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

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.

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

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

The sponsor of this ADDitude webinar is…

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

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

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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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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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There is nothing effective or compassionate about punishing your child to transform a frustration response. It is better to directly (and proactively) involve your child in solving the root problems that trigger their outbursts. This is the evidence-based approach called Collaborative and Proactive Solutions (CPS), a non-punitive intervention to decrease conflict and enhance relationships.

Follow the CPS model’s roadmap (abbreviated here) to uncover the roots of your child’s concerning behaviors and create lasting, positive change.

Collaborative Problem Solving for The Explosive Child

Be observant.

Identify the skills that make it hard for your child to respond adaptively to problems and frustrations. The mantra of the CPS model is: Kids do well if they can. If your child is responding maladaptively to a problem or frustration, it is because they’re struggling with important skills, such as flexibility/adaptability, frustration tolerance, problem-solving, and emotion regulation.

Identify unsolved problems.

Any expectation your child is having difficulty meeting, even if they can meet it sometimes and not others, is an unsolved problem. It is those unsolved problems that are causing your child’s frustration response (concerning behavior). In the CPS model, rather than try to modify those behaviors, you solve the problems that are causing them. But you have to identify them first. Both skills and unsolved problems are identified using an instrument called the Assessment of Skills and Unsolved Problems (ASUP).

[Get This Free Guide to Ending Confrontations and Defiance]

Prioritize problems.

Once you have a comprehensive list of the expectations your child is having difficulty reliably meeting, pick your top three to address. Here’s a process for prioritizing:

• Safety first. Are any of your child’s problems tied to dangerous behaviors (like hitting others)?
• Frequency. Which unsolved problems contribute to concerning behaviors most often?
• Gravity. Which unsolved problems have the greatest negative impact on your
  child or others?

Your child is your problem-solving partner. The problem-solving process involves the following steps:

1. Gather information from your child about what’s making it hard for them to meet an expectation. It might sound like this: “I’ve noticed you have difficulty turning off your video game when it’s time for dinner. What’s up?” If your child doesn’t answer, make a few guesses. Ask them to rate each guess on a scale of one (not true) to five (very true).

2. Explain why it’s important that the expectation be met. Concerns usually fall into one of two categories: how the unsolved problem affects the child or how the unsolved problem affects others. Typically, concerns are related to health, safety, and/or learning.

3. Work with your child on a solution that is realistic and mutually satisfactory.

[Get This Free Download: Your 10 Toughest Discipline Dilemmas – Solved!]

A Win-Win Approach

A father once told me about his young daughter’s reluctance to brush her teeth at night before bed. The father was sure that the taste of the toothpaste was the problem. He bought several flavors but the problem remained. He asked his daughter what was hard for her about brushing her teeth before bedtime. She said, “Water gets all over my face when I brush my teeth, and I hate the feeling.” This was a concern that different flavors of toothpaste would never have addressed.

Next, he outlined his concerns. “If you don’t brush your teeth, you could get cavities, which are painful and expensive to fill.” Then came the invitation to collaborate: “I wonder if there’s a way for us to make sure that you don’t get water on your face while you’re brushing your teeth, and also make sure that you don’t get cavities. Do you have any ideas?”

His daughter said, “Can I wrap a towel around my face before I brush my teeth?”

Problem solved. Both the father and daughter got their concerns addressed, and no one’s authority was undermined.

You may be thinking, “This plan sounds great, but how do I deal with my child’s behaviors during an eruption?” Once your child is escalated, you’re late. You don’t want to be late. The point of this parenting model is to solve problems proactively, so you don’t find yourself in the heat of the moment in the first place.

Collaborative Problem Solving: Next Steps

• Free Download: A 2-Week Guide to Ending Defiant Behavior
• Read: 6 Truths About Child Behavior Problems That Unlock Better Behavior
• Read: What Are the Lagging Skills Holding Your Child Back?

