Adult ADHD affects near five percent of the population, although the actual diagnosis rate is far lower. Many adults live unaware of what sits behind their chronic struggles with attention, time management, emotional self-regulation, and a host of related abilities that impact family, work, and well-being. And those already diagnosed often have a hard time finding providers familiar with adult ADHD management.
Dr. Lidia Zylowska is one adult provider aiming to make a difference. A friend and colleague of mine, Dr. Zylowska achieved some notice several years ago when she published a pilot study adapting for ADHD the acclaimed mindfulness based stress reduction program. While some were skeptical that adults and adolescents with ADHD could sit and practice mindfulness, almost everyone entering the program completed it - even with a meditation component built around attention training. Participants reported lower stress and an increased sense of well-being. Specific measures of attention and executive function improved.
Dr. Zylowska's new book The Mindfulness Prescription for Adult ADHD offers mindfulness through a practical, eight-step program. It includes accessible discussions of how ADHD related executive function deficits affect people day-to-day. It even integrates advice for how to maintain these practices consistently in the midst of a busy life. The Mindfulness Prescription for Adult ADHD is a unique resource for adults with ADHD, particularly those looking to explore the practice of mindfulness or to build on an already existing one.
If you are a harried parent, an adult with ADHD, or (as is common) both a harried parent and an adult with ADHD, mindfulness is meant for you. Through mindfulness we build an ability to attend more fully to our experience as it happens, wrestling less with a sense that things aren't as they ‘should' be. Whatever our natural tendencies, we increase an ability to focus our attention where we want while also cultivating compassion for ourselves and others. While a practice of meditation is often suggested, it is a style in which we never aim to eliminate thought, only to sit more comfortably with a busy mind.
ADHD also has a profound effect on relationships. Both a child's and a parents' symptoms affect the whole family, and parents of children with ADHD have a significantly increased risk of having this highly heritable condition themselves. And then adult ADHD makes it harder to stick to recommended parenting strategies which generally depend on consistent routines and limit setting, escalating a tough dynamic.
The executive function deficits inherent to ADHD don't affect only attention and impulse control, they interfere with a host of self-regulatory skills that can affect almost any aspect of daily living. Difficulty with executive function may be the most prominent feature for adults with ADHD, who commonly lack the ‘hyperactivity' component (as is also true for anyone with ADHD-inattentive type, or ‘ADD'). While much can be done to diffuse the situation, to address the potential impact of ADHD on a household we first need to know it's there. So, to identify the often hidden influences of ADHD, parents may first need to look at the possibility that they have it too.
If you're curious about yourself, a free adult ADHD screener is available through the World Health Organization. Information about adult ADHD and listings of resources are available through the ADDA. And many good books have been published about the effects of ADHD on families and relationships, offering tips for minimizing its effects on you and your loved ones. Finding the time to take care of yourself as a parent with ADHD is an often vital part of caring for your children... which may include proactively addressing the impact of your own ADHD.
Originally Published on March 30, 2012 by Mark Bertin, M.D. in Child Development Central
The fact that some individuals harbor unfounded doubts about ADHD isn't surprising to see in print once again. The fact that a reputable newspaper like the NY Times would publish an individual's opinion stated as fact, without regard to basic science, was more troublesome. If believed, last Sunday's op-ed about ADHD, "Ritalin Gone Wrong," would undermine the lives of countless children and families struggling with the condition.
ADHD is a proven medical disorder. Dozens if not hundreds of studies show that unaddressed ADHD (ADD is not unique from ADHD, it is considered a subtype) greatly increases the risk of everything from school failure and car accidents to obesity. These risks make sense when ADHD is understood as a condition that affects an individual's capacity to manage their lives, moment-to-moment, throughout the day.
To truly and compassionately support a child or adult with ADHD, we need to recognize its underlying - and proven - medical cause. An underactive part of the brain impairs an individual's ability to focus, organize, prioritize, and a host of other related life skills. The reason to seek diagnosis is not to decide about medication; it is to help understand an individual. Dr. Russell Barkley has said ADHD is not a disorder of not knowing what to do, but of not doing what you know. There is a huge difference between a child misbehaving because they have poor impulse control or are overly forgetful, and making the false leap that he doesn't care or is being intentionally ‘bad' in some way.
