But I was confused. I associated ADHD with fidgety grade-school boys. Little did I know that I, an adult woman, could also be diagnosed with ADHD. My daughter’s descriptions of time and organizational overcompensation, decision paralysis, procrastination, overwhelm, and hyperfocus resonated deeply with me. When I suggested that I might have ADHD myself, she agreed.

While waiting for an evaluation and the results, I had daily epiphanies as I connected my lifetime of experiences with information about the ADHD brain. Like so many of us, I’d spent years feeling inadequate, hypersensitive, and too ashamed to say any of it out loud. How many paralyzing hours did I lie on the couch, wondering what was wrong with me? My diagnosis came in August 2022.

[eBook: Women with ADHD: How Hormones, Symptoms & Late Diagnoses Impact Females]

Six years earlier, at almost 49, I’d unknowingly set in motion a seismic journey of personal reinvention with the decision to stop drinking (10 years in the making) and enter therapy for the first time. I was finally able to follow through on both steps, even in the face of intense anxiety and self-hatred. My sobriety and therapy unleashed a flood of unresolved issues and traumas. Recovery was just the beginning of my self-discovery.

I ended my 26-year marriage and became an empty nester. My work as a commercial interior designer suddenly felt toxic. I had come to realize that there was a fundamental misalignment between my strengths, interests, and responsibilities. Near crippling self-doubt and fear of rejection had kept me tethered to my career for 28 years. Finally, my ADHD diagnosis shattered the narrative of not good enough, paving the way for self-compassion and newfound confidence and hope.

Standing at the intersection of creative expansion and personal revolution, I found a community of midlife women on similar paths and planted the seed for starting my company, Triple Moon Coaching. I enrolled in a holistic coach certification program so I could build a side practice and phase into full-time professional life coaching.

Empowered by clarity and optimism, I focused on creating my new vision. ADHD impulsivity has been a consistent thread for as long as I can remember. My resignation was bold and necessary, and a bit premature. But I was learning. No regrets.

I am on a solid path to successful entrepreneurship. It’s a joy and a privilege to coach women who are taking charge of their lives and growing into their own unique potential.

ADHD in Women: Next Steps

• Self-Test: Symptoms of ADHD in Women & Girls
  
• Sign Up: Essential Support for Women with ADHD
• Read: The Transformative Power of an ADHD Diagnosis for Older Women
  
• Read: 10 Books Every Woman Should Read After Her ADHD Diagnosis
  

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Living with ADHD makes us more likely to engage in all sorts of self-sabotaging behavior — patterns that prevent us from reaching our goals, achieving peace, and finding happiness. I say “us” because, though I coach clients with ADHD who are their own worst enemies, I am not immune to self-sabotaging behaviors. As someone with ADHD, I, too, sometimes work against my own best interests.

Why We Engage in ADHD Self-Sabotage

Self-sabotage is hitting the snooze button despite knowing that we’ll be late to work. Or thrwarting anything good that comes our way for fear that we’ll mess it up somehow. Or depriving ourselves of our needs as punishment, because we think we deserve it. Or shutting down in the face of problems — and sometimes dealing with the stress by self-medicating.

But don’t make the mistake of confusing ADHD symptoms and traits for self-sabotaging behaviors. Difficulty managing time, for example, is an ADHD symptom. Repeatedly choosing not to set and adhere to alarms that can aid with time management is self-sabotage.

[Read: “4 ADHD Defense Mechanisms – and How to Break Them”]

We all have different reasons for engaging in self-sabotage; the following are the most common:

1. We don’t trust our abilities. When ADHD symptoms repeatedly undermine our skills, we begin to believe that we are incapable. We hyperfocus on all the times we’ve messed up.

I had a client who accidentally threw away a pizza and stored its empty box in his fridge. “I can’t even get pizza right,” my client thought as he spiraled into self-criticism and self-sabotage. “Why should I try for anything else?”

In my own life, I have felt many times — like when I started my ADHD coaching center — that I was not mature enough to make big, overwhelming decisions. Who was I to take this on? I felt like I needed parental guidance, even as an adult.

2. We fear failure. Fear of falling short of expectations is a major barrier that drives so many of us to procrastinate or never get started. When I was writing my manuscript for my first book, I had no expectations, so there was no fear of failure then. However, with my second book, the fear of failure kept creeping in. I thought, What if it doesn’t go well? What if it doesn’t work?

3. We fear success. This is a real phenomenon that I often see in high-functioning, go-getter individuals. They’ll succeed once, and worry — sometimes due to inconsistencies in performance driven by ADHD — that they won’t be able to repeat success. This is a classic sign of imposter syndrome.

4. We lack self-awareness. We may be unaware of the negative thought patterns and behaviors that impede our success. A client of mine had an interview for a dream job but had lots of negative feelings about it. Why? Because she had been previously fired from her workplace due to lateness, and she had begun internalizing negative emotions and shame around her skills and capabilities as a result.

[Read: Why ADHD Self-Awareness is the Key to Effective Action, Change, and Progress for Each of Us]

5. We shut down when things get difficult. When pressure builds, avoidance is a coping mechanism. A client of mine who struggled to manage stress and uncomfortable feelings around her responsibilities stayed in bed the whole day — even though those responsibilities were still there for her the next day. Sometimes, feelings of inadequacy can drive these actions.

All self-sabotaging behavior, no matter the form, is rooted in self-preservation. We engage in self-defeating behaviors to protect ourselves and our egos, and to feel safe. The problem is that these behaviors often backfire.

How to Halt Self-Sabotage

To break the cycle of self-sabotage, you must approach your challenges with the sense that you can understand, overcome, and even grow from them. Begin with these exercises:

• Identify the feelings behind your self-sabotaging behaviors using this format: When I feel [emotion], I tend to [self-sabotaging behavior]. Use a feelings wheel to guide you. An example: When I feel uncertain and vulnerable, I tend to

• Next, unpack the story behind your feelings. Does feeling uncertain make you feel stupid? Do you feel vulnerable when you don’t have all the answers, which causes you to procrastinate? What narratives are you creating in your mind that fuel self-sabotage?

Choose a Path Forward

Option 1: Reframe your negative emotions and experiences

The client who was nervous about interviewing connected with positive thoughts around the role and how it aligns perfectly with her interests and skills, which helped her feel much more confident during the interview. A negative experience in one workplace, she reminded herself, doesn’t define anyone.

Searching for the positive and having a sense of humor helps, too. The client who threw out a full pizza stopped berating himself long enough to recognize that the situation was pretty funny — and inconsequential.

Option 2: Accept your negative emotions, but stop self-sabotaging

You can acknowledge your negative feelings and refuse to let them dictate your actions. What got me to write and finish my second book, despite feeling overwhelmed, uncertain, and vulnerable, was accepting that writing sucks — and so what?

Option 3: Do nothing because self-sabotaging feels so good

This is really a false choice, since continuing down the path of self-sabotage isn’t how you overcome it. You may be tempted to choose this option because every other choice takes a lot more effort. Only you can get yourself out of self-sabotaging behaviors. That said, if you’re unwilling or unable to engage in the other options, consider seeking help from a certified ADHD coach or an ADHD-informed mental health provider.

