Tag: oppositional defiant disorder

Long before I knew my first fact about ADHD, and well before my own ADHD diagnosis, I knew that to be around people was often work. I had to be “on.”

When I’m “on” it feels like my mental faculties are on steroids. It’s like all the electrical fibers of my being are jacked up to the max, all in the name of social camouflage. I am ON.

Call it masking or impression management. Regardless, it’s a cover for us normally fidgety, possibly shy, and distracted interrupters who inhabit ADHD land.

Masking with ADHD Is Draining

“Masking” doesn’t feel how it sounds. “Herculean Hide” or “Backbreak Fake” sound more accurate. If you’ve ever masked, you know why: you’d give anything to be wearing a real mask in these situations.

Imagine having a roomy mask covering the entire front half of your skull, doing the work of being Fake You while Real You got to relax underneath. How luxurious would that be? You could stand there and not do or say a thing. You could relax and take a social nap behind Wonder Woman or Superman.

[Read: 7 Masks We Use to Hide Our Faults]

I wish it were as simple as wearing a literal mask – maybe one with talking powers.

Instead, masking is arduous, confusing, complicated, and draining. It’s multi-tasking to the nines while on stage without a lifeline, no parachute. That’s a far cry from chillaxing behind a cozy Wonder Woman mask. It’s having to be Wonder Woman, blindfolded.

A life with ADHD can give us the sense we’re less than. A mask temporarily fixes that. A mask takes the focus off us. It’s like hiding in tall grass while our hunters say to each other, “Nothing to see here. Let’s move on.”

It’s true that masking gets easier over time. We can become so expert at the practice that it’ll take a while – sometimes decades in the case of a late-stage ADHD diagnosis – until we learn about this ability that we’ve honed since childhood. It dawns on us that the arduousness and exhaustion we experienced all along in social interactions was not a given in the big universe of human experience.

But the maddening thing about masking is that, as we develop the skill, we also worry about how well we’re masking — a worry that sometimes ramps up into depression or anxiety.

So we put all this energy toward suppression, and for what? To only mask more and more until it drains the essence of us.

[Read: “We Are Who We Are. There’s No Shame in That.”]

Masking with ADHD: What Happened When I Let Go

As I began to educate myself on ADHD, I started to experiment with new ways of thinking and doing. One day, not long ago, I asked myself, “What if I let go of some of this masking? Would life be calmer? Would I survive without it?”

It turns out, yes.

I started small, in social situations where I had little to lose, or where I could practice taking off the mask without much notice. As soon as I decided I didn’t have to pretend I was Unreasonably Amazing Stephanie, the world got serene. It slowed down — my interior power grid stopped buzzing so loudly — and not one person seemed to care or notice. I learned that others do not have their attention glued to me as I had feared or assumed.

Since I’ve built the skills to better manage my ADHD, ditching the mask means I can manage my glitches as usual but without excessive social worry. I can’t tell you how freeing (and energy efficient) this is.

Making with ADHD: Next Steps

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I can still vividly recall my daughter’s meltdown during a trip to the Georgia Aquarium. As I sensed she was on the verge of losing it, it felt like someone scooped out every organ in my body. Still, I was fresh out of parent coaching training, and here — right in front of the otters’ exhibit smack in the middle of a giant aquarium — was an opportunity to show off the skills I learned. But, boy, did my daughter put on a show. She screamed and screamed, her tiny body thrashing against the aquarium floor, until her face turned red and her hair clung to her sweaty forehead.

Parent training didn’t prepare me for this. My husband and I stood there, quietly whispering to each other for an excruciating 20 minutes until our daughter finally calmed down. In that time, I was desperate for the screaming, the stares, and others’ well-intentioned, albeit unhelpful, suggestions (to give her a snack or a drink) to stop. This was not the highlight of my mothering career.

Eventually, all those things did (thankfully) come to a halt. My baby stood up quietly after her meltdown, looking disoriented. Then, she stumbled in my direction and finally held my hand instead of running ahead of us like we asked her to, which is what led to the whole fiasco in the first place.

Emotional Dysregulation: A Core But Overlooked Part of ADHD

Emotional dysregulation is not new — to my daughter or to any other person with ADHD. But it was an aspect of ADHD that took me a long time to fully appreciate.

The problem is that the diagnostic criteria for ADHD intentionally exclude emotion dysregulation, despite it being historically conceptualized as a crucial characteristic of the condition. Emotional dysregulation was written about as an issue related to ADHD symptoms as early as the 1700s up until 1968, when the diagnosis of hyperkinetic reaction of childhood was first introduced in the DSM-II. Around this time, emotion dysregulation started to become a forgotten part of the equation for ADHD, and public discussion of ADHD-fueled tantrums and angry outbursts all but halted.

[Get This Free Download: 9 Truths About ADHD and Intense Emotions]

This is why, despite my psychology graduate coursework and training in ADHD, my daughter’s behavior was still confounding. On the one hand, I knew that she struggled with ADHD from an early age because her symptoms were consistent with current diagnostic criteria. On the other, her obvious emotional challenges compared to other girls and children her age, were not reflected in the DSM.

Could My Daughter’s Intense Emotions Be a Sign of DMDD?

Adding to my confusion was the fact that emotion dysregulation isn’t exclusive to ADHD. For example, children with disruptive mood dysregulation disorder (DMDD) display irritable mood and emotional outbursts that could be verbal or physical and that occur at least three times per week. It is a condition that goes beyond temper tantrums.

DMDD was added to the DSM-5 because mental health professionals were over-diagnosing bipolar disorder, a condition that causes extreme changes in mood in children. DMDD was meant to account for children who didn’t quite meet criteria for bipolar disorder, and who presented with more general irritability.

Without much mention of emotion dysregulation’s connection to ADHD in my training and in what doctors told me, my daughter’s intense emotional responses made me wonder — could this be a case of DMDD, too?

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

The Truth About ADHD and Intense Emotions

William French, M.D., explains that the key to differentiating between DMDD and emotion dysregulation as a part of ADHD is the child’s mood between temper outbursts. Children with ADHD (and adults, too, for that matter) experience emotions intensely, but these emotions are not all negative.

Individuals with ADHD can also be incredibly excited or calm between emotional outbursts. Russell Barkley, Ph.D., says the reason the negative emotions get so much attention is because they lead to obvious social and functional challenges. While someone with ADHD experiences various emotions between periods of intense negative emotional outbursts, a person with DMDD has more persistent irritable mood between episodes.

Without a shred of doubt, I understand today – though it took lots of time and headaches to get here – that my daughter’s intense emotions are part of her ADHD.

But in my own practice, where I see neurodivergent youth, I increasingly see patients come in with an ill-fitting DMDD diagnosis. As I’ve become more and more self-educated about ADHD and emotion dysregulation, I’m convinced that many clinicians, misled by current diagnostic criteria, may be readily misattributing this central feature of ADHD to DMDD.

This is a problem, for one, because inaccurate diagnoses delay access to life-changing treatment and can cause further health complications. In addition. whether we’d like to admit it or not, certain labels carry heavier stigma than do others. Before they see me, many children with the DMDD diagnosis are turned away from other private practices, deemed too “severe” to treat. Children can also be inappropriately judged by schools when they are given labels reflecting severely dysregulated mood.

It’s important to remember that the DSM, in general, aims to simplify. But, far from simple, human beings are nuanced, and so is the way ADHD presents.

If diagnosticians took a step back and actually looked at the ADHD brain and listened to the lived experiences of individuals, maybe then they could start to understand those who are so unnecessarily misjudged, like my daughter could have been.

ADHD and Intense Emotions: Next Steps

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More than half of adults with ADHD prefer to keep their diagnosis to themselves, according to a recent Understood.org survey of 2,100 adults conducted online by The Harris Poll. However, an even more concerning pattern emerges when we break down the results by gender: 66% of young women (ages 18–34) prefer to stay silent compared to 42% of young men with ADHD.

Why Women with ADHD Don’t Disclose Their Diagnosis

In part, the survey results suggest that women with ADHD are perceived differently than are men with ADHD — a finding that more than half of survey respondents (three-quarters of whom were women) agree to be true.

We know that self-stigma is a key barrier to seeking professional support. (Footnote 1) While the survey’s findings relate to ADHD specifically, they speak to a larger societal phenomenon: Individuals internalize public stigma, e.g., stereotypes, prejudice, and discriminatory attitudes endorsed by the public. We see examples of internalized public sigma across women’s mental and general health, including their ADHD diagnosis.

Although men and women are just as likely to have learning and thinking differences, girls with ADHD are diagnosed as often as boys. (Footnote 2) Many women receive their ADHD diagnoses in their 30s, 40s, and beyond. When a woman is diagnosed with ADHD later in life, she’s likely spent decades struggling without understanding why. A late-in-life diagnosis may be the route of frustration, self-doubt, and anxiety.

