ADHD in Girls Transcript

Cindy Lopez: Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen.

The data shows that ADHD is diagnosed in boys more often than girls. I wonder why that is? Join us today as we talk with Dr. Marjan Ebadi and Dr. Dylan Stewart, both psychologists at CHC, as we explore the factors behind this disparity. We’ll discuss how ADHD often looks different in girls, manifesting as inattentiveness or emotional sensitivity or even perfectionism rather than hyperactivity, and why these signs are frequently overlooked. And finally, we’ll share practical strategies for parents, educators, and caregivers to recognize and support girls with ADHD, empowering them to thrive. 

Welcome Dr. Ebadi and Dr. Stewart. We’re really excited that you’re here today to talk about this really important topic with us. I just wonder before we start our conversation about ADHD in girls, why don’t you take a minute to tell our listeners a little bit more about you?

Dylan Stewart, PsyD: My name is Dr. Dylan Stewart. I’m one of the clinical psychologists here at CHC. And I specialize mostly in the assessment of neurodiversity. So, you know, looking at things like ADHD, learning differences, autism, that’s how I tend to spend most of my time.

Marjan Ebadi, PhD: I’m Dr. Marjan Ebadi. I’m also one of the clinical psychologists here. And I also focus on assessment, but mostly on ADHD and anxiety and mood disorders at CHC.

Cindy Lopez: Yeah, talking about ADHD and girls, we’ve done quite a few podcast episodes on ADHD in general, or ADHD and medication or interventions or ADHD and superpowers of ADHD, all of that. We haven’t really talked about girls, so I’m excited for this topic today. And before we dive into that, the specific girl topic, let’s start by defining ADHD. What is it? How does it impact our youth?

Dylan Stewart, PsyD: Yeah, that’s a great question, you know, it’s helpful to set those parameters certainly here at the beginning. So, when we think about ADHD, we know that it’s a form of neurodiversity, which means that there are certain ways that the brain is working, which can lead to challenges, you know, at home, at school, throughout their everyday life. And when we’re thinking about ADHD, you know, some of the most common challenges we tend to see are things like hyperactivity, which is needing to move your body around really often, things like impulsivity, you know, quick kind of reactive behavior someone might be having, moments of inattention, moments where maybe they kind of have this hyper-focus or really focusing intensely on one thing, certainly we’ll see things like, difficulties with organization or planning, maybe, challenges starting tasks, kind of initiating school work or, you know, an assignment that they’re doing. We can see challenges with things like time management, certainly, some difficulties with emotional regulation. And, sometimes we’ll see things like forgetfulness as the symptoms we’re kind of, you know, trying to understand with regards to ADHD.

Cindy Lopez: As you’re going through that list. I’m like, “Oh, that’s me. Oh, that’s me.”

Dylan Stewart, PsyD: We all have moments similar to this in our everyday life, but you know, sometimes they’re a little bit more pronounced for some individuals and that’s where we would want to start to learn more about what’s going on for them.

Marjan Ebadi, PhD: And also depending on which symptom you have because there’s different types. So as you said, like, people will look at the list like, “Oh, I don’t have this,” or “I have that.” So you could have like the inattentive type that is mostly for difficulty with paying attention or being distracted often. There’s hyperactive and impulsive type, which is more of the fidgety and the more observant behavior that most people tend to see. And then you can also have the combined type, which just has all of the above. And with most kids or people with ADHD, usually presents in childhood. So you’ll be able to see some of the symptoms before the age six, but you can’t really diagnose it before age six, but you start seeing some of those symptoms.

And then it becomes a lot more significant when they start school or when they start kind of growing up and then there’s more structure and how your symptoms and the studying may not match. So then it starts to become a lot more present for people to be able to notice it. And it can impact throughout your life, it can impact your academic work, relationship, your sense of self, because you start noticing things about yourself and it can find challenges across your life, right? So it’s lifelong.

Cindy Lopez: So as I’ve read about ADHD, the data does indicate that more boys than girls are diagnosed with ADHD. So why do you think that is?

Marjan Ebadi, PhD: So the medical field has been studying ADHD for a long time, but a lot of our early research is on ADHD that was done with the male population, right? So because of that, a lot of clinicians become more aware of how ADHD symptoms present in boys. And again, they tend to present with more hyperactive-impulsivity symptoms, which is a lot more noticeable, right? Parents will notice it more because your kid’s running around or they’re more disruptive in the classroom. So they usually move toward like either getting assessed faster or for teachers to flag it to parents faster. So it gets noticed a little quicker.

For girls, however, it tends to be more subtle because even if they’re impulsive and hyperactive, it’s more contained, right? They can like fidget in their seat or play with their hair tie, kind of tap their feet. So it’s a little less disruptive. And then sometimes for some girls, they can also start masking it really well. So they can like be zoning out, but they got like the full face of like absolutely paying attention. So their brain is doing something else. And then some of them get really good at, this could happen for boys too, but I think because most girls will have inattentive where it’s more subtle, they have these like trigger words that sometimes their brain can tune in right back when somebody says “I have questions,” or “We have a pop quiz,” so then they just start paying attention really quickly so it doesn’t get flagged as fast.

And then with also a lot of their like impulsivity or dysregulation, right? Because there’s a piece of emotion dysregulation that tends to come with ADHD as well. And sometimes for girls, that gets flagged as more like, “Oh, they’re being sensitive,” or “They’re just feeling really anxious.” And then they’re having difficulty with managing it because they’re just an anxious person, rather than to have some neurodiversity with it. And then again with impulsivity too, it can look like more, they’re just–middle of talking to you, they’ll cut you off or they could kind of talk a lot faster. So disruptivity looks more into like relationships and kind of being slightly disruptive than running around in the class. Which again, that could happen for girls as well, but I think for a majority of them, it’s a little bit more subtle.

