Parenting a neurotypical teenager can be anything from challenging to maddening or worse - absolutely. But when you have an adolescent or young adult with ADHD, the complications and obstacles seem to pile up really quickly. Life can truly feel overwhelming and unmanageable for both your kid and you.

My son has ADHD and there were times when I simply wanted to walk out the door and not come back, to be honest. I wondered what I’d done wrong. I worried and fretted and exacerbated my own ADHD and anxiety.

In hindsight, I realize how much of my frustration and fear came from my lack of understanding about ADHD’s central component—emotional dysregulation.

Stay with me while I fill you in on the many ways our teens with ADHD are affected by their unpleasant emotions and how to manage it as their parent. And be sure to read my follow-up article on Substack today as well.

PODCAST INTRO

My son was diagnosed with ADHD and other learning issues like dyslexia and dysgraphia between 2^nd and 3^rd grade so we dealt with teacher complaints, medication issues, and getting homework done and turned in for years before he reached middle or high school.

And by the time he was in 4^th grade his self-esteem was shot, and he’d pretty much given up on school, I think. It was just difficult for him despite his high IQ and initial love of learning.

And from infancy on, he had meltdowns and temper tantrums on the regular. Maybe at some point along the way after his diagnosis, I associated this with ADHD and anxiety. But for years I mostly just considered him strong-willed, hard-headed, argumentative, and often just difficult (but still a sweet, sensitive, kind, caring, and highly moral child). I loved him and I dealt with it the best I could.

Based on the evaluations and discussions with the experts and the school, we put ADHD in the category of a learning issue, period—and that’s how we treated it. All the conversations with psychiatrists and evaluators focused on getting things done at school, focus, organization, paying attention, making the grades.

Unfortunately, I imagine that’s been your experience as well if you have a child with ADHD. But this disorder isn’t only about not being able to pay attention and get things done in school—it’s so much more widespread and debilitating than that.

ADHD is a neurodevelopmental disorder that impacts almost every facet of one’s life—and it can have major ramifications for adolescents (that have nothing to do with academics and can cause so many more serious repercussions than a bad grade or not getting into a great college).

I honestly regret all those early years I spent worrying about pleasing the teachers and administrators, trying to keep my son in lockstep with neurotypical kids, and trying to force him to fit in a box that just wasn’t made for him.

Instead, I wish I’d been more accepting of who he was and told everyone else to get on board or go home. Because you know what, I didn’t fit inside that box either. I feel like the box needs to change for all of our kids (but that’s a topic for another day).

I also wish that I learned much more about the non-academic side of ADHD so I could have prepared him more for real life issues—things that could have helped him stay safe and mentally healthier after he hit puberty.

This non-academic side of ADHD is almost solely related to emotional dysregulation and emotional impulsivity (but I’ll lump it all together as dysregulation).

Not understanding that the emotional dysregulation associated with ADHD produces a ripple effect that can lead to so many other problematic behaviors during adolescence, can really put you at a disadvantage – so much so, that you can actually make things worse. This goes for schools as well!

The crazy thing is that for some reason the diagnostic and statistical manual (the DSM, which is the guide for those diagnosing mental health and developmental disorders) doesn’t include emotional dysregulation among the signs and symptoms for a diagnosis of ADHD.

But researchers, mental health practitioners (and certainly many parents and patients if not teachers and administrators) are well aware that blow ups and meltdowns are very much part of their ADHD child’s being. Emotional dysregulation is a core component of ADHD.

Researchers have now labeled this very specific type of emotional dysregulation in people with ADHD as  “deficient emotional self-regulation” or DESR. And it’s not just found in kids with the disorder—adults with ADHD have it as well. If you’re a parent with ADHD or anxiety raising a kid with ADHD—everyone’s emotions are off the Chizzy!

According to Dr. Russel Barkley, a well-known expert in ADHD…DESR (again, deficient emotional self-regulation), includes deficiencies in four different areas of emotional regulation.

First, people (kids and adults) with ADHD don’t have the ability to inhibit (or restrain themselves) from acting out inappropriately when they’re triggered. It’s called emotional impulsivity. Remember impulsivity is part of ADHD, so we’re also impulsive regarding our emotions.

