Transcript
Rubrik Agent Cloud Announcer (0:00)
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Dr. Sharon Saline (0:34)
Welcome to the Attention Deficit Disorder Expert Podcast series by Attitude Magazine.
Annie Rogers (0:45)
Hi everyone, my name is Annie Rogers and on behalf of the Attitude Team, I am pleased to welcome you to today's ADHD Experts presentation titled Parenting Tweens and Teens with ADHD Getting buy in from your Adolescent. Leading today's presentation is our good friend Dr. Sharon Saline. Dr. Saleen is a clinical psychologist and an award winning author. She specializes in working with children, teens, emerging adults and families living with adhd, anxiety, learning disabilities, autism, choice, exceptionality and mental health issues. Her unique perspective growing up as a sibling in an ADHD home, along with her decades of clinical expertise helps her guide families toward effective communication and closer connections. You can visit www.doctor that's Dr. Sharonceline.com to learn more. In today's webinar we will discuss teen oppositionality. Dr. Saline will help us understand the root of defiant behaviors in tweens and teens with adhd. She will also share tools and strategies for reducing conflict, increasing engagement and encouraging collaboration. And finally, the sponsor of this webinar is Play Attention. Play Attention, inspired by NASA technology and backed by Tufts University. Research, strengthens executive function, emotional regulation and focus, turning resistance into cooperation. Your customized plan builds critical skills for success and fosters collaboration within your family. Click the link on your screen to schedule your consultation with Play Attention and learn how you can improve executive function in just 10 minutes a day. Home and professional programs are available. Visit www.playattention.com to learn more. Attitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content. Okay, without any further ado, I am so pleased to welcome Dr. Sharon Saline. Sharon, thank you so much for joining us today and for leading this incredibly important and close to home discussion.
Dr. Sharon Saline (3:23)
It's great to be here. Thank you so much for that lovely introduction. Let me ask you everyone who's joined today, do any of these things sound familiar? Monica, who's the mother of a teenager or 11 year old daughter, says, My 11 year old daughter Lily recently started having emotional outbursts that turn to panic and anxiety attacks. It's clear she doesn't understand what's happening, gets scared and has difficulty calming herself down. So then she attacks me. Charlie says, it's hard when Jericho gets chippy, when his verbal provocations don't work. Then he ratchets it up to physical behavior. There's no ownership. He's so convinced that it's all against him. He's punched walls, slammed doors and broken things. Let's hear from kids themselves. Joaquim, age 13, says, People get mad at me because I have a bad habit of back talking. I want to know why before doing something and then I want to say my piece. What's the problem with that? That's one reason that my dad and I get into fights. He's more like, do it because I told you so. I'm the father, you're the son kind of deal with my parents. It's like, stop nagging me. You're giving me such a hard time and making me feel like sh about myself. So I end up yelling at them to f off and leave me alone. Callie, age 16 Layla, age 15, says, I haven't been succeeding at school and life and I expect myself to succeed. My parents want me to get all A's and sometimes I just can't do it. So I yell at them. Today we'll be talking about how to live and work with teens who can be and tweens who can be resistant who give you pushback. And we'll learn some tools and techniques that you can use right away. After this webinar, I'll touch on some common major themes of pushback. But we're going to spend our time looking more at the process of changing and how to pivot rather than coping with this challenging behavior and that challenging behavior because I can't know all of the challenging behaviors you are experiencing. And when we work in the content we're really playing whack a mole. What do I do about this? What do I do about that? What do I do about the third thing? Yes, we want to have some idea of the major themes, but we also want to step back what I call zooming out onto this platform to look out and see what's happening with my parenting that this keeps occurring. In the question and answer section, I'll answer questions about your specific problems, so stay tuned. Next slide please. Now we know that ADHD rarely travels alone in adults and in children and teens. Nearly 2/3 of children and teens with ADHD have at least one co occurring condition. Behavioral oppositional conduct problems actually are most common. But we actually a recent Statistic says that if you combine the rates of learning disabilities and ADHD and mental health conditions, the co occurring rate is much higher, closer to 70, maybe even 80%. So what we see most commonly are oppositional or conduct problems, mostly in boys, around 52%, followed by anxiety at 34%, and depression, or between 16 and 30%. We know that the male female ratio in terms of diagnosis patterns are about three to one boys versus girls, and that coexisting mood and anxiety disorders are really common, particularly in the adolescent years. There's an increase in general and social anxiety, and that untreated anxiety can lead to depression. Unfortunately, what we know is that there are higher rates of attempts at suicide by kids with ADHD because they're having these big feelings and that combines with impulsivity. We see bipolar disorder at about 20% and we see OCD at around, you know, a little bit less. I think it's close between 15 and 20%. And the thing about it's the 30%. Excuse me. So with OCD, we see sort of unwanted intrusive thoughts or behaviors that people feel like they have to repeat. I want to say a few words about oppositional defiant disorder, which we'll be focusing on today. The rates of that in terms of occurring with ADHD are about 40%. And ADHD likely contributes to or could even cause oppositional defiant disorder, commonly known as ODD because of poor emotional regulation and the lack of control of verbal impulses or physical responses when angry or hostile or aggressive. We also see substance abuse. There's about 10% of kids with ADHD meet the criteria for a diagnosis of substance abuse disorder, but about 35% have a history of using some type of substance. And there was an