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ADHD in Girls

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When most people think of ADHD, they often think of the hyperactive boy being disruptive, naughty, and rude. What they do not picture is the girl who is sitting quietly doing her work at her desk.

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Approximately 4.2% of the population in Australia, under the age of 14 have ADHD. Boys are (on average) three times more likely to be diagnosed than girls. Girls are also diagnosed (on average) 5 years later than boys (average age of diagnosis for boys is seven and for girls it’s twelve). When you think of that in terms of years of intervention that are lost for girls, that is significant.

Quinn and Madhoo (2014) concluded that girls are often misdiagnosed with anxiety and depression instead of ADHD due to the way that ADHD looks in girls compared to boys. Often the same core symptoms look different in girls than boys. e.g., a boy might be physically hyperactive, where a girl might be verbally hyperactive. A boy might show aggression because of emotional difficulties related to ADHD, where a girl may withdraw or cry. Often girls with ADHD are labelled as “emotional.” Girls are also often better at masking their symptoms and demonstrate internalising disorders (e.g., depression, anxiety, withdrawal) more often than boys with ADHD, often making it difficult to “see” her symptoms.

Early identification and treatment for girls (and boys) with ADHD are vital. There are many great articles and websites if you are interested in the differences between boys and girls with ADHD (ADDitudemag.com here and here, Child Mind® Institute and a great YouTube episode from How to ADHD.)

Research into girls with ADHD is sobering, and their underdiagnosis is concerning. Dr Pat Quinn (Developmental Paediatrician) reports that, even when girls are displaying the same symptoms as a boy with ADHD, they are less likely to be referred or treated for ADHD, often ending up with a mental health diagnosis instead (e.g., anxiety, depression, Bipolar disorder). ADHD significantly increases the risk for many comorbid disorders and significantly worse long-term outcomes than girls who do not have ADHD. 

Research shows that in comparison to girls without ADHD: girls with ADHD,

  • Have lower self-esteem.
  • Is more likely to blame herself for her difficulties (e.g., “I failed the test, which means I’m so stupid!”) and live with more shame. 
  • Have more trouble making and keeping friends. They are known to have significantly more difficulty in friendships, peer interactions, social skills, and functioning, as well as a higher chance of being bullied.
  • Show unique issues during puberty, related to hormonal effects on ADHD and how they respond to treatment. Often girls with ADHD may not realise the impact on their functioning until they are older. Sometimes not until high school, university, or even, until they have children of their own.

Particularly during the tween, teenage and adult years, they are far more likely to struggle with mental health issues than girls without ADHD. Girls with ADHD are:

  • 5.6 times more likely to have Oppositional Defiant Disorder (ODD)
  • 9.4 times more likely to have conduct disorder (CD)
  • 3.2 times more likely to have anxiety 
  • 4.2 times more likely to have depression. 
  • There is also a significantly higher risk of suicide in people with ADHD (for boys and girls with ADHD across all age groups). Some studies have shown adolescents with ADHD are 10 times more likely to attempt suicide than adolescents without ADHD. The Black Dog Institute reports that suicide is the leading cause of death from people aged 5-17 years old.
  • More likely to have lower IQ and achievement scores. However, a higher IQ and satisfactory achievement at school should not rule out an ADHD diagnosis. Many girls with ADHD perform well at school, particularly in the primary school years. 

By now, I have probably scared you, and you are now panicking, thinking that our girls with ADHD are doomed. Take heart; studies do indicate that we can reduce the impact of ADHD with treatment. Gold standard treatment at this stage is both pharmacological treatment (medication) and psychosocial whole family interventions. 

As parents, carers, teachers, health professionals, and others who love, live, and work with girls with ADHD, we need to be aware of the difficulties that girls with ADHD may face. We must be proactive in providing the environment and supports they need. 

Here are some of my top tips for supporting for girls with ADHD – (I also want to be clear here that these are important and beneficial with boys with ADHD too!)

Proactive Professional Help

Before we dive in, I am not a psychologist. Every child with ADHD is different, and a one size fits all approach will not work. It is crucial to seek out support from a trained professional. Talking to your GP about options for psychology is a fantastic first step. In Australia there are many online programs, some of them free, that you can link into.

You don’t have to wait until there is a problem before booking your daughter in to see a psychologist. As a society, we often think that we must be in dire straits before reaching out for help. Girls with ADHD will often internalise their difficulties, opting not to discuss them with her parents or carers. You may not know she is struggling until it is too late. A ‘head in the sand’ approach to your child’s mental health could cost your daughter their life. 

It is crucial to be proactive and not reactive when working with a child’s mental health. Reactive mental health care means waiting until the child has a mental health problem to get help for it. Proactive mental health care can help people with life skills and coping competencies before they have any mental health issues. It can give her tools (e.g. problem-solving skills, strategies to deal with stressful life events, challenging negative thoughts) to deal with any mental health issues before they arise. As well as having a mental health professional monitoring her for any potentially concerning areas.

I have been both reactive and proactive with my children. With my son, by the time we really “needed” a psychologist, our family was at breaking point. His levels of aggression and anger were unbearable. We ended up having to wait months for an appointment (this was even privately). After several months, we had seen such a change in him and us! We didn’t stop the appointments there though. He would chat with his psychologist once every couple of months, about anything that was on his mind. Several more months down the track, he was having a hard time at school, as his best friend had left and changed schools. One day after school, he got into the car and asked me to make an appointment with his psychologist to chat about it. There was no shame in it for him. At the age of 9, he saw the value and importance of seeking help when you are having a hard time.

Prepare her   

Alexander Graham Bell (the inventor of the telephone) said “Before anything else, preparation is the key to success.”

I love this quote so much, and I believe it is vital for our children with ADHD. Research shows that girls with ADHD live with lower self-esteem and significantly more shame than their peers without ADHD. The shame of trying their best and still often falling short, continually having to say sorry, or consistently having to put up a mask to cover their difficulties.

If she is prepared for the difficulties that she may experience, (and be given strategies for support along the way), it can lessen the impact and her view of her challenges. It allows her to view them as a by-product of ADHD and not that there is something innately wrong with her.

Make discussions about ADHD and mental health commonplace. This not only takes away the stigma of mental health being shameful but also increases the chances that she will talk to you about them.

Read books together about feelings and mental health. My daughter with ADHD often struggles with anxiety. When she was younger, she asked almost every day to read the book In my heart: A book of feelings. Now, she is older, we read the book Hey Warrior. She loves it (as do I!) and now will tell me that her amygdala thinks there is a problem and is overacting. Hey warrior also has fantastic strategies for them to learn (such as deep breathing and positive self-talk).

My children know they have “ADHD brains.” They understand why they act and feel the way they do, and that doesn’t mean there is anything “wrong” with them, their brains just work differently. They also are very aware that puberty adds an increased risk of depression and anxiety due to having ADHD and family history.

Share with your child the difficulties that you face and overcome. By talking about mental health and making it a regular part of her life, she will be much more likely to speak with you about it.

I also want to help you get started! Download my Emotion Discussion questions printable for FREE. This one paged resource can give you some ideas for talking about feelings and emotions during book reading.

DOWNLOAD EMOTION DISCUSSION QUESTIONS PRINTABLE for FREE HERE

I have also made my Building Emotional Literacy package 50% off for my blog readers! Enter the code GIRLSWITHADHD in the discount code to receive this discount.

Get the BUILDING EMOTION LITERACY PACKAGE for 50% off here

Discount code: GIRLSWITHADHD

Prevention strategies

There are so many evidence-based lifestyle strategies that can benefit girls with ADHD (as well as all children). Research tells us the main activities linked with the prevention of mental health disorders are:

  • Regular engagement in sports or moderate to vigorous physical exercise. 
  • Maintaining a healthy body mass index by healthy eating
  • Not smoking and responsible drinking
  • Regularly participating in mental activities (e.g., visiting museums, reading books, listening to calm music, playing instruments.)
  • Daily practising yoga (we play this game at our place to make it fun!) or mindfulness (here is a great app to get started), keeping gratitude journals, thought journals and deep breathing are also linked to better mental health.
  • Regular social rhythms (e.g., going to bed or eating meals at the same time each day, or engaging in daily activities with peers and family). 
  • Regular “green time” has also been extremely beneficial for mental health in people with ADHD. Interestingly it has also been shown to improve symptoms of ADHD. 
  • Engaging in preventative mental health courses can also be extremely beneficial. The BRAVE program is one such example. It is an interactive, FREE online program useful in the prevention and treatment of childhood and adolescent anxiety. 

It is also important to model these strategies to prevent or reduce the impact of mental health challenges for our children.

Foster a growth mindset

Dr. Hallowell reports that children with ADHD, by the age of 12, have heard approximately 20, 000 more negative messages than their neurotypical peers. Girls with ADHD often internalise these messages as well as often have very black and white, fixed thinking patterns.  Having a growth mindset is believing that basic abilities can be developed through dedication and hard work—brains and talent are just the starting point. This view creates a love of learning and a resilience that is essential for great accomplishment. (Dweck, 2015)

I HIGHLY recommend the Big Life Journal! I bought my kids the Journals and multiple printable kits. I have also just ordered my son the journal for tween and teens as he just turned 11. They have a journal for children (ages 4-10) and the tweens and teens journal (ages 11+). They have printable kits and lots of free resources too.

I HIGHLY recommend the Big Life Journal! I bought my kids the Journals and multiple printable kits. I have also just ordered my son the journal for tween and teens as he just turned 11. They have a journal for children (ages 4-10) and the tweens and teens journal (ages 11+). They have printable kits and lots of free resources too.

