Working with a gender identity therapist was really helpful. She gave great advice, and we had weekly homework. One week, it might be to make a big effort to use the right pronouns. The next week, it might be to reach out to a family member and tell them about the new name, in front of Ashe to show them that we were supportive. At the beginning, Ashe would get upset when I or Ashe’s dad used the wrong pronouns, but they learned to accept that people are going to make mistakes. The therapy lasted a year, and Ashe’s confidence increased as we went through that.

“It All Made Sense:” An Empowering Diagnosis

At the end of 9th grade, Ashe’s therapist suggested a neuropsych. We knew Ashe had trouble at school — struggles with taking tests and keeping focus, but because they were such a likable person, teachers always gave them the benefit of the doubt. It really wasn’t until high school that we saw their grades drop drastically. The tests kept coming back failed. Assignments were not getting handed in on time.

It was unclear to us what was going on. Depression and anxiety run in the family so we were concerned about that, but Ashe had started to do their own research and they said, ‘I think I might have ADHD.’”

Ashe was right: the neuropsych revealed ADHD. It turned out that the anxiety Ashe was feeling came from the ADHD not being managed. The testing was reassuring, and validating. It all made sense. Ashe thought, ‘This is what I’ve been experiencing. Let me try to get everyone in my life to work with this.”

[Read: ADHD in Teens – Your Guide to Warning Signs & Treatments for Adolescents]

I know sometimes when kids with ADHD explore gender, parents can wonder: are they just being impulsive? Ashe is very quick to make decisions and can be very impulsive. But you’re not in your kid’s head, so you have to step back and support them while you see where it goes.

A Surprising Journey

The evolution of the gender journey was surprising. As Ashe moved through high school, after working with the gender therapist, they became really confident in themselves. They started wearing skirts and embracing what we would think of as more feminine presentation, but they were very clear that when they wear a dress, it doesn’t mean they’re a girl. As Ashe has grown older and more knowledgeable and confident, they’ve really learned to love their body. For me, that was a lovely surprise because there can be a lot of body dysmorphia during this kind of gender journey.

The name change was the hardest part for me. Ashe was not the name we gave them. They wanted a more neutral name that they felt suited them better. It hurt at first to not be a part of that process, but looking back and seeing the whole journey, I understand that ‘Ashe’ is the name they feel is them. Now it’s really strange to think back on the dead name, which we do have to use from time to time for legal stuff.

[Read: How to Support a Teen with ADHD Who Is Questioning Their Gender]

In the beginning I asked Ashe a lot, “Can you explain it to me?” Then I stopped, because I realized that I had to do the work of learning, myself — listening to podcasts, reading articles. It shouldn’t necessarily be the child’s responsibility to make you understand.

Support Now. Understand In Time.

I also realized that I didn’t really need to understand in order to support. I figured out that the understanding would come, one day, down the line. But what needed to happen, in that moment, was just support.

The relationships, including friendships, that Ashe has formed are extremely deep and supportive. Ashe now has a boyfriend, and they’ve been together for two years. They have amazing communication for a bunch of 19-year-olds, the way they talk about how to address each other and physical touch and what’s okay with that. There is a lot of really open communication and I think it comes from both of them being so comfortable with who they are.

A lot of people push down who they are — whether that’s gender or sexuality or neurodivergence. But seeing Ashe embrace themselves, I’ve thought, wow, everyone should know as much as they can about themselves — their neurodivergence, gender identity, sexuality. It can open you up to being so much more authentic, and fulfilled.

Gender Diversity and Neurodiversity: Next Steps

• Watch: Gender Diversity and Neurodiversity – How to Support a Child, Teen, or Young Adult with ADHD as They Explore Gender
• Read: How to Be a Neuroqueer Ally
• Read: The Clinicians’ Guide to Serving and Protecting LGBTQIA+ Youth

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

In fourth grade, my favorite teacher led an activity where we had to describe to our peers how to make a peanut butter and jelly sandwich as if they were aliens who had never heard of such a food. As bright fourth graders, we started by telling the other group to “put the peanut butter on the bread.” As you can imagine, the instruction was so vague that my peers, who were only following directions, placed the entire peanut butter jar on top of the bread, which was not our intention. “Working and communicating together in groups can be challenging,” my teacher told me. “Did you learn anything from this?”

Working in groups – and socializing in general – can be especially challenging for kids with ADHD. ADHD is not so much about knowledge-based deficits as it is about performance-based challenges. A lot of us know how to socialize and we understand what’s right and wrong, but we struggle when we need to display our social skills. That’s why it’s so important to practice skills in real time, and why it’s even more important for parents to support and replicate skill-building at home.

The following are three social skills activities I have found help children with ADHD because they can be practiced in a social-skills groups with same-aged peers AND outside of the office with the support of parents:

“LEGO My Creation”

The first strategy, derived from an activity book by Jennifer Cook O’Toole, is written for parents, clinicians, and educators of autistic children. Given the overlap between autism and ADHD, this resource may be helpful more broadly.

[Get This Free Download: A Friendship Guide for Kids with ADHD]

The goal behind this communication activity resembles that of my PB&J fourth grade bit. During the activity, children sit back-to-back and each pair is given identical LEGO pieces. In each pair, Child #1 creates a structure with the pieces while Child #2, still turned the other way, waits. Then, Child #1, who built the structure, practices clearly and patiently communicating what they created to Child #2, who is blind to what Child #1 created. Child #2 has to try to build a replica using only Child #1’s verbal description. Both partners can only see and compare structures at the end of the activity. Before the activity, clinicians and/or parents should discuss helpful tips for easier communication, and children should also be coached and given direct feedback during the activity.

I like this activity because, even if it turns out to be very difficult for the pair, it will likely serve to increase awareness of situations in which children may be misunderstood and need to explain things more clearly. Other versions of this same activity, like drawing, can help with clarifying thoughts and with communicating more effectively.

Two tips I’ve learned in my practice with neurodivergent youth: Make sure the LEGO pieces are large and simplify the task for them as much as you can. The goal is to teach them something, but also to make the task attainable and fun, so if the structure is too difficult to describe, that may suck the fun out of the activity and make the game unnecessarily stressful.

Spin the Confidence Wheel

Many of the neurodivergent pre-teens and teens with whom I work say they want to increase their confidence in social situations. Enter the Confidence Wheel, an activity I derived from my exposure therapy work with anxious youth. Each slice of the wheel is filled in with a unique social anxiety exposure or situation based on the child’s specific triggers. When the wheel stops, the child has to engage in the social anxiety exposure indicated. (For so much of anxiety, the only way out is through.) After discussing the rationale behind this activity and receiving some core coping skills, the child engages in the social anxiety exposure with the support of their social skills group and clinician; they can also practice outside of the office with parental support.

[Read: 5 Ways to Reframe Anxiety for Your Worried Teen]

I like this one because it is applied – it pushes the child to actually DO something rather than just discuss a skill, and it can be practiced with parents’ support. After all, it will be difficult to engage in real-life social skills practice if anxiety is holding them back.

Winging it with Improv

Improvisation has so many social skills built into it — changing and adapting personas based on context, getting used to quick cognitive shifts, following what others are saying, staying on topic – that can help neurodivergent youth rehearse in a funny and supportive environment.

Improv classes, programs, clubs, and camps are everywhere – another benefit of this activity. As individuals with ADHD, we need humor and movement to stay sane, and improv provides both. Here’s a display of one improv activity I’ve seen work well with neurodivergent preteens and teens: LiveKellyandMark.

In each of these activities, we encourage adolescents to interact with others in real time while facing their social fears in fun, supportive environments. These exercises and contexts teach them to love themselves for who they are while opening their minds to new strategies for becoming the best versions of themselves.

Social Skills Activities: Next Steps

• Read: Social Smarts — The Teen Years
• Read: Building (Real) Friendships in the Age of Social Media
• Watch: The Social Reboot – Helping Tween and Teen Boys with ADHD Make Friends

SUPPORT ADDITUDE
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One of the greatest gifts, and challenges, of this life stage is the freedom to explore and choose — in personal and professional realms. This is liberating, but if you’re a young adult with executive functioning deficits, dealing with housing, roommates, work, and relationship issues can be stressful.

Advice for Young Adults with ADHD

Follow these six rules for transitioning to independent living:

1. Pay your bills on time. Set up bill-pay reminders or automatic payments. Use a budget app to track how you spend money. Shop with cash only to limit impulsive purchases. Understand credit card terms and the importance of a good credit score. If you need help making a budget, ask experienced friends, your parents, or other caring adults.

2. Show up when you are expected. Give yourself more time than you think you’ll need (or even plan to arrive early). Use analog clocks, watches, and timers to manage time effectively. Use calendars to remind yourself of events and responsibilities.

3. Set routines. Create habits and schedules to support your health. Exercise regularly to improve ADHD symptoms, memory, and mood; eat a balanced diet; and stick to a regular sleep schedule.

[Get This Free Download: Get Control of Your Life and Schedule]

4. Notice your emotional triggers. Whether it’s a stomach knot or sweaty palms, pay attention to signals that indicate strong emotions before they escalate. In a calm moment, make a list of soothing activities to help you reset. Breathing techniques, stepping outside, or going to the bathroom to splash water on your face are a few ideas.

5. Learn to communicate effectively. Conflict happens. In tense conversations with friends, housemates, and colleagues, it’s important to communicate without blame and to listen without judgment. When your housemates are up until 2 a.m. on a work night, drinking and gaming loudly in the living room, rushing out of your bedroom to yell at them won’t help. You could ask them nicely to lower the volume or ask for a meeting the next day to express your frustrations using this formula: “I feel __________ when you __________ because __________ .” The goal is to reach a good compromise.

