Inattentive ADHD: Support for Your Child, Teen, and Spouse with Dr. Amy Moore and Sandy Zamalis

On this episode of the Brainy Moms podcast, cognitive psychologist Dr. Amy Moore chats with Sandy Zamalis about inattentive ADHD in children, teens, and adults. This subtype of ADHD is often overlooked and underdiagnosed because it manifests in behaviors that are less disruptive to a learning environment than the hyperactive subtype of ADHD. They share the criteria used to diagnose the inattentive type of ADHD inattentive, along with some strategies and techniques for supporting and communicating with a loved one with inattentive ADHD. Whether it’s a child, teen, or spouse with ADHD in your life, you can reframe your thinking to help from a place of empathy. 

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Transcript

DR. AMY: Hi, smart moms and dads. We're so excited to have you join us for another episode of the Brainy Moms podcast, brought to you today by LearningRx Brain Training Centers. I'm your host, Dr. DR. AMY Moore, joined by my co-host, Sandy Zamalis. And Sandy and I are going to chat about the inattentive subtype of ADHD. So it's a subtype that we think does not get enough emphasis in ADHD conversations. And it just happens to be the subtype that I have. So, it's near and dear to my heart. Hi, Sandy.  

SANDY: Hi. Well, listeners, in addition to hosting Brainy Moms, Dr. DR. AMY is a cognitive psychologist at LearningRx where 40 percent of clients have ADHD. And she's also a counselor who works with parents of kids with ADHD too. So let's start by defining what inattentive ADHD is.  

DR. AMY: Yeah. So there are actually three types of ADHD and, you know, we've renamed ADHD over the years. ADD, ADDH, and so that term “ADD” is no longer in the diagnostic manual.

So it is ADHD, and it's either ADHD-I, which is inattentive, ADHD-H, which is hyperactive, impulsive, and ADHD-C, which means you have the trifecta, the combined type of inattentive and hyperactive-impulsive. So, ADHD inattentive type has nine different criteria, and in order to be diagnosed with ADHD inattentive type, you have to have at least six of those nine criteria if you're being diagnosed as a child. And if you're being diagnosed as an adult, you have to have at least five of them, but you have to have evidence that they were present prior to being 12 years old. So do you want to know what those nine criteria are? 

SANDY: Yes, let's go through those. 

DR. AMY: Yeah. Okay. So the biggest one is a diminished attention span. But also poor listening skills, kind of spacing out, appearing to space out instead of listening. Forgetfulness. Losing things. Not focusing on details or making thoughtless errors or mistakes. Being distracted by unimportant stimuli. That's where the squirrel memes come from. Failing to complete work on time. Avoiding tasks that are going to require a lot of mental focus or concentration. And finally trouble with staying organized. So those are the nine.  

SANDY: Let's go into each of those just a little bit, just to give a little bit more of an example of those. I think that would be really helpful for parents as they're kind of thinking through what they're looking at from day to day or even from an educator perspective. So diminished attention span. Let's kind of spell that out. What is, what is that? What does that look like?  

DR. AMY: Yeah, so that is what we typically think of when we think of inattention and ADHD. So it's that inability to stay on task for a long period of time. It's that inability to focus long enough to complete a task. So it's the lack of ability to pay attention to the most important thing happening in your current environment.  

SANDY: So, for example, if your child is trying to get their homework done and they're getting up to get a drink of water every five minutes. Or doodling when they should be reading. Kind of constantly moving in and out of an activity,  kind of thinking. 

DR. AMY: Yeah, and that kind of overlaps with some of the other criteria. When I think of a diminished attention span, I think of a teacher starting a lesson, and while a child without ADHD can pay attention for the entire 20- or 30-minute lesson, a child with inattentive ADHD might only make it three or four minutes. 

SANDY: Okay.

DR. AMY: If that.  

SANDY: Hence the next criteria, which is poor listening skills and spacing out. So that's when they start to look like they're daydreaming. They're looking out the window.  

