Pathological Demand Avoidance: Key Takeaways

• PDA is a behavioral profile characterized by intense, anxiety-driven resistance to everyday demands and expectations.
• Children with PDA have extremely reactive nervous systems that prime them to interpret requests and expectations as threats. Alongside this pressure-sensitivity lies an intense need for equity and autonomy.
• Children who fit the PDA profile need a flexible, low-key, and low-demand parenting approach that prioritizes collaboration over command and connection over compliance.

What Is Pathological Demand Avoidance?

Learning about Pathological Demand Avoidance (PDA) — a profile characterized by intense, anxiety-driven resistance to everyday demands and expectations — finally helped me understand my son, Max, and how to support him.

During his early years, Max would frequently refuse to do what was asked of him and insist everything be done his way. He would inexplicably melt down or erupt in anger over seemingly minor issues. By the time he was 7, he had collected several diagnoses, including ADHD, autism, and ODD. Commonly suggested behavioral strategies for neurodivergent children — from setting clear rules to using checklists, visual timers, and liberally doling out praise — didn’t help. In fact, all they seemed to do was set up further power struggles where everyone lost.

If this story sounds familiar, learning about PDA may also help you.

Children with PDA have extremely reactive nervous systems that prime them to interpret requests and expectations as threats. Alongside this pressure-sensitivity lies an intense need for equity and autonomy. As such, children who fit the PDA profile need an approach that prioritizes collaboration over command and connection over compliance. They need a flexible, low-key, and low-demand parenting approach — an approach that, admittedly, did not come naturally to me and my husband. Oh, and did I mention that it requires parents to be very skilled at regulating their own emotions?

Ultimately, all parents raising unusually challenging kids want the same things. We all want to bring the best version of ourselves to our parenting. We all want a loving and stable connection with our child. We all want to feel less confused and overwhelmed and more confident, joyful, and hopeful along the way. We all want our kids — our complicated, wonderful kids — to thrive. To that end, here are the approaches that have helped us support our son more effectively and see positive change.

Pathological Demand Avoidance: 8 Essential Shifts for Parents

1. Look Through a Brain-Based Lens

Ross Greene, Ph.D., a clinical psychologist and author of The Explosive Child, has a saying that has served us well for navigating PDA: “Kids do well if they can.” 

[Read: 10 Rules for Dealing with the Explosive Child]

If you find yourself using words like disobedient or defiant to describe your child, it’s a sign that you’re viewing them through a behavioral lens. You are assuming that their challenging behaviors are intentional and fully within their ability to control. When it comes to PDA, it’s a lens that evokes frustration and anger.

Switch to a brain-based lens, and you’ll remember that: (1) Children who fit the PDA profile are predisposed to interpret demands as threats to their safety and autonomy; and (2) Demands and pressure trigger strong stress responses that emerge as challenging behavior. It’s a perspective shift that reduces frustration and leads to more productive responses.

2. Reduce Demands

In the context of PDA, the term “demands” refers to any expectation or perceived expectation placed upon an individual. Demands can be direct instructions (e.g., “put your shoes on”), routine tasks (e.g., showering or brushing teeth), implicit or social expectations (e.g., making eye contact in conversation, greeting someone politely), transitions and changes, or even internal demands such as those related to hunger, thirst, or toileting.

Because our pressure-sensitive children have very reactive nervous systems, demands can trigger intense anxiety and lead to resistance, avoidance, or emotional outbursts.

[Read: Defiance, Defused — A Roadmap to Radical Behavior Change]

Navigating a day’s worth of demands can progressively drain our child’s capacity to cope. To help them conserve energy so that they can meet unavoidable or essential demands, it’s important that we drop unessential ones to reduce the load.

3. Prioritize Connection and Collaboration

As parents, when we encounter resistance, avoidance, or refusal, it is frequently tempting to dig in ourselves and insist on compliance. When it comes to PDA, however, taking this approach often leads to power struggles that create additional distress. Prioritizing deep listening, flexibility, and collaborative problem solving will help your child feel safer and more in control.

4. Learn to Self-Regulate

Ultimately, we want our demand avoidant child to learn how to better regulate their own threat-response reactions and cope more effectively with demands. However, we parents are going to need all the self-regulation skills that underpin these abilities long before our demand avoidant children are capable of applying them consistently.

No matter how good you get at connecting and collaborating with your child, you are not going to be able to sidestep or defuse every meltdown or explosion. PDA kids are intense and it is easy to get swept up in their emotional storms. As such, it is essential for us as parents to get good at grounding ourselves—to learn how to better manage our own stress responses, frustration, and anger, so that we can stay calmer under pressure.

5. Plan for Explosive Moments

Intense meltdowns are common with demand-avoidant children. These episodes can be distressing for everyone involved, especially when they involve destructive or violent behavior. It’s important for parents to develop a contingency “rage plan” that identifies clear priorities during an extreme meltdown. “Protect, defuse, de-escalate” is our mantra for navigating explosive moments.

6. Upskill in Relationship Repair

At times your own grounding skills are going to fail you and you will experience parenting moments that you wish you could redo. What then? You practice self-compassion and then you repair. You return to that moment of disconnection, take responsibility for your behavior, and acknowledge its impact on your child. This will build trust and strengthen your connection.

7. Lean Into Your Child’s Fascinations

Many PDA children have strong special interests. They may love fishing, dinosaurs, Minecraft…you name it. You may not love these things with the same focused intensity as your child, but these fascinations are gateways to deep connection.

Spend time with your child as they engage in the things they love. Be with them, learn with them (let them teach you), play with them, and talk with them about their interests. When you genuinely take an interest in what they love, you’re building the sort of relationship that increases their willingness to join you when you ask things of them.

8. Focus on What You Can Control (Spoiler: That’s Yourself)

• Pick your battles. Raising a demand-avoidant child will force you to challenge your own hardwired assumptions about parenting. Most of us were taught to value hierarchy and authority. We often step into parenting expecting that our children “should” comply and obey. These approaches simply don’t work for children who fit a PDA profile. When I catch myself feeling like my child “should” be doing something they’re resisting, I pause and ask myself, “Why does this matter to me?” and “How important is this, really?”
• Remember the ultimate goal: A positive parent-child relationship. We may not be able to get our children to brush their teeth, take showers, attend school, or do any number of things we would like them to do. However, we can control who we are and how we show up in our relationships with them. Real change usually starts with us. When we focus less on “fixing” or “controlling” our child and more on understanding, adapting, and reshaping our expectations, we often see more of the connection and progress we’re longing for.

Pathological Demand Avoidance: Next Steps

• Free Download: How to End Confrontations and Defiance
• Read: The Parents’ Guide to Dismantling Oppositional, Defiant Behavior
• Read: 6 Truths About Child Behavior Problems That Unlock Better Behavior
• Read: 10 Rules for Dealing with the Explosive Child

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Defiant behavior may manifest as a child easily (and frequently) losing their temper, arguing with adults because of rules, or acting out violently. Reports suggest that 40% of children with ADHD experience oppositional and/or defiant behavior. ¹

[Free Download: Why Is My Child So Defiant?]

Behavioral disorders may stem from the deficits in executive functioning so commonly seen in ADHD, which can affect individuals’ abilities to plan, prioritize, and execute. All of this impacts the individual’s life — and the lives of those around them.

Family dynamics may be caught in the crossfire as children get frustrated with their caregivers, and caregivers tire of scaffolding a routine of daily tasks that their kids have difficulty sticking to, leading to nagging, frustration, and defiant behavior.

