ADHD in Teenagers
How to help kids handle the new challenges and expectations of high school
Licensed Clinical Psychologist, formerly with the ADHD and Disruptive Behavior Disorders Center
Child Mind Institute
There is no typical teenager with ADHD-symptoms and impairments vary by gender, by what type of ADHD they have, by the environment they're in, and by their individual strengths and any co-occurring disorder they might have. Overall, teens with ADHD tend to display fewer of the hyperactivity symptoms we associate with ADHD in children. That's the good news.
But once kids get to high school, the expectations for them, both academically and socially, are greatly increased, and that can be tough on teenagers with ADHD.
Developmentally, teenagers are expected to be able to handle more autonomy: less structure in their school and home lives and less teacher and parental oversight.
Think of it as a chart with the line for structure and supervision heading down, and the line for demands and expectation going up. The lines cross in adolescence, and as the gap widens, the challenges for kids with ADHD mount. In addition, adolescents are more susceptible to peer group influence, which becomes more powerful in the teenage years, as kids gradually separate from their parents and other authority figures.
If your child has ADHD, it's important to be alert for struggles in many areas, not just his functioning in school. You also want to keep an eye open for difficulties in relationships with friends, emotional functioning, driving, and risky behaviors. We'll take these areas one at a time.
Without support, teenagers with ADHD tend to have lower grade point averages and scores on standardized achievement tests, and higher rates of school failure and suspension for problem behavior. Even if hyperactivity and impulsivity are not significant issues for your teen, symptoms associated with inattention and difficulty with organization can take a big toll once academic expectations are ramped up.
How you can help: Make sure your teenager has access to accommodations in school and in testing if he needs them. Tutors or homework helpers can help him if he is struggling with particular academic material, or just with the self-discipline to apply himself to homework. Helping him get (and stay) organized can be critical, whether you do it by creating structure for working at home, or get him an organizational coach, whose mission is to help him learn to organize himself.
Above all, teenagers with ADHD need parents to stay in the picture and know what they need to do and when they're doing it, rather than assuming they are handling the work independently.
About half of adolescents with ADHD have serious problems with peer relationships. Research shows that they tend to have fewer reciprocal friendships, and are more likely to be ignored or rejected by peers. They're also more likely to be the victim of bullying, or to bully others. It may be due to impaired social and communication skills—they may not listen to friends, fail to pick up on important social cues, or act impulsively or intrusively.
How you can help: The most important thing you can do is know who your teen is spending time with, and try to encourage her to discuss friendship and relationship difficulties with you or another trusted adult. It's also important to encourage participation in extracurricular activities, which offer social opportunities in a structured environment. If you see her seriously struggling to make, and keep, friends, you might want to find a therapist who teaches social skills.
The teenage years tend to be an emotional roller-coasterfor all kids, but those with ADHD are prone to poor emotion-regulation, which may result in greater highs and lows. Their emotional impulsivity can make it especially difficult for them to cope with frustration. It can be tough on them, and those around them.
How you can help: One thing you can do is to help your teen practice cool down strategies and develop coping tools. You can also talk to him about the value of apologizing after he has lost his temper. For kids with ADHD who are having serious problems with volatility, cognitive behavioral therapy can be effective.
Research shows that teenagers with ADHD tend to start using cigarettes, alcohol and illicit drugs earlier than typical kids. Later, they tend to have higher rates of smoking and substance use, and higher rates of alcohol-related problems. They also tend to become sexually active earlier, be more likely to have unsafe sex, and have higher rates of sexually transmitted disease.
How you can help: It's especially important for parents to know where your teen is and who she is with at all times. Encourage participation in extracurricular activities to minimize unstructured and unsupervised free time. Teach your teen about the risks associated with substance use and sexual activity, and encourage her to have an open dialogue with you about these issues. You want her to know what your rules and expectations are, but you also want her to feel comfortable coming to you with questions or calling you if she finds herself in a problematic situation.
Teenagers with ADHD may have challenges behind the wheel because of inattention or impulsivity. Research shows that they have higher rates of traffic tickets and accidents, and the accidents they have tend to be more serious than average.
How you can help: It's very important to take extra care in teaching teenagers with ADHD to drive. In some cases it may be wise to consider delaying the age when your teen beings driving, and to limit how and when he can drive (and who can be in the car with him) until you are confident that his skill and judgment are sufficiently mature. If your child takes medication for ADHD, it may be important to make sure he is taking medication when he's behind the wheel. You should make sure he's aware of the difficulties associated with driving and ADHD, and recognizes the importance of monitoring his own behavior to make sure he's a safe driver.
Published: January 4, 2013