6. Be smart about dating. After you’ve connected with someone (online, at a party, or elsewhere), meet them at a public place you already know. Tell friends where you are going and with whom. Despite your ADHD go-with-the-flow impulses, don’t go home with them or bring them to your home right away. Give yourself time to evaluate this person, and let your friends meet them, too.

Advice for Parents of Young Adults

When decision-making moves from parents to adult children, the road turns rocky in new ways. The dilemma for many parents of young people with ADHD is this: When should I express my concerns about their choices or risky behaviors?

Parental authority and influence decrease dramatically as our children age. By the time they reach their 20s, a parent can only say and do so much. Then it’s time to let go.

[Read: ADHD Independence-Building Strategies for Parents]

Here are a few ideas to help parents foster connection and independence:

• Listen with genuine curiosity. Acknowledge what you hear. Before you respond, reflect on what you are going to say. Are you about to tell them what to do? If so, how can you reframe your suggestion as a question?
• Pick your battles. Agree on your role in giving reminders, for example, and the circumstances under which you will say nothing. Separate your anxiety from theirs. Wait 24 hours to process an upsetting issue so everybody cools down enough to have a conversation.
• Trust your kids. What did you want most from your parents? I wanted my parents to stop asking questions about how I was going to use my college degree and to trust the process of my explorations. Your kids will figure it out, ultimately, just as you did.

Watch for Warning Signs

You want to respect your adult child’s space, but you also want to be able to identify concerning behaviors or situations when they appear. Here are red flags that may signal trouble ahead:

• Substance use: Young adults with ADHD face an increased risk for substance abuse. Promptly address any signs of substance misuse, such as appearing impaired, experiencing problems meeting obligations at work or at school, or withdrawing from important activities.
• Anxiety at work: Watch for signs of workplace stress, and help your child brainstorm coping mechanisms. Maintain open communication about your young adult’s occupational challenges, including job stability and performance.
• Career planning: Is your college student exploring suitable career paths with access to accommodations? Ask about exploratory conversations with educators and career counselors.
• ADHD treatment: Do missed appointments or lost items suggest that your child is not consistently managing their ADHD medication? Encourage them to maintain steady treatment and secure support through therapy and academic or occupational accommodations.

Embracing Independence with ADHD: Next Steps

• Free Download: Securing ADHD Accommodations in College
• Read: Enabling vs. Supporting – Helping ADHD Kids Be Independent
• Read: 5 Life Skills Every Young Adult with ADHD Should (Eventually) Master

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The lives of girls and women with ADHD are jeopardized by exponentially higher rates of self-harm, suicidality, and intimate partner violence, as compared with their neurotypical counterparts or with neurodivergent boys and men.

“ADHD in girls portends continuing problems through early adulthood that are of substantial magnitude across multiple domains of symptomatology and functional impairment,” write the authors of the Berkeley Girls ADHD Longitudinal Study (BGALS) follow-up study.¹ “The sheer range of negative outcomes is noteworthy; the most striking include the high occurrences of suicide attempts and self-injury in the ADHD sample, confined to the childhood-diagnosed combined type.”

What We Know About Self-Harm

This is an arresting statistic, particularly considering how self-harm and suicidality have spiked in adolescent girls in general. The most recent CDC Youth Risk Behavior Survey (YRBS) report found that 1 in 10 girls has attempted suicide, and 1 in 3 of girls seriously considered suicide during the past year, which is an increase of nearly 60% from a decade ago.

Research suggests that neurodivergent girls face a significantly higher risk for self-harm than do neurodivergent boys, or neurotypical people of any gender. A 2020 study in European Child & Adolescent Psychiatry found that the rate of self-harm was four times greater in females than it was in males (8.7% vs 2.2%).²  A 2022 ADDitude survey found reports of self-harm among 18% of girls with ADHD versus 9% of boys with ADHD.

The correlation between teen girls with ADHD and self-harm is so strong that a 2021 study published in Child and Adolescent Mental Health proposed that all teen girls treated for self-harming behavior should be screened for ADHD:³ A full 83% of teen patients admitted to the hospital for self-harm were girls, the study found.

Indeed, early diagnosis and treatment of ADHD is critical to mitigating the risk of self-harm. “Girls and women with untreated ADHD are at double the risk for engaging in self-harm and significantly more likely to attempt suicide,” says Julia Schechter, Ph.D., of the Duke Center for Girls and Women with ADHD.

What We Know About Intimate Partner Violence

Low self-esteem, high rejection sensitive dysphoria (RSD), and social skill deficits put women and girls with ADHD at heightened risk for intimate partner violence (IPV). A study published in the Journal of Abnormal Child Psychology found that: ⁴

• Girls with ADHD were five times more likely to be victims of physical intimate partner violence than non-ADHD girls (30% vs. 6%)
• Greater ADHD symptom severity in childhood was associated with increased risk for physical victimization

“Findings indicate that in young women, childhood ADHD is a specific and important predictor of physically violent victimization in their intimate relationships,” write the authors of the study. “Given the devastating impact of intimate partner violence, additional research on how to empower females with ADHD in their social and romantic relationships is greatly needed.”

What We Know About Substance Use

The connection between SUD and ADHD has been well-established through research. We know that:

• People with ADHD are three times more likely to develop an SUD then those without⁵
• 25% of adults with SUD have ADHD⁶ 
• SUD is often more severe in individuals with ADHD⁷

Among the general population, we know that teen girls are more likely to use substances than are teen boys. According to the CDC’s YRBS:

• Alcohol: 27% of teen girls reported drinking in the last month vs 19% of boys
• Vaping: 21% of girls reported vaping in the last month vs 15% of boys
• Illicit drugs: 15% of girls reported ever using illicit drugs vs 12% of boys
• Misuse of prescription opioids: 15% of girls reported ever misusing opioids vs 10% of boys

That said, studies on the prevalence of SUD among girls and women with ADHD have resulted in mixed findings. An elevated risk of substance use was found in a large-scale study led by Joseph Biederman, M.D.,⁸  however no such association was found in the BGALS follow-up.

Most recently, researched at the University of Minnesota conducted a study investigating how ADHD symptoms may influence substance use in women and men, and it found a stronger association between alcohol use and ADHD for young adult women than for young adult men.⁹

“The current study confirms that ADHD-associated risk for adult substance problems is consistently greater in magnitude for women,” the authors of the study write. “The presence of adult ADHD increases risk for substance problems in women more than men.”

What We Don’t Know

No research exists on the relative efficacy of interventions that may reduce the risks for self-harm, suicidality, intimate partner violence, and substance use among girls and women with ADHD. Without fully understanding where these threats begin and how they escalate, we cannot devise and adjust solutions.

The BGALS follow-up study found elevated risks of self-harm and suicidality only among girls with combined-type ADHD, and not among those with inattentive symptoms alone, which leads researchers to speculate that impulsivity is associated with higher risk. Researchers also posit that psychosocial factors, such as the teen’s environment, contribute to the likelihood of self-harm. Longitudinal research is needed, however, to confirm this.

“What are the transition points — psychologically, family or school-related, community-wide — that predict impairment vs. resilience for girls with ADHD as they transition through adolescence to adulthood?” asks Hinshaw. “What are the strategies and supports that teen girls and women with ADHD find most helpful in self-advocacy and thriving?”

In the British Journal of Psychiatry,¹⁰ Hinshaw and doctoral student Sinclaire O’Grady call for longitudinal research on long-term correlated outcomes, such as the development of borderline personality disorder, as well as research into the intergenerational transmission of risk for negative outcomes in the children of women with ADHD.

Further research is needed to answer the following questions:

• What are the specific predictors and mediators of the high risk for self-harm in girls and women with ADHD?
• Does screening self-harming teens for ADHD reduce the occurrence of self-harm?
• What, exactly, makes early adulthood a time of heightened risk for substance use issues, specifically for women with ADHD?
• What are the impacts of ADHD treatment on intimate partner violence victimization?
• What psychosocial interventions, specific to girls and women with ADHD, may mitigate risk of intimate partner violence victimization?

Why It Matters

Researching suicidality, self-harm, intimate partner violence, and substance abuse among women with ADHD will, quite literally, save lives.

A study led by Russell Barkley, Ph.D., published in the Journal of Attention Disorders, found that life expectancy was 13 years lower for patients with combined-type ADHD diagnosed in childhood and with persistent symptoms, relative to control children.¹¹

However, because of the severely limited number of females in the study, the findings are largely not relevant. No major study has investigated the impact of ADHD on life expectancy specifically in women.

With dramatically higher rates of self-harm and suicidality, as well as intimate partner violence, this research is desperately needed to protect women from bodily harm, as well as devastating emotional consequences.

What ADDitude Readers Tell Us

Feelings of loneliness, RSD, emotional dysregulation, anxiety, and low self-worth exert a crushing emotional burden — and prompt some readers to harm themselves, to abuse substances, and to maintain toxic relationships.

“I made poor choices that led to abuse,” says Debs, an ADDitude reader in the United Kingdom. “I’ve taken substances to make the pain less, and I have self-harmed to try to take away the pain.”

“The inner turmoil just seems to get louder and louder and more difficult to turn down, which leads to unhealthy ways of coping like self-harm to help manage the stress,” shares Laura, an ADDitude reader in Texas.

