Parenting with ADHD
An interview with ADHD expert, Dr. Julia Schechter, on how to know if you have ADHD as a parent and what you can do about it
Source: Elina Fairytale/Pexels
In today’s newsletter, I interviewed Dr. Juila Schechter about the challenges of parenting when you have a diagnosis of ADHD. Dr. Schechter is a licensed psychologist and co-director of the Center for Girls and Women with ADHD at Duke University. Julia and I met when we were both working at Duke and now have a similar mission of getting research-backed information into the hands of people who need it— with her focus currently being helping individuals with ADHD and their caregivers. I previously interviewed her about girls with ADHD specifically and you can read the interview here or listen to it here.
Listen to the podcast version of this week’s newsletter here:
Dr. Cara Goodwin: Hi everyone. Welcome to the Parenting Translator Newsletter. I'm Dr. Cara Goodwin and I'm here today with Dr. Julia Schechter. Julia is the co-director of the Duke Center for Girls and Women with ADHD. Julia, could you please introduce yourself and tell us a little bit about your experience with ADHD?
Dr. Julia Schechter: Thank you so much for having me back, Cara. I'm really excited to be here. My name is Julia Schechter and I am a Clinical Psychologist and Assistant Professor in the Department of Psychiatry and Behavioral Sciences at Duke University School of Medicine. I'm a clinician and a researcher and I am also the co-director of the Duke Center for Girls and Women with ADHD. The center is focused on promoting evidence-based information about girls and women with ADHD, engaging in outreach with patients and the public, and also conducting research. The last thing I will also mention is I am also a parent of a six-year-old and a three-year-old.
Dr. Cara Goodwin: Wonderful. Can you remind us, what is ADHD? Just explain to us the official diagnosis so we can keep that in mind going forward.
Dr. Julia Schechter: ADHD stands for Attention Deficit Hyperactivity Disorder. It is a neurodevelopmental disorder, which is just a fancy way of saying that it is a brain-based condition. Research has shown that there are differences in the brains of people with ADHD compared to the brains of people without ADHD. It is one of the most common neurodevelopmental conditions. Studies indicate that around 10% of children and adolescents and about 4% of adults in the United States have ADHD. People with ADHD can experience significant difficulties with inattention. Symptoms like being easily distracted or forgetful, not seeming to listen when people are speaking to them, or high levels of hyperactive and impulsive behavior. Things like excessive energy, or trouble staying seated when you're supposed to, or interrupting others. Some people have difficulties with both attention and hyperactivity and impulsivity.
One point I do want to make here is that inattention and hyperactive and impulsive behavior really do exist on a spectrum. Every person on the planet is going to fall somewhere on this spectrum, right? But ADHD is not just one or even a few of these symptoms. For a diagnosis of ADHD, we really do need to see more of these behaviors happening more of the time in more than one environment. On the spectrum, people with ADHD are consistently falling at the higher end across many of these symptoms. In addition to receiving a diagnosis of ADHD, we really have to see what we call a functional impairment. These symptoms are really messing things up for people in some way. I want to really stress these points because I think there is this misconception that we all have a little ADHD. While it is true that we all might have times that we have difficulties paying attention or sitting still, this consistent and pervasive pattern of difficulties that we see with individuals who are living with ADHD is different and it really can cause significant problems.
I highlighted a few of these problems last time I was on your podcast but I do think they're worth repeating that children and adolescents with ADHD can experience difficulties with performing academically in school or challenges getting along with peers. They can have anxiety or emotional difficulties. Adults with ADHD experience more problems in their relationships, challenges holding down jobs, and financial hardships. I mentioned last time that people with ADHD had even been found to be more likely to die earlier. And like last time, I don't say these things to frighten people, but I mention these to underscore that ADHD is a real brain-based condition that can have a significant impact on people's lives if it's not identified and not treated.
Dr. Cara Goodwin: Thank you so much. That is so helpful. I want to add, if you didn't listen to the previous interview I did with Julia on girls with ADHD, that came out in March. Please check that out [read the interview here or listen to it here] because that has a wealth of information on girls with ADHD. I think when we all think of somebody with ADHD, we all picture a child. Please explain to me, how can adults have ADHD? And how do you know as an adult if you have ADHD? It seems like we all think of a child having difficulty in school and that being a red flag to seek an evaluation. But how does an adult know?