Ross W. Greene, Ph.D., created the Collaborative and Proactive Solutions (CPS) model of care. He is the author of The Explosive Child (#CommissionsEarned) and Lost at School (#CommissionsEarned), and the founding director of the nonprofit Lives in the Balance.

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Children who are quick to anger and lash out are sometimes labeled as oppositional or defiant. According to the Collaborative & Proactive Solutions (CPS) model, those concerning behaviors are best viewed as frustration responses that communicate a child is having difficulty meeting a particular expectation. In the CPS model, those expectations are called unsolved problems. Whether it’s completing chores or homework, ending video game time, or sitting at the dinner table, those problems will remain unsolved as long as caregivers use incentives and consequences to motivate adaptive behavior. Rewards and punishments don’t solve problems. What’s causing a child to be frustrated in the first place is where parents should focus.

This webinar will introduce the CPS model, and collaborative and proactive problem-solving strategies. This three-step roadmap empowers caregivers to approach a child’s concerning behavior with new understanding and new practices. Caregivers will learn:

• Why some children are more prone to act out
• About the situations that often drive children to exhibit concerning behavior
• How to be truly proactive rather than reactive
• Why rewards and punishments fail to inspire change
• The three steps involved in solving problems collaboratively and proactively

Watch the Video Replay

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PDA and ODD: More Resources

• Download: 10 Rules for Ending Confrontation & Defiance
• Read: The Facts About ODD and Attention Deficit
• Read: Back From the Brink: Two Families’ Stories of Oppositional Defiant Disorder
• eBook: The Parent’s Guide to ADHD Discipline

Obtain a Certificate of Attendance

If you attended the live webinar on July 31, 2024, 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

Ross W. Greene, Ph.D., is a clinical psychologist and the originator of the innovative, evidence-based approach called Collaborative & Proactive Solutions (CPS), as described in his influential books The Explosive Child, Lost at School, Lost & Found, and Raising Human Beings.

He also developed and executive produced the award-winning documentary film The Kids We Lose, released in 2018. Dr. Greene was on the faculty at Harvard Medical School for more than 20 years, and he is now founding director of the non-profit Lives in the Balance. He is also currently an adjunct professor in the Department of Psychology at Virginia Tech and adjunct professor in the Faculty of Science at the University of Technology in Sydney, Australia.

Dr. Greene has worked with several thousand kids with concerning behaviors and their caregivers, and he and his colleagues have overseen implementation and evaluation of the CPS model in countless schools, inpatient psychiatry units, and residential and juvenile detention facilities, with dramatic effect: significant reductions in recidivism, discipline referrals, detentions, suspensions, and use of restraint and seclusion. Dr. Greene lectures throughout the world. He lives in Freeport, Maine.

Listener Testimonials

“Very helpful info! Excellent speaker.”

“I use the C&PS strategies with my older son and I’m planning to start with my younger. This was just the motivation I needed.”

“Thank you for advocating for misunderstood children!”

“I can’t wait to learn more. This approach makes so much sense.”

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Use the tips below to guide you in putting this behavioral strategy into action. Remember that redirecting your attention takes time and practice to perfect. Some caregivers also work with a professional trained in effectively utilizing this parent strategy.

How to Manage Attention-Seeking Behaviors

1. Ignore the behavior if it is minor and reinforced through attention. This can include:

• whining
• arguing
• interrupting
• yelling
• being purposefully annoying

2. Do not ignore or tolerate dangerous, destructive, or unsafe behavior. Intervene to stop those behaviors immediately and implement appropriate consequences.

3. Do pay attention to other concerning behaviors. If your child is dragging their feet about brushing their teeth in the morning, for example, they’re probably not doing it to get your attention. You shouldn’t let your child avoid the task, even if they’re whining about it. (In this case, you should think about strategies to encourage your child to brush their teeth, like setting a tooth-brushing alarm, establishing specific rewards for dental hygiene, or maybe changing their toothpaste flavor.)