Researchers have primarily based assessment tools on studies of boys and they do not norm for female populations. Gender bias built into testing instruments is one of the biggest reasons women and girls with ADHD may go undiagnosed, something 87% of survey respondents acknowledged, the survey revealed.

[Free Resource: What to Ask Yourself to Find the Perfect Job]

Women diagnosed with ADHD later in life often express how they made efforts and investments to get answers, but providers routinely dismissed their concerns as “hormones,” “mom brain,” or “lack of self-care.” Many received diagnoses of depression or anxiety instead of ADHD.

They finally got an accurate diagnosis after enduring years of unsuccessful treatments — along with blame for non-compliance. The experience of having their providers meet their initial concerns with disbelief, in a sense, trained women not to disclose.

Many women develop the core belief that “there’s something wrong with me.” And this doesn’t change overnight. Often, women need time, support, and community to learn how to voice their newly learned diagnosis in a way that feels right to them.

Choosing not to disclose an ADHD diagnosis is a logical response to stigma, bias, and backlash. Half of the adults surveyed believe that the negative stigma surrounding neurodiversity is stronger now than ever before. Among respondents with learning and thinking differences, 59% worry that disclosing their diagnosis would negatively impact their careers. Nearly 1 in 4 respondents who requested workplace accommodations said they lost their jobs or got demoted after asking. In that kind of workplace culture, it’s no surprise that people stay silent.

[Take the ADHD Self-Test for Women]

How to Create an Inclusive Culture

The culture that too often makes silence the best option for women must shift. The solution to silence is not as simple as telling women to “speak up” at work. We need to create a culture that places women’s voices and needs at the core. We need to raise awareness and challenge the stigma around neurodivergence (particularly ADHD and dyslexia) for women. We need better resources, awareness, and action, to start the shift toward progress.

Here are a few steps individuals, providers, and employers can take to create a more inclusive culture:

• Learn: Patients, employers, and providers need to let go of old assumptions and dial up their curiosity because the information about ADHD has historically been based on homogeneous, primarily male experiences. Even among the most knowledgeable, there’s still much to learn and unlearn.
• Embrace the gray: Disclosure isn’t “on” or “off.” You don’t need to share your diagnosis with everyone. You get to choose who, when, and how much you share.
• Listen: Often people don’t speak up because when they do, they aren’t heard or understood. For providers, this means actively listening to clients and patients. Employers need to actively listen to employees and take their concerns and requests seriously. Individuals need to listen to their inner voice without judgment.

Inclusive Culture: Next Steps

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The average person makes thousands of decisions a day, from “simple,” subconscious choices to complex ones. The more our days are filled with effortful, conscious decision making, the more susceptible we become to decision fatigue.

If you find yourself overanalyzing options, avoiding decisions, feeling overwhelmed, and then making hasty choices that you later regret, use the following tips to overcome decision fatigue and ADHD paralysis. In other words, “CHOOSE” differently to curb the choices your ADHD brain makes on the daily.

ADHD Decision Fatigue: Solutions

Care for Yourself

Decision-making becomes exponentially harder when your body and mind are not at their best. Caring for yourself reduces stress, improves focus, and eases decision making through the day.

• Nourish your body and brain with regular, healthy meals.
• Set up a good bedtime routine that allows for a restful night’s sleep.
• Give yourself the positive mental effects of mindfulness meditation for a few minutes each day.

High-Priority Appraisal

If a decision you must make is critical and will have a lasting impact, use a pros and cons list to help you analyze it objectively. If making the choice is not urgent, then take your time to make the list and then appraise it the next morning when you have more energy to make the decision. Review your crucial choices with a trusted friend to confirm your thinking process and gain an objective opinion.

[Get This Free Download: The Eisenhower Matrix for ADHD Decision-Making]

Opt Out

Ask yourself, “How important is this decision, really?”  If you realize that your decision and its outcome is not going to matter a week from now, find an easy, fun way to make the decision.

• Flip a coin to decide which route you will take home.
• Assign numbers to household chores and then roll dice to determine what you will do first.
• Close your eyes and point at a list to choose a restaurant for lunch.

Opportunities for Others

You do not have to be the sole decider. Give others the chance to decide. Try delegating reasonable decision-making opportunities to co-workers and family members. This gives them a chance to learn and grow. Avoid the temptation to micromanage; be open to observing how well things turn out.

Simplify

Take choice out of the equation! Cut down on the number of daily decisions in your life with routines and habits. Think of the routine activities in your life and opportunities to limit your options.

[Read: The Antidote to ADHD Fatigue and Exhaustion? Stacking Habits (and Spoons)]

• Designate a set number of outfits for work so you can just grab and go in the mornings.
• Assign specific meals to each day of the week and then rotate through two or three weekly schedules of meals. (Think school cafeteria schedule.)
• Create a grocery shopping master list that includes ingredients needed for the assigned weekly meals.

Effectively Realistic

Worrying about making the best decision – a form of perfectionism – is mentally taxing and leads to added stress and decision paralysis. There is no need to seek the perfect solution or choice. Instead, focus on what is realistic, effective, and good enough for the situation.

ADHD Decision Fatigue: Next Steps

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It’s been a while since my ADHD diagnosis. Though I’ve put lots of things in place to manage my symptoms and support my executive functions, it’s still so easy to lurch from day to day, ignoring the sneaky things that make living with ADHD needlessly difficult.

Recently, I had the bright idea to assess my life. I aimed to end up with a self-improvement plan comprised of high-impact (and relatively low-effort) actions I could take to better daily living with ADHD.

What I came up with was a process that I invite you to try for yourself to manage ADHD’s impact across all facets of your life. (Be sure to grab papers and a pen before you start.)

Step 1: Where are you struggling most right now?

Think:

• What aspects of your life with ADHD are most annoying to you at the moment?
• Where are your ADHD symptoms creating the most obstacles and hot spots in your life?
• Where are you paying too high a price (finances, relationships, etc.)?

Another way to think of it: Are there any areas of your life that need more improvement and attention than other areas?

[Get This Free Download: Lifestyle Changes That Benefit Adults with ADHD]

Some areas you might think about:

Select three to six areas of focus at a time. I chose medication, food, motivation, and daily/weekly planning systems.

Step 2: Pen to paper.

Once you’ve narrowed down your areas, grab some sheets of paper. Each area of focus you selected in the prior step will get its own sheet of paper, which you’ll indicate at the top of each sheet. Then, fold each sheet in half width-wise.

Step 3: Get specific about trouble spots.

The top half of each sheet is where you’ll respond to the question: “What’s not working?” Vent a little but be sure to get specific. No matter the obstacle or inconvenience, write down anything that isn’t going your way and gives you a hard time in this area.

On my “food” sheet, for example, I wrote, “It drives me crazy to have to wrestle with myself whenever I need to eat. How can boiling cauliflower feel so impossible?!?” I also wrote about how overwhelming I found all aspects of eating, from thinking about what to eat and buy (ADHD decision fatigue is no joke) and putting it together to cleaning up after myself, all for a few bites. Trying to eat more vegetables was especially difficult; they took too long to wash, cut, and cook on the spot, so they were never ready when I wanted them.

[Read: 6 Secrets to Goal Setting with ADHD]

Note that this step isn’t about writing down what you think you “should” be doing. It’s a space for you to note what stands in the way of what you really want.

Step 4: What can make it better?

After you’ve written about everything that’s not working, turn your attention to the bottom half of the sheet. Here is where you’ll brainstorm: What can make life better? Get creative and use that ADHD superpower of idea generation! Let your ideas flow; think of how you can create different arrangements, tweak your existing systems, incorporate new objects/technology, and find other forms of support that – and this is important – work for you. (You’ll narrow down on a few actionable solutions in the next step.)

For my food troubles, I thought about how great it would be to always have prepared, ready-to-eat foods in my kitchen. An effortless grab-and-go for when I’m hungry and don’t want to think about prepping food, much less make an entire meal. I thought about how great it would be to never forget that I have vegetables in the fridge and to have prep work on said veggies completed well in advance.

How could I make this happen? This is some of what I wrote down:

• To reduce decision fatigue, I can come up with three easy meals as staple options. This will make grocery shopping so much easier, too, since the ingredients for those chosen meals will always be on my shopping list.
• I’m a visual person. Why don’t I hang up photos of my favorite meals on my fridge to help me remember them?
• I seem to remember to eat veggies when I can clearly see them, not when they’re hidden in the back of the fridge or in a drawer. I’m also more inclined to eat veggies when all the prep work is done. Maybe I can prep veggies when I have time, like on weekends, and put them in clear containers.

Step 5: Mold your ideas into an action list.

From your solutions, circle up to three ideas that seem worth trying. Now, activate the ADHD gift of problem-solving, and think of how to put each of your chosen solutions into action.

