My youngest daughter has been struggling in her quest to lose a few pounds, so her older sister suggested an unusual method — something she’d seen on Comedy Central. Essentially, you set a desired target for yourself, and if you don’t meet it within the agreed-upon time, a third party will send a pre-arranged, extremely embarrassing photo of you to someone important — say, your boss. How ingenious, I thought, because it plays on the fear center of the brain, wired for our very survival.

There’s just one problem: No matter how dire the consequences, threats, and punishments — like blasting out your most embarrassing photo — this strategy just doesn’t work effectively on a child with ADHD. No matter how many times you try.

It’s hard for most adults to understand this because consequences, threats, and punishments do work on us. We show up to work on time because we don’t want to get fired. We take out the trash because we don’t want overflowing garbage. We go to bed instead of watching one more “Naked and Afraid” episode because we don’t want to be grumpy-tired the next day. We fill up the gas tank so we don’t wind up stranded on our long journey.

Why does this work for us, but not for our kids with ADHD?

Risk vs. Reward in a Preoperational Brain

When an adult considers consequences, they engage a part of the brain called the prefrontal cortex. It is responsible for critical thinking, for weighing information from other parts of the brain, such as the fear center — the amygdala — and for deciphering the abstract grays of a situation and not just the tangible, immediate black-and-white. In other words, the prefrontal cortex will stop an adult from late-night chocolate cake grazing, acknowledging the future threat of the embarrassing photo hitting the boss.

But the prefrontal cortex doesn’t reach its full operational capacity until adulthood. So, information from the amygdala may not get properly deciphered, causing irrational responses, like big tantrums. Until the teen years, childhood thinking ranges from sensorimotor to pre-operational to concrete operational – fancy words coined by developmental psychologist Jean Piaget to mean that the young brain is mostly pre-logic and egocentric, capable of just a black-and-white, tangible immediacy. In other words — Yum, chocolate cake, right now! (What embarrassing photo? No idea what you mean, don’t care.)

[Read this Next: ADHD Minds Are Trapped in Now (& Other Time Management Truths)]

Then, fold in a sprinkle of ADHD. What we know of the ADHD brain using PET scans and magnetic resonance imaging is that the prefrontal cortex is even less developed — by up to three years — and, also less stimulated than it’s neurotypical cousin due to a lack of certain neurotransmitters. In other words, formal operational thinking is even further delayed.

How Rewards Kick Start the ADHD Brain

What this really means is that the ADHD brain is not unwilling, but rather absolutely unable, to conceptualize the abstract threat of losing that cherished privilege — that video game or that favorite toy.

Which is why therapist after therapist encourages the use of rewards. My clients sometimes fight this — I fought this myself — because it feels like we’re bribing our children to behave. Why should we pay them when they don’t hit their brother? That’s bananas!

Despite how it feels, here’s why it works:

The anticipation of a reward creates dopamine, one of the neurotransmitters not playing nice in our kids’ brains. By coaxing the creation of dopamine, we’re helping to gas up the prefrontal cortex so that it can go the distance we’re asking it to go — to sit still, pay attention, keep hands to self. But the anticipation of a negative outcome creates no dopamine. No dopamine, no gas, no working brain.

[Read this Next: ADHD Minds Are Trapped in Now (& Other Time Management Truths)

The ultimate delivery of the reward they earned creates dopamine as well, further aiding the brain in the operational thinking required to remember that there is an enjoyable consequence to good behavior.

Rewards don’t have to be expensive, tangible items to be effective. They can be your encouraging words, time spent with a loved one, a ticket worth ten minutes of screen time. They simply need to be meaningful to your child.

If it still feels like bribery, consider this: while the threat of getting fired might keep you on-time at work, your prefrontal cortex still has the concrete expectation that you will be paid for doing your job. Accessing operational thinking in an under-functioning prefrontal cortex is hard work for our children. By rewarding them, we are teaching our kids that hard work pays off. Now, go reward your terrific parenting with some well-earned chocolate cake. Never mind about that silly photo!

Rewards and ADHD: Next Steps

• Understand: The Delicate Balance of Rewards and Consequences
• Read: Motivating Kids with External Rewards
• Download: Everything You Need to Know About CBT

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Q: “My son, Jake, is 15 and I am so frustrated that he doesn’t seem to remember anything I say to him. It’s like he has selective hearing. I’ll ask him to do things or remember to check on his sister or even meet me after school and it’s as if he never heard me in the first place. It makes me really angry. Is it ADHD? Can you help me figure this out?” – Remembering Mom

Hi Remembering Mom:

What you are describing is working memory, which is an executive functioning skill often impacted by ADHD. It’s the ability to hold on to new information and have it stored in the brain so you can pull it out and use it (even at a later time) when needed. I equate working memory to a two-lane highway: Information coming in must tether itself to the brain; and information must be ready to go out when prompted.

