Elaine Taylor-Klaus: Welcome back, everybody. We are excited to have a conversation with our guest today, Dr. Sarah Cheyette, a pediatric neurologist. We’ll be discussing what’s most important for parents to understand when raising teens and young adults with ADHD. So, welcome, Sarah! We’re thrilled to have you.

Dr. Sarah Cheyette: Thanks for having me.

Diane Dempster: Awesome. Sarah, why don’t you start by telling us a little bit about what you do with families of complex kids and how you came into this line of work?

Dr. Sarah Cheyette: Sure. As a pediatric neurologist, I work with brain-related issues, although we also deal with muscles and the spinal cord. 

For today, though, the focus is on the brain. I work with kids who experience developmental differences, including conditions like autism and ADHD. 

Some pediatric neurologists, myself included, also address issues such as anxiety, depression, and learning challenges. Essentially, anything that involves the brain falls within our scope.

Diane Dempster: Awesome. And how did you end up doing this work? What’s part of your path?

Dr. Sarah Cheyette: It’s actually interesting. I started thinking about ADHD in the context of treating difficult headache patients. 

I had a few teens who had constant, unrelenting headaches that wouldn’t go away. It turned out that the stress caused by their ADHD was a major factor in their headaches. To address the headaches, I had to start managing their ADHD. 

While most of my ADHD patients don’t experience headaches, that’s how I initially got into this work—because treating headaches is one of the roles of a pediatric neurologist.

Elaine Taylor-Klaus: Did you notice that many of these kids already had ADHD, or did you uncover the ADHD during the process?

Dr. Sarah Cheyette: Yeah, these kids were seeking treatment for their headache pain, but when we started discussing the factors contributing to the headaches, it became clear they were struggling in school—a constant source of stress for them. They were also having difficulties at home. 

You could try every headache medication with those kids, but they wouldn’t improve. However, once we started addressing and treating their ADHD, the headaches got better. It’s definitely an unusual way to enter the field of ADHD, but that’s how I found my path.

Elaine Taylor-Klaus: That’s fabulous. Yeah. I think that’s probably true in many areas with ADHD—when you treat the underlying ADHD, so many other challenges improve. I know, for me, my anxiety got so much better.

Sarah Cheyette: Anxiety is huge. Sometimes it’s hard to determine whether the difficulty in concentrating is due to ADHD or anxiety. Oftentimes, it’s both. Sometimes, it’s primarily anxiety. Anxiety makes it harder to focus on tasks. 

By the time kids reach double-digit ages, a lot of time has passed, and many mindsets have developed. So it’s not necessarily just ADHD or just anxiety—it’s often a mix of everything. 

And that’s not even mentioning depression and poor self-esteem, which I see as distinct from depression. Sleep issues also play a role.

Elaine Taylor-Klaus: Yeah, and those are all things we hear from parents all the time. I want to check in with you because I often say something to parents, and I want to make sure I’m being accurate. 

I usually explain that when ADHD is untreated, a child can’t meet the expectations of the world around them. That inability creates anxiety, and over time, that anxiety can lead to depression. Does that progression make sense to you?

Sarah Cheyette: Yes, though I don’t know if it’s quite so sequential. That’s a valid perspective, so let me start by saying that. However, people respond differently. Some people lean more toward depression, low self-esteem, or anxiety. 

We all have different tendencies, so I can’t necessarily say that the sequence is reliable. But all of those things can happen and often overlap, depending on how someone is wired. 

When we look at treatment, it’s like we’re reading the ADHD chapter and using ADHD medications, then reading the anxiety chapter and using anxiety medications. But in reality, it’s often not so simple to separate people into these neat categories or labels.

Diane Dempster: Right. What’s coming up for me is one of the things we like to discuss with parents: what they need to understand better in order to identify these challenges. 

For example, when is anxiety okay? When is it ADHD? When does it become troublesome enough that you should take action? That sort of thing.

Sarah Cheyette: Yeah. You know, I’m excited to be on the podcast today because, oftentimes, when people come to my office, all of this has been going on for a long, long time. 

These patterns have become deeply ingrained in their relationships. So sometimes, I feel like I’m the mop-up crew—or maybe more accurately, putting out the fire after it’s already turned into an inferno. I think that’s a better analogy.

Elaine Taylor-Klaus: I know exactly how you feel.

Diane Dempster: Absolutely.

Sarah Cheyette: I bet you do.