Dr. Julia Schechter: Yes, great question. Adults can have ADHD too. Historically, ADHD has really been thought of a diagnosis that only occurs in childhood, but studies have consistently shown that adults can also have ADHD. In fact, we really think of ADHD as more of a chronic condition and one that impacts people across their lifetime. Studies that have looked at the persistence of ADHD beyond childhood have generally found that about 65% or so of kids with ADHD continue to meet diagnostic criteria in adulthood. Interestingly, a recent paper looking at a sample of adults who've been diagnosed during childhood and then followed up by researchers over time showed that about 90% of people in the sample continue to experience at least some symptoms in adulthood, if not a full-blown diagnosis.
One thing that does make it hard to pin down how many adults have ADHD that persists from childhood is that the way that ADHD shows up for people really changes as their brains continue to develop and their environmental demands change. So most typically we see hyperactive and impulsive symptoms tone down over time and we see more of those inattentive symptoms become more obvious as people get older. We also see the same symptoms look different in adults than they do for kids. For example, one of the hyperactive impulsive symptoms is running or climbing in situations that are inappropriate. This behavior can be really clear in kids, but we don't often see that in adults. But in adults, what we might see is this internal feeling of restlessness, rather than actual running and climbing.
If you are an adult, one other thing I'll mention is adults can also be diagnosed with ADHD. even if they didn't have the diagnosis during childhood. How might you know if you are an adult with ADHD? Things to look for are those persistent challenges with attention and behavior that just don't seem to be explained by other factors. For example, if you find yourself making a lot of careless mistakes at your job, or having trouble keeping your attention focused during conversations with your friends, or being really highly distractible when completing tasks around the house so that a lot of chores go unfinished or bills don't get paid, if you're experiencing things like this and it's really getting in the way of your life, then ADHD might be something to explore.
Dr. Cara Goodwin: That's so helpful— knowing what these symptoms are. I was laughing thinking about an adult like running and climbing when they shouldn't— that would be very socially strange situation.
How does an adult get an ADHD diagnosis? I know you told us last time if you're worried about your child having ADHD to talk to your pediatrician. So obviously we don't see pediatricians. If you're like me, you're bad about even seeing medical professionals at all as an adult. So how do you go about getting a diagnosis if you're concerned about yourself as an adult? Where do you start?
Dr. Julia Schechter: I'll start by saying that getting an evaluation for ADHD in adulthood can be tricky for a few different reasons. One reason is that it often does require meeting with a specialist, like a psychologist or a psychiatrist. However, it is usually best to start by talking to your primary care provider. They may or may not be able to actually diagnose ADHD, but at least they will hopefully listen to your concerns and then help with ruling out any other reasons like a medical condition that might be contributing to what you're experiencing. Then hopefully they also would be able to help you with navigating next steps if an assessment for ADHD is warranted. Those next steps usually do include completing rating scales to better understand how the symptoms that you're experiencing differ from what would be expected from the typical population. Remember that idea of all these things are on a spectrum.
In addition to receive a diagnosis of ADHD in adulthood, and actually not just adulthood, anytime, there needs to be some indication that several symptoms were present during childhood. And as you might imagine, this can be really tricky to assess in adults. It can be really hard to remember what we were like as kids. So rating scales might be requested from somebody who did know you as a kid to reflect back and remember you as a kid and rate you on those scales. Having collateral information like old report cards can also be helpful if they're available. In addition to those rating scales, an evaluation in adulthood should also include a clinical interview to understand how these symptoms look for you over time. We also have to make sure that no other conditions that sometimes kind of mimic ADHD, like anxiety or, or PTSD or depression, aren't better explanations for what you're experiencing.
I know this sounds lke a daunting process and it really certainly can be. I think if I were to recommend one place for an adult who's considering pursuing an ADHD evaluation to start, it would be starting just to collect some of their own data on their symptoms. Just starting to write down what they found challenging day to day, asking for feedback from people who know you well, like partners or friends or co-workers and just starting to identify any patterns. Collecting this information can really be helpful as you make decisions about if and when you're going to pursue an ADHD evaluation and also can help with guiding the discussion with your medical and mental health providers when you are going through an evaluation.
Dr. Cara Goodwin: Okay, that's very helpful to knowwhat ADHD looks like in adults and how we can seek help if we are concerned. What does science say about how ADHD can impact parenting? Maybe we can just start at the beginning. Is there any data on adult ADHD and pregnancy and any changes in hormones that happen? How does that impact ADHD symptoms?