Dr. Sroufe's perspective absolutely slams parents. ADHD causes intense stress because of all the difficulties it leads to in life, and parents of children with ADHD report higher levels of anxiety, depression and divorce. Simply getting out the door in the morning becomes a daily crisis. And this happens regardless of how a child was raised: ADHD is not a parent's fault. ADHD symptoms are influenced by environment and parenting style, and we should continue to explore how we can best manage it, but no reputable study has ever suggested that ADHD is caused by environment alone.
Lastly, regarding medication. No respectable practitioner wants to use medication unnecessarily. Yet there actually are clear, research based guidelines demonstrating concrete benefits to ADHD medications that the NY Times op-ed dismisses. We certainly need to explore behavioral and educational interventions that could help any individual, and I often suggest them first. When trying ADHD medications, these non-medical approaches are still needed; even when well utilized and well tolerated, medication alone can't solve everything. Parents and clinicians alike must consider a wide range of possiblities to fully address this complex condition.
At the same time we should aim to help parents find some objectivity in decision making, to step away from the bombast and propaganda inflamed by essays like "Ritalin Gone Wrong." Regardless of what any individual family chooses, they should at least know that the research says non-medical interventions rarely improve ADHD symptoms nearly as much as medication. Decisions should be made as much as possible by seeking facts, not stoking fear.
In regards to the claims made in the op-ed: Multiple studies do show long-term benefits of ADHD medications, with improvements in academics and many other aspects of life. As examples, Dr. Robyn Powers in a 2008 Journal of Child and Adolescent Psychopharmacology report showed that adolescents, off medication by then, were doing better academically if they took medications when younger than others students with ADHD who never did; one from the Journal of American Psychiatry by Dr. Tomohiro Nikao in 2011 documents a trend towards normalization of brain functioning in those who took medications as children. And the Times article fails to mention that recent, larger studies of ADHD medication do not suggest any persistent growth changes. Meanwhile, while any medication has potential side effects, simply allowing a child to regulate their own behavior well enough to succeed in school, socially, and to have an easier relationship with their family even for a few years has a profound impact on their long term well-being.
It is sad to see these ADHD myths perpetuated. We need to reach out to families that are dealing with it by acknowledging their struggles. A child with ADHD has a developmental delay in their capacity to manage life - and an ADHD diagnosis helps us define the supports they need at home and school to thrive, separate from decisions about medication. Medication itself has been shown, to the best of anyone's knowledge to date, to be at minimum a useful option that does not have long term side effects. Suggesting otherwise lets down children and parents alike.
Originally Published in Child Development Central on February 8, 2012.
Compassionate ADHD care starts with fully understanding executive function.
For each area of executive functioning in your child, there is a reality: Does my child have these executive function skills, or don't they? Be curious; look for patterns. As best you can, look objectively at your child's abilities in comparison to their peers. Attributing ADHD traits to willfulness or assuming they will simply be outgrown increases your own stress, strains relationships, and may frustrate your child. It also doesn't usefully address the underlying problem.
Children with ADHD are as bewildered as the adults in their lives as to why things that are so easy for other kids come so hard to them. Like everyone else in the world they would like to be happy, at ease, and successful. They may begin to wonder, what's wrong with me?
They often need an intense short-term safety net, a realignment of demands and commitments balanced with lots of structure to make sure they learn and keep up at home and at school. And then they benefit from a coherent, long-term plan to develop their abilities and coping strategies.
Understanding a child with ADHD, and optimally supporting and helping her, means understanding how executive functions relate to ADHD. In order to offer compassionate support, build confidence, and create a plan for the future, the first step for parents is to sort out the reality of underlying issues present in ADHD, including all the varied implications of executive function. By holding onto these basic facts, you can appropriately challenge your children to grow while building for long term success.
One of today’s standards of American education is the concept of ‘heterogeneous grouping' within ‘mainstream' classrooms: Children of every skill level remain together in every subject. This may be a pushback against a time when grouping children according to their abilities lead to a sense of isolation, with kids seeming to languish on the special education track. Yet to meet any long-term goal of integrating children with their peers, the short-term concern should be addressing immediate educational needs—a goal not always accomplished in the mainstream.
