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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
  

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

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.

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

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

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

Certificate of Attendance: For information on how to purchase the certificate of attendance option (cost $10), register for the webinar, then look for instructions in the email you’ll receive one hour after it ends. The certificate of attendance link will also be available here, on the webinar replay page, several hours after the live webinar. ADDitude does not offer CEU credits.

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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.

Admittedly, ADHD brains do not typically excel at making — and following through with — plans. But they can expertly pivot and devise ingenious solutions on the fly when setbacks arise. Sometimes, these new, spontaneous plans result in opportunities and rewards that would have otherwise remained unfulfilled.

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”

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.

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

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.

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

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.

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.

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.”

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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Q: “When our child comes home from school, they immediately get on their phone or play video games. I allow this because it’s their downtime, but the transition to getting them off their screens to do homework or chores is rough. How can we make this easier?”

Children need decompression time after school. It is challenging for an inattentive or hyperactive student to stay focused and on point for the duration of the school day. So I am all about them coming home from school and just going outside or watching videos for 30 to 40 minutes. But at 40 minutes, the alarm on their phone or a caregiver’s phone should go off, and the student’s phone should go back to its docking station or be otherwise out of reach.

If they refuse to give up their device or stop playing video games willingly, you need to confiscate the electronics. I’ve shut down my kid’s phone remotely using a deactivation tool from my cell phone provider. She learned pretty quickly that I was serious. If you decide to deactivate your child’s phone for a period to prove your point, you might say: “When you follow these rules, your work gets done, and you feel better. If you do not follow the rules, we will need to prevent access to your phone or video games in the evening so you can get your work done.”

Then, have your child work on homework for 30 to 40 minutes, followed by a 10-minute break, and repeat. Your child should not have access to electronics during any breaks.

[Download: 5 Academic Challenges Rooted in ADHD Executive Dysfunction]

Experts say it takes 21 to 30 days to make a habit stick. Once kids get into the after-school routine of transitioning from downtime to schoolwork, they will start to develop self-discipline.

Listening to Music While Studying

Q: “Should I allow my teen to listen to music while studying and doing homework?”

Yes. Listening to music while studying is a great idea if they can manage it.

Music stimulates the release of dopamine, which regulates motivation, working memory, attention, and focus — all needed for tackling homework — and often in short supply for people with ADHD. I sometimes ask my patients, “How do you study best? Do you like listening to music? Does it help you get into hyperfocus, or is it distracting?”

Half of my patients say music helps them study and focus. If playing music works for your teen and helps promote focus and calm, that’s great.

[Download: 11 Tips for Redirecting Focus]

Have your child make a playlist lasting 30 to 40 minutes. Leaving their phone in another room while music plays on a remote speaker or Bluetooth headphones will make it less likely that they will check their text messages or otherwise get distracted.

After-School Routines: Next Steps

• Free Download: Free Checklist of Executive Dysfunctions in the Classroom
• Read: How to Tune Out Distractions & Focus on School
• Read: Fun (and Functional) Fidgets for ADHD Brains
• Watch: “‘I Can’t Focus!’ When ADHD Impacts Your Child’s Math & Writing Performance”

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.

Heavy social media use and poor sleep quality can alter brain activity related to executive function and reward processing in adolescents, suggest findings from the American Academy of Sleep Medicine (AASM) presented last month at the SLEEP 2024 annual meeting.

The findings demonstrate a strong correlation between greater social media use, shorter sleep duration, and lower activity in the inferior and middle frontal gyrus regions in the prefrontal cortex of adolescents ages 10 to 14. The inferior frontal gyrus brain region influences inhibitory control; weakness in this region may impact how teens assess and respond to social media’s rewarding stimuli. The middle frontal gyrus region is tied to executive function and decision-making, impacting how teens balance the immediate dopamine hits of social media with other priorities, like sleep. AASM researchers analyzed data from the Adolescent Brain Cognitive Development Study of 6,516 adolescents for the study.

Prior research established a link between poor sleep hygiene and social media engagement. A 2022 survey from the AASM found that 93% of Gen Z members (people born between the late 1990s and early 2010s) have lost sleep by staying up “past their bedtime” to view or participate in social media.