Cindy Lopez: Yeah. That’s so interesting. And as you’re talking, I think, well, boys could do that too. Why don’t they? Why is it that more boys don’t? And I don’t know, you know, how much our societal norms affect that too.

Marjan Ebadi, PhD: The gender roles and cultural roles can play a lot into it, right? Because traditionally for a lot of girls are encouraged to be like more agreeable on minimizing your problem compared to boys. They tend to also internalize because of that one. So most often they get very good at behavioral management in settings, right. Cause then again back in the day, like, you don’t want to be heard, or it’s good to be graceful. So I think for a lot of that, it’s still within the norms, even though we’re kind of shifting.

So for some of the girls that tends to be more contained than whereas with the boys is like, well, boys will be boys anyway, or they’re just fighting each other. So it’s okay, whereas with the girls is more like, you know, be graceful and calm. So it’s more, tend to get misdiagnosed as, like, “Oh, they’re anxious or depressed, or they just can’t learn this stuff.” You can certainly have all three and have ADHD, but I think those tend to get flagged more and then lead to more misdiagnosis and not being able to catch ADHD earlier.

Cindy Lopez: Interesting. I’m wondering if there are some differences in brains between boys and girls?

Dylan Stewart, PsyD: Yeah. We actually know quite a bit about that. We do these really big brain scan studies, and we can see that even like the physical development of a girl with ADHD’s brain is different than a boy with ADHD’s brain. So, some parts of a girl with ADHD’s brain will develop more compared to a boy. So we tend to see more kind of cognitive development in some of maybe like the language centers of the brain, maybe somewhere kind of referred to as like the temporal lobes.

There’s this area of the brain called the basal ganglia, which is used for things like motor control, planning, memory. And we tend to see that those parts of the brain actually develop quite a bit more for girls than they do compared to boys. And you know, that might explain why we might see a little bit more of the hyperactivity-impulsivity symptoms in a male population versus girls with ADHD because they have a little bit more control over some of these behaviors, the motor control, the motor planning, they may not feel like they need to be doing cartwheels down the aisles of their classroom every single day.

Cindy Lopez: Yeah. The brain is fascinating.

Dylan Stewart, PsyD: Yeah, well, you know, by comparison, there are some areas in the brain for girls where that’s actually underdeveloped compared to boys as well. So, there’s a type of connective tissue in the brain called gray matter. And you know, gray matter sort of at the most simple level is what helps our brain regions communicate with one another. So, you know, it plays a role in sort of like processing information and then sending that to the other parts of the brain. And for girls, we actually tend to see that their brains have a little bit less gray matter compared to boys within this ADHD population. And so, that is one of the reasons we can maybe hypothesize that some of the emotional symptoms show up a bit more quickly.

We do know that gray matter plays a really important role in terms of being able to regulate your emotions, kind of keep things under control a little bit more often. And if you have less of that, some of those emotional symptoms might just be prone to showing up a little more quickly for girls than they might be for boys.

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Cindy Lopez: So, I know that ADHD can go undetected or undiagnosed, or even, Dr. Ebadi, you said misdiagnosed in girls. Can you talk a little bit more about that?

Marjan Ebadi, PhD: The gender roles and cultural norms can play a part in it again, because they traditionally are encouraged to kind of go with the flow of things or not be disruptive, right? So then also on top of it, I think they also tend to internalize a lot of symptoms, so girls tend to be more anxious, and it matches more what people expect of girls to happen, right? So even if you complain about something, they’re always like, “Oh, you’re just feeling a lot more anxious or they’re emotional or manage your emotions,” right? So more often people tend to see it that way too. And then it kind of gives you the message that you need to contain everything, right? Or be able to manage it on their own.

So it tends to be misdiagnosed or labeled as again like you’re anxious or moody instead of they’re inattentive or impulsive and like I said earlier, you can certainly have ADHD and mood disorders together, right? That doesn’t mean it’s not one or the other, but because girl symptoms are often less disruptive in classroom, it tends to get flagged later unless it like, you know, sometimes we have kids coming in that they’ve been having these symptoms for a long time, but they’re in high school, and they’re finally like, I’m working really hard, but it’s not working, right? I feel like I’m studying triple the amount that everyone else is, but I’m still not getting the result. So sometimes we’re getting them really late because they’re really smart or they can adjust really well, but then academic work just becomes too much for them to be able to manage it. So then because of that, it becomes a lot later, or even if it gets flagged, sometimes the questions that comes in is like, “Oh, we think they have a learning disorder, right? Or they’re not learning this stuff because they missed half of the information. So they’re not building the building blocks that everyone else is doing. And they also can have like coming in with like, “Oh, she’s very anxious.” And then while mid testing is like, let’s also look for ADHD because I feel like you’re very inattentive, or you’re also hyperactive and no one’s catching it because you’re very subtle. So I think definitely it gets called out later, than if you have more externalized behavior.

Cindy Lopez: So my background is education and early childhood, and I know that young kids can be very active, and they’re still learning self-regulation skills. So I’m wondering, how does that play into ADHD or not?

Dylan Stewart, PsyD: We know that needing to move your body around and, you know, especially for younger children, that’s how they learn. That’s how they play is they kind of express themselves through moving around their environments and all the ways that they’re able to, you know, the kind of turning point is when it becomes maybe more clinical is when that movement or that hyperactivity is getting in the way of them being able to participate in school, doing things at home. I know that it’s maybe natural for a five or six year old to want to get up from the dinner table and only sit for a couple of minutes at a time. But if they can’t sit down for any meal at any time, and it’s making it so that they can’t actually get the right number of calories into their body to grow and be healthy that’s when we would start to say that maybe these hyperactivity symptoms are a little bit more pronounced for them. It’s really impacting them. And similarly at school, in most kindergarten classrooms, we expect there to be a lot more play, a lot more movement involved during the day, but if, you know, they’re in fourth grade, seventh grade, and they’re needing to move their body that same amount, it might make it difficult for them to actually participate in the classroom. And so, you know, we try and really think about what their age range is when we’re looking at some of these symptoms. And this is, as Dr. Ebadi alluded to, you know, we want to be careful of diagnosing it before six because child under six, we’re expecting them to actually have that much movement and that’d be just a regular part of their typical development.