Individualized planning requires an objective exploration of strengths and weaknesses. This perspective often reveals a need for smaller, more structured classrooms and more refined placements; for any student who has extensive academic, behavioral or social difficulties, we need to consider all possible options. Yet due to policy trends in education and presumably the pressure of economics, many schools have eliminated these possibilities entirely. Now, left behind is a ubiquitous policy of placing every child in a single setting; a trend that fails many of our children.
All for One ...
School districts today tend to educate everyone lumped together. Instead of modifying content, this style of ‘individualized' plan doesn't adjust the basic material—even though a student may not yet have grade-level skills. Children with special needs receive a few minutes of direct attention targeted to their particular abilities during the day, but the vast majority of time is spent trying to keep up with everyone else.
Academic motivation develops best through success and mastery and is undermined when children flounder with work that is over their heads. Steve, a ninth grader in my practice with reading disabilities, is a good illustration of this. He was asked to read Ulysses over the course of several months, in spite of the fact, that he lacked the ability to decode the words and comprehend the story. A teacher's aide outlined and helped him with vocabulary when he felt like asking questions. As that had become habitual, Steve instead checked out on the entire project.
Given a more skillfully chosen book that Steve was capable of reading with minimal support, he might have continued to engage. With remediation to close the gap in his reading skills, which he was no longer receiving, he might have caught up. Even with tutoring he struggled, not only with reading, but motivation in general, overwhelmed by school work far beyond his abilities. Any potential benefits of spending his days with mainstream peers were completely overshadowed by his belief, mostly correct at that point, that he couldn't do the work even when trying his best.
... And One for All
Leaving students together throughout the day also means the curriculum is not tailored for remediation. Academic interventions are typically added by having teachers and therapists visit kids in their classroom, often called ‘push-in' services. These in-class networks of therapists and special educators work for some children, but many feel singled out. Living as the only one who doesn't easily ‘get it' in a classroom of kids who generally do, leaves many children dwelling on the difference, and feeling like failures. Why am I the only one who has all these extra teachers?
Another push-in approach adds a special education teacher to an otherwise mainstream classroom. This set up (often called an ‘inclusion' or ‘integrated' setting) helps children whose primary requirement is additional adult attention, such as those with behavioral issues. And having a second adult in the room with a special education background can be beneficial to all, lowering the teacher-student ratio and adding a specialist's expertise. Yet, as a catch-all intervention inclusion does not inherently address the needs of all children with special needs such as those with learning disabilities, ADHD, autism, or any other concern that requires a more targeted curriculum.
There are also logistical issues when adding a special education teacher to a mainstream class. Grouping children for direct instruction by the special educator, while another teacher continues a lesson for the rest of the classroom is often distracting for all the children, and limiting for the special educator. And like other push-in services, children may feel more stigmatized, not less, when pulled aside from peers in the same classroom. Lastly, as in mainstream settings there is frequently a requirement that children tag along with grade-level content and pacing most of the day instead of following their own prescribed curriculum.
A Custom Fit
On a practical level, contained settings address the needs of children in ways often impossible to implement otherwise, and they still do exist in places. There are classrooms and even entire schools geared to evidence-based academic instruction for children with learning disabilities. Some are structured to meet the needs of children with ADHD, allowing these intelligent, typically well-motivated children an opportunity to learn as well as any of their peers. Others are tailored for development of social and communication abilities in children with autistic spectrum disorders.
Every fall, I see children blossom after switching rooms, able to manage their work on their own, and to master it with the same level of help all the children around them receive. In spite of fears to the contrary, children generally feel more at ease when moved to a well-supported setting. Suddenly, they realize that their issues don't define them: Here I am with ten other kids, all of us are smart and all of us can't read well! I'm not different after all! Reduced stress and gains in self-esteem lead not only to academic growth but to social and emotional benefits outside the school setting. While kids should never be ‘stuck' on a special-education track, self-contained settings are sometimes their clearest path to social-emotional well-being and academic success.
New ADHD guidelines encourage improved preschool diagnosis and intervention
The American Academy of Pediatrics just released updated guidelines for the evaluation and treatment of ADHD. Although specialists have been identifying ADHD in preschool children before now, the guidelines expand the 'official' age range for diagnosis down to age four. They still encourage behavioral interventions before medication in preschool children. Early identification often allows families to address issues before they escalate, and helps keep children on track in their development.
