Talk around ADHD often focuses on elementary aged children, when diagnosis is most common. However, teenagers often have difficulty with managing their symptoms while becoming more independent. The core symptoms required for a diagnosis of ADHD – inattention, hyperactivity, and impulsivity – remain the same in adolescence as they are in childhood. Yet, the specific pattern of symptoms and impairment may change as they mature. For example:
Inattention – Adolescents with ADHD may be more likely to show difficulties resulting from inattention (i.e., academic difficulties, inability to complete chores at home) then younger children due to increased demands and expectations for independent functioning.
Hyperactivity – Adolescents with ADHD typically show less gross motor hyperactivity than younger children. Hyperactivity is more likely to be demonstrated through fidgeting and restlessness than through gross motor activity.
Impulsivity – Adolescents with ADHD are most likely to demonstrate impulsivity through poor decision making and lack of consideration of the consequences of their actions.
Executive Functioning – ADHD is often most strongly evident in adolescents through poor executive functioning. Executive functioning refers to the ability to organize and monitor one's own activities, divide attention, and develop and maintain long-term plans. Adolescents with ADHD are often disorganized, distracted, and have difficulty handling the extra responsibilities that are placed on them as they mature.
These difficulties, coupled with many pitfalls of adolescence, can be extremely difficult for teenagers to manage on their own. Impairment is most commonly seen in the following areas:
Academic Performance: High school requires more work and demands more organization and independent functioning from students then lower grades. Adolescents with ADHD often struggle with the increased demands of high school. Many of the tasks hat are required for successful academic performance in high school may be very challenging for adolescents with ADHD, including:
Note-taking
Long-term projects
Studying for exams
Arriving to school/classes on-time
If these difficulties significantly impair academic performance, the student may qualify for classroom accommodations which will assist with taking tests or organizational support. These accommodations will allow the student to get the necessary services they need to perform up to their abilities.
Academic Performance: High school requires more work and demands more organization and independent functioning from students then lower grades. Adolescents with ADHD often struggle with the increased demands of high school. Many of the tasks that are required for successful academic performance in high school may be very challenging for adolescents with ADHD, including:
Note-taking
Long-term projects
Studying for exams
Arriving to school/classes on-time
If these difficulties significantly impair academic performance, the student may qualify for classroom accommodations which will assist with taking tests or organizational support. These accommodations will allow the student to get the necessary services they need to perform up to their abilities.
Social Functioning: Peer relationships are important in adolescent years. Teens with ADHD experience more difficulties with peer interaction and peer rejection than their peers. Some adolescents with ADHD prefer to socialize with deviant peers or develop inappropriate peer groups. Peer difficulties can have significant impact on academics, behavior, and emotional functioning in adolescents.
Home functioning: Adolescents are often expected to take on more responsibility at home as they mature, such as completing more chores at home, taking a part-time job, or providing supervision for a younger sibling. Adolescents with ADHD may experience more difficulty with these increases demands than their peers, as their inattention and impulsivity can lead them to forget to complete chores, be terminated from jobs, and fail to behave responsibly when caring for a sibling. Adolescents with ADHD may require additional assistance and training to help them develop independence and responsibility.
Parent-Teen Conflict: Parenting an adolescent can be stressful regardless of whether or not they have ADHD, but parent-teen conflict is significantly more frequent when the teen had ADHD. Adolescents with ADHD have more difficulty complying with requests, demonstrating responsibility, and considering the consequences of their actions. Adolescents with ADHD may thus be more likely to fail to complete chores, break curfew, succeed academically, engage in risky behaviors, use substances, and behave appropriately at home, which can significantly increase parent-teen conflict.
Two other areas are important to give more information on, as they are specific to adolescence. More information on drug and alcohol use in teens with ADHD, and driving for teens with ADHD is below.
Substance Use in ADHD
One of a parent's biggest concern, regardless if their child has ADHD or not, is the potential for drug and alcohol use. Teenagers often encounter these substances for the first time and have to make important choices. Recent studies suggest that adolescents with ADHD are 4 times as likely to use substances as their peers, and are at a higher risk for developing substance use in adolescent and adult years than their peers. When ADHD is comorbid with other disorders, such as depression or anxiety, the risk of substance abuse may increase further. While it is very important to be aware of the risk, there is no current literature on effective preventative measures for reducing alcohol and substance use in teenagers with ADHD.
Additionally, Many parents of teenagers with ADHD are concerned that their child's psychostimulant medication may result in substance use or abuse. However, there is no evidence of a link between appropriate medication treatment and substance use in teens with ADHD. Rather, studies have shown that substance use rates are highest in teenagers with untreated ADHD. Studies have suggested that stimulant medication use in childhood and adolescence may decrease the risk of substance use. However, psychostimulant medication does have the potential to be abused as a recreational drug. It is crucial that adolescents be assessed for substance use disorders prior to being prescribed psychostimulant medications. If an adolescent has an existing substance use disorder, it may be inappropriate to prescribe psychostimulant medications. In patients with comorbid ADHD and substance use disorder, the substance abuse treatment should be instituted first. Following remediation of the substance use disorder, medication treatment for ADHD may be considered if there is not evident risk of abuse. Further, both teens with ADHD and parents should remain vigilant on the location of the psychostimulant medication, so that it is not easily accessible to others.
Driving with ADHD
All parents of newly-licensed drivers are aware of the dangers of driving. In fact, motor vehicle accidents on the highway are the leading cause of death for adolescents aged 15 to 20. However, the impulsivity and inattention associated with ADHD can significantly impair adolescents' ability to learn safe and responsible driving habits. Inattention puts teenagers at risk for car accidents and speeding tickets. Teenagers who are not paying attention may not be aware of how fast they are going, may not be fully keeping their eyes on the road, or may become easily distracted by what is happening around them. Adolescents with ADHD are also often very impulsive, and may thus engage in risky behavior behind the wheel. For example, adolescents with ADHD may be more likely to speed, "drag race," or make risky turns or decisions while driving than their peers. Overall, adolescents with ADHD are involved in nearly four times more car accidents, are three times as likely to get speeding tickets, and are far more likely to cause injury in accidents then their peers. There are some circumstances that can be particularly risky for these teens, such as driving with other teens in the car. The presence of other teens can be very distracting, and may also lead to more risky behaviors to "show off." Additionally, adolescents with untreated ADHD are significantly more likely to have difficulties while driving then adolescents whose ADHD is being effectively treated.
Thankfully, there are some tips for teens with ADHD and their parents when it comes to driving. Specifically:
Ensure that the adolescents receives plenty of supervised experience driving before allowing them drive independently. This may take the form of additional driver's education, such as a safe/defensive driving courses. Such experience may reduce their rate of risky driving behavior.
Set rules on driving to reduce the risk of accidents. Rules may include restrictions such as:
Removing distracters such as cell phones, music, etc. while the adolescent is driving.
No nighttime driving
No driving unsupervised with other teens in the car
Ensuring that the adolescent has taken all prescribed medications prior to driving.
Revoking driving privileges for risky or unsafe driving behavior.
Successfully driving is a learned skill, much like other skills that adolescents must master. Safe and appropriate driving can become a habit. The more practice that an adolescent has in a supervised setting, the more likely they are to exercise good judgment when driving independently.
