The average American checks their phone 205 times each day and spends about one-quarter of their waking hours on that addictive device each day. Time surrendered to screens has increased at least 30% in just the last five years; the unchecked proliferation of digital media and its influence over our lives is arguably the defining feature of the 21^st century.

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

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

How Do Screens Affect Us?

Perpetual Distraction

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

The Fiction of Multitasking

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

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

Aversion to Delays

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

FOMO and Anxiety

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

Restore Control: How to Unplug

Check In with Yourself

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

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

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

Commit to Conscious Change

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

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

Screen Addiction and ADHD: Next Steps

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

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

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Waiting sounds basic, but it’s far from simple to practice. As a Certified Financial Planner®, I know that many people spend their entire lives struggling to wait — a habit that is at the root of all kinds of financial problems, from impulsive spending and overblown budgets to reaching retirement age with few or no savings.

I am not perfect. Delaying gratification has not come easy for me because of my ADHD, a condition marked by impulsivity and dopamine-seeking. Still, I have slowly but surely gotten better at waiting. As ADHD and financial problems are linked¹, it’s safe to assume that children with ADHD may benefit from practicing the essential skill of waiting. It’s never too early to start.

[Read: Great Ideas for Teaching Your Children to Manage Their Dollars and (Spending) Sense]

Delayed Gratification: How to Teach Your Child to Wait

• When-Then. Granting video game time for completed homework is one way to teach the valuable skill of waiting, as is an ice-cream run for finished chores.
• Use goal-specific allowance jars. Help your child create a short-term goal jar for small rewards (like a sweet) and a long-term jar for big-ticket items (like a new video game or a special outing.) Seeing the jars side by side can help your child visually understand the trade-offs between immediate and delayed rewards.
• Introduce waiting periods for spending their allowance. For instance, if your child wants a toy, they should wait one week for every $10 it costs. This will teach them that expensive things often require more patience and planning.
• Offer matching contributions. For every dollar your child saves, reward them with another at the end of the year.
• Model delayed gratification: When making a big purchase for the family, talk about why you’re saving for it and how you’re making trade-offs to reach your goal.
• Discuss the pitfalls of comparison, especially the ‘Keeping up with the Joneses’ dynamic often seen on social media. Explain how this can fuel unhealthy comparisons and distort perceptions of money and wealth. Help your child understand that what they see online doesn’t always reflect reality or wise financial decisions.

How to Teach Kids About Money: Next Steps

• Read: Mo’ Problems? Raising Smart Spenders (and Savers) with ADHD
• Read: “The Expensive Lessons We’ve Learned About In-App Purchases”
• Read: How to Teach Teenagers About Money

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “Smart Money Habits for People with ADHD” [Video Replay & Podcast #522] with Otto Rivera, CFP®, EA, which was broadcast on September 24, 2024.

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

Sources

¹ Pelham, W. E., Page, T. F., Altszuler, A. R., Gnagy, E. M., Molina, B. S. G., & Pelham, W. E. (2020). The long-term financial outcome of children diagnosed with ADHD. Journal of consulting and clinical psychology, 88(2), 160–171. https://doi.org/10.1037/ccp0000461

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

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

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

In this webinar, you will learn how to…

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

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

Meet the Expert Speaker

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

Learn more at www.drsharonsaline.com.

Teens with ADHD: More Resources

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

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

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

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

In this webinar, you will learn:

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

Watch the Video Replay

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

Defusing Defiance in Children with ADHD: More Resources

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

Obtain a Certificate of Attendance

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

Meet the Expert Speaker

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

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

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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

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

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

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

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

Genetics, Prenatal Factors Impact BMI

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

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

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

Impulsivity Linked to Poor Dietary Decisions

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

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

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

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

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

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

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

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

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

Preventing Childhood Obesity

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

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

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

Sources

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

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

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

What School Refusal Looks Like

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

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

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

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

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

Identifying Underlying Fears of School

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

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

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

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

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

[Download: Social Anxiety Facts and Falsehoods]

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

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

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

Below is a sample hierarchy plan:

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

Working with Your Child’s School

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

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

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

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

[Download: 30 Great Accommodations for Children with ADHD]

Staying Home from School

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

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

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

The night before:

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

The morning of:

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

Reader Insights

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

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

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

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

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

School Refusal & Avoidance: Next Steps

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

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

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

Collaborative Problem Solving for The Explosive Child

Be observant.

