Teens with social anxiety disorder experience persistent and excessive fear in social settings that goes beyond shyness or nervousness. They worry so much about being judged, embarrassed, or humiliated in front of others that they avoid activities they would otherwise enjoy. Social anxiety often manifests as physical symptoms like sweating, trembling, or a racing heart, as well as emotional signs like irritability, self-doubt, and withdrawal from social interactions.

Social anxiety disorder is associated with other mental health conditions, including ADHD. “Many teens and young adults with ADHD are susceptible to social anxiety due to executive functioning challenges that impair emotional control, working memory, and self-awareness (metacognition),” writes Sharon Saline, Psy.D. “They may avoid specific triggering situations such as in-person classes or feel intensely nervous and uncomfortable in any social environment.”

Recognizing the signs of social anxiety disorder in your child is crucial for early intervention and support. Answer the questions in this self-test to help you assess whether your teen may be showing symptoms of social anxiety disorder. Share the results with your child’s doctor.

Time's up

Can’t see the self-test questions above? Click here to open this test in a new window.

The questions in this social anxiety test for teens are informed, in part, by criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). This social anxiety test for teens is designed to screen for the possibility of SAD symptoms, and it is intended for personal use only. This social anxiety test for teens is not intended as a diagnostic tool.

Social Anxiety Test: Next Steps

• Get This Free Download: Social Anxiety Facts and Falsehoods
• Read: Where Does ‘Introvert’ End and Social Anxiety Begin?
• Read: 5 Ways to Reframe Anxiety for Your Worried Teen
• Find: Specialists or Clinics Near You

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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.

¹ National Institute of Mental Health. Social Anxiety Disorder. https://www.nimh.nih.gov/health/statistics/social-anxiety-disorder#part_2642

Peer pressure is a formidable force, and teenage boys with ADHD will likely engage in some forms of risky behavior. Research shows that adolescents are more willing to lean into uncertainty than are adults. This tolerance for risk is part of your teen’s development — though, obviously, too great a tolerance could end in disaster.

It is our job, as parents, to allow our adolescents space to grow while reminding them of the serious, even lethal, consequences associated with some risks. Daredevil driving, substance use, and unprotected sex are a few of the risks that you should never tolerate or ignore.

[Get This Free Download: How to Evaluate Your Teen’s Emotional Control]

Teens are generally more influenced by their friends than by their parents, but family conversations will still likely affect their thinking and decision-making. Start by talking to your son about the risks that worry you most and why they keep you up at night. Make sure to focus your concerns on your son, rather than making the conversation about his friends.

If your teen feels that he needs to defend his friends, you risk turning the discussion into an argument. Staying emotionally balanced can also avoid disagreement or harsh words. Share your thoughts from a place of curiosity and concern for his best interests, rather than judgment.

Whenever the opportunity presents itself, take time to talk and connect with your son without being overbearing. Keeping the dialogue alive and positive can help remind him to avoid the more dangerous risks he will encounter. Of course, there’s no guarantee that your son won’t cross a line, such as experimenting with drugs, that impacts your relationship and trust.

If this happens, it’s up to you to start the process of healing and repairing your bond. A teen boy with ADHD is unlikely to apologize for his mistakes. It’s more likely that he’ll try to avoid responsibility or become oppositional. Preserving your relationship is critical if you’re going to help him manage the consequences of his risky behavior or try to prevent future transgressions. And that means more hard conversations. Before talking with him, plan out the conversation.

[Read: How to Heal a Strained Parent-Teenager Relationship]

• Decide how you’re going to approach your son to initiate the conversation. What is the best time and place for it? Will you be patient and compassionate or commanding yet caring?
• Get clear on your intentions. What are your objectives? What boundaries do you intend to set? What consequences will you enforce if he crosses them?
• Be sure to account for your potential triggers. How will you manage them if they arise so that you can respond in a healthy way, rather than react from negative emotions?

Above all, remember that your son is still growing and learning. He’s a teen, and teens mess up. But they’re also resilient and have a lot of years ahead of them. Their mistakes don’t have to ruin their lives, and, usually, they won’t.

Peer Pressure and ADHD Teens: Next Steps

• Read: When Your Teen Has Questionable Friends
• Free Download: Transform Your Teen’s Apathy Into Engagement
• Read: You Can’t Change Your Defiant Teenager…

Brendan Mahan, M.Ed., M.S., is the producer and host of the ADHD Essentials podcast.

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.

Peer acceptance, a sense of self-efficacy, and a stress-is-enhancing mindset are strong predictors of resilience in older teens with ADHD, according to a small longitudinal study published in Child Psychiatry & Human Development.¹

The study, which followed 113 adolescents with ADHD from 10th to 12th grade, found that higher levels of peer acceptance, self-efficacy, and a growth mindset in 10th or 11th grade predicted higher levels of resilience 1.5 to 2 years later.

Peer Acceptance & Mechanisms of Resilience

Participants from the present study were assessed at three points:

• Fall/winter of 10th grade for peer acceptance
• Spring of 10th or 11th grade for self-efficacy, a stress-is-enhancing mindset, and baseline resilience
• Spring of 11th or 12th grade for follow-up on resilience

Peer acceptance at the start of the study explained 24% of the variance in resilience at follow-up. Teens with less severe ADHD symptoms were significantly more likely to report feelings of peer acceptance.

Resilience was measured using the Brief Resilience Scale (BRS), which asked teens to measure their agreement with statements such as “I tend to bounce back quickly after hard times” and “I take a long time to get over setbacks in my life.”

Self-Efficacy

Self-efficacy mediated the relationship between peer acceptance and resilience, accounting for 39% of the variance in resilience at follow-up.

“Greater self-efficacy has been associated with positive outcomes for children and adolescents with ADHD, including lower levels of depression and internalizing symptoms, and reported higher quality of life,” wrote Elizabeth Chan, lead author of the study.

Though ADHD symptom severity did not change the positive effect of self-efficacy on resilience, existing research shows that ADHD symptoms can negatively impact self-esteem.

A Stress-Is-Enhancing Mindset

A stress-is-enhancing mindset accounted for 31% of the variance in resilience. Individuals with this mindset view obstacles as opportunities for learning and development. Teens with more severe ADHD symptoms needed at least a moderate stress-is-enhancing mindset to promote resilience.

A Positive Mindset Has Broad Impact

“One of the key attributes of resilient children and adults is when problems come up, they view these problems as challenges to be solved rather than overwhelmed by,” said Robert Brooks, Ph.D., a leading expert on resilience and motivation.

Healthy peer relationships are also critical for kids with ADHD, many of whom struggle to initiate and maintain friendships. Children tend to experience increased interpersonal problems as they enter adolescence.¹ Between 50% and 80% experience peer rejection, according to one study, which found classmates’ opinions of ADHD students are developed within the first 30 minutes and persist long after.²

“We have to help our children become much better problem solvers and believe in themselves… to start to feel that there are these problems, but there are [also] things we can do,” said Brooks during his 2022 ADDitude webinar “Nurturing Resilience and Motivation in Children with ADHD: The Search for ‘Islands of Competence.”

