Attention Deficit Hyperactivity Disorder (ADHD) in Teens

• Attention deficit hyperactivity disorder (ADHD) is a behavior disorder that is characterized by hyperactivity or restlessness, impulsivity, and/or distractibility that interfere with the person's life in some way.
• ADHD is common, affecting millions of teens.
• While there is no single cause of ADHD, there are many factors that increase the risk of developing the disorder.
• Symptoms of ADHD in teens tend to be somewhat different compared to the disorder in younger children or in adults.
• There can be some differences between teenage boys and girls in their symptoms of ADHD.
• If a medical or mental-health professional suspects that a teen has ADHD, he or she will likely undergo an extensive medical interview and physical examination.
• Treatment of ADHD usually involves some combination of organizational and/or educational changes, psychotherapy, and/or medication.
• It is important for the ADHD teen and his or her family to work closely with the prescribing doctor to decide whether treatment with medications is an appropriate intervention. Monitoring for effectiveness and potential side effects of medications is also essential.
• There are many possible complications associated with ADHD, particularly if it remains untreated.
• ADHD usually requires treatment for it to be adequately managed.
• There are many support groups for people who suffer from ADHD.

Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder that involves abnormal thought processing. The symptoms of this disorder have been described in the known medical literature for at least the past 200 years. It is characterized by problems focusing, sitting still, and/or controlling impulses. It can have a significantly negative impact on the sufferer's ability to make and keep friends and other relationships and do well in high school, at work, and/or the community in general. Low self-esteem is a common side effect of the behaviors displayed by a teen with ADHD.

Types of ADHD in Teens

ADHD is understood as either one of three types: the primarily inattentive type, the primarily impulsive/hyperactive type, and the combined type. The primarily inattentive type is characterized by the person having great difficulty listening, focusing, organizing his or herself, and completing tasks. A teen with the inattentive version of ADHD generally does not have a significant problem managing their impulses or activity level. The primarily impulsive/hyperactive type of ADHD tends to result in the opposite set of symptoms compared to the inattentive type. Such a patient will have significant attention problems since he/she has great trouble sitting still, waiting their turn to talk, and managing their impulses. The individual who has the combined type of ADHD struggles with some aspects of inattention, impulsiveness, and hyperactivity.

ADHD is quite common. Among school-aged children, this disorder has been found to occur from 2%-20%, translating to 4.5 million children 3-17 years of age. While boys are still thought to develop this illness more often than girls, improved assessment of girls has resulted in the gender gap in diagnosis being significantly less than in years past.

ADHD in Teens Causes and Risk Factors

While there is no single known cause of ADHD, boys tend to develop this condition a bit more often than girls, and young people who have one or both parents with the disorder are more likely to develop it. Children who have ADHD are at risk for becoming teenagers and adults with the condition. A child whose mother suffers from depression, smoked cigarettes, or used other drugs or whose parents have lower levels of education are more at risk for having ADHD. Other risk factors for developing ADHD include the person's mother having medical problems and trauma to the abdomen during their pregnancy. There is some birth order research that supports the theory that first-born children tend to have a higher likelihood of developing ADHD compared to their siblings.

Common symptoms and signs of ADHD can include the following:

Inattention

• Trouble paying close attention or making careless mistakes
• Does not seem to be listening when directly spoken to
• Avoids or fails to follow through on instructions or to finish tasks (including homework)
• Has difficulty organizing tasks and activities
• Often avoids or dislikes tasks that require sustained attention
• Frequently loses things needed to perform tasks or activities
• Tendency to get distracted easily
• Often forgetful or inattentive

Hyperactivity and Impulsivity

• Tends to fidget
• Has trouble staying seated when doing so is necessary or expected
• Trouble engaging in activities quietly
• May feel restless or easily bored
• May talk excessively
• Often blurts out answers or interrupts others impulsively
• Frequently has trouble waiting his or her turn during activities

ADHD symptoms and signs in teenagers

While symptoms of hyperactivity in people with ADHD tend to decrease with age, most of the differences in symptoms of this disorder in adolescents compared to children and adults have much to do with the tasks that tweens and teens are called on to do at this stage of their lives. For example, teens with ADHD tend to show lower grade point averages, lower levels of class placement (for example, remedial versus honors or advanced placement), and higher rates of course failure. Also, teens with this diagnosis tend to complete and turn in a much lower percentage of in-class and homework assignments and are much less likely to be working up to their potential. Adolescents with ADHD are significantly more likely to be absent or tardy from school, and they can be over eight times more likely than adolescents without ADHD to drop out of high school. ADHD teens tend to be more impulsive drivers and have more accidents due to risky behaviors. Research has also shown that ADHD teens have more difficulty making and keeping well-adjusted friends. Unfortunately, in the face of the unique and significant impact that ADHD can have on their lives, teens tend to be the least willing to receive treatment compared to their younger and older counterparts. Research shows that adolescents are often more likely to have a negative perception of treatment and to be more likely to expect to have a bad experience as a result of ADHD treatment. Substance abuse is more common in teens with ADHD than their peer non-ADHD population.

