Q: How Can We Grant Her More Independence When She Makes Such Bad Decisions?
All teens want more independence. Unfortunately, for many teens with ADHD, granting independence can lead to poor decisions — particularly if the medication isn’t working as it should. Here’s how to teach kids to be more responsible, without loosing the reins too quickly.
Q: “My 12-year-old daughter takes Concerta for ADHD and appears to keep needing dosage increases to keep behaviors under control. I am not comfortable with continuing to increase the dose and feel she needs to learn other strategies. She ‘forgets’ every household rule and takes little responsibility for her actions. She leaves clutter and messes behind her everywhere she goes and makes impulsive choices with no regard for others. She is genuinely sorry when things go wrong and usually is agreeable to requests to clean up, but we often have to follow her around and give very specific instructions in the realm of ‘do this, not this.’ She is pushing to have the same level of independence that her peers have, but we feel she does not consistently make responsible choices. She took a babysitting course a year ago and wants to try for babysitting jobs, but I don’t think she is ready to be caring for a child alone. Is there more we can do to build these skills? Should we consider therapy or is this just a reflection of her maturity level? I don’t want to wait until she has more independence from us to find out that this is not something she is growing out of and we missed on opportunities to foster this growth at the right developmental age. We hold her accountable, we have her fix her own mistakes, and we avoid compensating for her, but she just doesn’t seem to be able to consolidate these skills in the absence of our prompting — and it worries us.” —BexMom
I’m sure many parents empathize with your challenges regarding your daughter’s medication, impulsivity and disorganization. It’s tough to figure out how to help your tween daughter with attention deficit disorder (ADHD or ADD) strengthen her executive functioning skills, develop effective routines, and build her capacity for independence at the same time. It sounds both complicated and exasperating because it is.
Getting medication just right is tricky, and you’re right that pills don’t teach skills. Stimulant medications like Concerta, when they’re working well, help improve the ADHD brain’s efficiency so your daughter is more available to learn, process, and retain information. But medication cannot change the fact that ADHD brains typically mature more slowly than do neurotypical brains, with a lag of as much as three years. This means that, in several areas of her executive functioning, she is younger than her years and benefits from the kind of support you might offer to a 9 or 10 year old.
Of course, your daughter is 12, which makes things confusing for everyone. She’s a middle schooler who wants to fit in. Like many kids with ADHD, she probably misses social cues, key phrases of conversations, and details about get-togethers. When you throw in academic challenges, teen drama, and fluctuating hormones, it’s overwhelming. Home is the one place where she doesn’t have to hold it all together. You bear the brunt of her letting it go — emotionally and otherwise. While she knows that she needs your assistance, like many teens, she also resists it. Therapy could be useful for improving her self-awareness and providing a neutral place for the family to discuss frustrations, brainstorm solutions, and improve communication.
With or without counseling, though, your daughter requires help with organization, impulse control, and working memory. Her sincere apologies and agreeability show that she wants to do the right thing, but her ADHD brain makes it hard to consistently access those positive choices. Keeping things neater, thinking before speaking or acting, and remembering stuff requires direct instruction and lots of repetition. Once these skills come more naturally, you can slowly start to remove supports.
What we want to do is set up a program of Double Cueing.
Let’s get started:
- Sit down to talk with your daughter about the household rules. Ask her which ones she usually forgets and which she would like to remember on her own. Share your observations. Write down everyone’s answers and see if there is any overlap. People can only change one thing at a time, so jointly pick that one thing. Your mutual agreement fosters her buy-in. In a month or so, when you’ve noticed improvement, you can add another goal.
- Let’s say you’ve agreed that leaving her stuff around the house is the biggest problem. Make a list of numbered tasks that she must follow to pick up after herself. The numbers establish an order for her to follow. Be very specific and break things down into small components. ‘1. Pick up your coat and hat and hang them in the mudroom.’ Each time she finishes something, she returns to the list to check it off. She will get one point for doing each task and a bonus if she completes everything with only one reminder. You remind her to check the list — not to do the action. This gives her a chance to use that autonomy she desires. She reads and follows the sequences herself. It’s Double Cueing because she hears the direction from you and she also sees the written steps.
- Brainstorm small and large incentives that matter to her. Small incentives, like extra screen time, should be redeemed daily if she gets enough points. Larger ones, like going shopping, can build up for a week or two. Remember that kids with ADHD get bored quickly, so change up the incentives to keep her interested.
- If she asks for your company, give it. Many kids like having their parents around when they put away their laundry or organize their backpack. If she drifts off, gently bring her back to the task at hand.
- Praise her efforts and her accomplishments. Expect setbacks so that, when they happen, you can roll with it. If she still has trouble remembering things, use post-it notes as reminders.
As your daughter develops these skills, she’ll become more trustworthy for jobs like babysitting. That’s probably too big a leap at the moment. She might, however, be ready right now for the role of a mother’s helper as an intermediary step. Rest assured, she will eventually become the independent adult that you want so desperately to see emerge.
The opinions are suggestions presented above are intended for your general knowledge only and are not a substitute for professional medical advice or treatment for specific medical conditions. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your own or your child’s condition.