DR. AMY: Yes. And, you know, along with poor listening skills is that inability to listen to the most appropriate thing happening. So a teacher, or if you're a home educator, you could be trying to teach the child with ADHD a lesson, but instead of listening to instruction, your child is listening to the bird chirping on the windowsill. One of the things that really impacted me in college, I can remember being in a really large auditorium with, you know, 200 students in a lecture hall, and I would begin listening to the pencil tapping of the student next to me. So not only was I being distracted by that, but my listening focus was on that pencil as well.  

SANDY: The next one you listed was forgetfulness and we'll also tie in “loses things” in with that. That piece of the puzzle can really cause a lot of friction and frustration, not only for the adults, but also for the student. Let's kind of talk about that a little bit. 

DR. AMY: Yeah. So forgetfulness can include forgetting what your instruction was, right? “Hey, go upstairs and grab the laundry basket full of your dirty clothes and bring them back downstairs.” And so, you know, your child goes upstairs and forgets why they went up there. Forgetfulness includes forgetting to turn in homework, forgetting to do the homework, forgetting that they have soccer practice after school and they got on the bus and came home instead of staying for soccer practice. Forgetting where they put something, right? So they might've completed their homework, but they forgot where they put it and so they can't turn it in.  

SANDY: Yeah. The loses thing. So like losing your keys, forgetting where you put your backpack.

DR. AMY: Losing your homework, losing your lunch, losing the money that Mom gave you for lunch. Absolutely. Losing your flute.  

SANDY: Let's talk about the next one that you highlighted, which was— we've talked about it in terms of attentional piece and like people talking in a lecture, but what about failing to focus on details and making thoughtless mistakes? That's going to show up in things like homework, right? Like for example, algebra, algebra has a lot of steps. Being able to walk through those steps and get all of the pieces done in order to get a full grade.  

DR. AMY: Yeah. So tasks that require a lot of mental focus are not fun. They're not interesting.

And so a lot of times, the ADHD brain wants to just get it over with. And so, we have a tendency to rush through things. And when we rush through things, then yes, we can make careless errors. We will miss a step. So if you're doing algebra, and there are four steps, we may miss a critical step because we're trying to get through it more quickly. Or we're midway through a task, we lose concentration on that task, come back to it at a different place where we lost focus. So we may think we have completed step number three when we really haven't. 

SANDY: Okay. We went through some of these others as well. We did the squirrels, distracted by unimportant stimuli, failing to complete work. Why don't we talk about that trouble with organization? Let's kind of lay that one out. What would that look like? Other than, you know, obviously the typical, maybe time-management piece of that or not having an organized room or workspace. 

DR. AMY: Yeah, so organizing the steps required to complete something, you know, that is an executive planning function. And so typically steps are disorganized for kids and adults with ADHD. So we'll either jump right in in the middle or we'll skip a step. We just don't stay organized in our processes. So, “Hey, first, we need to do A then B, then C, then D,” as opposed to just starting right in the middle and hoping for the best. But that organization piece impacts everything from our desk to our backpacks to our purses to our cars to our rooms. So not only are we disorganized in our processes, we're disorganized in our time management, we're disorganized in our calendar. We're also disorganized with clutter. 

SANDY: Yeah, we've talked about this before, but I don't think it would hurt to bring it up again in terms of, you know, what's happening biologically in the brain for an ADHD  student, child, or adult. And then also let's talk about like what processes, what cognitive processes are affected and are showing up as these symptom areas. Because there's some cognitive processing stuff that we see in research that kind of lets us know what those typical weak areas might look like from a cognitive perspective. But let's do the biological first and just kind of retell our listeners what's happening in the brain with an ADHD brain. 

DR. AMY: Yeah, I love that question. So the ADHD brain is not typically capable of differentiating what is most important or what is even second most important And the ADHD brain has a hard time responding to rewards. And so it's because of, we believe, the absence of, or the deficits of dopamine and norepinephrine neurotransmitters in the brain, that this is happening. So because we can't tell the difference between what's important and what's not important, the ADHD brain looks at a scenario or a situation or a piece of homework or a task and says, “Everything is important. It's all important.” Well, when everything is important, that's paralyzing and overwhelming. Right? So if you're not able to look at the steps of a task and say, “Hey, this is the most important thing that I need to focus on,” you're looking at the steps in a task and saying, “Oh my gosh, it's all important. Where do I start?”  Then you're just paralyzed. And so that's really the biggest contributor, we think to why it's hard to be able to decide. “Okay, where do I start? What do I do first? What do I do next?” Because it all seems important.  And then we know that connections in the brain are disrupted in ADHD. And so when we have disrupted connections specifically to the prefrontal cortex, which is the CEO of our brain responsible for those executive functioning, planning and executing tasks, then by default, we're going to struggle with organization.  