We also listen to their podcast together as a family. My girls LOVE it, and even my 11-year-old son enjoys them. He often will ask to have them on while he goes off to sleep! 

The big life journal allows you to develop a fixed mindset as a family, building resilience into your child with ADHD.

Praise effort and the journey

Interestingly, girls with ADHD often struggle with perfectionism. It can lead to a negative cycle of stress, anxiety, and shame. 

My 8-year-old daughter (who has ADHD) wrote me a letter last week. Part of what she wrote was, “Mum, I am sorry I lie all the time. I am never going to lie to you again.” Two days ago, we were having a cuddle, and she said, “Mum, I’m really sorry!” with tears in her eyes. We chatted more, and it turned out she had been thinking of the letter. She told me that she was a terrible daughter because she had lied to me several times since giving it to me. 

Right there, I had the opportunity to bring shame for several impulsive decisions to lie (probably to get herself out of trouble) or to praise the effort and journey. I told her that despite whether she lied or not, the fact that she didn’t want to lie to me, made me proud of her. She beamed and gave me a big cuddle. 

Girls with ADHD often can put serious effort into their work or “good” behaviour, but still not achieve a great result. A symptom of ADHD is also poor motivation towards tasks that they find boring, difficult or not necessary. Research shows that praising children for effort over results or abilities is more likely to encourage their persistence at a task! Check out this excellent blog post by Big Life Journal to get you started.

Promote her strengths & Provide support for her weaknesses

Another saying I LOVE is, “Everybody is a genius. But if you judge a fish by its ability to climb a tree, it will live its whole life believing that it is stupid.” by Albert Einstein. 

Children with ADHD often struggle in a classroom setting. They are like the fish, that is told to climb a tree to determine their intelligence and worth. Children with ADHD are more likely to have language and learning difficulties than their neurotypical peers. But even children who have ADHD, with average or high intelligence, with no learning or language difficulties, often show a mismatch between their ability and how they perform. 

When I was a new graduate speech pathologist, I remember getting a report for a beautiful young lady from a psychologist. The psychologist wrote, “This child, with the severity of her intellectual impairment, will more than likely, always struggle in all key learning areas in the classroom. Provide her with the opportunity to shine and demonstrate her natural talents and seek out areas of interest, to ensure she is building her self-esteem.” 

I have never forgotten that report. It completely changed my perspective. If a child has a specific difficulty with learning, she may always struggle to keep up in school. But she will be good at lots of other things! Observe and foster her strengths, create an environment of success for her outside of the classroom. This will go a long way to supporting her self-confidence and self-esteem. And this is so important for all girls with ADHD, not only girls with learning difficulties.

Is she a fantastic artist, or painter, or dancer? Enrol her in an art class or a dance class, or work together to set up an online shop to sell her art. Is she drawn to babies or the older generation? Help her start a babysitting business or volunteer at your Sunday school. Can she knit? Buy her some wool and let her knit mittens for premature babies or scarves for the older generation? 

I do also believe that while it is essential to promote the girl with ADHD’s strengths, it is equally important to provide support for her weaknesses. What areas do you see your daughter struggling with? Is it maths? Hire a maths tutor. Is it language and literacy? See a speech pathologist or learning support teacher. Is it peer relationships? See a psychologist. 

One final word on this, be careful with what you take away to fit in her supports. I had a beautiful friend, who decided to take her child out of a team sport (which her child loved), to put her into maths tutoring. The child was devastated. Instead of being involved in a sport that helped her build positive relationships, and gave her an outlet for her energy, she had to go to maths tutoring.

Be creative in planning supports. There are fantastic online resources for support if you are time-poor, or your daughter would feel more comfortable learning in her own home. And she will be able to fit it in around her hobbies.

Let’s get ADHD Done Differently!

Share with me in the comments if this blog post has helped you! I love hearing your feedback!

ADHD

SEEK HELP

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Content in this blog contains discussions of infertility, miscarriage, suicidal ideation, mental illness and mental health crisis, which some readers may find triggering. If you need support at any time, please call the National Suicide Prevention Lifeline (Australia) at 1800-273-8255, reach the Crisis Text Line by texting “START” to 741 741 or call Lifeline on 13 11 14. If you are in immediate medical crisis, please call 000 (Australia).

Raising children with ADHD can be difficult. It’s a bit like anything: You don’t know how difficult it is until you have lived it. I’ve shared little bits of my story throughout my other posts, but I want to share some of the struggles I’ve had – and even continue to have – raising my children with ADHD. Most importantly, what I want you to get out of this post is that it’s okay not to be okay, and asking for help when you need it, is one of the bravest things you can do.

I started ADHD Done Differently for many reasons. In our world, children are often treated so poorly. Add an unseen, socially controversial diagnosis into the mix and these children are at serious risk of psychological harm. I want to educate parents, teachers and health professionals to better understand, live, love and work with children and adolescents with ADHD. I want to be a voice for children and adolescents who don’t yet have their own voice.

The truth is, that I’ve had a hard 11 years raising my children with ADHD. It’s taken a huge mental, emotional and physical toll on me and my relationships. I know now that I am not alone in this. Research tells us that parents, particularly mothers, of children with ADHD live with a significantly higher level of stress than parents of neurotypical children. A study published in 2019 outlined four common themes in parents’ experiences when raising children with ADHD:

  • The child with ADHD’s behaviour seems like a wrecking ball
  • Parents are coping with a war at home
  • Families are divided: relationships don’t survive, and
  • Parents are in dire need of support

Overall, parents of children with ADHD felt this stress came from children’s behavioural challenges, unmet needs for support and social stigma.

As I write this, I literally have tears in my eyes. Last weekend for me was horrific. I can honestly say that those four themes mentioned in that study, came through loud and strong. My children pushed me to my breaking point with their “wrecking ball” behaviour. I am usually calm and have worked super hard at ensuring I maintain an even emotional state when my children are off the wall, but last weekend, I snapped. I yelled and lost my crap. I felt as though I would explode and truly just wanted to run away.  

I honestly felt like I was in a “war zone”. I was fighting battles one after another. I was finding it especially difficult because my husband was working, and nothing I seemed to do made any difference. Things were constantly escalating all day. When my husband finally came home, I was at the end of my rope and we had a fight. A big one. We don’t normally fight, but because of the unrelenting stress in our home, I snapped.

I want to be completely authentic with ADHD Done Differently. I don’t want people to think I have it all together. I don’t. I’m still learning, and sometimes I get it wrong. But I do feel like I’m quite a way along the ADHD journey and have attempted to take on this challenge to ensure that I am raising my children to be the best possible versions of themselves. And I’d like to share what I’ve learned with you.

Here are three of the most important things I’ve learned:

  • You need support.

One of the most difficult things for me to do at the beginning of my journey was admit that I wasn’t ok and needed help.

My first child was conceived using IVF after a horrible 5-year infertility battle. Oh my goodness, how excited I was when I found out I was pregnant, but this little miracle was hard work from birth. He was always active and never slept. By the time his first birthday came around, I was exhausted. He was on the go every second of every single minute of every single day. Around the time I had a miscarriage, and it tipped me over the edge. I had significant depression and was trying to parent this active, noncompliant little treasure.

At this stage in my life, I couldn’t tell anyone I wasn’t coping. Not even my best friend or my husband. I felt as though saying I needed help would mean that people would think I wasn’t grateful for my son who we’d tried so hard to conceive. I wanted the world to think I was the best mum in the world, and that I had it all together. And I certainly made sure it looked like that on Facebook. However, the reality is that I had alienated myself from the majority of my friends because I couldn’t cope with this child of mine. We stopped going places because of his behaviour, and I felt like I couldn’t have anyone over to my place because he was a tornado that destroyed everything in his path and I couldn’t keep on top of the housework. I was screaming silently inside for help and for support.

In hindsight, I should have asked for help straight away, but it took me years. I am extremely lucky to have a best friend who has been a huge support for me. She doesn’t have children with ADHD, but she listened. She allowed me to cry on her shoulder, to wallow in my self-pity, but she was also able to tell me the hard truths and challenge me. She encouraged me to seek professional help, and I will be forever grateful to her for that. I saw a psychologist for years and worked through some huge issues and mindsets that I didn’t even know that I had. I know I couldn’t have got through the journey of early childhood with my son, his diagnosis, then my daughter’s early years and diagnosis without her. She was a huge support and still is.

The bottom line here is that we can not parent our children with ADHD well without a strong support network. Raising children with ADHD is a hard job. Some days it feels near impossible. I honestly feel as though, if I hadn’t sought help when I did, my family would look completely different to it does now. Yes, we have bad days, but we also have so many good ones. I have learned invaluable strategies through my psychologist, my children’s psychologists, research and reading that have made my family so much better.  I wouldn’t change my children for all the money in the world… and I couldn’t have always said that.

Who is in your support team?

Not everyone’s support team is going to look the same, and that’s okay. I feel very grateful to have friends and family who can support me in my journey. I completely appreciate that not everyone has the resources I do, or you might not feel that you’re able to talk to people in your circle just yet.

I’d like to offer for you to join our Facebook group – ADHD Done Differently Community. There are currently only a handful of members, but already it’s a great place to have access to like-minded individuals where you can be yourself, and share your challenges without judgement with people who are walking the same journey.  

I’d also like to encourage you to seek professional support. There are so many amazing resources for people who are struggling with stress and mental health in Australia. (Sorry for my international readers – but I’m sure most countries have similar resources!) Before I was ready to actually go out and seek support and help for stress and depression, I sought out online resources. I ended up doing a Cognitive Behavioural Therapy (CBT) online program through the Mindspot Clinic. This way, no one knew I was doing it, and I could do it from home with my kids running around me. No need for babysitters or travel!

