problem solving and adhd

• Patient Care & Health Information
• Diseases & Conditions
• Adult attention-deficit/hyperactivity disorder (ADHD)

Signs and symptoms of ADHD in adults can be hard to spot. However, core symptoms start early in life — before age 12 — and continue into adulthood, creating major problems.

No single test can confirm the diagnosis. Making the diagnosis will likely include:

• Physical exam, to help rule out other possible causes for your symptoms
• Information gathering, such as asking you questions about any current medical issues, personal and family medical history, and the history of your symptoms
• ADHD rating scales or psychological tests to help collect and evaluate information about your symptoms

Other conditions that resemble ADHD

Some medical conditions or treatments may cause signs and symptoms similar to those of ADHD . Examples include:

• Mental health disorders, such as depression, anxiety, conduct disorders, learning and language deficits, or other psychiatric disorders
• Medical problems that can affect thinking or behavior, such as a developmental disorder, seizure disorder, thyroid problems, sleep disorders, brain injury or low blood sugar (hypoglycemia)
• Drugs and medications, such as alcohol or other substance misuse and certain medications

Standard treatments for ADHD in adults typically involve medication, education, skills training and psychological counseling. A combination of these is often the most effective treatment. These treatments can help manage many symptoms of ADHD , but they don't cure it. It may take some time to determine what works best for you.

Medications

Talk with your doctor about the benefits and risks of any medications.

• Stimulants, such as products that include methylphenidate or amphetamine, are typically the most commonly prescribed medications for ADHD , but other medications may be prescribed. Stimulants appear to boost and balance levels of brain chemicals called neurotransmitters.
• Other medications used to treat ADHD include the nonstimulant atomoxetine and certain antidepressants such as bupropion. Atomoxetine and antidepressants work slower than stimulants do, but these may be good options if you can't take stimulants because of health problems or if stimulants cause severe side effects.

The right medication and the right dose vary among individuals, so it may take time to find out what's right for you. Tell your doctor about any side effects.

Psychological counseling

Counseling for adult ADHD generally includes psychological counseling (psychotherapy), education about the disorder and learning skills to help you be successful.

Psychotherapy may help you:

• Improve your time management and organizational skills
• Learn how to reduce your impulsive behavior
• Develop better problem-solving skills
• Cope with past academic, work or social failures
• Improve your self-esteem
• Learn ways to improve relationships with your family, co-workers and friends
• Develop strategies for controlling your temper

Common types of psychotherapy for ADHD include:

• Cognitive behavioral therapy. This structured type of counseling teaches specific skills to manage your behavior and change negative thinking patterns into positive ones. It can help you deal with life challenges, such as school, work or relationship problems, and help address other mental health conditions, such as depression or substance misuse.
• Marital counseling and family therapy. This type of therapy can help loved ones cope with the stress of living with someone who has ADHD and learn what they can do to help. Such counseling can improve communication and problem-solving skills.

Working on relationships

If you're like many adults with ADHD , you may be unpredictable and forget appointments, miss deadlines, and make impulsive or irrational decisions. These behaviors can strain the patience of the most forgiving co-worker, friend or partner.

Therapy that focuses on these issues and ways to better monitor your behavior can be very helpful. So can classes to improve communication and develop conflict resolution and problem-solving skills. Couples therapy and classes in which family members learn more about ADHD may significantly improve your relationships.

More Information

• Cognitive behavioral therapy

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Lifestyle and home remedies

Because ADHD is a complex disorder and each person is unique, it's hard to make recommendations for all adults who have ADHD . But some of these suggestions may help:

• Make a list of tasks to accomplish each day. Prioritize the items. Make sure you're not trying to do too much.
• Break down tasks into smaller, more manageable steps. Consider using checklists.
• Use sticky pads to write notes to yourself. Put them on the fridge, on the bathroom mirror, in the car or in other places where you'll see the reminders.
• Keep an appointment book or electronic calendar to track appointments and deadlines.
• Carry a notebook or electronic device with you so that you can note ideas or things you'll need to remember.
• Take time to set up systems to file and organize information, both on your electronic devices and for paper documents. Get in the habit of using these systems consistently.
• Follow a routine that's consistent from day to day and keep items, such as your keys and your wallet, in the same place.
• Ask for help from family members or other loved ones.

Alternative medicine

There's little research to indicate that alternative medicine treatments can reduce ADHD symptoms. However, studies indicate that mindfulness meditation may help improve mood and attention in adults who have ADHD , as well as those who don't have ADHD .

Before using alternative interventions for ADHD , talk with your doctor about risks and possible benefits.

Coping and support

While treatment can make a big difference with ADHD , taking other steps can help you understand ADHD and learn to manage it. Some resources that may help you are listed below. Ask your health care team for more advice on resources.

• Support groups. Support groups allow you to meet other people with ADHD so that you can share experiences, information and coping strategies. These groups are available in person in many communities and also online.
• Social support. Involve your spouse, close relatives and friends in your ADHD treatment. You may feel reluctant to let people know you have ADHD , but letting others know what's going on can help them understand you better and improve your relationships.
• Co-workers, supervisors and teachers. ADHD can make work and school a challenge. You may feel embarrassed telling your boss or professor that you have ADHD , but most likely he or she will be willing to make small accommodations to help you succeed. Ask for what you need to improve your performance, such as more in-depth explanations or more time on certain tasks.

Preparing for your appointment

You're likely to start by first talking to your primary care provider. Depending on the results of the initial evaluation, he or she may refer you to a specialist, such as a psychologist, psychiatrist or other mental health professional.

What you can do

To prepare for your appointment, make a list of:

• Any symptoms you've had and problems they've caused, such as trouble at work, at school or in relationships.
• Key personal information, including any major stresses or recent life changes you've had.
• All medications you take, including any vitamins, herbs or supplements, and the dosages. Also include the amount of caffeine and alcohol you use, and whether you use recreational drugs.
• Questions to ask your doctor.

Bring any past evaluations and results of formal testing with you, if you have them.

Basic questions to ask your doctor include:

• What are the possible causes of my symptoms?
• What kinds of tests do I need?
• What treatments are available and which do you recommend?
• What are the alternatives to the primary approach that you're suggesting?
• I have these other health problems. How can I best manage these conditions together?
• Should I see a specialist such as a psychiatrist or psychologist?
• Is there a generic alternative to the medicine you're prescribing?
• What types of side effects can I expect from the medication?
• Are there any printed materials that I can have? What websites do you recommend?

Don't hesitate to ask questions anytime you don't understand something.

What to expect from your doctor

Be ready to answer questions your doctor may ask, such as:

• When do you first remember having problems focusing, paying attention or sitting still?
• Have your symptoms been continuous or occasional?
• Which symptoms bother you most, and what problems do they seem to cause?
• How severe are your symptoms?
• In what settings have you noticed the symptoms: at home, at work or in other situations?
• What was your childhood like? Did you have social problems or trouble in school?
• How is your current and past academic and work performance?
• What are your sleep hours and patterns?
• What, if anything, appears to worsen your symptoms?
• What, if anything, seems to improve your symptoms?
• What medications do you take?
• Do you consume caffeine?
• Do you drink alcohol or use recreational drugs?

Your doctor or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your time with the doctor.

• Attention-deficit/hyperactivity disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. Accessed Jan. 26, 2019.
• Attention-deficit/hyperactivity disorder. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml. Accessed Jan. 26, 2019.
• AskMayoExpert. Attention-deficit/hyperactivity disorder. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
• What is ADHD? American Psychiatric Association. https://www.psychiatry.org/patients-families/adhd/what-is-adhd. Accessed Jan. 26, 2019.
• ADHD. National Alliance on Mental Illness. https://www.nami.org/Learn-More/Mental-Health-Conditions/ADHD/Overview. Accessed Jan. 26, 2019.
• Adult ADHD (attention deficit hyperactive disorder). Anxiety and Depression Association of America. https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd. Accessed Feb. 11, 2019.
• Geffen J, et al. Treatment of adult ADHD: A clinical perspective. Therapeutic Advances in Psychopharmacology. 2018;8:25.
• Adult ADHD. American Association for Marriage and Family Therapy. https://www.aamft.org/Consumer_Updates/Adult_ADHD.aspx. Accessed Feb. 11, 2019.
• Kooij JJS, et al. Updated European consensus statement on diagnosis and treatment of adult ADHD. European Psychiatry. 2019;56:14.
• Fields SA, et al. Adult ADHD: Addressing a unique set of challenges. Journal of Family Practice. 2017;66:68.
• Mitchell JT, et al. Mindfulness meditation training for attention-deficit/hyperactivity disorder in adulthood: Current empirical support, treatment overview, and future direction. Cognitive and Behavioral Practice. 2015;22:172.
• Bhagia J (expert opinion). Mayo Clinic, Rochester, Minn. June 13, 2019.
• Hyperthyroidism (overactive). American Thyroid Association. https://www.thyroid.org/hyperthyroidism/. Accessed June 13, 2019.
• Low blood glucose (hypoglycemia). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/low-blood-glucose-hypoglycemia. Accessed June 13, 2019.

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How to Help Children With ADHD Develop Problem-Solving Skills

What’s inside this article: Background information as to why kids with both ADHD and autism struggle with developing problem-solving skills. Strategies you can use to help them develop better problem-solving skills, and board games that help them practice these skills.

Disclaimer: This post contains affiliate links

We don’t always see it as adults, but kids actually run into a lot of problems. Between arguing with siblings, disagreeing with parents’ rules, school work, balancing fun and responsibility, it’s tougher to be a kid than you think.

It seems there’s always some problem plaguing children. It might seem minor to your, but it isn’t to them. This is why we need to help them develop problem-solving skills .

It’s important for kids to learn how to problem-solve on their own because this is one of those critical life skills that they need.

Problem-Solving Skills & ADHD

Problem-solving skills are an executive function. Executive functions are the more complex functions of the brain.

This matters for children with ADHD because executive dysfunction is a hallmark ADHD symptom. In fact, kids with ADHD are, on average, 30% behind their peers when it comes to executive functioning.

To put that into perspective, if you have an 8-year-old, they probably only have the problem-solving skills of a typical 5-year-old. This becomes an issue because they may already struggle with social skills and now handling conflict with their peers is another challenge.

Spending extra time practicing problem-solving skills and other executive functions can help children with ADHD to develop these important life skills.

Set Realistic Expectations

Adjusting your current expectations, or knowingly setting realistic expectations for your child can help you see that your  child is doing the best that they can.  

As a parent, you can acknowledge this and help your child develop better problem-solving skills.

In the meantime, if your 8-year-old only shows the skill of a 5-year-old when they encounter a problem, you should assume they only currently have the ability of a 5-year-old. Set your expectations to match their current ability.

When your expectations are realistic, your children have more opportunities to be successful. This builds their confidence and helps them thrive.

How to Help Kids Develop Problem-Solving Skills

There are a number of ways you can help children “practice” their problem-solving skills, which over time helps them become more competent.

This involves both games that use their skills and also push them out of their comfort zone a little.

Start with games and situations in which your child will be highly successful. You want to begin by building their confidence so they will be more willing to try solving more challenging problems on their own later.

These strategies are helpful for all children but children with executive dysfunction may need extra time and practice to work on their skills.

Thinking of Possible Solutions

I took a training class on behavior intervention strategies and problem-solving skills were part of the discussion. The instructor said to us:

In order to problem-solve, you need to be able to come up with at least two possible solutions

This statement stuck with me. Kids with ADHD and autism often struggle with cognitive rigidity.

When it comes to problem-solving, cognitive rigidity could look like a child getting “stuck” on the first solution that comes to their head and seeing no other possible way to make a situation work.

For children, that first solution is often impulsive and probably not the best way to handle the situation.

So first of all, find out if your child can think of multiple solutions to issues, either independently or working collaboratively with you.

Start with a brainstorming game. Write a “problem” in a bubble and then ask your child for different ways to handle it and write them down.

After you have a list, see if they can figure out what the “best” way would be to deal with their problem.

Start simple, or even begin with hypothetical problems about their favorite fictional characters.

For example:

In the example above, the most practical solution is to eat something else instead. But if your child gets “stuck” on things they may see no resolution because hotdogs are all that they will eat and will say they won’t eat until you go to the store and buy more.

If they aren’t able to see other possible solutions this may lead to an outburst or meltdown.

Regular practice with this brainstorming activity, especially hypothetical situations where their emotions aren’t involved, will help children to think about multiple solutions to their problems.

Ask Open Ended Questions

When your child is struggling with something, open-ended questions can help them think about things in a different way without you directly intervening and handling their problem for them.

• Can you identify the problem?
• What do you want to do?
• What do you think would happen if you did that?
• How would that make other people feel?
• What other ways might work?

Be that listening ear that your child needs while they work through these big feelings.

Games That Involve Problem-Solving

Strategy and board games often require a higher level of thinking that helps activate the problem-solving region of the brain, known as the prefrontal cortex.

For example, kids may strategically plan a couple of moves ahead in a board game but then need to problem-solve and adjust their strategy after their opponents’ turn.

There are board games for all skill sets and abilities so there’s definitely something out there that is developmentally appropriate for your child and you can work up to more challenging games over time.

Some games you can try include

• Tic Tac Toe
• Think a Link
• Daily Dilemmas Jar

Even though these games don’t include specific problems that your child is facing or may encounter, they still help.

The brain is moldable, so the more you practice using any type of problem-solving, the more connections form in the brain. With practice, this actually improves real-life problem solving too.

The Problem Solving Wheel

The problem-solving wheel is simply a wheel of generic solutions that may help your child solve their problems. This may be helpful if your child struggles to come up with possible solutions because it will prompt them to think about the situation in other ways.

You can use the problem-solving wheel for hypothetical situations, or through role-playing and pretend play scenarios, or as a way to prompt your child to work through their current problems independently .

Do Not Resolve Sibling Conflicts for Them

When siblings start to fight, perhaps over a toy, or which movie to watch, it feels natural as a parent to step in and handle it.

You decide who is right and who is wrong, or you dictate what the fair “compromise” will be. But, every time you intervene and solve this sibling conflict for them you are stealing away an opportunity for them to p ractice their problem-solving skills.

Instead, shift to the role of a mediator and guide them to solve their own problems.

For example, your kids are playing with Play-Doh together and you hear arguing. You look over and see them fighting over the same tool. There are a few ways this scenario plays out.

• You could intervene and say that since no one is getting along then nobody can use the play-doh
• Perhaps you could intervene and dictate which child gets the first turn and which goes next.
• You could reason with them, telling them about all the other cool play-doh tools and hope one of them is enticed to try something different.

