The First Day Back to School after Vacation: Was it Difficult for you and your Child/Teenager with ADHD?

In my previous blog entry, I talked about how to diminish the amount of arguing between the child with ADHD and his parents. As children with ADHD grow older, moments of contention are arguably sparked by specific situations. For example, some parents of children with ADHD as well as the children themselves may arguably find the the first day of school after a vacation to be a difficult day.

On these children’s vacation days, they have typically been engaged in activities at a much slower pace than the ones in which they are engaged on a school day. Additionally, oftentimes, the activities in which they participate on their vacation are typically of their own choosing as well as ones that they enjoy, such as going to the movies, playing video and computer games, and going to shopping malls, etc., among others.

Then, all of a sudden, vacation is over and once again, they have to attend school the next day. As soon as school starts, children with ADHD’s schedule is not only much more restricted, but in addition, is not controlled by them. Their schedule is now controlled by their parents. They have to go to bed at a certain time, get up at a certain time, do their homework, remember to put their homework in their school bag, (which is not always so easy!) as well as to adhere to a restricted nightly routine, such as taking a shower, brushing their teeth, etc., among many others.

Believe it or not, children with ADHD are much more productive when they complete their daily responsibilities according to a restricted schedule. That being said, one way to seemingly reduce the tension between your child/teenager with ADHD over their schedule is to make the schedule together. In that way, they will learn the art of compromise, which is really the only way to diminish unpleasant interactions that may include anything from minor disagreements to major arguments.

In addition to designing the child’s schedule together, another way to diminish unpleasant interactions is to reduce the child’s stressful reactions to anything that might result in an argument. In order to reduce stress, any chore that might possibly be completed before the morning, when time is of the essence, will most definitely reduce an argument between the child/teenager with ADHD and his parent.

For example, make sure that he picks out his clothes in the evening before he goes to bed. If your child is one who finds it difficult to decide on what to wear, or changes his mind, let him pick out two outfits, with a clear understanding that he will chose one of those outfits in the morning. Even though you required him to choose clothes in the evening that he will wear in the morning, he retains some control when you ask him in the morning, “Which outfit are you going to wear?”

Let me know what you think…..

To Argue with your Preteen with ADHD or not to Argue: That is the Question

When I have meetings with the parents of the preteens with whom I work, they often come to me to tell me that all of a sudden they are arguing with their child with ADHD about every little thing, where as previously, they never argued. These arguments may be over what time to go to bed, what to eat breakfast, and what time to do homework, especially if the decisions concerning those issues have been constant. Preteens with ADHD also have been known to argue over what other children are permitted to do independently. Some children with ADHD argue about the weather. Others have been known to argue over whether or not they have both been arguing with each other, if only to argue about some issue!

Up until a certain age, parents typically mold their children with ADHD and as part of that experience, arguably, control what are their child’s responsibilities, schedules and activities. Sometimes, as arguably is the case in terms of only children, these parents allow themselves to become manipulated more often than in homes where there are multiple siblings, because their decisions only impact one child.

As children with ADHD grow older, they begin to reject their parents making decisions for them, and that is when “…the wild rumpus starts.” This is especially true with only children, especially if their parents have permitted themselves to become manipulated by their child. FYI: Every parent has been manipulated, one would assume, from one time to another.

However, the more that parents have been manipulated, the more that there is a struggle over control. What can you do in order to have peace in your household again, as well as to get along better with your child? Here are some ideas:

1.      Make sure that both parents agree with each other in terms of how to behave toward their child, as well as what decisions to make. If one parent agrees with the child, instead of agreeing with the other parent, a terrible imbalance of power will be set in motion that will be almost impossible to unravel.

2.      Try not to start arguments yourselves. Let the small differences of opinion go. You want to win the war, even if you have to lose a few battles.

