Does your child or teen ever tell you that they are having a panic attack? Or, do they describe symptoms such as shortness of breath, a pounding heart and the sudden feeling like the world is closing in on them? Panic attacks are awful for everyone who experiences them. Kids can feel terrified, unsure about what is happening to them. Parents, desperate to assist their kids can be freaked out themselves and confused about what to do. Kids who live with ADHD typically struggle managing their big feelings anyway. In these moments of acute anxiety, they told me  that it’s like flailing around in rough waves with no raft. Since there’s no rational thinking in the midst of a panic attack, it doesn’t work to trying to talk to your child reasonably in these moments. Yelling at them to calm down is equally ineffective. Panic attacks are best managed by having a concrete set of steps to follow that you and your child or teen have figured out beforehand. When you work together to name the triggers and notice the warning signs, it’s easier to create an effective strategy to use in a panicked moment.

The goal isn’t to eliminate panic attacks: that may be unrealistic for now. Instead, the immediate goal should be to teach your son or daughter techniques for self-soothing in uncomfortable moments. Focus on becoming familiar with the clues that anxiety is rising and how to respond to those signals to lessen their intensity. We want to turn down the volume on the anxiety so it doesn’t mushroom into a panic attack. 

Following the plan that you’ve previously created and practiced together instead of trying to find a solution in the middle of a heated, emotional moment keeps things from escalating even further. Over time, by learning how to use tools to reduce anxiety, kids become more confident about what to do to soothe themselves when they start to feel agitated. The frequency of panic attacks goes down. 

While the following suggestions are meant to be helpful, they do not substitute in any way for taking your child to see their physician to rule out any physiological issues that could be causing panic. Please check out other causes too, such as bullying, learning disabilities, problematic teacher dynamics or other environmental factors. Here’s what you can do: In a quiet moment, sit down with your son or daughter and talk about how you can work together as a team to cut down panic attacks and reduce anxiety. Ask them what internal changes signal that they are feeling anxious and later panicked. Share some of your own too. Increased heart rate, shortness of breath, perspiration, a knot in the stomach or sudden headache are common signs that anxiety is rising. Write these insights down.    Next, show them the list of tools below and customize each option for them. Put the final document on both of your phones, computers, iPads, etc. and make a copy for the kitchen, the car and their room so everybody can refer to it when necessary. Consider sharing this with your child’s school counselor or teacher as well so you are all on the same page. 

1. Breathing exercises: Alternate nostril yoga breathing calms you down quickly. Put your index finger on your right nostril: breathe in and out of your left nostril. Now switch and breathe in and out of your right nostril. Do this on both sides for 4-6 times until you start to settle down. 
2. Make a playlist of songs that you love, soothe you or just make you smile. Give the playlist a fun title like “Cooling down tunes.”
3. Change your environment: If you are inside, go to a different room or step outside. Notice what’s happening around you as you are inhaling in for 4 counts and exhaling for 4 counts. 
4. Go to the bathroom and wash your face and hands. Tell yourself something encouraging such as: “You’ve got this.” “This has happened before and you’ve survived.” “It’s just your fears trying to run the show. Slow down so you can calm down.” 
5. Physical movement:  Walk, run, ride a stationary bike, jump on a trampoline, etc. Get the body moving so kids move their attention from out of their heads and into what’s happening around them.
6. Comfort activity: Reading, drawing, coloring, Soduku, playing with a pet, Lego’s, listening to a story, receiving a hug–these can also quiet the system until the storm passes.

As a parent, your motivations and intentions behind a statement might greatly differ from how your child interprets it. How do you know when you are giving feedback or criticism, and who is to decide? For example: Your 16 year-old daughter, Layla, agrees to clean her room and picks things up nicely except for the balled up pair of socks and crumpled tee shirt she leaves on her bed. Instead of simply saying, “Wow. Great job!” you want her to notice what she’s missed. You say, “That’s pretty good, but to be fully clean you missed the socks and tee shirt on your bed.” Your daughter loses her cool and starts screaming at you about how she’s never good enough and demands that you leave her alone. What happened?

How your child might view feedback or criticism:

You may think that you’re making an innocent comment aimed to teach your teen what a cleaned room really looks like. But, in reality, what she heard was only the negative part: what she missed on the bed erased the value of the rest of her good work.

When I was doing interviews with kids for my book, they told me repeatedly that there’s no such thing as positive feedback: it all feels negative to them. Fed up and frustrated with consistently missing the mark, despite well-meaning efforts to do things, kids with ADHD blow their tops- just like Layla.