“I abuse cannabis,” explains ADDitude reader Elizabeth, in the United Kingdom.

“Sometimes I feel worthless and want to self-harm because of RSD, assuming I’m not loved by my loved ones.”

“I get myself in relationships that aren’t good for me as I’m just happy that somebody finally loves me despite my flaws,” explains ADDitude reader Annika in Germany. “Self-harm comes into play when I feel like a failure because the relationship is rocky, and I get invalidated or criticized.”

“I constantly feel like I’m failing, which makes the thoughts about self-harm pop up often, although I haven’t given in to those for a while now,” says Lizzy in the Netherlands.

“I drink a lot right now,” says Nicole, an ADDitude reader in Washington. “I know it is unhealthy, but it is the only way for me to cope.”

“I have a history of self-harm, which was sometimes brought on my intense feelings of worthlessness and loneliness,” shares an anonymous ADDitude reader.

What ADHD Experts Say

The long-term ravages of underdiagnosed and undertreated ADHD in women are dire — a matter of life and death in some cases. To develop effective interventions, research is essential.

“There is a critical need for studies into how increasing degrees of isolation, shame, and despair lead to self-harm and earlier mortality, exploring the relationships to early chronic trauma, impulsivity, poor self-care,” says Ellen Littman, Ph.D. “Research must respond to outcomes signaling such a significant public health crisis.”

“Too little is known about later-adult outcomes of females with ADHD,” write Hinshaw and O’Grady. “Overall, we contend that the extraordinarily high risk for self-harm incurred by girls with ADHD as they mature requires a shift in clinical perspective.”

“Girls and women with untreated or undertreated ADHD — or those who have been misdiagnosed with other conditions — have been put at higher risk for an array of negative outcomes including higher rates of depression and anxiety, intimate partner victimization, and risky sexual behaviors resulting in teen and unplanned pregnancies,” says Schechter. “Research specifically devoted to girls and women with ADHD is not only an issue of equity but a life-or-death issue for some girls and women.”

Self Harm & Intimate Partner Violence: Related Resources

• Suicide &Crisis Lifeline: Call or Text 988
  988lifeline.org
• National Sexual Assault Helpline: 1-800-656-HOPE
• National Substance Abuse Helpline: 1-800-662-HELP
• Stop Bullying

Related Reading

• Teen Girls Are Not Alright. ADHD Magnifies the Crisis.
• ADHD in Women and Girls: Why Female Symptoms Slip Through Diagnostic Cracks
• Why Do Toxic Relationships Swallow People with ADHD?
• Girls and Women with ADHD: Unique Risks, Crippling Stigma
• Substance Use Disorders and ADHD: 5 Key Facts and Additional Resources
• “If the Story of My Unplanned Pregnancy Helps Just One Person, It Was Worth Sharing.”

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

1. Sex Difference in ADHD
2. The Health Consequences of Delayed ADHD Diagnoses on Women
3. How Hormonal Changes Impact ADHD Symptoms in Women
4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
5. The Elevated Risk for PMDD and PPD Among Women with ADHD
6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

Sources

¹ SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012 Dec;80(6):1041-1051. doi: 10.1037/a0029451. Epub 2012 Aug 13. PMID: 22889337; PMCID: PMC3543865.

² Ohlis, A., Bjureberg, J., Lichtenstein, P. et al. Comparison of suicide risk and other outcomes among boys and girls who self-harm. Eur Child Adolesc Psychiatry 29, 1741–1746 (2020). https://doi.org/10.1007/s00787-020-01490-y

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

⁴ Guendelman MD, Ahmad S, Meza JI, Owens EB, Hinshaw SP. Childhood Attention-Deficit/Hyperactivity Disorder Predicts Intimate Partner Victimization in Young Women. J Abnorm Child Psychol. 2016 Jan;44(1):155-66. doi: 10.1007/s10802-015-9984-z. PMID: 25663589; PMCID: PMC4531111.

⁵ Wilens T. E. (2004). Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. The Psychiatric clinics of North America, 27(2), 283–301. https://doi.org/10.1016/S0193-953X(03)00113-8

⁶ Charach, A., Yeung, E., Climans, T., & Lillie, E. (2011). Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 9–21. https://doi.org/10.1016/j.jaac.2010.09.019

⁷ Wilens, T. E., & Morrison, N. R. (2011). The intersection of attention-deficit/hyperactivity disorder and substance abuse. Current opinion in psychiatry, 24(4), 280–285. https://doi.org/10.1097/YCO.0b013e328345c956

⁸ Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Klein KL, Price JE, Faraone SV. Psychopathology in females with attention-deficit/hyperactivity disorder: a controlled, five-year prospective study. Biol Psychiatry. 2006 Nov 15;60(10):1098-105. doi: 10.1016/j.biopsych.2006.02.031. Epub 2006 May 19. PMID: 16712802.

⁹ Elkins IJ, Saunders GRB, Malone SM, Wilson S, McGue M, Iacono WG. Differential implications of persistent, remitted, and late-onset ADHD symptoms for substance abuse in women and men: A twin study from ages 11 to 24. Drug Alcohol Depend. 2020 Jul 1;212:107947. doi: 10.1016/j.drugalcdep.2020.107947. Epub 2020 Feb 27. PMID: 32444170; PMCID: PMC7293951.

¹⁰ O’Grady SM, Hinshaw SP. Long-term outcomes of females with attention-deficit hyperactivity disorder: increased risk for self-harm. Br J Psychiatry. 2021 Jan;218(1):4-6. doi: 10.1192/bjp.2020.153. PMID: 33019955; PMCID: PMC7867565.

¹¹ Barkley, R. A., & Fischer, M. (2019). Hyperactive Child Syndrome and Estimated Life Expectancy at Young Adult Follow-Up: The Role of ADHD Persistence and Other Potential Predictors. Journal of Attention Disorders, 23(9), 907-923. https://doi.org/10.1177/1087054718816164

Hormonal contraceptives (HC) may help stabilize the fluctuations in estrogen and progesterone that occur during the menstrual cycle and in perimenopause that are particularly impairing for neurodivergent women, however research has found a correlation between some types of oral HC use and higher rates of depression in women with ADHD.

The impact of sex hormones, including estrogen and progesterone, on ADHD symptoms in women has only recently become the subject of scientific inquiry. A recent study found that various ADHD symptoms wax and wane depending on the menstrual phase. Researchers found that estrogen has a protective effect for both cognition and emotional regulation, and that ADHD symptoms tend to worsen when estrogen drops. ¹

These findings are reflected in the lived experience of ADDitude readers. In a recent survey, a full 98% of respondents reported experiencing hormone-related changes in cognitive function and/or mood, including changes in focus, attention and memory as well as emotional regulation.

Oral HC, or birth control pills, typically contain synthetic estrogen and progesterone. In addition to preventing pregnancy, they are often used to treat heavy menstrual bleeding, painful cramps, irregular periods, polycystic ovarian syndrome, and acne. In addition, some clinicians prescribe oral HC to stabilize hormone levels in women and treat premenstrual syndrome (PMS) and/or premenstrual dysphoric disorder (PMDD), which impact two-thirds of women with ADHD, according to an ADDitude survey.

Until recently, the implications of oral HC use for women with ADHD were entirely uninvestigated, however a recent study published in Journal of the American Academy of Child and Adolescent Psychiatry (JAACP),² revealed that:

• Women with ADHD who used combined oral contraceptives (COC) or progestogen-only pills (POP) had more than five times the risk for depression compared to women without ADHD who did not use hormonal contraceptives.
• This elevated risk was not found among women with ADHD who used non-oral HCs, such as hormonal IUDs or progestogen implants. These women had the same risk of developing depression as did their non-ADHD counterparts.
• This elevated risk was also not found among women without ADHD who used oral HC.
• Women taking HC for medical reasons (heavy bleeding, irregular periods, PCOS) were twice as likely to develop depression as those who took it primarily to prevent pregnancy. Taking HC for medical reasons was more common in women with ADHD than it was in women without ADHD.

“Systemic hormonal contraception contains progestins that inhibit the ovulatory cycle and thereby ‘smoothens’ the hormonal profile, but it may also mimic the negative mood symptoms experienced from natural progesterone during the luteal phase of the menstrual cycle,” explains Lotta Burg Skoglund, M.D., Ph.D., a lead author on the study. “However, most women do not experience these negative mood effects and, somewhat counterintuitively, some progestins may even alleviate symptoms of PMDD.”

An ADDitude survey of nearly 5,000 women revealed that 93% of respondents aged 45 and older experienced elevated and aggravated ADHD symptoms in perimenopause and/or menopause. More than half of these women said their ADHD symptoms — including feelings of overwhelm, procrastination, and memory issues — had a “life-altering impact” in menopause. We know that for hormone replacement therapy (HRT) can effectively alleviate common symptoms of menopause, such as hot flashes, mood lability, and insomnia, and it may offer other benefits.

“Studies show that HRT, if initiated within 10 years of menopause, reduces all-cause mortality and risks of coronary disease, osteoporosis, and dementia,”³ explains Jeanette Wasserstein, Ph.D., in the ADDitude article, “Menopause, Hormones & ADHD: What We Know, What Research is Needed.” “Overall, recent research suggests that the risk in using any type of HRT is lower than previously reported in literature.”

Research has revealed heightened risk for some cancers associated with some forms of HRT, so Wasserstein highlights that a thorough consultation with a medical provider is critical before beginning HRT.

What We Don’t Know

No studies have probed the implications of HRT use for climacteric women with ADHD and we know very little about the potential benefits or risks of HC for women with ADHD.