For example, if your kid has ADHD, you’ve seen their low tolerance threshold for frustration, they just aren’t very patient, they’re very quick to get angry, they can be aggressive (like punching holes in walls for instance) and are just generally more emotionally excitable (they just respond to things going on in their environment in a more emotional way—you might consider them sensitive).

Again, Dr. Barkley believes this is all just part of the impulsivity dimension of ADHD.

The second emotional deficiency people with ADHD have, is an inability to self-soothe and calm down once upset. They feel their emotions much more intensely and are just more likely to stay upset for much longer than the neurotypical person. Sound familiar?

The third deficiency is an inability to (and I’m gonna’ quote Dr. Barkley here) “refocus attention from emotionally provocative events”.  First of all, people with ADHD are much more sensitive to input from the environment, so all incoming stimuli is magnified – they’re hypersensitive to things. Which means, again, they’re quicker to react. And when something happens that stirs a big negative reaction in them, they just cannot let it go—they’ll ruminate over it and talk about it and vent and complain forever—so much so that it can crowd out other things they need to be thinking about.

And the fourth part of this problem of DESR is the inability for people with ADHD to determine that the way they respond to their negative emotions is not healthy for them long-term, and to figure out a more appropriate way to deal with their emotions.

They do, however, begin to develop a deep sense of shame and regret over their lack of control over their emotions and emotional responses. This is especially true when this behavior causes the personal and academic issues it often does—and even more so if they don’t understand why they act this way—they don’t understand it’s because of their ADHD. And these feelings of shame and confusion and regret and longing to be “normal”, only further their lack of control. It becomes a horrible spiral.

Now, all of this makes total sense when you consider the parts of the brain that are impacted by ADHD encompass the amygdala (the part that triggers emotions and the fight or flight response) and the prefrontal cortex (the part that manages the brain’s executive functions like self-control, emotional regulation, and making good decisions).

And, by the way, during adolescence, these same regions of the brain change in structure and function for all adolescents, not just those with ADHD.

From puberty on through the mid-twenties, the emotional center of the brain is much more sensitive than during childhood or adulthood, and the part of the brain that manages executive functions is weakened. It depends on the teen to what extent these brain changes have on their behavior, but they all have the potential for emotional impulsivity and lack of self-control – I talk about it all the time.

So, it only makes sense that adolescents with ADHD are like emotional superconductors with little ability to control their behavioral responses.

Anxiety disorders are another issue that can pop up during adolescence because of these same parts of the brain. This is true for both neurotypical teens and those with ADHD – but much more so in kids with ADHD. When your amygdala is overreactive and gets into a pattern of overreacting, and you have little control over it, it can quickly spin into anxiety.

As a matter of fact, it’s hard to distinguish the symptoms of ADHD from the symptoms of anxiety in kids and teens. Both can cause lack of focus and emotional dysregulation. But anxiety and ADHD most often go hand in hand – they’re considered comorbid conditions (or those that occur simultaneously). It’s a major double whammy that many teens and parents deal with.

And just so you know, another comorbid condition associated with ADHD is Oppositional Defiance Disorder or ODD. ODD is a combination of emotional dysregulation and social conflict or oppositional behaviors. And again, the emotional dysregulation piece can lead to anxiety in teens. Some even believe that because so many kids with ODD also have ADHD that it’s the ADHD that causes it. ODD is actually managed well with ADHD medication if the kid also has ADHD.

And, by the way ODD is quite overdiagnosed. Again, there’s a lot of symptom overlap between ODD, ADHD, and anxiety. Plus, plain old adolescent behavior can often mimic ODD. You take a neurotypical teen who is stressed out and triggered under the right circumstances, being defiant and oppositional, over a period of time –

especially if it’s happening with parents, and you could easily get an ODD diagnosis from some over-eager clinician.

Defiance and temper tantrums and even issues with peers and teachers—do not equate to ODD. If it did, I certainly would have been diagnosed with ODD back in the day.

