# data[].attributes.attachment_link.description
The Society for ADHD empowers underserved individuals, families, and communities affected by ADHD and co-morbid conditions through advocacy, education, and support. Explore ADHD symptoms, diagnosis, Neurodivergent, adhd specialist near me, adhd coaching certification coaching, online adhd therapy and treatment. Our mission is to eliminate stigma, raise awareness, and ensure equitable access to ADHD resources and solutions, especially for underserved communities.

# data[].attributes.attachment_link.title
Flyer 3_ Supporting Your Child with ADHD

# data[].attributes.headline
8 Simple Strategies for Students with ADHD

# data[].attributes.subject
8 Simple Strategies for Students with ADHD

# data[].attributes.attachment_link.readable_text
Raising a child with ADHD is tough, especially when symptoms are already obvious at a young age. Most children aren't diagnosed with ADHD until they are school aged. However, 2.4% of children ages two to five are diagnosed with ADHD, according to the American Academy of Pediatrics.﻿﻿

If you learn to recognize the signs of ADHD early, you will know what you are dealing with and can get interventions in place.

Environmental Changes

Whenever there is an abrupt change in a child's behavior, the first question to consider is whether or not there have been any recent changes that may create more stress in a child's life such as a move, a loss, a new baby, changes in the routine, or lack of sleep.

Need for More Intense Interventions

Your child may initially respond to your interventions but may subsequently need more intense interventions. This might include more frequent redirection and feedback and more immediate and more powerful rewards. It also helps to be aware of triggers and plan for problem situations including roleplaying and teaching appropriate skills. Continue to be consistent, as well.

Proactive Parenting Strategies

Kids who are impulsive have a really hard time controlling and inhibiting their behaviors and responses. They react without considering consequences. They also often don't connect their actions to the consequences that will follow, especially at this young age.

That's why proactive strategies like redirecting, frequent reminders, preparing for transitions, keeping the day very structured, channeling extra energy with physical movement, offering choices to give him a sense of control, giving one-step directions, and teaching calming strategies, can really help.

Close Supervision and Monitoring

Continue to monitor your child closely. He will need constant supervision around younger siblings. Try to identify triggers to your child's outbursts so you can intervene and redirect in positive ways before the behavior becomes destructive and aggressive. Do meltdowns seem to occur at a particular time? Around transitional times? When the child is overstimulated? Overtired? Frustrated with a task or in trying to verbalize or communicate desires?

Remain Calm, Get Support and Don't Forget Self-Care

It is hard, but try to remain as calm as possible. Sometimes what happens with kids with ADHD is their behaviors can become so difficult and exasperating that the parents may begin to respond in ways that may not be quite as effective (perhaps responding with inconsistency or disapproval and anger).

This, in turn, escalates the child's acting out. It cannot be reiterated enough that parenting a child with ADHD is tough. It requires even more patience and supervision and creative interventions on the part of the parent.

It can be draining, so work with your partner or network of family and friends to figure ways to take care of yourself. That way, you have the energy to parent calmly and productively. Make sure you are consistent and if in a two-parent household, make sure you are on the same page parenting-wise.

Communicate Openly With Your Child's Doctor

It can be difficult to decide whether to start your preschooler on medication for ADHD. For children ages 4 or younger, with significant hyperactivity, inattention, and behavioral concerns who have not responded to behavioral therapy and/or changes to parenting approaches, medication might be an option.

Share your concerns with your child's pediatrician. A low dose of stimulant medication may be recommended if environmental changes and behavioral approaches are not enough to significantly improve symptoms.

If your child is placed on medication, it will be important to monitor closely and communicate frequently with the doctor to make sure side effects are minimized and your child's health is good. If your child is already on medication, an adjustment may be recommended. Either way, open communication with the doctor is essential.

# data[].attributes.attachment_link.title
How to Improve Behavior in Preschoolers With ADHD

# data[].attributes.attachment_link.description
Raising a child with ADHD is tough, especially when symptoms are already obvious at a young age. Most children aren't diagnosed with ADHD until they are school aged. However, 2.4% of children ages two to five are diagnosed with ADHD, according to the American Academy of Pediatrics.﻿﻿ If you learn to recognize the signs of ADHD early, you will know what you are dealing with and can get interventions in place.

# data[].attributes.attachment_link.readable_text
Welcome to ADDitude's 10-week Success @ School email program - a self-guided course for neurodivergent students and their families.

In a recent ADDitude survey, less than half of educators said they receive formal training to help them understand and effectively teach students with ADHD and its comorbid conditions. Many teachers rely on the expertise and ideas of their students' families, which is why ADDitude has created this guided, curated email learning series to equip caregivers with accurate, up-to-date information about ADHD, plus realistic and effective solutions to the specific academic and behavioral challenges associated with ADHD in the classroom.

Your training will begin immediately with an introduction to ADHD and executive dysfunction, myths and misinformation that impact learning and self-esteem, and ideas for starting off the school year right. Each week, you will receive a new lesson about effective accommodations, common learning differences and behavior problems associated with ADHD, homework strategies, social skills help, and much more...

PART ONE: ADHD Misinformation
PART TWO: ADHD Accommodations
PART THREE: Distractibility and Inattention
PART FOUR: Weak Executive Functions
PART FIVE: Behavior Challenges
PART SIX: Homework Problems
PART SEVEN: Learning Differences
PART EIGHT: Social Struggles
PART NINE: School Collaboration
PART TEN: Motivation and Resilience
NOTE: This resource is for personal use only.

# data[].attributes.attachment_link.description
This self-guided program equips caregivers and students with realistic and effective solutions to the specific academic and behavioral challenges associated with ADHD in the classroom while educating them about the sometimes surprising ways ADHD manifests, especially in girls.

# data[].attributes.attachment_link.readable_text
ADHD and anger can be connected, and some kids with ADHD experience frequent outbursts of anger. Although common, these intense emotions can make it hard for a child to maintain friendships and behave in school, and they can put a strain on family life.

Understanding the causes of anger and frustration among kids with ADHD, along with some strategies for managing these intense emotions, can help prevent these short bursts of anger from causing long-term damage.

The Link Between ADHD and Anger

Children with ADHD often experience emotions with a greater intensity than their peers without ADHD. What's more, comorbid conditions such as impulsive aggression and oppositional defiant disorder (ODD), as well as medication side effects, may make it more likely that your child will feel bad-tempered, aggressive, impatient, and angry. Here are some of the most common reasons why kids with ADHD may exhibit angry outbursts:﻿﻿﻿﻿﻿

Impulsivity

Impulsivity is a symptom of ADHD that is often caused by an inability to focus and control behaviors. The impulsive nature of ADHD means that if your child feels angry, they communicate it right away. They don't have a few seconds of lead time that a child without ADHD has, and they haven't yet developed strategies that adults with ADHD develop.

More than 50% of preadolescents with ADHD experience impulsive aggression,﻿﻿ which is also known as affective aggression, and is characterized by strong, unplanned emotions, usually anger, that often take place in the heat of moment.

Emotional Sensitivity

Kids with ADHD tend to be emotional, sensitive, and feel things very deeply. They also have a hard time regulating those feelings. This can cause them to cry easily (which can be very embarrassing for them) or feel intensely angry.

In fact, up to 50% of children with ADHD experience emotional dysregulation, or a poor ability to manage emotional responses or to keep them within an acceptable range of typical emotional reactions. This can refer to a wide range of emotions including sadness, anger, irritability, and frustration.

Moodiness and Mood Disorders

Moods change very quickly throughout the day when you have ADHD. There can be many episodes of happiness, sadness, and frustration-allin one afternoon.

In addition, kids with ADHD experience high rates of comorbid mood disorders that can cause irritability and fuel mood changes and flashes of anger, including:

Frustration

Frustration is an emotion that stems from challenges that stand in the way of goals. The ability to deal with frustration is known as frustration tolerance. Low tolerance to frustration can mean that your child feels frustrated quickly, and this can quickly result in anger outbursts.

Poor Self-Esteem

It's common for children with ADHD to experience low self-esteem.﻿﻿﻿ ADHD symptoms can make it difficult for kids to experience academic achievement and make it difficult to make and keep friends, which can lead to a sense of isolation and lowered self-esteem. Low self-esteem and feeling anxious about a situation they can't control can also lead to your child feeling anger.

Medication Side Effects

Sometimes children experience a difficult period when their stimulant medications are wearing off, resulting in increased meltdowns and tantrums. This is known as medication rebound, and is a result of the speed at which your particular child metabolizes the medication.

Let your doctor know if your child is experiencing medication rebound. Since it tends to occur more frequently with shorter-acting stimulants that can move out of your child's system quickly, your doctor may add a very small dose of immediate-release medicine about an hour before this rebound effect occurs so that the transition off the medicine is smoother.

A recent double-blind study found that children on stimulants had a reduction in irritability and tantrums after being given the antidepressant Celexa (citalopram).

Excess Energy

Excess energy, or hyperactivity, can present as physical and/or verbal overactivity. The energy and restlessness that comes along with ADHD may be too much to handle at times until it finally bubbles over into angry words or physical reactions.

Oppositional Defiant Disorder

Approximately one-third of all children with ADHD also have oppositional defiant disorder. Children with ODD display defiant, hostile behaviors towards authority figures.

They often lose their temper, frequently argue with adults, actively defy rules, blame others, deliberately annoy others, are touchy, easily annoyed and behave in angry, resentful ways overall.

Obviously, some oppositional behaviors are expected in children, and ODD is only diagnosed if the pattern of behavior is significantly more intense and frequent when compared to other children of the same age. If you think your child might have ODD, book an appointment with your pediatrician.

How to Help Your Child

As a parent, it can be hard to see your child losing control. While you can't make the anger disappear, you can help your child better manage these intense emotions. Here are a few tips to help.

Work With Your Child's Doctor

Working closely with your child's doctor is a crucial part of managing your child's anger. They can prescribe appropriate medication and recommend therapy, special accommodations, social skills, and lifestyle changes-and then it's up to you to keep them informed about medication side effects and what is and isn't working to help manage your child's anger.

Encourage Exercise

If anger is an issue for your child, be sure to provide appropriate outlets. Strenuous outdoor play and exercise can be very powerful releases for children with ADHD. Running, jumping, skipping, climbing-these basic physical activities will help release some of the tension, restlessness, and extra energy that often accompanies ADHD. Make sure your child is engaging in this type of play daily.

Try Martial Arts

Consider enrolling your child in a martial arts class. Martial arts are an excellent exercise choice for an ADHD child. It helps develop self-discipline and self-control, which in turn helps with impulsivity. It also improves self-esteem and is an excellent way to release energy.

Help Your Child Express Emotions

Encourage your child to "use their words" rather than act aggressively. To begin with, it might be hard for them because it is a new skill. However, with practice and a little help from you, it will become easier. Being able to articulate how they are feeling lessens their need to express themselves through anger. For example, "Jimmy took my red car and I feel mad."

Notice Patterns

There may be particular times of day that your child's anger appears to peak. Taking note of any patterns can ensure you're better prepared to handle these outbursts. For example, you may notice their anger is more intense:

After school, when your child is able to let down their guard and release pent-up feelings

When they are feeling hungry or tired

When they are experiencing frustration with a task

When their ADHD medication is wearing off

Limit Screen Time

Supervise the programs your child watches on television or on the computer. Much of the media on TV, movies, video games, etc. is violent, aggressive, and inappropriate.

Set Clear, Consistent Rules

Make sure you have clear house rules around behavior. When your child is settled and able to talk, sit down and come up with the rules together. Discuss expectations and consequences for behaviors, including a reward system. Then once they are in place, stick to them.

Don't change the rules or make up consequences in the middle of an outburst. Be matter-of-fact: "If that happens, then this is the consequence." Strong boundaries are helpful for you both. If your child is working with a therapist or counselor, you may want to ask for recommendations of discipline strategies that work well for kids with ADHD.

A Word From Verywell

It's tough for both parents and kids when a child with ADHD loses control and struggles with anger. If your child has angry outbursts, and especially if these intense emotions interfere with their relationships, education, and quality of life, it's important to teach them the skills they need to deal with their feelings in a healthy way. Together, with guidance from your child's doctor, you can ensure that anger does not interfere with your child's well-being and success.

# data[].attributes.attachment_link.title
Understanding Anger in Children With ADHD

# data[].attributes.attachment_link.description
ADHD and anger can be connected, and some kids with ADHD experience frequent outbursts of anger. Although common, these intense emotions can make it hard for a child to maintain friendships and behave in school, and they can put a strain on family life.

# data[].attributes.attachment_link.description
ADHD symptoms in girls often look different than in boys and can go unrecognized. Here are 20 signs to help you identify ADHD in girls so you can seek help.

# data[].attributes.headline
ADHD in Girls: The Symptoms that are Ignored in Females

# data[].attributes.subject
ADHD in Girls: The Symptoms that are Ignored in Females

# data[].attributes.attachment_link.readable_text
ADHD in Girls: Recognizing Key Symptoms

ADHD in girls - particularly if it's the inattentive type of ADHD formerly called ADD - can look like this:

daydreaming quietly in class

feeling anxious or sad

exhibiting silliness or apparent ditziness

acting shy or inattentive

trouble maintaining friendships

picking at cuticles or skin

being a perfectionist

ADHD in Girls is Often Missed

Twenty-year-old Andrea Burns fits the description of ADHD in girls perfectly. She wasn't officially diagnosed with attention deficit hyperactivity disorder (ADHD or ADD) until her freshman year at Indiana University, even though she showed obvious signs of ADHD in middle school.

After Burns nearly failed out of school, an academic advisor had her undergo a LASSI (Learning and Studies Strategy Inventory) screening to evaluate learning behaviors and academic achievement. The results indicated what she and her family had long suspected: ADHD.

"In high school, I had a tutor to help me with different subjects, but once I got to college, I was expected to do it all by myself. I was studying all of the time, but doing poorly on tests because I'd freeze up," says Burns. "And I'd try to listen in class, but I had a hard time concentrating and focusing on what the teacher was saying. I'd take lots of notes, but when I reviewed them, I couldn't make sense of what I wrote," says the communications major, now entering her junior year.
[Self-Test: ADHD Symptoms in Women and Girls]
After a diagnosis of ADHD - Primarily Inattentive Type, Burns was prescribed ADHD medication. She saw almost immediate results: "I was finally able to focus during a lecture and take good notes, which helped improve my grades. For the first time I felt in control in the classroom."

Burns is relieved to have identified the cause of her poor school performance, and happy she's able to treat it. But it's unfair that she, like so many other girls, suffered a decade or more with an untreated condition that can negatively impact life in so many ways. Why are girls being diagnosed so much later than boys, if at all? And what do teachers, pediatricians, and parents need to do to bring about a change?

Symptoms of ADHD in Girls

One of the key reasons girls are so often overlooked is that they exhibit hyperactivity differently than boys, according to Patricia Quinn, M.D., director of the National Center for Gender Issues and ADHD in Washington, D.C. "In a classroom setting, a boy might continually blurt out answers or repeatedly tap his foot, whereas a girl might demonstrate hyperactivity by talking incessantly," she says. A girl who talks all the time is often viewed by the teacher as chatty, not hyper or problematic - and thus is less likely to be recommended for an evaluation.

Another reason that ADHD is often missed in girls is that they're more likely than boys to suffer from inattentive ADHD. The symptoms of this sub-type (which include poor attention to detail, limited attention span, forgetfulness, distractibility, and failure to finish assigned activities) tend to be less disruptive and obvious than those of hyperactive ADHD. Put simply, a (hyperactive) boy who repeatedly bangs on his desk will be noticed before the (inattentive) girl who twirls her hair while staring out the window. "I believe I was overlooked for so long because I didn't show hyperactivity the way my two brothers with ADHD have," says Burns.
[Self-Test: Could Your Child Have Inattentive ADHD?]
Why ADHD in Girls Goes Undiagnosed

It comes as no surprise that a recent national online Harris Interactive poll reaffirms that, with respect to ADHD, girls have gone largely unnoticed. Dr. Quinn and Sharon Wigal, Ph.D., associate clinical professor of pediatrics at the University of California at Irvine, surveyed 3,234 people, including members of the general public (adults without ADHD whose children don't have the condition), parents of children with the condition, teachers, and children with ADHD, ages 12 to 17. Among those polled, 85 percent of the teachers and more than half of the parents and the general public believe that girls with ADHD are more likely to go undiagnosed. They said that girls are more likely to "suffer silently" or show fewer symptoms. And four out of 10 teachers report more difficulty in recognizing ADHD symptoms in girls than in boys.

Polled parents and teachers also said that, among children with ADHD, boys are more likely than girls to exhibit behavioral problems, while girls are more often inattentive or struggling with a mood disorder. Drs. Quinn and Wigal said these differences cause some girls with ADHD to slip through the cracks. "The failure to recognize ADHD symptoms in girls probably results in significant undertreatment," they wrote. "...it is not a trivial disorder for them, and they are equally in need of professional care."

Girls with ADHD Face Serious Risks

Another revelation from the Harris poll: Females may suffer more negative effects from their ADHD than their male counterparts. The survey showed that girls are more likely than boys to be asked to repeat a grade due to poor school performance. When a boy struggles, he's more likely to be evaluated for ADHD or LD (and then diagnosed) than held back. But a teacher who observes a disorganized female student - one who can't plan ahead, meet project deadlines, and so on - believes that she'll benefit by being held back a year. "A year later, the girl is no better off because she still hasn't figured out the source of her problems," says Dr. Quinn.

The self-esteem of girls with ADHD also appears to be more impaired than that of boys with ADHD (which may explain why the survey found that girls were three times more likely to report taking antidepressants prior to being diagnosed). It's not surprising, then, that the condition can take a toll on a female's emotional health and general well-being. According to Dr. Quinn, girls with ADHD tend to have more mood disorders, anxiety, and self-esteem problems than non-ADHD girls. "They might get an A on a report, but because they had to work three times as hard to get it, they see themselves as not being as smart as other people," she says.

Another reason that girls go undetected for so long has to do with how differently each gender approaches school. Dr. Quinn offers this example: "A male and female student with ADHD are assigned a long-term project. They each put off the work for weeks. Then, the night before the project is due, each remembers the deadline. Rather than attempt to get the work done, the boy decides to watch back-to-back episodes of SpongeBob. Meanwhile, the girl freaks out and tries to make a perfect project overnight. (Perfectionism is another common behavior in ADHD girls.) She demands that her mother help her while she stays up until 1 a.m. to finish her work. When she hands in the assignment the next day, the teacher has no clue that it was done at the last minute."

Girls seem compelled to get their schoolwork done because our culture encourages them to be more socially conscious. They want to please more than boys, and they're expected to do well in school.

Because grades K through six aren't as challenging as higher grades, a girl with undiagnosed ADHD might do fine in elementary school - and then falter. "In middle and high school, the attentional demands are greater for a student, so she can't get by working at 50 percent efficiency," says Andrew Adesman, M.D., director of the division of behavioral and developmental disorders at Schneider's Children's Hospital in New Hyde Park, New York, and member of the national board of directors for CHADD. "And because the kids in junior high and high school more often change classes, teachers don't have the time to get to know the kids and spot problems."

Some girls also compensate by developing strategies that mask their ADHD. As mentioned earlier, it might be perfectionism. For instance, a girl might spend hours taking notes on each chapter she's being tested on in order to assure a good grade. Or she might become obsessive-compulsive, checking and rechecking her backpack to make sure she has everything.

ADHD gender differences also show up outside the classroom. Research shows that girls with ADHD may be rejected more often by their peers than boys. The main reason is that, compared to boys', girls' friendships require greater sophistication and more maintenance. "Two boys can meet on the playground and start digging a hole to China with their shovels, and they're instant friends. Friendship among girls is more complex, even at young ages. It requires picking up on social cues and bonding," says Dr. Quinn.

With tendencies toward impulsivity, hyperactivity, and forgetfulness, it can be hard to keep your mouth closed, not to constantly interrupt, or to remember your best friend's birthday. And when everyone in the group is admiring Jessica's new earrings and the girl with ADHD blurts out something totally unrelated, the other girls look at her and wonder where she's coming from. This kind of social awkwardness makes it difficult for a girl to feel good about herself and sustain relationships.

Unfortunately, these signs often aren't enough to suggest ADHD. In the case of 14-year-old Danielle Cardali of Suffolk County, New York, it took two evaluations before her teacher and parents were able to pinpoint why her grades remained low. Being classified with ADHD in fourth grade, she was entitled to 45 minutes a day of one-on-one teacher time in a resource room. But real improvement didn't come until seventh grade, when she was prescribed Strattera and Concerta. "After that first quarter on the medication, I got high C's and low B's," says Cardali. "I seemed to have a better understanding of what was going on in class."

In some cases, a parent will stumble upon ADHD after a learning disability is discovered. (They often co-exist, which is why it's important when testing for one also to screen for the other.) That was the case with 7-year-old Allison Isidore of Montclair, New Jersey. Her mom, Liz Birge, had an opportunity to see her daughter at work in the classroom for 45 minutes once a week, when she volunteered to assist in a writing workshop. Liz discovered that her first-grader was having a great deal of trouble matching sounds to letters and that she showed no interest in trying to write. Testing revealed that Allison has both a learning disability and ADHD.

Helping Girls with ADHD

If parents suspect that their daughter has ADHD (or a learning disability), Drs. Quinn and Wigal urge them not to wait, even if teachers haven't expressed concern. As mentioned earlier, teachers usually look for hyperactivity, disorganization, or forgetfulness as the signs of ADHD before recommending an evaluation. But the way ADHD often expresses itself in girls - excessive talking, poor self-esteem, worrying, perfectionism, risk-taking, and nosiness - is seldom read as such [see Easy-to-Miss ADHD Symptoms In Girls].

Your daughter's pediatrician may be able to do an evaluation (if your daughter is an adolescent, find out first if the doctor is comfortable working with teens), but it's best to work with an ADHD specialist. Make sure the evaluating clinician takes a thorough medical history (including family history, due to the high heritability of ADHD). The doctor should also work with your child's school to obtain more information about her behaviors. "And since adolescents are a great source of information about their own experience, encourage a teen to talk directly with her doctor," advises Dr. Wigal.

Ultimately, for a girl suffering from ADHD, an official diagnosis can be welcome news. "Everyone presumes that a diagnosis of ADHD is a stigma," says Dr. Quinn. "In fact, 56 percent of the girls in our survey said that they felt better after finally having a name for what they felt. Only 15 percent said they felt worse. For most, it was a relief to find out they weren't lazy, crazy, or stupid."

More good news: Parents of girls diagnosed with ADHD are more likely to seek treatment than parents of boys diagnosed with ADHD, because only the more severe cases are diagnosed. "Girls may be at a slight advantage over boys in one sense," wrote Quinn and Wigal in the Harris survey paper. "Once they are suspected of having ADHD, their parents tend to be more willing to seek medical advice." And that bodes well for girls.
[Self-Test: Could Your Daughter Have Rejection Sensitive Dysphoria?]

# data[].attributes.attachment_link.title
ADHD in Girls: The Symptoms That Are Ignored in Females

# data[].attributes.attachment_link.description
Girls with ADHD - especially those with inattentive symptoms - are often drowned out by loud, hyperactive boys who demonstrate the condition's stereotypical behavior. Learn how to recognize the mistaken, misunderstood symptoms of ADHD or ADD in girls, and turn around this unfair unbalance for your daughter or yourself.

# data[].attributes.attachment_link.readable_text
By Rae Jacobson, MS

One of the most common myths about ADHD is that it's a childhood condition that mostly affects boys. The truth is that ADHD is a lifelong condition and girls are just as likely as boys to have it. (It's the same with adults - women are just as likely to have ADHD as men are.)

Still, the experience of having ADHD can be differet for girls than it is for boys. First, girls aren't as likely to be hyperactive as boys are. They also tend to have less trouble with self-control. That often means that they're less disruptive at home and in class.

But girls still have trouble with attention - a key ADHD symptom. They may seem distracted or off in their own world. Doctors might refer to this as ADHD without hyperactivity. (Some people may also call it ADD rather than ADHD.)

Kids with ADHD who aren't hyperactive don't stand out as much as kids who are constantly in motion. So it's easier to overlook their challenges. While girls have ADHD as often as boys, they're diagnosed less frequently, at least in childhood.

That creates extra challenges. Girls with ADHD may be dismissed as just being "daydreamy." People may mistake their struggles with focus for laziness. And girls who aren't diagnosed may not get treatment or other types of support to help with their ADHD symptoms.

Dive deeper

# data[].attributes.attachment_link.description
One of the most common myths about ADHD is that it's a childhood condition that mostly affects boys. The truth is that ADHD is a lifelong condition and girls are just as likely as boys to have it. (It's the same with adults - women are just as likely to have ADHD as men are.)

# data[].attributes.attachment_link.readable_text
Many children and adults who have ADHD also have a sleep disorder-almost three out of four children and adolescents, and up to four out of five adults with ADHD. Not getting enough sleep, or needing to sleep at times that don't mesh with school or work obligations, can have significant long-term effects. Those can include physical illness, behavioral issues, and mood changes. While adults may seem obviously tired when they are behind on sleep, fatigue in children often looks like exaggerated ADHD symptoms: hyperactivity and impulsivity-sometimes even aggressiveness and acting out.
Causes of sleep problems
Circadian rhythm disorders. Researchers have repeatedly found that sleep problems are common among people who have ADHD. They think that one reason is because ADHD can mess up what is considered to be a standard sleep-wake cycle, or circadian rhythm. If your circadian rhythm is off, you may have a hard time falling asleep at a standard bedtime, or your sleep may be regularly disrupted, with lots of wakeups throughout the night. Either of those can make it hard for you to wake when your alarm goes off or stay awake and think clearly at work or at school. In general, people with ADHD feel more alert in the evening than they do in the morning. That is the opposite of the way it is for people who do not have ADHD.

For young children with ADHD, it can be difficult to settle down at the end of the day. It may be the child who is wound up from the day's events can't stop reliving them and talking about them, or the child who gets so lost in a book or a puzzle doesn't want to stop reading to brush her teeth and put on pajamas. Although these are not troubling behaviors, when they occur every night, they can frustrate both the child and his or her parents, and in turn further mess with sleep habits.

Caffeine and ADHD medications. Caffeine in soda, coffee, and chocolate, as well as stimulant medications, can also get in the way of a good night's sleep. Yet even nonstimulant ADHD medications can affect sleep by making people sleepy after taking them-they may need a nap during the day.

Alcohol. Alcohol can make people fall asleep quickly but struggle to stay asleep.

Other conditions. Many conditions that commonly coexist with ADHD, such as anxiety or depression, can have a significant effect on sleep as well.

Electronics. For anyone, too much time on a smartphone, playing video games, or watching television in the evening can mess with the ability to fall asleep and stay asleep.

Common sleep disorders. A number of diagnosable sleep disorders are associated with ADHD.

Breathing disorders. Obstructive sleep apnea, snoring, and other sleep-related breathing disorders are common among children and adults who have been diagnosed with ADHD, though doctors aren't really sure why. When kids with ADHD and sleep-related breathing disorders have their tonsils removed, they often see an improvement in symptoms of both.

Restless Legs Syndrome. Another common coexisting condition is Restless Legs Syndrome (RLS). People with RLS have an almost uncontrollable need to move their legs. It is especially noticeable in the evenings and when they are in bed. RLS is not common among the general population of children, but many children who have ADHD also have RLS. Researchers aren't sure why yet. It may just be that the symptoms of the two conditions are very similar and it's hard to tell them apart when a person is sleeping.

Also in this series:
References:

# data[].attributes.attachment_link.description
Many children and adults who have ADHD also have a sleep disorder-almost three out of four children and adolescents, and up to four out of five adults with ADHD. Not getting enough sleep, or needing to sleep at times that don't mesh with school or work obligations, can have significant long-term effects.

# data[].attributes.headline
ADHD and Sleep Problems: This is Why You're Always Tired

# data[].attributes.subject
ADHD and Sleep Problems: This is Why You're Always Tired

# data[].attributes.attachment_link.readable_text
ADHD and Sleep Problems

Adults with ADHD rarely fall asleep easily, sleep soundly through the night, and then wake up feeling refreshed. More often, ADHD's mental and physical restlessness disturbs a person's sleep patterns - and the ensuing exhaustion hurts overall health and treatment. This is widely accepted as true. But, as with most of our knowledge about ADHD in adults, we're only beginning to understand the stronger link between ADHD and sleep, that creates difficulties:

Sleep disturbances caused by ADHD have been overlooked for a number of reasons. Sleep problems did not fit neatly into the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) requirement that all ADHD symptoms must be present by age 7. Sleep disturbances associated with ADHD generally appear later in life, at around age 12, on average. Consequently, the arbitrary age cutoff has prevented recognition of night owls and sleep disturbances in ADHD until recently, when studies of adults have become more common. Just as ADHD does not go away at adolescence, it does not go away at night either. It continues to impair life functioning 24 hours a day.

In early attempts to define the syndrome, sleep disturbances were briefly considered a criterion for ADHD, but were dropped from the symptoms list because evidence of them was thought to be too nonspecific. As research has expanded to include adults with ADHD, the causes and effects of sleeping disturbances have become clearer.

For now, sleeping problems tend either to be overlooked or to be viewed as coexisting problems with an unclear relationship to ADHD itself and to the mental fatigue so commonly reported by individuals with ADHD. Sleep disturbances have been incorrectly attributed to the stimulant-class medications that are often the first to be used to treat ADHD.

The Four Big ADHD Sleep Problems

No scientific literature on sleep lists ADHD as a prominent cause of sleep disturbances. Most articles focus on sleep disturbance due to stimulant-class medications, rather than looking at ADHD as the cause. Yet adults with ADHD know that the connection between their condition and sleep problems is real. Sufferers often call it "perverse sleep" - when they want to be asleep, they are awake; when they want to be awake, they are asleep.
[Watch This Video: 5 Fixes for "I Can't Sleep"]
The four most common sleep disturbances associated with ADHD are:

1. Difficulty Falling Asleep with ADHD

About three-fourths of all adults with ADHD report inability to "shut off my mind so I can fall asleep at night." Many describe themselves as "night owls" who get a burst of energy when the sun goes down. Others report that they feel tired throughout the day, but as soon as the head hits the pillow, the mind clicks on. Their thoughts jump or bounce from one worry to another. Unfortunately, many of these adults describe their thoughts as "racing," prompting a misdiagnosis of a mood disorder, when this is nothing more than the mental restlessness of ADHD.

Prior to puberty, 10 to 15 percent of children with ADHD have trouble getting to sleep. This is twice the rate found in children and adolescents who do not have ADHD. This number dramatically increases with age: 50 percent of children with ADHD have difficulty falling asleep almost every night by age 12 ½ by age 30, more than 70 percent of adults with ADHD report that they spend more than one hour trying to fall asleep at night.

2. Restless Sleep with ADHD

When individuals with ADHD finally fall asleep, their sleep is restless. They toss and turn. They awaken at any noise in the house. They are so fitful that bed partners often choose to sleep in another bed. They often awake to find the bed torn apart and covers kicked onto the floor. Sleep is not refreshing and they awaken as tired as when they went to bed.

[How Sleep Deprivation Looks a Lot Like ADHD]

3. Difficulty Waking Up with ADHD

More than 80 percent of adults with ADHD in my practice report multiple awakenings until about 4 a.m. Then they fall into "the sleep of the dead," from which they have extreme difficulty rousing themselves.

They sleep through two or three alarms, as well as the attempts of family members to get them out of bed. ADHD sleepers are commonly irritable, even combative, when roused before they are ready. Many of them say they are not fully alert until noon.

4. Intrusive Sleep with ADHD

Paul Wender, M.D., a 30-year veteran ADHD researcher, relates ADHD to interest-based performance. As long as persons with ADHD were interested in or challenged by what they were doing, they did not demonstrate symptoms of the disorder. (This phenomenon is called hyperfocus by some, and is often considered to be an ADHD pattern.) If, on the other hand, an individual with ADHD loses interest in an activity, his nervous system disengages, in search of something more interesting. Sometimes this disengagement is so abrupt as to induce sudden extreme drowsiness, even to the point of falling asleep.

Marian Sigurdson, Ph.D., an expert on electroencephalography (EEG) findings in ADHD, reports that brain wave tracings at this time show a sudden intrusion of theta waves into the alpha and beta rhythms of alertness. We all have seen "theta wave intrusion," in the student in the back of the classroom who suddenly crashes to the floor, having "fallen asleep." This was probably someone with ADHD who was losing consciousness due to boredom rather than falling asleep. This syndrome is life-threatening if it occurs while driving, and it is often induced by long-distance driving on straight, monotonous roads. Often this condition is misdiagnosed as "EEG negative narcolepsy." The extent of incidence of intrusive "sleep" is not known, because it occurs only under certain conditions that are hard to reproduce in a laboratory.

Why Do People with ADHD Have Problems Sleeping?

There are several theories about the causes of sleep disturbance in people with ADHD, with a telling range of viewpoints. Physicians base their responses to their patients' complaints of sleep problems on how they interpret the cause of the disturbances. A physician who looks first for disturbances resulting from disorganized life patterns will treat problems in a different way than a physician who thinks of them as a manifestation of ADHD.

Thomas Brown, Ph.D., longtime researcher in ADHD and developer of the Brown Scales, was one of the first to give serious attention to the problem of sleep in children and adolescents with ADHD. He sees sleep disturbances as indicative of problems of arousal and alertness in ADHD itself. Two of the five symptom clusters that emerge from the Brown Scales involve activation and arousal:

Organizing and activating to begin work activities.

Sustaining alertness, energy, and effort.

Brown views problems with sleep as a developmentally-based impairment of management functions of the brain - particularly, an impairment of the ability to sustain and regulate arousal and alertness. Interestingly, he does not recommend treatments common to ADHD, but rather recommends a two-pronged approach that stresses better sleep hygiene and the suppression of unwanted and inconvenient arousal states by using medications with sedative properties.

The simplest explanation is that sleep disturbances are direct manifestations of ADHD itself. True hyperactivity is extremely rare in women of any age. Most women experience the mental and physical restlessness of ADHD only when they are trying to shut down the arousal state of day-to-day functioning in order to fall asleep. At least 75 percent of adults of both genders report that their minds restlessly move from one concern to another for several hours until they finally fall asleep. Even then, they toss and turn, awaken frequently, and sometimes barely sleep at all.

The fact that 80 percent of adults with ADHD eventually fall into "the sleep of the dead" has led researchers to look for explanations. No single theory explains the severe impairment of the ability to rouse oneself into wakefulness. Some patients with ADHD report that they sleep well when they go camping or are out of doors for extended periods of time.

One hypothesis is that the lack of an accurate circadian clock may also account for the difficulty that many with ADHD have in judging the passage of time. Their internal clocks are not "set." Consequently, they experience only two times: "now" and "not now." Many of my adult patients do not wear watches. They experience time as an abstract concept, important to other people, but one which they don't understand. It will take many more studies to establish the links between circadian rhythms and ADHD.
[Read This Next: Tired of Feeling Tired? How to Solve Common Sleep Problems]
How to Get to Sleep with ADD

No matter how a doctor explains sleep problems, the remedy usually involves something called "sleep hygiene," which considers all the things that foster the initiation and maintenance of sleep. This set of conditions is highly individualized. Some people need absolute silence. Others need white noise, such as a fan or radio, to mask disturbances to sleep. Some people need a snack before bed, while others can't eat anything right before bedtime. A few rules of sleep hygiene are universal:

Use the bed only for sleep or sex, not as a place to confront problems or argue.

Have a set bedtime and a bedtime routine and stick to it - rigorously.

Avoid naps during the day.

Two more elements of good sleep hygiene seem obvious, but they should be stressed for people with ADHD.

Get in bed to go to sleep. Many people with ADHD are at their best at night. They are most energetic, thinking clearest, and most stable after the sun goes down. The house is quiet and distractions are low. This is their most productive time. Unfortunately, they have jobs and families to which they must attend the next morning, tasks made harder by inadequate sleep.

Avoid caffeine late at night. Caffeine can cause a racing ADHD brain to grow more excitable and alert. Caffeine is also a diuretic, although not as potent as experts once thought, and may cause sleep disruptions brought on by needing to go to the bathroom. It is a good strategy to avoid consuming any liquids shortly before bedtime.

Treatment Options for ADHD-Related Sleep Problems

If the patient spends hours a night with thoughts bouncing and his body tossing, this is probably a manifestation of ADHD. The best treatment is a dose of stimulant-class medication 45 minutes before bedtime. This course of action, however, is a hard sell to patients who suffer from difficulty sleeping. Consequently, once they have determined their optimal dose of medication, I ask them to take a nap an hour after they have taken the second dose.

Generally, they find that the medication's "paradoxical effect" of calming restlessness is sufficient to allow them to fall asleep. Most adults are so sleep-deprived that a nap is usually successful. Once people see for themselves, in a "no-risk" situation, that the medications can help them shut off their brains and bodies and fall asleep, they are more willing to try medications at bedtime. About two-thirds of my adult patients take a full dose of their ADHD medication every night to fall asleep.