“ADHD is a common illness, but few studies have looked at the association of hormonal stages and ADHD symptoms,” write the authors of a systematic review of sex hormones, reproductive stages, and ADHD published in Archives of Women’s Mental Health.⁴ “Notably, we did not find any studies investigating ADHD symptoms in other female physiological states such as pregnancy or menopause or looking at the response of patients with ADHD to hormonal treatments such as hormone replacement therapy.”

The small puzzle pieces of existing data are surrounded by questions. Why, for example, did women with ADHD on oral HC experience far higher rates of depression while those on hormone implants or IUDs did not? Until more research is conducted, researchers are left to theorize.

“It may be that, when taking oral birth control, women with ADHD might be extra susceptible to forget to take their birth control pills or may take them irregularly, causing hormonal fluctuations that may destabilize mood,” explained Skoglund in her ADDitude webinar, “The Emotional Lives of Girls with ADHD.” Also, a woman’s hormonal levels will fluctuate during assumed pill-free intervals.”

Some anecdotal reports suggest the use of oral HC, which minimize hormonal fluctuations, may improve ADHD symptoms in some women.

“I was surprised and amazed by the extent to which my focus and my executive functioning improved since I started hormonal birth control,” said Silvia, an ADDitude reader in Italy. “I totally reshaped my life: I decided to start coaching people again, joined a company and am thinking of going back to university again to obtain a second degree. I don’t experience mood swings anymore and I feel less exposure to RSD.”

These anecdotal reports offer promise. But without research, clinicians lack a solid foundation of data to make treatment recommendations.

“We need to find out why some women feel better with oral contraceptives and others feel depressed,” says J.J. Sandra Kooij, M.D., Ph.D. “It is about hormone sensitivity, and how hormones interact with neurotransmitters such as dopamine in women with ADHD, but exactly what drives this difference is still unclear.”

Given a total lack of research studies, there is virtually no reliable science regarding the risks and benefits of HRT for peri- and post-menopausal women. Among the many questions that remain unanswered are the following:

• Does HRT improve symptoms of ADHD in climacteric women?
• Does HRT pose unique risks, either physiological or psychological, to women with ADHD?
• Does HRT impact the efficacy of stimulant or non-stimulant medication for ADHD?
• Are there women with ADHD for whom oral HCs mitigate ADHD symptoms? If so, what is known about this patient profile that can help clinicians make treatment recommendations? What types of oral HCs are most effective and least disruptive for this group?
• What factors account for the increase in depression in some women with ADHD on HC? If oral contraceptives are taken daily as indicated, does the risk decrease?
• Does oral or non-oral HC impact the efficacy of stimulant or non-stimulant medication for ADHD?

Why It Matters

Hormonal contraceptives are among several first-line treatments for PMS and PMDD, which impact women with ADHD with heightened frequency and intensity.⁵ Symptoms of these mood disorders are frequently debilitating, and include suicidal ideation. A comprehensive understanding of possible treatment options for these women could significantly improve quality of life and reduce the risk of self-harm.

Reliable, well-tolerated contraception is also critical for girls and women with ADHD because they are six times more likely to give birth as teenagers compared with women without this diagnosis, according to a recent study led by Skoglund. ⁶

These dramatically heightened rates of unplanned pregnancy were also found in the groundbreaking Berkeley Girls with ADHD Longitudinal Study, led by Stephen P. Hinshaw, Ph.D., professor of psychology at the University of California, Berkeley. “By the time they reached their mid to late 20s, about 43% of the BGALS participants in the ADHD group had one or more unplanned pregnancies,” Hinshaw told ADDitude.

Research has found that experiencing unwelcome psychological side effects is the most commonly reported reason for the discontinuation of hormonal contraception, a decision which could have far-reaching implications.⁷

“Unwanted pregnancy undermines women’s schooling, health and social status and is directly linked to the negative psychosocial impact of ADHD on health, autonomy, academic performance, and quality of life,” Skoglund says. “Averting underage parenthood through effective contraception methods will likely benefit women’s education, empowerment, health and quality of life, their families, offspring, and society from a health economic perspective and have broad and public health benefits, extending far beyond the targeted group.”

What ADDitude Readers Tell Us

Hormonal contraceptives earn mixed reviews from readers, some of whom find them helpful in balancing mood and reducing ADHD symptoms; others report that HC use increases in anxiety, irritability and depression, among other intolerable side effects.

“Hormonal birth control affected me so negatively that I went off of it. It was highly disruptive to my mood and overall wellbeing,” says Jen, a reader in Utah. “I don’t mess with the hormones — even though they love to mess with me.”

“I had an IUD for 7 years. Within a few days, I could not believe the change in my mood. I felt more emotionally even and steady than I had felt in years,” shares ADDitude reader Anne.

“My PMDD was exacerbated by any hormone preparation, including the pill. The low-dose Mirena was an absolute nightmare for me,” says Nicole, an ADDitude reader. “I’m so hesitant to try anything to manage impending menopause, which has me ever more on edge, and I’m not sure yet how to advise my teen on these matters.”

“I started birth control due to PMDD. The mini-pill has been fantastic for my ADHD. I have fewer hormonal fluctuations,” says Karen, an ADDitude reader in Idaho. “I can finally rely on myself to be functional every day (as long as I get enough sleep and take my ADHD meds).”

“I detested the combined pill. It wrecked my mental health, and gave me dangerous migraines),” offers another ADDitude reader. “I was still disorganized, unmotivated with the added bonus of all the physical and mental downsides of the combined pill.”

ADDitude readers often report improved brain fog, memory issues, and mood swings while on HRT, though some say their doctors resist prescribing hormone replacement.

“As I approach menopause, my ADHD symptoms have worsened exponentially — severe memory and concentration problems, plus brain fog, mood swings, acne, sleep problems, fatigue. I’ve been barely able to work for almost a year now,” says Jennifer, an ADDitude reader in California. “I begged my doctor for HRT, but they won’t prescribe it since I’m not technically in menopause yet. They put me back on the pill to see if that would help, but it didn’t help at all with any of my current symptoms and gave me terrible cramps and made me feel crappy the whole time.”

“I am really glad to be on estrogen HRT because it is preventing the double-whammy of menopause and ADHD, at least for now,” says Jaime, an ADDitude reader in North Carolina.

“I have recently started on hormones for women in (peri)menopause, and the horrendous brain fog I’ve been dealing with for the past 18 months has lifted a great deal,” says Isabella, an ADDitude reader in the Netherlands.

“I am postmenopausal, and take estrogen replacement daily,” says Amy, an ADDitude reader in Michigan. “I think my ADHD is worse on days that I miss my dose of estrogen.”

What ADHD Experts Say

Given the known relationship between fluctuating hormones and ADHD symptoms, researchers must explore how we can safely employ HC and HRT to ameliorate both mood and cognitive symptoms.

“Given the increased risk of depression in women with ADHD, which may be further increased by oral HC use, future clinical trials on contraception need to include women with mental health problems, including ADHD, to guide prescribers on the best available choices for these women,” write the authors of the JAACP study.

“In medicine, women are still understudied because they are considered less reliable research subjects than men, due to hormonal changes during the lifespan,” explains Kooij in “Hormonal Sensitivity of Mood Symptoms in Women with ADHD Across the Lifespan.”⁸ “Women with ADHD have been even more understudied, while exactly their hormonal mood changes and increased severity of ADHD urgently need our research attention.”

“Females with ADHD are usually excluded from studies on contraceptive effectiveness and tolerability,” Skoglund explains. “As contraception is a burden for women to carry due to male methods being less effective, lack of knowledge on how different contraceptives affect women with ADHD may create an undue burden.”

Next Steps

• Contribute to research on the impact of perimenopause and menopause on ADHD symptoms by completing ADDitude’s ADHD in Menopause survey.
• Download this free resource: ‘Interventions for Treating ADHD During Perimenopause and Menopause’
• Read these new recommended reads on menopause:
  • The Menopause Brain: New Science Empowers Women to Navigate the Pivotal Transition with Knowledge and Confidence, by Lisa Mosconi, Ph.D.
  • The New Menopause: Navigating Your Path Through Hormonal Change with Purpose, Power, and Facts, by Mary Claire Haver, M.D.

