A Letter: To the Parent of a Child with ADHD

 

Dear Loving and Possibly Exasperated Parent,

 

Wherever you find yourself on a scale from “zen” to “at the end of your rope”, take a moment to congratulate yourself for two things: 1) for being a parent who cares so much about your child that you are learning more about ADHD and 2) for bringing such a wonderful, sensitive, inquisitive, and unique child into the world. Parenting any child can challenge you to your core. It forces you to face your own hang-ups and insecurities and may leave you daunted by your own shortcomings. But if your child has ADHD, you might feel the weight of these challenges to an even greater degree because the strategies that often work for other children don’t seem to do the trick. This does not make you a horrible parent. Nor does it mean something is wrong with your child. It just means you don’t yet have all the knowledge and tools you need to support your child’s ADHD brain. But there is good news! Though there is no cure for ADHD, it is treatable. With the right supports, your child can be an independent, functioning, and well-adjusted adult who loves himself/herself. Successful ADHD treatment begins with parents who are well-informed, so let’s start with some basics.

 

You may have found in your own research that sources on ADHD often start with a medical definition and diagnostic criteria. This is important information to be aware of, and it’s what a clinician will be looking for when considering an ADHD diagnosis for your child. But for a host of reasons, your child might not present with ADHD in the way you’d expect. This is why I want to go beyond the diagnostic criteria and fill you in on some other characteristics that are common for kids with ADHD. See if any of these sound familiar.

 

• Hyperfocus: This means that your child can become completely absorbed in activities they like while superhumanly tuning everything else out. They can become so engrossed that they forget to eat, drink, or go to the bathroom. They don’t register when you call their name and seem to ignore you. This can seem confusing at first because the stereotype is that ADHD makes you distractible. But that’s misleading. It’s not that people with ADHD can’t focus. It’s that they have trouble directing their focus. No one likes to do activities they dislike, but an ADHD brain has a harder time being motivated to do the task anyway. If they like what they’re doing, they have no problem staying focused on it. In fact if they like what they’re doing, it feeds them. It’s interesting and stimulating, but often comes at the cost of their other responsibilities. For example, this is why they can’t put their clothes in the hamper that is 3 ft from their door but can spend 4 hours building a complex lego system.

 

• Heightened sensitivity to perceived rejection: People with ADHD are more sensitive emotionally. Their sense of shame and rejection is activated more easily which means they are prone to internalizing blame. Studies show that an ADHD brain has more trouble than a non-ADHD brain in distinguishing between negative and neutral facial expressions. Even though you may be feeling neutral, your child with ADHD is more likely to interpret your expression as negative. This may show up as “overreacting” or “blowing things out of proportion”. What seems like a minor disappointment or hurt to you might elicit a major meltdown from your child. When you combine this heightened sensitivity with the impulsivity that also comes with ADHD, your child is more likely to have a big emotional reaction and to make snap judgments about people or situations. For example, on the first day of school in a new class, they may very quickly identify the villains, the neutral players, and the good guys based on one interaction. They are more prone to making meaning without all the information present.

 

• Hypervigilance: Kids with ADHD often stand out from their peers and receive more negative attention due to their impulsivity or inattentiveness. This not only contributes to a heightened emotional sensitivity, but it can also manifest as a heightened sense of alertness or hypervigilance. To prevent that heightened shame response from being triggered, kids with ADHD often are in an alert, fight or flight mode more often. This can exacerbate the already existing issues with sensitivity and executive functioning. Hypervigilance can also show up as over-control, rigidity, and OCD.

 

• Difficulty regulating emotions: Kids with ADHD have a deficiency in the feel-good chemicals in our brain that stimulate our frontal lobe. This is the part of the brain that helps you organize, plan, delay gratification, wait your turn, and regulate your emotions. Because this part of their brain isn’t online, they can often feel out of control or overwhelmed. They have a harder time getting enough distance from their emotions to have perspective and some sense of control. It can feel like they are being tossed about by raging waves without anything to hold on to. You might also notice that they tend to have meltdowns at the same time every day. This is because they’ve spent a lot of cognitive and emotional effort to regulate their emotions at school. By the time they come home, they’ve run out of steam. This is why the 4-6 pm time frame can be so challenging.

