Module 5 – Moving into Adolescence with ADHD

Moving into Adolescence with ADHD

Estimated Time: 60 minutes

In this module, you will learn:

·       Why a later diagnosis can be problematic

·      How to spot the signs of ADHD in adolescence

·       The impact of ADHD on the adolescent

·      Treatment for adolescent ADHD symptoms

 

Moving into Adolescence with ADHD – 5m43s

5.1 Why a Later Diagnosis Can be Problematic

Even though ADHD can affect children as young as four, it is sometimes not diagnosed until the teenage years.

It is widely accepted that there is a better chance of ADHD being well managed when it is caught at an early age. A treatment plan and coping strategies can be put in place, and become part of the child’s established routine long before they hit the difficult teenage years. Later diagnosis – when the child has already moved into adolescence – can be problematic.

The problem with a later diagnosis is that the condition has most likely already had a harmful impact on their life, and could have caused other serious issues such as low self-esteem, anxiety and depression. Furthermore, an adolescent already used to feeling like a failure is going to find it harder to engage in any new strategies suggested as part of a treatment plan.

However, that is not to say that at this stage of their development that all is lost, because that is certainly not true at all. Instead, a different approach is needed to make sure that the condition is brought under control.

If a teenager’s ADHD has not been spotted early enough – or at all – they will almost certainly have spent many years being misunderstood and having their behaviour criticised. The resulting lack of self-esteem, coupled with others’ negative perception of them, means they are far more likely to get into difficulties. This may be at school, where they could struggle to fulfil their academic potential, and be labelled as lazy or a troublemaker; or it could be in their social life or family life, where they begin to take more risks, leading to bad choices and further trouble.

For example:

Research has shown that teenage drivers who have ADHD are more likely to be in a car accident than their neurotypical peers. This is largely attributed to the way in which the condition affects their concentration, as well as their decision-making: they are more used to taking risks, acting impulsively and are prone to distraction.

It’s interesting to note that girls with ADHD are far more likely than boys to get a late diagnosis. There are a couple of reasons for this: girls are more likely to have the inattentive type of ADHD, and even if they have the hyperactivity-impulsivity type, their symptoms are subtly different to those displayed by boys.

Girls with inattentive type ADHD often get overlooked well into their teenage years or even into adulthood. Their symptoms – such as forgetfulness, daydreaming or distractibility – are not as obvious as the symptoms presented by those with the hyperactive type. Because there are proportionately more girls with this type of ADHD as compared with boys, it means that more of them slip through the cracks.

Girls with hyperactivity-impulsivity type ADHD are also underdiagnosed. This can be attributed to the way their symptoms manifest and are perceived. For girls, hyperactivity can present as incessant talking, which is often put down to them simply being chatty, whereas boys’ symptoms can often be far more disruptive and obvious.

Regardless of whether ADHD has been diagnosed in early childhood, or later in adolescence, there are new challenges when the child reaches their teenage years. Puberty can exacerbate symptoms, schoolwork becomes more demanding, and the child may push for a new level of independence they are not yet emotionally ready for. It’s a challenging time for everyone involved and requires a great deal of patience and the application of new strategies.

5.2 How to Spot the Signs of ADHD in Adolescence

So, how can parents tell if their adolescent child is struggling? And if ADHD is the cause, or something else?

Greater awareness will make it easier for you to spot if a teenager is showing signs of ADHD. The difficulty is, however, that you need to determine if it is ADHD or some other kind of behavioural issue, or if they are just going through teenage angst. Also, for it to be considered ADHD, they must have had some symptoms before the age of 12.

How does ADHD affect a teenager’s life?

65% of children with ADHD continue to display symptoms during adolescence. Spotting ADHD in the ups and downs of your teenage child’s life can be more challenging than it appears. You have to look for symptoms over a period of time and make sure you’re not confusing normal teenage behaviour with ADHD symptoms.

Teenagers with ADHD may forget due assignments, become bored with classwork (and then become fidgety and disruptive), and lose their books. They may blurt out answers out of turn without waiting, or interrupt conversations. They may rush through assignments and sports, and perform poorly on the athletic field. They are more likely to get into car accidents and fights. Teens with ADHD are often thrill seekers, impulsive, and immature in judgement and decision-making.

It is no coincidence that adolescents with ADHD are more prone to substance abuse – whether that be drugs or alcohol. It is thought to be linked to their lack of impulse control, poor judgement, and in some cases a need to self-medicate. Adolescents with ADHD, particularly those who remain undiagnosed, may be trying to find something which will make them feel calm.