Elaine Taylor-Klaus: I’m totally used to that.

Sarah Cheyette: I bet you are. That’s part of why I started writing books. I want to reach people before they’re at the point of seeking help because, by then, it’s often much harder to make changes.

Elaine Taylor-Klaus: That’s a common question we get from parents. We work with parents, and we used to say we help those with kids aged four to 24. Now we say three to 33 because we’re seeing a lot of parents with young adults. 

Oftentimes, once the kids are about 10 or older, parents worry that it’s too late—especially by 10, 12, or certainly past puberty. They come in with this story they’re telling themselves: that it’s too late, that they’ve missed the boat. 

And since you’re here to talk about teens and young adults, let me start by asking a yes-or-no question: Is it too late?

Sarah Cheyette: Of course not. Never.

Elaine Taylor-Klaus: Great. Let’s talk about that a little bit.

Sarah Cheyette: I have adult patients who are remaking their lives in their 50s. It’s only too late if you decide it’s too late. 

What I’m trying to say is: it’s never too early to start, and it’s never too late to keep working on it. Life is a process.

Elaine Taylor-Klaus: So if you’re starting after puberty or when you’ve already got some “infernos” in place—when things have been going on for a long time and haven’t yet been addressed—what do parents need to understand in order to shift their mindset and effectively provide support?

Sarah Cheyette: I think the main thing is to remember that a school year is going to come and go, and grades are going to come and go. You’ll either get the grades or you won’t, but you can’t truly help your child unless you make a connection with them. 

To get your child from point A—wherever their point A is—to point B, which is where you envision they could be, you have to start at point A. And sometimes, the best thing you can do for your child is to simply take them out for ice cream. Just sit there and eat ice cream.

Elaine Taylor-Klaus: And not talk about school.

Sarah Cheyette: Not even talk about anything, if you don’t want to. Just sit there and eat the ice cream.

Diane Dempster: Eating ice cream sounds good to me.

Sarah Cheyette: You know what, there are days like that, right? So it’s about finding a way to make a connection in a non-threatening, "I’m not trying to change you" kind of way. It doesn’t have to be ice cream. 

You could go for a walk or do something else. I just think it’s easier to get people to sit and eat ice cream than pretty much anything else I can think of. 

The connection is the important thing, and being able to see things from your child’s point of view is crucial too—stepping outside of yourself and trying to understand things from their perspective. Listening is key.

Diane Dempster: Yeah. And as you’re saying that, what comes up for me is the interplay between anxiety and ADHD. 

I’m wondering if kids are generally more comfortable talking about feelings of anxiety than about their struggles with getting their brain to do what they want it to do.

Sarah Cheyette: I think anxiety is often the more obvious thing for people. They know they're worrying, but they don’t always know why they’re worrying. Especially with kids, they usually don’t have a lot of insight into things like, "This is the executive part of my brain." They just know they’re falling behind. So the obvious thing is the panic attack. The less obvious thing is what’s driving it.

Elaine Taylor-Klaus: Well, I was thinking about this because I shared earlier that I have a daughter who’s been studying for the MCATs, and it’s been really intense. She struggles with both anxiety and dyslexia, as well as ADHD. What she noticed was that the anxiety was the biggest problem. 

She would start to get anxious about what would happen if the dyslexia kicked in or became a problem. So those things were playing off each other, but ultimately, it was the anxiety that really derailed her.

Sarah Cheyette: Yeah. And what people don’t realize is that the anxiety part of your brain actually shuts down the rational thinking part of your brain. So when you’re anxious, whatever you’re thinking about, you’re not thinking about it very clearly. It may seem real in the moment, but it’s not really. 

You all know that when you calm down and think about it later, it never feels the same way. The thought process is completely different, and that’s a neurological thing. 

There’s a direct connection—because when you get anxious, your body doesn’t want you to think things through, like, "Wow, is that really a tiger over there? I’m not sure. Do tigers have spots or stripes?"

Diane Dempster: Maybe I'll be okay if I just stand here.

Elaine Taylor-Klaus: Maybe it’s a leopard, not a tiger.

Sarah Cheyette: Right, exactly. I like leopards. They’re big cats. What’s wrong with cats? So the people who survived were the ones whose brains said, "Run. Don’t think." That’s how we’re all built now.

Elaine Taylor-Klaus: Yeah. So, from your perspective, I love what you’re saying. Diane and I often tell parents that if they don’t know what to do, there are two places to look: either lean into self-care or lean into the relationship. 