3.      DO NOT ARGUE WITH YOUR CHILD! Realize that you, an ADULT, are in “combat” with a 10, 11 or 12 year old CHILD!

4.      The moment that your child begins to argue, ask her if she is upset about something that happened at school, on the bus, or with her friends. If she continues to argue with you, tell her that you will be happy to discuss that issue when she is calm. Tell her to come to see you when she would like to talk about what is bothering her. The moment that she begins to yell or scream, walk away until she calms down.

5.      When she comes to talk to you, drop everything to talk to her. Let her begin the conversation, and do nothing but listen to her conversation, until she stops talking. Do NOT discuss the fact that she was arguing with you, which would be a nonproductive discussion. Instead, tell her how happy you are that she came to discuss those issues with you, and that you will try to help her in any way that you can, now, and in the future, as well. This is the time to build trust, before she grows into a full-fledged teenager.

Hopefully, this intervention will encourage many more productive conversations with your child with ADHD and less arguing!

Please Read this Request about Completing a Survey to Collect Data for my New Book

Esta M. Rapoport, Ed.D
E-Mail: estamrapoport@gmail.com
Website: http://www.socialskillstrainingservices.com/
Blog: adhdanswers.blogspot.com
Twitter: adhdanswers

February 22, 2012

Hi Everyone:

As some of you already know, a few years ago, I wrote a book based on my doctoral research entitled ADHD and Social Skills: A Step-by-Step Guide for Teachers and Parents, published by Rowman and Littlefield. (FYI: Here is the Amazon link: http://www.amazon.com/ADHD-Social-Skills-Step---Step/dp/1607092808/ref=sr_1_1?ie=UTF8&qid=1329941895&sr=8-1)(My book is also available as an e-book on https://rowman.com/ISBN/9781607092803)

I have been asked by my publisher to write a book on teenagers with ADHD. I am collecting data via a short survey, where I am asking those adults with ADHD to reflect on their teenage years, and those who are teenagers, to reflect on their current experiences. I am also asking the parents of those teenagers to complete a separate survey. NO NAMES WILL BE USED IN THE BOOK. If you agree to complete my survey, I will email you the survey as well as an informed consent, which I will ask you to sign.

I would so appreciate if as many of you as possible who have ADHD could complete the survey, as well as your parents. This book, hopefully, will help the millions of teenagers with ADHD and their parents to manage both of their lives more easily and productively.

PLEASE FEEL FREE TO SEND THIS LETTER TO ANYONE YOU KNOW WHO HAS ADHD, just in case they are interested in helping me to collect the data, so that I will be able to write this book.

If you have any questions, please do not hesitate to contact me. Thank you so much for helping “the millions!”

Dr. Esta M. Rapoport

What is Critical to do when you are Teaching Social Skills to a Child/Teenager? GET the PARENTS on BOARD!!

The process of teaching social skills is a long, but inevitably successful one for children and teenagers with ADHD. This process involves helping children and teenagers with ADHD to realize that their socially inappropriate behavior may oftentimes be the reason why they have difficulty making and keeping friends.

What are some of these socially inappropriate behaviors? For example, they do not maintain eye contact; they do not know how how to join in when others are playing; they constantly interrupt, among other socially inappropriate behaviors.

If they do not know and understand why they need to learn those social skills, they will not internalize them. Let us remember that unfortunately, children/teenagers with ADHD’s socially inappropriate behavior has resulted in their receiving negative attention, which tends to increase that inappropriate behavior rather than diminishing it. This negative attention is similar to the response that the class clown received, who we all remember from our school days.

As much as it is imperative to get the child on board, it is also vital to get the parents on board, as well. This is not always so easy. Why? The child/teenager’s parents have been interacting with their child in a certain way for many years. Even though they know that their child needs help, they somehow arguably have adjusted their behavior in order to accommodate their child’s behavior. All of us who have children with ADHD are all too familiar with giving in to a certain behavior as a trade off for a few minutes of peace…seriously!

It is therefore vital to get the parents on board. The parents must be willing to interact in the same way that the person who is teaching social skills to their child is interacting. It is difficult enough to teach the child to modify his/her behavior, nonetheless to have the parents revise their own behavior.