Check out this YouTube clip for some amazing online resources, or if you are ready to take the big leap and see a psychologist face to face, go and chat to your GP. Seeking help is not weak. It is not cowardly. It is truly the most courageous thing you will ever do.

  • Look after yourself!

In my mind when I think of the phrase “self-care”, I imagine a woman sitting in a spa, hair in a towel, feet soaking in a foot spa, sipping cocktails, and getting nails done. Seriously, who has the time for that when you are a mum of children with ADHD? Honestly, I’m lucky to take a shower some days, because my children need almost constant supervision, so they don’t hurt each other or themselves. And besides, I certainly don’t have the money for that. My children’s medication costs over $150 every month, and when you add together all the appointments with the psychologists, paediatricians, occupational therapists, speech pathologists… well, the list goes on.

But, here is something that I have learned: self care doesn’t have to mean a spa day. Self-care can honestly mean something as simple as buying yourself a new tea and sipping it while you supervise your kids in the backyard. It can be making sure you always have fruit in the house and reaching for that before you reach for the chocolate (ok… so maybe I haven’t got this one down yet!) It can mean buying a new pair of good shoes so you can get some exercise with the kids or inviting a girlfriend over for a chat and letting the kids run around you. It can mean getting a book from the library and choosing to read that before you go to sleep at night. Or, yes, it can even mean a spa day!

How can you add self-care into your day?

Think about some ways you can add self-care into your day. Do you work full time out of the home? Buy yourself a new mug with an uplifting saying on it. Go for a walk at lunch time. Are you a stay at home mum and have no one to look after the kids for you? Make an effort to eat out at a park once a week and let your kids run free! Brainstorm some ideas and write them down.

It is not selfish to add self-care into your day. You can not take care of children who demand the amount of attention and supervision as our kids with ADHD without looking after yourself as well.

  • Take the time to work on your spiritual health.

Now before you stop reading, I am not trying to convert you to any religion here. The definition of spirit in the Collins Dictionary is “the part of you that is not physical and that consists of your character and feelings.”

Spirituality is suggested to have five characteristics: meaning, value, transcendence, connecting (with yourself, others, the environment and God or a supreme power), and becoming (the growth and progress of life). According to numerous studies conducted, spiritual health leads to improved mental health, physical health and may even assist people in pain relief.

This is going to be different for everyone. For me, as a Christian, I believe that there is a God who can give my life meaning and hope. I feel energised and refreshed when I talk to God, when I meditate on Scriptures from the Bible or sing a song to God. But I also feel fantastic when I can yell at God and tell him what I am feeling and thinking. I can tell him some days that I think he put too much trust in me to raise my amazing babies with ADHD. I believe he can take it. I know on the days where I spend time working on my spiritual health, it benefits me greatly. And it doesn’t have to be hour long prayers. For me, sometimes stepping outside onto my back deck and appreciating the lovely view and saying a 30 second prayer energises me enough to be able to step back in and parent well.

How can you improve your spiritual health?

Your journey of spiritual health might not look the same as mine. It might look like meditation, yoga, positive affirmations, or something completely different. No matter what your journey, I’d encourage you to ponder these questions to get yourself started:

  • What gives your life meaning and purpose?
  • What gives you hope?
  • What do you do to comfort yourself when you are grieving or having tough times?
  • When do you feel most at peace?
  • How can you infuse your day with spiritual health? (Can you wake up and meditate? Listen to a mindfulness app before you go to bed? Go for a walk and connect with nature? Pray? Keep a gratitude journal? Focus on your breathing?)

I’d like to leave you with this: “A bad day does not mean a bad life.”

I love this quote! I don’t know who said it but, wow, I love their attitude. I had this quote printed at my desk at work several years back when I was in the throes of my first child being diagnosed with ADHD. It was so helpful for me to remember this. Things can always change. Things can always get better. There was a time in my life where I truly didn’t believe that, where I truly felt there was no way out but to end my life.

But I promise you… even from the depths of the deepest darkest pit, where you feel as though you are drowning, or maybe already drowned and only surviving minute to minute, life can get better. You CAN actually enjoy your life again.

There is hope.

Let’s get ADHD Done Differently. xx

Photo by Anthony Tran on Unsplash

ADHD

Reframing ADHD

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I was listening to a podcast this week about how to raise children who know their purpose. It struck a chord with me and began ruminating about my three children: their talents, their dreams, their skills, and their personalities.

My 11-year-old son is quick witted, extremely creative, musically talented, very insightful, popular, and extremely social. He truly could be anything he wanted to be. Based on who is he today, if I had to guess what his future would be, I’d imagine he’d be an entrepreneur who plays the PS4 in his spare time.

My 7-year-old daughter is the most incredible drawer, singer, and performer. She is effervescent, loud, hilarious, popular, fantastic with little kids and so very, very funny. I think she will end up being a famous actress, a fashion designer, a stylist, or a teacher.

My youngest daughter is 6-years old. She is the kindest, most selfless, compassionate, helpful child I have ever known. She loves any kind of animal, and they love her back. I think she will be a vet or a conservationist.

It really started to make me think – you know what did not make my list? ADHD. When I thought about my incredible children and who they are, inattention, hyperactivity and impulsivity did not make the list. 

How many times, though, does ADHD seem like an all-consuming diagnosis? I know it’s something that I have to think about and deal with every single day. The never-ending hyperactivity that drains me of my own energy and wants to make me scream; the impulsivity that is the reason for many trips to the emergency room; and the frustrations of inattention… seriously, how can you always lose just one shoe!? ADHD can feel all consuming, but it is not who our children are. It is not their defining characteristic.

Don’t think for a second that I am ignoring ADHD. It is very hard to live with. It’s stressful, difficult, and exhausting. The very real fact is that families who have a child or children with ADHD are living with a significantly increased amount of stress compared with families of neurotypical children (Leitch, 2019, Theule, 2010.) You need a good support network around you, including professional who can walk you through this journey.

As I was pondering my children, a quote came to mind:

“What you feed yourself, will eventually grow. Whether be good or bad, it will grow. It will affect your entire mood, environment, and the way of thinking… Most of all, it will affect your entire outcome of your today. (Not to mention your tomorrow.)” – Rafael Garcia

ADHD is a chronic condition. Our children are not going to wake up one morning and be “cured”.  These amazing kids have ADHD, however, these children are not ADHD. The double-edged sword of ADHD means that while there will always be some things they struggle with, and they will likely always exhibit behaviours that are challenging to live with, they have something that makes them incredible and fiercely passionate about life. The key point I want to make here is that our reactions to these qualities actually shape the way our children think of themselves. How often do we focus on the negative aspects of ADHD when we could be focusing on the positive?

Some of the characteristics of ADHD we find difficult to deal with now, could lead to them being world changers! My son gets up at 4-5am every morning. While I find being regularly woken up at this hour very challenging, what a great opportunity for my son to start his day with exercise and watch the beautiful sun rises! My daughter will not be told no: If she wants something, she does not stop until she gets it. Yes, this is frustrating for me when I need her to clean her room, but imagine this quality if she is knocked back by a casting director. Kate Winslet ended up starring in the Titanic movie because she wouldn’t take no for an answer!

Dr. Edward Hallowell, found Children with ADHD hear 20,000 more negative messages by the age of 12 than their neurotypical counterparts. They are not going to compartmentalise those negative messages about their symptoms of ADHD, against who they are. Imagine the toll of that on their self-esteem.  We have an incredible opportunity as parents of children with ADHD to switch the perspective, and thus the narrative. We can recognise that what is typically seen as difficult can be a significant driving force to who and what our kids become.

I challenge you this week to set aside time to ponder who your children are. What are they good at? What are their passions? How can you reframe the qualities of ADHD you currently find challenging, to qualities that can take them to great heights for their future?

And let’s get ADHD Done Differently

ADHD

The Point of Performance for children with ADHD – Home Edition!

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Do you feel like you tell your child with ADHD the same thing over and over but they never learn or remember? Are you facing the same battles day in and day out? Have you have tried everything you can think of to change their behaviour, but it seems, no matter how many times you plan, discuss or provide consequences their ‘behaviour’ never changes?

What is the Point of Performance?

In our house, we have a snack cupboard. It was originally part of my pantry, and then it moved into a cupboard next to the pantry, then it moved to the cupboard above the bench. Now, it is a cupboard up above the range hood, as high in the kitchen as I can make it. The contents of this snack cupboard are only for lunchboxes when the kids go to school. It’s out of bounds for the kids when they’re at home, because we always have other snacks available.

My 11-year-old son with ADHD is the reason that the contents of this cupboard has needed to move so many times. When he was younger and could reach the pantry, he would constantly help himself to the lunchbox snacks. No matter how many times we went over the rules and imposed consequences for taking snacks, he never learned. So, the snack cupboard was moved into another cupboard next to the pantry. But he found it… the same day.  So, we moved the cupboard up higher, which worked for a couple of weeks, until he discovered where the cupboard was. When I wasn’t in the kitchen, he would climb onto the bench, open the cupboard and help himself. Later, when I’d go to pack the kids’ lunchboxes for school, we’d have no snacks left. After many weeks of frustration and imposed consequences (no snacks, chores to pay to replace the snacks, only fruit in lunch boxes for snacks) it didn’t change. Nothing worked. Until I found out about the Point of Performance.

