Identify the source of your challenges to get the right solutions. Generally, if one family member has ADHD , they’re not the only one. Some people with ADHD find their symptoms, such as forgetfulness or messiness, affect their relationships with other people. The ability to regulate emotions when they become intense is a skill that many people with ADHD struggle with. Unless you’ve been stranded on an island for the past decade, you’ve probably heard and read a lot about the phenomenon of adults getting diagnosed with ADHD . Many people age 18 and over feel like they have significant problems focusing, getting things done, procrastinating, and generally being efficient in their jobs and their personal lives. Many of these individuals have been successful academically; they may have even been honors graduates and high achievers. Their experiences look typical on the surface, but they say their life is a mess. Not to mention, social media has thousands of blogs, testimonials, and other resources about adult ADHD. There’s even a YouTube channel called “How to ADHD.” This post gives you questions you can ask yourself to help decide if you might have ADHD and benefit from a formal evaluation from a psychologist. 1. Do your symptoms disrupt your ability to function at work or at school? People often think they might have ADHD if the problems they have functioning are quite disruptive. Their struggles prevent them from being efficient, which means things take much longer than they should to complete. Many people hate their jobs because they feel like their responsibilities highlight the weaknesses they have in being efficient and organized. Or they get incredibly bored with their work, so they can’t always put their best foot forward. They may question their career choices or majors in college because they don’t feel motivated to complete tasks on time. 2. Do you struggle in personal relationships? Some people find their ADHD symptoms affect their relationships with other people. They may be forgetful, which annoys their friends or partner, they’re messy and disorganized, they talk too much or too loudly, or they constantly interrupt people. The quality of their relationships is therefore compromised by their challenges. Note: If similar problems are disruptive to your professional or personal life, it’s definitely time to seek support from someone with expertise in assessing and treating ADHD. 3. Do you experience intense emotions? The ability to regulate emotions when they become intense is a skill that many people with ADHD struggle with. They talk about losing control of their emotions, becoming reactive quickly, and being unable to calm down after getting really upset or excited. There are other mental health conditions for which this is also potentially an issue, but it’s much more common among people with ADHD than has been talked about in the research until recently. 4. Do other people in your family struggle with, or have they been diagnosed with, ADHD? You may not know if other people in your family have been diagnosed, so it’s worth having a conversation with a parent or sibling to find out more. There is a genetic component to ADHD, so it can run in families. Generally, if one family member has it, they’re not the only one. 5. Are you struggling with other conditions or circumstances that might mimic the ADHD experience? It is true that you could be one of those people who have compensated and functioned well, despite having ADHD that was overlooked when you were younger. It happens, and I do evaluations routinely with clients who meet the criteria, according to the DSM-5. But you may not know that there are other mental health conditions that affect focus, which can result in many of the other problems that we attribute to ADHD. Individuals with a history of trauma , for example, may exhibit some of the same cognitive symptoms, such as inattention, trouble making decisions, difficulty with organization, and trouble finishing things they start. These symptoms are also present in many people with depression and related mood disorders and anxiety. Additionally, individuals with chronic medical conditions, like thyroid disease and anemia, can also experience cognitive symptoms similar to those of ADHD. Sometimes people struggle with focus and disorganization if they’re overcommitted. Our society encourages us to be busy, to be involved in a lot of things, and to fill our days, but it’s possible to be too busy, and when this happens, it’s hard to focus on what is right in front of us. We have high expectations for ourselves and struggling to meet them may create an experience that feels like ADHD. Understanding the underlying source of your challenges is important because interventions, including medication, may change, depending on the reason for them. Getting to the bottom of why you struggle with these challenges needs to be investigated if they are becoming disruptive to the life you want to have. Talk to a mental health professional about your concerns, so that you can get the right answers. Carla Shuman, PhD - Website

Do You Struggle With ADHD and Shame? Seven strategies for overcoming shame and embracing life with adult ADHD. Introduction Living with adult ADHD can be challenging, and one often overlooked aspect of the condition is the experience of shame. Shame can create a constant internal battle and hinder individuals from reaching their full potential. However, understanding the nature of shame and implementing effective strategies can help you overcome it and lead a fulfilling life. In this post, I explore seven strategies for overcoming shame and embracing life with adult ADHD. By implementing these strategies, individuals with adult ADHD can break free from shame’s grip and thrive. 1. Self-Education One of the first steps in overcoming shame associated with adult ADHD is to understand the condition comprehensively. Educating yourself about ADHD’s symptoms, causes, and treatment options can help dispel misconceptions and reduce self-blame. Knowledge empowers individuals to recognize that ADHD is a neurobiological condition and that their struggles are not a result of personal shortcomings. According to Barkley (2010), “ADHD is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.” Understanding the neurobiological basis of ADHD can help individuals reframe their experiences and reduce self-judgment. 2. Self-Compassion Practicing self-compassion is crucial in overcoming shame. Individuals with adult ADHD often internalize societal stigmas and develop negative self-perceptions. Engaging in self-compassionate thoughts and actions involves treating oneself with kindness, understanding, and forgiveness. It is important to remember that ADHD is not a character flaw but a unique way of experiencing the world. Neff (2003) defined self-compassion as “being kind and understanding toward oneself in pain or failure, rather than harshly self-critical.” By cultivating self-compassion, individuals with adult ADHD can counteract shame and develop a more positive self-image. 3. Seeking Support Seeking support from understanding individuals, such as friends, family, or support groups, can be immensely helpful in overcoming shame. Sharing experiences, challenges, and triumphs with others who have similar struggles can foster a sense of belonging and reduce feelings of isolation. Support groups can provide a safe space for open discussions and exchange of coping strategies. Research by Matza et al. (2005) highlighted the importance of social support in managing ADHD. They found that individuals with higher social support levels reported better health-related quality of life. By connecting with others who understand their experiences, individuals with adult ADHD can find a sense of validation and support to overcome shame. 4. Reframing Negative Self-Perceptions Shame often arises from negative self-perceptions associated with ADHD-related difficulties. Individuals can reduce shame and improve self-esteem by reframing these negative thoughts into more realistic and compassionate perspectives. Recognizing personal strengths, achievements, and resilience can help shift the focus from perceived inadequacies to growth and progress. Lam and Dvorak (2019) stated, “Reappraising shame-inducing situations can lead to reductions in feelings of shame and increases in self-compassion.” By challenging negative self-perceptions and adopting a more compassionate outlook, individuals with adult ADHD can cultivate a sense of self-worth and decrease shame. 5. Practicing Self-Care Engaging in self-care activities is essential for individuals with adult ADHD to improve overall well-being and reduce shame. Regular exercise, adequate sleep, healthy nutrition, and stress-reduction techniques like mindfulness and meditation can contribute to better emotional and cognitive regulation. Prioritizing self-care allows individuals to manage ADHD symptoms better and enhances self-confidence. Dvorsky and Faraone (2014) found that excessive smartphone use, which often interferes with self-care practices, is associated with cognitive deficits similar to ADHD. Individuals can improve their overall well-being and reduce excessive smartphone use by focusing on self-care activities and reducing ADHD-related challenges. 6. Setting Realistic Goals Setting realistic goals is crucial for adults with ADHD to manage expectations and minimize shame. Breaking down larger tasks into smaller, manageable steps helps to avoid overwhelm and increase productivity. Celebrating each accomplishment, no matter how small, fosters a sense of achievement and boosts self-esteem. Hwang et al. (2019) emphasized the role of goal setting in academic functioning for individuals with ADHD. They found that goal setting mediates the relationship between ADHD symptoms and academic performance. By setting realistic goals and acknowledging progress, individuals with adult ADHD can overcome shame and experience a sense of accomplishment. 7. Embracing Personal Strengths Instead of focusing solely on weaknesses, adults with ADHD should acknowledge and celebrate their unique strengths. ADHD often brings creativity, hyperfocus, and the ability to think outside the box. By embracing these strengths, individuals can cultivate a sense of pride and self-acceptance, reducing shame and unlocking their full potential. White and Shah (2011) explored the relationship between ADHD and creativity in adults. They found that individuals with ADHD exhibited uninhibited imaginations and higher creativity levels than the control group. By recognizing and embracing their creative abilities, individuals with adult ADHD can build self-confidence and challenge shame-based beliefs. Conclusion Overcoming shame associated with adult ADHD is a journey that requires self-education, self-compassion, support, reframing negative self-perceptions, self-care, setting realistic goals, and embracing personal strengths. By implementing these strategies, individuals with adult ADHD can break free from shame’s grip and thrive. Scott Shapiro, MD - website Barkley, R. A. (2010). Taking charge of ADHD: The complete, authoritative guide for parents (3rd ed.). The Guilford Press. Dvorsky, M. R., & Faraone, S. V. (2014). Comparing the cognitive deficits associated with ADHD and excessive smartphone use. Journal of Attention Disorders, 18(2), 162-169. Lam, C. S., & Dvorak, R. D. (2019). Understanding the relationship between ADHD and shame: The roles of emotion dysregulation, perseveration, and self-compassion. Journal of Attention Disorders, 23(6), 603-613. Matza, L. S., Rentz, A. M., Secnik, K., Swensen, A. R., Revicki, D. A., & Michelson, D. (2005). The impact of ADHD on health-related quality of life in pediatric and adult patients. Quality of Life Research, 14(1), 137-149. Neff, K. D. (2003). Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self and Identity, 2(2), 85-101. White, H. A., & Shah, P. (2011). ADHD traits are associated with creative achievement in adults. Journal of Personality and Individual Differences, 51(7), 799-803.

