Attention Magazine April 2023

Launching Successful Young Adults with ADHD: The Role of Self-Motivation

The transition to adulthood is a highly challenging time for individuals with ADHD. In fact, the gap between youth with ADHD and their peers widens after high school. While many eighteen- and nineteen-year-olds without ADHD move out of the house, enroll in higher education, and begin mature relationships, individuals with ADHD often struggle to launch into adulthood.

Young adults with ADHD are eleven times more likely than peers to be both unemployed and not in school. Those who enroll in college are more likely to fail courses and drop out. Those who choose employment earn lower wages and change jobs more frequently. Young adults with ADHD are more likely to live with family, less likely to have a savings account or credit card, and report higher rates of depression, problems with marijuana, and lower life satisfaction.

The good news is that these outcomes are not set in stone. About half of young adults with ADHD learn to effectively manage their symptoms and are finding a niche that suits them. So, what can we do to help young people with ADHD move toward this positive path?

Strategies that build motivation
There are a range of strategies that can help a person with ADHD learn to effectively manage their symptoms. Besides medication, these include using time management tools, schedules, lists, organization systems, and learning to write things down. However, you may have noticed that it can feel nearly impossible to motivate young people with ADHD to use these strategies. My team’s research shows that 75% of adolescents with ADHD say that they dislike using organization strategies! About 60% are willing to use them anyway but eventually end up forgetting to do so consistently. We also know that many teens with ADHD are uninterested in taking medication, because they do not like the way it makes them feel.

If you have tried to get help for your teen with ADHD, you may have noticed them say things like “I am fine, I don’t need this help,” “I am embarrassed about doing this program,” “I don’t care about doing better,” or “I am just not good at school.” Some parents become exhausted trying to help their teen succeed. They give up trying. Others double down and become the teen’s personal assistant. Neither of these cycles feels good to parents.

You may be asking yourself, what good is teaching teens new tools if they aren’t going to do them anyway? How do you build self-motivation to care about doing your best so that the teen successfully launches into young adulthood?

If you have ever taken your teen with ADHD to a psychologist, you may have been told to create rewards systems at home to motivate your teenager. Maybe you tried to require two hours of homework time before your teen could access electronics. For a long time, rewards programs were the only known tool for motivating adolescents with ADHD. In truth, this tool can be powerful under some circumstances, particularly when natural consequences are insufficiently motivating. However, this strategy does not address long-term motivation and it does not address self-motivation. Once rewards systems are discontinued, adolescents usually go back to their original behavior.

It turns out that the biology and life experience of a person with ADHD lead to many simultaneous motivation impairments. You may have noticed that your teen has less interest in school, friendships, or extracurriculars than other kids. Adolescents with ADHD are less motivated by natural rewards, are less likely to set long-term goals, and have trouble with consistency. They often lack a sense of urgency and demonstrate low autonomy, becoming reliant on others for prompts and reminders. Even when their intentions are good, they may forget their reasons for wanting to try hard, believe that they are inferior to others, and feel that self-improvement is impossible. Research suggests that the self-motivation deficits of people with ADHD are a multi-pronged problem. Therefore, addressing these difficulties requires a multi-pronged approach.

We are moving out of the era of the one-pronged approach to motivating people with ADHD using only rewards and towards greater recognition that self-motivation builds slowly. Self-motivation cannot be summoned rapidly (i.e., in ten weeks of psychological treatment)! Rather, it is built over time by the small actions taken each day by parents, educators, and adult allies of youth with ADHD. Below I offer nine small things you can do to start this journey.

1Help adolescents with ADHD discover their interests.
Pleasure-based motivation systems are relatively intact in people with ADHD. More than people without ADHD, those with ADHD need to find educational and/or career paths that hold their interest long-term. Helping a teen identify productive areas of genuine interest may spark them into lifelong interests that become their livelihood, even if they are not what you had envisioned as a parent.

2Watch for environmental fit.
Help adolescents with ADHD find environments that value their strengths. Avoid environments that lead to demoralization. Protecting self-esteem is critical. You can help an adolescent gather information about a wide range of career and educational options, weighing the pros and cons of each environment’s fit.

3Set goals using baby steps.
Help the teen set their own goals. These goals should represent baby steps (just a little more than you are seeing from them now). Focus on better performance not good performance. Most importantly, goals should be personally meaningful to the youth.