I teach parents about working memory with this example: Your student is in math class at 8 am and learning fractions. At that time and in that moment, he understands what is being taught. Now fast forward to 8 pm. Your student opens up his math homework, looks at it, and says, “I have no idea what this is. I never learned it.”

Did he hear it? Yes. Did he learn it? Yes. Did he remember it? No. What is actually happening is that the information or instructions he was given earlier in the day did not “superglue” to his brain. It boomeranged right out. So what might look like “selective hearing” is really his brain’s inability to solidify and hold on to information. When you are telling him something you want him to do later on in the day, he is hearing you… at that moment. He’s just not remembering later on.

So how do you help your child to remember?

[Read: Why Working Memory Fails and How to Bolster It]

1. Break down information. Any instructions or requests should be given in bite-sized pieces. If you’re giving your son multi-step directions or instructions, give them one at a time so he has a chance to process each one.

2. Limit the “oh by the ways” and “don’t forgets.” Your child is running out the door (or you are) and you call out, “Oh, by the way, don’t forget to meet me at 3 pm by the side door of the school!” The likelihood that your child will remember that information is pretty slim. As much as you can (and I know this is a tricky one), try to find quiet and distraction-free times to impart instructions. Aim for the night before if you can. And to ensure that your son hears you, make sure you are in the same room and have his full attention. Better yet, write it down.

And a tip within a tip. Don’t demand eye contact. Many children with ADHD cannot auditorily and visually process at the same time. Your son may need to move around to fully listen and be engaged.

3. How is he going to remember? Are y0u asking your son, “How are you going to remember that?” You son needs a scaffolding method to remember information. So asking HOW does just that. Perhaps he can use the Notes App on his phone, set a reminder or an alarm, or even take a picture of written instructions. Encourage him to find a strategy that works for him.

[Read: 15 Memory Exercises for Forgetful Kids]

4. Repeat it backwards. I learned this method from a middle school teacher! She explained that when she wants her students to truly solidify information she has taught, she has them repeat it to her backwards. Her reasoning? That the brain has to work harder to recall information when it remembers backwards, so it’s more likely to stick. So instead of asking your son to repeat back to you what you just said, ask him to do it backwards. I use this trick with all of my student coaching clients, and it works!

Good Luck!

Selective Hearing or ADHD: Next Steps

• Self-Test: Could Your Child Have a Working Memory Deficit?
• Read: “I Remembered Not to Forget!” How to Improve Working Memory in Children
• Read: 10 Ways to Improve Your Teen’s Executive Skills

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

Submit your questions to the ADHD Family Coach here!

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

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Two Psychologists Raising a Difficult Child

My husband and I are both clinical psychologists with more than 20 years of practice between us. We know a lot about several disorders, including ADHD. We were formally trained in understanding, assessing, and diagnosing it. We both specialize in ADHD in adults.

We also have a 6-year-old son with ADHD.

Naturally, and informed by our profession, we have been trying to do all the “right things” in raising him. We have followed a predictable routine at home since he was born (and years before we knew he had ADHD). We have used a token economy for years, applied behavioral and medicinal treatments, and kept up with the latest on ADHD by reading copious books, listening to ADDitude podcasts, and more. All the while, we have continued to educate our clients on ADHD and to help them manage their lives.

Despite all our knowledge and resources, raising our son is by far the hardest challenge we have ever faced. There are good times, but it often feels like there are more negative, frustrating moments than rewarding ones.

The Hardest Parts of Raising a Difficult Child

Raising a neurodiverse child is hard. The judgement from others — from the dismissive opinions of other adults to the looks you get when your child has a public meltdown – is demoralizing. Seeing his peers doing “normal” things is defeating.

Heck, we’ve never taken our son to a movie theater or a live show. We haven’t been on a family vacation in years (being home is hard enough). I haven’t even traveled with him on a bus.

[Read: “When Strangers Notice Your Child’s ADHD First”]

Our son started school just a few months ago, and, to our delight, is apparently years ahead in reading and mathematics. But every day, there are reports about his behavioral issues. Sometimes, it’s like his medication isn’t working at all. He has to be dragged away from other children at times. Teachers have had to lift him off of classmates on whom he decided to lie on top. He can’t attend the after-school programs, and he is developing a reputation with other parents. Just the other day, a parent asked us whether he “just” had ADHD, or something else, too. We think it’s “just” ADHD, but nothing seems definite.