ADHD symptoms in adolescence

The symptoms that an adolescent may display when it comes to ADHD are typically the same as those in a child, so we are talking about an inability to concentrate or focus, being easily distracted, being irritable, or having poor impulse control and hyperactivity.

However, there is one major difference, and it is crucial that you are aware of this. Thanks to the hormonal upheaval of puberty, the symptoms of ADHD will often get worse at this point in their life. Undiagnosed teens may have their symptoms noticed for the first time, and adolescents who have already been diagnosed may find that their normal coping strategies are less effective.

Another concern is that as the child moves into their teenage years, they are likely to desire, and gain, more freedom. However, when there is an issue with impulse control and hyperactivity, it is common for the adolescent to take more risks and make some poor choices. Parents need to be mindful of this and be ready to guide and support their child.

We will now review the symptoms to help you to identify if there is indeed an issue. Please remember they must present with these symptoms to a greater degree than other adolescents their age:

• Easily distracted
• Showing a lack of focus
• Being forgetful
• Being disorganised
• Being hyperactive
• Fidgeting excessively
• Showing heightened emotions and sensitivity
• Being impulsive
• Making poor decisions
• Having poor concentration
• Having trouble finishing tasks

As with childhood ADHD symptoms, there may be more of an emphasis on inattentive symptoms for some and hyperactive symptoms for others. Furthermore, the severity of symptoms may vary, and they may fluctuate depending on specific challenges faced at home or school. What is consistent is that the symptoms have a profound impact on the life of the teenager.

FACT

Parents can help their adolescents with ADHD by offering breaks when they work on tasks, rewarding positive behaviour, and making sure the teen gets enough exercise, which helps to burn off excess energy.

Source: Youngminds.org.uk

It can be difficult for parents or teachers to spot ADHD in teenagers. Many ADHD adolescents have favourite interests in which they can show sustained focus and achieve great success, for example in art, music or sport. This can be confusing, as it makes it appear as if the teenager could always focus if only they tried harder at their less-appealing tasks. As we already know, this is not the case.

5.3 The Impact of ADHD on the Adolescent

The symptoms of ADHD have a significant impact on the life of an adolescent, at school and at home.

In addition to the impact of observable symptoms, parents should also be aware of the underlying issues which cause them, and how they will affect the child’s progress. There are developmental delays which could impact them well into early adulthood and can make them vulnerable to several significant risks as they begin to operate more independently.

Many of the problems of ADHD are due to these developmental delays, particularly those around executive function and behaviour regulation. Skills such as sustained attention, time management and planning/organisation tend to develop in neurotypical people throughout adolescence and are established by their early 20s, but for those with ADHD, they are often delayed by as much as 5 years. Similarly, people with ADHD tend to remain emotionally immature for a significantly longer time than their neurotypical peers.

Teens with ADHD are also at a greater risk of developing comorbid conditions such as depression and anxiety, and they often do less well academically.

It is not too uncommon for adolescents with ADHD to fall behind at school, for the following reasons:

• They forget assignments or are generally disorganised
• They are inattentive or inclined to daydream
• They are prone to interrupting other students or the teacher
• They struggle to sit still in class and then become disruptive
• They may be impatient and rush through an assignment, not completing it correctly
• They focus on the wrong things and get distracted from their goals

As you can imagine, all of these things have the potential to cause problems for them when it comes to their academic performance. This can be a source of frustration for many ADHD teens, as they try hard to keep up with their schoolwork, but find it impossible due to their symptoms.

It is not only in the classroom that ADHD can cause a problem for adolescent children. ADHD can affect interaction with their peers, and the relationships that they are building at that stage can also be negatively affected. This all makes growing up even harder than it should be.

There are many risks for the ADHD adolescent as they grow and reach for independence. The teenage years are traditionally strewn with milestones such as experimenting with alcohol or engaging in sexual activity for the first time, and these transformative events can mean problems for people with ADHD.

The main risks associated with this period of their lives are as follows:

• Substance abuse: It is thought that impulsivity, poor judgement, and a need to belong put ADHD teenagers at greater risk of drug and alcohol abuse than their neurotypical peers.
• Issues with their peers: Due to them either being seen as too quiet or perhaps too loud and always in trouble, social interactions can be difficult for teenagers with ADHD.
• STIs and unwanted pregnancies: Teenage girls are at greater risk of having an unwanted pregnancy or an STI than their neurotypical peers, because of risky behaviour brought on by hormonal changes at puberty.
• Inappropriate social media/internet use: People with ADHD sometimes lack the social skills required to communicate online, where it’s often more difficult to understand social cues.
• Car accidents: Teenagers with ADHD are more likely to be involved in serious car accidents than their neurotypical peers because they often act impulsively, can be thrill-seekers and are prone to distraction.
• Medication diversion: Teenagers and young adults are vulnerable to being approached to sell their stimulant medication, and they may be unaware of the consequences of this action.