• What will prompt you to put the solution in motion? Involving other people? Gamifying it? Connecting it with your interests? Think of the conditions and factors that tend to facilitate action for you. You may find it helpful to think about the areas of your life where things are going smoothly. What’s working in those areas, and how can you translate those elements to these problem areas?
• How can you get around potential snags? Do you need checklist to help you remember the steps? Reminders on your phone? On your calendar?
• Write down your action list for each area of focus on a fresh sheet of paper. As you think of and draft each action step, keep the following in mind:
  • Make your action steps realistic. Aim for the biggest wins you can achieve with the least amount of effort. (That win you consider small is actually a big win if you can do it completely and consistently!)
  • Craft clear action steps. Note what you’ll do, how long it will take, and what “finished” looks like.

My action list looked a little like this:

• After dinner today, I will spend one hour creating a poster of my three favorite meals in Canva.
• On Saturday, before I head to the supermarket, I will spend 20 minutes writing all items I need to prepare my favorite meals on my phone. I will then pin the note for easy reference.
• On Sunday mornings, I will dedicate one hour to preparing veggies. I will set a recurring reminder on my phone to put the prepared veggies in clear containers and store them in the fridge.

Step 6: Do the actions!

…or do what you can. Because, if you’re anything like me, you’ll rush through half your action list, trudge through the next few items, and then grind to a halt before finishing all your action steps. And to that I say: Magnificent! That’s way more than you would have done without the review. But if you find yourself making no progress at all, consider making your action steps smaller. Either way, resist perfectionism. A small step can be plenty in improving quality of life.

Put your action list somewhere you’ll easily see it. Think positive as you carry out your action steps. Visualize how much easier your life will be — and how much energy you’ll have to do things that really matter to you — once you take these steps. Aim to revisit your self-improvement plan once or twice a year.

Manage Adult ADHD: Next Steps

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I’ve held roughly 30 jobs in my lifetime — most of them before I discovered my ADHD at age 30. I’ve been in my current role for two and a half years. While my ADHD symptoms have caused difficulties at work, my organization openly discusses how to make improvements and what resources are needed to work through them.

I am grateful that my company takes a “bring your whole self to work” approach. That attitude has encouraged me to discuss my experience as an adult living with ADHD and it has taught me the importance of creating an inclusive, supportive workplace for colleagues with neurodiverse conditions. I realize that many people with ADHD are not so fortunate.

People with ADHD are chronically unemployed or underemployed. This doesn’t affect their ability to succeed at work, but it may hinder their chances of getting past the hiring stage.

Once hired, many people with ADHD wrestle with whether to reveal their diagnosis in the workplace. Understandably, many feel that disclosing their disability could attract stigma and discrimination. But if no one discloses their ADHD, how can an organization ensure that it is being inclusive?

Senior leaders and decision-makers must foster a sense of openness by actively promoting an inclusive culture. I view inclusivity as a net; the wider it is, the greater the population caught. Some tools are created for specific reasons, such as an automatic door to assist someone using a mobility device. However, this adjustment also helps someone with arthritis or a new parent pushing a stroller. In other words, the benefits of accommodations are often wider and deeper than we first imagine.

[Get This Free Download: What to Ask Yourself to Find the Perfect Job]

7 ADHD Accommodations at Work

Here are more ways to create a more inclusive workplace for individuals with ADHD.

1. Job Application Accommodations

A supportive workplace culture takes root during the hiring process. Employers must value individuals beyond their CVs and resumes, and prioritize the person ahead of the qualifications. A small change that can significantly impact the inclusivity of your hiring process is providing job applicants with materials in different formats and offering alternatives to submitting traditional CVs or resumes, such as creating video applications.

2. Targeted Training

Because ADHD affects individuals differently, employers and colleagues must understand the symptoms of inattentive, hyperactive, and combined-type ADHD — and how each one manifests. They can do this by collaborating with an ADHD expert with lived experience, seeking tailored training programs, or simply listening to colleagues with ADHD.

3. Clear Communication

To help people with ADHD stay focused and reduce overwhelm, simplify communication by summarizing key points and action items in emails. Use bullet points and highlight important information to make it quick and easy to access.

4. Visible Meeting Notes

During meetings, provide written notes or prompts. If the meeting takes place virtually, use the chat box function. This helps team members who might get flustered or need to refer to the discussion points.

[Read: DIY ADHD Accommodations for Your 9 to 5 Job]

5. Recording and Transcription Services

Recordings and transcripts of meetings can be invaluable for those with working memory challenges, allowing them to revisit the information as needed.

6. Flexible Working Hours

Some people with ADHD find they are more productive outside traditional work hours. Allowing flexible work times can maximize productivity and reduce mistakes.

7. A Balanced Perspective

When ADHD is called a “superpower,” I hear toxic positivity. Perceived strengths like creativity or resilience do not overshadow the real challenges that individuals with ADHD face; it’s important to acknowledge that it is a disabling condition with some inherently beneficial traits as well. A balanced perspective is essential for genuine inclusivity.

Supporting colleagues with ADHD in the workplace requires understanding and practical adjustments. Organizations can create a workplace where all employees thrive by promoting open communication, providing targeted training, and avoiding toxic positivity. The goal is to ensure everyone on the team feels valued and supported to do their best work.

Inclusion in the Workplace for ADHD: Next Steps

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The following is a personal essay reflecting the opinions of the author.

A few years ago, Michael, a nine-year-old boy, was brought to my office by his parents. Mom and Dad seemed comfortable when I greeted them in the waiting room, and they easily conversed as they followed me back to my office. They joked with Michael, and he appeared at ease.

After talking for a few minutes, I asked them, “So, why did you bring Michael to see me?

“The teachers say that he has a lot of trouble staying focused in the classroom,” his mom responded. “They say that he is very bright but doesn’t do well on tests because he rushes, doesn’t check his answers, and seems to stare off. Often, he only completes half of his tests. While he answers questions correctly, he fails the test because he does not complete it.”

At this point, Dad spoke up. “Wait a minute, Gayle. You know my mother told you I had the same trouble in school, but I turned out fine.”

I would have missed it had I not been sitting directly across from her, but it was at this moment that Michael’s mom rolled her eyes.

[Free Guide: What Every Thorough ADHD Diagnosis Includes]

After some testing and discussions with the teacher, Michael was diagnosed with ADHD. However, over the next five years, his father resisted the idea of treating Michael with ADHD medication, even though he responded extremely well to it, with minimal, non-serious side effects.

Dad also frequently “forgot” to give Michael his ADHD medication. If I had missed this earlier warning, I am sure I would have eventually picked up on Dad’s resistance. But the point of this story is not that Michael’s medical care would have been compromised had I missed the eye-rolling. It is that every person emits hundreds of these small, non-verbal communications every hour. And all of us, including physicians, unconsciously interpret these communications, usually accurately. Telehealth interferes with those subtle cues, which may result in a patient’s misdiagnosis or inappropriate treatment decisions.

Pros & Cons of Telehealth Evaluations for ADHD

There are certainly advantages to telehealth medical evaluations for ADHD. For one, they are relatively easy to set up. They eliminate the need to travel from home to a clinic or office, which can be problematic for some. For patients who do not have a steady income source, these evaluations also may be less expensive than in-person evaluations.

Regardless, there are serious concerns about the accuracy of telehealth evaluations. Since there are no blood tests, specific laboratory findings, X-ray findings, or diagnostic findings on a patient’s physical or neurological evaluations, the diagnosis of ADHD usually depends on a patient’s (or their parent’s) self-reporting.

[Free Directory: ADHD Specialists Serving Patients Near You]

This has proven problematic — and, in some cases, fraudulent. In June, the Justice Department charged two executives at the telehealth company Done Global with allegedly distributing Adderall and other stimulants for ADHD to patients without a proper diagnosis. Done reportedly made ADHD diagnoses based on a patient’s minute-long self-assessment and a 30-minute or less virtual evaluation with a provider.

A Better Way to Evaluate ADHD

Most pediatricians will evaluate their young patients with one parent in the room. I strongly encourage both parents to come to the initial evaluations and follow-up visits.

During the 40 years that I have evaluated patients for ADHD, I have noticed that subtle non-verbal facial expressions and messages reveal much more about how each parent feels about their child’s diagnosis or treatment than what they say. These cues could be easily missed during a telehealth evaluation.

For example, I met Danny several years ago. His mother sat in front of my desk, with Danny to her right. He appeared uninterested in our conversation but was in a good mood and smiled occasionally. While his mother spoke, Danny fidgeted, looked out the window, moved around in his seat, and interrupted occasionally.

When I asked Danny’s mom what her biggest concern was, she said, “Well, he is highly intelligent, but he has a tough time staying focused and quiet in school. As a result, he has a difficult time learning. He is very scattered.”

So, I asked my usual questions: When did this start? How was he doing in school? How were his grades? How did he get along with other kids?

[Free Series: The Caregiver’s Guide to ADHD Diagnosis]

She tried to answer each question but became visibly frustrated. Her voice quivered, and she seemed on the brink of crying. Then, she stopped talking and reached into her bag. She pulled out a brightly colored, ragged spiral notebook and handed it to me.

