If Your Adolescent Has ADHD: An Essential Resource for Parents (Adolescent Mental Health Initiative)

by Thomas J. Power

When your child has ADHD, your parental anxiety may be ratcheted up several notches. ADHD—short for attention-deficit/hyperactivity disorder—is a condition characterized by persistent problems with paying attention, controlling impulsive behavior, or being overactive.

Five Key Skills for Parents

In fact, much of the information in this book can be boiled down to five key parenting skills: •Preparing yourself to face new challenges as your child with ADHD gets older •Informing yourself about the best tools and techniques for managing teen ADHD •Maintaining a strong attachment with your child throughout the adolescent years •Supporting your child’s budding independence while staying involved in his or her life •Building partnerships with the other adults in your child’s life, including therapists, doctors, teachers, and coaches

This book was created under the auspices of the Annenberg Public Policy Center (APPC) of the University of Pennsylvania,

In the early 2000s, APPC launched an initiative aimed at spreading the word about adolescent mental health issues. It convened a panel of experts and published a series of books on several mental and behavioral health conditions affecting teens, including depression, bipolar disorder, anxiety disorders, substance abuse, eating disorders, schizophrenia, and suicide.

we’ve designed the book so that each chapter can stand alone.

Tips on Finding What You Need Quickly

These tips may help: •If you want to delve deeper into a specific subject, let us point the way. At numerous places throughout this book, we mention websites that provide further details on a particular issue. At the end of every chapter, we also highlight at least one online resource where you can learn more. •If you want to read more about ADHD in general, turn to the appendix, Resources for Parents and Teens, at the back of this book. It lists organizations, websites, and other books that provide helpful information about ADHD and related conditions. •If you’re a health or mental health professional or an educator, check out the appendix, Books for ADHD Professionals. •If you don’t remember what a scientific or educational term means, flip to the Glossary at the back of this book. •If you’re interested in non-standard ADHD treatments, keep reading! We’ve focused primarily on behavioral approaches and medication in these pages because they’re considered the gold-standard treatments for ADHD. There’s strong scientific evidence to support their effectiveness. However, we know that you may be curious about other approaches as well, so we’ve discussed them more briefly at relevant places throughout the book. Among the topics

addressed are complementary approaches in general (Chapter Three), neurofeedback (Chapter Three), executive function training (Chapter Three), meditation and yoga (Chapter Three), fatty acid supplements (Chapter Four), elimination diets (Chapter Five), and physical exercise (Chapter Six). At the end of every chapter, you’ll find a short list of Key Points.

The reality is, most children with ADHD grow into preteens and teens with ADHD.

Often, that realization comes as a wake-up call. By late elementary school, you might have felt as if you were finally getting a handle on how to raise a distractible, hyperactive, or impulsive child. Then middle school and high school arrived, bringing a whole new set of challenges. The schoolwork is much harder now. And the expectations for your child— such as driving, babysitting, holding down a summer job, and filling out college applications—are much bigger and more consequential.

Instead of cutting up in class and talking nonstop at home, your child may suddenly be failing tests, acting defiant, or hanging out with the wrong crowd.

here are three things to remember, which underlie everything else you’ll read in this book: •ADHD is a real, brain-based condition, not an indictment of your parenting ability or your child’s character. •Changes in behavior are very common in adolescents in general—and changes in behavioral symptoms are very common in adolescents with ADHD. •You can learn strategies and find resources that help you and your child manage the teenage version of ADHD.

Following are a couple of stories shared by parents who volunteered to be interviewed for this book. You’ll find other family stories sprinkled throughout these pages.

Emily’s Story

She’s got this impulsive thing where, out of nowhere, she’ll jab someone or throw a pencil,

“People want to know why she can’t just get control of herself, and she’s always hearing that she’s too willful. It makes her very insecure and very anxious. I mean, she struggles with that a lot. Kids are so vulnerable in high school.”

Jayden’s Story

Jayden doesn’t have a problem keeping his body still. For him, the challenge is getting his mind to settle on one thing ...

So last year, when Jayden was in seventh grade, he and his parents decided to stop the medication. Now they’re rethinking that decision, however, because eighth grade has turned into an ordeal. “Off his medication, getting any work done is very, very difficult for him,” Angela says.

ADHD is a complex condition that can cause a wide variety of symptoms. These symptoms can be grouped into three categories: inattentive, hyperactive/impulsive, and combined.

In recognition of this fact, ADHD categories are now known as “presentations,” referring to how the condition presents at a particular time in a person’s life.

As you read through the descriptions of ADHD presentations in the next sections, you’ll notice that many of the listed behaviors sound quite common.