Existing research on ADHD has associated adaptive outcomes with a growth mindset, as noted by the authors. A growth mindset — the belief that one can change their abilities and circumstances — predicts fewer negative emotions, greater efficacy, and less avoidant coping.^{3, 4}

In contrast, those with a stress-is-debilitating mindset view stress consequentially and are more likely to act on impulse — a core symptom of ADHD. A study published by Society for Research in Child Development and cited by the authors found that, among 1,343 adolescents, more adverse life events predicted greater distress and decreased self-control.⁵ When participants viewed stress as beneficial, they were less likely to respond impulsively to negative events.

Support from Caregivers

No significant interaction was found between a stress-is-enhancing mindset and peer acceptance. According to research cited by the authors, support from parents and teachers may be more influential than support from peers in promoting this enhancing mindset, ^{6, 7} particularly when caregivers praise effort over ability.

Additionally, the presence of a charismatic adult — someone from whom children gather strength — has been associated with resilience in kids with ADHD.⁸ “In the absence of a good co-regulator, a solid, charismatic adult… we know that the likelihood of going on to have positive outcomes goes down,” said Cheryl Chase, Ph.D., in her 2022 webinar with ADDitude on how stress and trauma impact child development. “One charismatic adult can make a massive difference.”

“Despite the adverse outcomes associated with ADHD, some adolescents with ADHD perform as well as or better than their non-ADHD peers in one or more functional domain(s),” wrote Chan et al. “These individuals appear to exhibit resilience, or a pattern of positive adaptation, with some thriving despite the neurobehavioral risks associated with their diagnosis.”

Limitations & Future Research

This was the first study to look at peer acceptance as a predictor of resilience and self-efficacy as a mediator. It was also the first to examine a stress-is-enhancing mindset in the context of ADHD.

Analyses controlled for sex, ADHD symptoms, baseline resilience, and cohort. To be included, participants were required to meet DSM-5 criteria for ADHD combined or inattentive type. Adolescents were excluded if they had a previous or existing diagnosis of autism spectrum disorder, bipolar disorder, dissociative or psychotic disorder, or an organic sleep disorder.

Future research should examine the potential causes of gender discrepancy in levels of resilience, which were significantly lower among females with ADHD. A more diverse sample is also needed, as the population was mostly male (67%) and White or Non-Hispanic (81%). A large percentage of the variance in resilience (61%) was unaccounted for; researchers should consider other contributing factors. Self-report scales were used as a primary measure; more objective reporting tools should be considered for future studies. Exploring interventions that encourage greater peer acceptance and a stress-is-enhancing mindset would benefit the study population.

Sources

¹Chan, E.S.M., Dvorsky, M.R., Green, C.D., et al. (2024). Predictors and mechanisms of resilience for high school students with ADHD: a prospective longitudinal study. Child Psychiatry Hum Dev. https://doi.org/10.1007/s10578-024-01704-3

²Ferretti N.M., King S.L., Hilton D.C., Rondon A.T., & Jarrett M.A. (2019). Social functioning in youth with attention-deficit/hyperactivity disorder and sluggish cognitive tempo. Yale J Biol Med, 92(1), 29-35. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6430168/

³ Burnette, J.L., Babij, A.D., Oddo, L.E., &Knouse, L.E. (2020). Self-regulation mindsets: relationship to coping, executive functioning, and ADHD. Journal of Social and Clinical Psychology, 39(2), 101-116. https://doi.org/10.1521/jscp.2020.39.02.101

⁴ Pay, C. (n.d.). How can I foster a growth mindset in my ADHD kids? Utah State University. https://extension.usu.edu/relationships/faq/how-can-i-foster-a-growth-mindset-in-my-adhd-kids

⁵ Park, D., Yu, A., Metz, S.E., Tsukayama, E., Crum, A.J., & Duckworth, A.L. (2018). Beliefs about stress attenuate the relation among adverse life events, perceived distress, and self-control. Child Dev 89(6), 2059–2069. https://doi.org/10.1111/cdev.12946

⁶ Haimovitz, K., & Dweck, C.S. (2016). What predicts children’s fixed and growth intelligence mindsets? Not their parents’ views of intelligence but their parents’ views of failure. Psychol Sci 27(6), 859–869. https://doi.org/10.1177/0956797616639727

⁷ Park, D., Gunderson, E.A., Tsukayama, E., Levine, S.C., & Beilock, S.L. (2016). Young children’s motivational frameworks and math achievement: relation to teacher-reported instructional practices, but not teacher theory of intelligence. J Educ Psychol 108(3), 300. https://doi.org/10.1037/edu0000064

⁸ Ofiesh, N.S., & Mather, N. (2023). Resilience and the child with learning disabilities. In: Goldstein, S., & Brooks, R.B. (Eds.). Handbook of resilience in children. Springer, Cham. https://doi.org/10.1007/978-3-031-14728-9_25

The mental health of U.S. high school students is trending upward after a decade of unprecedented  depression, violence, and suicidality among adolescents. Still, the youth mental health crisis is far from over, as more teens are experiencing school-based violence and school absenteeism, according to a new report by the Centers for Disease Control and Prevention (CDC) comparing 10-year trends and data from the 2021-2023 Youth Risk Behavior Survey (YRBS).¹

Among the 20,000 public and private high school students surveyed, 40% said they experienced persistent sadness or hopelessness in 2023, down from 42% in 2021. Suicidality rates also fell slightly: One-fifth of students seriously considered suicide, compared to 22% two years ago.

Survey results broken down by students’ sexual and gender identity revealed that depressive symptoms remained stable or declined in most subgroups:

• 65% of LGBTQ+ students experienced sadness or hopelessness, down from 69%.
• 53% of female students experienced sadness or hopelessness, down from 57%.
• 41% of LGBTQ+ students seriously considered suicide, down from 45%.
• 28% of male students experienced sadness or hopelessness, unchanged from 2021.
• 27% of teen girls seriously considered suicide, down from 30%.
• 14% of male students seriously considered suicide, unchanged from 2021.

The Mental Health Status of Girls

Though the changes appear small, these incremental decreases represent potentially significant changes in teen mental health, especially for girls. Just last year, the CDC reported that nearly 60% of teen girls “were suffering through an unprecedented wave of sadness and trauma,” which was double the rate reported a decade ago and twice the rate in boys.²

Girls with diagnosed and undiagnosed ADHD are at a much higher risk for depression, suicidal thoughts and behaviors, and sexual violence than their neurotypical peers. According to the Berkeley Girls ADHD Longitudinal Study (BGALS), girls with combined type ADHD are three to four times more likely to attempt suicide than their neurotypical peers, and they are 2.5 times more likely to engage in non-suicidal self-injuring behavior.³

“Girls and women with untreated ADHD are at double the risk for engaging in self-harm and significantly more likely to attempt suicide,” said Julia Schechter, Ph.D., of the Duke Center for Girls and Women with ADHD.

