What Research Tells Us

Studies suggest that self-directed speech may be more prominent among people with ADHD traits, pointing to differences in how inner dialogue manifests and how it supports behavior (Benfield & Cole, 2025). As researchers describe it:

“With respect to use and function, self-directed speech has been associated with a large range of behaviours and tasks. These appear to benefit from the self-regulatory, reflective, and management aspects of the phenomenon. Such behaviours and tasks include those concerned with, for example, problem-solving, decision-making, emotional processing, working memory, resisting temptation, attentional focus, mind-wandering, imagination, and creativity.”

Other cognitive research has found that children tend to use more self-directed speech when tasks become more complex. This research aligns with Vygotsky’s idea that inner speech becomes especially important when we’re planning, problem-solving, or regulating ourselves under pressure.

Inner Voice in Everyday ADHD Life

In my work with ADHD teens and adults—and in my own life—I’ve come to see inner dialogue as a genuinely useful tool for planning, processing, remembering, and staying focused, especially during transitions, such as when you have a few moments to let your mind wander, say, while commuting. Johann Hari, in Stolen Focus, highlights the importance of unstructured thought as vital for creativity, future planning, and deeper insight—a necessary counterpart to focused attention.

Think about the early morning hours. Your brain is still waking up, but you need to move through a specific sequence of tasks within a limited window of time. Or it’s the end of the day, when energy is fading, but there are still loose ends to tie up before you can truly relax.

In these moments, planning, working memory, and attention are all doing a lot of heavy lifting. A supportive inner voice can function like a quiet coach—helping you break tasks into steps, keep track of what comes next, and offer encouragement when motivation is lacking.

If positive self-talk doesn’t come naturally—especially first thing in the morning—it can help to outsource some of that support. Music, a brief podcast/ morning affirmation, or familiar routines can provide structure and emotional grounding. Sometimes an upbeat song can do what your inner voice just isn’t ready to do yet.

How Parents and Loved Ones Can Support

If you’re parenting a child with ADHD, modeling a calm, neutral inner voice by staying composed during transitions can help them feel secure and understood.

For parents or partners of older ADHDers, support may look different. Sometimes it means giving space. Your loved one may need time to mentally organize a specific sequence of steps to navigate a transition smoothly. One practical way to help is to pick one predictable task to do consistently—like making the same grab-and-go breakfast in the morning or filling a water bottle and leaving it in the same spot. The goal is to allow your loved one to cognitively offload something, without introducing extra decisions that could interrupt their focus.

When Someone Seems “Stuck in Their Head”

If your loved one seems more inwardly focused than usual, it may simply mean they’re juggling several demanding tasks at once. If you’re worried, try bringing it up gently and without judgment at a time when you usually connect.

You might say:

• “I’ve noticed you seem more in your thoughts lately. Do you want to talk about it?”
• “Is there a way I can support you right now?”

Starting with gentle observations, offering choice, and asking permission to help can foster feelings of being seen and cared for without shame or pressure.

A Final Thought

Therapy can help shift the inner voice from something that feels critical or overwhelming into something more supportive and steady. It can also support caregivers and loved ones by offering practical, realistic strategies that make sense for your family.

If you’re looking for support, consider reaching out to an ADHD-informed therapist who understands both the research and the lived experience of ADHD.

By Emily Varlas, LMSW, MS Ed.

Emily is a therapist at Jonah Green and Associates, LLC, which offers therapy services for children, teens, families, and adults in North Bethesda, Maryland, serving clients in Montgomery County, DC, and the surrounding areas.

References:

Benfield, E., & Cole, G. G. (2026). Self-directed speech and attention deficit hyperactive disorder-like behaviours. British Journal of Psychology, 117, 301–313.

Hari, J. (2022). Stolen Focus: Why You Can’t Pay Attention—and How to Think Deeply Again. Crown Publishing Group.

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Building on Strengths

While many symptoms of ADHD make it hard for kids to cope, kids with ADHD may also be more spontaneous, creative, and curious. They may think quickly, be capable of intense focus, or hold passionate interests. It is essential to emphasize these strengths when talking with your teen. Encourage them to understand ADHD not as a label but as a tool to help them understand their brain, strengths, and areas where they may need extra help. The goal is not to “fix” them but to build on their competencies and empower them with strategies to help them manage their unique challenges through offering tools, support, and opportunities. 