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

Identify unsolved problems.

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

[Get This Free Guide to Ending Confrontations and Defiance]

Prioritize problems.

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

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

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

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

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

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

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

A Win-Win Approach

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

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

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

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

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

Collaborative Problem Solving: Next Steps

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

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

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

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

ADHD gives me plenty of skills I can model for my kids, but good frustration tolerance isn’t one of them. I can make up silly songs on demand, but I’m rubbish at remaining unruffled when my 6-year-old’s temper flares.

My younger child is a lovable ball of brightness, kindness, and fun, but many things short her circuit and invoke her iron will, from unsolicited carrots to socks that won’t reach their requisite height.

She might well be neurodivergent herself. (We’re waiting in line for assessment.) But whatever the root of her proneness to grievance, it feels like we’re peas in a pod. My patience is apt to desert me the second she loses hers.

There are things I can give her directly to help her stay grounded and happy: empathy, boundaries, nutritious meals, plenty of nourishing cuddles, choice where possible, my fullest attention, the conscious uncoupling of me and my phone. But kids need a stable, consistent caregiver who they can watch and copy. If I can’t manage my own frustration, how will she ever handle hers?

Modeling Calm When Anger Strikes

I’ve been thinking a lot about how to model calm when it counts, and it strikes me that there are two things I need to nail if things are to be less shouty around here.

[Get This Free Download: 5 Ways to Improve Emotional Control at Home]

1. Meeting my own needs first

Most of what gives me balance is basic. Exercise, fresh air, and eating well. Walking up hills and through parks. Pilates and painting and learning new things. Time with no screens or voices to allow me to drift and dream.

They’re simple remedies, but my mental health slides if I fail to give them priority. Luckily, my partner has his own list too, so we tag-team to tick off as much as we can.

2. Keeping my cool in the moment

Much harder to master is the consistent deployment of effective strategies when my daughter digs her heels in.

When my child gets stuck in an emotional vortex, reason cannot reach her. I know how that feels myself and I’m often inclined to join her. But some recent therapy has helped me to see that I do have a choice in the moment. I can either hop aboard the resentment express and trot out a pointless monologue that spikes my cortisol and guarantees escalation. Or I can pause and make a conscious decision about how I’d like to proceed.

It’s not easy. The stress in my body is physical and real. I feel it in my chest and my neck. My ears ring and my heart races. But there are ways of letting it go. I can notice the tightness and relax the tension. My mind will often follow. I can focus on breathing more slowly and deeply (if I’m actually breathing at all). I can silently soothe myself in the tone of a grown-up who knows this will pass. When I pull it off, I’m not faking or in toxic denial. I just feel a lot more balanced and able to ride out the storm.

[Read: When Angry Kids Lash Out – How to Defuse Explosive Reactions]

Modeling Calm – Putting Techniques to the Test

I get a chance to deploy my new tactics in the art of non-reaction on a Saturday, when we fancy a walk in the woods. The little one won’t get dressed, of course. Weekends are for lying down, she declares, as she burrows under our duvet, tucking it in around her to secure her fortress against potential incursion.

We could be here a while, I think. Last week we aborted completely. I implore her to put on some clothes. She kicks off the covers and thrashes around, emitting a grating whine. My chest tightens, my heart rate quickens, and I want to launch into my lecture.

But I stop. I breathe. I remember that calm breeds calm and that staying centred will help us both. She performs a series of loud exhalations, but I say to her softly that we’re leaving. Voices do not get raised. I exit the room and in minutes she’s clothed and skipping out to the van.

She briefly objects to my offensive plan to take a jacket just in case. But I let it wash over me and it burns out fast. Off we go in peace.

The same trick works on Tuesday when I commit a transgression with celery and she CANNOT EAT THIS LASAGNA (she does) and again on Friday when it puts to bed a debate over whether jellybeans constitute breakfast (they don’t).