A 2022 ADDitude survey of 1,187 caregivers shared similar findings: Eighteen percent of girls with ADHD had engaged in self-harm within the past two or three years compared to 9% of boys.

“The emotional toll of ADHD on teen girls is profound — especially when it isn’t diagnosed early,” said Lotta Borg Skoglund, M.D., Ph.D., during the 2024 ADDitude webinar, “The Emotional Lives of Girls with ADHD.” “And, for teens who menstruate, we can’t ignore fluctuating hormones, which invariably affect emotions, behaviors, and functioning. Is it any wonder that so many teen girls and young women say that regulating emotions and energy levels are their biggest ADHD-related problems?”

“Being a teen girl sucks. Being a teen sucks. ADHD intensifies everything,” said an ADDitude reader from Kansas.

“Schools should do a better job acknowledging the needs of teen girls,” said an ADDitude reader from Florida. “There needs to be better support to accommodate their needs that filters into clubs, after-school sports, etc.”

The improved state of adolescent mental health, especially for girls, is encouraging, but it is no cause for celebration. “As seen in 2021, female students are faring more poorly than male students across almost all measures of substance use, experiences of violence, mental health, and suicidal thoughts and behaviors,” the CDC report stated.

Disparities persist among students who identify as (LGBTQ+). The report found that LGBTQ+ students still experience more violence, signs of poor mental health, and suicidal thoughts and behaviors than their male, cisgender, and heterosexual peers.

Rise in School Violence and Bullying

“These data show that we’ve made some progress in tackling these issues in recent years, which proves that they are not insurmountable,” said Kathleen Ethier, Ph.D., director of the CDC’s Division of Adolescent and School Health. “However, there’s still much work ahead.”

Returning to school was a welcome relief for caregivers and students after the COVID-19 pandemic. However, in-person classes have created more opportunities for physical encounters — and consequently more school violence and bullying, the CDC says. From 2021 to 2023, bullying in school grew from 15% to 19%. In 2023, 16% of students experienced electronic bullying via text, Instagram, SnapChat, or other social media channels.

“School bullying remains a serious problem in U.S. schools, particularly for students with ADHD, autism, learning differences, and other comorbidities,” said Rosanna Breaux, Ph.D., during the 2023 ADDitude webinar, “Teen Bullying Solutions: Help for Neurodivergent Adolescents.”

In a 2022 ADDitude survey, 61% of more than 1,000 caregivers said their neurodivergent child was bullied at school. Kids were also bullied through social media (32%), on the school bus (30%), and via text messages (27%).

“My girl is anxious and worries about bullying, girls pranking her, and kids saying she is ‘fat,’” shared an ADDitude reader from South Carolina.

Upward trends in injuries with a weapon on school property and sexual violence among high school students are cause for concern. LGBTQ+ students reported significantly higher rates of sexual violence than their cisgender and heterosexual peers. Of the 9% of high school students who had ever been physically forced to have sexual intercourse, 17% identified as LGBTQ+ compared to 13% of female and 4% of male students. In addition, 11% of high school students said they were forced to perform sexual activities (including kissing, touching, etc.); of those, one-fifth identified as LGBTQ+.

Increases in School Refusal Behaviors

Alongside bullying and violence, rates of school avoidance have risen sharply as well. According to the CDC,

• School absenteeism due to students feeling unsafe at school or traveling to and from school rose from 9% to 13%.
• Female students who missed school because of safety concerns increased from 10% to 16%.
• Male students who missed school because of safety concerns increased from 7% to 10%.

“It’s so important that children get treatment for school refusal behaviors,” said Alana Cooperman, LCSW, senior social worker for the Anxiety Disorders Center at the Child Mind Institute during the recent ADDitude webinar, “School Avoidance & Refusal: Root Causes and Strategies for Parents and Educators.”

School refusal can begin with negative self-talk and quickly spiral to self-harm or suicidality. The long-term effects of school avoidance can lead to declining grades, peer alienation, and increased tension at home. “These struggles don’t go away,” Cooperman said. “They follow children as they become adults. We see increases in anxiety and depression and potential substance abuse as adults.”

“Our girls are not okay,” said an ADDitude reader from California. “My 11-year-old daughter with ADHD was the victim of sexual harassment at her school. As a result, she developed PTSD. She had extreme emotional dysregulation, experienced suicidal ideation, and refused to go to school out of fear. She has not returned to her school since.”

Cooperman recommends treating school refusal behaviors with cognitive behavioral therapy (CBT) and that caregivers work collaboratively with their child’s school and therapist to develop a comprehensive treatment plan.

Mental Health Resources

The CDC recommends the following programs to help schools and communities improve adolescent health, well-being, and safety.

• What Works in Schools
• Promoting Mental Health and Well-Being in Schools: An Action Guide for School and District Leaders
• Violence Prevention in Practice: | VetoViolence (cdc.gov)
• Youth Violence Prevention Resource for Action (cdc.gov)

Get Help

Suicide &Crisis Lifeline: Call or Text 988
988lifeline.org

National Sexual Assault Helpline: 1-800-656-HOPE

National Substance Abuse Helpline: 1-800-662-HELP

Stop Bullying

Contact the 988 Suicide & Crisis Lifeline if you are experiencing mental health-related distress or are worried about a loved one who may need crisis support.

If you or someone you know may be considering suicide or be in crisis, call or text 988 to reach the 988 Suicide & Crisis Lifeline

Sources

¹Centers for Disease Control and Prevention. Youth Risk Behavior Survey Data Summary & Trends Report: 2013–2023. U.S . Department of Health and Human Services; 2024 https://www.cdc.gov/yrbs/dstr/index.html

²Centers for Disease Control and Prevention (2023). U.S. Teen Girls Experiencing Increased Sadness and Violence. Youth Risk Behavior Survey cdc.gov/healthyyouth/data/yrbs/pdf/YRBS_Data-Summary-Trends_Report2023_508.pdf

³Hinshaw, S. P., Nguyen, P. T., O’Grady, S. M., & Rosenthal, E. A. (2022). Annual Research Review: Attention-Deficit/Hyperactivity Disorder in Girls and Women: Underrepresentation, Longitudinal Processes, and Key Directions. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 63(4), 484–496. https://doi.org/10.1111/jcpp.13480

Teens and young adults with ADHD fall into cannabis use for many reasons. Some do it to achieve quick relief from boredom, racing thoughts, and uncomfortable feelings. Some claim it helps them focus and sleep. Some use cannabis to feel “normal.”

Chronic users are especially resistant to and defensive over suggestions to discontinue or reduce cannabis use. Some may deny that their cannabis use is a problem, or that it’s dangerous at all. Others may claim that cannabis is the only thing that helps them — and why stop something that delivers relief?

The truth is this: Chronic cannabis use causes more harm than good in the long run, and there are better, more effective ways to get relief.

