“Dopamine fasting” is a buzzy term for the practice of temporarily abstaining from stimulation — via smartphones, social media, video games, and other platforms that deliver reliable dopamine hits — to feel more pleasure later. Here, psychologist Wes Crenshaw, Ph.D., weighs in on the Silicon Valley and TikTok trend that is gaining momentum, particularly among people in their 20s who have ADHD.

Q: People say they go on a dopamine fast or digital detox to “reset their dopamine levels” so that they will feel heightened pleasure when they return to their screens and other forms of stimulation. Does this work?

Our minds are so habituated to a heightened level of engagement from near-constant phone or computer interaction that taking a pause seems wise. But when it comes to video games, TikTok, and other high-dopamine-hit engagements, doing a “fast” isn’t the way to go because you’re not really changing anything about your brain. It’s better to moderate your device usage to have an effect that’s less negative than stopping cold.

[Read: “My Phone Was My Drug”]

Q: Can a digital detox help your brain overcome addictions to compulsive behaviors like checking social media and high levels of stimulus delivered via texts and alerts?

The idea of using abstinence to address addiction is not supported by research. And it’s not a practical solution for behaviors integral to functioning in the modern world, such as using social media and texting. These tools, when used in moderation, are a regular part of modern life. But when these devices draw you away from more necessary activities, or impair your ability to do daily tasks, they become destructive.

I have college-age clients who put their phones in timed lock boxes for, say, three hours during their study time. Once the box is locked, there’s no opening it without a sledgehammer. This technique is referred to as “precommitment,” and in my experience, it is much more effective than other phone apps.

Q: Can individuals exert control over their dopamine levels or is sensitivity to stimulation just baked into your DNA?

[Read: “I Need a Digital Detox. How Do I Break a Social-Media Habit?”]

The timed lock box is a good example of exerting control, except you’re not really controlling your dopamine; you’re moderating your behavior. That’s about the best anyone can do. Another kind of moderation is setting an alarm to signal when it’s time to exit a game or social media, or shutting down the Internet at 10pm to avoid interrupting sleep with multiple dopamine hits.

Q: Are there risks associated with dopamine fasting? Should people be trying it?

I think the risk is that you constantly feel uncomfortable. Unfortunately, feeling uncomfortable is exactly what a lot of people are trying to escape with so-called addictions. They want things that are easy, fun, and stimulating to their brains instead of the tedium of getting business done.

Dopamine Fasting and ADHD: Next Steps

• Read: Wasting Time on Social Media? 6 Ways to Stop ADHD Brains from Doom Scrolling
• Read: Hooked on Social Media? How to Break the Habit
• Read: My ADD Sabotages My Social Skills Online

Carole Fleck is Editor-in-Chief of ADDitude.

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ADHD Family Coach Leslie Josel, of Order Out of Chaos, will answer questions from ADDitude readers about everything from paper clutter to disaster-zone bedrooms and from mastering to-do lists to arriving on time every time.

Submit your questions to the ADHD Family Coach here!

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Register to reserve your spot for this free webinar and webinar replay ►

Not available May 18? Don’t worry. Register now and we’ll send you the replay link to watch at your convenience.

Inexperienced teen drivers with ADHD face an outsized risk for serious motor vehicle accidents due to attention deficits, impulsivity, and other ADHD-related challenges. Understanding the factors that contribute to elevated driving risk, as well as strategies and training plans that can mitigate these risks, is critical for caregivers and teen drivers.

In this webinar, you will learn about:

• Research that documents the driving risks associated with ADHD
• Factors that contribute to this risk, including one key mechanism: visual inattention
• Factors that lessen the risk of accidents, including environmental changes in the driving environment, pharmacological intervention (i.e., stimulant medication), and a new training program targeting visual inattention, enhanced FOcused Concentration and Attention Learning (FOCAL+)
• Practical tips for navigating driving as a developmental milestone with your neurodivergent teen

Have a question for our expert? There will be an opportunity to post questions for the presenter during the live webinar.

Meet the Expert Speaker:

Annie Artiga Garner, Ph.D., is an Associate Professor in the Department of Psychology at Saint Louis University and a licensed clinical psychologist in Missouri. Her clinical and research expertise is in ADHD across the lifespan, with a particular focus on the impact of ADHD on driving. Dr. Garner co-developed FOCAL+ and was a co-investigator on a study examining the effect of FOCAL+ for teen drivers with ADHD.

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The sponsor of this ADDitude webinar is…

Brain Balance is an integrative cognitive development program designed to help kids with ADHD, Learning Differences, Anxiety & beyond. An exploratory study with Harvard’s McLean Hospital found the Brain Balance Program to be as effective as low-dose stimulant medication in alleviating ADHD symptoms in children. Visit brainbalance.com to learn more about Brain Balance today.

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In ADHD grandfamilies, grandparents are raising or helping to raise their grandchildren for a variety of reasons — while simultaneously learning how to parent and support a neurodivergent child, often for the first time. So much has changed in our understanding of ADHD and its comorbidities, and grandparents are working hard to catch up and help out.

If your grandchild has ADHD, you likely struggle with kickstarting the morning routine, tackling and turning in homework, doing chores, and even sitting at the dinner table. Navigating your role as a grandparent—whether you’re raising your grandchild or just contributing to childcare—requires patience and energy when your grandchild presents with inattentive, hyperactive and/or impulsive behavior.

In this webinar, grandparents will learn:

• About the three presentations of ADHD and how each can affect a child’s life at home, at school, and in peer relationships
• About evidence-based behavior management strategies to improve interactions with your grandchild
• How to address everyday struggles, such as getting ready in the morning, starting and completing homework, following directions, and balancing screen time
• How to avoid common pitfalls, such as yelling and using escalating threats

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.

More on ADHD Grandfamilies

• Download: 3 Rules for Organizing Your Child (or Grandchild)
• Read: “Let Me Tell You How ADHD Runs in My Family”
• Read: A Strong Foundation

Obtain a Certificate of Attendance

If you attended the live webinar on April 26, 2023, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Caroline Mendel, Psy.D., is the Senior Director of Clinical Services for School and Community Programs and a psychologist in the ADHD and Behavior Disorders Center at the Child Mind Institute. She specializes in the assessment and treatment of youth with ADHD, disruptive behavior, and other co-occurring conditions. She is skilled in behavioral parent training approaches and is a certified parent-child interaction therapy (PCIT) therapist. She also has experience providing evidence-based interventions including cognitive-behavioral therapy (CBT), interpersonal psychotherapy (IPT), and dialectical behavior therapy (DBT).

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Technology is an inescapable — and important — facet of everyday life for teens. Video games and social media allow adolescents to connect with friends, have fun, and learn new ideas. But for teens with ADHD, in particular, video games and social media can become addictive and lead to an unhealthy lifestyle. Some teens may resist doing homework or other tasks to stay online. It is important for caregivers and teens to discuss what makes screen use problematic and to develop strategies for screen use that is balanced and healthy.

In this webinar, caregivers will learn:

• About the symptoms of behavioral addictions and how these relate to screen use
• How video games, social media, and technology in general are designed to be addictive, and how this can be particularly problematic for teens with ADHD
• Approaches to discuss and instill healthy gaming and social media use in your teen
• Identify specific tools and treatments to help those struggling with problematic screen use

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.

More on Addictive Technology & Teens with ADHD

• Download: An Ethic’s Manual for Your Teen’s Electronics
• Read: WHO Classifies Gaming Disorder As a New Mental Health Condition
• Read: “How Much Screen Time Is Too Much?”

Obtain a Certificate of Attendance

If you attended the live webinar on April 19, 2023, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Jeremy Edge, LPC, IGDC, is the owner and founder of the counseling practice, Escapingthe.com, PLLC. Jeremy is an international gaming disorder certified counselor, which is the leading certification for working with people with gaming disorder. He’s also obtained a digital wellness certificate through the Digital Wellness Institute. He provides counseling services to help clients experience balanced, healthy screen use.