[Free Resource: Is It More Than Just ADHD?]

Studies suggest that some parenting techniques are more effective than others in addressing defiant behavior among children with ADHD, specifically. Such techniques can be especially useful in helping parents establish routines with their children.

Prescription ADHD medication used in conjunction with behavioral parent training helps many families learn how to best stem and respond to defiant behavior, as outlined in the ADDitude article, “ Why Is My Child So Angry and Defiant? An Overview of Oppositional Defiant Disorder” and in the recent webinar, “The Power of Behavioral Parent Training .”

In a recent survey, ADDitude asked its readers whether their children with ADHD displayed defiant behaviors and, if so, how those behaviors affected family dynamics. Several respondents said have felt a significant impacted and that they are struggling to develop productive and healthy responses.

Life with My Defiant Child

“Everyday, every request is a battle. A simple request such as, ‘Please brush your teeth’ or ‘Let’s finish your homework,’ turns into a fight. We are all on edge and really dread homework time, dinner time, and bedtime.”

“Having a child with ADHD often comes with some oppositional defiance challenges. Things can be going smoothly, and then, out of nowhere, something that seems minor to you can trigger a reaction, setting off a chain of events.”

“It takes a lot of mental energy to get through the days, especially when you also have ADHD and the emotional dysregulation is tough. Your other kids suffer because you are always focused on getting the child with ADHD through the day. My daughter is nearly 18, and I think we are slowly coming out the other side. It isn’t a straight path, and we have tried many different things — different schools, sports, medication, psychiatrists, psychologists. I think you just have to hold on for the ride and get through each day.”

“It is so hard. No matter what we do, our daughter pushes us away and refuses to do simple necessary activities, like brushing her teeth and getting dressed. She’s 8 years old, and I wonder if this behavior is ever going to end. It is very taxing when everyone else is ready, and we still have a defiant child refusing to get ready.”

Parenting Techniques to Address Defiant Behavior

“Both of my ADHD kids appear defiant when they are anxious and trying to control the situation, or when they feel overwhelmed. In those circumstances, they return a reflexive ‘no’ to every question before they have the chance to think about it. This has impacted our lives far less since we learned to slow down and figure out what is happening in their heads rather than let the behavior shake us.”

“Telling them to do something will never result in it getting done. You need to gently ask and convince them to do it.”

“Almost every time I ask my son to do something, even if it is something he likes or a simple request, he instinctively says no. It took a while, but I realized I could wait a few minutes for him to actually process what I said, and then gently repeat my request. He would usually have no problem complying once given the time to mentally process and transition. This break means he can communicate his thoughts, and we can discuss with cool heads.”

“My daughter has a history of oppositional defiance since a young age. It often looks like her needing to do something opposite of what we ask for the sake of being opposite. With the help of a child psychologist, we’ve worked hard as a parenting team to praise/reinforce following rules, and this has worked well to stem this behavior.”

My Defiant Child: Next Steps

• Read: “The Parents’ Guide to Dismantling Oppositional, Defiant Behavior“
• Watch: ““From Battles to Bonding: A Parent’s Guide to Trading Defiance for Cooperation“
• Free Download: “Why Is My Child So Defiant?“

Sources

¹ Riley M, Ahmed S, Locke A. “Common Questions About Oppositional Defiant Disorder.” American Family Physician (Apr. 2016). https://www.ncbi.nlm.nih.gov/pubmed/27035043

Poor impulse control can cause teens with ADHS to make poor choices – and lie about those choices. Lying stems from avoidance, denial, or a desire to skirt punishment.

But lying compounds the problem. There’s the lie, and then there’s the original problem that caused the lie.

There is something called earned trust. Through their actions, children and adolescents build on or destroy what has accumulated in a “trust bank account” with their parents. Kids think their trust bank accounts are flush with cash just because they exist. That’s not the case. Trust is earned. When a parent loses trust because a child lied, the child must earn it back, perhaps by complying with agreements or behaviors you both negotiated, for example.

When younger kids with ADHD lie, it doesn’t typically mean they’re trying to deceive you. Usually, kids lie to increase comfort in the present moment. Kids or teens may lie because they feel uncomfortable or ashamed, or in hopes of reducing stress or minimizing conflict.

[Free Download: Your 10 Toughest Discipline Problems — Solved!]

I suggest that you sit down with your child or adolescent and say, “There’s lying going on. How do we want to handle that? Let’s talk about agreements and logical consequences.”

Here’s a critical point to remember as a parent: You can’t ask for honesty and then punish it. If you say, “I want you to call me at any hour, wherever you are, and I’ll pick you up,” then you must follow through on this promise without judgement.

The ride home is not the time for lectures or to express your frustration. Refrain from telling them all the things that they’re going to lose; otherwise, they’re not going to confide in or call you again when they’re in a pickle. Instead, wait and gather your thoughts carefully. There’s nothing wrong with making your kids sweat a little bit. Then have the conversation later when everybody is calmer – and more clear-headed.

A positive response to dishonesty includes discussion and understanding; don’t shut things down with anger, guilt, blame, and shaming. When you show up with curiosity and compassion, you offer your child the opportunity to come clean and work with you on collaborative solutions to earn back your trust. This process builds connection and reduces conflict.

Parenting a Habitual Liar: Next Steps

• Read: A Survival Guide for Parents with ADHD: Strategies from Preschool to High School
• Free Download: Questions to Get Your Child Talking
• Watch: “A Parent’s Guide to Trading Defiance for Cooperation”

Sharon Saline, Psy.D., is a clinical psychologist who specializes in working with children, teens, and families living with ADHD and coexisting conditions.

As many as 62% of kids with ADHD receive a diagnosis and a prescription for medication without a recommendation for any type of parent behavior training or family therapy, according to the American Academy of Pediatrics. In a recent ADDitude survey, 57% of parents said they had participated in parent training. Of those, an astounding 93% recommended it.

Caregivers exert the greatest influence on their kids’ lives, and, let’s be honest, raising a child with ADHD can be extremely challenging. Parents may become frustrated, lose their temper, make allowances for inappropriate behaviors, or just give up in the face of relentless negative habits and attitudes. This is where parent behavior training, also called behavioral parent training (BPT), can help.

Moving from Reactivity to Proactivity

Parent training refers to a series of interventions designed to help caregivers learn effective strategies to manage their own emotions as well as their child’s behavior. The goals revolve around using positive reinforcement, setting effective boundaries, and providing scaffolding to increase positive connections, reduce negativity, and enhance a child’s successes.

This type of training helps parents learn to be proactive rather than reactive. The reactive parent responds to a child’s behaviors with threats of punishment based on intense feelings rather than logical thinking. Punishment fails to work in the long term because children with ADHD will need other options in their toolkit.

[Free Download: Your Guide to Parent Training Programs]

A good parent behavior training program can do the following:

• Teach parents real-world strategies for positive reinforcement and consistent discipline.
• Teach self-regulation, de-escalation, and calming strategies.
• Improve parent-child communication through reflective listening and accountability.
• Help parents set realistic expectations and routines based on their child’s skills and abilities.
• Replace reactive parenting with proactive strategies that rely on incentives rather than threats.

6 Popular Training Programs

The most effective parent training programs increase positive parent-child interactions by elevating the quality of attachment, the ability to communicate effectively, and the willingness to set and enforce boundaries. Here are six programs popular among families living with ADHD.

Parent-Child Interaction Therapy

Format: A therapist in an observation room watches parents interact with their child in real time. Parents wear an earpiece to receive in-the-moment parenting strategies from the therapist.