Develop Self-Supporting Behaviors

Meet Your Five Basic Needs

Self-sabotaging behaviors often arise from neglecting fundamental needs: survival (which includes nutrition, hydration, and sleep), power, love, fun, and freedom. Are you giving yourself enough rest, water, and the right food? If you’re feeling powerless over a situation, how can you gain some autonomy? If you resent that you lack fun in your life, how can you make space for it every day? How can you gain a sense of freedom and choice — which is so important for ADHD brains?

Add a Positive Character to Your Inner Dialogue

If the super critical voices in your head often drive you to self-sabotage, try introducing a supportive character that can help quiet the self-loathing. This could be a figure from literature, a movie, or even someone from your own life. Picture this character reassuring you: “Calm down, everything will be fine. Let’s keep things in perspective.” To help you narrow down on a character, think hard about why you’ve chosen them and how they’ll help you stop self-sabotaging.

Seek Formal Supports

Cognitive behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR), along with other formal supports, therapies, and treatments for ADHD, are highly effective for those who are repeatedly self-sabotaging.

Self-Sabotage and ADHD: Next Steps

• Free Download: The ADHD Healthy Habits Handbook
• Read:  “I’m Way Too Hard on Myself”
• Read: “I Am Fraught with Guilt and Shame When I Procrastinate”

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “Interrupt the Cycle of Self-Sabotage in the New Year” [Video Replay & Podcast #492] with Tamara Rosier, Ph.D., which was broadcast on February 15, 2024.

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Some of these women feel overwhelmed with overcommitment and dread moral judgment of their efforts. They feel ill-equipped to manage life’s complexities. These are the women with hidden ADHD: undiagnosed, untreated, and underserved.

Evading ADHD detection for so long suggests these women were able to present a seamless façade; that they passed for neurotypical, which may have felt like a win. But perfectionistic masking almost always comes at a high emotional cost. The self-monitoring is relentless; the hypervigilance, fueled by anxiety, exhausting.

While hiding their true selves may have seemed necessary to escape anticipated judgment and rejection, women who receive an ADHD diagnosis later in life report a new appreciation for the courage and determination that served them for so long.

Getting an ADHD Diagnosis Can Be Revelatory

Diagnosis at midlife unleashes a kaleidoscope of sensations—shock, anger, relief, regret, shame, fear, guilt, resentment, and sadness. On the life-changing journey toward understanding and acceptance, your first step is to learn everything you can about ADHD in women. Make use of audiobooks, articles, podcasts, webinars, support groups, and therapy.

[Read: Women with ADHD – No More Suffering in Silence]

Gradually, the explanation for your years of distress and confusion will emerge with increasing clarity. Share it with the people most important to you. Honor the regret you feel about the opportunities lost, then embark on building a more rewarding future.

The Impact of Hormones

For women with ADHD, declining estrogen levels in perimenopause and menopause trigger a perfect storm: functionality suffers as the severity of ADHD symptoms and coexisting anxiety and depression spike. Fluctuating hormones also disrupt mood, memory, sleep, concentration, and motivation. Shame and self-doubt, amplified during the premenstrual phase, become more intrusive and destabilizing.

Ambushed by tsunamis of emotion and memory lapses, many women attribute their worsening struggles to character flaws and judge themselves harshly. Since women now spend about a third of their lives in menopause, it’s a game-changer to discover that your unpredictable functioning is hormonally mediated.

Reinvent Yourself

We cannot change our age, history, or brain wiring, but we can change the lens through which we view our world. Changing our perspective and redefining our identity is best achieved through an alliance with a therapist who has expertise in working with women with ADHD.

[Read: Relief, Grief, and More Raw Reactions to an Adult ADHD Diagnosis]

In the meantime, begin the process of creating a new version of yourself by doing the following:

• Embrace your strengths. Understanding the far-reaching impact of ADHD in midlife enables a more realistic assessment of your strengths and weaknesses. After years of ruminating about your limitations, you’ll learn that there is strength in knowing when you need help and asking for it.
• Trust your unique vision. Non-linear thinkers are differently abled. Your passion and creativity enhance the neurotypical status quo with novel solutions.
• Create boundaries. To many women, social acceptance is an indicator of self-worth. Social dynamics are confusing, and you may consider others’ agendas more important than your own. Boundaries can help you find a balance between feeling trapped by overcommitment and withdrawing from interactions to avoid confrontation.
• Prioritize self-care. It takes a serious investment in your wellbeing to change the way you interact with your body. Women with ADHD tend to skimp on attention to their health. Creating a bedtime routine to improve sleep requires small changes over time. Eating healthier foods, drinking more water, and maintaining an exercise routine demand healthy vigilance. Balance conflicting needs—protection vs. connection, self-care vs. accommodating others, and passivity vs. assertiveness. Each small step will improve your quality of life.
• Develop systems that work for you. When chaos and clutter threaten to consume your environment, you may feel more frantic and unable to envision solutions. Creating organization and routine will help you manage your time and space more effectively.
• Seek pleasure. Take a designated amount of time each day, even just 15 minutes, to do something you find pleasurable. This transition will allow your brain to revel in unstructured downtime, whether that means chilling out with music, meditating, or having a cappuccino while playing Wordle.

After decades of shame, apologizing, and fearing criticism, a diagnosis gives you explicit permission to forgive yourself for being your own harshest critic. Whether you’ve punished yourself in the past with isolation, substance abuse, binge eating, or other kinds of self-harm, a midlife diagnosis can help you accept that you are worthy of being nurtured—by yourself and by others.

Diagnosis at midlife is the beginning of an ongoing journey toward enlightenment and transformation. Seize this unexpected second chance to believe in yourself. As you get the hang of reinvention, you will rejoice.

Reinvent Yourself Post-Diagnosis: Next Steps

• Watch: The Science Behind Diagnosing and Treating ADHD in Older Adults
• Download: Free Guide to ADHD in Older Adults
• Read: ADHD in Older Adults – Distinct Diagnostic and Treatment Considerations

Ellen Littman, Ph.D., a clinical psychologist in New York, is co-author of The Hidden Side of Adult ADHD, Understanding Women with ADHD, and Gender Differences in ADHD.

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To study this emerging issue, our team at the Simons Foundation analyzed 25 datasets collected across 18 studies that involved 600 children with autism. We created and ran an algorithm to identify differences between kids with autism and their neurotypical counterparts. We then correlated the microbiome against so-called cytokines, which are immune markers, to see how the gut microbiome is linked to individuals’ immunity and inflammation. ¹

This is important because many chronic disorders, such as inflammatory bowel disease and diabetes, demonstrate components of immune dysfunction. Identifying the immune-microbe link in autism not only creates new opportunities for managing autism symptoms, but it also introduces ideas regarding how the microbiome could be manipulated to regulate immune response.

Gut Microbiota May Signal Autism

When we looked at the microbes predicted to be associated with autism and compared them with microbiota likely associated with neurotypical controls, we observed a strong difference between the two groups. Further investigation suggested that we could distinguish accurately between individuals with autism and neurotypical controls just by using their measured gut microbiota. This means that future research might unlock autism diagnoses through gut microbiome analysis, potentially guiding symptom management and therapeutic developments.

[10 Foods (and Supplements and Vitamins!) to Boost Your ADHD Brain]

When we compared the gut-brain axis — the gut microbiota and human brain pathways, or the enzymes responsible for the breakdown of products in the brain — we observed a strong overlap between pathways detected in the gut and those detected in the brain. This suggests that diet affects gut diversity and brain function, from thinking to mood.