Dr. Russell Barkley is a Clinical Professor of Psychiatry who first introduced me to the idea of the Point of Performance in his book –  Executive Functions: What they are, How they work and Why they Evolved (2012). He states that the point of performance is the “critical place and time for performing a behaviour or task in the natural setting where the behaviour takes place like home or school.” In lay terms, this means it is the actual place, at the exact time, the child is doing something.

So, some examples of the point of performance for my kids are:

Brushing their teeth before bed – In the bathroom at 7:25pm

Eating dinner – at our dining table in the dining room at 6:30pm.

Homework – at the desk in the study at 4pm (before COVID-19!)

From the example of my son sneaking the snacks from the out-of-bounds cupboard, the point of performance is right now, in the kitchen, standing on the bench, multiple times a day.

So, now that we now about the point of performance, why does it matter?

Well, according to Dr. Russell Barkley, it is vital that for children with ADHD, any teaching, consequences and rewards – in fact any behavioural modification at all – needs to take place at the point of performance. It needs to happen instantly. That is, it needs to happen in the location, at the time the child is performing the action for it to be effective.

It is well documented that children with ADHD struggle with the passage of time. Rather than seeing time as past, present and future they live in the present with little hindsight or forethought. Edward Hallowell calls this “now” or “not now” brains. The now, is well… now. And the “not now” is everything else. The past, the future, even five minutes ago. If it isn’t happening now, it isn’t happening ever. This is why providing feedback and consequences or teaching at the point of performance is necessary for a child with ADHD. A child with ADHD really can’t process the questions “How many times do I have to tell you not to…?” You could tell your child a million times to do something, but if it isn’t at the point of performance – that is, in the moment where and when it’s happening – their brain isn’t going to identify that teaching and information as necessary for the “now”.

I’m pretty sure I can tell what you’re thinking, because I thought the exact same thing when I first read about this: “I can’t be everywhere at once!” I get it, I really do. I already constantly watch my kids as much as I can, and yet my son purposefully waited until I wasn’t around to sneak snacks from our out-of-bounds cupboard! While it would be ideal to be at the point of performance all the time, you don’t have to be for this to be effective.

According to Dr. Russell Barkley it is just as useful to externalise important information and motivation at the point of performance. What does this mean?

  1. We need to put in view (externalise) what the child needs to know (important information) where they need to know it (the point of performance)
  2. We also need to put in view or remind our child (externalise) why it’s important that they need to do something (motivation) where they need to know it (the point of performance).

What does this look like in real life?

Let’s go back to the example of my son sneaking into the lunchbox snacks cupboard. Because I knew I couldn’t possibly be in the kitchen every waking moment, I externalised the important information at the point of performance.

I put up a sign on the cupboard that looks like this. This is an external reminder (a sign) at the point of performance (the cupboard), reminding him not to take food out of the cupboard.  

Another issue we always had was the kids leaving their clothes all over the floor in the bathroom despite having three laundry baskets right in front of them. So, I made a visual for the bathroom to assist them with planning and organisation of where to put the clothes.

It is at the point of performance (in the bathroom), where they typically remove their clothing. It is a physical reminder, so they don’t have to remember which basket to put their clothes in.

We also have visuals above our bins in the kitchen. We have three bins – one for landfill, one for recycling, and one for Redcycling (for soft plastics such a chip packets). It was always very difficult for our children to remember which bin was for which type of rubbish. So, we now have pictures above the bins with examples of each type of rubbish, so they can independently sort it – at the Point of Performance.

My children also have an external reminder of how to clean their room using simple steps. Please feel free to download it here!

This is another example of an external reminder (chart with pictures) at the point of performance (their bedrooms). It is there for when they need to clean their room without me having to stand and give orders!

It can also be used as reminders of social expectations.

For example, my daughter with ADHD struggles to share and be kind during play with her younger sister. She likes to be in control of play and if that control is threatened, she often acts out.

By having a visual reminder at the point of performance (in the play area in their bedroom), it can be a help her to be kind during play.

So, how does the point of performance actually help the child with ADHD?

Part of the reason that children with ADHD don’t appear to listen, learn from their mistakes, or even be able to do something one day and not the next, is because of two main issues: Impulsivity and working memory deficits.

Impulsivity is a deficit of inhibiting actions prior to thinking about the consequences. Children with ADHD struggle to stop and think before they act; this is impulsivity. I love what Dr. Edward Hallowell says, “They have a race car engine, with bicycle breaks”. You can think of impulsivity as a deficit in forethought: they have difficulty predicting future consequences from past actions. Therefore, it seems as though children with ADHD do not learn from their mistakes, they seem to just keep repeating them.

Working Memory deficits are extremely common in children with ADHD. Working memory is an executive function (mental process), that we can think of as the mind’s Post-it Note. It holds a little bit of important information (the memory) so that we can do something with it (the working part). The Post-it Note is only small, and is only designed to hold a small amount of information. This is known as its capacity. In children with ADHD, their capacity is smaller than their neurotypical counterparts. This is why many parents, carers and teachers report that the child with ADHD may appear to be listening but only follows one instruction at a time, or even has just stood and listened to the instructions but almost immediately forgot what was said.

You can see why the strategy of externalising important information and motivation at the point of performance is so powerful. It acts as the child’s Post-it Note to support working memory deficits and gives them a powerful visual reminder to help stop curb some of their impulsivity.

I hope that you’re able to get as much out of the point of performance strategy for the home as I have. However, there are two main things to remember as you give this a go:

  1. Of course, this strategy isn’t 100% full proof. My son still sometimes completely ignores the external reminder and just takes snacks out of the cupboard because he wants to. This is a choice he makes, and we continue to reinforce the consequences for his poor choices.
  2. Children with ADHD need things to be novel, exciting and interesting. If you find that an external reminder (such as a chart) isn’t working anymore, shake it up! The laundry basket reminder that I shared with you is actually the second chart I’ve used there. The first chart had pictures of clothes as examples and that worked really well for a while, but then it became part of the furniture and was ignored. So, I came up with the monster chart. We have some fun with it, because if I see clothes on the floor in the bathroom, I now say, “The monster wants to eat your clothes, guys!” and they laugh and go and sort their washing! And it doesn’t have to be a printed chart! It could be an ornament or a picture! Anything to provide them with an external reminder at their point of performance.

I’d really like to help you implement the point of performance into your lives. Please comment below what specific issues you might be having and I will make some external reminders for your point of performance, so we can get ADHD Done Differently.

Next blog: look out for how the point of performance can be used for helping children with ADHD during school activities and learning tasks!!

ADHD

How to deal with non believers and unsolicited advice. Creating Team ADHD.

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“Every kid these days ends up diagnosed with ADHD.”

“It’s just made up to cover up bad parenting.”

“Back in my day there was no ADHD. It was called, sit down, shut up and do your work or you will get a smack, not drugging them to make them listen.”

I’m sure everyone who has children with ADHD has heard advice like this. I am often saddened and angered by the comments and advice I receive or overhear.

There are a lot of people still who don’t believe in ADHD. People state it’s an excuse for lazy parenting, made up by “big pharm”to sell drugs to children so parents can have hypercompliant drugged children, and the list goes on. Some scholars even believe that ADHD is an epidemic, due to the lifestyle of children in this modern era: reduced outdoor play, increased demands on learning activities, the over use of screens, and so on.

Thankfully, science doesn’t care what people believe, and the scientific evidence of ADHD’s existence is irrefutable. All major medical associations and government health agencies in the developed world recognise ADHD as a real disorder. The International consensus statement on ADHD was published in 2002 by researchers, scientists, and doctors agreeing on this fact. And for the most part, the world has come a long way in its recognition of ADHD, but we still have an incredibly long way to go in advocating for people diagnosed with the disorder.

There are a significant number of people raising kids with ADHD, who find themselves in a daily battle with family, teachers, friends and strangers over all things ADHD. This adds an incredible amount of stress for people who already are living with higher stress levels, increased marital discord and divorce, as well as anxiety and depression than their counterparts without children with ADHD.

So, what can we do when we are in the position of receiving unsolicited and extremely unhelpful advice about ADHD or the choices we make for our children? A response I’ve always wanted to say is, “Sorry to disappoint you, but I can’t smack the ADHD out of my child any more than I can smack the stupid out of you”. Perhaps not the most helpful of responses, but I do feel like saying it at times.

My goal today isn’t to give you words to defend yourself and the decisions you make in regards to your child, as I don’t believe we ever should have to defend our choices. Instead, I want to give you some concrete steps to work through to be prepared for difficult situations that may arise for you.

I have put together a little workbook for you today with some steps to really make some changes if this is an area that you need support with. Get it below and work through the following steps.

Team ADHD WorkbookFREE Download HERE

STEP 1. Identify who is giving you unsolicited advice, making you feel bad, or as though you need to defend yourself.

Think about who judges you. Who makes snide remarks or comments loudly next to you? Who doesn’t adhere to your rules you have set in the best interest of your children?

In the attached workbook, write these people down. It doesn’t have to be in any special order, just do a big brain blurt. Grab the workbook, a pen, some tissues (trust me), a cup of tea, and sit out in the garden while your kids chase the dog.

Think about all the people you see on a regular or semi-regular basis. They might give you “advice”, challenge your treatment plan or judge you. Write them all down.

It is natural to be emotional about this step (that’s why there are tissues!) You have poured your heart and soul into your children and to be criticised or judged is painful.

Feel free to take your time with this step as you may not be able to identify everyone straight away. Be mindful over the next few weeks and add to your list as you identify them. 

STEP 2. Determine who’s in your children’s ADHD team

Now, I want you to write down who is in your child’s ADHD team. These people may have to be in the team. These people may be yourself, your partner or teachers.