Marjan Ebadi, PhD: One more thing like you said, because emotional regulation can be contained or matched to any other disorders as well, right? For ADHD wise, we want to make sure that it’s across the lifespan so it’s not based on one setting, and it happens at home, it happens at school, it happens at work. So it’s a little bit more like with all the settings than just a one-time event that is making you dysregulated or because life happens and then things can become very difficult to manage at times too.

Cindy Lopez: We’ve talked about for girls, they can go undiagnosed, undetected, or even misdiagnosed. What are the implications of not recognizing ADHD?

Dylan Stewart, PsyD: Yeah, this is a really important question because we want to hopefully be able to recognize these needs as early as possible. One of the big implications there is they may miss out on those opportunities for early intervention, and we know that the sooner we can recognize these things, the sooner we can provide treatment, the better the long term progress usually tends to be. You know, similarly, as Dr. Ebadi was alluding to if they’re given a diagnosis that doesn’t as accurately capture what their needs are, they may not be receiving, you know, the most effective treatment. Maybe if they’ve been given a dyslexia diagnosis, they may be getting academic intervention when maybe they really would be benefiting from some more of the ADHD specific interventions moving forward.

So, similarly, if it takes a long time for them to kind of access the right interventions, you know, we start to see some of those consequences build up for them. For girls, this tends to be a lot more in the emotional symptoms. So they become more prone to having experience of like lowering their self-confidence, higher levels of anxiety and depression, just because as they’re continuing to try and, you know, match what the world is asking of them. And it feels like their neurodiversity is really holding them back. They start to become more self-critical. A lot more of that stress kind of finds its way into their experience. And, you know, kind of practically, we do see them falling behind very often in school, they can be very, very smart, very capable students, but they may not be able to accurately demonstrate what they know, what they’ve learned on a test or in an in class assignment if they’re easily distracted in those environments, you know, they tend to become burnt out pretty quickly and easily if they’re working so hard, especially as you get to the middle school, high school range where the academic demands just go up and up and, you know, it really can start to again, just create more room for that stress to sneak in for them.

Cindy Lopez: What strategies can you share with our listeners to help them effectively support girls with ADHD?

Dylan Stewart, PsyD: Yeah, well, you know, different strategies are going to work best in different environments. So maybe I can share some for school to think about initially here. The first is really making sure that the educators are aware of the neurodiversity of their students as they know that these are the specific needs of the students in my class, and this is how I might be able to support them.

Some of the practical things they might be able to do might be making sure that, you know, students have a way to kind of see and hear all the information that they’re talking about. You know, kind of combining that auditory and visual information together may help some students; brains just process it in the way that works best for them. So it might be something like, you know, giving the student the lecture slides ahead of time so they can just write small notes instead of having to copy down every word that is up on the board or that the teacher is saying at the same time, you know, really helping them to focus on just one thing that works as well for them as it possibly can. 

You know, similarly in the classroom, we really want to attend to those hyperactivity needs as much as possible. So, you know, giving students fidgets, adaptive seatings like a wobbly chair to sit, on a standing desk, kind of that hands on learning. So they can kind of integrate the movement into their day is really going to help with retaining some of that information too, as well as some of the, you know, kind of organizational sides of it. So, you know, maybe providing rubrics, helping them organize their approach to the project, which part am I going to do first, which part am I going to do next so they can know the next steps there. And you know, sometimes even just breaking a test or a project into smaller chunks might make it feel a little bit more manageable for these students, kind of providing those overall executive functioning skills that might be harder for the student to come up with on their own. It really will vary so much from student to student. So, you know, really communicating with them, communicating with the family, just making sure everybody’s kind of on the same page is gonna be a real big help, I think, for the educators.

Marjan Ebadi, PhD: Parents wise, what parents can do for a while, basically the more you can become their executive functioning part of their brain. So in a way they’re able to observe and learn these skills from you cause they can observe it. You’re sort of playing like an external executive functioning drive. So you kind of like hanging out outside their brain. You can do that by making observational comments for the behavior, such as like, I can see your body’s fidgeting a lot right now. It looks like you need a break or let’s plan for breaks ahead of time. So all of those can help a lot. Some practical things like creating reminders, checklists, helping them organize it on their calendars, help them with time management, like how much time you need for this essay or this project. And let’s break it out, kind of like how we do at school, but we’re transferring it to home. You can also model good organization and time management because kids tend to learn a lot through observation and modeling. And then it’s a good opportunity for them to be able to see the strategy you use at home and how that works for you. And then they can also start adapting it for themselves, definitely encouraging them to take breaks so they don’t get burned out during homework. And again, those planned breaks. So this is where your observational comments come in place. If your kid’s doing math homework and you start noticing the fidgets happen within 10, 15 minutes, plan for a 15 minute break. So then you can give him those movements. 

And then I think talking with your child about how they’re doing, validating their feelings and experiences, right? If it’s frustrating, naming it for them and kind of helping them understand what’s happening with them and demonstrating good coping skills too. So, kind of again going with modeling like regulating what you deal with when frustrated about a project because we all also get frustrated at work or with things that we can’t work the way we want to, so how do you regulate and then help them co-regulate with them? And also collaborate with them to problem solve, like collaboration is kind of important because you still want their input in it, right? And you just want them to also be able to find things that works for them so they can adapt it and use it later on.