SANDY: So that's kind of biologically what's happening. Let's talk about from a cognitive processes perspective. What is impacted there that is manifesting in those symptoms list that you just gave out? What would we typically see?  

DR. AMY: So, you know, we did this really neat study, I've talked about it before, where we created cognitive profiles of more than 5,000 children and adults with ADHD and we wanted to see, “Hey, which cognitive skills are strong and which cognitive skills are kind of weak in the ADHD brain?” And what we found was that attention was kind of right in the middle, a little below average, but working memory, long-term memory and processing speed were really deficient in the ADHD brain across the lifespan. And so, you know, we're always focused on this idea that attention is the problem. I've said before, we don't have a deficit of attention. We have too much attention. We're paying attention to everything because everything seems important. And so we have to look also at these other cognitive skills that we've shown in research to be weaker. And so if memory is weak, then we have a hard time keeping things in mind while acting on them, right? So that's what working memory is, right? Keeping a piece of information in our mind and then using that information in some way. And so if that's a weak skill, then that piece of information is gone as soon as, you know, it's put in there, and then it's gone. You know, with processing speed being slow, that means that cognitive tasks take longer to finish.  Well, if you're struggling to stay focused, and your cognitive task, any kind of learning or thinking task, is taking too long, then that's a really reasonable explanation for why the ADHD brain has trouble sticking with it.  

SANDY: That's so … it's always so interesting to kind of think it through that way. Does ADHD inattentive type, does it tend to be found more in boys or girls?

DR. AMY: That's a great question. Actually in girls. 

SANDY: In girls? 

DR. AMY: Yeah. So we do see it weighted more heavily in girls. And it's the other reason why it looks like there are more boys typically with ADHD in general. People with the inattentive type sometimes fall through the cracks. Inattentive ADHD does not typically manifest the same behavioral issues that we see with the hyperactive impulsive type. And while we, people with inattentive type ADHD can absolutely have some impulsive behaviors, absolutely have some overactivity, they don't have enough of those behaviors to meet the criteria for being a hyperactive-impulsive type. So, because these are the kids who appear to be listening in the classroom, but really they may be daydreaming or doodling. They're not acting out, so they don't appear to have a struggle, right? Until you start seeing grades come in and then you go, “Wait a minute, what's happening here? Something's amiss.” But because we know that typically, kids and adults with ADHD have average or above average intelligence,  another reason why an inattentive type ADHD child will fall through their cracks is because their grades are average. And we know in a traditional school system, average grades don't raise red flags, right? Failing grades do. So you've got a child who has the potential to be a high performer, right, with a little bit of intervention. But instead they're going to be average performers because they're not raising a red flag because they don't have behavior problems. 

SANDY: Do we tend to see, you know, just low self-esteem issues or things like that with ADHD and attentive types? 

DR. AMY: Yeah, absolutely. Because we know what we're capable of, but we're fighting against the struggle. And so we aren't accomplishing things at the level we know we can, or we begin to think that there's no way we'll ever be able to. Like, we're acutely aware of the struggle, right? We're acutely aware of the fact that I'm not able to, you know, complete this task. I'm not able to stay organized. My desk is a mess. My backpack is a mess. My purse is a mess. My room is a mess. And so we begin to think there's something wrong with us.  And so that absolutely is going to impact self-esteem.

SANDY: Yeah. So let's, let's be proactive. Let's give our listeners some tips. Tips for parents or maybe it's an adult who's listening that needs some tips too. Tips for parents to help their child who's struggling with an attentive ADHD. What are some things we can do? 