To be considered a disorder, ADHD symptoms must seriously interfere with a teen’s daily life or development. These are some facets of teen life that are often affected: •Getting along with family members •Making and keeping friends •Performing academically in school •Finishing and turning in homework •Controlling behavior at school •Having positive self-esteem

Inattentive Presentation

Inattention refers to difficulty staying mentally focused. The kinds of behaviors that are typical of adolescents with the inattentive form of ADHD include the following:

Not paying close attention to detail, even when they like what they’re doing •Making “silly” mistakes on tests, even when they know the answers •Having trouble paying attention to anything for an extended period •Finding it hard to stay focused long enough to read a book chapter •Not listening to what others say, even when spoken to directly •Seeming as if they are always distracted during conversation •Starting to do their homework, but quickly becoming sidetracked •Having a backpack so messy that they can never find what they need •Missing homework due dates or getting to class late frequently •Putting off writing reports or filling out college applications until too late •Losing their eyeglasses, school supplies, wallet, keys, or phone repeatedly •Finding it hard to tune out irrelevant sights and sounds when studying •Neglecting to do chores or run errands that they intended to do •Forgetting to keep appointments or meet up with friends as planned

Hyperactive/Impulsive Presentation

Hyperactivity refers to excessive physical movement or to extreme talkativeness or restlessness. Impulsivity refers to hasty actions made without giving any thought to the possible repercussions.

•Squirming or fidgeting when they’re expected to sit still •Having a habit of repeatedly bouncing a leg or tapping a foot •Walking around the classroom at inappropriate times •Being unable to enjoy any quiet hobbies or leisure pastimes •Finding it difficult to sit through a movie or restaurant meal •Feeling restless, jittery, or impatient much of the time •Being always on the go, to a degree that others find exhausting •Chattering constantly, to the point where others become annoyed •Blurting out rude or thoughtless comments without thinking •Yelling out an answer without waiting for the question to be finished •Not waiting for their turn in conversation or during games •Finding it exceptionally difficult to wait in checkout lines •Butting into other people’s private conversations •Barging into other people’s activities without being invited

Combined Presentation

Impulsivity often diminishes in adolescence as well, but it may still cause significant problems. For example, poor impulse control may lead to social blunders, such as blurting out thoughtless remarks or butting into private conversations. Such missteps interfere with making friends and increase the risk of teasing and rejection.

During the teen years, problems caused by inattention may come to the fore as academic demands increase and expectations of personal independence grow.

many coping strategies for adolescents with ADHD aim to help them harness their attention, manage their time, and organize their activities.

In an ideal world, all health care providers would conduct a comprehensive, best-practices evaluation before diagnosing ADHD. Unfortunately, in the real world, that doesn’t always happen.

The ADHD Gender Gap

Girls with ADHD are more likely to have mainly symptoms of inattention.

Years ago, it was thought that boys were four to six times more likely to have ADHD than girls. More recent research suggests that boys are actually only about two to two-and-a-half times more likely to have the condition.

The doctor can check for other possible causes of ADHD-like symptoms, such as hearing problems, sleep disorders, or undetected seizures that can mimic inattention.

Be ready for the professional to also ask you questions about your child’s •Development and health history •Past behavior •Current lifestyle •Ongoing symptoms •Possible co-occurring problems •Parent–teen relationships •Sibling interactions

Rating scales are a quick, easy way to evaluate your child’s behavior. They provide valuable information about how your child’s behavior compares to that of other adolescents of the same age and sex.

The mental health professional may also ask your child to complete rating scales.

Typically, the mental health professional will use a scale that is specifically designed to assess ADHD symptoms and impairments as well as a scale that assesses a broader range of emotional and behavioral concerns.

Differential Diagnosis

Comorbidity Assessment

In some cases, the mental health professional may discover that your teen meets the diagnostic criteria for both ADHD and another condition. Comorbidity is the technical term for the coexistence of two or more health conditions in the same individual.

In fact, when it comes to ADHD, comorbidity is the rule rather than the exception. The majority of adolescents with ADHD have at least one other emotional, behavioral, or learning disorder. Such disorders interact with ADHD, often worsening the symptoms and making it harder to succeed in daily life. To reduce the added distress and disruption, it’s crucial to identify and treat any comorbid conditions.

Anxiety Disorders

anxiety disorders lead to fear or worry that is excessive, persistent, and difficult to control.

ADHD can interfere with a teen’s ability to succeed in school and connect with peers, which may lead to stress, worry, and self-consciousness. An anxiety disorder may magnify those feelings to the point where they’re disabling. To help the teen feel more at ease and confident, treatment needs to address both ADHD and anxiety.