Among several other recommendations, the guidelines also emphasize looking for conditions that co-occur with ADHD, a vital aspect of care. Most children with ADHD have something else going on with it, ranging from a learning disability to oppositional behavior to any number of concerns. For families using medication, the importance of 'titration' is reaffirmed, as best results frequently require trying more than one medication and various doses before choosing what fits for any individual child. While there is little emphasis in the paper on the role of executive function, the guidelines should improve care and clarify evaluation and treatment of childhood ADHD.
The holiday season can be a time of great, uncomplicated joy -- honestly it can. It doesn’t have to be an intense, draining, consumer-driven mess. We cram into four weeks a stew of stress-raising ingredients for our families, letting it simmer until New Year’s Day. But with a little mindfulness and mental effort, we can keep ourselves grounded and together and help our families find a sense of peace in the midst of it all.
We can start by taking an honest look at what we’re doing to ourselves these next few weeks. Forewarned is forearmed. A short list of what the season serves us: Too little sleep, too much food, too little sunlight, too much alcohol, strained budgets, challenging gift purchases, hours of schmoozing with people we see once a year at the same party but never in between, too little exercise, too much travel, extreme weather, and various family crises. And our kids live through the season on sugar and poor sleep and lack of exercise, and probably have become certain that the only path to true happiness is to have the hottest new ... whatever fits their vision of nirvana.
It’s stressful even writing about it. The holiday season, meant to bring us all together in happiness, consistently accomplishes exactly the opposite for so many people. So what’s the point? What can we do instead?
There is another option. Instead of letting it all just happen, we can remind ourselves what matters most -- and what we’d like our kids to learn. Emphasize, for our own sanity and for that of our children, the simpler side of the holidays. Find time for fun activities outdoors or in the city or wherever else, without settling for the lowest common holiday denominator of overspending and overscheduling.
In spite of the external pressures, we can value taking care of ourselves. Too little sleep amplifies stress; exercise reduces it. Also helpful is eating healthily, not necessarily at the parties themselves but perhaps the rest of the month. Schedule quiet time alone or with someone who calms you or makes you laugh. Find the humor in the midst of the seasonal insanity. Whatever works for you the rest of the year, instead of letting it slide for a month, protect it, a holiday gift for yourself.
Avoid perfectionism. We sometimes amplify the emotional impact of buying gifts or hosting parties by unconsciously holding them to impossible standards, fitting them to the storybook pictures we’ve created in our minds. Not only do we invite all our family and friends but we expect angelic behavior from our kids, or stay up late meticulously centering the candy noses on cookie reindeer, or maybe actually expect our parents not to bicker this year, although they have fought fairly consistently over the last few decades. “No bloodshed and a few good laughs” may be more than enough for any given event.
Let yourself mentally quiet down at times throughout the day. Left unattended, one stressful thought leads to another, and the cycle ramps up all day long. Eventually, life feels like a crisis even on a relatively ordinary December day. Without disrupting your schedule, without adding another “thing to do,” take fifteen slow breaths as needed, focusing as best you can only on the physical sensations related to breathing.
Instead of letting your thoughts escalate, let your mind settle. Spend a moment not doing or planning anything. Don’t expect a holiday miracle; your mind will remain busy much of the time. We can’t completely stop ourselves from thinking, and there’s no need to try. But on the train, in the aisle of the toy store, trying to get the children to the dinner table, or whenever you feel yourself ratcheting up, give yourself a break for a few moments.
As suggested in a recent New York Times article, one other trick to lowering stress is to make a practice of gratitude. In spite of the millions spent in seasonal marketing to convince us our long-term well-being depends entirely on a massive TV set or a diamond necklace, we know better. Instead of buying into the hype, express appreciation at the end of every day for several things that went well. On an off day maybe simply relish the opportunity to put it behind you and go to sleep. Whatever you discover, small or large, write it down or spend a few moments mentally giving thanks.
We can’t eliminate all that the season throws our way. We can’t do anything about that or the people around us who may be more wound up than usual. But we can acknowledge the inevitable challenges without getting sucked in. Instead of letting the holiday season run amiss, we can find the opportunity to celebrate and connect with friends and family and create for ourselves and those around us healthier, more relaxing, and restorative times.
Fifty years ago, the first fast food restaurants opened in our country. Since that time there has been a steady increase in obesity. Whenever American fast food is introduced in a new nation, obesity soon follows. Obesity is an epidemic related to the modern proliferation of fast food chains, along with other similar style food products and marketing, yet fast food restaurants are now so ubiquitous it's hard to say how to address the issue on a societal level.