HRT, Birth Control & ADHD: Related Reading

• Q: “Can Hormonal Birth Control Cause Depression?”
• Women, Hormones, and ADHD
• Depression Risk Higher for Women with ADHD on Birth Control: Study
• Menopause, Hormones & ADHD: What We Know, What Research is Needed
• Hormonal Changes & ADHD: A Lifelong Tug-of-War
• PMDD Has Affected My Whole Life
• PMS and ADHD: How the Menstrual Cycle Intensifies Symptoms

We Demand Attention: A Call for Greater Research on ADHD in Women

Intro: Top 10 Research Priorities

1. Sex Difference in ADHD
2. The Health Consequences of Delayed ADHD Diagnoses on Women
3. How Hormonal Changes Impact ADHD Symptoms in Women
4. How Perimenopause and Menopause Impact ADHD Symptoms, and Vice Versa
5. The Elevated Risk for PMDD and PPD Among Women with ADHD
6. The Safety and Efficacy of ADHD Medication Use During Pregnancy and While Nursing
7. How ADHD Medication Adjustments During the Monthly Menstrual Cycle Could Improve Outcomes for Women
8. The Long-Term and Short-Term Implications of Hormonal Birth Control and Hormone-Replacement Therapy Use Among Women with ADHD
9. How and Why Comorbid Conditions Like Anxiety, Depression, and Eating Disorders Uniquely Impact Women with ADHD
10. Early Indicators of Self-Harm, Partner Violence, and Substance Abuse Among Girls and Women with ADHD

Sources

¹ Eng, A.G., Nirjar, U., Elkins, A.R., Sizemore, Y.J., Monticello, K.N., Petersen, M.K., Miller, S.A., Barone, J., Eisenlohr-Moul, T.A., & Martel, M.M. (2024). Attention-deficit/hyperactivity disorder and the menstrual cycle: Theory and evidence. Hormones and Behavior, 158(105466). ISSN 0018-506X. https://doi.org/10.1016/j.yhbeh.2023.105466

² Lundin, C., Wikman, A., Wikman, P., Kallner, H. K., Sundström-Poromaa, I., & Skoglund, C. (2023). Hormonal Contraceptive Use and Risk of Depression Among Young Women With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 62(6), 665–674. https://doi.org/10.1016/j.jaac.2022.07.847)

³ Langer, R. D., Hodis, H. N., Lobo, R. A., & Allison, M. A. (2021). Hormone replacement therapy – where are we now?. Climacteric : The Journal of the International Menopause Society, 24(1), 3–10. https://doi.org/10.1080/13697137.2020.1851183

⁴ Camara, Bettina, et al. “Relationship between sex hormones, reproductive stages and ADHD: a systematic review.” Archives of Women’s Mental Health, vol. 25, no. 1, Feb. 2022, pp. 1+. Gale OneFile: Health and Medicine

⁵ Ali SA, Begum T, Reza F. Hormonal Influences on Cognitive Function. Malays J Med Sci. 2018 Jul;25(4):31-41. doi: 10.21315/mjms2018.25.4.3. Epub 2018 Aug 30. PMID: 30914845; PMCID: PMC6422548.

⁶ Skoglund C., Kopp Kallner H.,,Skalkidou A. et al. Association of attention-deficit/hyperactivity disorder with teenage birth among women and girls in Sweden. JAMA Netw Open. 2019; 2e1912463 https://doi.org/10.1001/jamanetworkopen.2019.12463

⁷ Lindh I., Hognert H., Milsom I. The changing pattern of contraceptive use and pregnancies in four generations of young women. Acta Obstet Gynecol Scand. 2016; 95: 1264-1272 https://doi.org/10.1111/aogs.13003

⁸ Kooij JS. Hormonal sensitivity of mood symptoms in women with ADHD across the lifespan. Eur Psychiatry. 2023 Jul 19;66(Suppl 1):S23. doi: 10.1192/j.eurpsy.2023.92. PMCID: PMC10417850.

The increasing decriminalization of cannabis and cannabis-derived products has resulted in greater access to the drug and has reduced perceptions of harm related to frequent cannabis use. These factors are related to escalation of and frequent cannabis use. Despite the limited, federally approved medical uses for cannabis-derived products, cannabis is perceived to be relatively harmless, and to improve insomnia and ADHD symptoms. However, individuals with ADHD may be more vulnerable to developing problematic cannabis use than their neurotypical peers due to ADHD-related traits.

This webinar will examine the research on risks and benefits of cannabis-derived products, specifically regarding how it relates to sleep and ADHD. Sleep is a frequent motive and may be a driver of daily cannabis use. This webinar also will discuss the role of sleep health and substance use, the challenges of communicating these findings to youth who are at greatest risk, and some harm-reduction strategies for engaging youth in reducing drug use.

In this webinar, you will learn about:

• Effects of infrequent and frequent cannabis use on cognition
• Risks of frequent cannabis use among ADHD youth today
• Sleep disturbances in ADHD, cannabis use motives, and how frequent cannabis use affects sleep health over time
• Strategies to improve sleep health and engage youth in reducing problematic cannabis use

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Substance Use Disorder and ADHD: More Resources

• Download: Sleep Disorders Linked to ADHD
• Get: The Parents’ Guide to Raising a Teen with ADHD
• Learn: SUD Risk Is Elevated by ADHD
• Q&A: “My Teen is Smoking Marijuana and Changing Before My Eyes. What Do I Do?”

Obtain a Certificate of Attendance

If you attended the live webinar on May 7, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Mariely Hernandez, Ph.D., is a clinical psychologist and a Postdoctoral Research Fellow in the Division on Substance Use Disorders at Columbia University Medical Center. After completing her undergraduate degree in Neuroscience & Behavior at Columbia College, Dr. Hernandez pursued a master’s in general psychology and researched mood disorders in pediatric and adult populations for 7 years before shifting her focus to research of ADHD and substance use risk during her doctoral studies at the CUNY Graduate Center.

She also runs a part-time private practice, specializing in helping adults with ADHD thrive. Identifying as part of the ADHD community herself, Dr. Hernandez is also a mother to two very active boys, one recently diagnosed with ADHD.

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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Intensive parenting now extends from childhood into young adulthood as some individuals with ADHD take longer on their journey to independence than do their peers. Some parents assume the roles of financial and career advisor, emotional support cheerleader, and sounding board for their young adult children. And with the increasing rates of anxiety and depression among adults ages 18 to 34, some parents might add mental health counselor to their list of ongoing roles.

In this webinar, Anthony Rostain, M.D., will offer practical advice to parents who are struggling to support their 20-something kids during the prolonged transition known as emerging adulthood. He will address what has made it harder for young people to mature, and how to adapt to this protracted dependence on parental support.

In this webinar, caregivers will learn:

• How “delayed adulthood” has become the new normal for many American young adults and how parents can adjust to this new reality
• How to rethink assumptions and biases that may interfere with healthy parent-young adult relationships
• How to develop better communication skills with young adults with ADHD and related disorders
• How to help young adults overcome executive function difficulties that may interfere with their ability to gain self-sufficiency, autonomy and effective problem-solving
• How to identify and address excessive digital media usage in young adults with ADHD and related disorders

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

ADHD in Emerging Adulthood: More Resources

• Download: Questions to Get Your Child Talking
• Get: 7 Core Executive Functions in Children & Teens
• Read: 5 Critical Life Skills That Build Independence & Confidence
  
• Read: “Stop Trying to Fix Everything!” Scripts for Reflective Listening

Obtain a Certificate of Attendance

If you attended the live webinar on May 1, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Anthony L. Rostain, M.D., M.A., is Chair of the Department of Psychiatry and Behavioral Health at Cooper University Health Care. He is also a Professor of Psychiatry and Pediatrics at Cooper Medical School of Rowan University. His research interests focus on improving clinical outcomes for patients across the lifespan with neurodevelopmental disorders.

Dr. Rostain is the co-author with B. Janet Hibbs of the just-released book, You’re Not Done Yet: Parenting Young Adults in An Age of Uncertainty. He has also co-authored The Adult ADHD Tool Kit: Using CBT to Facilitate Coping Inside and Out; Cognitive-Behavioral Therapy for Adult ADHD: An Integrative Psychosocial and Medical Approach; and The Stressed Years of Their Lives: Helping Your Kid Survive and Thrive During Their College Years. (#CommissionsEarned)

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“Very impressive presentation today. It presented the overall context of delayed adulthood and then gave some ADHD specifics. I really liked the process of developing a meeting between young adults and parents that is collaborative and tolerant of inevitable struggles.”

“I very much appreciate the gentle perspective given today. As a parent of an ADHD 21-year-old who is struggling, I often feel judgment ― especially by health practitioners ― about how I parent. Thank you!”

“I really appreciate the advice to seek vocational assessment and coaching for an adult who ‘doesn’t know what he wants to do.'”

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“I feel dumb. My brain fails me all the time. It’s no use asking for help.”

“I’m always overwhelmed. If I’m not disciplined, everything becomes chaotic.”

We can’t talk about ADHD in teen girls without digging into emotions. Even before a diagnosis, many teen girls talk about the downstream effects of ADHD on their emotions. They call themselves “stupid.” Their self-esteem drops through the floor. They try so hard to be perfect that they burn or spiral out.

The emotional toll of ADHD on teen girls is profound — especially when it isn’t diagnosed early. And, for teens who menstruate, we can’t ignore fluctuating hormones, which invariably affect emotions, behaviors, and functioning. Is it any wonder that so many teen girls and young women say that regulating emotions and energy levels are their biggest ADHD-related problems?

Emotional dysregulation is a core feature of ADHD. Understanding this is the first step to safeguarding the emotional health of teen girls with ADHD. To help them develop emotional intelligence and resilience, and to help them pursue healthy lives, follow the steps below.

How to Protect and Empower Teen Girls with ADHD

1. Understand Your ADHD Profile

ADHD is a neurodevelopmental disorder that is highly genetic. It is not a sign of weakness, laziness, or poor motivation. Understanding how the ADHD brain is wired and how it processes information is Step One. Use simple terms and concepts to help your child make sense of their inner world in a non-judgmental way. It’s sometimes difficult to shift out of negative, toxic thoughts because the ADHD brain’s “gearbox” sometimes gets jammed, so be patient and positive.

Also, stress that no two teen girls with ADHD have identical symptoms, feelings, strengths, challenges, and co-occurring conditions. Encourage your child to be curious about their unique ADHD brain and profile.

[Get This Free Download: Learn How Hormones Impact ADHD Symptoms]

2. Understand the ADHD-Hormone Interplay

Through the menstrual cycle, the rise and fall of estrogen may affect your individual child’s symptoms, behaviors, mood, functioning, and even medication efficacy. Arm your teen with this information about herself, so she can independently prepare for her personal highs and lows, without shame.

