Month: July 2024

Truth and Trust: Managing Lying in Children and Teens with ADHD

Dear Dr. Saline:

Is it standard for an ADHDer to lie so vehemently? Like he has been caught red handed and he denies it while his hand is in the cookie jar? Or is this because he’s a 13 almost 14 year old boy that thinks he can get away with everything? He lies about taking his medicine then complains we act like we can’t trust him. He is old enough to know what’s right and wrong but still refuses to acknowledge something if he thinks he can get away with it. Then says he didn’t know. What should I do?— Rosie

Dear Rosie: 

Living with ADHD means doing things that you regret, wish had never happened and want to avoid at all costs much more often than you would like to. We know that the ADHD brain lives in the present moment: it’s a Now/Not now existence. Lying is saying something false with a desire to deceive someone. Lying attempts to make the present moment better either through denial (“No, I didn’t eat any of that pie you made for dessert.”) or omission (“Oh yeah, I forgot to tell you that I failed my science test.) Lies aim to increase comfort in what’s happening now, to reduce stress about a problematic situation or to decrease conflict about something that happened in the past. 

ADHD and Lying

With their poor impulse and emotional control and other executive functioning challenges, many children and teens with ADHD engage in lying. Today, tweens and teens are also facing a number of mental health challenges as well. This means that they get themselves into sticky situations more frequently than neurotypical children and teens. When this happens, they will frequently lie to wriggle their way out. This is different from honestly getting facts mixed up, misremembering what occurred or elaborating on stories. Lying is an ineffective coping mechanism in real time situations where kids (or adults) lack alternatives or fear unpleasant consequences. 

Lies also involve magical thinking. For instance, let’s say that your son is wishing away that he didn’t break Grandma’s lamp when he was throwing his tennis ball in the living room even though he’s not supposed to. When you confront him, he may well say: “No, I didn’t do that,” even though you are holding the glass shards in your hands. He believes that if he wishes it away and denies it effectively, you, too, will believe that it didn’t happen.

Lying and Working Memory

But there’s also a very real issue of working memory for kids with ADHD. In some circumstances, it’s not completely a lie if a child or teen truly doesn’t actually remember it. So if you ask your son if he has everything he needs for school, he may say ‘yes’ but has forgotten his lunch on the counter because he was racing around to find his phone. In these instances, there’s no intent to deceive so it’s not really lying. It’s just ADHD forgetfulness and distractibility. When you add worry and shame about ‘messing up’ again into the mix, it can be tough to figure out what is really going on.

The Trust Bank Account

Trust is something that most teens expect their parents should give them automatically. But trust is actually earned. I like to use the analogy of a trust bank account: kids make deposits with truthful and cooperative words and actions. They make withdrawals when they purposefully do not tell the truth, when they do not follow agreed upon house agreements and when they are oppositional. Withdrawals can result in the loss of earned privileges. It’s more helpful to set up consequences in advance rather than create them on the fly when you are distressed.  

Let’s face it, lying behaviors are SUPER frustrating and really maddening. It’s natural for us to get activated, become demanding (“Are you kidding me? Of course you broke the lamp!!!”) and lose our tempers. The problem is that when we lose our cool with our kids, our upset becomes the focus, not whatever they did. 

Building Trust and Nurturing Honesty 

Start by defining lying in a family meeting. Write down what it is and what it is not. Post this in the kitchen as a reminder. Then use these five tools based on my 5C’s of ADHD™ approach:

  1. Self-Control: Lies occur between two people. How does your response increase the likelihood of lying or intensify it in the moment? Settle yourself before you speak to your son. Consider how his neurodivergence might be contributing to what is going on. Take a big pause if you need to manage yourself before responding to him. 

2. Compassion: You cannot ask for honesty and then punish it. That’s neither compassionate nor fair. A positive response to honesty includes having a discussion about what has happened when everybody is calmer. You don’t want to shut things down with anger, guilt or blame. Let him stew on the knowledge that the jig is up for a while and consider what would be a consequence that makes sense to him. Remember, he’s dealing with two things: the lie and and the failure of the attempted cover-up. Neither of these feel particularly good, despite what he may be showing you. This is where your empathy comes into play.

3. Collaboration: Create opportunities for cooperation and restoration. Give your son a chance to make things right and be part of the solution. Brainstorm ideas for Apologies of Action–to move beyond a quick, seemingly disingenuous, “I’m sorry”, to reparation and personal responsibility. What can he do to demonstrate his regret and make things better? Teach and show what a heartfelt apology looks like. If he needs incentives to engage with this process, that’s fine. Many kids struggle initially and need to earn something afterwards.

4. Consistency: Consider your expectations. Growing up as a neurodivergent boy in a neurotypical world is tough. How can your son be who he is and work towards improvements simultaneously? What are realistic expectations for him that you both agree about? He’s got to have skin in the game to build a habit. There is no perfection: we are aiming for his steadiness in honesty–that is to say more often than not. 

5. Celebration: Notice when he is honest and offer specific praise and acknowledgement. You don’t need to bake a cake but a high-five or a call-out will let him know that you see his efforting. Give him a chance to correct himself by offering a ‘Take back of the Day.” He can think about what lie or omission he said and then take it back right afterwards without negative consequences . The whole family can use this as it builds trust and personal accountability.

Changing habits related to lying in children and teens with ADHD takes time, practice, cues and repetition. People of all ages create lies to avoid shame. It’s important to remember that your son’s lying can be a reflexive response to wishing he had made a different choice. He just may not be able to say that–yet.