After personally experiencing the negative effects of problematic gaming, Jeremy devoted his work to helping those find balance with online activities. In addition to problematic screen use, Jeremy works with men of all ages, and his team works with teens, young adults, adults, and families.

He received his Master’s degree in community counseling at University of Texas San Antonio and a Bachelor’s degree in psychology from UT Tyler. Jeremy is married to a pediatrician and they live in Dallas with their two kids.

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The first college in the U.S. to exclusively serve students who learn differently (dyslexia, ADHD, autism, executive function challenges, etc.), also offers short-term programs that help neurodivergent high schoolers make the successful transition to college, academically and socially. Visit www.landmark.edu/teen to learn more about residential and online options.

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Grouchy. Moody. Easily frustrated and annoyed. Short-tempered.

All youth experience these symptoms of irritability — an emotional state characterized by proneness to anger — from time to time. But irritability, especially if it’s persistent, intense, and impacts functioning, could indicate something more than typical adolescence development. From attention deficit hyperactivity disorder (ADHD) to disruptive mood dysregulation disorder (DMDD) to bipolar disorder (BPD), irritability is a symptom and trait shared by several psychiatric conditions.

Accurately tracing clinically significant irritability to the right condition(s) — a process requiring careful differential diagnosis — is Step One to managing it. But regardless of diagnosis, all children and teens experiencing intense irritability can benefit from building emotional and behavioral regulation skills. Emerging research on irritability in youth provides valuable ideas and directions for interventions.

What Causes Irritability in Children?

Irritability (at normative levels) may be caused and triggered by stress, insufficient sleep, and/or mood swings during puberty. Irritability rises to clinically significant levels when it is persistent, severe, and/or inconsistent with age and development. Serious irritability is thought to affect up to 5% of people.¹ Irritability is also among the most common reasons for youth referral to psychiatric care.² Researchers believe that deficits in certain brain processes explain pathological irritability.

Irritability and Frustrative Non-Reward

Irritability occurs when we are unable to attain the goal or reward we want — a concept known as frustrative non-reward. Healthy brains learn when to expect rewards and how to adjust behaviors to make attaining a reward or goal (and avoiding punishment) more likely. Researchers hypothesize that irritable youth exhibit deficits in these processes, which make the experience of frustrative non-reward more likely, and the task of working around it more difficult.²

[Read: Top Emotion Regulation Difficulties for Youth with ADHD]

Irritability and Threat-Processing Deficits

Anger and aggression are normal responses to a threat. But compared to non-irritable children, irritable youth may misinterpret neutral or low-level stimuli as highly threatening — a deficit in threat-processing that could give way to temper outbursts and aggression.² Researchers theorize that both reward- and threat-processing deficits interact and intensify irritability in children.

Tonic Irritability vs. Phasic Irritability

Understanding irritability based on its persistence is especially useful for diagnosis. A patient exhibits tonic (chronic) irritability when anger, grouchiness, and annoyance are persistent and part of their baseline mood. This type of irritability predicts subsequent internalizing disorders, like depression and anxiety.³

Temper outbursts and aggression, on the other hand, characterize phasic (episodic) irritability. This dimension of irritability predicts subsequent externalizing disorders like ADHD and ODD, to name a few.³

Irritability Across Conditions: Distinguishing Features

As a non-specific, transdiagnostic symptom, irritability is to mental health providers what fevers are to pediatricians. Just as a fever is a core symptom of numerous illnesses and infections, irritability is a core symptom of many mental conditions.

[Read: Why Is My Child So Angry and Defiant?]

We can narrow down irritability to its likely cause by looking at the diagnostic criteria and associated features of the conditions wherein irritability factors prominently.

DMDD

Chronic, severe irritability is at the core of DMDD, which causes children to have frequent and extreme outbursts, often in response to frustration, that are out of proportion to the situation or trigger. Outbursts can be in the form of verbal rage or physical aggression.

DMDD first appeared in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in response to concerns that a subset of chronically irritable children was being incorrectly diagnosed and/or treated for pediatric bipolar disorder.

Mood Characteristics

• Temper outbursts must occur, on average, three or more times per week in at least two settings, and for over a year, to merit a DMDD diagnosis.
• Between outbursts, children with DMDD must display a persistently irritable or angry mood in at least two settings. As such, tonic and phasic irritability, at the highest levels, characterize DMDD.

Associated Features

DMDD can co-occur with ADHD, conduct disorder, and major depressive disorder (MDD).

Age of Onset

DMDD cannot be diagnosed before age 6, but symptoms should be present by age 10.

Exclusions

• DMDD cannot co-occur with oppositional defiant disorder (ODD), intermittent explosive disorder (IED), or bipolar disorder. If a child meets criteria for ODD and DMDD, they should only get the latter diagnosis.
• DMDD cannot be diagnosed if a child has experienced a manic or hypomanic episode.

ODD

A pattern of angry/irritable mood, argumentative/defiant behaviors, or vindictiveness define ODD. The following three symptoms make up the angry/irritable mood category of ODD:

• often loses temper
• is often touchy or easily annoyed
• is often angry and resentful

Additional Mood Characteristics

• Given ODD’s diagnostic criteria, whereby children need at least four symptoms from any of these categories to merit diagnosis, it’s possible that some patients may fall under the irritable/angry subtype of ODD, while others fall under the argumentative/defiant subtype.
• Tonic and phasic irritability characterize the angry/irritable subtype of ODD.

ODD vs. DMDD

• While temper outbursts and irritability occur in ODD and DMDD, they are more severe and frequent in DMDD.⁴
• ODD behaviors should occur at least once a week for at least six months and need only be confined to one setting to merit diagnosis, unlike with DMDD.

Associated Features

• The angry/irritable subtype of ODD is associated with increased risk for depression and anxiety.⁵
• ODD and ADHD are highly comorbid; ODD may be the most common comorbidity among children with ADHD.⁶

Age of Onset

Though ODD symptoms can appear during the preschool years, ODD typically develops a little bit later, generally after the onset of ADHD. ODD can also onset later in adolescence.

Bipolar Disorder

Irritability is one of the cardinal signs of the manic episodes that occur in bipolar disorder, which is characterized by extreme changes in mood and behavior. The following symptoms may accompany irritability during a manic episode:

• inflated self-esteem or grandiosity
• decreased need for sleep
• talkativeness
• racing thoughts
• distractibility
• risky, impulsive behaviors

Additional Mood Characteristics

Irritability in bipolar disorder in episodic/phasic. When a child with bipolar disorder is euthymic (i.e., not in an episode of mania or depression), they are not irritable — a key factor that distinguishes bipolar disorder from DMDD and other conditions where irritability is tonic/chronic.

Age on Onset

Bipolar disorder generally emerges during adolescence or adulthood, though a portion of diagnosed patients had symptoms of the disorder before age 13.⁷

Associated Features and Risk Factors

• A family history of BPD greatly increases the odds that a patient will develop BPD.⁸
• Early onset depression and seasonal patterns to mood episodes may all be “yellow” flags for BPD.

ADHD

While mostly thought of in terms of inattention, impulsivity, and hyperactivity, ADHD brings significant emotional regulation difficulties, including elevated levels of irritability, for nearly half of children with ADHD.⁹ In fact, many researchers consider emotional dysregulation to be a core feature of ADHD.