Goals:

• To help your child feel calm, confident, and secure in your relationship
• To learn how to be confident and calm in the face of your child’s most difficult behaviors

The Incredible Years

Format: Trained facilitators use video vignettes to present content and stimulate discussion. Separate programs are offered for parents of toddlers, preschoolers, and school-age children.

Goals:

• To strengthen parent-child interactions
• To foster parents’ ability to promote kids’ social and emotional development
• To reduce school dropout rates and delinquent behaviors
• To promote academic success

[Free Webinar: “The Power of Behavioral Parent Training for ADHD”]

Positive Parenting Program (Triple P)

Format: This online program is designed for two groups: parents of children ages 12 and under, and parents of children ages 10 to 16. The program provides a mix of videos, worksheets, tips, and activities that take 30 to 60 minutes to complete.

Goals:

• To set discipline guidelines
• To build parent confidence
• To raise happy children

Helping the Noncompliant Child

Format: Training sessions for parents and children ages 3 to 8. Skills are taught using active teaching methods, such as extensive demonstration, role play, and real-time practice.

Goals: To foster positive interaction by:

• Reducing parental coercive behaviors
• Giving positive attention to the child for appropriate behavior
• Setting limits and consequences

Parent Management Training

Format: Parents of children with moderate to severe behavioral difficulties work with a certified trainer online, in person, or over the phone.

Goals:

• To teach parents how to help their children cultivate positive behavior
• To learn how to effectively deal with anxiety and negative behavior

GenerationPMTO

Format: GenerationPMTO is an intervention program that is provided to individual families or parent groups, in person or via telehealth. The structure of individual training programs differs by location, both nationally and internationally.

Goals:

• To promote social skills that reduce delinquency, deviant peer associations, and mood disorders in parents and youths

Tips for Finding a Provider

Ask these key questions when interviewing a prospective therapist, coach, or program administrator:

1. What is your education in a particular parent behavior training model? Do you hold a certificate, license, or other accreditation in your field?
2. What is your training in ADHD and child development?
3. How do you monitor and support your clients’ progress?
4. What additional support is available after the program ends?

Behavioral Parent Training (BPT): Next Steps

• Free Download: 5 Ways to Improve Emotional Control at Home
• Read: How Does Behavior Therapy Work?
• Read: When Behavioral Parent Training is Working — But Tough to Maintain
• Sign Up: Parenting Class for ADHD Families

Sharon Saline, Psy.D., is a clinical psychologist and author.

Ryan Wexelblatt, LCSW, is a school social worker, camp director, and father to a son with ADHD and learning differences.

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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.

Reserve your spot in this free webinar, and get the event replay link plus a 15% discount to ADDitude magazine

Not available June 17th? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.

Summer is tricky. The break from school is liberating and renewing, but for children with ADHD, the long days and lack of structure can lead to meltdowns and screentime overuse — common complaints among parents. With the right strategies and thoughtful routines, however, caregivers can build the summer-specific structure needed to ease transitions, encourage ongoing organization, and smooth the bumps of school break.

In this interactive webinar, viewers will have the opportunity to ask questions to Dave Anderson, Ph.D., an expert in child behavioral development, and gain practical strategies to create a balanced summer routine that promotes fun and reduces stress.

In this webinar, you will learn:

• How to maintain a semi-structured schedule that supports consistency and reduces anxiety
• Effective strategies to help manage kids’ video game and other tech device use
• How to set realistic goals for your child and use small rewards to encourage progress
• The importance of fostering your child’s independence while maintaining behavioral boundaries for a smooth, enjoyable summer.

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Summer Activities and ADHD: Resources

• Free Download: Your Guide to a Smarter Summer
• Read: How to Survive Summer Vacation
• Read: Summer Survival Guide for Parents of Extreme Children
• Read: The Best Summer Is a Strategized Summer
• eBook: Your ADHD Summer Survival Guide

Meet the Expert Speaker

Dave Anderson, Ph.D., is Vice President, Public Engagement and Education; and Senior Psychologist, ADHD and Behavior Disorders Center, at the Child Mind Institute.

Dr. Anderson specializes in evaluating and treating children and adolescents with ADHD and behavior disorders. He also has broad experience with anxiety and mood disorders. His expertise includes cognitive behavioral therapy, behavioral parent training, school-based consultation, and classroom behavioral support. Dr. Anderson is devoted to ensuring that patients receive innovative, cutting-edge care tailored to each family’s specific needs.

Certificate of Attendance: For information on how to purchase the certificate of attendance option (cost $10), register for the webinar, then look for instructions in the email you’ll receive one hour after it ends. The certificate of attendance link will also be available here, on the webinar replay page, several hours after the live webinar. ADDitude does not offer CEU credits.

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Reserve your spot in this free webinar, and get the event replay link plus a 15% discount to ADDitude magazine

Not available June 11th? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.

Does your teen with ADHD overreact to small comments, withdraw suddenly, or seem constantly on edge? They may experience rejection sensitive dysphoria (RSD), a phenomenon common with ADHD. Not a formal diagnosis, RSD refers to intense feelings of pain following an actual or perceived rejection; a person with RSD may anticipate someone pulling back friendship, love, or support over a gesture, a misunderstanding, or a small disagreement.

Parenting teens with ADHD typically means navigating intense emotional storms, executive functioning challenges, and unpredictable hormonal shifts. When you add RSD to the mix, this combination can feel overwhelming and exhausting for everyone.

This webinar is designed to increase your ability to understand what’s really going on beneath the surface and to offer support through the ups and downs of adolescent sensitivity with compassion and clarity. Award-winning author, international speaker, and consultant Dr. Sharon Saline will explain how to manage the heightened emotional sensitivity in teens that often accompanies ADHD. After discussing the science behind RSD and how it relates to social anxiety, she will explore how hormonal changes in adolescence amplify emotional intensity and increase dysregulation in teens. Dr. Saline will show you how to assist kids in identifying triggers, reducing negative self-talk, and lowering shame. You’ll learn practical, evidence-based strategies for helping your adolescents feel more in control of their emotions, more connected to you, and more confident in themselves.

Learning Objectives:

• Understand the connections between ADHD and RSD in teens
• Learn how hormonal changes during puberty impact brain development, mood swings, and emotional sensitivity
• Recognize common signs of Rejection Sensitive Dysphoria (RSD) in teens, including emotional shutdowns or outbursts
• Gain practical tools for de-escalating emotional outbursts and helping your teen name, manage, and recover from big emotions
• Explore communication strategies that foster trust, reduce shame, and build resilience

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

RSD in ADHD Teens: Resources

• Free Download: Evaluate Your Teen’s Emotional Control
• Read: How ADHD Ignites RSD: Meaning & Medication Solutions
• Read: Have a Teen with ADHD? Encourage Communication & Avoid the Drama
• Read: The Key to ADHD Emotional Regulation? Cultivating Gratitude, Pride & Compassion
• eBook: The Parents’ Guide to Raising a Teen with ADHD, Part One

Meet the Expert Speaker

Sharon Saline, Psy.D., is a clinical psychologist and author of the award-winning book, What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life and The ADHD Solution Deck (#CommissionsEarned) specializes in working with children, teens, emerging adults and families living with ADHD, anxiety, learning disabilities, autism, twice exceptionality and mental health issues. Her unique perspective, as a sibling in an ADHD home, combined with decades of experience as a clinical psychologist and educator/clinician consultant, assists her in guiding families and adults toward effective communication and closer connections. She lectures and facilitates workshops internationally on topics such as understanding ADHD, executive functioning, anxiety, motivation, different kinds of learners, and the teen brain. Dr. Saline is a regular contributor to ADDitude and Psychology Today, a featured expert on MASS Appeal on WWLP-TV, and a part-time lecturer at the Smith School for Social Work. Her writing has been featured in numerous online and print publications including MSN, The Psychotherapy Networker, Smith College Studies in Social Work, Attention Magazine, ADDitude Magazine, Psych Central, and Inquirer.com. Learn more at www.drsharonsaline.com.

