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

by Thomas J. Power

Depression

In the mental health world, however, the term depression has a more specific meaning. Teens who meet the formal criteria for major depression feel down, empty, hopeless, or irritable for weeks on end. They may lose interest in most things they once enjoyed, and they may pull away from family and friends. Major depression can cause a wide range of other troublesome symptoms as well, such as changes in eating and sleeping habits, frequent tiredness, feelings of worthlessness, and, at times, thoughts of suicide.

When ADHD and depression occur together, they often make each other worse. ADHD may lead to repeated negative interactions with parents, teachers, and peers. These experiences are demoralizing, and they only add to depressed feelings of hopelessness, helplessness, and low self-esteem. Depression, in turn, may sap a teen’s motivation, making it harder to marshal the effort needed to get ADHD symptoms under control. When a teen is stuck in this negative cycle, treatment needs to address both ADHD and depression.

Disruptive Mood Dysregulation Disorder

Depressive feelings may also manifest as disruptive mood dysregulation disorder (DMDD)—a relatively new diagnosis in the mental health field. The hallmark of this disorder is persistent irritability and frequent, severe temper outbursts. Teens with DMDD tend to lash out when feeling frustrated—for example, by yelling, throwing things, or hitting someone. Even when they aren’t flying into a rage, teens with DMDD are in a chronically cranky or angry mood. The constant irritability and hair-trigger temper of DMDD go far beyond normal teenage moodiness. DMDD can wreak havoc with relationships. Also, because teens with DMD...

Oppositional Defiant Disorder and Conduct Disorder

Oppositional defiant disorder (ODD) is characterized by an ongoing pattern of frequent defiance, hostility, and spitefulness. Some pushback against authority is a natural, and often healthy, part of growing up. In teens with ODD, however, stubbornly refusing to cooperate with adults and arguing with authority figures can become a constant source of tension.

ODD is one of the most frequent of all comorbidities in teens with ADHD.

Some teens with conduct disorder engage in aggressive behavior, such as bullying, carrying weapons, or getting into physical fights. Others destroy property, lie, steal, skip school, or stay out past curfew. This is more than just ordinary teenage rebelliousness. It’s a persistent pattern of behavior that gets teens into serious trouble at home, at school, and sometimes with police.

Learning Disorders

For example, dyslexia impairs the ability to read and spell, and dyscalculia impairs the ability to understand and use numerical information. Teens with learning disorders read, write, or do math at a level lower than what would be expected based on their age, grade level, or developmental level.

ADHD and learning disorders each affect the ability to acquire and use new information. Taken together, they may lead to constant struggles and repeated failures at school. These negative experiences, in turn, may foster pessimism and low self-esteem. In that frame of mind, it’s even harder for teens to find the motivation to do their best academically. To break out of this cycle, teens with ADHD and learning disorders need appropriate help for both conditions.

Substance Abuse

Adolescents with ADHD are more likely than their peers of the same age and sex to drink alcohol or abuse drugs. They also tend to start using these substances at an earlier age. Plus, they have an increased risk of developing alcoholism and drug addicti...

Some teens with ADHD may turn to alcohol, drugs or smoking in an attempt to self-medicate,

They may be looking to soothe ADHD symptoms or ease anxiety and self-consciousness about feeling different.

Tics and Tourette Syndrome

ADHD often runs in families.

There is about a 40% chance that at least one biological parent of a child with ADHD also has the condition.

Gene Expression

An individual with one or more specific genetic variants may have the potential to develop ADHD. But that potential may only be activated when conditions are ripe inside body cells, where genetic information is put to work. Gene expression is the technical term for the process by which the information encoded in one of these genes is used to direct the production of a protein in a cell. Proteins are needed for the structure and regulation of every tissue and organ in the body, including the brain. So the expression of certain genes affects the brain, and the brain influences behavior.

The DRD4 Gene and Attention

Trauma and Chronic Stress

More Risk Factors

Prenatal and birth factors.

Premature birth and low birth weight are also associated with an increased risk for ADHD.

Causes of Comorbidity

A study by the Psychiatric Genomics Consortium revealed that 28% of the variability in ADHD occurrence can be traced to genetic factors that are shared with several mental health conditions, including major depression.

The Perils of Letting Go Too Soon

The hands-off approach may seem especially alluring now that your child is older. Parenting a child with ADHD isn’t easy, and fatigue can build up year after year after year. By this point, you may be feeling exhausted and burned out. And you may believe that it’s time for your teen to start figuring things out on his or her own. There might also be an element of denial at play. Admitting to yourself just how much your teen is struggling can sometimes be difficult. Yet ignoring the warning signs and refusing to face the realities of ADHD can be particularly risky during the adolescent years. Following are just a few of the possible consequences of unmanaged ADHD: •Accidental injuries. Children and teens with ADHD have more frequent and severe injuries, on average, than their counterparts without ADHD. Inattention and impulsivity make them more likely to get into an accident as a pedestrian, while riding a bicycle, or while driving a car. •Difficult peer relationships. Inattentive teens may be seen by their peers as standoffish, and hyperactive or impulsive teens may be seen as troublemakers. Such negative perceptions often lead to rejection. For one study, CDC researchers surveyed a nationally representative sample of parents about their children ages 4 to 17. Parents reported that children with a history of ADHD were 10 times as likely to have difficulties with friendships as children without ADHD. •High-risk sex. Adolescents with ADHD are more likely than those without t...

