503- The Journey to Independence: A Parent's Guide to Delayed Adulthood with ADHD

Carol Fleck
Welcome to the Attention Deficit Disorder Expert podcast series by Attitude magazine.

Hello everyone. Thanks for joining us. I'm Carol Fleck, and on behalf of the Attitude team, I'm pleased to welcome you to today's ADHD experts presentation titled the journey to independence, a parent's guide to delayed adulthood in teens and young adults with ADHD. Leading today's presentation is Doctor Anthony Rothstein. Doctor Rostain is chair of the department of Psychiatry and Behavioral Health at Cooper University Healthcare.

He is a professor of psychiatry and pediatrics at the Cooper Medical center of Rowan University in New Jersey. His focus is on improving clinical outcomes across the lifespan for patients with neurodevelopmental disorders. Doctor Austin is also the co author of the just released book, you're not done parenting young adults in an age of uncertainty. As many of us know all too well, it's common for older teens and young adults with ADHD to struggle with the transition to adulthood. Many of today's young adults take longer than in previous generations to move out of their parents home, finish higher education, get married and have children and achieve financial stability.

For young adults with ADHD, the journey to independence may take even longer. In today's webinar, doctor Ross Dane will address the factors that make it more difficult for young adults with ADHD to become fully independent and how parents can support their children without enabling counterproductive behaviors. Finally, the sponsor of this webinar is brain balance. When your teen or young adult is struggling and you know they're capable of so much more, it can be overwhelming, especially when it feels like no one sees their potential. But brain balance.

Parents know better. They know better academic and mental health outcomes, and they know happier children. They also know they're surrounded by a community of supportive parents and brain balanced staff ready to work together hand in hand to make a positive impact in their child's life, there is hope and a better way forward. Scan the QR code on screen or visit brainbalancecenters.com attitudemeg to contact Brain Balance's support team and get started. Attitude thanks our sponsors for supporting our webinars.

Sponsorship has no influence on speaker selection or webinar content. So without further ado, I'm so pleased to welcome Doctor Anthony Rothstein. Thank you so much for joining us today and leading this discussion. Well, I'm so happy to be here and thanks for inviting me. I feel it's a great privilege to be part of the attitude community.

Anthony Rothstein
I've supported it for decades. I really believe in the work you're doing, and today we're going to focus on parenting young adults in this particularly difficult period of time in history. We call it the age of uncertainty. And I've added a little note at the beginning. It's from empty nest to open nest, to sort of signal the idea that we've got to get away from our old ways of thinking, that somehow young people have to just leave and that's it.

I think the notion of an open nest, where sometimes kids come back home, is really more the norm than ever before. Now, I want to give credit to my partner in this, Doctor B. Hibbs. She and I wrote a book together a few years ago called the stressed years of their lives, helping your child survive and thrive their college years. And we were looking to write a sequel to that.

And this is what we came up with. And a lot of what I'm going to talk about today can be found in this book. But clearly this is a new challenge for parents, how to get used to the idea that launching is not as straightforward as it might have been in the past, and it's especially difficult for young adults with ADHD. We're going to talk a little bit about how delayed adulthood is now the new normal and how are you going to adjust to that fact. Really trying to help you rethink your assumptions and biases that might make it hard to get along with your young adult child and how to develop better communication skills and a focus on both executive functioning difficulties as well as problems with excessive digital media usage in young adults with ADHD.

And I mentioned related disorders because we see a lot of anxiety, a lot of depression and substance use in our young people, and we need to learn how to help them with those challenges. So let's start with the basic notion. What is adulthood anyway? What are the milestones to being an adult? Or as young people say, adulting?

Because it's a verb, it's not a noun. Are you adulting yet? These milestones were developed in the 1950s when the world was a very different place. And these were the five milestones. You were to finish your education, start on a career path, become financially independent, have a partner, and if so desired, become a parent.

And people were supposed to be done with these milestones by their mid twenties. Well, it turns out that at this point in time, it's no longer mid twenties. This emerging adulthood, which we call the period of time in which you're finding that path, lasts for many people into their thirties. So it does begin at the time that secondary school or post secondary education ends. But it's when does it end?

When do you really become a full adult? It's turned out that over the last several decades, especially in industrialized countries, it's later ages of marriage and parenthood, longer education, birth control, delaying having kids, and other forms of living together have become more accepted. With people with ADHD, this lengthening of the emerging adulthood takes even longer. Just like through earlier parts of life where ADHD, young people do have a delay in achieving certain milestones, especially the social emotional milestones. This is what we tell parents is, hey, you can expect this is going to take longer.

Now, what are they, what are young people doing in this period of time? And these are the key themes that emerge in this age group. First of all, identity exploration, trying to find out who you are in the world and what is your authentic self identity. It may not be what you thought you were going to be when you were finishing high school or going through college. So where do you find these suitable sense of identity?

And it's complicated process. There's also feelings of instability, vulnerability and uncertainty. So young people can be indecisive, they may be erratic, they may move in with friends, and then they come back home because it didn't work out. Then there's a theme of self preoccupation because as they're trying to find their identity, they seem to be self absorbed. And this may appear to parents to be selfish or self centered, but actually this is not an unusual quality of this time in life.