[Get This Free Download: Your Guide to Ending Confrontations and Defiance]

4. Don’t ignore your child outright. While ignoring some behaviors, you’re also waiting for the opportunity to give attention to the behavior you want to see. Meet the desired behavior with positive attention as soon as you see it. Say something like, “Thank you for waiting so calmly as I finish up dinner.”

5. Watch your non-verbal communication. There are plenty of ways you can inadvertently give attention to behaviors. Be mindful of facial expressions, eye rolls, huffs and puffs, crossed arms, stances, and other forms of attention. (This takes lots of practice!)

6. Should you explain to your child why you’re ignoring them? It’s not necessary, but this approach can be effective, provided you are mindful of your tone. Consider using “when-then” statements to encourage the behavior you want to see. Don’t say, “I’m not responding to you because you’re whining. That’s not how we talk to each other.” Say, “When you ask me nicely, then I will answer your question.”

7. Expect the behavior to get worse before it improves. When you withdraw your attention from a behavior that used to get your attention, the problem behavior will often get worse before it gets better. (We call this phenomenon an “extinction burst.”) Everyone at home should be prepared for these behaviors to escalate and to continue to ignore them — provided they are not dangerous.

[Read: How to Leverage Video Game Psychology to Improve Your Child’s Behavior]

8. Be consistent. It is important to make sure that all of a child’s caregivers can clearly define the problem behavior and are on board with the plan to ignore it. Consistently ignoring the problem behavior, while praising the positive behavior that you want to see, will yield the best results.

Attention-Seeking Behaviors and ADHD: Next Steps

• Download: 50 Discipline Tips for Kids with ADHD
• Read: Your Child Is Sending You Signals. Are You Ignoring Them?
• Read: How to Manage Your Child’s Toughest Behavioral Problems

The content for this article was derived from the ADDitude webinar titled, “Parenting Styles That Work for Neurodivergent Children” [Video Replay & Podcast #481] with Caroline Mendel, PsyD, which was broadcast on November 29, 2023.

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Disrespectful behavior from your child is a signal, says Sharon Saline, Psy.D. Getting curious about what’s triggering that warning signal is Step One in dealing with lying, pushback, and rudeness.

• Look underneath your child’s words and behaviors. Oppositional behavior often masks other emotions such as anxiety, depression, poor self-esteem, confusion, boredom, fear, and frustration. Many kids with ADHD will resort to lying as a form of coping; impulsivity and poor self-regulation skills sometimes make them do things they regret, and rather than dealing with those things directly, they’ll deny their actions. Avoid addressing these surface behaviors in the moment — expect that your child will act out at times. Opt to come back to the topic later when emotions have cooled.
• Establish doable routines. How can your child’s routines change to increase their confidence and decrease frustrations that cause problematic behaviors?

[Get This Free Download: A 2-Week Guide to Ending Defiant Behavior]

• Manage your own feelings. Provocative behaviors from your child can trigger reactivity on your part and escalate the situation. To manage reactivity and avoid saying things you don’t mean, ask yourself, “Why am I talking now?” There are times when it makes more sense to stay silent and listen rather than get into it.
• Set up a “take-back-of-the-day” system where everyone in the family has a chance for a redo. This practice helps address impulsivity, and it also gives your family the opportunity to practice forgiveness.
• Rely on natural and logical consequences. When you stand in the rain, you get wet. When you begin a huge school project the night before it’s due, you may get a poor grade. Your punishments and threats won’t do much to change your child’s behaviors, but natural and logical consequences will because they empower your child.
• Set clear and appropriate expectations. Expectations should fit the child you have, what they can do, and what they can almost do. Avoid focusing on goals that are barely reachable for your child.

Watch Dr. Saline’s ADHD Experts webinar, “Motivating the Unmotivated: Strategies for Middle and High School Students with ADHD,” for more insights on teen behavior challenges.