Other people are invited into the team, such as Paediatricians or Psychologists for support. And then there are people, who are part of the team because they are part of family life, such as grandparents, aunts and uncles, family friends, babysitters or church friends.

Most people are in this team whether they have chosen this role or not. They are part of your child’s team whether they agree that ADHD exists or not and whether they agree with your parenting or not, but they have an active role in your child’s future. These people are critical in your child’s physical, educational, vocational and psychological success. What an important job.

Now look at both lists of people you have just written down from Steps 1 and 2. Are there any people on both lists? Highlight them.

Is it your child’s grandparents? Someone who looks after your children with ADHD while you work or so you and your partner can go out on a date? But they constantly tell you that you have made a terrible decision to medicate your child?

Is it your child’s teacher? The teacher who has worked with your child 6 hours a day most of the year, but consistently supports their suspensions for poor behaviour?

Is it your child’s other parent who loves them deeply, but just can’t get on board with the parenting style that the psychologist recommended?

I believe that the people you have outlined in the first two steps above, fit into two categories, when it comes to how to deal with unsolicited advice, judgements, arguments and non-ADHD believers.

Group 1 – People who we need to put our effort into as part of the child’s team

Group 2 – People who are not in the child’s team or are too toxic, and not worth the added stress of worrying about their opinions.

This may sound harsh, however, after years of listening and attempting to everyone’s opinions on ADHD and raising my children, I’ve realised that in order to be the best Mum to my children with ADHD, I have to prioritise my mental health. This is then where I can make the difficult decisions in the best interest of my family.  

LET’S GET SORTED

So, how do we decide which group each person fits into? We ask ourselves if this person a necessary team member. It’s as simple as that.

Let’s start with how to deal with the second group.

Group 2 – People who are not in the child’s team or are too toxic, and not worth the added stress of worrying about their opinions.

For people who fit into the second group, think about why you are worrying about their opinions when they do not actually need to have input into your child and the decisions you make. The bottom line is this: It takes so much wasted time and effort attempting to change another person’s mind, particularly someone who is set in their ways. I, personally, would rather put that energy into my children and family. This doesn’t have to mean cutting these people out of your life. But it does mean it is not worth battling with them, because even if they are important to me as a friend or family member, they do not have to be an active member in my child’s ADHD team.

Ponder here, what is the current way you are handling the ADHD conflict with this person? Is it working? If they share their opinion, does it hurt you or make you angry? Do you end up fighting? Or do you bottle it up and then explode at your partner later that evening? Or do you end up being frustrated with your child with ADHD? Write this down.

I have found over the years, that when I allow myself to take on board opinions of people who are not in my child’s ADHD team, it adds a significant amount of stress to my life.

I encourage you to write down a kind, yet assertive statement you can say to this group of people, when they start making comments or judgements. Planning your response in advance allows you to simply recall a learned response, rather than reacting to the emotion of the moment. Write out some ideas in your workbook. Here are some ideas to get you started.

“Thank you for your advice, however I might have given you the wrong impression. I’m not looking for advice on this topic.”

“My husband/wife/partner and I have come up with our plan for handling this, but thank you for sharing your perspective with me.”

“I know it must be really hard for you to not have a say into the way we parent our children. Ultimately my wife/partner and I need to make these decisions, and I need you to be okay with not having a say in these decisions.”

Remember to ask yourself: Is it worth the battle? If you believe it is worth the battle, then these people belong in the first group. Let’s talk about them now.

Group 1 – People who we need to put our effort into as part of the child’s team

The first group are people we must put our effort into engaging, because they are a critical part of your child’s current and future team. But how are we able to change somebody’s viewpoint?

Christopher Dwyer,  (a Psychologist from the National University of Ireland) states, it can be difficult to change someone’s mind, “unless they themselves are willing to reflect on their own opinions, be open-minded, seek the truth for themselves, withhold judgement before engaging all the evidence and have a desire to progress or change.” In other words, we can’t force an idea on anyone.

However, while we can’t force an idea on someone, we can present information using a procedure where we state our position, present core evidence, address the conflicting viewpoint as a myth or misinformation and explain why the conflicting viewpoint is a myth, while we reinforce our position.

The key here is knowledge. Learn everything you can about ADHD. Keep up to date with new research. So, there is no need to argue of fight for our point of view. It could look like this:

Grandma: “You know if you give your child Ritalin, they will end up a drug addict!”

You: “Grandma, I love that you care so much about your grandchild. Interestingly children who are medicated with methylphenidate (Ritalin) are at no higher risk of substance abuse compared to their non-medicated counterparts, and studies suggest stimulant use protects against later drug abuse in ADHD. I can understand how it may feel counterintuitive to give a stimulant drug to a child, but it is a myth that using Ritalin will lead to later drug use. People with ADHD who have substance abuse disorders, are less likely to have had been treated with Ritalin throughout their childhood and teenage years. I can print out some information if you would like to read it?

Keep in mind though, that you may not change that person’s opinion about ADHD, however, they may realise you are unwavering in your quest to present evidence-based information, and it is not worth the fight or judgement. Knowledge is vital. There are so many resources out there that you can access to learn all you can about ADHD, so that you can advocate for your child in all situations. Head over to my recommended resources page for books, websites and podcasts that can help you continually increase and update your knowledge.

If you find that education and advocacy alone are not working, I encourage you to come up with a statement for people in Team ADHD. While this is going to be coming from a position of wanting to put forward scientific evidence, I believe this statement can include emotive language. These people are important to you and need to know how their comments and judgements are affecting you and your family.

Write something like this, or something you’d like to say, down in the workbook.

“Dad, I love you and are so thankful for everything you do to help my family. I am finding that you are making a lot of comments about our parenting and the choices we are making for our child with ADHD. It is really hurting me. We are making these decisions based on advice from professionals and research. I know that you may not agree with the choices we make, and that’s ok, but rather than making comments in front of my child with ADHD, could we set aside some time to discuss some of the concerns you have?”

WHY DOES THIS MATTER?

Why is this process important? Because our children are worth it. Because ensuring your children are treated for ADHD and supported by people in their team is a matter of life or death. Think I am overexaggerating? 

Research studies indicate that 64% of children with ADHD will have a co-morbid disorder, compared to only 11% of neurotypical children. A comorbid disorder is when a person has two or more disorders or illnesses occurring together, which have an interaction and impact on each other.

Current Directions in ADHD and Its Treatment (2012) author, Jill Norvilitis, states that in children with ADHD, learning disorders are over two times more likely, Conduct Disorder and depression are almost fourteen times more likely. Anxiety is 9 times more likely, speech difficulties are four times more likely, and Autism Spectrum Disorder is ten times more likely than for their neurotypical peers.

In 2018, Dr. Russell Barkley, found that children with ADHD had a nine year reduction in life expectancy when compared with children without ADHD and in the more severe cases, ADHD reduced life expectancy by twenty-five years when compared to their neurotypical counterparts. This is an extremely debilitating disorder.

Now, these are extremely hard statistics to read as a parent or person who loves and knows a child with ADHD, but there is a silver lining here. These findings were from people with untreated or under-treated ADHD. Research has found that with accurate diagnosis and the continued use of evidence-based treatment, people with ADHD may add years back to their lives.

I did not tell you that to scare you, but to reinforce, that your child needs you to advocate for them. I want to be able to say to my adult children with ADHD that I did my absolute best to raise them, with the information I had at the time. I will be able to stand there, far, far away from parental perfection, but knowing, I did my absolute best for them.

Will you join me, and let’s get ADHD Done Differently?

Download your free workbook

ADHD, emotional dysregulation

5 Questions to ask after Emotional Dysregulation

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Our brain is like a double story house. It has both an upstairs and a downstairs.

Disclosure: Please note this blog post may contain affiliate links. If you click on the link and make a purchase, I will receive a small commission, at no additional cost to you.

Downstairs is the primitive part of our brain, where all our automatic and basic functions are located (e.g. breathing, swallowing). It is where our limbic system triggers primary emotions and impulses and where the flight/fight/freeze response originates. It is basically in charge of keeping us alive.

Upstairs is where the higher-level mental processes happen. This is where our executive functions are – in the penthouse! This part of the brain helps us think before we act, regulate our emotions, and show empathy. This is the logical brain.

The downstairs brain is developed, with early reflexes, impulses and primary emotions when we are very young. The upstairs brain, however, continues to develop until we are approximately twenty-five years old… that is, in a neurotypical brain. Research suggests that an ADHD brain’s development is approximately 5-6 years behind at this age, and therefore a person with ADHD may not have the executive functions and upstairs brain fully developed until their early 30s.

When our downstairs mind activates (because of fear or anger, for example), we basically demolish the staircase between the two levels and so can’t access the upstairs. In other words, we lose our ability to effectively use our mental processes and be logical.

So, when our child with ADHD has an intense emotional reaction to something, they are not capable of accessing their logical thought and forethought; their upstairs brain isn’t working. Their downstairs brain is only thinking of either:

  1. fighting, which can look like hitting, kicking, spitting or screaming.
  2. fleeing, which can look like running away, slamming doors, storming off or
  3. freezing, which can look like shutting down, hiding or even shaking or tensing up.

So, when we attempt to punish a child or reason with a child while they are in meltdown mode, it is like beating our head against a brick wall. It is only going to make things worse!

Now, of course, our brain isn’t really a house, but it is a fantastic analogy to explain what happens in the brain during emotionally intense times. This is not my analogy; it is Dr. Daniel Siegel and Dr. Tina Bryson’s analogy from their book: The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s Developing Mind. I highly recommend this book if you want to read more about the upstairs/downstairs brain, as well as a lot of other fantastic insights.