They're also going to feel a lot of ambivalence because while they want to grow up and take on these responsibilities, they also may feel unprepared and they may be reluctant to take on chores or other kinds of responsibilities. And sometimes they'll even start taking on sort of younger age type behaviors. So that's another thing to watch for. And finally, young people are generally hopeful about the future, and that's a good thing. But it turns out that Gen Z is having a little bit harder time than the generations before them.

So what I'm basically saying is that the last two decades, more and more young people are living at home. The pandemic accelerated this trend. And at the moment, more than half of 20 somethings are living with their families. I'm going to say that again. More than half of 20 somethings are living with their families.

It's actually the norm now. Now the causes for this are socioeconomic and cultural, but it seems to us like we're getting back to the period in the early 20th century where most people were living in multigenerational families. Now, is this going to continue or not? A lot of this is unknown, but. But for most people this is a positive situation with rewards as challenges.

But the arrangement is complicated and the main task for you is to figure out what's going on with your Gen Z child. And that's part of what my purpose is today, is to give you some tools for doing that. It turns out that when we look at the mental health of Gen Zers, they are the least likely of all the generations to say that their mental health is excellent or very good. And this, by the way, was before the pandemic. This study, it's gotten even worse.

But you can see that Gen Z does not feel as happy with their mental health as older adults, and you can look and see where you are on these charts. But clearly there's a lot of stress in people in this age group. And a study taken during the pandemic showed that the most stressed out group of people during the Covid-19 pandemic were young adults between the ages of 18 and 24, far and away more anxious than older generations. So these are really indicators of the degree to which young people are feeling stressed out. And in some respects, we have to really accept the fact that the post Covid world is just harder for young people.

And a lot of it has to do with losing time by online learning, which for many people with ADHD is harder than in class. There was problems with organizational skills that get challenged, that were challenged during the pandemic. The in person learning environment. Return to that has been harder too. Colleges are noticing that young people are having trouble with interacting with a sense of confidence, and it may have to do with the fact that they were interrupted in their growing up period.

So we see a lot more social anxiety and we see a lot more dependence on parents, which may be a mixed blessing. Another important survey that came out last fall from the Harvard's making care common project is that young adults are really saying that they are really upset with a number of things. First of all, almost three in five of them report feeling that their lives lack meaning or purpose. And about half of them report that their mental health was negatively affected by not knowing what to do with their lives. More than half also had financial worries and achievement pressures, feeling really, really threatened easily by being asked to do things and not being sure that they're going to succeed.

A perception that the world is unraveling. A remarkable 45% that think that things are falling apart, relationship deficits, loneliness, and 42% said things like gun violence, climate change, and political leaders being incompetent or corrupt. A significant percentage of people in this age group are feeling that this is affecting their mental health. So the data speak for themselves. When we look at, you know, rates of depression going up, the dark black circle, the dark black triangles you can see, went up significantly in the two years leading up to the pandemic continuing to go up.

Young adults had the highest increase in mood disorders through this time period.

What are the underpinnings here? We saying, hey, kids are anxious. So where does that come from? And how do we understand anxiety? And being from Penn originally and studying with Doctor Aaron Beck, I was very influenced by his notion that there's a triad that occurs with people with anxiety disorders, feelings of anxiety and nervousness that are linked to thoughts about not being able to do things or feeling something is wrong and behaviors like escaping from the situation and avoiding it in order to feel better.

So there's a pattern of anxiety in which you tend to not feel you prepared to do things. The future is very difficult, and so then you avoid and avoid and avoid, and that makes you feel better temporarily, but it doesn't help you deal with the underlying challenges that you're facing. So what are the thinking? What kinds of distorted thinking goes on in people with anxiety disorders? And I'm saying this is a large number of young people, especially with ADHD, we've seen, and I've seen for a long time that anxiety is probably the major coexisting problem with ADHD or with any other neurodevelopmental challenge.

So people tend to catastrophize and think that situations that they're facing are gonna go terribly. Like, the worst case scenario is what people are expecting. There's a lot of emotional reasoning. Seeing that when I'm feeling bad, that means something bad is happening. They tend to over generalize, meaning one negative event is seen as a never ending defeat and an indicator of someone's ability to succeed rather than, okay, this didn't go so well, but maybe I can do better next time.

Mental filtering is another way of distorted thinking, which is to say people pick out the negative of a situation and obsess over it rather than looking at the bigger picture. This is especially common in many of the young people that I work with. Then there's labeling, sort of seeing yourself or other people in completely negative terms. Worthless, hopeless, stupid, loser. And finally, fortune telling, which is thinking that when something went wrong, that something's about to happen, and it's never going to work out.

Looking into the future, even though no one can really tell what's going to happen now. This anxiety, by the way, gets magnified in the family system because whenever a young person or a child senses danger or feels anxious as a result of a stressful event, what do parents want to do? Well, it's a natural thing for parents to want to help the child out, to want to make things better for the child. This is a normal reaction. But when it happens over and over again, and when parents themselves become stressed by their child's stress, you see this vicious cycle.