interesting study that came out in 2017 that said that about 74% of teens who were in therapy said that their provider had asked about substance use, but very few, particularly in the terms of alcohol. But very few had said that alcohol could make ADHD symptoms worse. And finally, in terms of sensory integration issues, and we see that at about 10 to 20%. And this would also include something called misophonia, where people are very sensitive to sound and eating disorders. Research shows that adolescent females with ADHD are three and a half times likelier to develop an eating disorder and five and a half times likelier to develop bulimia. I want to say one thing about bipolar disorder and adhd. With bipolar disorder, what we see is intense mood cycling. And sometimes this mood cycling can happen within an hour, sometimes within a few hours. And you know, there's a lot of symptom overlap with adhd, but they need different kinds of interventions. With adhd, there are more consistent triggers that set kids off. And with bipolar disorder, there's more random cycling. So that's the background of what we're talking about today. Next slide, please. Let's say a few things. I'd like to say a few things about the adolescent brain. So the brain develops from the back to the front and the inside out. The back of the brain is our physiological brain. It's often called our reptilian brain. And it keeps us alive. It's fully myelinated when we're born. This has to do with breathing and heart rate and blood pressure and some gross movement, motor movements. The middle of the brain is called the mammalian brain. And this is where we have the emotional brain. It's where we'll find the limbic system. It's actually also where we'll find the seat of memory and language. And the front of the brain is the prefrontal cortex. And if you take your hand and you put it on your forehead, you can join me in what I call the oh my goodness, what were you thinking? Part of the brain. Because that's what we, as appearance of teaching will say, oh, my gosh, what were you thinking? So this part of the brain, the prefrontal cortex, we know, develops, connects with the rest of the brain more slowly in kids with ADHD up to three years of a delay. And it really coalesces in neurotypical brains where around age 25. So we'll see that a little bit later for people with ADHD around age 28. And the last part, part of the executive functioning skills to really kind of pull together are the parts that have to do with judgment, self awareness, and what we call metacognition. So by the age of 18, about the brain is about 80%, you know, fully, you know, sort of, kind of connected and developed in adolescence. What we see are all kinds of physiological changes. Height, weight development, development of primary and secondary gender characteristics, you know, acne, hair growth, body odors, changes in sleep patterns, menstruation, sometimes erections, with or without ejaculation. The whole body is going through a big change, and so is the brain, the synapses, the brain, the parts of the brain which, you know, had had to do with like, learning new information and, and building neurons which proliferated in childhood, undergo a change in adolescence. And so what we see is that teens can learn new things really quickly, but it can be hard for the teen brain to pick out the right signals in the midst of all the activity that's happening. And so starting in puberty, the brain starts to prune away excess synapses, unnecessary information. We've all seen inside out 1 and 2, so we know how this works. And so this process of streamlining and pruning things away increases the brain's efficiency. So it's like a use it or lose it model. I remember from Inside out one where she goes up to part of the brain and she's like, do we need Beethoven's Ode to Joy or chopsticks? And she like throws o joy away and she says, chopsticks is just fine. You don't really play the piano anyway. So we also see in adolescence exploring gender identity and sexual preferences, as well as racial identity, socioeconomic awareness, and thinking about religion and big philosophical questions. We do know from the research that kids with ADHD engage earlier in sexual activity than their peers. We will see higher rates of unwanted pregnancies. Next slide, please. So when we're navigating the complexities of adolescence with our kids, we want to really think about how do adolescents think? What is adolescent cognition? And this means that they can create a hypothesis about an actual or a potential event and they have the capacity, capacity to test that against reality. Adolescents are interested in the process of problem solving, not just the solution, which is why we need to incorporate them into any plans they're making. Teens can be very self centered and self focused, and there's generally a movement away from family bonds into the society at large. They can be very critical of parents and adults in an effort to create distance, yet still, still dependent on them and connected with them. So there's a lot of experimentation and exploration and kind of what I call the push me, pull me of the parenting teen relationship. I'm going to push you away, but then I'm going to pull you near me. One of the things that we see a lot with teens is what I call the dump and jump. I'm going to come up to you, I'm going to dump all my big feelings or provoke you into an argument, and then I'm going to walk away feeling much better. And, and you, the parent, are holding this container of, you know, smelly trash that wasn't yours, but now you're all upset. Sometimes teens with ADHD will welcome help from adults, but often they're ambivalent about it or they downright reject any kind of well intentioned advice. Luis, age 17, says, yeah, you know, I'm like Well, I don't really need their help. I can deal with this on my own. Would I say I'm proud? Sure. I get a little cocky sometimes, though. You do need help from other people. Even though you're independent, you can't always just storm through life alone at all times. So why don't kids ask for help? Or they reject the help when you offer it? Shame and a real sense of again, wanting to feel separate from you but knowing they're not, that they need you, and then being confused about that. Rowan, age 15, recalls that as early as fifth grade I was embarrassed to ask for help, that I had a disability. I think I denied it, but I definitely knew that I was add. I argued for a long time because I didn't want to be seen as someone that needed extra help. Next slide please.