GI and Sleep Problems

Many children with autism have gastrointestinal (GI) and sleep problems. In one study, researchers found that the chances for behavioral problems substantially increase when children have GI and sleep problems. ²

Parents should track foods eaten, bowel movements, and sleep patterns to establish connections between these factors and their child’s symptoms. Preventing or treating GI symptoms may provide children with some relief and help them sleep through the night.

Research into the gut-brain axis, and what this correlation can tell us about certain conditions like autism and depression, is still new. In the near future, it is possible that knowledge of gut bacteria will help determine predictive biomarkers of disease, with implications for new therapeutics. What we know about the gut-brain axis will look very different 5 to 10 years from now.

Autism and Gastrointestinal Issues: Next Steps

• Download: Autism Evaluation Checklist
• Read: The ADHD Diet Plan — Healthy Foods and Supplements for Kids & Adults 
• Read: Autism vs. ADHD — A Parent’s Guide to Tricky Diagnoses

Jamie Morton, Ph.D., is an independent consultant who has previously worked for the National Institute of Child Health and Human Development.

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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.

Sources

¹ Morton, James T., Dong-Min Jin, Robert H. Mills, Yan Shao, Gibraan Rahman, Daniel McDonald, Qiyun Zhu, et al. (2023). Multi-Level Analysis of the Gut–Brain Axis Shows Autism Spectrum Disorder-Associated Molecular and Microbial Profiles. Nature Neuroscience 26 (7): 1208–17. 10.1177/1087054718816169

² Leader, G., Barrett, A., Ferrari, C., Casburn, M., Maher, L., Naughton, K., Arndt, S., Mannion, A. (2021). Quality of Life, Gastrointestinal Symptoms, Sleep Problems, Social Support, and Social Functioning in Adults with Autism Spectrum Disorder. Res Dev Disabil.;112:103915. 10.1016/j.ridd.2021.103915

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

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

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

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

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

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

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

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

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

ADHD Symptom Management: Next Steps

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

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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.

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An approach called the Life Course Model could significantly improve outcomes by keeping parents informed on the effectiveness of behavioral interventions and by ensuring consistency between home and school strategies.

The model’s primary aim is to foster collaborative family-school partnerships. Through meetings with the child’s academic and/or IEP team, parents can help make decisions regarding the best behavioral interventions to address the child’s needs.

[eBook: The Teacher’s Guide to ADHD and Classroom Behavior]

Daily communication about a student’s progress may also allow the teacher to advise on implementing interventions at home. However, successful student outcomes still rely on professional development and teacher training around ADHD interventions and strategies.

Life Course Model Implementation

These practice guidelines were created to help teachers address disruptive or noncompliant behaviors among students with ADHD by providing supports that build skills for independence and self-regulation. Interventions that reduce symptoms (e.g., medication) and accommodations that don’t necessarily build skills are given lower priority in the treatment plan sequence.

Life Course Model, Part 1: Services and Sequencing

Life Course Model, Part 2: Principles for Service Delivery

Behavioral Interventions for ADHD: Next Steps

• Free Download: Classroom Accommodations for Children with ADHD
• Sign Up: Free ADHD Teacher Training Program!
• Read: Could a Behavior Intervention Plan Help Your Student with ADHD? 

Marsha Ariol, M.S., is a third-year doctoral student in the school psychology program at Lehigh University in Bethlehem, Pennsylvania.

George J. DuPaul, Ph.D., is a professor of school psychology and associate dean for research in the College of Education at Lehigh University in Bethlehem, Pennsylvania.

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 Hustus, C.L., Evans, S.W., Owens, J.S., Benson, K., Hetrick, A., Kipperman, K., & DuPaul, G.J. (2020). An Evaluation of 504 and Individualized Educational Programs for High School Students with Attention-Deficit/Hyperactivity Disorder. School Psychology Review,49, 333-345.doi: 10.1080/2372966X.2020.1777830

² DuPaul, G.J., Chronis-Tuscano, A., Danielson, M.L., & Visser, S.N. (2019). Predictors of Receipt of School Services in a National Sample of Youth with Attention-Deficit/Hyperactivity Disorder. Journal of Attention Disorders, 23, 1303-1319.doi: 10.1177/1087054718816169

Alongside other ADHD advocates, I’ve been working for more than a decade to create systemic change in the way we educate students with ADHD. I will share exciting opportunities for civic actions you can take to encourage local and state legislators to implement these special ed reforms. As Margaret Mead famously said: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.”

Teacher Training Transforms the Classroom

I have conducted hundreds of ADHD-specific teacher trainings across diverse school districts nationwide that vary in size, economic status, and geography. They all share a common asset: teachers eager for additional knowledge, tools, and resources to enhance their students’ success. They aspire to spend less time dealing with challenging behaviors and more time addressing the needs of all their students. That’s where I come in. Within 12 hours, my training can transform how teachers perceive, interact with, and support students with ADHD, building their competence and confidence in the classroom.

Last summer, Lisa Reynolds, a parent in Kansas, asked if I would speak with one of her local legislators about creating a bill that would improve the way students with ADHD are taught. Reynolds pleaded for change after years of failed attempts to help her son receive appropriate education and support.

“If he required too many redirections, teachers recommended removing him from class and transferring him to the in-school suspension room for independent work,” Reynolds said of her son, who has ADHD. “These kids get labeled as lazy or bad. They don’t understand why school is so hard and why they are being punished.”

[Get This Download: An Educator’s Guide to Classroom Challenges & Solutions]

With Reynolds’s help, I drafted Kansas House Bill 2480, requiring each school district in the state to hire an ADHD specialist to train and support teachers. I then gathered stellar experts from across disciplines with the knowledge, experience, and research to support this effort. Not surprisingly, I found that many professionals share my determination to change the current educational methodology.

Bright Students, Poor Outcomes

George J. DuPaul, Ph.D., professor of school psychology and associate dean for research at Lehigh University College of Education, is one of many experts and clinicians prepared to testify on behalf of this ADHD legislation. He says that youth with ADHD face significant academic and mental health challenges in elementary and secondary schools. Typically, he says, they complete less assigned work, receive below-average grades, perform poorly on exams, and are more likely than their peers to drop out of school.

Many students with ADHD are of average or above-average intelligence. Yet they are at greater risk of underemployment, incarceration, and even suicide.

Every day, well-meaning teachers unintentionally create hardship, frustration, and worse by expecting students with ADHD to behave and perform according to neurotypical standards. Very bright students with ADHD may have slower processing speed (which creates overwhelm and disengagement), weaker working memory (they struggle to retain what is presented without visual or other supports), and other challenges that arise from underdeveloped executive function and emotional regulation skills.

[Click to Download: 10 Teaching Strategies that Help Students with ADHD]

Many educators have backgrounds in special education but no expertise in ADHD. Teachers are leaving the profession in droves due to overwhelming challenges and limited resources and support. We cannot ask more of teachers. But we can provide the training and resources they need to support their neurodivergent students.

Seeking Action Across America

While HR Bill 2480 is still working its way through the Kansas legislature, we are determined to proceed on a broader scale and create a national dialogue about supporting students and families impacted by ADHD. We hope that lawmakers will be inclined to consider legislation once they see similar bills successfully passed.