During this process, it is critical that the parents only express positive comments to their child concerning the social skills that the expert is teaching their child. Most children and teenagers with ADHD need to learn how to respect others, which is one of the most important of the social skills. If the parents disrespect the teacher to their child, by being critical of them, for example, then the child will in turn, disrespect the teacher, as well.

 If the parents do not adhere to the teaching methods that the social skills expert is facilitating, the child will learn positive social skills in the environment in which they are taught, but will not generalize those new skills to other settings, such as the home.

Each child with whom I work comes to me with years of exhibiting behavior that is inappropriate. The only way that children and teenagers with ADHD can succeed at learning new and positive social skills, is to be taught those new skills in one setting, and then to be taught to use those new skills in as many settings as possible.

Do you have a Teenager with ADHD? Would you (or your teenager) agree to complete a survey reflecting on those years for my new book?

(You will see an informed consent form below as well as a parent survey.)

 Hi Everyone:

I was wondering if I could ask you for some help. I am writing a proposal for a new book on teenagers with ADHD. If any of the parents of teenagers with ADHD out there (if your child is college age, you can still reflect) would not mind, I would so appreciate if you (parents) would complete the survey below for me, which asks you to reflect on your teenager with ADHD's teenage years. If your teenager would agree to complete a survey themselves, please email me and I will email one to them immediately.

PLEASE, HOWEVER,  PRINT OUT this INFORMED CONSENT FIRST, SIGN IT, or have your TEENAGER SIGN IT if they are completing a survey, and EMAIL BOTH THE INFORMED CONSENT AND THE SURVEY to my email address, which is estamrapoport@gmail.com. You will be helping some of the over 5,000,000 students with ADHD. Thank you!!!

If you need a separate email with the informed consent and/or the survey attached, please let me know. Thanks so much again.

Dr. Rapoport

Dr. Esta M. Rapoport

Research on Teenagers with ADHD

Informed Consent Form

1.      The study that you will participate in will involve research.

2.      The purpose of the research is to determine how teenagers have been affected by having attention-deficit/hyperactivity disorder (ADHD) in terms of their academic achievement, social interaction, making and keeping friends, self-esteem and self-confidence.

3.      You will answer questions in the format of a written survey. The answers to the questions in the survey will be collated, organized, and analyzed so that they serve as supportive documents for the topics in my book.

4.      There will be no foreseeable risks or discomforts to you.

5.      The benefit that you may reasonably expect from the research is a better understanding of the difficulties that teenagers with ADHD experience as a result of the symptoms of their ADHD.

6.      No real names will be used in the reporting of the answers to questions from the survey that Dr. Esta M. Rapoport distributes, whether online or by hard-copy. Any quotes that are used by Dr. Rapoport will include faux names.    

7.      You will be able to contact me, Esta M. Rapoport, at estamrapoport@gmail.com to ask any pertinent questions about the research as well as your rights.

8.      Your participation is purely voluntary, and any refusal to participate or discontinue  participation at any time will not involve any penalty or loss of any benefits to which you were otherwise entitled.

I have read and understood the information on this Informed Consent Form. I have agreed to participate in the research, and have received a copy of the Informed Consent Form.                                            