Frighteningly, we're letting the same thing happen to our collective health again. Just as the food industry undermined the dining habits of several generations, we are now allowing the media and entertainment industry to define how we use their own products. Parents, raised immersed in television and computers, often dismiss the problem. The kids are having fun, let them be. It doesn't seem pressing, and there are other things to worry about besides screen time. But without action - not eliminating media, but intervening and learning to handle it better - we're raising an entire generation at risk for ‘fast food brain,' with minds chronically unhealthy and cognitively out of shape.
This month in Pediatrics, a study showed that short-term exposure to a fast-paced cartoon affected mental skills called ‘executive functioning' for the worse. Executive functioning relates to overall well-being, as well as social, academic and work success. It acts as our brain manager, monitoring our behavior and the organization of our thoughts throughout the day.
In the Pediatrics study, executive function was measured after viewing nine minutes of a popular cartoon and after watching a slower-paced program. Children showed measurable decreases in their executive function after viewing the fast-paced cartoon, but not the slower-paced program. In other words, their ability to self-regulate suffered almost instantaneously. In the real world, when I ask families how much media time their children get every day, they often pause and do the math and end up somewhere between one and three hours - far more than nine minutes.
The cartoon used in the study isn't anything particularly violent or obscure. It is a wildly popular, geometrically shaped character who resides on the sea floor - Spongebob. We've all seen him around and have probably watched the show ourselves. And while the study's findings are unique, they support many others that have documented the long-term ill effects of media time, including concerns that too much media correlates with shorter attention spans - one of our most central executive function skills.
To set our children up for success we must encourage the growth of cognitive skills that help manage the ups and downs of life. Unattended media use gets in the way; excess media and inappropriate content for children correlates with everything from obesity to aggressive behaviors. It's easy to shrug it off - it can serve as a useful babysitter and is mindlessly fun - but that doesn't make all of it benign.
Media exposure affects brain development on a foundational level. Another study out this month shows again that television, as opposed to reading, impairs language growth and early literacy skills. With its underlying cognitive and developmental effects, ‘fast food brain' impairs social and academic progress and long-term happiness. Media is nothing more than cotton candy for the mind. A little is fine, but you don't want to overdo it too often.
However you've managed it up to now, the choice is yours as to what comes next. Don't live on autopilot. Don't let the effects of media passively happen to you and yours without making a conscious decision about what is wisest for your household. Kids shouldn't consume media without guidance any more than they should be permitted to eat fast food and candy all day long. Stop, reflect, and think proactively about both the amount and the content of television shows, video games, and movies your children experience and the potential effect on brain development. Will you decide how media is used in your family, or leave the choice to all the marketers aiming for your children?
With fast food we missed our chance to make intelligent plans as a society. Now we are scrambling to undo the damage. This time around we can make individual statements for our families, but also band together as a whole. We have time to refocus our culture on a healthy lifestyle, emphasizing what we know is best for child development, while still allowing for plenty of down time, random fun and for letting kids to be kids. The clock is ticking. The choice is ours to make.
Published on September 22, 2011 by Mark Bertin, M.D. in Child Development Central
A study out this month in the journal Pediatrics found that near sixty percent of children with ADHD have an associated writing disability. Beyond the effects of distractibility, rushing through assignments, impulsivity and all the rest of ADHD, these children have a neurologically based deficit around writing. The ability to effectively gather their thoughts, organize them, and get them onto the page is impaired directly, not only by their ADHD. Often overlooked and underdiagnosed, a writing disability impacts not only the specific tasks of producing coherent sentences, paragraphs and essays but also testing and note-taking. Without intervention the added time and stress around writing related tasks affects overall school performance
One of the most basic principles in supporting a child with ADHD is looking for other conditions that often tag along with it. These are termed ‘comorbid conditions' and common ones include developmental delays (fine motor, language, etc.), various learning disabilities and specific mental health conditions such as anxiety. Nearly two thirds of people with ADHD have at least one of these, and that statistic doesn't even count the far-reaching effects of executive function deficits inherent to daily living with ADHD.
School planning sometimes overlooks these possibilities, many of which are of particular importance in the classroom. Academic motivation depends on a sense of mastery and success and rarely develops when children feel at a loss or lack the tools they require to thrive. For students to enjoy and take ownership of their own academic career, underlying issues affecting school must be addressed first.