And it does lead at times to overprotection on the part of parents and sometimes polarization between parents. One parent saying, oh, you're being too protective, and the other parent saying, no, but you're being too insensitive. You know, our young person is very, very sensitive. They need more support. And I'm not going to answer this in one simple way, but I will say that there are things you can do, and we teach our patients to do to reduce anxiety.

It doesn't eliminate anxiety, it just reduces anxiety. And these principles come from a newer version, a new generation of therapy called acceptance and commitment therapy. First principle of acceptance and commitment therapy is focus on what's in your control. Just start there. Focus on what you can control.

Acknowledge your thoughts and feelings. Acknowledge. Okay, yes, I'm anxious. Yes, I'm feeling upset. Come back into and connect with your body.

Do whatever it takes to feel your body with your breath. Focus on everything that you're experiencing in your body, and then using that calming statement to try to engage in whatever you're doing and to commit to positive action rather than just beating yourself up and, or becoming pessimistic. And this, by the way, is good for parents as much as for young people. I would say just accept that you're having a tough time and being as kind as you can be. That's the compassion part.

And then trying to look at what matters most to you. What are your values? Acting on those values and then finding resources. So these are sort of the general steps I would take. We could talk for hours about this, but I believe that everybody is capable of engaging in steps to reduce anxiety.

And then what about the negative? When anxiety is not dealt with and it persists that what happens is that people become really more and more hopeless, feeling more helpless, and you begin to see a mood disorder emerge, because what happens is in this vulnerable state, any little event triggers in the middle. There, you'll see negative attributions, a sense of hopelessness, and a belief that nothing can change. So once you're in that state of mind where you don't think anything is going to work, you develop what we call learned helplessness. And if it persists, we would say that the entire body, not just the mind or the brain, but everything starts to shut down.

And you can see the stress hormones are at play. But the most concerning thing is that when people get depressed is that they withdraw from their relationships and from sources of support. So what can you do to help your young adult if you see that they're depressed? Well, you recognize this is going on. You share your observations, you support the young person in getting some help, and you do yourself.

Get involved in treatment when possible and appropriate and understand what's going on whenever there was a treatment plan made, share your observations and get help for yourself. Join a parent support group. Now, all of this you may know, you may say, hey, I've already done this, but let me just point out that the basics are the most important thing. Go back to the basics in order to help your young person. If they're not willing to go for help, then you start and get help for yourself first, because people, professionals like myself and doctor Hibbs and others who are in our field, recognize that if the young person isn't ready yet, we'll start with whoever's ready in the family and see what we can do to get things moving in a positive direction.

Now, beyond the clinical situation, I think we've got a bigger problem to deal with, which is that anxiety has become pervasive in our modern world. Wherever you turn, whatever you look at, you know, you see bad news everywhere. We see a culture now emerging that is major feelings expressed are fear, or one could also argue, anger. And this becomes self reinforcing and you begin to see more and more cognitive distortions about everything is awful and everybody's getting more and more anxious and less able to engage in what we would call social, meaningful social life. And how this affects parents is that over the last century there have been historical swings in how parents approach the job of raising kids.

During times of prosperity and relative stability, such as occurred after World War Two. In the fifties and sixties, parenting tended to really be more permissive. Let the kid do their own thing, let them find their way in times of economic hardship or change. And we're in a time of great change right now. What happens is that parents become, become more protective, and that's actually not anybody's fault.

We're not into blaming parents for this. I think most experts out there who are sort of blaming parents for this current situation are really barking up the wrong tree because nobody wants to do the wrong thing when it comes to parenting. It turns out it's the environment that makes it harder to give the child, the young person, a chance to find their way. So what can you do, though, if you have a person who stalled out? And I think the first and most important lesson here is that your young person needs to have you step back a little bit and let them struggle somewhat until they learn how to resolve these challenges.

Jumping in with the answer is not going to help them figure it out. So I think that the most daunting and difficult thing to be a successful parent of a young adult is to remind yourself that you're not parenting a child anymore, or even an adolescent. You have to do your best to see them as a young adult who's got to struggle a little bit to find their way and not to get so anxious if they're having this difficulty. So do your best, for example, to appreciate their strengths and their vulnerabilities, and to listen to what's on their minds, to see how they see the choices. You might see one set of choices, but if they don't see those choices, you're not gonna speak the same language.

And you gotta respect their need to figure things out for themselves. Cause that's what they wanna do more than anything else. Figure it out for themselves, don't you solve it for them. So how might you start with yourself then, getting yourself to that point? Well, the first question you might say is, ask yourself is, how different are my adult child's experiences from that time in my life?

What was it like for you when you were their age? And do you need to give them more adult guidance or parental guidance than you got? Maybe less. Can you think of them as kids or adults? Maybe you see them as both.

Okay, if you see them as both, how can you move towards helping yourself to acknowledge that they're no longer kids? What about if they're not flourishing? What if they're struggling? Hey, are you judging yourself as not a good parent? Because if that's the case, you're going to react through anxiety rather than through curiosity.