                                                 ____________________________________________

Dr. Esta M. Rapoport

Questionnaire for Parents

1. When and in what circumstance did you tell your child that he/she had ADHD?
2. How did you describe ADHD to your child?
3. How were you certain that your child understood what having ADHD meant?
4. How did your child feel about having ADHD?
5. What symptoms did your child exhibit as a young child?
6. What symptoms did your child exhibit as a teenager?
7. What symptoms did you exhibit as a child that diminished when you became a teenager?
8. What added symptoms did you exhibit as a teenager that you did not exhibit as a young child?
9. How did the symptoms of ADHD affect your teenager’s school work and grades?
10. How did you feel about the fact that your child had ADHD?
11. How did you respond to your child about the fact that he/she had ADHD?
12. How sympathetic were you to your child at the time you told him that he had ADHD?
13. How supportive were you to your child with ADHD when he experienced difficulties as a teenager?
14. How has ADHD been difficult for your child as a teenager?
15. How has having ADHD affected your teenager‘s self-esteem and/or self-confidence?
16. How did having ADHD affect your teenager’s social life, specifically making and keeping friends?
17. As a teenager, what did your child tell his friends about having ADHD?
18. As a teenager, what did your child tell his extended family about having ADHD?
19. If your teenager told his friends about having ADHD, what was their reaction?
20. Was your child bullied (teased) as a teenager?
21. What do you think was the cause of being bullied? (teased)
22. How was being bullied (teased) related to your teenager having ADHD?
23. What kind of techniques or methods did you teach your child that would stop him from being bullied?(teased)

         

        

     

Middle School Might be a Treacherous Time for Children with ADHD Unless........

The age that children enter middle school varies. In one school, the youngest children are in 5th grade, while in other schools, the youngest children are in 6th or 7th grade. At any rate, the middle school years can be treacherous for children with ADHD, from the changes in the organization of their classes, to the independence that is required of them, to the rapidly changing social mores.


You can see, therefore, why I call this a treacherous time. How can you prepare your child with ADHD for the upcoming challenges? Elementary schools typically take a tour of the middle school, probably in the Spring, which is far away in time for the child with ADHD to remember much about the school.

I would take your child on another tour in August. Trust me that the school does not mind. In that way, as a start, he will have a picture in his mind of the configuration of the school. Additionally, before you take a second tour, however, I would design a faux schedule, so you can show him how to go from room to room in the allotted time, as if that schedule was his actual one.

I would also try to begin a series of conversations, which will continue as the year progresses, on the various essential difficulties that are bound to sprout up during the middle school years. For example, here are a few possible areas of difficulty that your child might experience:
 Finding students with interests similar to your child’s interests

 Being included with other children at recess or lunch

 Using social media or text messaging, (outside of school) so that he can build and develop his friendships

 Joining in with clubs or activities

 Being accountable for his school work

 Being aware of social activities

 Joining in with social activities after school and/or on weekends

We will be discussing these topics in my next blog entry.

AD/HD and Teens: Information for Parents (National Resource Center on ADHD)

“Shouldn’t my teen have outgrown this by now!?!” You, along with many other parents, may be wondering why your child hasn’t outgrown his or her difficulties sitting still, thinking of consequences before acting, resisting distractions, organizing daily activities,

and managing time wisely. In contrast to what was previously thought, today’s research has shown that the majority of children do not outgrow AD/HD when they reach adolescence.1

AD/HD IN ADOLESCENCE

Symptoms: The core symptoms required for a diagnosis of AD/HD—inattention, hyperactivity, and impulsivity—remain the same during adolescence as they were earlier in childhood, but the pattern of symptoms and difficulties may change somewhat. In adolescence, some symptoms of AD/HD, particularly those related to hyperactivity, can become more subtle. However, the difficulties that teens experience as a result of AD/HD symptoms, such as poor school performance, may intensify due to increased demands and expectations for independent functioning.2

Some of the more pronounced symptoms in teens with AD/HD are related to deficits in “executive functioning.” Executive functioning refers to the functions within the brain that “activate, organize, integrate, and manage other functions.”3 Stated differently, executive function allows individuals to foresee longer-term consequences for actions, plan accordingly, evaluate progress, and shift plans

What We Know20B ad/hd and teens: information for parents 2

as necessary. In addition to difficulties with executive functioning, individuals with AD/HD may also exhibit lower frustration tolerance, exhibit emotional responses that are in excess of what is expected, or appear more emotionally immature than same-aged peers.4