Cindy Lopez: As you’re thinking about the school setting for students with ADHD or neurodiversity of any kind, you might want to take a look at something called Universal Design for Learning, which is created, published by CAST, and you can find that online. We can also add that to our resources, so you can see it in our resources and show notes section. Also think about executive function that Dr. Ebadi mentioned, we do have some other episodes on executive function. You can learn more about that. And executive function can be related to ADHD, but they’re also not. So, we know that kids with ADHD can be challenged and not have fully developed executive function skills, but that’s true for all of us.

And then also thinking about validation, that’s also a really good skill for all of us to have, and especially between parents and their kids. And there is another podcast episode on validation if you’re interested in finding out more about that.

So, we’ve talked about school setting, home setting, ideas for parents. Are there additional resources that could help?

Dylan Stewart, PsyD: Absolutely. Yeah. You know, we really want to help an individual with ADHD access the right supports, whatever environment they’re in, if we’re able to do that. So, sometimes that might be a clinical recommendation for something, like occupational therapy, you know, maybe medication management through something like a psychiatrist service, you know, certainly individual therapy, psychotherapy might be a really helpful way to support some of those emotional symptoms as they’re coming up, making sure to work really closely with your pediatrician so that the medical needs are kind of monitored and addressed as the child is going through the course of their development.

Also things in the community like connecting with sports teams, social groups, you know, extracurricular activities can be really wonderful ways to kind of feel that sense of belonging and really mastering some skills that might be different than, you know, the long division that you’re practicing all day in your math class,really helping them feel well there. And certainly we know that lots of things like games and playing can be a really important way to learn some of these executive functioning skills. So just making sure to provide opportunities for that instead of all of the after school hours need to be dedicated to making up for the neurodiversity that they’re navigating through the school day, really providing opportunities for them to develop skills where they feel like they’re gaining those strengths in ways that are important to them, too.

Cindy Lopez: There’s so much that you’ve shared, and we really appreciate you taking the time today to join us and for this conversation and Dr. Stewart and Dr. Ebadi, thank you for sharing your insights and expertise to our listeners. Thank you for joining us as well. And as we wrap up this episode, Dr. Stewart and Dr. Ebadi, I’m just wondering if there is anything else you want to make sure that our listeners hear from you today on this topic of girls with ADHD?

Dylan Stewart, PsyD: The field of research for, you know, girls and women with ADHD is growing so much at this time. We’re really starting to understand that it presents so differently than maybe we’ve even understood it before. And so there’s a lot of effort and energy going into understanding this as clearly as we can. So, you know, I hope that as we’ve talked about maybe some of the more nuanced ways that we understand ADHD and girls, that the listeners will know that they can find clinicians out there who specialize in this, like we do here at CHC, to be able to say, we can get the right treatment, we can access the right information so we know how to support our children. And, that’s something where if you’re able to learn that information as early as possible, you just have a longer runway to be able to support them. So that’s always what we would hope for parents and children to be able to learn.

Marjan Ebadi, PhD: I think it’s never too late to be evaluated for ADHD. It’s better late than than never, because it’s a lifelong condition. And the sooner you learn about how your brain works, your strength, your areas of need, the better you can get the targeted help. And I think it’s very important for kids and parents to learn to advocate for themselves, right? If you start noticing, they’re working twice as much, or they’re very frustrated, and their symptoms is impacting their school, social life, and just overall quality of life, get the help you need to get assessed or talking to the expert that can help you determine what’s the next steps. What will be helpful for your kids? So I think advocacy is very important.

Cindy Lopez: Yeah. And Dr. Ebadi, you just said it’s better late than never, which is absolutely true and also just think about how it could help your child if you get the help they need now. And Dr. Stewart mentioned early intervention, earlier in our conversation, the earlier you can get help, the better and the easier it will be for your child. So that’s something to think about and as Dr. Stewart said, we do have ADHD services here at CHC. Your child can be assessed. You can take part in therapy. So please reach out to us if you are in that situation, and you need some help or just some guidance. We also provide parent coaching. So, maybe your child has ADHD, and you’re trying to figure out the best way to communicate and really support your child. Parent coaching also could be a good option for you. So you can reach us at CHC at chconline.org. You can reach our care team at 650-688-3625, or you can email them at careteam@chconline.org. So thank you again, Dr. Ebadi and Dr. Stewart for joining us today and to our listeners, thank you.

Dylan Stewart, PsyD: Thanks for having us.

Marjan Ebadi, PhD: Thank you.

Cindy Lopez: Visit us online at podcasts.chconline.org.  Make sure to subscribe to Voices of Compassion so you never miss an episode,  and we’d love it if you’d leave us a rating and review. Have a question? Send us an email or a voice memo at podcasts@chconline.org. We’re here for you when you need us.

Cindy Lopez: Welcome. My name is Cindy Lopez, the host of this CHC podcast, Voices of Compassion. We hope you find a little courage, feel connected and experience compassion every time you listen.

Boundaries are an important part of parenting, but how do you know when and where to set boundaries and how to ensure your children respect those boundaries? In today’s episode, we talk with Victoria Cabrera, BCBA, and Hannah Fritz, both of whom are clinical psychology doctoral interns at CHC, and we explore the art of parenting with healthy boundaries. So listen in to learn what boundaries are, why they matter, and how setting consistent limits and clear expectations helps children feel secure and thrive. You’ll discover practical tips to create a balanced, respectful, and family dynamic.

Welcome, Victoria and Hannah. We’d love it if you could take a minute to tell our listeners a little more about yourselves and why this topic is an important one to discuss.

Hannah Fritz, MA: Thank you for having us on the podcast today. My name is Hannah Fritz. I’m a clinical child psychology intern at Children’s Health Council. My training has been in Los Angeles at USC, where I’m going to be getting my PhD in clinical psychology soon. I think this is a really important topic and one that we get a lot of questions about in the work that we do with families. A lot of the work that we do in therapy, in service of addressing children’s behavioral and emotional challenges is really actually work that’s done directly with the parents. And so whenever we have parents asking about, “Okay, how do I set appropriate limits? How do I set appropriate boundaries with my child?” We get excited because we know that that’s usually the most effective way to kind of scaffold behavior change in young children. We see your kid if they’re in therapy with us for only an hour per week, whereas you’re with your child 24-7. And so if we can be consistent about establishing good boundaries, healthy guidelines that can be really effective. 