Modeling Calm, One Little Test at a Time

There are blips involving poached eggs and car seats. I’m tired and hormonal and late – and I yell. But part of my internal deal is that I’m kind to myself when I fail. Improvement is still improvement if it’s only some of the time.

I’m buoyed by how things are going. My girl is more flexible and she’s proud of herself when she lets things go. I’m feeling quite proud of me, too.

So maybe I can crack this. Maybe soon I’ll add “measured response to frustration” to the list of things I can pass to my children. It’s not as fun as singing ditties about teachers or toilets, but it’s arguably a more essential skill that will serve them well in life.

How to Be a Calm Parent: Next Steps

• Read: ADHD and Emotional Regulation – A Parent’s Guide
• Free Download: Get a Grip on Tough Emotions
• Read: “Our Home Can’t Withstand All of These Emotional ADHD Explosions!”

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

Boredom causes a heightened stress response in impulsive people, as evidenced by the elevated cortisol levels documented in new research published in Physiology & Behavior.¹ The research deepens the scientific community’s understanding of the interplay between impulsivity and boredom, suggesting that this relationship may be mediated by the hypothalamic-pituitary-adrenal (HPA) axis.

“This research suggests that the lived experience of boredom feels more intense and aversive for people who are highly impulsive, transforming into an overwhelming need to escape that boredom,” explained Matt Parker, Ph.D., the study’s senior author and a neuroscientist at the University of Surrey.

The research comprised two studies. ​​The first, in which participants completed a dull task and self-reported levels of boredom, confirmed previous findings that individuals who identify as impulsive are more prone to boredom than are others. ^{2, 3,4,5}

In the second study, researchers tested the levels of salivary cortisol in a portion of these participants, both before and after they completed the boring task. They found that cortisol levels were higher in those who had trait impulsivity, indicating activation of the HPA axis.

These studies help researchers more fully understand the feedback loop that can occur between impulsivity, stress, and boredom. Not only are highly impulsive people more prone to boredom, but boredom often leads to impulsivity ⁶ and to a stress response.⁷ Stress, in turn, increases impulsivity, keeping the cycle in motion.

“These findings offer promise for personalized interventions, designed for high-impulsivity individuals, to alleviate the negative impacts of boredom and potentially break the identified feedback loop,” explained the study’s authors.

Risks of Chronic Stress Response

The study’s authors write that boredom remains understudied in psychiatric research despite having “significant implications for mental health, and cognitive functioning.” In highly impulsive people, Parker explains, the intense drive to avoid boredom leads to maladaptive coping strategies including risk-taking behaviors and substance use, which sometimes alleviate boredom and reduce stress in the short term, but rarely in the long term.

This, combined with the evidence of a heightened stress response associated with boredom in impulsive people, underlines the importance of discovering effective interventions. “If people undergo chronic stress over a long period of time, and there is prolonged activation of that HPA axis, there is increased risk for cardiovascular disease, weakened immune function, and mental health problems, such as anxiety and depression,” Parker said. “The best interventions may focus on stress-management techniques, things that are designed to reduce stress axis response.”

The new studies offer insight into an experience described by ADDitude readers who call ADHD boredom intensely aversive and acutely stressful.

“I experience boredom as a profound inner restlessness,” said Jenn, an ADDitude reader in Missouri. “It isn’t just like I want to do something else; it’s like I must do something else. It’s like the restlessness is crawling under my skin.”

“Boredom feels like there is this engine running inside of me telling me to push on the gas pedal but the brakes are on, so there is smoke coming from my car,” said another ADDitude reader, Marta, from the United Kingdom.

Natalie, a reader in Pennsylvania, said: “Boredom translates to agitation, physical discomfort in my own skin, anxiety, and feeling lost — panicked, trapped-in-a-horror-movie-and-can’t-find-the-exit lost.”

Sources

¹J.M.Clay,  J.I. Badariotti, N. Kozhushko, M.O. Parker, HPA activity mediates the link between trait impulsivity and boredom, Physiology & Behavior, 284 (2024), 114637, ISSN 0031-9384, https://doi.org/10.1016/j.physbeh.2024.114637.