Rude and Disrespectful Behavior in Teens: Next Steps

• Free Download: How to End Confrontations and Defiance
• Read: Should I Punish (or Ignore) My Teen’s Disrespectful, Snarky Behavior?
• Read: Don’t Freak Out! And 13 More Rules for Navigating Teen Behavior Challenges

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Defiance is commonly associated with ADHD symptoms like weak impulse control and emotional regulation, but repetitive acts of defiance could be a sign of oppositional defiant disorder (ODD) or pathological demand avoidance (PDA). To determine the root cause of a child’s behavior, we must dig underneath inappropriate words and actions.

Why Is My Child So Defiant?

Many oppositional teens have a loud internal voice that tells them they’re a failure; they can’t do things right; no one likes them; they’re stupid. You name it.

As a parent, you’ve likely witnessed pushback resulting from this internal narrative. Your child’s defiance is an unskilled and ineffective attempt to manage some of these feelings. They’re trying to manage their external surroundings when things feel out of control on the inside.

Oppositional tweens and teens may demonstrate the following behaviors:

• lack of cooperation
• inappropriate language
• refusal to do tasks such as homework or chores
• instant anger or reactivity
• threatening behavior
• destruction of property

[Download: Free Guide to Ending Confrontations and Defiance]

Oppositional Defiant Disorder (ODD)

ODD is classified as a disorder in the DSM-V, but symptoms of ODD often present situationally. Kids with ODD who are openly resistant in one setting or with one authority figure may be completely cooperative in other areas of their life. Their behavior presents like a switch — angry one minute and fine the next.

This can be confusing to the parent of a child who acts out at home but not at school. Children with ADHD may exert authority in an area where they feel relatively secure. They may direct their defiance toward the parent who they think is most likely to take and/or forgive it. They may push back because they can.

Pathological Demand Avoidance (PDA)

Defiant behavior may signal PDA when it occurs almost without exception. This profile is characterized by an overwhelming and consistent need to avoid or resist demands. PDA is more intense and pervasive than is ODD; it is not limited to certain people or situations.

Kids with PDA are obsessive in their resistance to requests that they perceive as overly assertive. They may avoid compliance by resorting to manipulative behaviors and even turn down activities they enjoy. Parents may notice sudden changes in mood that are associated with the need to control or reject a demand.

PDA is not a standalone diagnosis in the U.S., but it falls under the umbrella of the autism spectrum diagnoses. It is seen most often in people with autism, ADHD, and high anxiety.

[ADDitude Directory: Find an ADHD Clinic]

Solutions to Address Oppositional Behavior

Parental communication style (and substance) can contribute to a child’s oppositional behavior — for better or for worse. Invitations, tag teaming, collaboration, being a body double, and noticing your child’s efforts all contribute to better cooperation. Reconsider how you ask your child to engage in a task and what happens when they fail to do so.

1. Nix Non-negotiable Words

A “no” might be a response to what your adolescent views as a demand rather than a request. The use of words such as “need,” “must,” or “will” may be triggering for kids who have PDA. These non-negotiables give them the impression that a decision has already been made.

Try the following phrases to reframe your requests:

• “Is it okay with you if…?”
• “How do you feel about…?”
• “Do you mind doing this…?”
• “If you’d be happy to, I would really appreciate…”
• “When you’ve finished with this, could you then do…?”

2. Encourage Shared Involvement

You can also encourage cooperation by using words like “us,” “we,” “let’s,” and “together.” Or give autonomy and decision-making opportunities to your child by engaging them in directed free choice. This means offering them two or three options in a situation so they feel empowered to make a decision rather than resentful or angry about being told what to do. Kids may also want to play a bigger role in the brainstorming process.

3. Plan for Patterns

ODD and PDA are repetitive patterns of behavior, so don’t treat them like isolated events. Plan for explosions. What options are available when your child acts out? What logical consequences can they expect as a result?

