Let’s untangle...

Through articles, podcasts, book excerpts, and downloadable bookmarks, my goal is to share practical advice and research-backed guidance that addresses the big and small challenges that come with family life.

And if you’re in search of more timely resources, Untangling 10 to 20 is my new digital subscription offering a dynamic library of video content and articles for parents, caregivers, and teens.

Become a member

The Emotional Lives of Teenagers

The Emotional Lives of Teenagers

Lisa's latest New York Times best seller is an urgently needed guide to help parents understand their teenagers’ intense and often fraught emotional lives—and how to support them through this critical developmental stage.

Under Pressure

Under Pressure

Lisa’s second New York Times best seller is a celebrated, urgently needed guide to addressing the alarming increase in anxiety and stress in girls from elementary school through college.

Untangled

Untangled

Lisa’s award-winning New York Times best seller–now available in nineteen languages–is a sane, informed, and engaging guide for parents of teenage girls.

Join today

Untangling 10 to 20 is a dynamic library of premium content designed to support anyone who is raising, working with, or caring for tweens and teens.

Become a member

Already a member?

Log in

November 28, 2023

Ask Lisa Podcast - Episode 146

What’s the Best Way to Help a Kid with ADHD?

Episode 146

Dr. Lisa and Reena tackle the nuances of ADHD: what to look for, when to be concerned, and the overlap between ADHD and executive functioning challenges. Dr. Lisa unpacks how, ideally, an ADHD diagnosis is made and the treatment options for kids and teenagers who receive the diagnosis. The conversation also answers some key questions about when medication should be considered, whether taking medication for ADHD increases the risks of misusing substances, and whether a medication trial can be used to confirm an ADHD diagnosis.

November 28, 2023 | 27 min

Transcript | What’s the Best Way to Help a Kid with ADHD?

TRANSCRIPT | WHAT’S THE BEST WAY TO HELP A KID WITH ADHD?

Ask Lisa Podcast, Ep. 146: What’s the best way to help a kid with ADHD?

The Ask Lisa Podcast does not constitute medical advice and is not a substitute for professional mental health advice, diagnosis or treatment. If you have concerns about your child’s well-being, consult a physician or mental health professional.

The following transcript has been automatically generated by an AI system and should be used for informational purposes only. We cannot guarantee the accuracy, completeness, or timeliness of the information provided.

——

Reena Ninan
You know, I always get my Christmas tree the day after Thanksgiving.

Lisa Damour
I’m impressed, Reena.

Reena Ninan
I would get it probably the week before Thanksgiving, because I think Christmas should be a two month long celebration. But it’s a thing we always do in our household. But we were in Texas visiting my brother and Austin. And so we weren’t able to do it as soon as I would like. But I’m one of those believers that Christmas starts the day after Thanksgiving.

Lisa Damour
I’m not I we take a beat. And then we go get our tree. But I do love. I do love this time of year. It’s a ton of work. And it’s also really lovely. I remember when my kids were little though, you know, we were talking recently about sharing on social media. I put up a post that felt so deeply how I felt I took it off my Christmas tree. And I wrote Christmas with little children is so fun. I just wish they would stop touching everything.

Reena Ninan
That is spot on.

Lisa Damour
I don’t know if I should have shared that or not. But I did.

Reena Ninan
Oh, if we went back and looked at every single post we did it would just be a nightmare. But you know, one thing we want to touch on is ADHD. I know a lot of parents are struggling with that with their children. And I don’t know much about it. So I we thought this would make a great episode. I want to read you the letter that we got. It says Dear Dr. Lisa, I really enjoyed listening to your podcast concerning helping a disorganized teen. It hit home for me as I have a 17 year old son who was highly disorganized struggles with executive functioning is very messy and very bright. Would you offer any advice for kids who suffer from those traits, and may also have ADHD. I’m so grateful for you and have all your guidance from your books, articles and podcasts that have been given to me over the years. Thank you very much. Well, first off, okay, what do people need to know about ADHD that they might not know?