What if the reverse clinical history is present? One-fourth of people with ADHD either don't have a sleep disturbance or have ordinary difficulty falling asleep. Stimulant-class medications at bedtime are not helpful to them. Dr. Brown recommends Benadryl, 25 to 50 mg, about one hour before bed. Benadryl is an antihistamine sold without prescription and is not habit-forming. The downside is that it is long-acting, and can cause sleepiness for up to 60 hours in some individuals. About 10 percent of those with ADHD experience severe paradoxical agitation with Benadryl and never try it again.

Experts point out that sleep disturbances in people diagnosed with ADHD are not always due to ADHD-related causes. Sometimes patients have a co-morbid sleep disorder in addition to ADHD. Some professionals will order a sleep study for their patients to determine the cause of the sleep disturbance. Such tests as a Home Sleeping Test, Polysomnogram, or a Multiple Sleep Latency Test may be prescribed. If there are secondary sleep problems, doctors may use additional treatment options to manage sleep time challenges.

The next step up the treatment ladder is prescription medications. Most clinicians avoid sleeping pills because they are potentially habit-forming. People quickly develop tolerance to them and require ever-increasing doses. So, the next drugs of choice tend to be non-habit-forming, with significant sedation as a side effect. They are:

Melatonin. This naturally occurring peptide released by the brain in response to the setting of the sun has some function in setting the circadian clock. It is available without prescription at most pharmacies and health food stores. Typically the dosage sizes sold are too large. Almost all of the published research on Melatonin is on doses of 1 mg or less, but the doses available on the shelves are either 3 or 6 mg. Nothing is gained by using doses greater than one milligram. Melatonin may not be effective the first night, so several nights' use may be necessary for effectiveness.

Periactin. The prescription antihistamine, cyproheptadine (Periactin), works like Benadryl but has the added advantages of suppressing dreams and reversing stimulant-induced appetite suppression.

Clonidine. Some practitioners recommend in a 0.05 to 0.1 mg dose one hour before bedtime. This medication is used for high blood pressure, and it is the drug of choice for the hyperactivity component of ADHD. It exerts significant sedative effects for about four hours.

Antidepressant medications, such as trazodone (Desyrel), 50 to 100 mg, or mirtazapine (Remeron), 15 mg, used by some clinicians for their sedative side effects. Due to a complex mechanism of action, lower doses of mirtazapine are more sedative than higher ones. More is not better. Like Benadryl, these medications tend to produce sedation into the next day, and may make getting up the next morning harder than it was.

Problems Waking Up with ADHD

Problems in waking and feeling fully alert can be approached in two ways. The simpler is a two-alarm system. The patient sets a first dose of stimulant-class medication and a glass of water by the bedside. An alarm is set to go off one hour before the person actually plans to rise. When the alarm rings, the patient rouses himself enough to take the medication and goes back to sleep. When a second alarm goes off, an hour later, the medication is approaching peak blood level, giving the individual a fighting chance to get out of bed and start his day.

A second approach is more high-tech, based on evidence that difficulty waking in the morning is a circadian rhythm problem. Anecdotal evidence suggests that the use of sunset/sunrise-simulating lights can set the internal clocks of people with Delayed Sleep Phase Syndrome. As an added benefit, many people report that they sharpen their sense of time and time management once their internal clock is set properly. The lights, however, are experimental and expensive (about $400).

Disturbances of sleep in people with ADHD are common, but are almost completely ignored by our current diagnostic system and in ADHD research. These patterns become progressively worse with age. Recognition of sleep disturbance in ADHD has been hampered by the misattribution of the difficulty falling asleep to the effects of stimulant-class medications. We now recognize that sleep difficulties are associated with ADHD itself, and that stimulant-class medications are often the best treatment of sleep problems rather than the cause of them.
[ADHD Directory: Find an ADHD Specialist or Clinic Near You] William Dodson, M.D., is a member of ADDitude's ADHD Medical Review Panel.

# data[].attributes.attachment_link.title
ADHD and Sleep Problems: This is Why You're Always Tired

# data[].attributes.attachment_link.description
Does ADD make you tired? Sleep disturbances caused by ADHD have been overlooked for a number of reasons, including the late age of onset. But recent studies confirm that ADD symptoms do not go away at night. Here, understand the ADHD and sleep link and its most common manifestations.

# data[].attributes.attachment_link.readable_text
Attention-Deficit/Hyperactivity Disorder (ADHD) is a disorder that begins in childhood and encompasses symptoms of inattention, hyperactivity, and impulsivity. These symptoms interfere with functioning at school, at work, and in social situations. ADHD is present in approximately 5% of children, and it is more common in boys. For a majority of people the disorder continues into adulthood, though careful managing can greatly improve quality of life for people with ADHD.

An estimated 25 to 50% of people with ADHD experience sleep problems, ranging from insomnia to secondary sleep conditions. Doctors are starting to realize the importance of treating sleep problems and the impact this can have on both ADHD symptoms and quality of life for ADHD patients and their families.

What's the Connection Between ADHD and Sleep?

Beginning around puberty, people with ADHD are more likely to experience shorter sleep time, problems falling asleep and staying asleep, and a higher risk of developing a sleep disorder. Nightmares are also common in children with ADHD, especially those with insomnia. Sleep problems in ADHD tend to increase with age, though sleep problems in early childhood are a risk factor for future occurrence of ADHD symptoms.

Even those who are rarely hyperactive during the day may experience racing thoughts and a burst of energy at night that interfere with sleeping. For some, nighttime presents the perfect opportunity to "hyperfocus" on a project, as there are less distractions. Unfortunately, this makes it difficult to settle down for sleep and it can lead to a disrupted sleep-wake schedule. Over time, insomnia may worsen as people start to develop feelings of stress related to bedtime.

Many people with ADHD experience daytime sleepiness and difficulty waking up as a result of poor sleep. Others experience restless, non-refreshing sleep with multiple nighttime awakenings.

Sleep problems in ADHD appear to differ depending on the type of ADHD. Individuals with predominantly inattentive symptoms are more likely to have a later bedtime, while those predominantly hyperactive-impulsive symptoms are more likely to suffer from insomnia. Those with combined hyperactive-impulsive and inattentive ADHD experience both poor sleep quality and a later bedtime.

Many ADHD symptoms are similar to symptoms of sleep deprivation. Among others, adult ADHD sleep problems include forgetfulness and difficulty concentrating. In children, fatigue may present as being hyperactive and impulsive. Sometimes it can be difficult to tell whether these issues are brought on by ADHD or by a lack of sleep. This may lead to misdiagnoses or may allow sleep disorders to go undetected. Experts therefore recommend screening patients for sleep problems before prescribing medication for ADHD.

What's the Biology Behind the ADHD-Sleep Connection?

ADHD sleep problems may be a side effect of impaired arousal, alertness, and regulation circuits in the brain. Other researchers believe that ADHD sleep problems can be traced to a delayed circadian rhythm with a later onset of melatonin production. Despite similarities between certain sleep disorders and ADHD symptoms, research has failed to find consistent sleep abnormalities in people with ADHD.

Some individuals find it easier to sleep with the calming effects of stimulant medications that are commonly prescribed for ADHD. However, for many people, stimulant medications cause a number of sleep problems in their own right. Co-existing disorders such as anxiety, depression, or substance abuse, as well as poor sleep hygiene, likely also play a role in sleep difficulties.

How Do ADHD Sleep Problems Affect Daily Life??

Though there is little research on the subject of ADHD with accompanying sleep disorders, children and adults with ADHD plus a sleep disorder often report more severe ADHD symptoms and a lower quality of life. They may also be more likely to suffer from depression, anxiety, hyperactivity, inattention, difficulty processing information, and a higher BMI. Over the long term, chronic sleep deprivation leaves people vulnerable to physical health problems.

Daytime sleepiness can have serious effects on school and work. People may judge a person with ADHD for sleeping at inappropriate times, without realizing that it is part of their condition and very difficult to avoid. Sudden bouts of sleepiness may also be dangerous while driving or performing other activities that require concentration.

Not sleeping well at night can also cause daytime fatigue. Individuals with ADHD-related sleep deprivation may feel grumpy, irritable, restless, or tired, or they may have trouble paying attention at school or at work. Sometimes, these symptoms may be mistaken for a mood disorder. In turn, anxiety and behavioral difficulties have been linked to a higher incidence of sleep problems for children with ADHD.

These problems also take their toll on families and caregivers of people with ADHD. Preliminary research shows that primary caregivers of children with ADHD as well as sleep problems are more likely to be depressed, anxious, stressed, and late to work.

What Sleep Disorders Commonly Occur in People With ADHD?

In addition to generalized insomnia, people with ADHD have higher-than-normal rates of certain sleep disorders. Because ADHD symptoms often resemble the symptoms of these sleep disorders, underlying sleep disorders may go undiagnosed. Children in particular may have difficulty conveying what they are feeling, leading to a misdiagnosis of ADHD when in fact their problems stem from a sleep disorder. Or, they may have ADHD plus a sleep disorder.

Circadian Rhythm Sleep Disorder: Most individuals with ADHD, particularly adolescents, are more alert in the evening. This atypical schedule can make it difficult to honor work or school commitments. A smaller pineal gland, irregularities in clock genes, and later melatonin release may be responsible for circadian rhythm sleep disorders in people with ADHD. Taking melatonin supplements at targeted times or using bright light therapy may help adjust your schedule.

Sleep-Disordered Breathing: Sleep-disordered breathing (SDB), including snoring and sleep apnea, affects up to one-third of patients with ADHD. SDB leads to disturbed sleep and daytime sleepiness, and often causes symptoms typical of ADHD. The encouraging news is that treating SDB may reduce the need for stimulants in children believed to have ADHD. Studies suggest that removing the tonsils may help with ADHD and sleep apnea symptoms in children, while CPAP devices are a better choice for adults.

Restless Legs Syndrome: People with restless legs syndrome (RLS) are plagued by tingling sensations in the legs that make it hard to fall asleep. RLS or other types of periodic limb movement disorders may occur in almost 50% of people with ADHD. Children with both ADHD and RLS appear to spend longer in stage one light sleep, which is not as restorative. Researchers believe RLS is caused by iron and dopamine deficiencies, which are also implicated in ADHD. RLS may be treated with iron supplements or dopaminergic agents.

Narcolepsy: Individuals with narcolepsy tend to fall asleep suddenly during the day and may have difficulty sleeping soundly at night. Adults with narcolepsy are twice as likely to have had ADHD as a child. While the link between the two isn't clear, researchers believe that the sleepiness brought on by narcolepsy might provoke ADHD symptoms. It's also possible that both disorders might stem from a similar cause, such as a faulty gene or a problem with neurotransmitters. Narcolepsy is usually treated with medication.

Treating underlying sleep disorders is an important step toward improving sleep for people with ADHD. Ask your doctor for a sleep study to rule out any secondary sleep disorders that may need to be treated along with your ADHD. A good doctor should monitor potential sleep problems on an ongoing basis, as these tend to develop over time.

Sleep Tips for Children and Adults With ADHD and Sleep Problems

Experts are cautiously optimistic that sleep interventions may be key to improving not only sleep, but also ADHD symptoms and the effects of ADHD medication. Indeed, preliminary studies have found that behavioral sleep interventions improve sleep, ADHD symptoms, quality of life, daily functioning, behavior, and working memory.

For children, adolescents, and adults with ADHD, a consistent bedtime routine and healthy sleep hygiene practices can help reinforce the connection between bed and sleep. Try making gradual changes and note where you see improvements to develop a system that works for you. Some tips include:

Cut out sugar, caffeine, and alcohol within a few hours of bedtime

Avoid screen time for an hour before bed

Avoid doing stimulating activities and projects that require hyperfocusing in the evening

Make the bed a stress-free zone reserved for sleep and sex

Get enough exercise and sunlight during the day

Develop a bedtime routine that you enjoy, such as rereading a favorite book, spending time with pets, or taking a warm bath

Keep the bedroom dark, cool, and quiet, using a white noise machine if necessary to block out intrusive noises

Go to bed and wake up at the same time every day, choosing a time that is realistic and age-appropriate to get the recommended sleep for your age group

Use a weighted ball blanket

People with ADHD also frequently have trouble waking up in the morning. For help getting out of bed, try using light therapy or plan something enjoyable for when you get out of bed, such as exercise or a nice breakfast

The Children and Adults with ADHD organization recommends using a rewards-based system for sleep problems in young children with ADHD. It may also help to offer reassurance by checking frequently on your child. For people of any age with ADHD, talking with a trusted confidant, keeping a worry journal, or using relaxation techniques such as guided imagery may help make bedtime less stressful.

Sleep medication may not be appropriate for people with ADHD, but you can talk to your doctor about adding supplements or tweaking your medication schedule to optimize it for sleep. Some people with ADHD find it helps alertness to take their medication about an hour before waking up. Adolescents and adults with sleep problems may benefit from cognitive behavioral therapy for insomnia (CBT-I).

# data[].attributes.attachment_link.title
ADHD and Sleep Problems: How Are They Related? | Sleep Foundation

# data[].attributes.attachment_link.description
Attention-Deficit/Hyperactivity Disorder (ADHD) is a disorder that begins in childhood and encompasses symptoms of inattention, hyperactivity, and impulsivity. These symptoms interfere with functioning at school, at work, and in social situations. ADHD is present in approximately 5% of children, and it is more common in boys.

# data[].attributes.headline
Browse the FRC selection of books about ADHD here:

# data[].attributes.subject
Browse the FRC selection of books about ADHD here:

# data[].attributes.attachment_link.readable_text
At times preschoolers may have difficulty paying attention, following directions, and waiting or taking their turn. These behaviors can be common and age appropriate or they may indicate the need for an Attention-Deficit/Hyperactivity Disorder (ADHD) evaluation. As a parent, you might wonder whether your preschooler has ADHD or is just being rambunctious and acting typical for his or her age. This fact sheet will tell you more about ADHD in preschoolers and what to do if you are concerned about your child.

Can preschoolers have or be diagnosed with ADHD

Yes. Children as young as age 4 can be diagnosed with ADHD. According to the 2010-2011 National Survey of Children's Health, approximately 194,000 preschoolers (2-5 years of age) had a current ADHD diagnosis. Some children outgrow the symptoms, but others may not. Research shows that 3-year-olds who show symptoms of ADHD are much more likely to meet the diagnostic criteria for ADHD by age 13.

How can I tell if my preschooler has ADHD

Preschoolers with ADHD are more likely to be suspended from school or daycare because of their disruptive behavior. These kids have more trouble learning concepts at school, and many get special education placements at a very young age when compared to children without ADHD.

As a parent, you will want to know where your child's behaviors fit along a range of behaviors that are typical of kids the same age. Ask yourself, "When compared with other preschoolers of the same age, where does my child's behavior fall" Talking with your preschooler's teachers and/or childcare providers can let you know what are common behaviors in young children and not related to a disorder and what is of more serious concern.

What is involved in having my preschooler evaluated for ADHD

To be diagnosed with ADHD, a child must have a specified number of symptoms for at least 6 months that show up in more than one area of life. For example, if your child has behaviors at home that may look like ADHD but does not have these behaviors in situations outside the home, there may be another explanation. If you suspect that your preschooler has ADHD, you will want to talk to a professional who is trained to diagnose and treat ADHD such as your child's pediatrician, a child psychiatrist, psychologist, clinical social worker or other qualified mental health clinician. It is also important to have your child checked for other conditions such as vision, hearing, or sleep problems because sometimes the symptoms look like ADHD.

Evaluations for preschoolers should be thorough and follow the guidelines outlined by the American Academy of Pediatrics (AAP) and the American Academy of Child and Adolescent Psychiatry (AACAP). These guidelines recommend a detailed interview with you to determine how long the symptoms have been going on, how severe they are, how often they occur and in what settings. You and your child's teachers or child care providers will be asked to complete questionnaires with rating scales to evaluate your child's behavior. The ADHD professional will conduct a detailed review of your preschooler's school and medical records, talk with and observe your child directly, and check for other conditions your child may have along with ADHD. The professional may also suggest other psychological tests to help understand your preschooler's strengths and weaknesses in learning and thinking skills and screen for learning disabilities.

What are the symptoms of ADHD in children

A diagnosis of ADHD is based on The Diagnostic and Statistical Manual of Mental Disorders (DSM 5). The manual lists three presentations of ADHD-Inattentive, Hyperactive-Impulsive and Combined and the symptoms for each.

Inattentive

Fails to give close attention to details or makes careless mistakes

Has difficulty sustaining attention

Does not appear to listen

Struggles to follow through on instructions

Has difficulty with organization

Avoids or dislikes tasks requiring a lot of thinking

Loses things

Is easily distracted

Is forgetful in daily activities

Hyperactive Impulsive

Fidgets with hands or feet or squirms in chair

Has difficulty remaining seated

Runs about or climbs excessively in children; extreme restlessness in adults

Difficulty engaging in activities quietly

Acts as if driven by a motor; adults will often feel inside like they were driven by a motor

Talks excessively

Blurts out answers before questions have been completed

Difficulty waiting or taking turns

Interrupts or intrudes upon others

Combined, Inattentive & Hyperactive-impulsive

Has symptoms from both of the above lists

These symptoms can change over time, so children may fit different presentations as they age.

What are the causes of ADHD

Research has yet to determine the exact causes of ADHD. However, scientists have discovered a strong genetic link since ADHD can run in families. Other factors in the environment may increase the likelihood of having ADHD:

mother smoking cigarettes or drinking alcohol while pregnant

exposure to lead or pesticides in early childhood

premature birth or low birth weight

brain injury

Scientists continue to study the exact relationship of ADHD to environmental factors, but point out that there is no single cause that explains all cases of ADHD and that many factors may play a part.

The following factors are NOT known causes, but can make ADHD symptoms worse for some children:

watching too much television

eating sugar

family stress (poverty, family trauma)

Why is it important to address ADHD in my preschooler at an early age

Preschoolers with ADHD are more likely to have difficulties in daycare or school, including problems with peer relationships, learning, and a higher risk of injuries. An early diagnosis is important so that your child can get the needed help to minimize these problems.

Even for the preschooler who might have some symptoms but does not have ADHD, these early years are the time when significant brain development occurs. This is an optimal time for children to learn positive behaviors, and for you to know how to effectively help your child learn. It's best to address problematic behaviors sooner rather than later.

How should ADHD be treated in preschoolers

When it comes to treatment for preschool and kindergarten-aged children, the AAP calls for behavioral treatments first and medication only when needed. Behavioral therapy from child and adolescent therapists who specialize in ADHD will provide both the parents and the children techniques to teach and reinforce positive behaviors and skills. This will help a preschooler with ADHD to successfully function at home and school.

When medication is prescribed, the AAP recommends starting children ages 4-5 on a methylphenidate medication trial beginning with a low dose. Because children respond differently to medication, what may work for one child may not work for another. The health care professional can adjust the dose to determine if it is helping, if a different medication is needed or if any side effects are present. Treating ADHD is complex, and it is important to continually monitor children to see if the treatment is working. This includes periodically repeating the rating scale assessments to make sure the medication and behavioral therapy are having the desired effect. Additionally, the AACAP Preschool Pharmacology Working Group recommends that preschoolers who are taking ADHD medication have their medication stopped (under the prescribing doctor's direction) after 6 months to reassess the symptoms and to consider whether the medication should be continued.

What is parent behavioral training and how can it benefit me and my child

Children who have ADHD may not have the skills and behaviors that result in their receiving positive attention. Often they tend to misbehave and are in situations where they are punished more frequently than other children. This can have a negative effect on their self-image and cause them to increase their problem behaviors. Parents and caregivers (daycare providers, preschool teachers, and other caretakers) can learn to manage the behavior of preschoolers who have ADHD by becoming educated about the disorder and by receiving parent training in how to use behavioral techniques.

Parent training programs taught by trained therapists can give caretakers the tools and strategies to help children who have ADHD. A 2010 review by the Agency for Healthcare Research and Quality (AHRQ) found that effective programs:

help parents develop a positive relationship with their child

teach them about how children develop

help them manage negative behavior and increase positive behavior with positive discipline

Parent behavioral training programs for parents of preschool-aged children that currently have enough research evidence to be described as effective:

Triple P (Positive Parenting Program)

Incredible Years Parenting Program

Parent-Child Interaction Therapy

Other programs that focus on the same elements may also be helpful.

Parents and caregivers who wish to learn more about ADHD and ways to help their child may wish to enroll in Parent to Parent: Family Training on ADHD offered through CHADD.

Are preschoolers receiving the recommended treatments

The Centers for Disease Control and Prevention (CDC) reports that 1 in 2 preschoolers do not receive recommended behavioral treatment. The rates of preschool-aged children taking medication for ADHD has doubled in the last four years, and 1 in 4 receive only medication treatment, which should be the last resort.

There is a movement within the field of ADHD to increase access to behavior therapy for young children, particularly to behavioral parenting therapy that is considered evidence-based and effective. The hope is to decrease the rates of preschool and kindergarten-aged children taking medication for ADHD as a first line of treatment.
http://www.cdc.gov/ncbddd/adhd/treatment.html http://pediatrics.aappublications.org/content/128/5/1007.full

# data[].attributes.attachment_link.description
At times preschoolers may have difficulty paying attention, following directions, and waiting or taking their turn. These behaviors can be common and age appropriate or they may indicate the need for an Attention-Deficit/Hyperactivity Disorder (ADHD) evaluation. As a parent, you might wonder whether your preschooler has ADHD or is just being rambunctious and acting typical...

# data[].attributes.attachment_link.readable_text
While ADHD is most often diagnosed in school-aged children, it can be diagnosed in children as young as three.

Of course we expect all preschoolers to be active - more inclined to run around than to sit still. And we expect them to be impulsive - prone to doing things without thinking about the consequences. But some kids are extemely active - parents typically describe them as "bouncing off the walls" - and they're so impulsive they're extraordinarily difficult to manage.

These children may have ADHD, and early diagnosis and treatment can help them rein in impulsive behavior that's causing problems for them, and their families. They can get along better with other kids and be able to participate in activities appropriate for their age. But it's important to know that the recommended first-line treatment for preschoolers with ADHD is different from what's recommended for older kids.

ADHD experts and the American Academy of Pediatrics agree that behavioral therapy is the preferred treatment for preschoolers with ADHD, and that stimulant medication should be considered only if behavioral therapy isn't available or hasn't worked. It can also also be considered if the child or the family is at risk of serious harm.

It is usually hyperactive and impulsive behavior that leads to an ADHD diagnosis in preschoolers. They may have been kicked out of preschool or banned from playdates. Their parents worry constantly that they will run into the street or hurt themselves in some other impulsive way.

From 2 to 6 percent of preschoolers are estimated to have the disorder - a much lower percentage than school age kids. Boys are twice as likely as girls to be diagnosed.

Mark Stein, PhD, the director of the ADHD and Related Disorders Program (PEARL Clinic) at Seattle Children's Hospital, explains that behavioral problems are usually what cause parents to bring preschoolers in for evaluation. He notes that one of the screening questions he uses when taking a child's history is "What percentage of the time, when you give your child a command, do they obey you within five seconds?" By age four, he says, it should be 75 to 80 percent. "In my patients it's like 10 percent."

But Dr. Stein, who is also a professor of psychiatry and behavioral science at the University of Washington, emphasizes that diagnosing ADHD at this age should be done with great care, since all preschool children exhibit some hyperactivity, impulsivity and inattention, the key symptoms of ADHD.

Observing a child's behavior in the doctor's office is not sufficient for a diagnosis, as symptoms may not be present in that environment. Pediatricians are encouraged to collect screening questionnaires filled out not only by a parent but by at least one other adult who spends time with the child. Symptoms must be present in more than one setting - ie at home, at preschool or daycare, with relatives or family friends.

As Dr. Stein notes, it's harder to evaluate children who are not yet in a structured environment like preschool, where their behavior is easier to observe and compare to that of other kids.

Andrew Adesman, MD, a pediatrician who is Chief of Developmental & Behavioral Pediatrics at Cohen Children's Medical Center of New York, adds that for kids who have been kept at home, if parents are frustrated with their behavior and suspect ADHD, sending them to preschool or daycare can be a good way to get some validation, as well as some respite. "Parents know their child best, but they don't have the training, experience and perspective on what's typical at a certain age," he explains.

Dr. Stein notes that it's the diagnostician's job to rule out other conditions that look like ADHD. "There are medical mimics, like hypothyroidism, and poor sleep problems and medication effects. And there are psychiatric mimics, like having autism or depression or anxiety."

Parent training for behavioral management techniques is the recommended treatment for preschoolers with ADHD. Through these programs, parents learn how to more effectively shape the behavior of young children, and the children usually show marked improvement in their ability to comply with direction and rein in their impulsivity.

Why parent training, rather than therapy delivered directly to the child? Dr. Adesman explains that children are often referred for play therapy, but this is not a very helpful intervention for ADHD. "At its worst it's like an expensive play date. At its best it's a well-intentioned intervention that doesn't have any evidence to support it." What families should be pursuing is parent training in behavior management techniques.

"Intuitively one would think that if the child has the problem, the therapy should be focued on the child. The reality is that, while it's the child who has the problem, what we want to do is change the environment so we can set the child up for success. And that typically involves working with parents and teachers," he explains. "If a child has allergies - the problem is with the child but the solution is in working with the environment. You might get rid of the carpet or the drapes or find a new home for the cat. We can do things with the environment to help kids behave better."

These programs teach parents how to use praise, or positive reinforcement, to promote the behaviors they want to encourage. And parents are taught to deliver consistent consequences when kids don't comply. The result is that kids learn to modulate their behavior to meet expectations and the family conflict can be reduced, sometimes dramatically.

Programs that have shown evidence of effectiveness include:

Parent-Child Interaction Therapy (PCIT)

Parent Management Training (PMT)

Positive Parenting Program (Triple P)

The Incredible Years

Dr. Stein notes that the preschool years are the "sweet spot" for parent training, when evidence shows that it can have the most effect. "I always tell parents, you know, now is the ideal time. You don't want to be dealing with a noncompliant 15- or 16-year-old."

Dr. Stein also recommends that parents of preschoolers with ADHD get them into a structured school setting. When kids have behavior problems, parents often take them out of preschool, but they really need to get them more in.

If children can't behave well enough for a mainstream preschool, there are special preschools for children with behavioral problems. "The idea is to not run away from structure, but to get more intensive services. The parents need the respite, and the kids need to learn to be socialized."

Dr. Adesman adds that it's especially important that these children have some experience of meeting expectations in a structured setting before they go to kindergarten.

In general, stimulant medication should be considered only for preschoolers who haven't been helped by behavior therapy, or whose behavior is so severe that it's dangerous or it's severely impacting their lives, and their families' lives.

One reason to try behavior therapy first is that while stimulant meds are very effective for most school-aged children - the response rate is more than 70 percent - Dr. Adesman notes that in preschoolers the response rate drops to 50 percent.

Dr. Adesman offers this list, based on recommendations of the AAP, of situations in which medication might be an appropriate choice:

Prescribing to preschoolers can be confusing because there is a discrepancy between what is approved by the FDA and what is recommended by the AAP.

Of the two types of stimulant medication - those based on methylphenidate and those based on amphetamine - the FDA has approved only short-acting amphetamine-based medications (Dexedrine and Adderall) for children 3-5. The AAP, on the other hand, based on the results of the Preschool ADHD Treatment Study (PATS) that used mepthylphenidate, recommends methylphenidate-based medications for children 4-5.

A reasonable approach, Dr. Adesman adds, would be to use a methlyphenedate medication first, and if it's not working, try amphetamine-based.

What everyone agrees on is that if medication is used it should be an extremely low dose. And the good news here is that there are new formulations for preschoolers that not only don't require swallowing a pill, but they can deliver very small doses - "liquids that can be titrated down, or a patch that can be cut in half," he explained.

But Dr. Adesman stresses that medication should be considered only if parent training isn't working well enough, or if the situation is extreme.

"Children don't have ADHD because their parents are ineffective. But they can definitely be part of the solution," he said.

And one of the best things about parent training is that it helps kids whether or not they have an ADHD diagnosis, so there is no downside to trying it if kids are having behavior problems. "If there are behavioral challenges, with or without an ADHD diagnosis, parents should get training," he said. "It will help the child, it will help the parents, and it will help the other kids in the family, too. "

# data[].attributes.attachment_link.title
Preschoolers and ADHD - Child Mind Institute

# data[].attributes.attachment_link.description
While ADHD is most often diagnosed in school-aged children, it can be diagnosed in children as young as three. Of course we expect all preschoolers to be active - more inclined to run around than to sit still. And we expect them to be impulsive - prone to doing things without thinking about the consequences.

# data[].attributes.headline
ADHD in Preschools: 4 Signs You Might See

# data[].attributes.subject
ADHD in Preschools: 4 Signs You Might See

# data[].attributes.attachment_link.readable_text
By Amanda Morin

Lots of kids with ADHD need to move constantly. Your child may struggle to wind down at night and keep popping out of bed to do things. Or your child might struggle to sit still for circle time at the library or school. (Not all children with ADHD are hyperactive, though - some may seem daydreamy and off in their own world.)

2. Throwing tantrums at the drop of a hat

Kids with ADHD have trouble managing emotions. Your child may overreact to seemingly minor things by crying or yelling. At school, your child might fall apart during the slightest disagreement with another child. Tantrums are so common at this age, though, that it can be hard to know what's typical. Get an expert's take.

3. Needing constant direction

Kids with ADHD often struggle with planning and staying focused. Your child might refuse to play alone or need you to explain what to do lots of times. Following directions can be hard, too - especially if they have more than one step.

4. Seeming "all over the place"

Kids with ADHD tend to have trouble with self-control. That includes controlling movements. Your child may seem clumsy and accident prone. Or your child might ask a lot of questions but not stick around long enough to hear the answers.

About the author

Reviewed by

# data[].attributes.attachment_link.description
Lots of kids with ADHD need to move constantly. Your child may struggle to wind down at night and keep popping out of bed to do things. Or your child might struggle to sit still for circle time at the library or school.

# data[].attributes.headline
Is Preschool Too Early to Diagnose ADHD?

# data[].attributes.subject
Is Preschool Too Early to Diagnose ADHD?

# data[].attributes.attachment_link.readable_text
ADHD in Preschoolers: How Young Can You Diagnose ADHD in Children?

Ann Marie Morrison suspected that her son had attention deficit disorder (ADHD or ADD) when he was three. "John's temper tantrums were more intense than those of other three-year olds, and they came out of nowhere," says Morrison, of Absecon, New Jersey. "It took forever to get him out the door. He had to dress in the hallway, where there were no pictures or toys to distract him. He couldn't sit still, and he tore apart every toy. I carried gift cards in my purse, so that when he destroyed a toy at a friend's house, I could hand the mom a gift card to replace it."

When Morrison discussed John's hyperactivity and impulsive behavior with his doctors, her concerns were dismissed. "He's just an active boy," they said.

"One pediatrician said, 'Even if he has ADHD, there's nothing we can do for ADHD in children under 5,'" recalls Morrison. "That's like saying, 'Your son has a serious illness, but we can't treat it for another two years.' What was I supposed to do in the meantime?" The family moved to another part of the state when John was five years old, and, by chance, their new pediatrician was an expert in ADHD. She had been diagnosed with ADHD herself and had raised a son with the condition.

"At John's checkup, she was taking a medical history and John was, as always, unable to sit still. She stopped and asked, 'Have you had him tested for ADHD?' I started to cry. I thought, 'Oh, thank God. Someone else sees it,'" says Morrison. "After years of being told by relatives that I needed to discipline him more, after years of feeling physically and mentally exhausted, and thinking I was a horrible parent, someone realized what we were dealing with."

A thorough evaluation of John, which included input from John's teachers and family, led to a diagnosis of ADHD. Soon afterward, he was put on medication, which has helped him focus and improved his impulse control. Treatment has changed John's and his family's life. "If John had been diagnosed earlier, it would have helped a lot," says Morrison. "I don't know if we would have given him medication when he was three or four, but I would have learned techniques for getting him organized, disciplining him, and helping him establish a routine, without having to figure it out by myself. If I had known earlier that he had ADHD, I would have taken better care of myself, too. I wasn't prepared. It's not just the child who's affected by ADHD. It's the whole family."
[Click to Read: Starting with Preschool, Strive for Kids Who Thrive]
Mary K., of Hillside, New Jersey, suspected that her young son, Brandon, should be diagnosed with attention deficit disorder, too. At home, life was difficult - as it is for many families with children with ADHD.

"Brandon drew on the walls and didn't listen to anything we said. He threw pictures or silverware across the room when he was frustrated, which was all the time. We lived and died by Brandon's moods. If he was in a good mood, everyone in the house was in a good mood, and vice versa. I had a three-year-old running my household," says Mary.

At first, Mary and her husband ascribed Brandon's high activity level to 'boys being boys'. But when the preschool he attended asked the three-year-old to leave because of concerns about his aggressive and impulsive behaviors, she began to suspect an ADHD diagnosis was needed.

After Brandon was asked to leave a second preschool - he'd chased a girl around the playground with a plastic knife, saying he would "cut her up" - Mary booked an appointment with her son's pediatrician to ask about diagnosing the preschooler with attention deficit disorder. Her doctor's response, however, was that Brandon was much too young for an ADHD diagnosis.

The bottom line: This is simply not true. In extreme cases like these, an ADHD diagnosis in preschool is entirely appropriate - and often critical.
[Read: When Toddler Tantrums Are Actually ADHD - Early Signs of ADD and Emotional Dysregulation]
New AAP Guidelines on ADHD Diagnosis and Treatment in Children

Today, children like John and Brandon are being diagnosed and helped earlier in life, thanks to revised guidelines from the American Academy of Pediatrics (AAP). The AAP now recommends evaluating and treating children for ADHD beginning at age 4. Earlier guidelines, released way back in 2001, covered children ages 6 through 12. The new 2011 guidelines, which extend through age 18, also recommend behavioral interventions, especially for younger children.

"The AAP committee reviewed the research on ADHD done over the last 10 years, and concluded that there are benefits to diagnosing and treating ADHD in children younger than age 6," says Michael Reiff, M.D., professor of pediatrics at the University of Minnesota, who served on the committee that developed the new guidelines.

The updated AAP guidelines specify that diagnoses should rule out other causes of problem behaviors while assessing for coexisting conditions like anxiety, mood disorders, conduct disorder, or oppositional defiant disorder. A thorough diagnosis should include input from people in the child's life - teachers, care providers, and the immediate family - to be sure that ADHD symptoms are present in more than one setting. When a child has been diagnosed with ADHD, based on criteria in the DSM-5, the AAP offers these age-specific treatment recommendations:

For children ages 4 to 5, the first line of treatment should be behavior therapy. If such interventions are not available, or are ineffective, the physician should carefully weigh the risks of drug therapy at an early age against those associated with delayed diagnosis and treatment.

For children ages 6 to 11, medication and behavior therapy are recommended to treat ADHD, along with school interventions to accommodate the child's special needs. Evidence strongly indicates that kids in this age group benefit from taking stimulants.

For adolescents ages 12 to 18, doctors should prescribe ADHD medication with the teen's consent, preferably in combination with behavior therapy.

Diagnosing ADHD in Preschoolers

But can a doctor truly differentiate symptoms of ADHD from normal preschool behaviors in a patient who is only 4 years old? Yes, however the tipping point in diagnosis is usually a matter of degree.

"A child with ADHD is much more extreme than the average three-year-old," says Alan Rosenblatt, M.D., a specialist in neurodevelopmental pediatrics. "It's not just that a child with ADHD can't sit still. It's that he can't focus on any activity, even one that's pleasurable, for any length of time."

Larry Silver, M.D., a psychiatrist at Georgetown University School of Medicine, says that an experienced teacher, one with a baseline of appropriate 3-year-old behavior, can be a tremendous help. "You have to look at whether the behaviors are consistent in more than one environment," he notes.
["ADHD Diagnosis for My Hyperactive Boy: Kicking Before Birth"]
But experts caution that, even with "red flags," early diagnosis of ADHD can be difficult. "You have to delve deep into the root of certain behaviors," Silver says. "A child might have separation anxiety, his fine motor skills or sensory problems could be making it hard for him to behave, or it could be evolving autism spectrum disorder," he says.

Nonetheless, Laurence Greenhill, M.D., of Columbia University/New York State Psychiatric Institute, points to two behavioral patterns that often predict an ADHD diagnosis later in life. The first, preschool expulsion, is usually caused by aggressive behavior, refusal to participate in school activities, and failure to respect other children's property or boundaries. The second, peer rejection, is one that parents can easily identify. Children with extreme behaviors are avoided by their classmates and shunned on the playground. Other children are often "busy" whenever parents try to arrange playdates.

In these extreme cases, a parent should take her preschooler to a pediatrician for referral, or straight to a child psychiatrist. Diagnosis of ADHD should involve a thorough medical and developmental history, observation of social and emotional circumstances at home, and feedback from teachers and health professionals who have contact with the child. In many cases, neuropsychological testing may be needed to rule out conditions whose symptoms might overlap with ADHD, including anxiety disorder, language-processing disorders, oppositional-defiant disorders, autism spectrum disorder, and sensory integration problems.

