Counseling for ADHD in Children, Teens and Adults
IN CUMMING, GA
ADHD is one of the most common mental health diagnoses, affecting at least 5% of the population. Yet because it’s often used casually to refer to a tendency to be disorganized or constantly switch attention (whether or not a brain difference is driving it), it’s also one of the most misunderstood conditions.
While medication is frequently the first treatment discussed, counseling for ADHD plays a crucial role in addressing the emotional aspects of this complex condition – aspects that are often overlooked but essential for long-term success.
What is ADHD?
Depending on your source, you will find many definitions of ADHD. Because it involves the most complex living system we know of in the universe – the human brain and nervous system – there are many well-intentioned but limited or incomplete descriptions out there.
You’re probably familiar with the DSM-V diagnostic criteria, but I’ve found descriptions from three of the most rigorous and prolific researchers and writers on ADHD to be the most helpful:
Thomas E. Brown, PhD, (former Associate Director of the Yale Clinic for Attention & Related Disorders), describes it this way:
a complex syndrome of developmental impairments of executive functions, the self-management system of the brain, a system of mostly unconscious operations. These impairments are situationally variable, chronic, and significantly interfere with functioning in many aspects of the person’s daily life
Russell Barkley, PhD, (leading researcher and author on ADHD) describes it this way:
the current term for a specific neurologically-based developmental disorder seen in both children and adults that is comprised of deficits in behavioral inhibition, sustained attention and resistance to distraction, and the regulation of one’s activity level to the demands of a situation. In short, it is a disorder of self-regulation.
Dr. Ed Hallowell and Dr. John Ratey, who tend to emphasize the strengths that come along with ADHD when it’s treated, describe it this way:
it helps to think of ADHD as a complex set of contradictory or paradoxical tendencies: a lack of focus combined with an ability to superfocus; a lack of direction combined with highly directed entrepreneurialism; a tendency to procrastinate combined with a knack for getting a week’s worth of work done in two hours; impulsive, wrongheaded decision making combined with inventive, out-of-the-blue problem solving; interpersonal cluelessness combined with uncanny intuition and empathy; the list goes on.
A person with ADHD has the power of a Ferrari engine but with bicycle-strength brakes. It’s the mismatch of engine power to braking capability that causes the problems. Strengthening one’s brakes is the name of the game.
These experts, who have devoted their careers towards understanding and helping people with this type of brain, push beyond the very limited picture of a hyperactive, constantly distracted boy who can’t sit still in his seat in school. The vast majority of children and adults (the author included) with this type of brain don’t fit that description at all.
Statistics on ADHD
- In the US, it’s estimated 7-8% of people under 18 meet the diagnostic criteria of ADHD. This equates to 5-6 million school-aged children and adolescents – that’s 1 in 14, or roughly 2 per classroom.
- For adults in the US, it’s estimated at between 4-5%. Since ADHD is a life-long brain condition, it’s likely underdiagnosed in the adult population, especially women.
- In Dr. Russell Barkley’s own sobering research, he found that undiagnosed, untreated ADHD can shorten life expectancy by an average of 11–13 years compared to others of the same age!
History of ADHD and Treatments
Although it may seem like a recent fad, there have been references to ADHD in adults in the medical literature for the last 240 years. The names of the diagnosis over the last 100 years reflect the progression from a vague acknowledgement of a brain difference (first called ‘minimal brain damage or minimal brain dysfunction’), towards a focus on behavior in children (hyperactive child syndrome).
It became ADD (with or without hyperactivity) in 1980, and then renamed ADHD in 1987 with inattentive, hyperactive (or both) subtypes. Until recently, it was considered to be only a childhood condition characterized by hyperactive behavior.
Evolution of Treatment Approaches
In terms of drug treatment, there were some early experiments with stimulant medication for teens in the 1930s, but it wasn’t until the 70s and 80s that medication treatment for children really took off. In 1992, “Driven to Distraction” became one of the first mainstream self-help books that drew more attention to the condition among the general public.
Starting in 2000, the American Academy of Pediatrics began recommending parent and/or teacher training as the first line of treatment for preschool-aged children. For elementary-aged children, the recommendation was both medication AND parent/teacher training. However, most parents likely never heard the education and training recommendation from their providers.
With the explosion of medical treatments and books in the last 30+ years (not surprisingly running parallel to the boom in stock price of big pharmaceutical companies and the parenting ‘industry’ focused mainly on behavior and academics), there is still very little emphasis on the emotional experience of the child, teen, or adult dealing with ADHD.
To this day, the prevailing messaging to parents and adult clients exploring treatment for ADHD seems to focus primarily on medication alone.
Evolving Understanding of Executive Function and Emotion in ADHD
ADHD is still seen through the lens of the behavior (often impulsive) that goes along with it in some people with the diagnosis. The current diagnostic criteria is based on observable traits and behaviors that fit into research parameters.
