In the video above, Maggie Sibley, PhD, professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle’s Children’s Hospital, and Rhashidah Perry-Jones, an award-winning writer, parent educator, and ADHD coach, speak with moderator Micaela Birmingham about the reality of parenting a child with ADHD. In this installment of Scary Mommy‘s Live.Work.Thrive. series, created in partnership with Fatherly, they discuss discuss parenting tips for those with kids who have ADHD, the underdiagnosis of ADHD, and the traits of ADHD that can be superpowers for kids and adults.
The following has been edited for length and clarity.
Rhashidah, can you explain some of the key traits and symptoms that may signal to a parent that their child may have ADHD? And is it important for families to get an ADHD diagnosis?
Rhashidah Perry-Jones: Parents, we all know our children. Oftentimes children with ADHD can be very communicative, and some people say talk incessantly. Other times the children are very energetic; they like to run around a lot. And sometimes folks may say that they daydream; they’re imaginative. Those are some of the things you can look out for. Also, if your child has difficulty following multiple directions in a row and that they need to break them down into smaller parts, that can be another way. But the most important thing as you had mentioned is to get a diagnosis so that you’ll know what you’re dealing with and if there are any comorbid or co-occurring conditions.
We know that certain communities are underdiagnosed, notably children of color, with girls being underdiagnosed more frequently than boys. How does systemic racism play into this whole situation?
RPJ: Folks have generally thought that children with ADHD, particularly Black and brown children, have been overdiagnosed. But research shows that’s not the case. In fact, Black and brown children are more likely not to be diagnosed with having ADHD. If you’re a girl, that’s even less likely that you’ll be diagnosed. So it’s very important that if parents see any of the behaviors typical of ADHD, that they speak to the teacher, speak to the school about getting a diagnosis, or speak to the pediatrician about getting a diagnosis.
Oftentimes, Black children tend to be punished more so than their white counterparts when that behavior could actually be ADHD. So it’s important to get a diagnosis. It’s important to see with these types of racial disparities how they play into how the school and how that teacher may look at your child.
Dr. Sibley, if we want to dismantle this problem of underdiagnosis, is it a matter of changing the training of healthcare professionals? Do we need more diverse representation in the research side of things? How do you think we could begin to address this?
Maggie Sibley: We need to build awareness of what ADHD looks like and how the face of ADHD can be different in different kinds of kids. Kids who are Black and brown are more likely to be considered to just be having an attitude, whereas a child who’s white could have the same behaviors and be considered, “Oh, maybe they have ADHD.” So we need teacher awareness of that.
We also need professionals to be on the lookout for ADHD that isn’t a typical presentation: quiet kids with ADHD, who aren’t disruptive, kids who can be really good at school and still have ADHD. The more we can build awareness of ADHD that isn’t just a hyperactive, middle class, 8-year-old boy, the more providers can be on the lookout and parents can be on the lookout and everyone can be on the lookout for kids who are struggling and need help.
Often parents need an official diagnosis to access services and other programs for their child. Are there situations or circumstances when a parent may not want to disclose publicly about their children’s or child’s ADHD diagnosis?
RPJ: There could be. I tell parents that I work with that it is up to you what you do with that information, particularly if you get it done privately. If you get the evaluation done through the school, the school will know. But some parents, particularly African American parents, are concerned that their child may be impacted negatively by the school knowing about that diagnosis. So I say to parents it’s up to you, and you need to feel comfortable about sharing that information. But if you do not share that information and if your child needs Individualized Education Plans or 504 accommodations, you won’t be able to do that. If your child is having challenges in school, it’s best to share that information so you can get the supports and that your child needs.
In terms of getting support and necessary interventions, how does a parent navigate pharmaceuticals non-pharmaceutical interventions? Back in the day when I was a kid, it was like, “Give everybody the Ritalin. Everyone’s too excited. Just give it all to the children.” What is the current kind of standard now for assessing what is the best solution for a child?
MS: We’re so lucky that there are multiple solutions right now for kids. And that parents can choose the solution that feels most comfortable to them, and that’s in line with their values and what they care about. Specifically, pharmaceutical interventions like Ritalin, like Concerta, Adderall, or some of the ones people have heard of, they’re effective treatments when it comes to helping kids focus and control their behavior, especially when they’re asked to do things like long homework assignments.
In addition, we have behavioral interventions that can be delivered by psychologists and therapists and people in the schools that are also really effective at supporting kids to learn new skills, to master self-control and be more on top of their behavior. Some families choose to do both of these treatments at the same time and try to give the maximum supports. Some families try one first and then try the other. There’s no right way to do it. It’s really up to the family and their provider to talk about and to make those choices from a personal perspective.
What are the long-term effects of taking ADHD meds?
MS: Some evidence suggests that if kids take ADHD medications for a long time, there’s a slight impact on how tall they’ll be as an adult. We’re talking about maybe a centimeter or two, so this isn’t a big difference. But when kids take ADHD medications, one of the common side effects is appetite suppression, which means they’re not eating as much and not getting as many nutrients. That can translate into not being as tall later on.