Treatment Options for ADD in Preschool

If your preschool child is diagnosed with ADHD, what is the next step? Both the American Psychological Association and the American Academy of Child and Adolescent Psychiatry advise that ADHD treatment in children proceed according to the severity of the symptoms. For children who play well with others and who have healthy self-esteem, Carol Brady, Ph.D., a child psychologist in Houston, says that environmental changes can help. "A smaller classroom, with less stimulation, and a strong routine often make a tremendous difference in improving ADHD symptoms in preschoolers."

In most cases, parent effectiveness training or behavior therapy is the next course of action. There is increasing evidence that treating ADHD symptoms in preschoolers with behavior therapy can be extremely effective, even for children with a high degree of ADD-related impairment.

But what if your child with ADHD doesn't respond to behavioral interventions? Is medication the answer? A low dose of methylphenidate (brand names include Ritalin, Concerta, Quillivant, and others) is the AAP's recommendation to treat preschool-age children diagnosed with ADHD, when behavior therapy is tried first and unsuccessful. However, methylphenidate is not approved by the Food and Drug Administration (FDA) for use in children younger than six. While doctors can prescribe them for children under 6, insurance companies can refuse coverage for prescriptions not covered for a specific child's current age. As a result, some doctors prescribe amphetamine-based stimulant medications approved to treat ADHD in kids ages 3 to 5, such as Adderall, Dexedrine, Evekeo, and Vyvanse.

The Preschool ADHD Treatment Study, or PATS, conducted by the National Institute of Mental Health (NIMH), is the first long-term study designed to evaluate the effectiveness of treating preschoolers with ADHD with behavioral therapy, and then, in some cases, low doses of methylphenidate. In the first stage, the children (303 preschoolers with severe ADHD, between the ages of 3 and 5) and their parents participated in a 10-week behavioral therapy course. For one third of the children, ADHD symptoms improved so dramatically with behavior therapy alone that the families did not progress to the ADHD medication phase of the study.

Preliminary data were released in late 2006. "PATS provides us with the best information to date about treating very young children diagnosed with ADHD," says NIMH director Thomas R. Insel, M.D. "The results show that preschoolers may benefit from low doses of medication, when closely monitored."
[Read: Can a Six-Year-Old Be Treated for ADHD?]
Profiles in Preschool ADHD Diagnosis

As a speech therapist who works with children, Joe'L Farrar, of Wilburton, Oklahoma, recognized symptoms of ADHD in her daughter, Carey, at age one and had her diagnosed at age three. Because Farrar was already using many behavior therapy strategies at home, Carey's doctor suggested a trial of medication when she was four. It didn't go well.

"The side effects were too much for Carey," says Farrar. "We took her off medication and focused on behavioral modifications for a couple of years - and put her back on meds at six." Now 10, Carey takes Strattera, which Farrar says is helpful in managing Carey's hyperactivity and inattentiveness, but less effective in improving her impulsivity.

Despite mixed success with medication in Carey's early years, Farrar is glad she had her daughter diagnosed at three. She was able to get accommodations Carey needed at school. "When her kindergarten teacher said that Carey didn't like to take naps, we arranged for the special-ed teacher to take her to another room during naptime to do calm activities together."

Carey has done well in school, as well as in cheerleading and choir. Farrar has also put a positive spin on her daughter's ADHD. "I explained to her that there were chemicals missing in her brain that made it harder for her to sit still in a chair like other kids did," says Farrar, "but that didn't mean she wasn't as smart as they were."

Robin S., of Englewood, Colorado, wishes she had done things differently when she suspected her son, Jacob, now eight, had ADHD. "I wish I had trusted my gut," she says. "I was always making excuses for Jacob's behavior. I was ineffective as a parent. If I'd had a 'real' diagnosis, I could have advocated more effectively for my son."

Thanks to the changes in the DSM-V allowing kids as young as four to be formally diagnosed with ADHD, a growing number of health professionals realize the benefits of early diagnosis and treatment. Peter Jensen, M.D., Ruane Professor of child psychiatry at the Center for Advancement of Children's Mental Health in New York City, maintains that parents should intervene before major damage is done to a child's self-esteem. "You should avoid letting it get to the point that your child dislikes school or feels like a failure or is always in trouble. That can set the stage for a child to expect failure and act in self-protective ways (e.g., becoming the class clown or resorting to aggression) that, in turn, promote more negative feedback.

"Youngsters who are carefully diagnosed by competent professionals show great benefits from early intervention," says Brady. "They are more relaxed, more successful, and able to enjoy their childhoods."

For Mary and her husband, a chance meeting at the neighborhood pool when Brandon was 4 years old made all the difference. "I was trying to talk Brandon through yet another tantrum when a mom walked over to say that Brandon reminded her of her son, now 9. She gestured toward a boy sitting on a towel, quietly playing cards with a couple of other boys. Her son, as it turned out, suffered from severe ADHD. She gave me her psychiatrist's name and phone number and I called right there, from the pool, and made an appointment."

After a thorough evaluation, the psychiatrist diagnosed Brandon with ADHD and started him on a low dose of medication just before he turned five. Mary and her husband enrolled in a structured behavior modification program and joined a local parent group for extra support. "I can't say that life is perfect, but it is certainly light years ahead of where we were," she says. "Had I seen a different pediatrician earlier on, or known that ADHD could be diagnosed and treated at a younger age, I could have spared our family a lot of heartache."

The Preschool ADHD Treatment Study (PATS): What You Need to Know

Background

Sponsored by the National Institute of Mental Health, and conducted by a consortium of researchers at six sites, PATS is the first long-term, comprehensive study of treating preschoolers with ADHD. The study included more than 300 three- to five-year-olds with severe ADHD (hyperactive, inattentive, or combined type). Most exhibited a history of early school expulsion and extreme peer rejection.

Stage 1: Parent Training

Ten-week parent training course in behavior modification techniques, such as offering consistent praise, ignoring negative behavior, and using time-outs. Result: More than a third of the children (114) were treated successfully with behavior modification and did not proceed to the medication stage of the study.

Stage 2: Medication

Children with extreme ADHD symptoms who did not improve with behavior therapy (189) participated in a double-blind study comparing low doses of methylphenidate (Ritalin) with a placebo. Result: Methylphenidate treatment resulted in significant reduction in ADHD symptoms, as measured by standard rating forms and observations at home and at school.

Notable Findings

Lower doses of medication were required to reduce ADHD symptoms in preschoolers, compared to elementary school children.

Eleven percent ultimately stopped treatment, despite improvements in ADHD symptoms, due to moderate to severe side effects, such as appetite reduction, difficulty sleeping, and anxiety. Preschoolers appear to be more prone to side effects than elementary schoolers.

Medication appeared to slow preschooler growth rates.Children in the study grew half an inch less and weighed three pounds less than expected. A five-year follow-up study is looking at long-term growth rate changes. Look for preliminary results in 2009.

Bottom Line

Preschoolers with severe ADHD experience marked reduction in symptoms when treated with behavior modification only (one third of those in the study) or a combination of behavior modification and low doses of methylphenidate (two thirds of those in the study). Although medication was found to be generally effective and safe, close monitoring for side effects is recommended.

For more information on the Preschool ADHD Treatment Study: Journal of the American Academy of Child and Adolescent Psychiatry, November 2006. (jaacap.com), National Institute of Mental Health, ( nimh.nih.org).
[Read This Next: "My Child Was Diagnosed at Age 3 - and Thank God She Was."]
SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

# data[].attributes.attachment_link.title
Is Preschool Too Early to Diagnose ADHD?

# data[].attributes.attachment_link.description
Ann Marie Morrison suspected that her son had attention deficit disorder (ADHD or ADD) when he was three. "John's temper tantrums were more intense than those of other three-year olds, and they came out of nowhere," says Morrison, of Absecon, New Jersey. "It took forever to get him out the door.

# data[].attributes.attachment_link.readable_text
Have you ever been irritated by an itchy tag, or annoyed by someone chewing loudly? Maybe you've been unable to ignore these feelings once you notice them. That gives you a small glimpse into the experience of people with sensory overload, also called a sensory processing disorder.

Sensory processing disorder can make it difficult for people to function if they become overwhelmed by senses including touch or hearing. The condition is known to be closely related to autism, but research shows that sensory overload and attention-deficit/hyperactivity disorder (ADHD) can also go hand in hand.

This article will review the reasons why people with ADHD are prone to sensory overload, triggers, and how to cope.

ADHD and Sensory Processing Disorder

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects about 11% of school-aged kids. ADHD can cause symptoms such as trouble sitting still, difficulty paying attention, or impulsive behavior. An estimated two-thirds of kids with ADHD continue to experience symptoms as adults.

Research has shown that children with ADHD have trouble processing sensory stimulation from the outside world. Kids with ADHD tend to be over-responsive to such stimulation, such as bright lights, strong smells, loud sounds, or certain physical sensations, which can cause them to experience sensory overload.

A few of the symptoms of ADHD can make sensory overload worse, and result in a sensory processing disorder.

Lack of self-regulation: People with ADHD often struggle to regulate their emotions or reactions. Because of that, a sensation that is a minor irritation to neurotypical people can result in an outburst for people with ADHD.

Trouble with transitions: People with ADHD often struggle with transitions, which is also known as trouble with flexible thinking. This can cause people to fixate on an uncomfortable situation and have trouble turning their attention elsewhere.

Lack of awareness:People with ADHD are sometimes distracted, disorganized or rushed. This can lead to sensory overload when they encounter a sensation they don't like-like an itchy coat-but are unable to remedy it quickly.

Symptoms of Sensory Overload

Some people with sensory processing disorder underreact to sense stimuli, which can cause them to seek out more intense forms of stimulation. But more commonly, particularly in people with ADHD, this disorder causes hyper-sensitivity to sensory information. This can present differently among individuals, but some common symptoms include:

Picky eating habits, particularly avoiding foods with textures that the person finds unpleasant

Trouble settling down after activities

Sensitivity to smells or sounds

Dislike of certain fabrics, clothing items, or shoes

Discomfort with certain movements, like swinging or riding an elevator

These symptoms might seem minor, but they can be severe enough to interfere with a person's day-to-day functioning. In severe cases, sensory overload can lead to nutritional deficiencies or missing school, so it's important to address the symptoms.

Causes of Overstimulation in People With ADHD

People with sensory processing disorder can be overwhelmed by any of the five senses that most people are familiar with: touch, taste, sound, sight, or smell. They can also have trouble processing or be easily overwhelmed by other senses, including vestibular senses (head movements), proprioception (muscle and joint movement), and interception (internal bodily sensations such as hunger, thirst, or feeling cold).

People with ADHD are more likely to be overwhelmed by sensory input from any of these areas than people without ADHD. Common triggers of overstimulation in people with ADHD include:

The texture of certain foods, fabrics or body washes can overwhelm people with ADHD. This is one of the most common sensory overloads for kids with ADHD, and girls may be particularly at risk.

The way that certain clothes or shoes fit can be frustrating and overwhelming, particularly for kids. Others might experience overwhelm from bed sheets or car seats.

Some people with ADHD are sensitive to certain tastes, although food aversions are more commonly cause by textures.

Loud noises like a fire alarm or even subtle noises like someone chewing can cause stress.

People with a sensory processing disorder might be especially sensitive to smells, even those that are meant to be pleasant, like perfume or cooking food.

Visual clutter can provide too much stimulation.

Treating and Managing Sensory Overload in ADHD

ADHD is treated with a combination of medications and behavioral interventions. Treatment for sensory overload can be integrated into this protocol.

The best treatment for a sensory processing disorder is sensory integration therapy, which can be incorporated into physical or occupational therapy. Under this therapy, a person is exposed to sensory stimuli and learns how to respond appropriately.

If you're trying to address sensory processing and ADHD for yourself or your child, try these steps:

Speak with your healthcare provider. Sensory overload is common in kids with ADHD, and your healthcare provider might have strategies to suggest.

Identify triggers. Keep a diary to help identify the triggers or things that overwhelm your child. Where reasonable, avoid these.

Learn self-soothing techniques. Help your child learn how to calm themselves once they've become overwhelmed. This can be difficult for people with ADHD, so you might need to work with an experienced therapist.

Follow a routine. A routine can help with predictability and mitigate ADHD symptoms like disorganization and trouble with transitions, giving more resources to cope with ADHD.

Practice regulation. Find the tricks-like exercise, meditation, or painting-that help you or your child regulate their reactions and sensory input.

Many people are aware of the connection between sensory processing disorder and autism, but fewer people know that sensory overload and ADHD often occur together. Sensory processing isn't just a quirk of people with ADHD: it's a real condition, rooted in brain differences. Speak with your healthcare provider and therapists about interventions that can help with sensory overload.

A Word From Verywell

Sensory overload can make it difficult for people with ADHD to get through their daily routines. Sensory overload can also be frustrating, whether you're the person experiencing it or a parent or caregiver trying to help a child cope.

Remember that people with sensory overload and ADHD aren't trying to be difficult-they're experiencing a very real symptom of their condition. Talk with your healthcare provider and experiment with sensory integration therapy and other interventions that can help you or your child better regulate and respond to sensory information.

Frequently Asked Questions

What does sensory overload feel like in ADHD?

When a person with ADHD experiences sensory overload, they can become so fixated on a certain sensation, they're often unable to turn their attention away from the stimuli or focus on other tasks. This can make it difficult to meet expectations at school or work.

What does ADHD overstimulation look like?

People who are experiencing sensory overstimulation from ADHD might be unable to focus on anything other than the sensation. They may be irritable, frustrated, or upset because the sensation is unpleasant to them. In some cases, people might pull at their shirt, block their ears or take other steps to try to stop the sensation.

Can sensory issues be a symptom of ADHD?

Sensory issues and sensory processing disorders are prevalent in people with ADHD. Although scientists are still researching the exact correlation, research has shown that kids and adults with ADHD are more likely than neurotypical people to experience sensory overload.

# data[].attributes.attachment_link.description
Have you ever been irritated by an itchy tag, or annoyed by someone chewing loudly? Maybe you've been unable to ignore these feelings once you notice them. That gives you a small glimpse into the experience of people with sensory overload, also called a sensory processing disorder.

# data[].attributes.attachment_link.readable_text
By Amanda Morin

Quick tips for managing sensory overload

Food textures. The feel of certain types of clothing. Changes in routine. Sensory overload happens when something overstimulates one or more of the senses. There's suddenly too much information coming in for the brain to process. It's common in people with sensory processing issues.

Many people associate sensory overload with kids who have autism spectrum disorder (ASD). But it can happen with other diagnoses too, like ADHD. Researchers are still looking into exactly why this happens. But they've found there are certain types of sensory information, like clothing and food textures, that are more likely to cause it.

Some ADHD symptoms - like trouble paying attention to what's going on around you - may lead to sensory overload. When you're not tuned in, sensory information can sneak up on you.

Imagine rushing to leave in the morning and suddenly realizing how late it is. In the two minutes you have, you grab the first shirt and pair of shoes you find and throw them on. But the shirt you grabbed has an itchy tag, and the shoes pinch your feet. Once you're on your way, it's too late. Your uncomfortable clothing has already created a sensory overload situation.

There are also other reasons people with ADHD may experience sensory overload. Trouble with self-regulation can be a factor. So can struggling with switching gears ( flexible thinking).

Dive deeper

About the author

Reviewed by

# data[].attributes.attachment_link.description
Quick tips for managing sensory overload Food textures. The feel of certain types of clothing. Changes in routine. Sensory overload happens when something overstimulates one or more of the senses. There's suddenly too much information coming in for the brain to process. It's common in people with sensory processing issues.

# data[].attributes.attachment_link.description
Welcome to the FCPS Family Resource Center!
We offer a welcoming and engaging environment for families, educators, and community members. We provide access to information and resources to support the success of all students, including those with learning challenges, special needs and disabilities.
The Family Resource Center Lending Library contains over 10,000 books/e-books, DVDs, and CDs on topics related to parenting and educating all children including those with learning challenges, mental health concerns, special needs, and disabilities. Please call 703-204-3941 or email FRC@FCPS.edu us if you have further questions.

# data[].attributes.headline
Fidget Toys and ADHD: Still Paying Attention?

# data[].attributes.subject
Fidget Toys and ADHD: Still Paying Attention?

# data[].attributes.attachment_link.readable_text
ADHD Weekly, January 31, 2019
Has the fidget spinner fad finally passed? It's been more than a year and a half since the gizmos caught our collective attention. They seemed to be everywhere and in every little hand, and then poof! not a spinner to be seen.

Fidget spinners were intensely popular in ADHD circles, promising to help increase attention by giving the user an outlet for fidgeting. Adults took them into meetings and students had them in the classroom. Parents wanted their use included in academic plans and teachers worried about distraction during class.

Last summer, the spinners were all marked 75 percent off and the craze seemed over. But was there something to the idea that a fidget toy could help a person-especially one who struggles with ADHD symptoms-maintain attention and do better with his work?
The science of fidgeting
Several research studies have confirmed what many people have experienced through fidgeting: Their ability to pay attention, their memory recall, and their problem-solving improves. Another study concluded that the fidgety behavior displayed by children and adults with ADHD may be an effort to increase their attention and alertness. The amount of improvement varies by the person and the fidgeting activity can also become a distraction if it's too intense.

"If you are trying to focus on a task, but your hands are busy doing something else, it actually forces your brain to increase your efforts to focus on the task at hand," says Matthew Lorber, MD, a child psychiatrist at Lenox Hill Hospital in New York. "There have been some small scale studies that show people with ADHD do better on tasks if given some sort of outlet to get out their energy, to distract their hands. While fidget spinners specifically haven't been studied, there have been studies that have shown in general that someone with ADHD with something to fidget with-such as tapping a pen-perform better on tasks."

Fidgeting by children and adults is any small activity that helps to burn off a little bit of energy, such as twirling hair, tapping feet, drumming fingers on a tabletop or wiggling in chair. Often people will find some small item to play with-clicking pens, tossing a hacky-sack back and forth, doodling. Enter the fidget toy, a specially made item that aids in fidgeting.
Do fidget toys actually help?
While fidgeting is scientifically shown to help with attention, we lack studies showing that fidget toys do help. Simple fidgeting tools, such as textured putty or squeezy balls that allow quiet, non-distracting movement seem to be helpful. More elaborate toys like fidget spinners, twirling toys, or links pull attention away from where it should be, however.

What is the difference between a fidget tool and a fidget toy? The tool, like the squeeze toy, allows quiet activity that doesn't bring your focus toward it. Manipulating such an item can happen in the background of your activity. A toy, though, ends up capturing your attention because you either need to watch it to maintain control or you are actively trying to do neat tricks with it.

"The need for these spinners stemmed from a desire to control the symptoms of ADHD," says Cory Sicard, a middle school science teacher in Parker, Colorado. "Unfortunately the spinners can also take children's attention away from what they are seeing and hearing. Plus, the spinning and movement serves as a distraction to other students in the room."

Professionals who treat ADHD don't see the value in many gizmos marketed as fidget toys for this reason.

"My worry is that they're very much a distraction, not only to the child, but it distracts people from doing something that we know works," says Mark Stein, PhD, ABPP, of the PEARL Clinic/ADHD and Related Disorders Program at Seattle Children's Hospital.
Fidgeting to focus: what does help
If wiggling and fidgeting help you pay better attention, but most fidget toys end up causing you to pay less attention to the task at hand, what can you do?

It may take a little experimentation. Look for tools that help you get the wiggles out in ways that are quiet and autonomic. Putty, squeeze toys, fidget cubes, wobble seats for your chair, chewing gum, worry stones-all of these can be helpful. Activities using these items tend to fade to the background as you pay attention to your task. For children, many of these items can go quietly into a classroom without becoming a distraction.

Taking brief breaks at regular times can help to release energy. You may find that a walk or a snack improves your focus when you resume the task. Understanding how long you can maintain your attention is also important. This allows you to plan your activities with regular breaks rather than trying to push through and end up losing your attention on the task.

For children, adding brief amounts of exercise to their day can also improve their attention when it's time for seatwork. Gym class, recess, and playing outside after school can all help.
Interested in reading more on this? Join the discussion: What fidgets are helpful for you or your child?

# data[].attributes.attachment_link.title
Fidget Toys and ADHD: Still Paying Attention? - CHADD

# data[].attributes.attachment_link.description
Has the fidget spinner fad finally passed? It's been more than a year and a half since the gizmos caught our collective attention. They seemed to be everywhere and in every little hand, and then poof! not a spinner to be seen. Fidget spinners were intensely popular in ADHD circles, promising to help increase attention...

# data[].attributes.headline
The Body-Brain Connection: How Fidgeting Sharpens Focus

# data[].attributes.subject
The Body-Brain Connection: How Fidgeting Sharpens Focus

# data[].attributes.attachment_link.readable_text
"Focus!" "Mind over matter!" "You can do anything if you really want to!" "Just try harder!"

Anyone with attention deficit hyperactivity disorder (ADHD) has heard these exhortations, and have probably shared them with others struggling to concentrate at work or focus at school. The ADHD brain is indeed a powerful force for success.

But we know that relying on the brain can be frustrating and, at times, demoralizing. Our ADHD brains aren't our most reliable asset - allowing distractions to break our focus. But what if there were strategies that could prime our brains beyond "just trying harder"?

There are. Recent research suggests that the body affects the brain as much as the brain affects the body. In his recent book, John Ratey, M.D., shows that physical activity - even something as small as fidgeting the hands - increases levels of the neurotransmitters dopamine and norepinephrine in the way ADHD medications do. Both chemicals play a key role in sharpening focus and increasing attention.

Sydney Zentall, Ph.D., of Purdue University, studied the factors that help children with ADHD succeed in the classroom. In ADHD and Education, she notes that attention "deficit" increases with the length, familiarity, and repetitiveness of a task. In other words, you tune out when tasks get boring!

According to Zentall, an activity that uses a sense other than that required for the primary task - listening to music while reading a social studies textbook - can enhance performance in children with ADHD. Doing two things at once, she found, focuses the brain on the primary task.
[Free Download: The Secret Power of Fidgets]
Zentall calls these sensory-motor activities "distractions." We call them fidgets - mindless activities you can do while working on a primary task. We're not talking about wriggling in your seat. Fidgeting is more intentional. It's pacing or doodling while on the phone or chewing gum while taking a test.

Multitasking for People with ADHD

It's true that many people are successful only when they do one thing at a time, but for adults and children with ADHD the opposite is usually true. We need to respect the fact that there is neural diversity, that different people have different ways of doing things - not from preference or contrariness, but from need.

Fidgeting works for many children with ADHD. Karen was surprised to find that her bright son, who had been doing poorly in high school, suddenly started getting As. While delighted with his grades, she couldn't figure out what had changed. The only thing that was different was his wearing a hooded sweatshirt to school. She eventually discovered that her son was secretly listening to music on his iPod, under that hood. The music focused his brain and made a big difference in his classwork and test scores.

Mary, age 25, remembers that she had trouble sitting still and finishing homework in high school. Her mother found a solution: setting up homework stations around the dining-room table. Mary would stand at each station, working or reading as quickly as she could, until she got restless and moved on to the next station. Every night she raced around the table until her work was done. As an adult, Mary is using fidget strategies to help her get through medical school.
[Quiet Ways for Fidgety Kids to Release Energy at School]
Be Deliberate About It

Fidgeting must be deliberate to be effective. Intentional fidgets allow you and your child to self-regulate ADHD symptoms in a controlled, constructive fashion. An effective fidget doesn't distract you from your primary task because it is something you don't have to think about.

Doodling while listening to a lecture or when on a long phone call enables you to better absorb what's being said. Walking while talking helps your mind tune in to a conversation without missing a beat. We encourage respectful fidgeting - something that doesn't bother others.

For example, drumming your fingers or clicking your pen during an office meeting would be distracting to colleagues. Wiggling your toes inside your shoes would not.

To cultivate deliberate, effective fidgeting in your child, give him permission to do it. Never say, "Sit still!" "Look at me when I'm talking to you!" "Don't try to do two things at once!" We must recognize that these sensory-motor activities are a perfectly natural adjustment when an activity can't sustain our attention.

Experiment with a variety of strategies and encourage your child to try different fidgets. Remember that your favorite fidget may not work for him. Listening to music while reading may do wonders for your focus, but your child may prefer keeping his hands busy - squeezing a rubber ball or fiddling with his Little League ring.

Having options means there's always something that can be used to help your child stay on task in school and in life.

Here are eight fidgets worth trying:
1. Walk and talk.
When your child gets restless and tunes out an important conversation you're trying to have with him, try walking and talking. Any non-strenuous activity, like playing catch or doing a jigsaw puzzle together, will also work. This is a powerful strategy for talking over your child's day or having an important discussion with a partner who has ADHD.
2. Doodle.
Encourage your child to draw or write words or numbers when listening to a teacher's lecture (just make sure he doesn't doodle on the desk). Doodling will also help you focus when you're on a long phone call with a client or are in an endless, boring meeting.
3. Use multi-colored pens and pencils.
This fidget works well when your child needs to complete an assignment or read for comprehension (he can underline words as he reads). Scented markers may also help.
4. Busy your hands.
This facilitates focus when a child is listening, talking, or thinking about how to answer a tough essay question. Fidget toys for school or home include cool-looking pens or pencils, beaded bracelets, paper clips (they bend into interesting shapes and can be linked together), and clothes with interesting textures or doodads. For adults at work, a small, smooth stone - a worry rock - in your pocket will allow you to fiddle without your boss or colleagues knowing. Curling your hair around a finger also works. At home, clients of ours find that either knitting or squeezing a Nerf ball can increase attention.
5. Tune in.
Plugging into an MP3 player helps children stay on task when studying, reading, exercising, or even going to sleep. Choose music that is appropriate to the task: a stimulating beat when exercising, calming tunes for sleep, and something in between when studying or reading. At the office, use this strategy on days when you are working at the computer and have little interaction with colleagues.
6. Chew gum.
This helps your child when he has to concentrate for an extended period - doing homework or taking a test. Chewing gum in the office is effective when writing a memo or having to slog through a week's worth of e-mail. If gum is not an option, sucking on a lemon drop or other hard candy will also do the trick.
7. Beat the clock.
Set a timer for 20 minutes, and race to get as much done as possible before the alarm goes off. An adult can use this to accomplish any dull chore - doing dishes, paying bills, or picking up around the house. Your child can race the clock when doing worksheets, memorizing vocabulary, or cleaning up his room.
8. Stand up or move around.
Talk with the teacher about letting your child stand, at appropriate times, during the school day. A child can do this discreetly at the back of the room or at his desk. Some teachers assign a child two desks, so he can move from one to the other when necessary. Other teachers let restless kids be message runners and send them off on real or invented errands.

If you can't focus in a meeting at work, use a coffee break or a visit to the washroom as an excuse to stand. If you're really restless, use a bathroom visit to run up and down a flight of stairs, fast, a few times.

Managing ADHD involves recognizing our choices and taking action. Understanding what is going on in our brains and proactively choosing an appropriate strategy is the essence of the fidget approach.
[Stop Fidgeting?! Um, Bad Idea]

# data[].attributes.attachment_link.title
The Body-Brain Connection: How Fidgeting Sharpens Focus

# data[].attributes.attachment_link.description
"Focus!" "Mind over matter!" "You can do anything if you really want to!" "Just try harder!" Anyone with attention deficit hyperactivity disorder (ADHD) has heard these exhortations, and have probably shared them with others struggling to concentrate at work or focus at school. The ADHD brain is indeed a powerful force for success.

# data[].attributes.headline
6 types of fun fidgets for kids with ADHD

# data[].attributes.subject
6 types of fun fidgets for kids with ADHD

# data[].attributes.attachment_link.readable_text
By Lexi Walters Wright

Fidgets can help some kids with ADHD focus better. They're not "one size fits all," however. Different types of fidgets can meet different sensory needs. You can see which work best for your child, and then talk to the teacher about using them in class.

Understood does not endorse or receive financial compensation for the sale of any of these products.

Calming fidget: Wikki Stix

Sometimes kids with ADHD need help feeling settled so they can sustain their attention. Wikki Stix give kids many ways to do that - kids can bend them, twisting them or molding them into balls. Other calming-fidget options include extra-fuzzy pipe cleaners, plastic nuts and bolts, coiled bracelets or key chains, and weighted lap pads.

For some kids with ADHD, a little noise, color, or light can actually help with focus. If kids need that kind of stimulation, a fidget like Klicks can keep they busy. They can twist, bend, pull apart, and snap together the colored puzzle pieces. Pop Toobs are another alerting fidget. Spinning tops and color-changing light-up balls can also do the trick.

If your child's favorite is too disruptive for classrooms, it can just be used at home. It might be helpful to use during study sessions or while listening to an audiobook.

Chewelry was designed to help build biting and chewing skills. But it can also help kids who concentrate better when they keep their mouths occupied with something - like a pencil, their nails, or the sleeve of their sweatshirt. Chew Stixx is another example. You can also try chewable pencil toppers and silicone jewelry.

Gum may be just as effective as a chewy fidget, and something older kids may feel less embarrassed about using. You can talk with your child's teachers about allowing gum during lessons or exams.

Resistance fidget: Silly Putty

This classic toy can be great for kids who focus better when their hands are busy pushing, pulling, or squeezing toys with "give." Other options for resistance fidgets include kneaded erasers, ponytail holders, stress balls, corks (for picking apart), squishy toys, and magnetic balls or disks.

Tactile fidget: Koosh Balls

Some kids with ADHD find that touching different textures helps them focus. So anything that's sticky, gooey, slimy, hairy, or scratchy might work. Koosh balls are one example of a tactile fidget. Others include play foam, kinetic sand, rubbery squeeze toys, pop-beads, and Velcro strips.

Some kids with attention or sensory processing issues find the weight and motion of whizzing spinners helpful for focusing. Other kids (and their parents and teachers) find the movement and tactile input to be distracting.

Before sending your child to school with any fidget, consider crafting a document that sets expectations about what the fidget is for. This downloadable fidget contract can help provide your child with direction on how to use a fidget in an appropriate way.

# data[].attributes.attachment_link.title
Types of Fidgets for Kids With ADHD | Fidget Toys to Help With Focus

# data[].attributes.attachment_link.description
Fidgets can help some kids with ADHD focus better. They're not "one size fits all," however. Different types of fidgets can meet different sensory needs. You can see which work best for your child, and then talk to the teacher about using them in class.

# data[].attributes.headline
The Secret to Better Behavior: No Punishment at All

# data[].attributes.subject
The Secret to Better Behavior: No Punishment at All

# data[].attributes.attachment_link.readable_text
As a psychotherapist who specializes in ADHD and related conditions, I work with parents who feel frazzled and confused about how to best help their neurodivergent children with behavioral challenges. It is a thing I easily relate to, as the just-as-frazzled mother to three grown children who came into this world with a not-quite-neurotypical cocktail of fun.

How to best parent and discipline my children was rarely obvious or straightforward. At times, they were defiant. They ignored me. They threw major tantrums. They lied. They were often verbally and sometimes physically aggressive. No punishment seemed to work. Sound familiar?

Then years later, as I was completing a master's in counseling psychology, I came to understand something that completely changed the way I approached parenting: ADHD is actually not a behavior disorder! It is a neurological difference. My kids' difficult behaviors were not happening by choice. This realization allowed me to find and exhibit true compassion for my children - a game changer.

If you're exhausted and running out of ideas to correct your child's difficult behaviors, you're not alone. Improving behaviors in children with ADHD often means trying a few key strategies and one great twist - there's actually no punishment involved at all!

5 Steps to Dealing with Difficult ADHD Behaviors

Step 1: Accept That ADHD is Physiological

You can't begin to correct your child's difficult behaviors until you acknowledge this truth.

Children with ADHD largely struggle with executive functioning - the brain skills we all need to function in our daily lives. They include the ability to sustain attention, to organize and plan, to recall information, and to control emotions, among other skills. The prefrontal cortex - where attention, emotions, and behaviors intersect - is also implicated in ADHD.
[Read: Positive Parenting Strategies That Inspire Good Behavior]
Children with ADHD are also about three years behind their neurotypical peers in terms of brain development, meaning that they are often asked to function at higher levels than their brains can manage.

It's these circumstances that bring about difficult behaviors that are often out of a child's control. What's more, these behaviors will still appear no matter how well-versed a child is in the consequences. Harsher punishments will not make a dent.

Punishing a child with ADHD for difficult behaviors is ineffective and counterproductive because they don't have the luxuries of regulating their emotions and behaviors like a neurotypical child would. Punishment only results in them feeling guilty and ashamed for what they couldn't control. The guilt and shame can turn into frustration, defiance, and emotional outbursts - and they often do.

The true meaning of the word "discipline" is to teach, not to punish. Teaching helps to shape behavior positively so that difficult, impairing behaviors are less of an issue.

So how do we change problem behaviors and teach better ones without punishment?
[Related Reading: Never Punish a Child for Behavior Outside Their Control]
Step 2: Be a Detective, Not a Judge

All behaviors serve a purpose. Problem behaviors are representative of an unmet need and, in ADHD's case, can be due to impulsivity.

Rather than act like a judge and issue punishment to your child after a problem behavior occurs, it is better to put on your detective cap and try to decode the root or cause of the behavior. Determining the unmet need behind your child's difficult behaviors will give you the chance to meet the need and decrease the chances that the problem behavior occurs again.

Problem behaviors can broadly be divided into two categories:

Chronic behaviors, which tend to happen at the same time and in the same situations. (e.g. refusing to go to bed or to wake up; temper tantrums after getting off video games.)

Impulsive behaviors (e.g. your child hitting their sibling or having a meltdown out of the blue.)

The next time a problem behavior occurs, take note of all its surrounding factors and context. You'll come to find that your child's most difficult behaviors can be traced back to these common causes:

They don't know how to start the task and may not know how to ask for help.

They don't understand the task and the finish point. If you tell your child to clean their room, they may not know what 'clean' looks like.

The task is too difficult. If your child is unwilling to do homework, for example, it might be that the work is too challenging, or that there's too much to work through organizationally.

They need a transition time. ADHD is associated with time blindness. Telling your child they have five minutes left before stopping their video game is futile. You'll have to "show" them what five minutes looks like so they can really understand.

They are overwhelmed with too many instructions and can easily forget multi-step tasks. They will need large projects 'chunked' up.

They could not control their impulsivity.

They are ashamed of their behavior (especially if they lied).

Avoid assuming that the problem behavior is because your child is lazy, defiant, or because they simply want to "cause trouble." No one, not even your child, wakes up with the intention of having a bad day.

Step 3: PREP Your Child

Once you've truly thought through the causes behind the problem behaviors, you'll have to PREP your child to replace the bad behavior with a better one, or at least decrease its severity. PREP stands for:

Peaceful moment: It's much easier to deconstruct problem behaviors when your child is calm and tensions aren't running high.

Request good behavior: Ask your child open-ended questions to guide them to better behavior. If they are being disruptive during dinner time, for example, calmly ask them to remind you of the family rules. (Do we throw food? Do we interrupt one another?)

Explanation from your child: As your child answers your guiding questions, it will reinforce the information in their brain, allowing them to be more mindful of the situation.

Praise: Notice your child's efforts toward better behavior and do your best to ignore problem behaviors (so long as they are not dangerous). Your approval and enthusiasm can be a great motivator to your child.

Step 4: PREP Yourself

It's not easy to keep your cool as your child engages in difficult behaviors. At the same time, if we show them that we are annoyed, frustrated, and dysregulated, we are modeling these behaviors to them.

As parents, we tend to skip checking in with ourselves and making sure we are at our best to handle tough, stressful situations. To be a good behavior detective and undo unhelpful notions of parenting, we need to be level-headed and fully present. We must PREP ourselves, too:

Pause before you react, and practice mindfulness frequently.

Recharge often and engage in self-care.

Evaluate situations where your child's problem behaviors occur before you...

Proceed with next steps

Step 5: RE-MAP Your Parenting

Once you've prepped your child and yourself, you're ready to RE-MAP what parenting and disciplining your child is really about:

Regard your child with an unconditional, positive assumption that they want to do well.

Externalize misbehaviors. Remember that the behavior is not their fault - it is caused by a brain difference.

Mistake Acceptance. Learn to view misbehaviors as mistakes. Provide your home as a safe place to make those mistakes so that they can be used as learning opportunities to PREP your child about what to expect next time.

Praise your child often. Children with ADHD field lots of negativity and criticism every day. We may hardly ever stop to notice their efforts to fit into a neurotypical world - because it's behavior we expect and typically do not reward. Praising your child often, even for the little things, will go a long way.

Re-mapping in Action

How can we use these parenting principles to address common situations at home?
Behavior Problem #1: My child doesn't want to do their homework

Prep your child

Check that they have everything they need for the assignment and that they understand what is expected of them.

Break up the homework to smaller chunks and provide breaks.

Talk to teachers about reducing the homework amount.

Prep yourself

RE-MAP

Regard: Assume your child wants to do their homework.

Externalize: Know that ADHD and other factors make it so that the task is the problem, not your child.

Mistake Acceptance: If your child doesn't finish homework even if you've prepped them fully, accept this turn of events and move on. Learn from it and collaborate with your child on what might work better next time. Know that this is not the end of the world. (Things rarely are.)

Praise: Even if your child didn't finish the assignment, recognize how long they spent working on the task.

Behavior Problem #2: My child refuses to stop playing video games

Prep your child

Make sure they have clear guidelines around when they should stop playing.

Build in transition times.

Use a Time Timer or another visual aid to help your child see the passage of time.