Poor sleep quality due to excessive screen time is especially concerning for adolescents with ADHD since they spend more time on digital media and have more severe symptoms of problematic internet use compared to youth without ADHD.¹

“Among teens, high-frequency use of multiple forms of modern digital media (texting, visiting social media platforms, streaming videos, etc.) is associated with increased odds of ADHD symptom occurrence,” said Jeremy Edge, LPC, IGDC, during the ADDitude webinar “Addictive Technology and Its Impact on Teen Brains.”²

Poor Sleep Hygiene May Lead to Cannabis Use in Teens with ADHD

Some teens and young adults with ADHD use cannabis as a sleep aid, despite research showing that neurodivergent teens face an outsized risk for developing cannabis use disorder.³

“Cannabis is an unsurprising motivator given the extraordinarily high prevalence of sleep problems and disturbances associated with ADHD, from sleep apnea and insomnia to delayed sleep phase disorder and more,” Mariely Hernandez, Ph.D., explained during the ADDitude webinar “How Cannabis Use Affects ADHD Symptoms and Sleep in Adolescents.” ⁴

“In the short term, cannabis can help with sleep,” Hernandez continued. “But frequent cannabis use builds up tolerance; more and more of it is required to exert the same effect on sleep. Ultimately, chronic cannabis use only worsens sleep and feeds a vicious cycle. ⁵ Poor sleep increases cravings for cannabis and dampens the cognitive resources that allow an individual to resist cravings, make better choices, and curb impulsivity.”⁶

Sleep Hygiene Tips for ADHD Teens

Sleep interventions may help teens with ADHD improve their sleep quality and maintain a healthy relationship with social media. The AASM recommends that adolescents do the following:

• Get 8 to 10 hours of sleep per night.
• Disconnect from devices at night. Turn off all electronics at least 30 minutes before bedtime.
• Follow a relaxing nighttime routine. Take a warm bath or shower, read, or journal to help wind down.
• Leave phones in another room. Remove the temptation to get on the phone by keeping it in a separate room at night. If phones are used as a morning alarm, consider using an alarm clock instead.
• Turn off push notifications. If phones must be in bedrooms at night, turn off push notifications and sound to avoid phone usage.
• Set time limits on social media. Many phones and apps allow users to activate limits that notify them when they have reached their designated time amount on a site.
• Have a sleep schedule. Go to bed and get up at the same time. Don’t let scrolling stop you from getting precious hours of sleep.

Sources

¹ Werling, A. M., Kuzhippallil, S., Emery, S., Walitza, S., & Drechsler, R. (2022). Problematic Use of Digital Media in Children and Adolescents with a Diagnosis of Attention-Deficit/Hyperactivity Disorder Compared to Controls. A Meta-Analysis. Journal of Behavioral Addictions, 11(2), 305–325. https://doi.org/10.1556/2006.2022.00007

² Ra, C. K., Cho, J., Stone, M. D., De La Cerda, J., Goldenson, N. I., Moroney, E., Tung, I., Lee, S. S., & Leventhal, A. M. (2018). Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents. JAMA, 320(3), 255–263. https://doi.org/10.1001/jama.2018.8931

³ Zaman, T., Malowney, M., Knight, J., & Boyd, J. W. (2015). Co-Occurrence of Substance-Related and Other Mental Health Disorders Among Adolescent Cannabis Users. Journal of Addiction Medicine, 9(4), 317–321. https://doi.org/10.1097/ADM.0000000000000138

⁴ Hernandez, M., & Levin, F. R. (2022). Attention-Deficit Hyperactivity Disorder and Therapeutic Cannabis Use Motives.The Psychiatric Clinics of North America, 45(3), 503–514. https://doi.org/10.1016/j.psc.2022.05.010

⁵ Kaul, M., Zee, P. C., & Sahni, A. S. (2021). Effects of Cannabinoids on Sleep and their Therapeutic Potential for Sleep Disorders. Neurotherapeutics: The Journal of the American Society for Experimental NeuroTherapeutics, 18(1), 217–227. https://doi.org/10.1007/s13311-021-01013-w

⁶ Graupensperger, S., Fairlie, A. M., Ramirez, J. J., Calhoun, B. H., Patrick, M. E., & Lee, C. M. (2022). Daily-Level Associations Between Sleep Duration and Next-Day Alcohol and Cannabis Craving and Use in Young Sdults. Addictive Behaviors, 132, 107367. https://doi.org/10.1016/j.addbeh.2022.107367

