How do I talk to my kid about ADHD?

You’re not alone. Your child’s pediatrician should be your first stop in this journey. As a neurospicy pediatric neurologist with an ADHD child, this is how I discuss this topic with my patients and their families.

The first thing I ask my patients is, “Are you trying harder?” Because that’s what we keep telling them to do—try harder! Every single child nods eagerly because every single one is already trying harder. If trying harder were enough, we wouldn’t need to have this conversation.

ADHD has nothing to do with how smart, good, or motivated they are—only how good they are at focusing. Some people are great at math, soccer, or focus. Most people are average. Some people struggle in one (or more) of those areas, not because they’re bad or dumb but because that’s just not their strength.

This is why an appropriate diagnosis (or label) is so important. Kids are smart, and they notice things. Even kindergarteners can tell you who the smart kids in class are. They can tell you the funny kids, the popular kids, and the good kids. They can also tell you who the “bad” kids are. These are the kids who are yelled at for talking too much, moving too much, or just being too much. These are the kids who take too long with their tests or never know what’s happening because they’re staring out the window. They know—and, if it’s them, they internalize it. Lazy. Bad. Hyper. Space cadet. Wasted potential. When these are the words that they hear over and over, these are the words that they use to define themselves.

This is why we need these labels. They’re not bad kids, and they don’t have bad brains. They just have brains that work differently, and once they learn to use those non-standard brains, they can do amazing things.

I like to tell them that ADHD kids have Ferrari brains with bicycle brakes. Ferraris are great race cars, but they aren’t good at slowing down and stopping. ADHD brains are great at jumping around and/or that one thing that they really love (hyperfocus—the secret superpower!), but they are not good at moving steadily along on a subject that they’re not interested in.

Sometimes we can manage ADHD with school accommodations, therapy, and support, but at the end of the day, ADHD has to do with how the brain works on a chemical level. ADHD brains work differently—not badly, just differently. It all comes down to neurotransmitters. If you can’t make your own, store-bought is fine. This is where medicine comes in.

All of my families tell me, very earnestly, that they are not “medicine people.” I respond that in over 14 years of practice, I have never once met any “medicine people.” However, we are all “how can I help my kid people,” and sometimes, we need to try something different to do that. As parents, we like the idea of “natural.” However, as a physician, I don’t find “natural” and “unnatural” to be helpful categories. Lead, poison ivy, and bears are all natural, but we don’t want them to happen to us. Air conditioning, on the other hand, is not at all natural, but no one wants to live in Florida without it.

Many people with ADHD use medication to help with focus because that’s the only thing that actually addresses the difference in neurotransmitters. I describe them as being like glasses for the brain. I need my glasses to focus my eyes. It doesn’t matter how much I would like my eyes to see clearly without glasses because that’s not how my eyes work. I can get close to the monitor and squint, but that’s not very efficient and will absolutely lead to a headache. Or I can just wear my glasses and get on with things. Glasses aren’t perfect—we need to adjust to them, and sometimes we need to change the prescription if the first one isn’t a great fit. But most people who need glasses would agree that, despite the trade-offs, life with glasses is much better than life without glasses.

Another way of looking at this is to consider the saying “you’ve lost your marbles.” Most people keep their marbles in a nice little bag so they don’t get lost. ADHDers have marbles and no bag—the marbles are going all over the place! Medicine gives you a bag with a hole. Not perfect, but at least you can keep track of the marbles with some effort, and if you don’t like the first bag you get, you can always try a different one.

Very few of my families regret starting medication. In fact, most families wish that they had started earlier. It doesn’t mean that medication solves everything or that we’ll figure out the perfect one on the first try. I tell my families that finding the right medicine is like going shoe shopping. You may know that you’re a size 8, but not every size 8 is going to fit. Some are too big, some are too small. Some need to be broken in. Sometimes, we get lucky and find something that’s perfect right out of the box—but that doesn’t always happen. If we don’t like it, we can always stop it. These medications are all relatively short-acting, even when we would prefer for them to last longer. If you don’t like the medication or the side effects, just wait—it’ll wear off by bedtime or the next morning.

ADHD doesn’t go away, but people get better at figuring out how to use their brains, so not everyone needs medicine forever. Back to glasses—some people need glasses just for reading or just for driving. Some people need glasses but choose to get by without them. I need my glasses, so I just wear them all the time. As you get older, you figure out your own structure and what works for you. Some people manage well without medication. Some people don’t and stay on medication. (Some people manage poorly and still don’t take medication, but that’s a different issue.)

As parents, teachers, therapists, and physicians, our goal is the same: To help our kids grow up as happy, healthy, and independent as possible. By helping them to understand their brains—quirky as they are—we empower them to grow beyond labels like “hyper” and “distracted” into secure, confident—if somewhat neurospicy—individuals who are able to use their unique abilities to make a mark on the world.

Paige Kalika is a board-certified pediatric neurologist at the University of Miami. She is certified in headache medicine and has a special interest in neurodiversity and neurodivergence. She can be reached on Bluesky.