Or you can be their mediator.

Just say “I see that you both want to use that play-doh cutter right now and it’s pretty upsetting for both of you… What do you guys think would be a good idea so that everyone is happy playing with the play-doh?”

You would be surprised how often children will willingly suggest fair compromises when prompted instead of being told how to resolve their problems.

The child who would have thrown a fit and stormed away when you dictated they get the second turn will now be offering their brother the item happily.

Make sure you positively reinforce their problem-solving each time they are able to peacefully handle an issue on their own (or with your guidance).

Push Them To Make Choices on Their Own

Children who struggle to make choices also struggle to problem solve. Push your child to make their own choices as often as possible. From the small mundane ones to the somewhat larger choices. They need to be able to do this on their own.

If your child gets overwhelmed making broad decisions then offer options at first. For example, have them pick from two or three choices.

Your child needs to be confident in making their own choices in order to become confident at problem-solving

Let Them Experience The Natural Consequences

The next part of this equation is letting your child experience the natural consequences of their choices. Natural consequences are the inevitable result of your own actions.

If you shield your child from the natural consequence of a bad choice then they will never learn from that decision. The outcome of a poor choice is usually enough to teach your child without you needing to interfere. Just be there for them.

Don’t forget to praise your child for rising to the challenge and learning from their mistakes. Also, emphasize with them ( I know how hard this is) Keep building them up, they need to know that mistakes and failures happen but it’s important to keep going.

More Skills

It’s normal for children with ADHD to require extra time and teaching when it comes to developing social-emotional skills like problem-solving.

Read this list: 38 skills kids need to be successful

You’ll find lots of other skills and teaching tips to help your child develop all the skills they need.

The Take-Away

There are a few key points I hope you took away from this guide.

• Individuals with ADHD are, on average, about 30% behind their peers when it comes to all executive functions , including problem-solving skills.
• You need to set developmentally appropriate expectations.
• Children with ADHD need extra practice and extra time to learn and develop these skills
• Be a mediator that provides guidance instead of taking over and dealing with problems for them.
• Children need to experience the natural consequences of their actions
• Praise your child for trying, even if they aren’t a competent problem-solver yet.

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8 Tips for Living With ADHD as an Adult

Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.

Claire Eggleston, LMFT-Associate is a neurodivergent therapist and specializes in and centers on the lived experiences of autistic and ADHD young adults, many of whom are also in the queer and disability communities. She prioritizes social justice and intertwines community care into her everyday work with clients.

Anchiy / Getty Images

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental diagnosis that involves issues with attention, executive functioning, hyperactivity, and impulse control. Typically, ADHD symptoms emerge in childhood, but some people go undiagnosed—and untreated—until adulthood.

ADHD may not be diagnosed until later in life if the condition is mild, if it wasn't previously recognized by family members or others, or if it was well-managed until adult demands set in. Regardless of the reason, if you are an adult with ADHD whose symptoms are interfering with your functioning, these tips and strategies may help.

Figure Out What Works For You

Countless books, blogs, and articles have specific and detailed suggestions for living with adult ADHD. Although well-intentioned, these suggestions often require the same executive functioning skills that ADHD interferes with.

People with ADHD are often pressured to stick to schedules and systems that work for neurotypical brains. If you have difficulty sticking to a particular system, it is okay to let go of that expectation.

Notice what tends to work for you, and lean into that. For example, many people keep their keys on a hook by the door so they don't get lost. But people with ADHD might struggle to remember to return their keys to the hook or follow that organizational system .

Instead of choosing the best location for your keys and trying to remember to put them there, notice where you tend to put them naturally. Then, designate that location as the spot where your keys go.

Keep Things Visual

One sign of ADHD is forgetfulness . If something is out of sight, a person with ADHD may not remember it. Visual cues can keep important things at the forefront.

If you need a regular reminder of something, keep it in a basket in a location you pass regularly. Keep a schedule where you can see it. A whiteboard allows you to jot down what you need to remember each day.

Determine Your Optimal Level of Stimulation

Although ADHD is marked by specific symptoms, each person is unique and has different needs. Some people need background noise to focus on a task—though white or brown noise might be more distracting than music, a television show, or a podcast. Others might require silence to maintain focus.

Through trial and error, figure out what works for you. Then, set up your workspace to fit those needs. Remember that your needs might change over time, so be flexible and change your system as needed.

Remember That Your Brain Craves Novelty

ADHD brains process the neurotransmitter dopamine differently than neurotypical brains . Because of this, people living with adult ADHD will often find it easier to focus on things that are new. Regular changes to the environment or workspace can keep the brain engaged.

When you notice that your routine is not holding your attention as it did before, make a small change to keep things interesting and keep your mind engaged. People with ADHD tend to thrive in positions where they do a variety of tasks. This makes teacher, engineer, and small business owner all good jobs for people with ADHD . In these roles, their duties vary so they remain interesting and novel to the ADHD brain.

Practice Self-Compassion

Many people with ADHD also experience anxiety and depression. They often struggle to live up to neurotypical standards and keep neurotypical schedules. Even when these standards are not essential for functioning, society often punishes or ridicules people for diverging from them.

If something works for you and is not harmful, that is okay. Know that you can follow different routines, and that is not a reflection of your value as a human. Practice being kind to yourself and letting go of expectations that do not serve you.

Getting down on yourself for having different needs or brain functioning can be a vicious cycle, making you try harder to force yourself to meet these arbitrary expectations and becoming more upset with yourself when you are unable to do so.

Break Tasks Down

People living with adult ADHD can get overwhelmed by projects or tasks that seem too big or have too many steps. This can cause difficulty with motivation .

When starting a task or project, remember that you do not have to finish it all at once. You can do part of a task and then take a break. For example, if washing the dishes feels like too much, just wash one plate, and then stop. Half done is better than not starting, and it is okay to stop even if you have not finished everything.

If you find that starting the task gives you the energy to keep going, you can wash more. However, take things one step at a time, and give yourself permission to take breaks as needed or stop and start.

Use Alarms and Reminders

People with ADHD might experience meta-forgetfulness, or forgetting that they tend to be forgetful. You might find yourself thinking, “I don’t need to write that down; I will remember it.”

Instead, tell yourself that it is okay that you will not remember it. Now, you can write it down and set a reminder for yourself. People with ADHD also often lose track of time , so frequent cues and reminders can help you stay on track.

You might have to set multiple reminders for different things—since it is easy to dismiss an alarm, and you might forget that you dismissed it. Having several reminders or cues can help you follow through and remember what you are doing.

Try Body Doubling

“ Body doubling ” refers to having another person present while you complete a task. People with ADHD tend to do well with another person present while they work on something as this is a physical cue to remind them of the task and acts as an accountability booster.

Although research is lacking on the benefits of body doubling, some adults with ADHD have reported that this practice helps them stay on task and improve executive functioning. They've found it helpful when doing activities such as studying, doing dishes, and exercising.

There are many ways in which people living with adult ADHD can adjust their schedules and complete tasks. If you find that you're having a hard time staying on task, a mental health professional can help you create solutions that are tailored to your needs.

National Institute of Mental Health. Attention-deficit/hyperactivity disorder in adults: What you need to know .

Salavert J, Ramos-Quiroga JA, Moreno-Alcázar A, et al. Functional imaging changes in the medial prefrontal cortex in adult ADHD .  J Atten Disord . 2018;22(7):679-693. doi:10.1177/1087054715611492

Zhou R, Wang J, Han X, Ma B, Yuan H, Song Y. Baicalin regulates the dopamine system to control the core symptoms of ADHD .  Mol Brain . 2019;12(1):11. doi:10.1186/s13041-019-0428-5

Centers for Disease Control and Prevention. Attention deficit/hyperactivity disorder (ADHD): Data and statistics.

Molavi P, Nadermohammadi M, Salvat Ghojehbeiglou H, Vicario CM, Nitsche MA, Salehinejad MA. ADHD subtype-specific cognitive correlates and association with self-esteem: a quantitative difference .  BMC Psychiatry . 2020;20(1):502. doi:10.1186/s12888-020-02887-4

Brooker RJ, Moore MN, Van Hulle CA, et al. Attentional control explains covariation between symptoms of attention‐deficit/hyperactivity disorder and anxiety during adolescence .  J Res Adolesc . 2020;30(1):126-141. doi:10.1111/jora.12506

Eagle T, Baltaxe-Admony LB, Ringland KE. Proposing body doubling as a continuum of space/time and mutuality: An investigation with neurodivergent participants . Proceedings of the 25th International ACM SIGACCESS Conference on Computers and Accessibility. 2023;85:1-4. doi:10.1145/3597638.3614486

By Amy Marschall, PsyD Dr. Amy Marschall is an autistic clinical psychologist with ADHD, working with children and adolescents who also identify with these neurotypes among others. She is certified in TF-CBT and telemental health.

Treatment of ADHD

• Behavior Therapy, including Training for Parents

Medications

Parent education and support, tips for parents.

Get information and support from the National Resource Center on ADHD

My Child Has Been Diagnosed with ADHD – Now What?

When a child is diagnosed with attention-deficit/hyperactivity disorder (ADHD), parents often have concerns about which treatment is right for their child. ADHD can be managed with the right treatment. There are many treatment options, and what works best can depend on the individual child and family.  To find the best options, it is recommended that parents work closely with others involved in their child’s life—healthcare providers, therapists, teachers, coaches, and other family members.

Types of treatment for ADHD include

• Behavior therapy, including training for parents; and
• Medications.

Treatment recommendations for ADHD

For children with ADHD younger than 6 years of age, the American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment, before medication is tried. For children 6 years of age and older, the recommendations include medication and behavior therapy together — parent training in behavior management for children up to age 12 and other types of behavior therapy and training for adolescents.  Schools can be part of the treatment as well. AAP recommendations also include adding behavioral classroom intervention and school supports.  Learn more about how the school environment can be part of treatment .

Good treatment plans will include close monitoring of whether and how much the treatment helps the child’s behavior, as well as making changes as needed along the way. To learn more about AAP recommendations for the treatment of children with ADHD, visit the Recommendations page .

Behavior Therapy, Including Training for Parents

ADHD affects not only a child’s ability to pay attention or sit still at school, it also affects relationships with family and other children.  Children with ADHD often show behaviors that can be very disruptive to others. Behavior therapy is a treatment option that can help reduce these behaviors; it is often helpful to start behavior therapy as soon as a diagnosis is made.

The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate unwanted or problem behaviors. Behavior therapy for ADHD can include

• Parent training in behavior management;
• Behavior therapy with children ; and
• Behavioral interventions in the classroom .

These approaches can also be used together. For children who attend early childhood programs, it is usually most effective if parents and educators work together to help the child.

Children younger than 6 years of age

For young children with ADHD, behavior therapy is an important first step before trying medication because:

• Parent training in behavior management gives parents the skills and strategies to help their child.
• Parent training in behavior management has been shown to work as well as medication for ADHD in young children.
• Young children have more side effects from ADHD medications than older children.
• The long-term effects of ADHD medications on young children have not been well-studied.

Behavior Therapy for Younger and Older Children with ADHD [PDF – 466 KB]

School-age children and adolescents

For children ages 6 years and older, AAP recommends combining medication treatment with behavior therapy. Several types of behavior therapies are effective, including:

• Behavioral interventions in the classroom;
• Peer interventions that focus on behavior; and
• Organizational skills training.

These approaches are often most effective if they are used together, depending on the needs of the individual child and the family.

Learn more about behavior therapy

Learn more about ADHD treatment and support in school

Read about the evidence for effective therapies for ADHD

Medication can help children manage their ADHD symptoms in their everyday life and can help them control the behaviors that cause difficulties with family, friends, and at school.

Several different types of medications are FDA-approved to treat ADHD in children as young as 6 years of age :

• Stimulants are the best-known and most widely used ADHD medications. Between 70-80% of children with ADHD have fewer ADHD symptoms when taking these fast-acting medications.
• Nonstimulants were approved for the treatment of ADHD in 2003. They do not work as quickly as stimulants, but their effect can last up to 24 hours.

Medications can affect children differently and can have side effects such as decreased appetite or sleep problems. One child may respond well to one medication, but not to another.

Healthcare providers who prescribe medication may need to try different medications and doses. The AAP recommends that healthcare providers observe and adjust the dose of medication to find the right balance between benefits and side effects. It is important for parents to work with their child’s healthcare providers to find the medication that works best for their child.

CDC funds the National Resource Center on ADHD (NRC), a program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). The NRC provides resources, information, and advice for parents on how to help their child.  Learn more about the services of the NRC .

The following are suggestions that may help with your child’s behavior:

• Create a routine. Try to follow the same schedule every day, from wake-up time to bedtime.
• Get organized . Encourage your child to put schoolbags, clothing, and toys in the same place every day so that they will be less likely to lose them.
• Manage distractions. Turn off the TV, limit noise, and provide a clean workspace when your child is doing homework. Some children with ADHD learn well if they are moving or listening to background music. Watch your child and see what works.
• Limit choices. To help your child not feel overwhelmed or overstimulated, offer choices with only a few options. For example, have them choose between this outfit or that one, this meal or that one, or this toy or that one.
• Be clear and specific when you talk with your child. Let your child know you are listening by describing what you heard them say. Use clear, brief directions when they need to do something.
• Help your child plan. Break down complicated tasks into simpler, shorter steps. For long tasks, starting early and taking breaks may help limit stress.
• Use goals and praise or other rewards. Use a chart to list goals and track positive behaviors, then let your child know they have done well by telling them or by rewarding their efforts in other ways. Be sure the goals are realistic—small steps are important!
• Discipline effectively. Instead of scolding, yelling, or spanking, use effective directions , time-outs or removal of privileges as consequences  for inappropriate behavior.
• Create positive opportunities. Children with ADHD may find certain situations stressful. Finding out and encouraging what your child does well—whether it’s school, sports, art, music, or play—can help create positive experiences.
• Provide a healthy lifestyle. Nutritious food, lots of physical activity , and sufficient sleep are important; they can help keep ADHD symptoms from getting worse.

ADHD in Adults

ADHD lasts into adulthood for at least one-third of children with ADHD 1 . Treatments for adults can include medication, psychotherapy, education or training, or a combination of treatments. For more information about diagnosis and treatment throughout the lifespan, please visit the websites of the National Resource Center on ADHD  and the National Institutes of Mental Health

More information

For more information on treatments, please click one of the following links:

National Resource Center on ADHD

National Institute of Mental Health

Information for parents from the American Academy of Pediatrics

References:

• Barbaresi WJ, Colligan RC, Weaver AL, Voigt RG, Killian JM,  Katusic SK.  Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: A prospective study. Pediatrics 2013;131(4):637-644.