“Danny’s teacher uses this calendar notebook to communicate with her students’ parents,” she explained. “The teacher will write a short note about how Danny did that day. I can write a response or ask a question. The notebook goes from home to school and back again daily.”

Later that day, I started reading the notebook. But by the time I got to the third page, I felt tears in my eyes.

I didn’t need to continue reading to know what was in the rest of the notebook. I was so used to treating children with behavior and learning problems like a detective, objectively analyzing the facts, that I had forgotten what it felt like to a child and their parents. Suddenly, reading this notebook, I could tell exactly how Danny and his mother felt.

If I had used telehealth, I might have received the notebook eventually, but I would have missed how Danny’s behavior affected their lives. I might also have seen Danny’s mother’s tears on the computer monitor. However, my bigger concern was what I may have missed and how that could have affected Danny’s diagnosis and treatment.

Telehealth ADHD Evaluations: Next Steps

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On a recent Saturday, I woke from my daytime ADHD hyperfocus coma (which I didn’t realize I had slipped into) and was horrified to see that I had fallen behind my usual schedule. I write a few stories a week for the web, and weekends are critical in getting these ready to send off. But as the day drew to a close, I only had one story done.

How could time be so slippery? I went back and counted all the things I’d done earlier, because there surely had to be more accomplishments in my day. And there were — dishes, laundry, work tasks. Not bad — I’d assumed I’d only accomplished one thing, but I’d accomplished four, though three of those tasks could in no way account for all that time.

I went back through my day with a magnifying glass and — ah-ha! There they were! More accomplishments. Except these accomplishments were in the form of low-value but highly alluring distractions.

Was I mad at myself for wasting a precious Saturday? For once, I decided not to be.

A Guilt Trip Won’t Drive Me to Productivity Land

I looked down at the self-reproach stick I keep close at hand (if you have ADHD, you know the one) and flung it into the corner. Words came tumbling out of the stick and onto the floor. You shouldn’t have done what you did! How could you?!

[Read: “Shame Spiral Advice from the Counselor with ADHD Who Needs to Take Her Own Advice”]

I stepped on the words, squishing them. No mercy. Sometimes, we just need to be firm with our inner critical voices.

Instead of succumbing to self-reproach, I saw the opportunity to learn. I looked at how to prevent future Saturdays from looking like this Saturday.

I started by identifying what needed fixing and what needed encouraging, neither of which I could have done if I continued to harass myself over my missteps.

I decided to install a website blocker on my phone to deter me from reading the news, a big distractor. This worked for a while, and eventually it taught me that I don’t want to be looking at the news all day, anyway. These days, I don’t need the blocker. Instead, I purposely moved my news app four screens from the home screen. Every scroll to get there gives me a moment to mindfully pause and consider if I really want to read the news. The gap affords me the opportunity to choose better because I want to do better.

[Read: Silence Your Harshest Critic — Yourself]

I also set up a decent, doable game plan for my weekends. Instead of thinking I can get everything done, I now have a good balance of tasks. I don’t crack the proverbial whip — well, at least not as much as I did, or at least not as wickedly. I settle in and enjoy my work, task after task, and revel in crossing each one off my list. I acknowledge each completed task to myself, which fuels me on to the next thing.

Finally, I decided to program fun at the end of the day to reward myself. It’s not major – online puzzles before bed are very fun and simple treats, if I do say so.

All this, and no self-berating sticks, no “wasted” weekends. It’s such a luxury in comparison to the alternative. The pivot from being mad at myself to being happy with my progress is such a life-changer. The more I gently encourage small steps, one after the other, the more I’m rocking Saturdays like you won’t believe.

Feeling Guilty for Not Being Productive: Next Steps for ADHD Brains

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When I was diagnosed with ADHD and dyscalculia at age 38, I wept for 10-year-old me. For the little girl who could not make sense of numbers, whose legs would shake and voice tremble when forced to stand and recite multiplication tables. When I fumbled, my teacher would smack the chalkboard and shout “Wrong again!” as the class erupted in laughter. “Stupid, dumb me.” I whispered to myself as I retreated.

I also wept for teenage me, who was called “dumb” and told countless times that she just needed to “try harder.” For the girl who felt she needed to wear a mask. No matter what I did, it never felt like it was good enough.

The tears I shed after my diagnoses have been like healing rains. The grief and shame I feel are real, but I don’t want to stay in these places for too long. I want to move beyond them. So, I have decided to try to find the victory stories I never experienced as a child.

I wish my teachers knew about my ADHD and dyscalculia. I’m going to imagine what life would have been like if they did, and what they might have written in my report cards had they known the truth about my determination, suffering, and self-esteem.

1. Tends to lose concentration easily.

Erica’s wonderfully wired mind works hard to help her manage her focus and attention. To our delight, we’ve found that coloring, drawing, and playing with putty also helps her focus. I am so proud of Erica for her continued efforts to focus in the classroom. Erica, you are doing so well!

[Read: Your After-Diagnosis Acceptance Guide]

2. Is not an attentive listener.

Erica tries really hard to listen, which is so impressive, as we understand that her mind is constantly flooded with millions of different thoughts, some of them intrusive and overwhelming. I am really proud of Erica for trying, even with such a busy brain, to slow down and wait her turn. These are not easy things for her to do, but she keeps on trying.

3. Has confusion with number recall; needs to work harder.

Erica works so hard to remember her numbers but faces the challenge of dyscalculia, which is a significant learning disability. I encourage Erica to be kind to herself and know that she is doing a spectacular job. She will thrive and succeed in school and beyond because she is brave and creative. Knowing numbers is not the sum of a life well lived. Keep going, Erica!

4. Must try harder to be attentive and polite when others are talking.

Erica cares for others so deeply that, when her classmates share stories, her mind, eager to know more, explodes with questions. Sometimes she blurts out those questions, but she isn’t being rude or self-absorbed when she does so. She experiences impulsivity issues, and she also wants to make sure she can squeeze her thought in before she forgets it. She works hard to be attentive, and her zeal, kindness, and passion for connecting with others is remarkable! She has started writing down things when others talk so she can remember what was said and ask her questions later on. Good job, Erica!

5. Has allowed outside problems to impact her work.

Erica has had a tough semester. Though a bully assaulted her, it was Erica who received punishment for swearing at her bully. This incident was, understandably, massively disruptive for Erica, who also experiences RSD and justice sensitivity. In any case, Erica’s wellbeing is far more important than her schoolwork. I recommend she take a mental health month and that the incident with the bully be properly addressed.

[Read: “What Is Wrong With Me?” ADHD Truths I Wish I Knew As a Kid]

6. Disappointing results from a student with potential.

Erica will never be a disappointment. The challenges she faces with her diagnoses are plenty, and her courage and ability to continue trying and keep laughing is admirable. This is a student who is living beyond her potential every single day!

From report card to report card, and each challenge in between, onward I go with the liberating exercise of rewriting my life pre-diagnosis, no longer carrying defeat but walking in victory.

What I Wish My Teacher Knew About My ADHD: Next Steps

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On a chilly autumn morning, I sat beneath fluorescent lighting in a room full of my peers to take the PSAT. I had done well on the previous year’s test, so my hopes were high. The first hour or so was not too torturous. I breezed through the English passages and actually finished the section with lots of time to spare. Suddenly, I began to feel anxious. Why had I finished early? Had I chosen the correct answers? By the time the math section began, my confidence had dropped dramatically.

I finished a word problem, clicked answer C, yet something didn’t feel right. I had only clicked one answer, but my brain convinced me I needed to click all the other answer options to make it an even number. Once I did that, I then re-selected only my original answer, with a different finger, careful not to disrupt the pattern. Finally, I could move on.

I continued in this way throughout the test, my anxiety growing. I noticed the sound of keyboards clicking as my peers moved effortlessly from question to question. At the top of my browser, the seconds passed quickly and I began to fear I would not finish in time.

This sensation was all-too-familiar, but I’d never felt it in such a high-stakes environment. As the test dragged on, I felt more and more hopeless about my PSAT score — and I knew just what to blame.

My Life with OCD

I was diagnosed with obsessive compulsive disorder (OCD) at the age of 7, after my parents observed the little rituals and patterns I acted out constantly. My OCD began as a way of coping with my emetophobia, an extreme fear of vomiting. My brain told me that I could prevent myself from getting sick if I performed certain actions perfectly. If I got a “booboo” on one finger, I had to put bandages on all of my other fingers so they would “match.” When I would wash my hands, I had to turn the sink on and off seven times and use seven pumps of soap. If I messed up, I was determined to find a way to correct it. Until I did, I was plagued with a sense of impending doom.

[Take This Self-Test: Could Your Child Have OCD?]

The solution here may seem obvious: just don’t do the compulsion. Unfortunately, it’s not as easy as that. Imagine that you have a voice in your brain convincing you that, unless you turn the light switch on and off several times, your loved one will die. You know it’s an irrational fear but, still, you feel as though you could not tolerate taking that risk.