²C.J. Gerritsen, M.E. Toplak, J. Sciaraffa, J. Eastwood. I can’t get no satisfaction: Potential causes of boredom. Conscious Cogn, 27 (2014), pp. 27-41, 10.1016/j.concog.2013.10.001

³J. Isacescu, A.A. Struk, J. Danckert. Cognitive and affective predictors of boredom proneness. Cogn Emot, 31 (2017), pp. 1741-1748, 10.1080/02699931.2016.1259995

⁴A.A. Struk, A.A. Scholer, J. Danckert. A self-regulatory approach to understanding boredom proneness. Cogn Emot, 30 (2016), pp. 1388-1401, 10.1080/02699931.2015.1064363

⁵J.D. Watt, S.J. Vodanovich.Relationship between boredom proneness and impulsivity. Psychol Rep, 70 (1992), pp. 688-690, 10.2466/pr0.1992.70.3.688

⁶A.B. Moynihan, E.R. Igou, W.A.P. van Tilburg. Boredom increases impulsiveness: A meaning-regulation perspective. Soc Psychol, 48 (2017), pp. 293-309, 10.1027/1864-9335/a000317

⁷A.A. Moustafa, R. Tindle, D. Frydecka, B. Misiak. Impulsivity and its relationship with anxiety, depression and stress. Compr Psychiatry, 74 (2017), pp. 173-179, 10.1016/j.comppsych.2017.01.013

Dialectical behavior therapy (DBT) is an evidence-based treatment designed to help individuals who struggle with emotional dysregulation, aggression, self-harm, and other problem behaviors. DBT is an intensive, highly structured program that was originally created for adults in the 1970s and has since been adapted for children and adolescents. It can be an effective treatment for ADHD because it aids in the development of skills that support emotional regulation, problem-solving, and self-acceptance.

DBT works by helping children develop skills that decrease unwanted feelings and unhelpful behaviors, as well as skills that help them to accept difficult feelings about themselves and others without judgment. DBT patients participate in one-on-one therapy, group skills training, and/or phone coaching from their therapist. Parents learn the same skills as their children so that they can reinforce those skills outside of therapy.

In this webinar, you will learn:

• About the conditions that DBT treats in children and adolescents, and who would be a good fit for this therapy
• About DBT as a treatment model and how it works
• How DBT can support children and adolescents in managing mood, impulsivity, and anxiety
• About DBT strategies to support children in distress

Watch the Video Replay

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

Download or Stream the Podcast Audio

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

DBT for ADHD: More Resources

• Download: What Is Dialectical Behavior Therapy (DBT)?
• Read: Overview of ADHD Therapies
• Q&A: Why Deficient Emotional Self-Regulation is Central to ADHD
• eBook: The Parents’ Guide to Raising a Teen with ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on November 19, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Lauren Allerhand, Psy.D., is Co-Director of the Dialectical Behavior Therapy Programs and a psychologist for the Mood Disorders Center at the Child Mind Institute in the San Francisco Bay Area. She specializes in the evidence-based assessment and treatment of youth struggling with depression, anxiety, trauma, eating disorders, ADHD, and oppositional defiant disorder. She has extensive training in cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Dr. Allerhand is particularly passionate about providing DBT to improve the lives of high-risk, diagnostically complex youth who struggle with emotion dysregulation, suicidality, and self-injury.

Dr. Allerhand’s clinical practice also emphasizes supporting parents of children and teens with emotion dysregulation, oppositional behavior, or ADHD through evidence-based intervention. She has specialized trained in a DBT parenting intervention and Parent Management Training for parents of older children and teenagers. Dr. Allerhand is also certified in Parent Child Interaction Therapy (PCIT), an evidence-based intervention for families with preschool-aged children.

Listener Testimonials

“Praise to the speaker for her clarity. Excellent delivery.”

“The speaker was excellent, and the presentation outlined exactly the things I was hoping to find out about DBT. Thank you!”