What parents can expect in behavior therapy

Parents typically attend 8-16 sessions with a therapist and learn strategies to help their child. Sessions may involve groups or individual families.

• The therapist meets regularly with the family to monitor progress and provide support
• Between sessions, parents practice using the skills they’ve learned from the therapist

After therapy ends families continue to experience improved behavior and reduced stress.

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PARENTING HUB

57 Top Behavioral Interventions for ADHD

Dr. Roseann Capanna-Hodge

• August 16, 2023

Every parent wants the best for their child, especially when that child has Attention Deficit Hyperactivity Disorder (ADHD) and their child is prone to dysregulation . As parents, we sometimes feel lost and confused about how to best support our children, especially when conventional treatments, like ADHD medications, may not be enough or may have side effects. The good news is that behavioral therapy, specifically behavioral interventions for ADHD, can provide significant assistance and even improve outcomes for children with this condition.

Behavioral Parent Training for ADHD

Behavioral Parent Training involves teaching parents effective strategies for dealing with their child's ADHD behaviors. This can include setting clear and consistent rules, offering positive reinforcement for appropriate behaviors, and maintaining a structure that benefits the child's unique needs.

• Positive Reinforcement : Recognize and praise your child's good behavior. When your child behaves in a desirable way, provide immediate and enthusiastic praise. This could be verbal, like saying, “Great job tidying your toys!” or physical, like a high-five or a hug (Eyberg, 1988).
• Clear and Calm Instructions: Make sure your directions to your child are clear and calm. Too many instructions at once can overwhelm a child with ADHD. Break down tasks into smaller, manageable steps (Sanders, 2008).
• Skill Development: Encourage the development of key skills such as problem-solving and communication. This could be through games, role-play, or guided activities (Kazdin, 2005).
• Consistent Routines: Establishing consistent daily routines can help a child with ADHD understand what is expected of them and reduce anxiety. Make sure the routines are structured and predictable (Kazdin, 2005).
• Limit Setting: Set clear, reasonable limits for your child and stick to them. This can provide a sense of security and help your child learn self-control (Barkley, 1987).
• Modeling Appropriate Behavior: Children often learn by imitating adult behavior. Try to display behaviors you would like your child to adopt, like patience, calmness, and perseverance (Eyberg, 1988).

School-Based Interventions

School-Based Interventions are also a crucial part of managing ADHD as they help children with ADHD improve their academic and behavioral performance at school.

• Establish Clear Classroom Rules: Work with your child's teacher to set clear and consistent rules for the classroom. Ensure the rules are visually displayed and regularly reviewed (DuPaul, Eckert, & Vilardo, 2012).
• Use of Visual Aids: Teachers can use visual aids to help children with ADHD follow along with lessons. This can include charts, diagrams, or color-coding (DuPaul, Eckert, & Vilardo, 2012).
• Preferential Seating: Arrange for your child to sit closer to the teacher and away from windows or doors to minimize distractions (DuPaul, Eckert, & Vilardo, 2012).
• Break Down Assignments : Large assignments can be overwhelming for children with ADHD. Teachers can break down tasks into smaller, more manageable parts (DuPaul, Eckert, & Vilardo, 2012).
• Frequent Feedback: Teachers can provide regular feedback to children with ADHD, highlighting positive behaviors and gently correcting inappropriate behaviors (DuPaul, Eckert, & Vilardo, 2012).
• Incorporate Physical Activity : Regular movement breaks during the school day can help children with ADHD burn off excess energy and improve focus (Verret et al., 2012).
• Provide Additional Time: Allowing extra time for tasks can help children with ADHD work at their own pace and reduce the pressure they might feel to rush through their work (DuPaul, Eckert, & Vilardo, 2012).
• Peer Tutoring: Working in pairs or small groups can help children with ADHD improve their social and academic skills (DuPaul, Eckert, & Vilardo, 2012).
• Use of Technology: Assistive technology, such as speech-to-text software or digital organizers, can be beneficial for students with ADHD (DuPaul, Eckert, & Vilardo, 2012).

Self-Management Interventions

Self-Management Interventions can also be highly beneficial, as they empower children with ADHD to take control of their own behavior. Self-regulation is the foundation of learning in all areas and it is critical in the development of executive functioning. 

• Goal Setting: Teach your child to set realistic, achievable goals and create a plan to reach them. This helps improve their planning and organizational skills (Shapiro, 2011).
• Self-Reflection and Self-Regulation: Encourage your child to engage in self-reflection exercises to identify triggers, recognize their emotions, and develop self-regulation strategies. This intervention promotes self-awareness, impulse control and emotional control (Barkley, 2012).
• Self-Monitoring: Help your child learn to monitor their own behavior by keeping a diary or chart of their positive and negative behaviors. This awareness can promote self-control and responsibility (Shapiro, 2011).
• Visual Reminders: Using visual reminders, like stickers or charts, can help children track their progress towards achieving their goals (Shapiro, 2011).
• Cognitive Behavioral Techniques: Encourage your child to identify and challenge their negative thought patterns. This can help promote more positive thinking and behavior (Knapp, Dahl, & Swift, 2013).
• Time Management Strategies: Teach your child effective time management techniques, such as creating schedules, using timers or alarms, and breaking tasks into smaller, manageable steps. These strategies can help improve their organization and ability to prioritize tasks (Barkley, 2012).
• Self-Reward Systems: Implement a self-reward system where your child can earn rewards or privileges for meeting specific behavioral goals or completing tasks. This intervention can increase motivation and reinforce positive behaviors (Barkley, 2012).
• Problem-Solving Skills: Teach your child problem-solving techniques, such as identifying the problem, brainstorming solutions, evaluating options, and implementing the best course of action. This intervention enhances their critical thinking and decision-making abilities (Power, Karustis, & Habboushe, 2018).

Social Skills Training

Children with ADHD often struggle with social interactions. Social Skills Training can help them develop the necessary skills to navigate social situations effectively. This training focuses on improving communication, empathy, problem-solving, and other essential social skills. Through structured activities and guidance from professionals, children with ADHD can gain confidence and build meaningful relationships. Acquiring these skills not only improves immediate interactions but also sets a foundation for long-term social competence and success.

• Role-Play: Use role-play to practice appropriate social interactions and self-regulation . This could include taking turns, sharing, or responding to conflict (Shapiro, 2011).
• Practice Social Scripts: Role-play and practice social scripts with your child for common social situations, such as introducing themselves, joining a group, or initiating a conversation.
• Teach Conversation Skills: Guide your child in maintaining eye contact, listening attentively, and waiting their turn to speak during conversations (Shapiro, 2011). 
• Cooperative Games: Arrange activities where your child needs to cooperate with others. This can improve teamwork and negotiation skills (Shapiro, 2011).
• Provide Social Opportunities: Arrange playdates, outings, or group activities to provide regular opportunities for your child to interact with peers and practice social skills in different settings.
• Encourage Cooperative Play: Encourage your child to engage in cooperative play activities, such as building with blocks, completing puzzles, or playing board games, which promote turn-taking, sharing, and collaboration.
• Model Social Skills: Be a positive role model by demonstrating effective social skills yourself. Use polite language, active listening, and respectful behavior in your interactions with others.
• Prompt Social Behaviors: Provide gentle reminders and prompts to your child when engaging in social situations. Encourage them to greet others, ask questions, and express empathy or compliments.
• Teach Conflict Resolution: Guide your child in learning constructive ways to resolve conflicts or disagreements. Teach them strategies such as compromise, active listening, and finding win-win solutions.
• Promote Perspective-Taking: Encourage your child to consider others' perspectives and feelings. Discuss different points of view and help them understand the impact of their words and actions on others.
• Teach Empathy: Help your child understand and respect the feelings of others through stories, videos, or real-life examples (Shapiro, 2011).
• Foster Emotional Intelligence: Help your child develop emotional intelligence by encouraging them to recognize and label their emotions, understand the emotions of others, and respond appropriately in social interactions.
• Peer Modeling: Encourage your child to observe and learn from positive social behaviors exhibited by their peers. Peer modeling can provide valuable examples and help your child understand appropriate social cues and responses (Bellini & Akullian, 2007).
• Social Skills Groups: Consider enrolling your child in social skills groups or classes specifically designed to teach and practice social interaction skills with peers. These groups provide structured opportunities for learning and practicing social skills in a supportive environment (Laugeson, Frankel, & Mogil, 20 10).

Sensory Processing Interventions

In the realm of supporting children with sensory processing challenges, various interventions can make a significant difference in their daily lives. Sensory Processing Interventions encompass a range of strategies and activities aimed at helping children with sensory sensitivities or difficulties. 

By addressing the unique sensory needs of each child, these interventions provide targeted support to enhance their sensory experiences, promote self-regulation, and improve overall well-being. 

• Sensory Integration Therapy: Engaging in activities that involve the simultaneous input of multiple senses to improve sensory processing and integration (Watling & Hauer, 2015).
• Environmental Modifications: Making adjustments to the physical environment to reduce sensory distractions and create a more sensory-friendly space (Watling & Hauer, 2015).
• Sensory Diet: Create a “sensory diet” with a variety of sensory activities tailored to your child's needs, such as swinging, jumping on a trampoline, or deep pressure exercises (Bundy & Murray, 2002).
• Sensory Breaks: Provide regular breaks for sensory activities throughout the day. This can help your child stay focused and calm (Bundy & Murray, 2002).
• Fidget Tools: Use fidget tools, like stress balls or putty, to help your child focus and self-regulate (Bundy & Murray, 2002).
• Weighted Blankets: These can provide deep pressure which may help calm and comfort children with ADHD (Bundy & Murray, 2002).
• Deep Pressure Therapy: Applying deep pressure through techniques like weighted vests or deep pressure massages to promote a calming effect and sensory regulation (Koegel et al., 2012).
• Visual Supports: Using visual aids, such as visual schedules or cue cards, to enhance comprehension and provide structure in daily routines and activities (American Occupational Therapy Association, 2020).

Coping Skills Techniques

Coping skills techniques are invaluable tools that can empower children to navigate challenges, manage emotions, and build resilience. For children with ADHD, developing effective coping strategies is particularly important in promoting their overall well-being and success.

• Relaxation Techniques: Teach your child deep breathing exercises or progressive muscle relaxation techniques to help them manage stress (Sukhodolsky et al., 2005).
• Problem-Solving Skills: Help your child develop problem-solving skills by working through challenges together, step by step (Cunningham, 2006). This helps not only with frustration tolerance but also improves communication skills .
• Anger Management Skills: Teach your child to recognize signs of anger and use coping strategies like counting to ten or deep breathing (Sukhodolsky et al., 2005).
• Resilience Building: Encourage your child to learn from setbacks and persevere. This could involve discussing challenges and brainstorming ways to overcome them (Cunningham, 2006).

Mindfulness and Relaxation Techniques

Mindfulness and Relaxation Techniques provide valuable tools for promoting calmness, self-awareness, and emotional well-being in children. In the fast-paced and often demanding world we live in, children with ADHD can greatly benefit from these practices to enhance focus, reduce stress, and improve overall mental health.

• Mindfulness Exercises: Practice mindfulness exercises with your child, such as guided meditation or mindful coloring (Zylowska et al., 2008).
• Yoga: Encourage your child to practice yoga. Yoga can help children relax, focus, and improve self-awareness (Haffner et al., 2006).
• Neurofeedback: Teach your child to control their body's responses (like heart rate) using biofeedback and neurofeedback techniques (Monastra, Monastra, & George, 2002).
• Guided Imagery: Use guided imagery exercises to help your child relax and focus. For instance, have them visualize a peaceful place (Zylowska et al., 2008).

Contingency Management

Contingency Management is a powerful approach that helps children with ADHD develop positive behaviors and make effective choices. By utilizing rewards , consequences, and structured systems, this blog section explores the concept of Contingency Management and its application in supporting children's behavioral development. 

From implementing reward systems and behavior contracts to ensuring consistent consequences and using daily report cards, these techniques provide practical strategies for parents and caregivers.

• Reward System: Create a reward system for positive behavior. Use tokens or points that can be traded in for larger rewards (Fabiano et al., 2009).
• Behavior Contract: Develop a behavior contract outlining expected behaviors and consequences for not meeting those expectations (Fabiano et al., 2009).
• Consistent Consequences: Ensure consequences for inappropriate behavior are consistent and immediate (Fabiano et al., 2009).
• Daily Report Cards: Implement a daily report card system where your child's behavior is evaluated and rewarded each day (Fabiano et al., 2009).

As parents, we feel inspired by the transformative potential of learning about behavioral therapy, positive reinforcement, and parent training programs as empowering alternatives to ADHD medications for supporting our children with ADHD. 

By equipping ourselves with the knowledge and tools to implement these interventions, we have the opportunity to make a positive impact on our children's lives. Behavioral therapy offers a holistic approach, teaching our children new skills and strategies that can help them thrive. 

By implementing positive reinforcement techniques, we can create an environment that celebrates and reinforces their positive behavior, nurturing their growth and development. 

Parent training programs serve as invaluable resources, guiding us in navigating the challenges of ADHD and empowering us with effective strategies. By embracing these treatments, we can foster positive behavior and support our children's journey with attention deficit hyperactivity disorder (ADHD) in a manner that aligns with our values and aspirations. 

Through these interventions, we, as parents, have the power to create a nurturing environment that promotes positive behavior and enables our children to flourish.

Grab our free resource , “147 Therapist-Endorsed Self-Regulation Strategies for Children: A Practical Guide for Parents,” is a game-changer. 

American Occupational Therapy Association. (2020). Occupational Therapy Practice Framework: Domain and Process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 1-658.

Barkley, R. A. (1987). Defiant children: A clinician's manual for parent training. Guilford Press. 

Bundy, A. C., & Murray, E. A. (2002). Sensory integration: A. Jean Ayres' theory revisited. In A. C. Bundy, S. J. Lane, & E. A. Murray (Eds.), Sensory integration: Theory and practice (pp. 3–33). F.A. Davis. LINK

Cunningham, C. E. (2006). COPE: Large group, school-based, family-centered intervention. In R. B. Mennuti, A. Freeman, & R. W. Christner (Eds.), Cognitive-behavioral interventions in educational settings: A handbook for practice (pp. 447-472). Routledge. 

