AD/HD and Adolescence: A Formula for Risk and Vulnerability
Dr. Sam Goldstein describes the many risks and vulnerabilities teenagers with AD/HD face.
By Sam Goldstein, Ph.D.
Attention-Deficit/Hyperactivity Disorder (AD/HD) is characterized by a constellation of problems caused by symptoms related to inattention, hyperactivity, and impulsivity. These problems are developmentally inappropriate and cause difficulty in daily life. At one time AD/HD was considered a disorder of childhood, and it was thought that the symptoms of AD/HD diminished by the late adolescent years. The experiences of clinical practice and well-documented research, however, have shown that a significant number of children with AD/HD carry their symptoms and impairment into the adolescent years and on into adult life.
In many ways, the responsibilities and demands placed upon adolescents in comparison to children require an increase in competence and self-discipline, because teens in our culture are able to participate in many adult activities such as driving, surfing the Internet, and using substances (e.g., drinking alcohol and smoking).
The Nature of AD/HD
According to the revised fourth edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) - the standard diagnostic manual used throughout the world - Attention-Deficit/Hyperactivity Disorder encompasses three basic diagnoses: AD/HD-Inattentive Type, AD/HD Hyperactive/Impulsive Type, and AD/HD-Combined Type. AD/HD is a biopsychosocial disorder, which means there are strong genetic, biological, experiential, and social factors that contribute to the severity of impairment experienced by individuals with AD/HD. (Though teenagers with the Inattentive Type of AD/HD may be somewhat less vulnerable to these problems than those with the Combined Type of AD/HD, the diagnosis, regardless of subtype, speaks to significant risk.)
Approximately one in fifteen adolescents meets the criteria for symptoms and consequent impairment for a diagnosis of AD/HD. Early identification and proper treatment has been found to dramatically reduce the family, educational, behavioral, and psychological problems and risks experienced by youth receiving this diagnosis. Such problems include:
- school failure and dropout
- behavioral disorders
- vocational problems (into the adult years)
- relationship problems (into the adult years)
- substance use and abuse
Fortunately, it has been demonstrated that accurate diagnosis and proper treatment help manage or prevent the myriad of life problems experienced by a significant percentage of youth with AD/HD.
The Role of Self-control
An increasing body of current research suggests that the true nature of AD/HD lies in the inability of some individuals to develop effective self-discipline or self-control. It is not so much that individuals with AD/HD cannot pay attention but that they do not effectively regulate their attention, emotions, and behavior. AD/HD interferes with a teen's ability to sustain attention, particularly when self-control is required (e.g., while performing repetitive tasks). AD/HD impairs the ability to effectively manage one's emotions, activity level, and inhibition. Inhibition is the ability to prevent the impulsive expression of dominant urges so as to permit time for self-regulation. When it comes to behavior, teenagers with AD/HD appear to know what to do but do not consistently do what they know is appropriate . This is due to their inability to efficiently stop and think before responding, regardless of the setting or task. Thus, these teenagers seem to defy common sense. They understand the risks associated with their behavior, yet their limited capacity for self-control is often quickly overwhelmed, frequently leading to "non-thinking" behavior and a myriad of problems at school, home, with peers, and in the community. There is also research that suggests individuals with AD/HD are more likely to seek novelty and stimulation leading to risky behavior.
AD/HD can be thought of as a catalyst, which, under certain conditions, can "fuel" an extreme reaction. Consider this: If you place a teenager with AD/HD in a supportive context, the symptoms of AD/HD will cause problems but may not represent a significant risk through the adolescent years. But research to date shows these symptoms certainly do not represent an asset. If you were to place that same teen with AD/HD in a dysfunctional family, expose him to a poor school environment and other significant life stresses, add to that a lack of appropriate treatment for the condition, then AD/HD would represent a significant formula for risk and vulnerability during his teen years. In the face of adversity, the capacity to plan, inhibit, and consider alternatives and actions is a significant asset - one that teenagers with AD/HD typically lack.