But, what does this have to do with emotional dysregulation in children with ADHD?

Allow me to walk you through an example that happened several years ago. My son had finished his daily screen allowance on the PS4, although he was continuing to play his game. I told him to turn the game off and come to join the family at the dinner table. This is where his dysregulation began. It started with annoyance and frustration, although quickly escalated to yelling and arguing. He very loudly told me he didn’t want his dinner and he wanted to keep playing his game. I made the choice (not a great choice, I’ll admit!) to turn the PS4 off. This is when he began throwing things, stomping around the house like an elephant, screaming, and finally stormed out of the house, slammed the door behind him, and declared he was going to run away forever.

My son’s downstairs brain – that is, his primary emotions and the fight and flight responses – had been activated. The staircase to his upstairs brain was no longer accessible and, in that moment, he was unable to think logically about the consequences of his behaviour. He was having extreme difficulty regulating his emotions and had very limited strategies to self-soothe and regulate himself. He was out of control. Telling a child at this point to calm down or start up with imposing consequences for their emotional response is futile. We are asking our child, who currently has no access to their logical brain; to use their logical brain to stop an emotional response. We will not teach them anything here by disciplining them for their emotional reactions.

When we are out of control, we can’t be logical, use forethought or problem solve. We know from my previous blog post that at this stage, children with ADHD struggle to inhibit their emotions, which leads to longer and more intense displays of emotion. At this stage, our job is to maintain our calm, identify the underlying emotion our child is feeling and then label those feelings, without judgement. The aim of process is to support our children back down into their settled emotional range, where they can access their upstairs brain again. This may take a while at the beginning, but the more frequently we do this, the easier it is for the child to de-escalate because they know that you are going to listen to them. So, ride out the storm.

The NEXT step

Once you have ridden out the storm, and your child is back into a calm and settled emotional range, you can now begin to coach them.  This is where we get to teach emotional regulation, not just expect them to use skills that they do not yet have.

This is NOT a magic wand. It takes time, but it is worth the effort.

One of the first strategies our psychologist taught us for parenting our son with ADHD was this coaching method. It is a simple five question process that brought about significant change in our family. I really encourage you, if you have a psychologist, to talk through this method and see if it will work for you too.

When you start using these strategies to coach your child, you may feel like they are extremely repetitive – especially if your child is having meltdowns several times per day! However, repetition is essential for children to learn. The other great thing with repetition is that your children will learn these questions so well that it becomes their schema for self-reflection. Children with ADHD have a significantly more difficult time self-reflecting on their behaviour.

It’s also important to note that these need to be done as soon as possible after the child has returned to their calm state. Children with ADHD live in the right now, and the longer the time between the meltdown and you teaching them emotional regulation strategies, the less powerful the teaching moment is.

So, with a non-judgemental and empathic tone, work through the following questions with your child:

  1.  “What happened?”

Just listen here. Encourage your child to use a calm voice and explain how they saw things. Don’t say anything here – remember the aim is to be non-judgement. If they say “I don’t know!” (and they probably will at the beginning) you can outline the events, but don’t make judgements here.

Simply state the facts in a calm manner: “I asked you to turn off the TV and you yelled at me, then threw the remote and left the room”.

2. “How were you feeling when that was happening?”

Help them identify their feelings here. For a while, my kids always just said “angry” or “sad”. Here we always encouraged a bit of exploration, “Oh, you were angry and frustrated, because you were enjoying the game and I told you to stop.” Now, my kids will come out with lots of different emotions and reasons behind those emotions. What I have also found is that they can now identify it at the time of the emotional outburst. “I am SOOOOOO ANGRY AT YOU!!!!”

If your children are young, or have language or learning difficulties, then using a visual here can help to help them identify their emotions. You can download one as part of this week’s FREE download, at the bottom of the blog.

3. How do you think the other person felt when that was happening?

This is a really important step because it teaches children empathy, and encourages them to think about how their actions impact other people. When we started asking our children this question, I was initially shocked by their answers. My children with ADHD honestly struggled to identify the impact they had on others, and often would continue to blame the other person involved in the altercation. For example, if I asked my son this question at the beginning he would have said something along the lines of “You didn’t care about me” or “You just wanted to spoil my fun”, or even “It was your fault that I did it”.

So, I began turning it back and asking them to be in the shoes of the other person. For example: “When you yelled at me and threw the remote, how do you think I felt?” or “How would you feel if I yelled at you and threw the remote?” We often had discussions about how their reactions made me, and other people in our family, feel scared or unsafe. It was interesting that when my children realised this, it was often a turning point in getting them to realise they needed to apologise.

4. How can you fix the situation?

This question isn’t as easy as just wanting our child to apologise, although that is a part of the response we hope to get when we ask this question. However, it is important for the child to understand why they need to apologise and work through the process of coming to that decision themselves. Don’t force the child to say sorry. Of course, at the beginning you may need to model this for them and encourage them to do so.  

This is also where the natural consequences of their behaviour are also discussed. Natural consequences are outcomes that are not imposed but happen naturally as a result of behaviour. For example, if a child takes a lunchbox snack from the pantry after being told not to, they will not get a snack in their lunchbox the next day. It is important for our children with ADHD to see and understand connections between their behaviour and what happens to them and in their direct environment, because of those choices.

I have found that consequences are so much more powerful and effective when they are discussed and implemented, not just imposed. Discuss and brainstorm these as a team. Some examples of this may be:

  1. If they threw the remote, they pick it up and put it back on the TV.
  2. If they punched or kicked a hole in the wall, they help fix it, and do chores to pay for the damage caused.
  3. If they say something nasty to their sister, they could write a letter of apology, or make them something special.

The biggest rule with consequences is to make them natural and make them related to the incident. Remember that just inflicting consequences won’t automatically change the child’s behaviour next time. We must also give them strategies to use.

At this point, you might be thinking, “Wait a minute! This isn’t punishing my child for what they did! I would make them lose screens for a month!” I’ll be honest, that’s what I was thinking as I began this process too! However, I want you to really think about this and ask yourself whether those type of consequences actually work?

I know for my children they didn’t. I would take screens off them for a week after an incident like the one I described, and then give them back in one week, and we would go through the exact same incident a week later. Why? Because I never actually gave them strategies to deal with the situation. I just expected that they would somehow learn by me taking away privileges that they should act differently. But they didn’t.

This leads us to the final question:

5. Next time this happens, what could we do differently?

This is also a very important step. This is all about brainstorming together what strategies they might be able to implement next time the situation happens. This is also the time for you to collaboratively problem solve to stop this same escalation happening next time.

(Collaborative problem solving, or now known as Collaborative and Proactive Solutions [CPS],  is really worth looking into. I am not going to go into it in this post, but I will at some time in the future. I highly recommend the book The Explosive Child (Dr. Ross Greene) which goes into detail about collaborative problem solving, if you are interested in the meantime).

I have found the more input your child with ADHD has in this step, the more likely they are to take ownership and actually implement the strategies. This process takes time, but there is usually a solution that can stop future meltdown from happening. My son came up with the following solutions:

“Next time you could give me a 5-minute warning. Or you I could have my screen time earlier so I don’t have to turn the TV off right before dinner, and instead we can turn the TV off for a fun activity.”

Amazing! Our kids really can problem solve, when they are in control and supported to do so.

RESOURCES!

I’ve included a visual today to remind you of all the steps you can go through to keep your cool, emotion coach and guide your children to great behaviour. Keep it on your fridge or somewhere to remind you of the steps. It helps!

The emotion visual is also included in this download.

I’m my child’s emotion coach & Emotion visualFREE Download

Let me know how you go in the comments below!

And let’s get ADHD Done Differently.

ADHD, emotional dysregulation

Let’s Talk Feelings

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I’ll never forget the day I first used emotion coaching with my son who has ADHD. He looked at me, burst into tears and came straight over for a cuddle. I was in disbelief. This was in stark contrast to the screaming, spitting, destructive child who had been present a few seconds before.

Emotion coaching changed our family. Now, don’t get your hopes up that this is a quick fix to a child who is chronically emotionally dysregulated. This is not a magic wand. However, it is worth the effort! The frequency, intensity and duration of emotional dysregulation has significantly reduced at our place since starting this. I wanted to share our journey so you can give it a go for yourself and live in a less stressful environment – most of the time.

My understanding of emotion coaching comes from a range of influences. We did not do textbook emotion coaching and I am not a psychologist. Our approach was much more eclectic, based on our psychologist’s recommendations and what we learned from books.

If you want more information on emotion coaching and the strategies I talk about below, I highly recommend three books. These are Raising an Emotionally Intelligent child, How to talk so kids will listen and listen so kids will talk and The Whole-Brain child. Also, I would recommend that a professional helps you put into practice any new management plan or behavioural approach to ensure it is suitable for your child and family.

Let’s get started

Dr. John Gottman, PhD., has spent his career exploring the best methods for raising emotionally intelligent children. He determined that finding the emotional source of poor behaviour, not just managing a child’s poor behaviour was the key to raising emotionally intelligent children.

In his research, he identified 4 types of parents: dismissive, disapproving, Laissez-Faire & Emotion Coaching.

