I’m in the middle of teaching a course for Kansas Child Care Training Opportunities (KCCTO) on behalf of ADHDKC, Kansas City’s CHADD Chapter. It’s been such a powerful reminder of why early childhood education matters so much in the ADHD conversation.

I’m not a teacher (unless you count physicians as teachers — which, in many ways, we absolutely are), so you might wonder how I ended up teaching this course. A few years ago, KCCTO invited ADHDKC to create a class specifically for preschool teachers: a way to help them understand ADHD, recognize early signs in young children, and use simple, practical strategies that support all learners. And honestly, that last part is one of my favorite truths about ADHD education — anything that helps a child with learning or behavioral differences usually ends up helping the entire classroom.

As I’ve been teaching, I keep coming back to one big thought: we don’t talk nearly enough about ADHD in preschoolers. Many people don’t realize that children this young can be diagnosed — or that early recognition can make a meaningful difference. Yes, plenty of preschool behaviors are developmentally normal. But when something feels “more than expected,” it’s worth paying attention. Early identification leads to earlier support, and earlier support leads to better long‑term outcomes for kids at home and at school.

This article is my way of opening that conversation. Let’s explore what ADHD can look like in preschoolers, why early recognition matters, and how small shifts in understanding can change a child’s entire trajectory.

The Most Important Thing to Know

If your preschool-age child (ages 4–5) is struggling with extreme hyperactivity, impulsivity, or difficulty paying attention, getting an evaluation is the most important step you can take to learn if their behaviors are outside the typical behaviors for this age group.

Many parents worry that their child is “too young” for a diagnosis or that treatment means putting a small child on medication. But here is what the research shows: not getting help carries far greater risks than getting it — and for preschoolers, the first step in treatment is not medication, so no need to worry that they’ll be put on medication right away.

Why “Waiting It Out” Is Not the Safe Choice

It is natural to hope your child will simply grow out of it. But when a preschooler truly has ADHD, the challenges do not go away on their own. They may suffer several consequences, such as:

• Preschool expulsion: Children with ADHD are at significantly higher risk of being expelled from preschool and childcare settings, which removes them from structured learning and socialization at a critical age.

• Falling behind before school even starts: By the time a child with untreated ADHD enters kindergarten, they may already be behind their peers in learning readiness, self-regulation, and social skills — a gap that only widens over time.

• Damage to self-confidence: Even at age 4 or 5, children know when they are constantly getting in trouble or being separated from other kids. This early pattern of failure can cause lasting harm to how they see themselves.

• Safety: Preschoolers with ADHD are more impulsive and have a significantly higher risk of injuries — falls, burns, and poisonings — than other children their age.

• Worsening behavior: Without support, ADHD-related behavior problems can escalate into more serious defiance and aggression, making it harder for your child to succeed in any setting.

• Challenging family dynamics: The entire family system is affected by persistent disruptive behaviors. Parental mental health, the couple relationship, sibling well-being, and family finances can all be impacted. The effects are bidirectional: the child's behavior worsens family functioning, and deteriorating family functioning in turn amplifies the child's symptoms.

• Financial strains: ADHD significantly affects parental employment and productivity in addition to direct costs of medical care.

It can be tempting to use the wait-and-see approach. After all, you’re not doing anything other than see if they mature and behaviors improve, right? Unfortunately, choosing not to act is not a neutral decision. It is a decision that has consequences for your child.

Treating Preschoolers Diagnosed with ADHD

For Preschoolers, Treatment Starts With Parent Training — Not Medication

This is one of the most important things for parents of young children to understand: the recommended first treatment for preschool ADHD is behavioral parent training, not medication. This is the strongest recommendation from the American Academy of Pediatrics.

Behavioral parent training (sometimes called “parent management training” or programs like Parent-Child Interaction Therapy) teaches you practical, proven strategies to:

• Set clear expectations and consistent routines

• Respond effectively to difficult behaviors

• Strengthen your relationship with your child

• Help your child develop self-control

These programs are typically offered in group settings and are relatively low cost. They work — and they work well. Research shows that many preschoolers improve significantly with parent training alone, without ever needing medication.

When Is Medication Considered, What is Recommended and What are the Risks?

Medication is only considered for preschoolers when:

• Behavioral parent training has been tried and has not provided enough improvement

• Your child’s symptoms are moderate to severe

• The difficulties have lasted at least 9 months and are present in more than one setting (home and preschool/childcare)

If medication is needed, methylphenidate (a stimulant) is the recommended option for this age group because it has the most evidence for safety and effectiveness in young children. It is started at a very low dose and increased slowly, because young children process the medication more slowly than older kids.

Common side effects in preschoolers are similar to those in older children — decreased appetite, trouble sleeping, and sometimes irritability or emotional sensitivity. These are monitored closely and the medication can be adjusted or stopped at any time.

What a Diagnosis Does for Your Child

A diagnosis is not a label — it is a key that unlocks help:

• It qualifies your child for early intervention services and special education support

• It helps preschool teachers understand your child’s behavior and provide appropriate accommodations

• It gives you access to evidence-based parent training programs

• It allows your child’s doctor to create a treatment plan tailored to their needs

Without a diagnosis, your child may be seen as “bad” or “difficult” rather than as a child who needs support. A diagnosis changes that story.

Putting the Risks Side by Side

Getting an evaluation and starting parent training means investing time and effort in learning new strategies — with no medication side effects and strong evidence of benefit.

Not getting help means accepting a growing risk of preschool expulsion, falling behind academically, damaged self-esteem, escalating behavior problems, and injuries — risks that become harder to reverse the longer you wait.

The real question is not “Is my child too young for help?” — it is “Can my child afford to wait?”

Common Concerns

• “Isn’t this just normal preschool behavior?” — All preschoolers can be active and impulsive. But when the behavior is significantly more extreme than other children the same age, is present in multiple settings, and is causing real problems, it may be ADHD. An evaluation can tell the difference.

• “I don’t want my child on medication at this age.” — That is completely understandable, and the guidelines agree with you. Medication is not the first step for preschoolers. Parent training comes first, and many children do well without medication.

• “Will a diagnosis follow my child forever?” — A diagnosis is a medical tool, not a permanent record. It helps your child get the support they need now. As your child grows, the treatment plan will be adjusted based on how they are doing.

The Bottom Line

Your child’s early years are a window of opportunity. The brain is developing rapidly, and the right support now can change the entire course of your child’s life. Waiting and hoping is not the safe choice — it is the risky one.

For preschoolers, treatment starts with parent training, not pills. But it can only start if you take the first step: getting an evaluation.

Talk to your child’s doctor. Ask every question you have. You are not failing your child by seeking help — you are fighting for them.

For a look at how ADHD can look across the ages, see my pinned post:

For many parents of children with ADHD, one of the most confusing and exhausting experiences is this:

Your child has a massive meltdown over what seems like a minor issue:

• being told no —> challenge the answer, yell that you don’t understand, run upstairs and slam their door

• losing a game —> blame a teammate and the refs, avoiding all blame themselves and accusing them of being awful and the season is ruined because of them or take the full blame because they missed a minor play and feel that they’re no good and let the whole team down so they should quit the sport all together

• a sibling touching their things —> yell at them and say hurtful things

• a change in plans —> sudden anger, accusing a person that they don’t care about their feelings because they feel the change is directed at them rather than the situation

Then later?

They seem calm. Sometimes they may even deny how intense it was.

You may hear:

• “I didn’t yell.”

• “You were the one yelling.”

• “I didn’t do that, it wasn’t that bad.”

• “I didn’t say that.”

To parents, this can feel manipulative, dishonest, or even gaslighting. Gaslighting is a manipulative tactic designed to make you question your reality, memory, or perceptions. But in many children with ADHD, this often isn’t intentional deception. That’s an important distinction.

Their brain may genuinely process and encode the experience differently during emotional overload.

ADHD Is More Than Attention — It’s Also Emotional Regulation

Our understanding of ADHD is growing, and hopefully one day the emotional dysregulation associated with it becomes officially recognized and part of the diagnostic criteria.

ADHD affects the brain’s executive functioning systems, especially the prefrontal cortex—the area responsible for:

• Impulse control

• Emotional regulation

• Decision-making

• Self-monitoring

• Working memory

When children with ADHD become emotionally overwhelmed, their prefrontal cortex can essentially “go offline.” At that point, the brain’s more primitive emotional systems — especially the amygdala — take over. I use animals to help kids understand this and encourage you to detour to a recent post to learn more.

What Happens During an Emotional Explosion?

Think of it like this:

The amygdala (alarm system - watchdog):

• Detects threat, frustration, or perceived injustice

• Activates fight, flight, or freeze

The prefrontal cortex (thinking brain - wise owl):

• Helps pause

• Adds perspective

• Regulates reactions

• Supports memory organization

The hippocampus (memory - the elephant):

• Stores memories and uses them to give context to a situation

In ADHD, emotional intensity can trigger the amygdala faster and harder, while the prefrontal cortex struggles to keep up. The hippocampus retrieves and stores distorted memories.

This creates:

• Bigger reactions

• Poor impulse control

• Distorted interpretation

• Difficulty remembering events accurately afterward

Why They May Truly Remember It Differently

During extreme emotional states, the brain is focused on survival, not accurate memory recording.

Stress hormones like cortisol and adrenaline can impair:

• Working memory

• Self-awareness

• Sequencing of events

• Interpretation of tone

So when your child later insists:

• “You were the one yelling!”

• “I barely did anything!”

• “I don’t know why you’re so upset!”

…it may not be calculated lying. They’re not necessarily being manipulative.

Their nervous system may have encoded the event through a lens of emotional threat.

In other words:

If they felt attacked, overwhelmed, or unsafe internally, their memory may prioritize that emotional experience over objective details. They don’t remember the situation like you do. Their emotions alter how they store the memory, so that’s what they remember. They’re not lying or trying to gaslight you.

This Can Be Incredibly Frustrating for Parents

Remaining calm while your child escalates can still lead to accusations that you were the problem.

This disconnect can leave parents feeling:

• Invalidated

• Manipulated

• Emotionally drained

• Resentful

Understanding the neuroscience doesn’t erase the challenge — but it can shift the interpretation.

Your child may not be trying to rewrite reality.

They may have experienced it through a dysregulated brain.

Why “Little Things” Feel So Big

Children with ADHD often have:

1. Lower frustration tolerance

Small disappointments can feel neurologically enormous.

2. Rejection sensitivity

Correction may feel like personal failure.

3. Delayed regulation skills

Their emotional age may lag behind chronological age.

4. Sensory or cognitive overload

Fatigue, hunger, transitions, and overstimulation amplify reactions.

What Parents Can Do

1. Regulate Yourself First

Your calm nervous system is one of the most powerful tools.

Even when accusations feel unfair, your regulation helps model safety.

2. Address Behavior Later

During a meltdown, logic often won’t work.

Wait until the brain is calm before discussing:

• What happened

• Better choices

• Repair

3. Avoid Power Struggles About Memory

Arguing “Yes you did!” can intensify defensiveness.

Instead try:

• “I understand that’s how it felt to you.”

• “Your feelings were real, and some hurtful things happened too.”

4. Build Emotional Vocabulary

Help children recognize:

• Frustration

• Disappointment

• Embarrassment

• Sensory overload

The better they can identify emotions, the less explosive those emotions often become.

5. Consider Professional Support

ADHD-informed therapy, parent coaching, emotional regulation training, and appropriate medical care can significantly improve outcomes.

Recovery Is About Skill Building, Not Punishment

These children often feel ashamed after outbursts—even if they don’t fully process them.

What they need most is:

• Structure

• Co-regulation

• Consistency

• Accountability with compassion

This does not mean that they can do whatever they please. It means if you stop to consider what the underlying reason behind the behavior is, you can help support them to lessen future big reactions like this.

The Big Picture

Your child’s explosions are not “bad behavior.” They may reflect a nervous system that becomes overwhelmed quickly and struggles to regain control.

Their later minimization may not be dishonesty. It may be neuroscience.

Understanding this can help parents shift from asking:

“Why are they doing this to me?”

to:

“Why is their brain struggling to manage right now?”

That shift doesn’t remove boundaries.

But it often creates more effective, compassionate parenting.

Final Thought

Parenting a child with ADHD can be emotionally exhausting, especially when their reactions seem disproportionate and confusing.

But beneath those explosive moments is often a child whose brain is processing stress differently, not maliciously.

With knowledge, support, and nervous system-informed strategies, families can move from chaos toward connection.

Your child may not yet have the tools to regulate their storms.

But with your support, they can learn.

An Invitation to Learn with Me

Each month I teach skills like this to tweens, teens, and parents at the Kansas City CHADD chapter, ADHDKC’s “teen” event for middle and high schoolers. Join me as we talk about various issues related to ADHD and how to manage them. It’s not a boring lecture - no kid can sit through an hour talk in the evening. It’s interactive and kids can engage as much or as little as they feel like participating. This and all of the ADHDKC events are free.

In addition to the ADHDKCTeen events, the ADHDKC Parent Group offers monthly speaker-led events where you can learn from experts about various aspects related to ADHD and the new Book Club is a place to read and discuss ADHD books with others in an online community.

ADHDKC Events

I am also one of the TEACH Me ADHD team. We offer classes with fun themes for kids 8-12 years of age with their parents and workshops for teens. You can get on the Wait List now to be among the first to know of new TEACH Me ADHD offerings and get discounted rates.

TEACH Me ADHD Classes

This is the final part of a 3 part series on migraines. If you missed parts 1 and 2, they hold important basic information, so please review them.

For many girls, the start of puberty is also the start of more frequent, more severe migraines. This isn’t a coincidence — estrogen (the main female hormone) is one of the most powerful regulators of how sensitive the brain is to migraine triggers. When estrogen levels shift during the monthly cycle, they create predictable windows when migraines are much more likely. Recognizing this pattern is the first step to managing it.

A true "menstrual migraine" occurs in the 2 days before through 3 days after the start of the period — and it tends to arrive without the visual warning signs (called aura — things like seeing zigzag lines or blind spots) that some migraines have. It also tends to last longer and be harder to treat than migraines at other times of the month.

Tracking: making the pattern visible

The most useful thing a teen can do is track both her migraines and her cycle together for 2–3 months. Patterns that feel random and unpredictable often become clear once written down side by side. A simple notebook, a notes app, or a period-tracking app all work well.

Track for each headache

• Date, start and end time

• Severity (1–10)

• Cycle day (Day 1 = first day of period)

• Medications taken — did they help?

• Missed school or activities

Also note each day

• Hours of sleep the night before

• Meals skipped or eaten late

• Stress level (low / medium / high)

• Other symptoms (mood changes, bloating, fatigue)

For many teen girls, identifying the hormonal pattern is genuinely relieving. It transforms what felt like random, uncontrollable headaches into something predictable and manageable. That shift in understanding is often a therapeutic first step and allows targeted strategies to be used.

Management strategies

1. Anti-inflammatory medicines around the period: Taking ibuprofen or naproxen (anti-inflammatory pain relievers available over the counter) starting 1–2 days before the expected period and continuing for 3–5 days can often prevent period migraines from developing in the first place — rather than treating them after they start. This works best when the cycle is regular enough to predict timing, which is another reason tracking is valuable.

2. Triptans used preventively around the period: Triptans are prescription medicines specifically designed for migraine (such as rizatriptan or sumatriptan). For teens whose period migraines are predictable and severe, a triptan can be taken at the start of the high-risk window as a short-course prevention strategy — rather than waiting for a migraine to begin. This targeted approach avoids the need for daily medication.

3. Continuous birth control pills*: Standard birth control pill packs include a week of inactive (placebo) pills, during which estrogen drops — triggering both a withdrawal period and often a migraine. Taking the active pills continuously, without that placebo week, keeps estrogen levels steady and can eliminate period migraines entirely for some teens. This is worth discussing when migraines are clearly tied to the cycle and significantly affecting daily life. It requires a full conversation with your provider about whether it’s the right fit.

4. Extra attention to lifestyle basics in the pre-period week: In the week before the period, the brain’s migraine threshold is already lower due to falling hormone levels. That means the usual triggers — a skipped meal, a late night, extra stress — hit harder than they would at other points in the cycle. Being especially consistent with sleep, meals, hydration, and stress management during this window can make a difference.

*Important — migraine with aura and estrogen-containing birth control: Some people experience an "aura" before a migraine — warning signs like seeing zigzag lines, flashing lights, or temporary blind spots, or feeling tingling or numbness. If one has migraines with aura, combining estrogen-containing birth control (like most combined pills) with those migraines increases the risk of stroke — a serious blockage of blood flow to the brain. Teens with migraine with aura should generally use progesterone-only or non-hormonal contraception instead. Always tell your provider whether your migraines include aura symptoms before any hormonal contraception is prescribed.

Coping Skills

Although using the tips above can help manage hormonally driven migraines, it’s important to use relaxation and coping skills also. Get your free download of the relaxation and coping worksheets I created here.

Relaxation & Coping Skills

Our next ADHDKCTeen monthly event is June 2nd, and we’ll be talking more about impulsivity.

📅 Tuesday, June 2nd | ⏰ 5:30 PM CST | TIME ZONE CONVERTER

💻 Online via Zoom | 💸 FREE for all Middle and High School Students (10 - 18 years and their parents)

Learn More & RSVP

Middle and high school can feel overwhelming when your brain seems to move faster than your ability to hit pause.

Do you ever:

• Act before thinking and regret it later?

• Struggle to stop gaming, scrolling, or procrastinating?

• Make risky choices in the moment even when you know better?

• Feel like your brain wants one thing, while your goals need something else?