Additional Mood Characteristics

• Research indicates that about 30% of children with ADHD fit an angry/irritable profile. That is, they have high levels of anger, and take longer to return to baseline mood levels.¹⁰
• Symptoms of emotional lability (anger, irritability, low frustration tolerance, etc.) increase the severity of core ADHD symptoms in children.¹¹
• Phasic irritability (i.e., temper outbursts) is linked to ADHD.¹²
• Irritability is mostly associated with ADHD combined type over the inattentive and hyperactive/impulsive types.¹³

Associated Features

ADHD is comorbid with other conditions where irritability is a common trait or symptom, like ODD and DMDD. Some symptoms of ADHD not tied to irritability, like accelerated speech, distractibility, and unusual energy, overlap with bipolar disorder.

Other Conditions Linked to Irritability

• Depression: Irritability is a symptom of depression in children and adolescents, but not in adults.¹⁴
• Generalized anxiety disorder (GAD): GAD is the only anxiety disorder in the DSM-5 wherein irritability is a listed symptom, though research links irritability to multiple anxiety disorders.¹⁵

Managing Irritability: Transdiagnostic Approaches and Future Directions

If irritability is tied to a condition, early identification is important to arrest further development of psychopathology over time.

Though irritability differs in severity, frequency, and persistence across conditions, clinicians can still refer to a basic set of principles and approaches for its management, regardless of condition. Ongoing research also points to potential pharmacological interventions for irritability.

Follow the FIRST Program

The FIRST program is a treatment approach designed to address behavioral and emotional problems, including irritability and anger, in children and adolescents.¹⁶ The five principles of FIRST are as follows:

• Feeling calm: Self-calming and relaxation techniques (e.g., breathing exercises, progressive muscle relaxation) can help relieve frustration, anger, and irritability in the moment.
• Increasing motivation: Children need praise, rewards, and other attractive motivators to reinforce desired behaviors over maladaptive ones.
• Repairing thoughts: Thoughts influence feelings and behaviors. Identifying distorted thoughts that may give way to feelings of irritability and frustration could help reduce those outcomes.
• Solving problems: Problem-solving is a valuable skill that can help children overcome the issues that can aggravate irritability and anger.
• Trying the opposite: Children should engage in activities that directly counter the behavioral and/or emotional problem.

DBT-C

Dialectical behavior therapy for children (DBT-C) is designed to treat severe emotional and behavioral dysregulation in youth ages 6 to 12. DBT-C comprises parent training, child counseling, and parent-child skills training. Combined, these components help youth self-regulate.

Findings from a recent study on DBT-C adapted for youth with DMDD (which currently has no empirically established treatments) are promising.¹⁷ In the small study, children who underwent DBT experienced greater symptom improvement compared to children in the non-DBT group. Parents and children in the DBT group also expressed higher treatment satisfaction than did participants in the non-DBT group.

Medications

Stimulants, selective serotonin reuptake inhibitors (SSRIs), and atypical antipsychotics show promise in treating irritability in children and teens.² Stimulants are known to decrease irritability in children with ADHD alone and in those with comorbid DMDD.^{18 19} Risperidone is currently used to treat irritability across a wide range of conditions.

Recent research on citalopram, an antidepressant, points to new directions in potential treatments for irritability. In a small trial of youth with severe irritability symptoms who were pretreated with methylphenidate, those who took citalopram, as an add-on, saw a reduction in symptoms (including temper outbursts) compared to those who were given a placebo.²⁰ More research is needed to understand the efficacy of these medications in reducing irritability.

Irritability in Children: Next Steps

• Free Download: How to Deal with Anger From Your Child
• Read: The ADHD-Anger Connection
• Read: When Angry Kids Lash Out — How to Defuse Explosive Reactions

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “Emotion Regulation Difficulties in Youth: ADHD Irritability vs. DMDD vs. Bipolar Disorder” [Video Replay & Podcast #435] with William French, M.D., DFAACAP., which was broadcast on December 14, 2022.

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Cornacchio, D., Crum, K. I., Coxe, S., Pincus, D. B., & Comer, J. S. (2016). Irritability and Severity of Anxious Symptomatology Among Youth With Anxiety Disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 55(1), 54–61. https://doi.org/10.1016/j.jaac.2015.10.007

² Brotman, M. A., Kircanski, K., Stringaris, A., Pine, D. S., & Leibenluft, E. (2017). Irritability in Youths: A Translational Model. The American journal of psychiatry, 174(6), 520–532. https://doi.org/10.1176/appi.ajp.2016.16070839

³ Hawes M. T., Carlson G. A., Finsaas M. C., Olino T. M., Seely J. R., Klein D. N. (2020). Dimensions of irritability in adolescents: Longitudinal associations with psychopathology in adulthood. Psychological Medicine, 50(16), 2759–2767. https://doi.org/10.1017/S0033291719002903

⁴ Roy, A. K., Lopes, V., & Klein, R. G. (2014). Disruptive mood dysregulation disorder: a new diagnostic approach to chronic irritability in youth. The American journal of psychiatry, 171(9), 918–924. https://doi.org/10.1176/appi.ajp.2014.13101301

⁵ Déry, M., Lapalme, M., Jagiellowicz, J., Poirier, M., Temcheff, C., & Toupin, J. (2017). Predicting Depression and Anxiety from Oppositional Defiant Disorder Symptoms in Elementary School-Age Girls and Boys with Conduct Problems. Child psychiatry and human development, 48(1), 53–62. https://doi.org/10.1007/s10578-016-0652-5

⁶ Noordermeer, S. D. S., Luman, M., Weeda, W. D., Buitelaar, J. K., Richards, J. S., Hartman, C. A., Hoekstra, P. J., Franke, B., Heslenfeld, D. J., & Oosterlaan, J. (2017). Risk factors for comorbid oppositional defiant disorder in attention-deficit/hyperactivity disorder. European child & adolescent psychiatry, 26(10), 1155–1164. https://doi.org/10.1007/s00787-017-0972-4

⁷ Perlis, R. H., Miyahara, S., Marangell, L. B., Wisniewski, S. R., Ostacher, M., DelBello, M. P., Bowden, C. L., Sachs, G. S., Nierenberg, A. A., & STEP-BD Investigators (2004). Long-term implications of early onset in bipolar disorder: data from the first 1000 participants in the systematic treatment enhancement program for bipolar disorder (STEP-BD). Biological psychiatry, 55(9), 875–881. https://doi.org/10.1016/j.biopsych.2004.01.022

⁸ Goldstein, B. I., & Birmaher, B. (2012). Prevalence, clinical presentation and differential diagnosis of pediatric bipolar disorder. The Israel journal of psychiatry and related sciences, 49(1), 3–14.

⁹ Baweja, R., Waschbusch, D. A., Pelham, W. E., 3rd, Pelham, W. E., Jr, & Waxmonsky, J. G. (2021). The Impact of Persistent Irritability on the Medication Treatment of Paediatric Attention Deficit Hyperactivity Disorder. Frontiers in psychiatry, 12, 699687. https://doi.org/10.3389/fpsyt.2021.699687

¹⁰ Karalunas, S. L., Gustafsson, H. C., Fair, D., Musser, E. D., & Nigg, J. T. (2019). Do we need an irritable subtype of ADHD? Replication and extension of a promising temperament profile approach to ADHD subtyping. Psychological assessment, 31(2), 236–247. https://doi.org/10.1037/pas0000664

¹¹ Sobanski, E., Banaschewski, T., Asherson, P., Buitelaar, J., Chen, W., Franke, B., Holtmann, M., Krumm, B., Sergeant, J., Sonuga-Barke, E., Stringaris, A., Taylor, E., Anney, R., Ebstein, R. P., Gill, M., Miranda, A., Mulas, F., Oades, R. D., Roeyers, H., Rothenberger, A., … Faraone, S. V. (2010). Emotional lability in children and adolescents with attention deficit/hyperactivity disorder (ADHD): clinical correlates and familial prevalence. Journal of child psychology and psychiatry, and allied disciplines, 51(8), 915–923. https://doi.org/10.1111/j.1469-7610.2010.02217.x

¹² Cardinale, E. M., Freitag, G. F., Brotman, M. A., Pine, D. S., Leibenluft, E., & Kircanski, K. (2021). Phasic Versus Tonic Irritability: Differential Associations With Attention-Deficit/Hyperactivity Disorder Symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 60(12), 1513–1523. https://doi.org/10.1016/j.jaac.2020.11.022

¹³ Eyre, O., Langley, K., Stringaris, A., Leibenluft, E., Collishaw, S., & Thapar, A. (2017). Irritability in ADHD: Associations with depression liability. Journal of affective disorders, 215, 281–287. https://doi.org/10.1016/j.jad.2017.03.050

¹⁴ American Psychiatric Association. (2013). Major depressive disorder. In Diagnostic and statistical manual of mental disorders (5th ed.).