We live in New Zealand, and there is a limited range of medications available. There is also the monthly requirement of counting how many pills we have, how many the school have, and how many the pharmacy is giving us (which isn’t always correct!) for a prescription renewal. I look at the list of ADHD medications available in the U.S. and I yearn for some of them (that one you administer before bed and it starts working just before the child gets up in the morning – amazing!). Our son’s doctors care, listen to us, and are willing to try new things, but I often wish they had a child with ADHD so they could truly “get it.”

I recently broke a bone in my foot after rushing down the stairs to stop my son from destroying the living room. That situation was particularly upsetting because my own anger triggered his meltdown, resulting in six weeks of moon boot and crutches for me. (I also can’t drive for a while, as the injury was to my right foot).

This injury came with a lot of grief, as home life was already hard to manage. I realized I needed to think harder about how I was handling my emotions.

Even if you know a lot about ADHD, trying to keep your child on the straight and narrow is a daily struggle, and will probably be one for years. The rewards may be fewer and further between. There are more negative emotions getting in the way.

[Read: “My Child’s Neurodivergence Is Not a Choice. My Empathy Is.”]

How We’ve Struggled to Help Our Difficult Child

Considering that your child might benefit from medication may feel daunting — and defeating. I started thinking of that when my son was 3, when we first suspected ADHD. I had a negative reaction to the thought, despite knowing that medication was likely the most effective treatment.

When he started medication at age 5, we realized it made more of a difference to his behavior and everyone else’s mental health at home than all the behavioral treatments we had implemented before. That’s a bit of a punch to the gut when you’re a clinical psychologist. Kids with ADHD just don’t learn from rewards and punishments in the usual way.

We’ve had to accept that his social skills are delayed, that he often doesn’t notice the emotions of others, and that he doesn’t particularly care when he does. We know we are always going to have to explain his condition to teachers and wonder if they think we are exaggerating (they soon learn that we aren’t).

I am sad that his younger sister is frightened by his aggression, from which we try so hard to protect her. How will her life be affected by having an older brother with these behaviors? Will she have the empathy and perseverance to maintain a loving relationship with him into adulthood, or will she want nothing to do with him? How would her life have been different if her brother was neurotypical? Would it be better or worse? It’s possible to feel guilty about so many aspects of family life over which we have no control.

We remind ourselves frequently that at least our son was diagnosed and started ADHD treatment at a young age. Surely he can’t have as many difficulties as we see in adults in their 20s, 30s, 40s, or beyond who are just now diagnosed and starting treatment.

Maybe we can help him build his self-esteem by being open about his diagnosis and emphasizing his strengths. Perhaps he can avoid disabling mental health problems, relationship problems, financial problems, and the drug and alcohol problems that so many of my adult clients endure. Surely?

I’ve learned that, because life is so challenging at home, I need low-stress and low-expectation activities. My husband and I are able to pay for some help, including a nanny for several hours per week. It makes such a huge difference to our stress levels. But not everyone can do this; I am in awe of single parents of neurodiverse children, parents with more than one neurodiverse child, and parents who are neurodiverse themselves.

It has also helped us to get to know another family with a similar experience. Talking about the shared difficulties and the differences has been excellent. We can truthfully share how difficult things can be without being dismissed or judged as exaggerating and ungrateful.

I think I’ve mostly accepted the differences that neurodiversity has brought to our family. Acceptance does not mean I have to be happy about it, it just means I don’t waste time in a futile search for a cure.

ADHD will change in its presentation over my son’s life, but it will not go away. I will focus on being an advocate for my son and for others with ADHD. I’m lucky I am in a profession where I can do that. As more adults understand their symptoms and are diagnosed, the recognition of adult ADHD within the community increases. It takes time for these effects to permeate through the community. Then again, we have also seen lessening of stigma around mental health in recent decades, especially among the younger generation. I am hopeful this will continue to happen for neurodiversity.

I try every day to be calmer, less angry, less judgmental, and less irritable. I am making it a choice to spend more time with my son, on his own, and create positive moments with him. I’m going to be easier on myself and forgive myself when I don’t act the “right” way. It’s always a work in process. And it’s usually difficult.

Let us not pretend that we have it all worked out. Let us be able to be vulnerable and realize when we need to ask for some extra help. And let us hope that help is there when we need it.

Raising a Difficult Child: Next Steps

• Advice: Throw Out Everything You Assumed About Parenthood
• Blog: “10 Things People Say to You When You’re Raising an Extreme Child”
• Guide: How to Manage Your Child’s Toughest Behavioral Problems

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