Lisa Damour
There’s a lot Reena, actually. It’s one of those diagnoses that’s been around for a while you hear about it a lot. And I think there’s a lot of misunderstanding. So, you know, let’s just even start with ADHD versus executive functioning problems, right? Because this this letter writer is asking like, you know, my son definitely has executive functioning issues. He may also have ADHD, okay, well, how are these different? So one way we can think about it is that people who have executive functioning problems may or may not have ADHD, they’re, you know, you could have a perfectly strong capacity for attention and still struggle to, you know, with executive functioning. Almost anyone with ADHD is going to have executive function in problems. So that’s a way to sort of tease those apart a bit. Right, that they’re not the same, but there’s heavy overlap, especially for kids who know have ADHD.

Reena Ninan
What would you say that is the difference between struggling with executive functioning and having ADHD?

Lisa Damour
So what’s interesting in the letter, the parent says, like may have ADHD.

Reena Ninan
Oh, interesting. I didn’t pick up on that.

Lisa Damour
So part of what needs to happen here is to figure out if the kid has ADHD, like if that’s really at play here.

Reena Ninan
So let me back up. How do you know if your kid has ADHD? Are there like signs that are just clear warnings?

Lisa Damour
Well, you can strongly suspected when you see problems with attention, right, that’s the A or hyperactivity issues. That’s the age so as Attention Deficit Hyperactivity Disorder, now you don’t don’t always see both of those. Sometimes you see more attentional problems, sometimes you see more hyperactivity problems. But if you feel like, your kid doesn’t listen, they lose their stuff all the time, you know, they can’t do a three step thing, or they can’t sit still, or they’re as wiggly as can possibly be, or they fidget nonstop. Parents sometimes start to think like, Okay, this, this doesn’t feel just like the other kids I see around us, my kid feels higher on these traits. Or the school may say something, right? It’s not at all unusual for this to come into a family’s life by a teacher saying, Have you ever thought about or considered an evaluation for ADHD?

Reena Ninan
Okay, so when you’re talking about this mom, if they do diagnose, that they’ve got ADHD, what’s your best approach at that point?

Lisa Damour
Well, so let’s actually hover for a minute on the question of like, how do you even diagnose this, right? So the parent might be like, I don’t know, this is feels like this is hard for my kid in a way and hard for me in a way that doesn’t feel you know, in line, maybe with other kids are raised or you know, things like that, or the school may bring it up. So what I think doesn’t happen nearly enough, is a very, very careful diagnostic process. So when you ask, like, what do people need to know about ADHD, like you want a diagnosis really, really carefully. And I would say probably one of the number one things for people to know about ADHD is that it’s easy to confuse with depression. It’s easy to confuse with anxiety, right? If a kid is depressed or anxious, they are going to struggle to focus they are, you know, going to lose their things. I mean, there’s, you’re gonna see a lot of not necessarily maybe losing things, but you’re gonna see a lot of overlap in what we would say is the symptomatology where they can’t really focus or they, you know, are struggling with motivation, that can be something that is true for kids with ADHD, they kind of can’t follow through on things. Well, if you’re depressed, you can’t follow through on things. If you’re anxious, you may run into interferences with getting things done. So honestly, really, like I would say, the big, big thing I would want people to know is, we want to really be careful in coming to this conclusion. And I’ll tell you, like, this is so obvious. But so essential, and basic, and how we think about these things. If you don’t get the right diagnosis, you’re not going to do the right treatment. And if you don’t do the right treatment, the kids not going to get better. So, you know, that’s one of the things that like, was really, you know, hammered into me as a clinician is like, spend time on diagnosis, like don’t just, you know, shoot in the dark on these things, like really take time to do it.

Reena Ninan
Really take time to do it. I think a lot of times when we talk about ADHD, I don’t hear much about the diagnosis process. So tell me, what does that look like when you’re trying to diagnose a child whether they have ADHD or not?