Key Assessment Tools

Assessments can clarify whether your teen has ADHD. Tools to evaluate your teen’s symptoms and behaviors include:

• Checklists and Rating Scales: These tools document behavior patterns over time.
• Interviews with parents, teachers, and your teen illustrate symptoms at home, in school, and socially.
• Psychological Testing can help when the diagnosis or co-existing conditions are unclear.

A good assessment will help you better understand your teen’s strengths and areas for growth and guide the next steps.

Support for You

A critical part of treatment for ADHD involves support for parents. ADHD often affects how parents and teens interact, so working with a therapist to set clear expectations, reinforce positive efforts, and manage challenging behaviors effectively can not only help your teen but also improve parent-child relationships. Through parent sessions, you may learn strategies like:

• Setting up consistent routines: Structure helps ADHD teens feel grounded.
• Using positive reinforcement: Catch them doing things right and reinforce good behavior.
• Breaking tasks into smaller steps: This helps reduce overwhelm and makes tasks feel more manageable.

These skills help create a more supportive home environment where parents and teens feel heard and respected.

Family Therapy: An Opportunity to Build Bonds

When ADHD affects family dynamics, family therapy can help everyone better understand each other. It fosters empathy, improves communication, and builds mutual support. Key aspects of family therapy when there is a child with ADHD, may include Collaborative Problem-Solving or discussions where kids are “not in trouble” that encourage kids to express their feelings and desires and to hear yours. Family therapy can also focus on improving sibling relationships or helping you and your partner to work together better. Family therapy aims not only to “manage ADHD” but to strengthen bonds.

Executive Functioning Treatment

Teens with ADHD often struggle with executive functions—skills like planning, organizing, or time management. Therapy can offer teens the following tools:

• Timers and reminders: These are to help with managing time.
• Checklists and visual aids: These help with organization.
• Breaking tasks into steps: To make overwhelming tasks feel achievable.

These strategies can help them feel more in control and capable, reducing frustration and promoting independence.

Finding Settings that Foster Success

Many teens with ADHD benefit from smaller classrooms, resource rooms, and extra help. Advocating for 504 accommodations, IEPs, or outside supports can also be beneficial. Finding activities where your child can thrive can be very helpful. For instance, many children with ADHD have challenges navigating team activities. “Individualized sports, such as swimming or martial arts, can build fitness and self-confidence.

Medication: The Options

Medication can be a tool for managing ADHD, especially when symptoms are severe. There are two primary types of medications for ADHD:

• Stimulants such as Ritalin or Adderall can improve focus, attention, and impulse control.
• Non-stimulants like Strattera or Intutiv may also be effective.

Medical professionals can help you find proper medication.

Anger Management and Social Skills Training

Teens with ADHD may have difficulty with impulse control, leading to outbursts of anger or frustration. ADHD can also make it harder for teens to recognize social cues, maintain conversations, and handle conflicts. Anger management therapy can help them manage emotions and respond effectively in difficult situations, and social skills training can help improve peer relationships.

Building Self-Esteem and Self-Acceptance

Children with ADHD may face criticism or failure. Therapy can improve self-esteem and self-acceptance by:

• Strengthening self-awareness, especially of strengths and abilities.
• Teaching self-compassion: Encouraging them to be kind to themselves despite setbacks.
• Fostering a growth mindset: Reinforcing that they can improve with effort and that mistakes are opportunities to learn.

ADHD can present many challenges for teens and their families. With accommodations and support, it can also offer opportunities to build on strengths and help your teen and family thrive.

-Posted by Jonah Green, the owner and director of Jonah Green and Associates, LLC, which provides therapy for children, teens, families, and adults in North Bethesda, Maryland, as well as for clients in Chevy Chase, Montgomery County, Washington, DC, and the surrounding areas.

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Sleep

If a child does not get enough sleep, the different parts of their brains have a harder time working well and “talking” to each other. Sleep is important for the different parts of the brain that work on memory, attention, thinking, emotions, behavior, and deciding if something is a good choice. While sleep is important for everyone, it is especially important for kids with ADHD, because lack of sleep can cause the symptoms of ADHD to be worse (such as focus, attention, impulsivity, hyperactivity, irritability). Without enough sleep, kids are likely to struggle at home, school, and with their friends. They will have difficulty focusing in class, learning and remembering the lessons, and may not remember the answers for a test. Kids will probably have trouble controlling their emotions, and may have more behavior problems. It’s important to make sure that your child gets at least 8 hours of sleep each night. One way to help your child get enough sleep is to start a bedtime routine. Try to make sure your child goes to bed at the same time every night. Dr. Nowell says that kids should not have any screen time 2 hours before bed. Screens turn on the “awake” part of our brain, so you need to give the brain time to calm down and be ready for bed. Because of this, remove all TV or screens from the bedroom. About 30 minutes to one hour before bedtime, start the bedtime routine. For many families, this routine looks like taking a bath, changing into pajamas, brushing teeth, and reading a book with a parent.