Prep yourself
Understand how video games work. Consider having your child stop after a segment or level attempt is completed as opposed to a specific time.

RE-MAP

Regard: Your child doesn't want to disobey you - they just really enjoy the video game.

Externalize: Your child may have trouble stopping due to the dopamine rush he's getting with the game.

Mistake Acceptance: If they stopped playing well after you asked them to, ask them what happened and what can be done next time to make the transition off of gaming easier.

Praise: Even if they didn't stop at the agreed-upon time, recognize if they were closer to the stop point than last time; if their tantrum didn't last as long, etc.

Parenting a child with ADHD often involves a full reassessment and overhaul of everything you thought you knew about discipline. In following these steps, remember that it will take time to address problem behaviors, and that there will be mistakes along the way. Prep yourself as best as you can, but don't be afraid to own up to your errors and apologize to your child and to yourself. At the same time, keep problem behaviors and situations in perspective - a messy room or missing homework is not the end of the world. In the end, it's most important to create a happy, safe, and supportive environment for your child.
The content for this article was derived from the ADDitude Expert Webinar Discipline with a Twist: How to Manage Challenging Behavior Problems in Children & Teens with ADHD [podcast episode #353] with Merriam Sarcia Saunders, LMFT, which was broadcast live on May 6, 2021.
Child Discipline: Next Steps

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

# data[].attributes.attachment_link.title
The Secret to Better Behavior? No Punishment at All

# data[].attributes.attachment_link.description
If you're exhausted and running out of ideas to correct your child's difficult behaviors, you're not alone. As I've learned, disciplining children with ADHD often means trying a few key strategies with one great twist - there's actually no punishment involved at all!

# data[].attributes.attachment_link.readable_text
We think of kids with ADHD as having trouble paying attention. But for many of them - and their parents - behavior is a big problem, too. Sometimes a bigger problem. They may be quick to lash out, throw a tantrum or be defiant when they are asked to do things they don't want to do.

Tantrums and defiance are not symptoms of ADHD itself, but they are often a result of ADHD symptoms. Inattention and impulsivity can make it very difficult for kids to tolerate tasks that are repetitive, or take a lot of work, or kids find boring. Children with ADHD can be overwhelmed with frustration, and throwing a shoe or pushing someone or yelling "shut up!" can be the result of impulsivity. They are less able than other kids their age to manage powerful feelings without an outburst.

But behavior problems can also go beyond impulsive outbursts. Some kids with ADHD develop negative behavior patterns, and those, argues David Anderson, PhD, a clinical psychologist at the Child Mind Institute, are a response to years of finding themselves in conflict with adults

In cases where kids with ADHD are chronically defiant, they are also diagnosed with a behavior disorder called oppositional defiant disorder ( ODD). As many as 40 percent of kids with ADHD are also diagnosed with ODD. But many more of them are in conflict with parents or teachers over their behavior - as many as 80 percent, observes Dr. Anderson, a clinical psychologist.

Why do kids with ADHD act out?

To understand why kids with ADHD are often angry, aggressive or defiant, Dr. Anderson says, you have to think about their history growing up with ADHD.

Kids with ADHD are wired to be attracted by things that are outside the bounds of what we want them to be doing, he explains, which leads to conflict with parents from a very young age. "There's no malicious intent on the part of these young kids," he adds. "Because of the hyperactive and impulsive symptoms of ADHD, they don't want to stay in their seat. They want to explore the entire restaurant. They want to run away from you at the park to check something out that looks cool. That can result in pretty stressed out parents pretty quickly."

This leads to a lot of negative interaction. "If you're being told from an early age that your behavior is wrong, or isn't what a kid is supposed to be doing, either you internalize it and you start thinking, 'There really is something wrong with me,' or you react aggressively towards the people who are telling you that you're wrong."

Why do kids with ADHD throw tantrums?

For kids with ADHD, tasks that are repetitive or boring or require a lot of effort can be acutely challenging, and elicit a lot of resistance, especially if it means stopping something that's pleasurable - like playing a video game. So things like homework, going to bed, getting dressed and coming to dinner can become battlegrounds. Unfortunately for parents, the avoidance strategies that these kids typically use are tantrums, arguing, defiance and power struggles.

"If they throw a fit, it's very likely that someone will change the task demands, make it easier on them, or settle for the bare minimum compliance," adds Dr. Anderson. That works for the kid, so the behavior tends to be repeated.

Discipline strategies may not work

When kids have developed a pattern of negative interaction, discipline that works with other kids may be ineffective. "People do certain things naturally in parenting," says Dr. Anderson. "For most kids, it works just fine. For kids with a behavioral issue, these things fail miserably."

One thing that doesn't work is losing your temper. For a child who rarely misbehaves, a parent who raises their voice may have an impact. "But kids who misbehave often habituate to this quickly. If you yell a lot, they eventually decide that's the way of the world. People are just going to yell at them so why pay that much attention?"

Similarly, Dr. Anderson explains, punishment loses its effectiveness. "If kids get punished a lot, punishments stop mattering because, after all, they're living in a perpetual state of punishment. How much is it really going to matter if they get punished a little bit more?"

Discipline strategies that do work

Kids with ADHD often need more structure than other kids, and clearer instruction as to what kinds of behavior an adult is looking for. "As parents we need to help kids figure out what acceptable behaviors are, teach those acceptable behaviors and catch kids being good as often as we possibly can," says Dr. Anderson. Praise and opportunities for a positive relationship with parents are powerful tools for managing disruptive behavior, which tends to escalate when a relationship is mostly negative interactions.

Clinicians call this kind of proactive structure "scaffolding." Kids who are having trouble regulating their own behavior within acceptable limits need a family environment that provides external regulation of behavior. The structure that parents provide is a model for what we want kids to learn, and keeps them in good standing as they develop better self-regulation.

Trouble regulating emotions

Self-regulation is the ability to manage your emotions and behavior in accordance with the demands of the situation. It includes being able to resist highly emotional reactions to upsetting stimuli, to calm yourself down when you get upset, to adjust to a change in expectations and to handle frustration without an outburst.

Poor self-regulation is so common in kids with ADHD that some experts, including veteran ADHD researcher Russell Barkley, think it should be one of the core symptoms of the disorder.

But Dr. Anderson notes that it makes sense as an outgrowth of the impulsivity that's part of ADHD; these kids have difficulty with inhibition, with planning and with delay of gratification.

"You take all of that together, you've got a kid who's more likely to look for the short-term payoff than long-term payoffs," he says. "You've got a kid who doesn't want to wait, who finds it excruciating to wait, who's quickly distractable, and for one reason or another is impaired on repetitive tasks, tasks that take a lot of work or tasks that kids find boring.

Unfortunately, the behavior problems kids with ADHD exhibit often affect their relationships not just with adults but with other kids.

"There are a host of reasons why we see friendships being impaired by ADHD symptoms," notes Dr. Anderson. "For a kid who's highly distractable, it could be they can't keep up with a pace of conversation and their friends just notice they're zoned out. For the kid who's really impulsive, it might be they interrupt other kids and don't let anybody else get a word in edgewise. For kids who have real difficulty delaying gratification, it may be that they always have to choose the activity, and anybody who doesn't want to go along with it gets some impulsive speech directed at them."

In one study of kids at summer camp, after only a few hours of interaction, the boys with ADHD were far more likely to be disliked and rejected by their peers than the boys without a diagnosis.

The main reasons given for the quick negative perceptions was their explosive, retaliatory and impulsive behavior patterns, researchers found. Stephen Hinshaw, PhD, one of the authors of the study and now the professor of psychology at the University of California, Berkeley.

And Dr. Hinshaw notes that girls with ADHD are subject to even more peer rejection than boys, "probably because their behavior patterns are more gender atypical."

Help for behavior problems

When children with ADHD develop serious behavior problems, whether they had a diagnosis of ODD or not, the most effective treatment is parent training. There are many parent training programs, but what they have in common is that they teach parents how to reset the relationship with the child.

Parents learn how to use praise effectively, to encourage the behaviors they want to encourage, and how to deploy consistent consequences when kids don't comply. The result is that kids learn to modulate their behavior to meet expectations and enjoy much more positive interactions with their parents. Social skills training and individual cognitive behavioral therapy can also help kids interact in a healthier way with both adults and their peers.

For kids with ADHD, Anti-psychotic medications like Abilify (aripiprazole) and stimulant medication that reduces symptoms of inattention, impulsivity and hyperactivity may also help improve behavior. Risperdal (risperdone), which have been shown to reduce aggression and irritability, are frequently used in cases where a child is at risk of being removed from the school or home.

But even when medication is used, experts recommend that it be paired with parent training for the best results.

# data[].attributes.attachment_link.title
ADHD and Behavior Problems - Child Mind Institute

# data[].attributes.attachment_link.description
Tantrums, outbursts, defiance: How ADHD and behavior problems are related, and how to help kids with ADHD learn to behave better.

# data[].attributes.headline
The Relationship Between ADHD and Social Anxiety

# data[].attributes.subject
The Relationship Between ADHD and Social Anxiety

# data[].attributes.attachment_link.readable_text
As many as 80% of people with attention-deficit hyperactivity disorder (ADHD) will have at least one other psychiatric condition in their lifetime.﻿﻿ Just as untreated ADHD can lead to unnecessary problems in everyday life, comorbid conditions can cause a tremendous amount of harm in those with ADHD if left undiagnosed and untreated.

Though any anxiety disorder can coexist with ADHD, social anxiety disorder (SAD) is one of the most common. Learning the differences between the two conditions is important in the management and treatment of both.

SAD and ADHD

It's entirely possible that anxiety disorders occur much more frequently in people with ADHD than they do in the general population. According to the National Comorbidity Survey Replication, 47% of adults with ADHD have an anxiety disorder-approximately 30% have SAD, specifically.﻿﻿﻿ More research is needed to understand why ADHD and SAD co-occur in some people and not in others.

Still, others believe that ADHD symptoms, themselves, contribute to anxiety. Often, ADHD symptoms-such as inattention, hyperactivity, and impulsivity-put a person at greater risk for being teased, bullied, or otherwise socially rejected. Fearing further rejection, many withdraw into themselves, avoiding any social setting that they find threatening.﻿﻿﻿

On the surface, SAD and ADHD can sometimes look alike. The following are just a few ways symptoms of ADHD and SAD overlap:﻿﻿

Difficulty socializing: People with SAD may struggle to make and maintain friendships due to fears about rejection. Someone with ADHD is likely to have low impulse control and trouble picking up on social cues, making it difficult to sustain friendships.

Inattention: A person with SAD may seem tuned out, but they are really just distracted by worries. Those with ADHD are inattentive because of differences in the brain that affect focus.

Trouble completing tasks: People with SAD might become stuck on a task and be too anxious to ask for help. Those with ADHD might not turn in an assignment because of poor planning skills and forgetfulness.

Unfortunately, some symptoms of SAD can be misinterpreted as ADHD symptoms, and it isn't until outward behaviors-such as weight loss, sleeplessness, or refusal to attend social settings-that the social anxiety becomes more apparent. As a result, SAD often goes undiagnosed in those who also have ADHD.

There are no clear or published guidelines on how to treat co-occurring ADHD and SAD. Only after your doctor determines how your anxiety functions can they develop the best treatment plan to meet your needs.

For instance, if your anxiety and ADHD are functioning independently of one another, your doctor may decide to treat both conditions simultaneously. Or they may choose to treat whichever condition is causing you the most problems first before moving on to the other condition.

However, if your doctor believes that your anxiety is being caused or heavily influenced by your ADHD, your doctor may take a different approach to treatment.

Medications

If your anxiety is the result of ADHD, your doctor may decide to treat your ADHD first with medications as this may reduce your anxiety symptoms. Common medications used to treat ADHD include:

Stimulants: Although stimulants primarily treat ADHD symptoms, as ADHD symptoms are controlled, you may also find some relief from your anxiety. In one study examining children and adolescents with ADHD and SAD comorbidity, Ritalin (methylphenidate) was found to be associated with a significant improvement in both ADHD and SAD symptoms.﻿﻿ A similar study found the same improvements in adults using extended-release Ritalin.﻿﻿

Non-stimulants: Selective norepinephrine reuptake inhibitors (SNRIs) like Strattera (atomoxetine) may target both ADHD and anxiety symptoms. A 2009 study found that Strattera improved both ADHD and comorbid SAD in adults.﻿﻿

Talk Therapy

While medication has historically been the first line of treatment for ADHD, many people also benefit from non-medication therapies, and that is especially true of people who are also living with an anxiety disorder.

A specific technique your therapist might recommend is exposure therapy, a type of CBT most often used when treating SAD, in which you and your therapist work together to gradually expose you to anxiety-provoking situations so you can develop healthy coping mechanisms and, over time, the situations elicit less fear. In other types of CBT, you can learn and practice social skills and relaxation techniques.

A Word From Verywell

A co-occurring diagnosis of SAD can be a lifelong reality for someone with ADHD. It's OK to feel overwhelmed. Learning more about the connection between these two conditions is the first step toward lessening the impact they have on your life. Just take a deep breath and know that with the right support, you can manage both ADHD and SAD, and thrive in life.

# data[].attributes.attachment_link.title
The Relationship Between ADHD and Social Anxiety Disorder

# data[].attributes.attachment_link.description
As many as 80% of people with attention-deficit hyperactivity disorder (ADHD) will have at least one other psychiatric condition in their lifetime.﻿﻿ Just as untreated ADHD can lead to unnecessary problems in everyday life, comorbid conditions can cause a tremendous amount of harm in those with ADHD if left undiagnosed and untreated.

# data[].attributes.attachment_link.readable_text
ADHD Weekly July 19, 2019

Did you know that one in three people who have been diagnosed with ADHD also have depression or have experienced a depressive episode? Depression causes a person to feel sad, irritable, and empty, and lasts for an extended amount of time.

It’s estimated about 18.6 percent of adults are affected by both ADHD and depression. The symptoms of depression include the loss of interest in familiar activities, feeling tired a lot of the time, and experiencing unplanned changes in sleep and eating habits. Some people struggling with depression describe feeling numb to their own life, disconnected from others, and alone even when they are not. They may also feel agitated, with a sense of wanting to get out of their own skin.

Depression is different from the “blues,” or sadness that follows the end of a relationship or a period of grief after a loved one dies, although those can turn into depression if they last for the long term.

“Sometimes with situations like bereavement, a breakup, or a job loss, it can snowball into a clinical depressive episode,” says Roberto Olivardia, PhD, a clinical associate at McLean Hospital and lecturer in psychology at Harvard Medical School. Dr. Olivardia is a member of CHADD’s Professional Advisory Board. “So, if someone notices after about a two-week period that these symptoms are still happening, then they should definitely be talking to someone.”

ADHD and depression: travelling fellows

For some people, depression and ADHD just happen to coexist, but for others, depression is a result of ADHD, with low self-esteem and a poor self-image caused by ongoing feelings of being overwhelmed by life due to ADHD symptoms. The college student who struggles to finish a history paper worries how he’ll be able to hold a 40-hour-a-week job, pay bills, and raise a family someday, for instance. Or the young parent who is juggling work, family, and personal lives and feels she can’t do anything in those lives well.

“Part of treatment is to help them understand that it doesn’t necessarily work that way, that sometimes it could be easier to do the job that you love to do, than the history paper that you might despise. It’s not linear in that way, but it’s understandable,” says Dr. Olivardia. Similarly, it’s easy to understand why a man in his early 30s who has already been divorced three times due to the problems caused by his ADHD symptoms begins to feel worthless and then sinks into depression.

Misdiagnosed with depression

At the same time, Dr. Olivardia says he often sees people who have been misdiagnosed with depression when, in fact, what they have is ADHD. The two conditions are often mistaken.

“I’ll have patients who just have ADHD who say, ‘I wonder if I’m depressed because I feel this emptiness or sadness sometimes,’ and I’ll ask them if that’s true across all different situations,” says Dr. Olivardia.

One of the hallmarks of depression is a consistent loss of interest in activities the person once enjoyed. When his patients reply that they only feel that melancholy when they’re understimulated or bored, but that their moods change when they move on to an activity they enjoy or get involved in something with friends, Dr. Olivardia says he knows that they are not dealing with a clinical depression. Dr. Olivardia explains that that feeling could be related to their ADHD, giving the example of someone who once devoted a lot of time to playing piano but then stopped doing so.

“The question is, did you lose interest in it because of a mood issue, or did you just get bored with it, and then went on to something else?” Dr. Olivardia says. “That’s very common for people with ADHD—it’s really not due to mood as much as it’s due to a loss of stimulation or a loss of interest.” Depression is more internally focused, he says, while ADHD behaviors are more a response to external happenings. The same is true of difficulty with eating or sleeping, both of which are signs of depression but are just as common to people with ADHD. The key is whether any of those behaviors are out of the ordinary.

ADHD and other disorders

In addition, several studies show people diagnosed with ADHD who are depressed are at risk of attempting to or taking their own life five times more than people who are depressed but do not have ADHD. And, like a lot of behavior related to ADHD symptoms, many of those attempts at suicide and deaths by suicide are impulsive.

Dr. Olivardia strongly recommends that anyone who is being seen for any clinical psychiatric purpose should also be evaluated for ADHD, which he says is much more common than people think. It also affects what the original diagnosis will look like. For instance, Dr. Olivardia says if he is treating someone who has been diagnosed with obsessive-compulsive disorder, “when I know that they also have ADHD, I know the OCD will look different than in the patient with OCD who does not have ADHD.”

Treatment for depression and ADHD

Many kinds of treatment for depression or ADHD work equally well with the other. Cognitive behavioral therapyis an effective way to treat mood disorders and emotional regulation, as well as executive functioning skills. Many people find adding mindfulness techniques can be a helpful support for treatment. For some people, stimulant medications can help too, by improving their executive functioning. However, medication isn’t effective for everyone, cautions Dr. Olivardia.

“I’ve had patients who are depressed who can’t take a stimulant because when they do, the agitated symptoms that they get around their depression increase—it almost gives them more juice and they’re better able to focus on their depressive thoughts,” he says. Those individuals might do better with an antidepressant medication, coupled with either behavioral treatment or a nonstimulant medication for ADHD. For many people, establishing a crisis plan with their mental health provider will also be essential to their well-being.

Looking for more?

# data[].attributes.attachment_link.title
When Depression Co-occurs with ADHD - CHADD

# data[].attributes.attachment_link.description
Frequently, depression co-occurs with ADHD for both adults and children. How can you tell when depression symptoms are due to ADHD struggles and when they are separate from ADHD? We talked with an expert who treats young adults experiencing both conditions.

# data[].attributes.headline
ADHD-National Alliance on Mental Illness

# data[].attributes.subject
ADHD-National Alliance on Mental Illness

# data[].attributes.attachment_link.readable_text
Attention deficit hyperactivity disorder (ADHD) is a condition in which characterized by inattention, hyperactivity and impulsivity. ADHD is most commonly diagnosed in young people. An estimated 17 have ADHD. While ADHD is usually diagnosed in childhood, it does not only affect children. An estimated 8.8% of children aged 4- 4.4% of adults aged 18-44 have ADHD.

With treatment, people with ADHD can be successful in school, work and lead productive lives. Researchers are using new tools such as brain imaging to better understand the condition and to find more effective ways to treat and prevent ADHD.

Symptoms

While some behaviors associated with ADHD are "normal" and not a cause for concern to most people, someone with ADHD will have trouble controlling these behaviors and will show them much more frequently and for longer than 6 months.

Signs of inattention include:

Becoming easily distracted, and jumping from activity to activity.

Becoming bored with a task quickly.

Difficulty focusing attention or completing a single task or activity.

Trouble completing or turning in homework assignments.

Losing things such as school supplies or toys.

Not listening or paying attention when spoken to.

Daydreaming or wandering with lack of motivation.

Difficulty processing information quickly.

Struggling to follow directions.

Signs of hyperactivity include:

Fidgeting and squirming, having trouble sitting still.

Non-stop talking.

Touching or playing with everything.

Difficulty doing quiet tasks or activities.

Signs of impulsivity include:

Impatience.

Acting without regard for consequences, blurting things out.

Difficulty taking turns, waiting or sharing.

Interrupting others.

Causes

There are several factors believed to contribute to ADHD:

Genetics. Research shows that genes may be a large contributor to ADHD. ADHD often runs in families and some trends in specific brain areas that contribute to attention.

Environmental factors. Studies show a link between cigarette smoking and alcohol use during pregnancy and children who have ADHD. Exposure to lead as a child has also been shown to increase the likelihood of ADHD in children.

Diagnosis

ADHD occurs in both children and adults, but is most often and diagnosed in childhood. Getting a diagnosis for ADHD can sometimes be difficult because the symptoms of ADHD are similar to typical behavior in most young children. Teachers are often the first to notice ADHD symptoms because they see children in a learning environment with peers every day.

There is no one single test that can diagnose a child with ADHD, so meet with a doctor or mental health professional to gather all the necessary information to make a diagnosis. The goal is to rule out any outside causes for symptoms, such as environmental changes, difficulty in school, medical problems and ensure that a child is otherwise healthy.

Treatment

ADHD is managed and treated in several ways:

including stimulants, nonstimulants and antidepressants

Behavioral therapy

Self-management, education programs and assistance through schools or work or alternative treatment approaches

Related Conditions

Around two-thirds of children with ADHD also have another condition. Many adults are also impacted by the symptoms of another condition. Common conditions associated with ADHD include the following.

Symptoms from other conditions make treating ADHD more difficult. Talking to a skilled professional to help establish an accurate diagnosis can help increase the effectiveness of treatment.

# data[].attributes.attachment_link.description
Attention deficit hyperactivity disorder (ADHD) is a condition in which characterized by inattention, hyperactivity and impulsivity. ADHD is most commonly diagnosed in young people. An estimated 17 have ADHD. While ADHD is usually diagnosed in childhood, it does not only affect children. An estimated 8.8% of children aged 4- 4.4% of adults aged 18-44 have ADHD.

# data[].attributes.attachment_link.provider_name
Centers for Disease Control and Prevention

# data[].attributes.attachment_link.readable_text
Behavior or Conduct Problems

Children occasionally act angry or defiant around adults or respond aggressively when they are upset. When these behaviors persist over time, or are severe, they can become a behavior disorder. Children with ADHD are more likely than other children to be diagnosed with a behavior disorder such as Oppositional Defiant Disorder or Conduct Disorder.

Oppositional Defiant Disorder

When children act out persistently so that it causes serious problems at home, in school, or with peers, they may be diagnosed with Oppositional Defiant Disorder (ODD). ODD is one of the most common disorders occurring with ADHD. ODD usually starts before 8 years of age, but can also occur in adolescents. Children with ODD may be most likely to act oppositional or defiant around people they know well, such as family members or a regular care provider. Children with ODD show these behaviors more often than other children their age.

Examples of ODD behaviors include

Often losing their temper

Arguing with adults or refusing to comply with adults' rules or requests

Often getting angry, being resentful, or wanting to hurt someone who they feel has hurt them or caused problems for them

Deliberately annoying others; easily becoming annoyed with others

Often blaming other people for their own mistakes or misbehavior

Conduct Disorder

Conduct Disorder (CD) is diagnosed when children show a behavioral pattern of aggression toward others, and serious violations of rules and social norms at home, in school, and with peers. These behaviors can lead to breaking the law and being jailed. Having ADHD makes a child more likely to be diagnosed with CD. Children with CD are more likely than other children to get injured, and to have difficulties getting along with peers.

Examples of CD behaviors include

Breaking serious rules, such as running away, staying out at night when told not to, or skipping school

Being aggressive in a way that causes harm, such as bullying, fighting, or being cruel to animals

Lying and stealing, or damaging other people's property on purpose

Treatment for disruptive behavior disorders

Starting treatment early is important. Treatment is most effective if it fits the needs of the child and family. The first step to treatment is to have a comprehensive evaluation by a mental health professional. Some of the signs of behavior problems, such as not following rules, are also signs of ADHD, so it is important to get a careful evaluation to see if a child has both conditions. For younger children, the treatment with the strongest evidence is behavioral parent training, where a therapist helps the parent learn effective ways to strengthen the parent-child relationship and respond to the child's behavior. For school-age children and teens, an often-used effective treatment is combination training and therapy that includes the child, the family, and the school. Sometimes medication is part of the treatment.
Learn more about disruptive behavior disorders
Learning Disorder

Many children with ADHD also have a learning disorder (LD). This is in addition to other symptoms of ADHD, such as difficulties paying attention, staying on task, or being organized, which can also keep a child from doing well in school.

Having a learning disorder means that a child has a clear difficulty in one or more areas of learning, even when their intelligence is not affected. Learning disorders include

Dyslexia - difficulty with reading

Dyscalculia - difficulty with math

Dysgraphia - difficulty with writing

The combination of problems caused by having ADHD and LD can make it particularly hard for a child to succeed in school. Properly diagnosing each disorder is an important part of getting the right kind of help for the child.

Treatment for learning disorders

Children with learning disorders often need extra help and instruction that is specialized for them. Having a learning disorder can qualify a child for special education services in school. Because children with ADHD often have difficulty in school, the first step is a careful evaluation to see if the problems are also caused by a learning disorder. Schools usually do their own testing to see if a child needs intervention. Parents, healthcare providers, and the school can work together to find the right referrals and treatment.
Learn more about learning disorder
Anxiety and Depression

Anxiety

Many children have fears and worries. However, when a child experiences so many fears and worries that they interfere with school, home, or play activities, it is an anxiety disorder. Children with ADHD are more likely than those without to develop an anxiety disorder.

Examples of anxiety disorders include

Separation anxiety - being very afraid when they are away from family

Social anxiety - being very afraid of school and other places where they may meet people

General anxiety - being very worried about the future and about bad things happening to them

Depression

Occasionally being sad or feeling hopeless is a part of every child's life. When children feel persistent sadness and hopelessness, it can cause problems. Children with ADHD are more likely than children without ADHD to develop childhood depression. Children may be more likely to feel hopeless and sad when they can't control their ADHD symptoms and the symptoms interfere with doing well at school or getting along with family and friends.

Examples of behaviors often seen when children are depressed include

Feeling sad or hopeless a lot of the time

Not wanting to do things that are fun

Having a hard time focusing

Feeling worthless or useless

Children with ADHD often have a hard time focusing on things that are not very interesting to them. Depression can make it hard to focus on things that are normally fun. Changes in eating and sleeping habits can also be a sign of depression. For children with ADHD who take medication, changes in eating and sleeping can also be side-effects from the medication rather than signs of depression. Talk with your healthcare provider if you have concerns.

Extreme depression can lead to thoughts of suicide. Read more about suicide prevention.

Treatment for anxiety and depression

The first step to treatment is to talk with a healthcare provider to get an evaluation. Some signs of depression, like having a hard time focusing, are also signs of ADHD, so it is important to get a careful evaluation to see if a child has both conditions. A mental health professional can develop a therapy plan that works best for the child and family. Early treatment is important, and can include child therapy, family therapy, or a combination of both. The school can also be included in therapy programs. For very young children, involving parents in treatment is very important. Cognitive behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. It helps the child change negative thoughts into more positive, effective ways of thinking. Consultation with a health provider can help determine if medication should also be part of the treatment.
Learn more about anxiety and depression Learn about the FDA's warning when using antidepressants with young people
Difficult Peer Relationships

ADHD can make peer relationships or friendships very difficult. Having friends is important to children's well-being and may be very important to their long-term development.

Although some children with ADHD have no trouble getting along with other children, others have difficulty in their relationships with their peers; for example, they might not have close friends, or might even be rejected by other children. Children who have difficulty making friends might also more likely have anxiety, behavioral and mood disorders, substance abuse, or delinquency as teenagers.

How does ADHD interfere with peer relationships?

Exactly how ADHD contributes to social problems is not fully understood. Children who are inattentive sometimes seem shy or withdrawn to their peers. Children with symptoms of impulsivity/hyperactivity may be rejected by their peers because they are intrusive, may not wait their turn, or may act aggressively. In addition, children with ADHD are also more likely than those without ADHD to have other disorders that interfere with getting along with others.

Having ADHD does not mean a child won't have friends.

Not everyone with ADHD has difficulty getting along with others. For those children who do have difficulty, many things can be done to help them with relationships. The earlier a child's difficulties with peers are noticed, the more successful intervention may be. Although researchers don't have definitive answers on what works best for children with ADHD, some things parents might consider as they help their child build and strengthen peer relationships are:

Pay attention to how children get along with peers. These relationships can be just as important as grades to school success.

Regularly talk with people who play important roles in your child's life (such as teachers, school counselors, after-school activity leaders, healthcare providers, etc.). Keep updated on your child's social development in community and school settings.

Involve your child in activities with other children. Talk with other parents, sports coaches and other involved adults about any progress or problems that may develop with your child.

Peer programs can be helpful, particularly for older children and teenagers. Social skills training alone has not shown to be effective, but peer programs where children practice getting along with others can help. Schools and communities often have such programs available. You may want to talk to your healthcare provider and someone at your child's school about programs that might help.

Risk of Injuries

Children and adolescents with ADHD are likely to get hurt more often and more severely than peers without ADHD. Research indicates that children with ADHD are significantly more likely to

Get injured while walking or riding a bicycle

Have head injuries

Injure more than one part of their body

Be hospitalized for unintentional poisoning

Be admitted to intensive care units or have an injury resulting in disability

More research is needed to understand why children with ADHD get injured, but it is likely that being inattentive and impulsive puts children at risk. For example, a young child with ADHD may not look for oncoming traffic while riding a bicycle or crossing the street, or may do something dangerous without thinking of the possible consequences. Teenagers with ADHD who drive may take unnecessary risks, may forget rules, or may not pay attention to traffic.
There are many ways to protect children from harm and keep them safe. Parents and other adults can take these steps to protect children with ADHD.

Always have your child wear a helmet when riding a bike, skateboard, scooter, or skates. Remind children as often as necessary to watch for cars and to teach them how to be safe around traffic.

Supervise children when they are involved in activities or in places where injuries are more likely, such as when climbing or when in or around a swimming pool.

Keep potentially harmful household products, medications, and tools out of the reach of young children.

Teens with ADHD are at extra risk when driving. They need to be extra careful to avoid distractions like driving with other teens in the car, talking on a cell phone, texting, eating, or playing with the radio. Like all teens, they need to avoid alcohol and drug use, and driving when drowsy.

Parents should discuss rules of the road, why they are important to follow, and consequences for breaking them with their teens. Parents can create parent-teen driving agreements that put these rules in writing to set clear expectations and limits. Learn more about what parents can do from CDC's Parents Are the Key campaign.

For more injury prevention tips, visit CDC's Injury Center.

Oral Health

Children with ADHD have increased risk of injury to the mouth and teeth, as well as cavities (also known as caries or tooth decay). Learn about protecting children's oral health.

Health Risks

The core symptoms of ADHD, like impulsivity and inattention, might lead children to behave in ways that can put their health at risk or cause them to forget healthy and protective behaviors. Over time, if not addressed, these risks can lead to injury, disease, or even an earlier-than-expected death. In addition to injuries, children with ADHD are at increased risk for being overweight or having obesity. Healthy habits for children include:
Learn more about protecting the health of children with ADHD
References

Danielson, M. L., Bitsko, R.H., Ghandour, R.M, Holbrook, J.R., Kogan, M.D., & Blumberg, S.J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, 47(2): 199-212.

DuPaul, G. J., Gormley, M.J., & Laracy, S.D. (2013). Comorbidity of LD and ADHD: Implications of DSM-5 for assessment and treatment. Journal of Learning Disabilities, 46(1): 43-51.

Strine, T.W., Lesesne, C.A., Okoro, C.A., McGuire, L.C., Chapman, D.P., Balluz, L.S., & Mokdad, A.H. (2006). Emotional and behavioral difficulties and impairments in everyday functioning among children with a history of attention-deficit/hyperactivity disorder. Prevention of Chronic Disorders, 3(2):A52. Epub 2006 Mar 15.

Jerome, L., Segal, A., & Habinski, L. (2006). What we know about ADHD and driving risk: A literature review, meta-analysis and critique. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 15(3), 105-125.

# data[].attributes.attachment_link.title
Other Concerns and Conditions with ADHD | CDC

# data[].attributes.attachment_link.description
Attention-Deficit/Hyperactivity Disorder (ADHD) often occurs with other disorders. About 2 in 3 of children with ADHD referred to clinics have other disorders as well as ADHD.

# data[].attributes.attachment_link.readable_text
Information to assist school teams in determining if provided supports should be considered an accommodation or a modification.

What is an accommodation?

Changes HOW the student will learn or demonstrate his/her knowledge, keeping content expectations the same

Help support access to the general curriculum.

Do not change what is taught.

Provide adaptations for a child with a disability without setting different expectations.

What is a modification?

Changes WHAT the student is expected to learn

Perform objectives different from those of the rest of the class.

Adjustments to an assignment or a test that change the standard of what the test or assignment is supposed to measure.

Practices that change, lower, or reduce learning expectations.

The following information is intended to assist school teams in determining if provided supports should be considered an accommodation or a modification. Please note: A student might require an individual assignment modified and then demonstrate a full understanding of the content on a final assessment without modification. These students may be considered to be demonstrating mastery on non-modified instruction for the Special Permission Locally Awarded Verified Credit Accommodation (SPLAVC-A). This student may also be considered for return to in-person with group 5, Intensive Support Needs.

# data[].attributes.attachment_link.description
Information to assist school teams in determining if provided supports should be considered an accommodation or a modification. Changes HOW the student will learn or demonstrate his/her knowledge, keeping content expectations the same Help support access to the general curriculum. Do not change what is taught.

# data[].attributes.attachment_link.readable_text
There is no typical teenager with ADHD. Symptoms and impairments vary by gender, by what type of ADHD they have, by the environment they're in, and by their individual strengths and any other disorder they might have.

Overall, teens with ADHD tend to display fewer of the hyperactivity symptoms we associate with ADHD in children. That's the good news.

But once kids get to high school, the expectations for them, both academically and socially, are greatly increased, and that can be tough on teenagers with ADHD.

Developmentally, teenagers are expected to be able to handle more autonomy: less structure in their school and home lives and less teacher and parental oversight.

Think of it as a chart with the line for structure and supervision heading down, and the line for demands and expectation going up. The lines cross in adolescence, and as the gap widens, the challenges for kids with ADHD mount. In addition, adolescents are more susceptible to peer group influence, which becomes more powerful in the teenage years, as kids gradually separate from their parents and other authority figures.

If your child has ADHD, it's important to be alert for struggles in many areas, not just their functioning in school. You also want to keep an eye open for difficulties in relationships with friends, emotional functioning, driving, and risky behaviors. We'll take these areas one at a time.

Without support, teenagers with ADHD tend to have lower grade point averages and scores on standardized achievement tests, and higher rates of school failure and suspension for problem behavior. Even if hyperactivity and impulsivity are not significant issues for your teen, symptoms associated with inattention and difficulty with organization can take a big toll once academic expectations are ramped up.

How you can help: Make sure your teenager has access to accommodations in school and in testing if they need them. Tutors or homework helpers can help them if they are struggling with particular academic material, or just with the self-discipline to apply themselves to homework. Helping them get (and stay) organized can be critical, whether you do it by creating structure for working at home, or get them an organizational coach, whose mission is to help them learn to organize themselves.

Above all, teenagers with ADHD need parents to stay in the picture and know what they need to do and when they're doing it, rather than assuming they are handling the work independently.

About half of adolescents with ADHD have serious problems with peer relationships. Research shows that they tend to have fewer reciprocal friendships, and are more likely to be ignored or rejected by peers. They're also more likely to be the victim of bullying, or to bully others. It may be due to impaired social and communication skills-they may not listen to friends, fail to pick up on important social cues, or act impulsively or intrusively.

How you can help: The most important thing you can do is know who your teen is spending time with, and try to encourage them to discuss friendship and relationship difficulties with you or another trusted adult. It's also important to encourage participation in extracurricular activities, which offer social opportunities in a structured environment. If you see them seriously struggling to make, and keep, friends, you might want to find a therapist who teaches social skills.

The teenage years tend to be an emotional rollercoaster for all kids, but those with ADHD are prone to poor emotion-regulation, which may result in greater highs and lows. Their emotional impulsivity can make it especially difficult for them to cope with frustration. It can be tough on them, and those around them.

How you can help: One thing you can do is to help your teen practice cool down strategies and develop coping tools. You can also talk to them about the value of apologizing after they have lost their temper. For kids with ADHD who are having serious problems with volatility, cognitive behavioral therapy can be effective.

Research shows that teenagers with ADHD tend to start using cigarettes, alcohol and illicit drugs earlier than typical kids. Later, they tend to have higher rates of smoking and substance use, and higher rates of alcohol-related problems. They also tend to become sexually active earlier, be more likely to have unsafe sex, and have higher rates of sexually transmitted disease.

How you can help: It's especially important for parents to know where your teen is and who they are with at all times. Encourage participation in extracurricular activities to minimize unstructured and unsupervised free time. Teach your teen about the risks associated with substance use and sexual activity, and encourage them to have an open dialogue with you about these issues. You want them to know what your rules and expectations are, but you also want them to feel comfortable coming to you with questions or calling you if they find themselves in a problematic situation.