¹⁵ Cornacchio, D., Crum, K. I., Coxe, S., Pincus, D. B., & Comer, J. S. (2016). Irritability and Severity of Anxious Symptomatology Among Youth With Anxiety Disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 55(1), 54–61. https://doi.org/10.1016/j.jaac.2015.10.007

¹⁶ Weisz, J. R., & Bearman, S. K. (2020). Principle-guided psychotherapy for children and adolescents: The FIRST program for behavioral and emotional problems. The Guilford Press.

¹⁷ Perepletchikova, F., Nathanson, D., Axelrod, S. R., Merrill, C., Walker, A., Grossman, M., Rebeta, J., Scahill, L., Kaufman, J., Flye, B., Mauer, E., & Walkup, J. (2017). Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder: Feasibility and Outcomes. Journal of the American Academy of Child and Adolescent Psychiatry, 56(10), 832–840. https://doi.org/10.1016/j.jaac.2017.07.789

¹⁸ Fernández de la Cruz, L., Simonoff, E., McGough, J. J., Halperin, J. M., Arnold, L. E., & Stringaris, A. (2015). Treatment of children with attention-deficit/hyperactivity disorder (ADHD) and irritability: results from the multimodal treatment study of children with ADHD (MTA). Journal of the American Academy of Child and Adolescent Psychiatry, 54(1), 62–70.e3. https://doi.org/10.1016/j.jaac.2014.10.006

¹⁹ Baweja, R., Belin, P. J., Humphrey, H. H., Babocsai, L., Pariseau, M. E., Waschbusch, D. A., Hoffman, M. T., Akinnusi, O. O., Haak, J. L., Pelham, W. E., & Waxmonsky, J. G. (2016). The Effectiveness and Tolerability of Central Nervous System Stimulants in School-Age Children with Attention-Deficit/Hyperactivity Disorder and Disruptive Mood Dysregulation Disorder Across Home and School. Journal of child and adolescent psychopharmacology, 26(2), 154–163. https://doi.org/10.1089/cap.2015.0053

²⁰ Towbin, K., Vidal-Ribas, P., Brotman, M. A., Pickles, A., Miller, K. V., Kaiser, A., Vitale, A. D., Engel, C., Overman, G. P., Davis, M., Lee, B., McNeil, C., Wheeler, W., Yokum, C. H., Haring, C. T., Roule, A., Wambach, C. G., Sharif-Askary, B., Pine, D. S., Leibenluft, E., … Stringaris, A. (2020). A Double-Blind Randomized Placebo-Controlled Trial of Citalopram Adjunctive to Stimulant Medication in Youth With Chronic Severe Irritability. Journal of the American Academy of Child and Adolescent Psychiatry, 59(3), 350–361. https://doi.org/10.1016/j.jaac.2019.05.015

Intense children exhibit intense, often problematic, behavior with a frequency and severity that impacts everyone. Exhausted parents field regular phone calls from school administrators, frustrated teachers feel punishment (or leaving the profession) is their only option, and medical professionals assume medication is the only approach that truly works. No one benefits, certainly not the child.

Enter the Nurtured Heart Approach, a parent behavior training program developed from therapist Howard Glasser’s work with the most challenging and intense children. School and treatment centers report that it not only positively transforms “difficult” behaviors, but the Nurtured Heart Approach benefits all children by enabling and teaching adults how to channel their intensity into great qualities of character and leadership.

In this webinar, you will:

• Understand the dynamics of intense children and how to inspire success and greatness
• Understand why, despite sincere intention, conventional methods of parenting, education, and treatment often backfire with intense and challenging children
• Learn a methodology for inspiring success that is more powerful and encompassing than traditional approaches
• Understand how to uphold a great level of limits and accountability while avoiding the traps that make consequences backfire

Watch the Video Replay

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More on Positive Parenting and ADHD

• Download: Questions to Get Your Child Talking
• Read: “My Child Resists Everything! Will He Ever Open Up to New Experiences?”
• Read: Positive Charge: How to Reinforce Good Behavior

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Meet the Expert Speaker:

Creator of the Nurtured Heart Approach, Howard Glasser works in family treatment, clinical studies, and educational leadership. His formal studies, along with direct experience with the most intense and challenging children, form the basis of this approach. He has been referred to as one of the most influential persons working to reduce children’s reliance on psychiatric medications.

Howard is the author of 15 books, including Transforming the Difficult Child, a longstanding bestseller on intense and challenging children. (#CommissionsEarned)

Howard teaches Nurtured Heart Approach Certification Training Intensives at the Nurtured Heart Institute, the University of Arizona’s Integrative Medicine Program, and at the Zuckerman School of Public Health.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“As a heart-centered practitioner, I appreciated this approach!”

“Glasser got to the core of the parent-child relationship in such a beautiful and compelling way.”

“Excellent presentation. I was affirmed in some of my current practices with my 5th & 6th grade classroom & want to explore this approach further!”

“Thank you! So rich and helpful.”

“Thank you, Howard was fantastic. Lots to think about, and to redirect the focus is something I’m going to try starting now! Inner wealth… I love this idea.”

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From my perspective as a clinical psychologist who studies reward and punishment responses in children with ADHD, you are right to recognize a toxic dynamic at work here.

Even if it’s not deliberate, your child’s actions are reinforced every time you stand firm and then step aside to allow her to defy you. (To be clear, I recognize that this is an incredibly frustrating situation.) Your daughter remains oppositional because she has learned that defiant behavior gets her what she wants.

[Free Download: The 15-Day Fix to Stop Defiant Behavior]

Your own actions in those moments are also reinforced, though in a different way. You have learned that stepping away results in the removal of an aversive stimulus — your daughter’s defiant behaviors. It’s how you’ve learned to cope with the stress caused by your child’s defiance.

In short, there are many things to unpack here. It’s clear that behaviors on both sides perpetuate this cycle, and unlearning these behaviors is required to bring about change.

If your daughter’s behaviors cause lots of stress and conflict at home, it may be best to seek help from a psychologist or other health provider who is skilled in behavioral parent training for ADHD. They will help you understand how to encourage desired behaviors in your child, and the factors that intentionally and unintentionally influence behavior.

It will take time to change a dynamic that has been long reinforced. Be prepared to see an uptick in defiant behaviors from your child as you work toward change. In my field, we call that an “extinction burst,” or the principle of “it will get worse before it gets better.” Worsening behavior, in this case, actually means that your new strategies are working. You’ll just have to weather the storm to see the new dawn.

“My Kids Don’t Listen to Me:” Next Steps

• Free Download: What You Need to Know About Parent Training Programs
• Q&A: “What Rewards Will Motivate Good Behavior from My Child?”
• Self-Test: Could Your Child Have Oppositional Defiant Disorder?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “The Power of Positive Reinforcement: Why Rewards Trump Punishments for Students with ADHD” [Video Replay & Podcast #420],” with Gail Tripp, Ph.D., which was broadcast on September 8, 2022.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The deck is stacked against Owen. He has ADHD, learning disabilities, and an anxiety disorder — all of which affect how he learns and interacts with his classmates. He also has significant sensory processing differences. The typical classroom environment can be too much for Owen, leading to the panicked state I found him in during recess.