If so, you’re not alone — and you’re definitely not broken.

Join ADHDKCTeen for an engaging, interactive online event designed specifically for middle and high school students to better understand impulsivity, ADHD, motivation, and how to make safer, smarter choices.

These events are part of the Kansas City CHADD Chapter’s free monthly event series. The ADHDKCTeen group is for middle and high schoolers, but older elementary aged students are welcome to join with a parent if the parent feels it is appropriate for them. Whether you’ve been before or this would be your first time, you’re welcome to join me!

Learn more & Sign Up

and for parents and adults…

Our ADHDKC Parent Group holds monthly speaker events to share information and tips from a variety of professionals to help navigate raising complex kids. These are online so anyone can join.

We also have small discussion support groups for adults and women that are held in person in the KC Metro area.

All ADHDKC events are free and open to the public. I invite you to join any of the events that interest you.

ADHDKC Event Page

Before I dive into headaches and their friends, anxiety and ADHD, I want to suggest that you scroll to the bottom to learn about upcoming talks I’ll be giving to a group for tweens and teens and a parenting summit I’m a part of if you’re not interested in headaches.

Part 1 focus: younger children (ages 6–11)

At this age, parents are the primary managers of all three conditions. The goal is building solid routines and recognizing patterns early — before habits become harder to establish.

Part 2 focus: teens (ages 12-18)

Part 2 covers how migraine patterns change at puberty, the shift toward teen-led self-management, updated treatment options for teens, and how to navigate ADHD, anxiety, and headaches through the high-school years.

Part 3 focus: Hormonal migraines in teen girls

For many girls, the onset of puberty is also the onset of more frequent, more severe migraines. Why this happens and what to do about it will be covered in Part 3.

If you read Part 1, you know how these three conditions connect and what managing them looks like for younger children. If you missed it, you can check it out before continuing. It includes basic migraine information for all ages and focuses on younger kids.

The teenage years change the picture significantly — hormonally, socially, and in terms of who’s in charge of the day-to-day management. This post covers what shifts at puberty, what’s newly available treatment-wise, and how to support a teen in gradually taking ownership of their own health.

Come back next week to focus on hormonal triggers in girls.

How migraine changes at puberty

For many kids who had manageable headaches in elementary school, puberty is when migraines become a more serious problem. Several things happen at once:

• Frequency increases

  • Migraines often become more frequent during adolescence, particularly in girls, as hormonal fluctuations begin with the menstrual cycle. What was once occasional can become a monthly or weekly pattern.

• Pattern shifts toward the adult form

  • Teen migraines start to look more like adult migraines — one-sided throbbing pain, longer duration (4–72 hours), and more pronounced sensitivity to light and sound. The bilateral “whole head” pain of childhood may shift to one side.

• Stress load increases

  • Academic pressure, social complexity, extracurricular demands, and sleep deprivation all peak during the teen years — and all are significant migraine triggers. The conditions that interact with migraine (ADHD and anxiety) are also under greater strain.

• Sleep patterns shift

  • A biological shift in the body clock during puberty pushes teens toward later sleep and wake times. Early school start times work against this, leading to chronic sleep deprivation — one of the most reliable migraine triggers there is.

Migraine is more common in girls than boys after puberty, largely due to the influence of estrogen on the brain's migraine threshold. Hormonal migraines — those tied to the menstrual cycle — are covered in detail in Part 3 of this series.

Treating a migraine when it happens

The same core principle from Part 1 applies here: treat early, within the first hour. Teens often wait too long — either because they’re in school, don’t want to miss an activity, or hope it will pass. It usually doesn’t, and the window for effective treatment closes quickly.

Over-the-counter options

• Ibuprofen — first choice

  • Advil or Motrin. Most effective over-the-counter option. Take as early as possible — ideally within the first hour.

• Acetaminophen — second choice

  • Tylenol. Works, but generally less effective than ibuprofen specifically for migraine.

Prescription options for teens

Several migraine-specific prescription medications (called triptans) are FDA-approved for teens. These work differently from ibuprofen — they target the brain’s migraine pathways directly rather than reducing inflammation.

• Rizatriptan (tablet or dissolving strip) Ages 6+

• Sumatriptan/naproxen combination tablet Ages 12+

• Zolmitriptan nasal spray Ages 12+

• Almotriptan tablet Ages 12+

Limit all relief medications to no more than 6 days per month — including over-the-counter options. Using them more frequently can cause medication overuse headache, where the medication itself starts triggering a cycle of more frequent headaches. This is more common in teens than many people realize.

Lifestyle foundations

The same habits that mattered in childhood matter more than ever now — but the dynamic shifts. Parents can no longer control a teen’s sleep schedule, meals, or screen time the way they could for younger kids.

The goal becomes supporting a teen in building these habits for themselves, with the understanding that each one helps all three conditions simultaneously.

• Sleep

  • 8–10 hours nightly. This is not negotiable.

  • Consistent schedule — even on weekends, try not to vary by more than 1–2 hours

  • No screens for 1 hour before bed

  • No caffeine after noon

  • Dark, cool room

• Meals and hydration

  • Never skip meals — especially breakfast

  • Keep snacks accessible at school

  • Water throughout the day

  • Limit caffeine — too much triggers migraines, and withdrawal does too

  • Alcohol is a reliable migraine trigger (and not legal for teens, but many partake, so even if you don’t think your teen drinks alcohol, talk about the added risk with migraines)

• Exercise

  • 30–60 minutes most days

  • Regular exercise prevents migraines and improves both ADHD and anxiety

  • Warm up gradually — sudden intense exertion can itself trigger a headache

• Stress and screens

  • Break every 20–30 minutes during screen use

  • Blue light filters in the evening

  • Balance academics, activities, and downtime deliberately

  • Identify personal stress triggers — not just situational ones

  Relaxation & Coping Skills Worksheets

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Supplements for migraine prevention

The same supplements recommended for younger children are appropriate for teens, at slightly higher doses. They should be taken daily and given 3–4 months before assessing effect. They’re safe to combine with ADHD and anxiety medications.

• Riboflavin (vitamin B2): Best evidence

  • 200–400 mg once daily. Urine will turn bright yellow — this is expected and harmless, not a reason to stop.

• Magnesium

  • 200–400 mg daily, divided into 2–3 doses. Magnesium oxide or citrate are commonly used forms. Reduce the dose if stomach upset or loose stools occur.

• Coenzyme Q10 (CoQ10)

  • 100–300 mg daily. Generally well tolerated with few side effects.

• Melatonin

  • 3 mg at bedtime, 30–60 minutes before the desired sleep time. Most useful when sleep difficulties are contributing to headache frequency — which is common in teens.

• Vitamin D

  • 1,000–2,000 IU daily. Higher doses may be required if there is documented deficiency, but insurance often doesn’t cover testing.

A commonly used starting combination: riboflavin + magnesium + CoQ10. All three can be taken together and alongside ADHD and anxiety medications.

Behavioral therapies

Behavioral therapies are highly effective for all three conditions and are particularly well suited to the teen years, when the ability for self-reflection and independent skill-building is stronger than in childhood. Unlike medications, the skills learned in therapy don’t wear off.

• Cognitive behavioral therapy (CBT)

  • CBT teaches teens to recognize and shift unhelpful thought patterns around pain, anxiety, and academic pressure — and to respond to triggers differently. Research shows that CBT combined with other treatments outperforms medication alone for both migraine and anxiety. For teens who prefer flexibility or privacy, app-based and digital CBT programs are increasingly available and can be effective on their own or as a complement to in-person sessions.

• Relaxation training

  • Deep breathing, progressive muscle relaxation (intentionally tensing then releasing different muscle groups from head to toe), and guided imagery. The goal is building a daily practice — not just a tool to reach for during a headache. Many well-designed apps support this and fit naturally into a teen’s routine.

• Biofeedback

  • Uses sensors to help teens learn to recognize and control physical stress signals — like muscle tension or hand temperature — before they escalate into a migraine. Often requires visits to a specialized clinic to learn, but once the skills are learned they can be used anywhere, at any time.

• Mindfulness

  • Mindfulness practices — paying deliberate, non-judgmental attention to the present moment — have solid evidence for reducing both migraine frequency and anxiety. They also support focus, which benefits ADHD. Many teens find mindfulness more accessible than formal therapy, particularly through apps or short daily exercises.

ADHD medication and headaches in teens

Stimulant medications — like methylphenidate (Ritalin, Concerta) or amphetamine-based medications (Adderall, Vyvanse) — are the most effective treatments for ADHD and are safe to use alongside migraine management. A few things are worth knowing specifically for this age group.

The most common reason headaches increase after starting or adjusting an ADHD medication is skipped meals. Stimulants suppress appetite, and teens who aren’t hungry often skip lunch entirely — which then triggers a headache by mid-afternoon. The fix is to be consistent: eat breakfast before the morning dose, keep snacks accessible, and drink water throughout the school day.

The teen years are also when more of the medication management shifts to the teen themselves — which matters for headache prevention too. Inconsistently taking medication, stopping and restarting it, or taking it on an irregular schedule can disrupt sleep and appetite patterns in ways that make both ADHD and migraines harder to manage.

• For parents to support

  • Keep the medicine accessible and visible at home so it’s easy to take consistently

  • Watch for appetite suppression leading to skipped meals, especially lunch

  • Notice if headaches cluster on school days vs. weekends — timing can point to the cause

  • Encourage open conversations about side effects rather than silent stopping

• For teens to own

  • Take medication consistently — irregular use disrupts appetite and sleep rhythms

  • Be honest with your doctor about side effects, including headaches

  • Track whether headaches seem tied to medication timing or skipped meals

  • Understand how your medication affects your appetite and plan meals around it

School accommodations

Teens with ADHD, anxiety, and/or migraine often qualify for a 504 Plan or Individualized Education Program (IEP). These are formal agreements that put specific supports in place — and they become more valuable, not less, as academic demands increase through high school.

• For ADHD

  • Extended time on tests and assignments

  • Preferential seating

  • Permission to use a laptop for notes

  • Breaks during long tests or classes

  • Access to teacher notes or outlines

  • Check-ins with a counselor or advisor

• For migraine

  • Permission to go to the nurse at headache onset

  • Medication kept at school with documentation

  • Quiet space to rest during an attack

  • Permission to wear sunglasses indoors if light-sensitive

  • Access to water and snacks throughout the day

  • Makeup work and deadline flexibility after absences

• For anxiety

  • Extended time on tests

  • Advance notice of presentations or major tests

  • Alternative, quieter testing location

  • Permission to step outside briefly when overwhelmed

  • Counselor check-ins

Self-advocacy: a skill worth building now

One of the most valuable things a teen can develop during high school — before heading into college or work — is the ability to advocate for themselves. This means understanding their own conditions well enough to explain what they need and following through when accommodations aren’t being honored.

1. Understand your own conditions — what triggers your migraines, how ADHD affects your focus, what anxiety feels like for you specifically.

2. Know which accommodations actually help you, and be able to explain why. “I need extended time because when I’m anxious I read questions three times before I can process them” is more effective than just citing a diagnosis.

3. Attend your 504 or IEP meetings and share your perspective directly. Schools respond differently when the teen is present and engaged, not just the parents.

4. Speak up if accommodations aren’t being followed. Knowing that you have the right to ask — and how to do it respectfully — is a skill that transfers well beyond school.

When to reach out to your provider

Contact your teen’s doctor if:

• Migraines are happening more than 4–6 times per month

• Headaches are getting worse or changing in character

• Current treatments haven’t helped after 3–4 months

• Significant school or activities are being missed

• New symptoms appear: vision changes, weakness, or confusion

• Anxiety or depression seems to be worsening

• Your teen mentions thoughts of self-harm — seek help immediately

As teens move through high school, they'll take increasing responsibility for their own health — keeping track of symptoms, communicating with providers, managing medications, and practicing the habits that keep all three conditions in check. The goal of treatment at this age isn't just fewer headaches. It's building the self-awareness and skills to manage their health independently as they move into adulthood.

Up next · Part 3: Hormonal migraines in teen girls: understanding the cycle, tracking patterns, and what to do about it

Part 3 takes a close look at why migraines so often worsen with the menstrual cycle, how to spot the pattern, and the range of management options — from timed ibuprofen to hormonal approaches — along with important safety considerations.

🗓️ Invite Your Tween or Teen To Join Me

Our next ADHDKCTeen monthly event is June 2nd, and we’ll be talking more about impulsivity.

📅 Tuesday, June 2nd | ⏰ 5:30 PM CST | TIME ZONE CONVERTER

💻 Online via Zoom | 💸 FREE for all Middle and High School Students (10 - 18 years and their parents)

Learn More & RSVP

Middle and high school can feel overwhelming when your brain seems to move faster than your ability to hit pause.

Do you ever:

• Act before thinking and regret it later?

• Struggle to stop gaming, scrolling, or procrastinating?

• Make risky choices in the moment even when you know better?

• Feel like your brain wants one thing, while your goals need something else?

If so, you’re not alone — and you’re definitely not broken.

Join ADHDKCTeen for an engaging, interactive online event designed specifically for middle and high school students to better understand impulsivity, ADHD, motivation, and how to make safer, smarter choices.

These events are part of the Kansas City CHADD Chapter’s free monthly event series. The ADHDKCTeen group is for middle and high schoolers, but older elementary aged students are welcome to join with a parent if the parent feels it is appropriate for them. Whether you’ve been before or this would be your first time, you’re welcome to join me!

Learn more & Sign Up

and for parents and adults…

Our ADHDKC Parent Group holds monthly speaker events to share information and tips from a variety of professionals to help navigate raising complex kids. These are online so anyone can join.

We also have small discussion support groups for adults and women that are held in person in the KC Metro area.

All ADHDKC events are free and open to the public. I invite you to join any of the events that interest you.

ADHDKC Event Page

📣 For Parents: The Parenting Your ADHD Kid Summit

Parents — I’m also excited to share that I’ll be presenting on the Animals of the Brain at the upcoming Parenting Your ADHD Kid Summit, hosted by Kristina Manning. This free virtual summit will run May 11th-May 17th, and brings together 35+ top experts sharing strategies to help you create a more peaceful, connected, and thriving home.

I’m especially excited because some of my friends and colleagues will be there too:

• Dr. Nerissa Bauer and Julie Gates from TEACH Me ADHD — they work alongside me teaching kids and parents about ADHD through fun, weekly detective-themed workshops, and also offer courses for teens with a theater theme. They are fantastic.

• Elaine and Diane from Impact Parents — recurring speakers in our ADHDKC Parent Group events and powerful voices for parents navigating the ADHD journey.

Plus more than 35 additional parenting experts covering everything from executive function to family dynamics to self-regulation.

Those who attend will gain access to a workbook I developed for kids about the Animals of the Brain — the same framework we covered in this talk — along with many other free downloads from summit speakers.

Save your spot here: Parenting Your ADHD Kid Summit

Save Your Spot for the Summit

Headaches, ADHD, anxiety…

As a pediatrician, I see a lot of children who carry more than one of these diagnoses. That’s not bad luck — it reflects how these three conditions are genuinely connected in the brain. In this three-part series, I’ll explain what that connection means, and what you can actually do about it at each stage of your child’s development. Don’t miss the free 7-page worksheet of relaxation and coping skills to use with your child linked below.

Part 1 Focus: Young Children (ages 6–11)

At this age, parents are the primary managers of all three conditions. The goal is building solid routines and recognizing patterns early — before habits become harder to establish.

Part 2 Focus: Teens (ages 12-18)

Part 2 covers how migraine patterns change at puberty, the shift toward teen-led self-management, updated treatment options for teens, and how to navigate ADHD, anxiety, and headaches through the high-school years.

Part 3 Focus: Hormonal Migraines in Teens

For many girls, the onset of puberty is also the onset of more frequent, more severe migraines. Why this happens and what to do about it will be covered in Part 3.

Why these three conditions travel together

Research consistently shows that children with migraine are about twice as likely to also have ADHD or anxiety compared to children who don’t get migraines. When all three are present, headaches tend to be more frequent and harder to treat — which is exactly why treating them together, rather than one at a time, produces much better results.

The connection isn’t coincidence. All three conditions involve differences in the way the brain regulates certain chemical messengers called neurotransmitters and how the body responds to stress.

They feed each other in many ways:

• Anxiety amplifies pain and increases muscle tension.

• Worry and anticipation of headaches can become triggers.

• Pain and missed school from headaches increase anxiety and make focus harder.

• Disrupted sleep from ADHD or anxiety triggers headaches.

• Skipped meals due to weak interoception, medication side effects, or hyperfocus associated with ADHD can trigger headaches.

Breaking one part of that cycle helps all of them.

Prevention methods are recommended when migraines happen more than 4–6 times per month, or when they're causing significant missed school or disrupted daily life.

What migraine looks like in younger children

Migraines in children ages 6–11 often look different from the adult version — which is one reason they get missed or dismissed. Some things to watch for:

• Pain may be on both sides

  • Adults typically have one-sided throbbing pain. In younger children, pain across the whole head or forehead is more common.

• Episodes are shorter

  • Children’s migraines can last as little as 2 hours, compared to the 4–72 hours typical in adults — which can make them easy to brush off.

• Stomach symptoms are prominent

  • Nausea, vomiting, and stomach pain can dominate, sometimes more than the headache itself.

• Children may not describe it clearly

  • Watch for a child becoming pale, withdrawn, or wanting to lie down in a dark room — they may not have words for what they’re feeling.

    ---

Treating a migraine when it happens

The single most important principle at any age: treat early. Waiting until the headache is severe makes treatment significantly less effective. The goal is to treat within the first hour.