But absent in the diagnostic criteria is ANY reference to emotion. It’s as if the emotional triggers, drivers, and impacts intertwined with the impulse control and inattention struggles can be ignored. The message conveyed in the diagnostic criteria is ‘as long as you’re doing well enough in school/at work and not being disruptive, you must be okay.’
But as is true with the most common mental health diagnoses of depression and anxiety, many people learn to compensate, cover up, and ‘get by’ with their inner experience – often struggling and suffering in silence.
80-85% of children and adults with ADHD also have at least one other disorder, and for adults, more than half will have 3 disorders. In children, it’s most commonly a learning disorder, anxiety, or depression. In adults, substance abuse, anxiety, and depression are the most common co-occurring conditions.
Two of the pioneering researchers in ADHD, Barkley and Brown, emphasize that ADHD involves problems with executive function. They both specifically emphasize the central role emotion regulation plays in the condition.
Emotion Regulation – a hidden component of Executive Functioning problems and ADHD
Emotions play a central (and usually unacknowledged) role in the daily lives of people with ADHD. According to Brown, emotions are intrinsically linked to the core executive function impairments found in ADHD – not a downstream reaction to or by-product of them as has been traditionally theorized.
When we hear the word ‘executive,’ we usually think of heads of companies, in charge of overseeing the operations that ensure the company or organization keeps running. Executive functions include things like organizing, prioritizing and activating for tasks, along with focusing, sustaining and shifting attention between different tasks. But it also includes the capacity to modulate (inhibit OR stimulate when needed) the often unconscious emotions at play not just in productive tasks but also in relationships.
Brown argues emotions are the primary basis for moment-to-moment motivation. For example, people with ADHD can have inconsistent sensitivity to fear and worry, sometimes being excessively sensitive (getting overwhelmed) and other times not worried enough (procrastinating).
fMRI studies (brain imaging that shows real-time activity) have shown hyperactivation in the amygdala (fight or flight center of the brain) and greater connectivity between the amygdala (emotion center) and the lateral prefrontal cortex (CPU of the brain) in adolescents with ADHD. This can contribute to more emotional reactivity, but also fuels wonderful traits of enthusiasm, empathy, warmth, and relational engagement – an example of the paradox of ADHD.
It’s vital to emphasize that emotions play a pivotal role in prioritizing, initiating tasks, maintaining focus, regulating alertness, sustaining effort, and utilizing working memory – skills we usually associate only with thinking and doing.
To treat ADHD only with a focus on behavior and thinking does a disservice to the person with the diagnosis and everyone with whom they interact.
So how does counseling for ADHD at various ages across our lifespan help address these complex emotional and executive function challenges?
Play Therapy Counseling for Children with ADHD
Play therapy is considered the developmentally appropriate way of working with children 10-ish and under. It acknowledges that the child’s developing brain is still working to make connections between a) the expressive and experiential right hemisphere and b) the sequential left hemisphere where language develops.
Thus it doesn’t require children to only use language. It gives them a broader array of means (toys, art, puppets, sand tray, etc.) to express themselves, heal and grow – beyond only using words.
For children with ADHD traits who are struggling with impulse control and self-regulation, ADHD counseling for children through play therapy can be very effective. Self-regulation is really emotion regulation, and the emotional process preceding behavior is often unrecognized and underemphasized in helping kids with ADHD traits or an official diagnosis.
How Play Therapy Specifically Helps Children with ADHD
- Help them recognize emotion – Through the child-led play, the therapist keenly tunes into and gives words to the child’s experience in the moment. In these ‘real-time’ experiences, children internalize that they are emotional beings and that these impulses that go along with their interaction with the world are worth paying attention to.
- Help them be more self-aware and curious about themselves – As children learn to tune into their emotional impulses, they become more familiar with those impulses. With familiarity, there’s less fear. They begin to develop curiosity about this part of themselves, and the role this part plays in their behavior throughout the day.
- Help them name their emotional experiences and begin to understand the sources of them – Have you ever had a feeling, and then immediately judged yourself for having it? Most of us learned as children that some feelings are acceptable to feel, and others aren’t. In play therapy, through the attentiveness and verbal reflections of the therapist, children learn that emotions can be less intense when they’re labeled. Imaging from neuroscience research shows that naming emotions calms the emotional centers of our brain and lights up parts responsible for impulse control. ‘Name it to tame it.’
- Help them differentiate between emotions and behavior – In play therapy, children are given a unique kind of freedom to make choices in how to express themselves, AND they experience limit setting in ways that help them progressively practice stopping themselves, self-regulating, and bringing themselves under control. They get experiential practice with a caring adult who accepts them and their feelings, but doesn’t accept hurtful or destructive behavior.