That’s how I feel every day.

OCD Is Not What You Think It Is

Over the years, my compulsions have presented themselves in many different ways, but they all share this in common: they make “normal” tasks exponentially more challenging.

And then, of course, there’s the embarrassment of having to explain myself to others. In case you’ve forgotten, teenagers are not the most understanding audience for unconventional behaviors. If you were in Trig and saw the girl sitting next to you write and erase her name seven times on her worksheet, you’d probably be perturbed and think that she were a basket case. That’s not how I want people to regard me. Sure, I could explain to them that I did the behavior to prevent my imminent death, but how receptive do you think they’d be to that rationale? It’s an awkward position for both parties.

OCD myths and misperceptions contribute to this stigma and shame. One of the most popular myths is that OCD only presents as cleanliness, neatness, or attention to detail.

[Get This Free Download: Is It OCD or ADHD?]

“OMG, I have to organize my closet because I’m so OCD and can’t stand a messy house!” is a sentiment expressed by some people who are, in fact, just neat freaks. It may seem harmless, but this kind of misunderstanding can be incredibly invalidating to those who are suffering with OCD. While it is true that some OCD sufferers face compulsions relating to cleanliness, there is a difference between enjoying cleaning and feeling like your world will blow up if you don’t complete a specific ritual.

The reality of living with OCD is that it’s tiring and sometimes scary. Unlike these stereotypes, there have been times that compulsions could have put me in harm’s way. I have had compulsions to open the car door while driving or to touch a hot stovetop. Thankfully, I was able to resist these compulsions. This is where treatment comes in.

Managing OCD: Resisting Screaming Mimis

Back when I was 7 years old, my parents took me to see a therapist. She encouraged me to give my rituals a name. I didn’t fully understand this at the time but now I see her purpose was to have me think of my compulsions as enemies to defeat, and it’s easier to defeat something when you can see it outside of yourself. I thought of the funniest name I could think of, “Screaming Mimi,” and it just stuck.

That therapist taught my parents and I how to handle these “Screaming Mimis.” The more you give in to a ritual, the stronger it grows and the harder it is to resist. So, the most effective solution for OCD is to not give in to the urge, and the main coping mechanisms are to make it wait, to switch it up, or to do the opposite of the compulsion.

If I could tell parents of kids with OCD one thing, I would say that patience is key. Your child is not doing this to be annoying or funny, it’s something they genuinely feel that they cannot help. It’s important to remember that, while you can offer support, your child must be in charge of their journey and ultimately do the work. What you can do is offer them positive reinforcement when they make an effort to improve, compassion and care so they don’t feel alone in this, and, maybe most importantly, an open ear.

Living with OCD: Next Steps

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At nearly 30 years old, I have been fired twice from roles in my chosen career of public relations. It’s true that I have sent emails five minutes too late and missed a few typos, but I enjoy the field, even if I don’t love every aspect of it. And being fired – more than once – hurts deeply. I have been effectively told that I am not fit for the career on which I have set my sights, which has left me confused and anxious.

The ordeal hurts much more knowing that I have exclusively worked for places that center on addressing health disparities. While I never disclosed my ADHD diagnosis, I believe I still would have been met with discontent if I had, as my attempts to adjust processes and procedures to work with my brain were often met with annoyance. (Either way, it shouldn’t matter whether my disability was known; everyone works differently.)

Left in a Lurch

The more recent role placed me on a performance improvement plan just one month after I started. I was let go six months after my start date. I imagine that many neurodivergent individuals like myself know what it’s like to be on a PIP, and it’s not for a lack of skill or trying. If you ask us, these “plans” aren’t plans at all. Often missing from PIPs are tangible instructions and guidelines for helping us improve our skills.

[Get This Free Download: What to Ask Yourself to Find the Perfect Job]

One overarching thought I’ve had through all this is: How could my employers, who purport to pursue and create change to improve the lives of marginalized individuals, be so resistant to altering the way things are done? How could they be so intolerant of differences?

While these rejections have left me riddled with self-doubt and shame, I’ve been trying to reframe my experiences as opportunities to find a better fit. For now, I have found a new, part-time role in a different but adjacent field, though I’m not quite sure I’ve found my passion.

You’re Off to Great Places!

I’ve loved to write ever since childhood. I enjoy connecting with and helping others. Public relations seemed like a practical way to funnel these desires into a career.

I don’t know where my journey will take me, but I have brains in my head, feet in my shoes, and I’m armed with my ADHD diagnosis. Despite the bang-ups and hang-ups, I know one thing for certain: I’m going to continue to work hard and put my best foot forward. My mountain is waiting.

How to Get Over Being Fired for ADHD: Next Steps

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Gearing up for a road trip this summer? Stay safe behind the wheel with these road trip safety tips for remaining alert and distraction-free for miles and miles.

ROADTRIP: 8 Road Trip Safety Tips

Review it: Map your route ahead of time, taking note of tolls, planned road work, and other happenings that may impact your travel. While GPS is very helpful, a general understanding of your planned path improves your ability to adjust quickly to possible reroutes and other shifts that may be needed.

Give yourself more time than you think across your road trip and be realistic about the activities you can undertake along the way. By allowing plenty of time for your trip, you’ll avoid the temptation to rush, speed, and ignore details that could be important as you navigate the roads. You’ll also be able to stop for breaks to stretch, move, eat, and rest until the next leg of your drive.

Out of reach: Put cell phones and other potentially distracting items in secure places that are out of sight and out of your reach to reduce distractions.

Air it out: Turn on air conditioning or roll down the windows to keep cold air flowing inside the vehicle. Avoid warm temperatures that can make you feel drowsy.

[Read: “I’m Too Distracted When I Drive”]

Dine right: Stay away from sugary and salty junk food or jolts of caffeine when road-tripping, as you may feel sleepy when their effects crash out of your system. To maintain steady energy levels, hydrate with cold water (which will also help keep you alert) and eat small, energy-boosting snacks such as nuts, popcorn, seeds, bananas, kale, hummus, spinach, lean meats, dark chocolate, or whole grain cereal before you hit the road.

Track your eyes: Stay focused, especially on long stretches of road, by shifting your eyes every few seconds to scan the roadway or check your mirrors. Consistent eye movements increase alertness and awareness of surroundings while also avoiding the trance-like state that can occur over the monotonous interstate miles.

Revitalize: Give your brain sensory stimulation with gum or essential oils. Chewing refreshing mint gum can increase alertness and keep you from continually reaching for a snack while driving. Smelling invigorating scents such as peppermint can trigger the brain for alertness and focus.

Insert reminders: Set reminders to refuel, hydrate, and take bathroom and movement breaks. Consider programming location-based reminders to go off as you approach gas stations, service areas, and even touristy spots you don’t want to miss.

[Read: Road Trip Hacks for (and from) ADHD Families]

Prep before you go: Make sure you’ve adjusted your mirrors, seat, and car temperature before you hit the gas. Have a pre-made music playlist (so you won’t be tempted to look at screens to search for the right song) and consider adding upbeat tunes that keep you alert.

Road Trip Safety Tips: Next Steps

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Like many families with autistic kids, we used to avoid going to restaurants. An unfamiliar environment we couldn’t control was the perfect recipe for chaos. Eating out meant a menu that might not include our child’s safe foods. Coping behaviors might emerge, drawing unwelcome attention: stares, judgment, disapproval, comments, or unsolicited advice that makes us feel unwelcome.

But just like other families, we crave a “third place” where we can relax. So when we discovered Wheated, a gourmet pizza restaurant in our Brooklyn neighborhood, it filled a huge hole in our lives.

Our Third Place: A Neurodiversity-Affirming Pizzeria

I won’t soon forget the tang of the first sip of Umbria or the texture of the pizza’s sourdough crust. But what will stay with me forever is how the restaurant staff made us feel.

After a few visits, my son was on a first-name basis with the owner, who was also a huge soccer fan. He’d chat with my son about soccer as if he had all the time in the world, while the restaurant bustled around us. No matter what drama happened during the week, we had our Sunday night ritual to look forward to and to savor. The servers knew our complicated order and didn’t blink at all the substitutions.

[Take This Self-Test: Signs of Autism in Children]

We would arrive most Sundays just as they opened for dinner. We reserved the same table in the back corner every time. There was loud music, and at times our kid was overstimulated; at other times, I was overstimulated. Waiting for the food was hard. Sometimes, our son moved around in ways that were not the safest for the wait staff and the other diners.

But the staff was gracious to us, always, even when patience ran out on both ends. Even when my son had a meltdown during one of our first visits. Thankfully, it happened to be Super Bowl Sunday, and we were one of the only families there, but the moment was hard nonetheless.

Even as my son screamed and cried and jumped, we were treated respectfully and kindly. The staff set the tone for the other diners. We never had the feeling of hairy eyeballs on us that was so common in other places.