DuPaul, G. J., Eckert, T. L., & Vilardo, B. (2012). The effects of school-based interventions for attention deficit hyperactivity disorder: A meta-analysis 1996–2010. School Psychology Review, 41(4), 387-412. LINK

Eyberg, S. M. ( 2008 ). Parent-child interaction therapy: Integration of traditional and behavioral concerns. Child & Family Behavior Therapy, 10(1), 33-46. LINK  

Fabiano, G. A., Pelham, W. E., Coles, E. K., Gnagy, E. M., Chronis-Tuscano, A., & O'Connor, B. C. (2009). A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical Psychology Review, 29(2), 129-140. DOI: 10.1016/j.cpr.2008.11.001

Haffner, J., Roos, J., Goldstein, N., Parzer, P., & Resch, F. (2006). The effectiveness of body-oriented methods of therapy in the treatment of attention-deficit hyperactivity disorder (ADHD): results of a controlled pilot study. Zeitschrift für Kinder-und Jugendpsychiatrie und Psychotherapie, 34(1), 37-47. DOI: 10.1024/1422-4917.34.1.37

Kazdin, A. E. (2005). Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents. Oxford University Press. LINK

• Knapp, P., Dahl, M., & Swift, J. K. (2013). Handbook of cognitive-behavioral therapies. The Guilford Press.
• Laugeson, E. A., Frankel, F., & Mogil, C. (2010). Social skills training for young adults with high-functioning autism spectrum disorders: A randomized controlled pilot study. Journal of Autism and Developmental Disorders, 40(7), 867-876. DOI: 10.1007/s10803-011-1350-6

Monastra, V. J., Monastra, D. M., & George, S. (2002). The effects of stimulant therapy, EEG biofeedback, and parenting style on the primary symptoms of attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback, 27(4), 231-249. DOI: 10.1023/a:1021018700609

Sanders, M. R. (2008). Triple P-Positive Parenting Program as a public health approach to strengthening parenting. Journal of Family Psychology, 22(4), 506-517. DOI: 10.1037/0893-3200.22.3.506

Shapiro, E. S. (2011). Academic skills problems: Direct assessment and intervention (4th ed.). The Guilford Press.

Sukhodolsky, D. G., Kassinove, H., & Gorman, B. S. (2005). Cognitive-behavioral therapy for anger in children and adolescents: A meta-analysis. Aggression and Violent Behavior, 10(3), 247-269. LINK

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Are There Natural Remedies for ADHD?

Options include herbal medicines and lifestyle modifications

• Role of Diet

Lifestyle Modifications

Herbal medicines, supplements and vitamins, essential oils.

• Learning New Skills
• Additional Help for Adults
• Risks of Home Remedies

Attention deficit hyperactivity disorder (ADHD) is a neurotypical or neurodevelopmental disorder that impacts executive functioning for children and adults. Characteristics of ADHD include impulsivity, disorganization, and difficulties concentrating and regulating emotions—all of which can make living in a neurotypical world incredibly challenging.

To cope, some people take ADHD medication , but pharmaceutical treatment for ADHD may not work for everyone and many of these drugs can have side effects. Holistic treatment for ADHD includes complementary or alternative ADHD treatments. This article covers these alternative treatment options that can help reduce or manage symptoms of ADHD. 

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A Word From Verywell

Engaging in regular physical activities can help reduce restlessness and impulsivity associated with ADHD. Exercise can also improve the executive functioning (planning and problem-solving needed for daily life) of ADHD patients, thus making it a holistic approach to managing this condition. Similarly, foods rich in refined sugars can worsen ADHD symptoms.

Researchers have been looking at diet as a potential natural remedy for ADHD symptoms for years, with conflicting findings. Some studies suggest certain foods can increase risk or severity of ADHD symptoms while other foods may offer a protective benefit against symptoms.

Foods high in refined sugar and saturated fats, for example, have been associated with ADHD symptoms, but diets high in fruits and vegetables are associated with fewer or less severe symptoms.

Diets high in fruits and vegetables include:

• Mediterranean diet
• DASH (Dietary Approaches to Stop Hypertension) diet
• Vegetarian diet

What About Elimination Diets for ADHD?

Elimination diets for ADHD involve eliminating food items or ingredients one at a time in an effort to isolate foods that are potentially contributing to symptoms. They have not been well-evidenced and are said to be linked to nutritional deficiencies.

Lifestyle modifications are habits or behaviors that can be changed. Sleep and exercise fall into this category.

Sleep disorders and disturbances are common in people with ADHD—and not getting enough sleep can make ADHD symptoms worse.

Experts suggest:

• Practice healthy sleep habits, such as no screens before bed, set bedtime and wake time.
• Cut back or avoid stimulating substances like caffeine and alcohol, especially late in the day.
• Add relaxation techniques to your bedtime routine.
• Seek behavioral therapy for improving sleep habits, if necessary.

ADHD Medication and Sleep

If you’re taking ADHD medication and it’s interfering with your sleep, your prescribing healthcare provider may suggest switching to alternative medications. Never stop taking medication without consulting with your healthcare provider about next steps.

Exercise has been shown to immediately reduce ADHD symptoms such as impulsivity and hyperactivity and improve executive functioning (skills to manage everyday planning and problem solving). Longer-term results have not been well-studied.

Experts suggest setting up an ADHD-friendly exercise action plan. Some tips to consider include:

• Establish a set routine.
• Find a reliable workout partner.
• Have a variety of exercises to choose from .
• Experiment with new activities.
• Break physical activity goals into smaller, more attainable milestones.

It's recommended that adults get at least 150 minutes of moderate-intensity physical activity per week and two days of muscle-strengthening activity. If this is overwhelming, bear in mind that any activity is better than none. Consider tracking how you feel before and after exercising so you can notice the positive changes over time.

Herbal medicines may be used either in place of or in combination with medicine prescribed by a healthcare provider. They can come in tea, capsule, pill, tincture, or powder form. Always consult with a healthcare provider as many herbs interact with medications and research on effectiveness is often mixed. 

Herbs that may be useful for treating ADHD symptoms naturally but still require further research:

• Biloba ( Ginkgo biloba )
• Pine bark extract
• Saffron ( Crocus sativus )
• Ginseng ( Panax ginseng and Panax quinquefolius )
• Lemon balm ( Melissa officinalis )
• Water hyssop ( B. monnieri )
• Ningdong granule (NDG)
• Passionflower ( Passiflora incarnata )

Finding the right ADHD treatment can take trial and error. Consulting with a healthcare provider before starting, stopping, or changing any ADHD treatment plan, including holistic treatments, is recommended.

Some research suggests certain supplements or vitamins may be helpful for managing ADHD symptoms . But current evidence supporting this type of natural treatment for ADHD is still inconclusive—especially when looking at long-term outcomes.

The following supplements and vitamins are nonetheless associated with natural remedies for easing symptoms of ADHD:

• Omega-3 fatty acids or polyunsaturated fatty acids (PUFAs) 
• Melatonin  

Essential oils may be helpful in managing ADHD symptoms because their scent may stimulate the limbic system, the part of the brain involved in memory, behavior, motivation, and emotion.

Different oils have different effects. Common examples include:

• Chamomile and lavender oils: Calming, well-known, and evidenced for their anxiety-reducing effects
• Peppermint oil : Stimulating and potentially improving memory ability and performance
• Rosemary oil : Stimulating and potentially enhancing focus and short-term memory recall

As with other natural remedies for ADHD, a lack of evidence exists to support essential oil use as a standalone treatment.

Helping Children Learn New Skills

Experts say building daily habits or creating systems for routine activities like getting ready for school can make it easier for children to manage ADHD. Of course, symptoms of ADHD also increase the challenge of sticking with routines.

Helping your children learn new skills built around routines may strengthen their confidence and their ability to know when adjustments or accommodations are necessary. 

Further Help for Adults With ADHD

Finding the right type of help can take some time and patience. There are many options to explore, and what works for one may not work for another. Additional treatment options include:

• Cognitive behavioral therapy (CBT) : Studies suggest CBT is the most effective type of therapy for ADHD. It helps someone make desired changes to thoughts and behaviors contributing to ADHD-related struggles.
• Combination treatment approach : Studies suggest a combination treatment approach that includes ADHD medication and therapy is more effective than medication alone.
• Additional support : Talking with friends who understand ADHD or making connections in ADHD peer groups can offer a safe space to share your frustrations without judgment.

Risks to Home Remedies for ADHD

There are mixed findings when it comes to the safety and efficacy of home remedies for ADHD. Herbal medicines and nutritional supplements, for example, are not regulated by the Food and Drug Administration (FDA). And even though something is naturally derived, it doesn't mean it's safe for everyone. You may be allergic to certain essential oils, for example.

Researchers say the risk-benefit balance of natural treatments for ADHD should be carefully monitored by your healthcare provider when used as a standalone treatment or when combined with other ADHD treatments.

There is no one size-fits-all approach to managing ADHD. Rather, there are many options extending beyond medication, which may or may not be suitable for everyone.

A holistic approach to treating ADHD may involve dietary changes, lifestyle modifications, supplements and vitamins, essential oils, and other nondrug options like counseling or connecting with people who have an understanding of the real impacts of ADHD on everyday functioning.

It's important to consult with a healthcare provider when considering holistic treatments to ensure safety and efficacy.

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By Michelle Pugle Pulge is a freelance health writer focused on mental health content. She is certified in mental health first aid.

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Psychoeducation Intervention Effectiveness to Improve Social Skills in Young People with ADHD: A Meta-Analysis

Lauren amy powell.

1 University of Sheffield, Sheffield, UK

Jack Parker

2 University of Derby, Derby, UK

Anna Weighall

Valerie harpin.

3 Ryegate Children’s Centre, Sheffield Children’s NHS Foundation Trust, Sheffield, UK

Associated Data

Supplemental material, sj-pdf-1-jad-10.1177_1087054721997553 for Psychoeducation Intervention Effectiveness to Improve Social Skills in Young People with ADHD: A Meta-Analysis by Lauren Amy Powell, Jack Parker, Anna Weighall and Valerie Harpin in Journal of Attention Disorders

Attention Deficit Hyperactivity Disorder (ADHD) can be associated with limited understanding of the condition and poor social skills. Some evidence favors a psychoeducational approach, but little is known about the effectiveness of psychoeducation.

Systematic review and meta-analysis of studies assessing psychoeducational interventions that aim to improve social skills of young people with ADHD.

Ten studies, including 943 participants, reported across 13 papers met the inclusion criteria. Although effect sizes were small, findings suggest the included interventions significantly improved social skills in young people with ADHD.

Conclusions:

Results show promise for psychoeducational behavioral interventions . However, the recommendations that can be developed from existing evidence are somewhat limited by the low quality of studies. Further rigorous trials are needed. In addition, future research should consider the long-term outcomes for these interventions, they should be iteratively co-designed and research should consider the context they intend to be delivered in.

Introduction

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder affecting children and young people (CAYP) with a worldwide prevalence of around 3.4% of school age children ( Polanczyk et al., 2015 ), 9.4% of the US population ( Danielson et al., 2018 ) and 4.4% of adults ( Brattberg, 2006 ). The Diagnostic Statistical Manual 5 (DSM-5) reports three core symptoms of ADHD; developmentally inappropriate levels of inattention, impulsivity and hyperactivity and distinguishes three presentations; predominantly inattentive, hyperactive/impulsive or combined ( American Psychiatric Association (APA), 2013 ).

A number of difficulties have been reported in ADHD, such as executive dysfunction ( Castellanos & Tannock, 2002 ), emotional dysfunction with low levels of emotional control ( Anastopoulos et al., 2011 ), academic under achievement ( DuPaul et al., 2011 ), increased likelihood of being expelled from school and leaving school early ( McGee et al., 1991 ), poor social relationships and poor social functioning ( Wehmeier et al., 2010 ).

Social functioning refers to social skills, information processing and peer functioning ( Ros & Graziano, 2018 ). It is widely reported that CAYP with ADHD often display impaired social functioning ( Willis et al., 2019 ). For example, CAYP with ADHD often show disruptive and developmentally inappropriate social behaviors and demonstrate less turn taking and cooperative behaviors compared to CAYP without ADHD ( Barkley, 2014 ). CAYP with ADHD often display deficits in social communication skills ( Bignell & Cain, 2007 ), social processing ( Humphreys et al., 2016 ) and social cognition ( Willis et al., 2019 ). Although CAYP attempt to have friendships with peers, these attempts are often viewed as negative, immature and intrusive ( Ronk et al., 2011 ). CAYP with ADHD are also likely to be unaware of their impaired social skills ( Owens, 2007 ) leading to difficulties maintaining peer relationships ( Hoza et al., 2005 ).

ADHD is a highly co-morbid condition, particularly with Autism Spectrum Disorder (ASD) ( National Institute for Health and Clinical Excellence (NICE), 2018 ). Indeed, CAYP with ASD present with similar social skills difficulties to CAYP with ADHD. Prior to the National Institute for Health and Care Excellence (NICE) guidelines ( National Institute for Health and Clinical Excellence (NICE), 2008 ) and Diagnostic Statistical Manual 5 (DSM5) ( American Psychiatric Association (APA), 2013 ), ASD was not recognized as a comorbid condition with ADHD. Clinical experience, however, demonstrated that there was, in fact, a significant overlap and more recent research has confirmed this ( Ghirardi et al., 2018 ). Studies show that between 30 and 50% of individuals with ASD also show ADHD symptoms (particularly at pre-school age), and similarly, estimates suggest two-thirds of individuals with ADHD show features of ASD ( Davis & Kollins, 2012 ). In a large Swedish cohort study ( Ghirardi et al., 2018 ), it was found that 48% of those with ASD also fulfilled diagnostic criteria for ADHD and that 17% of those with ADHD had a diagnosis of ASD. It is important to note that findings from the Autism Treatment Network database suggest that co-occurrence of ADHD and ASD is associated with a lower quality of life and poorer adaptive functioning than in either of these conditions alone ( Sikora et al., 2012 ).

Hence improving social skills in CAYP with ADHD and co-morbidities would be beneficial and psychoeducation is considered a possible intervention to achieve this.

Definitions of psychoeducation are heterogeneous. Initially, psychoeducation described a behavioral concept including briefing a patient about their illness, problem solving, communication and self-assertiveness training, which included relatives ( Anderson et al., 1980 ). More recently, psychoeducation has been defined as interventions to teach individuals about their disorder by supporting them, providing information and disorder management skills ( Bai et al., 2015 ) or, more simply, as “systematic and didactic approach to informing patients, and their relatives, about their illness and its treatment, thereby promoting understanding and personal management of the illness” ( Ferrin et al., 2014 ).