Don’t assume that hormonal fluctuations affect all naturally cycling teens with ADHD in the same way. During the two weeks prior to menstruation, when estrogen is lowest, symptoms and functioning may worsen for some teens, especially those who experience PMS or premenstrual mood disorder (PMDD). For teens who struggle with impulsivity, high-estrogen states may be the problem, given the increased likelihood of engaging in risky behaviors when estrogen and dopamine are high.¹

Help your child track their cycle so they can see how changing hormones interact with their unique ADHD profile. If your child’s ADHD medication appears to lose efficacy at certain times of the month, talk to their doctor (and share any supporting evidence) about cycle dosing, or adjusting a medication’s dosage depending on hormonal status.

3. Sharpen Self-Awareness with Self-Monitoring

When girls and women mask their ADHD or mimic their peers in order to achieve social acceptance, one unfortunate byproduct is underdeveloped self-awareness. As a result of these coping mechanisms, your child may feel overwhelmed by questions like, “What are you feeling?” or, “What do you need?”

[Read: 5 Things Every Doctor (and Parent) Should Know about Girls and ADHD]

Start building self-awareness by helping your child track how lifestyle factors influence mood and everyday functioning. What does your daughter notice about her ability to regulate emotions when she gets eight hours of sleep? Six? Do they feel happier after basketball practice? What does it feel like when the ADHD medication starts to wear off? Have your child track the good and the bad using a journal, an app, or a calendar.

4. Reappraise Situations to Curb Rejection Sensitive Dysphoria (RSD)

RSD — an aspect of ADHD emotional dysregulation that causes painful emotional responses to real or imagined criticism, rejection, or failure — can turn distorted beliefs into self-fulfilling prophecies.

Your child may desperately want to make new friends, but RSD may cause her to misconstrue a classmate’s response to her question as annoyance, when the classmate is really just shy or tired. Still, your child thinks, “Everyone finds me annoying. Why do I even try?”

There is power in teaching your child to reappraise situations, especially with ADHD emotional dysregulation in mind. Encourage your child to pause, consider alternative explanations, and refrain from acting until they feel emotionally anchored.

5. Raise Self-Esteem with Self-Compassion

Peer inside the mind of a teen girl with ADHD, and you’re bound to find a harsh, negative choir of voices signing a tune of self-doubt, imposter syndrome, perfectionism, shame, and inadequacy. (The longer it takes to get diagnosed, the louder the chorus.)

Self-compassion transforms the vicious choir into a kinder one and heals a degraded self-image. To develop self-compassion, try developing a gratitude practice together. On the drive to school or at the dinner table each day, share three things about yourselves for which you are grateful.

6. Buy Time with Mindfulness

Emotional dysregulation and impulsivity sometimes lead to poor choices. Mindfulness can help your child buy time to reflect, recognize that emotions will pass, and respond to situations in healthy ways. From breathing exercises to progressive muscle relaxation, mindfulness is a habit that, practiced alongside distress-tolerance skills, can teach your child to withstand difficult emotions without resorting to unhealthy coping measures.

7. Set and Respect Empathetic Boundaries

Protect emotional health by setting empathetic boundaries — like asking for a timeout during a heated discussion before it turns into conflict. This discipline will take practice, but the results are worth it. Your child will demonstrate that they can stay in control and take responsibility for their emotions, which improves self-esteem and promotes healthy relationships.

8. Beware Bad Advice

In a world designed for neurotypical people, beware of useless or even harmful advice for neurodivergent brains. Teen girls with ADHD who struggle with emotional dysregulation, social struggles, and RSD do not need to hear, “If you’re angry, stand up for yourself and say what’s on your mind!”

Another terrible suggestion? “Live a little” or “take the edge off” with a drink. Given high rates of addiction in ADHD², older teens and young women with ADHD must understand the risks associated with drinking and taking other substances.

9. Establish Healthy, Fulfilling Lifestyle Habits

Healthy habits ranging from nutrition and movement to sleep, routines, and friendships can help your child cope with symptoms, big emotions, stressful times, and life’s demands over the long haul. Find safe, inclusive communities where your child can participate in sports, hobbies, and activities of interest. Help your child find environments and scenarios where they know their contributions are meaningful.

10. Parents: Learn to Listen Better

Emotional intelligence is built in interaction with others who respect us and make us feel safe. Practice active, reflective, and non-judgmental listening when your child speaks to you. Don’t rush to solutions and suggestions; try to simply reflect back what your child is telling you. To be heard and listened to builds emotional self-efficacy and is extraordinarily empowering.

Emotional Health of Teen Girls with ADHD: Next Steps

• Free Workbook: Track Your ADHD Symptoms Through the Menstrual Cycle
• Understand: Why Female Symptoms Slip Through Diagnostic Cracks
• Read: What Teen Girls with ADHD Need Right Now

The content for this article was derived from the ADDitude ADHD Experts webinar titled, “The Emotional Lives of Girls with ADHD” [Video Replay & Podcast #488] with Lotta Borg Skoglund, M.D., Ph.D., which was broadcast on January 23, 2024.

ADDitude readers: Sign up to access LetterLife, an app co-founded by Dr. Lotta Borg Skoglund that provides users with personalized insights — on hormonal cycles, ADHD symptoms, and lifestyle factors — to better manage ADHD.

Use the discount code ADDWEB20 to get 20% off Dr. Skoglund’s book, ADHD Girls to Women, when purchased via uk.jkp.com.

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Sources

¹Roberts, B., Eisenlohr-Moul, T., & Martel, M. M. (2018). Reproductive steroids and ADHD symptoms across the menstrual cycle. Psychoneuroendocrinology, 88, 105–114. https://doi.org/10.1016/j.psyneuen.2017.11.015

²Wilens, T. E., & Morrison, N. R. (2011). The intersection of attention-deficit/hyperactivity disorder and substance abuse. Current opinion in psychiatry, 24(4), 280–285. https://doi.org/10.1097/YCO.0b013e328345c956

Teenage girls who often ruminate exhibit patterns of brain activity different from their non-ruminative peers after encountering social rejection, according to new research published in Developmental Cognitive Neuroscience.¹ Increased activity was seen in the parts of the brain involved in developing self-concept, which researchers say suggests that ruminative teens internalize social rejection and integrate it into their view of themselves.

“Everyone experiences rejection, but not everyone experiences it in the same way,” explained Amanda Guyer, Ph.D., one of the study’s authors and associate director of the Center for Mind and Brain at the University of California at Davis. “Our results suggest that girls who tend to ruminate are experiencing more than just momentary sadness after rejection. They are deeply internalizing this negative feedback into their self-concept.”

The study, conducted by researchers at the UC Davis Center for Mind and Brain, involved 116 female participants, aged 16 to 19, who were asked to self-report their tendency to ruminate, defined by the study’s authors as engaging in repetitive, negative thought patterns. The participants were also asked to perform two tasks related to social selection. In their initial visit, participants viewed photos of 60 teens, and were prompted to select 30 they’d like to talk to online. At the follow-up visit, the teens were informed of which of those selected teens had chosen them, and which teens had not. While receiving this information, the teens received functional MRIs to measure blood flow and electrical activity in different areas of the brain.

Social Rejection Plus Rumination Impacts Self-Concept

The study showed that, among girls who ruminate, there was increased activity in the parts of the brain associated with developing one’s sense of identity and interpreting the intentions of others. This led researchers to conclude that ruminative teen girls tend to deeply reflect on the negative feedback of social rejection, incorporating it into their self-concept.

This type of emotional distress is frequently experienced by people with ADHD, among whom rejection sensitivity is common, and painful. “The emotional intensity of rejection sensitive dysphoria (RSD) is described by my patients as a wound.” explains William Dodson, M.D., in his ADDitude article “New Insights Into Rejection Sensitive Dysphoria.” “One-third of my adult patients report that RSD was the most impairing aspect of their personal experience of ADHD.”

The pattern of brain activity revealed in the study also helps explain why teen girls who ruminate are compelled to analyze peers’ behavior, particularly social rejection, which researchers say “aligns with high ruminators’ need to understand a situation and their propensity to ask ‘why’-type questions.”

Rumination Taxes Working Memory

The study also found that rumination caused increased activity in the parts of the brain associated with working memory. Researchers believe that because ruminative teen girls are using much of their working memory to revisit negative social feedback, it may be harder for them to perform cognitive tasks that demand working memory.

For individuals with ADHD, who frequently struggle with deficits in working memory, this may cause additional strain on already limited resources.

Impact of Rumination on Mental Health

By demonstrating the neurobiological basis of rumination and its relationship to rejection sensitivity, the study reveals the importance of equipping teen girls with strategies to decrease rumination.

Left unaddressed, rumination, which is more common among girls than boys, is associated with a higher incidence of many mental and behavioral health challenges. Previous research has demonstrated that rumination is a risk factor for:

• Depression and anxiety²
• Substance abuse ³
• Self-injury ⁴
• Disordered eating ⁵
• Sleep problems ⁶
• Aggressive behavior ⁷

Rumination Intervention Strategies

To avoid these negative outcomes, the study’s researchers stress the benefit of interventions that break the rumination cycle.

“Our study suggests that it can make a difference to reframe their [teens’] negative experiences in a way that makes them feel better afterward instead of worse,” said Guyer.

These strategies may be particularly important for individuals with ADHD, among whom patterns of negative thinking are common.