I think the opposite of, I would take a curiosity stance, maybe. Let me figure out what's happening here and not jump to conclusions yourself. Because if they're not flourishing and they're upset, that may not be a bad thing if they're using that to prompt a period for themselves of self discovery. So that's the key question, is, are they trying to figure things out, or are they just self indulgent and avoiding everything? And in that case, you do have to start to talk with them.

So how do you talk with them if that's the case? If it looks like, hmm, they're really not taking charge of these challenges they're facing? Well, the first thing is you got to ask open ended questions. Hey, I'm wondering, you know, I see that you're having some trouble. Do you want to talk about it?

You know, let's. Let's. Let's have a discussion and don't give advice in an unsolicited way and give everybody the benefit of the doubt. These questions need to be asked without an expectation or judgment and doing your best to not get too stressed out yourself. Now, if things are getting stressed out, you need to acknowledge, hey, you know what?

This conversation isn't going so well. I think I'm really anxious or I'm really angry or annoyed. And so just step back a little and say, okay, let's try. Take a time out. Let's try and talk about it some other time when we're both ready.

Thanks for even making the time to talk about this. So you do have to practice an open mindset approach. And the first half of the book, you're not done yet, is all about looking at your mindset, looking at your presuppositions, and doing your best to adopt a less judgmental and more open minded approach. Doing everything you can to be curious about what's going on, giving them the benefit of the doubt and being open to constructive criticism. Because maybe your young person feels like you're being too nosy or too bossy, or they don't want you checking up on them so much.

You know, that's all of that is important information to listen to and do the best you can to replace any defensiveness with self awareness. So if your body is getting tense, if it's revving up, then you start to try to calm down, try to pay attention to how you're feeling, how you're coming across, and do your best to acknowledge that you're trying to not be defensive, but rather to listen thoughtfully and respond empathically. Okay. And always, always acknowledge when the other person's got their own point of view, even if it's different from yours. Okay.

I see things are different for you than they were for me. I guess you're thinking that I'm being unrealistic with the things I say. Yes, you're being unrealistic. You don't know what? It's like this.

Da da da da da da. Just listen and listen and keep listening. Now, if it was just this, that was the problem, you know, we wouldn't have to have this, this long seminar here because you'd have figured out for yourself there are other barriers affecting young people that really do make it difficult for them to answer the questions, what am I doing with my life? And how do we get moved forward? So, for example, we know that young people with ADHD have executive functioning difficulties.

They have trouble managing their actions and their emotions and regulating themselves across time towards a goal. Okay? And, you know, Russell Barkley, who's probably one of the greatest of all the psychologists out there, understands this really, really well, clarifies the notion that without these executive functions, all of these growing up, all these adulting is very, very difficult because it's hard to figure out where you're going and how to get there and doing it in a way, by the way, that does utilize social and cultural supports, but also respects the individual's values. Everybody's got different goals and values in life. So when it comes to where they get stuck, often is that they don't manage time or they don't organize themselves, they take too long, they avoid, they are trouble with motivating.

Okay, so it isn't just attention problems, it's also intentional motivation. And you can't just snap your fingers and get someone who has trouble with motivation to motivate. Similarly with emotional self regulation, you know, people get upset. You have to factor that in. This is part of what their challenge is as a young person with ADHD and executive functioning difficulties.

And so respecting the power of these challenges will enable you as a parent to not feel like it's your job to solve it, but rather to help your young person in whatever way possible, start to address it. And there are lots of different interventions for executive function difficulties. In fact, one of the greatest improvements I've seen over the years has been the development of these interventions, specifically targeting this inefficiency, if you will, with problem solving and with, and reaching your goals. So there's self education, understanding how it applies, modifying the environment, making lifestyle changes. Coaching has been very, very helpful.

It's come a long way since it was first introduced. There's cognitive behavioral therapy. There are some also other kinds of therapy, computer based training, family based interventions, and if needed, medication as well. There's a lot of options here. There's no one cookie cutter approach.

It has to be individualized. I particularly feel great pride in having helped develop this area of CBT for executive function disorders with my colleague Russ Ramsey, who's been a guest on this program, but also with Doctor Mary Solanto. I mean, we're really clear that there are very systematic approaches to getting young people, anybody with ADHD, to understand the diagnosis, to commit to change, to learn to modify the environment, and to understand their own negative beliefs that make it harder for them to carry out things like time management, planning, and then particularly dealing with things like procrastination and handling stress. There are many, many others who've been on this podcast talking about the specifics. I will say that I believe that promoting adaptive thinking is the task for everyone who has ADHD and for the rest of us who are trying to help them, is to try to get them to see things in a more balanced way so that they can meet the challenges in front of them.

Finally, the last area that I want to focus on, which is clearly makes it very different to be a young person today than 20 or 40 years ago, is the role of interactive digital media use. Now, I don't need to tell you this, that it's everywhere, right? Mobile devices have now become ubiquitous in the environment, and people really aren't putting them down enough. They're spending up to 7 hours or more a day on these mobile phones. And so this is affecting everyone.