Sometimes people worry that if you take ADHD medications throughout childhood, that your child might be more likely to be open to taking drugs when they’re older. I want to reassure people that there’s no evidence for that. There’s no concern that taking ADHD medications as a child is going to make your child more open to using substances.
One thing that can happen is that if people take ADHD medications for a long time, sometimes they seem to get a little less effective over time. That is normal. People who drink lots of coffee, it doesn’t affect them as much because they drink so much. It’s similar to that. There are professionals out there who may advocate for things like taking a break for a little while to recover from some of these possible effects and then going back on at a time you need to. That’s something you can talk to your doctor about, but we don’t have any evidence of any serious long-term effects that anyone really needs to be worried about related to these medications.
Rhashidah, tell us a bit about some of the ADHD traits that you’ve seen maybe in your own daughter or in families that you’ve worked with that kids can leverage for good and actually use as a superpower.
RPJ: One of the manifestations, as I like to say, is the whole being laser-focused or hyperfocused. If you have a child that has ADHD or you know a child that has ADHD, you might have been able to see that when they are interested in something, they are very interested and they can hyperfocus. Using that hyperfocus to your advantage is something that’s important. See what your child is interested in, see if they’re using that hyperfocus, and let them use that to their best ability. The other thing is multitasking. They can sometimes have the ability to do more than one thing, and actually that may be more helpful for them so they won’t be bored.
Another thing is energy. A lot of children with ADHD are pretty energetic. Use that to your advantage. They may be able to do a bit more than someone else may be able to do. Oftentimes children with ADHD are very empathetic and very compassionate. They could be great with working and volunteering with animals and working with children because of that empathy. They’re also very, very creative. Use their creativity, hone in on that creativity to the best of their ability. Encourage them to think outside the box and not necessarily do something like the other student is doing.
Let them know that their differences can be a strength, can be a superpower and give them opportunities to build and to hone in on those traits.
This idea that some of these manifestations can be seen as superpowers, it’s a very empowering idea. Is there scientific research to show that this is true?
MS: It’s really important to think about ADHD on a continuum. Some people have it really severely, and other people have it more mildly. And even people without ADHD sometimes have ADHD-like tendencies. When we have a milder form of ADHD, we sometimes can see some positive benefits of that. For example, someone who’s a little impulsive could be spontaneous and fun, but someone who’s really impulsive can get themselves into dangerous situations or do risky things or even be intrusive. So one of the things that we see is that as people learn to overcome their ADHD and bring it into a more mild form of the disorder, the research does suggest that there can be some positive aspects of that. Creativity is one that has the most research backing.
However, it’s also important to see the other side of that coin, which is that if we don’t help people learn the skills to manage and cope with their symptoms, they won’t get to turn down the volume of those symptoms and get to the place where there can be some benefits. It’s really important to take a strength-based approach with ADHD. It’s important to see that strengths can be related to ADHD, and also people have strengths not related to their ADHD, and those can also be leveraged to help them succeed and get their ADHD under control. Parents shouldn’t be discouraged if they’re not seeing any of those positive aspects right now. Especially in younger kids. Sometimes they start to come out a little bit more as the individuals get older and start to become their own person and really start to find their interests.
Rhashidah, how do you support parents who may be struggling to recognize this strength-based approach when on a day-to-day basis, that can be very challenging?
RPJ: It’s important for parents to understand the challenges, educate themselves about ADHD, know what ADHD is, talk to professionals and make sure you have a care team around your child to support you. You need support. Make sure that you have a team of individuals that are professional, that are helping you with your child. That type of support can help you deal with the challenges, because there will be some challenges.
Some people may say your child is bossy, but you can see it as having leadership qualities. It can be challenging, and you have to look at it in a way to reframe it yourself. And in your reframing, you allow those that are around you, particularly teachers, counselors in school to also reframe it, to not look at your child as being somebody that’s just bossy. But look at that child as being a leader. And if you’re a parent and you’re raising a child that is Black or brown, those tendencies to look at those behaviors more negatively, it’s even more important for you to reframe those for the people that deal with your child, so they can see them as you do. And for you to have a support system so that you can be reinforced when things get tough for you.
Can you suggest ways to talk to your child with a new ADHD diagnosis to understand the condition? At what age do you begin to talk to your child about them having this superpower?
RPJ: It really depends on how old your child is. If you’re talking to a five-year-old, it may be a bit difficult to explain that. You can say to your child, “Listen, we went to the doctor,” explain to them that you noticed that they may be a little bit different than other children, and that it’s fine, that we love you. That there may be some things that you may need to do, or that may be a bit more difficult for you than other children. And we are here to support you and work with you and do whatever needs to happen to make sure that you’re successful.
It’s all based on the type of relationship that you already have with your child and your comfortability with explaining and talking to them, and also how you think that they will respond to it.