Dismissive parents will:

  • trivialise a child’s feelings
  • distracts a child from emotions
  • ignores feelings
  • shut down negative emotions

Disapproving parents will:

  • judge and criticise emotions
  • try to control emotions
  • reprimand/discipline/punish the child for expressing emotions

Children with dismissive or disapproving parents will:

  • think their feelings are invalid
  • not trust their own emotional responses
  • have difficulty regulating their own emotions

Laissez-Faire parents will:

  • freely accept all emotional expression from their child
  • won’t set limits around emotional reactions
  • offer no guidance through emotional reactions

Children with Laissez-Faire parents often:

  • don’t regulate their own emotions
  • have difficulty getting along with others

Emotion coaching parents will:

  • value negative emotions as an opportunity for intimacy
  • see them as an opportunity to teach their children
  • not judge or make fun of emotions
  • guide their child through emotions

Children with emotion coaching parents:

  • learn to trust their own feelings
  • learn to regulate their own emotions
  • learn to solve problems
  • often have high self-esteem and get along well with others

See the Raising an Emotionally intelligent child book for a self-test.

Where to start

So, how can we move towards that type of parenting style? Here were the stages in our family’s journey.

At the start of our journey, I was a dismissive and disapproving parent.

I hated when my children expressed negative emotions. It would start up my flight/fight/freeze response so, I would start using consequences straight away, to maintain the feeling of control.

It still takes a lot of effort for me to try not to control my children’s emotional responses by imposing highly strict control freak consequences. This never worked anyway, and I just ended up escalating their dysregulation.

Here is a real-life example, that would happen very regularly, with my son.

Son: “Mum can I watch TV?”

Me: “No mate. You’ve already watched screens today.”

Son: becoming angry and dysregulated “That’s not fair!”

Me: “I beg your pardon. If you don’t stop being so rude, you will lose screens for a week!”

Son: “WHAT – NO WAY! THAT’S STUPID!!”

Me: “Ok done! No screens for a week.”

Son: EXPLODES – swears, throws the remote, yells at me. “I HATE YOU!”

I would stand there thinking seething in anger. I was being a firm, non-permissive mother. I was not giving in, and I never did. This is what all our previous psychologists told us to do – be firm and stick with consequences. But the behaviour never improved, it was in steady decline – for years. This is what led me to the belief that my kids didn’t learn from consequences.

What I didn’t understand was that I was not only dismissing his feelings, but punishing him for sharing them with me. Sure, he may not have done it in the way I would have liked, but he wasn’t misbehaving.

I knew my style of parenting wasn’t working, so after lots of investigation, we settled on emotion coaching as our new strategy. We were skeptical at first. It did not make sense to me how allowing our children to have big emotions, would teach them to regulate their emotions. But I am so thankful now, that we did it anyway!

Step 2: Identify emotions – BOTH your own and your children’s emotions.

The first step in Gottman’s emotion coaching is to identify your child’s emotions. This is essential, but I found, it is equally important to identify our own.

Part a) Ask yourself what am I feeling when my child is dysregulated? Is my response to my feeling helping this situation or making it worse?

This step will take self-reflection and honesty. Are you fearful? Why? Are you worried about what other people will think of you or your child? Are you angry? Are you frustrated? What is underlying your response to your child’s emotional dysregulation?

As hard as it is to admit, I had three underlying beliefs that I needed to challenge to move forward.

  1. I didn’t believe that my children’s feelings were valid. After all, I provided all their needs and wants and they had an easy life.
  2. I felt that I was a terrible mother. A good mother wouldn’t have emotionally volatile, non-compliant kids.
  3. I was embarrassed and cared what people thought of me as a mother.

Where am I now?

During my years on the emotion coaching journey, I have learned:

  1. my children don’t have, and shouldn’t have to have, the same feelings to me.
  2. what may not seem like a big deal to me is a big to them, and I need to respect that.
  3. if our kids don’t get understanding with the little things, how can we expect them to share the big things.
  4. my children’s emotions have nothing to do with my parenting.
  5. their education and strategies to learn emotional regulation is up to me.
  6. I am doing the best I can do.
  7. I am not responsible for what other people think of me or my parenting.

I have been judged countless times in my almost 11- year mothering journey. For many years, that led to isolation, so I could avoid people seeing me as a bad mum. As any parent with a child with ADHD will know, you really have very little control over what they do in public.

But here is the bottom line. I will be judged no matter what! For having a child with ADHD, medicating my child with ADHD, not medicating my child with ADHD, letting my children watch TV, not letting my children watch TV, giving in to a child crying for chocolate in the supermarket, not giving in to a child crying for chocolate, being too permissive, or being too strict. No matter what you do, you will be judged and criticized, so commit to the type of parent you want to be, and be that!

I remember a time where I was sitting on the floor in Woolworths with a huge trolley full of groceries, riding out an extremely loud emotionally dysregulated child moment, after she was told no to getting a chocolate. A woman came up to me and said I was a horrible mother, and that I should give my daughter a smack, to stop her making a scene in a shopping centre.

I informed her that I am ok with my child making a scene in the shopping centre. The person huffed off, muttering under her breath about what a terrible mother I was. But you know what. I have never seen that person again. Ever. I had decided I was an emotion coaching parent and I stuck by that. About 10 minutes later, my child was happily helping me pack our trolley and, may I add, with no chocolate.

But what would have happened if I had imposed strict consequences, or spoken angrily at my child? I know what would have happened because I had done it before. I would have lost control of my emotions, my child would have continued and even escalated their emotional dysregulation, and I would have been horribly embarrassed and left the store feeling like a failure. But instead, I was in control of my own emotions, which allowed me to model, assist and train my child to regulate their own emotions, and we ended up having a good day. The best way to deal with a child in emotional dysregulation is to be regulated.

I know it seems straight forward in theory, however anyone who has been present with a child with ADHD having an emotional meltdown will know: this is not easy to do in the moment. Nothing sets off my emotional dysregulation like seeing my child being angry and hitting, punching, kicking, spitting and swearing or running away.

I encourage you to really take time with this step. I have added a printable for free download today to help you work out what is underlying your feelings about your child’s emotions. I find writing it down and looking for patterns really helped me learn about my responses and beliefs.

emotion coaching printable Download

Part b) Our child’s feelings are just as valid as ours. Our children are trying to communicate their feelings, wants and thoughts to us. In order to truly teach our children emotional regulation, we need to know which underlying emotion to work through.

Through my investigation in this area, I found an invaluable tool called, the emotion wheel. This was originally developed by Dr. Gloria Wilcox.  I use it to really think about what underlying emotions a child (or yourself) might be.

What we might see as anger (Primary emotion), may actually be rooted in frustration, jealousy, anxiety, fear, embarrassment or even remorse (secondary emotion).

Just yesterday, my daughter had a massive meltdown over the fact that she wasn’t allowed to play a game on the PS4. Why? Because she had been given a consequence several days ago for damaging a screen, and so lost screens privileges for a week. Her siblings were allowed to play the game on the PS4, and so she was sad and unable to regulate her sadness. We sat together for a while having a cuddle, while she told me that I was a horrible mum for taking away her screens.

Now, I had a choice here: I could either dismiss her feelings and shut them down by saying something like, “Excuse me!!! You are the one who damaged the tv. This is what you deserve.” And, although that actually might have been true, I sat there with her, thinking through the possible underlying emotions behind her dysregulation. She was jealous that her siblings were allowed to have their screen time, but she wasn’t.

What’s next though?

Don’t impose consequences during emotional dysregulation. Ride out the storm, give your full attention to the child. They need your help and are struggling to inhibit their emotional response.

  • pay attention to what they are saying
  • acknowledge their feelings.
  • don’t judge their feelings, just listen.

The book How to Talk so kids will listen and listen so kids will talk, they recommend using little words like “oh”, “I see” or “mmm” at this time.  

I remember my daughter was having a hard day, with lots of sibling fights. She said to her dad, “I hate my sister”. My husband answered her straight away with “No you don’t!” She yelled back “I DO! I HATE HER!” I jumped in here and said, “Oh you’re feeling like you hate her?” She burst into tears and said yes. I responded with, “I see”.

Now of course, we don’t want her to hate her sister, but if that’s how she is feeling at the time, then I let her feel that emotion. Then, we can work through it and problem solve it once she is emotionally regulated.

Step 3. Help the child label their emotions, while listening with empathy and not shutting down their feelings.

Once you know what your child is feeling, tell them! “Oh, you are frustrated that I said no” or “You’re disappointed that I said no to chocolate!” We are not dismissing their feelings or telling them to stop having emotions. We don’t distract them, we don’t problem solve. We allow them to feel, and give them words for their feelings.

When not to use emotion coaching

When a child is endangering themselves or someone around them, you are not going to simply label their emotions. If they scream at you and look like they will run across a road, grab them! Emotion coach later. I love what Dr. Sam Goldstein, neuropsychologist, says “ACT! DON’T YAK”.

There are also times where we can still emotion coach, but not stay around. Saying something like, “You’re angry at me, but you can’t throw things at me. Let me know when you want me back”.

Children really do learn from this. Maybe not the first time, but with consistency they do. I will leave you with a funny story.

My son, around the age of 5, used to scream and yell a lot when he was dysregulated. Our response was always. “I can see you’re angry at me. When you have stopped screaming at me we can talk”. After many months of modelling this, I had a bad day. I came out yelling about something he had done. He held his hand up to say stop and said, “I can see you are angry at me, Mum. But I will not talk to you while you are yelling at me.” I burst out laughing. It had really worked!

Feel free to download the printable to help you get started on your emotion coaching journey. Leave a comment below if this has helped you and share with anyone who you think could use this!

Emotion coaching printableDownload

Let’s get ADHD Done Differently!

What’s next?

Next week I want to share with you the next step in the process. It is an incredibly powerful step that helps children work through their emotions, build empathy, learn from past experiences and then problem solve for future dysregulation.