Virginia is a good example. Academic outcomes for Virginia students with learning differences have been inexcusably poor in recent years. These students scored lower on Standards of Learning assessments, on average, than their neurotypical peers. Worse, they were 52 percent more likely to drop out of high school.

After a scathing report on the state’s failure to comply with basic federal special education program requirements, and an ongoing probe by the U.S. Department of Education, lawmakers passed a bill that aims to dramatically change the way educators are trained to identify and support students with learning differences and disabilities.

The bill was signed into law and became effective July 1, 2024. However, it could take until the 2025-26 school year for some, if not all, of the widespread changes to be implemented, says Virginia Delegate Carrie Coyner, who co-sponsored the bipartisan bill with Delegate Barbara Favola.

The new law requires every teacher and administrator statewide to receive professional development by regional coaches and experts in special education. The state will also fund regional parent resource centers to help caregivers advocate for students with diagnosed or suspected learning differences.

Coyner says she spent one year interviewing and surveying educators and special education systems across the country to learn about best practices. She studied lawsuits filed by parents against school districts in Virginia involving claims of inadequate education supports for their students, and she worked with the University of Virginia law school on public policy measures to address current challenges.

We need states across America to prioritize the importance of adequate training for teachers and recognize that it can change the lives of future generations of students. Employing an on-site ADHD specialist can provide education, re-teaching, and effective problem-solving, enabling these students to become assets to the entire school population.

Your Call-To-Action Guide

It is up to us to create a groundswell of support by approaching school boards, and local and national legislators, to push for change. Experiences from local parents and professionals will have the most impact regionally; however, their shared information and approach can apply to all states.

• Ask your local school board how teachers are being taught to support students with ADHD. How current is the training, how recently has it been provided, and how many staff members have received the most recent training?
• Use the template below to approach your local school board, state senator, and state representative, as well as your U.S. senators and congressional representatives, to advocate for legislation at both the local and national levels.

How to Approach Your Representatives

• Start by writing a letter or an email addressed to each of your school board members and state senators and representatives. Each state has an education committee in the state House and the state Senate. Search for “Education Committee in Congress” and “Senate Education Committee” in your state for the names of committee members.
• Include an overview of the problem, a fact sheet to support your views, and information about how all students would benefit from your proposed changes.

Then ask your representatives to do the following:

• Enact legislation requiring all educators to undergo training on the impact of ADHD on the brain, and its implications for teaching, classroom design, and support. [See Proposed Teacher Training Solutions to get more specifics.]
• Equip every educator with a fundamental understanding of the social and emotional impact of ADHD and executive function challenges on learning, motivation, and behavior.
• Encourage universities to incorporate a curriculum on ADHD for general education teachers.

Your Fact Sheet

Help legislators understand the prevalence and consequences of ADHD with these facts:

• The American Psychiatric Association recognizes ADHD as a prevalent mental disorder in children.
• The Centers for Disease Control and Prevention estimates that roughly 10 percent of school-age children have ADHD, though some reports skew higher. This means that virtually every classroom has at least one student with ADHD.
• ADHD is a chronic and sometimes debilitating disorder. It is known to impact the academic achievements and daily functioning of students.
• People diagnosed with ADHD have an elevated risk for school failure, drug and alcohol abuse, accidental injuries, premature death, and suicide.
• ADHD is not specifically identified in the Individuals with Disabilities Education Act (IDEA). Instead, it falls under the “other health impairment” category in IEPs. This distinction might contribute to differences in training compared to training about autism, which affects one-quarter as many school-age children.

Proposed Teacher Training Solutions

Tell your legislators that employing a school district-wide ADHD specialist is the most cost-effective and impactful way to support teachers and students. The ADHD specialist may be an educator or administrator who is already on staff, regardless of discipline. They can:

• Train current and incoming staff to manage the social and emotional impact of ADHD by introducing effective teaching methods. Many simple adjustments in teaching style and classroom environment can significantly improve the learning experience for all students.
• Reduce the time teachers spend managing ADHD students who fall off task, or those with challenging behaviors, by offering guidance and sharing best practices and evidence-based teaching strategies to address situations in the classroom.
• Support parents by explaining how ADHD affects learning, motivation, and behavior. This knowledge will empower parents to become more collaborative and effective partners with teachers.

Over time, these investments in teacher training will lead to a stable and experienced education workforce, while reducing teacher stress, burnout, turnover, and associated costs.

These steps will also improve students’ retention, mental health, underemployment, and rates of incarceration and self-harm.

Effective ADHD specialist training should include:

• A comprehensive, research-based description of the social and emotional impact of ADHD and executive function development on learning, motivation, behavior, and the family system.
• Strategies to address executive function skill development in task initiation, organization, time management, self-advocacy, emotional regulation, and attention regulation. Executive function deficits are addressed by helping each student develop internal and external strategies and skills.
• A program to address challenging behaviors with a strengths-based, collaborative problem-solving approach designed to improve conflict resolution, productivity, and motivation.

Teacher Training for ADHD: Next Steps

• Read: “We Are Behind the Times” Only 4 in 10 Educators Receive ADHD Training
• Sign-up: Free ADHD Training for Educators
• Download: What Every Teacher Should Know About ADHD – A Poster for School
• Read: Everything You Never Knew About Learning Disabilities
• Read: Inadequate Teacher Training Stifles Students with ADHD

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The upshot? Most of the survey respondents said they wish they’d started medication sooner.

Here, ADHD families share their stories of starting stimulants and non-stimulants.

“We were reluctant to use medication but decided to give it a go as our son reached an age when he could tell us if he felt it made a difference. He asked for the tablet the second day because he felt a change in his ability to concentrate.”

“I was reluctant to try medication at first, given the frightening reputation of amphetamines, but my psych provider encouraged me to look past the headlines and investigate the decades of research on stimulants and their effect on ADHD. I was reassured, took the meds, and never looked back.”

[Get This Free Resource: 2024 Scorecard of ADHD Treatments]

“For anyone out there who thinks, ‘I don’t want medication. I can treat ADHD without it,’ you’re probably wrong. I have more self-control than I’ve ever had. Maybe medication isn’t for everyone, but you’ll never know what it can do if you don’t try. Start with a very low dose if you’re nervous. Also, a balanced diet, sleep, and proper supplements have a huge impact on symptoms.”

“I had fears about how meds would affect my teenage son, so after he lost weight on the first couple of stimulants he tried, we were ready to try a non-stimulant. He’s been on it for about two months, and so far, so good.”

“By the time our son was in first grade, he was struggling every single day and was being corrected and fussed at by pretty much every adult in his life. We got him diagnosed, but my husband was adamantly against ADHD medication. The fact is, if our child had cancer or diabetes, we wouldn’t be withholding medication. My son started medication and it was absolutely the best thing we could have done for him. I only wish we’d started it earlier.”

“I wish doctors approached stimulant medications with less fear, particularly around cardiovascular risk. The willingness of at least some doctors to sacrifice treatment for ADHD, a lifelong and potentially harmful condition, in favor of a slightly lower perceived cardiac risk is a real impediment to effective treatment.”