Recipients of psychoeducation interventions can vary and include the individual, parents, teachers or others ( Bai et al., 2015 ). Objectives of psychoeducation have been identified as learning about the disorder, facilitating informed disorder management and including the relative with this, patient empowerment and improving treatment adherence ( Bäuml et al., 2006 ).

A plethora of evidence demonstrates the benefits of psychoeducation on adult populations ( Willis et al., 2019 ). However, evidence also shows that psychoeducation could benefit young people with mood disorders ( Cummings & Fristad, 2007 ; Fristad, 2006 ; Ginsburg et al., 2005 ). Regarding ADHD, it is argued that providing condition education, including a diagnostic label, can improve knowledge and attitudes in children and adults and that brief teacher training can improve knowledge and correct misconceptions of ADHD ( Nussey et al., 2013 ). Evidence also favors providing age appropriate psychoeducation to CAYP with ADHD as a precursor to other formal treatment ( Young et al., 2020 ) and suggests that parent education can improve treatment adherence in CAYP with ADHD ( Nussey et al., 2013 ). Psychoeducation may enable the young person to become a partner in their ADHD treatment and improve their adherence to treatment ( Wolraich et al., 2005 ).

Psychoeducation is recommended in a number of clinical guidelines for CAYP with ADHD for example, in the UK, NICE recommends psychoeducation for parents of CAYP with ADHD and for information to be provided to people with ADHD at a developmentally appropriate level, tailored to their individual needs ( National Institute for Health and Clinical Excellence (NICE), 2018 ). The Canadian Clinical guidelines state that psychoeducation should empower patients and their families by providing information on the “. . .impact on daily functioning, treatment options, strategies for optimizing functioning” ( Canadian ADHD Practice Guidelines, 2011 ). Similarly, the Spanish clinical guidelines recommend educational programs for parents, teachers and CAYP with ADHD ( Guías de Práctica Clínica en el SNS, 2017 ).

Psychoeducation interventions that aim to benefit CAYP with ADHD can vary based on the form they take and the recipient of the intervention. For example, behavioral parent interventions are often based on social learning principles and include providing parents with strategies to reduce behavioral problems in their child and to improve parental attitudes toward parenting ( Rimestad et al., 2019 ). The efficacy of parent interventions is also supported by meta-analysis data ( Fabiano et al., 2009 ; Lee et al., 2012 ; Rimestad et al., 2019 ). However, concerns have been raised about the efficacy of parenting interventions in managing ADHD due to evidence that effect sizes drop to almost zero ( Lee et al., 2012 ) when only data from blinded participants is analyzed ( Sonuga-Barke et al., 2013 ). Larger effect sizes have however been reported in relation to parenting competence, which also moderately decrease over time and it has therefore been argued that exploration of sustainability of the effects of parental training over time requires further scrutiny ( Lee et al., 2012 ). It should be noted that it can be challenging to blind participants when taking part in an RCT assessing a behavioral intervention.

Classroom-based interventions can include behavioral strategies for teachers and for example, promote the use of rewards to reduce problematic classroom behavior ( Tarver et al., 2014 ) and focus on academic performance improvement ( DuPaul et al., 2011 ). There is evidence in favor of classroom-based interventions ( Tarver et al., 2014 ) and it appears that integration between home and school to ensure consistency with the behavioral approach is important ( Raggi & Chronis, 2006 ).

Randomized controlled trial (RCT) evidence has demonstrated that psychoeducation interventions with families of CAYP with ADHD could help to reduce ADHD symptoms ( Ferrin et al., 2016 ). Psychoeducation can also help people understand their condition and the treatment they receive leading to ownership of their treatment ( Willis et al., 2019 ).

However, lack of adherence to treatments can weaken the impact of both pharmacological and psychosocial interventions ( Bai et al., 2015 ), thus improving adherence is considered critical ( Acri et al., 2018 ).

Interventions where CAYP with ADHD themselves are the recipients include child psychological therapy involving components such as social skills training, anger management and problem solving ( Tarver et al., 2014 ). Evidence supporting these interventions is limited ( Storebø et al., 2019 ) and little is known about the effectiveness of the psychoeducation mechanisms of the interventions and the impact they may specifically have upon the social skills of CAYP with ADHD.

Some review evidence does suggest that behavioral interventions ( Fabiano et al., 2009 ) and social skills training can improve outcomes and social skills in CAYP with ADHD, respectively ( Fabiano et al., 2009 ). Meta-analytic evidence shows improvements in social functioning resulting from peer involvement interventions ( Cordier et al., 2018 ) however there was no specific assessment of psychoeducation included in these reviews.

A recent systematic review assessed psychoeducation interventions for parents and teachers of CAYP with ADHD ( Dahl et al., 2020 ). This review concluded that psychoeducation can lead to improvements in ADHD symptoms and parent reported behavioral problems but did not assess the impact upon social skills in CAYP with ADHD or include interventions when the young person with ADHD is the recipient.

Therefore, this review aims to address the specific research question “Do psychoeducation interventions improve social skills in CAYP with ADHD?”

The systematic review protocol was registered with PROSPERO (CRD42019157454) and was undertaken in accordance with the principles recommended in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Meta-Analysis Reporting Standards (MARS) ( Moher et al., 2009 ; APA Publications and Communications Board Working Group on Journal Article Reporting Standards, 2008 ).

Search Methods

In line with the Cochrane Handbook ( McKenzie et al., 2019 ) the Population Intervention Comparison Outcome Study Design (PICOS) framework helped to dictate the inclusion criteria and search terms for this review. The population for this review is CAYP with ADHD aged 18 years or under, the intervention is any intervention that aims to improve social skills (outcome) in CAYP with ADHD and included studies were RCTs only. The search terms were selected based upon the PICOS framework, Cochrane literature and information specialist advice.

Databases were searched from 1994 to 2019. This is because the Fourth edition of the Diagnostic Statistical Manual (DSM IV) ( American Psychiatric Association, 1994 ) introduced the three subtypes of ADHD. Please note the current DSM edition DSM-5 ( American Psychiatric Association (APA), 2013 ) was published in 2013. Authors decided publications since 1994 would be appropriate as changes made since DSM IV are subtle and including only publications since 2013 would significantly limit results presented in this review.

The search was conducted in the following databases in November 2019: MEDLINE, PsychINFO, The Cochrane Library, CINAHL, Web of Science (Core Collection), ProQuest, ASSIA and Scopus. Medical Subject Headings (MeSH) keywords used were child, child behavior, adolescent, young adult, adolescent health, adolescent psychiatry, students, minors, young adult, attention deficit and disruptive behavior disorders, attention deficit disorder with hyperactivity, conduct disorder, attention, hyperkinesis, patient education as topic, education, health education, teaching, schools, training support, knowledge, patient medication knowledge, behavior, adolescent behavior, behavior control, behavior therapy, child behavior, problem behavior, behavioral research, behavioral symptoms, attitude, attitude to health, social skills, social behavior, interpersonal relations, social isolation, social problems, social skills, peer group, communication, interpersonal relations, friends.

Text terms used were child disorders, young people, young person, teenage, student, school age, minor, boy, girl, YP, teen, youth, young, juvenile, Juvenescent, pubescent, conduct disorders, child behavior disorders, ADHD, ADDH, ADHS, HKD, TDAH, behave, disrupt, disorder, defiant, impulsive, inattentive, inattention, psychoeducation, educate, education medical, train, teach, school, tuition, tutor, coach, guide, instruct, inform, knowledge, develop, lesson, behavior change, behavioral, conduct, disruptive, impulse control and conduct disorders, habit, prosocial, interact, social, social develop, disrupt, peer reject, communicate, empathy, peer problem, peer interact, Social dysfunction, Peer relationship, peer function, peer reject, friendship.

Terms were combined using Boolean logic (“AND,” “OR”). MeSH are specific recognized terms used to identify journal articles and books in electronic databases. Free text terms and synonyms are specific words that the search strategy looks for in the title and abstract.

The MEDLINE search strategy is available in Supplemental Appendix 1. Electronic references were downloaded to reference management software.

For the purpose of this review, psychoeducation is defined as an intervention which “ includes information about the illness and its treatment, skills development, and patient empowerment ” ( Montoya et al., 2011 ).

This approach is consistent with a recent review ( Dahl et al., 2020 ). As a result, studies included in this review deliver psychoeducation in a variety of formats, to a variety of audiences with differing content and modes of delivery.

The inclusion criteria are outlined in Table 1 . Details of the included outcome measures can be found in Supplemental Appendix 2.

Inclusion/Exclusion Criteria for this Review.

Quality Assessment

The methodological quality of the included RCTs was assessed using the Cochrane Risk of Bias Tool (CRoB) ( Higgins & Altman, 2008 ). This tool addresses fields including sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, and selective outcome reporting. RCTs were stated as having either a low risk of bias if they were rated as low for three key areas: allocation concealment, blinding of outcome assessment and completeness of outcome data. They were stated to have an overall high risk of bias of any of these three key areas were judged as having a high risk of bias. RCTs stated to have an overall unclear risk of bias were so if any of the three key areas were stated to be unclear. Quality of evidence of the trials was also assessed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach using GRADE Pro software. GRADE provides a robust and transparent framework for presenting summaries of evidence, providing a systematic approach to making clinical practice recommendations. It is a widely used tool for evaluating the reliability of the evidence with over 100 organizations worldwide officially endorsing GRADE. The use of this framework ensures rigorous and replicable assessment of the quality of evidence and enable decisions to be made about the relative weight that should be given to included studies when developing recommendations for practice ( Brignardello-Petersen et al., 2018 ). AW assessed the quality of evidence and LP and JP checked the assessment.

Data Extraction

Titles, abstracts, and/or full text papers were screened independently by two review authors (LP, JP) to identify studies compliant with the inclusion criteria. Reviewers resolved disagreements through discussion. A standardized Microsoft Excel form was used to extract data. Details of the study characteristics, including location of study, participants, the intervention, comparator and results were recorded. Data extraction was carried out by reviewer LP and checked for accuracy by reviewers AW and JP.

Data Synthesis

A random effects meta-analysis and narrative review was undertaken with tables and text providing supporting evidence. Revman5 ( The Cochrane Collaboration, 2014 ) was used to conduct the meta-analysis. A random effect size model with 95% confidence intervals was adopted and effect sizes calculated to indicate intervention efficacy to improve social skills in CAYP with ADHD. Data required for the meta-analysis was extracted by author LP and checked for accuracy by authors JP and AW.

The electronic literature search yielded a total of 20112 records following deduplication. Two additional citations were identified via handpicking methods. This involved reviewing reference sections of papers during the selection process. Therefore 20114 citations were screened by authors LP and JP and 19625 articles were excluded based upon information in the titles and abstracts. At this stage, 67 full texts were obtained, 54 were excluded (see Figure 1 ) and 13 obtained to be included in this review. Ten studies were reported across the 13 included articles.

Search results.

Overall, there were 943 CAYP with ADHD recruited across all included studies ( n  = 10) with 886 participants at follow up. This means there was a mean of 94 participants at baseline and 89 at follow up with a mean of just five participants dropping out per study.

The 10 included studies included one from the UK ( Ferrin et al., 2016 ), one from Sweden ( Östberg & Rydell, 2012 ), one from Australia ( Wilkes-Gillan et al., 2016 ) and the remaining 10 were conducted in North America ( Chacko et al., 2009 ; Haack et al., 2017 ; Mikami et al., 2010 ; Pfiffner & McBurnett, 1997 ; Pfiffner et al., 2007 , 2014 , 2016 , 2018 ; Webster-Stratton et al., 2011 , 2013 ). Collectively, all included studies involved 943 participants at baseline and 886 at follow up including control groups, equating to an average of a 6.04% dropout overall. Child participants had a mean age of 8.6 (range: 5.3–10.95).

Medication Status

One study stipulated ADHD medication must be “stable” for at least 1 month before they took part in the study ( Ferrin et al., 2016 ), one did not report whether CAYP with ADHD were medicated ( Pfiffner et al., 2007 ), one trial stipulated that their participants must not be taking ADHD medication ( Webster-Stratton et al., 2011 , 2013 ) and the remaining trials simply reported the percentage of CAYP with ADHD who were medicated when they were recruited ( Chacko et al., 2009 ; Haack et al., 2017 ; Mikami et al., 2010 ; Östberg & Rydell, 2012 ; Pfiffner & McBurnett, 1997 ; Pfiffner et al., 2014 , 2016 , 2018 ; Wilkes-Gillan et al., 2016 ).

Eight of the 10 trials observed significant improvements following the intervention in social skills in CAYP with ADHD ( Haack et al., 2017 ; Mikami et al., 2010 ; Östberg & Rydell, 2012 ; Pfiffner & McBurnett, 1997 ; Pfiffner et al., 2007 , 2014 , 2016 , 2018 ; Webster-Stratton et al., 2011 , 2013 ; Wilkes-Gillan et al., 2016 ).

Comorbidities

Three of the included studies did not report on comorbidities of their participants ( Chacko et al., 2009 ; Pfiffner & McBurnett, 1997 ; Pfiffner et al., 2016 , 2018 ), one excluded CAYP with ADHD that had diagnoses of any “major developmental disorder” ( Wilkes-Gillan et al., 2016 ). One study reported on comorbid oppositional defiant disorder (ODD) only ( Webster-Stratton et al., 2011 , 2013 ), and two studies reported on comorbid anxiety, depression and ODD ( Haack et al., 2017 ; Mikami et al., 2010 ; Pfiffner et al., 2014 ). The remaining three studies fully reported on comorbid conditions ( Ferrin et al., 2016 ; Östberg & Rydell, 2012 ; Pfiffner et al., 2007 ).

The results of the meta-analysis are presented graphically in Figures 2 and ​ and3. 3 . Three parent and teacher reported outcome measures (Social skills rating system: SSRS; Social skills improvement system: SSIS; Social competence scale: SCS) were included in the analysis. This means that for the meta-analyses of parent reported and teacher reported outcome measures, five studies reported across eight papers and four studies reported across six papers were included, respectively. The Incredible years study ( Webster-Stratton et al., 2011 , 2013 ) was included in the parent but not the teacher reported outcome meta analyses as they did not adopt a suitable teacher outcome measure. The remaining five studies were not included in the meta-analysis as they also did not report on suitable outcome measures to be fairly compared with the other studies.

Meta-analysis of parent reported outcomes of social skills in CAYP with ADHD. Included in this meta-analysis were five studies reported across eight papers.

Meta-analysis of teacher reported outcomes of social skills in CAYP with ADHD. Four studies reported across six papers were included in this meta-analysis.