• Ibuprofen — first choice

  • Advil, Motrin, or store brand all come in liquid, chewable, and swallow capsules. Follow package directions based on weight. This is the most effective over-the-counter option for children’s migraines. Give it as early as possible.

• Acetaminophen — second choice

  • Tylenol or store brand all come in liquid, chewable, and swallow capsules. Follow package directions based on weight. Acetaminophen is effective, but generally less so than ibuprofen for migraine.

• Rizatriptan — available by prescription only

  • If over-the-counter medicines aren't working, the prescription option available for children as young as age 6 is rizatriptan — a medication specifically designed for migraine. Ask your child's doctor if this may be appropriate.

Whether using ibuprofen, acetaminophen, or a prescription medication, limit acute (as-needed) use to no more than 6 days per month. Using pain relief more frequently than this can cause "medication overuse headache" — a rebound effect where the medication itself starts triggering more frequent headaches over time. If headaches are happening more frequently, prevention measures should be taken with the help of your pediatrician.

Lifestyle foundations

Don’t underestimate the power of healthy habits to prevent migraines. These are the highest-yield part of treatment for younger children — and parents are the ones who make it happen. Each of these habits targets migraine, ADHD, and anxiety at the same time, so it’s worth the effort!

• Sleep

  • Ages 6–11 need 9–12 hours nightly

  • Same bedtime and wake time every day, including weekends

  • No screens for 1 hour before bed

  • Calm, dark, cool bedroom

  • A predictable wind-down routine

  • If sleep is problematic, talk to your pediatrician

• Meals and hydration

  • Never skip meals — one of the most common and preventable triggers

  • Breakfast every day

  • At least a small amount of protein at lunch, even if appetite is down

  • Healthy snacks (think mini-meals with a fruit or vegetable and protein)

  • Water throughout the day

  • Limit sugary drinks and caffeine (caffeine can trigger migraines)

• Activity

  • At least 60 minutes of active play most days

  • Sports, dance, or other activities that get activity on the calendar and help with consistency are great, but free play works too — just make sure it happens

• Screen time

  • Break every 20–30 minutes during screen use

  • No screens in the bedroom

  • No screens for at least 1 hour before bed

    ---

Supplements for migraine prevention

These are often the first preventive step I recommend — they have good safety profiles, reasonable evidence in children, and can be started before considering prescription medications.

The key is daily use for at least 3–4 months before assessing whether they’re working. These do not work at the time of a headache — they must be given regularly for months to benefit.

Keep a symptom log to recognize if things are improving with any change.

• Riboflavin (vitamin B2): Best evidence

  • 100 mg twice per day (200 mg total) for children under 40 kg (~ 90 lbs)

  • 200 mg twice per day (400 mg total) for children over 40 kg (~ 90 lbs)

  • Urine may turn bright yellow — this is harmless and expected, not a reason to stop.

  • Dietary sources of riboflavin should also be encouraged. Beef, chicken, pork, fish, dairy products, eggs, fortified grains, nuts, mushrooms, and green vegetables are high in riboflavin.

• Magnesium

  • About 4mg per pound daily, divided into 2–3 doses.

  • Example: a 55-pound (25 kg) child would take roughly 220 mg total, split across the day.

  • Easy calculation: double the weight and give it twice a day.

    • 55 pound child =110mg twice a day, or whatever is closest with the supplement available. If the supplement has 50mg per gummy, give 2 gummies twice a day.

  • Reduce the dose if stomach upset or loose stools occur.

  • Magnesium-rich foods include nuts (almonds, cashews), seeds (pumpkin, chia), leafy greens (spinach, Swiss chard), legumes (black beans, edamame), dark chocolate, avocado, and whole grains.

• Coenzyme Q10 (CoQ10)

  • 100 mg daily for younger children.

  • Well tolerated with few side effects.

  • Although found in food, dietary amounts are often low. CoQ10 (Coenzyme Q10) is found in highest concentrations in organ meats (heart, liver, kidney), fatty fish (salmon, mackerel, sardines), and oils (soybean, canola). Other sources include broccoli, spinach, peanuts, sesame seeds, and poultry.

• Melatonin

  • 1–3 mg at bedtime, given 30–60 minutes before the desired sleep time.

  • Most useful when sleep difficulties are contributing to headache frequency.

  • Sleep habits cannot be ignored because melatonin is given. See above.

• Vitamin D

  • 1,000–2,000 IU daily.

  • Dietary sources are not able to provide sufficient amounts of Vitamin D. Sunlight is a natural source, but can damage skin. Supplementation is recommended for all infants, children, and teens.

A commonly used combination: Vitamin D + riboflavin + magnesium + CoQ10.

Behavioral therapies

Behavioral therapies are among the most effective tools available for all three conditions — and among the most underused.

For younger children, a therapist works closely with parents, who then reinforce the skills at home. Sessions are shorter and use age-appropriate tools like games, stories, and imaginative exercises.

• Cognitive behavioral therapy (CBT)

  • CBT teaches children to recognize and shift unhelpful thought patterns around pain, worry, and difficult situations.

  • For younger children, this looks less like traditional talk therapy and more like play-based activities and storytelling.

  • Parents learn the same techniques so they can reinforce them between sessions.

  • Research shows CBT combined with other treatments works better than medication alone.

• Relaxation training

  • Simple breathing and muscle relaxation exercises adapted for children — “smell the flower, blow out the candle” for deep breathing; tensing and relaxing muscles like a “robot vs. rag doll.”

  • These can be practiced daily at home.

  • The goal is building a habit, not only using it during a headache.

  • Many free apps and videos for children make this accessible and I’ve made a set of worksheets to learn skills. Please use this button to access the free download. It is 7 pages of helpful tools!

Download a free pdf to learn skills

• Biofeedback

  • Uses sensors to help children learn to notice and control physical signs of stress — like muscle tension or skin temperature — that can precede headaches.

  • Often presented as a game to keep younger children engaged.

  • Children as young as 7 can benefit.

  • Once the skills are learned, they can be used anywhere.

ADHD medication and headaches

Stimulant medications — like methylphenidate (Ritalin, Concerta) or amphetamine-based medications (Adderall, Vyvanse) — are the most effective treatments for ADHD and are safe to use in children who also have migraines. Headache is a listed side effect, but it’s usually mild, and children with ADHD have higher baseline headache rates even before any medication starts.

The most common reason headaches increase after starting an ADHD medication is skipped meals — stimulants suppress appetite, and children who aren’t hungry skip lunch or eat very little, which then triggers a headache. The fix is usually straightforward: eat breakfast before the morning dose, pack snacks, and encourage water throughout the school day. If headaches persist, talk with your prescriber about adjusting the dose or trying a different formulation.

School accommodations

Children with ADHD, anxiety, and/or migraine often qualify for a 504 Plan or Individualized Education Program (IEP) — formal agreements with the school that put specific supports in place. Getting these documented early is worth the effort.

• For ADHD

  • Preferential seating near the teacher

  • Extended time on tests

  • Movement breaks

  • Written instructions alongside verbal

  • Reduced or modified homework

  • Daily check-ins with a counselor

• For migraine

  • Permission to go to the nurse at headache onset

  • Medication kept at school (requires documentation)

  • Quiet rest space during an attack

  • Seated away from bright lights or windows

  • Access to water and snacks

  • Makeup work after absences

• For anxiety

  • Check-ins with a trusted adult

  • Advance notice of changes in routine

  • Breaks when overwhelmed

  • Alternative, quieter testing location

  • Permission to use calming strategies in class

To get accommodations in place: ask your child's doctor to document the conditions, then request a meeting with the school in writing. Bring that documentation. Review and update the plan each year as your child's needs change.

When to reach out to your provider

Contact your child’s doctor if:

• Migraines are happening more than 4–6 times per month

• Headaches are getting worse or changing in character

• Treatments haven’t helped after 3–4 months

• Significant school is being missed

• New symptoms appear: vision changes, weakness, confusion

• Anxiety or behavior seems to be worsening

Up next · Part 2

When your child becomes a teen: shifting the approach for ages 12–18

Part 2 covers how migraine patterns change at puberty, the shift toward teen-led self-management, updated treatment options for teens, and how to navigate ADHD, anxiety, and headaches through the high-school years.

🗓️ Invite Your Tween or Teen To Join Me

Our next ADHDKCTeen monthly event is TODAY, May 5th, and we’ll be digging into Movement & Impulse Control — a topic that connects directly to everything we talked about this month (hint: moving your body is one of the best tools for calming that watchdog).

FREE RSVP

These events are part of the Kansas City CHADD Chapter’s free monthly event series. The ADHDKCTeen group is for middle and high schoolers, but older elementary aged students are welcome to join with a parent if the parent feels it is appropriate for them. Whether you’ve been before or this would be your first time, you’re welcome here.

and for parents and adults…

Our ADHDKC Parent Group holds monthly speaker events to share information and tips from a variety of professionals to help navigate raising complex kids. These are online so anyone can join.

We also have small discussion support groups for adults and women that are held in person in the KC Metro area.

All ADHDKC events are free and open to the public. I invite you to join any of the events that interest you.

ADHDKC Event Page

📣 For Parents: The Parenting Your ADHD Kid Summit

Parents — I’m also excited to share that I’ll be presenting on the Animals of the Brain at the upcoming Parenting Your ADHD Kid Summit, hosted by Kristina Manning. This free virtual summit will run May 11th-May 17th, and brings together 35+ top experts sharing strategies to help you create a more peaceful, connected, and thriving home.

I’m especially excited because some of my friends and colleagues will be there too:

• Dr. Nerissa Bauer and Julie Gates from TEACH Me ADHD — they work alongside me teaching kids and parents about ADHD through fun, weekly detective-themed workshops, and also offer courses for teens with a theater theme. They are fantastic.

• Elaine and Diane from Impact Parents — recurring speakers in our ADHDKC Parent Group events and powerful voices for parents navigating the ADHD journey.

Plus more than 35 additional parenting experts covering everything from executive function to family dynamics to self-regulation.

Those who attend will gain access to a workbook I developed for kids about the Animals of the Brain — the same framework we covered in this talk — along with many other free downloads from summit speakers.

Save your spot here: Parenting Your ADHD Kid Summit

Save Your Spot for the Summit

Have you ever snapped at someone and immediately regretted it? Frozen during a test? Sent an angry text and wished you could take it back? Felt your heart race over something that, looking back, wasn’t really a big deal?

If you answered yes to any of those, your brain is working exactly as designed. That doesn’t mean it always feels good. But understanding why it happens is the first step to getting control back.

I recently explored one of my favorite topics at a recent ADHDKCTeen event: the animals of the brain. These are the characters that live inside your head, influencing how you think, feel, and react — often before you even realize it.

Let me introduce them to you.

🦉 The Wise Old Owl — Your Decision Maker

(Frontal Lobe & Prefrontal Cortex)

The owl is your rational brain. It’s the part of you that can pause before reacting, think things through, make a plan, and solve problems. When the owl is online, you can take a breath before firing off a response you’ll regret. You can weigh your options. You can think.

Here’s the catch: the owl is still developing in teens. The frontal lobe doesn’t fully mature until at least your mid-20s. If you have ADHD, it may take even longer. So be kind to yourself. You’re not broken. You’re still building this skill. Even adults can learn.

🐘 The Elephant That Never Forgets — Your Memory Keeper

(Hippocampus)

The elephant stores your memories, especially emotional ones. Its job is to compare what’s happening right now to what’s happened before, and help answer the question: “Is this actually dangerous?”

When things are calm, the elephant is helpful. It might remind you: “This feels stressful, but I’ve handled something like this before.” That context keeps you grounded.

But when things get intense, the elephant gets confused — and that’s where things get messy.

🐕 The Watchdog — Your Alarm System

(Amygdala)

The watchdog is your brain’s built-in security system. It scans for threats 24/7, and when it senses danger — real or imagined — it reacts instantly. No questions asked.

When triggered, your body kicks into full survival mode:

• Heart racing

• Muscles tensing

• Breathing intensifying

• Sweating

• Pupils enlarging

This is your fight, flight, or freeze response — and it’s ancient. It evolved to help your ancestors run from tigers. The problem? Your watchdog can’t tell the difference between a tiger and a math test. Between a physical threat and an unanswered text. It reacts the same way to emotional threats as it does to physical ones.

When the dog barks, something important happens: the owl flies away. The stress chemicals your brain releases actually suppress the prefrontal cortex — your thinking brain goes offline. And when that happens, the elephant gets confused, too. Your memories become unreliable, emotionally charged, and incomplete.

You cannot reason with a barking dog. You have to calm it first.

🐜 The ANTs — Automatic Negative Thoughts

When the watchdog is activated, a swarm of ANTs — Automatic Negative Thoughts — moves in fast. These thoughts feel true. They pile on. And they come in several flavors:

• All-or-Nothing Thinking: “Nobody ever listens to me.” “I always mess things up.”

• Focusing on the Negative: One bad moment ruins an otherwise good day.

• Mind Reading: “She won’t want to hang out with me, so I won’t even ask.”

• The Bully: Telling yourself “I’m stupid” or “I’m no good.”

• Fortune Telling: “I already know this group project is going to be a disaster.”

• The Rule Maker: “I should have done better. I must try harder.” (Often paired with shame.)

• Blaming Others: “The teacher doesn’t explain things right, that’s why I failed.”

Here’s the most important thing about ANTs: they are not facts. They are fast guesses your brain makes when it’s stressed. Just because you think it doesn’t mean it’s true.

🐜➡️🦔 The Anteater — Your Thought Checker

The fix for ANTs is the anteater. Its job is to notice a thought, challenge it, and replace it with something more realistic.

Here’s how it works with an example:

Trigger: You have to give a presentation. ANT: “I’ll embarrass myself.” Feeling: Nervous. Overwhelmed. The dog starts barking. Action (with the ANT in charge): Avoid preparing. Spiral. Do worse.

Now, bring in the anteater:

New Thought: “I can do hard things.” Feeling: Empowered. Hopeful. Action: Prepare. Practice. Perform better.

Training your brain to catch ANTs takes practice — but it genuinely changes how you feel and what you do.

🦊 The Fox — Your Attention Gatekeeper

(Reticular Activating System)

The fox is always scanning your environment, deciding what deserves your attention and what gets filtered out. When the system is calm, the fox helps you see options, stay flexible, and problem-solve.

“They didn’t text back… maybe they’re just busy.”

But when the watchdog is loud, the fox gets stuck — or overwhelmed. It might jump to worst-case thinking, or generate so many possibilities you freeze.

The good news: you can train your fox. Here’s how:

• Set specific, written goals — vague goals don’t give the fox direction

• Use visual reminders — vision boards, planners, routines help the fox know what matters

• Practice mindfulness — being present helps you control your attention

• Use positive affirmations — “I’m not broken. I’m building skills.”

• Make tasks emotionally meaningful — connect boring work to something you care about

• Celebrate small wins — every time the fox pays attention, give it a treat

• Get quality sleep and try HIIT exercise — both are powerful for brain health and focus

🐢 The Turtle — Your Daydreamer

(Default Mode Network)

The turtle is your brain’s quiet, reflective thinker. It’s active when you’re daydreaming, planning, or doing self-reflection. When the system is calm, it’s actually a beautiful thing — creativity, imagination, and self-awareness all live here.

But when the dog starts barking, the turtle shifts gears. It starts scanning for problems. Suddenly, everything feels urgent or threatening. You can’t stop thinking about that one situation. Your attention gets stuck.

To help your turtle:

• Give yourself quiet time to think and reflect

• Use mindfulness or grounding exercises to bring your focus back gently

• Balance active tasks with rest

• Celebrate your creative thinking — it’s a strength, not a flaw

• Remind yourself: “Daydreaming is part of my creativity.”

When the Dog Takes Over: The Amygdala Hijack

Here’s what it looks like when all the animals go haywire at once:

You text a friend: “Hey, are you coming tonight?” It says Delivered. Ten minutes go by. Nothing.

Your watchdog notices something feels off. It starts barking. Your heart rate goes up. Your muscles tighten. The elephant tries to help but pulls up emotionally charged, incomplete memories: “This feels like that time I got left out…”

ANTs start marching in: “They’re ignoring me. They don’t want me there.”

And the owl? Gone. You’re not able to calmly evaluate the situation.

That’s the amygdala hijack — and it can make you send that second text, that regrettable message, that explosive reaction.

Twenty minutes later: “Sorry! Just got out of practice!”

Nothing was wrong at all.

How to Calm the Dog: Three Tools That Actually Work

Tool #1: Breathing Reset

Inhale for 4 counts. Exhale for 6 counts. Repeat 5 times.

The longer exhale tells your nervous system: “We are safe.” Here’s a powerful fact: the intense chemical rush of an emotion only lasts about 90 seconds. If you can breathe through that initial wave, you can prevent a full meltdown.

Tool #2: Grounding (5-4-3-2-1)

• 5 things you can see

• 4 things you can feel

• 3 things you can hear

• 2 things you can smell

• 1 thing you can taste

This pulls you into the present moment — and we don’t worry about right now. We worry about the past and the future. Grounding interrupts that spiral.

Tool #3: Move Your Body

Jumping jacks. A quick walk. Wall push-ups. Shake it out.

Movement burns off adrenaline. You’re literally telling the dog: “We survived. You can stand down.”

A Note for ADHD Brains Specifically

ADHD brains are more susceptible to letting these animals get out of control. The watchdog may bark louder. The owl may take longer to return. Working memory is weaker, which makes it harder to remember your tools in the moment — which is exactly when you need them most.

This does not mean you’re broken.