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

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

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

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PDA and ODD: More Resources

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

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Meet the Expert Speaker

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

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

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

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Decision-making deficits may signal and lead to social problems for children with ADHD. Strong feelings of delay aversion — which cause individuals with ADHD to choose the option most likely to avoid delays and wait times — drive poor decision making for youth with ADHD, according to a two-phased longitudinal study published by Nature in March.¹

The study is the first to investigate and link general deficits in decision making to social problems in ADHD. Children aged 8 to 12 completed the Cambridge Gambling Task (CGT) in 2016 and again four years later.² At both time points, poorer risk adjustment and stronger delay aversion were associated with social problems for participants with ADHD, but not for typically developing children.

The CGT is a computerized test developed to assess decision-making and risk-taking behavior across a variety of disorders, including ADHD, mood disorders, and traumatic brain injury. Participants were shown 10 boxes — some red, some blue — and asked to guess which of the two colors hid a yellow token. The proportion of red to blue boxes varied between rounds.

Participants also estimated the likelihood of their choice being correct by clicking on a wager value displayed on the screen, in ascending or descending order, as a percentage of total points. Points were either awarded or deducted from the participant’s starting score of 100 based on the accuracy of their bets.

Four outcomes were measured using the CGT: delay aversion, risk adjustment, reflection time, and risk proneness. Delay aversion at baseline was the main predictor of social problems in children with ADHD. Although the difference in delay aversion between the ADHD and control groups was not significant at follow-up, performance at baseline still predicted greater social problems over time. Risk adjustment was the only trait that remained consistently poorer in children with ADHD over four years. At both points in the study, their ability to weigh risks by learning from previous choices was significantly worse than controls.

Delay Aversion & Social Problems

More than half of children with ADHD struggle with peer relationships.³ In a 2022 ADDitude survey on youth mental health, children and teens with ADHD were twice as likely to be bullied compared to neurotypical students. Bullying most often occurs in middle or high school.⁴

According to lead author and researcher Lin Sorenson, delay aversion — recognized as a factor of ADHD since the 1980s — has been shown to cause social problems by leading to impulsive and disruptive behavior. In the present study, social impulsivity in ADHD was not due to longer reflection times or risk proneness, but rather the ability to adapt to changing social situations. Inconsistent social performance, not deficits in social skill acquisition, impact social outcomes in children with ADHD.⁵

“The inconsistency in motivation and performance is the most puzzling aspect of ADHD,” writes clinical psychologist Thomas E. Brown, Ph.D. “It seems like the child or adult with the disorder who can show strong motivation and focus very well for some tasks should be able to do the same for most other tasks… However, ADHD is not a matter of willpower. It is a problem with the dynamics of the chemistry of the brain.”

The delay aversion hypothesis suggests that ADHD behaviors are triggered, at least in part, by the motivation to escape or avoid negative emotions that surface when confronted by wait times, prior to receiving a reward or completing a task.⁶ In the ADHD brain, the imposition of a delay activates the amygdala’s fight or flight response and can overpower other motivating factors.⁷ Delay aversion has also been associated with a preference for smaller immediate rewards and with inattentive symptoms, and may be stronger in boys with ADHD.⁵

Conduct & Mood Problems

As in previous studies, parents of children with ADHD reported greater social, mood, and conduct problems over the course of the study. Researchers measured negative affect using the Child Behavior Checklist (CBCL), a widely used parent-report instrument with subscales for social problems, conduct problems, and anxiety/depression problems. While none of the CGT parameters predicted negative outcomes, all but risk proneness were associated with social, conduct, and mood problems.

Limitations & Future Research

“Our results indicate that these [social] problems are predicted by difficulties in adapting dynamically to changing contextual conditions,” Sorenson wrote. “On the CGT, this can be observed by difficulties in adapting choices to the changing patterns of outcome probabilities (poorer risk adjustment).”

Study limitations included a low sample size and medication inconsistency. Of the 70 participants present at baseline, 47 participated in the follow-up. Most of the children in the ADHD group were on medication but were drug-naive at baseline. Participants were aged 11 to 17.