Maybe your teen is given one free hour of screen time a day. They can earn additional screen time after completing cooperative activities such as basic chores and homework. If they get angry, scale back on this incentive. Reduce the free screen time allotment. This teaches the lesson that “have-to” tasks are necessary to get “want-to” rewards.

4. Institute Takebacks

Lying is a social behavior that occurs between two people due to avoidance, denial, or a desire to avoid punishment. It creates comfort in the present and minimizes conflict based on something that’s happened in the past. Kids with ADHD may lie due to poor impulse control or inattention. They might not realize that they misinterpreted an event until after they’ve said it out loud.

This is when we want to give them an option to take it back. I call this the “take back of the day” or TBD approach. I did it with my kids when they were growing up and I’ve recommended it to hundreds of families as a tool to diffuse tension and bring awareness to disrespectful comments. I think it’s helpful when everyone in the family has a chance to take back something they said without risk of penalty–including adults who can model how it works.

5. Meet in the Middle

If your child is stuck, it may be that your demands are too difficult to meet. Fatigue or low energy could also be signs of sleep deprivation or depression. Technology addiction, while composed of many things, is often related to an ADHD brain hunting for dopamine. Creating a balance or flow with high dopamine and low dopamine activities helps kids with building their abilities for shifting and flexibility. If your approach is not working, ask some open-ended questions about what’s going on with your child that is interfering with their compliance (e.g. ‘What is making it tough to do this? What would make it more appealing? How can I offer you support to get through this?’), and adjust as needed.

To encourage your child to cooperate or tell the truth, you might also create ground rules that are negotiable in certain situations. Maybe your ground rule is no swearing, and your child broke that rule. Instead of imposing consequences right away, take a pause. Consider the STAR method: stop, think, act, and recover. This process includes taking a pause with a planned, self-soothing activity, coming back together to discuss what each person thinks they could have done differently occurred, what the next right action will be and doing it and then giving time and space for recovery and moving forward.

6. Acknowledge Effort

If you notice that your child’s behavior is improving, acknowledge it. “Efforting” is what I call a full-body experience for outside-the-box thinkers. It’s emotional, it’s social, it’s cognitive, and it’s physical. It’s more than simply trying. It may result in accomplishing something or it may show genuine efforts without completion. It’s the process that contributes to growth mindset. We want to acknowledge, validate, and encourage the progress that we see our kids making.

Oppositional Teen Behavior: Next Steps

• Download: 5 Ways to Improve Emotional Control at Home
• Read: You Can’t Change Your Defiant Teenager…
• Read: Two Families’ Stories of Oppositional Defiant Disorder

The content for this article was derived, in part, from the ADDitude ADHD Real-Time Support Group session titled, “Helping Oppositional Teens with ADHD” with Sharon Saline, Psy, D., which was broadcast via Facebook Live on February 10, 2023. Live support group meetings take place on Facebook most Fridays at 4 p.m. ET.

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From my perspective as a clinical psychologist who studies reward and punishment responses in children with ADHD, you are right to recognize a toxic dynamic at work here.

Even if it’s not deliberate, your child’s actions are reinforced every time you stand firm and then step aside to allow her to defy you. (To be clear, I recognize that this is an incredibly frustrating situation.) Your daughter remains oppositional because she has learned that defiant behavior gets her what she wants.

[Free Download: The 15-Day Fix to Stop Defiant Behavior]

Your own actions in those moments are also reinforced, though in a different way. You have learned that stepping away results in the removal of an aversive stimulus — your daughter’s defiant behaviors. It’s how you’ve learned to cope with the stress caused by your child’s defiance.

In short, there are many things to unpack here. It’s clear that behaviors on both sides perpetuate this cycle, and unlearning these behaviors is required to bring about change.

If your daughter’s behaviors cause lots of stress and conflict at home, it may be best to seek help from a psychologist or other health provider who is skilled in behavioral parent training for ADHD. They will help you understand how to encourage desired behaviors in your child, and the factors that intentionally and unintentionally influence behavior.