Lisa Damour
Okay, so I’m gonna give you the like, ideal circumstance, like, you know, optimal world version of this, which is expensive and time consuming, and not easily accessible to everybody. And then I’m going to give you what often happens, or what can kind of happen, you know, as the alternatives. So in the dream scenario, right, like boundless resources and time and access to those resources, right, so not everyone, very few families are probably going to enjoy this, I would have kids get a psychological evaluation that involves a testing done by a psychologist who specializes in academic or educational testing. There’s also a neuro psychologist who specializes in this. It’s time consuming battery, it involves an IQ test. It involves academic measures, it involves attentional measures, depending on what’s going on for that kid, they may throw in additional measures. Also, in this deluxe package of doing a really good diagnostic evaluation, there would be rating forms that went home to the family, where they rate their kids on measures of attention and hyperactivity, and symptoms related to ADHD, they will go to the teachers who also do the ratings. And then if the kid is old enough that the kid themselves would rate so we have these forms that we can use. And so all of that will be brought together. And then assessed by someone who does this, like all day long, right? is assessing kids like this all day long and can look at all of those pieces and parts, tease out depression, tease out anxiety, tease out, you know, any variety of other concerns and then home in and say yes, you know, the All signs point to ADHD is the main explanation. So that’s the deluxe version. Okay, what often happens, and I’m not I mean, because like, life happens, reality happens like what I just described like not a lot of people are going to have that kind of access time or, frankly money to cover those things. Is pediatricians are often you know, trying to manage this is because we are asking them to do so much frontline work on these things. They may have Families fill out reading forums, they may, you know, have teachers fill out reading forums. Here’s the pros and cons of the reading forums. What’s great about the reading forums is that they are normed meaning that we have used the same rating forums to assess like, literally 1000s and 1000s. And 1000s of kids have every single agent, you know, gender. And so we asked, you know, parents fill out this form about, like how your kid acts at home. And the parent may be like, Oh, my God, my kid is totally off the wall, and definitely has ADHD. And we’re like, actually, when you hold your numbers up against 1000s of 14 year old girls, she’s right smack dab in the middle right are. So the the rating forms are very valuable in that they help norm things. Technically, we don’t use them to make a diagnosis, like it’s really not seen as like kosher to be like, Okay, your kids like high score on the rating form your kid has ADHD.

Reena Ninan
So how do you get that diagnosis? Yes or no?

Lisa Damour
So ideally, with the deluxe version, I think it often happens that pediatricians schools, you know, are sort of working with reading forums working with what they’re observing, right that they, you know, the nice thing is teachers see a lot of kids like they, they do have a very strong sense of their own internal norms for like, fifth graders should be able to do X, Y, and Z. And you know, your kid is off the charts on this. So it is sometimes the case that a pediatrician will make the call and be like, You know what, enough signs are pointing in this direction. And I would like to refer you for a psycho educational evaluation that is either never going to happen, or you don’t have the resources or it’s not going to happen in a timely enough way. So in truth, Reena, right. The call sometimes gets made. And and I’m saying this with no judgment, like sometimes the call gets made, you know, without having met the threshold of my ideal, you know, dreamy diagnostic level of evaluation.

Reena Ninan
Lisa, I’m going to ask you a little bit about ADHD medication because I know people of my generation Generation X, I know a lot of men in particular who were put on ADHD meds and there’s a whole whole thing on that at an early age. But I I’m just curious, if you go and you put your child on ADHD meds, does it in any way open the door to them wanting to try other drugs?

Lisa Damour
So we’ve studied this, and I will say it’s helpful when something is relatively common in the culture, right? ADHD diagnosis is pretty common. And medication as a treatment is pretty common. Because what’s helpful is it lets us actually assess Okay, so then what are the outcomes? Like we can look at these in large numbers, we’re not just guessing, like, you know, could a bad thing happen? And I will tell you, Reena, the research on this point is actually quite reassuring. And what it shows is that when ADHD is properly treated, and kids and teens, and I’m just going to put a pin in this, which may or may not involve Mets, we’ll come back to proper treatment that may or may not involve meds. But when ADHD is properly treated, it actually reduces the risk of substance use and teenagers. It sounds counter functioning better. Well, that’s but that’s the hope, is it right, that they’re functioning better. They’re in less distress, because the thing about ADHD, like, you know, I, you know, I like live for, like, the technical, like, here’s how we diagnose and here’s, you know, whatever, is thanks for the kid, right? I mean, there’s a lot of things you can say about ADHD. And I’m gonna say something that is like, surprisingly accurate across most kids, but again, not every kid, kids with ADHD tend to ride behind, academically and socially, like somewhere between 10 and 30%, you know, of their peers. So if you have ADHD, and it’s untreated, this is not fun for you, you are in school all day, every day, you know that you are missing things you are seeing often the academic impact. You are hanging out with kids all day, every day. You are also they’re missing things, or you’re hyperactive in a way that actually starts to be frustrating to your peers. And so you’re starting to get, you know, into more social difficulty. So, ADHD, beyond being taxing for teachers taxing for parents, right, which it is. What really matters is it’s really hard to be a kid whose neurological hand they were dealt is not particularly well designed for what we asked kids to do in a day, right like and you know, in other settings, kids who have this diagnosis will thrive all day long. But if you put them in a conventional school, it’s a long day. So if we reduce distress by getting their ADHD properly treated? I think the theory is, and I this seems to be very, very likely, you know, well, kids who are in less distress are less likely to go seeking substances as a way to feel better.