Whatever treatments you decide, understanding you have ADHD makes a difference. Most adults with ADHD have never been diagnosed and are therefore going through life untreated. Many people with ADHD struggle with inattentive symptoms, such as distractibility, forgetfulness, disorganization, and poor time management. ADHD can be a risk factor for marital dissatisfaction , poor health, reduced lifetime earnings, traffic accidents, and substance abuse. Ari Tuckman, PsyD, CST, is the author of four books on adult attention-deficit/hyperactivity disorder (ADHD), most recently ADHD After Dark: Better Sex Life, Better Relationship. He is a psychologist and sex therapist in private practice in West Chester, PA, a former board member of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) National, and co-chair of the CHADD conference committee. MB: Thanks for taking the time, Ari. I’m curious, before we start talking about treatment, what are your thoughts on where we are with adult ADHD today? How common is it, and how often is it recognized and diagnosed? AT: The irony about ADHD in adults is that we know a lot about it—the problem is in getting that information out to clinicians and the general public. We're doing a pretty good job of identifying ADHD in kids, but most adults with ADHD have never been diagnosed and are therefore going through life untreated (which doesn’t just mean medication, of course). Most kids with ADHD retain at least some of those struggles into adulthood, but we stop looking for it when someone graduates. Probably about 4 percent of adults have ADHD, which is not a small minority. MB: What does adult ADHD typically look like? A lot of the recent research talks about the health implications of under-managed ADHD, and time management is core to adult ADHD, too. Are there adults, from your point of view, who are struggling with health or chronic stress who could unknowingly have ADHD? AT: Some people think of ADHD as mostly the hyperactive boy type, but many people with ADHD struggle mostly with inattentive symptoms, such as distractibility, forgetfulness, disorganization, procrastination, and poor time management. Also, hyperactive kids tend to settle down as they become adults, so it's less visibly obvious. For many people, it’s the inattentive and impulsive symptoms that continue to be a struggle, which can lead to additional stress as they try to keep up on all their responsibilities. This can also affect how they take care of their physical health, from forgetting to schedule follow-up appointments or tests to sticking with a generally healthy lifestyle of sleep, diet, and exercise. But if their ADHD isn't addressed, then it will always be harder for them to be more consistent about these good habits. Therefore, people who chronically struggle with inconsistency may want to consider the possibility of ADHD—it's certainly not the only cause of poor follow-through, but it is a common one. MB: Understanding what’s going on with ADHD can make a huge difference, in my experience, separate from any treatment choices. What impact have you seen as people begin to understand what executive function means in day-to-day life, and how it relates to living with ADHD? It’s often a way to let go of a lot of self-blame and judgment, for example, when working with families. AT: Just the act of getting diagnosed can be a real game-changer in how someone sees themself and understands their past struggles. I say that it's like reading the last chapter of a mystery novel, where everything comes together and all of a sudden their life makes much more sense—such as, "no wonder I kept shooting myself in the foot like that, despite knowing better." Understanding those struggles as a neurologically based information-processing weakness can feel less moralistic than all of the other prior explanations they had used or been told. Also, understanding how ADHD impacts how you navigate through your days, why it makes some tasks harder but doesn't affect other tasks, enables you to approach demands in ways that are more likely to be effective. There's no need to re-invent the wheel if other smart people have figured out good ADHD strategies before you. MB: What role does the research say medication can play in adult ADHD? Is it any different from pediatric ADHD? AT: The medication we use today for ADHD is the same medication that has been used for decades, so we know a lot about the benefits and side effects. Medication isn't magic, but the stimulants can be very effective for many people with ADHD, regardless of age, and tend to have manageable side effects. I say that stimulant medication closes the gap between intentions and actions and helps people with ADHD to be more consistent, planful, and efficient in what they do. We know that untreated ADHD can be a significant risk factor for marital dissatisfaction, poor health, reduced lifetime earnings, traffic accidents, substance abuse, etc.—pretty much all the outcomes that most of us want to minimize. I can understand that some people don't like the idea of taking medication, but we also need to consider what are the risks that come from not taking medication. Trying harder and using good systems and strategies is always going to be a requirement for a happy and effective life, but untreated ADHD makes it much harder to use those good habits in an enduring way. A little bit of the right medication can bring it all together so those good intentions work out more consistently. MB: So how can people work with the rest of ADHD, all of the organizational and time-management stress, and the health implications? AT: Most people need good systems and strategies to live well and stay on top of obligations. People with ADHD perhaps need it a little more. Good systems work much more reliably than just trying harder. This could mean strategies like really committing to using a calendar system with reminders, creating a less distracting work environment, reducing clutter, and checking in regularly with your romantic partner/coworkers on who is doing what. Perfection is not at all necessary—even just using these systems a little more often will probably lead to an improvement you can feel. Also, regardless of what you did yesterday, put in the effort to make today a good day and to use those strategies again. MB: What’s something practical people can try out, starting today? AT: Get enough sleep! Everyone does better with a good night's sleep, but it can be a challenge to come by, especially if you have ADHD. But make it a priority. Resist distracting activities that you get stuck in that keep you up too late. Maybe even set an alarm to tell you to go to bed. And don't believe yourself when you say that you can stay up "just a little bit later" since often that becomes a lot later. Even if you aren't perfect about it, doing somewhat better on sleep is another one of those differences that you will feel. Mark Bertin MD - website - books

Approaching ADHD with knowledge and empathy. Tommy sat at his desk, and he opened his laptop. The essay instructions were on the screen, and he dutifully began to read. However, after just a few minutes, his attention drifted, lured away by the intricate spider web that adorned the entry door. Tommy became frustrated as he realized that he couldn't recall a single word he'd just read. He made an effort to refocus, but his mind proved elusive, slipping away once more. This scenario was all too familiar to Tommy. Every time he attempted to tackle his homework; it seemed like an uphill battle. His friends effortlessly breezed through assignments, while Tommy found himself wrestling with his wandering thoughts, constantly veering off course . At the age of 13, Tommy received a diagnosis that shed light on his struggles: Attention Deficit and Hyperactivity Disorder (ADHD) . It was a revelation that carried both relief and sadness. Finally, he understood that his inability to concentrate wasn't a character flaw, and he wasn't simply "lazy," as his parents and teachers had sometimes accused him of being. But while the diagnosis provided clarity, it didn't provide a magical solution. Tommy's mind remained a restless wanderer, continually venturing down rabbit holes of distraction. Despite knowing the root cause of his difficulties, the challenge of managing his focus persisted, leaving him to grapple with his own mind, one essay at a time. Research into the neural mechanisms underlying ADHD has unveiled an intriguing perspective. It suggests that ADHD is not primarily characterized by abnormalities within specific regions of the brain but is instead a disorder rooted in disruptions of functional connectivity. A pivotal player in this connectivity conundrum is the default mode network (DMN). This network springs to life when individuals are in a state of rest and not actively engaged in cognitive tasks, like, for instance, tackling homework. Conversely, when