It means you may need extra support systems: visual reminders of calming techniques, a fidget or worry stone in your pocket, daily affirmations. The more you hear something positive, the more your brain starts to believe it. You have to say the positive things more than the negative ones.

When your brain feels unsafe, it prioritizes speed over accuracy. When your brain feels safe, it can focus on clarity and choice.

🗓️ Invite Your Tween or Teen To Join Me

Our next ADHDKCTeen monthly event is on May 5th, and we’ll be digging into Movement & Impulse Control — a topic that connects directly to everything we talked about this month (hint: moving your body is one of the best tools for calming that watchdog).

FREE RSVP

These events are part of the Kansas City CHADD Chapter’s free monthly event series. The ADHDKCTeen group is for middle and high schoolers, but older elementary aged students are welcome to join with a parent if the parent feels it is appropriate for them. Whether you’ve been before or this would be your first time, you’re welcome here.

and for parents and adults…

Our ADHDKC Parent Group holds monthly speaker events to share information and tips from a variety of professionals to help navigate raising complex kids. These are online so anyone can join.

We also have small discussion support groups for adults and women that are held in person in the KC Metro area.

All ADHDKC events are free and open to the public. I invite you to join any of the events that interest you.

ADHDKC Event Page

📣 For Parents: The Parenting Your ADHD Kid Summit

Parents — I’m also excited to share that I’ll be presenting on the Animals of the Brain at the upcoming Parenting Your ADHD Kid Summit, hosted by Kristina Manning. This free virtual summit will run May 11th-May 17th, and brings together 35+ top experts sharing strategies to help you create a more peaceful, connected, and thriving home.

I’m especially excited because some of my friends and colleagues will be there too:

• Dr. Nerissa Bauer and Julie Gates from TEACH Me ADHD — they work alongside me teaching kids and parents about ADHD through fun, weekly detective-themed workshops, and also offer courses for teens with a theater theme. They are fantastic.

• Elaine and Diane from Impact Parents — recurring speakers in our ADHDKC Parent Group events and powerful voices for parents navigating the ADHD journey.

Plus more than 35 additional parenting experts covering everything from executive function to family dynamics to self-regulation.

Those who attend will gain access to a workbook I developed for kids about the Animals of the Brain — the same framework we covered in this talk — along with many other free downloads from summit speakers.

Save your spot here: Parenting Your ADHD Kid Summit

Save Your Spot for the Summit

Your Challenge This Week

Think of ONE trigger you want to handle better. Write it down. Then write what you’ll do the next time it happens — whether that’s breathing first, using your anteater to check the thought, or moving your body to burn off the adrenaline.

You have more control than you think. Your animals can be trained.

Get a free pdf to print a workbook to use with your kids!

Get Your Workbook

Parenting a child with ADHD comes with unique challenges — but you don’t have to navigate it alone! 💛

I’m thrilled to invite you to the Parenting Your ADHD Kid Summit, where 35+ top experts will share invaluable strategies to help you create a more peaceful, connected, and thriving home.

If you’re ready to stop feeling overwhelmed and start parenting with more confidence and ease, then you won’t want to miss the Parenting Your ADHD Kid Summit!

My friend Kristina Manning has handpicked over 35 experts in ADHD, parenting, and child development for this complimentary summit on:

✔️ Build sensory-smart routines for your ADHD child

✔️ Make informed decisions about ADHD medication

✔️ Use diet and nutrition to support focus and behavior

✔️ Understand how ADHD shows up differently in girls

✔️ Discipline with connection—not yelling, shame, or punishment
… and so much more!

Join us LIVE May 11th-May 17th by signing up today.

Sign Up Today

✨ Meet Some The Expert Speakers! ✨

I’m joining the conversation, along with so many renowned ADHD and parenting experts, including:

🕵🏾 Dr. Nerissa Bauer – Behavioral Pediatrician and Creator of TEACH Me ADHD

🎢 Elaine and Diane – ADHD Coaches and Founders of Impact Parents

🧠 Dr. Cindy Hovington – Neuroscientist and Founder of Curious Neuron

🌿 Vivan Dunstan – Founder of ADHD Support Australia

🎭 Dani Donovan – Author and ADHD Comic Creator

🎯 Dr. Emily King – Child Psychologist and Founder of The Neurodiverse Classroom

🔥Ryan Wexelblatt- Creator of The ADHD Dude!

🌟Alyssa Campbell – Founder of Seed & Sew and Best Selling Author

… and so many more!

You’ll walk away with practical tools to better understand your child, reduce daily struggles, and build a more cooperative, connected relationship.

🔗 Reserve Your Spot Now (Spots are limited!)

Save My Spot

Let’s empower our kids together! I can’t wait for you to join us. 💙

P.S. Know another ADHD parent who’d love this? Share this email and the summit link —because parenting is easier when we have a village! 😊

Share

During this free online event, you’ll learn about:

✅ The Role of Emotional Intelligence in ADHD

✅ Screen Time: Guidelines and Strategies for Parents

✅ Mindfulness for the ADHD Brain

✅ Systems and Tools that Actually Work for ADHD Brains

✅ The Neuroscience behind Emotions

✅ Understanding and supporting your child’s sensory needs

… and so much more!

You don’t want to miss it LIVE May 11th-May 17th!

Save Your Seat

For many parents, one of the hardest decisions after an ADHD diagnosis is when to start treatment.

You may find yourself wondering:

• “Are they too young?”

• “What if this is just a phase?”

• “Should we wait and see?”

• “Maybe this supplement will be enough.”

These are thoughtful, loving questions. But a large recent study published in JAMA Psychiatry (580 ,132 individuals born in Finland between January 1, 1990, and December 31, 1999, followed up until age 20 years) reinforces something clinicians have understood for years:

👉 Earlier diagnosis and appropriate treatment of ADHD lead to better long-term outcomes.
👉 Delaying treatment can increase the risk of ongoing challenges.

ADHD Is Not a Phase

ADHD is a neurodevelopmental condition, not a temporary stage of behavior.

While symptoms may change over time, untreated ADHD often leads to:

• Academic struggles

• Low self-esteem

• Increased anxiety and depression

• Social difficulties

• Risk-taking behaviors in adolescence

When we “wait and see,” what we’re often doing is allowing these patterns to become more deeply established. Even in those who are able to mask outward symptoms and appear to be doing well, internal struggles may grow.

What the Latest Research Shows

The recent large-scale study mentioned above adds to decades of evidence showing that:

• Children who receive earlier treatment have better long-term functioning

• Untreated ADHD is associated with worse outcomes across multiple areas of life

• Delays in treatment can compound difficulties over time

This doesn’t mean every child needs medication immediately—but it does mean doing nothing is not a neutral choice.

Treatment Doesn’t Mean “Medication First” for Every Age

For those who are worried that a diagnosis will force medication, it’s important to know that early treatment does not always mean early medication.

The American Academy of Pediatrics (AAP) recommends a thoughtful, age-based approach:

Ages 4–5 (Preschool)

For children in preschool, many behaviors associated with ADHD are typical and developmentally appropriate, but it is possible to make a diagnosis of ADHD for those who through careful evaluation. Preschoolers who have difficulties more than their peers with learning and behaviors, especially if they’re at risk for safety concerns, deserve an evaluation. An early diagnosis is important for them to get the needed help to minimize these problems.

Even for the preschooler who might have some symptoms but does not have ADHD, these early years are the time when significant brain development occurs. This is an optimal time for children to learn positive behaviors, and for you to know how to effectively help your child learn. It’s best to address problematic behaviors sooner rather than later and the first treatment for behavior challenges with or without a diagnosis are behavioral management. For more, see CHADD’s Preschool section.

First-line treatment:

• Parent training in behavior management

• Behavioral classroom interventions

Medication:

• Considered only if:

  • Symptoms are moderate to severe

  • There has been at least 9 months of impairment

  • Behavioral strategies have not been effective

Even then, careful dosing and monitoring are essential.

👉 The key point: We treat early—but we start with the right tools for this age.

Ages 6–11 (Elementary & Middle School)

At this stage, the evidence shifts and medication becomes the first-line treatment recommendation. Stimulant medications are generally preferred over non-stimulants as the first choice because they work quickly and have fewer failures. Evidence shows improved educational outcomes and decreased risk of accidents and criminality over time when medications are used to treat ADHD.

Behavior supports continue to be recommended, but without medication, the increasing academic demands and social complexity over the years become more challenging and youth with ADHD can struggle without proper supports.

Recommended approach:

• Medication (often stimulants)

• PLUS behavioral strategies (parent training and/or school supports)

👉 This is where medication becomes first-line, because research shows it is highly effective and improves outcomes.

Ages 12–17 (Adolescents)

Adolescent years are notoriously difficult due to rapid brain development, intense hormonal changes, and the demands for developing identity and peer acceptance. ADHD significantly impacts this age group with impaired emotional regulation, leading to heightened frustration, lower self-esteem, and increased anxiety or depression. Teens with ADHD struggle more than their neurotypical peers with social interactions, conflict, and sustaining healthy friendships due to impulsivity and poor reading of social cues. These challenges can lead to higher risks of substance use, bullying, and impulsive behavioral choices.

Recommended:

• Medication

• Behavioral supports at home and school

At this age, untreated ADHD can significantly impact:

• Academic success

• Driving safety

• Mental health

• Independence skills

The Real Risk: Waiting Too Long

Parents often worry about the risks of getting labeled due to a diagnosis, but fail to consider that it is the behaviors that will earn a label. Well-managed ADHD is not seen. Kids can show their strengths better and become known for those characteristics rather than a negative label.

Starting medication is another common fear, but we have many years of data showing not only that these medications are overall safe and effective, but the benefits far exceed the risks. If there are side effects, we can either change something about the situation, adjust the dose, or change the medication.

• An example of a child who has appetite suppression due to the medication could be to:

  • Adjust the situation by eating a bigger breakfast, having a healthy mini-meal for lunch, and eat a typical lunch after school to get all the calories in at times the medication is not active.

  • Lower the dose of medication or change to a short-acting version to allow hunger to be less affected mid-day.

  • Change to a different medication to see if it alters appetite less.

But we also need to consider the risks of delaying treatment, including:

• Falling behind in school

• Developing negative self-image (“I’m lazy,” “I’m not smart”)

• Strained family relationships

• Increased anxiety, depression, or oppositional behaviors

👉 The longer ADHD goes untreated, the more labels become a self-identity.

The longer ADHD goes untreated, the more these patterns can take hold. Over time, children may begin to internalize the labels they hear, (commonly “lazy,” “not trying,” or “unmotivated”) and those messages can become part of how they see themselves.

Instead of recognizing that they are struggling with a neurodevelopmental condition, they may start to believe they are simply “not good enough.” This shift from “I’m having a hard time” to “I am the problem” can significantly impact self-esteem and emotional well-being.

Appropriate treatment helps interrupt this cycle. When children experience more success at school, at home, and with peers, they begin to build confidence, develop a more accurate understanding of their strengths and challenges, and form a healthier, more positive sense of self.

Reframing the Question

Instead of asking:

❌ “Is my child too young for treatment?”

A more helpful question is:

✅ “What is the right treatment for my child at this age?”

Because:

• Early support builds skills

• Early success builds confidence

• Early intervention changes long-term trajectories

A Balanced, Thoughtful Approach

Good ADHD care is never “one-size-fits-all.”

It involves:

• Careful diagnosis

• Age-appropriate treatment

• Ongoing monitoring

• Collaboration between parents, schools, and clinicians

And most importantly:
👉 It evolves as your child grows.

Working to Teach Skills

I truly believe that when children and parents understand ADHD, they can thrive. But I also see the reality every day that finding therapists and coaches who can teach these skills isn’t always easy or accessible.

That’s why I’ve become actively involved in the Kansas City CHADD chapter, ADHDKC. We offer free, online monthly parent education events from a range of professionals to help families better understand ADHD and how to support their children.

find ADHDKC event recordings

I’m also involved in an interactive program called TEACH Me ADHD, where kids and parents learn about ADHD in a fun, engaging way. In the program, kids become “detectives,” completing weekly missions and deeds that reinforce important skills. They’re having fun—and often don’t even realize they’re building the tools they need to manage their ADHD.

learn about TEACH Me ADHD

Supporting adolescents is especially important to me. Each month, I lead the free ADHDKCTeen event—an online group for middle and high school students (generally ages 10 and up). The teens help choose the topics, and each session is an interactive hour focused on ADHD and related challenges, especially anxiety. No diagnosis is required, and it’s open to anyone who wants to learn and connect.

See all upcoming ADHDKC events

In addition, Dr. Bauer, who created TEACH Me ADHD, has partnered with me to expand these opportunities through a series of deeper-dive workshops called Director’s Cut. These workshops go beyond our monthly teen events and can be taken individually or as part of a group, offering more in-depth skill-building for teens.

Learn about Director's Cut

You can explore upcoming events and programs here:
https://www.adhdkc.org/event-list
https://www.letstalkkidshealth.org/virtual-courses

Bottom Line for Parents

• ADHD is not something children simply “grow out of”

• Early intervention, both behavioral and medical, is linked to better outcomes

• Waiting is not risk-free

• Treatment should match your child’s developmental stage

If you’re unsure what to do next, that’s okay. You don’t have to decide everything at once, but taking the first step toward support is one of the most powerful things you can do for your child.

Talk to your pediatrician.

See if your community has a local CHADD Chapter or find online events you can join from anywhere.

Find a local CHADD Chapter

CHADD Online Events

Learn How You Can Advocate for Earlier Diagnosis

I write articles like this to help parents understand why earlier diagnosis matters. Too often, children are able to hide their struggles while working twice as hard just to keep up. That effort is misinterpreted as “doing fine” and from the outside, things may look okay. Underneath, many of these kids are overwhelmed, exhausted, and quietly falling behind and becoming more emotionally impacted.

I see far too many children, teens, and families who reach a breaking point, whether it’s academically, emotionally, or both. In hindsight it’s tempting to wonder if things would be better if they could have gotten the support they needed all along. My goal is to help stop that cycle before it gets there.

This is especially important for girls. Compared to boys, girls are more likely to mask their ADHD symptoms, making them easier to overlook. They may appear organized, compliant, or high-achieving, while internally struggling with attention, anxiety, or burnout. Because of this, many girls miss the opportunity for a diagnosis that could support them not just now, but throughout their lives.

That’s one reason I became involved with Find the ADHD Girls, an organization dedicated to increasing awareness and advocating for girls living with ADHD. If you’re passionate about helping more children be seen, understood, and supported earlier, I encourage you to join the movement.

Find the ADHD Girls

Have you been feeling “off” lately? Perhaps you’ve noticed your heart racing when you stand up, persistent brain fog that won’t lift, or digestive issues that don’t seem to have a clear cause.

Many of these symptoms are tied to the Autonomic Nervous System—the “autopilot” of your body that controls everything from blood pressure to digestion.

I’ve been dealing with autonomic dysfunction since adolescence but have never been fully assessed in a medical setting, even when presenting with the main concern of dizziness as a teen and young adult.

Autonomic dysfunction is not often considered in a medical setting. I suspect this is due to the variety of body systems that can be involved and lack of accessible screening tools, so I played around with AI tools to help develop an automated screener based on the COMPASS-31 from Mayo. The COMPASS-31 is validated for individuals ranging from 16 to 80 years old. While mainly used for adults, it has been used for children as young as 4 in some research studies but it is not validated for kids under 16 years of age and results for children will need to be interpreted cautiously.

Why This Survey Can Help

Navigating complex symptoms can be overwhelming, especially when several body systems can be impacted and symptoms can mimic other issues.

Differentiating between anxiety and autonomic dysfunction can be challenging because they often have overlapping symptoms, such as heart flutters (palpitations), dizziness, and shortness of breath. Screening tools can help distinguish between these conditions when coupled with careful clinical assessment, diagnostic tools, and sometimes referral to specialists.

This assessment helps to:

• Identify Patterns: Pinpoint which specific systems (like cardiovascular, gastrointestinal, or sleep) are under the most stress.

• Measure Severity: Provide a weighted score that helps distinguish between mild fluctuations and significant autonomic dysfunction.

• Facilitate Better Conversations: Give you a structured summary of your symptoms to bring to your next medical appointment.

Who Should Take the Survey?

This tool is designed for individuals experiencing persistent, unexplained symptoms, including:

• Orthostatic Issues: Dizziness, lightheadedness, or fainting upon standing.

• Temperature Sensitivity: Being unusually sensitive to heat and cold.

• Cognitive Challenges: “Brain fog,” difficulty concentrating, or memory lapses.

• Chronic Fatigue: Persistent exhaustion that isn’t improved by rest.

• Digestive or Bladder Changes: Frequent bloating, constipation, diarrhea, nausea, urine retention or changes in urinary urgency.

• Gland Problems: Too much or too little sweating, dry mouth, dry eyes.

• Eye Issues: Light sensitivity, focusing problems.

How It Works

Once you complete the confidential digital form, our system automatically calculates your weighted scores across 12 different health domains. You will receive a personalized summary report via email that highlights your “Top Symptom Areas” and provides a calculated score for your records.

⚠️ A Note on Your Health

This survey is an educational screening tool and not a formal medical diagnosis. Autonomic symptoms can overlap with many different conditions. Always consult with your physician regarding any results or health concerns. Never disregard professional medical advice or delay seeking it because of information provided in this assessment.

Take the first step in understanding your body’s “autopilot.” By tracking these patterns today, you can advocate for the care you deserve tomorrow.

TAKE THE SURVEY

Specialist Guide for Autonomic Symptoms

If symptom scores indicate a positive screen, the next step is often a referral to a specialist who focuses on the specific system showing the highest “burden.”