Diagnosing AD/HD in Adolescence

Some teens with AD/HD were not diagnosed in childhood and may begin to struggle more as demands increase in adolescence. You or your teen’s teachers may suspect that AD/HD symptoms are contributing to these struggles. For teens not diagnosed in childhood, obtaining a diagnosis of AD/HD in adolescence can be complicated for several reasons.5,6 First, to qualify for a diagnosis of AD/HD, symptoms must be present in some way prior to age seven; however, recalling symptoms that were present in the past is often difficult. Second, many of the symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) diagnostic criteria are primarily written for younger children (e.g. “runs about or climbs excessively”) and may not be applicable to teens. Third, obtaining reliable reports of teens’ symptoms from external observers, such as parents or teachers, is more difficult. This is because adolescents usually have several different teachers, each of whom sees them for a small portion of the day. Similarly, you likely have less direct contact with your teen during the teenage years than you did during their younger childhood. Fourth, as mentioned above, some of the striking symptoms of AD/HD, such as extreme hyperactivity, may be more subtle in teens than in younger children. Finally, the presence of other disorders may complicate the diagnosis of AD/HD. If you suspect that your teen may have undiagnosed AD/HD, it is important to seek a comprehensive evaluation that includes a careful history, clinical assessment of academic, social, and emotional functioning, and reports from you, teachers, other involved adults (such as coaches) and your teen. This evaluation should also include a physical examination to rule out other causes of observed symptoms. If you would like to have your teen assessed for AD/HD, see a psychologist, psychiatrist, or other clinician with expertise in AD/HD.

CAUSES OF AD/HD

Research has clearly shown that AD/HD is highly genetic, and the majority of cases of AD/HD have a genetic component. AD/HD is a brain-based disorder, and the symptoms shown in AD/HD are linked to many specific brain areas.7 Other causal factors, such as low birth weight, prenatal maternal smoking, or other prenatal complications, also contribute to some cases of AD/HD. Patterns of parenting and family interaction may help reduce the impact of the symptoms of AD/HD or may make them worse; however, parenting styles do not cause AD/HD.

CO-OCCURRINGCONDITIONS IN THE TEEN YEARS

It is common for other conditions to occur along with AD/HD.8,9 These conditions may have been present since childhood, or may emerge with the additional stress of adolescence. In fact, up to 60% of children and teens with AD/HD have been found to have at least one additional disorder. 10,11 These disorders can make parenting more challenging, and many parents find professional assistance helpful in providing support, resources, and additional parenting strategies for their teens.

Some of the most common conditions experienced • by teens with AD/HD are difficulties with disruptive behavior, including Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD). ODD is characterized by a pattern of excessive noncompliant and defiant behavior and refusal to comply with requests and rules. CD is a more severe form of noncompliant and defiant behavior that is also associated with difficulty maintaining relationships and causing harm and destruction to people and animals. Research has shown that teenagers with AD/HD are 10 times more likely to experience disruptive

“Patterns of parenting and family interaction may help reduce the impact of the symptoms of AD/HD or may make them worse; however, parenting styles do not cause AD/HD. “ What We Know20B ad/hd and teens: information for parents 3

behavior disorders.12 Other research has estimated that anywhere between 25 – 75% of teens with AD/HD have one of these disruptive behavior disorders.

Mood disorders, including depression and • dysthymia (a type of negative mood similar to depression but longer in duration), can also be prevalent in teens with AD/HD. Research has estimated that between 20% – 30% of teens with AD/HD have a co-existing mood disorder. Bipolar disorder is another type of mood disorder sometimes discussed as co-morbid with AD/HD. However, diagnosing bipolar disorder in teens with AD/HD is controversial13 and a diagnosis of AD/HD does not appear to increase the risk for bipolar disorder.14

Anxiety disorders may be present in as many as • 10 – 40% of teens with AD/HD. Anxiety disorders are characterized by excessive worry and difficulty controlling worries. Individuals suffering from anxiety may also experience physical symptoms including headaches, upset stomach, and rapid heartbeat. They can also experience “anxiety attacks” and begin to avoid anxiety-provoking activities.

