So you think your young’n is exhibiting some ADHD traits. Maybe she seems to have a bit more trouble transitioning or initiating tasks than others her age, or perhaps he has particularly strong emotional reactions to criticism or frustration. Now what?
Understatement: Parenting is hard. Under-er statement: Parenting + ADHD can be even harder. One of the reasons behavioral therapy for ADHD is hit or miss is because behavioral treatments aren’t really that effective long term or across multiple settings. ADHD differs from other mental illnesses by being a genetic neurodevelopmental disability characterized by differences in the brain, so it’s less of something you treat and more of something you manage. Though there are new discoveries and studies happening every day, currently the most effective treatment for ADHD by far is stimulant medication.
That being said, there are plenty of things caregivers can – and should – do to support the small ADHDers in their life; and many have the added bonus of being super helpful for most children. So when ADHD kids come in for therapy, I spend the majority of my time working with the adults that care for them. Everyone is different, but here’s a few of the suggestions I give frequently.*
- Consult with their pediatrician first. There are several medical conditions that can mimic or exacerbate ADHD symptoms, and it’s important to rule out/in autism spectrum disorder – which overlaps with ADHD quite a bit.
- ADHD is not a disorder of knowing what to do, it is a disorder of doing what you know. I’m going to repeat that because it’s so important: ADHD is not a disorder of knowing what to do. It is a disorder of doing what you know. Maybe I’ll hang this in my office somewhere, because I think this is where we as adults fail when it comes to addressing ADHD kids. We tend to approach their shortcomings as “teaching moments.” We lecture, or try to explain the right way to do something and why what they did was the wrong way. And they’ve already tuned us out. Because most of the time, they know it. They just can’t do it. They don’t need someone to tell them what to do; they need someone to model how to do it. So with that in mind:
- Remember that until their brains are developed to do so on their own, you are their emotional regulator. They will follow your lead. Stay calm and be as direct as you can. Be present with them as long as you’re able, and help them de-escalate. Show them what it looks like to be in control of your reactions. It’s always a good thing to teach coping skills like deep breathing and taking a walk, but remember that even if they know those things they won’t be able to do them on their own – while upset – for a long time. Brains with ADHD are on average three years behind neurotypical brains developmentally. I hate saying that (selfishly), but it is pretty well-supported. Try to use this information to hold realistic expectations and give your child, and yourself, a break.
- However: Let ADHD kids gain competence whenever possible. While this is important for all kids, it is essential for ADHD kids. It is soooo hard to watch a kid struggle with a task we could complete in seven seconds (especially if we also have ADHD). But the more you give them opportunity to make choices and take agency, the stronger their neural pathways will become and the less you will need to engage in power struggles.
- By age 12, researchers estimate that ADHD kids receive 20,000 more negative comments than their neurotypical peers. This not only sucks, it might make ADHD symptoms worse. Whatever positive affirmation you’re giving, double it. Some parents have found it helpful to carry coins or poker chips in their pocket and remove one for every positive comment, in order to remind themselves to point out what their kids are doing right.
- Exercise! Make sure your ADHD kids are getting plenty of outside and activity time – especially if they are having behavior issues. I really discourage taking away physical activity or outside recreation as a means of discipline, because that can make behavior much worse.
- Amp up the protein and omega-3s (like fish) in their diet. Protein is a more steady source of dopamine and omega-3s can improve memory.
- Prioritize sleep hygiene for ADHD kids even more than their peers. We tend to need even more sleep to function well, and difficulty falling/staying asleep is very common for us. Things like a consistent bedtime routine (even on weekends), a long wind down period with no screens, and guided meditation or reading can go a long way.
- Don’t be scared of meds. Stimulant medication gets a really bad rep, but the truth is it’s extremely safe. The first documented use of stimulants for ADHD symptoms in kids was in 1937. The two most common medications, methylphenidate and amphetamine/dextroamphetamine (Ritalin and Adderall), have been in circulation since the 50s. Therapy and environmental support is important too, but medication is a crucial part of a multimodal approach because it can actually help the brain retain the benefits of behavioral interventions.
- Talk with them about their diagnosis. Don’t make it shameful. Sometimes we withhold this kind of information from kids to prevent them from feeling abnormal or alienated, or using their disability as a “crutch.” I assure you, they already feel abnormal and alienated. Providing a name for that alienation is a powerful gift you can give your child. Remember that without speaking about their ADHD, you are not only hiding the limitations that come with it – you are also hiding their unique strengths. I like to use the analogy of Spiderman when talking with kids about ADHD…when Spiderman discovered his powers, it was really hard to get the hang of them at first. He couldn’t figure out how to make his web work, and he was knocking over lamps and stuff. But he trained, and practiced, and eventually he could practically fly. That’s what they can do: fly.