we turn our attention to cognitive tasks, specialized task-related networks kick into gear to help us complete the task at hand. In those without ADHD, there exists a delicate balance between the DMN and these task-related networks. When one network becomes more active, the other tends to quiet down, creating a seamless transition between resting and cognitive engagement. However, for individuals with ADHD, the DMN doesn't obediently retreat during cognitive tasks. Instead, it persists, stubbornly maintaining its activity. This unusual behavior within the DMN is associated with the intrusion of unrelated thoughts or daydreams during these tasks. It's as if there's an ongoing tug-of-war in the brain between the DMN and the cognitive demands of the moment. This neurological battle offers an illuminating explanation for why those with ADHD often experience a constant, magnetic pull away from their current task, easily succumbing to distractions. It's not a mere lack of willpower; it's a neurological dance between two competing networks that makes focusing on a single task almost impossible. Unlike typically developing children , who often outgrow these difficulties as they mature, individuals with ADHD commonly continue to wrestle with these challenges throughout their lives. This enduring struggle can result in learning impediments and difficulties in social interaction. In recent years, there has been a noticeable increase in the diagnosis of ADHD in the United States. Approximately 9.4% of children aged 4-17 are affected, with boys more commonly diagnosed than girls. Moreover, around 4.4% of adults in the US are believed to have ADHD, although this number may be underestimated. One area where the impact of ADHD becomes evident is decision-making. Decision-making is closely intertwined with cognitive abilities, as it involves assessing various options and choosing the most favorable one. Individuals with ADHD often exhibit differences in their decision-making styles compared to neurotypical individuals, especially in decisions involving risk and the consideration of future consequences. This inclination toward risk-taking often persists into adolescence and adulthood, leading to behaviors such as delinquency and substance abuse. Raising a child with ADHD like Tommy can be a daunting journey for parents. Understanding what their child is experiencing, including difficulties in focusing, daydreaming, procrastination, non-compliance with instructions, and restlessness, can be perplexing. It's essential for parents to recognize that these behaviors are not intentional; children with ADHD require their parents' patience and understanding. Living with ADHD can be an extremely frustrating experience. Individuals often recognize that their actions are suboptimal, yet they feel powerless and incapable of altering them. Additionally, they grapple with the challenge of being misunderstood, as it's difficult to convey their experiences to those who don't share the condition. By approaching ADHD with empathy and knowledge, we can make a meaningful difference in the lives of those affected by this condition, helping them navigate their unique paths to success and well-being. Isabelle Brocas, Ph.D. - Website I. Brocas, "Decision-making and ADHD", LABEL reports April 2020 I. Brocas, "The Neuroscience of ADHD: Technical Report", LABEL reports, April 2020

12 ways to help your 11- to 14-year-old with ADHD build resilience and strength Early adolescence is a time of change in every dimension of a person's life, including intense brain-building. From age 11 to 14, neural plasticity is greater than at any time other than early childhood. Early adolescence is a time of great vulnerability as well as opportunity, a heightened danger for ADHD kids. Here are 12 ways parents can support their ADHD kids in thriving, building coping skills and resiliency. A young person can be forgiven for feeling out of control when everything—their body, brain, hormones, interests, perspectives, identity, and relationships—are all changing. The people around them are changing, too, in their expectations and interactions. This period is more fraught, more challenging, and more dangerous for kids with special needs like ADHD . Early Adolescence: Intense Brain-Building Laurence Steinberg, a psychologist specializing in adolescence, describes the period from 11 to 14 as the “age of opportunity,” a time when so much can go so wrong, but also a time of great possibility, a time when a young person can find and develop strengths that will help them thrive into adulthood. It’s a time of intense brain-building, with all of the vulnerabilities and possibilities that that suggests. Steinberg writes about early adolescence as a time when brain plasticity is heightened, second only to early childhood in opportunities for developing good (or bad) habits, and a critically important time for strengthening skills, resilience, and emotion regulation. The Age of Vulnerability Early adolescence is a time for your child to consolidate their ability to monitor and regulate their emotions and behavior . As true as that is for all kids, it’s absolutely essential—and terribly difficult—if your child has ADHD. Given their distractibility, need for stimulation, and problems with impulse control, they’re more likely to be interested in drugs and alcohol and befriend older kids engaged in high-risk activities. Because kids with ADHD usually need more structure and scaffolding than others, their academic frustrations can increase as they move into higher grades where the expectations are higher but the support is lower. As kids with ADHD move into early adolescence, they can feel increasingly ignored or rejected by other kids, acting impulsively or in ways that others find intrusive or emotionally excessive. At an age when friendships matter enormously, this can result in social isolation, a retreat into the virtual world, or spending time with troubled kids because they’re the only ones who accept them. Parenting Challenges Intensify As your child moves into early adolescence, they can appear to need you less. They can actively reject your requests and demands or your invitations to spend time together. But don’t fall into the trap of taking it personally, and don’t be fooled by it. They need you just as much as ever, but what they need is different than what they needed when they were younger. What can you do to help your child find opportunities in the challenges? 1. Take good care of yourself. Practice breathing techniques and other habits that support your mindfulness and good health . You’ll be better at managing your own stress, and you’ll provide your child with a better model of coping with life’s challenges. 2. Be present . Do your best to be openly available for relaxed conversation whenever you’re in the presence of your child. Whenever possible, set aside your phone and pay attention to their mental state. Be warm, welcoming, and positive. Don’t judge or criticize. Your being patiently available at the right moment can make the difference between a good decision and a dangerous one. 3. Take your child’s friendship concerns seriously. Their worries might seem trivial or fleeting, but being liked and accepted by their peers is one of the most urgently important dimensions of your child’s life right now and one of the areas most likely to trouble them. Support them in figuring out how to solve the problems of the day. 4. Encourage and facilitate healthy social activities. Sports, choirs, clubs, and other extracurricular activities can provide social opportunities in a structured environment. This is true for all kids, but it is especially important for an early adolescent with ADHD. It can help with social connection, the need for structure, and emotion regulation. 5. Include your child in a network of social support. Having a strong network of social support can prevent the social isolation and loneliness that can be dangerous at this stage. Your child will benefit enormously from feeling part of a rich network of warm and caring people—adult friends, relatives, and neighbors—and so will you. 6. Actively support your child’s coping skills. Depending on how impetuous or volatile your child is, they might benefit from having a tutor or counselor to help them develop and strengthen their coping skills. Strong emotion regulation skills can make a difference in the trajectory of their life going forward and will become critically important when they start to drive. 7. Talk with your child about risky behavior. Talk openly with them—thoughtfully and respectfully—about the serious problems associated with substance abuse, sexual activity, vandalism, and other risky behavior. Let them know you have rules and expectations but that you’re open to talking if they run into issues. 