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Webinar Sponsor

The sponsor of this ADDitude webinar is…

Play Attention: Play Attention, inspired by NASA technology and backed by Tufts University research, offers customized plans to improve executive function, emotional regulation, and behavior through behavior therapy principles and mindfulness. Each family is assigned a personal focus coach, and our family plan provides tailored programs for both kids and parents, so everyone can thrive together. Schedule a consultation or take our ADHD test to discover how Play Attention can support your family’s cognitive, emotional, and behavioral development. Call 828-676-2240. www.playattention.com

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“It takes forever to get these coins when you’re playing,” he said, showing me the game. “I can spend $1.99 and get 800 coins, but only if I do it now! It’s 90% off, but the deal only lasts for 58 more minutes! Please, Mom?”

“Luca,” I said. “When a game tells you something is 90% off, that’s just marketing designed to make you want to spend money.”

“It’s working,” Luca said earnestly. “I do want to spend my money. And it’s my money.”

I sighed.

Luca’s request had come a few days after my husband and I opened a debit account for him and his older brother, Max, for their 9^th and 11^th birthdays, respectively.

“We told you your savings was your money,” I said to Luca. “But we also said we weren’t going to let you spend it on just anything, remember?”

[Self-Test: Could Your Child Be Showing Signs of Gaming Addiction?]

“This is not just anything. It’s only $1.99 and I’ve been playing this game for weeks and this is the best deal I’ve ever seen. Ever.”

“OK,” I finally said. “This is a yes.”

I pressed my thumb on the sensor to authorize the purchase and a delighted Luca raced off to show Max, my ADHD-wired firstborn.

This, my friends, is when all the trouble really started.

The Big Business of In-App Purchases

Max quickly appeared to demand a similar purchase in a game. Eager to allow my boys to exercise their decision-making muscles, I said yes. So when the boys showed up repeatedly in the following days with additional purchase requests, I kept saying yes.

Two weeks later, both boys had spent more than $150. I was getting very worried. Though I tried to dissuade or delay them each time they came to me, their interest wasn’t waning, even as they burned through their savings. But while Luca’s spending eventually slowed, Max’s didn’t. If anything, he was picking up speed — requesting more expensive purchases, more frequently.

[Read: Why Screens Mesmerize Our Teens — and How to Break the Trance]

This was very out of character for Max, who had previously been resistant to spending any money — preferring instead to save it and plot about spending it on completely age-inappropriate things, like spear guns for fishing. After his first in-app purchase, it was shocking to see how quickly he transformed from miser to spendthrift.

When Max came to me for the second time in a single day requesting to spend another $26, I decided I wasn’t prepared to let him spend all his savings.

“I think we need a circuit breaker here — a pause,” I told Max. “I think that I should say ‘no’ to in-app purchases for the next week. What do you think?”

Unsurprisingly, Max did not think we needed a circuit breaker.

We settled on this: Max still had the choice to go through with this particular purchase (which he did) and then we would have a 10-day “no purchases” circuit-breaker.

That original circuit-breaker temporarily slowed things down, but it did not completely quell his willingness to spend money.

I know our family is far from alone in these struggles. In moderation, in-app purchases can be an easy way to have a bit of fun in a game. But in-app purchasing has become a billion-dollar business. Many iPad games are sophisticated marketing machines that use gambling tactics and other predatory techniques to market directly to children. The dopamine rush of leveling up in a game after spending money is addictive and the consequences are profound. Some parents report that their kids have become secretive and deceitful — guessing or stealing passwords, using credit cards without permissions, resetting devices to restore permissions, and finding other workarounds that will enable them to keep clicking “purchase.” Our children with ADHD, who struggle with impulse control and regulation, are far less equipped to resist this powerful temptation.

So what can parents do? What do I recommend as a psychologist, as the mother of a demand-avoidant pre-teen with ADHD, and as someone who’s learned a lot about this the hard way in the last couple of years?

My first piece of advice: Keep this Pandora’s Box closed for as long as possible. If you haven’t yet started down this path, don’t.

• Invest in games, gaming systems, and subscription services such as Apple Arcade that don’t offer in-app purchases and/or show ads. They are worth the money.
• Make it a family norm early on that you don’t download games that offer in-app purchases.
• If and when you do download a game that offers in-app purchases, make it clear that you will never authorize any in-app purchases for this game. Take it a step further and disable in-app purchases on your child’s device.