How to Help Teens Who Rely on Cannabis

1. Understand what draws your teen to cannabis. One of the best ways to engage anybody in a conversation about substance use is to ask about its appeal and perceived benefits. What does your teen like about cannabis? Why did they start? What do they get out of using it? Are there aspects of cannabis that they don’t like? Expect to have ongoing conversations about cannabis with your child.

2. Has your teen tried to quit? Unsuccessful efforts to cut down or limit cannabis is a possible sign of problematic use. But many don’t know where they stand, since they’ve never actually tried to quit.

[Read: What Should My Teen Know About Marijuana and ADHD?]

If your teen doesn’t see an issue with their cannabis use and is resistant to quitting, present a short challenge. Say, “If it’s not a problem, can you see how you feel if you don’t use it for three days? What if you delay the first use of the day?” The goal is to get your teen to see what they’re like on and off cannabis.

Abstaining for a few days or a week may result in improved memory and attention. At the same time, acute cannabis use affects judgment. Over time, it’s difficult for users to notice how they may have accommodated their life to fit cannabis use. Work with your teen to help them notice changes.

3. Make it inconvenient. Barriers of any kind can help, especially if your teen struggles to reduce cannabis use because of availability. Encourage your teen to let their supply completely run out. If willpower and accountability are issues, consider storing cannabis in a time-lock safe.

4. Help your teen get better sleep. Sleep disturbances may drive cannabis use, but cannabis use only worsens sleep problems over time. Help your teen build healthy sleep habits, like adhering to regular sleep-wake times, avoiding screens close to bedtime, and practicing relaxation exercises prior to sleep. Spending time in natural light can help regulate the sleep-wake cycle.

Heavy users may experience insomnia when reducing or quitting cannabis — a common withdrawal symptom that can last up to three weeks. Talk to your teen’s doctor about a temporary sleep aid if this happens. In addition, targeted sleep interventions from CBT for insomnia to chronotherapy are available. Work with a doctor to find the right fit for your teen.

5. Is your teen’s ADHD being treated? Chronic cannabis use may be your teen’s way of coping with ADHD, depression, anxiety, a sleep disorder, and/or other underlying conditions. Is your teen’s cannabis use linked to any of these conditions? If so, are the conditions being treated optimally? Identifying and effectively treating all underlying issues can reduce your teen’s motivation to use cannabis to self-medicate.

6. Discuss relevant benefits of sobriety. How will refraining from cannabis use help your teen be present for activities and experiences that matter to them? From playing a sport to driving a car, your teen will need access to their full physical and cognitive abilities to engage, which won’t be possible if they’re under the influence.

7. Band with other parents who are in the same boat. It will be more challenging for your teen to stop or reduce cannabis use if their friends are also using. If circumstances allow for it, collaborate with the parents of your teen’s friends to collectively curb their cannabis use.

8. Make your teen aware of the truth. Teens may think themselves immune to any negative outcomes from cannabis use, especially when it provides them with quick relief. But your teen needs to know some potentially sobering truths: Chronic cannabis use changes the brain, zaps motivation, and worsens executive functioning, which is already impaired in ADHD, and it triggers other outcomes.^{1 2 3} It alters the brain’s reward center so that cannabis becomes the only thing the brain may find rewarding, and barely at that.

Your teen may be using cannabis to distance themselves from their problems, but the unfortunate reality is that chronic use only attracts more problems and impairs your teen’s distress tolerance skills. Reducing cannabis use will allow your teen to feel discomfort – a necessary motivator for change – and perhaps recognize that they can withstand tough feelings or learn to tolerate them with the help of a doctor. Either way, there are better, healthier ways of coping.

How to Stop Smoking Weed: Next Steps for Parents of ADHD Teens

• Self-Test: Signs of Substance Use Disorder
• Read: Better Sleep May Reduce Cannabis Use in ADHD Adolescents
• Read: How to Treat a Teen Self-Medicating ADHD and Anxiety with Marijuana

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “How Cannabis Use Affects ADHD Symptoms and Sleep in Adolescents” [Video Replay & Podcast #504] with Mariely Hernandez, Ph.D., which was broadcast on May 7, 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 Burggren, A. C., Siddarth, P., Mahmood, Z., London, E. D., Harrison, T. M., Merrill, D. A., Small, G. W., & Bookheimer, S. Y. (2018). Subregional hippocampal thickness abnormalities in older adults with a history of heavy cannabis use. Cannabis and Cannabinoid Research, 3(1), 242–251. https://doi.org/10.1089/can.2018.0035

²Broyd, S. J., van Hell, H. H., Beale, C., Yücel, M., & Solowij, N. (2016). Acute and chronic effects of cannabinoids on human cognition-a systematic review. Biological Psychiatry, 79(7), 557–567. https://doi.org/10.1016/j.biopsych.2015.12.002

³Peraza, N., Smit, T., Garey, L., Manning, K., Buckner, J. D., & Zvolensky, M. J. (2019). Distress tolerance and cessation-related cannabis processes: The role of cannabis use coping motives. Addictive Behaviors, 90, 164–170. https://doi.org/10.1016/j.addbeh.2018.10.047

Each Fall, many families dive headfirst into big ideas for doing things differently in the new school year… only to see those hopes and ambitions unravel before Halloween. Kids get out of bed grumpily, arrive late to school, struggle to do homework, and fight about their chores. The constant cycle of arguments, reminders, and stress leaves everybody frustrated and unhappy. What if you could nurture cooperation and accountability in your family instead? You can — by learning how to begin this school year with practical tools for a smooth transition.

In this webinar, Dr. Sharon Saline will show you how to change self-defeating cycles by improving key executive functioning skills related to productivity for students. Many children and teens with ADHD become so easily frustrated or overwhelmed that they cannot engage in the organizational tools that would help them. Beginning with methods for understanding and managing time, Dr. Saline shows you how to collaboratively teach realistic planning and effective prioritizing. When kids know how to realistically assess the amount of time they need for an activity, and then arrange tasks according to urgency, importance, and level of difficulty, they develop the independence needed for success at school and at home.

In addition to our standard question-and-answer period, we’ve added a live “Solve My Problem” portion of the webinar where Dr. Saline will address three specific scenarios submitted by ADDitude readers during the webinar registration process. You will leave this webinar with a set of practical strategies and solutions to use right away!

In this webinar, caregivers and educators will learn how to:

• Identify the executive functioning skills that affect productivity, organization, and follow-through
• Use tools for improving time management, planning, and prioritizing
• Develop strategies for effective decision-making that reduce stress and negativity
• Create effective routines with meaningful incentives that foster performance and goal-directed persistence
• Increase cooperation and reduce pushback for challenging tasks

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.

Time Blindness & Executive Function in ADHD Students: More Resources

• Sign Up: ADHD @ School: A Free Class for Parents
• Read: Prioritize & Organize With These Planner Pointers
  
• Read: Activity Ideas to Hone Brain Skills
  
• Read: Teaching Sequence and Schedules
• eBook: A Parent’s Guide to Effective Routines
  

Obtain a Certificate of Attendance

If you attended the live webinar on August 28, 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

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 exceptionalism, and mental health issues. (#CommissionsEarned) 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, among many other leading publications.