Also, African American kids and teens are disproportionately diagnosed with ODD, when again, it could be ADHD, situational, any misunderstood behavior, or just plain old racism at work.

And, by the way, African American kids and teens are also underdiagnosed with ADHD for a variety of reasons, including bias among clinicians.

So, do your research, or at least get a second opinion if your kid’s gotten an ODD diagnosis and make sure they evaluate them for ADHD and anxiety as well. I think an ODD diagnosis could do even more damage to a teen’s self-esteem than ADHD.

The emotional dysregulation that accompanies ADHD not only vastly increases the possibility of developing an anxiety disorder, but can lead to other internalizing issues like depression, shame and rejection sensitivity, huge blow-ups and conflict with parents, teachers, and peers, self-harm, substance use, risky sexual behaviors, and peer rejection.

This is why it’s so important to get a diagnosis early and to be aware of these issues so you can be prepared. I’d read and heard that kids with ADHD were more likely to engage in substance use but I just never thought it would actually happen. I didn’t see it coming because I buried my head in the sand and said, “not my child”. Plus, I was so worried about school work, homework, grades, and accommodations, that I honestly never considered it until it slapped me in the face.

Come back to me a minute if you’re multi-tasking and listen to what I’m telling you; I know you’re concerned about homework, grades, school and getting into college. But I’m telling you that you need to put those issues in their proper place, which I feel is more towards the bottom of the list.

I don’t want to worry you or cause you to panic, but I do want you to sit up and take notice and prioritize dealing with your kid’s emotional dysregulation first and foremost, because of the vast and devastating issues it can have for your teen.

If these other issues take over, their grades are going to plummet anyway so you’re better off approaching everything from an emotional regulation and impulse control perspective.

For example, teens with ADHD are more likely to start dating and have sex earlier, have shorter relationships and more partners, have unprotected sex, have an unwanted pregnancy, and catch an STI or STD.

They’re more likely to have car accidents and get traffic tickets, self-harm, use substances at a very young age, develop substance use disorders, get in trouble legally, become involved with the juvenile justice system, and drop out of high school.

Basically, all the worst things a parent can think of, right?

I know—but hang on, it doesn’t have to be this way. There are so many things you can do. Let’s talk about that.

 

Medication

According to the scientific research and the top experts in adolescent ADHD, one of the best ways to protect your ADHD teen from the risky behaviors caused by emotional dysregulation, is making sure they’re on medication, and that they take it every day—even on the weekends.

The overwhelming majority of scientific research shows that ADHD medication works for kids and teens—and it’s not just beneficial for getting their school work done. Studies show that it helps teens in other areas of their life as well—those impacted by emotional dysregulation (from car accidents to substance misuse).

For example, emotional dysregulation and impulsivity can lead to reckless driving, speeding, driving under the influence, or just not paying attention, all of which can lead to car crashes and traffic tickets.

Teens with ADHD are twice as likely than neurotypical teens to drive under the influence and 150% more likely to get a ticket for a DUI, DWI or a speeding ticket and 37% more likely to be involved in a car accident.

A joint study from MIT and Massachusetts General Hospital, found that teens with ADHD who received a stimulant medication were 67% less likely to have a car accident than teens with ADHD who did not receive medication.

They put the teens through a virtual roadway with things popping up out of nowhere like oncoming traffic. And those teens who took the medication did much better. They also reacted 9.1% faster than the teens without medication.

And just to understand how much faster that reaction actually is, the researcher said let’s say the unmedicated teen was driving at 65 miles per hour or around 105 kilometers per hour, their car would travel around another 11 feet (or a little over 3 meters) before reacting to a sudden obstacle that the kid who did medication reacted to 3 meters before. As he said, that’s far enough to “have serious — even deadly — consequences” for the kid without medication.

And because older teens drive at night and further distances, this research indicates that teens should not skip medication on the weekends, and even more importantly, the researchers suggest that taking a short-acting medication about half an hour before driving, could literally save a life.

When you consider most dating and other potential risky behaviors happen on the weekends or evenings, it certainly makes a compelling case for never skipping medication.