8. Minimize the rules. Make rules only when necessary for your child’s protection or your sanity. You don’t want to spend valuable time and parenting capital enforcing the rules you make. 9. Welcome power issues and conflict. You’re a good parent if you find yourself arguing frequently with your teenager, as long as there’s also love, warmth, and good humor in your relationship. A hot debate is a great way for your teenager to discover what you care about and why it’s worth caring about. 10. Be open to non-academic learning opportunities. School can feel irrelevant to an early adolescent. Education does matter—and it’s important your child knows you believe that—but figuring out who they are and feeling good about that is a lot more important at this stage. Everything else builds on this going forward. 11. Work on balance. Encourage good habits of sleep, nutrition, outdoor time, social interactions, and pleasurable activities, along with all the responsibilities of home and school. Keep technology use to a minimum. 12. Stay connected to your child’s best self. Your early adolescent is changing quickly and will try on a series of different identities, some of which you won’t like very much and some of which they might not like very much, either. By believing in what’s best in them and seeing past the clothes and attitudes of the current phase, you can help them make good decisions in the long run. Dona Matthews, Ph.D., - Website - Book - References Age of Opportunity: Lessons from the New Science of Adolescence by Laurence Steinberg

In the amygdala, the cerebellum, and elsewhere. There are few things more infuriating to mental health professionals than hearing "ADHD is not real." Yes, even today, there are still critics, cynics, criticizers, and non-believers vying for the opportunity to disprove the diagnosis. Do I personally believe that the DSM-5 does a great job of outlining the criteria for the diagnosis? Not by a long shot. Do we need more research to help rule out other disorders that overlap with ADHD symptoms? 100 percent. Does the disorder perhaps even need a different name entirely? Absolutely. (ADHD individuals tend to have no issue focusing on the activities and experiences that they enjoy, hence hyperfocus—which the DSM does not even acknowledge—which I argue is grounds for a new name in and of itself.) ADHD is not a disorder of attention deficit; instead, it is a disorder of regulating attention and emotions due to structural and functional differences in the brain and neural networks. I suspect that the doubt and suspicion of the disorder stem from the belief that ADHD is categorized by a single deficit (again, I blame the name) rather than categorized dimensionally. ADHD is not a disorder of ability but performance due to neuroanatomical differences. Regardless, it's time that ADHD be recognized for what it is: a neurodevelopmental disorder, not a myth, nor a result of poor parenting. Below I will outline structures of the brain that are different in volume and shape and how those differences are thought to be linked to behaviors associated with ADHD. The ADHD brain is structurally and functionally distinct, and hopefully, the evidence below will keep the naysayers quiet... for now. How the ADHD Brain is Different A 2017 MRI imaging study found that overall brain volume and brain volume in six of the seven brain structures listed below were smaller in people with an ADHD diagnosis. Multiple studies have validated significant brain developmental delay and 3-5 percent smaller whole brain volume in individuals with ADHD compared to neurotypical brains. Please note that "smaller" does not equate to "less intelligent." We do not need to perpetuate stigma and misinformation further. Bigger does not translate to "better" in this case. As Craig Surman, the Professional Advisory Board Co-Chair for the organization Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) said in an interview about the results of the study, "It may be that these regions are used less in people with ADHD. Or that they are smaller because they are organized differently, or because the supporting tissue is different." Caudate nucleus . The caudate is associated with goal-directed behavior and motivation. As such, smaller volume and asymmetry of the brain structure that help make up part of the basal ganglia could be associated with difficulty getting started on tasks, planning movement, and sustaining momentum toward accomplishing goals, which are defining impairments related to ADHD. Putamen . The putamen is associated with learning and motor control, including speech articulation. The lack of volume may be responsible for symptoms of ADHD related to deficits in tasks related to fine motor skills such as handwriting, coordination, and or clumsiness. In his interview, Surman stated, "the caudate and the putamen work together and act as the gateway for motor activity. Disorders of these regions can result in hyperactivity of the motor system, a common symptom of ADHD." It may also be responsible for the frequent co-occurrence of apraxia and ADHD. Apraxia is a motor speech disorder that results in difficulty speaking. Nucleus accumbens . Smaller nucleus accumbens may be associated with motivated behavior, reward information, and emotional problems in ADHD via its function in reward processing. Variations in the nucleus accumbens could give us insight into one of ADHD's most impairing features: lack of motivation. Individuals with ADHD are often unnecessarily and unfairly portrayed and stigmatized as "lazy," "unmotivated," and even "indifferent," when in reality, their brains are structurally different. Amygdala . The amygdala, one of the oldest parts of the brain, was also found to be smaller in study participants with ADHD. The amygdala is often associated with experiencing emotions, specifically fear and aggression, including detecting threats and activating appropriate fear-related behaviors. Emotional dysregulation, another deficit in executive functioning central to ADHD, is characterized by emotional lability or quick and exaggerated changes in mood, which could be caused by variations in the amygdala resulting in the lack of emotional regulation. Cerebellum . The cerebellum is associated with the coordination of motor movements balance control, gait, posture, muscle tone, and voluntary muscle activity. Damage to this area in humans results in a loss in the ability to control fine movements, maintain posture, and motor learning. A 2017 study found that children with ADHD had significantly smaller cerebellar volumes. This structural difference could help account for the fine motor delays often seen in ADHD, i.e., using a pencil or grasping a spoon. It could also be responsible for dyspraxia, a developmental coordination disorder, which can co-occur with ADHD. Prefrontal cortex . The prefrontal cortex (PFC) is related to self-awareness, decision-making, judgment, insight, empathy, and the ability to self-regulate emotion and behavior. Studies have found that ADHD is associated with weaker function in the PFC, thinner PFC, and different structure of the prefrontal cortex. This may help us account for the ADHD shortfalls in advantageous decision-making, planning for the future, time management, procrastination, poor social skills, difficulty in maintaining relationships, externalization behaviors such as disruptive, aggressive, and defiant behaviors, lack of impulse control, and disorganization. Hippocampus . The hippocampus in individuals with ADHD is larger, not smaller. This brain structure is associated with long-term memory and working memory. Working memory is the ability to hold on to information in your memory while performing other tasks, a skill often used when following instructions, concentrating, or memory that's needed in the present moment—for example, listing to directions while remembering an address, remembering the steps of a math problem while doing a math problem. A study conducted in 2006 found that children and adolescents with ADHD had larger hippocampal volumes than neurotypical children. Researchers concluded that the increase in hippocampal volume might be the brain's attempt to compensate for disruptions in time perception, the tendency to avoid waiting, and sensation-seeking behaviors associated with ADHD. Kailey Spina Horan, Ph.D., LMHC - website