DR. AMY: Yeah, so some things that we can do if we have an inattentive ADHD brain is work on plussing up some lifestyle practices first. And so, I really encourage listeners to go to our prior episode where I talk about the five pillars of ADHD, where I talk about the importance of sleep and nutrition and stress and emotional management, physical activity, and cognitive training. And we can talk about that a little bit more here, too. So I really encourage listeners to go to that episode where we really dive deep into those lifestyle factors that exacerbate symptoms or make them worse and things that we can do kind of to lessen the burden of those ADHD symptoms. But what I will say in that area right now is a lot of times food allergies and food sensitivities create brain fog and inattention. And so that is the first place I would look if you or your child is experiencing brain fog or really struggling with that inattention piece is to say, “All right, are there any food allergies? Are there any food sensitivities?” Get tested for those or do an elimination diet and see if those symptoms improve at all. And then along with looking for food sensitivities and food allergies, reducing sugar because we know that sugar is inflammatory. If the body is inflamed, so is the brain. Reducing pesticide burden. So try to eat organic when possible. And then we know the research on food dyes is really scary, right? So they did this huge meta-analysis and found that over 87 percent of studies since the 1980s have shown a direct correlation between food dyes, artificial food dyes, and ADHD symptoms. So, get rid of any foods that have artificial food dyes. Okay, so that would be for lifestyle changes related to those five pillars, that would be the first place that I would start. 

SANDY: Okay. You ready for the next one?

DR. AMY: Yeah. One of the things I like to encourage parents to do is to begin to build some empathy for the struggles associated with inattentive ADHD. So some of those struggles include sleep problems, sensory issues, self-esteem, like we just talked about, and emotion dysregulation. A lot of times, because when we're focused on ADHD symptoms, we're thinking about the impact on thinking and learning. We're not always thinking about the impact on day-to-day living. And so to be able to recognize that, you know, sensory problems and sleep issues and this low self-esteem and these huge emotions that we see in ADHD are related to the ADHD, then we as parents can begin to build empathy and understanding and say, “Oh, okay, I see that this is, you know, one of the symptoms of ADHD that my child is experiencing. And so I'm going to approach this from this mindset of curiosity.” Right? “I wonder what's happening. I wonder if we tried this, if that would help improve the symptom.” And so I like to say that it always starts with us. We have to be the ones that say, what can we change in our child's environment? What can we change in the way we communicate with our child? What can we change in routines? How can we change in the way that we respond to our child's big emotions? Because we're the adult. And so it starts with us if we want to help our child. We can't just automatically say, “Well, our child should be better now because we've done this.” Right? We have to say, we have to recognize that we're a huge variable in that process. 

SANDY: Let's talk about it from an adult perspective for a second, because I think especially women who maybe were never diagnosed as kids are getting late diagnosed with ADHD and attentive type, and I suspect there are many men who are non-diagnosed ADHD inattentive type because we only really truly diagnose—for the most part—the hyperactivity version, right? So with that kind of empathy in mind, because it's kind of my weird frustration in social media when people go after others for being forgetful, for this list. You just gave your list of nine things to look for. and I know adults who struggle with these things. And then you get the kind of adult no-empathy response of, “know better, do better.” You know what I mean? Like, something so infuriating when you know, okay, but what is the likelihood that they have ADHD and that they need some support as well? Let's look at it from that perspective. What would you say in terms of having empathy for a spouse who has an attentive ADHD type?  

DR. AMY: Yeah, so first I want to say that as much as we love social media and how fun it can be to scroll and learn cool stuff, I think it has done us a disservice in popularizing some neurodevelopmental disorders and mental health diagnoses to point of everyone is all of a sudden saying, “Oh, I have this!” Right? “I'm bipolar” or “My ex-husband is a narcissist” or, you know, right? Like because social media has popularized this notion that if you see this behavior, it means this. Right? For example, just because we're sad about something doesn't mean we have clinical depression. Just because we're worried about tomorrow's test doesn't mean that we have anxiety. Just because sometimes we have trouble focusing or paying attention doesn't mean we have ADHD. And so I listed those nine criteria where we have to have at least six as a child or five as an adult, but that's in addition to it has to impact you in more than one setting. So it can't just impact you in school. It has to impact you in school and at home and/or socially, right? Or if you're an adult, it has to impact you at work and at home and/or socially, right? So we have to look at it from that perspective too. It has to significantly interfere with our functioning, and it can't be the result of another diagnosis. So a food allergy could be the other diagnosis. A traumatic brain injury could be the other diagnosis. Right? So we have to look at it not just, “Oh my gosh, I read these nine and my husband has five of these. He must have ADHD.” That isn't how, that is not how ADHD is diagnosed. So just, I want to preface that by saying we're not, I don't want to fan this flame of popularizing what ADHD is. Okay. So the other half of the question, and because I have ADHD, I have forgotten what it is.  