Because the autonomic nervous system is the “control center” for the whole body, you may need a specific type of specialist depending on which scoring column was flagged as high.

How to Request a Referral

When speaking with your PCP, it is helpful to be specific. Instead of saying “I’m dizzy,” you can use your new data to be specific, such as

“Here are results from an autonomic dysfunction screening based on COMPASS-31. It showed a high weighted score in ___. Since this suggests problems with autonomic function, could you refer me to ___?”

Reminder: Bring a printed copy of your Detailed Summary to your appointments to help them see the full picture.

Take the Survey

Learn More

Some resources I’ve found helpful related to dysautonomia, in no particular order:

https://thedysautonomiaproject.org/

• The Dysautonomia Project is a non-profit collaborative effort of volunteer healthcare providers, patients, and community leaders working together to bridge the gap between what autonomic specialists know and what community-based providers and patients need to know.

https://www.bendybodiespodcast.com/

• The Bendy Bodies Podcast is a place where patients, caregivers, and healthcare professionals trade insights about hypermobile conditions.

https://batemanhornecenter.org/

• The Bateman Horne Center provides information about ME/CFS, Long COVID, and fibromyalgia and offers online support groups.

https://www.ehlers-danlos.com/assessing-joint-hypermobility/

• Beighton scoring to do at home or in the clinic to assess for hypermobility

https://www.ehlers-danlos.com/info/

• Information on EDS and HSD

https://www.ehlers-danlos.com/echo/

• EDS ECHO is a free series of programs and courses for healthcare professionals and communities who want to improve their ability to understand Ehlers-Danlos Syndromes (EDS), hypermobility spectrum disorders (HSD) and associated symptoms and conditions. Participants in our programs are able to share their cases and questions in the sessions and are guided to further educational materials and support.

I was recently scrolling and came across a question: Is it true ADHD is a neurological issue that can be seen on brain scans? The comments were across the board, but many people commented that it was part of their diagnostic evaluation. Some commented on it being expensive, including someone spending $5000 in Australia (which is around $3500 USD) despite their universal healthcare. In the US insurance often doesn’t cover these scans either.

You also may hear about “brain scans,” “objective ADHD tests,” or high-tech devices that claim to diagnose ADHD online or from your provider. It can be confusing to know what actually matters and what might just be expensive add-ons.

I want to share an overview of how ADHD is currently diagnosed in the United States and what newer technologies can (and cannot) do right now. Read all the way to the bottom to learn about a free resource for your tweens and teens to learn about how their brain works.

Clinical Diagnosis is the Gold Standard

ADHD is a clinical diagnosis, which means it is made by a trained clinician using a careful evaluation rather than a single medical test.

In the U.S., major guidelines such as those from the American Academy of Pediatrics recommend that diagnosis include:

1. A detailed clinical history

This includes questions about:

• Attention and focus

• Impulsivity

• Hyperactivity

• Organization and executive functioning

• Emotional regulation

• Development and school performance

2. Standardized rating scales

Parents and teachers usually complete validated questionnaires such as:

• Vanderbilt scales

• Conners scales

These tools are actually quite accurate, with research showing:

• Sensitivity: about 80–92%

• Specificity: about 75–94%

3. Symptoms across multiple settings

ADHD must affect functioning in more than one environment, such as:

• home

• school

• work or social settings

4. Clinical judgment

It’s important to remember that rating scales are only one part of the evaluation. They are helpful tools, but they should never replace a careful clinical history.

Unfortunately, I often hear stories from families who were told their child (or even the parent) does not have ADHD simply because their survey scores were not high enough, even when their day-to-day story clearly fits the diagnosis.

A questionnaire score alone should never outweigh a detailed history of real-life challenges.

When I evaluate for ADHD, I always talk with both the parent and the child about what school actually feels like, in addition to reviewing teacher rating scales. Sometimes teachers see what appears to be an “ideal student,” but the child or parent may describe a very different experience. Some students work extremely hard to mask their symptoms. They can hold it together at school, earning good grades, but using enormous effort to do so. In those situations, the teacher’s survey may not fully show the level of difficulty the student is experiencing.

This can happen with parent rating scales too. Surveys ask general questions, but they may not capture the full picture of what a typical day looks like. A child may struggle with routines, homework, emotional regulation, or family interactions in ways that aren’t fully reflected in the rating scale responses.

That’s why the story matters. A thoughtful ADHD evaluation combines rating scales, clinical interviews, and real-life examples of functioning across settings. No questionnaire alone can tell the whole story.

An experienced clinician evaluates:

• whether symptoms meet DSM-5 criteria

• whether another condition explains the symptoms

• whether multiple conditions are present (which is common)

This comprehensive process remains the gold standard for diagnosis.

What About Brain Scans?

You may have heard that ADHD is “a brain disorder,” which is true. Research using brain imaging has shown consistent differences between ADHD brains and neurotypical brains.

However, those differences are small and variable, so they can’t diagnose an individual child.

They do show that ADHD is a real difference in brains, not a choice or a personal failure. That’s why trying harder doesn’t fix the problem.

What research studies have found

Structural MRI studies

Researchers have identified small average differences such as:

• slightly smaller frontal cortex

• differences in the basal ganglia

• changes in the corpus callosum

• thinner areas of the prefrontal cortex

Another important finding is that brain development in ADHD often shows a delay in maturation, especially in the frontal and parietal regions responsible for executive function. Some studies suggest this delay may be 2–5 years. That’s why it takes longer for kids with ADHD (even those with a very high IQ) to master certain skills, such as remembering to brush their teeth.

Functional MRI studies

Functional imaging shows that people with ADHD may have:

• reduced activation in attention and cognitive control networks

• differences in reward processing

• altered connectivity between attention networks

White matter studies (DTI)

These studies show subtle changes in brain wiring between areas involved in:

• attention

• impulse control

• motor activity

Why brain imaging isn’t used clinically

Even though these findings are real, they cannot diagnose ADHD in an individual patient.

The differences are:

• small

• overlapping with typical brains

• different from person to person

Because of this, major organizations such as the American Psychiatric Association state that no neuroimaging biomarker currently exists for ADHD.

If someone suggests a brain scan to diagnose ADHD, it’s important to know that this is not recommended in routine clinical care. It may be costly, so you may need to find another experienced clinician if yours recommends a scan.

Computerized Attention Tests

Some clinics offer computerized tests that measure attention, impulsivity, and movement.

One example is the QbTest, an FDA-cleared, 15–30 minute computer-based assessment for ADHD that measures attention, impulsivity, and activity levels in individuals aged 6–60. It combines:

• a continuous performance test (watching for targets on a screen)

• motion tracking using an infrared camera

The test measures three areas:

• inattention

• impulsivity

• activity level

How accurate are these tests?

When used alone, their accuracy is moderate.

Research shows:

• Sensitivity: about 78%

• Specificity: about 70%

They cannot reliably diagnose ADHD on their own but can be used as an optional supplement to a full evaluation. If the diagnosis is not clear after the gold standard clinical assessment, it may be helpful.

When these tests might be helpful

In some cases they can:

• help clinicians reach decisions a bit faster

• increase confidence when the history is unclear

• help assess for ADHD when symptoms are borderline

What About EEG Devices?

Some companies market EEG tests that measure brain wave patterns.

One example is the NEBA system, which measures the ratio of two types of brain waves (theta and beta).

Even though the device received FDA clearance, later research showed that the findings could not be reliably replicated.

Because of this, the American Academy of Neurology specifically advises against using this test to diagnose ADHD due to the risk of false positives.

This is an important reminder that FDA clearance does not necessarily mean strong scientific validation.

Other High-Tech Tests You May Hear About

Researchers are studying several new technologies that could someday assist diagnosis.

These include:

Virtual reality classroom tests

These simulate real-world distractions to measure attention in more natural environments.

Eye-tracking technology

These systems track how eyes move while completing tasks and may reveal attention patterns.

Wearable devices

Activity trackers and sleep monitors are being studied for behavioral patterns associated with ADHD.

Artificial intelligence and brain imaging

Machine learning models are being tested to analyze brain scans and behavioral data together.

Some of these methods show promising results in research studies, but they still have major limitations:

• small study sizes

• inconsistent results across different clinics

• difficulty distinguishing ADHD from other conditions

• expensive equipment

Because of this, none of these technologies are ready for routine clinical diagnosis.

Why the Clinical Evaluation Still Matters Most

ADHD is a complex neurodevelopmental condition, not a single measurable signal.

It involves:

• attention networks

• executive functioning

• emotional regulation

• motivation and reward systems

• development and environment

No single test can capture all of that.

An ADHD-aware clinician can consider:

• history

• behavior

• rating scales

• school information

• developmental context

to create an accurate diagnosis and treatment plan.

The Bottom Line for Parents

Here are the most important takeaways:

1. ADHD is diagnosed clinically.
A thorough evaluation with rating scales and history remains the best method.

2. Brain scans are not used for diagnosis.
They are valuable research tools but not useful for individual diagnosis.

3. Computerized tests may sometimes help—but only as an extra tool.
They cannot replace a comprehensive evaluation.

4. Be cautious about expensive “objective ADHD tests.”
Many offer limited additional value.

5. The most important factor is an experienced clinician.
Good clinical judgment still outperforms any current technology.

If you suspect ADHD, it’s worth talking with your physician, even if previous testing did not result in a diagnosis. Sometimes evaluations rely too heavily on survey scores and may miss the bigger picture.

When you meet with your clinician, be sure to describe what day-to-day life actually looks like. Talk about the strategies your child or teen uses to “look normal,” the amount of effort it takes to keep up, and whether there is emotional exhaustion or dysregulation from constantly trying to meet expectations.

Rating scales are helpful tools, and I use them in my own evaluations. But they are only one piece of the process. The real-life stories families share about school, home routines, homework, organization, emotions, and relationships often provide the clearest evidence of whether the diagnostic criteria for ADHD are being met.

A good evaluation looks at both the numbers and the narrative to understand how a child is truly functioning.

Meet the Animals of the Brain to Learn Neuroscience

Okay, so after talking about the science of the brain and facts of ADHD, why am I including animals of the brain here?

There is no wise owl or watchdog actually in the brain, but these metaphors are a great way for kids to learn how their brain works.

And I’m talking about these animals tonight at the monthly ADHDKCTeen Group event. This is a group for kids 10 years and up that meets on the 1st Tuesday of each month online as part of the KC Metro’s CHADD Chapter, . All of our events are free and open to the public, and I would love for you and your kids to learn with us.

ADHDKC Events

💻 Event Details

📅 Tuesday, April 7th | ⏰ 5:30 PM CST | 💻 Online via Zoom

Time Zone Converter

💸 FREE for all Middle and High School Students

🔗 RSVP with the link above to get a Zoom link

The Animals of Our Brain: Understanding Neuroscience with Animals

Calm the Barking Dog to Bring Back the Wise Old Owl and Elephant Who Never Forgets

Tweens and Teens: Have you ever:

• Snapped at someone and immediately regretted it?

• Frozen during a test or presentation?

• Spiraled after someone didn’t text back?

• Felt your heart pounding and didn’t know why?

You’re not “too sensitive.”

You’re not “overreacting.”

And you’re definitely not broken.

You just have a very loyal watchdog in your brain.

🧠 Meet the Animals Running Your Brain

At our last ADHDKCTeen session I mentioned the barking dog to explain a topic and the participants were interested in learning more about the animals in our brain. We’ll talk about some I’ve mentioned before and introduce some new characters:

🐶 The Watchdog (Amygdala) – the part of your brain that scans for danger and sometimes barks at everything.

🐘 The Elephant (Hippocampus) – the memory keeper that reminds you of every awkward moment you’ve ever had.

🦉 The Wise Owl (Prefrontal Cortex) – the decision-maker that helps you pause, think, and choose what to do next.

🐜 ANTs (Automatic Negative Thoughts) - persistent negative thoughts that you need to shoo away to feel and perform better.

🦊 The Fox (Reticular Activating System) - the gatekeeper of sensory information.

🐢 The Turtle (Default Mode Network) - the quiet thinker and daydreamer.

And most importantly… what to do when the dog barks so loudly that it scares away the owl.

This is not a lecture. It’s an interactive, real-life skills workshop.

Why This Matters

When emotions run high it’s because your watchdog is doing its job a little too enthusiastically.

Anxiety and ADHD often go together, but everyone is at risk of their dog being overprotective and keeping the other animals from doing their jobs.

The good news?

You can train the dog.

With practice, teens can learn to:

• Pause instead of react

• Respond instead of explode

• Think clearly even when stressed

• Build confidence in handling hard moments

This class gives them practical tools they can start using immediately.

Who Should Attend?

✔ Middle & high school students and their parents if they desire

✔ Tweens and teens with ADHD

✔ Tweens and teens with anxiety

✔ Tweens and teens who struggle with emotional intensity

✔ Tweens and teens who want better control over reactions

No diagnosis required. Just bring your curious brain.

Hi everyone,

I’m excited to share that I was recently interviewed on the Executive Function Podcast with Sarah Kesty!

Listen to the episode

You can listen to the full episode on Spotify or Apple.

If you listen, I’d love to hear what resonated most with you!

This was such a meaningful conversation—one that brought together both my professional work as a pediatrician and my personal journey with ADHD.

What we talked about

We covered a range of topics that many of you will recognize from our work together:

• My journey into ADHD advocacy—from pediatrics to parenting to community education

• Why executive functioning is often overlooked, even though it impacts everything

• The concept of “masking” ADHD, especially in high-achieving kids (and adults)

• My favorite way to explain the brain to kids using simple, memorable analogies:

  • The “barking dog” (amygdala)

  • The “wise old owl” (prefrontal cortex)

  • The “ANTs” (automatic negative thoughts)

I’m talking all about these animals at the next ADHDKCTeen event - free for middle and high schoolers to join me online - learn more and RSVP here. 

Join the ADHDKCTeen online group to gain access to a free pdf for a workbook after the talk.

• Practical tools for managing anxiety, overwhelm, and getting unstuck

• Strategies like:

  • breaking tasks into smaller steps

  • time blocking

  • brain dumps

  • “dopa menus” and reward systems

  • body-based regulation (movement, breathing, cold water, etc.)

One of the biggest themes?
👉 These skills are learnable, but they’re much easier with support, practice, and the right tools.

Why this conversation matters

We also talked about something I see every day:

Many kids (and adults) are told they’re “doing fine”—
but that often hides the effort, exhaustion, and dysregulation underneath.

Understanding executive function helps us:

• recognize what’s really going on

• reduce frustration and blame

• and build more effective, compassionate support systems

Stay connected

If you’re looking for more practical strategies and insights, you can always find me:

• Here on Substack (where I write about ADHD, anxiety, and executive function)

• Through ADHDKC events and programs

• In our TEACH Me ADHD classes for kids and teens

Thank you for being part of this community and for continuing to learn alongside me.

Warmly,
Kristen

I was recently asked if there was any evidence for the use of Lion’s Mane to treat ADHD. Online promotions of these mushrooms claim that they can rewire the brain and lift brain fog.

On a related note, mushroom coffees combine regular coffee with powdered medicinal mushrooms (most commonly Lion's Mane, Cordyceps, Chaga, or Reishi) to provide the stimulant effects of caffeine alongside promoted health benefits from mushroom bioactive compounds. Companies and ‘health influencers’ claim that mushroom coffee provides an array of holistic benefits, including more energy, better sleep performance, and immune benefits.

Is it too good to be true? The messaging is strong, but what about the science?

First: What Is Lion’s Mane?

Lion’s Mane (Hericium erinaceus) is an edible mushroom traditionally used in East Asian cuisine and medicine. It has gained popularity in recent years as a “nootropic” supplement marketed for memory, focus, mood, and even ADHD.

It contains several bioactive compounds, including:

• Hericenones

• Erinacines

• Polysaccharides

Laboratory studies suggest these compounds may have neuroprotective and anti-inflammatory effects. But what does that mean clinically?

Proposed Mechanisms: Interesting but Early

Preclinical research (cell cultures, animal models, and computational modeling) suggests Lion’s Mane may:

• Increase brain-derived neurotrophic factor (BDNF)

• Activate CREB signaling pathways

• Reduce oxidative stress in hippocampal neurons

• Decrease inflammatory signaling in microglia

• Potentially modulate the gut–brain axis

These findings are biologically intriguing. Increased BDNF and neurogenesis are theoretically relevant to mood disorders and cognitive decline.

However, most of this evidence comes from:

• In vitro studies (cells in petri dishes)

• Animal models

• Ex vivo models (study of cells, tissues, or organs removed from a body, not a living animal)

• Computational docking studies

Mechanistic plausibility is not the same as clinical effectiveness.

Human Clinical Evidence: Very Limited

There are only a handful of human trials examining Lion’s Mane for cognitive or mood outcomes.

1. Mild Cognitive Impairment (Mori et all 2009)

A small double-blind placebo-controlled study of 30 adults with mild cognitive impairment found cognitive test improvements after 16 weeks of 3 g/day Lion’s Mane. However:

• Effects disappeared 4 weeks after stopping.

• The study has not been replicated.

• Sample size was small.

2. Healthy Young Adults (Docherty et all 2023)

A pilot study in 41 adults showed:

• Slight improvement in processing speed.

• A trend toward reduced stress after 28 days (not statistically significant).

Authors emphasized cautious interpretation due to small sample size and mixed results.

3. Systematic Reviews

A 2024 review in Neuroscience and Biobehavioral Reviews found:

• Epidemiological studies suggest possible associations between mushroom consumption and better cognition.

