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:
- To become independent from his parents;
- To establish an identity/find out who he is and what he stands for;
- To learn how to make deep, close interpersonal bonds with members of both sexes;
- To understand and come to terms with his emerging sexuality;
- To complete his education and decide on a career direction.
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:
- the severity of the teen's AD/HD
- the family environment4
- the presence of co-morbid problems/disorders in the teen. Such conditions commonly may include learning disabilities, mood disorders, anxiety disorders, and disruptive behavior disorders, including Oppositional Defiant Disorder or Conduct Disorder.
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)