Strategies for clinicians to support the mental health of LGBTQ+ parents. Parents today are facing a spike in parental and work demands as well as parental stress. LGBTQ+ parents may face additional stressors stemming from discrimination and social stigma. Clinicians can help address the distinctive stressors of LGBTQ+ parents via inclusive practices. The U.S. Surgeon General’s 2024 Advisory on the Mental Health and Well-Being of Parents highlights the notable stress that parents are currently facing. For example, 41% of parents say that most days they are so stressed they cannot function and 48% of parents have reported that most days, their stress is completely overwhelming. While this data was not broken down by demographic groups, the Surgeon General’s report did note that “LGBTQ-parent families may face challenges such as discrimination and societal stigma that could exacerbate their stress and mental health challenges.” The distinctive stressors that LGBTQ+ parents face is an issue of growing concern as 18% (2.57 million) of LGBTQ adults are parenting children and approximately 5 million children are being raised by an LGBTQ parent in the USA (Williams Institute). To effectively address the sociostructurally stressors and related mental health challenges faced by LGBTQ+ parents, clinicians and psychologists should prioritize the creation of an inclusive and affirming clinical environment. This includes utilizing gender-affirming language, respecting individuals’ pronouns, and ensuring that intake procedures and assessments are sensitive to diverse family structures. Research has consistently shown that the therapeutic alliance is critical in determining treatment outcomes, and LGBTQ+ parents, in particular, may have prior experiences with healthcare discrimination. By cultivating a practice that acknowledges and affirms these unique familial configurations, clinicians can significantly enhance rapport and therapeutic engagement. In addition to individual-level interventions, psychologists should advocate for broader systemic and community-based changes. Psychoeducation on the intersectional stressors experienced by LGBTQ+ parents, such as discrimination, heteronormativity, and parenting stress, can enhance mental health literacy and improve coping mechanisms. The minority stress model (Meyer, 2003) provides a valuable framework for understanding how external stressors related to societal stigma exacerbate mental health challenges. Clinicians are encouraged to collaborate with local LGBTQ+ organizations or advocacy groups to provide clients with access to a broad array of community-based resources, enhancing the supportive networks available to these families. Clinicians should also be sensitive to the LGBTQ+ need for family of choice networks due to discrimination from birth families and/or religious communities. Research has shown that many LGBTQ+ parents turn to these chosen families—comprised of close friends, partners, and supportive individuals outside their biological kin—to fulfill emotional and social needs that their birth families may not meet due to prejudice or exclusion. Clinicians should actively validate and incorporate these chosen family dynamics into therapeutic interventions, as they play a crucial role in providing emotional support, resilience, and stability for LGBTQ+ parents. Chana Etengoff, Ph.D., - Website - References Etengoff, C., & Daiute, C. (2015). Online coming-out communications between gay men and their religious family allies: A family of choice and origin perspective. Journal of GLBT Family Studies, 11(3), 278-304. Horne, S. G., Johnson, T., Yel, N., Maroney, M. R., & McGinley, M. (2022). Unequal rights between LGBTQ parents living in the US: The association of minority stress to relationship satisfaction and parental stress. Couple and Family Psychology: Research and Practice, 11(2), 141. Murthy, V. (2024). Parents Under Pressure: The US Surgeon General's Advisory on the Mental Health & Well-Being of Parents. Wilson, B. D., & Bouton, L. J. (2024). LGBTQ Parenting in the US.

Learn to spot think thinking associated with maladaptive worry. Worry can be helpful and adaptive or unhelpful and maladaptive. Unhelpful worry repetitively asks “what if…?”, wants guarantees, and says “this time is different.” Unhelpful worry overestimates danger and underestimates your resilience. Unhelpful worry keeps reacting to past experiences or past lessons that are no longer relevant. The first post in this blog series, “3 Ways to Tell if Worry Is Helpful”, explained why people worry and covered the “3 A’s of adaptive worry”. This post discusses five ways to spot maladaptive, unhelpful worry. Worrying can be helpful and adaptive – or unhelpful and maladaptive. Worrying more than you need is stressful. It’s hard on you and often on the people around you. How can you tell when a worry is excessive? What are hallmarks of maladaptive worrying? Here are five signs of maladaptive worrying. 1. Unhelpful worry keeps saying “What if…?!!” Maladaptive worry proposes a series of horrifying “What if’s". Vivid, scary pictures of bad things that “might” happen come to mind, even if they are inaccurate or unlikely. Getting reassurance helps temporarily but worry returns again and again. If one worry is resolved, another takes its place. 2. Unhelpful worry wants total safety and certainty. Maladaptive worry makes unrealistic, impossible demands. It wants guaranteed safety. Unhelpful worry says if something frightening is possible, it is likely and you should worry. It confuses lack of absolute certainty with proof of danger. In reality, life has never offered guaranteed safety. Life offers risks and opportunities . 3. Unhelpful worry overestimates danger and underestimates your ability to cope and survive. Maladaptive worry tells you, “Danger is likely, and you won’t be able to cope!” It overestimates how serious the possible dangers are. Even when worries come true, they are often not as bad as the worry predicted. Unhelpful worry tells you to worry about dangers that do not exist or are so unlikely that worrying makes no sense. I call these “meteor” worries. For example, it is possible that a meteor may crash through the roof as I type these words, but I don’t worry about the possibility because it is so very unlikely. Unhelpful worry also underestimates your ability to cope. As humans, we are a resilient, coping species. Find reasons to trust yourself. Remember the difficulties you have surmounted and the challenges you have met. Think about your accomplishments, strengths, resources, and problem-solving skills. 4. Unhelpful worry wants you to believe that “This time is different!” Maladaptive worry has a terrible track record. Most of what it predicts never happens, but it wants you to ignore that. It tells you each new worry is accurate, realistic, and likely. It always finds something to worry about, shifting from one thing to the next until it finds something that makes you anxious. Once you feel anxious, it is natural to think you are facing a threat. As discussed in the first blog of the series, your brain’s alarm system (your amygdala or “reacting brain”) can misfire and send false alarms. Just because you are afraid does not mean you are threatened. Test your worry against the “three A’s of adaptive worry.” 5. Unhelpful worry can be triggered from past experience. You may be more likely to worry if past experiences made you believe you are vulnerable or unable to cope, others cannot be trusted, and/or the world is a dangerous place. The primitive "reacting brain" remembers and worries because of your past – even when there is no danger in your present. You may remember Jonathan from the first blog in this series. Jonathan constantly worried that his car was going to have a serious problem even though no problems occurred, and his skilled mechanic repeatedly checked and reassured him. Jonathan’s sense of impending danger and his trouble trusting stemmed from lessons he learned growing up with an alcoholic father. Jonathan never knew when his father would be drunk and angry, so he was always anxiously on guard. This hypervigilance was helpful in childhood but it continued into adulthood, keeping Jonathan unnecessarily worried and tense. Jonathan grew up hearing his fathers say over and over, “You can’t trust anyone. They’re all incompetent idiots. They take your money and screw you over.” These lessons made it difficult to trust which contributed to his maladaptive worry. Summary Worry can serve a useful purpose – or create unneeded stress. Worry can be adaptive – or maladaptive. Maladaptive worry is not accurate or consistent with the facts, it urges you to take actions that are not appropriate, and it stays around or keeps coming back. Be skeptical if your worry says any of the following or prompts you to think along these lines: “What if…?” Focus on what could go wrong. “Are you sure?” You need guaranteed safety and total certainty. “Danger is likely; you can’t cope.” The likelihood of danger is overestimated; your strength and resilience are underestimated. “This time is different!” This time worrying is justified. Disregard the fact that past worries were wrong. “Keep reacting to lessons from the past” Unhelpful reactions from the past continue even when your life has changed. Elizabeth McMahon, Ph.D. - website - book References: For more information about coping with anxiety, worry, or panic, read the "Overcoming Anxiety and Panic interactive guide." McMahon, E. (2019). Overcoming Anxiety and Panic interactive guide. San Francisco, CA: Hands-on-Guide.