Dr. Julia Schechter: This is such an important question, that is really growing in its significance, in part because there is greater awareness of how ADHD presents in girls and women, which is leading to more females being identified as having ADHD earlier in their lives. What this leads to though, is that more and more women are entering childbearing years with a diagnosis of ADHD and having to make decisions about ADHD treatment in pregnancy. Another reason why this is important is that we also know that having ADHD, particularly untreated ADHD, increases the odds of having a teenage pregnancy, as well as experiencing unplanned pregnancies in adulthood. Understanding the intersection between ADHD and pregnancy is important. Unfortunately, we don't currently have a lot of data on ADHD in pregnancy or guidance for what to do to help support people who are pregnant with ADHD.
What some of our research has shown in terms of ADHD medication use in pregnancy is that there may be a small increased risk in specific types of heart defects associated with taking a common ADHD medication, methylphenidate specifically. However, we also have data indicating that when not treated during pregnancy, ADHD symptoms can be linked to some negative health behavior. Such as being less likely to take care of yourself in your pregnancy, not taking your prenatal vitamins, not eating healthy, or smoking during pregnancy. We also have data to indicate that untreated ADHD in pregnancy is linked to greater depressive symptoms and challenges in functioning in your personal and professional lives. I would say the take home message here is first of all, we need more data. I guess the second thing is that this is a complicated issue. I think anyone who is pregnant with ADHD should really talk with their doctors about what is going to be their right choice for them while managing their symptoms during pregnancy.
Dr. Cara Goodwin: I love how you explain that because I'm pregnant right now and I think the attitude towards pregnancy is don't take anything at all, ever. But you also have to look at what are the pros and cons. For example, driving with untreated ADHD is a lot more dangerous and that's not great for the baby if you get into a car accident. You can't just say to pregnant women, “Don't take anything,” because you have to consider what are the impacts of an untreated condition. We obviously think about that with depression during pregnancy as well as anxiety, and all different mental health conditions. I think it's important for pregnant mothers to know it's not a clear cut answer and that the answer may be different for different individuals.
More generally, how does being a parent with ADHD impact parenting? What are some of the challenges that you might encounter?
Dr. Julia Schechter: First, I think everyone listening to this podcast knows that parenting can be really hard at times. Adding a parent's own ADHD diagnosis into the mix can make an already hard job even harder. For example, adults with ADHD can have more challenges with organizing, planning, and forgetfulness. What this might look like as a parent is it might mean that you have a harder time setting up and following regular daily routines in your home. You might have more trouble planning ahead for transitions and helping your child move from one activity to the next. Remembering and keeping track of the items that kids need for school could be difficult. We also know, or have seen in the literature, that mothers and fathers' ADHD symptoms have been linked to just more disorganization and chaos in the household.
People with ADHD can also have trouble with distractibility. If you are trying to respond to your child's behavior consistently, this might be hard to do if your attention is really easily pulled away to another task. Also, people with ADHD have trouble just sustaining their focus on things and monitoring their child's behavior. During early childhood, this might result in more accidental injuries for the child. During adolescence, this less monitoring might be associated with more problematic behaviors like skipping school or hanging out with deviant peer groups. We also know that individuals with ADHD have a really hard time waiting. They're just more impatient. We know that the ADHD brain gets bored more easily and has trouble with delayed reward. We also know that parenting requires an incredible amount of patience and delayed gratification. Even just thinking about teaching your child a new task, like tying their shoes, right? A parent with ADHD might have a harder time with this, this kind of slower task, and this might lead to more inconsistencies in parenting or more permissiveness.
We also know that individuals with ADHD can also have challenges with self-regulation. Think of this as that little voice in your head that says, “Oh, I probably shouldn't do this or I probably should go do that instead.” In the context of parenting, this might be because my toddler is definitely pushing my buttons right now and I think I need to take a little break for myself. It might be harder for individuals with ADHD to slow themselves down in that way or inhibit certain behaviors and have that more planful response. So they may be more reactive to their child's behavior or discipline them more harshly than they would like to. I know this sounds like a lot of negative stuff and I really want to stress that being a parent with ADHD does not make you a bad parent. I think it's just important to acknowledge that having ADHD can make it harder for parents to parent in the way that they want to. They might have a harder time being kind of calm and consistent and attentive.
Dr. Cara Goodwin: That makes a lot of sense. I think that really helps to highlight what it might look like. I see a lot of parenting advice on social media and so much of it is geared towards what I would call neurotypical parents and neurotypical kids. But like a lot of parenting advice it sounds great to be prepared for every situation in this way. That's not always possible. Some people's brains function in different ways. It's harder to be prepared for every situation that might come up as a parent and to have the self-regulation skills to stay calm in that moment. I think it's very important to remember that these strategies aren't going to apply to all parents. It will be a lot harder for some parents. What strategies can adults with ADHD use to make parenting a little bit easier? Is there anything that parents can do that might help?