As a matter of fact, effective ADHD medication can protect against all sorts of unwanted consequences from emotional dysregulation. It can help teens calm their emotional state just enough to access the part of the brain that can help them use self-control or make a better decision.

Let me remind you about the teen brain for a second. Remember that all teens have heightened emotional and risk-taking behaviors, and because of their still-developing prefrontal cortex they have a really hard time regulating their emotions, using self-control, and making good decisions potentially all the way up until their mid to late 20s.

But a teen with ADHD has a much harder time with these skills and for a longer period of time—they’re around 2 years behind their peers in terms of maturation of the prefrontal cortex.

Your teen needs extra help if they have ADHD. The need help learning these executive function skills of the prefrontal cortex and they need the extra help just to be able to access that part of their brain when they need to.

Perhaps you worry about giving your kid or teenager a stimulant medication, which is classified as a controlled substance. Could it be addictive or lead to addiction of other substances?

Actually, the science proves that no it is not addictive and no does not lead to any sort of addiction issue.

It’s been shown over and over again that the medical treatment of ADHD, helps combat emotional dysregulation and impulsivity, which means they are less at risk for developing a substance use disorder than if they do not take ADHD medication.

And I know this is a scary statistic, but here me out: Generally speaking, someone who has ADHD in childhood is twice as likely to develop a substance use disorder than those who didn’t have childhood ADHD.

However, if people take medication for their ADHD in childhood, they are 60% less likely to develop a substance use disorder than those who didn’t medicate their childhood ADHD.

Think about it. Medication not only helps with emotional dysregulation and impulse control (two big issues that lead to substance use in the first place) but it also improve a kid’s social life (fewer friendship and peer issues) and academic performance, which leads to higher levels of self-esteem, which also seems to have the effect of reducing substance use.

Research has also shown that people with ADHD who go into treatment for substance use disorder can triple their rate of staying in treatment and maintaining their sobriety by taking ADHD medication.

Researchers have also linked self-harm to ADHD and believe medication can help.

For example, statistically speaking, it appears that over half of teen girls with ADHD symptoms engage in self-harm versus only 19% of neurotypical teen girls.

Teens who self-harm are generally thought to do so because they lack the ability to regulate or express their emotions. Researchers believe the high incidence of teen girls with ADHD who self-harm is because of the impulsivity, emotional dysregulation, and high incidences of anxiety and depression in ADHD teens.

Some researchers have even suggested that all teen girls who self-harm should be tested for ADHD because of this strong connection. They also suggest that if medication helps with emotional regulation and impulse control in teens with ADHD, the logical conclusion is that it would help prevent self-harm in teens with ADHD.

These are all very clear arguments in favor of 7 day a week medication for teens with ADHD (and even a booster before driving in the evening).

Just remind yourself that medication doesn’t just treat your teen’s basic ADHD symptoms of inattention and lack of focus but can prevent all sorts of collateral damage that ADHD can cause in someone’s life.

Now, of course, on the other side of the medication argument, that is quit valid, is that we know some teens misuse their stimulant medication and even share it or sell it to their friends. This is actually one reason most clinicians prescribe the extended-release forms of stimulant medications rather than the fast-acting—they are less likely to be abused because they don’t give the same rush or high.

It’s also a good reason to maintain parental control over the medication in some way. I kept all of my medication in a lock box at my house, but for the week supply for everyone. I believe that’s the responsible thing to do when other kids and people are coming into your home. I did that long before there was a substance issue.

I would just put his one capsule a day in the weekly pill container and either my husband or I would also give it to him in the mornings just to make sure he took it. If you want them to learn to take it themselves, just check behind them to make sure they did before the leave the house (but use that weekly pill container to be sure).

You can even request a liquid form of some of this medication if your kid is known to “cheek it” and save it for later. I know that seems extreme but for some kids this could be necessary.

And if your teen is resistant to taking ADHD medication (my son certainly is and always has been) one expert says he asks his patients what they’d change in their life if they could. For example, maybe they want to make more friends, wish they didn’t have so many breakups, they want to get their homework done faster so they can play video games. If applicable (and most things will be) explain to them how ADHD medication can help with those issues.