Practical self-help ideas to lower stress in social situations. Sometimes what people label as "social anxiety" is actually a reasonable way of being. Most social anxiety comes from unrealistic expectations of ourselves or those of people with whom we're interacting. Different tactics are needed depending on whether that social anxiety is based on reasonable or unreasonable expectations. Everyone gets nervous in some social situations — perhaps a first date, an important meeting, or giving a presentation. But when the fear extends to avoiding or being too quiet with other people, and it’s lasted for months or longer, it’s often termed “social anxiety disorder” or “social phobia disorder.” But “social anxiety” is like a headache: The cure depends on the cause. Perhaps it’s not a disorder but a reasonable way to be. It’s possible that what some people label as “ social anxiety disorder ” is a sensible approach to interaction. For example, a reasonable basis for accepting yourself as quiet rather than pathologized as socially phobic is to realize that wise people may choose to remain silent when they perceive the risk-reward ratio to be poor: that their idea needs more work, would sidetrack the discussion, or be better expressed later, perhaps in writing or in a subsequent meeting. Another sensible rationale for remaining quiet is if you believe it’s wiser or kinder to listen and learn than to speak and regurgitate: By listening attentively, you’ve given the other person the opportunity to express and further develop their thoughts—talking can clarify. When I’ve worried that I haven’t provided a client with enough input, I’ve sometimes gotten a reassuring thank-you for having listened carefully. But if you perceive your anxiety about social situations to be unhealthy, it usually derives from the fear that you’ll fail to meet either realistic expectations or unrealistic ones. Here are approaches to each. When you’re unlikely to meet realistic expectations Sometimes, despite your best efforts, you may not achieve what you’d hoped to, but these strategies can help you improve for the future. Be better prepared for example, if you’re scared about an upcoming meeting, would it help to make an extra effort in preparing for it, whether by reading, writing, or talking with someone? If you’re nervous about a first date, prepare a couple of conversation starters such as, “What do you enjoy doing for fun?” or “Do you want to tell me about your family?” Be prepared to answer those questions yourself. Accept your right to be flawed realize that you have a right to speak your truth even if imperfect or not well-received. When expectations are unreasonable More often, social anxiety is caused by unreasonable expectations. One or more of these may help: Self-reflection by thinking or journaling. You might explain to yourself why your anxiety is undue. For example, “Whatever the flaws in what I say, they’re unlikely to be deal-killers.” If you’d like to look for other roots of your social anxiety, list significant recent or past interactions with your parents, siblings, friends, romantic partners, boss, coworkers, and clerics. For each, ask yourself if any are causing your current social anxiety. Perhaps there are lessons to be learned from that review. Progressive exposure. Below, derived from a Mayo Clinic list, are some social activities that are less challenging than, for example, going to a party. List them in ascending order from least to most scary to you. Then try the first one and progress to others when you feel ready. At home, eat with someone you trust. Make eye contact and small talk, even just, “How was your day?” Try the above in a restaurant. Say hello to someone who’s not too scary: for example, a friendly coworker or perhaps the person next to you in line at the supermarket. Give a compliment, such as, “Your scarf is pretty.” Ask a store clerk where some product is located. Ask a friend to get together. When you do, have something to say at the ready: for example, what you did today, are looking forward to, or are thinking about. General stress reducers Remind yourself that you’ll survive. Just before you’re about to begin a scary interaction, remind yourself that you can survive even saying something stupid, perhaps cutting your losses with something like, “Excuse me, I misspoke.” Take a special breath. Then, and again later, if you start to feel stressed , take one special breath: breathe in slowly, hold for a moment, and then breath out even more slowly. See a cognitive-behavioral therapist? If the above hasn’t sufficiently helped, consider having some sessions with a cognitive-behavioral therapist . They tend to be effective in helping phobic people. You can find a therapist near you on Psychology Today’s Therapist Directory. The takeaway. Social anxiety usually comes down to a fear of not meeting expectations, your own or those of the people with whom you’ll be interacting. That’s why even socially anxious people tend to be less fearful when interacting with children, developmentally disabled people, or pets. But the good news is that social phobia, indeed all phobias, are among the most ameliorable of emotional problems. Marty Nemko, Ph.D. - Website - Books

7 effective treatment approaches for clients with health-related fear. A variety of popular therapeutic modalities can be helpful for clients with illness anxiety. Clinicians need to understand the most effective therapeutic approaches for helping illness anxious clients. Illness anxiety , while sometimes overwhelming and frightening, can be coped with. Some popular commonly used therapeutic modalities may be effective in assisting clients who are struggling with intrusive and obsessive thoughts about their physical health status. Following are 7 therapeutic interventions and how they can be implemented to help these clients. Cognitive Behavioral Therapy (CBT) CBT is perhaps the first-line treatment of anxiety disorders, including Illness Anxiety Disorder (IAD.) Because it teaches clients to question and challenge their anxiety-driven conclusions, it allows for building evidence to discredit the anxious thought. In simple practice, it may look like this: Event: Client experiences chest pain. Automatic Thought: “I am having a heart attack, and I need to call 9-1-1.” Challenge to Automatic Thought: “I am not experiencing any other physical symptoms. I am also prone to heartburn, and I ate something spicy at lunch.” New, adaptive thought: “I am most likely not experiencing a heart attack and this physical discomfort I feel is likely unrelated to a heart attack. It is more likely that I am experiencing indigestion. At this moment, I probably do not need emergency services.” This type of “thought stopping” and challenging, cornerstones of CBT, can help a client slow the rush and flood of thoughts that occur following an unexpected and uncomfortable physical symptom. Rational Emotive Behavioral Therapy (REBT) An offshoot of CBT, REBT focuses on the “unconditional acceptance” of ourselves, our lives, and our situations through a rational, rather than an emotional , lens. REBT teaches clients to “dispute” irrational thoughts in the service of arriving at a more sensible, logical view of a situation. Because anxious cognitive patterns often lack logic, REBT is helpful in restoring and promoting a healthier, alternative way of looking at a situation. Dialectical Behavioral Therapy (DBT) DBT helps patients find a cognitive “middle ground” between the emotion-driven mind and the logic-oriented mind. Because anxiety is most often emotion-based, it tends to ignore logic and rational thinking. This single-mindedness can result in unhealthy behavioral responses . Learning and implementing DBT skills can assist clients in tolerating feelings of discomfort rather than having to react emotionally to them. In the case of IAD, if a client learns to slow their cognition following an uncomfortable feeling, they have a greater opportunity to utilize logic to arrive at an appropriate behavioral response. For the IAD patient, this may mean the difference between seeking unnecessary emergency care and having a more reasonable response, such as scheduling a doctor’s visit in the near future. DBT teaches clients to work and respond from their “Wise Mind,” the healthy overlap of the emotional mind and the rational mind.2 Somatic Therapy The word somatic, from the Latin for “of or pertaining to the body,” refers to anything body-related. Somatic therapy is an umbrella concept which includes a number of body-based interventions such as meditation, yoga, physical exercise, dance or movement therapy, breathing exercises, and massage. Somatic therapy highlights the importance of the brain-body connection and should be considered as an option to help those struggling with IAD. Generally, somatic therapy skills can be taught to a client by a therapist