more than two weeks between rewards, your child may lose motivation. If you think it will take more than two weeks to fill up your jar, draw a line on the side of the jar at point that seems like a more reasonable target. Or consider using cotton balls instead of marbles. Cotton balls will fill up the jar much faster.

When you follow these basic steps you’ll be experiencing the magic of the marble jar in no time! It’s a great way to teach new skills and behaviors, while staying positive and keeping it fun.

1. Focus on “do” rules rather than “don’t” rules. All kids, especially those with ADHD, learn best when they are told what to do rather than what not to do. Consider this example: the doorbell rings when your child’s best friend arrives for a playdate, and your child starts to run down the stairs. You call out, “No running in the house!” What does your child do? They slide down the banister. Did your child follow the instruction? Yes they did! But did they do what you really wanted? Not even close! If you had told the child what to do “Remember, we walk in the house,” then they would have clearly known what was expected, and would have been more likely to follow the direction.
2. Keep the list short. Kids with ADHD have a hard time keeping track of lengthy lists of rules. So, limit your list to 5 rules. Rules that apply across a variety of situations can help you meet this goal. For example, “We respect others” captures a wide range of problem behaviors, like grabbing a toy from another child, using a sassy tone of voice, criticizing a sibling, etc. Some of my favorite family rules for kids with ADHD are, “We wait our turn to talk.” “We follow directions the first time.” “We show good sportsmanship whether we win or lose.” “We put things back where they belong.”
3. Set rules based on ability level. Think about each child in your family, and his or her actual ability to follow each of the rules right now. Consider this house rule, “We put things back where they belong.” ADHD will make it hard for kids to follow this rule, even as they get older. If your child almost never puts things back right now, you may need to remind him or her to follow the rule in the beginning. So, try starting with this version instead: “We put things back where they belong with one or fewer reminders.” Eventually, as new behaviors become habits, you can increase your expectations and drop the reminders portion of the rule.
4. Praise and reward good behavior. Kids with ADHD rely on feedback from others and positive reinforcement to follow rules and learn new behavior. So, praise your child when you see them following one of the rules. And the praise should be specific to the rule. “Great job putting your toys back on the shelf where they belong!” Do this often! The more often you praise your child the more likely you are to see changes in behavior.

When structured correctly, family rules can work for kids with ADHD and their siblings. In fact, they’ll provide a solid foundation that will help your family flourish!

 Bedtime can be challenging, especially when your child has ADHD. Try these tips to break the bad bedtime cycle:

1. Have a set time each night for when your child starts getting ready for bed, and stick to it. Leave enough time to get everything done (teeth brushed, tomorrow’s clothes picked out, etc.) that they will be done in time for bedtime.
2. Turn off all of the screens at least 1 hour before bedtime. The blue-light that emits from LED screens disrupts sleep. Especially for kids!
3. When you tell your child to get ready for bed, get their attention first, then tell them to get ready for bed. That way, you know they’ve heard you. Then stay with them until they’ve started to get ready for bed. (Don’t walk away when you tell a child to go to bed. You’ll come back in 15 minutes to find nothing has happened.) Staying focused and staying with them lets them know that you mean business.
4. Create a list with the steps of your child’s bedtime routine, and post it up in a place where your child can check it every night. They may need you to supervise them, or provide a couple of reminders when they are first starting to use their new checklist.
5. Provide a lot of specific praise when your child follows through, “I really like how you looked at the checklist and then started to brush your teeth right away!” If they need some extra motivation, provide a reward when they complete all of their bedtime routine steps. For example, if they finish their steps by 8:20, then you’ll read a book together for 10 minutes.

Your child’s summer plan should be two-fold. First, it should include camp experiences that allow them to do the things they already enjoy and develop new skills by trying out sports and arts that they’ve never done before. Second, it should include an educational plan that will keep them from backsliding over the summer. Kids with ADHD need academic support year round to maintain their skills and be prepared for school in the fall.

This week we’ll talk about strategies for finding the right summer camps and social programs for your kids. Next week, we’ll talk about how to avoid academic backsliding over the summer.