Dr. Julia Schechter: I think the first thing to think about is to make sure that you are managing your own ADHD symptoms as best that you can. The old adage of putting on your own oxygen mask on before helping others, I think really applies. Making sure that you're receiving the proper care and support that you need to function and this might be taking your own ADHD medication or being in therapy. I think it's important for all parents to take care of themselves in general and this often is not prioritized. But for parents living with ADHD, it may be even more crucial to prioritize themselves to make sure that they're able to make their brains work in the way that they want them to.
In addition to evidence-based interventions like medicine and therapy, you're just figuring out the tips and strategies that work for you as a parent and can be really helpful. Maybe it's setting extra alarms to remind you of important things like picking your kids up from the bus stop on time, or religiously using your calendar to keep track of family events, or setting bills to auto-pay. Really embracing the strategies that work for you can be helpful when managing the duties of parenting.
Another set of strategies that we know can be helpful when parenting is an evidence-based approach to treatment called parent management training, or behavioral parent management training. This type of intervention really focuses on using parent attention to get more of the behaviors that you want like really focusing on the positives, setting up consistent expectations and rewards, and using effective discipline strategies. We know that this can really help with improving the parent-child relationship, increasing parents' sense of competence, and also improving kids' compliance. Some of these interventions do have to be implemented by a mental health professional, but there are also some free resources out there that I just wanted to highlight. One in particular is a program called Triple P, and it offers free parenting courses and some other online training and resources. You do not have to be a parent with ADHD to benefit and your child doesn't have to have ADHD to benefit from these evidence-based skills that can make parenting easier for many people.
Dr. Cara Goodwin: I will say Triple P is backed by a lot of great research. I think that's a great option for parents to use with and without ADHD. I know that we talked about this a little bit in our last interview, ADHD can impact social emotional functioning of children, making some social situations a little bit more difficult and emotional regulation can be difficult. Might you see some of these same challenges as a parent with ADHD and how can you cope with that as an adult?
Dr. Julia Schechter: Yes, we do often see some challenges with emotional and social difficulties in adulthood as well. Luckily, adults' brains are more developed than kids', so we know that regulation is usually better in adults than kids, but these difficulties can still persist in terms of regulating attention and regulating behavior and regulation of emotions as well.
We also know that adults with ADHD are at higher risk for mood disorders and anxiety, which can further make emotional functioning and social functioning more challenging. To cope with these challenges, again, I want to reiterate adults taking care of themselves. So again, this might be medication and therapy. They often are both important parts of the treatment puzzle. Figuring out if there are tips and tricks that can really help you with regulating your own emotions, whether that is making sure you're taking time for yourself during the week to just do something for you, taking care of your physical health, to things like diet, exercise, making sure you're getting as much sleep as you need. We also hear about the importance of connecting with others and connecting with other parents. I wanted to highlight another organization that sometimes can help with this connection, and it's called CHADD. That stands for Children and Adults with ADHD. They have resources for people with ADHD across the lifespan, including some great parent resources.
I think one last key point here is just to give yourself some grace. Being a parent with ADHD can be so emotional, so making sure that you are being kind to yourself.
Dr. Cara Goodwin: That's wonderful advice. That's really helpful, just remembering that we can give ourselves a little compassion and grace. It's OK if we as parents struggle with this more than it seems that other parents do. I always advise parents who have more trouble with emotional regulation that it's OK to take a minute if you need to calm down before dealing with a situation. There's no reason that you have to jump into a difficult situation with your child right away. If you need to take a time out for yourself and calm down, that is more than OK. You're actually modeling great skills for your children, showing them it's OK to take a break and calm down and come back to the situation when you're ready.
I know that ADHD has a genetic component. If you are a parent with ADHD, what are the chances that your child also has ADHD? What challenges can you expect if you both have ADHD? And how do you handle that situation?
Dr. Julia Schechter: ADHD is highly heritable, which means it runs in families. Estimates indicate that over half of adults with ADHD have at least one child with the disorder, and up to half of children with ADHD can have a parent with ADHD. I cannot tell you how often I hear from adults that they first started to consider that they might have ADHD after they completed an evaluation for their child. They were filling out these forms for their child, and they're thinking, “This sounds a lot like me.” So bottom line, if you have a child with ADHD, the odds are higher that you yourself may have ADHD, or at least have some challenges with ADHD-like behaviors.