4Create accountability and limits.
Adolescents with ADHD need consequences to create guard rails. They may not immediately respond to consequences and may even get angry when asked to accept limits. Consequences should be discussed in advance, rather than imposed as a reaction to a negative behavior. Doing so helps a teen learn good decision-making by making consequences predictable. Many youth with ADHD respond best to immediate consequences—and small consistent consequences are actually more effective than big unpredictable punishments. Only set consequences you are prepared to follow through on and make sure the punishment fits the crime (for example, an apology letter for being disrespectful, gardening tasks on Saturday for sneaking onto video games in the middle of the night).

5Keep a home routine.
Consistent home routines create daily structures that cue responsible behaviors like homework and chores. You can strategically build in incentives (such as electronics time starts after homework, dessert comes after dishes) and avoid placing hard-to-stop activities right before important responsibilities (for example, watch one Netflix episode to unwind after school because it has a clear end time unlike video games). Good structure reduces the need for reminders and punishments.

6 Manufacture opportunities for autonomy.
Parents can offset restrictions on freedoms by creating healthy opportunities for independence building. Though it may feel unnatural, look for opportunities to grant responsibilities in situations with low consequences for failure. Doing so will allow the teen to practice decision-making, planning, and self-sufficiency. Because the teen may not be self-motivated yet, you may need to go out of your way to research community activities that promote these skills or give teen special responsibilities that promote autonomy (cooking dinner, sending off with a shopping list, planning a weekend vacation for the family).

7 Build self-confidence.
Adolescents with ADHD have lower self-esteem than peers—they receive a higher level of negative feedback from others. Help your teen gain skills in areas where they have natural interests. Let them see themselves being successful, putting them in a position to hear more good messages about themselves than negative ones. Go out of your way to draw attention to your teen’s positive actions. Help them find in-person friends who are accepting and share their interests.

8 Hold a weekly meeting.
A weekly meeting with the teen can be held at a favorite coffee shop, diner, or park. This meeting creates proactive and enjoyable, rather than reactive and stressful, discussions about important topics. Plan out meeting topics in advance (for example, recognizing positive efforts, looking at grades online, reviewing responsibilities, problem-solving challenges, researching a new activity, asking teen for feedback).

9 Elicit, don’t impart.
Promote self-exploration. Avoid shaming the teen when you are frustrated with their decisions. Avoid arguing or trying to convince them that they are wrong. Elicit from the teen their own ideas about changes they would like to make, listening in a way that shows you heard. Use open-ended questions to get them thinking (such as, if you could have three wishes, what would they be?). Ask them to outline their own plans before you step in. Let them try things that you know will not work. Debrief afterwards to help them process what happened and learn from mistakes.

ADULT ALLIES! You will take a lot of actions on this journey that will show no immediate results. Take them anyway. It is the small things you do over time that will make a difference in the long run, preparing the teen to be a self-motivated adult who successfully manages ADHD.

Margaret H. Sibley, PhD, is an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and Seattle Children’s Research Institute. She received her PhD in clinical psychology from the State University of New York at Buffalo in 2012. She is a licensed clinical psychologist in Florida and Washington and a member of the Motivational Interviewing Network of Trainers. Dr. Sibley’s work focuses on the diagnosis and treatment of ADHD in adolescents and young adults. She developed a parent-teen therapy for ADHD (Supporting Teens’ Autonomy Daily) that combines motivational interviewing and skills training for parents and teens. She has authored or coauthored over eighty scientific papers on ADHD and published a book with Guilford Press on treating executive functioning and motivation deficits in teens. She holds grant funding from the National Institute of Mental Health and the Institute of Education Sciences with past projects funded by the Klingenstein Third Generation Foundation and the American Psychological Foundation. She has received awards for her work from CHADD, the Association for Behavioral and Cognitive Therapies, and the American Psychological Association. Dr. Sibley serves on editorial boards for the Journal of Abnormal Child Psychology, Journal of Clinical Child and Adolescent Psychology, Journal of Consulting and Clinical Psychology, School Mental Health, and Assessment. She is a member of CHADD’s professional advisory board and serve on the editorial advisory board for CHADD’s Attention magazine.