It’s normal for teens to be impulsive, forgetful, and distracted at times. Their energy levels can fluctuate as well, depending on how much sleep they’re getting and what’s going on at any given moment in their lives. Some teens, unfortunately, struggle on a daily basis with being able to focus, remember everything they need to do, stay reasonably organized, and not act on every impulse. Basic skills other teens take for granted seem to elude those living with attention deficit hyperactivity disorder – or ADHD for short. Every area of their life – school, work, relationships, and family life – can be painfully affected.
As a parent, it can difficult to make the distinction between normal adolescent behavior – which often includes some impulsivity, forgetfulness, and lack of focus – and the potential signs of something more serious. This brief guide is designed to help you know the signs to watch for and the steps to take if you believe your teen has ADHD.
ADHD Statistics and Facts
Following are several statistics and facts about ADHD:
- An estimated 3% to 5% of individuals in the U.S. have ADHD
- ADHD is one of the most common mental health conditions affecting children
- According to a 2011 CDC survey, 11% of parents surveyed reported having a child (between the ages of 4 to 17) diagnosed with ADHD
- ADHD is more frequently diagnosed in boys than girls
- As many as 50% to 90% of children with ADHD have at least one other psychiatric disorder
- For individuals with ADHD, 25% also have anxiety, and anywhere from 20% to 30% also have depression
- Teens with ADHD have a higher risk of alcohol and drug abuse compared to other teens, with alcohol abuse twice as likely to occur and drug abuse (not including marijuana) three times as likely to occur
- The risk of depression and suicide attempts are 4 times greater in youth (ages 9 to 18) with ADHD according to a 2010 study; Compared to 1.6% of youth without ADHD, 12% of those with ADHD reported having a specific suicide plan
- Girls with ADHD may have a higher risk for depression and suicide than their male peers
Co-Occurring Disorders
It’s very common for individuals with ADHD to have an additional psychiatric disorder as well. The two most common co-occurring disorders are major depression and anxiety. Other disorders that often co-occur include:
- Substance use disorder
- Oppositional defiant disorder
- Conduct disorder
- Bipolar disorder
- Disruptive mood dysregulation disorder
- Obsessive-compulsive disorder
- Learning disorders
- Tourette’s syndrome
Risk Factors
Although there is no definitive cause of ADHD, there are several factors that may play a role in the increased risk of developing ADHD, such as:
- Environmental toxins, such as exposure to lead
- Having an immediate family member with ADHD or another psychiatric disorder – genetics are likely to play a role in the development of ADHD
- Being born prematurely
- Having a mother who smoked or used alcohol or drugs during the pregnancy
- Childhood trauma, such as exposure to abuse or domestic violence
Looking for and Recognizing the Signs of ADHD
If left untreated, ADHD can significantly interfere with every area of your teen’s life. While symptoms are often spotted during the childhood years, many individuals with ADHD aren’t diagnosed until adolescence or even adulthood. ADHD can significantly interfere in many areas of your teen’s life, including hindering his or her academic performance (and potentially ruining plans for college), social life, family life, and safety while driving. The disappointments, failures, and embarrassment caused by ADHD can also trigger or exacerbate feelings of depression or anxiety.
Knowing what to watch for and how to recognize the signs of ADHD will enable you to take the necessary steps to help your teen. Delayed intervention can lead to serious consequences for your teen’s life, both now and well into his or her future.
ADHD subtypes
ADHD symptoms fall into two categories – 1) hyperactivity and impulsivity and 2) inattentive. The former separate, but related, diagnosis of “ADD” (attention deficit disorder) is no longer used by most professionals. Instead, one of the 3 subtypes listed below is used to clarify which category of symptoms are predominant:
- Predominantly inattentive – most of the symptoms pertain to difficulties with attention and focus; there are few symptoms of hyperactivity and impulsivity
- Predominantly hyperactive-impulsive – the majority of symptoms pertain to impulsivity and hyperactivity; some inattentive symptoms may be present
- Combined – a combination of both inattentive and hyperactive-impulsive symptoms is present; neither category is predominant. The combined subtype is the most common.
