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

by Thomas J. Power

Clonidine and guanfacine belong to a group of medications that have long been used to treat high blood pressure.

extended-release (ER) versions of these drugs also helped improve attentiveness and decrease hy...

Some of the initial studies of these medications raised questions about their benefit for adolescents with ADHD.

However, more recent research using a higher dose of medication than the original studies suggests that they may be beneficial.

To prevent a sudden drop in blood pressure or heart rate when treatment first begins, the medication is started at a low dose and then gradually increased.

Choosing a Treatment Strategy

Medication Plus Behavioral Therapy

How much medication should my child take, and when? •Should my child take the medication every day or just on school days? •Should my child take it before, with, or between meals? •What should I do if my child forgets a dose? •How long will it take for the medication to begin working? •How can I tell if the medication is working the way it should? •What are the common side effects, and what should I do if they occur? •What are the rarer but serious side effects, and what should I do if they occur? •How should this medication be stored?

Or you can visit the websites of the Partnership for Prescription Assistance (pparx.org) and the Patient Assistance Program Center (rxassist.org) to search for programs that your family may qualify for.

Under federal law, stimulant medications are classified as Schedule II controlled substances with the potential for abuse.

Schedule II prescriptions can’t be refilled. Your teen’s doctor must issue a new prescription each time. You and the doctor’s office need to work together to ensure that your teen doesn’t run out of medication in special circumstances, such as when your child is out of town for an extended time.

What You Can Do

There might come a time when you and your teen’s doctor believe that ADHD medication is still a good idea, but your teen has a different opinion. If this happens, it can be very frustrating, but try to respond with patience. Becoming angry just draws the battle lines, making it more likely that your teen will become firmly entrenched on the other side.

Instead, try to understand your teen’s point of view. Start a conversation about your teen’s concerns, and really lis...

When it’s your turn to talk, hopefully your teen will be just as open to listening to and respecting your point of view. You have a better chance of being heard if you’ve already established a close relationship based on strong communication and negotiation skills. You’ll find pointers on how to do that in the next chapter.

Then be prepared to follow through if your teen still chooses the medication-free path.

That may mean developing a more comprehensive behavioral contract than would otherwise be necessary. It may also require intensive behavioral management strategies not only at home but also in conjunction with the school. You’ll need to work closely with school personnel, and you might also want to seek guidance from a behavioral therapist.

What if you suspect that your teen with ADHD may already be abusing drugs or alcohol? It’s vital to share this information with the treatment team. If a professional assessment shows that your teen likely does have a drug or alcohol problem, this needs to be addressed sooner rather than later. Generally speaking, your teen’s doctor will want to see progress toward managing the substance abuse problem before starting or continuing medication to treat ADHD.

Pass along the facts. And when you do, remember: Your words of warning are more likely to have the desired effect on your teen when you’ve already established a strong relationship and an open line of communication.

Parental supervision is another key to preventing stimulant abuse and diversion. An adolescent may gradually assume more responsibility for taking his or her own medication. But you should still keep a watchful eye on how things are going. Try to spend some time with your teen every morning, even if it’s just a couple of minutes over breakfast. This gives you a chance to observe your teen actually taking the medication. A predictable routine that links taking medication to a daily activity, such as eating breakfast, also helps your teen remember the medicine every day. Check the medicine bottle on a regular basis to make sure it contains the right amount of medication. If the bottle goes from full to half-empty in a couple of days, you know there’s a problem that needs to be addressed. Store the medication in a secure place where siblings and visiting friends can’t take it accidentally or on purpose.

managing ADHD is a team sport, not an individual event. The core positions on the team include: •Family: you, your partner (or anyone else who shares parenting duties), your teen •Health care: your teen’s doctor, your teen’s therapist •School: your teen’s teachers, the school psychologist, other school personnel Ideally, these three groups should coordinate their efforts seamlessly. There may also be supporting players, such as community agencies and after-school programs. In a perfect world, they should be fully integrated into the treatment plan as well. In the real world, the pieces of your teen’s treatment may not fall into place quite this neatly. You can help unify the process by making sure everyone is working toward the same goals. These goals should take into account your and your teen’s preferences and priorities for treatment. Don’t be afraid to speak up. Don’t hesitate to ask questions. And don’t be surprised if this year’s goals are a little different from those of the year before. Key Points •Your teen’s ADHD symptoms may no longer respond

Raising any child is a big job, and raising a child with ADHD entails additional challenges. In some families, relationships break under the added strain.

Be a firm, but warm and loving parent. •Show affection in meaningful ways. •Provide appropriate rules and supervision. •Foster communication and problem-solving. •Affirm successes and limit criticism.

Beyond that, show up for school and community events to support your teen. If your child is playing in a sports tournament or singing in a school musical, make every effort to attend. Realistically, there will likely be times when you have work or family conflicts, and you can’t be in two places at once. But know that each time you do show up, your teen notices.

Another way to reaffirm your relationship with your child is by shining a light on positive behavior. At times, however, finding the bright spots can take some extra effort.

into chasms. Twenty-year-old Ryan, a college student, lives at home with his parents and two younger siblings. Since high school, he and his dad have clashed over Ryan’s drug use, poor grades, and “bad attitude.” “Ryan has big issues with his father,” says his mom, Beth. “At this point, they don’t speak anymore even though we’re all under the same roof.”

The family meetings never seemed to resolve anything. “It was like Ryan and his father were on two different planes,” Beth says. “And I would be caught in the middle all the time, which was a stumbling block for me.” Eventually, Beth stopped trying to play mediator and began excluding her husband from the conversation. “I used to run everything past my husband, but he was constantly so hard on Ryan,” says Beth. “After a while, I just took my husband out of the equation so I could start moving forward with Ryan. Basically, now I just let my husband know what I’m doing but I’ve taken him out of the decision-making.”