Learn more at www.drsharonsaline.com.

#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.

Listener Testimonials

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Teens who take prescription stimulants to manage their diagnosed ADHD face no elevated risk for later prescription drug misuse (PDM), according to a study published in Psychiatry Services.¹

Further, young adults with ADHD who took stimulants as teens are less likely to misuse stimulants compared with same-age peers who did not receive stimulant therapy. The strongest predictor of prescription stimulant misuse in young adulthood? Prescription drug misuse in adolescence.

The multi-cohort, U.S. national longitudinal study included 11,066 participants, ages 17 or 18, who completed questionnaires every two years until the age of 24. The questionnaires asked about the number of times participants used a prescription drug (benzodiazepine, opioid, or stimulant) without a doctor’s order.

Substance Use Disorder Rates Lower for Medicated Youth

This study marks the newest exploration in a body of research on the relationship between stimulant use and substance use in people with ADHD, conducted by a team that includes Timothy E. Wilens, M.D., Chief of Child and Adolescent Psychiatry, and Director of the Center for Addiction Medicine at the Massachusetts General Hospital.

“People with childhood ADHD are nearly twice as likely to develop a substance use disorder as are individuals who don’t have childhood ADHD,” ² explained Wilens in the ADDitude article “Treating a Child with ADHD Medication Diminishes His Future Risk of Substance Abuse.” “However, the risk of substance abuse decreases substantially when patients are treated with stimulant medication – even though it is considered a controlled substance. ADHD patients treated with stimulants experience a 60% reduction in substance abuse disorders compared to those who were not treated.” ³

In fact, Wilens added, the longer the child is treated for ADHD, the more robust the protective effect: Research suggests a 10% reduction in risk for substance use disorders for every year of ADHD treatment.⁴

The fact that stimulants decrease the risk of later substance abuse for youth with ADHD comes as a surprise to many parents. A common misconception that makes caregivers hesitate to medicate children for ADHD is the worry that stimulants will pave the way for addiction later on.

“I was worried that medications whose names sound like illegal drugs could lead to addiction,” explained a reader in a response to ADDitude’s 2023 treatment survey. “I wish I had known that ADHD medication helps prevent addictions to dangerous substances for people with ADHD.”

“The fact that unmedicated kids are much more likely to develop addiction was an important factor for us to consider in our decision to medicate our six-year-old,” wrote another ADDitude reader. “We assumed it would be the opposite: introduce them to meds now and they’d be looking for meds later — but understanding how the meds work to support him, it makes so much sense.”

Sources

¹ McCabe, Sean & Schulenberg, John & Wilens, Timothy & Schepis, Ty & Werner, Kennedy & McCabe, Vita & Veliz, Philip. (2024). Attention-Deficit Hyperactivity Disorder Stimulant Therapy and Prescription Drug Misuse During Transition to Young Adulthood. Psychiatric services (Washington, D.C.). 75. appips20230418. 10.1176/appi.ps.20230418.

² Charach et al. “Childhood Attention-Deficit/Hyperactivity Disorder and Future Substance Use Disroders: Comparative Meta-Analyses.” Journal of the American Academy of Child & Adolescent Psychiatry. 2011; 50(1): 9-21. doi: 10.1016/j.jaac.2010.09.019

³ Chang Z et al. “Stimulant ADHD medication and risk for substance abuse.” J Child Psychol Psychiatry. 2014; 55(8):878-85. doi: ^{10.1111/jcpp.12164}

⁴ McCabe SE, et al. “Age of Onset, Duration, and Type of Medication Therapy for Attention-Deficit/Hyperactivity Disorder (ADHD) and Substance Use During Adolescence: A Multi-Cohort National Study.” J Am Acad Child Adolesc Psychiatry. 2016; 55(6):479-486: doi: ^{10.1016/j.jaac.2016.03.011}

Dramatically higher rates of self-harm among youth with ADHD are reflected in many studies, including the Berkeley Girls ADHD Longitudinal Study (BGALS), which found that girls with combined-type ADHD are 2.5 times more likely than their neurotypical peers to engage in non-suicidal self-injury, and 3 to 4 times more likely to attempt suicide. A recent study found that, among self-harming teens, the incidence of hyperactivity and emotional dysregulation were so much higher than in the control group that the researchers concluded that self-harm may serve as a first presentation of ADHD, especially among girls who might otherwise go undiagnosed.² They further suggested that all teens who present with self-harm should be screened for ADHD.

The newest research has revealed that rates of self-harm among youth with ADHD may be even higher than past studies suggested. A 2024 study published in Psychiatry Research³ that involved 5,100 youth in Australia found that subjects with ADHD were 25 times more likely to self-harm than were their neurotypical peers.

Why Do Kids and Teens Self-Harm?

For some people, self-injury is an effective way to regulate unwanted emotions like anxiety and sadness, which they feel very, very strongly in their bodies. For some individuals, self-harm may bring them back into their body if they feel disassociated or emotionally numb.

Sometimes, the function of the self-injury is to communicate needs, or for kids to feel in control of their bodies and minds. There’s something about the behavior, symbolically, that allows kids and teens to take something amorphous — a bundle of abstract feelings — and put it somewhere on their body. They claim the power of defining the look of it, of expressing, “this is what these emotions look like,” and then the body heals it.

[Read: We Demand Attention on Self-Harm, Intimate Partner Violence, and Substance Abuse Among Women with ADHD]

Typically, the self-injury results from a trigger, causing a cascade of intense emotion that the person then wants to be rid of. Common categories of triggers include:

• Interpersonal stressors: a sense of rejection or relationship stress
• Performance anxieties

Self-Harm Patterns and Red Flags

While self-injuring behaviors vary by individual, studies have provided us with data about general patterns of self-harm among children and teens: ^{4 5}

• Average age of onset: 11-15 years old
• 25% of youth who self-injure do so only once
• 75% of youth report multiple episodes of self-injury
• Most youth who repeatedly self-injure stop within 5 years
• Self-injury can be cyclical and occur again after periods of stopping

[Read: Teen Girls Are Not Alright. ADHD Magnifies the Crisis.]

Self-Harm Red Flags:

Non-physical signs:

• Persistent changes in mood or character

Physical signs:

• Scars or wounds, especially multiple injuries clustered together
• Wrist coverings or inappropriate dress for the season (i.e. long sleeves in summer)
• Confusing paraphernalia in unexpected places (i.e. sharp object in bed)

What to Do If Your Child is Self-Harming?

If you find out your child is self-injuring, it’s important to form your response thoughtfully. Parents’ reactions to self-harm matter: Conversations that go well can really open doors for healing, but conversations that go poorly can do the opposite.

1. Remain neutral. Don’t display shock, pity, or judgment.

Discovering your child has been self-injuring can trigger many emotions including fear, shock, guilt, confusion, and anger, but it’s very important that you don’t attempt to talk to your child until you’ve worked through and subdued these feelings. Broach the topic only when you feel you can be dispassionate and centered.