If you ever do decide to allow your child to make in-app purchases, have some discussions first:

1. Set clear limits – but expect boundary-pushing. Establish how much money they have available to spend and how quickly they can spend it. Even with these limits, brace for fallout, pleas, and arguments when their money runs out, and plan ahead for how you will respond to that fallout.

2. Express your wants. The day that Max came to me twice to make an in-app purchase, I told him I had two wants. “I want to allow you to make your own decisions,” I said. “And I want to help you make wise decisions and teach you how to resist the powerful desire to buy things.”

3. Teach your kid about marketing tactics such as price anchoring, charm pricing, and the scarcity effect. When they come to you about a purchase, challenge them to spot the marketing tactics being used on them.

4. Talk to your child about other dynamics that drive in-app purchasing, such as chasing the dopamine buzz, the social pressure of keeping up with friends, the desire to make progress fast in a game, and so on.

5. Talk to your child about their ADHD brain. They should understand that impulse control challenges come with the territory, which makes it especially hard to resist the temptation to buy.

6. Invite your child to problem-solve when issues come up. Be open with your child about any concerning patterns or behaviors you’ve noticed regarding in-app purchases. Ask for their input as you find a viable way forward.

7. Experiment with different approaches and solutions to limit in-app purchases. Some ideas to get you started:

• X-day/week blackout periods
• weekly or monthly spending limits
• waiting periods for spending (e.g., wait 24 hours before making an in-app purchase)
• written agreements that include consequences for circumventing the rules

8. Don’t be afraid to feel your way forward.
Just because you’ve agreed to a measure doesn’t mean that you will do things this way and forevermore. In fact, don’t expect any solutions you negotiate to hold for longer than a couple of months. Expecting to revisit this issue regularly will help you be more patient and feel less frustrated.

The other day, I asked Max for advice he thought I should give other parents who are in this situation. “Just say no, and NEVER SAY YES,” he responded. “Basically, be way stricter with them than you’ve been with us.”

“But what about families like ours where we’ve already said yes sometimes?” I said. “What can you do then?”

“Well,” Max said, getting more creative. “Tell your kids that the currency for the game has changed, and you can’t get any of that new currency. So, it’s broken. You just can’t do it.”

“So… lie?” I asked. “Yes,” Max said. “Lie.”

In moments when we may be tempted to lie to our kids, I often wish we had in-parenting purchase options — for upgrading patience, boosting problem-solving skills, or short-circuiting conflicts. Alas, the game we’re playing as parents is a no-shortcuts quest.

In App Purchases: Next Steps

• Get This Free Download: Too Much Screen Time? How to Regulate Your Teen’s Electronics Use
• Read: 5 Tips for Teaching Children with ADHD to Manage Money
• Get This eBook: Positive Parenting Tips — ADHD Strategies for Improving Behavior

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

So, when a last-ditch effort to score a ticket to your favorite band’s show lands you backstage, or a late entry into a neighborhood Super Bowl pool means winning $750, you can thank your ADHD propensity for spontaneity.

Here, ADDitude readers share more stories of when they reaped the rewards of spontaneity.

Have you ever benefited from spontaneous decision-making or a failure to plan? Share your story in the comments.

Rewards of ADHD Spontaneity

“On a vacation with my husband a few years ago, I got rewarded for failing to plan. Upon arriving at the Mammoth Cave National Park, I realized that I needed to order tickets to tour the caves weeks in advance. As a result, we could only enter the public park areas. Once the initial ‘Oh no, we drove here and can’t go in’ feeling solidified into reality, it allowed for total spontaneity. We explored on our own and enjoyed a nice lunch. Instead of the trip being about the destination, it was about the journey. To this day, we still use the expression ‘It’s a Mammoth Cave day’ to describe how a failure to plan resulted in a good outcome.” — Lisa, Wisconsin

[Get This Free Download: 25 Things to Love About ADHD]

“I was given the task of planning the family vacation. I kept putting it off, paralyzed by the thought of wading through travel brochures and finding a deal within our budget. Three days before the holidays, I saw a local travel agency advertise a reduced-price trip to Florida for two weeks that was a cancellation. It turned out to be the holiday of a lifetime. My grown children still talk about it being the best trip ever!” —Jacinta, Lancashire, England

“When my kids were little, I took them on midnight runs to IHOP on their birthdays.” —An ADDitude Reader

“I forgot to submit my entry to a neighborhood Super Bowl pool and had to take the last block available. I ended up winning $750!” — Kate, Pennsylvania

“I wrote a poem for my parents’ 25th wedding anniversary in the bathroom of the banquet hall 20 minutes before the toast. It was so well received that my parents still gush about it 30 years later!” — Beth, Colorado

[Self-Test: Do I Have Hyperactive-Impulsive ADHD?