• Intervention trials show mixed results.

• Larger, more rigorous trials are needed.

Overall, human data remain preliminary and underpowered. The promotions are overstated at the time.

ADHD-Specific Evidence: None in Humans

For ADHD specifically:

• No human clinical trials exist.

• One 2025 study used molecular docking to suggest that compounds in Lion’s Mane might interact with the serotonin transporter (SLC6A4).

• This was computational modeling only — not clinical evidence.

Systematic reviews of herbal ADHD treatments (e.g., in Frontiers in Pharmacology) do not include Lion’s Mane among evaluated therapies due to lack of data.

A 2023 review in The Lancet. Child & Adolescent Health examining non-pharmacologic ADHD interventions found insufficient evidence for most supplements overall.

Bottom line for ADHD:
There is currently no clinical evidence supporting Lion’s Mane as a treatment.

Mood, Anxiety, and Depression: Mostly Animal Data

Rodent studies suggest Lion’s Mane may:

• Reduce depressive-like behaviors in forced swim tests in rats

• Improve anxiety behaviors in rats

• Enhance hippocampal neurogenesis in rats

• Influence BDNF/TrkB signaling pathways in rats

These findings are promising for research — but translating rodent behavioral models to human psychiatric treatment is notoriously unreliable. We are not rats.

Safety Profile

Lion’s Mane appears generally well tolerated in available studies and reviews.

Reported issues:

• Mild gastrointestinal symptoms

• One documented case of anaphylaxis after consuming fresh mushroom

Compared with stimulant medications, herbal products are often perceived as “safer,” but that does not automatically mean they are:

• Effective

• Standardized

• Consistently dosed

• Free of drug interactions

Commercial preparations vary widely in:

• Fruiting body vs. mycelium content

• Extraction methods

• Concentration of erinacines/hericenones

• Independent quality testing

Long-term safety data are limited.

Lion’s Mane and Possible Medication Interactions

While Lion’s Mane appears generally well tolerated, there are no formal drug interaction studies in humans. That means we don’t have clear answers about how it might interact with common medications.

Here’s what we do know — and what remains theoretical. These interactions are based on laboratory and animal studies, not human research.

1. Blood Thinners (Anticoagulants and Antiplatelet Drugs)

Lion’s Mane has shown blood-thinning and antiplatelet effects in preclinical studies. These are done to show enough safety before starting human trials, but I did not find any reports of active human trials, so it may be a long wait for human study results.

If taken with medications like:

• Warfarin (Coumadin)

• Aspirin

• Clopidogrel (Plavix)

• Other prescription blood thinners

there is a theoretical risk of increased bleeding.

What this means:
If someone is on a blood thinner, they should talk to their clinician before using Lion’s Mane and monitor for unusual bruising or bleeding.

2. Diabetes Medications

Lion’s Mane has demonstrated blood sugar–lowering effects in lab and animal studies.

If taken with:

• Insulin

• Metformin

• Sulfonylureas

• Other glucose-lowering medications

there is a theoretical risk of low blood sugar (hypoglycemia).

What this means:
People with diabetes should monitor blood glucose carefully if adding Lion’s Mane and discuss it with their provider.

3. Blood Pressure Medications

Preclinical studies suggest Lion’s Mane may help lower blood pressure.

If combined with:

• ACE inhibitors

• ARBs

• Beta-blockers

• Diuretics

• Other antihypertensive drugs

there is a theoretical risk of blood pressure dropping too low.

What this means:
Blood pressure should be monitored if someone is taking both.

4. Immunosuppressive Medications

Lion’s Mane polysaccharides appear to affect the immune system (sometimes stimulating it in laboratory studies).

If taken with:

• Corticosteroids

• Cyclosporine

• Tacrolimus

• Other immune-suppressing medications

there is a theoretical possibility that Lion’s Mane could interfere with how well those medications work.

Important: This has not been documented in human trials — it is based on biological plausibility only.

A Major Knowledge Gap: Liver Enzymes (CYP450)

Many drug interactions happen because herbs affect liver enzymes (called CYP450 enzymes) or drug transport systems like P-glycoprotein.

• Lion’s Mane has not been formally studied for effects on these systems.

• That means we do not know whether it speeds up or slows down the metabolism of other medications.

This is an important unknown.

What About Mushroom Coffee?

Mushroom coffees provide lower caffeine content than regular coffee while adding minerals and bioactive mushroom compounds. The combination aims to provide caffeine's cognitive benefits while potentially lowering some of its negative effects through a decreased dose and mushroom phytochemicals, similar to how polyphenols in tea modulate caffeine's psychophysiological effects.

In addition to the lack of evidence that the mushroom blend offers any benefits, the lack of product standardization makes it difficult to ensure consistent dosing and quality.

For most healthy adults consuming moderate amounts, mushroom coffee appears safe but offers no clear advantage over regular coffee from an evidence-based perspective.

A 12-ounce bag of mushroom coffee typically costs $20-40, compared to $8-15 for premium traditional coffee according to the Google AI summary, so you’ll spend considerably more on mushroom coffee compared to a standard brew.

Who Should Be Especially Cautious?

• People taking blood thinners

• People with diabetes

• People on blood pressure medication

• People taking immunosuppressants

• Anyone with a known mushroom allergy (one case of anaphylaxis has been reported)

• Pregnant or breastfeeding individuals (no safety data)

• Children (limited safety research)

Important Takeaways

The absence of documented interactions does not mean Lion’s Mane is interaction-free.

It means:

• Studies haven’t been done.

• Data are limited.

• Clinically significant interactions could exist but remain undocumented.

If someone is taking prescription medications, especially for chronic conditions, it’s wise to:

• Inform their healthcare provider

• Talk with their pharmacist about potential interactions

• Monitor relevant labs or vital signs (blood sugar, blood pressure, bleeding symptoms)

• Avoid assuming “natural” equals “risk-free”

The cost of these unproven products may be another risk not calculated into the above.

Clinical Perspective

From an evidence-based standpoint:

• Mechanistic data are interesting.

• Human trials are small and limited.

• Findings have not been replicated.

• There is no ADHD-specific clinical evidence.

At this time, Lion’s Mane cannot be recommended as an evidence-based treatment for ADHD or other psychiatric conditions.

That does not mean future research won’t find benefit — but we are not there yet.

In short

When considering using Lion’s Mane, keep in mind:

• It appears low risk for most people.

• It is not proven effective for ADHD.

• It should not replace established treatments.

• If used, it should be monitored like any medication or supplement.

• Discuss potential interactions with a clinician.

• Because it is not highly regulated as a pharmaceutical, product quality, potency, and purity can vary widely between brands.

• The cost may be considerable and may not fit into your budget.

Not because I’ve stopped talking about ADHD — quite the opposite. I just forget this page is here. 😊

So here’s where I’ve been and where to find me soon — both in the community and online.

Where I’ve Been

🎙 Kansas City MomCast — Episode 91

Along with my dear friend Jeremy Didier, I was featured on the Kansas City MomCast where we talked about navigating life with ADHD — real talk, practical tools, and hope for families and individuals alike. You can listen to Episode 91 here:
👉 https://kansascitymomcollective.com/navigating-adhd-hope-tools-and-real-talk-with-adhdkc-kansas-city-momcast-episode-91/

🎭 TEACH Me ADHD: Jr. Detectives in Action

I’m currently in the middle of an 8-week TEACH Me ADHD session, and our Jr. Detectives are doing a fabulous job learning about ADHD and how to manage the various challenges that come with it.

There is nothing better than watching kids gain confidence, language, and real-life skills week by week. Seeing them realize, “Ohhh… this is how my brain works!” never gets old. Here’s a collage of pictures related to the Mission Meetings with clues to what we talk about:

Learn About TEACH Me ADHD

🎙 Women & ADHD Panel Discussion

I recently had the honor of being one of four panelists in a discussion among women with ADHD. It was an honest, thoughtful conversation about the realities of living, parenting, and working with ADHD as women.

If you missed it, you can watch the replay on the YouTube channel:

Where To Find Me Soon

💥 Upcoming ADHDKCTeen Event: From 0 to 100 — Tools for When Your Feelings Explode

Each month I lead the Teen group for middle and high school students.

The March topic will help students understand emotional escalation and how to move from overwhelm to regulation with practical, real-life tools. If emotional explosions are familiar in your home, this session will offer support, language, and strategies your teen can start using right away. ADHDKCTeen events are free, online, and open to any middle or high school student who wants to learn skills (and their parents if desired).

ADHDKCTeen Event Information and RSVP

👨‍👩‍👧 ADHDKC Parent Group – March 10

I’ll be speaking to the ADHDKC Parent Group on March 10th at 6:30 PM.

We’re especially excited to once again offer an in-person gathering in addition to online viewing. There’s something powerful about being in a room with other parents who get it.

You can find details and register from this button:

Parents Under Pressure

🎧 The Executive Function Podcast

I’ll soon be a guest on The Executive Function Podcast with — more details coming soon!

I’m looking forward to diving deeper into practical strategies for building executive functioning skills in real life.

Listen here:

🎙 Monthly: ADHDKC Conversations

You can also find me regularly on the ADHDKC Conversations podcast each month. We talk about real-life ADHD, parenting, mental health, and practical tools that actually work and introduce upcoming ADHDKC Parent Group speakers.

Listen on Spotify:

Or watch on YouTube:
👉 https://www.youtube.com/@adhdkc/podcasts

Thank you for continuing to learn alongside me — however you are able to join me. I’m grateful to be part of this community.

It’s been several years since I’ve written about NAC so I decided to look into it again.

If you missed my previous article, see it here:

Curiously I did not find evidence to support NAC use in children despite years of seeing kids and teens appear to benefit from it. Studies in adults do show some evidence, but those in kids are not able to show the same results.

Are study designs simply not asking the right questions or are my patients reporting improvements that would be there without the NAC due to other things they’re doing? Hard to say.

I have seen many children and teens who failed therapy or choose to skip therapy due to lack of time, poor or nonexistent insurance coverage, or stigma surrounding therapy successfully stop their unwanted behaviors after starting NAC, so I continue to believe that it holds some benefit despite the trials failing to show benefit. Research also shows it may help anxiety, which is related to these behaviors, so maybe that’s the key - it helps the anxiety, so the behaviors are able to fade.

Let’s first review some of the conditions for which NAC has been used.

Body-Focused Repetitive Behaviors

Body-focused repetitive behaviors (BFRBs) include habits like hair pulling (trichotillomania), skin picking (excoriation disorder), and nail biting. These behaviors are common and can cause significant distress and physical damage.

OCD

OCD (Obsessive-Compulsive Disorder) is a mental health condition characterized by a cycle of intrusive, unwanted thoughts (obsessions) and repetitive behaviors (compulsions) performed to relieve the anxiety caused by those thoughts. It can significantly interfere with daily life.

Key Links & Similarities of BFRD and OCD

Body-Focused Repetitive Behaviors (BFRBs) like hair pulling (trichotillomania) and skin picking (excoriation) are closely linked to OCD but are distinct. Repetitive urges and distress occur in both, but for different reasons, but are treated similarly.

BFRBs are often considered part of the broader OCD spectrum or related disorders due to their compulsive nature and commonality with OCD. People with BFRBs have higher rates of OCD, and those with OCD have higher rates of BFRDs.

BFRBs are often subconscious ways to regulate feelings, whereas OCD compulsions serve to relieve anxiety of the intrusive thoughts.

What is N-Acetylcysteine (NAC)?

NAC is an amino acid supplement available over-the-counter without a prescription. As with all supplements in the US, it is not regulated by the FDA. It works by affecting glutamate, a chemical messenger in the brain that may play a role in repetitive behaviors.

What Does the Research Show?

In Adults: Studies in adults have shown some benefit. In one study of adults with skin picking, 47% of people taking NAC improved compared to 19% taking placebo. A large review of studies failed to show benefit in adults with hair pulling.

In Children and Adolescents: The evidence is disappointing and doesn’t validate what I’ve seen in clinic. The main study in young people with hair pulling found no significant benefit - 25% improved with NAC compared to 21% with placebo. This means NAC worked about the same as a sugar pill in children and teens. There is limited evidence that in children and adolescents who fail treatment with SSRIs for Obsessive Compulsive Disorder (OCD), the addition of NAC may offer benefit. Preliminary findings studying NAC in autism suggest improvements in irritability and hyperactivity, but did not identify strong evidence specific to ADHD.

What About Side Effects?

NAC is overall safe with only mild side effects in a small number of people:

• Nausea (14%)

• Constipation (6%)

• Dry mouth (3%)

• Other mild effects: blurred vision, fatigue

In clinical trials, there were no serious adverse events to using NAC and very few people stopped taking it due to side effects.

Are there Drug Interactions with ADHD and Anxiety Medications?

ADHD and anxiety are common among those who have any of the body-focused repetitive disorders, so what about using medications for those along with NAC?

With the limited information available, using NAC with medications for both ADHD and anxiety appears to be safe.

Want to get nerdy with me?

I love science, so let’s talk science. NAC’s mechanisms of action (glutamate modulation, antioxidant effects, and anti-inflammatory properties) are not likely to interact with SSRIs or ADHD medications.

NAC works primarily through restoring extracellular glutamate concentration in the nucleus accumbens and increasing cellular production of glutathione, whereas ADHD and anxiety medications affect serotonin, dopamine, or norepinephrine.

No drug interactions between NAC and stimulant or non-stimulant ADHD medications have been reported.

When NAC has been studied with SSRIs (medication class used for anxiety and depression), at dosages between 2000-2400 mg/day, it appears safe and well tolerated.

What does this mean?

NAC can likely be safely combined with SSRIs and ADHD medications in patients with body-focused repetitive disorders and anxiety and/or ADHD.

Dosing Information

When NAC has been studied in children and adolescents, the typical approach involves:

• Starting at a low dose

• Gradually increasing to 2400-2700 mg per day, divided into multiple doses

• Treatment duration in studies: 6-12 weeks

What Treatment Works Best?

Behavioral therapy, specifically habit reversal training, is the most effective treatment for body-focused repetitive behaviors in both children and adults. This therapy teaches:

• Awareness of the behavior

• Competing responses (doing something else instead)

• Strategies to manage urges

Habit reversal training has shown larger benefits than any medication, including NAC. It should be considered the first-line treatment for your child.

Important Limitations

• Most studies lasted only 6-12 weeks - we don’t know about long-term benefits

• We don’t know if benefits continue after stopping NAC

• NAC is a supplement, so quality can vary between manufacturers

• No studies have directly compared NAC to behavioral therapy

Should Your Child Try NAC?

Given the evidence, here are important considerations:

Reasons to be cautious:

• Studies in children and teens have not shown NAC works better than placebo

• Behavioral therapy has much stronger evidence of benefit

• We don’t know about long-term effects or how long to continue treatment

• There are other supplements with similar names - make sure you’re buying the supplement you intend to use

• Supplements are not regulated in the US, so you may not get what the label says - buy from a reputable brand

Possible reasons to consider (discuss with your doctor):

• Your child has not responded to behavioral therapy

• Behavioral therapy is not available in your area

• You want to try it as an addition to behavioral therapy

• The low risk and cost of NAC make it appealing to try

My Recommendations

1. Start with behavioral therapy first - it has the strongest evidence for children and adolescents

2. If considering NAC, discuss with your child’s doctor:

   • What therapists in the area are available for habit reversal training

   • Dosing and monitoring

     • One dosing strategy for children over 45 pounds is to give a 600 mg capsule twice per day (1200 mg) for a week and increasing to 2 capsules twice per day (2400 mg) after 4 weeks if needed.

     • I have also seen titration methods beginning with one capsule daily for the first week (600mg), then one capsule twice a day for the 2nd week (1200mg), then 3 capsules divided in 2 unequal doses (1800 mg) for the 3rd week and 4 capsules divided in 2 doses (2 capsules twice per day = 2400 mg).

   • How long to try it before deciding if it’s working

   • How long to continue it if you see benefit

3. What to look for in supplements for quality

   • Nationally Recognized Brands: Reputation matters, so these companies invest a lot of time, resources and effort to ensure their products live up to their reputation

   • Third-Party Testing: Products tested by independent, third-party laboratories (NSF, USP) for purity, potency, and safety

   • GMP Certification: Ensures the manufacturer follows Good Manufacturing Practices

   • Certificate of Analysis (COA): Ensures the manufacturer provides transparency about ingredients and contaminants

4. Monitor carefully for both benefits and side effects, especially behavioral changes

5. Consider combining approaches - some evidence suggests using multiple techniques together may be most helpful

Bottom Line

While NAC appears safe and has shown some benefit in adults with body-focused repetitive behaviors, studies in children and adolescents have not demonstrated effectiveness. Studies are limited though and I have now seen many children and adolescents who seem to benefit from NAC and successfully stop nail biting, hair pulling, or skin picking.

It is a low-risk and low-cost treatment to try with possible benefits.

Behavioral therapy with habit reversal training remains the treatment with the strongest evidence for children and teens, so it should be attempted first or along with NAC.

If you’re considering NAC for your child, discuss its use with their healthcare provider.

References

1. “N-Acetylcysteine for Obsessive-Compulsive and Related Disorders in Children and Adolescents: A Review”. The Annals of Pharmacotherapy. 2023. Parli GM, Gales MA, Gales BJ.

2. A Review of N-Acetylcysteine in the Treatment of Grooming disorders. International Journal of Dermatology. 2019. Braun TL, Patel V, DeBord LC, Rosen T.

