Parenting and Adolescents With AD/HD: An M.D.'s Advice

Does your teenager have AD/HD? Learn how to keep lines of communication open while promoting his indpendence.

By Shashank V. Joshi, M.D.,FAAP

Many parents wonder what kinds of challenges and changes kids with Attention-Deficit/Hyperactivity Disorder (AD/HD) experience during their teen years. Dr. Shasank Joshi, a pediatrician and child psychiatrist, answers:

Parents are often interested in knowing whether puberty will lead to specific physical and emotional changes in their teens with AD/HD. Contrary to popular belief, teens do not routinely go through a "really hard time" adjusting to puberty and the developmental tasks of adolescence. According to some classic work by Conger (1977), there are at least five such tasks for the average teen:

Robin (1998) expands on this, and comments that a teen is expected to successfully complete these tasks while getting along with his family and doing his schoolwork!4 So, although puberty per se may not predispose teens with AD/HD to different problems than teens without the condition, it may be that adolescence as a period of development is more contentious for a teen with AD/HD. In this article, I'll address questions parents often ask about AD/HD in teenagers.

Do teens struggle with anxiety and acceptance of their AD/HD?

When a child with AD/HD reaches early adolescence (age 11-14) several factors may affect his ability to cope. They include:

Even if a teen doesn't meet diagnostic criteria for any of the disorders listed above, he and his family may have a hard time adjusting to this adolescent stage. Younger teens typically have the most trouble accepting that they have AD/HD, and they're often less eager to try ways to cope with it, such as classroom modifications, behavioral interventions, or medication management. Older adolescents (aged 15-19) are usually better able to acknowledge and accept their AD/HD, and are often more willing to actively deal with their problems.

Although most teens with AD/HD are not "worriers," they may experience more nervousness than when they were younger. This may actually be due to a sort of performance anxiety in the context of their new developmental tasks.4 For the first time, they may notice that they're "different" from their peers, and may lack confidence in social, family, and academic situations. When faced with an unexpected crisis or asked to perform a job/task for which they are not prepared, they may overreact emotionally and display (temporary) panic and/or anxiety symptoms. In fact, some research indicates that up to 35% of teens with AD/HD have a diagnosable co-morbid anxiety disorder (compared to 9% of their non-affected peers).1

Do AD/HD symptoms change during puberty?

During adolescence, kids with AD/HD may experience several changes, as summarized in the work of Lily Hechtman, M.D.2 While a small group of children actually seem to "outgrow" their AD/HD, the majority continues to have significant problems with regard to attention, concentration, and impulse control. These may continue to impair their functioning, both at school and at home, and negatively impact their self-esteem and their ability to achieve some of the necessary developmental tasks of adolescence.

A small group of teens with AD/HD may develop patterns of antisocial behavior and/or substance abuse. In fact, those at highest risk for the latter are those whose AD/HD has not been treated or managed properly. (Early treatment for children with AD/HD may have a direct positive effect on decreasing later substance abuse as teenagers.3)

Are there behavior differences between adolescent boys and girls with AD/HD?

Girls are more often diagnosed with the "Inattentive" subtype of AD/HD than other types. Even though boys are diagnosed with all types of AD/HD more often than girls, having the inattentive type often allows girls to get through their elementary school years relatively "normally," though they may have been struggling all along. Perhaps due in part to societal expectations, a girl with AD/HD may not be the "squeaky wheel" that gets the teacher's attention and is regularly sent to the Vice Principal due to disruptive behaviors. Contrast this to the inattentive, noisy, impulsive, fidgety boy, who is the prototypical child with AD/HD. A girl with AD/HD may begin to show the most difficulty as the school work gets harder, and when sustained attention, organization, and concentration become crucial to success (as in middle school).

Facts to consider before talking with your teen about AD/HD

Before discussing AD/HD with your teenager, you'll want to understand the cause and effects of the condition. Keep the following facts in mind:

What to tell your teen with AD/HD

Many authors have written thoughtfully on this topic.2, 4, 5 Here are some suggestions for what to tell your teenager:

What risky behaviors do some teens with AD/HD engage in?

There are data from scientific research to indicate that teens with AD/HD are more likely to get into car accidents, to have lower self-esteem, and to have more negative risk-taking behaviors (including substance abuse, especially if they go untreated) than their peers without the disorder. This makes it especially important that kids be assessed and treated as early as possible.

What can parents do if their teen refuses to take medication for AD/HD?

It's very important for a teen to feel that he's the "captain of the ship" regarding his treatment, and that his parents and other adults (e.g., teachers) are in more of a supporting role. This is especially true of taking medication, which can have deep psychological meaning for a teen. Selected research assessing teens' perceptions of stimulant medications showed that the two most important factors influencing whether or not they would take the medication are: 1) the perception that taking medication makes them feel as if there's something wrong with them, and 2) feelings of embarrassment about receiving the medication publicly.6 Many doctors believe teens should retain "veto power" over most, if not all, decisions regarding medication.4, 8 However, a system of checks and balances also means that parents can restrict certain privileges if the teen elects not to follow the treatment plan. For example, for safety reasons, parents may withhold driving privileges from a teen who refuses to take his medication for AD/HD.4, 8

How can parents offer their teens with AD/HD independence but still provide necessary structure and supervision?

As discussed earlier in this article, realize that it's natural for most teens to want individuation from their parents; this is a normal developmental task of adolescence. Although teens with AD/HD feel they should have exactly the same rules and privileges as their non-affected peers, parents of teens with AD/HD have good reason to be extra-vigilant. Barkley (1995) and Robin (1998) offer these supervision tips for parents of teens with AD/HD4, 9:

AD/HD by Other Names and Acronyms

While Attention-Deficit/Hyperactivity Disorder (AD/HD) is the official term and acronym used by today's mental health care professionals, it is sometimes referred to by other names and abbreviations. For example, it is sometimes called:

ADHD (without the "slash" in the middle)

Attention Deficit Disorder (ADD)

Attention Disorder

References

  1. Biederman J, Faraone S, et al (1996): A prospective 4-year follow-up study of Attention-Deficit Hyperactivity and related disorders. Archives of General Psychiatry , 53, 437-446.
  2. Hechtman LT (1992): Long-term Outcome in Attention-Deficit Hyperactivity Disorder. Child and Adolescent Psychiatric Clinics of North America, 1, 553-565
  3. Wilens TE, Faraone SV, Biederman J, and Gunawardene S (2003): Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-analytic Review of the Literature. Pediatrics, Jan; 111(1): p. 179-85
  4. Robin AL(1998): ADHD in Adolescents, NY: Guilford Press
  5. Guyer BP (2000): ADHD: Achieving Success in School and in Life, Boston: Allyn & Bacon
  6. Bowen J, Fenton T, & Rappoport L(1990): Stimulant medication and Attention-Deficit Hyperactivity Disorder: The child's perspective. American Journal of Diseases of Childhood, 145, 291-295.
  7. Conger JJ (1977): Adolescence and Youth: Psychological Development in a Changing World. NY: Harper
  8. Joshi SV, Khanzode L, Steiner H (2003): Psychological issues in pediatric medication management, in: Steiner, Handbook of Mental Health Interventions in Children and Adolescents: An Integrated Developmental Approach, SF: Jossey-Bass
  9. Barkley RA (1995): Taking Charge of ADHD: The Complete, Authoritative Guide for Parents. NY: Guilford Press