Okay? We're really distracted by this technology because we're all designed by nature to be information foragers. We like information. We search for information. It's useful to survival.

But what happens is we end up spending almost too much time looking at what's the notifications and the little pings and dings. And that distracts us a lot. And if you have ADHD, it distracts you even more. And then there's this fiction of multitasking. Oh, I can have my cell phone and I can do some reading, or I could work on a project.

Not true. Task switching from one thing to another is costly to brain functioning. It does reduce our attention span. In fact, three to five minutes is generous. I think it's gotten even lower in the last couple of years when scientists are measuring average attention span.

I think the way that the Internet is set up is rewarding speed and quick interactions rather than more sustained ones. And it also makes us more adverse to any delays. You notice yourself sometimes getting impatient when your phone's not booting up as quickly as you'd like or your computer's taking too long, you notice how impatient you become. That's got to do with us being conditioned by these devices, believe it or not, we're all seduced by this, and it leads to a lot of anxiety. If you're trying to stay connected, you worry, oh my God, what's happening?

You know, FOMo fear of missing out. It also, I think, leads to things like distracted driving. So it's not a minor issue how the, how these, how these shiny screens have now entered our lives and threatened, really, to move us in all kinds of ways that we don't want. And I'm not a Luddite, I'm not against these devices. I just think that right now we don't have enough controls mechanisms on them.

They're starting to take over. So even none other than the surgeon general issued this report which said that it's time to look at these social media platforms and try to create a safer, healthier online environment for everyone. Because even though they are great at keeping us connected, they have downsides. So what happens when you overuse these media? You don't sleep enough.

Depression and anxiety get worse. Other substance use gets worse. And there's no question that academic performance adjustment, all of those things come about and make life more difficult. So how do you manage this? First of all, you know, ask yourself, is your smartphone a problem for you?

For myself? Is it? Are you spending more time on your smartphone than you want? Are you distracted? Are you compulsively looking at the phone?

Are you worrying too much? Are you having a hard time resisting it? And are you really not happy with your social media presence? I've talked to everyone about this lately, and I can tell you, I hear stories from everybody who are saying things like, I just swore off TikTok, it was driving me crazy, or I just stopped doing all the instagramming because it was taking up too much time.

I think to take charge of your social media usage, the bottom line is you really have to reduce overall time online. You can use an app, you could turn off your phone. At times, you can just not take your phone to bed, disable the notifications, or interrupt yourself from compulsively checking your phone. And as I mentioned, some people are just taking the social media and just getting rid of it. So I think that, you know, you really need to ask yourself, are you using social media as a substitute for real life?

Are you making conscious decision? Are you an active or a passive user? Like passive scrolling, just scrolling and scrolling and scrolling. And does it end up making you feel worse about yourself because you're wasting so much time? Finally, I think that taking charge of social media also says you can use the time better.

You can practice gratitude. You can use time for reflection and get away from all of the negatives. Use as much energy as you can to practice mindfulness, to be in the present moment, to acknowledge what you're thinking and feeling, and to ground yourself when you're feeling stressed. Do, as I said earlier, do what you can to stay focused on what's in your control. Do what you can to be in the physical world in real life, as they say, IRL, and spend time doing things that make you feel good, even if they're not online.

I mean, that to me would be a major step forward. Bottom line, turn off the phone because you're spending too much time. Chances are we're spending too much time on it. And with that, I will turn it over to Carol and to others who want to ask me some questions. Well, thank you so much for that very helpful and illuminating presentation, Doctor Ustane.

Carol Fleck
We really appreciate it. Before we start the Q and A, I'd like to thank brain balance once more for sponsoring this webinar. I'd also like to share the final results from today's poll question what is the biggest obstacle to your child becoming independent? Here's what you said. 27% said addressing ADHD related challenges such as impulsivity and emotional dysregulation.

Probably no surprise there to you. 21% said making plans for the future. 19% said establishing health habits and routines, 10% said fear of failure. And another 10% said spending time offline away from social media use and video games, as you just said. Now to your questions.

My son is 27 and moved to LA three years ago to try to make it in a music video business. He's taking a regular job while trying to make inroads in that business, but he's always asking me for money. I give him what he asked for because he's in survival mode and I don't want to be a dream crusher. How should I handle this? Well, thanks.

Anthony Rothstein
First of all, thanks for the question. I really respect that you're struggling with this pros and cons. You know, it might make you feel better to know that supporting your young person in seeking their dream is a good thing for parents to do as long as you've expressed some sort of expectations on your part. And he's made it clear, what are the limits about which he can ask you for support? Because, you know, everybody's got limits.

But giving your child a chance at achieving their dream is very important. I think perhaps you could you and he should have a conversation about how much. Looking tracking back on how much has been donated so far. Is that a reasonable amount? Is that too much?