3. Habit-Reversal Training: A Psychotherapeutic Approach in Treating Body-Focused Repetitive Behaviour Disorders. Clinical and Experimental Dermatology. 2023. Rahman SM, Jafferany M, Barkauskaite R.

4. Habit Reversal Training and Variants of Decoupling for Use in Body-Focused Repetitive Behaviors. A Randomized Controlled Trial. Cognitive Therapy and Research. 2022. Moritz S, Penney D, Bruhns A, Weidinger S, Schmotz S.

5. Pharmacotherapy for Trichotillomania. The Cochrane Database of Systematic Reviews. 2021. Hoffman J, Williams T, Rothbart R, et al.

6. N-Acetylcysteine in the Treatment of Trichotillomania: Remarkable Results in Two Patients. Journal of the European Academy of Dermatology and Venereology : JEADV. 2016. Özcan D, Seçkin D.

7. Treatment Strategies for Pediatric Trichotillomania: State-of-the-Art Review on Progress and Persistent Challenges. Pediatric Dermatology. 2025. Sharifi S, Estill M, Tordjman L, Millan SH, Ouyang JX.

8. Assessment and Treatment of Trichotillomania (Hair Pulling Disorder) and Excoriation (Skin Picking) Disorder. Clinics in Dermatology. 2018. Jones G, Keuthen N, Greenberg E.

9. Pharmacological and Behavioral Treatment for Trichotillomania: An Updated Systematic Review With Meta-Analysis. Depression and Anxiety. 2020. Farhat LC, Olfson E, Nasir M, et al.

10. The Emerging Role of N-Acetylcysteine in Psychiatry: A Narrative Review of Available Data. Current Medicinal Chemistry. 2025. Marazziti D, Caruso V, Cappellato G, et al.

You may have heard doctors, therapists, or even your favorite online influencers talking about something called the Default Mode Network, or DMN. Lately, it’s been popping up everywhere — on social media, in podcasts, and even in Paris Hilton’s Infinite Icon, which I had the chance to see thanks to donated tickets to private ADHDKC showings.

To learn more about ADHDKC, our local CHADD chapter, visit adhdkc.org. Take a look at the Events page when you’re there and sign up to hear me talk about parents managing their stress at their March event.

Parents Under Pressure

In the documentary and in interviews, Paris describes DMN as “the demon in her mind.”

With the DMN becoming more visible in conversations about ADHD, anxiety, and depression, I thought it would be helpful to take a step back and explain what it actually is, why it matters, and how many of our treatments make more sense when we look at the brain through this lens.

Despite the name (and yes, it does sound a little like “demon” when you say it out loud) the DMN isn’t something scary or harmful. In fact, it’s a completely normal and important part of how our brains work. One simple way to think about it is as your brain’s “inner voice” network. It’s the system that turns on when you’re reflecting, remembering, imagining, or thinking about yourself and others.

The DMN is most active when the brain is not focused on the outside world. It turns on when you are:

• Daydreaming

• Thinking about yourself

• Replaying past events

• Worrying about the future

• Imagining what others think about you

In other words, it’s the brain network that supports self-reflection, memory, and meaning-making.

Why the DMN matters in kids and teens

When kids are doing homework, playing a game, or listening in class, different “task-focused” brain networks are working. But when their mind drifts — staring out the window, lying in bed at night, or zoning out — the DMN takes over.

During adolescence, the DMN is still developing. This is the same time kids are:

• Becoming more self-aware

• Comparing themselves to peers

• Thinking more deeply about identity and belonging

That’s normal and healthy.

But research shows that in anxiety and depression, the DMN can become overactive or poorly regulated. Instead of helping kids reflect and learn from experiences, it can get stuck in loops of:

• Rumination (“Why did I do that?”)

• Negative self-talk

• Excessive worry

• Replaying mistakes or fears

This helps explain why anxiety and depression often feel like being trapped in your own thoughts, even when nothing “bad” is happening in the moment.

Importantly:
👉 This is not a character flaw
👉 It’s not a lack of worth
👉 It reflects how brain networks are communicating during development

Understanding the DMN helps parents see mental health struggles as brain-based, real, and treatable.

Why DMN Matters for Mental Health

In ADHD, anxiety, and depression, the issue often isn’t too little effort or not enough motivation.

Instead, the brain may be:

• Spending too much time in the DMN

• Having trouble switching out of internal thought mode

• Getting stuck in rumination, worry, or self-criticism

This explains why kids might say:

• “I can’t stop thinking”

• “My brain won’t turn off”

• “I know what to do, but I can’t start”

Nothing is “wrong” with them — their brain networks just aren’t shifting flexibly yet.

What This Means for Treatment

How Anxiety & Depression Treatments Help the Brain (Including the DMN)

One of the most hopeful findings from neuroscience is this:
Effective treatments actually change how brain networks work — including the DMN.

Different treatments help in different ways, and that’s a good thing.

1. Therapy (especially Cognitive Behavioral Therapy – CBT)

CBT helps learn to:

• Notice unhelpful thought patterns

• Challenge negative self-talk

• Shift attention away from rumination

On a brain level, CBT helps the DMN become less dominant and improves communication with networks responsible for:

• Focus

• Emotional regulation

• Problem-solving

Think of therapy as helping the brain practice switching gears, rather than getting stuck in “inner critic” mode.

2. Mindfulness-based approaches

Mindfulness teaches how to:

• Notice thoughts without getting pulled into them

• Anchor attention in the present moment

Emerging research shows mindfulness can quiet DMN overactivity, especially the parts involved in rumination and worry. Some newer therapies even use brain-based feedback to help kids learn this skill more directly.

3. Medication (such as SSRIs)

For some kids and teens, medication is an important part of treatment.

From a brain perspective, SSRIs can help rebalance communication between the DMN and emotion-processing networks (like the amygdala). This can reduce the emotional “volume” of negative thoughts and make therapy skills easier to use.

Medication doesn’t change who your child is — it can help their brain be more flexible and responsive.

4. Why combination treatment often works best

Research consistently shows that therapy + medication together is often more effective than either alone, especially for moderate to severe anxiety or depression.

That’s because:

• Therapy builds skills and insight

• Medication supports the brain networks that allow those skills to work

What parents should take away

✔ Anxiety and depression are linked to how developing brain networks function
✔ The DMN plays a central role in worry, rumination, and self-talk
✔ Treatments don’t just “mask symptoms” — they support healthier brain connectivity
✔ Improvement takes time, and that’s normal

Most importantly: your child’s brain is still developing, and the brain is remarkably adaptable. With the right support, those networks can learn new, healthier patterns.

The online focus from dopamine → DMN helps explain why multiple supports often work best:

• Medication can support brain chemistry and make networks more flexible

• Therapy (like CBT) helps kids notice and redirect unhelpful thought loops

• Mindfulness and regulation strategies help quiet DMN overactivity

• Skills and structure support attention and task-focused networks

No single approach fixes everything — because no single system causes everything.

The Big Takeaway for Parents

✔ Mental health is about how the brain shifts, connects, and adapts.

This newer lens moves us away from asking, “Why can’t my child try harder?”

And toward asking, “What does their brain need to shift gears more easily?”

That’s a much more hopeful — and helpful — place to start.

Shifting gears to teens and executive functioning…

For those of you with teens who struggle with executive functioning and emotional regulation, I invite your middle and high schoolers to join me at the ADHDKCTeen online events, which are usually the first Tuesday of the month. In March we’ll be talking about Rejection Sensitivity, so sign up for the ADHDKC newsletter if you don’t want to miss any upcoming events. All are free and open to the public.

Due to some very unfortunate (and very inconvenient) car problems, the March ADHDKCTeen was rescheduled.

New date: February 17 at 5:30 PM CST

RSVP to get the link

RSVP for ADHDKCTeen's March Event

Over the past several years in my clinical practice, I’ve noticed a recurring pattern, particularly among adolescents and young adults with ADHD. Many of these patients don’t just struggle with attention, impulsivity, or executive functioning. They also report dizziness, chronic fatigue, gastrointestinal discomfort, brain fog, and difficulty tolerating standing or physical activity at higher rates than my patients without ADHD.

At first these symptoms can appear unrelated. But as I began looking more closely, a pattern emerged: a significant number of these patients also had joint hypermobility. When I started screening for hypermobility with a Beighton screening and testing orthostatic changes with an Active Stand Test, many met criteria for hypermobility and/or Postural Orthostatic Tachycardia Syndrome (POTS).

This pattern isn’t coincidental. A growing body of research suggests that autonomic dysfunction may be the central link connecting ADHD, joint hypermobility, and POTS.

Why I’m Writing About This

This isn’t just something I’m seeing in patients. It’s personal for me.

Since my teen years, I’ve had episodes of dizziness, swelling in my feet, palpitations, brain fog, and other symptoms that would come and go. I think everything started after I had mono my freshman year of high school, though it’s been long enough that my memory may not be perfect and something else could have triggered things for me. We do know now that some viruses, especially EBV (the cause of mono) and COVID, can trigger POTS, so that timing fits.

By the time I was in medical school and residency, classmates teased me about how much water I drank, but I already knew that staying hydrated was one of the only ways to keep the dizziness away. I could go months without any issues, then suddenly have several episodes a day for weeks. I now suspect little upper respiratory infections triggered symptoms because that seems to hold true now that I’m tracking things more closely, but didn’t make the connection for many years. Episodes became less frequent over time, which was appreciated.

Until the pandemic started.

I was fortunate to not get infected with COVID in the early days. I thank my N95s for that, even though they were re-worn many times due to shortages.

After my first COVID vaccine I had episodes of dizziness and palpitations again. I didn’t connect the dots until after a series of vaccines. Episodes were relatively mild but frequent for several weeks, then became less frequent over time, then repeated with each vaccine, but symptoms were milder and shorter-lived each time.

Each vaccine has been met with fewer of these effects, but when I dropped my guard a few years into the pandemic, I got infected with COVID and it flared my dizziness and heartbeat episodes significantly again, much more than any of the vaccines. The vaccine is always safer than the infection, so I will keep getting vaccinated to keep my immune system primed to fight and will continue to work to prevent infections with other precautions, including wearing masks.

These episodes make me feel overwhelmed and panicky. A feeling of impending doom with each episode. It is not fun.

I’ve resumed drinking more water, started wearing compression socks, and work to reduce stress to limit episodes. More recently I’ve realized that the position of my neck matters too. If I curl up in a chair to read or watch TV, I sometimes get palpitations, dizziness, and a strong sense of unease. But if I sit up straight and adjust my neck, the symptoms settle quickly.

Why am I sharing this?

Along with my own symptoms flaring, after everyone started getting infected with COVID I started to notice a larger-than-typical number of adolescents coming in with dizziness, brain fog, GI complaints, and other seemingly unrelated issues, especially in my patients with ADHD. I started looking more closely and noticed a common thread: many of these patients also had joint hypermobility.

I’ve lived with these symptoms on and off for many years, but only recently started connecting the dots. I’m sharing what I’ve learned so that if you or your child experience similar things, you’ll have a better understanding, allowing better self-advocacy when you see your physician.

Understanding the Conditions

Before we get into what ties these things together, let’s just briefly review what each of these is.

ADHD

ADHD is one of the most common neurodevelopmental conditions and involves differences in attention regulation, impulse control, and executive functioning. It starts in childhood and often persists through the adult years, but symptoms can change over time.

Joint Hypermobility & Hypermobility Spectrum Disorders

Joint hypermobility refers to joints that move beyond the typical range. When hypermobility is accompanied by symptoms such as pain, fatigue, or instability, it may fall under Hypermobility Spectrum Disorder (HSD) or hypermobile Ehlers-Danlos syndrome (hEDS).

Postural Orthostatic Tachycardia Syndrome (POTS)

POTS is a disorder of the autonomic nervous system characterized by increased heart rate increase upon standing. Those with POTS may notice dizziness, fatigue, brain fog, palpitations (rapid or pounding heart rate or skipped heartbeats), and intolerance to exercise.

I wrote an e-book on dizziness as part of a promotional series and would like to offer it for free here. Sign up for it with this form: Dizziness in teens

Autonomic Dysfunction: The Common Thread?

Research suggests that autonomic dysfunction links ADHD, hypermobility, and POTS.

Common Symptoms Across These Conditions

Those experiencing overlap may report:

• Joint pain, instability, or frequent sprains

• Chronic fatigue or exercise intolerance

• Dizziness or lightheadedness when standing

• Rapid heart rate or palpitations (heart pounding, racing, or skipping beats)

• Brain fog or difficulty concentrating

• Gastrointestinal symptoms such as bloating or nausea

• Sleep disturbances

• Temperature regulation difficulties

• Anxiety or mood changes

Autonomic dysfunction (or dysautonomia) is a condition where the autonomic nervous system (ANS) doesn’t work correctly. Our autonomic nervous system controls all of our basic survival functions, such as heart rate, digestion, breathing, and blood pressure. It operates through two main divisions:

• sympathetic (fight-or-flight, activating alertness)

• parasympathetic (rest-and-digest, promoting calm)

These systems work together to regulate everything we need to survive without needing to think about it. When these systems are disrupted, we notice symptoms like dizziness, fainting, brain fog, fatigue, digestive issues (constipation, bloating, diarrhea), urinary problems, abnormal sweating, and sexual dysfunction.

How Common Is Autonomic Dysfunction in Hypermobility?

• Dysautonomia is present in approximately 65% of females and 44% of males with hEDS or HSD.

• Nearly half of patients with hypermobility meet criteria for POTS.

Autonomic dysfunction appears to play a role in many of the symptoms seen across these conditions.

How These Conditions May Be Connected

This is an area that is still under investigation and is not completely understood. Here’s a summary of what I’ve found that is known or suspected.

Shared Genetic and Developmental Factors

There may be shared genetic or early developmental factors that influence connective tissue, autonomic regulation, and brain development.

Connective Tissue and Vascular Function

One leading theory tying all of these together involves abnormalities in connective tissue that affect blood vessels. In addition to ligaments allowing increased flexibility of the musculoskeletal system, people with hEDS and HSD have blood vessels that stretch more than normal. This can lead to blood pooling in the legs and swollen feet, causing decreased blood flow to the brain. Less blood in the brain can lead to dizziness and brain fog.

When brain fog happens regularly, it can mimic ADHD symptoms and exacerbate existing ones. Frequent brain fog causes forgetfulness, poor concentration, and memory issues that can look like the inattention and executive dysfunction of ADHD.

Connective Tissue and the Nervous System

Connective tissue proteins play a role not only in joints and blood vessels but also in the structure and function of the nervous system. Changes in these tissues may affect both physical stability and neurological processing.

Autonomic Nervous System Dysregulation

Baroreflex is one of the autonomic nervous system functions that helps to maintain blood pressure at nearly constant levels. Those with hEDS often have altered baroreflex sensitivity. This may explain why symptoms fluctuate and why people can have exaggerated responses to posture, stress, or illness — in other words, standing leads to an elevated heart rate with this sensitivity.

Altered Body Awareness

Hypermobility can affect proprioception (awareness of body position), potentially contributing to coordination challenges, autonomic dysfunction, and attentional regulation difficulties.

It also affects interoception, which is how the body interprets internal signals like hunger, fullness, and nausea. This can lead to picky eating by altering how food feels inside the body. It can also lead to missing hunger cues (restricting intake) or failing to notice fullness (overeating), causing anxiety-driven food avoidance.

Deconditioning and Cardiac Remodeling

Many patients with hypermobility and autonomic symptoms develop exercise intolerance. Studies show that over 75% of those with dysautonomia experience significant activity limitation, leading to cardiac deconditioning.

This creates a vicious cycle: symptoms lead to reduced activity, which worsens autonomic instability.

Graded exercise programs under the guidance a physical therapist or exercise physiologist who has experience with hypermobility and autonomic dysfunction can help.

Mast Cell Activation

Mast cell activation syndrome (MCAS) may also play a role. Mast cells live within connective tissue and can release mediators that affect blood vessels and autonomic signaling. This can mimic allergies or anaphylaxis, including hives, flushing, digestive issues, fatigue, and brain fog.

What Does This Mean For You?

Screening

If you or your child has ADHD, chronic fatigue, dizziness, joint pain, or can contort in ways most people can’t, ask your physician to screen for all of these conditions, not just the primary concern at a visit. This may require multiple visits to adequately address each system.

Keep in mind that symptoms change over time. Children cannot be diagnosed with hEDS before puberty. Rescreening may be necessary over time as symptoms change.

Treatment Approaches

As mentioned above, there is no cure for any of these related conditions. Treatments depend upon symptoms:

• Autonomic support: hydration, increased salt intake (when appropriate), compression garments.

• Exercise therapy: gradual, recumbent-to-upright conditioning programs guided by an experienced physical therapist or exercise physiologist.

• Physical and occupational therapy: joint stabilization and proprioceptive training to prevent injury or for injury rehabilitation, occupational therapy to work on interoception.

• Behavioral and cognitive supports: for ADHD-related challenges.

• Multidisciplinary care: involving primary care, cardiology, rheumatology, physical therapy, and mental health professionals

• For Joint Hypermobility

  • Physical and Occupational Therapy: Core stabilization, strengthening, and joint protection help to stabilize joints and manage pain.

  • Targeted Exercise: Low-impact, structured exercise programs designed to build strength without overstressing joints.

  • Joint Protection Strategies: Bracing, pacing, and ergonomic support as needed.

• For POTS

  • Hydration and Salt Intake: Increasing fluids (often ~2 liters/day) and salt intake (up to ~10 grams/day, if appropriate).

  • Compression Garments

  • Exercise Training: Gradual, recumbent-based exercise programs that progress over time.

  • Medications may be required if the above fails.