Substance use and abuse is a significant concern • of many parents of teens. Indeed, risk for substance use among children with ADHD ranges from 12 – 24%. Use of medication to treat AD/HD is not associated with increased substance use. In fact, use of medication to treat AD/HD may protect adolescents from developing substance abuse disorders later in life.15 The strongest predictor of substance use among teens with AD/HD is an additional diagnosis of conduct disorder. Symptoms of substance use in teens may include: smelling of alcohol or smoke, changes in eyes or face (i.e., bloodshot eyes or flushed face), mood changes, deceitful or secretive behavior, changes in motivation or decreased academic performance, and/or changes in peer group.

Learning and communication problems can be • significant and research has indicated that learning disorders may be present in as many as 1/3 of youth with AD/HD.16 The demands of middle school and high school place additional stress on teens and parents should remain aware of their teen’s academic performance and carefully monitor any changes or declines in performance. Communication disorders include not only difficulty with speech production (such as stuttering), but also difficulty with understanding language and the ability to express one’s self clearly. When parents are concerned about their teen’s communication, they should express their concerns to the teen’s school and/or consult a speech/language pathologist for an evaluation.

Sleep disturbance is also common in teens with • AD/HD. Changes in sleep cycles are normal for all teens as youth begin to stay up later at night and consequently desire to sleep later in the morning. Teens also require more sleep overall. In youth with AD/HD, sleep disturbance may be even more pronounced and is not necessarily a side effect of medications. Given this risk, sleep should be carefully assessed prior to starting medication to determine pre-existing sleep disturbance as separate from medication side effects.17

At this time, it is not possible to predict which teens will experience these additional conditions. It is likely that genetics play a role. The additional stresses experienced by teens with AD/HD, such as social criticism or internal frustration, may also make teens more vulnerable to these difficulties. For more information on these co-occurring conditions, please see What We Know #5: AD/HD and Co-existing Conditions. What should you do if you suspect that your teen may suffer from any of these additional conditions? If you would like to have your teen assessed, see a psychologist, psychiatrist, or other clinician with expertise in AD/HD.

AD/HD in theTeenYears

What does it feel like to have AD/HD? Teens with AD/HD may experience stigma or embarrassment related to their diagnosis. They may also wish to deny that they have AD/HD. Teens that have AD/HD may feel different their peers, and they may wish to believe that their symptoms have faded or disappeared with age. It is important for parents of teens to normalize their AD/HD. Explain to your teen that having AD/HD is not due to any mistake he or she has made and is not a punishment. Liken AD/HD to other medical conditions, such as asthma or poor eyesight. Explain that it is not the teen’s fault that he or she has the problem, but that treatment will be essential to avoid letting it limit his or her success.

Teens with AD/HD may also have concerns related to their self-perception and be vulnerable to poorer self-esteem than their peers. A sample of teens with ADHD and learning disabilities reported feeling severely stressed when going to school and sitting in class, feeling What We Know20B ad/hd and teens: information for parents 4

tired, frequent quarreling with close friends, feeling different from other classmates, having low self-esteem, and feeling that their parents didn’t understand them.18 Engaging teens in activities which they enjoy and where they feel successful can be powerful ways to address and reverse these concerns. When teens feel successful and confident about themselves in one aspect of their life or abilities, these feelings can often generalize to other areas of functioning as well.

AD/HD AFFECTS…

Academic Performance:• High school is characterized by a more frenetic pace, more demands to juggle, and less supervision. Academically, the workload and difficulty of the material increases, and long-term projects rather than daily homework assignments are the norm. These factors all present challenges to the teen with AD/HD. Adolescents with AD/HD may benefit from assistance with note-taking, study skills, and organization/time management. It is important to help provide teens with the skills necessary so that they can shift from relying on parents or teachers to structure their time and schoolwork schedule to relying on their own abilities. If your teen has a diagnosis of AD/HD and AD/HD symptoms impair academic functioning, he or she may qualify for classroom accommodations. Accommodations can include extra time on tests, taking tests in a separate location where distractions are minimized, or additional organizational support. Inquire with school personnel for more information if you feel that your teen may qualify for and benefit from these accommodations. For more information on your child’s educational rights, please see What We Know #4: Educational Rights for Children with AD/HD.