And I would also ask, make sure that your son has a sense of how to keep a budget, you know, and live within that budget, because I think nothing upsets parents more who are giving generously to their kids to keep getting asked more and more and more without a sense of, well, what's the limit here? So I salute you for supporting your son and pursuing his dream, giving him a chance to see if he can make it. Hopefully he has a job that earns him some money. But, you know, young people right now, even those that are well educated, many of them have had to take relatively lower paying job in jobs in this economy. So having a little parental subsidy seems to me to make sense.

As long as you set limits and you discuss what the. You know, what the duration is of this experiment. Okay. Another question is our daughter was traumatized by her first two years of college, and now she's paralyzed from doing almost anything. How do we encourage her to overcome this?

So sorry to hear about your daughter. I didn't get into talking about this, but rates of PTSD among young people with ADHD is very high. And, like, we can see that your daughter right now probably needs some help with overcoming that trauma. So being as encouraging as you can to talk to her that PTSD is common, that PTSD can be treated, there are lots and lots of different approaches, therapeutic approaches, and letting her know that you realize that living with this trauma may make it very hard for her to believe that she can succeed in the future, but that you're committed to helping her get the help she needs to. To challenge those thoughts and to really treat the underlying PTSD.

Carol Fleck
Okay, here's a question that I know a lot of parents will relate to. How do we get our children past the why bother? Because the world sucks attitude?

Anthony Rothstein
That is such a great question. I have this. This comes up all the time in my practice. Okay, for, first of all, you know, there's. You can't make them think the world doesn't suck.

You can't argue with it. I guess the question I would ask your child is, okay, if the world sucks, why bother? What do you think is going to happen down the road for you? Like, where do you see this all going? And not in a hostile way, but rather in an exploratory way, because escaping into virtual.

I mean, I'll never forget in the early days when the Internet was starting to get really going, one of my patients was staying up all night and missing out on going. He lost several jobs because he was playing more and more games and came in and I said, so what's up with you in the video games? And he said, well, the world sucks. I don't really want to be part of it. So I said, oh, so you're on strike.

In other words, you're like, you don't want to participate. And, yeah. He said, yeah. So what we ended up having to do was fashion a way for him to have his time to do what he wants, but also to contribute to the family household, because after a while, I can tell you, it starts to get boring. And so he was able to agree to do some things around the house that were productive for the family and little by little, engaged in a conversation.

Again, this is under with treatment. Hey, you must have some values. You must have some things that you care about. What might you be able to discover about taking those values and putting them into action? Because the temptation is to just withdraw and to be completely sort of stuck in.

Stuck in this virtual world. I don't think if you can't get through to him or her, then I would say, okay, I need to go talk with someone who can give me some ideas, but really waiting it out for a bit, not expecting it to be to happen overnight. Eventually people say, hmm, I'm not getting any. I'm not getting any younger. Time is passing.

Maybe I need to do something. But I've had people take several years to get out of that funk. And even with treatment, they take whatever time it takes. So encouraging exploring non withdrawal as an option. But if they're so stuck that they're not leaving their room, then I would make a point to try to get that your young person evaluated for depression.

Carol Fleck
Okay, another question. How do I counter the oppositional defiance that my young adult is showing in terms of launching or delaying? Launching. Okay, so that's a big. That is a huge issue.

Anthony Rothstein
First of all, I fit that into the, those of you that answered fear of failure, I think most oppositional behavior, and an answer to the earlier question, the one we just asked about withdrawing, I think the oppositional behavior is often a sign of feeling stuck and not having a sense of what to do next. So when the parent tries to suggest, well, you could do this, you could do this, you could do that. You run into all kinds of, you know, no, that's not going to work. Negative, negative, negative. So I think the first step is to sort of have a frank conversation.

Okay, what do you think are your goals, how can I help you get there? Rather than these should be your goals or these are the things you should be doing? Because I think it all gets back down to what are people's fundamental goals and values? What do they want to do in life? And doing it in a way that is not for, with argument or with, you know, replays of the same old thing.

Oh, you stayed up all night last night and you, you didn't, you know, now you're not up in the morning. I can't stand that. All of that is more, feeds into the oppositionality. It's almost rewarding to the oppositionality because then the young person says, yeah, you don't get it, but if you said, hey, you know, this must be really hard for you. It must be so hard for you to feel like you don't have any chances that are worthwhile, that you're not really able to mobilize to do some things that you want to do.

That must really be tough. And I don't know what I can do to help you, but I certainly want to know what is it like for you? Like what's really happening and how might we come up with something like, we call it a transition plan, okay. Maybe start checking things out that might appeal to you, doing things that you would find fun as well as rewarding as well as being able to earn some money. And by the way, the other interesting point is that oftentimes young people aren't coached well enough about finding out what kind of work they do.

We have a whole chapter in our book about finding job, finding a suitable career. And it turns out that young people and parents, too think, oh, they, they're interested in this. They should go get a, pursue a career in this area that they're interested in. But, you know, what you're interested in is not necessarily what you're good at. So we recommend vocational assessments.

The way to get around this oppositionality might be to suggest, like, okay, listen, you haven't come up with something you want to do. How about we find out what you might be good at that might help you find a path out of this where you're stuck. And I think what we're missing out in this country is helping young people well before college start to look at the things that they're good at and where they might go in terms of careers or occupations. And I think vocational coaching is huge. It's become for me something that I recommend more and more because, especially when there's a gap between what the young person is trying to do and how hard it is for them to do it.