Another expert gives teens a list of values (like making money, making and keeping friends, etc.) and asks them to circle what’s important them.

Don’t make this conversation about pleasing you or making better grades for you – let them decide what’s important and then you can explain how medication can help.

Of course, you can’t force them at this age to swallow a pill. This has to be a discussion where there’s give and take. It can’t be a lecture, and it may need to take place over a period of time.

Therapy

In addition to medication, it would be incredibly helpful for your teen to receive therapy from a highly trained therapist experienced in working with teens with ADHD. Cognitive behavioral therapy or CBT is generally considered to be the most effective therapy for anyone with ADHD – even better when combined with medication.

CBT will help your teen understand more about their thoughts, emotions and behavior. It helps them spot their negative thinking patterns (a common thing for many teens even without ADHD) they learn to reframe those thoughts and improve how they feel, which leads to improved behavior. In other words, they develop skills to deal with their emotional dysregulation.

A subset of CBT is Dialectical Behavioral Therapy or DBT. And many people swear by this type of talk therapy for anxiety as well so this may be a good option for your teen with ADHD since they so often come as a package and emotional dysregulation is the primary component of both. The goal is the same: teach teens to regulate their emotions so they can improve their behavior. The main skills DBT teaches are mindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness (which basically means having better relationships).

Something else that could be helpful for your ADHD teen (although not in the realm of emotional regulation) is an executive function coach. They solely focus on the academic side of ADHD, but you may luck up and find a coach that is also a therapist and helps in all areas.

Now lets talk how you can help more directly on a day-to-day basis.

First, I suggest talking to your teen about their ADHD and explaining the emotional dysregulation part of it. Let them know that it’s one of the reasons for medication and therapy - so they can feel better and more in control.

Additionally, if you want to help your teen become more emotionally regulated you need to learn more about their particular emotional states, what triggers their anger, when are the most likely to have an explosion (what time of day, under what circumstances, around what people). You have to pay attention and even make notes.

No, I’m not saying walk on eggshells but while you’re working to help them learn to regulate their emotions, it would be extremely helpful to try and prevent their dysregulation as much as possible so as not to make it worse and create more anxiety for them.

You should also learn more about your emotions and how to regulate them as well as learning how to emotion coach your teen.

If you can manage your emotions, you’ll also cut way down on their emotional dysregulation in response to your dysregulation and you’ll be able to stay calm and do what you need to do to help them. So, that’s where I recommend you start because you can’t help them until you can manage your emotions.

Then you should learn all about emotion coaching. Emotion coaching is all about see your teen’s emotional moments as an opportunity to connect with them emotionally and help them learn to manage their emotions better. It’s about truly listening to your teen, reflecting what they say and validating their feelings by using the correct word to describe their emotions—even providing a comforting touch if appropriate in the moment.

Emotion coaching not only helps them calm down when they’re emotionally dysregulated, but it will help them learn to recognize and articulate their feelings. I have several podcast episodes in addition to free parenting guides on both topics that I’ll link to in the show notes. As I say all the time, one of the biggest factors in your teen’s behavior is your own. Change your behavior and help your teen change theirs.

So, to wrap it up, please understand that ADHD is so much more than issues of focus and attention to school work. School work issues pale in comparison to the other issues caused by our kids’ ADHD symptoms – most specifically those issues caused by emotional dysregulation.

Medication and therapy are also key in this realm of ADHD…as is learning some specific skills to help you manage your emotions, teach them to manage their emotions and cut way back on the power struggles at the same time.

You can do this. I teach these skills in Parent Camp. It works for parenting all teenagers and it’s greatly needed when you’re parenting a teen with ADHD or anxiety.

Again, look for links to everything I’ve mentioned, in the show notes. And subscribe to my Substack to read more about this topic in today’s post.

Alright, that’s it for Speaking of Teens today. Thank you so very much for being here with me to the end. I hope you got something out of this episode and will consider sharing it with a large group of your friends. My goal is to reach as many parents as possible with this information, so I’d really appreciate your helping doing that.

Until next time, remember to connect with your teen in at least some small way each and every day.