In summary, the risks faced by ADHD teenagers are significant, and can seriously impact their life in the present and the future. They require guidance and coaching from their parents and other caregivers in order to mitigate these risks. The good news is that many of these risks are lessened if the teenager is on ADHD medication and/or receiving behaviour therapy and their symptoms are under control.

5.4 Treatment for Adolescent ADHD Symptoms

Finally, we review treatment options for adolescents with ADHD.

Treatment for ADHD in the teenage years is much the same as in childhood – meaning, therapy and medication – but with some subtle differences. If medication is used, getting the dosage right will be a moving target, due to hormonal changes and growth spurts. New side effects to medication may emerge and will have to be addressed. In some cases, the teenager may be reluctant to take medication at all, or to engage with other treatment options such as therapy.

It can be a challenging time, but there are some things you can do to help the child and yourself:

Understand treatment options

It used to be the belief of many that behavioural therapy was the only solution that was required when it came to the treatment of ADHD in teenagers, but research has consistently shown that as much as 80% of teenagers with the condition can benefit a great deal from using medication.

Therapy should also be encouraged – a combination of therapy and medication is key to controlling symptoms. Many of the treatments detailed in the next module are suitable for teenagers, such as CBT, behaviour therapy and coaching.

Get help from a paediatrician/psychiatrist and other therapists

If they are only going to see a specialist for the first time, get as much help and information as possible from them, especially in those areas that you feel you are struggling with. They are there to help and no question or comment is going to be seen as being silly.

If they were diagnosed earlier in life, it is still important that you keep in touch with their specialist and seek help for the new challenges of adolescence.

Keep a close connection with their school

As teenagers spend a large proportion of their time at school, it makes sense that you should maintain a close connection with their teachers. Ensure any new issues which could affect their level of engagement in school are communicated, and raise any concerns you have with how the school is supporting them.

Keep lines of communication open

Neurotypical adolescents need a lot of support and guidance through those turbulent teenage years of change. ADHD teenagers need even more help. It’s important that they feel able to talk openly to an adult, be it a parent, grandparent, family friend or teacher, and ask for the aid they require.

Understand the role of an adult

If you are caring for a teenager who has ADHD, you must be clear on your role and how you can help.

There are clear steps that you can take in your approach to the situation:

• Make sure you give clear instructions and clear expectations at all times
• Create a schedule or routine for them
• Reduce the number of limitations as much as possible
• Get them involved in activities where they can have individual success
• Model positive behaviour at all times
• Work at building their self-esteem, as this is often low
• Give rewards for success
• Help the teenager when it comes to getting themselves organised
• Have a reminder system in place for anything that is important
• Always stay calm, no matter how difficult that may be at times
• Always make sure that they get the sleep they need, as lack of sleep is a major trigger
• Get to know their other triggers and reduce exposure to them where possible, or find coping strategies

That may sound like a lot to contend with, but it is all about giving teenagers with ADHD some sense of order to prevent them from feeling overwhelmed. A teenager with ADHD will require a substantial amount of guidance from you, but the effort will be well worth it.

This is not a battle that you have to fight all on your own, as there is help and advice out there, but you have to take the lead and use all available resources to find the best approach for the teenager in question.

Assignment

Moving into Adolescence with ADHD

Time: 30+ minutes

Work your way through this worksheet to see how well you have understood the relevant information.

Download the worksheet below print out and complete.

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SUMMARY

In this module, we have focused on adolescence and ADHD. Many children that are diagnosed with this condition are diagnosed during this stage of their development.

Children who are diagnosed later in life are at a disadvantage compared with others who received their ADHD diagnosis in early childhood. They often already have low self-esteem and other mental health issues by the time they find out the cause of their problems.

Girls are more likely to be diagnosed late than boys because they more commonly have the inattentiveness type of ADHD, which is more easily missed.

Teenagers need a lot of support and guidance as they navigate life with ADHD. Because of their impulsivity, they are at greater risk of car accidents or making mistakes with substance use, sexual activity, or inappropriate social media/internet use.

Medication and therapy are still the cornerstones of ADHD treatment during adolescence, and can make a huge difference to managing symptoms during these challenging years.

In the next module, we will look at how ADHD can affect people in their adult life.

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