Teenagers with ADHD may have challenges behind the wheel because of inattention or impulsivity. Research shows that they have higher rates of traffic tickets and accidents, and the accidents they have tend to be more serious than average.

How you can help: It's very important to take extra care in teaching teenagers with ADHD to drive. In some cases it may be wise to consider delaying the age when your teen beings driving, and to limit how and when they can drive (and who can be in the car with them) until you are confident that their skill and judgment are sufficiently mature. If your child takes medication for ADHD, it may be important to make sure they are taking medication when they're behind the wheel. You should make sure they're aware of the difficulties associated with driving and ADHD, and recognizes the importance of monitoring their own behavior to make sure they're a safe driver.

# data[].attributes.attachment_link.title
ADHD in Teenagers - Child Mind Institute

# data[].attributes.attachment_link.description
There is no typical teenager with ADHD. Symptoms and impairments vary by gender, by what type of ADHD they have, by the environment they're in, and by their individual strengths and any other disorder they might have. Overall, teens with ADHD tend to display fewer of the hyperactivity symptoms we associate with ADHD in children.

# data[].attributes.attachment_link.readable_text
"Shouldn't my teen have outgrown this by now?" You, along with many other parents, may be wondering why your child hasn't outgrown his or her difficulties sitting still, thinking of consequences before acting, resisting distractions, organizing daily activities and managing time wisely. People used to think that only young kids had ADHD and that children grew out of it as they got older. Now we know differently. Today's research has shown that most kids do not outgrow ADHD when they reach adolescence, and most teens don't outgrow ADHD when they become young adults.
ADHD in adolescence
The core symptoms of ADHD-inattention, impulsivity and sometimes hyperactivity-remain the same during adolescence as they were earlier in childhood, but the pattern of symptoms and difficulties may change somewhat. In adolescence, some symptoms of ADHD, particularly those related to hyperactivity, can become more subtle. However, the difficulties that children experience as a result of ADHD symptoms, such as poor school performance, may intensify when they are teens due to increased demands and expectations for independent functioning.

Some of the more pronounced symptoms in teens with ADHD are related to deficits in executive functioning, the brain's ability to prioritize and manage thoughts and actions. In other words, executive function allows individuals to foresee longer-term consequences for actions, plan accordingly, evaluate progress and shift plans as necessary. In addition to difficulties with executive functioning, individuals with ADHD may also exhibit lower tolerance for frustration, have emotional responses that are in excess of what is expected or appear more emotionally immature than their same-aged peers.
ADHD in the teen years
What does it feel like to have ADHD? Teens with ADHD may experience stigma or embarrassment related to their diagnosis. They may also wish to deny that they have ADHD. Teens that have ADHD may feel different their peers, and they may wish to believe that their symptoms have faded or disappeared with age. It is important for you to talk honestly to your teen about ADHD. Explain that having ADHD is not due to any mistake he or she has made and is not a punishment. Liken ADHD to other medical conditions, such as asthma or poor eyesight. Explain that it is not the teen's fault that he or she has the problem, but that treatment will be essential to avoid letting it limit his or her success in life.

Teens with ADHD may also have concerns related to their self-perception and be vulnerable to poorer self-esteem than their peers. When surveyed, teens with ADHD and learning disabilities reported feeling severely stressed when going to school and sitting in class, feeling tired, frequent quarreling with close friends, feeling different from other classmates, having low self-esteem, and feeling that their parents didn't understand them. Engaging in activities that they enjoy and where they feel successful can be powerful ways to address and reverse these concerns. When teens feel successful and confident about themselves in one aspect of their life or abilities, these feelings can often generalize to other areas of functioning as well.
Challenges for Teens with ADHD
ADHD can affect many aspects of your teen's life. While most teens face academic challenges, social difficulties and problems at home, having ADHD may make these issues more difficult to deal with or more severe.

Academic Performance: High school is characterized by a more frenetic pace, more demands to juggle and less supervision. Academically, the workload and difficulty of the material increases, and long-term projects rather than daily homework assignments are the norm. These factors all present challenges to the teen with ADHD. Adolescents with ADHD may benefit from assistance with and training in note taking, study skills and organization/time management. It is important to help teens gain the skills necessary so that they can shift from parents or teachers structuring their time and schoolwork schedule to relying on their own abilities. If your teen has a diagnosis of ADHD that impair academic functioning, he or she may qualify for classroom accommodations. Accommodations can include extra time on tests, taking tests in a separate location where distractions are minimized or additional organizational support. Inquire with school personnel if you feel that your teen may qualify for and benefit from these accommodations. For more information on your child's educational rights, please see Education.

Social Functioning: Many children with ADHD exhibit difficulties in peer interaction due to impulsivity, hyperactivity and aggression. Younger children with ADHD may be intrusive in social interactions, louder than their peers and more disruptive. Peer problems and peer rejection experienced during childhood can continue into adolescence. In addition, a lack of positive peer relationships in earlier years can limit opportunities to practice and refine social skills, thus making existing deficits worse. Finally, the importance of peer relationships increases during adolescence. Therefore, difficulties in establishing and maintaining relationships can become increasingly disruptive to functioning. Teens with ADHD are at risk for associating with the "wrong crowd" or for experiencing peer rejection. Providing your teen with opportunities to participate in structured social activities, such as sports, clubs or youth groups, can help provide positive experiences to offset other, potentially negative, interactions.

Home Life: On average, households of adolescents with ADHD are characterized by more parent-teen conflict. Parenting a child with ADHD is stressful. Parenthood requires that you place certain demands on your child, such as completing homework, participating in chores and returning home before curfew. Teens with ADHD have more difficulty complying with requests and need more reminders and supervision. This need for supervision can be frustrating for both you and your teen, and may lead to a cycle of negative interaction. When you repeatedly place demands on your teen with which he or she does not comply (due to inattention, lack of interest, or lack of ability), there is often an escalation of negativity. In such a cycle, you may find yourself lecturing, yelling, or punishing your teen who then responds with anger, additional lack of compliance or other negative behaviors. As this occurs repeatedly, more minor demands and infractions on rules can trigger the escalation of negativity. An additional source of conflict in the home is that teens with ADHD often require more supervision and help with organization than others their age, at a developmental stage in which they desire additional freedom and independence. What can be done to interrupt this cycle? Clear communication is always important, including explicitly stating rules and expectations and establishing consistent rewards and consequences. Discussing issues when you are angry is counterproductive. Instead, set aside a time when all parties are calm to discuss any areas of disagreement or conflict. If family conflict is exacting a large toll on your family, consider seeking professional help from a qualified mental health professional.
Parenting the teen with ADHD
Teens with ADHD are facing the same issues that prove challenging for their peers: development of identity, establishment of independent functioning, understanding emerging sexuality, making choices regarding drugs and alcohol and setting goals for their futures. However, teens with ADHD may also face some unique difficulties in successfully accomplishing these developmental tasks. Given their difficulties with executive functioning, teens with ADHD may require more support and monitoring from parents than teens without ADHD. If your teen has been diagnosed since childhood, you have already likely learned ways to maximize his or her success. However, the challenges teens with ADHD present to parents are different than those presented by younger children. Below are some areas that may be unique to adolescents.

Behavior management: All children seek additional freedom as they enter adolescence. Be clear with your expectations for responsible behavior, reward appropriate behavior with additional privileges and enforce consequences for inappropriate behaviors to help your teen learn from his or her mistakes and successes. If you are experiencing difficulty with managing your teen's behaviors, consider seeking additional help from a qualified mental health professional.

Driving: Inattention and impulsivity can lead to difficulties with driving. Drivers with ADHD have more tickets, are involved in more accidents, make more impulsive errors, and have slower and more variable reaction times. The use of stimulant medications when prescribed has been found to have positive effects on driving performance. Talk to your teen about safe driving habits, such as using a seat belt, observing the speed limit and other rules of the road, and eliminating distractions such as texting or eating while driving. Consider restricting the number of individuals that can be in the car while your teen is driving.

Adherence to medication regimen: Nearly half of children do not take ADHD medications as directed for a multitude of reasons, and the use of ADHD medications decreases over the teenage years. Parents and teens often disagree on the degree of impairment that results from ADHD symptoms. In addition, adolescents may have negative attitudes toward medication use. If your teen expresses a desire to discontinue his or her use of medications, it may be helpful to discuss this with his or her physician and consider a trial period without medication under the physician's supervision. During this period, you can work with your teen to specify goals and develop a plan that includes tutors or behavioral interventions to achieve those goals. Also, specify with your teen what indicators might illustrate the need to resume medication. These could include declining grades or increases in conflict at home and with peers. Set a date and time to evaluate progress and re-evaluate the decision to discontinue medication.

Medication diversion: Studies show that the use or abuse of ADHD stimulant medications (such as Adderall or Ritalin) among individuals for whom these medications are not prescribed is an increasing problem. Teens may divert (give away or sell) their medications either as a favor to friends or for financial gain. Reasons for use of non-prescribed stimulants may either be academic or recreational. It is recommended that you talk to your child openly and honestly about ADHD and its treatment. Inform teens that selling or giving away prescription medications and the use of such medications by individuals for whom they were not prescribed is illegal and could have serious legal consequences. In addition, ADHD medications are safe and effective when taken as directed, but can be dangerous if used without medical supervision. It is important to talk to your child about peer pressure so that he or she will be prepared to respond appropriately if asked to divert medications.

Boosting your teen's confidence: Living with ADHD can be challenging for you and for your teen. Don't forget to emphasize your love and support for your teen. Communicate that you are there to help him or her work through difficulties and that you believe that he or she can be successful. Try to help your teen identify his or her strengths and find opportunities to experience success. Many teens with ADHD find that the school environment does not suit their personality or maximize their natural talents. For example, if your teen excels at sports, art or music, help him or her find appropriate outlets for practicing and demonstrating these skills.

Disclosing the diagnosis of ADHD: When your child was younger, it is likely that you made decisions regarding when and with whom your child's diagnosis of ADHD would be shared. As your child matures, you may find that your feelings regarding disclosure differ from those of your teen. A frank conversation with your teen on the potential risks and benefits of disclosure may help clarify this issue for both of you.
Your teen's future
Teens with ADHD are at risk for potentially serious problems as they transition into adulthood. As many as two-thirds of teens with ADHD continue to experience significant symptoms of ADHD in adulthood. In addition, as they become adults, adolescents with ADHD are at higher risk for lower educational attainment, greater job difficulties and greater social problems; have a higher likelihood of acquiring sexually transmitted diseases; and are more likely to become parents at an earlier age compared to individuals without the disorder. However, these are only risks, they are not prophecies. Many teens with ADHD go on to become successful, productive adults. Continued awareness and treatment is crucial in helping your teen avoid these risks and fulfill his or her potential.

Questions and Answers

From Ask The Expert Webinar
How can I communicate effectively with my teenager?
You can use a three step communication process to help keep the relationship in the forefront. First, you want to acknowledge their experience. Teenagers want to be seen and heard. Start by acknowledging the situation and normalizing their experience. Try saying, "It's perfectly normal for you to be going through this," "It makes sense that you're going through this," or "I know it's hard."

Next you want to connect with compassion. Show you can relate to their experience and the challenge they are facing. Compassion helps enhance your acknowledgement of the situation and makes you a human piece in the puzzle rather than just someone telling them what to do.

The last step is to explore solutions together. You want teenagers to start making their own decisions and doing their own problem solving. Thinking of multiple solutions together allows you to help them problem solve in a practical way. By collaborating to find solutions rather than starting with them, you're no longer putting your teen on the defensive. You're giving them the opportunity to learn how to figure it out on their own.
What can I do to motivate my teen to do things, such as chores, exercise, take medication, do homework, etc.?
Motivation is a key part of telling the ADHD brain to engage in action. However, one of the common mistakes parents make is trying to motivate our kids to do what they want them to do. Instead you need to focus on the five things that really motivate the ADHD brain: novelty, urgency, interest, competition and enjoyment.

Focusing on these five things helps you gain buy-in from your teenager. Rather than approaching a scenario from why you want it to happen, you really want to look at how interested your teenager is in doing what you want them to do. They need to know what's in it for them. The best motivation is going to be them wanting to do things for their own reasons. Through open conversations, find the interest and engagement for them.

For example, if you want to get your teen to go to bed earlier have a conversation about the situation. While they may not be interested in going to bed earlier, you might find that they are interested in a related situation, such as getting to school on time in the morning. Once you find out what they are interested in, then problem solve that particular scenario. One solution that they come up with could be to go to bed earlier.
I want to support my teenager. How do I know when to offer help and when my support may be too much?
The most important piece of supporting teens is to not see them where you want them to be, but where they are. You want to meet them where they are and raise the bar from there. Let them try some different things such as chores or homework without offering support. If they can do it independently 80% of the time with whatever systems they use, then they can do it on their own.

On the other hand if they are struggling with something, fall back on the three step communication strategy. Sometimes our teens can't do what they know they should be able to do. It's maddening and frustrating for them. Offer support in the form of a conversation that begins with acknowledgement and compassion. Then invite them to grow in little steps.
How do I know if situations are my child's ADHD or typical teenager behavior?
The bottom line is, it's about loving and supporting your teenager through their teenage years. If whatever's happening in their brain is neurological because of their ADHD, neurological because of their hormones or the result of their girlfriend breaking up with them yesterday, then it really doesn't matter if it's the ADHD or not. It's more important to stay connected with your teen so you can help them problem solve through situations, support and empower them.
Additional Resource: ADHD and Your Teens infographic

# data[].attributes.attachment_link.description
"Shouldn't my teen have outgrown this by now?" You, along with many other parents, may be wondering why your child hasn't outgrown his or her difficulties sitting still, thinking of consequences before acting, resisting distractions, organizing daily activities and managing time wisely. People used to think that only young kids had ADHD and that children...

# data[].attributes.attachment_link.title
ADHD in Teens: Parenting Strategies in High School

# data[].attributes.attachment_link.description
Teens with ADHD face a unique set of challenges as puberty aggravates their symptoms, challenging high school classes tax their executive functions, and independence beckons. Here's how parents can...

# data[].attributes.headline
What's ADHD (and What's Not) in the Classroom

# data[].attributes.subject
What's ADHD (and What's Not) in the Classroom

# data[].attributes.attachment_link.readable_text
Many children with ADHD show signs of the disorder before they reach school age. But it's in school, when they are having trouble meeting expectations for kids in their grade, that most are referred for diagnosis.

ADHD is one of the first things that's suspected when a child's behavior in class, or performance on schoolwork, is problematic. A child who can't seem to sit still, who blurts out answers in class without raising his hand, who doesn't finish his homework, who seems to be daydreaming when the teacher gives instructions-these are well-known symptoms of ADHD.

But these are also behaviors that can be a result of other factors, from anxiety to trauma to just being younger than most of the kids in the class, and hence a little less mature.

That's why it's important for teachers and parents both to be aware of what ADHD looks like in the classroom, and how it might be confused with other things that could be influencing a child's behavior. Observing kids carefully is especially important when kids are too young to be able to articulate what they are feeling. And referring struggling kids for diagnosis and appropriate support can help them succeed in school and other parts of their lives, too.

There are three kinds of behavior involved in ADHD: inattention, hyperactivity and impulsivity. Of course all young children occasionally have trouble paying attention to teachers and parents, staying in their seats, and waiting their turn. Kids should only be diagnosed with ADHD if their behavior is much more extreme in these areas than other kids their age.

These symptoms of ADHD are divided into two groups-inattentive and hyperactive-impulsive. Some children exhibit mostly inattentive behaviors and others predominantly hyperactive-impulsive. But the majority of those with ADHD have a combination of both, which may make it very difficult for them to function in school.

Here are behaviors you might observe in school in those two categories.

Inattentive symptoms of ADHD

Makes careless mistakes in school work, overlooks details

Is easily distracted or sidetracked

Has difficulty following instructions

Doesn't seem to be listening when spoken to directly

Has trouble organizing tasks and possessions

Often fails to finish work in school or chores in the classroom

Often avoids or resists tasks that require sustained mental effort, including doing homework

Often loses homework assignments, books, jackets, backpacks, sports equipment

Hyperactive or impulsive symptoms of ADHD

Often fidgets or squirms

Has trouble staying in his seat

Runs and climbs where it's inappropriate

Has trouble playing quietly

Is extremely impatient, can't wait for his turn

Always seems to be "on the go" or "driven by a motor"

Talks excessively

Blurts out answers before a question is completed

Interrupts or intrudes on others conversations, activities, possessions

Serious impairment

It's important to keep in mind that not every high-energy or impulsive child has ADHD. Children are diagnosed with ADHD only if they demonstrate these symptoms so often that they are causing real difficulty in at least two settings-i.e. at school and at home. And the pattern that's causing them serious impairment must persist for at least 6 months.

It's also important, when considering a child's behavior, to compare it to other children the same age-not to the range of kids in his class or grade. Within any given grade, kids' ages can differ by almost a year, and a year can make a big difference in a child's ability to self-regulate.

Two studies in the last few years concluded that kids who are youngest in their class are disproportionately diagnosed with ADHD. A Michigan study found that kindergarteners who are the youngest in their grade are 60% more likely to be diagnosed with ADHD than the oldest in their grade. And it doesn't affect just kindergarteners: a North Carolina study found that in fifth and eighth grade, the youngest children were almost twice as likely as the oldest to be prescribed medication for ADHD.

When children exhibit behaviors that we associate with ADHD, it's important to keep in mind that they could be caused by other underlying factors. A child who is inattentive could be distracted by chronic anxiety, by a worrisome or painful situation at home, or because she's being bullied in the playground. These are all things a child might be embarrassed by and go to some lengths to keep secret.

Another thing children often hide is undiagnosed learning disorders. If a child is fidgeting when she's supposed to be reading, it may be that dyslexia is causing her great frustration. And if she bolts from her chair, it could be because she is ashamed that she doesn't seem to be able to do what the other kids can do, and intent on covering that fact up.

The stereotype of ADHD is boys disrupting the classroom by jumping up from their seats, getting in other kids' business, or blurting out answers without raising their hands. But girls get ADHD too, and they tend to be diagnosed much later because their symptoms are more subtle. More of them have the only inattentive symptoms of ADHD, and they get written off as dreamy or ditzy. If they have the hyperactive-impulsive symptoms they are more likely to be seen as pushy, hyper-talkative, or overemotional. Impulsive girls may have trouble being socially appropriate and struggle to make and keep friends.

But a big reason that many girls aren't diagnosed is that they knock themselves out to compensate for their weaknesses and hide their embarrassment about falling behind, losing things, feeling clueless. The growing awareness, as they get older, that they have to work much harder than their peers without ADHD to accomplish the same thing is very damaging to their self-esteem. Girls who are chronically hard on themselves about their lapses may be struggling with thoughts that they're stupid or broken.

Keeping a keen eye on kids' behavior in the classroom is important not just because it affects their learning-and potentially the ability of other kids in the class to learn-but also because it's a window into their social and emotional development. When kids are failing or struggling in school for an extended period of time, or acting out in frustration, without getting help, it can lead to a pattern of dysfunctional behavior that gets harder and harder to break.

That's why it's important for parents to get a good diagnosis from a mental health professional who takes the time to carefully consider the pattern of a child's behavior and what it might (and might not) indicate. Being not only caring but precise about defining and treating a child's problems when he is young pays off many times over in the long run.

# data[].attributes.attachment_link.title
What's ADHD (and What's Not) in the Classroom - Child Mind Institute

# data[].attributes.attachment_link.description
Learn what is ADHD in the classroom and what's not. Child Mind Institute explains that some of the symptoms of ADHD in children may be signs of other mental health problems.

# data[].attributes.headline
ADHD In Grade School: 4 Signs You Might See

# data[].attributes.subject
ADHD In Grade School: 4 Signs You Might See

# data[].attributes.attachment_link.readable_text
By Amanda Morin

Are you concerned your grade-schooler has ADHD? There are a lot of things you might notice beyond kids being fidgety or " hyper." Here are signs of ADHD you might see in grade school.

1. Trouble finishing anything

Kids with ADHD can be easily distracted by noises, sights, and even their own thoughts. Your child may start putting toys away but abandon the job to see why the dog is barking. At school, your child may know the answer to test questions, but leaves some of them blank.

Kids with ADHD often talk nonstop and without filtering what they say. Your child may interrupt while you're on the phone or take forever to tell a story. At school, your child may get in trouble for talking when it's quiet time.

3. Needing to have things now

Kids with ADHD can be impulsive and struggle with self-control. They might have trouble waiting for or giving up on what they want. Your child may argue and pester for something long after you've said no. At school, your child may cut to the front of the line and insist on being first.

Kids with ADHD often have trouble paying attention and following directions. They might seem off in the clouds. Your child may ask "what?" a lot even when you're talking one-on-one. At school, your child might get in trouble for not following directions.

About the author

Reviewed by

# data[].attributes.attachment_link.description
Are you concerned your grade-schooler has ADHD? There are a lot of things you might notice beyond kids being fidgety or " hyper." Here are signs of ADHD you might see in grade school. 1. Trouble finishing anything Kids with ADHD can be easily distracted by noises, sights, and even their own thoughts.

# data[].attributes.headline
Classroom Accommodations to Help Students With ADHD

# data[].attributes.subject
Classroom Accommodations to Help Students With ADHD

# data[].attributes.attachment_link.readable_text
Students with ADHD have difficulty with attention and self-control. And at school, that can look like inattention, distractibility, hyperactivity, impulsivity, and disorganization - all of which can get in the way of learning. What classroom accommodations can help students with ADHD? Here are some strategies teachers can try.

Setting up the classroom environment

Use flexible seating, like wiggle chairs, standing desks, footrests, seat cushions, or resistance bands on chair legs.

Increase the space between desks or work tables (if social distancing guidelines aren't already in place).

Designate a quiet work space in the classroom.

Set up preferential seating close to the teacher and/or away from high-traffic areas.

Post a written schedule for daily routines and rules. When possible, let the student know ahead of time about schedule changes.

Building organization skills

Use an assignment notebook or an electronic calendar.

Provide an extra set of books to keep at home.

Provide folders and baskets of supplies to keep desk organized.

Color-code materials for each subject.

Provide typed notes or an outline of the lesson to help with taking notes.

Teach note-taking strategies, like using graphic organizers and mind-mapping software.

Have a buddy take notes for the student.

Give directions out loud and in writing, and have the student repeat them.

Provide a lesson outline that details instructions and assignments.

Keep instructions simple, clear, and concrete.

Use pictures and graphs to help create visual interest.

Provide a rubric that describes the elements of a successfully completed assignment.

Help the student break long assignments into smaller chunks.

Completing tests and assignments

Allow understanding to be demonstrated in different ways, like oral reports, posters, and video presentations.

Provide different ways to respond to test questions, like saying the answers or circling them.

Minimize the number of questions and problems per worksheet.

Schedule frequent short quizzes, rather than one long test at the end of each unit.

Give credit for work done instead of taking away points for late or partial assignments (with a plan for moving toward completing assignments).

Grade for content, not for neatness.

Give extra time and quieter space for work and tests.

Use a behavior plan with a reward system.

Use a nonverbal signal (like a sticky note on the desk or a hand on a shoulder) to get the student's attention and indicate the need for things like taking a brain break.

Talk through behavior problems one-on-one.

Check in frequently to monitor the student's "emotional temperature" or frustration level.

Do you have a student who you think has difficulty with attention and self-control? See a fact sheet about ADHD.

About the author

About the author

Amanda Morin is the author of "The Everything Parent's Guide to Special Education" and the former director of thought leadership at Understood. As an expert and writer, she helped build Understood from its earliest days.

Reviewed by

Reviewed by

Ginny Osewalt is a dually certified elementary and special education teacher with more than 15 years of experience in general education, inclusion, resource room, and self-contained settings.

# data[].attributes.attachment_link.description
What types of accommodations can help students with ADD and ADHD? Here are some classroom accommodations to talk over with your child's school.

# data[].attributes.attachment_link.readable_text
How to Get an IEP: After the School Assessment

After the school completes its evaluation and assessment of your child, it will send you a letter scheduling a meeting to discuss whether your child qualifies for an IEP or a 504 Plan. A 504 Plan is usually offered as sort of a consolation prize for students who are deemed not sufficiently disabled to qualify for an IEP.

In some cases, the school will determine that a child is ineligible for services and will notify you by letter. Schools usually do not hold a meeting to notify you about ineligibility for services. Of course, you can dispute the finding by requesting an IEE at the school's expense ( see Step 6).

Some school teams will assess the child and make their recommendations of 504 Plan services without your input. Other schools seek the input of parents to discuss services. With IEPs, parents are a designated part of the team and must participate in all phases of applying for and determining services like ADHD accommodations.
[Free Chart Comparing IEPs to 504 Plans]
At the assessment meeting, parents are entitled to have all assessment information explained to them before the next meeting at which accommodations and services are to be determined. Parents should ask the person who administered the assessment to give them a copy of the report and meet with them to explain the report several days before the assessment meeting. This enables the parents to think through the information before making decisions for their child. If all IEP decisions are based on the information from the assessment, parents should be informed about the assessment results in a way they can understand.

Depending on the school district, some IEP and 504 Plan teams propose accommodations and services at the assessment meeting. It is a better idea for parents to request a second meeting to discuss specific accommodations and services. This gives them time to review the assessment with their child's doctor, therapist, or learning specialist.

The school assessment team recommended that a 504 Plan would work best for my son. I thought an IEP would better suit his challenges. What are the differences between an IEP and a 504 Plan?

Let's start at the beginning. There are two laws governing special services and accommodations for children with disabilities: the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act of 1973. These laws are different.

All schools receiving federal funding are required to provide services under Section 504, but IDEA applies to all students, even those in private schools that do not receive federal funding. Children with ADHD often receive services under Section 504 because the requirements for IDEA are more stringent.
[Expert Webinar: How to Fight for Your Child's Rights - and Happiness]
Under IDEA, there are 13 specific categories of disabilities:

1. Autism Spectrum Disorder

2. Blindness

3. Deafness

4. Emotional Disturbance

5. Hearing Impairment

6. Intellectual Disability

7. Multiple Disabilities

8. Orthopedic Impairment

9. Other Health Impaired (ADHD is covered in this category)

10. Specific Learning Disability

11. Speech or Language Impairment

12. Traumatic Brain Injury

13. Visual Impairment

ADHD falls into the classification of Other Health Impaired (OHI). Because IDEA is very specific, children who have been diagnosed with ADHD only are often denied services under this law. If your child has another challenge, such as a learning disability, this law might apply. If your child's ADHD is so severe that it causes major impairment, he might qualify under IDEA. If so, a document called an Individualized Education Program (IEP) is designed to outline services, accommodations, special education, and goals for your child.

The IEP document is usually about 10 to 12 pages long. It must contain goals and transitional services that might be needed after high school.

Under Section 504 of the Rehabilitation Act of 1973, the needs of children with physical and mental impairments are required to be met as adequately as those of children without disabilities.
[Free Guide: Easy Accommodations to Help Students with ADHD or LD]
It covers children with ADHD who do not meet the eligibility requirements for an IEP, but who need extra help at school. It is common for children diagnosed with ADHD to receive a 504 Plan.

To be eligible for services under Section 504, you must have a disability. A disability is considered a physical or mental impairment that "substantially limits one or more major life activities." Learning is considered a major life activity. That means, if ADHD limits your child's ability to learn in an educational setting, he may qualify for accommodations or services under Section 504 - things like extended time on tests, cues from the teacher to keep the student focused, and so on.

The Section 504 document is less formal than an IEP. Most are two pages long, and some are only one. It lists all services, accommodations, and modifications your child will receive. Unlike the IEP, the 504 document does not include goals or transitional services after high school.

The easiest way to think about the differences between an IEP and a 504 Plan is that, if a student needs accommodations only in a regular classroom, he will generally get a 504 Plan. If the student needs special education services outside of a regular classroom, he will qualify for an IEP.

Can my child get the same services under a 504 Plan as an IEP?

Yes, a child can receive any services, accommodations, or modifications deemed necessary under Section 504, except for special education.

Both an IEP and a 504 Plan are binding legal documents. That means that once your child has received an IEP or Section 504, the school does not have the right to deny services or accommodations listed in the document. For older children, the IEP must include a transition plan for life after high school.

Teachers, even if they don't agree with an accommodation, must follow the document. Suppose your child's 504 Plan provides for her to receive extra time to take tests, but the teacher doesn't think your child needs this accommodation. If the teacher refuses to provide the extra time, you have the right to file a complaint or ask for a due process hearing (see Step 12).

Consider Adam and Christine, who both live in the same school district. Adam has ADHD and severe dyslexia. His reading is two grade levels below the average. He attends regular education classes at some times during the day, but also attends special education classes to help with his dyslexia and give him extra help in reading. Adam has an IEP.

Christine has ADHD and dyslexia. She struggles with reading and spelling but is at grade level. She is in a regular education class and doesn't require any special education. She does need help, such as extra time on tests or taking tests orally, dividing assignments into small sections, and getting a copy of notes from the teacher. Christine has a 504 Plan.

Both Adam and Christine have ADHD and dyslexia. Adam, however, is two grade levels below in reading, while Christine is reading at grade level. According to the school district, dyslexia does not qualify a student for an IEP unless the child is at least 1.5 grade levels behind. That is why Adam qualified for IDEA, but Christine did not.

# data[].attributes.attachment_link.title
Is an IEP or 504 Plan Best for Your Child? How to Decide

# data[].attributes.attachment_link.description
Which is better for a child with ADHD: an IEP or a 504 Plan? Here, understand the differences in accommodations and special services, learn how to secure the most effective school help for your child, and understand how the process works from the first assessment to the final paperwork.

# data[].attributes.headline
The ADHD-Anger Connection: New Insights into Emotional Dysregulation and Treatment Considerations

# data[].attributes.subject
The ADHD-Anger Connection: New Insights into Emotional Dysregulation and Treatment Considerations

# data[].attributes.attachment_link.readable_text
Anger issues stemming from emotional dysregulation – while noticeably missing from diagnostic criteria for attention deficit hyperactivity disorder (ADHD or ADD) – are a fundamental part of the ADHD experience for a significant number of children and adults. Even when controlling for related comorbid conditions, individuals with ADHD experience disproportionate problems with anger, irritability, and managing other emotions. These problems walk in lock step with the general difficulties in self-regulation that characterize ADHD. Recent findings, however, suggest that problems with emotional regulation, including anger and negative emotions, are genetically linked to ADHD, too.

Ultimately, emotional dysregulation is one major reason that ADHD is subjectively difficult to manage, and why it also poses such a high risk for other problems like depression, anxiety, or negative self-medication. Scientific and clinical attention are now increasingly turning to correct the past neglect of this integral aspect of ADHD.

Recognizing this inherent relationship between emotional dysregulation and ADHD is also important when discerning between related and similar conditions, like disruptive mood dysregulation disorder (DMDD), bipolar disorder, intermittent explosive disorder (IED), depression, anxiety disorders, and oppositional defiant disorder (ODD). In all, paying mind to anger issues and emotionality in patients with ADHD is crucial for successful treatment and symptom management in the long term.

Anger Issues and ADHD: Theories & Research

Though separated from ADHD in official nomenclature today, emotional dysregulation and anger were connected to ADHD in the mid-20th century before current diagnostic norms were created, and have continued to form part of personal and clinical experiences. Decades ago, when ADHD was known as “minimal brain dysfunction,” criteria for diagnosis actually included aspects of negative emotionality.

Anger problems and emotional dysregulation in individuals with ADHD are sometimes explained by co-occurring mood disorders, such as anxiety or depression. However, these associated disorders do not explain the near universal anger and emotional issues that ADHD individuals experience.

[Click to Read: When It’s Not Just ADHD: Symptoms of Comorbid Conditions]

A critical aspect to consider, then, is ADHD’s nature as a disorder of self-regulation across behavior, attention, and emotion. In other words, any difficulties in regulating our thoughts, emotions, and actions – as is common with ADHD – may explain the irritability, tantrums, and anger regulation issues these individuals experience. And the majority do.

About 70 percent of adults with ADHD report problems with emotional dysregulation1, going up to 80 percent in children with ADHD2. In clinical terms1, these problem areas include:

Irritability: issues with anger dysregulation – “tantrum” episodes as well as chronic or generally negative feelings in between episodes.

Lability: frequent, reactive mood changes during the day. .

Recognition: the ability to accurately recognize other people’s feelings. Individuals with ADHD may tend to not notice other people’s emotions until pointed out.

Affective intensity: felt intensity – how strongly an emotion is experienced. People with ADHD tend to feel emotions very intensely.

Emotional dysregulation: global difficulty adapting emotional intensity or state to situation.

Explaining ADHD and Anger via Emotional Profiles

Emotional dysregulation remains a constant in ADHD even when analyzing personality traits, making the case for emotional profiles or subtypes around ADHD.

[Read: Could High-Tech Brain Scans Help Diagnose ADHD?]

Our own study of children with ADHD that used computational methods to identify consistent temperament profiles found that about 30 percent of kids with ADHD clearly fit a profile strongly characterized by irritability and anger2. These children have very high levels of anger, and low levels of rebound back to baseline – when they get angry, they can’t get over it.

Another 40% had extreme dysregulation around so-called positive affect or hyperactive traits — like excitability and sensation-seeking. Children with this profile also had above-average levels of anger, but not as high as those with the irritable profile.

Thinking of ADHD in terms of temperament profiles also becomes meaningful when considering the role of brain imaging in diagnosing ADHD. Brain scans and other physiological measures are not diagnostic for ADHD because of wide variation in results among individuals with ADHD. However, if we consider brain scans based on temperament profiles, the situation may become clearer. Data from brainwave recordings makes the case that there is distinct brain functioning among children who fall under our proposed irritable and exuberant ADHD profiles2.

In eye-tracking tests among the participants, for example, children in this irritable subgroup struggled more than those in any other identified subgroup to take their attention off negative, unhappy faces shown to them. Their brains would activate in the same areas when they saw negative emotions; this did not happen when they saw positive emotions.

Genetic Basis for ADHD and Anger Issues

From a genetics standpoint, it appears that emotional dysregulation is strongly associated with ADHD. Our recent findings suggest that genetic liability for ADHD is related directly to most traits under emotional dysregulation, like irritability, anger, tantrums, and overly exuberant sensation-seeking3. What’s more, irritability appears to have the biggest overlap with ADHD versus other traits, like excessive impulsivity and excitement, in children.

These findings refute the idea that mood problems in ADHD are necessarily part of an undetected depression — even though they do indicate higher future risk for depression as well as higher possibility of depression being present.

Anger Issues: DMDD, Bipolar Disorder & ADHD

ADHD, DMDD, and bipolar disorder are all associated in different ways with anger and irritability. Understanding how they relate (and don’t) is critical to ensuring proper diagnosis and targeted treatment for anger issues in patients.

Anger Issues and Disruptive Mood Dysregulation Disorder (DMDD)

DMDD is a new disorder in the DSM-5 primarily characterized by:

Severe tantrums, either verbal or behavioral, that are grossly out of proportion to the situation

A baseline mood of persistent grumpiness, irritability, and/or anger

DMDD was established in DSM-5 after a crisis in child mental health in the 1990s in which rates of bipolar disorder diagnoses and associated treatment with psychotropic mediation in children skyrocketed – inaccurately. Clinicians at that time assumed, in error, that irritability in children could be substituted for actual mania, a symptom of bipolar disorder. We now know from further epidemiological work that, in the absence of mania, irritability is not a symptom of hidden bipolar disorder in children. When mania is present, irritability can also emerge as a side feature of the mania. But mania is the primary feature of bipolar disorder.

Mania means a notable change from normal in which a child (or adult) has unusually high energy, less need for sleep, and grandiose or elevated mood, sustained for at least a couple of days — not just a few hours. True bipolar disorder remains very rare in pre-adolescent children. The average age of onset for bipolar disorder is 18 to 20 years.

Thus, DMDD was created to give a place for children older than 6 years of age with severe, chronic temper tantrums who also do not have elevated risk for bipolar disorder in their family or in the long run. It opens the door for research on new treatments targeted these children, most of whom meet criteria for severe ADHD, often with associated oppositional defiant disorder.

DMDD is also somewhat similar to intermittent explosive disorder (IED). The difference is that a baseline negative mood is absent in the latter. IED is also usually reserved for adults.

As far as ADHD, it is important to recognize that most patients who meet criteria for DMDD actually have severe ADHD, sometimes with comorbid anxiety disorder or ODD. This diagnosis, however, is given to help avoid a bipolar disorder diagnosis and take advantage of new treatment insights.

[Self-Test: Could Your Child Have DMDD?]

Anger Issues and ADHD: Treatment Approaches

Most treatment studies for ADHD look at how core symptoms of ADHD change. Treating anger problems in individuals with ADHD has only recently become a major research focus, with useful insights revealed for patient care. Alternative and experimental approaches are also increasingly showing promise for patients with emotional dysregulation and anger issues.

Interventions for Children with Anger Issues

1. Behavioral Therapy4

Cognitive Behavioral Therapy (CBT): Some children with anger issues have a tendency to over-perceive threat – they over-react to an unclear or ambiguous situation (someone accidentally bumps you in line) when no threat is actually present. For these children, CBT can help the child with understanding that something ambiguous isn’t necessarily threatening.