And if possible, do both. That’s the big picture. So I really love this message of focusing on the relationship, focusing on connection and communication. A lot of parents struggle with that at first, though, because there’s so much to do. 

They’re worried about what needs to be done or their child falling behind. Can you speak to that a bit?

Sarah Cheyette: You know, it’s not a race. There’s plenty of time. Until you can make that connection and be together at that point A, you really can’t do anything else.

 And if you have an anxious kid, there’s a good chance you’re operating out of anxiety too, because it’s a heritable, genetic tendency. So, there’s time. We all have timelines in our heads, but they’re usually artificial.

Diane Dempster: It’s like the lion, right? We envision a lion in our heads because we’re afraid for our kids’ future, instead of realizing that’s the opposite. 

We just need to take a deep breath and be willing to consider that we can wait a little while or take the time to connect with our kids.

Elaine Taylor-Klaus: So maybe it was just a cat, not a lion.

Diane Dempster: It really is a cat, not a lion.

Sarah Cheyette: Also, take the time to recognize that your personal characteristics are probably more correlated with success than anything else. It’s not so much about your grades as it is about your ability to persevere and recover from failures, and all of those other qualities. 

I know we’re all focused on the SATs, GPAs, and all these other abbreviations, but it’s not about what college you go to—it’s about who you are when you get there. So there’s no hurry, but all three of us are seeing people in crisis a lot of the time. 

We see people we need to help get on the right track, but we can only do so much in the office. You all have to have a relationship at home. It’s about the two of you. I can give you advice, but it’s really about your relationship more than anything else—and how you repair it.

Diane Dempster: I’m kind of going in two different directions here. Part of me wants to talk about how to rebuild relationships, and part of me wants to talk about once you’ve got that foundation. 

Since we’ve got you and your physician on the hook here, can we talk about this: okay, I’ve got a good relationship with my kid—or at least a decent one—how do I talk to them about their anxiety? How do I talk to them about their ADHD? How do I help them maneuver through that process, assuming the relationship is in a good place?

Elaine Taylor-Klaus: Well, and can I just piggyback on that? What I hear is, first, the relationship, and then what I hear Diane saying is, okay, what’s the next step?

Sarah Cheyette: Right. So again, we’re all programmed to notice the bad things. There’s a negativity bias in our brains, meaning the bad things stand out. That’s probably evolutionary. 

So, if you’re trying to get your kid to do some work—homework, or whatever—again, see it from their perspective. I have a lot of parents of eight-year-olds telling me, “Ah, that kid just wants to finish quickly and doesn’t care about the quality of the work.” And I’ll say, “Yeah, of course.” 

I mean, if you were eight, and four years ago you were just playing with Play-Doh, nobody says, “Oh, you like Play-Doh, so do more Play-Doh.” And then you’re like, “Whatever, coloring, do coloring.” 

If you don’t like doing something, you don’t have to do it. And then all of a sudden, they’re 5, 6, 7, 8, and people are handing them things to do, and they’re thinking, “What is this? I don’t want to do it, so forget it.”

Elaine Taylor-Klaus: Can you blame them, right?

Sarah Cheyette: Not really. So the things that are obvious to parents—like, people who try their best are good people and should try harder—these aren’t things that come naturally or are obvious to a younger child. 

I have 15-year-olds who come into my office and say, “Dr. Cheyette, look at this report card. I got a bunch of A’s.” And I’ll say, “Wow, that must have been really hard. A lot of hard work went into that.” 

And they’ll say, “Yes.” And I’ll reply, “But you spent the last five years telling me you wanted to avoid working hard.” And they’ll be like, “Oh, yeah, right.” So, pointing out the good feelings is where I’m going with this. 

When people complete work, they don’t take the time to notice that it feels really good. If you don’t notice that, then it’s just work. For an eight-year-old, it’s just something to get through so they can do the other stuff.

Elaine Taylor-Klaus: What you just said, Sarah, wasn’t “I’m proud of you,” but more like, “You must be really proud of yourself.”

Sarah Cheyette: Yeah. Or, “What a good feeling that is.”

Diane Dempster: Yeah. And it wasn’t about the A; it was about the work.

Sarah Cheyette: It’s not about the work; it’s about the feeling. That’s what I would say. The work isn’t important. You’ll learn about, I don’t know, what do people learn in social studies and math—factoring, algebra, and stuff like that. 