Signs to watch for include:
Indicators of hyperactivity and impulsivity:
- Frequent fidgeting
- Difficulty sitting quietly or still for more than a few minutes
- Being overly talkative
- Frequently interrupting the other person in conversations
- Constantly “on the go”
- High energy levels / “hyper” behavior
- Intruding upon others’ activities or conversations
- Impatient; doesn’t handle having to wait
- Impulsive; frequently acts without thinking about potential consequences
- Gets bored very easily / requires constant stimulation
Indicators of inattention:
- Difficulty concentrating or staying focused for very long
- Frequent daydreaming
- Very easily distracted
- Forgetful
- Often loses or misplaces objects
- Difficulty getting and staying organized
- Often seems to not be listening when spoken to
- Dislikes or avoids doing tasks (e.g. homework) that require being focused
- Often makes careless mistakes
- Lack of attention to detail
- Difficulty following instructions
- Often doesn’t finish tasks
- Frequently procrastinates
Other signs that may be directly related to ADHD:
- Alcohol or drug abuse (often in an attempt to cope or medicate painful emotions)
- Depression
- Anxiety
- Poor grades
- Suicidal thoughts and behaviors*
*Suicidal thoughts or behaviors should never be ignored. Don’t make the grave mistake of assuming your teen is just being “dramatic” or manipulative. Adolescents with ADHD have a 4 times greater risk of attempting suicide than their non-ADHD peers.
Knowing the First Steps to Take
If your teen is exhibiting signs of ADHD, the first steps to take are:
1 – Talk to your teen. Let him or her know that you are genuinely concerned regarding the behaviors you’ve been observing and that you want to help in any way you can. Assure your teen that you’re willing to listen and talk about anything that may be troubling him or her.
2 – Set up an appointment for an evaluation. Your family doctor or pediatrician is a good place to start. He or she can perform an initial evaluation, including a physical examination to rule out any underlying medical issues that may be causing or contributing to your teen’s symptoms.
When it comes to adolescent ADHD, as with any mental health issue, it’s important to have your teen evaluated by a psychologist, psychiatrist, or another mental health professional who specializes in working with adolescents. Ideally, find someone who has a lot of experience diagnosing and treating ADHD. Look for someone who 1) is both cautious and thorough when it comes to making a diagnosis, and 2) truly understands the risks and challenges associated with this disorder for this particular age group. Your doctor may be able to give you a referral or recommendation.
3 – Get your teen into treatment. As with all psychiatric disorders, early intervention is important, especially if your teen was never diagnosed as a child. There are varying opinions among professionals when it comes to the treatment of ADHD. However, most of the research supports a combination of behavior therapy and medication. Currently, there’s no cure for ADHD, so the primary focus and goal of treatment is to learn effective ways to manage and cope with symptoms.
Individual therapy – One of the most effective types of therapy for ADHD for children and teens is behavior therapy or behavior modification. Teens may also benefit from cognitive behavior therapy and other forms of talk therapy in addition to behavior therapy, especially if they are suffering from depression, anxiety, or other co-occurring disorders.
Medication – Medication for ADHD is most effective when combined with therapy, rather than used alone or as the primary treatment. Many parents are understandably wary of ADHD medications; however, they can be very effective in helping teens manage their symptoms more effectively.
Stimulant drugs – The most frequently prescribed medications for ADHD are stimulant drugs. There are two categories of stimulant drugs – amphetamines (Adderall, Dexedrine, Vyvanse) and methylphenidates (e.g. Ritalin, Concerta, Focalin, Daytrana). One of the rare, but most serious, potential risks of stimulant medications is sudden death due to underlying heart problems.
Non-stimulant drugs – There are several non-stimulant medications that may be used to treat ADHD, although they don’t work as quickly. These include Strattera, Intuniv, Tenex, Catapres, Kapvay, and antidepressants such as Wellbutrin.
Family Therapy – Family therapy may also be helpful when dealing with a teen with ADHD. Family therapy can help improve communication, problem, and conflict solving, and help other family members learn healthy ways to support a teen with ADHD.
Supporting and Encouraging Your Teen
There are many things you can do to support and encourage your teen. Two of the most important things to remember are that 1) ADHD isn’t a sign of weakness and 2) it isn’t something your teen can simply overcome on his or her own. Take it seriously and think of it as you would any other health condition.
