Attention Deficit Hyperactivity Disorder (ADHD)
Symptoms for ADHD
Though symptoms differ according to ADHD subtype — inattentive, hyperactive/impulsive, or combined — and with comorbidities, teens with attention deficit hyperactive disorder commonly experience some or all of the following symptoms more than other teens their age:
- Distractibility and lack of focus
- Disorganization and forgetfulness
- Self-focused behavior
- Hyperactivity and fidgeting
- Heightened emotionality and rejection sensitive dysphoria
- Impulsivity and poor decision making
- Poor concentration and trouble finishing tasks
ADHD Symptoms in Teens: Chronic, Not Constant
Despite their chronic difficulties with these symptoms (listed above), virtually all of those with ADHD have a few specific activities or tasks for which they have no difficulty in exercising their executive functions quite well which can be a source of confusion among parents, physicians, and psychologists. This may be in playing a favorite sport or video games; it could be in making art or music or some other favorite pastime. Seeing these exceptions, some parents assume that ADHD is simply a lack of willpower when, in fact, ADHD is not a willpower problem. It is an impairment with the chemical dynamics of the brain.
How Common are ADHD Symptoms in Teens?
The Centers for Disease Control and Prevention (CDC) reports that about 9.4 percent of U.S. children between the ages of 2 and 17 have been diagnosed with ADHD, making it one of the most commonly diagnosed neurodevelopmental conditions today. Experts say that 80 to 85 percent of preteens continue to experience symptoms into their adolescent years, and 60 percent of children with ADHD become adults with ADHD. The impact of ADHD symptoms may increase or decrease over time depending on the individual’s brain development and the specific challenges faced in school or at work.
How Do ADHD Symptoms in Teens Get Worse During Puberty?
The teenage years are grueling — for adolescents and for their parents. Even the most well-adjusted teen struggles with peer pressure, academic expectations, and emotional and physical changes. Teens with ADHD face an extra set of challenges: puberty aggravates their symptoms, higher academics tax their executive functions, and a drive for independence sometimes triggers their dangerous impulsivity just at the time they’re facing transitional milestones like learning to drive, engaging in sexual activity, experimenting with drugs and alcohol, and forming relationships with new or different friends. For many families, moving through the teen years is a bumpy ride.
Parents navigating these challenges benefit by working closely with school officials and finding a clinician experienced in treating teens with ADHD. With treatment — a combination of medication, behavior therapy, and family-management training is recommended — and timely intervention, caregivers can help their teens avoid or minimize risks for negative outcomes.
Many of your teens’ problems at home, at school, and in social settings arise due to neurological delays. ADHD is tied to weak executive skills — the brain-based functions that help teens regulate behavior, recognize the need for guidance, set and achieve goals, balance desires with responsibilities, and learn to function independently. Executive dysfunction hinders the following key skills, critical to school and life success:
- Response inhibition (being able to stop an action when situations suddenly change)
- Working memory
- Emotional control
- Sustained attention
- Task initiation
- Planning/prioritizing, organization
- Time management
- Goal-directed persistence (sticking with a task when it becomes “boring” or difficult)
- Metacognition (the awareness and understanding of your own thought processes)
On average, these executive skills don’t fully develop for anyone until their early 20’s. The timeline is 3 to 5 years longer for adolescents with ADHD, who are more likely to struggle with tasks that require executive functioning. In the meantime, teens with ADHD are unfairly labeled lazy or oppositional because these neurological deficits are largely invisible and misunderstood.
As their bodies grow and change, teens with ADHD tend to lag behind their peers in emotional maturity as well. Experts say a young person with ADHD will not achieve the emotional maturity of a neurotypical 21-year-old until they reach their mid or late 30s due to developmental delays in the brain’s frontal lobes.
How are ADHD Symptoms in Teens Diagnosed?
ADHD is most often diagnosed in elementary school — the average age of diagnosis is 7, and hyperactive boys are still the most likely to be evaluated. But if your child has the inattentive type of ADHD, as is often the case with girls (quietly staring out the window rather than paying attention to the lesson, or leaving their work undone), signs may be missed through elementary school — ADHD doesn’t suddenly develop during the teenage years but it may not be fully apparent until the challenges of high school.
For some teens, ADHD symptoms are not clearly noticeable until they move away from home and enter college. Research suggests that males are diagnosed with ADHD six times more often than females in childhood and three times more often in adolescence.
To be diagnosed with ADHD, a teenager must demonstrate a history of ADHD symptoms in at least two settings (usually at home and at school) that began before the age of 12. What’s more, the symptoms must interfere with the teen’s functioning or development.
Diagnosis is seldom accomplished with a quick visit to a general pediatrician. Proper diagnosis involves gathering information from parents, teachers and family members, filling out checklists, and undergoing a medical evaluation (including vision and hearing screening) to rule out possible medical issues and differential diagnoses.