or counselor. Mindfulness-Based Cognitive Therapy (MBCT) It is a Buddhist belief that anxiety “lives in the future,” and the importance of mindfulness and presence in the moment cannot be overstated in the treatment of IAD. Mindfulness teaches clients to replace “what if” with “what is.” In the case example given above, “what if” sounds like “My chest feels tight and that means I’m going to have a heart attack,” whereas “what is” sounds like “My chest feels tight right now in this moment.” The “what is” thought is simply an acknowledgment of what is happening, without an attached assumption or conclusion. Through acknowledgment of our feeling in the moment, we are able to “be with” our feelings rather than respond emotionally or behaviorally to them. Narrative Therapy (NT) Narrative therapy teaches us to view our lives as a story but cautions us against focusing on only one part of the story. Often, we become singularly focused on the “problem story,” the part of the larger narrative influenced by our challenges and problems. NT urges us to take a broader, more inclusive view of our life story, noticing and honoring both the problematic and challenging parts as well as the more comfortable and victorious sections. Through this approach, we begin to see our personal narratives as nuanced rather than one-dimensional. For an anxious person, anxiety loosens its grip and becomes only a portion of the story, not all of it. Imaginal Exposure Therapy Visualizing and imagining the situations that frighten us can be helpful in beginning to feel safe again and can promote a gradual return to activities and situations that have caused anxiety or avoidance. For example, a therapist may guide a care-avoidant client through an imagined scenario in which they have a medical visit at a doctor’s office. Because the visualization is done within the safe confines of the therapy office, the exercise may begin to rebuild safety and comfort within the anxious client’s mind regarding the situation, promoting an eventual return to the actual situation. Once the client can visualize safely returning to a previously feared situation, they often can return to the situation in real life. Phil Lane, MSW, LCSW - Website - References Ellis, A., & Ellis, D. (2019). Rational emotive behavioral therapy. American Psychological Association. Lane, Phil. (2024). Understanding and Coping with Illness Anxiety. Routledge. White, M., & Epston, D. (1990). Narrative means to therapeutic ends. W.W. Norton & Company, Ltd.

Performance anxiety can keep kids from activities they enjoy. Here's how to cope. Performance anxiety can lead to symptoms that compromise high performance. Children who believe that they are no better than their last win maintain a deficiency in their self-concept. Children motivated by unconditional love—not fear—will more typically achieve high levels of performance. Some children focus on performance to compensate for an impoverished self-concept. Performance anxiety presents as unusually strong worry or fear around activities that involve accomplishment. It can be experienced in any number of areas that range from public speaking to athletic performance, academics to sexuality, test-taking to interviewing. The causes of performance anxiety are varied, but the process is the same. The threat of failure or lowered performance can lead to symptoms that can compromise high performance. Athletic performance anxiety is a subset of generalized performance anxiety. Ironically, performance anxiety can actually increase the risk of injury among athletes. What are the signs of performance anxiety in children? The symptoms of performance anxiety include physical symptoms such as increased heart rate, elevated blood pressure, fast or shallow breathing, dry mouth, sweating, and pale or flushed skin. These symptoms can be accompanied by ruminations centered around the fear of failure and/or negative outcomes associated with failure. “I’ll never get into college with these grades.” “No one will like me if I mess up the speech." “If I perform a dance at the talent show, the whole school will laugh at me.” Behavior patterns can vary widely, particularly in children. Some children may become obsessed with practicing, studying, or repetition, while other children can become task-avoidant, delay homework or competitions, or display an “I don't care” attitude. How can parents figure out what's going on? Parents need to observe their children’s behavior and attitudes carefully. Asking these questions can also help. Does my child seem overly worried or anxious about performance issues? Does my child demonstrate excessive concern about performance such as staying up all night to study, being unable to sleep from worry around an exam or competitive event, or refusing to see friends in order to prepare or study? Has my child begun to avoid performance activities? Paradoxically, does my child act like they don't care about performance? It is important for parents to talk to their children and ask them about their feelings around performance. Does the child feel satisfied or dissatisfied? Does the activity interfere with their child’s happiness or pleasure in life? Does it keep them from engaging in activities that they enjoy? Do they feel anxious or worried about performance? How do they feel about themselves if they don't make the grade they're hoping for or fail to compete at the level they desire? What are some things that parents can do to help their children cope with performance anxiety? Help children realize that failure is survivable. Performing poorly from time to time is simply a part of life and does not have catastrophic consequences. Sharing stories about Uncle Edward who performed poorly in business but persisted and later was successful when he developed a new company is important. Build a positive self-concept, generally, by loving your child unconditionally. Children need to know that self-esteem is not dependent on performance but is an ongoing steady state. Accepting that the unexpected rain on the day of the bicycle race, which interfered with course conditions and his finish, is just another example of learning to accept and live with adversity and imperfection. Teach that success is not a comparative process. Parents should encourage children to reach for their “personal best” and help them develop their own steps in their chosen direction. In this way, it is important to avoid focusing on Betty who made a perfect score on the spelling test. More important is Edward’s solid improvement from 80 to 85 percent on his spelling words week over week. Reinforce children for effort. “You are working hard at your French and making progress. I bet you'll be able to speak to the waiter in the French restaurant in no time,” versus “Suzie is a real French whiz, I hear.” Encourage children to take charge where they can control things. They can train for a certain number of hours per day, or they can take classes from a classically trained musician. The focus here is on those opportunities, not the outcome. Celebrate the joy of the game and encourage your child to do the same. Both model and reinforce the benefit of fulfillment and happiness in the process of mastery. Be available with equal measures of affection for both the wins and losses over the course of your child’s efforts. Help children understand that life is a long time, and that their love of biking or swimming or basketball will persist. People bike at eighty, swim at sixty and seventy, and teach their children and grandchildren how to play the sports they love. Athletics is not just about performance. In the end, it is more about fulfillment and enjoyment as both a competitor and a fan. What are some things that kids can do to cope with performance anxiety? Prepare in advance. Practicing, training, and rehearsing skills build confidence over time and are certainly required in order to perform well. Engage in daily exercise as an anti-stress activity. Develop pre-performance strategies to build confidence. For example, athletes may do cross-training in order to help their skill base, practice speeches at home before the actual presentation, or rehearse and memorize information in order to improve recall. Visualize the task or event with successful outcomes. Use self-calming such as meditation or mindfulness. There are a number of online tools to help both children and adults with these skills. Learn breathing exercises and practice other pre-performance rituals. Talk with a therapist. There are a number of treatment strategies available, including cognitive behavioral therapy , therapy that helps children learn specific tools to manage anxiety and performance, or more general counseling that helps people to feel more powerful and in control. What are some helpful things that parents need to know about raising child athletes? Parents must realize that their job is not to put more pressure on their child but rather remove pressure from them. This is done primarily through unconditional love that remains constant over time: “I love you no matter what the outcome is.” “I will help you in any way I can as you try to reach your goal.” “Your value never changes in my eyes, and my affection for you never diminishes.” Children who grow up believing that they are no better than their last win maintain a deficiency in their self-concept that can last a lifetime. Consider the following more foundational goals: My child has… confidence in their ability to work hard, respect for their skills and abilities, developed knowledge of themselves and others, experienced fond memories of being a part of a team or group, shared meaningful experiences with their mothers and fathers, felt celebrated and supported through victory and defeat, known love as constant, and had fun along the way. Children motivated by love—not fear—will more typically achieve high levels of performance and reach personal fulfillment in their areas of interest and achievement. Portions of this post also appear on the Scary Mommy Blog and drmaryannlittle.com. Mary Ann Little, Ph.D., - Website -