Given all of Owen’s needs, we knew his recess meltdown that day wouldn’t be the last of it. We desperately needed to come up with a plan to help him advocate for himself and thrive in school despite his daily challenges. But how could we empower Owen to make this change when survival alone was so depleting?

The Explosive Child: Dr. Ross Greene’s CPS Model

The answer was in The Explosive Child — a favorite read in neurodivergent parenting circles. In this book, Dr. Ross Greene outlines his collaborative and proactive solutions (CPS) model, which rests on this important concept: Kids do well if they can.

Problematic behaviors and other issues arise when children struggle to adapt to meet what’s expected of them. The key is for adult and child to collaboratively problem-solve (i.e., work with your child, not against them or without them) so that the child can get back to doing well.

[Free Download: Required Reading for Parents of Kids with ADHD]

From tiny setbacks to seemingly impossible troubles, problems emerged just about every day during the school year. Our family made it a point to stick to Dr. Greene’s model: Let Owen talk about his challenges in school and the reasons behind them; speak about our concerns together; and brainstorm solutions as a family for that particular problem.

What we learned after a straight year of following this model altered the course of our family for the better.

Collaborative Problem Solving: What We Learned

1. Truly listening to your child conveys your trust in them and builds self-advocacy skills. When we invited Owen to share his experiences every day, he understood that we saw his perspectives as inherently valid and important, which allowed him to connect with us and feel like an active partner in the problem-solving process. What’s more, we could only collaborate on successful solutions to the degree that Owen knew himself and could identify his own problems. The more we listened to Owen, the more he began to trust himself and increase his self-knowledge.

2. You’ll uncover your true hopes and desires as a parent. There’s room for parents to air their concerns, too, in the CPS model. Issue after issue, we learned that we valued our son’s mental health and happiness over staying on grade level, completing assignments, meeting attendance requirements, and other non-essentials. Having this clarity and focus was pivotal for us in moving forward with countless decisions relating to school and beyond.

[Read: 6 Truths About Child Behavior Problems That Unlock Better Behavior]

3. Neurodivergent creativity gets a chance to shine. The CPS model is inherently creative, as every new problem requires fresh solutions. My son’s creative ADHD brain became our most valuable asset during every problem-solving session, as it allowed him to quickly generate unexpected, delightfully surprising solutions to his challenges.

Where’s Owen Now? Flourishing

While we turned to the collaborative process to help our child thrive in a traditional school setting, it actually led us to the choice to homeschool him – a creative solution Owen came up with himself. Owen had developed enough self-insight to realize that traditional schooling might not be the way for him. With our priorities clear, we were inclined to leave the standard schooling path if it meant Owen’s happiness. After a year of trust-building and collaborative problem-solving, we knew that we’d be able to solve whatever challenge we encountered on this unfamiliar path.

I cherish the child emerging before my eyes — self-assured, bravely creative, collaborative, and wide open to exploring the road-less-traveled. We’ve come a long way from the panicked boy in the school playground. My son now has his shoulders back and his head high.

The Explosive Child and ADHD Parenting: Next Steps

• Read: 10 Rules for Dealing with the Explosive Child
• Read: What Are the Lagging Skills Holding Your Child Back?
• Read: How to Shepherd — Not Carry — Your Child Toward Fulfillment
• Get This eBook: The ADHD Positive Parenting Guide

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Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

It’s not in your head — there is growing evidence that children with ADHD differ from their neurotypical peers in their sensitivity to rewards. For many children with ADHD, a far-away reward won’t work to reinforce desired behaviors. That means you’ll almost certainly have to adjust how you approach and set up rewards to encourage desired behaviors in your child.

The more you understand about ADHD brains and the factors that influence reward effectiveness therein, the better you’ll get at troubleshooting and engineering effective motivators for your child.

Rewards for Kids with ADHD: Guidelines and Quick Tips

1. Rewards come in many forms.

• Material rewards comprise tangibles like money and toys.
• Activity rewards center on preferred, enjoyable actions.
• Social rewards include reinforcers like praise, smiles, high-fives, and other forms of encouragement. They are perhaps the most powerful reward type.

Each reward type has its pros and cons, and what is effective for your child may not work for another. Ask yourself the following questions as you select and craft rewards:

[Get This Free Download: Ending Confrontations and Defiance]

• “Does my child care about this reward?” Rewards must be meaningful to inspire change. If your child’s behavior isn’t changing for the better, then it may be that they don’t find the reward all that rewarding. Depending on your child, activity rewards may be more effective than, say, external rewards like toys and money. Ask your child what kind of payoffs they find appealing.
• “Could I leverage my child’s desired activities?” Activities your child genuinely enjoys can serve as effective, appealing rewards that reinforce behaviors your child may otherwise struggle to do. (Your child might be more motivated to do chores, for example, if they know they’ll be rewarded with a trip to the park.)
• “Am I making good use of social rewards?” Harness the power of encouragement. Use social rewards on top of other rewards if possible. Pats on the back and “good jobs” are easy to access and deliver, and they have long-enduring appeal.

2. Children with ADHD respond to immediate rewards.

Could your rewards be losing effectiveness because they take too long to kick in? A reward loses its appeal if it’s collected far off in the future, so be sure that your child can tolerate the gap between behavior and reward. Consider the reward’s ease of access and delivery. Could you close the gap on any otherwise appealing rewards to maximize their effectiveness?

[Read: The Science of Reward and Punishment for Children with ADHD]

If rewards are not immediate, ensure that they are at least highly desirable and worth waiting for.

3. Waiting for a reward should be awarded, too.

Waiting is an onerous, effortful task, especially for children with ADHD.¹ We know from research that children with ADHD will often engage in what looks like misbehavior to try to distract themselves from the fact that they are waiting.

Unfortunately, waiting isn’t typically a behavior we acknowledge, yet alone reward. Remember that waiting is a desired behavior. Social rewards are especially useful for rewarding a child’s patience.

4. Match all task/behavior demands to your child’s abilities.

The behavior you seek or task you demand from your child may be incredibly difficult for them to act on, even with a powerful reward at the end. Your child may even experience that task as punishment – a formidable problem considering that children with ADHD are more sensitive than their neurotypical peers to punishment.^{2 3}

We don’t often think of homework as punishment, for example. But if the material is outside your child’s ability level, or if focusing on homework for extended lengths of time is far too difficult, they may begin to experience homework as punishing. Despite the promise of a reward after completing homework, they may avoid the task altogether.

If a reward isn’t working, examine the desired behavior and consider ways to bring that behavior within reach. If you recognize that the task or behavior in question demands lots of effort, be sure to dole out lots of rewards along the way.

Rewards for Good Behavior: Next Steps

• Free Resource: 8-Week Parenting Class for ADHD Families
• Read: The Delicate Balance of Rewards and Consequences
• Read: The ADHD Brain Processes Rewards & Consequences Differently

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “The Power of Positive Reinforcement: Why Rewards Trump Punishments for Students with ADHD” [Video Replay & Podcast #420],” with Gail Tripp, Ph.D., which was broadcast on September 8, 2022.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Tripp, G., & Alsop, B. (2001). Sensitivity to reward delay in children with attention deficit hyperactivity disorder (ADHD). Journal of Child Psychology and Psychiatry and Allied Disciplines, 42(5), 691–698. https://doi.org/10.1017/S0021963001007430.