Counseling: Anger problems can also be caused by difficulties with tolerating frustration. Counseling can help children learn how to tolerate normal frustrations and develop better coping mechanisms.

Parent Counseling: Parents have a role in how a child’s anger manifests. A parent’s angry reaction can lead to negative and mutual escalation, such that parents and kids both start to lose their balance. This can form a negative loop. With counseling, parents can learn to react differently to their child’s tantrums, which can help reduce them over time.

2. Medication:

Regular stimulant medication for ADHD helps ADHD symptoms much of the time, but is only about half as helpful with anger problems. Selective Serotonin Reuptake Inhibitors (SSRIs) may be next for treating severe anger problems. A recent double-blind study, for example found that children with severe tantrums, DMDD, and ADHD who were on stimulants saw a reduction in irritability and tantrums only after being given Citalopram (Celexa, an SSRI antidepressant) as a second medication5. While only one study, these findings do suggest that when mainline stimulant medications are not working, and severe anger problems are a core issue, then adding an SSRI may be a reasonable step.

Interventions for Adults with Anger Issues

Behavioral counseling (as in CBT) has clear evidence pointing to its benefits in treating emotional regulation problems for adults with ADHD. Specifically, these therapies improve skills in the following:

Interior regulation: refers to what individuals can do within themselves to manage out-of-control anger. The key element here is learning coping skills, practicing them, and checking back with a counselor for refining. Important for patients to understand is that learning about coping skills without practice, or trying some self-help without professional consultation is generally not as effective. Some examples of coping skills include:

anticipatory coping, or devising an exit plan to the triggering situation – “I know I’m going to get angry next time this happens. What am I going to plan ahead of time to avoid that situation?”

appraisals and self-talk to keep temper under control (“Maybe that was an accident, or they’re having a bad day.”)

shifting attention to focus elsewhere instead of on the upsetting situation.

Exterior supports

Social connections – talking to others and having their support –are tremendously beneficial for adults struggling with ADHD and anger

Exercise, stress reduction, and other self-care strategies can help.

Strategies with Limited Benefits

Typical ADHD medication helps with core symptoms, but has only modest benefits on emotional dysregulation for adults with ADHD6

Meditation classes offer some benefits7 for managing ADHD symptoms and emotional dysregulation for teens and adults (and for children if parents join in the practice too), but most studies on this intervention tend to be of low quality so it is difficult to draw strong conclusions.

High-dose micronutrients may help adults with ADHD emotionality, based on a small but robust study8. Omega-3 supplementation also appears to have a small effect in bettering emotional control in children with ADHD9.

Problems with emotional dysregulation, in particular with anger reactivity, are very common in people with ADHD. You are not alone in struggling in this area. Anger may indicate an associated mood problem but often is just part of the ADHD. Either way, changes in traditional ADHD treatment can be very helpful.

Anger Issues and ADHD: Next Steps

Read: Why Is My Child So Angry?!

Learn: Mapping the ADHD Brain – MRI Scans May Unlock Better Treatment and Even Symptom Prevention

For Clinicians: Comorbid Considerations Q&A – Treating Bipolar Disorder, Depression, Anxiety, or Autism Alongside ADHD

The content for this webinar was derived from the ADDitude Expert Webinar “You’re So Emotional: Why ADHD Brains Wrestle with Emotional Regulation” by Joel Nigg, Ph.D., which was broadcast live on July 28, 2020.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

View Article Sources

¹ Beheshti, A., Chavanon, M. & Christiansen, H. (2020). Emotion dysregulation in adults with attention deficit hyperactivity disorder: a meta-analysis. BMC Psychiatry 20, 120. https://doi.org/10.1186/s12888-020-2442-7

² Karalunas, S. L., Gustafsson, H. C., Fair, D., Musser, E. D., & Nigg, J. T. (2019). Do we need an irritable subtype of ADHD? Replication and extension of a promising temperament profile approach to ADHD subtyping. Psychological Assessment, 31(2), 236–247. https://doi.org/10.1037/pas0000664

³ Nigg, J., et. al. (2019). Evaluating chronic emotional dysregulation and irritability in relation to ADHD and depression genetic risk in children with ADHD. Journal of Child Psychology and Psychiatry 61, 2. https://doi.org/10.1111/jcpp.13132

⁴ Stringaris, A., Vidal-Ribas, P., et. al. (2017). Practitioner Review: Definition, recognition, and treatment challenges of irritability in young people. Journal of Child Psychology and Psychiatry, 59 (7). https://doi.org/10.1111/jcpp.12823

⁵ Towbin, K., Vidal-Ribas, P., et. al. (2020). A Double-Blind Randomized Placebo-Controlled Trial of Citalopram Adjunctive to Stimulant Medication in Youth With Chronic Severe Irritability. Journal of the American Academy of Child & Adolescent Psychiatry, 59(3). https://doi.org/10.1016/j.jaac.2019.05.015

⁶ Lenzi, F., Cortese, S. et. al. (2018). Pharmacotherapy of emotional dysregulation in adults with ADHD: A systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews, 84, 359-367. https://doi.org/10.1016/j.neubiorev.2017.08.010

⁷ Xue, J et. al. (2019). A meta-analytic investigation of the impact of mindfulness-based interventions on ADHD symptoms. Medicine 98(23). 10.1097/MD.0000000000015957

⁸ Rucklidge, J., Frampton, C., Gorman, B., & Boggis, A. (2014). Vitamin–mineral treatment of attention-deficit hyperactivity disorder in adults: Double-blind randomised placebo-controlled trial. British Journal of Psychiatry, 204(4), 306-315. doi:10.1192/bjp.bp.113.132126

⁹ Cooper, R., Tye, C. et.al. (2016). The effect of omega-3 polyunsaturated fatty acid supplementation on emotional dysregulation, oppositional behaviour and conduct problems in ADHD: A systematic review and meta-analysis. Journal of Affective Disorders 190, 474-482. https://doi.org/10.1016/j.jad.2015.09.053

# data[].attributes.attachment_link.title
The ADHD-Anger Connection: New Insights into Emotional Dysregulation and Treatment Considerations

# data[].attributes.attachment_link.description
Irritability, anger issues, and emotional dysregulation in general contribute significantly to the psychosocial burden of ADHD in children and adults. The latest research suggests that these problems are inherent to ADHD and may require specific treatment.

# data[].attributes.attachment_link.readable_text
By The Understood Team

Quick tips for helping people manage anger

People with ADHD tend to feel emotions more intensely than other people do. At the same time, they often have a hard time managing those emotions. They may also have trouble keeping things in perspective. It's all part of ADHD.

Even small problems can spark an angry outburst. Kids might lash out at siblings for taking a toy. Adults might yell at a co-worker who misplaced something. And the anger may last a while.

People with ADHD don't want to overreact and lose their cool. In fact, they often feel terrible about it afterward. They need to develop the skills to keep a lid on their anger.

Self-control is part of a group of skills called executive functions. People with ADHD often struggle with these skills. Many kids with ADHD develop more self-control as they get older. But some struggle with anger into adulthood. With practice, people can learn these skills.

Dive deeper

# data[].attributes.attachment_link.description
Quick tips for helping people manage anger People with ADHD tend to feel emotions more intensely than other people do. At the same time, they often have a hard time managing those emotions. They may also have trouble keeping things in perspective. It's all part of ADHD.

# data[].attributes.attachment_link.readable_text
Individuals with ADHD often experience social difficulties, social rejection, and interpersonal relationship problems as a result of their inattention, impulsivity and hyperactivity. Such negative interpersonal outcomes cause emotional pain and suffering. They also appear to contribute to the development of co-morbid mood and anxiety disorders.

Because very little research has been published regarding social skills in adults with ADHD, the suggestions given in this sheet are based primarily upon sound clinical practices and upward extrapolations from the research on children's social skills and ADHD.
Overall impact of ADHD on social interactions
It is not difficult to understand the reasons why individuals with ADHD often struggle in social situations. Interacting successfully with peers and significant adults is one of the most important aspects of a child's development, yet 50 to 60 percent of children with ADHD have difficulty with peer relationships. Over 25 percent of Americans experience chronic loneliness. One can only speculate that the figure is much higher for adults with ADHD.

To interact effectively with others, an individual must be attentive, responsible and able to control impulsive behaviors. Adults with ADHD are often inattentive and forgetful and typically lack impulse control. Because ADHD is an "invisible disability," often unrecognized by those who may be unfamiliar with the disorder, socially inappropriate behaviors that are the result of ADHD symptoms are often attributed to other causes. That is, people often perceive these behaviors and the individual who commits them as rude, self-centered, irresponsible, lazy, ill-mannered, and a host of other negative personality attributes. Over time, such negative labels lead to social rejection of the individual with ADHD. Social rejection causes emotional pain in the lives of many of the children and adults who have ADHD and can create havoc and lower self-esteem throughout the life span. In relationships and marriages, the inappropriate social behavior may anger the partner or spouse without ADHD, who may eventually "burn out" and give up on the relationship or marriage.

Educating individuals with ADHD, their significant others, and their friends about ADHD and the ways in which it affects social skills and interpersonal behaviors can help alleviate much of the conflict and blame. At the same time, the individual with ADHD needs to learn strategies to become as proficient as possible in the area of social skills. With proper assessment, treatment and education, individuals with ADHD can learn to interact with others effectively in a way that enhances their
social life.
ADHD and the acquisition of social skills
Social skills are generally acquired through incidental learning: watching people, copying the behavior of others, practicing, and getting feedback. Most people start this process during early childhood. Social skills are practiced and honed by "playing grown-up" and through other childhood activities. The finer points of social interactions are sharpened by observation and peer feedback.

Children with ADHD often miss these details. They may pick up bits and pieces of what is appropriate but lack an overall view of social expectations. Unfortunately, as adults, they often realize "something" is missing but are never quite sure what that "something" may be.

Social acceptance can be viewed as a spiral going up or down. Individuals who exhibit appropriate social skills are rewarded with more acceptance from those with whom they interact and are encouraged to develop even better social skills. For those with ADHD, the spiral often goes downward. Their lack of social skills leads to peer rejection, which then limits opportunities to learn social skills, which leads to more rejection, and so on. Social punishment includes rejection, avoidance, and other, less subtle means of exhibiting one's disapproval towards another person.

It is important to note that people do not often let the offending individual know the nature of the social violation. Pointing out that a social skill error is being committed is often considered socially inappropriate. Thus, people are often left on their own to try to improve their social skills without understanding exactly what areas need improvement.
Research on children with ADHD and social skills
Researchers have found that the social challenges of children with ADHD include disturbed relationships with their peers, difficulty making and keeping friends, and deficiencies in appropriate social behavior. Long-term outcome studies suggest that these problems continue into adolescence and adulthood and impede the social adjustment of adults with ADHD.

At first, these difficulties of children with ADHD were conceptualized as a deficit in appropriate social skills, such that the children had not acquired the appropriate social behaviors. Based upon this model, social skills training, which is commonly conducted with groups of children, became a widely accepted treatment modality. In the typical social skills training group, the therapist targets specific social behaviors, provides verbal instructions and demonstrations of the target behavior, and coaches the children to role-play the target behaviors with one another. The therapist also provides positive feedback and urges the group to provide positive feedback to one another for using the appropriate social behavior. The children are instructed to apply their newly acquired skills in their daily lives.

More recently, ADHD has been re-conceptualized as an impairment of the executive or controlling functions of the brain. It follows from this conceptualization that the social deficits of the individual with ADHD may not be primarily the result of a lack of social skills, but rather a lack of efficiency in reliably using social skills that have already been acquired. Social skills training addresses the lack of skills, but does not address inefficient use of existing skills. Medication produces direct changes in the executive function of the brain and may therefore help children with ADHD more reliably use newly acquired social skills. Researchers have also added components to social skills training that help children with ADHD reliably apply what they have learned in various settings. To accomplish this goal, parents and teachers are trained to prompt and reinforce children with ADHD to use newly acquired social skills at home and in school.

Only a small number of controlled investigations have studied the effectiveness of social skills training for children with ADHD. These studies have found that social skills training improves the children's knowledge of social skills and improves their social behavior at home as judged by parents, and these positive changes last up to the 3 or 4 month follow-up periods in the studies. However, these changes only partially generalize to school and other environments.

Researchers have also found that embedding social skills training within an intensive behavioral intervention, such as a specialized summer camp program, is a highly effective way of increasing the chances that the children will maintain and generalize the gains that they have made. There is no research yet that addresses the question of whether children with ADHD who benefit from social skills training have more friends, are better accepted by their peers, and have better interpersonal relationships as they move into adolescence and adulthood. Clearly, this is an area where more research is necessary.
Specific ADHD symptoms and social skills Inattention
Tips for identifying subtext:

Look for clues in your environment to help you decipher the subtext. Be mindful of alternative possibilities. Be observant.

Be aware of body language, tone of voice, behavior, or the look of someone's eyes to better interpret what they are saying.

Look at a person's choice of words to better detect the subtext. ("I'd love to go" probably means yes. "If you want to" means probably not, but I'll do it.)

Actions speak louder than words. If someone's words say one thing but their actions reveal another, it would be wise to consider that their actions might be revealing their true feelings.

Find a guide to help you with this hidden language. Compare your understanding of reality with their understanding of reality. If there is a discrepancy, you might want to try the other person's interpretation and see what happens, especially if you usually get it wrong.

Learn to interpret polite behavior. Polite behavior often disguises actual feelings.

Be alert to what others are doing. Look around for clues about proper behavior, dress, seating, parking and the like.

A momentary lapse in attention may result in the adult with ADHD missing important information in a social interaction. If a simple sentence like "Let's meet at the park at noon," becomes simply "Let's meet at noon," the listener with ADHD misses the crucial information about the location of the meeting. The speaker may become frustrated or annoyed when the listener asks where the meeting will take place, believing that the listener intentionally wasn't paying attention and didn't value what they had to say. Or even worse, the individual with ADHD goes to the wrong place, yielding confusion and even anger in the partner. Unfortunately, often neither the speaker nor listener realizes that important information has been missed until it is too late.

A related social skills difficulty for many with ADHD involves missing the subtle nuances of communication. Those with ADHD will often have difficulty "reading between the lines" or understanding subtext. It is difficult enough for most to attend to the text of conversations without the additional strain of needing to be aware of the subtext and what the person really means . Unfortunately, what is said is often not what is actually meant.
Impulsivity
Impulsivity negatively affects social relationships because others may attribute impulsive words or actions to lack of caring or regard for others. Failure to stop and think first often has devastating social consequences. Impulsivity in speech, without self-editing what is about to be said, may appear as unfiltered thoughts. Opinions and thoughts are shared in their raw form, without the usual veneer that most people use to be socially appropriate. Interruptions are common.

Impulsive actions can also create difficulties as individuals with ADHD may act before thinking through their behavior. Making decisions based on an "in the moment" mentality often leads to poor decision-making. Those with ADHD often find themselves lured off task by something more inviting. Impulsive actions can include taking reckless chances, failure to study or prepare for school- or work-related projects, affairs, quitting jobs, making decisions to relocate, financial overspending, and even aggressive actions, such as hitting others or throwing items.

Rapid and excessive speech can also be a sign of impulsivity. The rapid-fire speech of an individual with ADHD leaves little room for others who might want to participate in the conversation. Monologues rather than dialogues leave many with ADHD without satisfying relationships or needed information.
Hyperactivity
Physical hyperactivity often limits the ability to engage in leisure activities. Failure to sit still and concentrate for concerts, religious ceremonies, educational events, or even leisure vacations and the like may be interpreted by others as a lack of caring or concern on the part of the person with ADHD. In addition, difficulties lookingattentive leave others feeling unattended.
Assessment of social skills
Interviews and self-report questionnaires are the primary tools for assessing social skill deficits and interpersonal interaction problems in adults with ADHD. During the course of a diagnostic evaluation for ADHD (see What We Know #9, "Diagnosis of ADHD in Adults"), a mental health professional will thoroughly assess the social interactions of the adult. When questionnaires are used, it is important to include both a self-report by the individual with ADHD and reports by spouses, significant others, and friends on a comparable version of the questionnaire. The questionnaire may include the following types of items:

Difficulty paying attention when spoken to, missing pieces of information

Appears to ignore others

Difficulty taking turns in conversation (tendency to interrupt frequently)

Difficulty following through on tasks and/or responsibilities

Failure to use proper manners

Missed social cues

Disorganized lifestyle

Sharing information that is inappropriate

Being distracted by sounds or noises

Become flooded or overwhelmed, shutting down

Disorganized or scattered thoughts

Rambling or straying off topic during conversations

Ending a conversation abruptly

Treatment strategies
When the social skill areas in need of strengthening have been identified, obtaining a referral to a therapist or coach who understands how ADHD affects social skills is recommended (see Coaching). Medications are often helpful in the management of ADHD symptoms; in many cases, an effective dose of medication will give the adult with ADHD the boost in self-control and concentration necessary to utilize newly acquired social skills at the appropriate time. However, medications alone are usually not sufficient to help gain the necessary skills (see Medication Management).

As discussed earlier, social skills training for children and adolescents with ADHD usually involves instruction, modeling, role-playing, and feedback in a safe setting such as a social skills group run by a therapist. In addition, arranging the environment to provide reminders has proven essential to using the correct social behavior at the opportune moment. These findings suggest that adults with ADHD wishing to work on their social skills should consider the following elements when seeking an effective intervention. It is important to note that these treatment strategies are suggestions based on clinical practice, rather than empirical research.

Knowledge. Oftentimes social skills can be significantly improved when there is an understanding of social skills as well as the areas in need of improvement. Reading books such as What Does Everybody Know That I Don't, ADD and Romance, or You, Your Relationship & Your ADD can provide some of that knowledge .

Attitude. Individuals with ADHD should have a positive attitude and be open to the growth of their social skills. It is also important to be open and appreciative of feedback provided by others.

Goals. Adults with ADHD may want to pick and work on one goal at a time, based on a self-assessment and the assessments of others. Tackling the skill areas one at a time allows the individual to master each skill before moving on to the next.

The echo. Those who struggle with missing pieces of information due to attentional difficulties during conversation may benefit from developing a system of checking with others what they heard. "I heard you say that. Did I get it right Is there more " Or an individual with ADHD could ask others to check with them after providing important information. "Please tell me what you heard me say." In this way, social errors due to inattention can be avoided.

Observe others. Adults with ADHD can learn a great deal by watching others do what they need to learn to do. They may want to try selecting models both at work and in their personal lives to help them grow in this area. Television may also provide role models.

Role play. Practicing the skills they need with others is a good way for individuals with ADHD to receive feedback and consequently improve their social skills.

Visualization. Visualization can be used to gain additional practice and improve one's ability to apply the skill in other settings. Those who need practice in social skills can decide what they want to do and rehearse it in their minds, imagining actually using the skill in the setting they will be in with the people they will actually be interacting with. They can repeat this as many times as possible to help "overlearn" the skill. In this manner, they can gain experience in the "real" world, which will greatly increase the likelihood of their success.

Prompts. Adults with ADHD can use prompts to stay focused on particular social skill goals. The prompts can be visual (an index card), verbal (someone telling them to be quiet), physical (a vibrating watch set every 4 minutes reminding them to be quiet), or a gesture (someone rubbing their head) to help remind them to work on their social skills.

Increase "likeability." According to social exchange theory, people maintain relationships based on how well those relationships meet their needs. People are not exactly "social accountants," but on some level, people do weigh the costs and benefits of being in relationships. Many with ADHD are considered to be "high maintenance." Therefore, it is helpful to see what they can bring to relationships to help balance the equation. Investigators have found that the following are characteristics of highly likeable people: sincere, honest, understanding, loyal, truthful, trustworthy, intelligent, dependable, thoughtful, considerate, reliable, warm, kind, friendly, happy, unselfish, humorous, responsible, cheerful, and trustful. Developing or improving any of the likeability characteristics should help one's social standing.

Although ADHD certainly brings unique challenges to social relationships, information and resources are available to help adults with ADHD improve their social skills. Most of this information is based upon sound clinical practice and research on social skills and ADHD in children and adolescents; there is a great need for more research on social skills and ADHD in adults. Seek help through reading, counseling, or coaching and, above all, build and maintain social connections.

# data[].attributes.attachment_link.description
Individuals with ADHD exhibit behavior that is often seen as impulsive, disorganized, aggressive, overly sensitive, intense, emotional, or disruptive. Their social interactions with others in their social environment - parents, siblings, teachers, friends, co-workers, spouses/partners - are often filled with misunderstanding and mis-communication. Those with ADHD have a decreased ability to self-regulate their actions and...

# data[].attributes.attachment_link.readable_text
ADHD can make it hard for people to focus and pay attention. But it affects more than just school or work. ADHD can affect social skills, too.

Here are five common social challenges people with ADHD may face - and ways you can help.

1. Trouble picking up on social cues

The ADHD link: People with ADHD might not notice how their behavior affects other people. They may interrupt a lot and even bug people by breaking social rules.

2. Trouble keeping friends

The ADHD link: ADHD can make it hard to manage emotions. People with ADHD may lash out when they're upset. Or they may have meltdowns at an age when it's no longer appropriate.

About the author

About the author

Amanda Morin is the author of "The Everything Parent's Guide to Special Education" and the former director of thought leadership at Understood. As an expert and writer, she helped build Understood from its earliest days.

Reviewed by

Reviewed by

Bob Cunningham, EdM serves as executive director of learning development at Understood.

Tell us what interests you

# data[].attributes.attachment_link.description
People with ADHD often struggle in social situations. Here are five examples how ADHD impacts social skills and behavior, and how you can help.

# data[].attributes.headline
How to Improve Social Skills in Children With ADHD

# data[].attributes.subject
How to Improve Social Skills in Children With ADHD

# data[].attributes.attachment_link.readable_text
Having positive peer relationships and friendships is important for all children. Unfortunately, many kids with attention deficit hyperactivity disorder ( ADHD) have a hard time making and keeping friends and being accepted within the larger peer group. The impulsiveness, hyperactivity, and inattention associated with ADHD can wreak havoc on a child's attempts to connect with others in positive ways.﻿﻿

Not being accepted by one's peer group, feeling isolated, different, unlikeable and alone-this is perhaps the most painful aspect of ADHD-related impairments and these experiences carry long-lasting effects. Positive connections with others are so important. Though kids with ADHD desperately want to make friends and be liked by the group, they often just don't know how. The good news is that you can help your child develop these social skills and competencies.

Increasing Your Child's Social Awareness

Research finds that children with ADHD tend to be extremely poor monitors of their own social behavior.﻿﻿ They often do not have a clear understanding or awareness of social situations and the reactions they provoke in others. They may feel that an interaction with a peer went well, for example, when it clearly did not. ADHD-related difficulties can result in weaknesses in this ability to accurately assess or "read" a social situation, self-evaluate, self-monitor, and adjust as necessary. These skills must be taught directly to your child.

Teach Skills Directly and Practice, Practice, Practice

Children with ADHD tend to have a hard time learning from past experiences. They often react without thinking through consequences.﻿﻿ One way to help these kids is to provide immediate and frequent feedback about inappropriate behavior or social miscues. Role-playing can be very helpful to teach, model, and practice positive social skills, as well as ways to respond to challenging situations like teasing.

Many kids with ADHD have difficulty with the basics, like starting and maintaining a conversation or interacting with another person in a reciprocal manner (for example, listening, asking about the other child's ideas or feelings, taking turns in the conversation, or showing interest in the other child), negotiating and resolving conflicts as they arise, sharing, maintaining personal space, and even speaking in a normal tone of voice that isn't too loud.﻿﻿

Clearly identify and give information to your child about social rules and the behaviors you want to see. Practice these prosocial skills again and again and again. Shape positive behaviors with immediate rewards.﻿﻿

Create Opportunities for Friendship Development

For preschool and elementary school-age children, play dates provide a wonderful opportunity for parents to coach and model positive peer interactions for their child and for the child to practice these new skills.﻿﻿ Set up these playtimes between your child and one or two friends at a time-rather than a group of friends. Structure the playtime so that your child can be most successful.

As a child gets older, peer relationships and friendships are often more complicated, but it is equally important for you to continue to be involved and to facilitate positive peer interactions. The middle school and high school years can be brutal for a child who struggles socially. Even if a child remains unaccepted by the peer group at large, having at least one good friend during these years can often protect the child from the full-on negative effects of ostracism by the peer group.

Research and get involved in groups in your community that foster positive peer relationships and social skills development like Boy Scouts, Indian Guides, Girl Scouts, Girls on the Run, sports teams, etc. Make sure the group leaders or coaches are familiar with ADHD and can create a supportive and positive environment for learning prosocial skills.

Communicate with the school, coaches, and neighborhood parents so you know what is going on with your child and with whom your child is spending time. A child's peer group and the characteristics of this group have a strong influence on the individuals within the group.

Work With the School to Improve Peer Status

Once a child is labeled by their peer group in a negative way because of social skill deficits, it can be very hard to dispel this reputation. In fact, having a negative reputation is perhaps one of the largest obstacles your child may have to overcome socially.

Studies have found that the negative peer status of children with ADHD is often already established by early-to-middle elementary school years and this reputation can stick with the child even as they begin to make positive changes in social skills. For this reason, it can be helpful for parents to work with their child's teachers, coaches, etc. to try to address these reputational effects.

Young children often look to their teacher when forming social preferences about their peers. A teacher's warmth, patience, acceptance, and gentle redirection can serve as a model for the peer group and have some effect on a child's social status.

When a child has experienced failures in the classroom, it becomes even more and more important for the child's teacher to consciously find ways to draw positive attention to that child. One way to do this is to assign the child special tasks and responsibilities in the presence of the other children in the classroom.

Make sure these are responsibilities in which your child can experience success and develop better feelings of self-worth and acceptance within the classroom. Doing this also provides opportunities for the peer group to view your child in a positive light and may help to stop the group process of peer rejection. Pairing the child up with a compassionate "buddy" within the classroom can also help facilitate social acceptance.

Collaborate with your child's teacher to make sure the classroom environment is as " ADHD-friendly" as possible so that your child is better able to manage ADHD symptoms. Work together with the teacher (and coach or another adult caregiver) on effective behavior management approaches, as well as social skills training.

Medication, when appropriate, is often helpful in reducing the negative behaviors that peers find off-putting.﻿﻿ If your child is on medication to help manage symptoms of ADHD, be sure to work closely and collaboratively with your child's doctor. In order for the medication to provide the optimal benefit that it can in helping to manage the core ADHD symptoms, there is often an ongoing need to monitor, fine-tune, and make adjustments along the way.

# data[].attributes.attachment_link.title
Negative ADHD Behaviors Can Impact the Social Skills of Children

# data[].attributes.attachment_link.description
Having positive peer relationships and friendships is important for all children. Unfortunately, many kids with attention deficit hyperactivity disorder ( ADHD) have a hard time making and keeping friends and being accepted within the larger peer group.

# data[].attributes.headline
ADHD in Children: Symptoms and Treatment

# data[].attributes.subject
ADHD in Children: Symptoms and Treatment

# data[].attributes.attachment_link.readable_text
ADHD can create a number of challenges for kids who live with the condition. Parents can help by learning more about these challenges and ensuring that their kids get the treatment and support that they need to cope.

This article discusses what it is like for kids with ADHD, including the challenges they face and the effects on their lives. It also covers some of the steps you can take to help and support your child.

Challenges for Kids With ADHD

In general, young children tend to be active, rambunctious, and impulsive. They often play loudly and love to climb and run. They squirm and fidget and love to be up and out, exploring the world around them. It is not unusual for kids to have trouble listening, remembering, and following directions. This is all a normal part of being a child.

For a child with attention-deficit/hyperactivity disorder (ADHD), however, normal childhood behaviors and challenges are amplified. The symptoms of ADHD are pervasive, chronic, and disruptive, and they cause significant problems for the child at school, at home, and with friends.

Children with ADHD can become frustrated and overwhelmed very easily. They have trouble regulating their emotions and struggle with executive function issues. They may, for example, have great difficulty:

Planning

Prioritizing

Paying attention

Remembering details

They also tend to be less mature developmentally. Some children with ADHD are very charismatic, personable, and popular. For many others, however, behavior problems result in rejection, isolation, and plunging self-esteem.

Recap

The symptoms of ADHD can make it more difficult for kids to pay attention, sit still, and manage their emotions. The effects on a child's life can vary but may result in behavior problems and peer rejection.

ADHD in Children

About 9.4% of children ages two to 17 in the United States have ever been diagnosed with ADHD, according to information from the 2016 National Survey of Children's Health. The median age of ADHD diagnosis in children is seven years old.

According to the American Academy of Pediatrics (AAP), it's difficult to diagnose a child younger than four years old with ADHD because of how quickly they change.

There are three subtypes of ADHD, and each has corresponding symptoms. For a diagnosis, symptoms must be present for at least six months, disruptive, and inappropriate for the child’s developmental level. In other words, the impairments are far greater than in other children of the same age.

Inattentive: Difficulty paying attention and finishing tasks, easily distracted, forgetful, disorganized, doesn't appear to be listening when spoken to

Hyperactive/impulsive: Difficulty sitting still and waiting for their turn, excessive talking and interrupting, difficulty staying in seat

Combined: Symptoms of both inattentive and hyperactive/impulsive types

Combined type is the most common form of ADHD, while hyperactive/impulsive is the least common. Hyperactivity tends to subside as a child gets older.

The likelihood of being diagnosed with ADHD is greater for boys than girls. However, this could be because girls more commonly have the inattentive type of ADHD, which can be harder to notice, while boys more commonly exhibit hyperactive/impulsive symptoms.

ADHD Symptoms In Kids

Difficulty paying attention to detail

Dislikes tasks that take a long time to finish

Easily distracted

Interrupts others

Not listening

Talks out of turn

Trouble following directions

Trouble sitting still

Effects of ADHD in Kids

It can be tough living with ADHD. Children may experience a broad spectrum of emotions, including:

Confusion

Disconnection

Feeling lost

Feeling out of control

Feeling overwhelmed

Frustration

Restlessness

Children with ADHD are often labeled with inaccurate, negative terms. They may begin to feel like “the bad kid” or “lazy” or “dumb” when this is not true at all.

Living with ADHD can mean challenges for children in all areas of their life. It is hard for them to cope with their big feelings and lack of executive function, and they face difficult consequences.

School: Inattentive behaviors can result in difficulty finishing schoolwork, while hyperactive behaviors can disrupt classroom activity and lead to disciplinary actions.

Relationships: Children with ADHD can experience struggles in their peer relationships and friendships.

Development: ADHD is classified as a neurodevelopmental disorder, and children with it exhibit developmental delays.

A 2013 study published in Frontiers in Human Neuroscience examined cognitive performance (attention, timing, impulsivity, and hyperactivity) in a group of children ages six to 11. It found that those with ADHD were mostly comparable to those without the disorder who were one to three years younger, except for hyperactivity, in which the gap was wider.

Effects of ADHD Medication

Stimulant medications are most commonly prescribed for ADHD. While these can be helpful in reducing ADHD symptoms, they may also come with side effects, including:

Anxiety

Decreased appetite

Headache

Irritability

Sleep disturbances

Stomachache

Common side effects of non-stimulants, which may be prescribed if a child is not tolerating a stimulant, can vary depending on the medication. The first non-stimulant to be approved for the treatment of ADHD was Strattera (atomoxetine). Common side effects of Strattera in children and adolescents include:

Abdominal pain

Decreased appetite

Fatigue

Nausea

Somnolence

Vomiting

If your child's doctor has prescribed medication, they will monitor how it is affecting your child. They will look for a medication regimen that is effective and doesn't produce uncomfortable side effects. For example, if a stimulant medication is making it difficult for a child to sleep, their doctor may change the dosage of the stimulant or prescribe a non-stimulant medication instead.

Behavioral interventions, specifically parent training behavior management, are recommended as a first-line treatment in children ages four and five. These children may be too young for medication; the effects of some ADHD medications on developing brains are poorly understood.

The Importance of Understanding ADHD

It can be empowering when a child understands more about ADHD, what it is and is not, and how it affects them. With understanding, they can work with parents and teachers to develop coping strategies and to find their areas of strength and build upon them.

When children see themselves as having both challenges and strengths and receive support and recognition, self-esteem grows. Instead of seeing themselves as damaged, they can see themselves in a more positive, capable, and accurate light.

Similar Conditions

Some conditions have similar symptoms to ADHD, such as bipolar disorder. This can get in the way of a proper diagnosis and, therefore, proper treatment. It's important for ADHD to be distinguished from conditions including:

Anxiety

Depression

Learning disabilities

Autism

Seizures

Sleep disorders

Myths

Myths about ADHD also may create an obstacle to treatment and be detrimental to a child's self-esteem. These include believing:

A child is too young to have ADHD.

It's not a real condition.

It only occurs in boys.

The child's behavior is the parents' fault.

The child will outgrow it.

The symptoms are just a form of laziness.

Stigma

Another potential obstacle to treatment adherence and the well-being of children diagnosed with ADHD is the stigma that surrounds it. Skepticism regarding diagnosis and symptoms, along with negative perceptions about medication, have contributed to this stigma.

Both adults and peers have been found to stigmatize children with ADHD in different ways. A 2020 review in The ADHD Report summarized that peers perceived their classmates with ADHD to be more violent, more likely to get in trouble, and less caring than others. Teachers perceived their academic performance more negatively, and parents' internalized stigma played out in criticism and irritability.

Recap

Factors including misdiagnosis, common myths about ADHD, as well as the stigma surrounding the condition can also present challenges for kids with ADHD.

How You Can Help

If you are a parent or caretaker of a child with ADHD, there are steps you can take to help them manage their condition and reduce frustration for everyone. Learn as much as you can about ADHD. Work with their teacher and other school personnel to make sure they have the accommodations they need to succeed. At home, focus on:

Clear communication: Provide clear directions when communicating with them.

Organization: Help your child stay organized by keeping their things in consistent places.

Positivity: Encourage and support your child in the areas where they show strength and help them recognize their abilities in themselves.

Structure and routine: Stick to a regular schedule and create predictable routines.

Rewards: Ensure they know when they're doing the right thing. Praise them or offer rewards.

Parent training may be a part of behavior therapy treatment for your child if they are younger than 12 years old. This training teaches parents skills they can use to help improve a child's behavior.

A Word From Verywell

ADHD is the most common behavioral disorder in children. With proper treatment, however, symptoms can be managed.

It's also important to remember that children with ADHD have strengths and positive attributes that should be celebrated. Some characteristics, like being more high-energy, can be an asset and help them in life and certain professional settings.

To improve your child's quality of life, recognize their strengths, dispel myths, and help them get the treatment and accommodations they need. Along with your love and support, this will help provide an environment for them to succeed.

Frequently Asked Questions

How do you help kids with ADHD?

Professional diagnosis and treatment are the first steps toward helping a kid with ADHD, but there are also other strategies you can use to support your child. Provide consistent structure and routine. Try to stick to the same schedule as much as possible. Also, remember that it may take some time for your child to adjust to any new interventions, so focus on being patient and supportive as your child adjusts.

How do you teach kids with ADHD?

Because kids with ADHD have a harder time with attention, try to keep lessons brief and be creative in your teaching methods. Incorporate visual displays, hands-on activities, and games. This will help to prevent them from becoming overwhelmed or bored. Encouragement and positive reinforcement are essential and can help you child feel good about themselves and their learning experience.

How do you discipline kids with ADHD?

While every child is different, remember that kids with ADHD benefit from having clear rules and expectations. Be consistent about enforcing these rules and rely on positive reinforcement rather than punishment. Work on breaking tasks down into more manageable steps and try to be understanding, patient, and flexible. Giving your child plenty of chances for physical activity can also help them manage excess energy and improve behavior and attention.

# data[].attributes.attachment_link.title
Understand What It’s Like for Children With ADHD

# data[].attributes.attachment_link.description
Kids with ADHD often face a number of challenges. Learn more about what ADHD is like for kids and explore ideas for making their life easier.

# data[].attributes.headline
Abandon Your Pre-Conceived Notions of ‘Success’ (and More Advice for Parents of Teens with ADHD)

# data[].attributes.subject
Abandon Your Pre-Conceived Notions of ‘Success’ (and More Advice for Parents of Teens with ADHD)

# data[].attributes.attachment_link.readable_text
Watching teens with ADHD transition to adulthood is not for the faint of heart.

When our children are younger, our energy is spent on behavior - helping them manage outbursts, make friends, and take responsibility for chores and schoolwork. But when our kids with ADHD hit high school, we experience a marked shift in focus and priorities.

We turn our attention to their inevitable launch - leaving the nest and independently building the life they want. We become increasingly preoccupied by unknowns. Will they be ready? What will they do? How will they manage? What if, what if, what if...?

All of this worry likely contributes to our kids' stress and holds them back from becoming resilient, independent adults. From adjusting our expectations to focusing on better relationships, here's what parents can do to better empower their teens with ADHD.

The Transition to Adulthood: 3 Key Steps for Parents

Revisit Our Ideas About Success

Our ideas about what a successful future "should" look like can present real barriers to our children. Dan B. Peters, Ph.D., a psychologist and the executive director of the California-based Summit Center, says parents need to recognize that kids with learning and attention issues are living on their own timeline, and balance that awareness with our own goals for them.
[Click to Read: Your Teen's Brain - and How to Unleash Its Superpowers]
"Our differently wired kids need time to grow, and to recover from whatever terrible schooling or social experiences they have had," Peters says. "Those experiences affect their development, attention, focus, and executive functioning. And so we want to take a step back and ask, How are we going to approach our teen's launch?"