According to the Journal of Adolescent Health assessing ADHD in teens is challenging due to variability in access to pediatricians who provide care for mental health issues. Another complicating factor is that many primary care physicians (PCPs) aren’t sufficiently trained in the idiosyncrasies of ADHD and its overlapping comorbid conditions, and as a result, are not equipped to perform the in-depth evaluation needed. Diagnosis rates diminish as children age through middle and high school.
What Are the Greatest Risks Facing Teens with ADHD?
As a group, teenagers make notoriously bad decisions. Among the most serious risks facing teens with ADHD are:
- drug use and addiction
- unwanted pregnancy
- sexually-transmitted diseases
- lower test scores
- higher rates of not completing high school
- regrettable internet and social media use
- serious car accidents
Thanks to the popularity of vaping, there are renewed worries about nicotine and marijuana and the more debilitating way these substances may impact the ADHD brain.
But perhaps more dangerous is the fact that ADHD impulsivity — exacerbated by peer pressure and disrupted treatment — may prompt teens to make some very unwise and potentially fatal decisions. Research overwhelmingly concludes that long-term use of ADHD medication lessens the risk of poor and/or impulsive decision making among adolescents.
To further counter this threat, teens need continued guidance. However difficult, parents must keep the lines of communication open, closely monitor their teens’ behavior, and set clear limits.
A recent study found that PCPs fail to educate and assess their teen patients with ADHD for driver readiness, risky sexual behavior, and medication diversion during checkups and sick visits. School counselors and medical practitioners are no substitute for a caregiver’s guidance and hard questions regarding sexual activity, safe driving, drug, and alcohol use.
The following are the most common and potentially dangerous problem areas for teens with ADHD:
Drug and Alcohol Abuse Among Teens with ADHD
A teen’s need to belong puts them at heightened risk for alcohol and drug use; low-self-esteem makes them more susceptible to peer pressure. The three leading causes of death in adolescents are accidents (unintentional injury), homicide, and suicide. Sadly, alcohol is frequently involved with each cause.
Most research shows no clear association between greater alcohol use in teens with ADHD compared to their peers without it. One study, however, found that 40 percent of children with ADHD had used alcohol before age 15, compared to only 22 percent of children without ADHD What’s more, studies do show elevated alcohol use among adolescents with both ADHD and oppositional defiant disorder. More research is warranted, however, parents are advised to know the following signs of substance abuse:
- Sudden and dramatic mood changes, particularly after a night out with friends.
- Red or heavy-lidded eyes with dilated pupils
- Deceit and secretiveness; stories that don’t add up
Automobile Accidents and Teens with ADHD
Learning to drive is a scary time for most parents. When you have a teen with ADHD, the fear is more than justified. Motor vehicle accidents (as a category) are the leading cause of death in teenagers and research shows that untreated ADHD is more likely to impair a driver’s ability due to core symptoms of distractibility, inattention, and impulsivity.
A 2019 study conducted by the Children’s Hospital of Philadelphia (CHOP) and published in Pediatrics found that drivers with ADHD had a 62 percent higher rate of injury crashes, and a 109 percent higher rate of alcohol-related crashes than did their neurotypical counterparts.
What’s more, delaying the driving age to 18 doesn’t appear to remedy the problem since many state laws designed to protect new drivers — stiffer penalties for the use of phones, limits on the number of passengers permitted in the vehicle, etc. — do not apply to drivers age 18 and older.
Since executive functioning skills and emotional maturity may lag significantly behind in children with ADHD, parents must carefully consider whether their teens are mature enough to drive. While some teens with ADHD are very careful drivers, others are not ready to manage driving safely. High impulsivity and emotionality may indicate that a child is not ready for this responsibility.
Medication Diversion Among Teens with ADHD
Medication diversion is a serious and all-too-common problem in high school and on college campuses, where stimulant medication may be abused as a study or diet aid. An alarming 25 percent of middle and high school students (and 50 percent of college students) diagnosed with ADHD were approached in the past year to sell, trade, or give away their stimulant medication.
Stimulants are a controlled substance and many adolescents with ADHD are not aware of the serious personal, legal, and financial consequences of selling or sharing their medication.
Parents should stress the idea of being discreet in sharing information about stimulant use. They should explain the serious risks of diverting medication and keep tabs on whether their teen is dealing with requests for pills or showing any signs of medication misuse. Reconnecting a teen to the prescribing physician when issues arise will allow for continued understanding and acceptance of ADHD and the medications made to treat it.
Oppositional Defiant Disorder and Conduct Disorder, two other common ADHD comorbidities among teens, are marked by antisocial, hostile, and unusually adversarial behavior. These disorders may place teens with ADHD , especially impulsive boys, in dangerous or even criminal situations. If symptoms emerge, quick and effective intervention with a trained professional is imperative.
If you have exhausted your local resources in getting your teen help, and are considering a therapeutic boarding school, contact us for more information.