Reena Ninan
Well, that makes me feel better to hear you say that, and that doesn’t open the door. But I do want to ask you, let’s say someone does have ADHD. If the meds work for your child on ADHD, does that 100% mean, of course, they have ADHD, see, the meds are working?

Lisa Damour
Okay, so there’s two questions here. Like I want to really unpack because like, the meds question around ADHD is so loaded, and I really I have sat with families where they’re like, I do not want to give my kid…

Reena Ninan
Absolutely right. I think I would feel that way. Yeah,

Lisa Damour
I get it, I think absolutely. Like, it’s really scary to think about giving your kid a medication that’s going to alter who they are, or how they function in the world. Like, I do not minimize that for a minute. So the thing I want to say, first and foremost, is right now, meds and educational interventions, and we can come back to that are considered the standard of care for ADHD. And what I mean by that, and I hope people find reassurance in this as clinical communities, we come to agreement about what is the standard of care for any given concern. And this is true in the medical world, too, right? If you show up at the ER with a heart attack, it’s not likely you’re like, I don’t know, what do you want to do today? Right? I mean, like, they have the systems, they have the agreed upon, like, when somebody comes in with these symptoms, we all agree like we across the whole medical universe agree? This is what you do. Okay, we have the same in psychology, right? So if a kid gets a great diagnosis of ADHD, like a well done diagnosis of ADHD, the standard of care, like what we have studied and come to agreement on is medication plus educational interventions. Now, that doesn’t mean that’s what every kid should have. But for parents who are like, ah, yikes, that makes me super anxious, which I think would be most parents. I just want you to know, we’re not flying by the seat of our pants on this. We’re not making it up as we go. We’re not experimenting on your kid. I mean, like we’ve really thought this through. Okay, so we’ll come back to the question of like, what if it’s a no go on the mats? Like, what if you want to try something else? But one thing that people ask and it’s like, exactly what you just asked, it’s such an important question is, well, what if I think my kid has ADHD? And we just put them on meds and they get better? Is that how we can make the diagnosis? Right? Like if if they if they improve because of meds? And we skip the whole, like, complex diagnostic process? Like, does that check the box? Okay, here’s the deal. anyone’s attention and focus is improved by ADHD meds, like if you were I took Adderall, today, we would have a highly productive day like we wouldn’t get it done. So we don’t expect that as a way to make the call on whether or not a kid has ADHD because anybody’s going to have their intention and focus improved by that.

Reena Ninan
Wow, that’s so interesting. I didn’t realize that least when you’re looking at this, and I have to say like, the Indian Baron and me were, you know, I come from Iowa, Veva, these natural holistic treatments, right? There’s a part of me like you were talking about a heart attack. If someone has a heart attack, you go in and you do things to get it done. And you are probably maybe on medication, possibly right. But ADHD, and I just feel like, you know, could I give him a little bit more watermelon or some sort of he’s just deficient in some sort of mineral that I can, you know, give him a solid hardier meals that might help. I mean, are there alternatives to medicine that are proven to work for ADHD?

