Dr. Carrie McMillin is a naturopathic physician that specializes in treating adults and children with ADHD and anxiety.
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At our first parent conference in February of 2019, I had the opportunity to teach parents about executive function deficits--what I consider to be the most important piece for understanding ADHD. I have decided to include my slides here as a resource to help parents understand why ADHD looks the way it does, and how to offer support with specific struggles.
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Welcome to part 2 of my blog post on how to effectively communicate with and motivate your ADHD teen. Here I will cover principles 6-10 (for the first part of this article, click here).
6. Realistic/appropriate consequences
When rules are broken, consider what the appropriate consequence is for the behavior. For example, you may have a rule in your home that lights go out at 9:30 PM. One night you find her wide awake at 1:00 AM watching videos on her phone. Your first instinct may be to ground her from hanging out with her friends this weekend. A more appropriate consequence for this would be that she has to give her phone/tablet/laptop to you at bedtime. Also explain that the reason you have this rule in place is because sleep is important to her physical and mental health.
7. Encourage independence
Our goal as parents is to raise children that grow into positive and independent members of society. Adolescence is a time when most of the independence training happens, and teens with ADHD are going to need extra time and guidance when it comes to learning these skills. Seek out opportunities that your teen can practice being independent as often as possible, but without loading too much responsibility on at once. You may put him in charge of setting his own alarm to wake up each morning, or give him the job of packing his own lunch. As he gains some skills, move on to some bigger responsibilities such as doing his laundry, or making dinner one night per week. Not only will being familiar with how to do these tasks help when he moves out of the house, they also can give him a sense of pride and improve self esteem-- which are opportunities that should always be taken advantage of!
8. Involve adolescents in decision-making when possible
When you are creating rules or guidelines for what you expect, include your teen in the conversation. Let her know that your priorities are her safety, mental well-being, and supporting her so that she can become an independent and responsible adult. For example, she may ask to hang out with friends in the evening. Have an open conversation about what rules make sense to have in place, keeping her safety in mind. Perhaps you are comfortable with her going out as long as she has an app on her phone that allows you to see where she is at, and that she is home by midnight. She may ask if she can stay out until 12:30 because they are going to a movie which will run late. Consider the request, and whatever your decision is, let her know what your reasons are. Of course, she may still be unhappy with your decision, but it is important for her to feel like you’ve heard what she has to say.
9. Frequent feedback
“Good job remembering to bring home your jacket today.” “Thank you for remembering to clear your plate after dinner.” “Awesome job working on your essay after school!” Be vocal and give frequent positive feedback when your teen is doing something well, even if it seems small. Everyone likes to hear that they are doing a good job, but those with ADHD need it even more. Frequent positive feedback is another self-esteem booster and a good motivator. Even if your kiddo doesn’t act like he cares about the pat on the back, keep it up. He does.
10. Mindfulness for parents
You are human. Teens are frustrating. There’s a good chance you or your spouse has ADHD, which can make keeping your cool even trickier. Practicing mindfulness can help you to stay calm in the difficult moments. Simplified, mindfulness is really about being present in the moment and observing your reactions without judgment. One of my favorite, simple mindfulness activities is called a sensory scan. Take a moment to close your eyes and focus on your senses. How many different things can you hear right now? What can you feel? What do you smell? Want more resources for how to practice mindfulness? Check out my upcoming post on quick and easy mindfulness exercises.
You're probably thinking that parenting an ADHD teen is a lot of work. I hear you, loud and clear. I am on the front lines with you and each day I have to remind myself of almost every one of the points I listed here. But take a breath, commiserate with a parent who gets it, (scream if necessary), and try again. Because your kiddo is worth it.
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I won’t sugarcoat it. Parenting adolescents is TOUGH, and when you add ADHD to the mix it certainly doesn’t get easier. Unfortunately, I don’t have a magic formula to make it a cake walk. But I do have some basic guidelines to help improve communication and ease frustrations for everyone involved. In part 1 of this blog post, I detail 5 of the 10 guiding principles that can be a game-changer for how you communicate and motivate your ADHD teen.
1. Don't take it personally
When your teen leaves a pile of dirty dishes on the coffee table for the eighth time this week, and you are left to clean up the mess yet again, it can be hard to keep your cool. Of course part of you understands that his ADHD plays a role in this behavior, but a small part of you probably thinks, "Does he think that my time is less valuable than his?" Try to pause in these moments and remember that he did not leave a mess due to a lack of respect for you. In fact, most of the kids I work with harbor some amount of guilt (often hidden) about their behavior. Keep a disability perspective and curb the anger. But this does not mean that he doesn't have to put away the dishes. Have him put them away, or do a different comparable chore if you have already taken care of the mess. Also, see #10 (part 2).