² Furukawa, E., Alsop, B., Sowerby, P., Jensen, S., & Tripp, G. (2017a). Evidence for increased behavioral control by punishment in children with attention-deficit hyperactivity disorder. Journal of Child Psychology and Psychiatry, 3(58), 248–257. https://doi.org/10.1111/jcpp.12635.

³ Furukawa, E., Alsop, B., Shimabukuro, S., & Tripp, G. (2019b). Is increased sensitivity to punishment a common characteristic of attention deficit/hyperactivity disorder? An experimental study of response allocation in Japanese children. ADHD Attention Deficit and Hyperactivity Disorders, 11(4), 433–443. https://doi.org/10.1007/s12402-019-00307-6.

In the weeks leading up to his first home visit, Cal asked us to keep a diary of Kips’ behaviors. But I couldn’t do it. I really tried, but it was impossible.

I tried to explain this to Cal, who listened sympathetically and patiently as I timidly handed him 25 pages of illegible scribble. He looked at my crumpled pages and asked if they were labeled for each day.

“That’s just one day,” I said, mildly. “Half a day, actually.”

Boundless Hyperactive Energy on Display

Finally, the day of the home visit came. I’d been mentally prepping myself all morning. This will be positive! Cal will offer a new perspective and wonderful strategies. We’d have a cup of tea; chat; Cal will interact with Kip and watch his behavior. He knows kids, right?

[Take This Self-Test: Symptoms of Hyperactive Impulsive ADHD in Children]

As Cal pulled into our driveway, Kip raced out the door toward his car before it had made a full stop. Cal greeted us with his easy smile, gently reminded Kip about the dangers of rushing towards a moving car, and asked me if we could sit, chat, and observe Kip.

“Great,” I said, going to check the kettle. I was feeling as enthusiastic as Kip appeared to be. Really good start, I thought optimistically.

But Kip, so excited to have a visitor to entertain, decided that he wanted to get the tea bags ready for us. So he shot toward the house, wrenched open the sliding door with a bang, vaulted a chair to get in first, and, in all his hurry, knocked the kitchen sugar bowl to the floor.

“Whoops, sorry,” he called over his shoulder.

He grabbed the jar of tea bags, pulled out two bags, and slammed the lid shut while I cleaned up the sugar on the floor. Without looking, he reached quickly behind himself to put the jar back in its usual place on the shelf. But he missed, and the jar fell, knocking down the salt, pepper, and other herb bottles.

[Read: Could My Toddler Really Have ADHD? How Can I Tell?]

“Whoops… sorry, Mum!”

Cal tried to speak. “Whoa! Slow down, mate!” No effect whatsoever.

While I picked up jars and bottles and made apologetic gestures to Cal, Kip was busy getting mugs for our tea. He was so ridiculously exuberant, and although he was always this ‘helpful’ and fast, he seemed to have completely lost his mind with Cal’s visit.

When Toddler Hyperactivity Intensifies

Kip grabbed two mugs, kicked the cupboard door shut with a bang, and turned without looking. He tripped on the edge of the mat and fell face first to the floor. One mug rolled across the floor and the other smashed into his chin and lip as he fell.

Cal made a startled noise. I didn’t. This was a pretty normal morning for us.

Blood dripped from Kip’s bottom lip, onto his shirt, and to the floor. But Kip simply leapt up, wiped his mouth on his sleeve and glanced at me. “Whoops,” he said.

I cleaned his lip, checked that his teeth were intact, rubbed arnica on his chin (for two seconds, because that’s all he stood still for), and went back to the kitchen to clean up the blood and pick up the mugs. All the while, I tried to smile and make small talk about the weather and traffic so Cal would feel comfortable.

Kip, who was talking nonstop from the moment Cal arrived, went straight back to the cupboard, determined to help set us up for tea. Along with his insane amounts of energy, Kip could focus on a task while constantly talking and changing subjects, from tea to dogs to the weather to cars and to games.

Before Kip could open the cupboard door again, I gave him an ice pack to hold to his lip, which was now black, blue, and swollen. Perhaps having only one hand free would slow him down. Good idea? Maybe. (These thoughts raced through my mind as I desperately attempted to keep conversation flowing in Cal’s direction.) Still, Kip grabbed two new mugs with his free hand and slammed them down on our table once more. He tossed a tea bag into each mug and madly heaped a large teaspoon of sugar into each (whether Cal took sugar seemed to be irrelevant) while spilling sugar all over the place.

Finally, the kettle whistled – and Kip instantly leapt toward to the stove.

This was what finally propelled Cal into action. He jumped forward ahead of Kip, reached for the kettle of boiling water, and said (much more loudly than he intended), “I’ve got it!” Crisis averted. We finally got the cups of tea poured.

I grabbed Kip mid-stride to hold him still for a second and sent him outside to run off a little bit of energy. Kip, legs already moving, happily yelled, “Okey-dokey, but Mum, I’ve got lots of energy today!”

Outside he sprinted, threw a ball to the dog, climbed over chairs, and swung around the bar of the rotary clothesline, all while saying things like, “Watch me! Did you see that?”; “There’s a crow!”; “It’s cloudy today!”; “How fast does Cal’s car go?!”

This gave me time to hand Cal his tea. (I hoped he liked sugar.) I took a deep breath as soon as we sat down, yet before we were able to take our first sip of tea, the back door flew open. Kip had returned, skidding to a halt right in front of us.

“Can Cal play with me now?” Kip asked.

Cal was beginning to get an inkling of our everyday life.

Lessons from Raising a Hyperactive, Neurodivergent Child

This was at the beginning of our journey, 20 years ago. Since then, I’ve learned the following lessons to manage daily life with a neurodivergent child:

• Keep a sense of humor. Learn to laugh at yourself.
• Remember: If it won’t matter in five years’ time, it doesn’t matter now.
• What other people think doesn’t matter; we’re not here to please them.
• Surround yourself with people who are positive and full of praise and understanding, not judgment.
• One awkward event doesn’t last that long.
• The relationship you have with your child lasts forever.

Signs of ADHD in Toddlers: Next Steps

• Read: Isn’t My Child Too Young to Be Diagnosed with ADHD?
• Read: “My Child Was Diagnosed at Age 3 — and Thank God She Was.”
• Read: Give Your Impulsive Child Forgiveness

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Screen time and video game play are tied to emotional dysregulation and compulsive behavior in children, respectively. The first finding comes from a new study published in JAMA Pediatrics that found frequent use of digital devices to calm young children may lead to increased emotional dysregulation, particularly in boys and children with strong temperaments.¹

Researchers said using devices, such as mobile phones or tablets, to soothe dysregulated young children may hinder the children’s chances of learning emotion-regulation strategies over time and decrease their executive functioning. Emotional regulation allows children to “stay calm, focused, and flexible as they face new challenges,” the researchers said.

Young boys and children who were hyperactive, impulsive, and had more intense emotions were more susceptible to emotional dysregulation when parents used screen time to calm them, according to the study. However, the study insights are likely relevant to most families, as screen time has increased across most demographic groups since the beginning of the pandemic.²,³

Signs of increased emotional dysregulation could include rapid shifts between sadness and excitement, a sudden change in mood or feelings, and heightened impulsivity.

Researchers from the University of Michigan analyzed parent and caregiver responses to assess how often they used devices as a calming tool and how dysregulated their 3- to 5-year-old child’s behavior. The study lasted from August 2018 to January 2020 and included 422 parents and 422 children.

This study arrives at the same time as one published by UC San Francisco researchers in the Journal of Adolescent Health that found playing video games and watching videos could lead early adolescents to develop obsessive compulsive disorder (OCD).⁴

“Time spent playing video games is significantly correlated with problematic video game use, including spending a lot of time thinking about playing video games, feeling the need to play video games more and more, and being unable to play video games less despite trying,” researchers said.⁴

Playing video games and streaming videos were most connected to compulsive behaviors. According to researchers, each additional hour spent on video games increased the risk of developing OCD by 13%, and the risk increased by 11% for each additional hour spent watching videos.