Should I Take ADHD Medication? Next Steps

• Free Download: What to Ask Before Starting ADHD Medication
• Watch: Medication Strategies for Hard-to-Treat Complex ADHD
• Read: How Does ADHD Medication Work?
• Read: Your Top 10 Questions About ADHD Medications for Children

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Stimulant medications, mainly methylphenidate and amphetamine, remain the primary medications used to treat ADHD. For more than 80 years, stimulant medications have been used to safely and effectively treat ADHD, however some basic questions from patients linger. I’ll address a few of them here.

Q: “How Do Patients Decide Whether to Try Medication for ADHD?”

I believe people with ADHD are best served by medication. If your doctor recommends medication, try it. If it helps and doesn’t cause side effects, continue taking it under medical supervision. If the medication isn’t effective or causes side effects, talk with your doctor about alternatives.

At first, most of my patients want no part of ADHD medication. My job is to make sure they make their decisions based on facts, rather than rumors and negative press. Once they know the facts, 90% of my patients decide to give meds a try. If you don’t like the medication, stop taking it. It will be out of your system within a day. But opting not to even try medication is like saying to your eye doctor, “Let’s try a year of squinting before we try eyeglasses.”

[Free Guide: What You Need to Know About ADHD Medications]

Q: “How Do Providers Decide Which ADHD Medication to Prescribe?”

Though there are basic parameters, patients’ responses are unpredictable. How a given medication affects one person may be completely different from how it impacts someone else. So how do we decide? It’s trial and error. For the first trial, I usually offer methylphenidate (e.g., Ritalin) or amphetamine (e.g., Adderall).

Q: “What Is a Good Starting Dose of ADHD Medication?”

I start low and go slow. Prescribers may change the dose every three days if a patient is not seeing any improvement. Some people need only a small dose, while others need a bigger one. For example, Ritalin at 5mg or 10mg once or twice a day is a typical starting dose for some kids.

Once it’s established that a medication works, the prescriber may switch your child to a long-acting methylphenidate like Concerta or Ritalin LA, or a long-acting amphetamine like Vyvanse or Adderall XR, which is taken after breakfast. Some children take an immediate-release Ritalin or Adderall, which I call a “homework pill,” around 3 or 4 p.m. as well.

Q: “How Do You Know If Your Child’s ADHD Medication Is Working?”

Before your child starts medication, make a list with your doctor about what you hope it will address. You might say that you hope your child will get dressed and out the door without a struggle in the morning, that they will finish their homework more quickly, that they will be less forgetful and get better grades, and that they will be more engaged in class and less disruptive.

[Free Download: The Ultimate Guide to ADHD Medication]

Use your list as an objective measure of the medication’s effect. If you see no improvement in your child, ask your prescriber to find a dose of a medication that provides symptom improvement with no side effects (other than appetite suppression without unwanted weight loss). Keep in mind that about 20% of people with ADHD don’t benefit from any medication.

Q: “What Medication Do You Turn to If the First Two Stimulants Don’t Work?”

I might have my patients try Mydayis, a very long-acting form of amphetamine. The non-stimulants approved for ADHD include Strattera (atomoxetine); Qelbree (viloxazine); Intuniv or Tenex (guanfacine); and Kapvay (clonidine). Several medications that have proven effective for ADHD off-label include the stimulant modafinil (Provigil or Nuvigil); Wellbutrin (bupropion); and amantadine, a dopaminergic anti-viral agent that’s primarily used to treat Parkinson’s disease.

Q: “What Are the Most Common Side Effects of ADHD Medications?”

Appetite suppression in children is the most common side effect of stimulants. Less common side effects in adults and children include elevated blood pressure and heart rate, and insomnia. This is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.

It’s important to monitor weight, sleep, heart rate, blood pressure, and moodiness or irritability. If you or your child has problems with moodiness, weight loss, or sleep, talk with your doctor and make changes promptly.

For further details on ADHD medications, including dosages, precautions, and interactions, visit the WebMD Drugs & Medication Database.

Managing Medications for ADHD: Next Steps

Free Download: What to Ask Before Starting ADHD Medication
Q&A: “How Do Doctors Decide Which ADHD Medication to Prescribe First?”
Read: How Safe Are ADHD Medications?
Find: ADHD Specialist or Clinic Near You

Edward “Ned” Hallowell, M.D., is a child and adult psychiatrist and a leading authority in the field of ADHD.

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This quote perfectly sums up the pervasive fear among adults and caregivers of children diagnosed with ADHD. And it remains as detrimental now as it was when authors Edward Hallowell, M.D., and John Ratey, M.D., first published it in their book ADHD 2.0 (#CommissionsEarned).

The first-line medications for ADHD are some of the most effective, best studied, most scrutinized, longest known, and safest drugs in all of medicine. They have been safely prescribed to children for decades. Nonetheless, no other class of medications in virtually all of medicine inspires more baseless fears, intentional disinformation, and wild beliefs as do the stimulants used to treat ADHD. Interestingly, these fears are almost entirely an American phenomenon that hardly exists elsewhere in the world.

ADHD and Stimulants: A Disinformation Campaign Begins

In the late 1970s, a public backlash against treating ADHD with stimulant medication began after groups launched nationally organized, and extraordinarily effective, disinformation campaigns. This instilled a climate of fear among physicians, parents, and educators, and sowed anxiety and confusion among the public. Moreover, it planted in the minds of Americans the otherwise nonsensical idea that it was the treatment of ADHD that was dangerous — not the untreated medical condition itself.

It is also important to make a distinction between side effects due to stimulant medications and those unpleasant experiences caused by poor clinician training and experience. Finding a good clinician is much more difficult than it should be. Establishment medical education has failed miserably to prepare clinicians to diagnose and treat ADHD at all ages.

[Free Download: The Caregiver’s Guide to ADHD Treatment]

The goals of medication treatment include:

• Rule #1: The right medication and dosage matched to the right person should be dramatically beneficial and have virtually no side effects.
• Rule #2: Finely tuned ADHD medication should help you be “the best version of you.”

The Dangers of Untreated ADHD

Clinical neuropsychologist Russell Barkley, Ph.D., has demonstrated that untreated ADHD is not just highly impairing, it can be deadly. In fact, having ADHD lowers a person’s estimated life expectancy by 12.7 years.¹ Barkley has noted that most of the contributors to this mortality are lifestyle-related and can be reversed with treatment.

Research shows that untreated ADHD, with its impulsivity and inattention, raises the risks for serious traffic accidents, addiction, unsafe sexual practices, and self-harm, as well as challenges with academic performance, relationship difficulties, financial struggles, and chronic stress for children, teens, and adults.

ADHD and Stimulants: Facts Over Fears

Baseless fears about stimulant medication have scared caregivers away from seeking proper treatment for their children diagnosed with ADHD. The benefits of ADHD medication, based on decades of research and medical practice, used in conjunction with cognitive behavioral therapy, are profound for many people. The risks stemming from untreated ADHD are equally profound.

[Read: What Are the Long-Term Effects of ADHD Medication on the Brain?]

These are the fears I hear most from caregivers about ADHD medication, and my responses:

Fear #1: Will medication change my child’s personality?

The first-line stimulant medications affect a person with ADHD differently than they do a neurotypical person. Stimulant medications calm and soothe the hyperarousal and loss of emotional control associated with ADHD. A neurotypical person on an ADHD stimulant, by contrast, becomes more agitated, jittery, irritable, and unable to slow down.