As all parents of kids with ADHD know, finding the right summer camp is challenge! Here are some things to look for in a camp that’s a good fit for your child:

• Does the camp have activities that my child is excited about? Kids with ADHD are most focused and often at their best when they are engaged in activities that they find interesting. So, have your child come up with a list of fun things they’d like to do at camp this summer, and search for programs that have at least some of these activities.
• Look for camps that have a small staff to student ratio. Kids with ADHD typically need a bit more supervision than kids without ADHD. If your child tends to struggle socially in new settings, having more counselors around will help them catch problems early, before they escalate into crises.
• Look for camps that have a high level of structure. Kids with ADHD tend to struggle most during unstructured time, so in most cases, the more structure the better.
• As a parent, you know your child better than anyone. Think about your child’s strengths and weakness. How would you like to see them grow this summer? For example, would you like to see them become less shy and more comfortable around kids their own age? Would you like to see them improve their good sportsmanship skills? Or would you like them to be in a setting where the adults are more positive than their teacher may have been last year? Choose a camp that gives your child a chance to explore and work on these areas.
• Once you’ve narrowed down your selections and have made your list of growth goals for your child, contact the camps. Talk to them about the strategies they use to manage behavior, how they facilitate friendships or handle social conflicts, how they structure their days, and the camper to counselor ratio. When it comes to managing behavior, make sure the camp is using praise, positivity and earning privileges, as opposed to things like time-outs and removal of privileges as punishments for kids. Look for camps that have games and activities that help kids get to know each other. Also look for camps that pay attention to the differences in individual children and pair them up with teammates, bunkmates and partners that are well suited for each other.

Most importantly, the camp should be someplace that both you and your child are excited about!

• Make a list. Together with your child make a list of things that should be in the backpack. Be very specific. For example, if your child likes to keep library books in their backpack, allow them to carry only one book (two at most) at a time.
• Have a homework folder. Select one specific folder that is used to bring homework sheets to and from school. Use the left side of the folder for unfinished work, and the right side for completed worksheets. Check the homework folder every day to make sure the “completed” side is empty when your child comes home. Kids with ADHD often forget to turn in completed work!
• Have a second folder for notes to parents and other papers. Keep permission slips, notes for parents, and papers that don’t belong in the “homework folder” in a second folder. This keeps the backpack from getting cluttered with loose paper.
• Use a pencil pouch. Keep pencils, pens, and erasers in a pouch. They’ll be easy to find and will be less likely to be lost or broken.
• Set limits on toys in the backpack. Kids often want to keep non-school related items, like figurines, stuffed animals, or trading cards, in their backpacks. Usually they’ll get into trouble with teachers when they pull these things out in class. So, it’s best to keep them at home. If your child insists on bringing toys to school, set limits. Allow only one item at a time.
• Do a backpack check every day. To keep the backpack in tiptop shape, you’ll need to do a quick backpack check every day. Give your child lots of praise when they’ve used their checklist and organization plan! If they are backsliding, catch it early. Try not to criticize. Just let them know what is out of place and how to fix it.
• Clean out the backpack every week. Pick a time once a week when your child will go through the backpack checklist and do a cleanout. Check the backpack once the cleanout is complete, and help them along the way if they need it. Praise their effort! If they meet their checklist goal, consider providing a small reward.

An organized backpack is a great way to start teaching important organization skills that can help kids stay focused and get things done.

• Good mornings start with a good nights’ sleep. According to the National Sleep Foundation, children between the ages of 6-13 require 9 to 11 hours of sleep, and teens between the ages of 14-17 need 8 to 10 hours of sleep.
• Wake your child up at the same time every day. This routine will help regulate their circadian rhythm and make it easier for them to get out of bed in the morning.
• Create a checklist. Together with your child, make a list of the things they need to do each morning. Try to keep the list limited to no more than 7 items. For example:
  • Wake up with only 1 reminder from mom by 7:20
  • Brush my teeth
  • Wash my face
  • Brush my hair
  • Get dressed
  • Eat breakfast and finish my 7:50
• Post the checklist in a spot where your child can see it every morning. Make it look fun and let your child decorate it -- it helps your child feel like they own the routine too.
• When your child finishes all the steps, provide a lot of praise. Make sure your praise is truthful, specific and positive. “Great job brushing your teeth without needing a reminder.” or “7:45am and done? High five! Way to go!”
• Consider providing your child with a reward as an extra incentive to finish their morning routine independently and on time. Rewards can be simple, but they should be immediate. Things like picking a special snack for lunch, choosing the radio station in the car on the way to school, getting a special hair style, or getting 10 minutes of screen time.
• When your child is first learning their new routine, you may need to provide supervision and an occasional reminder. So, try to get yourself up and ready a bit early on the first few days of the new routine. This way you’ll be able to give your child your full attention when they need it.