A Friendly and Inclusive Space

The more we visited, the easier the dining experience became. I brought art supplies and noise-canceling headphones. We danced in our seats near the open kitchen, where our son could watch the chefs twirling dough in the air. There were some swift exits and half-eaten meals—but through these experiences, my son developed new skills, and we enjoyed ourselves together.

[Read: “A Love Letter to My Son’s Special Interests”]

We became loyal customers. Eventually, over years, our son got used to the many noises of a busy restaurant. He learned dining etiquette, how to order his own dinner, and where he could safely stim while keeping the aisle clear for servers. We took our family and friends to the restaurant, and were able to have lovely, relaxed celebrations because our kid was known and accepted for who he was there.

I will forever be grateful to that restaurant for helping my son gain social skills and confidence while accepting him unconditionally. The sense of belonging to a “third place” will stay with him as he grows up and branches out to other restaurants and public spaces.

I’d like to think that our family had a positive influence on the restaurant as well. (At the very least, we tipped well!)

If you’re looking for that “third place” for your own family, don’t give up. Inclusive places are out there, and they are delicious.

Autism Acceptance: Next Steps

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Picture this: You’re back in high school. You’re in the cafeteria, and you notice two classmates eating lunch at a nearby table. One of them looks at you, laughs, and then whispers something to her friend. How would you interpret this situation?

Without fail, all of my female clients reply, “They are laughing at me.”

This painful thinking pattern – sensitivity to rejection – is etched into our brains, a pattern that arguably developed for an evolutionarily adaptive purpose. It’s also a pattern that appears to be much more amplified in the female ADHD brain.

Rejection Is an Existential Threat

According to neuropsychiatrist Louann Brizendine, M.D., author of The Female Brain (#CommissionsEarned), girls’ brains are “machines” that are “built for connection.” From infancy, girls respond more to the cries of other babies and gaze longer at faces compared to boys.

Unlike men, who are physically larger and stronger, women have historically needed other people and social connections to ensure their own safety and that of their offspring. The female brain, Brizendine posits, likely tuned into the potential for social rejection as an evolutionarily protective function.

So great is the fear of exclusion among women that it informs bullying behaviors. Peer relationship research shows us that, unlike males, who engage in more physical forms of bullying, females generally rely on more relational or reputational methods, such as excluding another girl from their social group, spreading rumors, or saying something mean directly to the victim’s face. In other words, we toy with other females’ emotions by threatening exclusion from an early age because that is really what we fear the most — being rejected and alone.

[Take the RSD Self-Test: Rejection Sensitive Dysphoria Symptoms]

The ADHD Brain and Emotional Reactivity

The amygdala, which Brizendine describes as the brain’s “emotional gatekeeper,” is where fear and anger are initially processed. Once the amygdala detects a threat — real or perceived — that information is sent to the hypothalamus. The hypothalamus then heightens the uncomfortable fight-flight sensations (e.g., faster heartrate and breathing) we experience when we are anxious or angry. The amygdala also sounds the alarm to the prefrontal cortex (PFC), the executive functioning center of the brain, which then decides whether and how to react.

And here lies the pivotal point where the differences between girls with and without ADHD come to light. Our ADHD brains, prone to greater emotional flooding, crank up the volume on the aforementioned process. Our fear of exclusion is amplified. We interpret a situation as threatening when it likely isn’t.

Regardless, our brains get carried away with the threat. The alarm bells of “danger” ring, ring, and ring. We struggle to regulate, and, due to poor executive functioning, we struggle to respond effectively. There’s a reason psychiatrists Edward Hallowell, M.D., and John Ratey, M.D., describe the ADHD brain as a Ferrari equipped with bicycle brakes.

The way those of us with ADHD experience rejection is so unique that there’s a term for it: rejection sensitive dysphoria (RSD). Psychiatrist William Dodson, M.D., notes that some of his patients with RSD even describe feeling physical pain – as if they’ve been stabbed in the chest – as a response to rejection.

[Read: How Does RSD Really, Actually Feel?]

I can attest to this; after I got into an argument with someone very close to me, I sobbed in my husband’s arms and could only say, “It hurts.” Yes, I was hurting emotionally. But I was also in literal, physical pain. The female brain’s propensity to relay intense emotions into actual physical sensations is not lost on me. Feelings of emotional pain can register as physical pain responses for us, according to Brizendine.

As women, but especially as women with ADHD, our brains are wired to scan for rejection at every turn. Yes, this probable evolutionary adaptation – developed for protection – is turbocharged under ADHD. Yes, RSD and emotional reactivity are the excruciating result. But our sensitivity and ability to feel deeply, dare I say, has its advantages, too.

Fear of Rejection, RSD, and ADHD: Next Steps

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FREE WEBINAR ON JULY 17, 2024:
Click here to register for “College Accommodations for Neurodivergent Students”

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May and June are tricky months to be on social media if college graduation is up in the air for your child, as it is for mine. It seems like it was just yesterday that we posted photos of high school graduation, then the college drop-off, wherein I stood awkwardly in my kid’s dorm room trying to smile through tear-smudged mascara.

We didn’t know what to anticipate over the next four years. We expected some setbacks, but secretly imagined our kids soaring, hoping they would avoid some of our own college mistakes. We wanted them to take interesting classes, make new friends, have fun, and develop a work ethic that would carry into internships and jobs upon graduation.

But when you have a child with ADHD who struggles academically, and for whom college graduation within the traditional four years is an elusive goal that alternates between impossible and slightly in reach, these spring and early summer months are fraught with stress and anxiety.

Acing the ADHD Test

My oldest son came out of the womb with ADHD. From the time he was 3 months old, he was in constant motion unless he was asleep. He would wake up by repeatedly throwing down his legs onto the crib mattress, waking us up with a rhythmic thump-thump-thump on the baby monitor. He crawled, walked, and climbed out of his crib all before he was 16 months old. A thoroughly exhausting toddler, he rarely stopped jumping, climbing, or running.

Fast forward to First Grade. At a parent-teacher conference, his teacher told us to keep an extra eye on him for ADHD. She said it kindly, noting that he was an extremely “spirited” child: not necessarily bad in the classroom per se, but rather extremely busy. He was always moving his feet, looking around the classroom to see what he was missing, and tapping his pencil on the desk. We nodded, knowing all too well just how spirited he was.

[Get This Free Download: Securing ADHD Accommodations in College]

Daily homework started in the third grade, and we quickly learned that organization and study skills were going to be challenging areas for my son. I structured my workday to be home at 3 p.m. to sit with him while he did homework, the school “momitor.” I tried every which way to instill the importance of to-do lists and planners for organization. We experimented with different ways of learning, like making flash cards and drawing pictures.

He loved sports, and his reward for doing homework was beloved baseball practice. We always found it so ironic that he gravitated toward a sport that was boring for most kids. (So much standing around waiting for the ball to come their way!) But we learned early on that while our son could not focus on short stories and would forget math facts within a few weeks, he loved to pitch a baseball. When he was on the mound, you would have never known that he had ever taken a single medication for ADHD, or that getting through what should have been 90 minutes of homework took him at least two hours longer.

He worked quickly in games, throwing batters off with his fast pace. My son loved all of it — the more pressure the better. And it paid off: A smaller Division I college in New England offered him money to pitch there. Instantly, we had a solid college plan. Baseball was the tether that allowed him to continue his education while doing something that he loved.

ADHD in College, Pandemic Version

But going to college in 2020 was an arduous challenge for him as it was for most students. The focus required for statistics, biology, and other subjects that were difficult for my son under normal circumstances proved much more strenuous when classes happened over Zoom. He struggled even more when baseball season started, as it meant he had to balance sports and academics. I stood by with hands tied behind my back, 17 hours away, knowing full well that my days of emailing teachers and finding tutors ended the moment my son graduated from high school. My son would call and say he was on top of his schoolwork, but his grade report reflected a different story. Every semester was a struggle, no matter how much I tried to help him navigate things from 1100 miles away.

[Read: 13 College Survival Tips from Graduates with ADHD]

College graduation is now on the horizon, and my son’s academic status is still a day-to-day question. He is still a few credits shy of receiving his diploma, but close enough that he might be able to walk across the stage anyway and take the final classes over the summer. He has never been a straight-A student, and it does not help that he failed at least one college class almost every semester. He is the very definition of a procrastinator, and is not a student that stands out amongst his peers in the college classroom.

The Achievements That Also Matter

But when I think about the last four years, I think about this: My son has gifts that even a perfect SAT score would never reflect. He is infinitely kind and generous to a fault. There is no extra cord on a graduation gown for a student like him, someone who is terrible at managing money, but buys lunch for homeless people in fast food parking lots. My son will forget that he needs to undergo a physical exam for baseball until the day before it is due, but will sit with a friend he’s only known for a week in the emergency room until the friend’s father, who lives four hours away, shows up. He fought me when we found a therapist for him when he was on academic probation in his sophomore year, but I later learned from one of his roommate’s mothers that my son’s compassion and listening ear were one of the only things that kept her from driving to campus every weekend when her own son was struggling with a breakup that year.