You’ll learn it, or you won’t. But the feeling of accomplishment—that’s the point of all of this. It’s a good feeling. And if you pay attention to that, you’ll want to do it more and more. If you don’t pay attention to that, it’s just, “Oh, got through that, got through that, got through that.”

Elaine Taylor-Klaus: You know, the other thing that’s coming up for me as you’re saying this is that I think the other thing you’re pointing to is this values issue. 

The parents have a value around work ethic, but the kid at eight doesn’t yet have it. And so the parent becomes worried that there’s a moral failure, and I see this a lot with the issue of lying.

Sarah Cheyette: With what?

Diane Dempster: Lying.

Elaine Taylor-Klaus: Lying and truth-telling is something where the parent has a really strong value around honesty, and then the kid tells a lie. The parent feels like, “My kid’s going to jail.” So there’s something going on here.

Sarah Cheyette: And the kid is feeling like, “Wow, how clever! Look what I did.”

Diane Dempster: And I’ve got to fix it now. The lion shows up again. It’s like, “Oh my gosh, this is terrible. My kid is a liar. I’ve got to nip it in the bud, or he’s going to end up a pathological liar.”

Sarah Cheyette: [inaudible] and all that stuff. So yeah, that’s the most expedient way for kids to get out of a situation. It feels terrific to them. They feel clever. And you’re thinking, “You’re going to be in big trouble.” And they’re thinking, “Why? I just did something fantastic.”

Elaine Taylor-Klaus: So, what would you say to parents about that? We’ve come up with two examples, and there are probably a dozen places where, as parents, we catastrophize our kids’ typical behavior and begin to worry that it’s some indication of who they’ll be for the rest of their lives—like morally they’re not developing properly or something. How do you address that with parents?

Sarah Cheyette: I would say there are a couple of different things. I would acknowledge, like, “Yeah, it really did get you out of that situation. That was the positive. That’s why you keep doing it.” But on the other hand, here’s the negative: I can’t believe a word you’re saying. 

You have to be supervised. So it’s about the lack of trust and trying to get them to understand what it feels like to be lied to, from the parent’s perspective. It’s like, “Yeah, you got away with it in the short term, but in the long term, your parents aren’t going to let you go on that website without supervision. 

Would you trust yourself? Nobody would bet money on you, kid.” So I’m trying to get them to understand it from the other perspective, because I think that, from a parent-child relationship, the trust—or lack of trust—and how that develops influences a lot of different aspects.

Elaine Taylor-Klaus: Well, and what I love about what you’re saying is that it’s not coming from a place of judgment, shame, or blame. It’s coming from a place of understanding and helping the kid have a reason not to lie, which is, “I want my parent to trust me so I don’t have to be supervised.”

Diane Dempster: It’s a natural consequence. And I think that’s one of the things that’s hard—to keep it as a natural consequence and not have it show up as judgment. And it sounds like that’s an important piece. It goes back to that relationship and trust.

Sarah Cheyette: I think so. I never thought about it that way, but yeah, in general, the best motivation is one that comes from you, not from a fear of the consequence, like, “My parents will catch me” or “Somebody will catch me,” because that just drives me to try to be more clever, you know what I mean? 

Try to get around it better, cover my tracks. So I think the self-motivation is what we’re trying to build, because when the parents go away—at college time or whenever—it’s really important to have that motivation within yourself.

Elaine Taylor-Klaus: For sure. So I think what I’m hearing you say is that parents can have a more powerful impact on their kids by letting go of all the “doing” and really focusing on being in relationship, cultivating that relationship, and also helping the kids find their own motivation instead of some external force. Anything else?

Sarah Cheyette: You know, most of the time, parents will talk down to younger kids on some level. They’re trying to parent, and they may be playing their own parent tapes in their head—how they themselves were parented. 

But if you let a kid talk, the kid will often be pretty insightful about what’s going on in their head and trying to figure it out. Really understanding how they’re thinking depends on a lot of listening. I’m a big proponent of giving kids responsibilities. I guess this is all part of respecting the kid as a person. 

So I think it’s important for parents to lead the kids, tell them things they should do, and give them responsibility. But part of that is not talking down to them but talking to them—not necessarily like an equal—but valuing what they have to say and making sure that’s part of the interchange. 

I mean, we all have to tell our kids to pick up things, and there will always be those things coming out of your mouth, but asking the kids, “What do you think about the dynamic here? What do you think about how you’re doing?” and listening to the answer is really very valuable.