I hope that you found your time spent in my corner of the internet this week valuable, and that you were able to take away ideas or inspiration to help you along the way.  If you have any questions or thoughts about ADHD and lying, I’m always available at Ask Dr. Sharon and appreciate your thoughts and feedback – it helps keep me inspired for future books and blogs!

ADHD and Depression: 5 Strategies for Better Living

You’ve spent all the money, all the time, and all the energy planning for this – your son’s 11 year old birthday party. The gathering went off surprisingly well, everyone seemed to have a good time, and the day was filled with many special moments. So why are you feeling bad? After allowing yourself to accept accolades from friends and families, you start wandering around the dark corners in your mind of insecurity and self-doubt. Wasn’t the lasagna a bit soggy? Were the games too babyish? Did people really have fun or just say so to be polite? Despite the outward success of the day, you’ve circled right back to feeling like a failure with a bit of shame and self loathing thrown in for good measure. Your underlying depression and its symptoms have officially re-entered the arena. 

ADHD rarely travels alone

I frequently say that “ADHD doesn’t travel alone”, and it is very true – an estimated 18% of adults with ADHD also have major depressive disorder, and about half of adults with ADHD have anxiety.  This is often referred to as “co-occurring conditions”- when two or more diagnoses (or symptoms of diagnoses) exist at the same time. Depression is estimated to be 2.7 times more prevalent in adults with ADHD than those without.  So how do you know which one came first, and more importantly, how do you know which should be treated first?

Explaining Depression

Depression is a complex mental health condition with a variety of symptoms that can affect somebody’s physicial, cognitive and emotional functioning. Typical signs of depression include: feelings of sadness, hopelessness or worthless; irritability; changes in sleep patterns (too much, interrupted sleep or too little); lethargy including; physical problems (including headaches or digestive issues) with no clear cause; suicidal thoughts or attempts; increased use of drugs or alcohol; isolation and withdrawal from social contact.

While depression can affect concentration and focus, these issues vary and mostly occur under stress. Depression is first and foremost a mood disorder so troubles with paying attention are secondary to emotional and physical distress. If you (or someone around you) are having several of these symptoms persistently (for most of the day, nearly every day, for at least two weeks), then please seek professional help by contacting your primary care provider. 

Key Traits of ADHD

ADHD is a neurologically-based condition that typically presents with a range of symptoms seen to inattention, hyperactivity, and impulsivity. In ADHD,  unlike depression, problems with concentration are primary and stem from the executive functioning challenges that come naturally. Inconsistency with attention is one of the hallmarks of having ADHD and one of its most frustrating aspects. Common issues for people living with ADHD include: disorganization, procrastination, emotional dysregulation, forgetfulness, distractibility, excessive talking or interrupting and chronic lateness.

People with depression and ADHD may experience chronic brain fog due to feeling emotionally overloaded in conjunction with their biological attentional challenges. They may also experience low motivation, a lack of joy from activities they previously enjoyed, persistent low energy and profound sadness.

Get Help!

If you are experiencing any of these symptoms typically associated with ADHD and depression, it is important to start with a professional evaluation to help rule in (or out) each of these diagnoses, and understand the impact they might have on each other (and yourself!).  This information will help you and your provider develop a plan with targeted priorities and measurable goals.  In terms of treatment priorities, typically the symptoms that most impact your day to day life will be of initial focus.  

Tips for Reducing Depression with ADHD

Whether you are diagnosed with co-occurring ADHD and depression or struggling with some of the issues outlined above, here are some important tips to keep in mind to help you along the way: 

  1. MOVEMENT: I can’t emphasize enough how beneficial moving your body can be to your overall physical, mental, and emotional well-being. Having endorphins surge through your brain elevates your mood and helps with focus. Whatever you choose to do, start small that you can actually accomplish each day. Keep it simple – gentle stretching, a short walk in the neighborhood, riding a bike around the park–these are great activities to start with. Exercise in any form can help create new routines that brains wired for ADHD and/or depression really benefit from. 
  2. BE EASY ON YOURSELF. Be kind to yourself in the ways that you would treat a friend or loved one. When brains wired for ADHD experience depression, it can make even the most simple of tasks feel doubly insurmountable. There are days when getting a shower or putting away groceries require all of our mental, physical, and emotional reserves. When struggling with ADHD and depression, these reserves are already in even shorter supply, and so completing even the smallest of tasks is worth celebrating.  Be kind to yourself, and celebrate the smallest of successes each day along your journey.
  3. A WORD FOR WOMEN: Women tend to be referred for anxiety or depression instead of even considering ADHD. As familial, work and social pressures increase in intensity with age, women are more than twice as likely to develop depression compared to those without ADHD . ADHD and depression often “look” different in women than men, as these symptoms and feelings are more often internalized (kept inside, invisible to others) than externalized (able to be seen or observed by others typically in anger).  
  4. START SMALL. For brains that get bored easily (yet also struggle with organization and motivation), it may be tempting to feel as though you need to make ALL the changes, RIGHT NOW.  And while change can be good, it’s important to think long term – what is sustainable, and easy to do again and again? What will fit your lifestyle? What is a good “environmental  fit” – ie, what small changes can you make that will meet you where you’re at, in this moment, that you can do consistently each day? Imagine beginning to feel better like training for a marathon – start small, do it each day, and slowly increase the difficulty as you feel better each day.  
  5. ARM YOURSELF WITH KNOWLEDGE. Simply reading this newsletter helps to make protective, positive deposits in your knowledge “bank”!  When our brains struggle with symptoms of ADHD and/or depression, education can be an incredible tool to help tame negative self-talk, and counter spirals of shame and self-doubt that repeat in our head.  Use trusted resources and information from professionals available online, and consider time spent online working towards feeling better time well spent!