Diet

One of the best things you can do for the diet is to eat less sugar and more protein. Protein is in foods like meat, fish, eggs, beans, nuts, and dairy products like cheese and yogurt. Protein helps the different parts of the brain communicate better, and helps lower hyperactivity (high energy) and impulsivity (doing things without thinking).  If you’re in a rush and don’t have time to cook a chicken breast or make some rice and beans, Dr. Nowell suggests packing cheese sticks – an easy, hassle-free option for protein throughout the day. You could also try low-sugar protein bars or shakes, or a handful of nuts.

Screen Time vs. Green Time

Studies show that too much screen time and video games increase symptoms of ADHD. On the other side, research has shown that exercise and time outside (“Green Time”) reduces symptoms of ADHD. Does this mean that kids with ADHD should never be allowed to use their phones, watch TV, or play video games? No! Just make sure that you keep the screen time to a reasonable amount, and spend as much time as possible outside playing. Most professionals recommend no more than 30 minutes to 2 hours per day depending on the child’s age.

Make Things Visual

If someone struggles with ADHD, it can be difficult to keep organized. Try using clear storage organizers and drawer dividers. This helps keep things organized, helps you and your child find things more easily, and lets you know what you have.

Kids have a hard time understanding the concept of time and how long things take. So, when you tell your child that they have 15 minutes of video game time, this doesn’t mean much to them. There are visual timers like the Time Timer and the Time Tracker Mini hat help kids understand how much time they have left for an activity. If you don’t have one of these timers with you, you can also use an example that makes sense to them (“You have 30 minutes left to play. That’s the same amount of time as one episode of BeyBlade”)

Time Timer/Time Tracker Mini

Even with the best of intentions, sometimes it’s hard to remember things in our head – especially if we have ADHD. If your child has trouble remembering to do things, try putting up visual reminders. This may be a checklist of things to do in the morning, or a picture on the bathroom door reminding them to wash their hands.

Earned Incentives

Kids respond well to positive rewards and incentives for their behavior. I often hear from parents, “I’ve tried star charts. They don’t work for my kid.” If this is the case in your family, don’t give up on positive rewards! Usually if a “star chart” system hasn’t worked in the past, it’s because the reward was too far away, the incentive didn’t seem worth it to the kid, or there were too many things the child had to do to earn a reward or star.

The first step to creating a reward system for your child is to decide what things are unconditional – what things your child doesn’t have to do anything to earn. These are usually things like love, respect, safety, three meals a day, basic clothing, 30 minutes of play time, etc. Then decide what things are earned (special food like favorite candy, trendy clothes, new toys, extra video game time, etc.).

Now for the reward part – Choose ONE behavior that is challenging for your child (such as brushing their teeth, flushing the toilet, getting dressed in the morning before the bus comes). Each time your child does the behavior, give them a token or card that can be redeemed for their earned incentive of choice. Once they are consistently doing the behavior, choose a new goal. The most important things to remember are to work on one goal at a time, and keep the rewards immediate. As your child gets older or gets a better understanding of the reward system, they can begin to work towards saving up tokens for longer term goals.

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The Waiting Game

This clever game gives children the chance to learn the ever-challenging skill of waiting.

1. Pick a space clear of distractions, and allow your child to pick an enticing toy with several components to it. I like to use a train track with many cars, or a box of sand with a bucket of toy animals.
2. Allow your child to pick two or three small toys to play with at a time (2 or three trains or animals, for example). Keep most of the toys in your control, just behind your back or on a higher surface.
3. Set up a timer and tell them they are allowed to play freely with their chosen toys until the timer goes off, at which point they can pick 2-3 more toys.
4. While they wait, teach them that they can have fun with what they already have! Engage and distract them with the toys they do have and remind that they will have to wait for more. Point to the timer and let them know how much time is left.  If they reach for more toys before the timer goes off, gently remind them that you know it is hard, but that they are practicing waiting.
5. Congratulate your child when they successfully wait for extra toys.

Hands Up

This is a fun game for little ones who just can’t seem to keep their hands off things.

1. Give them toys they love and practice saying “hands up,” every 30 to 90 seconds.
2. When they look at you and put their hands up, give them a big smile and praise them for listening! This will help next time you are in Ikea or Safeway and little hands start to go astray.