We also often have parents who have kind of an overload of information. We’re in this era of the internet and social media and tons of parenting books and parents at the PTA talking about what they just read in the New York Times, right? So there’s just this overwhelming flood of information for parents. And so, it’s important to think critically and parse through that information and really think about, okay, what is going to be healthy and effective for my child and for our family situation? So hopefully we’ll be able to provide some guidance or some direction for some of you all this morning.

Victoria Cabrera, MS, BCBA: And I’m Victoria Cabrera. I’m also a clinical child psychology doctoral intern at CHC, and I’m receiving my doctorate from Florida International University in Miami, where I’m from, and I’m also a bilingual clinician that provides services in English and Spanish. And actually parenting and setting boundaries is really one of my favorite spaces to work in, and I feel really passionate about this area just because it does have such, like, long-term impacts on children with the rest of their lives, really, just because it’s a foundational area in helping them interact in other settings with other people, so, interpersonally with relationships, and is really helpful thinking about how this can also impact their ability to work in careers down the line. So definitely, I see this as a very, very important area.

Cindy Lopez: So we all know we’re talking about boundaries today or setting limits. So let’s define boundaries. What are boundaries? Let’s talk about that for a minute before we dive into more questions and content.

Hannah Fritz: So boundaries in sort of the most basic definition is the limits that we set with children and teens. They are the rules and expectations that we set, the routines that we have in families and in school systems. And they really communicate our expectations, usually for behavior, but also for participation in social environments, in family life, in school. And they really are kind of the basic limits that we set and expectations that we have for how children will behave and participate.

Victoria Cabrera: I definitely think that it’s also helpful to consider that boundaries are things that everyone has to learn at one point or another, and you’ll probably hear Hannah and I use the words boundaries, expectations, limits, interchangeably because they can mean different things to different people, or even rules, for example, in the classroom would be an example of boundaries too. So overall, the role as a parent, a big role that parents have is to help set these precedents of how to interact or be in different settings and situations. And it’s really natural that as kids are exploring with their environment, they might push back on some of these things. And part of that too is because they’re in the process of learning what is healthy and appropriate behavior for different types of settings. So I think when we talk about boundaries and expectations, sometimes it’s not things that kids are super excited to follow, and I think that that’s really natural and makes a lot of sense.

Cindy Lopez: Boundaries and expectations are really part of any healthy relationship. And today we’re just focused on the parent/caregiver relationship with their child. So there might be boundaries that you have with your spouse or partner or that you have with other family members. And today we’re specifically focused on that parent/caregiver-child relationship.

Hannah Fritz: I’d love to add something to what Victoria’s saying about pushback. And it’s not only that we can expect that there may be pushback. We need to anticipate that there will be pushback. The way that I like to think of it is that it is a child’s job to find the limits and to find the edges of what’s okay and what’s allowed. And it’s important too, it’s developmentally appropriate, they are learning the rules of the space, they are learning the rules of their social environments, they are learning the rules of how to communicate with other people, physical space boundaries as well, right? And so, If we can think of it actually as their job to push against the boundaries that we set, it can also help us to be a little bit more empathic or compassionate when we are having a really tough moment where the kid is pushing back on our boundary, and remind ourselves that this is a very critical developmental process, and it is them doing the best that they can to be able to learn kind of what the scaffolding is of their environment. So yes, we need to expect that they are going to push back and that’s all right and that’s important. So we want to set clear, firm boundaries that are consistent, but also that are compassionate and kind of padded, if you will, so that they can really press up against those boundaries and bounce back.

Cindy Lopez: I really appreciate what you said, too, about it is the job of the child to like, press against the limits and to find out what is it that I can do within these boundaries? And as we think about that, how can parents or caregivers ensure that the children are respecting the boundaries that have been set? It’s not all about always telling them, no, don’t do that. So maybe talk about that a little bit.

Victoria Cabrera: Absolutely. So I think one of the first considerations that comes to mind is asking the question of is this a boundary that my child can implement independently without my support or is this something that they really need support on, and I’m going to really have to be like the leading figure in keeping the boundary. So for example, a really common situation that I hear from parents is children having a difficult time disconnecting from screen time and parents will feel really frustrated, for example, if they’ve given an instruction like please turn off the TV and the child isn’t turning off the TV. So that’s a situation where perhaps like the way to set the child up for success is really putting the boundary in place by the parent doing so, so meaning like at 10 pm, I’m gonna turn off the TV because it’s bedtime at that time.

So really asking, is this something that my child is ready and able to do on their own, or is this more appropriate for me to really step in and take a leading role here? And I think often times through that process of repetition, giving the child opportunities and then seeing like, oh, it seems like they need more support, so I’m going to take more of a leading role is helpful. And then overall too in psychology, we talk a lot about these terms that are called reinforcement, right? And reinforcement basically means having a behavior happen more frequently because of something that follows it. So, we use the term consequence and sometimes the word consequence can be loaded as something positive or negative, but in psychology, the word consequence literally means anything that happens directly after a behavior, an instruction. So through positive reinforcement, what this looks like is putting in like extra praise or attention or even rewards related to going along with those boundaries. So, “I really loved how you took your plates to the sink. So you get an extra cookie after dinner because I didn’t even have to ask you to do it, you did it all by yourself.” So that’s an example of a child following an expectation and the parent kind of adding in something to help it become more likely that the child will go along with the expectation or boundary that’s put in place by the parent.