#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.

Webinar Sponsor

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Certificate of Attendance: For information on how to purchase the certificate of attendance option (cost $10), register for the webinar, then look for instructions in the email you’ll receive one hour after it ends. The certificate of attendance link will also be available here, on the webinar replay page, several hours after the live webinar. ADDitude does not offer CEU credits.

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Behavioral parent training (BPT) can be especially effective for children with ADHD and related behavioral struggles. BPT teaches caregivers the skills and strategies that can help improve their child’s behavior, self-control, and self-esteem. BPT is recommended as a first-line treatment for young children with ADHD, and starting treatment with BPT may reduce the need for ADHD medication.

BPT can help children and teens improve their ability to stay on task and control impulses at home, in school, and in social settings. It can improve the parent-child relationship and promote calm in the household.

In this webinar, you will learn:

• About behavioral parent training and why it is especially helpful for children with ADHD
• About the specific behaviors that BPT addresses
• Skills and strategies to help your child learn to manage and improve their impulse control and emotional regulation
• How BPT improves communication at home, in school and in social settings
• Why it’s important to partner with your child’s teachers and how to collaborate effectively
• How to use rewards and consequences to improve behaviors

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

ADHD Parent Training: Resources

• Sign Up: Parenting Class for ADHD Families
• Read: Train the Parent, Help the Child
• Read: How Behavioral Therapy Targets Executive Dysfunction — with Positivity and Praise
• eBook: The ADHD Positive Parenting Guide

Obtain a Certificate of Attendance

If you attended the live webinar on April 15, 2025, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Speaker

Nicole Schatz, Ph.D., is the Clinic Director with the Florida International University Center for Children and Families and a Research Associate Professor in the FIU Psychology Department. Dr. Schatz is also a licensed clinical psychologist in Florida and New York with expertise in behavioral interventions for children and adolescents with ADHD, including behavioral parent training.

Through her clinical work, Dr. Schatz has worked directly with parents of children with ADHD to implement behavioral parent training. Dr. Schatz has also provided clinical training and supervision in behavioral parent training to trainee clinicians. As a clinical researcher, Dr. Schatz’s program of research has emphasized the development and evaluation of behavioral interventions for children with ADHD.

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But studies suggest that we can teach kids effective skills for regulating their emotions, improving their behavior, engaging in active problem solving, and building positive relationships. How? The intervention I’ve found most helpful is dialectical behavior therapy (DBT).

“Dialectical” is simply the idea that two things that seem like opposites are true at the same time. Some examples of dialectics are: “I am independent, and I sometimes need help,” or “I’m really frustrated with you, and I love you.”

A simple approach to incorporating dialectical thinking into your parenting is to replace “but” with “and.” When you tell your child, “I know you’re angry, but you need to put your coat on,” that communicates that the first part of the sentence (the child’s side) is less important than the second half (the parents’ side). Replacing “but” with “and” communicates that both sides are equally important.

[Watch: Managing ADHD and Emotion Dysregulation with Dialectical Behavior Therapy]

Deeply Feeling Kids are “Supersensors”

When families arrive at DBT, they’ve often heard negative interpretations of their kids’ challenging behavior – and accusations that they are manipulative or spoiled. DBT asserts that, if you put a highly sensitive kid in a chronically invalidating environment, tantrums, risky behavior, and relationship problems are sure to follow. In DBT terms, a sensitive kid is an emotional “supersensor,” with reactions that are immediate, extreme, and long-lasting.

Validation is a kind of fire extinguisher for these emotional explosions. It doesn’t involve solving the child’s problems. It doesn’t mean agreeing with the child’s behaviors, thoughts or feeling. It simply involves communicating that these feelings make sense and are legitimate.

[Free Download: What Is Dialectical Behavior Therapy (DBT)?]

How to Validate Your Child’s Feelings

• Listen with awareness and avoid judgmental facial expressions.
• Reflect what your child is saying: “Math was really hard today.”
• State the unstated: “It sounds like you’re really hurt by what your friends said. Is that right?” Even an incorrect guess helps them think through their feelings.
• Communicate how their behavior makes sense given past circumstances. “I know the cafeteria is loud and overwhelming. I get why you’d be nervous about lunch today.”
• Confirm that their behavior is not unusual. “It makes sense that you were disappointed by the cast list. You worked hard preparing for that audition.”
• Cheerlead: Express belief in your child’s abilities. “It makes sense that you’re worried, and I know you are strong and up to the challenge!”

Validation is the salve for a chronically invalidating environment. It doesn’t solve the child’s problems or mean you agree with their behaviors, thoughts, or feelings. It simply communicates that they make sense and that their feelings are legitimate.

Parent Responses to Avoid

Avoid invalidating responses, which tend to exacerbate supersensors’ problematic behavior. Consider these two examples:

• During a child’s explosive episode, the caregiver says: “You’re making a spectacle of yourself!” or “You’re overreacting.” This dismisses the child’s experience.
• When a child complains that an activity is hard or boring, and doesn’t do what they said they would, caregiver says: “I don’t want to hear excuses. Do as you’re told.” This rejects the child’s efforts to communicate their feelings and oversimpliflies the process of meeting a goal.

Usually, parents or teachers say these things with good intentions, but these sentiments rarely help supersensors. These kids get the feedback that their emotions are wrong or illogical, and they start to doubt their own experience. Feeling misunderstood often turns up the dial on their distress.

Validating Deeply Feeling Kids: Next Steps

• Watch: How ADHD Amplifies Emotions
• Read: When Angry Kids Lash Out – How to Defuse Explosive Reactions
• Learn: 10 Rules for Dealing with the Explosive Child

Lauren Allerhand, Psy.D.. is co-director of the Dialectical Behavior Therapy Programs and a psychologist for the Mood Disorders Center at San Francisco’s Child Mind Institute.

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U.S. Senator Tommy Tuberville (R-Ala.), during a confirmation hearing for Health and Human Services Director nominee Robert F. Kennedy, Jr., last week said this: “We have an attention deficit problem in this country… When you and I were growing up, our parents didn’t use a drug, they used a belt and whipped our butt… Nowadays, we give them Adderall and Ritalin. They are like candy across college and high school campuses.”

Kennedy, in his response to Tuberville, falsely claimed that 15% of American children are taking Adderall or other ADHD medications, and that the U.S. is “overmedicating our children” with stimulants, SSRIs, and benzodiazepines for mental health conditions. This juxtaposition — criticizing the American pharmaceutical industry after suggesting corporal punishment as a healthier alternative — struck many in the ADHD community as toxic and dangerous.

The American Psychological Association (APA) passed a resolution in 2019 urging against physical discipline for children, citing research demonstrating that corporal punishment harms children’s mental health and increases the likelihood of aggressive behavior in the future. “Use of physical discipline predicts increases — not decreases — in children’s behavior problems over time,” the resolution said.

The clinical practice guidelines developed by the American Academy of Child and Adolescent Psychiatry (AACAP) recommend medication as the first-line treatment for ADHD in school-age children, citing a formal review of 78 studies on the treatment of ADHD, which “consistently supported the superiority of stimulant over the non-drug treatment.”