- Help them redirect aggressive behavior into more constructive directions and outlets – Consistent with the premise ‘all feelings are acceptable; not all behaviors are,’ children in play therapy have many opportunities to redirect the action tendency fueled by emotions into constructive, non-destructive ways. This can manifest in externalizing behaviors like hitting the punching bag or pounding clay. But it also helps address internalizing behavior like withdrawing into their own world that can show up as depression or anxiety, or in self-harming or compulsive self-regulating behaviors like skin picking.
- Help them be more accepting towards themselves, increase their self-esteem, and develop empathy towards others – Children with ADHD behavior patterns have gotten in trouble at school and at home, and feel bad about it (even if they don’t talk about it). They tend to have higher highs, and lower lows, and those mood swings last longer. They tend to struggle more with self-esteem – even if that comes out in rigidity, hyper-competitiveness, or anxiety symptoms.
As these children experience acceptance from the therapist, AND as they learn more about the ADHD brain and how it works a little differently, they learn to accept themselves. They learn to integrate the emotional awareness, labeling of feelings, redirection of emotional energy into acceptable outlets, and self-acceptance into an integrated positive inner picture of themselves. This view invariably spills out in how they treat others around them, and in their academic performance.
Counseling for Teens with ADHD
The adolescent and teenage years involve THE biggest brain changes in human life (outside of those right after birth). These changes prepare the teenager for adulthood and a fully integrated brain, but also contribute to the stereotypes in parenting of their child being unrecognizable.
Brain changes in the early teen years cue up four prevailing traits of the adolescent mind: novelty seeking, social engagement, increased emotional intensity, and creative exploration.
The dopamine (motivation and reward) neurons are more active and responsive in adolescents than adults. This, combined with the fact that the brain develops connections from the back to the front, explains why teens will often say they don’t know why they did something foolish or irresponsible. The last part of the brain to connect with the rest is the prefrontal cortex, where impulse control, greater awareness of consequences, and overall self-regulation originate.
As you can imagine, teens with ADHD struggle even more with impulse control and emotion regulation than the average teenager. The teenage brain has incredible capacities for learning, but this also makes them more susceptible to learning the wrong things, including addiction, which builds much faster and is harder to overcome. This is especially true in the teen with ADHD.
How ADHD Counseling for Teens Specifically Helps
- Emotion regulation – ADHD counseling for teens provides a safe, non-judgmental space to express and get support for the flood of emotions present in the teenage brain and heightened with ADHD. The hormones we associate with adolescence are new to the teenage brain, and the areas responsible for regulating them are still under construction. So teens are responding instinctually to the emotional impact of experiences. Having a dedicated and consistent space to express and process emotions builds the kind of brain connections every parent wants – leaning into a healthy relationship for support (instead of withdrawing, numbing, or acting out).
- Increases capacity for academic and social learning – Teens are learning what they’re good at, where their strengths lie, and are developing neural ‘habit’ networks that they will need to navigate the challenges of adulthood. Counseling helps teens (especially those with ADHD) cope with and manage the emotions that can disrupt academic performance. Teens with ADHD also can struggle more than other teens with social connection and relationships. Counseling helps them navigate peer relationships and bolster their belief in themselves to seek out healthy connections and set limits on unhealthy ones.
- Protects them from harmful impacts of stress – The teenage brain is far more susceptible to the effects of stress, their environment, and chemicals/drugs than the adult brain. The expanding teenage brain has enormous potential for growth and accomplishment, but this ‘openness’ also makes it vulnerable. Counseling can provide both a protective shield and an external emotional ‘immune system’ to help the brain and developing personality repair itself in the midst of stress.
- Practical help with understanding ADHD and organizational strategies – Many teens just want to lean into the emotional support therapy provides. But some are also open to learning how their brain works and discovering strategies to enhance performance and focus. ADHD counseling for teens can provide this too!
Counseling for Adults with ADHD
Many adults come to therapy for other things like relationship problems or struggles with depression and anxiety. It’s worth considering if mild or moderate ADHD could be underneath these presenting concerns.
Adult women are often the people that can most benefit from an ADHD diagnosis – they’ve known all their lives they were different but often worked really hard to compensate and even mask their symptoms. These can be struggling with organization, task completion, and overwhelm. But they can also be more subtle ones like impostor syndrome, self-esteem struggles, or fluctuating mood not otherwise explained by hormonal changes, past trauma, or stress.
How ADHD Counseling for Adults Specifically Helps
- Learning about how your brain actually works – Neuroscience is rapidly upending our understanding of how our brain works, and this is especially true in our understanding of emotion, attention, and relationships. ADHD counseling for adults can help move beyond a vague sense of ‘something off’ or being un- or misdiagnosed with something so vague that it doesn’t lead to action and life changes that actually help.