Our ideas about success are a legacy handed down from our parents and even theirs. Until we stop the cycle and reconcile our own vision of success with our teen's ideas, we'll impose a similar stamp on our kids. They'll respond, react, and rebel accordingly.

Any time we stumble on a premise that feels like a "has to happen," we should take a closer look at that belief. Is it true that the only way my child will be happy is if she attends a four-year college? Am I certain my daughter needs to get a part-time job to be able to live independently? When we question our own fears, our kids will be freer to discover what's right for them.

Invest in Our Relationships

Teens are wired to prioritize relationships with peers, but they still crave (and need) connection with us. Dr. John Duffy, author of Parenting the New Teen in the Age of Anxiety (#CommissionsEarned) , describes investing in our relationships with our kids as the key to keeping our joint "emotional bank account" in the black. We want our teens to feel safe sharing their dreams and fears with us.
[Have a Teen with ADHD? Encourage Communication & Avoid the Drama - Here's How]
We can do this by showing our curiosity and respect, and by letting our kids know we believe in them. We want our teens to feel seen and known by us. And we want to see and know our teens. Instead of imposing our goals on our children, we should help them discover and invest in their own. Some ideas for connecting with your teen include:

Make time for walks and talks. Get out for walks (or bike rides) to create screen-free opportunities for conversation. Don't feel the need to fill the silence or have an agenda - this is about creating the space for connection. If your child does start talking, ask open-ended questions. Use the phrase "Tell me more..." to keep things going, and take pauses (count to five) when she's done speaking rather than jumping right in.

Instead of praise, ask about process. Praising or rewarding accomplishments may feel like the right move, but doing so can foster division, as well as send the message that we value accomplishments over who they are. Instead, ask your teen about the inspiration behind their accomplishments (What inspired your painting?).

Stay calm, no matter what. If we want our kids to trust us with the big, difficult stuff, they need to know we can handle whatever they've got to share. Don't react externally when they tell you something that sets off your internal alarms. Listen, nod, and remain calm in the moment. Then, get the support you need afterward to process, and circle back with your child when you can do so with a clear head.

Respect before all. Part of having a deep connection with your teen is respecting their budding independence and agency. It can be hard to retrain ourselves, especially if we've spent much of a child's early years acting as his frontal lobe. Feeling respected and capable is key if your goal is for your child to be self-motivated.

Help Our Kids Engage Authentically with Life

These days, teens feel pressured to do and be everything, and to take advantage of every opportunity. They know they need a passion to stand out on college applications or build a foundation for the future. They worry when they don't have one. Yet research shows that this focus on "passion" misses the mark, and it may be a stumbling block to our kids' realizing their potential.

Instead of pushing our teens to identify a passion, we want to help them engage with their own lives. We do this by showing interest in their interests, by noticing what sparks them, and by encouraging their exploration of ideas from different angles without trying to shape their experience. Doing so helps them become self-aware and feel empowered to make the best choices for themselves.

"If they can do that in a healthy way," Peters says, "I don't think it matters which direction they go, because they're building essential ingredients to health and wellness - the knowledge that they have choice and that they can cope when things don't go their way."

And that they can count on and reach out to us for help when they need it.

The Transition to Adulthood: Next Steps

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication

# data[].attributes.attachment_link.title
Abandon Your Pre-Conceived Notions of 'Success' (and More Advice for Parents of Teens with ADHD)

# data[].attributes.attachment_link.description
The transition to adulthood is a roller-coaster ride - for teens and their parents, too. We worry incessantly about their future, and never know when to intervene or pull back. Here, learn how parents can strike a balance that actually empowers their teens.

# data[].attributes.attachment_link.readable_text
By Rae Jacobson, MS

"ADHD is just about being hyper." "It's something only boys have."

These are two of the many myths about ADHD. There's some kernel of truth behind them, though: Even though boys and girls are just as likely to have ADHD, boys are more likely than girls to be diagnosed with ADHD.

The reason is that boys often have hyperactivity as a symptom - more so than girls. And hyperactivity can be easier to notice than other ADHD symptoms.

Boys with ADHD often get called out or criticized for their hyperactive and impulsive behavior. They may get into trouble a lot at home and at school. And their behavior can turn off other kids and make it hard to fit in socially.

Every child with ADHD is unique. There are lots of boys with ADHD who struggle with other ADHD challenges, like trouble focusing. But in many cases, the experience of ADHD for boys can be very different from the experience for girls.

Dive deeper

# data[].attributes.attachment_link.description
"ADHD is just about being hyper." "It's something only boys have." These are two of the many myths about ADHD. There's some kernel of truth behind them, though: Even though boys and girls are just as likely to have ADHD, boys are more likely than girls to be diagnosed with ADHD.

# data[].attributes.attachment_link.readable_text
DO YOU HAVE A QUESTION FOR RYAN WEXELBLATT?
Ask your question about ADHD in boys here!

1. Difficulty with Self-Directed Talk

"We all have an internal dialog in our heads that we use to talk to ourselves. When someone has ADHD, they are not always hearing that internal dialog or 'brain coach.' When your brain works with ADHD, the volume on your brain coach is turned down too low. The self-directed talk is there; they just aren't hearing it very well."

2. Hyperfocusing on Things That Are Interesting and Difficulty Sustaining Attention on Things That Are Not

"Parents say to me, 'How do I help my son concentrate better?' I have never found anything that works for this other than medication and helping kids develop their self-directed dialog, and that's a long process. If your son tends to hyperfocus on things that are interesting to him, that could help him become very successful in life."

3. Weak Episodic Memory

"Kids with ADHD have difficulty remembering past experiences and the emotions associated with those past experiences. If you've explained something to your son, and he says he doesn't remember how to do it, that may be true."

4. Poor Future Thinking Skills

"People with ADHD have difficulty visualizing things in the future because they tend to live in the present. If you've ever said to your son, 'If you do your homework every night this week, you can have a reward on Friday night,' and it didn't work, it was because the reward was too far in the future."

5. Difficulty Sensing the Passage of Time

"People with ADHD have difficulty feeling time as a concrete concept. Often, they will spend more time arguing about a task than it would actually take to do the task because they have difficult conceptualizing how much time is required."

6. Inconsistent Situational Awareness

"I can situational awareness 'reading the field' with kids. This is how we take different pieces of information from our environment, put them together as a whole, and make meaning from them. If someone has difficulty understanding the bigger picture because they focus on the small details, they will likely have difficulty with situational awareness."

7. Poor Perspective Taking Skills

"If your son has trouble reading social cues, it means he really has trouble with perspective taking - understanding other's thoughts and feelings, and understanding how he comes across to others. It's not that your son lacks empathy; it's that he lacks perspective taking skills."

8. Trouble Putting Problem Size in a Relevant Context

"This is why kids with ADHD may over-react or under-react to the size of the problem."

9. Difficulty with Unexpected Change

"When they have to do something like get off video games to start homework, that is really challenging because they are going from a preferred task to an non-preferred task without time to prepare for that."

10. Rejection Sensitive Dysphoria

"People with ADHD have a propensity to react strongly to perceived or actual rejection. People with ADHD tend to live in big emotions and have a strong reaction to received rejection. The opposite of this is Recognition Response Euphoria. People with ADHD tend to be very responsive to praise and recognition when it is purposeful and helps a child recognize their strengths in themselves - not when it is empty. Give your son recognition for things that require effort."

WATCH THE VIDEO BELOW FOR SOLUTIONS FOR PARENTS OF ADHD BOYS

ADHD in Boys: More Resources

1. Read This: Inside the Mind of a Teenage Boy with ADHD
2. Read This: How Do I Get My Son to Branch Out Beyond Video Games?
3. Read This: When ADHD and Puberty Collide in Boys
Ryan Wexelblatt, LCSW is the facilitator of the ADHD Dude Facebook Group and YouTube channel. Submit your questions about ADHD in boys here!

# data[].attributes.attachment_link.title
The Top 10 Manifestations of ADHD in Boys

# data[].attributes.attachment_link.description
DO YOU HAVE A QUESTION FOR RYAN WEXELBLATT? Ask your question about ADHD in boys here! "We all have an internal dialog in our heads that we use to talk to ourselves. When someone has ADHD, they are not always hearing that internal dialog or 'brain coach.'

# data[].attributes.attachment_link.readable_text
Attention Magazine April 2022
What comes to mind when you think of a boy with ADHD? One who is impulsive, blurts out answers in school, fidgets, and seems to be in constant motion? This was my viewpoint, until my son was diagnosed with inattentive ADHD. Parenting a child with this type of ADHD forced me to change my perception of what I thought I knew about the disorder.

ADHD was initially defined based on observations of hyperactive behavior in boys. In the 1845 children's book Struwwelpeter, German psychiatrist Heinrich Hoffmann described Fidgety Philip, a boy who had trouble listening, paying attention, could not sit still, and made a mess. Unfortunately, this perception of a child with ADHD has changed little, even over the past several decades. Boys are three times more likely to be diagnosed with ADHD due to the presence of hyperactive and impulsive behaviors, compared to girls, who predominantly display symptoms of inattention.

There is more to ADHD than just hyperactive little boys, however. My husband and I were fortunate that my son's second grade teacher recognized his ADHD, since her older son had been diagnosed with inattentive-type ADHD.

According to the National Institute of Mental Health, this type of ADHD is less likely to be diagnosed and treated. The primary resource used by mental health professionals for classifying and diagnosing mental disorders is the Diagnostic and Statistical Manual of Mental Disorders. In the most recent edition-published by the American Psychiatric Association in 2013 and referred to as the DSM-5-the criteria for diagnosing ADHD was modified to identify the inattentive subtype with more accuracy. Previously, for example, the diagnostic criteria for ADHD required that symptoms be present in the child by age seven; however, the onset of inattentive-type ADHD symptoms may not be evident until ages nine to eleven.

Since the symptoms of inattention, disorganization, and forgetfulness only affect the child, children with the inattentive subtype of ADHD continue to fly under the radar at school and are often labelled as lazy or apathetic. According to a 2016 report from the US Centers for Disease Control and Prevention, nine out of ten children with ADHD received classroom accommodations in school. However, most children with ADHD are not in special education programs and their teachers may know little about ADHD behaviors. My son has been pigeonholed as lazy and uninterested by some teachers based on their misunderstanding of his inattentive ADHD symptoms. Thankfully, he has also been understood by just as many teachers.

Filling the information gaps
Parenting a child with inattentive ADHD is no small task. A Consumer Reports survey of 934 parents of children diagnosed with ADHD found more than half of the parents did not have a clear understanding of their child's strengths and weaknesses; nor did they have a plan for managing their child's behavioral problems. Despite having a PhD in pharmacology and studying ADHD medications, my background as a scientist did not prepare me to handle the challenges of being a mom to a son diagnosed with inattentive ADHD-which usually affects girls, or so I thought. When searching for books to help me as a parent, I discovered that the current literature falls short of discussing inattentive ADHD in boys.

The combination of finding insufficient available information and witnessing my own son's difficulties motivated me to write Andrew's Awesome Adventures with His ADHD Brain: Helping Children and Parents to Understand Inattentive-Type ADHD, to educate both children and adults about the often-overlooked subtype. The book shares my son's challenging, humorous, emotional, and creative experiences with ADHD, and my experiences as someone in the trenches helping my son to manage his ADHD.

For example, there have been countless times I have begun a sentence with the words "Why can't you just" when speaking to my son about a task he is supposed to complete: Why can't you just clean your room... start your homework... study for your test... put your bike away? Before I understood my son's ADHD, it never occurred to me that he couldn't just get things done. It was not a question of understanding what needed to be done or being defiant; he has difficulty focusing on disliked and mundane tasks, like cleaning up his room or doing his homework.

I need to remind myself often that ADHD is a neurobiological disorder, and that my son is not choosing to fail classes in school, be disorganized, or have uncontrollable emotional outbursts. I am continually learning to work with my son's ADHD brain to help him to be successful. The strategies for completing homework, staying organized, and remembering to do important tasks all need to include his input because what works for my neurotypical brain does not work for his ADHD brain.

Since my son's inattentive ADHD is not outwardly apparent, advocating for him and teaching him to advocate for himself is one of my most important jobs as a parent. Inspired by the story of a father who would send letters to his son's teachers to explain the boy's learning disability, I email my son's teachers at the beginning of each semester detailing his ADHD, his weaknesses, and, most importantly, his strengths. I was pleasantly surprised that the reaction from many of his teachers over the years was positive; they were grateful for parental communication and support.

Find strengths and embrace the positives
I know my son's performance does not always reflect his capabilities. Kids with ADHD are often singled out for their inabilities and not their extraordinary abilities. To help my son be successful, I have tried to steer him in a direction related to his passion: space travel and technology. This seems like a logical plan-encourage your child's interests-but it is critical for kids with ADHD. Despite their struggle to focus on mundane tasks, kids with ADHD can focus intensely on something they are interested in, almost to the point of obsession. Hyperfocus is truly a gift of having ADHD, enabling your child to become an expert at something and boosting his or her confidence despite daily struggles with the negative symptoms of ADHD. For my son, it is his relentless learning about anything related to outer space and space travel.

The combination of my son's innovative ADHD brain and his passion for learning about space technologies led him to be selected as a national finalist in an essay contest about traveling to Mars. In the fall, he will attend a small university that focuses on aviation and aerospace. It will be difficult for me to step back when he goes to college and let him learn to fail and advocate for himself. But I can breathe a little easier knowing my son will be in an environment where he is most likely to thrive.

There are other positive characteristics associated with having ADHD. Although my son describes his ADHD brain as an overstuffed garbage can with a lid that does not stay on and things falling out all over the floor, his diffuse attention allows him to be a creative problem-solver who rises to a challenge. He will dive headfirst into the unknown, and neither the magnitude of a challenge nor a lack of experience stop him. I truly admire my son's bold action. Interestingly, some characteristics of ADHD-hyperfocus, outside-the-box thinking, and risk taking-are known characteristics of entrepreneurs. ADHD does not have to limit our kids, but instead they can have limitless possibilities.

According to the CDC and the National Center for Health Statistics, approximately sixty percent of children with ADHD will have ADHD as adults, so there is a good chance your child is not going to grow out of their ADHD. In fact, the DSM-5 included criteria for diagnosing ADHD in adulthood. This is my son's life; he will always have ADHD, and over the past nine years I had to learn to embrace the creative and unique way his mind works and help him navigate through the negative symptoms of his ADHD.

It is time to pay more attention to inattention and not overlook the quiet, daydreaming, forgetful child who stuffs worksheets in his or her desk, has a messy room, and cannot remember to turn in school assignments on time. It's also time to understand that ADHD is not simply negative symptoms that need to be treated, but can include creative thinking, hyperfocus, and unique problem-solving skills. Some days it is a monumental task to keep everything in perspective, especially when I am being tuned out as he plays a computer game, homework is not being turned in, and it looks like a bomb exploded in his bedroom-although a flutter of excitement goes through me when I see he has put his socks in the hamper.

Kristin Wilcox holds a PhD in pharmacology from the University of Mississippi Medical Center. She has spent over twenty years in the field of behavioral pharmacology studying drugs of abuse and ADHD medications at Emory University and John Hopkins University School of Medicine. She has authored several manuscripts published in peer-reviewed scientific journals. Currently, Dr. Wilcox serves on the executive board of the Inattentive ADHD Coalition, hoping to increase awareness and understanding of the inattentive subtype of ADHD. She lives in Maryland with her husband and is a mom to two sons, one with inattentive-type ADHD. Andrew's Adventures with His ADHD Brain: Helping Children and Parents to Understand Inattentive-Type ADHD is her first book.

REFERENCES

Applegate B, Lahey BB, Hart EL, Biederman J, Hynd GW, Barkley RA, Ollendick T, Frick, PJ, Greenhill L, McBurnett K, Newcorn JH, Kerdyk L, Garfinkel B, Waldman I, Shaffer D. (1997). Validity of the age-of-onset criterion for ADHD: A report from the DSM-IV field trials. Journal of the American Academy of Child and Adolescent Psychiatry 36: 1211-1221.

Danielson ML, Visser SN, Chronis-Tuscano A, DuPaul GJ. (2018). A national description of treatment among US children and adolescents with ADHD. Journal of Pediatrics 192: 240-246.

Hoffmann H. (1995). Struwwelpeter in English Translation Mineola, NY: Dover Publications.

# data[].attributes.attachment_link.description
What comes to mind when you think of a boy with ADHD? One who is impulsive, blurts out answers in school, fidgets, and seems to be in constant motion? This was my viewpoint, until my son was diagnosed with inattentive ADHD. Parenting a child with this type of ADHD forced me to change my perception...

# data[].attributes.headline
20 Classroom Accommodations That Target Common ADHD Challenges

# data[].attributes.subject
20 Classroom Accommodations That Target Common ADHD Challenges

# data[].attributes.attachment_link.readable_text
The best IEP is the one with accommodations designed for your child's very specific symptoms. Here are some of our favorite solutions for addressing common ADHD challenges at school.

A bored and unmotivated ADHD child needs encouragement to succeed in school.

Students with ADHD often benefit from special ADHD accommodations established by teachers and parents who spend thoughtful time pinpointing problematic ADHD symptoms, and then devising classroom accommodations that help solve those problems.

Following is a list of common challenges faced by students with ADHD, and the accommodations that can help bring success at school.
[Quiz: How Well Do You Know Special-Ed Law?]
Classroom Setup

Assignments
[The 10 Biggest Lies About Learning Disabilities]
Distractibility

If your child: Is unable to keep up during classroom discussions and/or note taking
Try: Providing peer assistance in note taking and ask student questions to encourage participation in discussions
[Free Guide: 40 Best Accommodations for Children with ADHD or LD]
Behavior

If your child: Is constantly engaging in attention-getting behavior
Try: Ignoring minor inappropriate behavior

If your child: Fails to "see the point" of a lesson or activity
Try: Increasing immediacy of rewards and consequences

If your child: Needs reinforcement
Try: Sending daily/weekly progress reports home

Organization/Planning

If your child: Can't keep track of papers
Try: Recommending binders with dividers and folders

Moods/Socialization

If your child: Does not work well with others
Try: Encouraging cooperative learning tasks

If your child: Appears lonely or withdrawn
Try: Encouraging social interactions with classmates; plan teacher-directed group activities

# data[].attributes.attachment_link.title
20 Classroom Accommodations That Target Common ADHD Challenges

# data[].attributes.attachment_link.description
The best IEP is the one with accommodations designed for your child's very specific symptoms. Here are some of our favorite solutions for addressing common ADHD challenges at school.

# data[].attributes.headline
Preparing for the Road Ahead: Teens and the Transition to Adulthood

# data[].attributes.subject
Preparing for the Road Ahead: Teens and the Transition to Adulthood

# data[].attributes.attachment_link.readable_text
Few stages in the life of a child are more crucial than the transition between adolescence and young adulthood. Wes Crenshaw, PhD, has spent his career working next door to a major midwestern university and a few miles down the road from one of the largest and best junior colleges in America. Specializing in teen and young adult psychotherapy, he's worked thousands of hours with kids who have ADHD and has learned a lot about how they can succeed and how they can fail on the path to a better tomorrow.

What is a parent to do?
Fear not, Dr. Crenshaw says. Despite this grim picture, all is not lost. Regardless of which category your teen fits into, the solution is hope.

Keep reading Young ADDulthood: Preparing Late Teens for the Road Ahead by Dr. Crenshaw in Attention magazine for what you can do to help your teen prepare for adulthood.

The late teens years are a time of preparation and transition as young people move into adulthood. The road isn't always smooth, especially for teens affected by ADHD.

# data[].attributes.attachment_link.title
Preparing for the Road Ahead: Teens and the Transition to Adulthood - CHADD

# data[].attributes.attachment_link.description
Join the discussion. Few stages in the life of a child are more crucial than the transition between adolescence and young adulthood. Wes Crenshaw, PhD, has spent his career working next door to a major midwestern university and a few miles down the road from one of the largest and best junior colleges in America....

# data[].attributes.headline
Emotional and Mental Wellness for Families

# data[].attributes.subject
Emotional and Mental Wellness for Families

# data[].attributes.headline
Attention Deficit Disorder Association (ADDA)

# data[].attributes.subject
Attention Deficit Disorder Association (ADDA)

# data[].attributes.attachment_link.title
Home - ADDA - Attention Deficit Disorder Association

# data[].attributes.attachment_link.description
Empowering adults with adhd to live their best lives A Different Brain Requires a Different Approach Whether you're newly diagnosed, wondering if you have ADHD, or simply ready to take charge of your life - we're here to help. Have ...

# data[].attributes.attachment_link.description
ADHD symptom tests, ADD medication & treatment, behavior & discipline, school & learning essentials, organization and more information for families and individuals living with attention...

# data[].attributes.attachment_link.title
CHADD - Improving the lives of people affected by ADHD

# data[].attributes.attachment_link.description
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) is the nation’s leading nonprofit organization serving people affected by ADHD.

# data[].attributes.headline
Alexandria CHADD Parent Support Group  4th Mon. of each month at 6:30 pm.  Contact:  Susan,  ADHDParentMountVernon@gmail.com  or call 303-903-9972.

# data[].attributes.subject
Alexandria CHADD Parent Support Group  4th Mon. of each month at 6:30 pm.  Contact:  Susan,  ADHDParentMountVernon@gmail.com  or call 303-903-9972.

# data[].attributes.headline
West Fairfax/Burke CHADD Parent Support Group  1st & 3rd Thur. of each month at 8:00 pm Contact:  Cathy,  ocgreulich@aol.com  

# data[].attributes.subject
West Fairfax/Burke CHADD Parent Support Group  1st & 3rd Thur. of each month at 8:00 pm Contact:  Cathy,  ocgreulich@aol.com  

# data[].attributes.headline
CHADD of Northern Virginia and DC. Support Groups .

# data[].attributes.subject
CHADD of Northern Virginia and DC. Support Groups .

# data[].attributes.body
https://www.meetup.com/novachadd/?_cookie-check=Z8aIETRBRn3LkplJ

# data[].attributes.headline
School accommodations for ADHD and 504 plans

# data[].attributes.subject
School accommodations for ADHD and 504 plans

# data[].attributes.attachment_link.readable_text
Some common school accommodations for ADHD include providing more time to take tests, access to a low distraction environment, and extra help breaking down larger projects.

These accommodations are not special privileges but tools that give all students the same chance of succeeding. They are available to students of all ages, including college students, and depending on location, they may be a legal right.

In the United States, schools may provide plans for how they will accommodate a student's needs. This may be a 504 plan or an individualized education plan (IEP). Some students have both.

Read on to learn more about school accommodations for ADHD, including examples of accommodations that may help with focus, organization, and behavior, as well as the differences between 504 and IEP plans.

Students with ADHD are legally entitled to the least restrictive possible environment. This means that, wherever possible, schools should not remove them from their class.

Beyond this basic requirement, there are additional accommodations schools can make to ensure the class environment is best suited to the student's needs.

For example, a school may:

seat the student away from distractions, such as class pets

provide space or opportunity to move around

limit screen time

display clear visual reminders of the class rules, today's focus, or deadlines

Learn more about ADHD in children.

People with ADHD can experience difficulties with executive function, which is the ability to plan one's actions. For this reason, ongoing communication is also an important form of support for students.

It may help to:

ask students what would be helpful for them

give clear, specific, and direct instructions

give frequent reminders, when it is relevant, of what students need to do

designate one space, either in the classroom or online, where students can find schedules, deadlines, and other important information

communicate clear class expectations and boundaries

provide regular feedback and positive reinforcement

communicate regularly with parents and caregivers

Organizational skills to ADHD management, but what people find helpful can vary.

Some of the ways neurotypical people organize themselves may not be useful for neurodivergent students, so it is important to be open-minded and flexible.

Strategies that may encourage students to find approaches that work for them include:

encouraging the class to keep their own diaries or planners

color-coding schedules or timetables

streamlining the paperwork or number of resources students take home with them

helping students break down a larger project into smaller pieces

using mini deadlines during a bigger assignment

An IEP might also entitle a student to organizational training or classes.

ADHD can make timed exams and assignments more challenging to prepare for and complete. Depending on the student, educators may need to offer accommodations such as:

more flexible due dates

extended test-taking time

testing in a separate, quiet room

A crucial aspect of behavior management for ADHD is understanding what is and is not an ADHD symptom. Punishing people for ADHD symptoms does not help them. It can be a form of disability discrimination.

Schools and teachers need to learn about the condition and the specific ways it affects their students and then find ways to work with them so they can thrive at school.

This might include:

setting clear expectations and boundaries around behavior in the classroom

communicating the consequences of breaking those boundaries and enforcing them consistently

positive reinforcement of helpful behaviors, such as allowing others to take their turn

motivating rewards for reaching medium- or long-term goals

creating a personalized behavior plan

It is also important to note that not all people with ADHD have outward hyperactivity. Those with inattentive ADHD may seem quiet or daydream a lot. Supporting these children is just as important, as quieter students may go unnoticed and unsupported by teachers.

Learn more about inattentive ADHD.

IEP and 504 plans describe how schools will support students with disabilities. However, the two kinds of plans are slightly different.

Section 504 of the Rehabilitation Act, which bans disability-based discrimination in schools that receive federal funding, led to the production of 504 plans. These outline the accommodations that elementary or secondary schools will provide to students in a traditional classroom environment.

IEP plans outline students' access to specialized teaching or other special education services. The stipulations of an IEP typically come from the Individuals with Disabilities in Education Act, and getting one is a more involved process than getting a 504 plan.

Not all students with ADHD require an IEP. Some may only have 504 plans, while others may have both. If a federally funded school refuses to provide accommodations or a 504 plan, they could be breaking the law.

School accommodations for ADHD can include many measures that make learning easier, such as creating a calm, distraction-free environment, using positive reinforcement to manage behavior, and giving extra help with projects and tests.

The goal of these accommodations is to support students in learning skills they may need to flourish and to put them on equal footing with their peers. In the U.S., the right to accommodations or special education services for those with an ADHD diagnosis is protected by law.

Both children and adults in federally funded educational institutions can ask for 504 plans. Some may also benefit from IEPs. It is important to base any accommodations on what works best for the student, as no two people with ADHD are the same.

# data[].attributes.attachment_link.title
School accommodations for ADHD and 504 plans

# data[].attributes.attachment_link.description
School accommodations for ADHD may make it easier to focus, break tasks down, remember deadlines, and to manage behavior. Learn more here.

# data[].attributes.attachment_link.readable_text
Dear Teacher,

In a recent ADDitude survey, less than half of educators said they receive formal training to help them understand and effectively teach students with ADHD and its comorbid conditions. This is unacceptable. So, as a first step, ADDitude has created this guided, curated email learning series to equip educators with accurate, up-to-date information about ADHD, plus realistic and effective solutions to the specific academic and behavioral challenges associated with ADHD in the classroom.

Your training will begin immediately with an introduction to ADHD and executive dysfunction, what these looks like in the classroom, and how a teacher can tranform the learning and happiness of neurodivergent students. Each week, you will receive a new lesson about effective accommodations, common learning differences associated with ADHD, effective teaching strategies for different learners, encouraging consistently positive behavior, and much more...

PART ONE: Understanding ADHD and Executive Function
PART TWO: Accommodations and the Parent Relationship
PART THREE: Learning Challenges
PART FOUR: Focusing and Following Directions
PART FIVE: Better Behavior
PART SIX: Organization and Time Management
PART SEVEN: Addressing Hyperactivity
PART EIGHT: Motivation, Emotions, and Self-Esteem
PART NINE: Homework and Studying
NOTE: This resource is for personal use only.

# data[].attributes.attachment_link.description
This guided newsletter series equips educators with realistic and effective solutions to the specific academic and behavioral challenges associated with ADHD in the classroom while educating them about the sometimes surprising ways ADHD manifests, especially in girls.

# data[].attributes.headline
How Teachers Can Initiate and Promote Inclusive Education

# data[].attributes.subject
How Teachers Can Initiate and Promote Inclusive Education

# data[].attributes.attachment_link.readable_text
Imagine sitting in a class, feeling like you are drowning because you can't keep up with your classmates. You know it's not your fault - you have a different way of processing things - but sinking downward is a horrible feeling all the same.

Now imagine what would happen if your teacher changed their delivery. The next time you walk into class, they draw a mind map on the board to illustrate how certain ideas and concepts link together. Bingo! You understand immediately because you have a clear, visual picture right in front of you.

It feels life changing.

This hypothetical is actually based on something that happened to me when, in my role as a teacher trainer, I suggested one, small change of approach to another teacher. He couldn't believe how easy it had been to make things more accessible for his students with dyslexia.

I see this all the time in my line of work.
[Click to Read: Teaching Strategies for Students with ADHD]
Most teachers go into the profession because they feel a calling. They genuinely want to help, support, and potentially change a young person's life.

And yet, in my role, I am often met with resistance and cries of, "I don't feel qualified to teach someone with special needs," or "That sounds great, but I don't have enough time/energy/knowledge to do this."

What I hear is fear. Fear that if you try and help a student with a learning difference, you could somehow mess it up.

A survey conducted by The ADHD Foundation (2017) found that almost half of teachers polled had not been trained to teach young people with ADHD.

More resources dedicated to teacher training are always welcome, but we can't assume that funding and tools are the all-encompassing solution for 'neurodiverse' students. In my experience, initiative can go a long way toward helping all learners.

First, I recommend that teachers spend just 10 minutes per day - 45 to 50 minutes a week - reading and learning about specific learning differences. I have seen this practice contribute to a significant change in teachers' awareness and perception of their students.

Next, implementing meaningful change for students with learning differences can be quite simple. Changing the background color of boards and handouts, for example, greatly benefits students with dyslexia, who sometimes experience vision changes when looking at black writing on a white background. This practice has now become a permanent change at my school.
[Read: 12 Teacher Strategies to Inspire Listening, Learning, and Self-Control]
The delivery of verbal information is another common and crucial area of potential improvement. A common thread among students with learning differences is poor verbal working memory. This means that their brains are only able to take in so much verbal information before they lose track, and words effectively begin to lose meaning.

Given this, I advise teachers to use short, clear, and concise sentences, and to avoid the passive voice.

The passive voice can sound like this: "The first piece of information that needs to be found is the one that was set for you in last night's homework. It is required that you discuss this with your group."

Many students, learning difference or not, find this language very vague and confusing, which can create immense learner stress. Teachers can reword the same instruction like this: "Talk with the people in your group. Answer these three questions." Accompany and reinforce these prompts with numbered instructions displayed on the board. This approach is clear, literal, and to the point.

Sometimes, I hear teachers say that they don't want to "dumb down" their classes by implementing these simple, effective techniques. This couldn't be further from reality. A learning difference means that a student cannot help the way they process information. These strategies are tools that help them succeed - like eyeglasses to a child with poor vision. We shouldn't withhold them from students with learning differences.

Research also indicates that accommodations for students with learning differences can benefit the rest of the class. I often hear of 'neurotypical' students thanking their teachers for making changes that helped them in unanticipated ways.

Childhood educators, know this - there is nothing to be scared of in pursuing an inclusive environment for your learners. Any change you can make, even just reading up on a learning difference, could have a significantly positive impact on a student's life.

The more often teachers adopt these changes as a permanent part of their practice, the more all students will benefit.

"We will know that inclusive education has really become embedded in our culture when the term becomes obsolete." - From Choosing Outcomes and Accommodations for Children (#CommissionsEarned) by Michael F. Giangreco et.al.

Inclusive Education: Next Steps

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

# data[].attributes.attachment_link.title
"How Teachers Can Initiate and Promote Inclusive Education"

# data[].attributes.attachment_link.description
"Childhood educators, know this - there is nothing to be scared of in pursuing an inclusive environment for your learners. Any change you can make, even just reading up on a learning difference, could have a significantly positive impact on a student's life."

# data[].attributes.headline
The Amazing Advantages of ADHD in the Workplace

# data[].attributes.subject
The Amazing Advantages of ADHD in the Workplace

# data[].attributes.attachment_link.readable_text
Fingerprint For Success (F4S) is a collaboration and performance technology that empowers individuals and teams to achieve amazing things at work and in life. Based on more than 20 years of research, F4S' revolutionary predictive analytics have achieved more than 90% reliability in forecasting personal and team motivations, behaviors, and performance. In 2020, F4S launched the world's first AI Coach 'Marlee' to help users optimize their talents and bring out the best in themselves and their teammates.

What did our study on ADHD in the workplace measure?

From July 2022, we pioneered a global study What are the superpowers of ADHD at work? We wanted to find out whether people who experience ADD/ADHD have distinct motivations or cognitive patterns that drive them at work. F4S surveyed more than 700 people from 71 countries, with a range of respondents from different age brackets (Gen Z, Millennials, Gen X and Baby Boomers).

We aimed to explore how individuals with ADD/ADHD thrive and realize their full potential at work, and to help leaders provide a supportive workplace that embraces and celebrates cognitive diversity.

So, what did we learn?

Overall, what are the advantages of having ADHD?

According to F4S research, having ADHD offers a range of advantages that contribute to workplace success. An ability to hyper-focus on the details, along with an unconventional approach to work problems makes ADHDers born to break ground and innovate.

People with ADHD are also highly adept in remote work settings and have demonstrated greater tolerance for different workstyles and approaches to problems.

F4S research highlights the unique advantages of ADHD at work

It's still early days, but we've uncovered groundbreaking findings on the advantages of ADHD in the workplace. We believe these preliminary findings, combined with the existing scientific literature, will have wide-ranging implications for the future of work, and people with ADHD's place within it.

Here are some of the most exciting preliminary results, relativized to the US working populations, with 50% being the average.

Remote work is a win for ADHDers

According to our research, individuals with ADHD have a high preference to work uninterrupted and in solo spaces ( Solo Environment). This may include working alone, being in a space where people can't spontaneously interrupt, and blocking out time to work individually on tasks. While some people have mixed feelings about the shift to remote working, many ADHDers across the working world likely rejoiced. The general 'hum' of an office can be highly distracting for people with ADHD. Chatty coworkers may easily be ignored by a neurotypical person, but to an ADHDer, it can be kryptonite to their productivity.

It's little wonder that people with ADHD exhibited a strong preference for working in solo spaces. In their own space, they can be in control, and eliminate distractions. It's here that people with ADHD are able to hunker down, focus and thrive.

What can we learn from this? It means that people with ADHD are far more motivated to thrive in remote working environments and virtual teams. In a new era where remote or hybrid work are more common, many people with ADHD are able to access their talents more than ever.

While it isn't common knowledge, there is strong evidence to suggest that Leonardo Da Vinci ², Alexander Graham Bell ³, and Thomas Edison ⁴ would have been diagnosed with ADHD if they lived today. What each of these great innovators had in common was a need for their own solo working spaces, this is where they could get into the mindset they needed to work their magic.

The question is: how many other ingenious innovators have been cooped up in a noisy office until now?

Overall the research found most people with ADHD are far better able to access their unique genius when they're alone. Given that remote work is now much more common, we may well be on the cusp of a wave of ADHD-powered innovation.

Watch this space!

People with ADHD have a high motivation for identifying problems

This was one of the most revolutionary findings in our research study, as it indicates many people with ADHD are highly motivated to solve and identify problems ( Away From Problems). They are likely to thrive in projects and roles where they can prevent and deal with complex challenges, and navigate around roadblocks.

People with ADHD are far more energized by navigating awayfrom and solving problems than by setting and achieving goals. While much of our culture lionizes the importance of goal setting, actually, a robust, disruption-ready organization also needs people who are problem-oriented.

In an increasingly tumultuous business landscape, the prevalence of this trait among ADHDers highlights the tremendous value they have to forward-thinking organizations.

ADHD employees drill down into the details

When it comes to an area of expertise, passion or something they genuinely love and are highly motivated by, our preliminary findings show that ADHDers on average have the ability to really drill down into the details ( Depth). This is known as hyperfocus, and it's one of the key superpowers that give people with ADHD a distinct advantage. ⁵ They're often so focused on what's occupying their attention that nothing else matters.

Consider the stories of a young Bill Gates (who was later diagnosed with ADHD ⁶) when he was writing the code that would become Microsoft.

Gates famously worked day-in, day-out. He often fell asleep at his desk, woke up and immediately began writing code again. These intense bouts of focus came at the exclusion of all other things that weren't related to what interested him most: Building Microsoft. ⁷ While we at F4S believe in a healthy work life balance, Gates' story does illustrate the tendency we see in people with ADHD to dive deep into the details, and lose track and awareness of time. To a casual observer, the young Gates' bedraggled appearance and lack of care for mundane daily tasks may have appeared as a lack of attention to detail. In reality, he was so deep in the details of what interested him that there was no room for anything else.

ADHDers are open-minded and value diversity

Our preliminary findings show that people with ADHD are highly motivated to accept and appreciate the unique styles, customs, perspectives, and rules of others ( Tolerance). A high emphasis on this motivation promotes a supportive work culture that prioritizes psychological safety, open communication, inclusivity, and the uniqueness of others.