It’s common to feel anger, which often results from worry, and there may be an urge to ask, “What are you doing? Why would you do this? Stop it!” Be sure to refrain from any condemnation, shame or criticism, as this may exacerbate the behavior.

2. Communicate three sentiments:

“I love you.”

“I’m sorry you’re hurting.”

“I’m here to help.”

Verbalize these messages to your child. It’s what they need to hear.

3. Don’t fixate on the wounds:

While it’s normal to be concerned about self-inflicted wounds, you should steer clear of placing too much emphasis on the physical injuries themselves. Instead, focus on the underlying reasons for the injurious behavior. Research shows that is what kids want to talk about, and understanding what’s causing the behavior is the first step toward meaningfully and effectively addressing it.

If kids don’t want to talk: That’s okay. Evasiveness is common at first. The most important thing isn’t getting the information you want, it’s establishing a connection, and keeping that connection open.

If you blow it: Don’t spend too much time worrying about it. Just go back to your child later and say, “That didn’t go the way I wanted it to go. Let’s try again.”

Distinguishing Non-suicidal Self Injury from Suicidal Ideation

Self-injury, most often, is not a suicidal gesture. The behavior typically originates from kids and teens wanting to feel better, not wanting to end their life.

That said, self-injury is a sign of distress and, in some cases, children and teens who engage in this behavior may be considering suicide. It’s important to differentiate between non-suicidal self-injury, and self-injury associated with suicidality.

The best way for parents to find out if the child is having suicidal ideation? Ask them.

Ask your child: “Can you tell me if you feel or have felt like you want to end your life?” If they say yes, you should determine how immediate the threat is by asking, “Are you feeling that now?” If the answer is “yes,” you need to reach out to a professional right away.

If your child responds, “no,” but you suspect they’re not being totally honest, tell them, “I love you. I’m here for you,” then continue to observe them and broach the topic again at a later time. The most important thing for parents to do is to keep the door of connection open.

Is Self-Harm Addictive?

Early detection is important because self-harm can become habit-forming. One quarter of youth who have self-injured report that they only did it once, but for three quarters of youth, there were multiple episodes. Individuals report having to do more over time to get the same response and they report feeling the desire to self-injure outside of a triggering situation.

It isn’t uncommon for people to acquire more contexts and reasons to self-injure as time goes on and this makes it harder to stop. As it becomes a more central part of how a person manages their emotions, it becomes a bigger lift to replace it with something else over time.

Is Self-Harm Contagious?

Self-injury can be contagious, especially within institutions, such as schools.

If your child is self-injuring and you believe it’s also something their peers are doing, it can help to find the person who is likely the epicenter of the behavioral trend. Often, this is a high-status peer, who may be signaling that this is cool, even if that is not their intent.

Try to engage this student as an ally and explain that there’s some contagion happening, and they have the ability to help in many ways, from minimizing the attention they give to self-injury to getting help themselves. Don’t assume that this child is your enemy: often, they’re not aware of what’s happening, and they don’t want their friends to be hurting.

Self-Harm Treatment

If a child is self-injuring, especially if they have other underlying issues including anxiety, depression, and/or ADHD, it’s important to find a good therapist. Look for providers who have experience working with young people and with dialectical behavioral therapy (DBT), which is the most commonly used modality to treat self-harm. DBT’s focus on understanding and accepting emotions and distress tolerance as well as learning healthy coping skills can be effective for addressing self-harm.

It’s important to note that self-injury can be tough to treat because it works very effectively for some people to down-regulate. We all have preferred ways of coping, and this becomes some people’s deeply preferred way. It’s not as easy as just replacing the behavior with other techniques.

Because of this, therapists often won’t start by addressing the self-injury directly. Instead, they might start by addressing an underlying issue that’s driving it, the psychological architecture that gave rise to it in the first place.

Kids and teens who self-injure have to learn to lean on something else that feels as effective, which just takes time, practice, and guidance. 

Self-Harm and ADHD: Next Steps

• Read: Straight Talk on Suicide and ADHD
• Free Download: Get a Grip on Tough Emotions
• Read: DBT Skills – The Go-To Treatment for ADD?

Janis Whitlock, MPH, Ph.D., is director of the Cornell Research Program of Self-Injury and Recovery.

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

¹Swannell, S.V., Martin, G.E., Page, A., Hasking, P., & St. John, N.J. (2014). Prevalence of nonsuicidal self-injury in nonclinical samples: Systematic review, meta-analysis and meta-regression. Suicide and Life-Threatening Behavior, 2, 1-31.

²Ward JH, Curran S. Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health. 2021 Nov;26(4):303-309. doi: 10.1111/camh.12471. Epub 2021 May 3. PMID: 33939246.

³Ping-I Lin, Weng Tong Wu, Enoch Kordjo Azasu, Tsz Ying Wong. (2024), Pathway from attention-deficit/hyperactivity disorder to suicide/self-harm, Psychiatry Research, Volume 337, https://doi.org/10.1016/j.psychres.2024.115936.

⁴Cipriano, A., Cella, S., & Cotrufo, P. (2017). Nonsuicidal self-injury: a systematic review. Frontiers in psychology, 8, 1946.

⁵Whitlock, J.L. & Selekman, M. (2014). Non-suicidal self-injury (NSSI) across the lifespan. In M. Nock (Ed.), Oxford handbook of suicide and self-injury. Oxford Library of Psychology, Oxford University Press.

Parent and educators can help the children in their lives flourish by teaching them how to hope by following these steps.

1. Talk about hope.

Hope is not frivolous or fleeting. It is a mindset centered on taking action to achieve the future one wants. Hope is powered by three key components: goals, pathways (i.e., how to move towards goals), and willpower (i.e., keeping your eye on the prize).

[Free Webinar: Learn About the Science and Power of Hope]

Hope does not sprout from a one-time conversation, so talk to your child or students often about hope, its components, and hopes they hold personally.

2. Find examples of hope in age-appropriate media.

Children’s movies, television, and books are filled with lessons on hope, as characters commonly work toward goals in the face of barriers and adversity.

While reading a book or watching a movie, ask your child or student about the goals of a character. How is the character trying to achieve their goals? What barriers does the character face, and how does it affect their hope? Does the character struggle to maintain motivation? Does the character eventually keep going? If so, what motivates them? How did they change course to overcome the barriers?

In practically all children’s media, the main character can’t overcome barriers without the help of friends. This is the social gift of hope. Ask: How can you rely on friends and others to help you overcome barriers? How can you help your friends remain hopeful in reaching their goals?

[Read: ADHD & the Art of Persistence — Teaching Goal-Setting Skills]

3. Create a visual map of hope.

Help your child or students map out their goals and hopes in a powerful visual reminder of what it means to take action toward a better future. Help them find pictures that represent a goal, that goal’s pathways (at least three), and willpower. Have them write a few sentences about how a picture symbolizes a component of hope. The final product will be a graphic display of hope, goals, pathways, and willpower in a framework.