The authors encourage future studies to test the prediction of suboptimal decision-making driven by delay aversion on social competence in ADHD. Identifying and understanding poor decision-making driven by delay aversion can help inform psychoeducation and training programs for caregivers and children.

Actionable Strategies

Parents and teachers can use the following strategies to help improve social outcomes among children with ADHD:

• Incorporate timers into your child’s routine. “Parents can help improve delay aversion by using timers that chunk work into smaller bits,” says psychologist Carla Counts Allan, Ph.D. “If the whole homework routine, which lasts an hour, is too painful for your child, set the timer for 10 minutes of active work and then let him take a short break or earn a small piece of a reward for later.”
• Use reflective listening with your child. “Let’s say you have a kid who doesn’t necessarily read the room and alienates people,” said Caroline Maguire, M.Ed., in her webinar, “Why Will No One Play with Me?” “He may have some opinions about school that drive you nuts or that just don’t seem true. You use this reflective listening technique by simply repeating back their words and what they say…. If you repeat back someone’s words, they feel very validated and they have the chance to clarify.”
• Provide positive feedback for good behavior and special talents. Doing this in front of classmates can help improve self-esteem and peer recognition.
• Watch for problematic screen time. Teens with ADHD are more vulnerable to the risks of social media such as depression, anxiety, and self-harm than same-age peers without ADHD, according to an ADDitude survey on social media use. Teens are also more likely to become addicted to video games.⁸
• Enroll in behavioral parent training. The American Academy of Pediatrics recommends this as a first-line treatment for ADHD in young children. “Kids with ADHD need to be taught in the moment, which is why parents and educators can be most helpful in building social executive function skills,” said Ryan Wexelblatt, LCSW, in his webinar, “The Social Reboot: Helping Tween and Teen Boys with ADHD Make Friends.”

“Your child may make a social breakthrough one day and appear to take several steps back the next – and that’s perfectly normal,” says Wexelblatt. “Be patient. Results will come slowly and with time – not overnight.”

Sources

¹ Sorensen, L., Adolfsdottir, S., Kvadsheim, E., et al. (2024). Suboptimal decision making and interpersonal problems in ADHD: Longitudinal evidence from a laboratory task. Scientific Reports, 14, 6535. https://doi.org/10.1038/s41598-024-57041-x

² Sorensen, L., Sonuga-Barke, E., Eichele, H., van Wageningen, H., Wollschlaeger, D., & Plessen, K. J. (2017). Suboptimal decision making by children with ADHD in the face of risk: Poor risk adjustment and delay aversion rather than general proneness to taking risks. Neuropsychology, 31(2), 119–128. https://doi.org/10.1037/neu0000297

³ CHADD. (n.d.). Relationships and social skills. CHADD. https://chadd.org/for-adults/relationships-social-skills/

⁴ Centers for Disease Control and Prevention. (2024). Youth violence prevention: About bullying. CDC. https://www.cdc.gov/youth-violence/about/about-bullying.html?CDC_AAref_Val

⁵ Paloyelis, Y., Asherson, P., & Kuntsi, J. (2009). Are ADHD symptoms associated with delay aversion or choice impulsivity? A general population study. Journal of the American Academy of Child and Adolescent Psychiatry, 48(8), 837–846. https://doi.org/10.1097/CHI.0b013e3181ab8c97

⁶ Van Dessel, J., Sonuga-Barke, E., Mies, G., Lemiere, J., Van der Oord, S., Morsink, S., & Danckaerts, M. (2018). Delay aversion in attention deficit/hyperactivity disorder is mediated by amygdala and prefrontal cortex hyper-activation. Journal of Child Psychology and Psychiatry, 59(8), 888-899. https://doi.org/10.1111/jcpp.12868

⁷ Green, R. (2023). ADHD symptom spotlight: Delay aversion. Verywell Mind. https://www.verywellmind.com/adhd-symptom-spotlight-delay-adversion-7104447

⁸ Weinstein, A., & Weizman, A. (2012). Emerging association between addictive gaming and attention-deficit/hyperactivity disorder. Current Psychiatry Reports, 14(5), 590–597. https://doi.org/10.1007/s11920-012-0311-x

“My autism is extremely invisible,” Lehmann says. “Society has more tolerance for a child having a meltdown but when an adult male who doesn’t look disabled does it, it comes across as very threatening.”