With their sensitive nervous systems, ⁸ people with ADHD can be highly empathetic towards different types of people. For this reason, they're adept at understanding and tolerating differences in others. ⁹ On a sociological level, people with ADHD have often felt othered, or ostracized for simply being themselves, and so they may feel a natural affinity with other people who are different. ¹⁰ They have also been found to have a higher injustice sensitivity, making them great advocates for fairness and tolerance. ¹¹

This trait makes people with ADHD natural allies for marginalized groups, and they can bring extra passion and energy to roles related to social justice.

Take the highly acclaimed director of Barbie and ADHDer 12 Greta Gerwig for example.

Gerwig is noted for her ability to actively encourage actors to include their own personalities in their performances. ¹³ It isn't uncommon for writers and directors to be prescriptive of what they want from their actors, but this isn't Gerwig's style. Instead, she takes the role of facilitator. This is typical of leaders in the workplace who have a strong bias for tolerance, they listen, and appreciate the unique perspectives their employees bring to the table.

People with ADHD are out of the box thinkers

Our research found that ADHDers are overall less energized by following company rules ( Compliance), and are highly motivated to be creative out-of-the-box thinkers ( Indifference). This motivational combination is incredibly useful for breaking new ground and inventing diverse ways of working.

When outside-the-box thinking is needed, adherence to the rules can only get you so far. That's where people who aren't motivated by status quo thinking can become your most valuable asset. And people with ADHD, overall, were found to have this trait in spades.

Children with ADHD are often stereotyped as being rule breakers and mischievous, but given the right conditions, this same trait can lead to high achievement in adults.

Take the late founder of IKEA and (you guessed it) ADHDer, ¹⁴ Ingvar Kamprad.

At the age of 5, Kamprad began running his own business selling matches. While this might not sound too mischievous, keep in mind that this was 1931. A time when small children "should be seen and not heard." He was oblivious to the "rule" that 5-year-olds didn't run businesses; he was too busy marching to the beat of his own drum. Fast forward 12 years later, and he founded IKEA. Under his leadership, IKEA became the largest, most groundbreaking homewares retailer in the world and has maintained its innovative, always moving and evolving, very ADHD brand identity ever since.

So, we can see that the pioneering, entrepreneurial spirit is alive and well in people with ADHD. But does this mean ADHDers are always ignoring the rules?

Your ADHD team members are reliable, and motivated by consistency

Our research findings show that ADHDers derive energy from maintaining stability and consistency ( Sameness). They have a strong preference for finding patterns, mapping new information against what they already know. Surprisingly in some situations, ADHDers very much enjoy doing the same things over and over and may often prefer things to stay the same.

But wait, aren't they also trailblazing innovators who ignore the status quo?

The answer is complicated - they're often both.

To reach their goals, many people with ADHD have learned to be highly disciplined. They may adhere to their own personal unwavering systems and processes, and rely on them to create order in their lives, and this tendency is often present in the workplace. It may not necessarily be an in-built trait, rather, an adaptation to their condition. And indeed, many ADHD coaches, or therapists teach these skills. ¹⁵

Take, arguably, the most decorated athlete of all time and proud ADHDer, Michael Phelps, ¹⁶ for example.

Phelps was known, even when compared to other elite athletes, to have a highly structured and regimented training program. ¹⁷ He swam 13 kilometers a day, 7 days a week, even on birthdays. And that's just in the pool. He also had his weight training (3 days a week), his stretch routines that bordered on the religious, and his highly monitored and optimized diet. But this lifestyle didn't come naturally to Phelps. As a teenager, he struggled to pay attention and to keep up with the day-to-day routine of school life. The strict routines that he later developed were an adaptation that his coach, Bob Bowman helped Phelps to implement.

So, while people with ADHD may not be naturally motivated by consistency, Phelps's story and our research demonstrates that they can, and do adapt. With the right coaching or assistance, people with ADHD can be highly systematic and process driven, more so than the broader population.

ADHDers are highly motivated by commercial performance

Another finding from our research study was that people with ADHD have an interest in the commercial and financial aspects of business ( Money). This may manifest as a focus on grounding projects, products, services, and business ideas in the commercial space, or feeling empowered to carefully track and monitor financials.

Take founder of Kinko's and author of Two Billion Dollars in Nickels, Paul Orfalea, for example.

Orfalea was born in a time when awareness of ADHD was low. He was labeled a "problem child". Though he struggled in the classroom, he had a well attuned business acumen with a focus on dollars and cents from a young age. After scraping his way through school and into university, it was there that he noticed professors and students were paying US$0.10 to make copies of their class materials. After crunching the numbers, he saw that he could provide a much cheaper service, and Kinko's was born.

With an estimated net worth of US$250 million, Orfalea credits his struggles with ADHD to his success with business. As a struggling teenager, he was forced to forge his own path and find opportunities to leverage his strengths, which is exactly the path he took in business as an adult.

The bottom line: ADHD is a win for the modern workplace

In short, our preliminary findings demonstrate that it's time to start thinking of ADHD as a huge asset to any organization. Companies that foster their ADHD talent can fully leverage the unique magic they bring to the workplace. ADHDers' problem-solving acumen, ability to spot threats and weaknesses and unconventional approaches are traits that companies are wise to embrace.

# data[].attributes.attachment_link.title
Our new research reveals the amazing advantages of ADHD in the workplace

# data[].attributes.attachment_link.description
Discover the incredible advantages of ADHD in the workplace

# data[].attributes.headline
How to Translate Websites | Cómo traducir sitios web

# data[].attributes.subject
How to Translate Websites | Cómo traducir sitios web

# data[].attributes.attachment_link.readable_text
Flexibility requires being able to revise plans in the face of obstacles, setbacks, new information, or mistakes. A young child can adjust to a change in plans - a substitute teacher coming in when the regular classroom teacher is absent - without distress. A high school student can accept an alternative, such as a different job, when the first choice is not available. For some kids with attention deficit disorder (ADHD), though, dealing with unexpected change is a problem. Many can't deal with open-ended tasks - ones for which there are no single right answers, no well-defined starting points, and no obvious end. They can't determine what's important and what isn't, making it hard for them to take notes or to study for tests.

Adapting to Change in the Classroom

Prepare students for changes in schedules and routines whenever possible. If you know you're going to be absent, lay down some ground rules for behavior in your absence.

Put in place a "default" strategy if a routine has to be changed unexpectedly. The strategy might be having the student check in with a designated person, so that he can be walked through the revised plan.

Adapting to Change at School

Hand out an outline before you start a lecture. List key concepts or topics, but leave room for students to fill in details. When the lecture is over, hand out the completed outline, with all the important details, so the student can compare his note-taking with yours.

Teach students how to study for tests. Have them use study strategies in class; talk about which ones work best. Provide detailed study guides, so they know where to invest their time.

Show, don't tell. Walk the child through tasks step-by-step, making each transition explicit, rather than expecting her to get it.

Schedule "take 5" breaks to avoid meltdowns. Some teachers put together individual "take 5" bags, where kids keep stress balls or sketchpads and markers to use to calm down during the break.
[Free Download: Sample Schedules for Reliable Family Routines]
Teach kids to identify when they are becoming upset. If they feel their faces flush or their hearts beat faster, they should use a coping strategy you've given them to prevent an impending upset.

Creating - and Disrupting - Routines at Home

Keep daily routines. Children who have trouble dealing with change are comforted by routines and feel less stressed when they are followed.

Give extra support for homework assignments that are open-ended. Some kids genuinely don't know how to approach the tasks. Getting them started, or sitting with them to provide guidance when they get stuck, may be enough.

Reduce the complexity of tasks. Inflexible children panic when they think they won't remember everything they have to do, or when they think they won't succeed at what they're expected to do. Breaking tasks into smaller steps will reduce the panic.
[How to Teach Sequence and Schedules]
Use visual cues when changing a routine. If your child won't be coming home straight from school during the next couple of weeks, have him draw pictures of the changes - he might go to soccer practice or take guitar lessons first - and arrange them to show the new schedule.

Disrupt the schedule in fun ways. To get kids used to unexpected change, introduce small changes into their schedule. Most kids are happy to go out for an ice cream sundae on a school night.

Give them coping strategies for changes that cause them the most upset. This could be as simple as counting to 10, walking away from the situation, or asking a specific person to intervene.

Give your child a script for unexpected change. Role-play the situation, with you playing your child, to show him how he can talk himself through it. Then have him play himself. Give him positive feedback about how he handled the situation. Practice role-playing briefly several days in a row, so that your child can learn the process.
[Free Webinar: Ready, Set, Work: Help Students Fight Procrastination and Get to Work]

# data[].attributes.attachment_link.description
It's hard enough for children with attention deficit disorder (ADHD) to get organized and stick to schedules. Can kids with ADHD also learn to adapt to change? Try these tips to help your child learn to adjust when routines change.

# data[].attributes.headline
Test-Taking Strategies for Every Exam Type

# data[].attributes.subject
Test-Taking Strategies for Every Exam Type

# data[].attributes.attachment_link.readable_text
I remember a quiz I took in high school. I had studied hard, but as I read the first question, my brain shut down. I couldn't remember any answers or solve any problems. Fear paralyzed me.

Does your ADHD student ever have brain-lock? If so, there are ways to keep the brain working in the exam room despite the sometimes-paralyzing symptoms of attention deficit disorder.

Before taking a test, follow these test taking strategies to maximize your success:

Ask the teacher for extra time

To relax your mind, visualize yourself sitting down, answering the questions, and getting a good grade

Figure out the average time you'll have to answer each question (if there are 10 questions and the test is 30 minutes long, you have at least three minutes for each question)

Bring a timer and be sure to use it to stay on task.

[Smart Homework Strategies for Teachers & Parents: A Free Handout]
Now here are pointers to help you excel on every type of test:

Multiple-Choice Tips

Take your time. Read each question and each answer to yourself-twice. Underline as you read to ensure that you've read every word of the question and all the answers.

Going with your gut, circle the correct answer. Nine out of 10 times, our first guess is right, but we often talk ourselves out of it. Don't change an answer unless you're absolutely sure.

Answer every question that you're sure of. Put a dash next to those you're unsure about and a star next to those that you don't know at all.

After you've run through the test, revisit the difficult questions. If there's time, slowly reread and answer each question. Unless you read a question differently the second time, stick with your first answer.
[Free Webinar Replay: How Parents and Teachers Can Use Brain Science to Increase Motivation in Children with ADHD]
Math and Calculation Tips

Write down all formulas. You might want to jot down a practice problem you've done at home to give yourself a key to solving tough math problems.

Copy down each problem on scrap paper. Write out the problem slowly, number the steps, and double-check what you've written. Remember this adage: Go slow to go fast. Though our brains are hyper-fast, slow is the way to accuracy and great grades.

Write big and bold. This will allow you to see a mistake, keep from confusing numbers, letters, or signs, and give your brain room to think. Careless errors often creep in because you don't give yourself enough space to see and solve the problem.
Star and/or dash difficult questions. This way, you'll know to review them after running through the test. We often transpose numbers; reviewing the test allows you to correct mistakes.

Essay Tips

Answer the simple questions first. This builds momentum. If you start with the difficult questions, you may linger and run out of time for the easier ones.

Answer in sandwich form - topic sentence, three supporting sentences, a conclusion. If your handwriting's terrible, or if you're dyslexic or an auditory learner, ask to take an oral exam, use a computer to type your answers, or use speech-to-text software that 'types' your words.

Create a rough draft. Consider drawing out an answer or jotting down a list of sentences on scratch paper (intro point, key points, conclusion) before writing your answer on the exam.

Taking tests is like strengthening your muscles. It's difficult at first, but, over time, you'll ace it!

Classroom Aides

Some teachers allow students to bring a study sheet into the exam room. Here's how to assemble one:

Prepare the sheet days in advance, as you're studying the material, not the night before.

Write down general ideas as well as names, dates, and formulas- the specifics we often overlook.

Type up the study sheet in Microsoft Word or Excel, using an extra-small font to get as much information on the page as you can.

Consider adding color, icons, or graphics to make the most important information stand out.

[7 Secrets to Studying Better with ADHD]

# data[].attributes.attachment_link.title
Test-Taking Strategies for Every Exam Type

# data[].attributes.attachment_link.description
Students with ADHD tend to crumble under the pressure and information overload of bigs exams. Use these specific tips to prepare wisely for and ace all of your multiple-choice, math, and essay tests at school.

# data[].attributes.attachment_link.readable_text
Many children struggle with transitions, which are common triggers for behaviors that range from annoying (whining, stalling) to upsetting ( tantrums and meltdowns).

There are many ways parents and teachers can help kids have an easier time with transitions - and be able to behave better-but it may take a little experimentation to find out what clicks with each particular child.

These tools are useful to help kids of all stripes with transitions. But for kids with ADHD, anxiety, autism, or sensory processing, this kind of scaffolding is particularly crucial and can make the difference between a good day and a bad one. Over a period of time it can help pave the way for success.

Create routines: If a child "doesn't want to transition because they like consistency and routine and structure," says Michael Rosenthal, PhD, a clinical neuropsychologist, "then start by building in consistency and routine and structure into the transition process itself."

For transitions that will happen every day, like turning off the phone to go to bed, consistent routines can have big payoff. A bedtime routine, for example, might seem like something for babies, but having a predictable structure in place can be reassuring and helpful even for older kids (and adults!).

Preview and count down: Along with routines, previewing and countdowns are key. In the morning you might lay out what the day is going to look like. Dr. Rosenthal suggests doing a role-play in which you practice moving from activity to activity to "engage them in the process."

Then before each transition, give a timeframe and description of what will happen along with countdowns (in 20 minutes, then 10, then 5 it will be time to finish breakfast and head to school). This is "allows them to emotionally get ready for an event," explains Dr. Rosenthal.

Give it a sound track: For younger kids in particular, songs can be especially effective tools to help implement routines and ease transitions. The "clean up" song can be heard in preschools throughout the country for good reason, but there are countless other songs to be found (and made up!) to suit a variety of situations from tying shoes to brushing teeth.

Visual cues: Other kids may benefit from visual cues. Being able to point to a chart with drawings about what to expect from a particular transition or the steps involved can help some people immensely. These are common in lower grade classrooms but could be easily adapted at home.

Get their attention: For kids with ADHD in particular, says Matthew Rouse, PhD, a clinical psychologist, it's important to make a connection with the child to ensure that you have their attention and that the information is sinking in. This could mean eye contact, sitting next to them, a hand on their shoulder, or asking them to repeat back what you have said. Simply yelling at them from the other side of the room and assuming it's gotten through won't work and will only lead to frustration on both sides.

Use rewards: Rouse points out that rewards can be an effective tool for all kinds of kids and issues. These can be things like stickers, snacks, or a point system that leads to tangible rewards. Schools and parents alike can implement reward systems, and once the kid gets into the habit of seamlessly transitioning you might be able to phase it out.

Implement appropriate consequences: If a transition is not going well, David Anderson, PhD, a clinical psychologist at the Child Mind Institute, recommends paying less attention to it rather than escalating the situation.

"Ignore it as long as they're at least making an effort to make the transition or approximating the transition," he says. "If they're really egregiously misbehaving then use an appropriate consequence for that behavior that makes the child understand that behavior is off limits."

Praise good transitioning: Finally, Dr. Rouse urges parents to recognize when things go well. "For all the times it's gone wrong," he says, "there have probably been a lot more times when it's gone right. Don't lose those opportunities to be really enthusiastic and say this was so great, it went so smoothly, I really liked how you handed over the iPad right away and started brushing your teeth, and now we have more time to read."

Be specific in your praise, and follow up with a reward when appropriate.With the right support, children can learn to change gears without whining and tantrums.

# data[].attributes.attachment_link.title
How Can We Help Kids With Transitions? - Child Mind Institute

# data[].attributes.attachment_link.description
With the right support, children can learn to change gears without whining and tantrums and have smoother transitions in life and the classroom.

# data[].attributes.attachment_link.readable_text
Línea de ayuda de TDAH: información y referencia de lunes a viernes 1 p.m. a 5 p.m. hora del este (ET). Puede llamar al NRC al 866-200-8098 y pulse 2 para llegar a nuestra Especialista en Información del TDAH que habla español, que puede responder a sus preguntas y ayudarle a conectarse a los recursos en su área local.

Salud Libre (HealthUnlocked): participe en nuestra comunidad de TDAH en línea para hablar sobre temas relacionados con el TDAH. Puede enviar preguntas, iniciar conversaciones, y compartir ideas con otras personas afectadas por el TDAH. TDAH Padres Juntos es para los padres y Apoyo para Adultos con TDAH es para los adultos. Especialistas en Información del TDAH están disponibles para proporcionar aclaraciones, información basada en la evidencia y mayor comprensión.

# data[].attributes.attachment_link.description
Recursos en Español National Hispanic Heritage Month Latinos: Driving Prosperity, Power, and Progress in America El TDAH afecta a la comunidad Hispana y Latina. Los datos de la Encuesta Nacional de Entrevistas de Salud de CDC muestran que el doce por ciento de los niños Hispanos de tres a diecisiete años han sido diagnosticados con...

# data[].attributes.headline
Teaching Strategies for Students with ADHD: Ideas to Help Every Child Shine

# data[].attributes.subject
Teaching Strategies for Students with ADHD: Ideas to Help Every Child Shine

# data[].attributes.attachment_link.readable_text
Parents: Is your child's teacher doing everything possible to support learning? Teachers often dictate the success or failure of a child's education - particularly if that child has attention deficit hyperactivity disorder (ADHD or ADD).

Next to parents, teachers are the most influential people in a student's life. The best teacher will develop ADHD strategies to show students that they are capable and worthwhile.

Here are some strategies for teaching children with ADHD that work to establish a supportive, structured classroom that will encourage learning, enforce discipline, and boost self-esteem.

Strategies for Students with ADHD

Assign work that suits the student's skill level. Students with ADHD will avoid classwork that is too difficult or too long.

Offer choices. Children with ADHD who are given choices for completing an activity produce more work, are more compliant, and act less negative. Establish, for instance, a list of 15 activity choices for practicing spelling words like writing words on flash cards, using them in a sentence, or air-writing words.
[Get This Download: How to Teach Children with ADHD - Classroom Challenges & Solutions]

Provide visual reminders. Students with ADHD respond well to visual cues and examples. For instance, demonstrate a skill like essay writing on an overhead projector or on the board. When children get to their independent work, leave key points about a topic visible on the board. Post important concepts the children will use again and again on brightly colored poster board around the room.

Increase active class participation. Group strategies include asking students to write their answers on dry-erase white boards and showing them to the teacher, asking students to answer questions in unison (choral response), having students give a thumbs up or down if the answer to the question is yes or no - a level palm, if they don't know the answer. Paired learning is also effective. Have students work through a problem in a group and discuss for maximized understanding.

Encourage hands-on learning. Create learning opportunities where children experience things first-hand. Have students write and act out a play, record an assignment on videotape or take apart and put together a model of a miniature eyeball when studying the human body.

Establish Rules & Routines for ADHD Students

Post classroom rules for student with and without ADHD. With input from students, establish short, simple classroom rules. State them in positive terms that convey what you want students to do.
For example, instead of saying: "No loud talking when you come into class," say, "When you come into class, check the assignment on the board and start working quietly." Or, "Sit down first and then you may talk quietly with your neighbor until I start teaching."

[Click to Download: 10 Teaching Strategies that Help Students with ADHD]

Establish classroom routines. This will help students with ADHD stay on task. Routines for all students can include: homework always being written on the board, "row captains" checking to see that assignments are written and that completed work is picked up, etc. Students with ADHD can check in with the classroom aide at the end of the day to make sure they understand the homework assignment and what's required of them.

Give appropriate supervision to ADHD students. Children with ADHD require more supervision than their peers because of their delayed maturity, forgetfulness, distractibility, and disorganization. Help these students by pairing them with classmates who can remind them of homework and classwork, using student partners to team up on a project, and involving classroom aides as much as you can during and after class.

Offer Accommodations for ADHD in the Classroom

Some students with ADHD may need school accommodations to address academic challenges. Make sure they get them. Some accommodations can be as easy as monitoring the student's work and developing a plan to help him not fall behind and even accepting the occasional late assignment - this can give the student confidence and get her back on track.

Other common ADHD accommodations include:

Extended time on tests

Shortened assignments

Instruction in note-taking or designating a class notetaker

Segmented assignments for long-term projects (with separate due dates and grades).

The Attention Deficit Disorder Association ( ADDA) makes the following recommendations for accommodations:

Reduce potential distractions. Always seat students who have problems with focus near the source of instruction and/or stand near student when giving instructions in order to help the student by reducing barriers and distractions between him and the lesson. Always seat this student in a low-distraction work area in the classroom.

Use positive peer models. Encourage the student to sit near positive role models to ease the distractions from other students with challenging or diverting behaviors.

Prepare for transitions. Remind the student about what is coming next (next class, recess, time for a different book, etc.). For special events like field trips or other activities, be sure to give plenty of advance notice and reminders. Help the student in preparing for the end of the day and going home, supervise the student's book bag for necessary items needed for homework.

Allow for movement. Allow the student to move around or fidget, preferably by creating reasons for the movement. Provide opportunities for physical action - do an errand, wash the blackboard, get a drink of water, go to the bathroom, etc. If this is not practical, then permit the student to play with small objects kept in their desks that can be manipulated quietly, such as a soft squeeze ball, if it isn't too distracting.

Let the children play. Recess can actually promote focus in children with ADHD so don't use it as a time to make-up missed schoolwork or as punishment as you might for other students.

Focus on the Positive

Establish a positive relationship with students who have ADHD. Greet them by name as they enter the classroom or when calling on them in class. Create a class bulletin board for posting students' academic and extracurricular interests, photographs, artwork, and/or accomplishments.

Provide frequent, positive feedback. Students with ADHD respond best to feedback that is immediate. Use positive praise, such as "You're doing a great job" or "Now you've got it." If a student's answer is incorrect, say, "Let's talk this through" or "Does that sound right to you?"

Ask questions rather than reprimand. If the student misbehaves, in class, ask, "Is that a good choice or a bad choice?" The student will get the message that his behavior is inappropriate.

Partner with Parents

For best results, teachers must partner with the parents to ensure that their child is ready to learn in the classroom. Here are some guidelines to share with the parents of your students with ADHD:

Communicate regularly with the teacher about problems.

See that your child's ADHD medication is working effectively at school and during homework sessions.

Help your child organize papers for evening homework and prepare for the next school day.

Watch your child put completed homework in the proper folder.

Monitor completion of work in the classes that he is in danger of failing.

Save all completed homework until the semester is over.

Talk with the teacher about using a daily or weekly report, if needed.

[Your Free Download: The Teacher's Guide to Better Assignments for Students with ADHD]

# data[].attributes.attachment_link.title
Teaching Strategies for Students with ADHD: Ideas to Help Every Child Shine

# data[].attributes.attachment_link.description
Your child's teacher is your partner in a fair and equitable education, but does she have the ADHD tools she needs? The following ADHD teaching strategies will help all students - but especially those with ADD - learn to the best of their ability in any classroom.

# data[].attributes.attachment_link.readable_text
How can we help?

I want help with behaviors , learning , and everyday skills

We are Understood.
We are the lifelong guide for those who learn and think differently. In the past year, we've helped more than 20 million people discover their potentials, take control of their lives, and stay on positive paths.

We support the 1 in 5 Americans who learn and think differently.

Learn more

We believe difference is our greatest strength.

Learn more

When we shape the world for difference, we all thrive.

Learn more

Discover what's possible when you're understood.

We'll email you our most helpful stories and resources.

We just launched our "Be the Reason" stigma campaign. Learn more here.

Helpful guidance from Understood

Essential resource spotlight

Are you wondering why your child is struggling?

We're here to help if you're feeling overwhelmed. Take N.O.T.E. (Notice. Observe. Talk. Engage.) is a simple step-by-step tool that can help you figure out if the struggles you're seeing might be signs of a learning and thinking difference.

"I have a hard time focusing, mostly in school. When I do my homework, I kind of feel stressed out because it feels like so much even though it's not too much."

Emperor Kaioyus, Grade 4

Copyright © Understood for All, Inc.

Understood is a tax-exempt 501(c)(3) charitable organization (tax identification number 83-2365235). Donations are tax-deductible as allowed by law. Understood does not provide medical or other professional advice. The health and medical related resources on this website are provided solely for informational and educational purposes and are not a substitute for a professional diagnosis or for medical or professional advice.

Use of this website is subject to our Terms of Use and Privacy Policy.

Copyright © 2014-2023 Understood For All Inc.

# data[].attributes.attachment_link.title
Understood - For Learning and Thinking Differences

# data[].attributes.attachment_link.description
Understood.org is the resource that helps the 70 million people with learning and thinking differences anticipate the challenges, barriers, or opportunities in life and confidently reach their potential.

# data[].attributes.attachment_link.title
You searched for ADHD - Child Mind Institute

# data[].attributes.attachment_link.readable_text
How Does ADHD Impact Women Differently?

Do your ADHD symptoms worsen at certain times of the month? Is your thinking a little fuzzier the week before your period? Are you organized and efficient at mid-cycle?

Doctors have noted correlations between symptoms of ADHD and hormones, not only monthly but over the lifetime of a woman.

"The average age of diagnosis for women with ADHD, who weren't diagnosed as children, is 36 to 38 years old," says Patricia Quinn, M.D., director of the National Center for Girls and Women with ADHD, and author of Understanding Women with ADHD. "Before that time, girls and women are often misdiagnosed as having a mood disorder or an anxiety disorder. Even if these are secondary conditions, treating them does not get to the root of the problem, which is ADHD."

When doctors diagnose girls and women with ADHD, they rarely consider hormonal fluctuations when developing a treatment plan. But professionals are learning more about the connections between hormones and ADHD. Here, we outline four stages in a woman's life - from puberty to menopause - describe what's happening hormonally, and offer ways to manage symptoms.

ADHD and Adolescence

Megan, of Iowa, was diagnosed with the inattentive form of ADHD when she was 10 years old. She was put on a low dose of Adderall and did well in school. Things changed when Megan turned 12, and entered seventh grade. Surging hormones produced by the onset of puberty, along with the demands of middle school, were too much to handle.
[Self-Test: What Does ADHD Look Like in Women?]
"She was late to class, forgot to bring her textbooks home, and worked three hours on homework assignments, only to forget to turn them in," recalls her mom, Susan. "We didn't know if her problems were due to worsening ADHD, hormonal changes, having to switch classes and deal with six different teachers, or a combination of all these things."

Megan's doctor told her mom that, when girls hit puberty, they metabolize their ADHD medication more quickly. So he increased Megan's dosage. "During the next three years, we tried 10 different drugs at varying dosages," says Susan. "The higher concentrations of medication caused Megan to lose weight - and didn't even seem to help her - so we stopped the meds."

While increasing medication dosages sometimes helps teen boys when their ADHD symptoms worsen, "clinical experience suggests that this approach often fails with adolescent girls," says Quinn.

Through trial and error, Megan, now 15, found a way to manage symptoms: a small daily dose of Metadate and fish oil supplements. "She hasn't missed a school assignment in a year," says Susan. "She has enrolled in more challenging courses in high school, and she's much happier. And now that she's a little older, she's not embarrassed to talk about what's happening to her body. When she gets irritable, moody, or forgetful during those one or two days of the month, I can ask her, 'Are you getting your period?' If she says yes, I know I need to cut her a little slack."

Hormonal Effects on ADHD

The "raging hormones" that sometimes lead to rebellion and risky behavior in teenagers have profound effects on girls with ADHD, who typically start puberty between ages nine and 11 and get their periods between 11 and 14.

"We found that girls with ADHD in their early teens have more academic problems, more aggressive behavior, earlier signs of substance-related problems, and higher rates of depression than girls who don't have the condition," says Stephen Hinshaw, Ph.D., professor and chair of the department of psychology at the University of California/Berkeley, who has been studying girls with ADHD for more than 10 years. "Unlike teenage boys with ADHD, who tend to act out, girls with ADHD often internalize their problems. This makes their struggles easier to overlook."
[Free Webinar Replay: Girls and Women with ADHD: Unique Risks, Crippling Stigma]
Hormonal changes at puberty - especially the higher levels of estrogen and progesterone - can cause ADHD medications to be less effective. "Studies have shown that estrogen may enhance a woman's response to amphetamine medications, but this effect may be diminished in the presence of progesterone," says Quinn.

Solutions: Discuss different medications - or different dosages of current medications - with your daughter's doctor. It may take time to figure out what works best, so be patient. Behavioral strategies for time management and improving organizational skills can help.

"Identify your daughter's strengths and emphasize them during the worst times of her cycle," says Kathleen Nadeau, Ph.D., director of the Chesapeake ADHD Center of Maryland. "Too often, teachers and other adults in a girl's life focus only on her weaknesses."

If your daughter notices that her ADHD symptoms worsen at certain times of the month, encourage her to complete schoolwork before they hit. Have her prepare for a big test or finish writing a paper a week before it's due.

"Be patient with your daughter if she becomes argumentative or snippy," says Nadeau. "Instead of yelling, suggest that she rest for a while. You'll be teaching her self-management skills."

ADHD and the Reproductive Years

"Hormonal fluctuations definitely affect my ADHD symptoms," says 41-year-old Jamie Suzanne Saunders, an office manager in Louisville, Kentucky. "About three days before I get my period, and continuing through it, I feel hyper, inattentive, and restless. It's like I'm driving down a superhighway, and, instead of going straight, I veer off onto an exit, only to find myself on another highway with equally interesting exits. I lose my focus and can't get anything done."
Newly diagnosed, Saunders hopes that her ADHD specialist will help her take control of her symptoms, especially as she heads into perimenopause.

Hormonal Effects on ADHD

The average menstrual cycle is about 28 days, counting from the first day of your period. During the first two weeks, known as the follicular phase, levels of estrogen rise steadily, while progesterone levels are low.

Estrogen promotes the release of the feel-good neurotransmitters, serotonin and dopamine, in the brain. Not surprisingly, studies suggest that the first two weeks of the cycle go more smoothly for women with ADHD than the second two weeks, when progesterone levels rise. During the third and fourth weeks, called the luteal phase, progesterone diminishes the beneficial effects of estrogen on the brain, possibly reducing the effectiveness of stimulant medications.

Quinn believes that women with ADHD experience premenstrual syndrome (PMS) more acutely than women who don't have the condition. "Feelings of sadness and anxiety typically worsen in women with ADHD during this time," says Quinn. The good news? Treating ADHD can improve PMS symptoms, too.

Solutions: Keep a log of your ADHD symptoms for three months - charting when they occur and worsen during the menstrual cycle - and try to identify a pattern. Some women have problems only one or two days of the month, the week before their periods begin. Other women's ADHD symptoms worsen for 10 days or so during the luteal phase.

"I never understood how hormonal fluctuations affected my ADHD symptoms until I kept a journal," says Lori Scarmardo, age 34, mother of two, in Austin, Texas. Lori was diagnosed with ADHD six years ago. "Every month, in the week before my period, I would make entries like, 'I'm back in the fog' or 'I can't get anything done.' Noticing when my ADHD symptoms were severe helped me go easier on myself - I realized that my behaviors were due to hormonal changes - and caused me to develop strategies to minimize those symptoms. I cut back on caffeine and sugar in the week before my period, and I exercised regularly."

Medication can help. Taking a low-dose antidepressant or anti-anxiety medication one or two days before your period helps many women manage emotional highs and lows. Others find that upping their ADHD medication slightly, a few days before, makes them feel they're in control. Oral contraceptives improve ADHD symptoms in many women by minimizing hormonal fluctuations. Three weeks of pills that are formulated with estrogen alone, followed by one week of progesterone alone, seem to be especially helpful.

ADHD and Childbirth

Diagnosed with ADHD at age 29, Becca Keeton, of Lomita, California, took stimulant medication for a year before she tried to become pregnant. "I went off ADHD medication in my thirties, when I was pregnant with and nursing my three children," says Keeton. "During the first month of each pregnancy, my ADHD symptoms worsened. During my second pregnancy, I was in three minor car accidents - all my fault - in the first month. As time went on, my ADHD symptoms improved, and I felt better while nursing my babies, too."

Now, in her mid-forties, with her childbearing years behind her, Keeton takes Adderall daily, and says that upping her dose in the days before her period helps control her ADHD symptoms, which typically worsen at that time.

Hormonal Effects on ADHD

Virtually all hormone levels change during pregnancy, mostly because the placenta produces hormones itself and stimulates other glands - like the adrenals and the thyroid - to produce more hormones, as well. As hormone levels rise in the first months of pregnancy, moms-to-be with ADHD experience fatigue, mood swings, and anxiety. But as estrogen levels rise as pregnancy progresses, many women with ADHD say they feel better.

"Some research shows that panic disorder improves with each trimester of pregnancy, and relapses after delivery," says Quinn. "It's possible that a similar pattern occurs with ADHD."

Quinn points out that, while there are no studies showing that ADHD symptoms improve during pregnancy, there is anecdotal evidence that they do. "I get letters and case summaries from women, saying how much better they felt during pregnancy," she says.

In the weeks after childbirth, hormone levels drop. While these hormone drops can lead to mood swings, and to postpartum depression in all new moms, women with ADHD may be more prone to depression.

Solutions: You and your doctor should re-evaluate your ADHD treatment during your pregnancy and when you are breastfeeding. Studies show that some stimulants used to treat ADHD may lead to heart defects and other problems in developing fetuses. Breastfed babies may develop substance abuse problems later in life if their moms took stimulant medication while nursing.

Certain antidepressant medications appear to be safe to take during pregnancy and breastfeeding, but you and your doctor should discuss all of your options and determine what's best for you. Due to the hormonal changes discussed above, many women find that going off ADHD medications allows them to function better.

"Beyond medication, it's important to get help during pregnancy and after the child is born," says Nadeau. "Although hormonal changes may improve ADHD symptoms, the stress of work, pregnancy, caring for other young children at home, and the anxiety of getting ready for a new infant may counterbalance any hormonal benefits."

"The Change" and ADHD

Ten years ago, Ranjini Pillai, M.D., of Mt. Pleasant, South Carolina, had a hysterectomy, which sent her into menopause. "Suddenly, I felt anxious all the time," she says. "I was tired, disorganized, and out of focus; I couldn't think clearly."

A month after her surgery, she started estrogen replacement therapy, and her symptoms improved slightly. But she still struggled with disorganization and anxiety.

Doctors prescribed antidepressants, which didn't help.

Five years ago, a doctor diagnosed her as having ADHD, and prescribed Strattera. "The improvement was dramatic," says Pillai. "My thinking was clearer, my anxiety lifted, and everything started to make sense." Pillai needs both hormone-replacement therapy (a combination of estrogen and a small amount of testosterone) and twice-daily Strattera to control her ADHD symptoms. She learned behavioral strategies to help her stay organized and to remember things, like a basket near the front door to hold her cell phone and keys.

"I've also learned to delegate, and to accept the fact that I can't do everything," says Pillai. "My husband now handles our finances, and my two sons, ages 23 and 14, do chores to keep the house running, so I can focus on my work and things I enjoy, like cooking."

Hormonal Effects on ADHD

By menopause (average age, 51), estrogen levels drop about 65 percent, a gradual decrease that begins 10 or more years before menopause (known as perimenopause). The loss of estrogen leads to a decrease in serotonin and dopamine levels in the brain. Women going through perimenopause report moodiness, sadness, irritability, fatigue, fuzzy thinking, and memory lapses. These may be more pronounced in women with ADHD.
"Given a brain that, in effect, has less cognitive energy to begin with, it can be especially hard for women with ADHD at this time in their life to concentrate and to make good decisions," says Quinn.

Solutions: Oral contraceptives taken during perimenopause can stabilize hormone levels and improve brain function. After their patients' periods have stopped, many doctors recommend hormone-replacement therapy, at least for the first few years after menopause. "Studies have shown that women receiving hormone-replacement therapy perform better on cognitive testing, as well as on memory and reasoning-skills tests," says Quinn.

For many women, the best course of treatment is estrogen alone, for three to four months, followed by 10 days of progesterone. "As in Pillai's case, combining hormone-replacement therapy with ADHD medication often improves symptoms most effectively," says Quinn.

Quinn says it's important, at every stage in your life, to keep ADHD symptoms under control. This may mean working with several professionals - a psychiatrist or psychologist, an internist, and a gynecologist. Educate yourself about ADHD and what's going on with your body, keep lists of medications, chart symptoms, and, above all, demand the help you need from professionals.
[5 Things Every Doctor (and Parent) Should Know about Girls and ADD]

# data[].attributes.attachment_link.description
Do your ADHD symptoms worsen at certain times of the month? Is your thinking a little fuzzier the week before your period? Are you organized and efficient at mid-cycle? Doctors have noted correlations between symptoms of ADHD and hormones, not only monthly but over the lifetime of a woman.

# data[].attributes.headline
Protecting the Emotional Health of Girls with ADHD

# data[].attributes.subject
Protecting the Emotional Health of Girls with ADHD

# data[].attributes.attachment_link.title
Protecting the Emotional Health of Girls with ADHD

# data[].attributes.attachment_link.description
Safeguarding teenage girls with ADHD begins when we empower them to understand their brains and bodies, to develop emotional intelligence and resilience, ...