And, I think the other side of this, it’s not so much thinking about what parents are adding in. I think a huge part of whether or not a boundary will kind of be followed or not is consistency. So a lot of that comes from the parent side. So is the parent really adhering and following through with whatever that expectation was? So, let’s say the expectation is we need to be in bed by 9:30 so that in the morning we can have waffles for breakfast. So then that means that if the kids are in bed at 10, maybe they’re going to have eggs for breakfast and they’re not going to have waffles because that was the boundary or their expectation that was put in place. So, it’s really important to think about is the boundary or the expectation that I’m setting something that I’m able to be consistent with and follow through with regularly? It’s really through that practice of repetition that kids are able to really absorb a boundary or an expectation and eventually stop pushing back on it because they kind of understand that oh, this is how things are done. I think a really great example of that is how kids in the school setting really adhere super well with the transitions that happen between different subjects. And if you think about recess, it’s such a fun time for so many kids, but when the bell rings very often they’re running back to the class because they know that they have to go on to math or science, right? So they have so much history of repetition that that boundary is adhered to and that math and science start at this time, so it makes it easier for them to move through these routines.

Hannah Fritz: I’ll add a couple things to what Victoria was saying about positive reinforcement, just to kind of put a few more psychology terms or maybe put a finer point on some of her comments here. When we’re using positive reinforcement, it’s really important that the positive reinforcement follows the positive behavior as soon as possible. So the reward we want to be immediately after whatever the desired behavior is, you see the desired behavior and you immediately are giving that praise. And if you’re going to use praise, which for kids is really, really effective. A lot of times parents worry that praise isn’t going to be enough and we have to use rewards, that we have to use candy. Parent attention is hugely influential, even if it doesn’t seem like it’s sinking in all of the way in the way that you might want them to respond. Parent attention and praise is really, really effective, especially if it’s very specific and labeled. So, specific praise: Victoria’s example of, wow, I really love how you put your dishes in the dishwasher right after dinner. So that’s very specific. It’s telling the child, I really liked what you did, right? That’s the praise piece and the specific piece is I really like what you did and this is what you did that I liked, so we’re really being specific not just that like mom is happy with something that you did, but mom is happy specifically about the fact that you put the dishes in the dishwasher right after dinner. So we’re really kind of linking all of those pieces together to really guide that behavior to be repeated over time. Really wanting to make sure that we are very clear about what the behavior is that we are happy about and would like to see again.

Victoria Cabrera: I think another piece here is setting up the environment for success so that a boundary can be more easily adhered to. So for example, if it’s really important and valued in the family to not have so many sweets during the week, maybe having some deliciously baked chocolate cookies on top of the counter is going to be really, really hard to set the child up for success to adhering to that expectation. Or, for example, if you want your child in bed by 9:30 pm. If the TV is still on, it’s going to be really hard for them to really disconnect and want to go to bed at that time that’s desired. So, thinking ahead to, is the environment set up for success?

I think one of the biggest things too, kind of just related to screen time, because I feel like that’s such a common challenge for many families is a parent might give an instruction, but if the screen is on, it’s really hard for the child to be paying attention to that instruction and makes it less likely that they’re going to follow through with whatever that request is. So, like, thinking ahead, the strategy would be making sure that you have the child’s full attention before giving an instruction or setting an expectation.

Hannah Fritz: That works with partners too. I will say if my partner is doing something else on their phone, it is very difficult to get any of my boundary setting through or any communications really at all. So yes, definitely setting the person up for success is critical.

Cindy Lopez: What you referenced earlier, well, Victoria, you referenced some like school or classroom rules. And so from my lens, which is as an educator for almost 40 years, I’ve always been one and communicated to parents, like boundaries are important because the children know then what the limits are and they know there’s freedom within those limits and within that structure. And once they know what they are, they feel safe, and they feel more comfortable to really even take risks. And I think when we talk about learning and in the classroom, one of the things that for kids to really learn is to be able to feel like they can take risks. So as we think about all of that—and you referenced this earlier, Hannah—kids it’s their job to push back against those boundaries. So does that happen? What does that look like?

Hannah Fritz: Yeah, I really love what you’re saying about how boundaries are really important for kids to feel safe. I think that’s a huge takeaway is that boundaries are not punitive, right? They are designed to give scaffolding and structure to the developmental environment and that helps kids to feel safe and secure in their attachment relationships with parents and with teachers and other kinds of caregiving adults in their lives as well. If we don’t have those boundaries in place, that can feel really destabilizing and disorganized and unsafe because we don’t have a container, right? So if the kid is kind of bouncing up against the edge of the boundaries, really what they’re asking is, am I safe? Are you paying attention? Am I contained? Are you taking care of me really, right? And they may push back in a way that’s like, well, why are you telling me that I can’t eat ice cream for dinner, but ultimately, if we think about it on kind of a more meta level, they’re really asking, what are the guide rails here? Are there guide rails here so that I know that I’m safe and contained and that I have this secure relationship and you’re going to show up for me when I hit the edge of the boundary, right? That’s a really important piece. 

Victoria Cabrera: I think another thing that I started thinking about, now as Hannah was talking about this container that comes to mind, is boundaries around aggression and different behaviors, like sometimes kids will hit a sibling or will be like rough with sharing when it comes to a peer or a sibling. And when it comes to these types of difficulties, I think that they’re highlighting also like an emotion or self-regulation piece in the child and ultimately setting boundaries around those types of things is important because it helps the child understand how to go about regulating and why it’s important for them to also want to be regulating themselves.

So I think thinking about that when you’re dealing with a really young child, sharing is not super fun because if I can have the toy myself, I’m going to want to have the toy. So it’s almost like introducing this other element that’s going to help the child understand why is this important and ultimately support the development of a higher level skill and higher level behavior in a way that’s communicating to them how they can learn. So I think with boundaries it’s not always that it’s immediately clear to the child why it’s helpful for them to learn something, and I think again why it’s our role as like the adults to help teach these different abilities and skills.

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Cindy Lopez: So we’ve talked about kids kind of pushing the limits so to speak. So are all boundaries healthy?