Tuberville’s comment comes just days after an interview with Nicole Shanahan, an attorney and Kennedy’s former 2024 running mate, in which he blamed mental health medications for a rise in American school shootings, despite a lack of research backing this claim.

ADHD Community Response

“The effects of ADHD crush families, multiply health burdens, sap worker productivity, and increase penal system costs,” said Oren Mason, M.D., a family physician in Grand Rapids, Michigan, and author of Reaching for a New Potential, in response to Kennedy’s statement at the confirmation hearing. “Life is remarkably harder with autism and depression, and every bit of support is welcome. People with ADHD and similar mental health challenges need affordable and available medications, psychosocial support, and education/work modifications. Parents need evidence-based guidance and training opportunities and respite. Teachers need evidence-based methodologies and the time to implement them. Therapists and coaches need training in the most beneficial interventions. Scientists and researchers need funding and priority-setting leadership. As Secretary of HHS, this is what I will provide the people of our great nation.”

“This is what RFK, Jr., might have said if he was familiar with the far-reaching complexities of providing hope and care for those with mental health challenges,” Mason continued. “Instead, he chose an Internet-chatter meme to spotlight his grasp of the needs of almost 30 million Americans with a complex disability. The mortality rate of ADHD is higher than asthma and nearly that of heart disease. If he was trying to signal that his approach to America’s mental health will be heartless and evidence-free, he nailed it.”

Many people took to BlueSky to respond to Tuberville’s and Kennedy’s comments at the confirmation hearing and to reflect on their own experiences with physical discipline as children with ADHD. Here are comments posted to BlueSky late last week during the confirmation hearings:

“Child abuse is a serious problem in this country and NOT a treatment for ADHD. In fact there is an association between ADHD and being a victim of abuse.” — @trm99.bsky.social

“We did get punished in every way, from spankings to standing in the corner at school for having (what we later learned) was ADHD. I was told how disappointing I was, how it was a shame that I had poor self-control since I was so smart, etc.” — @ritamelindared.bsky.social

“The belt/strap never helped my ADHD just made me angrier and more rebellious!” — @ginakh.bsky.social

“Late diagnosis and therapy ended decades of self-loathing no doubt brought about by teachers and other adults who berated me as a kid.” — @mexhistorian.bsky.social

[Read: Does Trauma Cause ADHD? And Vice Versa?]

“As a 65 year old with ADHD (and I had it as a child) I can attest that THE BELT was not the way to handle things. I’m still traumatized.” — @veryvaluable.bsky.social

“I was diagnosed when I was 41; my brother was 6. He was treated very differently and far less violently than I was and is doing well.” — @atticusdogsbody.bsky.social

“My mom used a belt, and her hands, and The Denver Post, and wooden spoons, etc… and I still have ADHD and also CPTSD.” — @quickbeam711.bsky.social

“Beating your child was never a treatment for ADHD. It was and always will be abuse.” — @ pednspy.bsky.social

“ADHD is an actual condition, and you can’t beat it out of a child.” — @ nrvschultz.bsky.social

“The belt doesn’t cure ADHD.” — @davidcouldbewrong.bsky.social

“As a parent watching a 4-year-old kid and wondering if he has ADHD, my first and only concern is making sure he had tools to succeed, not that we beat it out of him or hide it due to stigma.” — @ viamarsala18.bsky.social

These comments shed light on the need for proper treatment to combat the shame and stigma that tend to come with an ADHD diagnosis.

RFK Hearing, Discipline, and ADHD: Next Steps

• Free Download: Best Discipline Strategies for ADHD Children
• Read: Childhood Trauma and ADHD — A Complete Overview & Clinical Guidance
• Read: Why Spanking Your Kids Is Harmful

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There’s no point spitefully opposing screens, digital media, and artificial intelligence. These tools keep us connected, learning, and informed, but the price we pay is the persistent erosion of our attention. Technology companies invest billions in developing powerful algorithms made to embezzle our attention, with little regard for the near- and long-term effects on health and wellbeing. The risks are particularly high for young people with ADHD who experience impulsivity, altered reward processing, time management challenges, and difficulty with boredom.

Multiple states are now issuing orders to curb phone use in schools and U.S. Surgeon General Vivek Murthy has called for warning labels on social media platforms, suggesting that digital media checks and balances are taking shape. To that end, here are steps you can take to regain control over your digital media use.

How Do Screens Affect Us?

Perpetual Distraction

Technology exploits the information-foraging nature of the brain. We evolved to seek and value information because it’s useful for survival. We don’t always know how to filter out too much information. That’s why it’s so tough to ignore the constant pings, dings, and other incessant notifications that force their way into our brains.

The Fiction of Multitasking

Our brains can only focus on one task at a time, yet many of us, seduced by our devices, assume that we can easily switch between tasks. Task switching is costly not just to productivity, but to brain functioning. It deteriorates attention span, which, according to some reports, has decreased from two and a half minutes in 2004 to about 47 seconds today.

[Think You May Be Addicted to Your Phone? Take This Screener] 

Aversion to Delays

The sheer speed of apps, sites, and game today has made us averse to delays. Ever notice yourself growing impatient if a page takes 10 seconds to load? We want stimulation constantly and immediately. An aversion to postponing gratification is problematic — patience and the ability to handle discomfort are essential for healthy functioning.

FOMO and Anxiety

Excessive pressure to stay connected to technology for fear of missing out (FOMO) drives anxiety, keeping us compulsively stuck to our devices and driving a feedback loop.

Restore Control: How to Unplug

Check In with Yourself

Ask yourself the following questions (and be honest in your answers) to gauge where you stand with your digital media habits:

• “Is my smartphone use a problem for me? If so, in what ways?”
• “Am I spending more time on my smartphone, computer, or device than I want?”
• “Am I too distracted by notifications on my smartphone, computer, or other device?”
• “Am I compulsively looking at my smartphone when I don’t really need to be?”
• “Do I worry too much about what I’m missing if I’m not checking my smartphone?”
• “Is it hard for me to resist looking at my smartphone when I’m doing other things, such as working, studying, spending time with people, walking, or driving?”
• “Am I unhappy with my social media presence?”
• “Am I an active or a passive user on social media?”
• “Am I using social media as a substitute for real life?”
• “Does social media leave me feeling inadequate or disappointed about my life?”

[Read: Can’t Stop Clicking? Here’s How to Beat “Infomania”]

Commit to Conscious Change

Reducing time spent online is critical — and difficult. It takes effort and real commitment to break free from what is an automatic behavior for many of us. Here are a few actionable steps to curb your screen and online time:

• Use and app to track your daily social media activity for an accurate sense of how much attention you’re surrendering.
• Turn off your phone at key times like while you’re driving, in meetings, and with family and friends.
• Don’t bring your device to bed. Park your devices in a dresser or keep them outside of your room during bedtime.
• Disable app notifications to avoid distractions and feelings of FOMO.
• Interrupt compulsive checking. Decide specific times for checking your phone, for example. Keep your phone out of reach. Have a good reason for checking so that it’s not mindless.
• Avoid passive scrolling, which is more likely to lead to negative feelings and disconnectedness.
• Fill the void. Do you check social media because you’re bored? Stressed? Anxious? Lonely? Dissatisfied with your life? Question your reasons for escaping into the online world and see how you can tune in more to the real world. Keep a gratitude journal and track the positives. Spend time doing things in the physical world that make you feel good so that you’re better able to stay rooted in the present and restore your attention span.
• Do what you can, but do something. What will it take for you to improve your digital media habits, even by a few minutes a day? If you can’t turn off your phone during dinner, can you commit to not looking at it for the first 5 minutes of your meal? If you can’t disable notifications, can you be more selective about which ones come through? Remind yourself why you want to be in better control of your usage and what’s at stake.