There certainly can be difficulties when both parent and child have ADHD. Kids with ADHD just require more care. There are medication appointments and there's therapy and there's school meetings and there's additional monitoring of their behavior. This is hard for any parent, but if you add in ADHD into the mix, those things are just going to be harder to do. So again, I know I sound a little bit like a broken record, but parents with ADHD should really make sure that they are able or they are taking care of themselves so that they're able to take care of their kids.
One last point I want to make here is that there is some indication that being a parent with ADHD may offer a unique insight into what your child with ADHD is experiencing. It actually can make you maybe more attuned or in sync to what your child is going through.
We also know that having ADHD can be associated with a lot of strengths. For example, maybe you are a parent who is just better able to keep up with the energy level of your child, or maybe you're more creative and can engage in more creative imaginative play. We know that when ADHD is well-managed, people, including parents, can really thrive.
Dr. Cara Goodwin: I love that positive spin on it. I think we often just hear such the negative side of ADHD or other conditions, and I think it's important to remember there are so many strengths. Especially when, as a parent, if you have ADHD and your child has ADHD, I imagine you have a different level of empathy for the challenges your child is experiencing. What interventions are available for adults with ADHD? Should you consider medication or are there types of non-medical interventions that adults should consider?
Dr. Julia Schechter: Yes, if you are an adult with ADHD, there are a couple different evidence-based interventions. We do have a lot of data to support taking medication, particularly stimulant medication, and this kind of medicine can be managed by your primary care doctor potentially. Or you may choose or may need to see a more psychiatric provider, so like a psychiatrist or a psychiatric nurse practitioner.
Adults with ADHD can also benefit from therapy, so specifically we have evidence to support Cognitive Behavioral Therapy, that's CBT for ADHD. CBT for ADHD really focuses on skills that adults with ADHD can practice to help themselves manage their symptoms. Things like how to manage the pile of mail that creeps up so frequently or how to make sure that things don't fall off their to-do list. We also know that there is an absolute connection between thoughts and feelings and behaviors including ADHD behaviors. CBT for ADHD really helps adults recognize the connection between the way that they're thinking and feeling and how this can impact their ADHD symptoms.
We also have some evidence supporting mindfulness-based strategies for ADHD. I know it might sound a little counterintuitive for someone with ADHD to be engaging in mindfulness practice like meditation, but we do have research to show that this can help with managing ADHD symptoms.
One last thing to mention here is just continuing to take care of yourself. As we’ve talked about today, parenting with ADHD can just be extra hard. In addition to engaging in these evidence-based treatments, finding your community and your support system that can really help you manage all of these things and listen to you when things are hard, that can be a really key part of just the treatment plan for individuals too.
Dr. Cara Goodwin: Okay, that is also helpful to know. It's good to know that adults like children also have lots of options to consider. Thank you so much for being here. I feel like there's just been a wealth of knowledge shared.
Can you let us know where to find more information if you are a parent with ADHD or think you might have ADHD?
Dr. Julia Schechter: Yes, a couple of places I'd like to highlight. I mentioned today, CHADD, that's Children and Adults with ADHD. CHAD is a great resource again for ADHD kind of across the lifespan. I will also make a plug for our center. Again, that's the Duke Center for Girls and Women with ADHD. We're also on social media. We have a lot of resources already up, but we are just continually developing resources as well. We have a particular interest in supporting parents and also, trying to help fill that gap related to pregnancy and adults with ADHD.
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Welcome to the Parenting Translator newsletter! I am Dr. Cara Goodwin, a licensed psychologist with a PhD in child psychology and mother to four children (currently a newborn, 3-year-old, 5-year-old, and 8-year-old). I specialize in taking all of the research that is out there related to parenting and child development and turning it into information that is accurate, relevant, and useful for parents! I recently turned these efforts into a non-profit organization since I believe that all parents deserve access to unbiased and free information. This means that I am only here to help YOU as a parent so please send along any feedback, topic suggestions, or questions that you have! You can also find me on Instagram @parentingtranslator, on TikTok @parentingtranslator, and my website (www.parentingtranslator.org).
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It is definitely interesting for parents to see their struggles when they see their children. I hope this newsletter helps parents to focus on their own self care if they have ADHD.
As someone who has spent a great deal of time assessing children, I often saw that the parents would learn a great deal about themselves and make connections to things they struggled with in the in take and assessment process. Thank you for sharing this interview!