Risk of Bias and Meta-Analyses

The left column of the figures provides the author and date of the relevant study. The means, standard deviations (SD) and weight of each study is then provided in the following columns for the intervention and control groups. The vertical line through the forest plot gives the 95% confidence interval. On the right-hand side of each figure, there is a summary of the CRoB results.

The meta -analysis found significant between group differences in favor of the intervention for improving social skills in CAYP with ADHD for both the teacher reported ( p  = .004) and parent reported measures ( p  = .0001). The effect size is also significant but small for both parent (.39) and teacher (.32) measures.

Interventions Aimed at a Single Audience (CAYP with ADHD or Parents)

Only one study reported an intervention whereby CAYP with ADHD are the only recipients of the intervention ( Wilkes-Gillan et al., 2016 ). Significant between group differences were observed compared to a control group for the Test of Playfulness outcome measure.

Three interventions across three articles reported RCTs whereby parents are the only recipient of the intervention ( Chacko et al., 2009 ; Ferrin et al., 2016 ; Mikami et al., 2010 ). Two of the three studies found no significant differences between groups for social skills. ( Chacko et al., 2009 ; Ferrin et al., 2016 ). One of the three studies found that Parental Friendship Coaching predicted improved parent reported child social skills post-test ( p  < .01) using the SSRS however, these results were not supported by teacher rated SSRS scores ( Mikami et al., 2010 ).

According to the parent reported Quality of Play questionnaire, Parental Friendship Coaching was associated with reductions in the amount of conflict ( p  < .01) and the amount of disengagement displayed by children on playdates ( p  = .52) ( Mikami et al., 2010 ). This measure involved teaching parents to structure their child’s playdates to optimize their child and friend’s social interaction and was therefore felt appropriate to include ( Mikami et al., 2010 ).

Interventions Aimed at Multiple Audiences

Two studies reported interventions across three articles that targeted both children and parents in separate groups ( Pfiffner & McBurnett, 1997 ; Webster-Stratton et al., 2011 , 2013 ), one study reported an intervention across two articles that included parents and children in separate groups but also included a classroom component ( Pfiffner et al., 2016 , 2018 ), one study reported an intervention involving parents groups, groups that involved the parent, child, therapist and teachers as well as a child group ( Pfiffner et al., 2007 ), one study reported an intervention across two articles involved family meetings and teacher consultations ( Haack et al., 2017 ; Pfiffner et al., 2014 ). The final study involved groups for parents and also meetings with teachers ( Östberg & Rydell, 2012 ). Of the six studies reported above, all reported improvements in social skills.

One study observed improved parent ratings of the SDQ ( p  < 0.05) with problematic behaviors reducing only in the intervention group. Prosocial behavior improvements in the SDQ were not observed ( Östberg & Rydell, 2012 ).

Pfiffner and McBurnett (1997) study showed improved SSRS and UCI parent rated social skills in those who undertook Social Skills Training (SST) and Parent mediated SST compared to the control group and these effects were maintained at a 4-month follow-up ( p  < .0001). However, teacher rated SSRS scores did not demonstrate a significant improvement in social skills ( p  > .1). The parent mediated SST group also demonstrated improved social skills as reported by the teacher rated SSRS from pre-treatment to post-treatment ( p .001) and from pre-treatment to follow up ( p  < .001). Significant differences were not found between the SST and control groups ( p  > .1) ( Pfiffner & McBurnett, 1997 ).

A further study by Pfiffner et al. (2007) found significantly improved parent and teacher ratings on the SSRS between groups post-treatment, ( p  = .0065). The Test of Life Skills Knowledge also found significant between group differences, favoring the intervention group, for knowledge of social and organizational skills taught during the intervention ( p  = .0001) ( Pfiffner et al., 2007 ).

The CLS study ( Pfiffner et al., 2016 , 2018 ) found significant between group differences post-treatment favoring the intervention as reported in the social skills subscale of the SSIS ( p  = .0393). They also found significant between group differences in favor of the CLAS intervention for both parent-reported ( p  = 0.04) and teacher reported ( p  = 0.02) SSIS. Differences were maintained at follow up but not then significant for teacher reported outcomes.

The Incredible Years Study ( Webster-Stratton et al., 2011 , 2013 ) found significant improvements in the Wally Problem Solving Test within the intervention arm 1-year post treatment ( p  < .001).

Quality Appraisal

The CRoB quality assessment summary can be found in Figures 4 and ​ and5 5 and further details of the full CRoB quality appraisal can be found in Supplemental Appendix 3. One of the 10 included studies was judged has having an overall low risk of bias ( Wilkes-Gillan et al., 2016 ). One of the studies was judged as having an overall high risk of bias as a result of having a high risk of bias for the blinding of outcome assessment domain ( Pfiffner et al., 2016 , 2018 ). The remaining eight studies were judged as having an overall unclear risk of bias ( Chacko et al., 2009 ; Ferrin et al., 2016 ; Haack et al., 2017 ; Mikami et al., 2010 ; Östberg & Rydell, 2012 ; Pfiffner & McBurnett, 1997 ; Pfiffner et al., 2007 , 2014 ; Webster-Stratton et al., 2011 , 2013 ). It should be noted that all studies gained a high risk of bias in terms of blinding of participants. This is a challenge in studies of this type of intervention.

Risk of bias summary: review authors’ judgments about each risk of bias item for each included study.

Risk of bias graph: review authors’ judgments about each risk of bias item presented as percentages across all included studies.

Parent and teacher outcomes were assessed using the GRADE quality assessment and found that there was on average, a low quality of evidence. This means that any conclusions and recommendations should be viewed with caution and further high-quality research is needed. Table 2 shows the results of this analysis and Table 3 summarizes the included studies in this review.

Summary of Findings and Quality Assessment Table.

Note. CI = confidence interval; SMD = standardized mean difference.

Study Summary Table.

Meta-Analysis Results

Two meta-analyses were conducted. Of the 10 included studies, eight were included in the meta-analysis.

Summary of Results

This review set out to answer the question “Do psychoeducation interventions improve social skills in CAYP with ADHD?” Following exclusions, 10 studies reported across 13 articles were included. Overall, there were 943 CAYP with ADHD recruited across all 10 included studies with 886 participants at follow up. This means there was a mean of 94 participants at baseline and 89 at follow up with a mean average of five participants dropping out per study.

Encouragingly, our meta-analysis indicated small but significant improvements in social skills in CAYP with ADHD in favor of the intervention for both parent and teacher reported outcome measures. Seven of the included 10 studies involved CAYP with ADHD as recipients of the intervention ( Chacko et al., 2009 ; Haack et al., 2017 ; Pfiffner & McBurnett, 1997 ; Pfiffner et al., 2007 , 2014 , 2016, 2018; Webster-Stratton et al., 2011 , 2013 ; Wilkes-Gillan et al., 2016 ). Six of these eight studies reported significant improvements in social skills in CAYP with ADHD ( Chacko et al., 2009 ; Haack et al., 2017 ; Pfiffner & McBurnett, 1997 ; Pfiffner et al., 2007 , 2014 , 2016, 2018; Webster-Stratton et al., 2011 , 2013 ; Wilkes-Gillan et al., 2016 ). These six studies all engaged CAYP interactively in the intervention through activities such as group work, role-play, problem solving, coaching, behavioral rehearsal and feedback. This could indicate that CAYP with ADHD are more likely to have a preference toward an interactive learning style.

One of the eight studies that included children as intervention recipients did not report significant improvements in social skills in CAYP with ADHD ( Chacko et al., 2009 ). This study concentrated on behavioral impairment rather than ADHD symptoms. This is important because although their participants included CAYP with ADHD, it was not the difficulties with social skills that resulted directly from the ADHD that were being measured.

Contribution to Knowledge

Recent systematic review evidence ( Dahl et al., 2020 ) has concluded that psychoeducation interventions for parents and teachers can lead to improvements in behavior in CAYP with ADHD and that there is little evidence in favor of behavioral interventions improving peer social functioning in CAYP with ADHD ( Morris et al., 2020 ). This review adds to the existing evidence base by only including studies evaluating interventions that involve a psychoeducational component and specifically assessing the impact these interventions have upon social skills in CAYP with ADHD.

Outcome Measures

Our meta-analysis shows that parent reported measures were likely to demonstrate a significant improvement in social skills in CAYP with ADHD. It should be acknowledged, however, that parents were not blinded to the intervention their children were receiving. This could indicate that parents, who would have invested their time and effort into the interventions, expected or hoped to observe improvements in their child’s social skills and could therefore reflect observer bias. It should, however, be noted that due to the nature of the interventions, it is often impossible to blind participants and their families to the arm of the study allocated to the participant. The meta-analysis also demonstrated that the teacher reported measures were significant in improving social skills for CAYP with ADHD, adding weight to the parent reported measure findings.

It is clear that social skills difficulties are a significant problem for CAYP with ADHD and their families. However, previous research as to the value of psychoeducation in establishing long term improvements in social functioning in CAYP with ADHD remains difficult for clinicians to interpret. The studies reported in this review involved significant time commitment from parents, teachers and clinicians.

Although 10 studies are included in this review, they include a large number of, often non-comparable, outcome measures ( n  = 15). This is why five of the 10 included studies were not included in the meta-analysis. It is important to note that the interventions included in this review do not focus solely on psychoeducation therefore results should be interpreted with caution as it is difficult to definitively state that the effectiveness of the interventions in the meta-analysis are due to the psychoeducation mechanisms provided.

Further, it would be beneficial if consistent outcome measures could be adopted across multiple trials to enable fair comparison across studies. In order to reduce bias, it may be useful to additionally adopt social skills assessments that do not involve subjective measures in order to decrease the potential for bias by the evaluators. This could involve the utilization of emerging objective measures such as the use of technology ( Hult et al., 2018 ; Muñoz-Organero et al., 2019 ).

Exploring Psychoeducation and Social Skills Training

This review does however highlight the potential for interventions for CAYP with ADHD to include a psychoeducational component that educates the child about ADHD and/or teaches them a new skill to help them cope with their ADHD related difficulties such as social skills training. This approach has been successful in other conditions such as depression in adolescents ( Jones et al., 2018 ), asthma in CAYP ( Marsland et al., 2019 ) and epilepsy in adolescents ( Snead et al., 2004 ), as well as in young people with ADHD ( Dahl et al., 2020 ). The clinical significance of these findings favoring psychoducation for CAYP with ADHD are particularly important as evidence suggests that those treated with psychoeducation as well as another treatment such as medication, tend to have better treatment acceptance, adherence and better long-term outcomes ( Adler & Nierenberg, 2010 ; Bai et al., 2015 ). Further, interventions that educate the parent were included in this review. Evidence suggests that parent knowledge of ADHD can lead to improved treatment outcomes for their child due to the parents’ improved confidence in enrolling their child in behavioral and psychological treatments ( MacKay & Corkum, 2006 ).

Further research is required to explore which components should comprise such interventions for CAYP with ADHD in order to make them successful.

It must however be noted that research to evaluate interventions to improve social skills in CAYP with ADHD is complex. ADHD is a highly variable, comorbid condition and the individuals involved often live in complex circumstances. No single intervention will work for every child.

A recent systematic review of 25 studies reported across 45 papers concluded that “there is little evidence to support or refute social skills training for children and adolescents with ADHD” ( Storebø et al., 2019 ). It must be noted that the Storebø review focused on social skills training and not psychoeducational mechanisms, as in the case of this present review. However other research suggests that there is in fact limited benefits of social skills training ( Mikami et al., 2014 ). Mikami et al. (2014) argued that traditional clinic-based social skills training may be ineffective because it focuses on teaching social skills knowledge without addressing the performance barriers that prevent the young people from using the knowledge gained in practical ways. It was hypothesized that social skills training is ineffective because it fails to consider factors that contribute to impaired relationships between children with ADHD and their peers such as different peer attitudes, exclusionary behaviors and negative attitudes toward young people with ADHD. However, not all social skills interventions both generally and in this review are traditional clinic-based interventions. This is important as applying knowledge in practice in varying contexts is key.

In the future, design of social skills interventions should consider both the variable personal and environmental context in which the intervention delivered ( World Health Organisation (WHO), 2018 ). That is, studies investigating these interventions should aim to answer the question “what works for whom under what circumstances and respects?” ( Pawson et al., 1997 ). This would enable resources to be targeted optimally. This can be achieved via methodologies such as Realist Evaluation (RE) that aims to explore the mechanisms underpinning an intervention ( Bonell et al., 2012 ). Having an in depth understanding of the theoretical mechanisms underpinning the intervention and what components work, for whom and in what circumstances could improve the outcome of the intervention ( Rycroft-Malone et al., 2010 ).

What Psychoeducation is Needed?

Social skills training interventions for CAYP with ADHD are often based upon the assumption that CAYP with ADHD do not understand social skills and need to be taught what they are. This often happens in a clinic setting that is not representative of real life scenarios, hence the argument that social skills training will not work in such an artificial situation ( Mikami et al., 2014 ). However, it has been reported that there may not be a deficit in CAYP with ADHD acquiring social skills knowledge, but a deficit may exist whereby the young person is unable to perform social skills ( Aduen et al., 2018 ). That is, understanding social sills may not be problematic, but putting them into practice may be. To this end, future psychoeducational social skills interventions for CAYP with ADHD may therefore wish to educate CAYP with ADHD around how to put their social skills into practice in real life situations to help enhance social skills performance, rather than only teaching them what social skills are.

It is also important to consider that there is no way of knowing the extent to which comorbid conditions have confounded the extent to which CAYP with ADHD may respond to the interventions in this review. This is especially challenging as three of the 10 included RCTs did not report on comorbid conditions and one RCT excluded participants who had a diagnosis of any other “major developmental disorder” ( Wilkes-Gillan et al., 2016 ). This is important because it has also been reported that different presentations of ADHD and different comorbidities such as Oppositional Defiant Disorder (ODD) may present different social problem profiles ( De Boo & Prins, 2007 ). Therefore, it is proposed that not only should future social skills psychoeducation for CAYP with ADHD to focus upon putting social skills into practice, but it should also be tailored to the individual and their needs. Future research should also report on all of the comorbidities of their participants.

Limitations and Future Research Recommendations

Of the 10 included studies, only one was conducted in the UK; one in Sweden, one in Australia and seven studies in North America. Therefore, the conclusions of this review must be generalized to an international population with caution. The included studies are also limited to those provided in the English language, which can cause information bias.

The evidence is limited to the broad definition of psychoeducation adopted ( Montoya et al., 2011 ). This was due to the heterogeneous definitions of psychoeducation in the literature. Future research may wish to address this and work toward a standardized definition of psychoeducation to guide clinicians. As with all RCTs of behavioral interventions, blinding can be problematic as can the inclusion of a pure control group due to naturally occurring confounds that cannot be controlled.