SANDY: (laughs) How do you have empathy for your spouse? 

DR. AMY: That was perfect. 

SANDY: So that you're not frustrated.  

DR. AMY: Or how do you have empathy for your podcast co-host who can't stay on task?  Listeners, I've been traveling and I've had like back-to-back podcasts and interviews and meetings ever since I got back. And so I'm running low on neurotransmitters today. I appreciate your grace and yours too, Sandy. And your empathy. So I liked when I do workshops on ADHD, I like to show images of the ADHD brain compared to the non-ADHD brain. And so I show MRI images, Spec scans, PET scans, QEEGs that very clearly document the differences between an ADHD brain and a non-ADHD brain. And I do that for the sole reason of building empathy. Pictures speak a thousand words. When you can see, “Oh, my goodness,” you have this “Aha!” moment that the ADHD brain really is different, right? That this is not just a collection of annoying behaviors, that this is explained by some neurobiological and structural differences in the ADHD brain. And when you see that, you begin to go, “Okay, maybe my spouse can't help it.” And that can fundamentally shift the dynamic from saying, “Oh my gosh, my husband needs to get it together,” or “My wife is driving me insane!” to “Oh my gosh, I have so much compassion for my spouse. Life must be extra hard because of those differences in his or her brain!” And so that's the first way that I try to build empathy, to know that it's no different than saying, “Okay, my spouse is a diabetic and they're having, you know, a low-blood-sugar crisis or an insulin crisis, and they need medication right away so that they can be remediated from this crisis!” Right? So you have to think of it the same way. “Okay, what supports can I help my spouse put in place so that they're not in this constant ‘Everything is important. I can't focus on anything. I don't know where to start. I can't finish this because it's too hard’ kind of day-to-day crisis.”

SANDY: Let's switch gears. Let's talk about how to help children get organized. 

DR. AMY: I love this question. 

SANDY: Do you have some suggestions?  

DR. AMY: So two of my kids have ADHD. They're adults now. The schools required them to have the school-issued planner. And it was a constant battle—a constant battle to get my kids to use this planner. And I didn't understand why. I thought, look, here's this great tool that the schools are using to keep the kids organized. There's even a time during the school day where their teacher would say, “All right, now write this in your planner.” And why my two children could not engage in the use of this planner drove me nuts. And looking back, I can see that that was a tool that just wasn't going to work for them, right? This did not speak to their need to get organized. And so I just want to say that there's not a one-size-fits-all solution for organization.  It's a system of trial and error until we find something that lands well. I have tried every planner known to man before I could find something that landed well with me. I've put things on sticky notes. I've put things on scrap paper. I've made notes in my phone, right? Like I've tried it all. And be willing to try lots of different things with your child before you find something that sticks. So recognize that and again, come at it from an attitude of curiosity. “Hey, I wonder if we tried this. Would that be helpful?” Right? And then ask your child to give it a week or two of trying it. If it epically fails, then say, “Okay, well, that wasn't the solution. Let's try another one.” But I think as parents, we have this tendency to get frustrated, right? We spend 50 on this planner so we think that it's the answer and we want it to work and so we're irritated and frustrated when it doesn't. But if we go into it saying, “Hey, we're just going to try this and see what happens,” then we're not as disappointed and frustrated when it doesn't work. So try different types of planners, whether they're paper and pencil, whether they're on their phone, whether it's an iPad planner, so it can be digital, it can be paper. It can be color-coded if your kid wants to try something fun like that. You know, maybe they want a different colored notebook for each subject and they write the homework at the top of the page for that day. Try lots of different things. There's no magic bullet here and so you just have to be willing to experiment.