So maybe you like this, but maybe you're not suited to it. So how do we help you find something that you're going to be good at and that's good enough for you to learn of the skills that are involved in doing that kind of work? Those are such great suggestions. Another question is, my son blames all bad outcomes and such as jobs and internships on others. He does not see his role and he doesn't wonder what he could do differently next time or why things didn't work out.

Carol Fleck
I assure him there are things he can do to change outcomes. How can I have him have some self awareness? Yeah, that's one of the, that kind of thinking process is a closed mindset. Okay? It's, we call it externalization.

Anthony Rothstein
Your young person is thinking it's everyone else's problem but mine. Then the question you can turn it on its head and say, well, if it's everybody else's problem, where do you think you can go with this? You know, what is left there for you? What could you do? Because it looks like everybody is not on your wavelength, looking at it as an interactional problem, rather than blaming him for his own failures, or he's not taking responsibility.

You know, how do we get people to take responsibility for anything? It's engaging their motivational system, and it has to be reward based. There has to be something. He might not be able to articulate it right away, where when he does it, he feels rewarded and successful. It's also worthwhile looking back on what were the experiences that he did have and when it didn't work out, what led to it not working out?

And if he says, well, it was a teacher's fault, I said, well, what was the teacher saying that wasn't happening, that needed to happen, because I wouldn't point directly at the person. I would look at it interactionally and say, hmm, you know, you were taking, you went for this job and you went to the job, and after a while you didn't seem to like the job. You think, what do you think was the reason you didn't like the job? And it may have to do with the fact that they weren't getting results they wanted. It didn't meet their expectations.

So then you can begin that, expanding it to say, so what are your expectations? What would be a suitable situation to find yourself in and using it, really looking at what floats their boat. Because we have a term called motivated abilities. Those are the things that people wake up saying, I really want to do this today. I mean, many of us go to work and there's a lot to do at work that we're not so happy about, but there's enough at work that we like that gives us some sense of satisfaction or fulfillment.

Now, if that ratio is not suitable, if there's more unpleasant, tedious, annoying, noxious things compared to rewards, then young people tend to give up on that. And not just young people, everyone. If you're not getting sufficiently rewarded, you don't stick with it. So I would reinterpret his oppositionality as something like, well, I think you're angry about the fact that you're not getting what you want out of the situations. You're not getting what you were hoping from the situation.

You're really not being rewarded in what you were hoping would be rewarding for you. And that way it becomes an exploration, a curiosity about, so what would be more rewarding? You know, what have, what things do you feel motivated to even put up with either boredom, tedium, lack of success in order to achieve. But I think what you're describing is that oppositionality is a defense against feeling like a failure. And that's a very tricky, tricky situation because when people feel like a failure, they avoid rather than engage.

And this is the, you know, if you were to look at the, one of the most basic tenets of our work with people with ADHD, it's that people with ADHD have a lot of experiences of failure or of not achieving their expectations or their goals. And as a result, they develop this learned helplessness and they start to avoid things, even things that aren't that hard they seem to be. I'd rather just not try. So you're describing someone, I think, who's feeling like they pretty much are quitting before they even had a chance to really see what they were good at. And I would just keep saying, well, you know, maybe that wasn't so good.

Maybe that didn't work out. What else might we try? And whenever you're ready to look at it, we can help you look at it. Yeah, that's a great answer. We had a.

Carol Fleck
A few questions around driving. Here's one. My high school senior is very immature. He has anxiety and he won't get his driver's license. How can I encourage this without being forceful?

He refuses to take responsibility. Also for other things in life, like getting up for school. And anytime we try to hand over the reins on anything, he opposes that.

Anthony Rothstein
Well, first of all, maybe he's telling you something that is important to listen to that he's just not ready to take driving on. I have a, you know, it's funny, I don't have a one size fits all answer to the issue of driving, because if someone does not want to learn to drive, then I think you have to respect that as a fundamental. I would want to know why, you know, why isn't he interested in learning to drive? Drive, is that he, like, he's afraid he's not going to learn to drive. He's afraid of having an accident.

Is it too much effort? Eventually most people end up learning to drive, but maybe not on the timetable. The other thing I would worry about is that if you did get him to learn to drive, but he wasn't really into it, that he might not really become an effective driver. This is an example of a motivation. You have to have a motivation to be able to master something like driving.

And. Yeah, I wish I had a, I wish I could tell you in three, two, three questions how to get him to examine his own assumptions. That would be the thing I would want to find out. What are his assumptions? What is his mindset about driving?

What is the good about it? And by the way, the other technique that I didn't get into, but we do write about in the book, is the importance of something called motivational interviewing, which, if you haven't heard about it, is the absolutely most important set of skills around talking about with someone something that they're having trouble either starting or stopping. Now, motivational interviewing was developed for working with people who had addictions like smoking, alcohol, etcetera. And this is the way you pose the question, what are the advantages to learning the drive? What are the disadvantages of learning to drive?