Recently on a work trip, Lehmann’s flight was delayed, causing his “Jenga tower of functioning” to come tumbling down. He kicked a trash can in frustration, attracting the attention of a heavily-armed police officer. Lehmann’s mother stepped in, explaining, “My son has autism. I’ve got this.” The officer took a step back, ready but waiting, as Lehmann calmed down.

Lehmann has had enough negative encounters with law enforcement — cornering him, cursing at him, shaming him — to know this was a best-case scenario. He’s terrified about what could have happened if he hadn’t had a traveling companion, or if the officer was more forceful. He wonders what the outcome might have been if he’d been Black.

The duty of law enforcement is to protect and serve, but when they encounter people with disabilities, too often the result is harm instead of help. Adults and teens with autism, ADHD, and other neurodevelopmental disorders appear to be at a heightened risk for negative outcomes every step of the way in the criminal justice system, from first police contact to questioning and detainment, to jail, trial, and beyond. Mishandled interactions can result in everything from distress and humiliation to jail time, or even death.

[Read: What the Americans with Disabilities Act Means For You]

While no comprehensive data exists on the collective outcomes when people with disabilities encounter police, we do know that neurodivergent individuals are over-represented in the carceral system. Rates of ADHD are six times higher among inmates than in the general public,¹  and rates of intellectual and developmental disabilities (including autism) are four times higher.²

Law Enforcement and the Neurodivergent: Unique Risks

Neurodivergent people face challenges with law enforcement as victims, witnesses, and especially as suspects. For individuals with autism, common behaviors like stimming, avoiding contact, or meltdowns arouse suspicion, which can lead officers to shout commands or make physical contact. This, in turn, intensifies sensory overwhelm and anxiety, making compliance less likely, not more.

Similarly, people with ADHD may have trouble following commands, because of impulsivity or distractibility, and this behavior can be viewed by police as uncooperative or disrespectful. An individual’s hyperactivity and restlessness, exacerbated by confinement to a chair in a small room, might be perceived as a sign of guilt. Working memory problems, time blindness, and memory distrust syndrome may cause a person with ADHD to have difficulty accurately answering questions or to reply, “I don’t know” to even simple questions such as: “Is this the road you live on?” Police may misinterpret this as evasiveness, another possible sign of guilt.

[Read About the Mom Spearheading Police Training on Autism]

In all these cases, what might have begun as a harmless situation can escalate quickly. “Officers that can’t identify the signs of disability may over-utilize force, may make an arrest for a situation that doesn’t call for one,” explains Texas Police Sergeant James Turner, who spent nearly a decade heading the Crisis Intervention Team (CIT) training in Austin, Texas.

Heightened Threats for People of Color

For neurodivergent people of color, the perils of an interaction with police are even greater. Black Americans are killed by police at twice the rate of White Americans, according to the Fatal Force Database, which has been tracking deadly police shootings since 2015.

Stephon Watts, a Black 15-year-old with autism in Illinois, was one of these victims. Watts’ parents called 911 to help respond to their son’s meltdown, but the arrival of the police only escalated Watts’ distress. Police fired two shots, killing Watts in his own home. In 2021, Illinois passed the Stephon Watts Act, also called the Community Emergency Services and Support Act (CESSA), which requires emergency responders to send mental health professionals to respond to mental or behavioral health calls.

Devastating stories like these keep Evelyn Polk Green, M.S., Ed., up at night. Past president of ADDA (Attention Deficit Disorder Association) and CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), Green says that as a mother to Black sons with ADHD, she worries about all the things that any mother of a person with ADHD worries about in a police encounter. “It’s just multiplied exponentially by all the other things that we already have to worry about on top of it,” she explains. “Unfortunately, so often law enforcement is ready to jump to the absolute worst conclusion and with Black and brown kids, it’s even worse, because they often automatically assume they’re up to something.”

Disability Awareness Training on De-escalation Techniques

Experts agree: training is the essential first step in ensuring better outcomes. “Most people call 911 when they don’t know what to do. We have to be properly equipped in that moment to handle that crisis,” says Sergeant Turner. “We are problem solvers but we have to have the tools.”