4. Be attentive to future-oriented statements.

Listen for statements about wanting to do something, like joining the school band or basketball team. These are future expectations, and it’s on you to help your child or student figure out how to engage in pathways and sustain motivation to achieve those goals.

Why Is Hope Important?: Next Steps

• Download: Unlocking Motivation in Kids with ADHD
• Read: “My Anxious Child Is Convinced She Can’t Do Hard Things.”
• Read: Shake Loose of Your Limiting Beliefs — A Guide for Teens with ADHD

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Science and Power of Hope” [Video Replay & Podcast #486] with Chan M. Hellman, Ph.D., which was broadcast on January 10, 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.

What’s sleep got to do with cannabis use? A whole lot.

Many teens and young adults with ADHD turn to cannabis to help them sleep, 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.¹

In the short term, cannabis can help with sleep. 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.² Poor sleep increases cravings for cannabis³ and dampens the cognitive resources that allow an individual to resist cravings, make better choices, and curb impulsivity. Insomnia, a common symptom of cannabis withdrawal, can drive further cannabis use.

Another potential outcome of chronic cannabis use? Dependence. Youth with ADHD — a group that may be far more likely to use cannabis daily to try to get some shut-eye because of condition-related sleep issues — are at greater risk for developing cannabis use disorder compared to neurotypical peers.⁴

[Take This Self-Test: Symptoms of Substance Use Disorder]

So what can be done? Improving sleep may be key to curbing cannabis use and even increasing adherence to substance use treatment.

A Primer on Sleep Interventions

First, assess the following dimensions of sleep quality in adolescent patients with ADHD. Developed by Dr. Daniel Buysse, the RuSATED acronym can be used to recall elements of multidimensional sleep health:

• Regularity — does the patient go to bed and get up around the same time daily?
• Satisfaction — does the patient feel well-rested after sleep?
• Alertness — how alert or sleepy is the patient during the day?
• Timing — does the patient feel sleepy/fall asleep around the same time regularly?
• Efficiency — how much time in bed is spent sleeping?
• Duration — How many hours of sleep does the patient get, including naps?

Next, consider the following sleep interventions for improving one or more dimensions of sleep quality:

• Sleep hygiene education
• Cognitive behavioral therapy for insomnia
• Transdiagnostic Intervention for Sleep and Circadian Dysfunction (TranS-C)
• Chronotherapy (light therapy)
• Brief Behavioral Treatment of Insomnia (BBTI)

[Read: Sleep Problems in Teens with ADHD — Causes and Solutions]

A benefit of behavioral sleep interventions is that they can be started immediately, even as the patient is still using cannabis. It may not take long to see incremental results. In addition to using these interventions, properly treating ADHD and other comorbid conditions that impact sleep and functioning is crucial. Patients may be less motivated to use cannabis if underlying causes of sleep problems are effectively treated.

Anxiety and pain may be other motivators of cannabis use, so be sure to inquire about other reasons your patient may be using. Pharmacologic or behavioral interventions to treat these concerns can be part of your patient’s treatment plan alongside reducing cannabis use.

Cannabis and Sleep for ADHD Adolescents: Next Steps

• Free Download: Sleep Disorders Linked to ADHD
• Read: How to Treat a Teen Self-Medicating ADHD and Anxiety with Marijuana
• Read: How to Fall Asleep with a Rowdy, Racing ADHD Brain

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “How Cannabis Use Affects ADHD Symptoms and Sleep in Adolescents” [Video Replay & Podcast #504] with Mariely Hernandez, Ph.D., which was broadcast on May 7, 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 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

² 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

³ 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 adults. Addictive behaviors, 132, 107367. https://doi.org/10.1016/j.addbeh.2022.107367

⁴ 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

Still, collectively, gender nonconforming youth face common obstacles and common threats: discrimination, harassment, bullying, massive barriers to appropriate care, and other forms of transphobia.

In the face of these threats, support from doctors, communities, schools, and family members has a powerful protective effect. According to a national survey conducted by The Trevor Project, 45% of LGBTQ+ youth surveyed seriously considered attempting suicide in the past year, but those who felt highly supported by their family reported attempting suicide at less than half that rate. A recent study in Child Development revealed similar findings: LGBTQ+ youth who received parental support experienced significantly fewer depressive episodes.

Understanding how to best provide support may be particularly confusing for parents of gender-expansive youth with ADHD, who struggle with impulsivity, executive dysfunction, and emotional dysregulation. Here, Paul Silverman, LCSW, a family therapist at the Gender and Family Project at the Ackerman Institute for Family in New York City, offers clarity, context, and evidence-backed guidance for supporting your gender nonconforming child — and insight into why it’s so critical.

Q: What are some common myths or misconceptions about gender-expansive youth?

The biggest misconception is that their gender identities are not authentic. The growing number of children identifying as transgender or gender non-conforming (TGNC) gets too often attributed to children influencing one another. The truth is that TGNC children have always been here. Across cultures, there have always been TGNC people, and thereby there have always been TGNC children.

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

When we look to the 2 Spirit people of indigenous American cultures or the Hijras people of south Asia, we know that transgender people have existed as long as gender has existed. With that knowledge, we can attribute the growing number of children identifying as TGNC to increased visibility, representation, and acceptance.

Q: What is the most common concern voiced by parents of gender-expansive youth? How do you address this?

Many parents worry that their child’s life will be more difficult if they are transgender or gender conforming, that they will face increased societal hurdles. However, we know that acceptance is protection. The data and research indicate that, while many TGNC youth often present with elevated rates of eating disorders, suicidality, and impacts to their mental health, these rates are drastically lower for children who have the support of their parents.

Q: Sometimes, parents of gender-questioning youth with ADHD worry that their child’s gender exploration is driven by characteristic impulsivity. What advice can you offer to them?

For any parent concerned that their child’s gender is a phase or characterized by impulsivity or related to behaviors impacted by ADHD, I would consider the impact of supporting their child through that period regardless of the child’s long-term gender identity. Children will always carry with them the parent relationship, whether affirming or rejecting, through the time of their gender transition.

If a child exploring their gender turns out to be cisgender, they will move through that period and be more secure knowing they had their parent’s unconditional support. If that gender-exploring child turns out to be transgender, then the parent’s support during that period is all the more crucial.

[Read: How To Be a Neuroqueer Ally]

Q: What’s something that’s surprised you in your work with gender-expansive youth?

When I encounter a family that is accepting of their child’s transition from the start, embracing their desired name, pronouns, and gender expression, I am surprised by just how easy and joyful the child’s life can be. The narrative about transgender youth and their experiences is often so heavy because it is burdened by transphobia. In that context, these surprising moments of joy and ease for children provide a helpful model for what we can aspire to as a society.

Q: What guidance can you offer for parents of youth who are just beginning to explore their gender?

I want to relay that their child’s gender is neither a burden nor a problem. The burdensome problem is the transphobia that their family will be up against. With this reframing, there is no need to protect the world or the child from their trans identity, but instead to stand with their child in the face of the transphobia that they will inevitably face.