There are no awards for the student who spends hours watching Hallmark movies with his grandmother over Christmas break. When he takes grandma sneaker shopping, he will forget everything I told him about the kind of supportive shoes she needs and will instead help her pick out the most colorful pair that they both love. My son will get defensive and argue relentlessly that he attends all of his classes, but he is always the first one to apologize when we argue. Even when we spend 15 minutes on the phone yelling at each other, he never, ever hangs up with telling me that he loves me.

I am not ashamed to say that I will absolutely be the mom who will post lots of pictures on my son’s graduation day, whenever it be in August or December. No one on social media knows what it took for us to get there. I will surely cry when I see him in a cap and gown, partially out of relief that he actually made it, but mostly because I know that many kids who struggled like he did would have given up. It is frustrating and sad to me that most of his professors will never know the real him. Procrastinator and time management disaster? Yes. But a kid with a heart so purely gold with gifts that mean nothing in academia? Absolutely.

Kids like him who struggle — whether it be from ADHD or a learning disability — know the reality of flying under the radar in the very worst of ways. And while I am so proud of my friends’ children who do have all the cords on their gowns, who are making their way into law schools and solid jobs with clear career paths after graduation, I have a secret place in my heart for people like my son, who might be unremarkable on paper, but are remarkable in one hundred other ways.

Social Media Envy with ADHD: Next Steps

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There is a lot of pride in my neuroqueer family. I call us a rainbow family because we represent so many different sexual identities and gender expressions, all knit together with love. I am proud to be part of such an amazing patchwork of people who understand that family is what you make it, and love is love.

There is also lots of neurodivergent pride in my family. And this Pride Month, I am thinking a lot about the layers of complexity that families like mine experience because we’re neurodivergent and members of the LGBTQIA2S+ community.

Even as a queer parent with ADHD myself, parenting in the age of enlightenment regarding identity can sometimes feel like an extreme sport. It’s admittedly hard to keep up with the changing ways we talk about gender, sexual orientation, neurodivergence, and other aspects of identity. Amid all this, one thing remains clear: Our ADHD and LGBT+ kids need us to fight even harder for their right to be seen, heard, and respected.

Fighting for LGBTQ+ Rights, Neurodivergent Style

The upside is that the fighting comes naturally to neurodivergent individuals. We know what it’s like to be on the fringes of society and experience stigma. We know what it’s like to mask parts of our identity to try to be accepted.

Our neurodivergent qualities also uniquely equip us to fight. Due to our strong sense of justice, it’s not a stretch to say that we’re likely to be on the front lines of equality movements. Our justice sensitivity is no doubt driven by rejection sensitive dysphoria – one of the most brutal aspects of living with ADHD. At the same time, feeling rejection to the extreme – in the form of homophobia, transphobia, and other forms of hate – can truly make life feel not worth living.

[Read: How to Be a Neuroqueer Ally]

As the mom of two gender-creative ADHD kids, I would do anything to protect them from this fate. Which is why I know that the best thing I can do is let my children see me fighting for them. At marches. At school. At the town hall. And yes, in the workplace.

As I write this, I am involved in a dispute at work, where grumbles and complaints about respecting people’s pronouns and gender identities happen near daily, despite company policies dictating that no discrimination of any kind is tolerated. What makes this situation scarier is the fact that my organization works with children, many of whom are gender non-conforming. In time, I hope my colleagues learn that using correct pronouns is lifesaving, especially for youth.

LGBTQ+ Joy Matters, Too

Fighting, however, is just one aspect of being part of the queer community. The other aspect — my favorite — is celebration. For Pride Month, we gather in our brightest clothes and most fabulous makeup. We have parades, we play music, and we dance in the streets. (ADHD creativity and spontaneity certainly help!) We are together. We see that we are not alone.

Another incredibly fun activity we do as a family is attend all-ages drag shows. The support for LGBTQ+ youth in these shows is unbelievable, like nothing you’ve ever seen. At every show, I take a moment to look around the room and see other rainbow families. I feel such pride in being part of a vibrant, creative, and bold community.

[Read: “I Didn’t Need to Understand My Teen’s Gender Journey to Support It.”]

Yes, the fight matters. Celebrating, living, and thriving – as a queer parent with ADHD – is part of the fight. It’s what neurodivergent and queer youth need to witness so they know it’s possible for themselves.

Neuroqueer Families: Next Steps

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Thirst is a bodily sensation that many neurodivergent children struggle to recognize due to sensory processing differences – an issue especially in the warm summer months. Children who have trouble with the interoceptive sense may feel internal discomfort but will struggle to register that it’s due to thirst or dehydration.

Help your child stay hydrated and healthy this summer (and year-round) with these strategies.

1. Follow a Hydration Routine

Develop a fluid-intake routine to train your child to better tune in to their senses.

Challenge your child to drink a minimum of eight cups of fluids — even better if it’s mostly water — spaced out every few hours throughout the day (e.g., after waking up, mid-morning, before lunch, mid-afternoon, and before dinner). Your child may need more fluids depending on activity level and the weather. Fluids can be paired with snacks and meals.

Monitor your child’s fluid intake — including time, amount, and types of fluids (water, juice, milk, etc.) they drink. Maintaining a log can help ensure they’re sticking to the routine and help you spot any unhealthy drinking patterns, like not drinking enough in one sitting, going for long hours without fluid intake, or hydrating too close to bedtime, which can disrupt sleep. Be sure to ask teachers, babysitters, and other caregivers to record your child’s fluid intake, too.

[Read: A How-To Guide to Summer Safety]

If your child struggles to tell when they’re thirsty, chances are that they also struggle to tell when they’re hungry and/or need to use the bathroom. A benefit of a hydration routine is that it can regulate all these bodily processes. Download my free chart here to track your child’s eating, drinking, and bathroom habits.

2. Set Reminders

• Set alarms using your watch, smartphone, and/or a device such as an Alexa to prompt your child and family to drink water and other fluids.
• Use pictures and other visual cues. Hang up an illustration of a child eating and drinking in sequence to remind your child what to do. Store cups next to plates and pack a carton of juice with your child’s lunchbox to visually connect eating with drinking.

3. Make Hydrating Fun

Encourage your child to choose a special cup or bottle, like one decorated with their favorite characters or animals, to motivate them to refill and stay hydrated. Novelty or musical reusable straws are also fun. Make water more interesting and palatable by adding natural flavors such as chopped mango, blueberries, or any fruit of your child’s choice, introduced at different times of the day.

[Read: How I Reduce the Summer Stress]

4. Incorporate Hydrating, Water-Rich Foods

Hydrating is not just about consuming cups of fluids. Water-rich foods – gelatin, popsicles, yogurts, and fruits – can also help your child stay hydrated. Though not a substitute for drinking fluids overall, these foods are a great compromise if your child resists drinking fluids.

5. Get Help from a Medical Professional

If keeping your child hydrated with the above strategies is a daily battle, you may be thinking, “Can’t I just let my child drink when they want to?”

Our bodies need to stay hydrated for many health reasons, from keeping the bladder clear of bacteria to carrying nutrients and oxygen to cells. Indigestion, constipation, and dysregulation are all results of dehydration.

But forcing your child to take in more fluid isn’t the answer. A medical professional can help you implement healthy strategies for your unique child.

Be mindful of the following symptoms, as they could indicate that your child is dehydrated. If symptoms are severe, call 911.

• dry mouth, lips, tongue, eyes, and skin
• tiredness and irritability
• headaches and dizziness
• dark, concentrated, strong-smelling urine
• urinating less frequently
• muscle cramps or spasms (may be noticeable during play)
• rapid heartbeat

Hydration Tips for Neurodivergent Kids: Next Steps

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Close your eyes for a moment and visualize a place of healing, rejuvenation, and wellness. What does that look like? What sounds do you hear? What’s the temperature? Is there a breeze blowing? What does it smell like?

Most people who do this exercise will describe a place in the natural environment – not a place behind a screen. It might be a sandy beach with the waves rolling in, a mountain meadow, or a forest of towering trees. It’s almost never an app or video game.

Humans are deeply connected to nature and we have been for as long as we’ve walked the Earth. We thrive when we spend time outdoors. But today that connection is hanging by a frayed thread, due largely to our overreliance on technology.

Today’s youth spend more time than ever before in front of screens. Even kids realize they are spending too much time on technology. A recent Pew study reports that 54% of young people say they are spending too much time on their phones. Then there’s the fact that excessive screen time has been linked to health issues from anxiety and depression to poor sleep, a cluster of issues that award-winning journalist Richard Louv dubs “nature-deficit disorder.”

The Power of No Power

The happiest teens use their phones less than one hour a day, according to a study. It might be difficult to convince a kid of that, but it’s clear that the happier kids are the ones finding ways to engage with the world rather than just looking at it online.