Diane Dempster: Yeah. Well, and it’s that distinction between mutual respect and finding a way not to feel like you’re losing your power as a parent, because I think a lot of parents get really worried that they’re somehow getting undermined by showing their kid respect.

Sarah Cheyette: Yeah. I think kids like to be shown respect, and they will grow into that respect. So if you treat your kid like they’re at the end of a leash, then that’s how the kid will behave, including trying to get the leash off. Right? 

But the respect is something that they will value, and I think that’s an important part of a lasting relationship. Also, walking the walk—it doesn’t work if you’re telling your kid not to be on their phone while you’re on your phone all the time.

Elaine Taylor-Klaus: Especially with teenagers and young adults.

Sarah Cheyette: Oh my gosh, they’re onto you.

Diane Dempster: So they’ll call you on it.

Sarah Cheyette: Demonstrating the pleasure in real-life activities by having a bunch of them that you do, you can’t be hypocritical. It just doesn’t work.

Diane Dempster: Yeah. So Sarah, what’s the best way for people to find out more about you or get in touch?

Sarah Cheyette: Sure. I have a website: sarahcheyette.com

Elaine Taylor-Klaus: And it will be in the show notes, so you can check that out if you'd like.

Sarah Cheyette: Oh, okay. Good. So, that's probably the best way to get in touch with me.

Elaine Taylor-Klaus: Great. You mentioned that you wrote a comic book for children—could you tell us a little about that? We’ll include it in the show notes as well.

Sarah Cheyette: Yes, I’ve written two ADHD books that are quite text-heavy. So, I decided to create a comic book format, which explains ADHD in a positive way. It’s called ADHD and Me. It’s available on Amazon, and I think it’s pretty cute, actually.

Elaine Taylor-Klaus: We’ll include a link to that in the show notes as well. I love it. Diane, should we do our wrap-up? Anything else? Before I wrap things up, I just want to say thank you—it’s been amazing to have this conversation with you.

Sarah Cheyette: Oh, I’ve enjoyed it, absolutely. Thank you so much for having me on your show. I’m looking forward to all the episodes. I know you’re starting with this one, and I’ll be sure to add you guys to my Spotify or wherever it’s available.

Elaine Taylor-Klaus: Thank you.

Diane Dempster: Awesome. Thank you. So, the question we want to wrap up with is: do you have a favorite quote or motto that you'd like to share with our parents who are listening?

Sarah Cheyette: Oh my goodness, a favorite quote. I’d have to think about that a little more. I think it would be “Do unto others.” I really don’t think you can beat the golden rule, which is to treat people with the respect and kindness you'd want to receive. I truly believe it comes back to you tenfold.

Elaine Taylor-Klaus: Yeah, and I couldn’t agree with you more as a parent. There’s probably nothing more important you can do than treat your kids with respect. They are autonomous, individual beings, your kids.

Sarah Cheyette: Unfortunately, right? Wouldn’t it be easier if they had off buttons, or if you had a little shock collar or control thing? I mean, geez, that would be terrific, but I think that’s probably illegal.

Diane Dempster: I’ll say, we might need to cut that part out.

Elaine Taylor-Klaus: Maybe not the shock collar part.

Sarah Cheyette: Yeah. Basically, I think respect is important, and responsibility is everything—it all goes together. If you treat them with respect, it also means giving them responsibilities. 

You know, I recently read the Little House on the Prairie series to my kid, and one thing that really stood out to me was the amount of responsibility the kids had back then. There was a lot of work to do, and the kids were given a lot of responsibilities. 

In Farmer Boy, this nine-year-old boy was hauling logs and spending a lot of time on his own in the woods. Wow, that probably was too much responsibility for a nine-year-old.

Elaine Taylor-Klaus: But he wasn’t doing three hours of homework every night.

Sarah Cheyette: No, that’s true. But they did go to school part of the year. But anyway, you’re right. There were some pros and cons, but it’s okay to give your kids responsibilities too.

Elaine Taylor-Klaus: Love it. Yeah.

Diane Dempster: Thank you so much, Sarah, for being with us today. It’s been delightful to talk to you, and we’re looking forward to what’s next.

Sarah Cheyette: You too, ladies. Have a great day.

Elaine Taylor-Klaus: We'll see the rest of you on the next show. Take care, everyone.

Sarah Cheyette: Bye.