Those tools are exactly what David Whalen, project director for Niagara University First Responder Disability Awareness Training (DAT), aims to provide. The DAT is an eight-hour comprehensive training that covers victimization, Americans with Disabilities Act (ADA) compliance, interface with CIT, interaction skills, proper language and specific information on identifying and understanding a dozen disabilities including ADHD, autism, Tourette’s syndrome, dementia, and epilepsy.

Sergeant Turner’s disability awareness training was received during a 40-hour CIT training, required for all cadets in Texas. CIT training addresses how to support people experiencing a mental health crisis, and Turner hastens to clarify: “People with disabilities are not mentally ill, though they can have that issue as well.” Because some of the techniques (including de-escalation) overlap, disability awareness is often folded into CIT training.

Key topics include:

• Recognition of Disability: Officers learn common signs and symptoms of disabilities. Not all individuals can self-identify, and some choose not to. Proper identification of disability prevents officers from jumping to erroneous conclusions, including that the person is intoxicated, and allows for ADA accommodations.
• De-escalation Techniques, including:
  • Giving the individual space and time to respond. Many encounters with disabled individuals take a tragic turn simply because of the speed at which they unfold, creating unmanageable (and often unnecessary) distress. “You don’t always need to rush up on them,” says Turner. “You need to ask yourself, what are the risks vs. benefits of delaying action?”
  • Appropriate communication is essential. If someone with autism is distressed or experiencing sensory overwhelm, for example, a loud, commanding voice may cause further overwhelm. Adjusting tone and pace of speech, or using a pad and pen or hand signals, might be appropriate. Sometimes, Turner says, the key might be to call a family member to ask for specific guidance about support.
  • When force is unavoidable, using less lethal tools like tasers and pepper spray can save lives.
• Connect with Community Resources: Often, Whalen says, it is invaluable for officers to help individuals pursue longer-term support. Turner agrees: “We are not the experts. We just need to know who the experts are.”

“Fighting for Crumbs of Funding”

It’s clear that training works to improve outcomes. Yet there’s enormous variability in how much, if any, disability awareness training police officers receive, since it’s largely determined on a local level.  Too often, Whalen says, training only happens as a term of a settlement after a person with disability, or their family, sues the police for wrongdoing.

This was the case in Maryland; the bill that now requires disability awareness training for all police officers — through the Ethan Saylor Alliance — was created only after a 26-year-old man with Down Syndrome was killed when sheriff deputies tried to forcibly eject him from a movie theater where he neglected to buy a ticket.

“It would be beneficial to have something mandated at the national level but you have got to have the funding to support implementation,” says Leigh Anne McKingsley, senior director of Criminal Justice Initiatives at The Arc. “This issue of disability justice has been bumped down the priority list, and we’re fighting for crumbs of funding to bring about the exposure and education we need.”

Beyond Training: Community Resources

Training is crucial, but McKingsley says: “You can’t just expect training to take care of everything,” This is why, as part of its training, The Arc’s Pathway to Justice program assembles Disability Response Teams (DRT). These are multidisciplinary planning teams that bring together law enforcement, people with disabilities, attorneys, victim advocates, and disability advocates to collaborate in an open dialogue.

“The mandate is, on the day of training, the DRT starts making a plan of action moving forward,” McKingsley says. That includes brainstorming how to address the most glaring gaps in support and services both short and long term, and figuring out how to expand disability training in the community.

Sergeant Turner, who served on a DRT in 2019, agrees that bringing together police officers and people with disabilities leads to better policing. “Anytime someone calls 911, well, it’s probably not the best day of that person’s life,” Turner says. “Showing what a person with a disability looks like when they’re not in crisis is important.” Lehmann agrees: “Get-togethers with fun activities allow police officers to see the human side of disability, and they give that context.”

On the flip side, Lehmann points out, these community events help people with disabilities familiarize themselves with police officers in a calm environment, alleviating anxiety and setting the stage for better outcomes.

To truly tackle the problem though, McKingsley says, we have to understand its contours more fully, and this requires research, which is currently scarce. “Data would help us better evaluate the training, to know what strategies work and why,” he says. “The more we can show how often these encounters are happening, the more we can bolster our ability to go to local and state entities for action.”