Fear #2: Are stimulants addictive?

Having ADHD increases a person’s risk of substance use disorder, regardless of whether they take medication. However, one large study of adolescents found that “current pharmacotherapy for ADHD is associated with lower risk for substance use problems as long as medication treatment is maintained, indicating that pharmacotherapy is likely to be a key part of efforts to reduce substance use risk in those with ADHD.²

Fear #3: What if my child loses weight on a stimulant and doesn’t grow?

Appetite suppression is a common side effect of stimulant medications that goes away when the medicine is taken consistently enough to develop a tolerance to it. Most children ultimately gain weight and grow just as they did before taking medication.

For a small portion of elementary school-age children, most of whom were already picky eaters, the side effect of appetite suppression does create a problem. If a child is losing weight, or just not gaining weight for more than one month, the protocol for reversing this is to:

• Lower the dose of stimulant.
• If that does not work, switch stimulant molecules
• If this is ineffective, use the lowest dose of a gentle antihistamine that is FDA-approved for children 3 years of age and older. While this is an off-label use, it often helps to maintain a very beneficial ADHD treatment until the child becomes tolerant of the medication. Antihistamines like cyproheptadine, for example, return appetite to previous levels for about six hours. They are usually taken 30 minutes before lunch and dinner.

Fear #4: What if a stimulant worsens my child’s anxiety?

ADHD shares a high comorbidity with anxiety disorder. Researchers conducted a meta-analysis of 23 studies of children diagnosed with anxiety who had started on ADHD stimulants and found that anxiety decreased significantly in almost all cases.³

Arm yourself with knowledge. Read about the findings from research studies that have investigated ADHD medication. Then you can make a rational, informed decision about what is best for your child and/or yourself.

ADHD and Stimulants: Next Steps

• Free Download: Reader Scorecard of ADHD Treatments
• Read: Treating a Child with ADHD Medication Diminishes His Future Risk of Substance Abuse
• Read: ADHD Medication Side Effects No One Should Tolerate

William W. Dodson, M.D., is a board-certified adult psychiatrist. He was named a Life Fellow of the American Psychiatric Association in 2012 in recognition of his contributions to the field of adult ADHD.

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#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.

Sources

¹ Barkley, R. A., & Fischer, M. (2019). Hyperactive child syndrome and estimated life expectancy at young adult follow-up: the role of ADHD persistence and other potential predictors. Journal of Attention Disorders, 23(9), 907–923. https://doi.org/10.1177/1087054718816164

² Schepis, T. S., Werner, K. S., Figueroa, O., McCabe, V. V., Schulenberg, J. E., Veliz, P. T., Wilens, T. E., & McCabe, S. E. (2023). Type of medication therapy for ADHD and stimulant misuse during adolescence: a cross-sectional multi-cohort national study. EClinicalMedicine, 58, 101902. https://doi.org/10.1016/j.eclinm.2023.101902

³ Coughlin, C. G., Cohen, S. C., Mulqueen, J. M., Ferracioli-Oda, E., Stuckelman, Z. D., & Bloch, M. H. (2015). Meta-Analysis: Reduced risk of anxiety with psychostimulant treatment in children with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 25(8), 611–617. https://doi.org/10.1089/cap.2015.0075

It’s important to diagnose and treat eating disorders early to prevent prolonged malnourishment and to improve a child’s prognosis.

Eating Disorders and Their Symptoms

Anorexia nervosa

The defining feature of this eating disorder is not actually being underweight or thin; it’s a fear of weight gain or becoming fat, so much so that people eat less and less throughout the day. A warning sign you might notice is that the person is skipping meals, or eating less than what is typical for them.

Atypical anorexia nervosa

This is a diagnosis of anorexia nervosa but in higher weight bodies. These individuals are at risk for going undetected with anorexia nervosa because of their physical appearance.

[Read: Eating Disorders in Children and Teens]

Avoidant/restrictive food intake disorder (ARFID)

This diagnosis is given to people who are not meeting their nutritional needs, but not because they fear weight gain, as in anorexia nervosa. Rather, they don’t prioritize eating. They might say, “I’m hungry, but I just don’t care enough to get myself something to eat” or “I can’t motivate myself to get up and make myself a meal.”

Sensory issues, such as the texture or smell associated with certain foods, may repel adolescents with ARFID, who start eliminating those foods from their diet to the point where they can become malnourished. Other people with ARFID have a fear-based reaction to food. Maybe they’re afraid of choking if this happened in the past, or perhaps they fear bad bouts of stomach upset.

One possible warning sign is a sudden refusal to eat anything but “safe foods” that patients and families feel certain they could eat day in and day out. Some folks with ARFID are very specific about how the food is prepared, or even specific brands and shapes.

[Self-Test: ARFID in Children]

Binge-eating disorder

This affects people who have repeated binge-eating episodes and feel out of control. They cannot stop eating once they’ve started, and they often feel guilty, ashamed, or disgusted with themselves afterward.

Bulimia nervosa

Bulimia involves binge-eating episodes paired with self-induced vomiting, abuse of laxatives or diuretics, and/or exercise to get rid of or make up for the calories that they’ve eaten.

Other specified feeding and eating disorder (OSFED)

This is the most common diagnosis for people who present with some but not all symptoms from several types of eating disorders.

ARFID, Anorexia & Bulimia: Next Steps

• Download: The Eating Disorders Associated with ADHD
• Read: “Foods Can’t Touch on My Plate:” On Life with ARFID and Food Aversions
• Watch: “Eating Disorders Comorbid with ADHD: What You Need to Know About ARFID, Anorexia, and Others”

Christine Peat, PH.D., is the Director of the National Center of Excellence for Eating Disorders (NCEED) and an Associate Professor of Psychiatry at the University of North Carolina at Chapel Hill.

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Bullying is learned behavior. It results, in part, from living in a world that normalizes bullying. We see this every day in the way certain politicians speak and act, and the way some adults and children express themselves on social media. There is an unspoken belief that bullying gets results. The truth is: From neuroscientific, medical, neurobiological, and physiological points of view, bullying and abuse do nothing positive. They only put the health and performance of kids’ brains at risk.

Bullying Trauma

All forms of bullying — yelling, insulting, shaming, berating, and ignoring — hurt different regions of the brain.

• Extensive research shows that bullying harms the prefrontal cortex, the part of the brain involved in executive functioning skills, such as acting reasonably, thinking intentionally, weighing pros and cons, and considering consequences.
• The amygdala, the brain’s threat detection system, may become enlarged as it becomes reactive and hypervigilant, constantly scanning for threats.
• The hippocampus, the brain’s learning and memory center, may shrink as it bathes in cortisol, a stress hormone.
• The corpus callosum, the bundle of fibers that connect the left and right brain hemispheres, may become demyelinated (losing myelin makes it harder for electrical signals to pass quickly and efficiently).

[Get This eBook: How the ADHD Brain Works]

If left untreated, the harm caused by bullying can lead to problems later in life, including substance abuse, anxiety, depression, aggression, conduct disorders, self-harm, suicidal ideation, and relationship issues. That’s the bad news. The good news is that our brains are wired to repair and recover.