Can you speak to the idea of not scolding or reprimanding kids for behaviors associated with ADHD, but instead trying to figure out how to support them in a way that’s positive?
MS: It’s really important for kids with ADHD to be getting just as much positive feedback, probably twice as much positive feedback as they are getting negative feedback. Because naturally they’re going to make more mistakes. And they’re going to say things that make their peers make fun of them or criticize them. They’re going to get more negative feedback from their teachers and even their parents as they walk through life. So we need to work hard to make sure that they are getting positive messages, because people with ADHD on average do have lower self-esteem than people without ADHD. And a lot of that starts in childhood with those negative messages.
So parents out there of younger kids, you guys are in the driver’s seat now. You still have the power to protect your kids from that, by making sure that they’re surrounded by people who see the good in them. It’s important for people to work with their schools, especially to analyze what the issues are and to set positive programs where kids have forward-focused goals and can be rewarded for when they take positive steps in the right direction, instead of a punishment-based approach where kids are made to feel bad or ashamed of who they are.
On the topic of school, what would be the biggest piece of advice you can offer to parents in this struggle to ask for accommodations. How does a parent begin to navigate the system when it seems like all the doors are being slammed in their face?
RPJ: If they have a diagnosis and evaluation, share that information with the school and to work with the school to create an IEP, or an Individualized Education Program. Put goals in that IEP and put different types of accommodations into that IEP. This is something that is required by law and that the school has to follow. If you are having difficulty with the school, make sure that you either get the 504 accommodations or you structure an IEP plan to make sure that your children or your child can succeed in school.
If you have goals stated in this IEP and they are not met over whatever the timeframe is, what is the re-course that a parent could take?
RPJ: I know of several parents who have actually sued school districts to make sure that their child gets the proper attention that they need. So that’s something a parent can do. Also, stay on top of that IEP. Oftentimes parents go into these meetings and because someone has all of these different letters behind their names, they can feel intimidated. It’s important that you get the IEP, that you talk to the professionals, that you also become educated yourself and you become your child’s advocate at all times. Don’t wait until that next year to look at the IEP again. Have regular meetings. When you first put the IEP together, check in maybe four weeks later to see how things are going so you can identify if they’re doing the job they’re supposed to be doing, or if they’re not, and you can make interventions right then.
Anxiety, is it a common trait for children with ADHD, or is it something that manifests if they don’t have the right supports?
RPJ: From my understand, anxiety is not necessarily a trait or a symptom. There may be a comorbid or a co-occurring condition that is rearing itself. You have to get that diagnosis to see what you’re dealing with.
MS: Anxiety plus ADHD can be a blessing and a curse. For one, it’s two different difficulties to be dealing with at the same time. But interestingly enough, sometimes anxiety puts the breaks on ADHD a little bit for people. So people with ADHD plus anxiety tend to respond better to treatment sometimes. Certainly it’s something that co-occurs pretty commonly.
On the anxiety side, is it better to push them past their comfort zones with new experiences or allow them to opt out if they’re uncomfortable?
RPJ: Ask them what they’re feeling anxious about. And if the anxiety is because they don’t think they’re smart, are these things true? These things are not true. Show them and talk to them about the things that we know, because anxiety is something where folks are looking ahead and they’re not necessarily in the present moment. Do practices like meditation that help them stay in the present. And these things that they’re anxious about, look at them to see if they’re true or not. Generally they’re not true. Have this conversation, bring them into the present to show them that these things that they’re anxious about really are things that not true.
How do you help them with their emotion regulation and impulse control?
MS: I’m taking a deep breath when I answer that question because it’s a long road. I want people to know that, but it can be done. There’s no quick fix for kids who are having trouble controlling their emotions, but it’s going to be an approach that has to do with teaching them skills they can learn to help calm themselves down.
If you’re having a child who is struggling with the emotional symptoms of ADHD, the best thing you can do is work with a psychologist because that’s one piece of ADHD that the medications don’t help with as much, but the psychology side of it really can help with it. And it is a long road, but as kids get older, those who have the right tools in their hand and the parents who’ve been doing the right things will see improvement over time.
RPJ: From experience with other parents and my own experience, behavior modification therapy is very helpful in helping with impulse control. We had a token system where my daughter was able to earn tokens for specific behaviors. It’s important not to try to change a whole bunch of behaviors at once, but to focus on one behavior. When you see them doing the behavior that you want to see, be very descriptive in your praise. Say, “Oh, John, I see that you really wanted that cereal, but you waited for five minutes until I came downstairs to get it. And I really, really appreciate that.”
How can you get support as a parent when you have ADHD also?
MS: ADHD runs in families, and a lot of times parents first realize that they have ADHD when their child gets diagnosed and they recognize some similarities. Just like for children, there are two primary forms of therapy for ADHD for adults. One of them is medication and the other is cognitive behavioral therapy, a type of therapy you can get from a psychologist. So I say to people, I think it’s really good for you and your child to be going through treatment at the same time, because you’ll be learning things from each other.