There is a big difference between feedback and criticism. Ideally, feedback takes into account intention, effort and progress. It’s a teaching tool. Criticism just looks at what isn’t right and often adds a mixture of blame, anger and disapproval. Nobody feels good after criticism, no matter how carefully it is worded.

How to use the ADHD Adapted Sandwich Feedback Method to formulate feedback instead of criticism

To make the shift from veiled or direct criticism to feedback that works more effectively, reframe your thinking. Use the ADHD Adapted Sandwich Feedback Method to prepare your statement like you would make a delicious sandwich. When you are hungry, you consider what might be tasty and which foods you want to place between the slices of bread. It’s a thoughtful, deliberate process with a yummy, anticipated outcome. Giving feedback can be similar. You start with positive observations as doughy top and bottom pieces, throw in an encouraging condiment, place a neutral piece of observed information in the middle and top it off with a piece of compassionate cheese.

Here’s how this approach could go with Layla: “Nice job cleaning your room, Layla. I like how you arranged your books and notebooks by color on your desk. Although it’s no big deal, I see that you missed a few pieces of clothing on your bed. Great work on picking up all of the items from the floor so I can vacuum your rug. Thanks!

My guess is that Layla will have a very different attitude about the socks and tee shirt with this “sandwich of feedback.” She’ll feel appreciated more for her efforts and respond to that validation, rather than focusing on the one thing she overlooked. It will be more likely to be interpreted as feedback than criticism.

The influence of the negativity bias on the value and memory of criticism.

We’ve got to remember that the negativity bias in human brains naturally overshadows positive information. For neurodivergent kids with ADHD, LD or ASD, they hear so many more negative statements in a day than positive ones. We’ve got to make concerted efforts to give them feedback they can actually absorb and use. That’s why we have to add extra validation and encouragement when we are responding to kids’s efforts for change, following through on tasks or taking risks.

I encourage you to try the ADHD Adapted Sandwich Feedback Method this week and see what happens. For an extra boost, ask them to repeat back one of the positive things they heard you say. This will help their working memory encode it and send it down the memory line for long-term storage. Be kind to yourself as you try to make this shift. It’s easier to blurt out something critical (even if you don’t mean to) than it is to thoughtfully generate useful feedback.

Learn more:

• Negative Memory Bias and ADHD: Tips to Help Kids and Youth with ADHD Remember the Positives
• Parenting Older Teens with ADHD: Land the Helicopter and Focus on Scaffolding
• ADHD and Anger: Tools for Reducing Family Conflict by Starting with Yourself

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Happiness during the holiday season for your family really depends on your ability to stay sane and stable in the midst of all of the shopping, planning and parties. When you are able to manage yourself with as much calm and clarity as possible, your son or daughter with ADHD will regulate better too. You are not only modeling for them how to regulate but why it’s helpful during busy times like these.

Good mental health during the holiday season starts NOW for the best results. The goal is to establish do-able routines for self-care now, so you will be in the habit when the stress intensifies later. Our brains need time to process the myriad of stimulating activities during this time so we don’t feel perpetually stressed, overwhelmed or burned out. Follow these tips for better self-care and, if you can, expand them to your kids too. Everyone will benefit from some time to slow down, plan ahead and focus on the important stuff. 

Follow these steps:

1. Create a daily routine for connecting with yourself: Whether it’s going to the gym, stretching before bed, meditating, taking a hot bath, listening to favorite music or walking outside, set up a plan for doing something at least twice a week. You need this time for integration and letting go throughout the year but, during the holidays, when the emotional, physical and psychological demands are greater, it’s more important than ever. Make this activity achievable by starting off with something small that you can actually accomplish. You’ll feel nourished in a way that only you can give yourself.
2. Take a moment and set goals for the holidays:  Instead of trying to be everywhere and everything for all of the people in your life, take a few quiet moments to reflect on what you would like to get out of this holiday season. What are your goals? What are your limits? What happened last year that worked and you’d like to repeat? What do you want to avoid?
3. Write these down: Look at them when you’re feeling frenzied, overwhelmed or discouraged. Ask your children and partners the same questions, identify shared intentions, add those to your list and focus on making these things happen.
4. Plan for what’s most important before shopping: You are only one person and you can’t do it all. Most people become overwhelmed because they’re not able to formulate a strategy for getting things done. Sit down with your partner and/or kids and make a list of who you want to make or purchase gifts for and what those items are. Ask your children to assist you in ways that are appropriate for their age and capability. Then assign days and blocks of time for shopping or creating.  When you have an action plan, you’ll feel more empowered and less freaked out.  

Good luck on your holiday escapades!