DOwnload the emotion coaching printable here

(c) ADHD Done Differently 2020

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Emotional dysregulation in children with ADHD

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Part 1 – Why is my child so emotional?

In my opinion, the most challenging aspect of living with and parenting a child with ADHD, isn’t the frustrating inattention and distractibility, the exhaustion of constant hyperactivity, or even the potentially dangerous impulsivity.

Disclosure: This blog contains affiliate links of which we receive a small commission from the sale of certain items, but the price remains the same for you.

Sure, these things are extremely difficult. However, for me, the hardest part of raising children with ADHD is having to deal with emotional dysregulation. And according to Dr. Russell Barkley (Ph.D.)1, I am not alone. He reports that emotional dysregulation is the primary reason that parents end up in the paediatrician’s office getting a diagnosis of ADHD for their child. This was true for both my children’s diagnoses.

We’d always known our son had ADHD. Many friends mentioned his activity levels and defiant behaviours, our GP confirmed it when he was 2, and a clinical psychologist further confirmed it when he was 3. At that stage, though, we could handle his inattention, hyperactivity and even risky impulsiveness. It wasn’t until he was 5, when we could no longer cope with the constant, violent outbursts, aggression and meltdowns that were taking over our life, we decided to take the step to a formal diagnosis. By this time, I felt like a complete and utter failure. I honestly believed that I must have been doing something wrong – parenting wrong. I had obviously broken this incredible miracle baby that I had been blessed with.

We often had holes in our walls, broken doors, and broken mirrors that had to be patched and replaced. We had heard horrible words come out of his mouth when we asked him to do something seemingly small. He could go from a happy, joyful child to a screaming maniac in two seconds flat, and then back again. The level of stress in our home was unbearable. No matter how much punishment we dished out, this was not getting better. In fact, it was getting consistently worse.

My daughter was at a whole other level: My husband and I were seriously concerned about her mental health prior to her getting diagnosed. She was extremely volatile, angry, irritable and moody. Her meltdowns were like she was demon possessed. She would scratch, bite, yell, scream and completely zone out. She seemed to cause conflict wherever she went. I’d had significant post-natal depression with her, so I lived with complete and utter shame and guilt that her mental health was broken because of me. She presented differently to my son, so, it took me longer to identify that she was having difficulty with emotional regulation. She wasn’t struggling with a mental illness, she was struggling with her ability to regulate her emotions.

What is Emotional dysregulation and how do we regulate it?

In extremely basic terms, emotional regulation is a human’s ability to control their emotional reactions. The current diagnostic criteria of ADHD (DSM-V), does not include any mention of emotional dysregulation, despite research indicating that all people with ADHD have difficulties with emotional regulation in differing severity. Research indicates that specific subgroups of people with ADHD (namely ADHD – Combined presentation, ADHD – Hyperactive/Impulsive presentation, and females with ADHD), have more severe deficits in emotional dysregulation2.

Humans have an amazing ability to use self-calming techniques to control their own emotions. This ability improves with age and moves from needing someone else to be responsible for soothing you (e.g. a baby needing to be cuddled and rocked when they are upset) to more self-calming or internal techniques6. Young children might move away from something that is evoking an emotion. For example, they might do a nudie run down the hallway to escape the ‘horror’ of a bath, cover their eyes so they don’t see something scary, or suck their thumb when they are feeling anxious. They still rely on their parents or carers to help control their emotions, but to a lesser extent. They have worked out some strategies for themselves.

In later childhood onwards, we can replace a negative emotion (e.g. anger/fear) with a more positive secondary emotion (e.g. happiness, joy, calm). This is us inhibiting our emotional responses to return to a liveable state, ensure our emotions are socially acceptable, and to stop escalating negative emotions. For example, if you have a fear of needles and you are waiting for a blood test, your natural primary emotion might be fear or anxiety. We can focus on the fear and anxiety, escalating to a point where we might cry, run away, or, in my case faint and vomit. So instead, we might think about something else: a special place, a loved one, a special event. It takes your mind off your primary emotion, and replaces it with a more liveable secondary emotion.

Emotional regulation in children with ADHD

A child with ADHD does not have anything wrong with their emotions. Research tells us that children with ADHD are unable to inhibit or stop their emotional responses.5 So, while they have the same emotions at the same intensity as their neurotypical peers, they are not able to inhibit them as well. This might look like impatience, quickness to anger, aggression, temper outbursts, violent reactions with negative emotions, as well as excessive excitement or extreme happiness with positive emotions.

Children with ADHD find it difficult to shift their attention away from the primary emotion they are feeling in the moment. They continue to ruminate and hyper attend to their emotion and do not inhibit their emotional response. This comes back to poor executive function abilities such as poor working memory, reduced ability to use visual imagery and difficulty manipulating and organising their thoughts. These also include problem solving, difficulty coming up with alternative thoughts or planning appropriate and more socially acceptable responses5 . When we understand this, it makes it easier to see why children with ADHD do seem more emotional than neurotypical peers. This is why we see long meltdowns, and sometimes violent, aggressive and highly emotional and volatile behaviours in children with ADHD. They often cannot inhibit these responses without support from someone else.

Children with ADHD have an approximate 30% delay in their executive functioning skills compared to their neurotypical peers5. This is the same in terms of emotional regulation. Children with ADHD are going to appear less mature in their ability to inhibit their emotions than other children of their age.

This means that a 5-year-old child with ADHD will have the inhibition ability of approximately a 3-year-old neurotypical child. What happens when a 3-year-old child takes a toy from another 3-year-old? Chances are the toy-taker will be met with tears, yelling, and maybe even a good punch or bite. This neurotypical 3-year-old child finds it extremely difficult to inhibit their anger or sadness, and this is typical. More than likely they will still need support from their parent to regulate their emotions and settle down.

Let’s contrast this by thinking about a neurotypical 5-year-old. They might have just started school and our expectations are that this child should be able to handle the same anger and sadness, without hitting or biting their peer. We might expect them to inhibit their emotions long enough to find a teacher to tell.

But what happens when a child with ADHD is 5 years old and a child takes their toy to school? They do not have a typical capacity to inhibit their emotions, so the parent of the ADHD child gets a phone call from the school, informing them that they have punched a child, broken a window, sworn at the teacher or a combination of all three. This child wasn’t choosing to be naughty or difficult, they were unable to inhibit their emotion long enough to problem solve and go and get the teacher, or ask the child for their toy back or replace their anger and sadness with a different emotion. And of course, we punish the child for their reaction without understanding why they have acted this way.  

I am not saying there shouldn’t be consequences for breaking windows and punching children – I believe there should be! But, now we can understand why they do it, and we are positioned to work with our children to assist them in learning emotional regulation and giving appropriate consequences.

What can be done?

There are many different ways and methods of teaching your child emotional regulation. One of my favourites is emotion coaching6! This method for training emotional regulation, has worked wonders in my family. When we introduced emotion coaching into our parenting toolbox, we saw a massive shift in our family stress levels and our children with ADHD’s emotional regulation abilities.

In my next blog we will discuss this method and I’ll share with you how it helped my family! If you are interested in emotion coaching, I can’t recommend this book highly enough – Raising an emotionally Healthy Child. It’s a game changer.

Final thoughts

My final thought and challenge for you this week – Emotional dysregulation is extremely hard to live with. Nothing increases my emotional dysregulation, like an emotionally dysregulated child. I struggle with my own ability to regulate emotions constantly! Particularly after a long day or week, or after another meltdown from my children or argument over cleaning up after themselves! With some children with ADHD, it is almost a full-time job to assist them in regulating emotions. That takes a toll on even the most patient, loving and kind parent.

However, I challenge you to think of a time where your emotional dysregulation, supported and modelled appropriate emotional control to your child. Yelling at our children not to yell or getting angry at them for being angry, while telling them not to feel angry! Not being able to pick ourselves up and dust ourselves off after disappointment, isn’t going to help our children to learn to regulate their own emotions. Trust me! I tried this for years.

We are all human. It is natural to be out of control at times. However, if this is something you feel you are struggling with consistently, please seek professional help. I have been to psychology many times in my life, to work through situations that have had a significant effect on me being able to regulate my own emotions. There is no shame in seeking help. Actually it is one of the bravest things you will do.

If we are unable to regulate our emotions, how can we effectively teach our children? Learn to regulate yourself and your family will thank you for it. I promise.

Check out part 2 of our emotion series where we look into emotion coaching! And what can we do after the meltdowns? Let’s get ADHD Done Differently.

Additional information/resources

  1. https://www.youtube.com/watch?v=V8nY3YtiU_E Long video! But worth the watch.
  2. Hirsch, O., Chavanon, M.L. & Christiansen, H. Emotional dysregulation subgroups in patients with adult Attention-Deficit/Hyperactivity Disorder (ADHD): a cluster analytic approach. Sci Rep 9, 5639 (2019). https://doi.org/10.1038/s41598-019-42018-y
  3. Deberdt, W., Thome, J., Lebrec, J. et al. Prevalence of ADHD in nonpsychotic adult psychiatric care (ADPSYC): A multinational cross-sectional study in Europe. BMC Psychiatry 15, 242 (2015). https://doi.org/10.1186/s12888-015-0624-5
  4. Theule, Jennifer & Wiener, Judith & Rogers, Maria & Marton, Imola. (2011). Predicting Parenting Stress in Families of Children with ADHD: Parent and Contextual Factors. Journal of Child and Family Studies. 20. 640-647. 10.1007/s10826-010-9439-7.
  5. https ://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018741/
  6. https://www.gottman.com/blog/an-introduction-to-emotion-coaching/