Parenting is a balancing act. On the one hand, parents want to be their children’s allies. On the other hand, they need to be in charge and willing to enforce rules. Research shows that teens thrive when parents find a happy medium between too permissive and too controlling. Striking that balance can be tricky, however, especially with a teen who has ADHD.

In fact, they may promote irresponsible or rebellious behavior and inflame tensions at home. These are some signs that parenting may have veered off course: •Too permissive. Overly lenient parents go along with whatever their teens want. They either don’t set rules or they don’t enforce the rules consistently.

Too controlling. Overly strict parents try to control every aspect of their teens’ lives. They don’t allow their teens an appropriate amount of freedom and independence. When an overly controlling style is combined with lots of affection, it can feel smothering and intrusive. When it’s combined with a low degree of affection, it can come across as authoritarian and domineering. Either way, when parents act too controlling, teens often respond by becoming stubborn and oppositional. It’s a vicious cycle that can fuel family conflict and seriously erode the parent–child relationship.

Psychologist Diana Baumrind has conducted some of the seminal research on this subject. She uses the term authoritative parenting to describe a child-rearing style that falls in the sweet spot between the two extremes. Authoritative parents exhibit these qualities: HIGH IN AFFECTION •Express affection without being smothering •Affirm and genuinely like their children MODERATELY HIGH IN CONTROL •Set appropriate rules and enforce them effectively •Provide close supervision throughout adolescence

Adolescents thrive when parents are warm and affectionate. Yet they may want their parents to back off on overt displays of affection, especially in public. You might have picked up on that. Chances are, the same child who happily walked into kindergarten hand-in-hand with you wouldn’t want to walk into ninth grade with you anywhere in sight.

Look for ways of showing affection that are accepted and appreciated. For example, a teen who would rather you didn’t shout out “Love you!” in front of a group of teammates may appreciate hearing those words at home every morning before leaving for school.

In families where people are quick to affirm and appreciate each other, there tends to be less conflict. And when you do need to correct your teen’s behavior, your words may carry more weight. Big punishments, such as grounding, may be needed less frequently.

adolescents do best when parents are firm but fair. Establish clear, consistent expectations for your teen’s behavior. These are some general guidelines rooted in proven behavioral principles:

•Limit the number of house rules so that you and your teen can stay focused on the most important ones. •Be sure your teen knows exactly what you expect and what the consequences of breaking the rules will be. •Monitor your teen’s behavior closely so you’ll know whether your teen is actually following the rules. •Be quick to notice and acknowledge when your teen has complied with the rules. •Make the punishment fit the “crime” when there’s an infraction. Ideally, it should be a logical consequence. •Avoid harsh or frequent punishment. It’s ineffective and may increase defiance and rule breaking.

Teens with ADHD are already at higher risk for oppositional behavior and conduct problems, and ratcheting up the conflict may only make things worse.

Teens whose parents provide close supervision are less likely to make risky choices that end up hurting themselves or others. A reasonable level of supervision for adolescents means: •You know where your teen is throughout the day. •You can verify your teen’s whereabouts at any time. •When your teen is away from home, you have a good idea of what your teen is doing and who else is there.

As your child matures and exhibits more responsibility, it’s appropriate and expected to gradually start loosening the reins. Just keep in mind that teens with ADHD often lag behind their peers developmentally. You can’t assume that your 16-year-old is ready for the same level of responsibility as the 16-year-old down the block.

Instead, you need to individualize decisions about how much freedom your child is—and is not—mature enough to handle.

Talking things through with other parents in an ADHD support group may help you reach a decision as well. If you’re still stuck, or if you and your partner disagree about when it’s time to let go, a mental health professional may be able to help.

Good communication lays the foundation for a strong parent–child relationship. When your child has ADHD, communication and negotiation skills are also crucial for collaborative problem-solving.

There are two sides to the communication process—listening and speaking—and both are important.

Good listening is the cornerstone of effective communication. Teens with ADHD often have trouble listening attentively and controlling the impulse to interrupt.

The two of you will take turns speaking, and when it’s one person’s turn to talk, the other will listen without interrupting. This might seem basic, but it can be challenging for both parents and teens to do.

One helpful listening technique is to periodically restate what your teen has just said, paraphrasing rather than parroting it back word for word. To do that, you need to listen closely to the verbal content of your teen’s message. But it also helps to pay attention to the emotional content as well as your teen’s intent and values. Then reflect those things back when you restate what you’ve heard: “You’re spending two hours on homework and still not getting it done, and you’re feeling frustrated. I know you really want to do well academically, and passing this class is important to y...

Practice listening many times per day, even for short periods of time, such as when you’re riding in the car, sharing a meal, or watching TV together. Allow your teen to control the agenda of the conversation during these times. Often, the best thing you can do is simply to listen to whatever your t...

there will undoubtedly be times when you need to express a concern about your teen’s behavior. When you’re able to do this without coming across as criticizing, berating, or yelling, you’re more likely to get a positive reception. At the same time, you’re serving as a role model.

Often, the best way to frame a concern is by making an “I” statement: “When you do X, I feel Y.” And don’t automatically replace the Y with “angry.” When you dig a little deeper, angry feelings toward your child are frequently rooted in fear and worry. For example, you might say, “When you don’t come home on time, I feel worried about you.” This communication helps your teen understand that your reaction is based on deep concern for the safety of your child.

Communication lies at the heart of your relationship. Improving your and your teen’s communication skills can have a huge impact on all your interactions.