The Healing Power of the Brain

From adolescence through early adulthood, neuroplasticity — the brain’s ability to change, get stronger and healthier — is intensive. Teaching children to use breathing strategies, mindfulness, visualization, and co-regulation as ways to shift their reactions toward stability and balance is vital.

All of the following techniques are backed by extensive, peer-reviewed, replicated brain science.

Breathing

When we breathe in a shallow way, quickly, and from our shoulders, our brain believes we are under threat and prepares us to fight, flee, or freeze. We can calm our brains and bodies by breathing from the belly in a slow, rhythmic way. This is how we tell our brains not to worry, to be restful and present, and to feel safe.

[Download: Kid-Friendly Mindful Meditation Exercises]

Visualization

This approach works for the bully and the bullied. When children are frustrated or feel defeated, work with them to actively imagine a different outcome. For example, if a child feels the impulse to lash out and bully their peers, challenge them to imagine what it’s like to be hurt or humiliated. Relating to the victim, rather than threatening them to increase personal superiority and power, can help in lessening or eradicating bullying behavior.

Likewise, when a child is bullied, ask them to visualize what might be going on in the bully’s life that would cause them to be threatening. The goal is not to excuse the aggressive behavior; it’s to understand that each of us has a nervous system that can put us into fight, flight, or freeze mode as circumstances warrant. Then, have them practice body language that exudes confidence, like walking tall and holding their head high as they ignore and walk away from the bully. Also, tell them not to be afraid to seek out a trusted adult for help.

Co-regulation

Help a targeted child feel safe by adopting a loving facial expression, speaking with a gentle tone of voice, offering physical affection, sharing your experiences, and using a melodic speaking pattern. When we speak in a higher-pitched, sing-song voice, as many of us do when we talk to a baby or a pet, it calms the other person.

Those who are targets of bullying can also make their brains more resilient by doing the following:

• Engaging in aerobic exercise
• Eating a healthy diet and taking omega-3 supplements
• Connecting with others
• Getting nine hours of sleep each night
• Spending time in nature

Each of these practices and self-care choices can improve the brain function of children and teens with and without ADHD.

Healing from Bullying Trauma: Next Steps

• Replay: Lifelong Effects of Bullying and the Brain’s Ability to Recover
• eBook: Mindfulness & Meditation for ADHD Symptoms
• Download: Questions to Get Your Child Talking
• Read: How Trauma and Chronic Stress Affect Developing Brains

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Still, clinicians have the power to improve care for Black patients by taking the time to understand and mitigate barriers. Education and action are the foundation.

ADHD in Context: Unseen Factors in the Room

No two patients, even from the same cultural background, are alike in their medical needs. That said, Black patients are disproportionately impacted by the following factors and contributing health issues, which often go unnoticed or ignored but greatly impact outcomes.

Trauma and Poverty

Black individuals are more likely than white individuals to experience childhood adversity, and children who have these experiences are more likely to struggle in school and have emotional and behavioral challenges.¹ Black children are more likely to live in poverty and in disadvantaged neighborhoods, where poor access to quality foods and close proximity to facilities that produce hazardous waste increase health risks.^{2 3} Poor sleep quality is also linked to poverty.⁴ A patient who has experienced or is experiencing one or many of these factors can absolutely have issues with focus, attention, behavior, and learning — issues that mimic, aggravate, and/or overlap with ADHD.

ADHD Stigma

Negative attitudes toward mental health conditions and their treatment are prevalent in Black communities.⁵ Some individuals believe, for example, that ADHD isn’t a real diagnosis — that it’s been made up by white people to get Black children in trouble. This is a belief I’ve seen in my own practice.

[Read: Evaluating and Treating ADHD in African American Children — Guidance for Clinicians]

I was performing an ADHD evaluation on a young Black child whose teachers and school counselor — all white — suspected that he was showing symptoms. His rating scales indeed indicated that he had ADHD. The patient’s mother told me, a Black clinician, “You think like those white folk.” These negative attitudes can erect barriers around somebody who needs help — even if the news is coming from a clinician of the same racial or ethnic background as the patient. Some communities, in addition, may look to faith instead of the medical system to address and overcome mental health concerns.

Medical Mistrust and Misinformation

Black communities may fear the medical system — and with good reason. Their fears are the lasting legacy of past abuses by the medical system (the Tuskegee Study is a harrowing example) and ongoing medical racism that leaves Black patients with worse health outcomes than patients from other groups.⁶ One of the most common and pervasive myths I have to dispel for my patients is that ADHD medication causes children to become addicts. I’ve also heard families express fears that medication is a mind-control tactic.

Fear of Labels

Many Black individuals and families regard the ADHD label and other mental health diagnoses as the start of the end. Parents fear that their newly diagnosed child will be held back and targeted academically — beliefs that must be viewed from the context of the school-to-prison pipeline, which impacts Black students with disabilities more than other students.^{7 8}

Clinician Bias

Clinician bias can skew evaluation and treatment outcomes. Black youth, for example, are more likely to be diagnosed with disruptive behavior disorders like oppositional defiant disorder (ODD) and conduct disorder (CD) and are less likely to be diagnosed with ADHD.⁹ In my experience, I’ve seen these diagnoses given when ADHD doesn’t respond to medication as expected and when emotional dysregulation, including anger, is present. In other words, many clinicians think, “If we can’t get it right, then it must be ODD or CD.” Sadly, many patients spend years with inadequately treated ADHD when success is simply a matter of increasing, adjusting, or changing the medication for better symptom control.

[Read: Why We Need Clinicians of Color to Normalize ADHD in BIPOC Communities]

Clinician bias also affects how much a doctor invests in treating a patient, an issue that impacts Black patients the most, as doctors are more likely to describe Black patients with negative descriptors (e.g., “difficult,” “not compliant,” “agitated”).¹⁰ When this is the case, patients are cut off from options that can better treat symptoms and improve functioning and wellbeing.

Communication Styles

Some patients and families may communicate issues using a certain vernacular, colloquialisms, verbiage, and/or a dialect that clinicians may misunderstand or misinterpret. Without any clarifying follow-up, there could be a missed diagnosis or misdiagnosis.

Racial Disparities in Health Care: How Clinicians Can Improve ADHD Care

1. Identify your blind spots. We all have them, and it’s our responsibility as physicians to go out of our way to check them regularly in order to better address our patients’ needs. Implicit bias training can help you identify your blind spots. Take the free Implicit Association Test (IAT) to learn about your hidden attitudes and beliefs. As you learn about and acknowledge your blind spots, tell yourself before you start your workday, “I know I have biases, but I am going to go above and beyond for my patients to make sure I do my job correctly.”

2. Don’t be afraid to ask questions. Questions communicate interest, not ignorance. When you ask a patient about themselves, and how their identity and intersects with their health and wellbeing, it shows that you are paying attention to who they are and it builds trust.

3. It’s your duty to get information out of your patient. Recognize that patients may express health concerns in ways you’re not accustomed to hearing. A comprehensive clinical interview is vital for understanding and clarifying your patient’s concerns, including issues that may mimic or co-occur with ADHD. Rating scales alone won’t cut it. Also remember that patients often have to jump through several hoops to make medical appointments; no one shows up to an appointment (a costly one at that if they don’t have insurance or full coverage) because they feel like it. Think twice before you deem patients “noncompliant” or judge their motivations for being there. There are real concerns to be addressed, and it’s your job to uncover those needs.