Things you can do include:
- Educate yourself about ADHD. Learning about the disorder and accompanying challenges will enable you to better help, understand, and support your teen in healthy ways
- Don’t ridicule, judge, or minimize the challenges your teen faces daily
- Be firm and clear with instructions; avoid nagging or lecturing your teen
- Don’t assume your teen is being disrespectful or ignoring you when he or she doesn’t seem to be listening or forgets to do something
- Find ways to minimize stress and over-stimulation in the home environment, as stress, chaos, and too much stimulation will exacerbate your teen’s ADHD symptoms
- Keep channels of communication open with your teen; be available and willing to listen to his or her struggles and concerns
- Avail yourself to parent training that will help you communicate effectively with your teen and assist him or her with skills such as staying organized and problem-solving
- Create a reminder system to help your teen stay on track with obligations, tasks, etc.
- Avoid getting into power struggles with your teen
- Give clear, concise, instructions for tasks and chores
- Affirm and reward the behaviors you want to encourage and nurture
- Keep a regular schedule and routine at home, especially with regards to your teen’s sleep schedule
- Set clear, concise rules, limits, and consequences regarding expectations and unacceptable behavior
- Be patient and keep negative emotions in check; blowing up at or being impatient with your teen will just make things worse
What to Do When Things Escalate
Due to the many risk factors associated with adolescent ADHD, things are most likely to escalate if your teen is:
- Abusing alcohol or drugs
- Being bullied or ridiculed by peers
- Unable to function at school or in other areas of life due to his or her ADHD symptoms or a co-occurring disorder
- Going through a period of high stress
- Attempting to cope with a recent traumatic experience
- Suffering from an additional psychiatric disorder, such as depression, anxiety, or other serious mental health condition
- Frequently engaging in non-suicidal behavior, such as cutting or burning
- Actively suicidal
If things start to escalate and your teen’s safety or wellbeing is at risk, don’t hesitate to reach out for help. You can:
- Contact your child’s treatment provider asap
- Enlist the help of a close family member or friend for immediate support or assistance
- Call an emergency suicide or mental health hotline
- Take your child to the nearest hospital emergency room (if you can do so safely)
- Call 911
When Individual Therapy isn’t Enough
Many teens with ADHD respond very well to a combination of individual therapy and medication. However, there are always exceptions. If your teen’s symptoms are severe or if he or she has an untreated substance use disorder or another psychiatric disorder for which individual therapy isn’t sufficient, a more intensive level of treatment will likely be necessary, at least for a relatively brief period. More intensive treatment options include:
- Intensive outpatient treatment (IOP) / Psychiatric day treatment
- Dual Diagnosis Treatment
- Residential treatment
- Inpatient psychiatric treatment
Intensive outpatient treatment or psychiatric day treatment can vary in terms of the amount of time spent in treatment and how many times a week your teen is required to go. These programs are typically the next step up from regular outpatient treatment.
Dual diagnosis treatment is usually indicated for teens who have a substance use problem in addition to ADHD. The effectiveness of individual therapy is almost always diminished when teens are using alcohol or drugs. Not to mention, it can be dangerous combining the medications used for ADHD with alcohol or recreational drugs. Dual diagnosis treatment focuses on addressing the substance use problem and ADHD (and any other mental health issues) simultaneously.
Residential treatment requires having your teen live at a non-hospital treatment facility that specializes in treating adolescents with ADHD and other mental health issues. Residential treatment typically lasts between 30 to 180 days, depending on the severity of symptoms and how well your teen is progressing in treatment.
Inpatient psychiatric treatment isn’t usually necessary to treat ADHD specifically. However, it may be a necessary intervention if your teen is suicidal or needs to be stabilized due to severe depression, mania, psychosis, or another psychiatric disorder. Patients are monitored 24/7 and hospitalization is usually brief.
Taking Care of Yourself
Having a hyperactive, impulsive, or inattentive teen is challenging for any parent. There will be times when you feel you’ve reached the absolute end of your patience and be tempted to lash out in anger and frustration. To maintain your own sanity and provide the love, acceptance, and support your teen needs in order to succeed, it’s imperative that you do things to take care of yourself. Things you can do include:
- Getting involved with a support group for parents of teens with ADHD
- Find healthy ways to manage your stress
- Get adequate rest; parenting a teen with ADHD can be exhausting at times!
- Seek support from close family, friends, church, or even a therapist if needed
With proper treatment and support, your teen can learn to effectively manage his or her ADHD symptoms and go on to live a happy, fulfilling life.