Screen Addiction and ADHD: Next Steps

• Read: Wasting Time on Social Media? 6 Ways to Stop ADHD Brains from Doom Scrolling
• Read: Phone Distractions Were Sabotaging My Relationships, Sleep & Self-Esteem
• Read: ADHD Brains on Screens  — Decoding a Complicated Relationship
• Watch: Time to Unplug? How Screen Time Impacts the ADHD Brain

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Journey to Independence: A Parent’s Guide to Delayed Adulthood with ADHD” [Video Replay & Podcast #503] with Anthony Rostain, M.D., M.A., which was broadcast on May 1, 2024.

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Does your tween or teen say ‘No’ as an automatic reflex? Do they dismiss your advice and often do the exact opposite? Do you feel powerless in halting their bad choices as they exert independence and ‘learn the hard way?’

If every day feels like a battle, and your child seems to make things unnecessarily difficult, you are not alone. Parenting tweens and teens with ADHD — and enduring their continued efforts to frustrate you at every turn — takes stamina, patience, and compassion. From intense emotional eruptions and friendship drama to snarky attitudes and bold defiance, adolescents with ADHD seem to cycle through self-defeating and self-destructive patterns exacerbated by puberty. These behaviors are ineffective attempts to hide the worry, frustration, hopelessness, and shame that they feel deep inside. How can you join with your adolescent to create and meet meaningful goals related to school and home life?

In this webinar, Sharon Saline, Psy.D., pulls back the curtain and shows you how to talk with kids about what’s really going on, how to create opportunities for collaborative solutions, and how to reduce conflict at home and at school. She will show you effective strategies for avoiding blowouts, improving motivation, and repairing relationship ruptures. You’ll learn practical techniques for transforming stuckness and obstinacy into optimism and cooperation.

In this webinar, you will learn how to…

1. Understand the biopsychology of adolescent development.
2. Identify collaborative interventions for self-defeating behavioral and psychological patterns in tweens and teens.
3. Explain practical, strength-based approaches for dealing with resistant, oppositional kids that foster cooperation.
4. Develop self-esteem and resilience in challenging adolescents.

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

Teens with ADHD: More Resources

• Free Download: Transform Your Teen’s Apathy Into Engagement
• Self-Test: Could Your Child Have Oppositional Defiant Disorder?
• Read: You Can’t Change Your Defiant Teenager…
• Read: “Take a Sabbatical from Teaching and Judging”

Obtain a Certificate of Attendance

If you attended the live webinar on February 12, 2025, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Sharon Saline, Psy.D., clinical psychologist and author of the award-winning book, What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life and The ADHD Solution Deck specializes in working with children, teens, emerging adults and families living with ADHD, anxiety, learning disabilities, autism, twice exceptionality and mental health issues. Her unique perspective, as a sibling in an ADHD home, combined with decades of experience as a clinical psychologist and educator/clinician consultant, assists her in guiding families and adults toward effective communication and closer connections. She lectures and facilitates workshops internationally on topics such as understanding ADHD, executive functioning, anxiety, motivation, different kinds of learners, and the teen brain. Dr. Saline is a regular contributor to ADDitudemag.com and PsychologyToday.com, a featured expert on MASS Appeal on WWLP-TV, and a part-time lecturer at the Smith School for Social Work. Her writing has been featured in numerous online and print publications including MSN, The Psychotherapy Networker, Smith College Studies in Social Work, Attention Magazine, ADDitude Magazine, Psych Central, and Inquirer.com. Learn more at www.drsharonsaline.com.

Webinar Sponsor

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Play Attention, inspired by NASA technology and backed by Tufts University research, strengthens executive function, emotional regulation, and focus, turning resistance into cooperation. Your customized plan builds critical skills for success and fosters collaboration within your family. Schedule your consultation and learn how you can improve executive function in just 10-minutes a day! Home and Professional Programs available. www.playattention.com

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Family life brings smiles and struggles, but when persistent tantrums, resistance, or negativity dominate, they can strain relationships and household harmony. In this transformative webinar, psychologist Jeffrey Bernstein, Ph.D., shares a proven program to help caregivers reduce conflict and eliminate disruptive behaviors in children, teens, and even struggling adult children.

This webinar explores the underlying causes of oppositional defiance, offering practical tools to restore peace and connection. Moving from battles to bonding will empower you to put those fruitless power struggles behind you by turning emotional reactivity into opportunities for connection and cooperation.

Critical handouts will be included for registrants in this webinar to help caregivers learn the strategies that prevent emotionally dysregulated children from becoming defiant.

In this webinar, you will learn:

• How to foster empathy by building stronger connections with children through understanding and compassion
• How to regulate your emotions and model calm responses for your child
• About the power of emotion regulation coaching to transform resistance into collaboration
• How to navigate parenting in an era of heightened anxieties and societal challenges
• About cooperative, connection-building games to foster trust, communication, and teamwork

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

Defusing Defiance in Children with ADHD: More Resources

• Download: 10 Rules for Parents of Defiant Kids with ADHD
• Sign Up: The ADHD Parenting Class
• Read: The Facts About ADHD vs. ODD
• Read: Two Families’ Stories of Oppositional Defiant Disorder
• eBook: The ADHD Positive Parenting Guide

Obtain a Certificate of Attendance

If you attended the live webinar on January 16, 2025, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Dr. Jeffrey Bernstein is a psychologist with more than 34 years of experience specializing in child, adolescent, couples, and family therapy. He completed his post-doctoral internship at the University of Pennsylvania Counseling Center and holds a Ph.D. in Counseling Psychology from the State University of New York at Albany. He has appeared on the Today Show, Court TV as an expert advisor, and CBS Eyewitness News Philadelphia, 10! Philadelphia — NBC and public radio.

Dr. Bernstein has authored several books, including The Anxiety, Depression, & Anger Toolbox for Teens, The Stress Survival Guide for Teens, Mindfulness for Teen Worry, 10 Days to a Less Defiant Child, 10 Days to Less Distracted Child, Liking the Child You Love, and Why Can’t You Read My Mind? He has also published the Letting Go of Anger Therapeutic Card Deck.

#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.

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Brain Balance helps kids, teens and adults with ADHD, learning differences, anxiety & more through our integrative cognitive development and brain wellness program. Our approach combines cognitive, physical and sensory training with nutritional guidance to strengthen and build brain connectivity without the use of medication. Stronger connections translate to improved attention, behaviors, and social-emotional well-being. | brainbalancecenters.com/additudemag

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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Children with ADHD are more likely to be obese, despite lower-than-average birth weights, according to a new study that found a correlation between elevated ADHD symptoms and higher body mass index (BMI) scores for both females and males. ¹The study, published in the Journal of the American Academy of Child & Adolescent Psychiatry, complements additional research tying ADHD impulsivity to unhealthy food consumption and overeating.

In analyzing data from the Millennium Cohort Study (MCS) of more than 19,000 families with children born between 2000 and 2002, researchers found that children with ADHD had significantly lower birth weights than did children in the control group. Both groups maintained similar obesity rates until age 5, when the ADHD group experienced a rise in obesity that continued throughout adolescence.

