Attention Magazine April 2024

It’s a rainy Friday night and you decide to order pizza for the family for dinner as a treat. You call in the large cheese pie and whip up a salad to go with it. As you get your keys and grab your jacket, your twelve-year-old son (who has ADHD and oppositionality) bounces into the kitchen. “I’m so hungry. WHEN will dinner be ready? I want to eat NOW!”

You start to feel the hair on the back of your neck prickle as that familiar irritation sets in, and you try to stay calm. “Soon. I’m leaving now to pick up the pizza. Why don’t you set the table so we can as soon as I get back?” “No. I need food THIS MINUTE. I can’t wait until you get back!” he says, turning up the volume considerably. In turn, you raise your voice: “I am trying to do something nice here and all you have to do is set the table to help out. NOW DO IT!” He yells “NOOOOOOO!” grabs a bag of chips, and runs to his room. You shout after him: “No eating in your room. Forget the ice cream I was going to get!”

How did a simple conversation escalate into an unpleasant argument? Why can’t your son modulate how he expresses herself and just cooperate with your request? Why did you allow yourself to be upset by him in the first place? Families of children and teens with ADHD often struggle with emotional reactivity and verbal impulse control. Negative feelings and unpleasant words can intensify in the blink of an eye so that the interaction derails quickly into hostility, screaming, and tears.

What is TOV—and how can it help?
In ADHD brains, where executive functioning challenges often outnumber strengths, the extra burden of effectively dealing with a rush of strong emotions, such as anger, can be especially tough. Both kids and adults with ADHD may react quickly with volatility instead of responding more patiently with consideration. When there’s an amygdala activation, people need enough awareness to keep it from steering them into a tailspin. This is especially difficult for maturing brains with ADHD.

These situations can be easily turned around by bringing everyone’s attention to TOV: Tone Of Voice. So often, kids (and adults) with ADHD don’t really hear how they say things to other people. They also may not fully understand the effects of what they are saying on them. They need help learning how to slow down and reflect on what they just expressed. But, since they are usually sensitive to criticism, direct feedback can frequently backfire.

Introducing TOV allows your child or teen to reflect for themselves on how they can say something differently. It also helps them cultivate greater awareness about when they are speaking. When you do this, kids learn several executive functioning skills simultaneously: emotional regulation, personal insight (metacognition), and self-control.

Let’s take a look at how TOV operates.

1. In a calm moment, you explain to your son or daughter with ADHD (and your other children, too) that sometimes everyone needs help learning how their words and their tone of voice affect others. To that end, you will be saying to them “TOV” when you think they should alter how they are speaking to you and, at times, to each other. Then, you will give them a minute or two to change how they are speaking and try again. Sometimes, people just need a do-over.
2. If your child or teen can’t manage to change how they are talking to you, then taking an immediate, timed break for personal space is warranted. This break allows everyone to calm down and regroup. Usually breaks of up to ten to fifteen minutes are sufficient, but some people need more time and others need less. Agree on the length of the breaks when you have the initial conversation.
3. When your son or daughter changes how they are speaking to you by lowering their volume, or altering their words from provocative ones to more neutral statements, or shifting their attitude, YOUR job is to respond to their new statements and move forward. Notice and appreciate their efforts to regroup after the conversation is over. This provides positive reinforcement for them.
4. Be prepared that they may call TOV on you sometimes too, especially if you are yelling. How you respond to this is critical: Try acknowledging your feelings or laughing at yourself or admitting that you could do better. However, the goal is not to create a constant calling out of TOV in your household. Once a day for everybody seems adequate. TOV works best when it’s used for helping your child (or yourself) regroup in selective moments. Overuse reduces its meaning and impact.

Change the household music with TOV plus TBD
TOV goes hand in hand with “Take Back of the Day” or TBD. Together, they address metacognition, self-awareness, and impulse control. TBD offers somebody the opportunity to notice what they have said and take it back. But it’s special: it’s only to be used once per day. Otherwise, you’d have a million little takebacks and they would be meaningless. It is best used when it is connected to an earned privilege which would be eliminated by the words they are using.

For example, you have a family agreement that no name-calling for the day results in twenty minutes of earned screen time after dinner when homework is done. If your child or teen is yelling or demanding something of you (as in DINNER NOW), you can gently suggest TOV. If they continue to escalate or call you names, then TBD is an option. But, they have to realize this on their own and you have to establish the logical consequences for using this in advance. You’ve given them a hint with TOV. Now, it’s up to them to act on it. If they do opt for TBD, then perhaps they can earn half of their screen privilege per your agreement.

Whether you use these separately or together, TOV and TBD can dramatically change the music in your household. With less yelling, more self-awareness, and time to reflect on what and how people are speaking, you and your kids will notice a shift towards kinder language and more consideration of each other.

Sharon Saline, PsyD, clinical psychologist and author of What Your ADHD Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life and The ADHD Solution card deck, specializes in working with children, teens, young adults and families living with ADHD, learning disabilities, twice exceptionality and mental health issues. With decades of experience as a clinical psychologist and educator/clinician consultant, she guides families and adults toward effective communication, closer connections and greater understanding. She lectures and facilitates workshops internationally on topics such as ADHD and neurodivergence, executive functioning, the anxiety spectrum, motivation, perfectionism and working with different kinds of learners. Dr. Saline is a regular contributor to ADDitudemag.com and hosts their weekly Facebook Live sessions, blogs for PsychologyToday.com, a featured expert on MASS Appeal on WWLP-TV and a part-time lecturer at the Smith School for Social Work. Her writing has been featured in numerous online and print publications including MSN, The Psychotherapy Networker, Smith College Studies in Social Work, Attention magazine, PsychCentral and Inquirer.com. Learn more at drsharonsaline.com.