Study participants came from a nationwide sample of 9- to 10-year-old children participating in the longitudinal Adolescent Brain Cognitive Development (ABCD) study.

Children initially reported roughly 4 hours of screen time per day. Screen time included watching TV shows, movies, or videos [e.g., YouTube], playing video games, texting, video chatting [e.g., Skype, FaceTime], and social media [e.g., Facebook, Instagram, Twitter]). (The study did not measure screens used for educational purposes.) At a two-year follow-up, 6% of the sample met the diagnostic criteria for OCD, with 4.4% of the children developing new-onset OCD. Children with OCD reported 4.4 hours per day of total screen time.

According to Roberto Olivardia, Ph.D., a clinical Psychologist and Clinical Instructor of Psychology at Harvard Medical School and ADDitude contributor, “OCD is characterized by obsessions and/or compulsions. Obsessions are persistent thoughts, impulses, or images that are intrusive and cause distress and anxiety.

“Compulsions are repetitive physical behaviors (such as hand washing or praying) or mental acts (such as saying words silently, counting, creating images) that a person feels compelled to do to undo or cope with the obsession. The compulsion may have nothing to do with the obsession.”

Researchers did not find any association between television watching and OCD. Researchers noted that traditional television viewing has fewer programming options than does YouTube, which may limit users’ engagement. “Thus, behaviors surrounding traditional television may not have the same potential for the clustering of specific content that may otherwise exacerbate intrusive thoughts or images,” researchers said.

“Future research should examine mechanisms linking these specific screen modalities to OCD development to inform future prevention and intervention efforts,” said the researchers, who cited several limitations of the study, including the difficulty for children to self-report and estimate screen time correctly. “OCD can have severely debilitating and long-lasting effects on adolescent development that extend into adulthood such as social isolation, having fewer relationships than their peers, comorbid mental illnesses, and diminished quality of life….”⁵, ⁶

Sources

¹Radesky, J.S., Kaciroti, N., Weeks, H.M., Schaller, A., and Miller, A.L. (2022). Longitudinal Associations Between Use of Mobile Devices for Calming and Emotional Reactivity and Executive Functioning in Children Aged 3 to 5 Years. JAMA Pediatr. https://doi.org/10.1001/jamapediatrics.2022.4793

²Meherali, S., Punjani, N., Louie-Poon, S., et al. (2021). Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review. Int J Environ Res Public Health. 18: 3432. https://doi.org/10.3390/ijerph18073432

³Nagata, J.M., Cortez, C.A., Cattle, C.J., et al. (2022). Screen Time Use Among US Adolescents During the COVID-19 Pandemic: Findings from the Adolescent Brain Cognitive Development (ABCD) Study. JAMA Pediatr. 176: 94-96. https://doi.org/10.1001/jamapediatrics.2021.4334

⁴Nagata, J.M., Chu, J., Zamora, G., Ganson, K.T., Testa, A., Jackson, D.B., Costello, C.R., Murray, S.B., Baker, F.C. (2022). Screen Time and Obsessive-Compulsive Disorder Among Children 9–10 Years Old: A Prospective Cohort Study. Journal of Adolescent Health https://doi.org/10.1016/j.jadohealth.2022.10.023

⁵Subramaniam, M., Soh, P., Vaingankar, J.A., et al. (2013). Quality of Life in Obsessive-Compulsive Disorder: Impact of the Disorder and of Treatment. CNS Drugs. 27: 367-383.https://doi.org/10.1007/s40263-013-0056-z

⁶Thomsen, P.H. (2000). Obsessions: The Impact and Treatment of Obsessive-Compulsive Disorder in Children and Adolescents. J Psychopharmacol. 14: S31-S37. https://doi.org/10.1177/02698811000142S105

Many parents are unsure when to give their child a smartphone. Ultimately, the decision is a personal and nuanced one, but we do know that most children today get their first smartphone by age 11.¹ Also, many tweens are on social media platforms, even though virtually all these platforms require registered users to be at least 13 years old.¹

That said, your child’s maturity level is the most important factor to consider when deciding when to give them a smartphone. In my opinion, 10 might be too tender an age for a smartphone and the social-media access it unlocks.

[Read: Is Your Teen’s Social Media Use Dangerous?]

There’s very little research on the impact of early initiation onto social media. But a study our lab conducted shows that children younger than 11 who are on social media platforms, namely Instagram and Snapchat, are more likely to report problematic digital behaviors compared to older tweens and teens.² These behaviors include having online friends or joining social media sites that participants knew their parents would disapprove of, as well as exposure to more harassment. Parental restrictions on phone use ameliorated some of the negative effects.

That same study also revealed a surprising upside: Children who were on social media before age 11 showed greater civic engagement online – in the form of supportive social media posts, raising awareness of social issues, event organizing, for example – compared to children who joined later. Overall, the study also showed that early adolescents more frequently engaged in positive digital behaviors than they did negative behaviors.

Access to a smartphone essentially means access to social media. If you decide to give your child a smartphone, it’s essential that you establish rules for its use and engage in ongoing conversations about healthy online experiences.

What Age Should a Kid Get a Phone? Next Steps

• Free Download: Too Much Screen Time? How to Regulate Your Teen’s Devices
• Self-Test: Could My Child Be Addicted to the Internet?
• Read: How to Set Boundaries on Your Child’s Devices

The content for this article was derived, in part, from the ADDitude Mental Health Out Loud episode titled, “The Mental Health Fallout from Social Media Use” [Video Replay and Podcast #416] with Linda Charmaraman, Ph.D., which was broadcast live on August 16, 2022.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Rideout, V., and Robb, M. B. (2019). The Common Sense census: Media use by tweens and teens, 2019. https://www.commonsensemedia.org/sites/default/files/research/report/2019-census-8-to-18-full-report-updated.pdf

² Charmaraman, L., Doyle Lynch, A., Richer, A., Grossman, J. (2022) Associations of early social media initiation on digital behaviors and the moderating role of limiting use. Computers in Human Behavior, 127. https://doi.org/10.1016/j.chb.2021.107053

Does social media harm teens? The answer is complicated.

Alarming news reports and research on social media are common — and understandably troubling to caregivers and professionals — today. One recent study found that teens who reported spending more than 3 hours a day on social media may face an elevated risk for mental health problems compared to teens who used no social media.¹ Instagram’s internal study found that its app worsens mental health in teen girls.² And that platform is one of several that have been hit with lawsuits claiming harm to youth.^{3 4 5}

However, that is not the full story. While some studies have documented associations between social media use and negative mental health outcomes, others have found no correlations, or even positive mental health associations, like increased sense of community (especially for marginalized groups) and stronger social connections.^{6 7} In fact, research at large has not established a causal link between social media use and negative mental health outcomes.

Digital media, social media, and other technologies are unavoidable. So what are parents and teens to do? From my perspective, based on research I’ve completed over the last 15 years, quality matters much more than quantity when considering the effects of social media and other digital technologies on youth. Individual personalities matter, too. What’s more, parents absolutely play an important role in shaping how their teens navigate social media and what they get from their online experiences.

What We Know About Social Media Use Among Teens

According to a Pew Research Center survey:⁸

• 95% of U.S. teens have access to a smartphone.
• Most teens use social media, and 35% say they use at least one of the top online platforms – YouTube, TikTok, Instagram, Snapchat, or Facebook – “almost constantly.”
• 55% of teens say the amount of time they spend on social media is “about right.”

The pandemic changed social technology behaviors among adolescents, with teens reporting spending more time checking social media than they did before the pandemic.⁹

[Take This Self-Test: Could My Child Be Addicted to the Internet?]