“Obsessing and ruminating are often part of living with ADHD,” explains ADHD coach Beth Main in her ADDitude article, “ADHD and Obsessive Thoughts: How to Stop the Endless Analysis.” “No matter how hard you try to ignore them, those negative thoughts just keep coming back, replaying themselves in an infinite loop.”

Rather than attempting to ignore ruminative thoughts, Main suggests the following strategies:

• Re-frame the experience: Cognitive reframing involves identifying familiar negative thought patterns, and then shifting the way situations, emotions or experiences are viewed.
• Repeat a mantra: Positive self-talk in the form of a short, repeated phrase with a positive message, like “I am worthy of love,” can counterbalance the negative self-talk to which ruminators are prone.
• Redirect focus elsewhere: Attention modification through a healthy dose of distraction can help break a negative loop, particularly if it’s something that demands your full attention. Activities involving exercise or being in nature can be especially therapeutic.

Sources

¹ Yoon L, Keenan KE, Hipwell AE, Forbes EE, Guyer AE. Hooked on a thought: Associations between rumination and neural responses to social rejection in adolescent girls. Dev Cogn Neurosci. 2023 Dec;64:101320. doi: 10.1016/j.dcn.2023.101320. Epub 2023 Oct 30. PMID: 37922608; PMCID: PMC10641579.
²K.A. McLaughlin, S. Nolen-Hoeksema, Rumination as a transdiagnostic factor in depression and anxiety, Behav. Res. Ther., 49 (3) (2011), pp. 186-193.
³A. Grierson, I. Hickie, S. Naismith, J. Scott. The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models.
⁴J. Ying, J. You, S. Liu, R. Wu. The relations between childhood experience of negative parenting practices and nonsuicidal self-injury in Chinese adolescents: The mediating roles of maladaptive perfectionism and rumination
Child Abus. Negl., 115 (2021), Article 104992.
⁵L.M. Hilt, C.A. Roberto, S. Nolen-Hoeksema. Rumination mediates the relationship between peer alienation and eating pathology in young adolescent girls. Eat. Weight Disord. -Stud. Anorex., Bulim. Obes., 18 (3) (2013), pp. 263-267.
⁶Y. Li, S. Gu, Z. Wang, H. Li, X. Xu, H. Zhu, et al. Relationship between stressful life events and sleep quality: rumination as a mediator and resilience as a moderator. Front. Psychiatry, 10 (2019), Article 348.
⁷K.A. McLaughlin, S. Nolen-Hoeksema, Interpersonal stress generation as a mechanism linking rumination to internalizing symptoms in early adolescents, J. Clin. Child Adolesc. Psychol., 41 (5) (2012), pp. 584-597.

ADHD doesn’t travel alone. Most teens with ADHD also have a co-occurring condition like anxiety or depression. Sometimes the co-existing condition is a result of the ADHD, and other times it operates alongside ADHD.

When a patient presents these conditions together, it can create a varied clinical picture because each diagnosis impacts, and is impacted by, the other. This can sometimes lead to misdiagnosis or inadequate treatment for at least one condition. The challenge in diagnosis and treatment can also be complicated by puberty.

In this webinar, you will learn:

• The symptoms of depression and anxiety disorders, and how to distinguish them from ADHD and normal child and adolescent development
• How depression or anxiety affects ADHD symptoms
• How ADHD can actually lead to, or affect, depression and anxiety
• How to devise a treatment plan when ADHD exists alongside anxiety or depression

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Depression, Anxiety, & ADHD in Teens: More Resources

• Download: A Parent’s Guide to Depression in Teens
• Replay: The ADHD-Depression Connection in Adults with Dr. Roberto Olivardia
• Learn: Why Anxiety Disorder Is So Often Misdiagnosed
  
• Q&A: New Approaches to Treating Depression and ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on April 9, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Roberto Olivardia, Ph.D., is a Clinical Psychologist and Clinical Instructor of Psychology at Harvard Medical School. He maintains a private psychotherapy practice in Lexington, Massachusetts, where he specializes in the treatment of attention deficit hyperactivity disorder (ADHD), executive functioning issues, and issues that face students with learning differences.

He also specializes in the treatment of Body Dysmorphic Disorder (BDD), Obsessive-Compulsive Disorder (OCD) and in the treatment of eating disorders in boys and men. He is co-author of The Adonis Complex, a book which details the various manifestations of body image problems in men. (#CommissionsEarned) Read more here.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“All of the webinars are very good. This was one of the best!”

“A fantastically rich and engaging presentation! I firmly believe that I’m now significantly better informed of the interaction and distinctions between anxiety, depression, and ADHD. Thank you, Dr. Olivardia and ADDitude!”

“Good info and good mention of cannabis findings at the end as a surprise inclusion. Did not know any of that.”

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Play Attention: ADHD and Executive function challenges can lead to anxiety, and this anxiety can further impair executive functioning by affecting the brain’s processing and decision-making abilities. That’s why Play Attention offers a personalized program designed to enhance executive function and improve self-regulation. Backed by research from Tufts University School of Medicine, Play Attention empowers individuals to improve attention, emotion regulation, and overall performance. Our NASA-inspired technology ensures tailored support for every aspect of life. Take our ADHD test or schedule a consultation to start your journey toward improved executive function and emotion regulation with Play Attention. Call 828-676-2240. www.playattention.com

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

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College prep looks different for teens with ADHD, who often lag behind their neurotypical peers in building the skills needed to navigate and succeed in life after high school. Learn how to assess your teen’s readiness for this forthcoming “solo expedition,” set realistic goals, and foster new and productive habits to support your teen’s transition from high school to college.

In this webinar, we aim to provide a clear roadmap to prepare teens for college, to empower parents, and to offer strategies to strengthen teens’ autonomy and self-reliance. Practical steps, milestones, a launch checklist, and a college timeline checklist will be provided to guide parents and support teens throughout this journey.

In this webinar, you will:

• Learn how to assess your teen’s readiness for the transition to college
• Learn how to help your teen build the skills necessary for independent living and navigating the college experience successfully
• Understand how to set realistic goals and foster new habits to support your teen’s independence
• See the actionable steps you and your teen can take using our easy-to-follow guide

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

College Prep for ADHD Brains: More Resources

• Download: How to Get ADHD Accommodations in College
• Get: The Parents’ Guide to Raising a Teen with ADHD
• Read: College Packing List for ADHD Undergrads
• Read: Half of College Kids Stop Taking Their ADHD Medication. Make Sure Your Teen Isn’t One of Them.

Obtain a Certificate of Attendance

If you attended the live webinar on March 28, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Laura Barr is an experienced college consultant who has propelled the educational journey of thousands of students from cradle to college. She works with students and their families to set goals and outcomes, empowering individuals to take ownership of their college search process and life choices. The benefits of this process extend far beyond school selection, as they help students develop confidence, perseverance, and a sense of accountability while bolstering communication and understanding between parents and children.

Laura’s expertise stems from decades of experience as an educator, administrator, writer, and instructional coach. She possesses a Master of Education (M.Ed.) in Early Childhood and Elementary Education, a Certified Education Planner (C.E.P.) credential, and a Certificate in Curriculum and Instruction – Student-Centered Coaching. She has launched four fiercely independent children of her own and believes in the transformative influence of education and the power of our youth to uphold democracy. As such, she continues to leverage her knowledge and resources to drive equitable educational opportunities for all.

Listener Testimonials

“Thoughtful points. Loved how it was delivered timely with specific planning steps. Thank you!”

“This was the most informative webinar because it’s exactly what I have been trying to prepare for and improve on with my teen. Laura Barr’s information is going to help us make effective momentum in preparing for college as well as completing high school with decreased stress.”

“Even though my little one is only in the fourth grade, today’s session was great for raising my awareness of some of the skills that I should start trying to instill even now!”

Webinar Sponsor

The sponsor of this ADDitude webinar is….

Landmark College offers summer programs to assist a wide range of students with learning differences, including rising high school juniors and seniors, recent high school graduates and students enrolled at other colleges. Students learn specific strategies to be successful in formal academic settings and grow personally and academically in an intentional and supportive academic community. | landmark.edu/summer

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

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Toxic relationships disproportionately impact individuals with ADHD. Adolescents with ADHD are at particularly high risk due to slow executive function development, low self-esteem, increased life stressors, and difficulties sustaining connections with others.

Led by Stephanie Sarkis Ph.D., this webinar aims to provide valuable insights for parents, educators, and mental health professionals on the following:

• What makes a relationship toxic and why it is dangerous to teens’ wellbeing
• How to help adolescents with ADHD identify signs of toxic relationships
• Why teens with ADHD are more susceptible to toxic relationships
• How to support adolescents through ending and recovering from a toxic relationship

Watch the Video Replay

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Click the play button below to listen to this episode directly in your browser, click the  symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO.

Teen Relationships: More Resources

• Download: Questions to Get Your Child Talking
• Replay: Gaslighting, Love Bombing & Beyond by Stephanie Sarkis
• Read: ADHD Teens and Dating — Relationship Advice for Parents
• Read: “How Toxic Relationship Residue Poisoned My Love Life”

Obtain a Certificate of Attendance

If you attended the live webinar on March 21, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Stephanie Moulton Sarkis, Ph.D., NCC, DCMHS, LMHC, is a psychotherapist specializing in narcissistic abuse and ADHD. She is the author of eight books and three workbooks, including Healing from Toxic Relationships: 10 Essential Steps to Recover from Gaslighting, Narcissism, and Emotional Abuse and Gaslighting: Recognize Manipulative and Emotionally Abusive People – and Break Free. (#CommissionsEarned) Dr. Sarkis is a National Certified Counselor, Licensed Mental Health Counselor, American Mental Health Counselors Association Diplomate (Clinical Mental Health Specialist in Child and Adolescent Counseling), and a Florida Supreme Court Certified Family and Circuit Mediator.  She has been in private practice for more than 20 years. Dr. Sarkis is a senior contributor for Forbes online and is also a contributor to Psychology Today. She hosts the Talking Brains podcast and is based in Tampa, Florida. You can visit her website at www.stephaniesarkis.com.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

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“Speaker totally touched on my child’s situation. Thanks.”