•Juvenile delinquency. Impulsivity can lead to making poor choices in other areas of life as well. This may result in trouble with the law, especially when coupled with conduct disorder. Youth with ADHD are three times more likely to be involved with the justice system, compared to their peers without ADHD. •Dropping out of school. Students with ADHD are more likely than those without the condition to repeat a grade or drop out of high school. A study from the University of California, Davis, found that about one-third of students with the combined form of ADHD failed to graduate high school on time—more than double the rate for students with no mental health disorder. To help your teen avoid these perils, resist the urge to let go too soon. Adolescents with ADHD continue to need close monitoring and loving guidance. They also need parents who advocate for them at school and in the community. Being there for your teen takes time and energy. But the demands may feel less overwhelming once you’ve learned how to use some proven strategies and where to turn for assistance and support.

Whether they are willing to admit it or not, teens like knowing they can turn to a parent for advice when they have a problem. The strength and quality of other relationships matter as well. Key adults other than parents—such as extended family members, teachers, coaches, and youth group leaders—may have a positive impact on academic achievement and self-esteem. Support from caring adults may also reduce the risk for conduct problems, risky sexual behavior, and substance abuse.

The Developmental Assets for adolescents fall into eight categories.

These are examples of the kinds of things that help teens grow into healthy, responsible adults: •Support—from family, other adults, caring neighbors, and school personnel •Empowerment—through feeling valued, feeling safe, and giving back to the community •Boundaries and expectations—via clear rules, high standards, and positive role models •Constructive use of time—for creative hobbies, youth programs, and religious activities •Commitment to learning—through engaging with school, doing homework, and reading •Positive values—such as integrity, honesty, responsibility, and social justice •Social competencies—such as friendship skills, cultural sensitivity, and the ability to resist negative peer pressure •Positive identity—via empowerment, self-esteem, and optimism about the future

Adolescent ADHD can be treated with the right mix of behavioral therapy, medication, educational strategies, and community interventions.

ADHD is a brain-based condition that affects attention and behavior, so it makes sense that behavioral therapy should play a role in managing it. For some adolescents with ADHD, behavioral therapy alone may suffice. If drug therapy is required, a combination of both medication and behavioral therapy is usually preferable to medication alone. In such cases, it’s generally more effective to start with behavioral therapy and then add medication as needed.

Behavioral treatments have much to recommend them: •They don’t carry the same risk of side effects as medication. •They can address the emotional and social fallout of ADHD, such as low self-esteem and troubled relationships. •They can help to promote successful academic performance. •They can target other mental health conditions that often go along with ADHD, such as anxiety, depression, conduct problems, and substance abuse. •They teach valuable skills that can be used for a lifetime.

A variety of treatment approaches have been touted for ADHD in adolescents. However, the one with the strongest research base is behavioral therapy.

This form of therapy focuses on identifying behaviors to change, taking steps to make it more likely that desired behaviors will occur, and providing appropriate consequences for behaviors. Although more research is needed, there is sufficient evidence to show that this approach generally works with adolescents who have ADHD.

you can model good listening and communication skills.

You can also help your child set appropriate goals and make daily schedules. These are known as the antecedents of the behavior.

The parents are taught how to use antecedents and consequences to promote more appropriate behavior.

learning to set goals for their child’s behavior and use rewards and punishments to nudge a target behavior in the right direction.

In contrast, a typical 15- or 16-year-old has developed a greater capacity to examine his or her own thoughts, reflect on the past, anticipate the future, and consider multiple options for behavior.

Organizational Skills Training

Homework, Organization, and Planning Skills (HOPS) program, developed by Dr. Joshua Langberg and his colleagues. This program is designed for middle school students with ADHD.

A school counselor or psychologist meets individually with students at school. There are about 16 meetings in all, each lasting no more than 20 minutes. The program focuses on practical skills needed for academic success. For example, to better organize their materials, students are taught how to arrange their backpacks, binders, and lockers more efficiently. They also learn to consistently record homework assignments, class projects, and upcoming tests in a planner. To better manage their time, students are taught how to break down big school projects into smaller pieces and then plan for the completion of each piece. They also create an evening schedule that balances homework and study time with extracurricular activities.

Combined Family–School Interventions

ABCs of Changing a Problem Behavior

Laying the Groundwork