Lisa Damour
I don’t think there are widely embraced on the academic and clinical side, non traditional interventions, beyond things like enough sleep is going to make a huge difference. I mean, like in terms of just biological intervention, sleep, of course, is always critical. And the reality is Reena, at this point, we have a lot of ADHD medications, stimulants is what they’re called, by and large, that’s the main class. And we’ve studied them for a long time. But if a family’s like, I don’t want to go there, like that just doesn’t feel right. You know, I mentioned that the standard of care is both meds and educational interventions. The other thing that has to happen with or without the meds is really supporting, essentially executive functioning right back to executive functioning. So if a kid has ADHD, with or without meds, they should have really good routines that help them focus they should be doing their homework in a place that is predictable. And also not that cluttered, right, like they can’t have too many other things that can possibly draw their attention. They’re gonna need help with motivation, probably, they may need someone who sits nearby, or they may need timers to like keep them going and then rewards at the end of a period of work, they’re going to need to get a planner, and they’re going to need to use it. And then they’re going to need someone to check in on whether or not they’re using it. They’re going to need checklists for their stuff. And whether or not they have all the stuff they’re supposed to have. They’re also going to need to not have things with them that they’re not supposed to have, like if they have homework, they should only have in front of them exactly what they need for that particular project and nothing else. So all of these things have to happen to so what I would say to a family that’s like, Ah, I don’t know about meds, minimally like then go all in on all this other stuff and see if that makes enough of a difference.

Reena Ninan
Wow, I guess we’re always looking for alternatives to medicine. And I know there’s a lot of parents out there that struggle with making that decision, but know that the meds can be a game changer.

Lisa Damour
They can. And actually Reena, there’s something else about these meds that’s pretty unique. And something I want folks to know, which is they’re extremely short acting. What does that mean? So they are in and out of a kid system, depending on their prescription? Like, within 12 hours, I think the outer limit, but like four to eight, I think is pretty typical.

Reena Ninan
Wow, I didn’t know that.

Lisa Damour
Yeah, no, it’s a pretty unusual thing. And you know, if you think about like treating someone for depression, if we’re going to use meds for that, those meds take two to three weeks to titrate up to a level that can have an impact. And then you have to be on them for a few weeks, at least to see if they’re really working. And then if they’re not like ideally, then you’re titrated off of those and titrated up on something else. Whereas if a parent is highly hesitant about meds, it’s not unusual for a clinician, and I’ve certainly done this in my clinical practice to say, you know, you can try this for a week, you can try this for a day, you give the kid the mad, you see the impact. It’s in and out of their system very, very quickly. And so, your reservations, you know, if you have reservations, like it’s not like you’ve committed to anything that you can basically kind of run through their system, and then it’s gone.

Reena Ninan
Well, I learned so much from you today about ADHD, but just standing back before we go into Parenting to Go, what’s the wide view you want the community at large to know about ADHD?

Lisa Damour
I think the wide view is if you can be cautious and systematic in the diagnosis. And you know, that may involve resources in your community that may involve, you know, talking to your insurance company, I mean, I really want people to do this well, because when we have a good clear diagnosis, the quality of the treatment goes up. And then of course, what really, really matters is the improvement for the child goes up there when we can treat Well, we can help kids. And that’s the whole point is that we want to help kids. And when we’re kind of messy about this process, or shooting in the dark on this process. The kid doesn’t tend to get the results they deserve.

Reena Ninan
Boy, you really have got me thinking a lot of things when it comes to ADHD that I didn’t realize and didn’t know, but can be a game changer for so many people. Lisa, what do you have for us for Parenting to Go?

Lisa Damour
So the bad news is, it’s hard on everyone. If a child has an ADHD diagnosis, the good news is we have really been working on the topic of ADHD as clinicians for a long time, we know that it’s a big tent, there are a lot of variables within it. But there are great resources online. And I would want people to feel comfortable using those. And if I were starting, I would start with the American Academy of Pediatrics. They have lots of resources about ADHD online and very reliable and thought through once. So what I would say especially around things like this can feel so tricky, and so new to the parent who’s having the experience of trying to figure it out. And what I often say when I’m caring for a family is like, look, this may be your first kid with ADHD. This is my 30th kid with ADHD like you don’t have to do this alone.

Reena Ninan
Thank you, Lisa. Again, like there’s so many issues that our kids might not be dealing with directly that understanding and having a better knowledge might make us a little bit more sympathetic and compassionate. But it’s just great information. And next week, we’re going to talk about harassment. Girls that are harassing boys. In fact, a mother writes in about her son being harassed by girls and asked what she should do. I’ll see you next week.

Lisa Damour

The advice provided by Dr. Damour here will not and does not constitute - or serve as a substitute for - professional psychological treatment, therapy, or other types of professional advice or intervention. If you have concerns about your child’s well-being, consult a physician or mental health professional.

My new book is now available!

The Emotional Lives of Teenagers Raising Connected, Capable, and Compassionate Adolescents