“After I finished an aerobics class at my health club, I asked for a job — and got it!” —Terri, Colorado

“Any sort of travel is always fun with a touch of spontaneity! I traveled alone in Thailand once, and I came across so many experiences and people just by winging it and wandering around!” — Kayla

“During COVID, I spontaneously moved to a new city without a job or knowing a single soul. In the three years since, this new place has offered me wonderful friendships, a career switch, and a more authentic life.” — An ADDitude Reader, Netherlands

“Despite being a huge fan of the band Wilco, I never followed through and bought a concert ticket when they came to town, and it sold out. On the day of the show, I went to the venue to search for a ticket. I started watching the soundcheck when a guy asked me what I was doing. When I told him I was trying to find a ticket, he said he was the show’s opener, and I could be his ‘roadie’ to get into the show. Afterward, he invited me and others, including Wilco members, for drinks. As I’m leaving, another guy asks me if he can catch a ride — and it turns out to be Leroy Bach, the multi-instrumentalist for Wilco at the time. Leroy invited me to Wilco’s Seattle show the next night. All of this happened because I failed to plan!” — Josh, Utah

“I met my husband on a blind date, and we got engaged two weeks later. We’ve been together 20 years.” — Vanessa, Australia

“One time at work, I did not sufficiently study the plan for a large project and could not contribute to the discussion. However, my ADHD brain spontaneously proposed a different and better solution that we used instead of the original plan.” — Allen, Michigan

“I randomly stopped at a neighborhood estate sale and bought a bag of costume jewelry for $1. After it was sitting in my drawer for three years, I finally took four or five gold pieces to a pawn shop. I made $300.” —Lisa, Virginia

“Being the mom of a 10-year-old, I can be rigid with plans to get everything done. But when I go off the list or veer from what we have planned, my daughter loves the spontaneity. An unplanned trip on our way home to get ice cream in a never-visited town recently was a lot of fun.” — Christine, Michigan

“During a deeply unhappy time at work, a recruiter called me out of the blue and offered me a job. Despite giving up a well-paid permanent position at a time when I struggled to make ends meet as a single parent, I took the position. It became one of the best moves I ever made.” — John, Yorkshire, U.K.

 “I convinced my husband to move us and our four young children to Greece. It wasn’t easy, but what a year or so we had!” —Julia

ADHD Spontaneity: Next Steps

• Free Download: Your Free Guide to All the Best Parts of ADHD
• Read: Who Says One Kind of Thinking Is Better Than Another?
• Read: Decision-Making Advice for Impulsive or Indecisive Adults with ADHD
• Blog: “Riding Motorbikes and Contemplating Death with ADHD”

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That study, published in the Journal of the American Medical Association, did not show a causal relationship. Patients in that study may have had conditions like diabetes or obesity, in addition to ADHD, that raised their risk of cardiovascular disease.

This is what I say to parents of my patients: ADHD causes all kinds of problems if it’s untreated. School failure, substance use, and, as an adult, poor job performance or getting fired, breakups in marriages — these are known risks when ADHD is not well managed.

In older populations, the risk for cardiovascular disease generally increases, but even then, I say to patients, “How are your diet, exercise, sleep, and other health habits?” These are the predictors of cardiovascular disease as best as we know. The study didn’t look at these factors.

Q: Does research show that nutrition plays a role in ADHD symptoms or symptom management?

We have every reason to think that healthy diets may lead to general benefits in mood and behavior. Large population-based studies suggest that food additives may have a relatively small negative effect on behavior. However, many parents report that children have hyperactive responses to sugar.