2. Wait for the moment and keep it short
Parents and spouses of people with ADHD become incredibly adept at knowing when someone is in listening mode and when she is not. So when you have something to say, wait for that moment. Keep what you want to say short and to the point. Don’t create elaborate explanations-- speak in bullet points.
3. Make rules and expectations clear
Whatever your expectations are, make sure they are realistic and crystal clear. "Keep your room clean" isn't a very clear expectation. “All dirty clothes must be in the hamper before bedtime” is much clearer. Keep tasks short and written in a highly visible location--visual reminders are essential. Consider posting a short list on the bedroom door or mirror listing what needs to be done each day. Aim for five tasks at most.
When discussing expectations, make sure that they are things that are in your teen’s control as much as possible. For example, instead of an expectation that they receive a grade of a B or higher in Language Arts, set the expectation that all assignments will be completed and turned in. Or that your student will spend 45 minutes studying for an exam with a tutor. Reflect on which piece is within your teen’s control, and set guidelines for the behavior around that piece. Make sure that your expectations are reasonable, taking into account other requirements, learning disabilities, etc. Not sure what is reasonable? Check in with your teen’s doctor or therapist.
4. Use positive reinforcement (incentives before punishment)
Focus primarily on motivating through rewards, instead of taking away privileges when something isn’t done. Something like: If you complete your math worksheet, you can watch your favorite show. Or if you do your three daily tasks every day Monday through Friday, you can walk to the coffeehouse with your friends on Saturday. More immediate rewards are usually the most motivating, but as kids get older they can start be motivated by rewards with a slightly longer wait time. For example, if you complete your math worksheet every day during the week, you can play video games with your friends over the weekend.
5. Be your kid's cheerleader
Your kid is awesome. Believe this. Teens with ADHD often spend the vast majority of their day in an environment that isn’t ideal for how their brain works. They are constantly reminded by teachers and peers that they aren’t doing what they should be. This is on top of the difficulties of adolescence-- trying to understand who they are and what their place is in the world. It can be easy for kids to start believing that they have little to offer. Help them to see their talents and strengths, even when they aren’t always used in school. And even when they have a setback, know that they can come back from it. It may require a new strategy, but they can do it. So make sure you are your kid’s #1 fan and that they know it!
Have I mentioned you are doing a great job? It is not easy to be in your shoes, but the fact that you are researching new ways to help your kids and your family shows that you don’t throw in the towel. Try some of the approaches I’ve listed here, give yourself a pat on the back, and stay tuned for part two of this blog post for more ways to improve communication with your ADHD teen.
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I'm sure you've heard that meditation can improve your focus. But have you ever really thought about using meditation or breathing exercises as a way to improve your ADHD symptoms? Perhaps it's time that you do.
Meditation is so incredibly impactful, that I can't even being to cover all of the ways that it affects our bodies and brains, especially not in only one post. Instead, let's take a look at the science that makes a compelling connection between breathing and ADHD physiology.
To begin, you should know that there is an area of the brain, called the locus coeruleus, which plays a vital role in both respiratory function and attention. A recent study hypothesized that this brain center is actually responsible for a synchronization between breathing and attentional focus. This study demonstrated that changes in breathing directly affected levels of noradrenaline (norepinephrine) in the brain. Norepinephrine is a neurotransmitter (chemical messenger of the nervous system) which plays a crucial role in ADHD, more specifically, those who have ADHD have been found to be norepinephrine deficient. In fact, norepinephrine has such an impact in ADHD that some medications such as methylphenidate and atomoxetine work by affecting norepinephrine levels. (For more information about the neurotransmitters involved in ADHD, check out this article by Additude.)
In less scientific terms, yes, meditation truly can help with ADHD and just staying focused in general. So, if you need a productivity boost, or find yourself having trouble staying focused, it may be best to start with a few minutes of mindful breathing, or meditation. I often have my patients start with a regular mindfulness meditation.
Don't know how to meditate? Don't worry, there are currently some fantastic apps and resources that make learning how easy. Personally, my favorite app is Headspace, which has several guided meditations specifically for anxiety, focus, kids, etc. Many options are free to try once you create an account, however you do need a subscription to access all files. There are still many other free options that don't require subscription. For example, the UCLA Mindfulness Awareness Research Center (MARC) has some fantastic audio files that are free to listen to! I hope you try out meditation for yourself, because you might be pleasantly surprised.
This is just the tip of the iceberg when it comes to the benefits of meditation and breathing exercises for improving focus, sleep, and reducing anxiety. I will go a bit more in depth on some of these other aspects in future blog posts!
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I often speak to teachers and school administrators about how to better understand kids with ADHD and how to help them succeed, and the question "Where can we find more resources and techniques" almost always comes up. Teaching Teens with ADD, ADHD, & Executive Function Deficits by Chris Zeigler Dendy, MS is definitely on my short list of recommended reading. This book goes a bit further in depth than other teaching books I have reviewed about how executive function deficits affect learning, citing specific challenges associated with each execution function. It also makes a more distinct connection between ADHD and executive functions.