*I am not a parent. My experience and education/training can speak to what research says is best for child development and ADHD treatment, but my recommendations on how to get there are based on what I’ve observed through my work and not what I have tried personally.
Parents: What do you do with your ADHD kids that works?
Adult ADHDers: What kind of support do you wish you had as a kid?
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The ADHD Manual 
Can you explain a little how the medication works? One big component of raising our three year old is his never ending struggle with emotional regulation. I feel like he is almost always bubbling under the surface. We have good days and bad days. I’ve always heard (stigma) that drugs like Ritalin and adderall have a filling effect on the person taking them. But I never knew they were stimulants. The thought of giving him a stimulant is a little mind blowing to me because I think of it as giving him a cup of coffee and that would be a very, very poor choice. 🙂
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There are actually many children (diagnosed with ADHD) who are given coffee to calm down, as it has the opposite effect than non-ADHDers. For instance, I can drink an entire pot of coffee and fall asleep immediately …and there are many times where I’ll fall asleep shortly after taking my prescribed adderall.
Stimulants “amp up” those who do not have ADHD.
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Haha! I’ve had similar experiences! I am not a coffee/tea drinker and have never been, but once as a teenager, I raided my dad’s coffee bean supply and ate a bunch of them straight up because I just wanted to munch on something. I had no problem falling asleep right after that.
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Great question. Stimulants are very confusing, especially because they have such widely varying effects on different people. It’s a common perception that stimulants just have an opposite effect on ADHD brains, but this isn’t quite accurate.
The simplest way to describe it is by looking at stimulants’ impact on dopamine. Most stimulants, including caffeine, increase the level of dopamine in the brain. Dopamine is a “feel good” neurotransmitter that sends messages to regulate attention, activate our reward system, control our emotions, increase motivation, etc. Like most things in the body, it works best if we have a balance of not too much, not too little. Too little dopamine and we have difficulty feeling pleasure and initiating action. Too much dopamine and our system is overwhelmed, our brain isn’t able to send messages efficiently, and subsequently our brain has trouble producing its own dopamine which brings us back to too little. “Just right” dopamine and we can direct attention, think before acting, and learn from consequences because our reward system is functioning properly.
We all have dopamine and it affects us in the same way, ADHD or not. This is why everyone feels more alert or focused when taking a stimulant medication, at least initially. The difference is that ADHDers have lower levels of dopamine to begin with; stimulants appear to have the opposite effect because we essentially have farther to go until we reach the tipping point. Not all stimulants are created equally, and ADHDers are still susceptible to the impact of too much dopamine (they’re not impervious to a meth high, for example).
Some stimulants increase dopamine indirectly by affecting other neurotransmitters. Some push the brain to produce more dopamine, some prevent reuptake to keep dopamine in the system longer, and some do both. Some flood the brain extremely quickly, and others release gradually over time. All of these factors impact the effect any given stimulant will have on a person, and everyone has a different “perfect level” of dopamine. This is why, although there are tons of stimulants (both prescription and illicit), only three of them specifically target the right receptors, with the right timing, and in the right way to effectively address ADHD symptoms. Just being a stimulant isn’t enough.
I know plenty of people – both neurotypical and neurodivergent – on whom caffeine has a sedating effect or no effect at all, and just as many who get extremely anxious or jittery. We consume caffeine in drinks and foods, and it’s impossible to know exactly how much we’re taking in. How you respond to caffeine is maybe a clue to how you will respond to ADHD stimulant medication, but it is certainly not a good indicator. And while there are people who use caffeine to self medicate, it is pretty rarely effective by itself and worth the side effects/unpredictability. In any case, it’s definitely not a great idea to utilize it as ADHD treatment for kids; at least not without regular consultation with a doctor.
There are tons of nuances to chemical substances, and plenty to explore. If you’re interested, here’s a helpful article on Ritalin vs. Adderall: https://www.additudemag.com/adderall-ritalin-adhd-medication-comparison/
Ultimately, when it comes to medication, only a doctor can really help you figure out what’s best for you.
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Thank you soooo much for this. It’s explained really well. Seems like there will probably be trial and error on finding the right drug and right dosage for a child. We are still a long way away from there, but I’m becoming more and more convinced of this possible diagnosis for our kiddo. Thanks also for the article.
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