“As children with ADHD are typically lighter in weight at birth than children without ADHD, the results suggest there may be a sensitive time period between the ages of 3 and 5 years during which this association reverses, and higher ADHD symptoms become associated with obesity,” the researchers wrote.

Researchers collected data when the 442 ADHD cohort members reached 9 months and 3, 5, 7, 11, 14, and 17 years. (The study excluded cohort members taking ADHD medications.) They found that weight gain began earlier for girls with ADHD (age 7) compared to boys with ADHD (age 11). “The weight changes in girls additionally seemed to be more long-lasting, whereas the observed changes in boys seemed to be transitory,” the researchers wrote. It is unclear whether these associations continue into adulthood.

Further analysis revealed that elevated ADHD symptoms in females at ages 7, 11, and 14 predicted higher body mass index (BMI) scores at ages 11, 14, and 17, respectively. The same association occurred in males at ages 11 and 14. These results suggest that ADHD symptoms are not entirely responsible for the uptick in weight children experience between the ages of 3 and 5 years.

Genetics, Prenatal Factors Impact BMI

Hormones and puberty contribute to weight gain. “Sometimes pre-teens can gain weight as the body prepares for a growth spurt in height,” says Roberto Olivardia, Ph.D., clinical psychologist at Harvard Medical School. “Therefore, BMI normalizes as they gain height.”

Prenatal factors, including the mother’s pre-pregnancy BMI, prenatal blood pressure, smoking during pregnancy, and poor nutrition, predicted a higher BMI at 5 years. Genetics may also increase the risk of obesity.

“It is possible that there is a common genetic background to both ADHD and [being] overweight or, as parents with ADHD are more likely to have children with ADHD, this may have an impact on executive function skills involved in parenting, such as planning healthy meals, which in turn may influence weight status,” the researchers wrote. “Parents with an increased genetic risk may be influencing their child’s home environment in ways that compound inherited risk.” ², ³

Impulsivity Linked to Poor Dietary Decisions

Another recent observational study found a strong link between impulsivity, a common ADHD trait, and unhealthy food consumption and overeating, specifically in the form of snacking. ⁴

The study, published in the Journal of Attention Disorders, analyzed data from the KOALA Birth Cohort Study of 810 adolescents aged 16 to 20 years. The researchers identified five dietary patterns

• Snack — high intakes of regular (non-diet) soft drinks, fruit juice/drinks, fried snacks, chips, nuts or snacks, and energy drinks
• Healthy — high intakes of lettuce, raw vegetables, fruit, eggs, and tea
• Animal-based — high intakes of animal dairy products, meat and chicken, and fish
• Sweet — high intakes of pastry, chocolate bars, candy bars, cake or biscuits, and sweets
• Beverage — high intakes of diet soft drinks, light fruit juice/drinks, sports drinks, and energy drinks

Among the five dietary patterns, adolescents with an ADHD diagnosis scored higher on the Snacking dietary pattern than did those without ADHD. Higher Snack scores were associated with difficulties with cognition, inattention, and impulsiveness. Impulsivity was inversely related to Sweet dietary patterns and positively related to Beverage dietary patterns.

Interestingly, adolescents with ADHD appeared no less likely than their neurotypical peers to engage in Healthy dietary patterns. “The lack of a reverse association between ADHD symptoms, especially impulsivity, and the healthy pattern is unexpected and raises questions,” the researchers wrote.

Though the study does not prove causality, the findings suggest that eating habits may differ based on the specific ADHD symptoms each individual experiences.

“When studying how ADHD impacts an adolescent’s diet, looking beyond a simple diagnosis and considering the specific dimensions of their ADHD symptoms, like inattention, hyperactivity, and impulsivity, provides a more nuanced understanding of their dietary behaviors, as these individual dimensions can differentially influence food choices and eating patterns, even among individuals with the same ADHD diagnosis,” the researchers wrote.

Both ADHD and high BMI are associated with poor health outcomes, including asthma, diabetes, and cardiovascular disorders, so it’s vital that children understand the potential consequences of their dietary decisions. ⁵,⁶

Adolescents have more independent access to food, which can also result in unhealthy choices when impulsivity collides with puberty. “Parents have less control over what teenagers eat since they are not always with them,” Olivardia says, “and this most likely plays a bigger role in weight gain.”

Preventing Childhood Obesity

Educating children about their food choices can help curb unhealthy food cravings. For example, instead of banishing carbs from your kitchen, Olivardia says, explain them in a way children can understand. “Say, ‘Simple carbs, like potato chips, taste good, but basically break down in the body as sugar. There is no nutritional value in simple carbs, and they get in the way of healthy weight, high energy, and other things that matter, like your complexion.’”

Caregivers can help children and adolescents make better dietary decisions by incorporating the following strategies:

• Set up a “food environment” that promotes healthy eating. Children with ADHD may not notice they’re hungry until they’re starving. To fend off unhealthy pantry raids, stock up on nutritious, easy-to-grab meals and snacks that require little preparation, such as peanut butter crackers, yogurt, or string cheese. Display healthy snacks and fruits in plain view in the refrigerator or pantry.
• Practice good sleep hygiene. In addition to regulating hormone levels, a good night’s sleep makes it less likely that children will turn to food for comfort in fragile moments.
• Set healthy eating rules. Create family eating rules that encourage children to eat attentively — for example, no eating while watching T.V. or eating straight out of the bag. Consider requiring children to eat only in the kitchen or dining area.
• Teach children mindful eating skills. Children are less likely to overeat when they practice mindful eating. Teach children to put down their fork in between bites. Or ask them to describe what they’re eating as though the person listening has never tasted that food.
• Set a good example. Children learn by watching others, especially their parents. Set a good example by making smart food choices, dishing appropriate portions, and not distractedly eating while engaging in another activity (like using your phone).
• Treat ADHD. Make sure children adhere to their ADHD treatment plan. ADHD stimulant medications help children better observe and regulate their behaviors and avoid impulsive eating. They also make it easier to follow through with healthy eating and exercise plans.

Sources

¹ Reed, C., Cortese, S., Golm, D., Brandt, V., et al. (2024). Longitudinal Associations Between Physical Health Conditions in Childhood and Attention-Deficit/Hyperactivity Disorder Symptoms at Age 17 Years. Journal of the American Academy of Child & Adolescent Psychiatry https://doi.org/10.1016/j.jaac.2024.09.009
² Barker, E.D., Ing, A., Biondo, F., Jia, T., et al. (2021). Do ADHD-Impulsivity and BMI Have Shared Polygenic and Neural Correlates? Mol Psychiatry;26(3):1019-1028. https://doi.org/10.1038/s41380-019-0444-y
³ Faraone, S.V., Larsson, H. (2019). Genetics of Attention Deficit Hyperactivity Disorder. Mol Psychiatry; 24(4):562-575. https://doi.org/10.1038/s41380-018-0070-0
⁴ Dalnoki, L., Hurks, P. P. M., Gubbels, J. S., Eussen, S. J. P. M., Mommers, M., & Thijs, C. (2024). Exploring the Relationship of Dietary Intake With Inattention, Hyperactivity, and Impulsivity, Beyond ADHD. Journal of Attention Disorders https://doi.org/10.1177/10870547241293946/a>
⁵ Arrondo, G., Solmi, M., Dragioti, E., et al. (2022).Associations Between Mental and Physical Conditions in Children and Adolescents: An Umbrella Review. Neurosci Biobehav Rev. https://doi.org/10.1016/j.neubiorev.2022.104662
⁶ Horesh, A., Tsur, A.M., Bardugo, A., et al. (2021). Adolescent and Childhood Obesity and Excess Morbidity and Mortality in Young Adulthood—a Systematic Review. Curr Obes Rep; 10, 301–310. https://doi.org/10.1007/s13679-021-00439-9

This isn’t about playing hooky. School refusal, also called school avoidance, is a serious matter. An acute case can last from two weeks up to a year; a chronic case might persist for a year or two. School refusal may stem from underlying struggles associated with ADHD, learning disorders, or separation or generalized anxiety. A student might be overwhelmed by academic challenges, bullied at school, rejected by peers, and/or troubled by family distress at home.

