Your son is seven—or 10—or 15. He has ADHD and related issues. His social, emotional, and executive functions have not developed intuitively. He has difficulty relating to others, never quite understanding their thoughts, feelings, sense of humor, or intentions. He doesn’t realize how he comes across to others. Getting the “bigger picture” is hard for him, as he often focuses on insignificant details at the expense of what’s important. He struggles with sharing the appropriate amount of information.
You know he needs help, but he’s not responding well to” talk therapy.” He dislikes seeing a therapist and the treatment itself doesn’t seem productive.
Many parents of boys with ADHD may recognize their sons in some, if not all, of that description. That comes as no surprise to Ryan Wexelblatt, a licensed clinical social worker and contributor to the ADDitude series ADHD in Boys. Wexelblatt suggests that traditional talk therapy often does not work for boys. He maintains that boys generally don’t want to sit still, make eye contact, and talk about their feelings.
Wexelblatt, one of the few professionals who specializes in teaching social skills to boys from a male perspective, recommends steering clear of psychotherapy. Kids with ADHD lag their peers in a number of essential skills that do not respond to medications and cannot be treated effectively by a therapist. When it comes to social cognition, executive functioning, and emotional regulation, ADHD is more a learning issue with a mental health component than a straight-up mental health issue. Therefore, in his opinion, psychotherapy is not suitable—and should not be used—for tackling the type of skill deficits that often accompany ADHD.
Likewise, social skills groups rarely work for boys with ADHD. Often designed primarily for kids with significant cognitive impairments, these groups usually provide one-size-fits-all scripts for socially appropriate behavior. Boys with ADHD, however, don’t need superficial skills and should not be taught to feign sincerity. Instead, they need trained professionals to address their fundamental social deficits, and teach them to think in a broad social context rather than a scripted one.
Male professionals are generally the best fit for boys with ADHD, yet 90% of those who teach social skills to boys are female.
The Better Option
Boys with ADHD should work with qualified and experienced clinicians and ADHD coaches who understand gender-based brain differences, are experienced in relating to boys, and can teach practical skills and strategies for ADHD-related challenges.
Although it may be time-consuming to find an expert with the right background for your son, it will make a world of difference in his progress. Use the following guidelines to get started:
- When interviewing professionals, ask how they will tackle your son’s particular social and executive function difficulties and what techniques they will use to work on emotional regulation.
- Familiarize yourself with particular treatments. For instance, cognitive behavior therapy (CBT) can be helpful in developing self-directed talk and addressing social anxiety, poor self-esteem, and depression. Dialectical behavior therapy (DBT) is useful in increasing emotional and cognitive regulation by teaching coping skills to avoid undesired reactions. Zones of Regulation is a curriculum that combines sensory and cognitive behavioral strategies to foster self-regulation and emotional control.
- Give your son time to progress. Once he begins working with a suitable clinician, be patient with the pace of his growth. Don’t allow him to dictate whether or not to continue getting help: he will not outgrow his ADHD deficits or pick up social skills on his own. Keep in mind—and help your son understand—that developing skills and strategies for social competency, executive functioning and emotional regulation is a process that takes time.
This article is based on an ADDitude webinar by Ryan Wexelblatt, LCSC, a licensed clinical social worker and school social worker who contributes expert Q&As to ADDitude’s series ADHD in Boys, and facilitates the ADHD Dude Facebook Group and YouTube channel. Eve Kessler, Esq., a criminal appellate attorney who recently retired from The Legal Aid Society, NYC, is Executive Director of SPED*NET, Special Education Network of Wilton (CT), and a Contributing Editor of Smart Kids.