And you begin that process of exploring the goods and the not so goods. Now this would be with someone who's willing to think about driving. If he's not even willing to think about driving, it's not going to work. You might just point things out like, well, you know, eventually you're going to have to learn to drive. And when you're ready, let's figure that out.

But if he's ready to think about it a little bit, that's called the contemplation stage. When they're not ready to think about it and they're in denial, that's pre contemplation. They're just not interested in talking about it. And some of the case examples we heard about earlier, that your young person might be in pre contemplation. I don't want to discuss it.

I don't want to look at it. But once they're ready to start to look at it, that's called contemplation. Then they can begin to say, okay, there's some goods and some not so goods with this idea. Let's look at all the goods. Let's look at all the not so goods.

Like, say, stopping, playing video games. What's good about video games? What's not so good about how much I play videos? So I would go back to the question about driving and say, what are your thoughts about what's bad about driving? Because you seem to, you know, most people, when the bads outweigh the goods, they don't do it.

And that's how I would approach it. It's like, well, what's, what's, what's the negative that's stopping you from even thinking about it? Another question is, how do I help my older teen, who's about to go to college, manage his meds when he moves out? Oh, well, I wish I could give you a. So first of all, he's got to start managing them now, not when he moves out.

And you got to just say, I'm not going to be around to give you your meds. Figure out the best strategy. Where is he going to keep his meds when he's in college? He or she, they got to have their meds locked away so that people don't steal them. So there's all this kind of prepping for going off to school with a vis a vis or meds.

But I think before they leave, they would need to learn how to keep track of what they're taking and to see how they manage without you reminding them, because you're not going to remind them. There are nice phone apps now that do ding when it's time to take your medicine. Yeah, we address this in the summer issue of Attitude magazine as well. Great. One suggestion was to time it with brushing your teeth or drinking coffee or something you do that's routine in the morning, for example.

Yeah. That's called chaining. That's chaining it. You chain one behavior to another behavior and you're more likely to remember it. Great idea.

Carol Fleck
And then this has to be our last question. How do you get the co parent on board with either letting your child fail or letting your child figure it out? As you mentioned earlier, when you have two different views about how to manage that.

Anthony Rothstein
I think that if the co parent is completely opposed and isn't willing to consider some in between, then I think you're going to have your work cut out for you. It's going to have to probably be a little by little approach. But I think both parents need to state where they're coming from, why they're feeling the way they are, acknowledging their feelings. Like sometimes parents are really angry at the young person for not growing up or for not taking responsibility. And that leaves them feeling helpless themselves.

They feel that, oh my God, I've worked so hard all my life to get where I am, but look at you, you're just taking the lazy way out. And so any kind of attribution, any kind of negative stereotyping that's going on, it's really important to explore all that because that mindset leads the parent to be very, very negative towards the child. So what you want to aim to is a more neutral and a more inclusive way of analyzing the situation. Yes, you're right. They are at times very resisting the growing up thing, the adulting thing.

Why don't we find out why? Why don't we learn what's going on with him or her? Why don't we really listen to what they're trying to figure out and what their solution might be? And lastly, most importantly, what role do they want us to play at this point? Because like I said, I think trying, trying to micromanage your young adult is not going to help them figure things out.

But just letting it go and walking away isn't helpful either. So it's finding the right distance and making sure you know your role. And if you're not feeling like you can, you know, agree to these things, then at least not making it worse. Okay. Not trying to undermine whatever plan is being hatched by the other parent.

Somebody's got to do the heavy engaging. And if the other parent is feeling like, no, I'm not up for this, then fine, let the one who is take that on. But try not to undermine. Because the conflict between parents is something that I think affects the young person, makes them feel worse about themselves. And it makes each parent less able to tolerate the uncertainty, the frustration, the sadness, the disappointment, whatever it is you're feeling about your young person.

And I think that in the long run, recognizing you're a human being, so is the other parent. We're all having a hard time here and maybe with just acknowledging that we don't have to fight about it. That's great advice. And unfortunately, that has to be our last question because we're out of time. But Doctor Rostain, thank you so much for joining us today.

Carol Fleck
And for sharing your expertise with our ADHD community. Thanks for having me. It was a lot of fun, and. Thank you to today's listeners. If you would like to access the event resources, visit attitudemag.com and search podcast number 503.

The slides and recording are posted a few hours after each live webinar. If you're listening in replay mode, simply click on the episode description. Please know that our full library of Attitude webinars is available as a podcast. It's called the ADHD Experts podcast and it's available on all streaming platforms. Make sure you don't miss future attitude webinars articles or research updates by signing up to receive our free email newsletters at Attitudemen newsletters thanks everyone.

Have a great day. For more attitude podcasts and information on living well with attention deficit, visit attitudemag.com. that's a d Dash.

503- The Journey to Independence: A Parent's Guide to Delayed Adulthood with ADHD

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1: Introduction

2: The New Normal of Adulthood

3: Impacts of Digital Media

4: Parental Guidance

5: Q&A Session

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