It will take time to change a dynamic that has been long reinforced. Be prepared to see an uptick in defiant behaviors from your child as you work toward change. In my field, we call that an “extinction burst,” or the principle of “it will get worse before it gets better.” Worsening behavior, in this case, actually means that your new strategies are working. You’ll just have to weather the storm to see the new dawn.

“My Kids Don’t Listen to Me:” Next Steps

• Free Download: What You Need to Know About Parent Training Programs
• Q&A: “What Rewards Will Motivate Good Behavior from My Child?”
• Self-Test: Could Your Child Have Oppositional Defiant Disorder?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “The Power of Positive Reinforcement: Why Rewards Trump Punishments for Students with ADHD” [Video Replay & Podcast #420],” with Gail Tripp, Ph.D., which was broadcast on September 8, 2022.

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A further complication: youth with ADHD are at higher risk for developing mood disorders, such as disruptive mood dysregulation disorder (DMDD) or oppositional defiant disorder.

During a recent ADDitude webinar on irritability, we asked nearly 1,000 attendees, “What is the most challenging aspect of emotion regulation for your child or patient?” Here are the answers they gave:

• Dysregulation of emotions in the moment (e.g., feelings often subjugate thinking): 37.8%
• Intensity of felt emotions (e.g., sudden, violent outbursts): 34%
• Unrelenting nature of irritability (e.g., always angry, bristly, mean): 14%
• Poor recognition of other people’s feelings (e.g., apparent and/or real lack of empathy): 7.1%
• Frequency of mood changes (e.g., dizzying emotional lability): 6.7%

Comments and questions submitted during the webinar, titled “Emotion Regulation Difficulties in Youth: ADHD Irritability vs. DMDD vs. Bipolar Disorder” provided deeper insight into how ERD impacts youth with ADHD.

Emotion Regulation Manifestation #1: Explosive Outbursts

“My child screams and breaks down over issues with friends.”

“My son is verbally aggressive and used to destroy doors and walls. It is truly hard for me to cope with his crisis.”

“My 11-year-old son’s physical and verbal aggression seems to be reserved for home. He controls himself at school but not at home, where he is very argumentative and defiant. He is easily triggered when he does not get his way (e.g., he pushes, hits, and calls us names).”

“My 14-year-old daughter keeps it together at school but is defensive, aggressive, and explosive with her 11-year-old sister and us (her parents) when we intervene.”

[Self Test: Does My Child Have Disruptive Mood Dysregulation Disorder?]

Explosive Outbursts: Next Steps

• Download: 9 Truths About ADHD and Intense Emotions
• Read: Why Is My Child So Angry?!
• Read: What Is Intermittent Explosive Disorder? 

Emotion Regulation Manifestation #2: Rejection Sensitive Dysphoria

“It is hard for my child with ADHD to not respond in a passive-aggressive, irritating way toward people she feels have rejected her. This might look like getting into others’ personal space by doing things she knows bothers them. This has gotten her in trouble with peers whom she feels are her bullies.”

“My son is 16 and has had explosive emotional outbursts due to environmental factors since he was 18 months old. The emotional outbursts have lessened substantially, but they still happen when he is super frustrated, upset, or gets his feelings hurt by his friends.”

RSD: Next Steps

• Download: Understanding Rejection Sensitive Dysphoria
• Read: How ADHD Ignites Rejection Sensitive Dysphoria
• Self-Test: Could It Be Rejection Sensitive Dysphoria? Symptom Test for ADHD Brains

Emotion Regulation Manifestation #3: Extreme Irritability

“Irritability occurs when there is a change in the child’s expectations of a situation. For example, it is not going to happen or not happening soon enough according to the child’s understanding or expectation.”

“My kid seems to be frequently irritable and grouchy and has angry outbursts.”