Hannah Fritz: That’s a good question. And that’s a question that we get quite a lot from parents. Again, I think we have to think about boundaries as something that help to facilitate security and structure and safety for a child, right? So, they’re critical developmental skills that as parents, you’re responsible for crafting, which is a tall order. And like we said before, you know, kids are going to kind of push back against those boundaries, that’s going to help them to feel safe and contained and supported and like the parents are paying attention. And those kinds of boundaries that are consistent and clearly communicated that are reasonable and developmentally appropriate, right? Those kinds of boundaries, generally speaking, are healthy kinds of boundaries because the child knows what to expect. They know what to expect every single time they behave in a certain way. They know exactly how Dad is going to respond in that kind of situation and that kind of consistency is very healthy and predictable for a child. If we’re getting into inconsistent kinds of boundary setting or punitive, reactive kinds of boundary setting. If we’re setting boundaries when we’re angry or scared, right? A lot of times when a child will do something that scares the parent, the parent will react with anger and will set a really hard boundary. We want to try to avoid doing that because we want the boundaries to be something that are expected and safe and healthy, something that we’re agreeing together that this is how we’re going to be with each other. So we want to try to avoid any kind of inconsistency or setting boundaries in those, kind of heated, hot kinds of moments that do sometimes come up.

Victoria Cabrera: I think related to that piece, I like what you mentioned, Hannah, there about boundaries are expected. So when I think about boundaries, I really think about them as expectations and not a reaction or a response to something that was undesirable or inappropriate, right? And the reason for that is typically, you’re going to get a lot more reaction and anger in response to something that’s set in the moment as opposed to something that’s been notified or discussed prior. So for example, setting the expectation of, we’re going to leave the birthday party an hour early because it’s important for us to make it to your grandmother’s house this afternoon. That’s setting a very clear expectation as opposed to being at the birthday party and saying, “It’s time to go because we have to go to your grandma’s.” We’re probably going to get a lot of like upset reactions in that situation. So always helpful to really lean on the expectation side of things and think about it as setting up the rules for a situation.

Oftentimes, we’ll ask parents to ask themselves, is the thing that I’m asking reasonable for my child’s age? Are other kids similar to them able to adhere to these certain expectations? And usually if that answer is, yes, it does feel like it’s a healthy, appropriate boundary to be setting for the child. I really encourage parents to ask that question because oftentimes, it can feel really overwhelming to endure distress with your child, to endure the pushback, and it really introduces a lot of self-doubt from the parent’s side of things, and it’s so, so hard and just because this consistency piece is so critical for really the boundaries being like healthy and setting the child up for success. I think it’s really important to help address what’s also going on for the parent in these situations. And oftentimes asking that question to themselves provides that validation and the reassurance to the parents of the thing that I’m doing is healthy and supportive of my child.

Cindy Lopez: So you’ve given us some really great examples of boundaries that parents might set and also just for parents and caregivers to be mindful of setting those expectations ahead of time, not just in the moment. Let’s talk for a minute about getting children involved in defining those boundaries or those expectations. How does that work? And do you want to do it?

Victoria Cabrera: So I definitely think children should be involved in developing boundaries, expectations, whenever it’s appropriate. There’s definitely some situations where a child is probably able to understand and agree with the boundary or expectation, and then maybe there’s some that are really hard for them to get on board with. So, for example, as a kid I would have eaten ice cream for every single meal and that seems like a really great idea to me, but it probably wouldn’t have been great for my health and my development and my overall growth. So, I think when it comes to boundaries where the child is less likely to understand or agree, having a conversation with them and letting them know what it is, is really important and that’s why I think that they’re involved in that regard.

So, communicating to them the reason behind a boundary first, I think, is always really effective, and you can do this in a concise way. I think that it’s also really helpful to always introduce the reason before the boundary itself because this helps kind of prevent some back and forth of negotiating or, but why, when the expectation or the boundary is set. So for example, I’m saying something like, for you to grow big and strong, it’s important to eat healthy foods. That’s helping set up the reason and again, limiting the, but why, when the next part follows, which is the expectation. And then a nice kind of trick or formula that I like to give families is something called a first and then statement or an if and then statement. So it communicates really clearly to the child what the expectation is. So first, you need to eat your dinner, and then you can have a cookie. So this is explaining very clearly, in terms that are appealing for the child, what needs to be done so that their interests can also be met in that situation.

Hannah Fritz: Yeah, I really agree. I think involving children and defining boundaries it is situation dependent and child dependent, but I think as much as possible involving children and defining those boundaries, what those boundaries actually are is really important especially if we’re thinking about boundary setting as a developmental skill that we are modeling for them, effective and healthy ways to negotiate in relationships. If we can demonstrate to them how to establish those kinds of healthy boundaries, how to communicate those healthy boundaries to other people, they’re more likely to be able to take those things on as they become teens and adults that they’re going to become, right, that they’re going to be able to have those kinds of boundary setting processes for themselves, you know, more firmly established.

I will say that even if the boundary itself or the limit itself is not something that the child, maybe agrees with like Victoria’s example of eating ice cream for dinner every night, I probably would have done that too. Actually, it would have been mac and cheese for me, and there was a boundary around that, but even if it is something that the child doesn’t necessarily agree with setting up the expectation in advance, having a conversation, so involving them maybe not necessarily in defining exactly what the limit or the expectation is but involving them in the process of setting that limit can be really useful and important for their development as well.

Victoria Cabrera: I think often times parents feel nervous or hesitant to have conversations about boundaries before the big event or the situation, right, like Hannah mentioned cause they’re worried that this will then bring up an argument when they’re not necessarily having to argue or deal with the situation, but it really does make it less likely that when the situation is occurring, there’s going to be confusion or negotiation or kind of pushback happening. So I definitely agree that having conversation leading up to boundaries or expectations is really, really helpful, and not just directly before the situation.