A parent recently shared this Joan Ryan quote, which I think encapsulates this idea well: “Parenthood is about raising and celebrating the child you have, not the child you thought you would have. It’s about understanding that they are exactly the person they are supposed to be. And that, if you’re lucky, they just might be the teacher who turns you into the person you are supposed to be.”

Gender Nonconforming Youth with ADHD: Next Steps

• Read: The Clinicians’ Guide to Serving and Protecting LGBTQIA+ Youth
• Read: “Just Let Him Be” – The Mother of a Neuroqueer Teen Shares His Story
• Watch: “Gender Diversity and Neurodiversity – How to Support a Child, or Teen with ADHD as They Explore Gender”
• Read: How to Support a Teen with ADHD Who Is Questioning Their Gender

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.

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

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

Fighting for LGBTQ+ Rights, Neurodivergent Style

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

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

[Read: How to Be a Neuroqueer Ally]

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

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

LGBTQ+ Joy Matters, Too

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

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

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

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

Neuroqueer Families: Next Steps

• Read: “Just Let Him Be” The Mother of a Neuroqueer Teen Shares His Story
• Watch: How to Support a Child, Teen, or Young Adult with ADHD as They Explore Gender
• Read: ADHD and Queerness — Living in the Neuroqueer Intersection

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.

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

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

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

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

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

When Neurodiversity Meets Gender Diversity

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

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

Transgender Teens: Countering Misconceptions

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

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

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

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

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

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

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

Supporting Genderqueer Teens

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

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

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

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

Genderqueer and Neurodiverse: Next Steps

• Read: How to Support a Teen with ADHD Who Is Questioning Their Gender
• Read: The Clinicians’ Guide to Serving and Protecting LGBTQIA+ Youth
• Watch: “Gender Diversity and Neurodiversity – How to Support a Child, or Teen with ADHD as They Explore Gender”

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It’s not uncommon for teens with ADHD to lose their motivation for a variety of reasons. For some kids, certain tasks might be too hard, too easy, or just boring. Maybe it’s difficult getting organized and started in the first place, let alone having to focus and sustain their attention, and use their working memory — common challenges for the ADHD brain.

5 Lack of Motivation Solutions

I recommend the following steps to any caregiver looking to help their teen on the path to independent living.

1. Reset

Although you might be frustrated, worried, or imagining the worst outcomes (e.g., my child will never move out), pause that thought process. The best way to support your teen is to withhold judgment. Make sure not to project your emotions and fears onto them.

[Free Download: Turn Your Teen’s Apathy Into Motivation]

2. Observe

What are your teen’s strengths, talents, qualities, interests, and passions? What do they get right? Acknowledge and validate their efforts. Then, observe their areas of weakness. Think about small ways to help them become more accountable and responsible. For example, allow them to determine the nutritious foods you’ll need for your household within a weekly budget. These management skills apply to various essential tasks.

3. Listen

Communicate authentically, respectfully, and transparently. Temper your emotions to create an atmosphere where your teen can speak honestly about their challenges and self-perceptions. Sometimes, what we perceive as a teen’s indifference, resistance, or laziness may actually be anxiety, fear, or lack of confidence. Try to understand and address what’s really interfering with their pursuit of autonomy.

4. Collaborate

Once the issues are identified, discuss opportunities that allow your teen to grow and thrive at something they are naturally good at or are passionately interested in. Many career and educational paths lead to success. Build a plan with small, actionable steps that lead your teen to their desired goals. Helping a teen see these as achievable reinvigorates their motivation and commitment.

[Download: Free Rewards Menu: 75 Fun, Effective Ideas for Kids]

5. Inspire

Your teen’s support team includes mentors, coaches, school advisors, career counselors, therapists, and other adults who can provide inspiration from different perspectives. Encourage your teen to connect with their trusted advisors as they navigate the transition to independence.

Lack of Motivation in Your Teen? Next Steps

• Free Download: Transform Your Teen’s Apathy Into Engagement
• Read: Steps to Independence
• Q&A: “How Can I Help My Teen Adopt a Growth Mindset?”
• Read: 5 Life Skills Every Young Adult with ADHD Should (Eventually) Master

Brandi Walker, Ph.D., is a clinical psychologist, who is working on a research study at the Womack Army Medical Center at Fort Liberty in North Carolina.

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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.

Moving on to college is a big transition, especially for students with ADHD who receive IEP accommodations that end with a high school graduation. There are no IEPs in higher education. However, accommodations for academics and, in some cases, housing, are available for neurodivergent college students — but the process for attaining these is unlike the process in high school.

First, students must disclose their disability with the college and advocate for the accommodations they need. For example, some colleges provide free tutoring, allow for extra test-taking time, or provide a one-on-one executive function coach. Some colleges allow students with executive function challenges to live in a dorm building with a cafeteria to ease time-management challenges like planning enough time to eat between classes.

This webinar will serve as a critical resource for parents and students seeking to understand the process of getting needed disability services.

In this webinar, you will learn:

• About the disability laws and services that apply to neurodivergent college students
• About the kinds of services, academic and beyond, that most colleges offer for neurodivergent students
• About the responsibilities of college students in disclosing a disability to seek services
• About the role and responsibilities of the Student Accessibility Services office
• About the process for applying for disability services, including what documentation might be needed

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; YouTube 

College Accommodations: More Resources

• Download: What Are Your Teen’s Weakest Executive Functions?
• Read: 5 Steps to College Accommodations
• Q&A: “504 Plan vs. IEP — What’s the Gateway to College Accommodations?”
• Read: 10 Myths About School Laws for ADHD Services
• Read: 13 Survival Tips from College Graduates with ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on July 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

Jillian Lillibridge Heilman, Ph.D., CRC, is a disability expert with more than 20 years of experience in disability education and advocacy. She is the Director of Student Accessibility Services at Connecticut College and provides training to other colleges and private organizations that seek to better serve individuals with disabilities.

Dr. Heilman also serves as an adjunct instructor at both Connecticut College and the University of South Florida in the areas of disability sciences and rehabilitation counseling. Her expertise led to the development of an online master’s program at the University of South Florida that trains professionals to work with people with physical, mental, and emotional disabilities. Read more about Dr. Heilman here.

Listener Testimonials

“Having done this with one of my children, I still learned new information and considered things we’d never even thought of (e.g., access to food via housing). Thank you for sharing your experience!”

“Thanks so much! We will be sending our daughter to college this fall, and this information will help her and us so much!”

“I teach high school special education. Today’s webinar was fantastic. It was so informative for teachers trying to support students in building independence skills at school to help them be ready to navigate college. I would love more of this type of content!”

Webinar Sponsor

The sponsor of this ADDitude webinar is….

Landmark College exclusively serves students who learn differently, including students with learning disabilities (such as dyslexia), ADHD, autism, or executive function challenges. The College offers associate and bachelor’s degrees as well as short-term programs on its Putney, Vermont campus, online dual enrollment courses for high school students, and a fully online A.A. in General Studies. Learn more at www.landmark.edu.

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

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