These solutions can alleviate anxiety rooted in toxic childhood stress. Anxiety disorders are often rooted in unresolved adverse childhood experiences . A combination of effective treatment strategies offers hope for resolving them. Anxiety , including panic attacks , is now the most common psychiatric condition in the U.S., affecting nearly one in five adults, and prevalence rates are increasing worldwide. Often, anxiety seems to have a life of its own: it seems excessive and unreasonable; you don’t know where it’s coming from; and willpower doesn’t stop it. For many, adverse childhood experiences (ACEs) provide a clue. This article addresses solutions for this common problem. 1. Address the root cause. Recall that attachment disruptions and other ACEs wire the brain to be on high alert. Unsettled, disturbing memories from childhood lodge in the non-verbal right brain , with its strong connections to the emotional and survival regions of the brain, often beneath conscious awareness. These memories continue to fuel anxiety until they are processed and settled. Fortunately, many strategies developed in recent years can soothe and settle these memories. Some are self-managed, and some are guided by specially trained trauma therapists (see, for example, Schiraldi 2021). In addition, the following skills can help. 2. Sit with the fear . Often, we tense up and try to fight our worries, which increases stress arousal. Or we might try to flee our worries. But avoiding our fears (for example, through addictions, procrastination , etc.) merely provides temporary relief. Mindfully sitting with your fears is a third, more effective option. Start by being aware of the breath. Breathe abdominally, low and slow, so that only your belly rises and falls as you breathe. (Stress-induced rapid, shallow breathing in the upper chest region often triggers anxiety and panic symptoms, so this is an important first step.) Then without judging, create a space to allow the anxiety to be. With curious interest and acceptance, notice where in your body you experience the anxiety. Soften around that area. Then breathe compassion (or lovingkindness) into that area. Paradoxically, this approach can lessen anxiety without trying to do so. 3. Confide your fears. Research has shown that simply writing the facts, feelings, and thoughts related to your fears for 15-30 minutes on each of four days dramatically reduces symptoms and improves health and sleep. You can write about old hurts, or you can write about present worries. Write in a neutral place, like a table in a corner. Write only for yourself. If it gets overwhelming ease up. During the day, postpone your worries, knowing you can address them during your writing period. 4. Flow with panic attacks. Should panic attacks occur, bracing and fighting them prolongs them. Panic attacks are simply stress responses “on steroids.” They typically run their course in 10-20 minutes, especially if you don’t fight them. Soften your body. Relax into, and flow with, the fear. Imagine that you are a reed bending with the wind. 5. Feed the gut microbiome . People with anxiety tend to have an imbalance of microbes in the gut, which activates the brain’s fear center, increasing anxiety. The balance of good to bad microbes can be optimized with a Mediterranean-style diet , which emphasizes fiber-rich plant foods (vegetables, fruits, nuts, whole grains, seeds, beans) and healthy fats (from sources like fish and olive oil), while minimizing red meats and processed foods. (This type of eating also helps to reduce the brain inflammation and oxidative stress that is often seen in anxiety.) 6. Hydrate. Even mild dehydration can cause anxiety symptoms. Drink plenty of water throughout the day. 7. Consider taking a full-spectrum vitamin and mineral supplement. Studies have found that supplements (one study looked at Centrum Silver, for example) can reduce anxiety and improve brain function. Turmeric is another supplement that can reduce anxiety. 8. Monitor your thyroid. An overactive thyroid gland can make you feel anxious, like you are on caffeine, resulting in racing thoughts, sleep disruption, and other anxiety symptoms. Many people with this common problem are unaware of it or are not properly treated. Discuss this with your doctor. 9. Avoid caffeinated energy drinks. Army research found that the regular consumption of energy drinks actually increased symptoms of anxiety, post- traumatic stress, fatigue, and disrupted sleep (Tobin et al., 2018). 10. Use tranquilizers cautiously. Benzodiazepines, such as Xanax, Valium, Klonopin, and Ativan, are widely prescribed for anxiety. A new survey (Ritvo et al., 2023) revealed that long-term consequences occur during and after the use of benzodiazepines in the majority of people using them. These consequences include anxiety, sleep problems, trouble focusing, and disruptions in personal and work life. Benzodiazepine use teaches no coping skills and discontinuation can be very difficult. Coping skills for anxiety can be just as effective, generally have no unpleasant side effects, and might enable you to minimize or avoid benzodiazepine use. 11. Move your body. We’ve known for many years that exercise improves anxiety, depression , low self-esteem , and troubled sleep. Among its many benefits, exercise expends excessive stress energy and produces master molecules that help the brain forge new, calmer neural pathways—making exercise particularly beneficial for survivors of ACEs. Even a ten-minute walk can help. Walking in the woods or near water can be especially calming. And don’t overlook tai chi, yoga, or qi gong. 12. Improve self-esteem. At the University of Maryland, we found that low self-esteem and anxiety are highly correlated, and that self-esteem can be improved by applying sound principles and skills (Schiraldi, 2016). 13. Sleep well. Regular, adequate, quality sleep is known to help regulate anxiety, promote positive memory storage, and reduce the intensity of negative memories. Most adults require 7-9 hours of sleep to feel and function at their best. Try going to bed and getting up at the same times every day to strengthen sleep cycles. Dim lights 1-3 hours before retiring (especially blue lights), and block noise and light from entering the room. 14. Take action when possible. You might try making a list of all the things you worry about. You might see that there are a handful of things, not an infinite number. Rank them from most to least concerning. Then go down the list, one at a time, and see what you can do to solve or improve them. Accept what you can and can’t do. “If you worry, you can’t do your best. If you are doing your best, why worry?” Conclusion Excessive anxiety is common but need not be a lifelong sentence. Rather than increasing anxiety by fighting or fleeing it, try as best you can to kindly and patiently accept your fears, soothe and settle them, and then move on. Often, small changes in the way you approach your fears can reap large benefits. Glenn R. Schiraldi, Ph.D., - Website - Books - References: Schiraldi, G. R. (2021). The Adverse Childhood Experiences Recovery Workbook . Oakland, CA: New Harbinger. Schiraldi, G. R. (2016). The Self-Esteem Workbook . Oakland, CA: New Harbinger. Tobin, R. L., A. L. Adrian, C. W. Hoge, and A. B. Adler. (2018). “Energy Drink Use in U.S. Service Members After Deployment: Associations with Mental Health Problems, Aggression, and Fatigue.” Military Medicine 183: e364–e370. Ritvo, A. D., Foster, D. E., Huff, C., Finlayson, A. J. R., Silvernail, B., and Martin, P. R. (2023). Long-term Consequences of Benzodiazepine-induced Neurological Dysfunction: A Survey. PLoS ONE 18 (6): e0285584.