Here are suggestions (in fewer than three hundred words) to avoid common pitfalls while planning for the upcoming year ...
•Make sure evaluations have looked for specific learning disabilities, especially when children with ADHD have persistent academic problems.
•Address difficulties with executive functioning at home and school. Children with ADHD require more structure and adult support to manage their work, and more direct instruction in organizational skills than peers. Because of ADHD they benefit from a scheduled routine instead of open-ended supports that say things like, ‘you can visit Ms. Jones if you feel you are falling behind.' Their capacity to identify a problem (‘I need help'), create a plan to address it, and then stick to it over time is directly impaired by ADHD. Instead of open-ended solutions, schedule supports into their day: ‘Right after fourth period, you have a study session. Would you prefer to meet with Ms. Jones or Mr. Frank?'
•Implement a structured, reward based behavioral plan proactively. Don't wait for classroom tension to start before focusing on behavioral change.
•Ask for placement with structured teachers who run classrooms that permit fewer distractions in the environment. Classroom set up (e.g., desks facing the teacher when she's teaching and not peers) and management (e.g., clear and consistent rules) matter greatly when children have ADHD.
•Encourage schools to use evidence-based instructional methods for children with ADHD. Today, the most commonly used curriculums rely on learning through exposure to academics without an emphasis on direct teaching of skills. Children with ADHD are less likely than peers to thrive without an emphasis on core skills, repetition and rote instruction.
Educational planning of this kind is one of the three foundations of ADHD care. Integrated with appropriate behavioral supports and judicious use of ADHD medications, children with ADHD can thrive at home and school through the upcoming year and beyond.
One common, under-addressed symptom of attention deficit-hyperactivity disorder (ADHD) is its impact on eating. A new study in the Western Journal of Nursing Research suggests the possibility of screening anyone with a chronic weight issue for ADHD since one in five adults who were obese turned out to have multiple symptoms of it, compared with around one in thirty in the general adult population. Previous studies have also found that children and adults with ADHD are significantly more likely to be overweight. With so many millions of people affected by ADHD, any risk of increased obesity influences the health of huge numbers of people. Is the connection with ADHD affecting you or someone you care about?
The link between ADHD and poor eating habits isn't surprising when you consider that it is a disorder of executive function, a set of cognitive skills which act as our brain manager. Executive function impacts almost every aspect of living, encompassing our ability to self-regulate, organize, plan, prioritize, and anticipate the future. Eating is only one of many facets of ordinary life influenced by ADHD, yet typically flies under the radar.
The Makings of Self-Control
Executive function deficits get in the way of everything from noticing when we are full to making healthy food choices in the midst of a stressful day. For kids and adults, impulsivity leads well-intentioned diets out the window in a moment, making it that much harder to walk past a MacDonald's or avoid the pile of donuts left by the coffee machine. Executive function affects the ability to judge time, perhaps to see that today's ‘exception' is part of a larger pattern. It's not a rare splurge, it's the same as four times this week already for ourselves or for our children.
Studies looking at eating habits in general, not specific to ADHD, have shown that distracted eating - eating while watching television, playing games, or simply daydreaming - increases calorie intake. Stress and anxiety, especially when amplified by ADHD, can push anybody of any age to reach for food. And then when a new diet or lifestyle is needed for a teen or young adult, executive function skills are required to develop and stick with the plan.
Guiding children with ADHD becomes even more important than it does for other kids, from behavioral patterns around food to the choices and the brands they encounter at home, and learn to prefer. ADHD causes some children, unless taught otherwise, to unknowingly overeat at every sitting or always grab an extra cookie from the pile. They may be less tolerant of hunger, quicker to raid the cabinet, melt down near the cash register candy, or experience any of a host of related moments that add up to a longer-term problem. Recognizing all the myriad ways executive function influences eating allows for a deeper perspective and suggests new possibilities for change.
A Hidden Ingredient
As a starting point, we must look for and identify the influence of ADHD in the first place. When children with ADHD overeat or begin to gain weight, we can dig deeper into their ADHD, looking for ways to manage it better. If an undiagnosed child struggles chronically around food, we should consider the possibility of ADHD, looking for symptoms in other areas of life. Other studies of obese adults have showed more than in four to be affected, and the rate in children could prove even higher as more kids have ADHD than grown-ups.