“Thank you. I could see myself on both sides of what you were talking about when I was growing up. Very interesting!”

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The sponsor of this ADDitude webinar is…

Play Attention: Research conducted at Tufts University School of Medicine demonstrates that Play Attention improves attention, emotion regulation, executive function, and overall performance. Harnessing cutting-edge NASA-inspired technology, Play Attention offers a customized program for both children and adults. Your dedicated Personal Executive Function Coach will tailor a plan for each family member to improve executive function and self-regulation. Home and professional programs are available. Contact us at 828-676-2240 or click here to schedule your FREE consultation and live demo! | www.playattention.com

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

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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Nobody likes taking medicine. So if a teenager doesn’t like taking medicine, I get it, one hundred percent. You can’t force it down their throats. You have to engage with them.

I ask: “What are the things in life that you wish were a little different?” Then I reflect what they communicate back to them: “It sounds like school is a struggle. We have some things that will help with that. Let’s talk about what they are, because we have a variety of treatment options and I want you to help choose one.”

[Read: The Key to Reducing Teens’ Risky Behavior? It Might Be Medication Coverage]

I make it clear that I’m not telling the teenager what to take, and that we’re only going to move forward if they think it helps enough to continue.

So, the key is really shared decision making, where you’re engaging the patient, where they get to be in control. A great example of this is what Maggie Sibley, Ph.D., does in her STAND program. She gives the adolescents in her group therapy a handout, which includes two dozen or so personal values, things like making more friends, passing classes, earning money. Then she asks the teenager, “What’s important to you?” and has them circle their answers on the sheet.

[Read: ADHD in Teens – How Symptoms Manifest as Unique Challenges for Adolescents and Young Adults]

It’s not what’s important to your mom, dad, clinician, psychiatrist, teachers, or therapists, but what’s important to you? Maybe that’s friends, maybe it’s being creative or social, making better grades, becoming a better athlete, feeling better about yourself, being less stressed. The question is: What’s important to you?

When we ask this question, we move away from adults talking at teens and move towards the beginning of a real conversation. It’s a really effective way to engage teens in their ADHD treatment.

Shared Decision Making: Next Steps

• Read: The Teens’ Guide to Making Meds Work
• Watch: ADHD Ages & Stages – Common Challenges and Practical Strategies for Teens and Young Adults with ADHD
• Read: “Stop Trying to Fix Everything!” Scripts for Reflective Listening

The content for this article was derived from a webinar presented by The American Professional Society of ADHD and Related Disorders (APSARD) titled “ADHD Treatment in the Primary Care Setting: The Teenage Years” with Greg Mattingly, M.D., which was broadcast on October 13, 2023.

Hi TiredinTennessee:

Your daughter’s ADHD may be significantly impacting her decision-making skills in several ways.

First, ADHD often makes it challenging to filter and organize information effectively. This can lead to difficulties in weighing options and making decisions. She may experience decision paralysis if she struggles to prioritize or sequence tasks or choices or because of the sheer volume of information and possibilities.

The executive function challenges inherent in ADHD, such as difficulties in planning, organizing, and managing time, also play a significant role in decision-making overwhelm, as many individuals find it tough to break down complex decisions into smaller, more manageable steps. The constant bombardment of distractions and difficulties maintaining sustained attention may prevent individuals from gathering the necessary information to make reasonable decisions.

ADHD can heighten emotional reactivity and sensitivity to stimuli. In decision-making scenarios, heightened emotions can cloud judgment, making it harder for teens to assess options rationally. This emotional intensity can add another layer of overwhelm to the decision-making process.

[Take This Test: Could Your Child Have an Executive Function Disorder?]

Impulsivity, a hallmark of ADHD, can also play a pivotal role. You may not see it, but your daughter might rush into decisions without fully considering the consequences. This could lead to added stress, decision fatigue, or regret as she faces the repercussions of her impromptu choices.

So, what can you do to help?

Indecisive Child: Solutions

1. Limit Choices

I can’t stress this enough. Offering a wide array of options may seem to be liberating or give your daughter agency, but for kids with ADHD, too many choices can induce decision paralysis. Instead, narrow down choices to a manageable few. For example, two or three options for dinner, two stores to visit, and two television shows to watch, rather than an assortment of possibilities.

2. Establish Routines and Structure

Setting times for certain activities, such as homework, chores, or even specific places for items to go, can reduce the number of decisions needed throughout the day.

3. Break Tasks into Smaller Steps

Big tasks can cause decision fatigue. Help your daughter break large tasks into small, more manageable steps. This approach makes it easier to focus on one step at a time, reducing the burden of how to tackle the whole task simultaneously.

4. Offer Time Limits

This is one of my favorites. Sometimes, setting deadlines for decision-making can be beneficial. Encourage your daughter to make decisions within a specific timeframe. This prevents overthinking and minimizes the stress associated with prolonged indecision.

[Get This Free Download: The Eisenhower Matrix for Prioritization]

5. Use Decision Guides

These really work! You create the frameworks or guides for the everyday choices your daughter faces. For example, if she can’t decide what to wear, create a guide based on weather, activity, or comfort.

6. Move the Decision Making

If shopping in a brick-and-mortar store is too overwhelming, order items to be tried on at home. If your pantry is overflowing with snacks, create one drawer or shelf in your kitchen that belongs solely to your daughter. This practice should help calm her sensory overload and allow her to stay in the moment to decide.

And I saved the best for last.

7. Write Down Past Decisions

I practice this strategy with my students, and I used to do this for my son when he was younger. Here’s how and why it works.

When I can gently remind or show a past decision my students have made that went well for them, it’s easier for them to make a similar decision. For example, for my son, I would write down the scenario at the end of the day, including a description of the situation, his decision, and its outcome (especially if it went in his favor). If a similar scenario appeared a few weeks later, I would show him what I wrote, pointing out the similarities and the decision that worked, and asked if he “Would you consider making the same one now?”

And here’s some food for thought: The only way to get better at something is to practice it. So try to avoid making decisions for your daughter because it may be easier or faster. My favorite “line” to say to my children or students is, “The choice is all yours. And I have all the confidence in the world you’ll make a great one.”

Good luck!

Indecisive Child with ADHD: Next Steps

• Read: Defeating Indecision — Decision-Making Made Easy!
• Q&A: “How Do I Help My Teen Make Better Decisions?”
• Download: Organizing Strategies for Children with ADHD

ADHD Family Coach Leslie Josel, of Order Out of Chaos, will answer questions from ADDitude readers about everything from paper clutter to disaster-zone bedrooms and from mastering to-do lists to arriving on time every time.

Submit your questions to the ADHD Family Coach here!

Anxiety is one of the most common comorbidities in teens and college students with ADHD, especially for girls. More than half of girls with ADHD will have some level of anxiety.

When I’m considering how to proceed with treating comorbid ADHD and anxiety, I always think: “What’s driving the bus?”

[Read: ADHD and Anxiety – Symptoms, Connections & Coping Mechanisms]

For some people, the anxiety is a true, primary diagnosis. This would include cases where the anxiety takes the form of OCD or panic disorder. In those cases, I would likely start by treating the anxiety, and then move on to treating the ADHD.

Then there are other situations where the anxiety may be directly related to the ADHD. In these cases, the anxiety may arise because the patient is feeling out of control, unable to manage time, unable to keep all these different balls in the air. Is the patient anxious because they’re overwhelmed by these things? If so, treatment of ADHD can help quite a bit with anxiety.

[Self-Test: Generalized Anxiety Disorder in Adults]

In these cases, I’ll usually start by treating the ADHD. While stimulants can sometimes exacerbate anxiety in some patients, this can typically be avoided by using long-acting, smooth-release formulations of stimulants and by starting low and going slow as you titrate dosage, monitoring anxiety throughout. Atomoxetine or viloxazine can also be effective at treating ADHD in people with co-occurring anxiety disorders. If other options don’t prove effective, guanfacine is an ADHD treatment option that doesn’t exacerbate anxiety.¹

Anxiety in Teens: Next Steps

• Read: 5 Ways to Reframe Anxiety for Your Worried Teen
• Read: What If You Are Enabling Your Child’s Anxiety?
• Watch: Anxiety in Children: Overlooked Signs and Effective Supports
• Read: 6 Types of Anxiety

The content for this article was derived from a webinar presented by The American Professional Society of ADHD and Related Disorders (APSARD) titled “ADHD Treatment in the Primary Care Setting: The Teenage Years” with Greg Mattingly, M.D., which was broadcast on October 13, 2023.

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Sources

¹Mattingly, G., Wilson, J., Ugarte, L., & Glaser, P. (2021). Individualization of attention-deficit/hyperactivity disorder treatment: Pharmacotherapy considerations by age and co-occurring conditions. CNS Spectrums, 26(3), 202-221. doi:10.1017/S1092852919001822