This review is also limited to the evidence in the literature, which as previously discussed, runs the risk of not being representative of a wider population of families who live with CAYP with ADHD and have difficulty accessing such support. Much of the evidence does not consider maintenance of efficacy and ongoing support needs. Future research is advised to consider this ( DuPaul et al., 2020 ) and to explore innovative ways by which ongoing support could be provided to CAYP with ADHD and their families.

Future research should report significant factors that could impact upon the effectiveness of their intervention. This includes gender, the presentation and severity of participants’ ADHD, whether or not a parent has previously attended a parent group, socio-demographic factors, comorbid conditions including ASD and if the child is taking ADHD medication at any point in the study. Where possible, this information should at least be collected at baseline and at the end of the study to highlight any changes during the duration of the study. If a young person is optimized on medication, does this improve outcomes of psychoeducation and indeed other behavioral therapies?

Patient Empowerment through Co-Design

Psychoeducational interventions for CAYP have the potential to empower the individual and to maximize self-care ( Barlow & Ellard, 2004 ) and offer the possibility of the need for less medication. They may also lay the foundations for improved outcomes in adult life. However, in order to increase the likelihood that the intervention will lead to impact (i.e., achieve the desired outcome), it is important that they are designed properly from the outset ( DuPaul et al., 2020 ). Co-design methodologies involving the end users and stakeholders at every stage of intervention development are recommended to achieve this ( Blower et al., 2020 ; Greenhalgh et al., 2016 ).

Co-design can be a challenging approach, especially when working with a population with attention difficulties such as ADHD. However, evidence suggests that it is indeed possible ( Fekete & Lucero, 2019 ; Powell et al., 2017 ). However, careful consideration for the mechanisms and components of design are essential to understand what component of subsequent treatment is leading to better social outcomes. Fekete and Lucero (2019) report a number of recommendations on how to effectively co-design with this population.

Conclusions

ADHD is a complex, comorbid condition. Individuals with ADHD can benefit from a package of care which includes a number of interventions targeting different facets of their difficulties ( National Institute for Health and Clinical Excellence (NICE), 2018 ).

The findings of this review indicate that behavioral interventions including a psychoeducation element could be valuable for improving social skills in CAYP with ADHD. The effect sizes in the present review are small but significant. Specifically, involving CAYP with ADHD interactively in the intervention shows promise and may be a reflection of CAYP with ADHD requiring support with the performance rather than the acquisition of social skills. However, the quality of the included studies is uniformly, limited so the conclusion should be generalized with caution. Blinding of the participant and their families is often impossible when delivering behavioral interventions within an RCT design. It would be beneficial if consistent outcome measures and optimal study design to reduce bias could be agreed.

We recommend that future interventions to improve social skills in CAYP with ADHD should involve a psychoeducational component, clear and transparent reporting, be co-designed, and consider the personal and environmental contexts in which the intervention is to be delivered. Only then can clinicians understand which interventions will best support the complex children, young people and families they strive to support.

Supplemental Material

Acknowledgments.

Authors would like to thank the authors of the included papers who assisted us with gathering manuscripts and for providing helpful information for this review.

Author Biographies

Lauren Amy Powell’s research interests focus on the use of innovative co-design methodologies in the design of complex interventions of children and young people with neurodisabilities with a focus upon cross disciplinary research. Her previous related work has focused on the level of evidence and suitability of available technologies for children and young people with ADHD to self-manage their condition. This has involved both mixed methods and systematic reviewing. She has also conducted a realist evaluation to co-develop guidelines to inform the future development of a complex intervention for CAYP with ADHD.

Jack Parker is following a 13-year career as a Royal Marines Commando where he specialised in physical training and rehabilitation, he undertook and gained a first class BSc (Hons) in Physiotherapy at Sheffield Hallam University, where he also undertook his PhD ‘Stroke patients’ utilisation of extrinsic feedback from computer-based technology in the home: a multiple case study realistic evaluation.’ He has published in a number of peer reviewed journals, book chapters, and NIHR publications. He has presented at and chaired national and international conferences as well as to academic and NHS trusts. He has also had the opportunity to lecture undergraduate and postgraduate Physiotherapists, Sport Therapists, university and NHS staff and medical students.

Anna Weighall is a cognitive developmental psychologist researching the relationships between sleep, memory and learning, spoken language development and vocabulary acquisition in children and adults. Dr Weighall is also interested in developing evidence based behavioural interventions to improve sleep for children and their families; and the role of sleep in typical and atypical cognitive development, including ADHD and paediatric narcolepsy.

Valerie Harpin is a consultant neurodevelopmental paediatrician. Her special interests include the care of children and young people with special needs and neurodisabilities, particularly Autism Spectrum Disorder, ADHD and learning disability. Dr Harpin's main research interests are in ADHD and Transition to Adult services.

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental Material: Supplemental material for this article is available online.

The Positives – there’s so many!

The most important part of raising a child with ADHD is to recognise their attributes . Focus on the positives and leave the negatives out! Remember – your child has a very different brain which makes him/her remarkable.

• Innovative and imaginative, lateral thinking
• Readiness to volunteer
• Kind, friendly and outgoing demeanour
• Good rapport with younger children
• Rises to a challenge if given responsibility
• A keen sense of justice and fairness

Visit https://adhdembrace.org/famous-adhd to see the well-known people who have/had ADHD and yet gone on to reach great heights.

Curious, Problem Solving Ability : ADHDers thrive on solving problems and puzzles. Give them an interesting problem to solve and they won’t be able to drop it until they’ve found the solution! Inventor Thomas Edison is believed to have had ADHD

Creative : Hands-on jobs are great for those who are restless or easily bored at a desk. They often offer the use of creativity and problem solving skills — areas people with ADHD often excel in. Research supports the common idea that people with ADHD are more likely to reach higher levels of creative thought and accomplishment. The racing ideas in the minds of people with ADHD can contribute to creative thinking. Writers, painters, musicians, film makers, designers, sculptors, comedians – the list goes on! Artistic talents are abundant. Composers Mozart and Beethoven are believed to have had ADHD.

Energetic: Yes, we all know about the hyper-activity but turn that to good use! It’s no secret that thoughts are constant and moving very fast for most people with ADHD. Harnessing that attribute can mean success on the job.  They thrive in an environment that is stimulating.

Eager: Many people with ADHD are motivated by interest and urgency. Jobs where you’re passionate about the subject matter provide motivation and focus, which can help you succeed. This can be any field that you have a deep interest in — the sky’s the limit. 

Sees connections others miss : Many ADHDers feel that they have a unique way of looking at the world, a perspective that others just don’t understand. You might say that they’re on their own wavelength!

Hyper-Focussed : The ability to hyper-focus is something that can be used to advantage. When kept under control and directed towards productive tasks, like accomplishing goals and living dreams, it can be an incredible asset that allows tem to get the job done, and done well!

Spontaneous

Persistent and Driven : When an ADHDer is bored with a task, completing it can seem like torture. But give them an interesting project to work on and watch out! When they want to succeed, and have the necessary tools to do so, there is no stopping them!

Entrepreneurial: Not only does an entrepreneur start their own business, but they are willing to take risks and think innovatively. Those are two positive skills inherent in many people with ADHD. It must be a field they are passionate about though, since running a business also requires areas where people with ADHD struggle, such as planning, organization, and self-motivation. Successful entrepreneurs with ADHD include Sir Richard Branson, founder of Virgin Group; David Neeleman, founder of JetBlue Airways; and Ingvar Kamprad, founder of IKEA.

Sense of Humor/Comedic Flair : Most ADHDers love to laugh, and many also have a knack for making others laugh! Famous comedians with ADHD include Whoopi Goldberg

Resiliency : There’s no denying that even though there are many great qualities that come along with ADHD, there are also challenges. But ADHDers have an incredible ability to bounce back from those challenges and to keep moving forward.

Intuition : ADHDers have a sharp sense of intuition. This may be due to highly tuned levels of perception, or great insight into the human mind, or something else that we have yet to understand. Whatever the reason, it’s a very useful gift!

Idea Generating : ADHDers are wonderful idea generators. They don’t usually like to be bothered with details, but can come up with ideas at lightning speed! They’re a true asset in brainstorming meetings.

• Mental Wellbeing

Emily Skye: smart, successful and just diagnosed with ADHD

She's on the road to self-acceptance 

In this article

Inside Emily Skye's adult ADHD diagnosis

How the fitness supernova is learning to love herself

Signs of undetected ADHD

Is your child addicted to gaming? Here’s what to do about it

Australian boxer Tina Rahimi is on a pursuit for Olympic excellence

How NYT bestseller Ryan Holiday uses stoicism to deal with life’s sh*t

After learning she had adult ADHD at 39, fitness guru, Emily Skye, is finally getting to know herself. But she’s just one of many high-profile, highly successful women who’ve recently shared a later-life diagnosis. Could you be one of them? And what does it mean if you are?

To the outside world, including her 15 million social media followers, Emily Skye appears to have it all. Gold Coast-based Skye runs a thriving fitness app, Emily Skye FIT , along with cult beauty brand, James Cosmetics. 

She has two gorgeous children with her ex-commando fiancé, Declan Redmond, who proposed with a dazzling solitaire rock in January, on a beach, amid scattered roses, while their two kids, six-year-old Mia and three-year-old Izaac, looked on. The former model and make-up artist is so successful she’s made several appearances on the Australian Financial Review’s Young Rich list. In short, her life is like a vision board.

But Skye has never seen herself as picture-perfect. For most of these years she felt strange, the odd one out. She never fit in. A super-sensitive overthinker with an intense fear of rejection, Skye thought that she was unintelligent, incompetent and unlovable. 

“I never belonged anywhere,” the business woman, fitness expert and qualified personal trainer admits. “We all need feelings of belonging and being loved and accepted. So, I did whatever I could to get those feelings.” Ergo, Skye became an expert mimic from a young age. “I subconsciously studied the way people behaved; their mannerisms, what they talked about, how they dressed. 

I didn’t know how to act socially, or what the right thing to do was. Other people always seemed to just pick it up.” 

In high school on the Central Coast north of Sydney, Skye struggled to concentrate on subjects she wasn’t interested in, such as maths, despite being bright. “My mind would go elsewhere. I’d doodle all over my page or think about what I was going to do after school – anything to make it look like I was focused, like ‘the good girl’, but I didn’t hear a word the teacher said. 

“I felt completely broken and abnormal for not being able to retain information. Even later in board meetings, I’d be off with the fairies.” If a topic did pique Skye’s interest, such as art, English, drama and, eventually, fitness, she could be hyper-focused.

When Skye was diagnosed with attention deficit hyperactivity disorder (ADHD) earlier this year, at age 39, her life suddenly made sense. She realised her perceived shortcomings were not her fault. “My brain is just wired differently.” And, as an increasing number of news headlines and social media posts confirm, she’s in good company, with high-profile public figures, including Em Rusciano, Abbie Chatfield, Mia Freedman, Lily Allen, Greta Gerwig and Barry Keoghan, all publicly revealing adult diagnoses.

Writer-slash-singer-slash-comedian Rusciano delivered a powerful speech to the National Press Club of Australia in 2022 about her ADHD diagnosis at 42, which “profoundly changed my core beliefs about myself… and triggered enormous grief”, she said. “I felt a deep sadness for that precocious, curious and chaotic 10-year-old girl who desperately wanted to get things right; the girl who tried hard all of the time.”  

It took Mia Freedman, the co-founder of Australia’s largest independent women’s media company, Mamamia, about a year to go public with her diagnosis, at the age of 49. 

“I am a very basic bitch because lately it seems like you can’t open Instagram without a woman in her 30s, 40s or 50s announcing she has ADHD,” Freedman wrote jokingly on Mamamia in 2022. “Today I’m adding my name to that list.” She went on to say it’s a growing movement, but considering a diagnosis is notoriously hard to get, it’s certainly not a fad. Ask any expert or patient; you can’t ‘fake’ this issue that influential voices around the world are now shining a light on, starting a national conversation that is long overdue.

Unscrambling ADHD

But first, some background on this hugely important health issue. ADHD is a largely inherited, neurodevelopmental condition that starts in childhood, with symptoms presenting in three ways: inattentive, hyperactive-impulsive and combination.  Someone with predominantly inattentive symptoms is easily distracted, struggles to organise themselves and has difficulty focusing on tasks they find boring. For example, they may forget things, lose things, constantly run late or procrastinate.

Someone with predominantly hyperactive-impulsive symptoms finds it hard to be still and they may fidget, talk or interrupt a lot. They can be prone to risk-taking behaviours or react quickly without thinking. Some people have a combination of both inattentive and hyperactive-impulsive symptoms.

Of course, everyone loses their keys or finishes other people’s sentences occasionally. Getting side-tracked by pings from your phone is de rigueur. Daydreaming during a work meeting? We’ve all done it. Does everyone have ADHD, then? No, says Dr Maddi Derrick, a Hobart-based clinical psychologist who, coincidentally, does have it. She insists symptoms are “significantly impairing” and are consistent from childhood – in all settings, not just at work, or just at school, or just in relationships.

This is not to say that people with ADHD can’t overcome these obstacles or become wildly successful, as per Skye… and Rusciano and Freedman et al. Quite the opposite. ADHD can, in some cases, be a superpower. Just ask basketball legend, Michael Jordan, who was diagnosed with ADHD as a child, but since said it helped him stay hyper-focused on the court and fuelled his iconic performances. Billionaire Richard Branson, whose diagnosis happened in adulthood, is adamant it gave him the ability to think outside the box and embrace risks.

In terms of prevalence, ADHD affects six to 10 per cent of kids and teens, and two to six per cent of adults. Many experts believe it has been underdiagnosed in Australia, especially among women; however, rates are on the rise. The number of total prescriptions that were issued for ADHD medications in Australia more than doubled between 2018 and 2022, from 1.36 million scripts to 3.17 million. However, we don’t know how many were written for adults versus kids (or men versus women), and not all people who are diagnosed will seek medication.

Most of Derrick’s new clients are women. “It’s important to note, they’re not going along fine and then suddenly think they have it,” she explains. “They’ve typically struggled with their mental health their whole life, maybe having been treated for anxiety and depression symptoms that were outcomes of unidentified ADHD.” 

Keeping up appearances

Perfectionism, explains Derrick, can be a hallmark of undetected ADHD. 

“A female can appear to be high functioning in a professional job, but might spend three hours at home each night working to catch up. Some women [with ADHD] desperately want to make everything perfect and to always please everyone, because if they don’t, they’ll be uncovered as an ‘imposter’.” 