[Get This Free Download: Too Much Screen Time? How to Regulate Your Teen’s Devices]

Studies show that time in nature improves children’s school performance, behavior, self-discipline, creativity, and problem-solving abilities. It also helps them feel more connected with nature, making them more likely to help protect the natural world.

For kids with ADHD and related conditions, the benefits of spending time outdoors are profound. While increased screen time is linked to more severe symptoms in these kids, exercise and time outdoors have been shown to reduce symptoms. One study found that even looking at natural greenery significantly decreased stress levels for kids with ADHD, and that they could focus better after being outside.

Being out and about and taking in fresh air helps us sleep better. A study found that a weekend camping trip can reset circadian rhythms. Spending time in nature has even been shown to improve eyesight. Another benefit of family green time? A better relationship with your child.

How to Help Your Child Plug Into Nature

I’m not suggesting we try to eliminate all screen time. I am advocating for the benefits of unplugging, or as I call it, “the power of no power.”

[Read: “Why We’re Drawn to Beaches, Gardens, and Forests”]

As parents, you have the opportunity to give your kids real-life experiences to help them break free from their digital trance. Here are a few suggestions, many of which cost little yet provide priceless benefits:

• Go for a hike. There are state and local parks everywhere. If not a hike, a stroll through your neighborhood’s greenest parts.
• Ride bikes along a greenway path.
• Go fishing.
• Visit a waterfall.
• Take your kids swimming in a lake or swimming hole to cool off on a hot summer day.
• Rent canoes or inner tubes and float a river or paddle a lake.
• Picnic at a spring, lake, or river.
• Create a scavenger hunt or try geocaching, a real-life treasure hunt that gives kids a connection to nature and the people who left those treasures behind.

Your best memories probably don’t start with “There I was, at the computer.” So don’t just read about life online — get outside and live it with your kids.

Nature Deficit Disorder: Next Steps

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Grayson’s journey as a trans boy didn’t come out of the clear blue sky.

Though he liked to wear skirts and play with makeup, he also cut his hair short and kept it that way — even when other kids teased him and said he “looked like a boy.” When Grayson, who was assigned female at birth, was about 7 or 8, we were talking about puberty when he made a horrified face and said, “I don’t want to go through puberty.”

During one of these conversations, I remember him saying, “I don’t want to live on this planet anymore.”

At the end of fifth grade, when he brought all his schoolwork home, I looked through the papers and saw that he’d been signing his work with the name “Michael.” I asked him about it, and he said he wanted to use they/them pronouns. A couple of months later, he requested that we start using he/him pronouns, and took on a different name. Then, when he was 13, he changed his name to Grayson, which has stuck. I love the name — it suits him so well.

At about the same time, Grayson was diagnosed with inattentive type ADHD. That too, was not exactly a surprise. While he was never very fidgety or busy, he often had to be redirected. There were a lot of school struggles: not following directions, not getting things done, forgetting to hand in homework, and losing things.

[Read: 5 Overlooked Signs of ADHD – the Inattentive Type]

When Neurodiversity Meets Gender Diversity

It’s interesting — I know so many people who are both neurodiverse and genderqueer or part of the LGBTQIA+ community. I’m not saying that there’s any kind of causal factor at play, but there does seem to be some kind of correlation. Maybe the difference they feel because of their neurodivergence makes them feel more comfortable exploring other aspects of their identity? Or perhaps they are better able to identify that difference that other people have but don’t take the time to question?

At 16 years old, Grayson is so secure in who he is; he’s blow-your-mind good at advocating for himself. He is out and proud! In the last couple of years, he hasn’t needed me to speak for him because he stands up for himself.

Transgender Teens: Countering Misconceptions

There are so many myths about genderqueer kids. A big one is that kids are doing it for attention. It doesn’t make sense to me, given how negative a lot of that attention is and how scary the world can be when you don’t fit into your assigned “box.”

[Read: “I Didn’t Need to Understand My Teen’s Gender Journey to Support It.”]

Another myth I hear a lot is, “It’s a phase; he might grow out of it.” Or, “he’s too young to make that kind of decision.” People think it’s easy to get gender care and just — poof! — transition. That’s not how it works.

We are lucky that we live in a very progressive area, and I’ve worked in health care for years so I know the landscape. Even so, knowing where to go and who to talk to — and dealing with insurance coverage — has been a lot. When we moved states, the waiting list to get into the new gender care clinic was long, and I was concerned because Grayson was already on puberty blockers at that point and I didn’t want them to wear off. Eventually, his doctor who we’d seen for ADHD called the gender clinic and was able to get him seen. But what happens to the people who don’t have that kind of support?

To those who think he should wait until he’s “old enough” — in other words, an adult — I say this: A lot of those kids are not making it until adulthood. And that is scary. We have so much research now that clearly shows that the way to reduce suicide among trans teens is to give them gender-affirming care. It saves lives, and that isn’t hyperbole or exaggeration.

Another damaging myth that we’ve encountered is that there’s a right way and a wrong way to be trans or to express gender. Grayson is solidly a boy, and he also happens to like some feminine things — and there’s nothing wrong with that. I’ve had people ask, “Are you sure he still wants to be a boy? Because that pink hair of his isn’t very masculine.” And I tell them, “It’s a lot to sort through and figure out. Just let him be.”

I love him and support him on this journey one hundred percent.

Supporting Genderqueer Teens

It’s a scary time to be a parent of a trans kid. There’s a lot of anxiety about what’s going to happen. We live in a “safe state,” but how long will it stay safe? That existential dread is constant — and if it’s bad for me, I’m guessing that it’s much more nerve-wracking for him.

It’s so important to find a supportive community. I’ve been lucky enough to have friends who have also experienced this journey. We often send messages back and forth: “So this happened today…” or “The school’s doing this. How did you deal with it?”

I sometimes hear parents who are just beginning this journey express feelings of grief, that the child they knew is gone. To anyone feeling that way, I say this: Your child is still here. They are the same kid they always were. Nothing has changed, except maybe pronouns and a name, and people change names for all kinds of reasons.

Complicated feelings are normal, but just work it out with your therapist, and not in front of your kid. This isn’t something that’s “wrong.” It’s just something that’s different — just like ADHD. Your child needs you to love and support them, to help them live an authentic life as their truest self.

Genderqueer and Neurodiverse: Next Steps

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When my son was diagnosed with ADHD at age 9, I threw myself into research. Given my own adult ADHD diagnosis, I wanted to protect my child from the shame, self-doubt, and negative self-talk that I developed while growing up undiagnosed and untreated.

What I found in my research was confusing. Assessing whether a medication was effectively treating ADHD seemed heavily reliant on subjective reporting. How was I to reliably tell if my child’s ADHD medication and dose were really working as well as they should?

I was frustrated and determined to get clear results – and then I had a lightbulb moment.

The Truth Before Our Eyes

One day, I was reading with my kid. I watched as their eyes darted all over the page, the focus slipping away right in front of me. This must happen to so many people with ADHD when they try to read, I thought.

That’s when it hit me: When we read, our eyes follow a specific pattern. Unless we have ADHD, and then our wandering minds might lead to wandering eyes, making our reading patterns different and more erratic.

[Get This Free Download: How Do We Know the Medication Is Working?]

Eye movement is key; tracking it could reveal patterns and lead to a methodology for ultimately measuring focus. I brought the idea to my sister, an AI and bioinformatics expert. Together, we began to use AI to analyze reading processes and eye-movement patterns. We found that by tracking these patterns, we could develop a tool that would provide a clear, data-driven picture of how ADHD medication affects concentration and impulsivity, thus, a way to measure treatment efficacy.

Turning a Novel Idea Into Reality

Enter Ravid, my rollerblading buddy who also has ADHD and expertise in digital health product development. The three of us made this wild idea a reality. While Ravid and my sister built the product, I reached out to clinicians.

I learned in those conversations that there was no tool available that could objectively track medication efficacy for a patient outside of the clinic. Clinicians and researchers loved our approach. Reading is universal but complex enough to capture different aspects of ADHD, and eye tracking can reveal both concentration and impulse control levels.

And that’s how iFocus was born. You can log in to our site from a webcam-enabled computer and read a paragraph with and without your meds. Our tool will track your eye movement through your webcam as you read and establish a score representing your progress compared to your baseline.

[Read This Special Report: ADHD Treatments Scorecard from Readers]

Each session only takes a few minutes, but the impact, we think, can be life changing.

Putting People in Charge of Their ADHD Treatment

Recently, my kid started a new medication, and we used iFocus to find the right dose. The experience was completely different. They tested themselves, reported how they felt, and we had meaningful discussions about the results.

The dose where my child felt best was lower than I anticipated, but both my child’s report and iFocus results confirmed that the dose was working. This is just one example of how iFocus empowers people with ADHD to take control of their treatment journey.

ADHD Medication Efficacy: Next Steps

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