Studies indicate that the symptoms of ADHD look different at times in teenage boys and girls. Specifically, girls tend to develop and be diagnosed with the disorder at later ages. Above preschool age, girls tend to exhibit inattention more often than impulsive and hyperactive symptoms and overall have more subtle symptoms. Girls also seem to be more at risk for also developing internalizing mental-health problems like depression, eating disorders, and suicidal behaviors compared to boys. Interestingly, boys of preschool age with ADHD tend to have less deviant, less severe symptoms compared to preschool girls with ADHD.

Many health-care professionals may help diagnose and treat individuals with ADHD: licensed mental-health therapists, pediatricians, family physicians, or other primary-care professionals, psychiatrists, psychologists, psychiatric nurses, licensed counselors, and social workers. If one of these professionals suspects that a teen has ADHD, he or she will likely undergo an extensive medical interview and physical examination. As part of this examination, the teen may be asked a series of questions from a standardized questionnaire or self-test to help assess the risk of ADHD.

Symptoms of ADHD may be associated with a number of other medical or mental-health conditions or can be a side effect of various medications. For example, teens with ADHD, depression, or bipolar disorder may all suffer from significant irritability. Therefore, routine laboratory tests are often performed during the initial evaluation to rule out other causes of symptoms. Occasionally, an X-ray, scan, or other imaging study may be needed.

Well-recognized diagnostic criteria for ADHD are as follows:

• Six or more symptoms of inattention that last for at least six months, is not adaptive, and not consistent with the sufferer's developmental level
• Six or more symptoms of hyperactivity/impulsivity for at least six months, is not adaptive, inconsistent with the sufferer's developmental level, and not solely symptoms of oppositional disorder, defiance, irritability, or trouble understanding the task or associated instructions
• Some of the above symptoms that caused problems occurred before 7 years of age
• Several of the symptoms take place in at least two settings (for example, school, home, work, with friends, relatives, other activities)
• Clear clinically significant problems in social, academic, or occupational functioning
• ADHD symptoms do not only occur as part of schizophrenia, or other psychotic disorder, and are not better explained by another mental-health disorder.

ADHD in Teens Treatment

There are a variety of treatments available for managing ADHD during adolescence, including several effective treatment medications, educational or vocational interventions, nutritional interventions, as well as specific forms of psychotherapy.

For individuals who may be wondering how to manage the symptoms of ADHD using treatment without prescribed medications, nutritional interventions are sometimes used. While treatment such as limiting exposure to food additives, preservatives, and processed sugars in the teen's diet have been found to be helpful for some people with some ADHD, the research data is still considered to be too limited for many physicians to recommend nutritional interventions. Also, placing such restrictions on the eating habits of a teenager can prove to be nearly impossible and set up a power struggle for the individual with ADHD and his or her parents and other caretakers. One natural remedy called phosphatidylserine (Vayarin) is being increasingly seen as a potentially effective treatment of ADHD. Vayarin is a prescription nutritional supplement that consists of omega-3 fatty acids and is thought to work by increasing what is thought to be a deficit in omega-3 fatty acids in the brains of many individuals with ADHD. There is some research that supports its use as an alternate to current standard therapy. However, a recent review of the literature did not fully support that finding.

Medical management of ADHD in teens may involve medications, educational or vocational interventions, psychotherapy, or some combination of these.

Medications in the stimulant class are known to be quite effective for treating ADHD. Examples of stimulant medications used to treat this condition include short-acting medications like methylphenidate (Ritalin) and dexmethylphenidate (Focalin), intermediate-acting medications like dextroamphetamine amphetamine (Adderall and Adderall-XR), and long-acting stimulants like methylphenidate slow release (Concerta, Daytrana), dexmethylphenidate (Focalin-XR), and lisdexamfetamine (Vyvanse). A long-acting dextroamphetamine (Adderall XR) is also available. However, for some individuals, the side effects of the medication prevent these medications from being appropriate. Therefore, specific nonstimulant medications, which are also approved by the U.S. Food and Drug Administration (FDA) for effective treatment of ADHD, are prescribed for those individuals. Examples of nonstimulant medications include atomoxetine (Strattera), guanfacine (Tenex or Intuniv), and clonidine (Kapvay). Medications that are often used to treat depression, like bupropion (Wellbutrin) and venlafaxine (Effexor), can also be helpful in the treatment of ADHD for some individuals.