“I can act confident; it doesn’t mean I’m feeling it,” says Skye, who’s collaborated with the Kardashians and major global brands including Good American. “All my life, I’ve put a facade on, especially online. I’m still me, but I created this avatar, a protective armour.”

Because females are often adept at ‘masking’ ADHD symptoms, even in childhood, the condition is twice as likely to be picked up in boys aged four to 11 years than in girls of the same age. This gap widens among adolescents aged 12 to 17, with almost 10 per cent of boys diagnosed, compared with just 2.7 per cent of girls. While boys with ADHD might disrupt the class or climb the walls at home, girls are often better at doing what’s expected of them. 

“It will start to show in the early school years, at a time when girls, on average, are maturing socially and emotionally ahead of boys,” explains Derrick. “So, boys might still be oblivious to what others, including the teacher, think of them. Meanwhile, developmentally, the average girl will start to focus on how others perceive them, and how to please the teacher.” 

“Boys tend to impact other people,” concurs Craig Woolf, 54, who was diagnosed as a 15-year-old and is now an ADHD coach. “They may talk out in class and be active, rough or boisterous. I was certainly told to shut up a lot in my household.” While Woolf’s ADHD was detected in adolescence, nothing was done about it until he was 30, when his symptoms became more obvious through living with his wife. “And because she’s very capable, she was always quick to remind me to take my meds.” 

Breakthrough, not a breakdown

Skye always suspected she had ADHD but didn’t seek a diagnosis until the proverbial wheels fell off. She figured it was that… or perimenopause. “I had moments of being in the house with the kids and nothing in particular would happen, but I’d start bawling,” she recalls. “Facing the day became overwhelming for me. I wasn’t functioning and knew something was not right in my brain. I thought, ‘I’ve got to do something about this.’”

Skye saw her GP and got referrals to several psychiatrists so she could join waitlists – “It can take 18 months to see someone,” she laments – and, luckily, got a cancellation spot within a few days. Her ensuing ADHD diagnosis brought immense relief.

“People said to me, ‘You’re 39, why bother getting diagnosed now? You don’t want a label.’ But, for me, the ‘label’ has allowed me to identify what it is and how to manage it better.” It’s also helping Skye reframe her brain, build her confidence and see the positives in her neurodiversity. “I’m learning to love myself,” she says. 

“It takes a lot to reprogram those thought patterns and beliefs that you have about yourself. It’s all just been a certain way for so long.”  

Symptoms can be managed with cognitive-behavioural interventions, medication and/or lifestyle changes, but, ultimately, how you choose to frame a diagnosis can be key. “It’s the acceptance and understanding of ADHD that enables a person to maximise their strengths, get help where needed and put themselves in an optimal environment where they can thrive,” says Dr Tamara May, a senior research fellow at Monash University and a clinical psychologist who works with adults with ADHD. “Ask yourself, ‘What am I good at? What tasks do I find easier?’ Then from there, try to find or set up an environment that will play to those strengths.” 

Many roles are almost tailor-made for people with ADHD, assert May and Derrick. Fast-flowing thoughts and limitless ideas, plus a penchant for risk, can lead to game-changing innovation and entrepreneurship. Research strongly suggests people who have ADHD are generally more creative and better at problem-solving. 

They often shine in a crisis, too, where quick thinking and being used to lots of stimuli help them keep their cool. “In an emergency, when a million things are going on at once, I don’t get overloaded by it,” adds Woolf. “I’m already overloaded by everything.” 

“We see concentrations of ADHD among people [who work in] emergency services – police, ambos, defence forces and in hospital emergency rooms,” confirms Derrick.

Skye says she unknowingly tapped into her ADHD traits over the years, especially when building her businesses. “You can be so focused, obsessive and creative,” she says. “If you’re interested in something, you can learn so much about it. Provided that you seek help, learn how to support yourself and stay on top of your health consistently, you are unstoppable.” 

Skye is finally on the road to self-acceptance and self-compassion. The fitness doyenne is grateful for her diagnosis, as well as her family, friends and especially Redmond, “who has stood by my side for 14 years, despite the challenges of living with me,” Skye told her loyal Instagram followers in February. “It still surprises me that he wants to marry me!” 

What would she say to someone who has been newly diagnosed with ADHD? “Welcome to the club. You belong. You’re my people.”

Think you or a loved one may have ADHD? Here’s how to get help and support.

It’s totally normal to be distracted, forgetful, restless, even impulsive from time to time, especially if you’re flat-out busy or tired. But if you have ADHD, its symptoms are ongoing, heavily impact your performance and relationships, and have been there since childhood. Here’s how to seek help and/or a diagnosis.

The first step in what may inevitably be a long journey: speak to your GP who, if aligned, will refer you to a specialist psychologist or psychiatrist.

Psychologists can only diagnose ADHD after a very detailed assessment, then provide practical mindset and lifestyle tools to manage symptoms.

A psychiatrist can also diagnose ADHD, but only they (or paediatricians, for younger patients) can prescribe initial medication in Australia. Note: there are very few ADHD specialists in Australia and the waiting lists for psychiatrists are notoriously long. 

More Coverage

To speed up the process, ask the psych’s office to send all the diagnostic forms, record requests and referrals they’d give at your first meeting the minute you’re on their waiting list. These often take time and other appointments to gather and will be a godsend if you score an earlier cancellation slot. It also means you can discuss diagnosis on visit one.

The cost of an ADHD assessment in Australia typically ranges from $1500 to $3000 – and that’s just to arrive at, or rule out, a diagnosis. Unfortunately, these costs aren’t generally covered by private health insurance.

For information and support, try the ADHD Foundation’s helpline on 1300 39 39 19 or visit adhdfoundation.org.au 

The peace and quiet comes at a cost

‘There’s no option but to do everything I can to win’

It’s far simpler than you may think

More From Forbes

Neurodiversity means more than just autism.

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Autism syndrome person and Autistic social developmental education disorder puzzle children symbol ... [+] as a child special learning icon as jigsaw pieces coming together to form a young student head in a 3D illustration.

The term neurodiversity is often associated with autism. Increasing awareness and higher rates of diagnosis mean greater focus on autism, yet it's important to underscore that neurodiversity is much broader than autism.

Neurodiversity is the concept that individuals perceive and engage with the world in diverse ways, rejecting the notion of a singular, "correct" way of thinking, learning or behaving. This idea encompasses various neurological and developmental conditions, particularly within the context of autism spectrum disorder, ADHD (attention deficit/hyperactivity disorder) and other learning disabilities or cognitive differences.

Essentially, neurodiversity means that brains work differently. No human brain is the standard, yet the more people’s brains work differently than the dominant group, the more likely they identify as neurodivergent. This is important because the dominant group, which more often identifies as neurotypical , has largely designed how society works, including cultural norms and workplace expectations. These often implied, unspoken rules may work for neurotypical people, yet not as well for neurodivergent people with diagnosed disabilities or cognitive differences.

Autism spectrum disorder (ASD) is a developmental disorder affecting social interaction, communication, and behavior. While autism accounts for a large share of the neurodiversity umbrella, neurodiversity encompasses far more, including:

• Attention-deficit/hyperactivity disorder (ADHD): a neurodevelopmental disorder characterized by hyperactivity, impulsive behavior and difficulties in sustaining attention
• Dyslexia: a learning disorder that affects reading, spelling and writing skills
• Dyspraxia: a condition that impacts motor coordination and planning, leading to difficulties in activities requiring coordination and movement
• Tourette syndrome: a neurological disorder characterized by repetitive, involuntary movements and vocalizations called “tics”
• Dyscalculia: a learning disorder affecting mathematical abilities and number sense
• Intellectual disabilities: a broad category including conditions characterized by limitations in intellectual functioning and adaptive behavior
• Sensory processing disorders: conditions where individuals may have difficulties processing and responding to sensory information

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It's important to note that neurodivergence is not limited to specific diagnoses and can encompass a broad spectrum of cognitive and neurological differences. In my interview with Pasha Marlowe , therapist and neurodivergent coach and speaker, she explained how the different lenses of mental health, neurodiversity, inclusion and neuroqueering intersect.

Neurodiversity is About Intersectionality

Marlowe says, “It is less important to focus on the diagnosis. People’s identities are a lot more than a diagnosis. Instead, we need to focus on the most marginalized identities to ensure that all people feel respected and valued.”

Marlowe noted that when someone identifies as neurodivergent, they're more likely to also experience other intersections of diversity such as queerness or gender fluidity. The idea is that when you learn more about your neurodivergent identity, it can lead to embracing other identities that you might have initially shied away from because of external pressure to conform.

Understanding the complexity of the human experience is critical. When people are suppressing or covering different dimensions of their identity to fit in with the neurotypical, cisgender, straight dominant group, society is not getting the most out of people. At work, that means less innovation, creative problem solving and productivity. Personally, that might impact relationship quality and less learning about different perspectives.

Challenges Neurodivergent People Experience

Marlowe shared that it is common for women, especially middle-aged women with recent neurodivergent diagnoses, to realize they may have been masking their neurodivergence long-term. Historically, the rates of diagnosis of autism and ADHD have been higher for boys than girls. Girls are conditioned to adhere to gender norms like pleasing others and being social, whereas boys are less encouraged to conform to these traditional feminine gender norms. As a result, girls learn to mask their neurological differences instead of embracing them.

It's important to acknowledge that the challenges neurodivergent people experience are because the world has been built for neurotypical people's needs. Common challenges neurodivergent people might experience include difficulty communicating or being able to think clearly in noisy or unnaturally lit settings. Marlowe describes her identities as autistic and having ADHD like “being dropped off by a spaceship from another planet onto Earth and not given any set of rules, having to learn them on your own.”

For example, commonplace norms like people asking how they're doing without listening for the response or using idioms or catchphrases that aren't logical can be very disruptive to somebody who’s neurodivergent.

Strategies to Be More Inclusive with Neurodiversity

To be better allies to those with cognitive differences, allies can:

• Use inclusive language – Rather than idioms or acronyms, tell people what you mean so they can clearly understand. This not only helps people who are neurodivergent, it helps everyone understand the message more clearly.
• Provide training – Offer training programs to help employees understand and appreciate neurodiversity, teaching effective communication and collaboration strategies.
• Flexible work arrangements – Offer flexible work schedules or remote-work options to accommodate the diverse needs and preferences of neurodiverse individuals.
• Create a supportive environment – Design physical spaces that are sensory-friendly, considering factors like lighting, noise levels and ergonomic furniture. Provide quiet or designated spaces for individuals who may need a break from overstimulating environments.
• Implement accommodations – Individualized accommodations, such as assistive technologies or modified workspaces, can significantly enhance the productivity and comfort of neurodiverse employees with minimal monetary investment.
• Mentorship programs – Establish mentorship programs that pair neurodiverse individuals with experienced colleagues to provide guidance, support, and opportunities for skill development.
• Promote diversity in hiring – Actively recruit and hire neurodiverse individuals and collaborate with organizations that specialize in neurodiverse talent recruitment.

Marlowe acknowledges the roles leaders have in embracing neurodiversity in the workplace. “If leaders want to be more inclusive, they need to ask, ‘What does support look like for you?’ and not assume they know what a neurodivergent person needs. Not all neurodivergent people need headphones, independent work or analytical assignments. Ask, don’t assume. Listen to what people need and accommodate them. Inclusive design solves for one and serves many.”

Neurodivergent people cannot solve the inclusion issues they did not create. Instead, all people need to understand the challenges faced by neurodivergent individuals to create truly inclusive environments.

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“Beyond Rewards & Consequences: A Better Parenting Strategy for Teens with ADHD and ODD” [Video Replay & Episode #220]

In this hour-long webinar-on-demand, learn how dr. greene’s collaborative & proactive solutions model can help you parent teens with odd and adhd..

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Episode Description

Search for parenting advice on Amazon.com , and you’ll see 70,000+ books filled with guidance — much of it contradictory, confusing, and/or ambiguous. These days, it’s tough to know what’s right or wrong, what to let slide, what to prioritize, and how best to respond when your child isn’t meeting expectations. If your teen is diagnosed with ADHD or ODD, the questions are more numerous and the challenges greater.

How can I motivate my teen? How can I make him obey me? These are often the first questions I hear. But they should be your last reaction if you want to have a good relationship with your teen and influence his or her development. Collaboration and problem-solving work a lot better.

In this webinar, you will learn about:

• Dr. Greene’s Collaborative & Proactive Solutions models
• How to influence, not control, your adolescent
• How to stop focusing on your teen’s behavior and start focusing on (and solving) the problems that are causing that behavior
• How to help your teen explore his or her own values and be aware of yours
• Why adult-imposed consequences may be counterproductive
• Why good parenting means “being responsive to the hand you’ve been dealt”
• The three steps that are involved in solving a problem collaboratively

Watch the Video Replay

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

Download or Stream the Podcast Audio

This ADHD Experts webinar was first broadcast live on June 6, 2018.

Related recommended resources:

• Helping Tweens Succeed
• Free Download: Why Is My Child So Defiant?
• [Self-Test] Oppositional Defiant Disorder (ODD) in Children
• Defiant Child Behavior Strategies for Parents… from Parents

Listener testimonials:

• “Excellent content and well-organized presentation.”
• “This was very informative. I received a lot of valuable information. Thank you.”
• “Insightful way of reframing how we think about ‘discipline.'”
• “Great information and very helpful to me.”

Ross W. Greene, Ph.D., is a member of the ADDitude Medical Review Panel

Meet the Expert Speaker:

Ross W. Greene, Ph.D. is the originator of the innovative, empirically-supported approach now known as Collaborative & Proactive Solutions (CPS), as described in his influential books The Explosive Child , Lost at School , Lost & Found , and the recently released Raising Human Beings . Dr. Greene was on the faculty at Harvard Medical School for over 20 years, and is now Founding Director of the non-profit Lives in the Balance .  He is on the adjunct faculty in the Department of Psychology at Virginia Tech and in the Faculty of Science at the University of Technology in Sydney, Australia. Dr. Greene has worked with several thousand behaviorally challenging kids and their families, and he and his colleagues have overseen implementation and evaluation of the CPS model in hundreds of schools, inpatient psychiatry units, and residential and juvenile detention facilities, with dramatic effect: significant reductions in discipline referrals, detentions, suspensions, and use of restraint procedures and solitary confinement. He has infused the parenting and teaching of all kids with humanity, empathy, and compassion.  Dr. Greene lectures throughout the world and lives with his family in Portland, Maine.

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