SANDY: And work with them. It sounds like you really work with them to figure out what works best with them. I just had a consultation. It was funny that this came up because a lot of … everything, especially for older kids, later middle school and high school, everything's digital anymore. And so it's all on different apps and different, so they're having to remember where to go look and find the thing that they need to do. And so you might have to work alongside them for yourself because school doesn't look the way it looked when we were kids, to try to figure out, “Okay, what would I do to troubleshoot this? Let's come up with some ideas and figure out what they like.” And then we can try to, you know, manage this process that way. Because that digital component really throws a wrench in the whole system in terms of having to help your child stay organized academically. 

DR. AMY: Absolutely. And if you're a home educator, you have a lot more flexibility and freedom in this. And so you can, you know, use a whiteboard, you can use a bulletin board with color coding. I mean, you can have very visual and aesthetically appealing ways to keep your child organized that don't, that don't have to fit in a backpack. And so, I mean, that is an absolute luxury when you are homeschooling that you have more options of what to try. But my encouragement would be to have your child be a participant in the decision-making process because they're more familiar with what's happening in their brain. And so to be able to say, “Hey, I saw this really cool thing. Do you want to look at it and see if you think that might be helpful for you?” and really give them the control over that choice. Now, might you have a child who says “no” to everything? Absolutely. And so then you want to problem solve. You want to say, “Hey, I noticed that you seem to be struggling in getting your homework turned in on time,” or “I noticed that you're really struggling to remember,”—right, because we know that memory is an issue—"you're really struggling to remember your next assignment. So let's talk about ways that we can make it easier to remember these things.” And so get them involved in the entire problem-solving process. It gives them power. It gives them control. And that buys you relational equity when you say, “Hey, your opinion matters just as much as mine.” And it's their brain, right? So you don't get to be the boss of their brain. You get to be the coach of their brain. And I think that's really important to differentiate. But there are other ways to get organized, right? So in addition to some sort of planner system, to-do list system, I think it's really important to help your child and yourself have a place for everything. When things are a mess that is paralyzing and will actually make your child less efficient. I used to try and argue with my mom when I was a child. I didn't want to put my clothes away and I would tell her, “Well, if they're all over the floor, then I know where they are because I can see them.” Yeah, she didn't buy that at all.

And she's like, “Okay, let's see if we can organize these by type.” Right? And so I've said this before: The worst thing that you can say to someone with ADHD is something like this. “Well, you just need to get organized.” That is the worst thing. If we could be organized all by ourselves, we probably would be. So the greatest gift that you can give to someone, a disorganized person with ADHD, is an offer to help them get organized. “Hey, I'd love to help you organize your desk today. Would that be a blessing to you? Or is that something that you would like?” Oh my gosh, if somebody offered to help organize my desk, I'd kiss them. 

SANDY: Well, that's a great segue to our next thought, which was adapting communication skills with someone with ADHD, because you just reframed that, right? You went from something that maybe expressed frustration to something that was more partner-oriented and really geared toward help. So what are other ways we can kind of manifest some better communication skills with our ADHD child?