Detained by Police? Keep This in Mind

If law enforcement stops you with questions, remember these three key pieces of advice from Rosemary Hollinger, J.D., founder of Partner Up, LLC:

1. First, pause. It’s important to not say the first thought that goes through your mind.
2. Tell the officer you have ADHD. Under the ADA, you’re entitled to reasonable accommodations, including modified questioning, fidgets, frequent breaks, and access to your medication.
3. Before you answer questions, make sure to have someone you trust, such as a lawyer or family member, with you to figure out exactly what happened. You must be truthful and accurate with police, so if you are forgetful and have time blindness, it’s essential to have a lawyer or trusted person with you to support you.

ADHD and the Risk of False Confession

Susan Young, Ph.D., a clinical psychologist in London, has conducted extensive research about people with ADHD in the criminal justice system. One study in which she was involved found that people with ADHD were at an increased risk of making a false confession, and the more severe the person’s ADHD, the greater the risk.³

If police don’t recognize that an individual’s difficulty following commands, sitting still, and answering questions is a result of ADHD, they may misinterpret these behaviors as evasive and guilty, explains Young. This may cause police to detain the person for even longer, which in turn exacerbates symptoms — particularly if the person’s ADHD medication has worn off. It’s a vicious, dangerous cycle which creates desperation.

“There’s all this anxiety; they want to get out,” says Young, who adds that sometimes, people with ADHD will choose to proceed without an attorney present, because they can’t bear to extend the process at all.

“They just want to leave,” Young concludes. “And they’ll say anything.”

The study concluded that safeguards for people with ADHD must be “put in place to prevent miscarriages of justice.”

Law Enforcement and Neurodivergent Justice: Next Steps

• Read: Crime, Punishment, and Redemption for My Son with ADHD
• Q&A: Recently Diagnosed, ADA Information
• Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children
• Upcoming Webinar: AuDHD Guidance – Why Autism Is So Difficult to Diagnose in Women and Girls with ADHD

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Sources

¹ Young S, Moss D, Sedgwick O, Fridman M, Hodgkins P. A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychol Med. 2015 Jan;45(2):247–58. https://doi.org/10.1017/S0033291714000762

²   Bureau of Justice Statistics, Disabilities Among Prison and Jail Inmates, 2011-2012 (U.S. Department of Justice, 2015), tables 4 and 5, http://www.bjs.gov/content/pub/pdf/dpji1112.pdf.

³ Gudjonsson, G. H., Gonzalez, R. A., & Young, S. (2021). The Risk of Making False Confessions: The Role of Developmental Disorders, Conduct Disorder, Psychiatric Symptoms, and Compliance. Journal of Attention Disorders, 25(5), 715-723. https://doi.org/10.1177/1087054719833169

New research proposes that ADHD may increase the risk of gaming disorder (GD) in college students, hindering academic success and sleep. ¹

The study, published in the journal PLOS ONE, reported that 35.7% of college students with GD display ADHD symptoms compared to 23.3% of students without gaming disorder.

Gaming disorder is a mental health condition marked by excessive and compulsive engagement in Internet games, which can significantly disrupt relationships, school, and work. The behavior must be present for at least 12 months (or shorter in severe cases) to receive a GD diagnosis.

After surveying 383 university students in Lebanon, the researchers determined that ADHD symptoms directly affect academic performance and indirectly increase the risk of GD. Among students classified as high academic performers with GPAs of 3.2 and above, only one met the criteria for symptoms of GD or ADHD.

“The absence of GD and ADHD symptoms among high academic performers suggests that academic engagement and success may be protective factors against these conditions,” the study’s authors wrote. “Alternatively, it may be that the symptoms of these disorders disrupt academic performance, which would be consistent with the negative correlation observed between disorder prevalence and academic excellence.”

Gaming behaviors may distract college students from academics as they prioritize playing video games over studying. The study reported that students with a gaming disorder spend more time gaming on weekdays and weekends than do those without the disorder. “The correlation between GD and gaming hours, particularly on non-school days, suggests that free time may exacerbate gaming behaviors, potentially leading to disorder,” the study’s authors wrote. “This finding has practical implications for the management of GD, as it highlights the importance of structured time and alternative leisure activities as part of the therapeutic approach.” ²

Gaming Disorder Affects College Students’ Sleep Habits

According to the researchers, GD also impacts students’ sleep quality and duration. On average, students with GD sleep 6.1 hours; 64.3% wake up in the middle of the night to game. In comparison, those without GD sleep between 6.8 to 7.2 hours, with negligible nocturnal awakenings for males and none for females.