 

• Able to focus with more physical input: This goes hand in hand with the last point. You might be thinking that if your child feels overwhelmed, they need fewer things going on and less movement to be able to calm down. But actually, the opposite is true. Most children with ADHD feel overwhelmed because their brain is understimulated, not overstimulated. This is why the most effective medications that treat ADHD are stimulants. Movement and physical feedback are effective (aka input) at helping to calm and focus your ADHD child because it stimulates their frontal lobe. This is why common strategies include using a bouncy ball instead of a chair or providing deep pressure through weighted blankets or squeezes. The ADHD body needs more physical pressure and movement input to feel regulated.

 

• Sensory sensitivities: Your child might have a hard time tolerating certain background noises like the tv or someone tapping a pencil. Or their skin might crawl when touching certain textures. Whatever the particular sensory issue is, sensory sensitivities can go hand in hand with ADHD. This may seem like a contradiction to the last point, but certain types of stimuli, like physical movement, are helpful because they activate the part of the brain that helps with focus. But other types of stimuli like light, noise, or sound can be distracting because they tax the ADHD brain’s already-limited ability to direct attention. Each brain is different and responds differently to different stimuli.

 

If you’ve read this far, my hope is that you’ve seen your child somewhere in these examples. With that recognition, I hope you gain some validation and understanding for what your child and your family have been experiencing. Your child is not being defiant or willfully difficult. Your child’s brain works differently, and he/she just needs help knowing how to access all of its potential. I mentioned earlier that the first step to successful ADHD treatment is informed parents. The second step is a parent who can access their compassionate self. Your child needs your compassion in those moments when they forget to pick their clothes up off the floor yet again and your frustration is mounting. And you need your compassion in those moments when you start to question your ability as a parent. You can do this. Keep asking questions. Keep asking for help. And keep reminding yourself that it will get better. And remember, your effort as a parent is ongoing. Your child won’t develop a skill overnight. Any kid needs constant education, patience, evaluation and reevaluation of where they are. But that development trajectory is so much slower with the ADHD brain. Keep evaluating and adjusting your expectations to match their unique pace. And give yourself permission to take it slow.

 

With warmth and respect,

 

A Supportive Therapist

 

P.S. If you’re wanting more detail on the official diagnostic criteria for ADHD or you’re curious about the factors that can complicate diagnosis, read on. 

 

Whether your child has been tested and given a formal ADHD diagnosis or you’re only starting to suspect your child has ADHD, you might be wondering, “What exactly is ADHD?” A helpful place to begin is with the DSM-5 criteria for ADHD. Under earlier versions of the DSM, kids either had Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD). However, now there is one diagnosis of ADHD with three potential types: Inattentive, Hyperactive/Impulsive, or Combined. You may still see older books or articles referring to ADD, but the correct clinical term now is ADHD and you’ll see a diagnosis further specified by which type is present. Even if your child doesn’t show signs of hyperactivity and impulsivity, they can still have a diagnosis of ADHD, but fall under inattentive type. To receive an ADHD diagnosis, a child has to meet a certain number of criteria involving difficulty with directing motivation or with impulse control. In addition, those difficulties have to have a significant impact on their ability to function in at least two environments (school, family, peers). The severity of ADHD can also range from mild to moderate to severe. Here are a few of the most common indicators of ADHD that you might already be familiar with:

 

• Forgetful/loses items frequently
• Difficulty with impulse control (frequently interrupts others, talks excessively)
• Difficulty with sustained attention on play or work activities
• Missing minor details or often makes careless mistakes on homework
• Struggles to follow through on instructions or complete tasks
• Struggles to wait for a turn
• Has a restless body (difficulty staying seated, fidgeting, running/climbing/jumping around in inappropriate settings)
• Blurts out answers before being called on

 

(For a full list, visit here.)

 

In fact, ADHD is still underdiagnosed. There are many barriers that get in the way of everyone with ADHD getting a diagnosis. One is that there are several factors that can impact the severity of symptoms or the ways in which symptoms manifest. For example, ADHD is more likely to go undetected for longer in girls because there is more social pressure to exercise impulse control in order to fit in. Additionally, the higher your IQ, the greater your ability to compensate for deficits in executive functioning. This means that if your child has a higher-than-average IQ and also has ADHD, their inattentive and impulsive symptoms might be less noticeable. Another common complicating factor is that kids with ADHD often have other mental health issues such as anxiety, depression, or OCD present at the same time. Sometimes the ADHD symptoms can be mistaken for or masked by those other issues.