“I’ve noticed a big increase in irritability for my 13-year-old son with ADHD.”

“My 12-year-old wants to buy things or have things bought for her. Telling her ‘no’ results in irritability and a major tantrum.”

Extreme Irritability: Next Steps

• Download: 10 Ways to Neutralize Your Child’s Anger
• Read: New Insights Into Emotional Dysregulation and Treatment Considerations
• Read: “My Child’s In a Bad Mood Every Morning!”

Emotion Regulation Manifestation #4: Lack of Flexibility

“My granddaughter is often agitated and gets things stuck in her head, and there is no working around it. Screen time is about all that keeps her focused and calm. Everything is a challenge — routines, grooming, sitting down to dinner. Everything”

“My son is very rigid and has no ability to cope when he doesn’t get his way.”

“I struggle with my daughter’s need to be in control of everything and everyone. So much so, even making doctor’s appointments are hard to do.”

Lack of Flexibility: Next Steps

• Download: Why Is My Child so Defiant?
• Read: What’s Really Behind Your Child’s Bad Behavior?
• Read: Exaggerated Emotions: How and Why ADHD Triggers Intense Feelings

[Self-Test: Does My Child Have ADHD? Symptom Test for ADHD]

Emotion Regulation Manifestation #5: Self-Harm

“I have an 11-year-old daughter who has had explosive outbursts and big highs and lows since age 4. She began expressing suicidal ideation and was self-harming and experiencing intrusive thoughts.”

“During fits, my child makes comments about ‘not wanting to live,’ and ‘can’t take it anymore.'”

Self-Harm: Next Steps

• Download: Easy Mindfulness Exercises for Kids with ADHD
• Read: ADHD & Self-Harm: How to Help the Girls Who Suffer Most
• Read: How Is Your Emotional Resilience? Learning to Cope with Intense ADHD Feelings

Emotion Regulation Manifestation #6: Overly Emotional

“We’re struggling with my son because he’s not combative, just EXTREMELY emotional. He has crying episodes or extended periods of being upset where he cannot regroup for up to an hour.”

“My son does OK in most environments, but at home, he displays a lot more irritability and dysregulation, anger, frustration, and sadness.”

“My son is explosive at times. I remain calm with few words spoken, but he escalates quickly by yelling and running out of the house. This creates a very stressful environment for everyone in the house. I don’t know how to get him out of his terrible moods, where he fixates on ‘small’ things that bother him.”

Overly Emotional: Next Steps

• Download: Evaluate Your Teen’s Emotional Control
• Read: Q: How Do I Teach My Teen to Manage Emotions?
• Read: Calm Starts at Home: How to Teach Emotional Regulation Skills

Emotion Regulation Manifestation #7: Physical Aggression

“My 8-year-old son with ADHD cannot focus or keep still long enough to finish his schoolwork. Then he gets frustrated, which ends with him hitting his peers or teachers.”

“My daughter has a very hard time with aggressive behavior and has had to have the ‘room cleared’ twice this month, along with three in-school suspensions.”

“So often parenting advice recommends setting firm boundaries with kids, such as saying, ‘you can be mad, but I won’t let you throw things/ damage furniture/ etc.” However, with my kid with ADHD, when his lid is flipped, and he’s having a rage outburst, any attempt to say those things seem to ‘feed the fire.’ He just escalates more, often becoming physically aggressive with us.”

Physical Aggression: Next Step

• Download: Free Guide to Ending Confrontations and Defiance
• Read: Anger Is Important — But Only When It’s Managed
• Read: When “Keep Your Hands to Yourself” Doesn’t Work: Fixes for Hitting

More on Emotion Regulation and ADHD

• Free Download: 15 Ways to Disarm (and Understand) Explosive ADHD Emotions
• Read: How Dysregulated Emotions Hijack the Teen ADHD Brain
• Read: ADHD and Emotional Regulation: A Parent’s Guide

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