Not All Social Media Users and Experiences Are Equal

Individual experiences and circumstances, including existing mental health problems, may influence social media’s effects and explain its associations with certain mental health outcomes among youth. That’s another way of saying that researchers are still trying to determine which comes first: mental health issues or social media use.

Take teens, social media, and body image. About 20% of teens report feeling down about their body image after going on social media.¹⁰ Teen girls, however, are significantly more likely than teen boys to experience social media-related body dissatisfaction. In all, teens who experience body dissatisfaction related to social media use are also more likely to have depressive symptoms, online social anxiety, difficulty making new friends, and a tendency to spend free time alone. Still, this cross-sectional study does not tell us if the teens had pre-existing body image issues, or if social media caused these problems.

Neurodivergent people, especially those with the focus and self-regulation challenges associated with attention deficit hyperactivity disorder (ADHD), could have a harder time regulating their emotions and unplugging from screens. This may help explain why some studies show an association between ADHD symptoms and digital media use/screen time.¹¹ Some individuals with ADHD may engage in gaming, for example, to cope with negative thoughts.¹² In addition, the sleep disturbances associated with ADHD may also influence — or be influenced by — screen time.

Many Teens Say Their Online Interactions Are Primarily Positive

Most teens say that social media better connects them to their friends’ lives and feelings, and they report positive feelings associated with social media use.¹³ That’s in contrast to about a quarter of teens who say that social media makes them feel worse about their own lives, either by a little or a lot.¹³

[Read: Diagnosing a Different Kind of Social Disease]

Youth Feel the Pressure of Social Obligations

Youth today will invariably navigate friendships through social media, which comes with its own set of rules and standards. Through “likes,” comments, and other engagements, teens report feeling pressured to keep up with friends’ social media posts.⁷ Features within certain apps take advantage of this pressure to keep users hooked. One example is Snapstreaks, a feature on Snapchat that measures how many days in a row a user and a friend have sent Snaps (videos or images) to one another.

It’s not uncommon for personal networks to grow quite large — and even include people or accounts teens don’t know well in person — on social media. (For many tweens and teens, turning down a friend request or hitting the unfollow button is a non-starter.) That said, the larger a user’s personal network of social relations, the more time they spend attending to social obligations and managing their profiles.¹⁴ The more time spent on social media, the greater the chances of being exposed to ads and other content – some of which may not be for the best.

Teens “Lurk”

Social comparison is a normative aspect of adolescent development, and it happens equally in school hallways and online. As teens scroll their feeds, they’re trying to figure out who they are in relation to what they see – whether they’re smart enough, beautiful enough, tall enough, funny enough, and so on. It’s common for teens to “lurk,” or passively observe posts without interaction (e.g., “liking”, commenting) — a practice of comparison associated with social anxiety, envy, and low self-esteem.^{15 16} At the same time, some comparison via social media may allow teens to learn about and relate to others in productive, positive ways.⁹

How to Approach Your Teen’s Technology Use and Social Media Habits

1. Watch for Warning Signs

Many parents wonder whether their child is “addicted” to social media. No consensus exists on what constitutes problematic social media use, but many researchers rely on a tool developed to screen for problematic and risky Internet use that asks the following questions: How often do you…

• …experience increased social anxiety due to your Internet use?
• …feel withdrawal when away from the Internet?
• …lose motivation to do other things that need to get done because of the Internet?

In addition to the above, consider the following questions to help you understand social media’s effect on your teen: Does your child…

• …get extremely upset or violent when asked to get off their device?
• …skip their daily tasks (eating, homework, extracurriculars, bedtime) because they prefer to be on social media?
• …feel like they can’t have normal interactions without the Internet?

If you are unsure how to decipher your teen’s emotions and behaviors, a therapist can help you understand what is inside and outside the bounds of typical adolescent development, as well as the possible impact of any existing conditions, like ADHD.

2. Understand Your Teen’s Motivations

What does your child actually do online? You don’t have to know all the answers, but understanding the quality of the content your teen consumes is much more important than an exact count of the quantity.

Your teen might be engaged in healthy conversation about homework and school, for example, while online gaming with friends.

It also helps to experience for yourself the platforms and apps your teen is using to understand the attraction. You may be able to find your child’s profile, too, and get a sense of what they do.

3. Pay Attention to Your Child’s Interactions

How many people/accounts does your child follow? How many friends do they have on each? Do they follow lots of celebrities (which is associated with increased likelihood of having depressive symptoms and online social anxiety)?¹⁰ No specific number should raise concerns, but following hundreds of accounts should raise questions. Remember that large networks may mean more social obligations, which may make your teen more likely to check social media frequently and experience anxiety over keeping up with friends and “performing” friendship.⁷

4. Have Ongoing Conversations About Online Experiences

Whether your adolescent just got a smartphone or has been on social media for a while, talking about online experiences can help them be mindful of their social media use and its effects on them. (If you don’t feel comfortable having these conversations with your child, ask another family member for help.)

• Just as you ask your child about their friends and acquaintances IRL, be curious about online friends and happenings.
• Try co-viewing your child’s social media feed, especially if they start feeling negatively about what they’re seeing. Your child might be able to point out what kinds of posts are causing their dissatisfaction. It’s OK to teach and reassure your child to unfollow, hide, or unfriend accounts and people that don’t make them feel good.
• Teens want privacy, and that’s OK. Older teens especially may have a “clean” profile for family members, schools, and future employers to see, and a second, private account where they can show their authentic selves to friends. Usually, these second accounts are innocent and silly, so don’t assume the worst.
• Check your reactions. Avoid judgmental, disproportionate responses when your child comes to you with a social media-related issue. Often, tweens and teens will keep things to themselves, afraid that their parents will tell them to deactivate their social media profiles or take away their devices altogether at the first hint of a problem. Should an issue come up, approach with curiosity and collaborate with your teen on a solution.

Social Media and Mental Health in Teens: Next Steps

• Free Download: Too Much Screen Time? How to Regulate Your Teen’s Devices
• Read: “Did I Really Just Post That?!” The Social Media Guide for Teens
• Read: Compare & Despair – Social Media & Mental Health Concerns in Teens with ADHD

The content for this article was derived, in part, from the ADDitude Mental Health Out Loud episode titled, “The Mental Health Fallout from Social Media Use” [Video Replay and Podcast #416] with Linda Charmaraman, Ph.D., which was broadcast live on August 16, 2022.

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Sources

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² Wells, G., Horwitz, J., Seetharaman, D. (2021) Facebook knows instagram is toxic for teen girls, company documents show. The Wall Street Journal. https://www.wsj.com/articles/facebook-knows-instagram-is-toxic-for-teen-girls-company-documents-show-11631620739

³ Social Media Victims Law Center. Meta lawsuit. https://socialmediavictims.org/meta-lawsuit/

⁴Social Media Victims Law Center. Tiktok lawsuit. https://socialmediavictims.org/tiktok-lawsuit/

⁵ Social Media Victims Law Center. Snapchat lawsuit. https://socialmediavictims.org/snapchat-lawsuit/

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⁹ Charmaraman, L. Doyle Lunch, A., Richer, A., Zhai, E. (2022) Examining early adolescent positive and negative social technology behaviors and well-being during the covid-19 pandemic. Technology in a Time of Social Distancing, 3(1). DOI: 10.1037/tmb0000062

¹⁰ Charmaraman, L., Richer, A. M., Liu, C., Lynch, A. D., & Moreno, M. A. (2021). Early Adolescent Social Media-Related Body Dissatisfaction: Associations with Depressive Symptoms, Social Anxiety, Peers, and Celebrities. Journal of developmental and behavioral pediatrics : JDBP, 42(5), 401–407. https://doi.org/10.1097/DBP.0000000000000911

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