I like that this book is geared toward teens in particular, and also talks about ADHD while still detailing specific executive functions. The areas where we see the greatest struggles in overcoming executive function deficits is often very different between elementary students and teens, therefore it is helpful to have a resource for teen-specific tools. I also really like that there is a section on legal rights for students and how these apply to ADHD, including IDEA.
Some general strategies for working with teens are given, such as using time limits for working memory deficits. But the greater value of the book comes in the specific inventions that are given, most of which I have listed below. There is a fairly thorough section on time management struggles as well--more than what I've found in most books.
- Modifications for assignments and testing
- Tips for working with disorders of written expression and math difficulties
- How to set up various tools such as graphic organizers, weekly reports, etc.
- Plentiful lists of resources (online, local, books, etc.)
- Thorough explanations of 504 and IEP plans
- Support for managing challenging behaviors in the classroom, broken down by specific behavior issues
- Section on conflict resolution, peer mediation, violence prevention, and anger management
If you are just beginning to explore ways to help your child or student in school, or just learning about 504s/IEPs for the first time, this book is going to be very overwhelming. But it is ideal for the teachers who have a basic understanding of working with kids with ADHD, and need more specific tools and ideas for the classroom. It is also fantastic for parents who have to offer a lot of at-home school support, or are having difficulty finding 504 accommodations or an IEP plan that works.
Book info: Teaching Teens with ADD, ADHD & Executive Function Deficits: A Quick Reference Guide for Teachers and Parents (2nd ed.) by Chris A. Zeigler Dendy, M.S. Woodbine House; Bethesda, MD; 2011.
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If you haven't yet heard of Dr. Russell Barkley, he is considered one of the foremost authorities on ADHD today. He has written many excellent books, gives informative talks (some available to view online), and does a pretty amazing job helping people to understand ADHD. His newest book, Managing ADHD in School: The Best Evidence-Based Methods for Teachers (PESI, Inc.; 2016), is very brief (less than 100 pages) but with the advantage of giving very succinct information. It offers a good starting point for understanding the connection between ADHD and executive functions, as well as how executive function deficits present in the classroom setting. There are some good general guidelines for working with students which will be helpful for both teachers and parents, such as remembering to "externalize information". Executive function deficits often make it difficult to rely on internal reminders to do various tasks (ex. take your vitamin), it is usually helpful to have visual cues and reminders to trigger this behavior (ex. write a note on the mirror, set vitamin bottle near coffee pot, etc.) Additionally there are specific tools given, such as a detailed sample of a Daily Behavior Report Card that can be copied. Dr. Barkley includes a small chapter on additional techniques for managing teens, as well as a section that explains ADHD medications.
If you are a parent of a newly diagnosed child who is beginning the 504 process, this is a great book to start with. It is also a good introduction to how to successfully work with kids with ADHD from a teacher's perspective. On the other hand, if you are already familiar with the basics of working with students with ADHD, this book doesn't offer much for you. Instead I would look into How to Reach and Teach Children and Teens with ADD/ADHD by Sandra F. Rief or Promoting Executive Function in the Classroom by Lynn Meltzer.
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In most situations, I think it is extremely important for kids to be familiar with how ADHD may affect them. This helps to foster a positive self image, and limit the negative self-talk that I often see persist into adulthood. Too many times patients come into my office using words like "lazy" or "stupid" when talking about their day-to-day struggles--which is almost always due to hearing these words directed at them since childhood. So I am always on the lookout for well-written books for children about ADHD.
Attention Girls! A Guide to Learn All About Your AD/HD by Patricia O. Quinn, MD (Magination Press; 2009) is one of my favorite books for kids, and I recommend it to almost every young girl who comes into my office. This book is aimed at older elementary/adolescent girls, but can be helpful for parents to look through as well.
The format is what I consider "ADHD friendly", allowing for jumping around easily to different sections, and with text broken into small chunks. Illustrations are also well done, meaning up-to-date and engaging. The first part of the book explains ADHD, using character descriptions of different girls with ADHD who present very differently. I particularly like this aspect of the book, as it is easy to read and helps girls to relate to and understand these characters, even if they see parts of themselves in several different ones. The book goes on to give examples of ways to manage ADHD symptoms, tools that may be helpful, and who to talk with for more support. There is also a fairly kid-friendly section on understanding medication, stressing that only the reader, her parents, and her doctor can decide if medication is the right choice for her.
I always encourage parents to read books on sensitive topics before sharing them with their child, to ensure it delivers information in a way that you are comfortable with. I find this book is a great introduction for girls to understand ADHD and how it affects them. It is a quick and engaging read, with a positive yet realistic tone. Recommended for ages 8-13.