School refusal has grown worse since the COVID-19 pandemic. When schools reopened and resumed in-person learning, experts say, many students didn’t return to the classroom. Generally, school refusal affects 5 to 28 percent of students at some time in their lives, according to the School Avoidance Alliance.

What School Refusal Looks Like

Elementary-age children cling to their parents and resist entering the school building. At home, they complain of stomachaches, headaches, nausea, or vomiting. They have tantrums when talking about homework or express worry about school. Sometimes, they run away from home to avoid going to school.

A child’s teachers might report a change in their behavior, or their mood might shift unexpectedly in school and at home. The child generally starts to worry about things unrelated to school.

[On-Demand Webinar: School Avoidance & Refusal Strategies for Parents and Educators]

School refusal looks different in adolescents and teens. Many of them leave school early, skip class, or avoid certain parts of the day by going to the nurse. Some have sleep problems and complain of stomachaches and other ailments. Some experience panic attacks.

Older students can’t always communicate their feelings or anxieties. Instead of saying something like, “School is really hard and I’m struggling,” they become defiant, irritable, and angry toward peers and family members. Older kids also become more self-conscious about their academic performance, how they think others perceive them, and their physical appearance.

Identifying Underlying Fears of School

Distractibility, sensory overload, poor working memory, disorganization, and time blindness can make school challenging for students with ADHD. Those with anxiety may seek to escape the pressure of classroom tests, quizzes, and social situations. Others may avoid school to gain access to rewards at home, like video games or screen time.

Addressing school refusal is critical — and achievable. Many therapists recommend cognitive behavioral therapy (CBT) because it can help kids identify their underlying fears and support a gradual shift in their behavior.

Children with ADHD commonly struggle with anxiety, which brings a fight, flight, or freeze response. Avoidance, an example of the flight response, is common for kids who have anxiety and ADHD. To improve anxiety, you must address avoidant behavior.

Think of it this way: A boy is scared of his neighbor’s dog. When he steps out of his house and sees it, his heart races and he thinks, “The dog is going to bite me.” He runs back into his house and calms down, but only temporarily.

When he sees the dog again, his anxiety grows in intensity because avoiding the dog only confirmed his anxiety. His urge to run away is even greater.

[Download: Social Anxiety Facts and Falsehoods]

So how does the child conquer his fear of dogs? By not avoiding them. The more children are exposed to what they fear — in safe, incremental doses — the more they teach their bodies to understand: “I can do this, even though it’s really hard.” This helps build a tolerance for things that are uncomfortable.

This process is called exposure therapy: It means exposing an individual to the fear that triggers their anxiety in gradual, increasingly challenging steps. This is a critical part of the treatment plan for school refusal. When kids confront their fear, and ride the wave of anxiety that builds, crests, and subsides, they learn that their anxiety will pass and that they can tolerate the feeling while it’s happening.

An effective school refusal treatment plan, called a hierarchy, requires a nuanced understanding of a child’s specific situation. The hierarchy should include motivating rewards upon completion of each step. But keep in mind: It’s important to break down the hierarchy into very small steps. Practice the first step until a child’s anxiety level drops from a rating of 8 out of 10 to a 4 or 5. Then move to the next step.

Below is a sample hierarchy plan:

1. Drive to school
2. Walk to school door
3. Walk through school door
4. Walk to selected location in school
5. Walk to classroom, sit outside for 5 minutes
6. Walk to classroom, sit outside with a friend for 10 minutes
7. Walk into class, sit in“safe spot” for 5 minutes
8. Stay in school 1 (2, 3, 4) period(s)
9. Stay in school until lunch
10. Stay all day

Working with Your Child’s School

An effective partnership between parents, the school, and a therapist may look like this:

• The child goes to CBT once a week or more. The therapist works on exposure therapy as well as cognitive reframing tools and coping strategies.
• The child’s parents meet with the therapist regularly to learn how to provide support.
• The school collaborates with the parents and the therapist on creating and implementing a re-entry plan.

Schools can offer supports and accommodations to ease the intense anxiety caused by attending school. This could include reducing the homework load, changing deadlines, moving the child’s seat, or having the child start their day in the therapist’s office.

If the child’s anxiety is so impairing that none of these interventions help, consider medication, or an alternate school setting, such as a therapeutic school with more robust supports.

[Download: 30 Great Accommodations for Children with ADHD]

Staying Home from School

If you allow your child to stay home from school, consider the following:

• Keep everything as boring as possible, including meals.
• Turn off the Internet. Remove devices until after school hours.
• Direct your child to do schoolwork and chores.
• Do not allow playdates, outsides activities, or rewards.

Make sure to prepare your child for their return to school the night before and the morning of.

The night before:

• Help your child engage in a relaxing activity.
• Use supportive statements and positive self-talk together.
• Practice strategies that will calm your child.

The morning of:

• Calmly state that you understand how your child is feeling. Say, “I can see this is really hard for you.”
• Express confidence in their ability to cope. Say, “I know you can do this.”
• Review rewards and consequences.
• Keep calm. Refrain from emotional reactions.

Reader Insights

ADDitude magazine asked readers whether their child ever refused to go to school for an extended period. Forty-three percent responded yes. Of this group, 41% said that school refusal lasted for days, 20% said weeks, 11% said months, and 28% said it lasted for a year or longer. Some shared their experiences.

“In kindergarten, it was hard for my oldest to leave the comfort of home. His ADHD made it hard to adapt to new expectations and routines. He ran away from school often, hid from his teachers, and just plain refused to leave the house in the mornings. When his teacher started preparing a card with a new word and definition for him each morning, inspired by his hyperfixation on words, he suddenly became excited to go to school. He kept those cards in a collection. Now he’s in fifth grade and absolutely loves school and his teacher.”

“It was too hard for my child to sit all day and the teachers didn’t understand. We sent him to a school that understood ADHD better. Now he gets up early and goes happily.”

“My son was willing to go to school, but not to stay in class. Health issues, peer bullying, and lack of educator support made him feel lost in the middle school classroom. We found private tutors who could work with him daily at home to rebuild his academic skills and confidence. After four months, he was ready to return to a new school.”

“My daughter hated middle school. She had a hard time socially, the school felt too big, and one day she announced she was never going back there. But, true to form for ADHD people, she had already thoroughly researched her options and found an online school that would give her academic support while allowing me to be her teacher. The program fit her learning needs, and when high school started, she was ready to return to a conventional school environment. It was a lot of work for me, but I admired her for articulating the problem and finding a reasonable solution on her own at the age of 14.”

School Refusal & Avoidance: Next Steps

• Download: The Top 6 Learning Challenges Associated with ADHD
• Sign Up: ADHD @ School — A Free 10-Part Class for Parents
• Read: Why School Stress Is Toxic for Our Children
• Read: 6 Good Reasons to Change Your Child’s School
• eBook: How to Teach (and Inspire) Students with ADHD

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