Simon Says or Red Light/Green Light

• These games require careful listening and a whole lot of self-control. Bonus, they get kids up and moving around.

Deep Breathing with Bubbles/Balloons

• To reduce impulses and self-soothe, try encouraging deep breathing. This sends signals from the body to the brain to help calm down. Encourage your children to blow bubbles or try to blow up a balloon. They don’t have to get it just right (they often can’t blow up balloons just yet), but the action will help them experience deep breathing.  They will then be able to “pretend” they are blowing bubbles in the future.

Elmo’s “Belly Breathing” Song

• Elmo’s Belly Breathing song can be very helpful for children who are a bit older and can make the connection between feeling angry and taking belly breaths to soothe themselves and reduce their impulses.

Rewards

• Reward systems can be helpful to reinforce and eliminate specific behaviors. For young children, it is most helpful to connect one behavior (i.e., keep your hands to yourself) with one reward (i.e., a cookie or 3 M&M’s).
• To encourage multiple positive behaviors throughout the day, I recommend breaking the day down into discrete chunks (breakfast, lunch, snack, and dinner, for example) and use those times as “checkpoints” to see if the child has been following their rule.  For example, if the rule is “you have to keep your hands to yourself to earn 1 mini Oreo,” check in at these times to see if your child has earned their treat. If they have earned their treat, give them their reward, say a few encouraging words, and remind them they have a chance for another treat in a few hours if they follow their rule.  If they don’t earn it, say, “Oh, looks like you didn’t keep your hands to yourself; let’s try to earn again next time.” No long lectures are needed!
• Of course, it is important for parents to help their children build internal motivation to manage their impulses through love, support, and fruitful conversation. Many little ones, however, are striving to manage very strong impulses, and external rewards can offer them the structure they need to be successful.

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While traditional treatments for LDs highlight academic remediation, family therapy can address underlying challenges that many families face. Families often put a lot of time and energy into finding successful academic supports for their children. While some children perform better in school with the assistance of these services, communication and relationship challenges often continue at home.  For example, many families describe home as a battleground when trying to complete homework.  This is not surprising because  children with LDs often perceive themselves as inadequate and their parents believe they are failing in their role as parents. This dynamic can set up an unfortunate cycle of negative behavior. A certain “dance” between child and parent occurs; the more parents push homework, the more resistance they encounter from their child/teenager. And the less homework the child/teen gets done, the more parents push. Siblings often can get caught somewhere in the middle; they may try to play the “peace-maker” in these battles, or may feel jealous of the extra attention his/her sister or brother might get due to him/her having a  LD.

The good news is that these unproductive cycles can be broken. Family therapy can assist all family members in feeling that their concerns are being heard and can remove “blame” from a specific family member (it is often the child/teen with an LD who holds- or at least perceives him/herself to hold- the “problem” label). When challenges are approached from a family, rather than individual, perspective it often feels less threatening to each family member.

Family therapy can facilitate understanding of the emotional toll that a LD takes on each family member.  Parents can come to understand the breadth and depth of their children’s feelings about their learning differences and may realize that their child  has been experiencing enormous frustration, discouragement, and feelings of worthlessness.  Conversely, children with LDs can become aware of how parents and siblings feel about the LD, and how it can affect the family as a whole. Family therapy not only helps bring many of these feelings to the surface, it also helps each family member embrace their own unique strengths and validate what each member adds to the family system.

In addition to generating a better understanding of thoughts and feelings, family therapy can help family members learn to improve their communication and problem-solving skills.  The therapist can provide the family with concrete strategies to address specific challenges such as homework battles.  Parents can learn  tools to encourage, guide, support, and set limits so that children with LDs can not only meet their challenges, but also build their sense of self-esteem and self-worth, and gain the discipline and confidence to keep going in the face of challenges.

As a family therapist, I feel fortunate to witness the healing dialogue that takes place between a child/teen with a LD and his/her family when the learning difference is addressed within a family setting. As family therapist Peter Steinglass, M.D., Executive Director of the Ackerman Institute for the Family, once said, “in the end the most powerful thing that happens in family therapy is that the family sits together in a room and hears each other speaking in a completely new way.”

–Posted by Kathy Voglmayr

Jonah Green and Associates, LLC provides therapy for children, teens, families, and adults in North Bethesda, Maryland, as well as for clients in Chevy Chase, Montgomery County, Washington, DC, and the surrounding areas.

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