• For ADHD

  • Behavioral and Cognitive Strategies: Skills-based supports remain essential, especially when physical symptoms exacerbate problems with attention or stamina.

  • Medications remain the primary treatment for ADHD, but careful monitoring is essential when autonomic dysfunction is present.

• Medication Considerations: Always talk to your prescriber before starting, adjusting, or stopping your prescription medications. Also be sure to let them know if you’re taking any over the counter supplements or products.

  • Medications used for ADHD symptom management that affect norepinephrine may exacerbate heart rate or orthostatic symptoms but are often tolerated when started at low doses followed by regular visits with the prescriber with each dose adjustment. These include:

    • Stimulants: Ritalin and Adderall families of medications

    • Selective Norepinephrine Reuptake Inhibitors (NRIs): atomoxetine/Strattera

    • Serotonin & Norepinephrine Reuptake Inhibitors (SNRIs): viloxazine/Qelbree, duloxetine/Cymbalta, venlafaxine/Effexor XR, desvenlafaxine/Pristiq

    • Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs): Wellbutrin

  • Alpha-agonists may improve ADHD symptoms and affect orthostatic symptoms. These include:

    • Guanfacine (Intuniv, Tenex): More selective for alpha-2A receptors, preferred for improving attention and impulse control. Generally less sedating than clonidine but still leads to sedation.

    • Clonidine (Kapvay, Onyda XR): Acts on multiple alpha-2 receptor subtypes and helps manage hyperactivity, tics, aggression, and sleep issues.

    • Both guanfacine and clonidine decrease heart rate and blood pressure through alpha-2 adrenergic stimulation, which may exacerbate symptoms in those with low heartrate or blood pressure so close follow up after starting and adjusting these medications is necessary to find an effective dose.

  • Medications for POTS may be required if orthostatic symptoms are not managed sufficiently with extra water, salt, compression garments, graded exercise, avoiding large meals, stress management, and other treatments. The medications used for orthostatic management and the side effects that require tracking include:

    • Fludrocortisone: potassium levels

    • Midodrine: hypertension

    • Beta-blockers: hypotension, fatigue, wheezing

Why All This Matters

Understanding the links between ADHD, hypermobility, and POTS helps explain why so many patients feel dismissed when care is fragmented across specialties.

Primary care physicians like myself do not have the training to manage all aspects of autonomic dysfunction. In fact, no one specialty “owns” autonomic dysfunction and is fully trained to manage all aspects of it. Cardiologists, neurologists, physical therapists, rheumatologists, and other specialists each view autonomic dysfunction through their specialty lens and may fail to recognize the full picture.

These are not isolated problems but are often treated as if they are, which leaves patients feeling unseen. Their seemingly unrelated problems may not be sufficiently identified addressed or cohesively managed.

Recognizing this overlap allows for earlier identification, more targeted treatment, and validation for patients who have long sensed that “something bigger” was going on.

While much remains to be learned, viewing these conditions through the lens of autonomic dysfunction provides a more coherent and compassionate framework for care. With a better understanding of this framework, I am hopeful we can find a better path toward improved quality of life.

If you or your child are experiencing symptoms that seem to overlap across systems, it’s worth having a conversation with your physician. Advocate for comprehensive care through a variety of specialists. When symptoms are addressed and preventative efforts are made, all of these conditions can be managed.

Remember: You’ve got this!

Too often, girls are overlooked because their symptoms don’t match the stereotypes.

Instead of hyperactivity, we see masking, perfectionism, anxiety, emotional exhaustion, and quiet struggle.

That’s why I’m joining Find the ADHD Girls on this live panel discussion.

Why Girls with ADHD Are Still Being Missed — and What Actually Helps

• Saturday, Jan. 17

• 9 a.m. PST / 11 a.m. CST / noon EST

• Live | Free | Recording Provided

REGISTER HERE

Featuring:

• Dr. Nerissa Bauer

• Dr. Kristen Stuppy

• Liz Lewis

• Angelina Greenwell

Moderated by Diann Wingert

In this conversation, these expert panelists will discuss:

• Why ADHD looks different in girls

• The early signs that are most often missed

• How masking and compliance hide real struggles

• What parents, educators, and clinicians can do differently

This conversation is for anyone who supports girls — parents, educators, clinicians, and advocates — who wants clearer insight and practical guidance.

REGISTER HERE

Hosted by FINDtheADHDgirls

TEACH Me ADHD Registration NOW OPEN UNTIL January 16th!

TEACH Me ADHD Registration Extended!

Good news, detectives! Registration for the Winter 2026 session of TEACH Me ADHD has been extended until January 14th - or until classes are full!

This 10-week online course for kids (ages 8–12) with ADHD and their parents is a fun and engaging way to learn together about ADHD, build confidence, and strengthen family connection.

NEW: TEACH Me ADHD is now a 10-week package (previously 8 weeks)!

Why the change?

Our HQ wanted to add more support for our Senior Detectives (a.k.a. parents)! You’ll now get two parent-only sessions with a certified ADHD coach — one before classes begin and one after the program wraps up. These sessions are designed to maximize your family’s success.

The original 8-week curriculum for kids and parents to take together remains unchanged — we just made it even better!

About TEACH Me ADHD

TEACH Me ADHD is a fun, interactive 10-week online course for children ages 8–12 and their parents to learn about ADHD together. Through engaging Zoom sessions, hands-on activities, and expert support, families build connection, communication, and confidence in navigating ADHD as a team.

What’s Included:

• 8 weekly Zoom classes with up to 11 other families

• 2 bonus parent group coaching sessions

• 6-month access to class replays

• 6-month membership to ADHD Sleuths 2.0

• Supplies shipped to your home

• Optional “Detectives Only” HQ community access

Learn more about the course:

Learn More and Register

“The coolest part was that we learned while having fun. Dr. Bauer welcomed us like family.”
– Sr. Detective Gram Cracker

Let’s navigate ADHD together — with curiosity, confidence, and a sense of adventure!

3 Class Times Available!

• Sundays starting January 18th

11am ET / 10am CT / 8am PT

led by Dr. Kristen Stuppy

• Sundays starting January 18th

8pm ET/7pm CT/5pm PT

led by Kim Erlich, PNP

• Sundays starting January 25th

5pm ET/4pm CT/2pm PT

led by Dr. Bauer

If you’re a Pediatric Partners patient, message me through the portal and I’ll send you a TOP SECRET coupon code for a discount. Patients of Dr Bauer, Kim, or the rest of the TEACH ME ADHD team can also get discounts by reaching out to them.

As a parent, patient, or even clinician, if you’ve ever been confused when trying to figure out where to start on the ADHD treatment path, you know how overwhelming it can feel to know what the best choice is. Parents are often flooded with conflicting advice from friends, family, physician, and online sources. Clinicians are faced with an ever-growing body of research that can be hard to keep up with.

My last post was on pharmacogenetic testing, often promising to give the “best” medication for an individual. If you haven’t read it yet, feel free to detour there now with the link below and then come back to learn how you can become informed to make the best decisions for your situation.

Medications, behavioral therapies, coaching, lifestyle changes, brain-based interventions… how do we know what actually works, who will benefit from each choice, and what are side effects and risks of each?

I recently learned of the EBI-ADHD Database (Evidence-Based Interventions for ADHD) and was impressed enough to want to share it for people who are considering optimizing treatment for their ADHD, parents who are unsure where to start with their child’s treatment, and even clinicians to be able to quickly review the latest literature.

What is EBI-ADHD?

EBI-ADHD is a free, online, interactive database designed to summarize what high-quality scientific research tells us about ADHD treatments. Instead of relying on individual studies or headlines, the platform pulls together findings from over 200 meta-analyses, representing tens of thousands of children, teens, and adults with ADHD.

In other words, it helps to find answers based on all the best studies.

Why this matters for families and clinicians

ADHD is not one-size-fits-all, and neither is treatment. Parents want reassurance that the options they’re considering are grounded in solid science, not trends or anecdotes. Clinicians want a clear way to compare treatments across ages, outcomes, and timeframes.

Sometimes people are tempted to use testing to see “which medicine will work best.” That’s understandable. If the prescriber recommends trying one medicine and then adjusting the dose based on response or changing to a different medicine if it’s not tolerated, the promise to choose a medicine based on your genetic profile sounds great, but the tests currently available do not show that despite what the clinician or online post may say. Evidence does not support routine pharmacogenetic testing for ADHD medications. As discussed in my last post, these tests do not predict which will work best.

So that leaves us back to trying to choose which option would be best to start with. EBI-ADHD was built specifically to help clinicians, individuals with ADHD, and families work together to choose treatments that fit both the evidence and the person.

What kinds of treatments are included?

The database covers a wide range of interventions, including:

• Medication treatments

• Behavioral and psychosocial therapies

• Parent training and skills-based interventions

• Cognitive and educational approaches

• Lifestyle and complementary strategies

• Brain-stimulation and emerging interventions

Rather than ranking treatments as “good” or “bad,” EBI-ADHD looks at how effective each option is for specific outcomes, such as ADHD symptoms, functioning, or quality of life.

An interactive way to explore the evidence

One of the most helpful features of EBI-ADHD is how user-friendly and visual it is.

Users can explore the evidence by:

• Age group (children, adolescents, adults)

• Type of treatment

• Outcome of interest (symptoms, functioning, side effects)

• Timeframe (short-term vs. longer-term effects)

The results are displayed in an evidence matrix, where each cell shows:

• How strong the treatment effect is

• How confident we can be in that result based on rigorous grading of evidence quality

This allows parents and clinicians to quickly see not just what may help, but how certain the science is.

Built with both science and lived experience in mind

Importantly, EBI-ADHD wasn’t created only by researchers behind closed doors. The platform was co-developed with clinicians and people with lived experience of ADHD from around the world. This helps ensure the information is not only scientifically rigorous, but also relevant and understandable.

The methods behind the database have been published in peer-reviewed medical journals, adding to its credibility and transparency.

What EBI-ADHD does—and doesn’t—do

EBI-ADHD does not:

• Tell families what they must choose

• Replace clinical judgment or individualized care

• Claim that one treatment works best for everyone

What it does do is:

• Clarify what the current evidence supports

• Highlight where evidence is strong, mixed, or limited

• Help guide thoughtful conversations about next steps

The bottom line

The EBI-ADHD Database is a powerful tool for anyone who wants to move beyond myths, social media soundbites, or outdated assumptions about ADHD treatment. For parents, it offers reassurance and clarity. For clinicians, it provides a high-level, evidence-based overview that supports nuanced care.

Most importantly, it reinforces an essential message: effective ADHD treatment is about informed choices, collaboration, and matching the right tools to the right person at the right time.

If you’re curious about what the science actually says, EBI-ADHD is well worth exploring.

EBI-ADHD

If you’ve ever contemplated what ADHD treatment option to use for yourself or your child, you may have come across genetic or pharmacogenetic (PGx) testing. These tests are often marketed as a way to “take the guesswork out” of medication selection, promising to help doctors choose the right ADHD medication more quickly.

I can easily see the appeal, since most prescribers will talk about the risks and benefits of several types of medication and share that we typically choose one at a low dose and adjust dosing as needed if it’s tolerated and change to something else if it’s not tolerated. That sounds (and is) difficult, so when there’s an easier option, it is very tempting to use it. Unfortunately the reality is far more nuanced. Anything that promises a quick fix or easy answers should be looked at with suspicion.

I’ve written about this before, but wanted to review literature to see if anything’s changed. (Quick answer: no.)

Let’s break down what these tests actually do, what they don’t do, and why that distinction matters.

What Is Pharmacogenetic (PGx) Testing?

Pharmacogenetic testing looks at specific genes involved in how your body processes medications. Some companies offer PGx testing for ADHD medications, suggesting that results can guide prescribers toward the best choice for you or your child.

The key word here is process, not effectiveness.

The Most Important Thing to Understand: What These Tests Cannot Do

Genetic tests cannot tell you which ADHD medication will work best for your symptoms.

This is the most common misunderstanding but the most important one to clear up.

Many families assume these tests will predict which medication will best improve:

• Attention

• Focus

• Hyperactivity

• Impulsivity

They do not.

What the Tests Measure vs. What People Think They Measure

What the tests actually measure

• How quickly your body breaks down certain medications (metabolism)

• Some genetic variations related to brain chemistry

What people often think they measure

• Which medication will best control ADHD symptoms

These are not the same thing.

Even if genetics influence how fast a medication is metabolized, that information does not reliably predict whether the medication will meaningfully improve ADHD symptoms.

Why Don’t Genetic Tests Predict Symptom Improvement?

Proper dose adjustment works regardless of genetics

One large review showed that after just three weeks of careful dose adjustment, medications were similarly effective across all genetic profiles.

In other words, genes did not determine which medication worked better. Good prescribing with follow up did.

Real-world outcomes

Studies comparing patients who had genetic testing with those who didn’t found:

• No greater improvement in ADHD symptoms among those starting methylphenidate vs atomoxetine

• More (not fewer!) medication changes in the tested group, opposing the reason to test first to find the right medication faster

• No better symptom control following testing first

Genetic associations ≠ clinical usefulness

While researchers have identified some genetic variations associated with medication response, no single gene or current commercial test can reliably predict which ADHD medication will work best for any individual.

What Do Major Medical Organizations Say?

The American Academy of Pediatrics (AAP) and AACAP (American Academy of Child and Adolescent Psychiatry) do not recommend psychogenetic testing for ADHD medication selection.

They’ve been clear: for these tests to be recommended, evidence would need to show that they:

• Change which medication doctors choose

• Improve ADHD symptom control

• Reduce side effects

• Lower overall costs

So far, none of these have been proven.

What These Tests Might Show

Some test results label people as “poor metabolizers” or “rapid metabolizers” for certain medications.

For example, some individuals metabolize a medication more slowly, leading to higher blood levels. But here’s the truth: prescribers already manage this without genetic testing by:

• Starting at a low dose

• Increasing gradually

• Monitoring symptoms and side effects

• Adjusting or switching medications as needed

This approach works well across all genetic profiles. Genetic testing isn’t required to do this safely or effectively. When testing is used, it rarely changes ADHD medication decisions and has not been shown to improve outcomes.

What About Cost?

Cost is another important consideration:

• Tests can cost hundreds to thousands of dollars

• Many are not covered by insurance

• Remaining out-of-pocket cost may be considerable, even if covered by insurance

• Insurance often requires proof that multiple medications have already failed

Recommendations for Prescribing ADHD Medications

Evidence-based ADHD care typically looks like this:

1. Start with a proven first-line medication (often a stimulant)

2. Begin at a low dose

3. Increase gradually based on response

4. Use standardized rating scales to monitor symptoms

5. Adjust dosing or switch medications if needed

This process is supported by decades of research and is highly effective for most people.

The key is systematic monitoring and dose adjustment, not genetic testing.

If a Prescriber or Company Recommends Testing, Ask These Questions

• Will this test tell me which medication will best improve ADHD symptoms?

• What evidence shows it improves outcomes compared to standard care?

• Will insurance cover it, and what will I pay out of pocket?

• What will you do differently because of these results?

• What happens if we skip the test and follow standard treatment?

Clear answers to these questions matter.

The Bottom Line

Despite strong marketing claims, genetic testing for ADHD medications:

• Does not improve symptom control

• Does not reduce side effects

• Does not shorten the time to finding an effective medication

• Has not been shown to outperform standard care

That’s why the American Academy of Pediatrics does not recommend it.

For most families, the most effective path remains evidence-based medication management:

• choosing proven medications

• adjusting doses thoughtfully

• monitoring response over time.

Coming Up Next

In my next post, we’ll take a broader look at how parents and patients can evaluate all ADHD treatment options, including medications, behavioral supports, school accommodations, and emerging tools, and how to make informed, shared decisions with your prescriber.

Because the goal isn’t just more information. It’s the right information, used wisely.

Find it here:

I was able to join her in 2023, leading groups of kids and parents on missions to learn about how to thrive with ADHD. A lot of people wonder what this course is, so I a made a short video about what we cover during the 8 weeks of online classes.

In the short video, I walk you through what this unique program looks like:
🕵️‍♂️ How kids become “junior detectives” with the help of their “senior detective” (AKA parent or other trusted adult)
📦 What’s inside the TOP SECRET box they receive at home
🧠 How each week builds skills like emotional regulation, organization, communication, and problem-solving
👨‍👩‍👧‍👦 How parents are supported as “senior detectives”

This isn’t just a class. No kid with ADHD would sit for a 75-minute online class! TEACH Me ADHD is an interactive experience designed to help kids understand their ADHD and feel empowered by it.

▶️ Watch the video above to get a glimpse into the TEACH Me ADHD Detective Academy.

If you’re interested in joining us, the best next step is to join the waitlist.
Waitlist members get:
✔️ Early access when registration opens
✔️ A special $100 VIP discount
✔️ First chance to secure a spot before sessions fill

But HURRY! Doors will open January 2nd for Priority Registration of the Winter 2026 teams and the Wait List closes while doors are open. Don’t miss your opportunity to get the special VIP discount!

Sign Up for the Wait List

The program only opens a few times a year, and spots are limited to keep groups small and supportive.

👉 Join the waitlist here: Wait List

I’d love for your family to be part of this experience. If you have questions about the course, comment below or on your Wait List sign up where it asks where you learned about the course. We can also try to squeeze in a free MINI session before Priority Registration starts so you can get a feel for how your child does with the online format. You can also use my Google Calendar to request a time. If I hold a session, I’ll post it to my FB and IG pages to let others request to join too so it feels more like the group class, so check there to see if there’s one scheduled at a time that works for you.

Request a Time