Many parents of children with ADHD have symptoms of the diagnosis as well. With adult ADHD it becomes that much harder to maintain long-term plans and healthier lifestyles, so the whole family may need outside support. Often these parents battle their own difficulties with self-regulation around nutrition, from how they manage the family pantry to their own eating style. Unaddressed, parental issues increase the risk that their kids will struggle with the same.
Parents are concerned about weight loss as a side effect to ADHD medication and rightfully so, although in practice most kids do fine. In fact, medical treatment of ADHD can lead to healthier eating habits through a decrease in impulsivity and distractibility and all the rest. Kids who start out overweight sometimes seem to lose weight only until reaching a more appropriate one for their height, and then resume typical growth. In some situations improved eating habits, not the potential medication side effect of appetite suppression, may explain their initial weight loss.
Recipe for Success
It's not only about what we serve or when we serve it, it's about the example we set. We can choose to model only eating when eating, instead of staying half-engaged in other activities, such as reading the newspaper, watching television, working, or daydreaming. When at the dinner table we can leave our food alone while in conversation, pausing instead of mechanically lifting our fork again and again. We can practice putting our utensils on the plate between bites, serving ourselves on smaller plates, or never eating directly from the bag. Our children watch, and learn.
We might even notice how we habitually shop. Maybe decide not to keep challenging foods in the house at all, or only to buy them when consciously deciding it's time for a treat. If a child raids the pantry, constantly debates about having more junk food, or refuses healthy snacks for the chips they know are available ... don't have the overly enticing items on the shelf. We do the shopping, we can choose not to have them around.
The practice of routinely having family dinner has been linked to healthier habits, as well as fostering various emotional and behavioral benefits, but keep in mind that having the television on during dinner reverses much of that. In the midst of a hectic afternoon or butting up against larger behavioral issues elsewhere in life, we may give in to complaining about food, or use food to calm irritated children. Or conversely, we might stick to a different routine: Two cookies after dinner and no junk the rest of the day, dessert only on Saturday, or whatever else best fits our lifestyle. Establishing these healthy habits early often heads off troubles before they start.
The Whole Enchilada
So often, we compartmentalize troubles related to ADHD: My daughter has a hard time focusing and is more reactive than I like, and overeats and misplaces her homework all the time. Maybe you wrestle with a similar set of difficulties as a parent. We often judge our kids or ourselves for being ‘bad' or to be failing in some way: How come this looks so easy for all his classmates, and is so hard for my son? We scramble to address ADHD through hodgepodge solutions targeting each bump in the road (or mountain) separately. Yet in reality these all reflect the same condition, the same executive function deficits.
Plenty more may be going on around food for any individual, rarely is it a simple relationship. Beyond the range of struggles typical for many of us, anyone may experience an eating disorder, mental health concern, or a difficult family situation that affects their relationship with food. And this entire article is written from the perspective of a country where famine is rare, where most of us have options; when food is truly scarce, everything must change.
While there may be layers and layers of emotional and behavioral habit contributing, observing eating through the lens of ADHD allows for a deeper exploration, instead of chasing only the end point - eat less and exercise more. That's an answer, but executive function lets it happen. For anyone with ADHD it may seem weight control and five or ten different things are going ‘wrong' at once, yet executive function ties them all together. While not a miracle cure, all will be easier managed when we acknowledge this often overlooked element in the recipe of life.
It's no leap of brilliance to state that kids require consistent limit setting. And yet, we all struggle in different ways as to how to go about implementing it. Our kids resist, often quite resourcefully. We want them to be happy, and we want to be happy ourselves, so we relent, perhaps because just at that moment we're too tired and rundown to rally. Maybe sometimes our neighbors set different standards and we worry they'll judge us, or that our kids will.
Further confusing the picture, some books and websites advocate for fewer limits. They encourage us to anticipate each need of our kids ahead of time, or to treat a two year old how we would another adult. Not only does this burn outparents, it flies in the face of what we know about cognitive development.
We absolutely want to minimize our children's distress and maximize their well-being, treating them with loving-kindness and respect. The overriding goal is a warm and supportive environment that balances clear rules with openness to discussion as children get older. Yet the bottom line is that kids require clear limits to grow, to develop resilience and frustration tolerance, to understand that boundaries are a part of life, and to learn how to interact with the world. From our position as well-meaning adults with the benefit of some life experience, we must strive to keep track of what's best for our children over the long haul.