As anything that is ingested carries a risk of side effects, it is important for the ADHD patient and his or her family to work closely with the prescribing doctor to decide whether treatment with medications is an appropriate intervention and, if so, which medication should be administered. The kinds of side effects caused by a medication are highly specific to which medication it is and to the group of medications it is in. The person being treated should therefore discuss potential medications with their treating physician and be closely monitored for the possibility of side effects that can vary from minor to severe, and can very rarely even be life-threatening.

The behavioral, educational/vocational, and psychotherapy components of treatment for ADHD are at least as important as the medication treatment. Dealing with the specific challenges that teens with ADHD present takes patience, understanding, and a balance of structure and flexibility. Knowing that the brains of people with ADHD tend to be about three years less mature than those of people without the disorder can go a long way in terms of learning how to handle ADHD teenagers at home or in the classroom. For example, the delay in brain maturation often results in teens with ADHD having trouble processing information and recalling information in a timely way. That often translates into challenges with tasks like writing essays or test questions, completing multistep math problems, recalling what is read, and finishing long-term assignments. Teachers and schools who are savvy at working with teens who suffer from ADHD often use techniques like physical and visual teaching materials, memory games, frequent breaks, and strategic seating to help the adolescent with this issue achieve their highest academic potential on a daily basis.

Another kind of psychotherapy used to treat ADHD is cognitive behavioral therapy (CBT). Behavior therapy seeks to help those with this condition identify and decrease the irrational thoughts and behaviors that reinforce maladaptive behaviors and can be administered either individually or in group therapy. CBT that seeks to help the ADHD sufferer decrease the tendency to pay excessive attention to potential threats has also been found to be helpful, particularly for teens who have anxiety or depression in addition to ADHD.

Behavioral techniques that are often used to decrease ADHD involve the parents, teachers, and other adult caretakers understanding the circumstances surrounding both positive and negative behaviors and how each kind of behavior is encouraged and discouraged. Specifically, learning when and where specific behaviors occur can go a long way toward understanding how to encourage the behavior happening again if it's positive or extinguishing it if the behavior is negative. Being aware of how the reactions of others contribute to a behavior's continuing or not continuing tend to help the teen with ADHD shape their behaviors more positively. Also, developing a fair and effective repertoire of ways to encourage positive behaviors and provide consequences for negative behaviors is a key component of any behavior management plan and therefore in parenting adolescents with ADHD.

Often, a combination of medication and nonmedication interventions produces good results. Depending on the course of treatment deemed most appropriate, improvement may be noticed in a fairly short period of time, from two to three weeks to two to three months. Thus, appropriate treatment for ADHD can relieve symptoms or at least substantially reduce their severity and frequency, bringing significant relief to many people with this condition. There are also things that people with ADHD can do to help make treatment more effective. Since substances like alcohol and illicit drugs can worsen ADHD, they should be avoided. Other tips to manage ADHD symptoms include getting adequate sleep, using visual techniques, as well as seeking reminders from parents or teachers to remember tasks and assignments, respectively.

People with an ADHD may also need treatment for other emotional problems. Depression and anxiety have often been associated with ADHD, as have alcohol and drug abuse. Recent research also suggests that suicide attempts are more frequent in people with ADHD. Fortunately, these problems associated with ADHD can be overcome effectively, just like attention deficit hyperactivity disorder itself. Sadly, many teens with ADHD do not seek or receive treatment.

There are many possible complications associated with attention deficit hyperactivity disorder. For example, people with ADHD have more academic risks and behavior problems like discipline problems, failing a grade, truancy, being expelled, dropping out, and not advancing to college. Teens with this disorder may have more accidents, both driving and otherwise. Particularly when untreated, people with ADHD are at risk for having trouble functioning at work, in relationships, and in society in general. Teens with the condition are also more likely to experience involvement with the juvenile justice system.

ADHD in Teens Prevention

As environmental and social insults like maternal drug use and medical and emotional issues are risk factors for developing ADHD, prevention or treatment of those issues can help prevent ADHD. Also, early treatment of people with ADHD can decrease the impact of the condition on the person's life as they move into adulthood.

ADHD in Teens Prognosis

ADHD can also have a significant effect on the mood, behavior, relationships, school, work, and other aspects of the lives of those who have it. For example, people with ADHD are more likely to experience a depressive illness than those without it. On a positive note, research indicates that when treated during childhood or adolescence rather than waiting until adulthood, individuals with ADHD tend to develop other psychiatric conditions less often than adults who do not receive treatment until adulthood.

Are there support groups for those with ADHD?

CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder): http://www.chadd-mc.org

Where can people find additional information on ADHD?

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org

American Counseling Association
http://www.counseling.org

American Psychiatric Association
http://www.psych.org

American Psychological Association
http://helping.apa.org

National Association of Social Workers
http://www.naswdc.org

National Mental Health Association
http://www.nmha.org