“The high incidence of nocturnal awakenings in the disordered gaming group (DGG) to continue gaming is a concerning trend that warrants attention due to the critical role of sleep in cognitive function, emotional regulation, and overall health,” the study’s authors wrote. ³

Findings also indicate that ADHD is more predictive of GD in females than in males, though other factors beyond ADHD may contribute to the development of GD, especially in females. These results echo a study published in June 2023 in the Journal of Attention Disorders. That study found a staggering 82% of individuals with GD had ADHD; more than half of the participants with ADHD (57%) had GD. ⁴

Why Gaming Appeals to College Students with ADHD

Why are students with ADHD symptoms more susceptible to gaming and, consequently, gaming disorder?

“From escapism and socialization to competition, video games are highly engaging, reinforcing, and stimulating by design,” said Jeremy Edge, LPC, IGDC, during the 2023 ADDitude webinar, “Addictive Technology and Its Impact on Teen Brains.” “Prolonged, excessive exposure to immediate rewards and dopamine hits in gaming may diminish the number of dopamine receptors in the brain over time, which can lead to tolerance and further stimulation seeking. ⁵ Gamers who are motivated by both escapism and achievement and who consider gaming part of their identity, are most at risk for problematic or disordered gaming.”

While the PLOS ONE study suggests a strong link between ADHD symptoms and GD, the study’s design does not establish causality and relies on self-reported data, which may introduce bias. In addition, the prevalence of ADHD in the sample is also higher than typical epidemiological estimates.

“More longitudinal studies are needed to clarify the causal relationships between ADHD and GD and to track how these relationships evolve,” the study’s authors wrote.

Edge emphasized that anyone showing signs of gaming disorder should talk to a doctor or mental health professional. “While still a growing field, help for technology addiction is available and ranges from psychotherapy and inpatient treatment clinics to recovery programs, support groups, and even medication,” he said.

Sources

¹ Hawai, N., Samaha, M. (2024). Relationships of Gaming Disorder, ADHD, and Academic Performance in University Students: A Mediation Analysis. PLOS ONE. https://doi.org/10.1371/journal.pone.0300680

² Buono, F.D., et al. (2020). Gaming and Gaming Disorder: A Mediation Model Gender, Salience, Age of Gaming Onset, and Time Spent Gaming. Cyberpsychology, Behavior, and Social Networking, 23(9): p. 647–651. https://doi.org/10.1089/cyber.2019.0445

³ Bourchtein, E., Langberg, J.M., Cusick, C.N., Breaux, R.P., Smith, Z.R., Becker, S.P. (2019). Technology Use and Sleep in Adolescents With and Without Attention-Deficit/Hyperactivity Disorder. J Pediatr Psychol. https://doi.org/10.1093/jpepsy/jsy101

⁴ Hong, J. S., Bae, S., Starcervic, V., & Han, D. H. (2023). Correlation Between Attention Deficit Hyperactivity Disorder, Internet Gaming Disorder or Gaming Disorder. Journal of Attention Disorders, 0(0). https://doi.org/10.1177/10870547231176861

⁵ Sussman, C. J., Harper, J. M., Stahl, J. L., & Weigle, P. (2018). Internet and Video Game Addictions: Diagnosis, Epidemiology, and Neurobiology. Child and Adolescent Psychiatric Clinics of North America,27(2), 307–326. https://doi.org/10.1016/j.chc.2017.11.015

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

How to Use Planned Ignoring for Attention-Seeking Behaviors

1. Use planned ignoring only for minor misbehaviors that are reinforced through attention. This can include:

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

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

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

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

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

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

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

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

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

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

Attention-Seeking Behaviors and ADHD: Next Steps

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

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

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• arts & crafts
• digital prizes
• events and experiences
• friend and family time
• “free passes”
• screen-free games and toys
• and more!

A behavior chart and/or points system may help encourage consistency and gamify the process. Remember: Rewards should come after your child demonstrates desired behaviors.