Limits are a large part of why kids need parents. If children knew how to behave in public, eat a balanced diet, pick clothes that make sense for the weather, treat their friends well, manage their time, handle responsibilities, and make healthy lifestyle choices from the start, we could get them an apartment when they go to kindergarten and leave them to it.
In reality our kids rely on us to help mediate between them and the world, to protect and teach them as they grow. During this phase in life we do everything we can to care for them, knowing that whenever they leave our home, life will present challenges. In anticipating those times our role is to cultivate skills that help in managing the ups and downs of life with autonomy such as emotional resilience, cognitive flexibility and patience.
We know from decades of research that experience shapes brain development. Parenting techniques, lifestyles, and preschool programs that emphasize core social-emotional skills increase the likelihood children thrive both socially and academically. Moving down this path to greater independence depends on our ability to teach boundaries now and to allow kids to encounter, and manage, occasional frustration along the way. Common-sense, old-fashioned parenting sayings - life isn't always fair, you can't have one just because your friend Joseph has one - may appear to be going out of vogue but are often what science suggests children need to thrive.
Would we deprive a child who stepped on a nail a required tetanus shot because they are screaming a blue streak? Of course not. A short-run battle, but long-term prevention. Reality is, children can get incredibly upset over almost anything. And one common flash point is when they encounter a limit: It's bedtime now. You can go out to play when your homework is done. You can't push your sister, go take a time out. These standards sometimes lead to an upset child or a tantrum, yet that reaction does not mean our choice was not healthy or valuable, or that we've let our child down.
It also doesn't suggest we are being ‘mean' to our kids. They may feel, and they won't hesitate to let us know, we are ‘depriving' them of the newest video game or funkiest shoes and wrecking their lives. It's not fair that the kid next door has a later bedtime. Still, the most skillful option we have is maintaining our open-minded objectivity, taking stock of the situation, making a choice, and then standing by our judgment of what is appropriate. We're rarely doing a child a favor by overindulging them or failing to guide their behavior.
Clear limit setting is therefore inherent to mindful parenting, paying full attention to our family with compassion for everyone. When we truly pay attention to our children - recognizing their temperament and abilities, knowing their likes and dislikes, and responding to their development through the years - we discover an evolving necessity for rules and guidance. At two years, at ten and into their teens the details will change, yet consistently upheld limits remain one of the most essential, loving parenting skills kids require from us.
So what gets in the way of our limit setting? Our own exhaustion, for one. Parents who immerse themselves in rearing children without any acknowledgement of their own needs are at risk for burn out - which often leads to inconsistently managed limits, and potentially a general state of over-indulgence. Yes, you can have the whole box of cookies for all I care as long as you let me finish this phone call and go play.
An important aspect of setting limits for kids is therefore understanding our own. Good parenting recognizes the necessity for time to take care of ourselves. Setting aside a few minutes a day to meditate or hang out with a friend or schedule a date night with our spouse can go a long way towards establishing consistency with our kids. It can be the refresher you need to hold your ground in the face of resistance.
Children are more likely to grow to be settled, happy adults if they develop ‘secure attachment' to others. From a psychological perspective, attachment refers to a strong, unwavering emotional bond between a caretaker and a child; it should not imply a child who never experiences frustration or disappointment. Secure attachment does not demand that every momentary desire be met and every problem solved for a child by an adult. Unconditional love, confidence your parents care for you and will protect you, is in no way antithetical to setting limits. Limit setting teaches self-regulation and builds resilience; secure attachment alone isn't enough.
Maintaining clear rules and guidelines also does not mean becoming rigidly strict or draconian. Guide behavior through reward and praise whenever possible. Have fun, make jokes. Offer reasonable options - you can do your homework now or in half an hour (but not at ten o'clock tonight). Pay attention to your choices, and stick to only as many limits as required. Recognize your role in the equation, and remember to take care of yourself. And then, remaining open to discussion and flexible about change when appropriate, establish clear boundaries you adhere to the remainder of the time. This is mindful, caring parenting.
Up Next: Part Two: Exploring Your Own Limit (setting): Mindfully Balancing Attachment and Limits At Home
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