DR. AMY: Yeah, so one of them is to make sure that they're making eye contact with you before you give an instruction. Now, I want to preface that by saying, I don't like the form of discipline where parents force their child to look at them, right? Because most children can still hear you even if they're not looking directly at you. But if you're giving instructions to an ADHD brain, typically your child is not going to be able to process those instructions unless they've stopped doing whatever it is that they're working on or playing with, they've stopped doing that and now they're looking and paying attention just to you. And so if someone is talking to me and I'm typing or doing another task and I'm not looking at them, I have no idea what they're saying. I know they're talking. I guess that they're probably talking to me, but I'm not processing it. And so I will have to look up and go, “I'm sorry. Could you repeat all of that now that I'm looking at you?” And so if we can have that conversation, “Hey, I think you're going to be able to remember this better if you stop what you do, you're doing and look at me while we talk.” So it's not punitive, right? You're not going, “Look at me!” Right? “I'm not doing this until you look!” It's not about that. It's about reducing the focus on other things and putting it on your next instruction. So make eye contact. And then be in close proximity when you give those instructions, or you're teaching a lesson, or you're talking to your child about what they need to do to get ready for school tomorrow. If you're yelling it from the kitchen and they're in another room, it's just not gonna land. And so, eye contact and close proximity are the first adjustments that I would ask parents to make if they want to maximize the chance that their child will process what they're saying and even help to remember it. And then you can also have them repeat it back to you. Again, not in a punitive way,  but, “Okay, could you repeat that back to me to make sure that I explained it well?” Right? So you're saying, “Hey, it might be me. I might not have explained it clearly, so I want to make sure I did.” So you're not saying, “Hey, I want to make sure you heard me.” You're saying, “I want to make sure that I explained that well. So could you repeat that back to me?” And you don't have to do that every time, but if it looks like they weren't processing it, I think that's a great way then for them to go, “Oh yeah, I think I heard you clearly. Okay. You said. to do A, B, and C.” Also, I would recommend using soft facial expressions, relaxed posture, and a calm voice. Because when we come at things loudly and imposing, then we can throw our kids into fight or flight. And when we're in fight or flight, we can't process anything. right? We stop thinking and we just start reacting from emotions. So just stay calm. I like to use the analogy of a duck floating across the pond. So the duck looks super calm, floating across the water and underneath the water their little feet are flapping a mile a minute. And that's you. As parents, right, our minds can be going a mile a minute. “Our kid needs to do this, and then they have to do this, and they have to get this done, and they need to do this, and they're not doing this right!” But on the outside, we need to look calm, and warm, and loving, and understanding, and curious, right?  And so that takes a little bit of practice. But we can do it. I think also communication that's most helpful is to break down large instructions into smaller steps, right? So if a task is complicated or our instructions are multi-step, let's break it down into smaller steps just to help it land better. 

SANDY: Right. So not, “Just go clean your room.” But, “Hey, let's go pick up all the clothes.”  Something that's more manageable.

DR. AMY: But it's not a question. So I tell parents this all the time, if there isn't a choice, don't ask it as a question. So don't say something like, “Would you clean up your room, please?” Or “Would you pick up your toys, please?” Well, then that gives your child a chance to say, “No, I won't pick up my toys.” So it can be a statement, right? “It's time to pick up your toys now.” Okay. Right. But in a sweet, calm way. And then be on the lookout for hyper-focus. So we know that kids with ADHD do have the capacity to be hyper-focused on something that they're really enjoying, right? A child with ADHD can hyper-focus on that video game. They can hyper-focus on that Lego project that they're working on. They can hyper-focus on an art project. Things that they really like, they can be hyper-focused on. And when they are hyper-focused, they will be resistant to change. And so recognize that, and you may have seen this already, you may get a big emotional response if you interrupt that hyper-focus, especially in a demanding, commanding way. So be gentle about that. I like to give five-minute warnings. “Hey, it's going to be time to clean that up in five minutes.” Right? And you're quiet and calm about it. You might come back at the two-minute mark. “Hey, you got two more minutes.” Right? So that you ease them into coming out of that hyper-focus. 

SANDY: So if our listeners, if they've been listening to us for a while, we'll not be surprised when we say that one of the things that you can do as a parent is to consider getting their cognitive skills tested. Let's talk about why that would be important in this case. 