- Foster awareness and regulation of emotions – Just as with children and teens, counseling helps adults with ADHD traits become much more aware of their inner emotional life that is unconsciously fueling behavior. Many adults grew up in settings where feelings were not even acknowledged, much less given opportunities for healthy expression.
- Shed light on often hidden connections between emotions and self-regulating behavior – Many bright people, but especially women, learn early in life that their brain works differently and so they adapt and compensate. They work twice as hard in school, they put a tremendous amount of effort into being organized. But eventually they get into situations with such high cognitive and/or relational demands (higher education, stressful job, becoming a parent, etc.) that the stress exceeds their ability to live up to the standards and goals they have for themselves. Counseling can help them recognize these patterns and the toll it has taken on them and their relationships.
- Learn how to navigate the co-occurring conditions with ADHD, often depression, anxiety, and trauma – ADHD is inherited. Many people that experienced abuse growing up, or had parents with relationship or substance struggles, likely had parents or grandparents with undiagnosed, untreated ADHD. Counseling can help identify these patterns and how both your genetics and home environment interacted to fuel your current situation and struggles.
- Identifying and focusing on strengths – Most people have plenty of places they can go to be reminded of where they need to improve or their shortcomings – demanding bosses, critical parents, blaming ex-partners, etc. Counseling for adult ADHD is focused on identifying and building on strengths and what’s ‘right’ about you rather than only on what’s not working.
- Cultivating self-acceptance – This is the most underemphasized value of counseling. In our performance and image-obsessed society, we all get messages we need to BE more and HAVE more in order to feel good about who we are. People with ADHD have the added challenge of brain wiring and lived experiences that reinforce a critical internal voice. Counseling can help people develop an attitude and practices of self-compassion and self-acceptance.
The Comprehensive Benefits of Counseling for ADHD
Counseling for ADHD helps people with ADHD traits or a confirmed diagnosis across the lifespan. Whether you’re:
- A parent looking to support your preschool or elementary-aged child with play therapy
- A parent of a teen struggling with the emotional and social impacts of ADHD
- An adult wondering if ADHD might be an underlying brain difference that you’ve never even considered
Counseling for ADHD can make a measurable positive difference in your life or the life of someone you love.
Unlike medication alone, therapy addresses the emotional regulation challenges at the heart of ADHD struggles. It provides tools for understanding your unique brain, building self-acceptance, and developing strategies that work with your neurological differences rather than against them.
Getting Started with ADHD Counseling
If you recognize yourself or your child in these descriptions, counseling for ADHD may be the missing piece in your treatment approach. Working with a therapist who understands the emotional complexity of ADHD can transform struggles into strengths and challenges into opportunities for growth.
The journey toward better emotional regulation, self-understanding, and practical coping strategies begins with taking that first step. Whether seeking ADHD counseling for children through developmentally appropriate play therapy, ADHD counseling for teens navigating the unique challenges of adolescence, or ADHD counseling for adults discovering how to work with rather than against your brain – professional support can make all the difference.
Sources:
- Barkley, Russell. Taking Charge of Adult ADHD: Proven Strategies to Succeed at Work, at Home, and in Relationships. The Guilford Press, 2021
- Barkley, Russell. Taking Charge of ADHD: The Complete Authoritative Guide for Parents. The Guilford Press, 2020
- Brown, Thomas E. A New Understanding of ADHD in Children and Adults: Executive Function Impairments. Routledge, 2013
- Brown, Thomas E. Smart But Stuck: Emotions in Teens and Adults With ADHD. Jossey-Bass, 2014
- Brown, Thomas E. Outside the Box: Rethinking ADD/ADHD in Children and Adults: A Practical Guide. American Psychiatric Association Publishing, 2017
- Jensen, Frances E. and Nutt, Amy Ellis. The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults. HarperCollins Publishers, 2015
- Siegel, Daniel. Brainstorm: The Power and Purpose of the Teenage Brain. Penguin Random House, 2014
- Hallowell, Edward M., and John J. Ratey. ADHD 2.0. Ballantine Books, 2021
ADHD Counselor for Kids, Teens, and Adults in Cumming, GA
I have ADHD myself and have spent the last 19 years learning all I could about this different type of brain.
The emotion regulation side of ADHD is so often neglected, and counseling for ADHD can help people of all ages thrive!
— Brent Sweitzer, LPC RPT
Counseling helps families in Cumming, Alpharetta and Johns Creek manage ADHD
If you’re committed to your partner and ready to lean courageously back into that bond, I believe authentic forgiveness and reconciliation after an affair is possible. I specialize in providing high-quality couples counseling at my Cumming counseling office. I can help you and your partner recover and heal.
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Other Counseling Services at Sweitzer Counseling
ADHD counseling isn’t the only service I provide at my Cumming Counseling office. I also help parents and children using play therapy, offer teen therapy, premarital counseling and individual counseling for issues such as stress and anxiety, grief and loss, and men’s issues.