[Free Guide to ADHD Brain Food: What to Eat, What to Avoid]

New research is beginning to teach us more about the importance of a healthy diet and healthy gut biome. We know that too much processed food leads to the generation of unhealthy bacteria in the gut, which can create chemicals that pass through the blood-brain barrier and lead to problems, such as depression, anxiety, and possibly even ADHD. So, a healthy diet (along with adequate sleep and regular exercise) is likely to benefit people with ADHD.

Q: Does screen addiction over a period of several years affect a young adult’s brain development?

Very good studies have shown that screen time can lead to brain changes. A number of neuroimaging studies have proven this even in randomized controlled trials. Specifically, violent video games, such as first-person shooter games, have been found to lead to decreased empathy and social connections, increased negative and hostile thoughts, and possibly harmful actions.

ADHD Symptom Management: Next Steps

• Download: Lifestyle Changes for Adults with ADHD
• Read: 5 Smart Screen Rules for Teens with ADHD
• Read: Your ADHD Treatment Options — Medication, Diet, Therapy & More
• Find: ADHD Specialists and Clinics Near You

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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

• Free Download: Scripts to Use When Emotionally Dysregulated
• Read: “Does ADHD Emotional Dysregulation Ever Fade?”
• Read: ADHD and Emotional Regulation — A Parent’s Guide
• Get the eBook: The Emotions of ADHD

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Navigating students’ emotional dysregulation can be one of the most challenging aspects of classroom management. In this one-hour webinar, educators will learn how to engage both proactive and reactive strategies for effectively managing emotional dysregulation in students.

Proactive Strategies Include:

• Building a Supportive Classroom Environment: Learn techniques for creating a classroom atmosphere that promotes emotional stability and resilience.
• Implementing Preventative Measures: Discover approaches to identify potential triggers and integrate preventative strategies that reduce the likelihood of emotional outbursts.
• Developing Emotional Regulation Skills: Explore methods for teaching students self-regulation skills and coping mechanisms that they can use independently.

Reactive Strategies Include:

• Deploying Immediate Response Techniques: Understand best practices for addressing emotional dysregulation as it occurs, ensuring interventions are effective and respectful.
• Engaging De-escalation Strategies: Gain practical skills for de-escalating tense situations and restoring a calm learning environment.
• Prioritizing Post-Incident Reflection and Support: Learn how to follow up with students after an emotional incident to provide support and prevent future occurrences.

Watch the Video Replay

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

Download or Stream the Podcast Audio

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

Classroom Management Strategies for Teachers: More Resources

• Download: Kid-Friendly Mindful Meditation Exercises
• Sign Up: The ADHD Learning Series for Educators
• Read: Top Emotion Regulation Difficulties for Youth with ADHD
• Read: 13 Trauma-Informed Teaching Strategies for Educators Today
• eBook: The Teacher’s Guide to ADHD School Behavior

Obtain a Certificate of Attendance

If you attended the live webinar on September 17, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Cheryl Chase, Ph.D., is a licensed clinical psychologist in private practice in Independence, a suburb of Cleveland, Ohio. She specializes in the diagnostic and neuropsychological assessment of various conditions impacting children, adolescents, and young adults including ADHD, Learning Disorders, and emotional concerns. She is PSYPACT certified and able to serve clients from the 40 participating states. In addition to her clinical practice, Dr. Chase is also an accomplished international speaker, leading workshops on such timely topics as executive functioning, dyslexia/dysgraphia, and creative ways to support those who struggle in school. Finally, Dr. Chase serves as an adjunct instructor at several colleges in the Cleveland area. She is an active member of the International Dyslexia Association, the American Psychological Association, and Learning Disabilities Association of America. For more information, please visit ChasingYourPotential.com or her LinkedIn page.

Listener Testimonials

“This webinar was beyond excellent. Dr. Chase’s strategies and encouraging comments ware great both for students — primary and high school — and teachers/parents/guardians. Thank you so much!”

“Excellent, well-informed speaker. Well paced and with a good amount of information to communicate in the time available.”

“There were great strategies that I had not been exposed to in previous trainings. Thank you!”

“From a parent perspective, thank you for the information provided to teachers. Very helpful for everyone! Loved when you reminded them to reflect on their own childhood.”

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