DR. AMY: Yeah. So, you know, we've talked about those typical cognitive profiles right in ADHD, you know, would be average to low average attention and then deficient memory and processing speed. But there are other cognitive skills that could also be responsible or contributing to the struggle. So, your child could have a problem with auditory processing. That is the basic language processing skills, the ability to manipulate sounds and letters.  And that's the basic skill set required for learning to read and write and spell. And so if they have low auditory processing skills, that could lead to an immense amount of frustration in reading, writing, and spelling tasks. So then your child may be off task and less focused on those because they're super hard for them. They could have low visual processing skills. So anything that requires the ability to manipulate images or to visualize things. If that skill needs to be strengthened, then you could see lack of focus and lack of attention and lack of task completion in tasks like that. Or their reasoning skills could be low, right? So if they're not able to engage logic skills, then math might be super frustrating for them. So, we can easily test those skills, right? A cognitive skills test, that takes, you know, about an hour or less, can show, “Hey, what are the strong skills that your child has for thinking and learning and what skills might need to still be strengthened in order to help them think and learn more easily?” And so that's why we always recommend a cognitive skills evaluation. And then if we see that there is more than one skill that needs to be strengthened, then we recommend an intervention like the one that we use all the time. And so a cognitive training intervention, and that's what we do at LearningRx, where we work one-on-one with each student, either in person or over Zoom. And we use hands on over 1000 different hands-on training tasks to help remediate those skills that need to be strengthened. They’re game-like, so they're super fun, but they're also intense and engaging. And we use a metronome to keep them moving along, creating that mental sweat. And then we also introduce deliberate distractions. You know, it's the prevailing wisdom that we want to remove distractions for kids with ADHD, but that's not the real world. The real world is full of distractions. And so we actually add distractions so that we force the training of sustained and divided attention skills.  

SANDY: I always tell parents, it's like if we think about it from the perspective of a juggler, we all have to learn how to juggle these different skill areas. And for some, juggling comes easy, but for others, it needs to be practiced over and over and over again in lots of different ways. And things like working memory require some juggling cognitively to be able to not go into cognitive overload. So building those skills only enhances that processing for an individual child and especially for students with ADHD who have, who have a severe struggle there, that juggling capacity is limited. So helping them build that skill is really, really important. Well let's read a word from our sponsor and then Dr. Amy, if there's anything that we missed or didn't hit for inattentive ADHD, we'll let you wrap that up.  

Emi was a ball of nerves about math. It made her so frustrated that she would avoid it at all costs. Then her family found LearningRx. The LearningRx team created a brain training program tailored to Emi's unique needs and goals. Her dad loved the one-on-one help, and her mom was thrilled with how adding deliberate distractions actually improved Emi's focus. After completing her training at LearningRx, Emi's confidence soared. In fact, she says she feels smart in math and science now and wants to be an astronaut when she grows up.  While your child may or may not achieve these same results, LearningRx would love to work with you to get answers about your child's struggles with learning.  Get started at LearningRx. com or head to our show notes for links to more helpful resources. 

Dr. Amy, how do you want to wrap us up? Amy, I think you're muted.  

DR. AMY: Well, I should unmute if you would like to hear how I'd like to wrap this up.  

SANDY: (laughing) I was like, what's happening?  

DR. AMY: So I would just like to say, we are not stuck with the cognitive cards we've been dealt. I say that all the time. Like, that we can make adjustments in lifestyle factors. We have an effective intervention right to remediate cognitive skills. And so I just want to leave this with a message of hope, right? That there are things that we can do. And then to just encourage parents to come at parenting a child with ADHD with that mindset of curiosity, with that mindset that, “Hey, we're going to try this and see.” And then really manage our own frustrations if it doesn't work, because then there's something else that we can try next, right? There's not just this one magic bullet that it's a, you know, it either works or it doesn't. No. If we come at it from all of these different angles, then we maximize the chance of really helping our kids and us, with ADHD to thrive. So if you'd like more information about the cognitive skills training we just talked about, we will put some free resources in the show notes. We're going to give you some free cognitive skills training exercises to try yourself or with your kids. And we'll put some other free things from LearningRx in the show notes. And you can read all about our research and find out more about our programs at Learningrx.com. If you want more information about me, my website's AmyMoorePhD.com. And you can connect with me on Instagram at the Brainy Moms. And on my new personal account @DrAmySaysGrace. You can find Sandy on TikTok @theBrainTrainerLady. And, of course, on Instagram @TheBrainyMoms. And we're going to put all those links and socials in the show notes along with all that cool free stuff. So thank you so much for listening today. If you liked our show, we would love it if you would leave us a five-star rating and review on Apple podcasts. If you would rather see our faces, you can find us on YouTube at The Brainy Moms. That is all the smart stuff we have for you today. So, we're going to catch you next time. 

SANDY: Have a great week.