4. Ensure all medical decision makers are in the room. In some families, a child’s grandparents — not their parents — may be the ones who ultimately decide on treatment. Take time to understand a patient’s family dynamics.

5. Help patients and families understand the benefits of an ADHD diagnosis. Parents should understand that ADHD is treatable, and that a diagnosis will allow their child to get the services to which they are entitled. Families should run to, not away from, special education services and their tailored resources. Explain to concerned parents that all educational services requiring funding — from gifted and talented programs to resources for students with disabilities — go through special education.

6. Obtain consent and ensure transparency. If you believe a patient will benefit from additional medical and wellbeing services, inform them and only put in an order after obtaining their approval.

7. Understand a patient’s circumstances and expectations. Do not assume that your approach, model, or ideas are the best fit. Really listen to what your patient identifies as their top issues, what they expect out of treatment, and what circumstances will allow them to pursue. Then devise a comprehensive treatment plan that covers those needs. Behavior parent training, for example, may necessitate an alternative approach if caregiver schedules and stressors interfere with the consistent application of positive reinforcement and discipline. No matter the plan, ensure that you, your patient, and other decisionmakers are on the same page.

8. Empower patients to advocate for their health. Most ADHD cases are treated by primary care physicians, but there are a host of providers — from nurse practitioners to psychiatrists — who can help. While insurance plans and financial circumstances may limit where patients choose to go, they should still be aware of these options. Comfort and compatibility are key when choosing professionals, so remind patients that there is nothing wrong with seeking second opinions. Often, the best way to find doctors — especially culturally competent providers — is by asking friends, relatives, faith and community leaders, and other trusted individuals for recommendations. BlackPsychiatryDirectory.com is a helpful resource.

9. Commit to ongoing education. As a psychiatrist, I consider myself a social scientist, and I invite all clinicians to take this approach. Be interested in people and cultures outside of your own. Books, news, films, television shows, and podcasts are all great ways to gain exposure to different cultures and identities.

Racial Disparities in Health Care: Next Steps

• Read: Why ADHD Is Different for People of Color
• Read: ADHD Clinicians Must Consider Racial Bias in Evaluation and Treatment of Black Children
• Read: We Need to Talk About ADHD Stigma in BIPOC Communities

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “Health Equity in ADHD: Addressing Racial Disparities in Diagnosis & Treatment” [Video Replay & Podcast #495] with Napoleon B. Higgins, Jr., MD, which was broadcast on March 7, 2024.

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Sources

¹ Bethell, C. D., Davis, MB, Gombojav, N, Stumbo, S, Powers, K. (2017). A national and across state profile on adverse childhood experiences among children and possibilities to heal and thrive. Retrieved from http://www.cahmi.org/projects/adverse-childhood-experiences-aces/.

² Shrider, E., Creamer, J. (2023). Poverty in the united states: 2022. U.S. Census Bureau. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2023/demo/p60-280.pdf

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First, ADHD is a complex condition comprising genetic, environmental, and neurobiological factors. This intricate relationship makes it challenging to pinpoint specific brain patterns or abnormalities that definitively indicate ADHD. Unlike some neurological conditions in which a distinct physical anomaly (e.g., tumor, stroke, etc.) or clear activity pattern (e.g., seizure) can be observed, ADHD presents a more nuanced picture.

Second, the symptoms of ADHD can vary widely among individuals. While difficulties with attention, motivation, and impulsivity are hallmark features, these symptoms present differently from person to person. Some may primarily struggle with attention and focus, while others exhibit more impulsive behaviors. This variability makes it difficult to identify a universal brain signature for ADHD across all affected individuals. In addition, claims of certain types of ADHD based on particular brain patterns go way beyond what the research supports. This is why using brain scans to diagnose ADHD is not supported by any of the professional organizations, including the American Medical Association.

Brain scans, such as functional MRI (fMRI) or PET scans, measure brain activity by detecting changes in blood flow or metabolic activity. These techniques provide valuable insights into brain function and can help detect certain kinds of neurological problems. Unfortunately, they don’t sufficiently capture the more subtle underlying neurochemical processes associated with ADHD. The brain’s intricate network of neurotransmitters, like dopamine, norepinephrine, and serotonin, are involved in ADHD. But their levels and interactions cannot be assessed through conventional brain imaging alone.

Clinical Assessments Are the Gold Standard for ADHD Diagnosis

ADHD is best diagnosed through comprehensive clinical assessments that consider a range of factors. These assessments typically include interviews with the individual, observation of behavior, reports from family members, and standardized rating scales. These methods provide a holistic view of a person’s symptoms, functioning, and history under real-life conditions and across time and circumstances. By contrast, brain scans capture a snapshot in time, sitting still in a scanning device. To put it bluntly, ADHD should be diagnosed based on an evaluation of real-life functioning, not test results.

[Get This Expert Resource: Unraveling the Mysteries of the ADHD Brain]

It’s essential to recognize that brain scans do contribute to our understanding of ADHD in meaningful ways. Research using neuroimaging techniques has identified differences in ADHD brain structure and connectivity, specifically in the regions involved in attention, executive function, and impulse control. While such findings are valuable for scientific knowledge, they are not yet precise or consistent enough to serve as diagnostic markers for individuals in clinical settings.

The interpretation of brain scan results requires expertise and context. It’s not possible to equate a particular brain pattern or system observed in an MRI or PET scan to ADHD. Many other factors can influence brain activity, function, and structure, including mood, medication effects, substance abuse, sleep deprivation, and co-occurring conditions such as anxiety or depression. Failing to consider all these variables and relying solely on brain scans for ADHD diagnosis can lead to misinterpretation or misdiagnosis.

ADHD Assessment Requires a Holistic View

Advances in technology and methodology may eventually lead to more refined ways of using brain imaging for ADHD diagnosis, such as incorporating machine learning algorithms to analyze complex brain patterns. In the meantime, a comprehensive and individualized approach remains the gold standard for ADHD assessment. This approach considers not only brain function, but also the psychological, behavioral, and environmental factors that contribute to an individual’s experience of ADHD. It emphasizes the importance of tailored interventions, including behavioral therapies, educational support, and medication management.

While brain scans offer valuable insights into the complexities of brain function, they currently don’t add much as diagnostic tools for ADHD. The disorder’s multifaceted nature, variability in symptoms, and the need for comprehensive assessment underscore the limitations of relying on neuroimaging. Understanding ADHD requires a holistic perspective, including clinical expertise, thorough evaluation, and ongoing research into its biological underpinnings.

Functional MRI (fMRI) for ADHD? Next Steps for Parents of ADHD Teens

• Self-Test: Do I Have ADHD? Symptom Test for Adults
• Download:What Every Thorough ADHD Diagnosis Should Include
• Read:Mapping the ADHD Brain: MRI Scans May Unlock Better Treatment and Even Symptom Prevention
• Watch: How Brain Imaging Helps Us Understand and Treat Attention Deficit

This personal essay reflects the opinions of the authors.

Stephanie Sarkis, Ph.D., is an author, mediator, and therapist.

Ari Tuckman, Psy.D., is a psychologist and the author of More Attention, Less Deficit: Success strategies for Adults with ADHD (#CommissionsEarned)

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