Hannah Fritz: Mm hmm. Yeah. Yeah, I really agree with that. I think especially involving the child as much as possible for any child is really healthy. A lot of the work that I do is with kids who’ve experienced trauma, and a lot of parents are really, really concerned that if they establish boundaries, that it’s going to harm their child or re-traumatize their child. That’s a very, very common concern, especially for parents who’ve had kids with really early life trauma or family related trauma. And even more the case with kids who’ve experienced trauma, they need those boundaries, they need extra padding around those boundaries, but they need those boundaries to feel safe and secure and to re-establish secure attachments. And they also need it to be very clearly articulated what the expectations are and even more consistent than ever before, right? So we want to be clear, we want to be reasonable, and we want to be as consistent as possible and involving them in that process can really help avoid any kind of retraumatization or any kind of fear response.

Victoria Cabrera: I think a way to involve children in this process too is by allowing choices within the boundary. So if the expectation is that it’s homework time, we need to sit down and complete homework. A choice could be, for example, do you want to work on the math homework first or the reading homework? So it’s providing autonomy within the greater situation or if it’s important to finish eating dinner, do you want to eat the protein or the vegetables, et cetera. But then that way, it does create a level of autonomy within the greater situation, which could be challenging when it’s initially being enforced or put in place.

Cindy Lopez: So as we’re talking about all of this, boundary setting, is it possible that parents or caregivers could set too many boundaries or, you know, like, could it cross over into controlling?

Hannah Fritz: Yes, it certainly can. It is generally best to set boundaries sort of only where they’re actually needed and to avoid setting extraneous boundaries where they’re not really necessary for your child or for your family. Boundaries are going to evolve across childhood as your child grows. So we want to be also loosening up some boundaries as your child grows up and is able to stay out later, might be having a curfew instead of a “no going out on the weekends with your friends” kind of boundary setting.

And actually thinking back to something that Cindy said earlier about how it’s important that when we set boundaries, kids know where the edges of expectation are and then they can be free within those boundaries. It’s really, really important to have freedom within those boundaries. So we’re not talking about stacking boundaries on boundaries on boundaries and limits on limits on limits so that they have no other choice over how they behave or over what kinds of things they do or say, but we are establishing just enough boundaries to provide the scaffolding for healthy development and for appropriate social behavior, right? But also we’re allowing for there to be as much flexibility as possible. So if you don’t need to set a boundary around that, don’t set a boundary around that, right. And until maybe you do find that you need to set a boundary around that, but some kids need quite a lot of boundaries and other kids really don’t need that much. And they can kind of figure out where those edges are for themselves. So facilitating that kind of freedom and autonomy within those boundaries is really important. It also really helps them to develop the person who they are too, right? If we’re thinking about how they’re going to manage their own relationships growing up, how they’re going to manage their own self-expression growing up, we want them to have the opportunities. Although sometimes it feels a little scary, right, for them to make mistakes and recover from those mistakes and kind of learn how to set those appropriate boundaries for themselves and how to express themselves in a way that’s really authentic to them.

Victoria Cabrera: Definitely having too many boundaries or expectations I do not think is effective and the reason why I don’t think it’s effective is really because not only does it kind of maybe remove a lot of space for fun? But it’s also incredibly difficult to be consistent with way too many things happening at the same time. And overall, if you want boundaries to be really supportive and beneficial for your child that follow through and consistency is really just so important. So sometimes having only a few boundaries or expectations that you really follow through with all the time is better than having 20 things that you’re mentioning or trying to keep track of.

So if boundaries are being loosely adhered to, then the child’s gonna loosely follow them. So that’s just again why that consistency piece is really just so so important. And if you’re listening to this podcast today really thinking about, “Oh, I’m so motivated to implement some boundaries with my family.” My first piece of advice is really to start small and maybe think about one area that you want to set some boundaries on and then just really adhere to that area consistently until you feel like you’ve gotten some kind of mutual understanding and respect to that boundary with your child before implementing or introducing something else. And again, the reason for that is if you want to set the child up for success in being able to kind of learn this new system or this new structure, you don’t want to be doing too much too fast because it could be really overwhelming.

Hannah Fritz: For the child and for the parent, right? Like if we’re establishing way too many boundaries, you’re going to burn yourself right out because you cannot remember all of them right for your child, cause they’re not going to remember all of them. You have to remember all of them. You have to remember what the limits were that you set. You have to be consistent and all of those things take energy and time and patience, patience, patience. And so if you set too many and you can’t actually hold all of that, you’re gonna burn out and your child is also gonna learn that the boundaries actually don’t really mean very much, and they’ll start to kind of tune them out, right? So selecting is essential.

Cindy Lopez: Thank you so much, Victoria and Hannah for being with us today, sharing your expertise and insights on this topic. Before we actually sign off, I’m wondering if there’s anything else that you really want to make sure our listeners hear from you today.

Victoria Cabrera: I’ve said this really throughout the podcast, and I hope that maybe it’s a theme that people have taken away, but I really do believe that consistency is so, so important and such a key ingredient for this being really effective for you as a parent and then also something that then your child will able to be able to benefit from. So I think that that consistency aspect is everything.

Hannah Fritz: Yeah, agreed. My takeaway would be that yes, boundaries are healthy, developmentally appropriate, and consistent boundaries are healthy. They’re really, really important for kids to feel safe and secure in their relationships, and they’re important for their overall development as a human being, being able to set those boundaries for themselves also eventually, as a really critical skill.

Thanks for having us on.

Cindy Lopez: To our listeners, if you’re in a place where you think you might need some help doing this, we do have parent coaching available at CHC. You can call our care team at 650-688-3625, or you can reach out to them via email careteam@chconline.org. So Victoria and Hannah, thank you again for joining us and to our listeners as well.

Hannah Fritz: Thank you so much.

Victoria Cabrera: Thank you.

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