Social Functioning:• Many children with AD/HD exhibit difficulties in peer interaction due to impulsivity, hyperactivity, and aggression. Younger children with AD/HD may be intrusive in social interactions, louder than their peers, and more disruptive. Peer problems and peer rejection experienced during childhood can continue into adolescence. In addition, a lack of positive peer relationships in earlier years can limit opportunities to practice and refine social skills, thus making existing deficits worse. Finally, the importance of peer relationships increases during adolescence. Therefore, difficulties in establishing and maintaining relationships can become increasingly disruptive to functioning. Teens with AD/HD are at risk for associating with maladaptive peers or for experiencing peer rejection. Providing your teen with opportunities to participate in structured social activities, such as sports, clubs, or youth groups can help provide positive experiences to offset other, potentially negative, interactions.

Home Functioning:• On average, households of adolescents with AD/HD are characterized by more parent-teen conflict.19 Parenting a child with AD/HD is stressful. Parenthood requires that you place certain demands on your child (e.g. completing homework, participating in chores, returning home before curfew). Teens with AD/HD have more difficulty complying with requests and need more reminders and supervision. This can be frustrating for both you and your teen, and may lead to a cycle of negative interaction. When you repeatedly place demands on your teen with which he or she does not comply (due to inattention, lack of interest, or lack of ability), there is often an escalation of negativity. In such a cycle, you may find yourself lecturing, yelling, or punishing your teen who then responds with anger, additional lack of compliance, or other negative behaviors. As this occurs repeatedly, more minor demands and infractions on rules can trigger the escalation of negativity. An additional source of conflict in the home is that teens with AD/HD often require more supervision and help with organization than others their age, at a developmental stage in which they desire additional freedom and independence. What can be done to interrupt this cycle? Clear communication is always important, including explicitly stating rules and expectations and establishing consistent rewards and consequences. If family conflict is exacting a large toll on your family, consider seeking professional help from a qualified mental health professional.

Treatment of AD/HD

Unfortunately, no cure currently exists for AD/HD and treatment focuses on symptom management. Although the symptoms of AD/HD may change with age, teens with AD/HD still require treatment to target these symptoms and may require treatment into adulthood. 20

Education is a necessary component to any treatment and provides teens and families with the tools to understand What We Know20B ad/hd and teens: information for parents 5



their disorder and treatment. It is likely that your family received this education when your child was first diagnosed with AD/HD. This education may have been focused directly toward you as the parent, particularly if your child was much younger at the time. As your teen’s ability to understand his or her diagnosis and responsibility for treatment increases, it is imperative that this education occur again and be targeted directly toward your teen. Education should also address possible negative attitudes towards AD/HD and treatment. However, education alone is not a sufficient treatment.

It is a myth that medication becomes less effective in the teen years. In fact, medications for AD/HD should be as effective, but patterns of co-occurring conditions may require changes to the treatment regimen.21 Additionally, many parents and teens may consider the change to long acting medications to provide better symptom management throughout the day as many teens have activities after the school day has ended and into the evening hours. Another myth is that medication use may increase the risk of substance use. In fact, as mentioned above, medications reduce the risk of substance use for teens with AD/HD.22 A thorough discussion of these medications is beyond the scope of this handout, but please refer to What We Know #3: Managing Medication for Children and Adolescents with AD/HD for more information.

Behavioral intervention is another common treatment approach for teens with AD/HD. Proven psychosocial treatments include parent-teen training in problem-solving and communication skills, parent training in behavioral management methods, and teacher training in classroom management.23 Please see What We Know #7: Psychosocial Treatment for Children and Adolescents with AD/HD for more information. Little or no research currently exists to support the use of dietary treatments, traditional psychotherapy, play therapy, cognitive behavioral therapy, or social skills training. However, these interventions may be effective in treating co-occurring conditions if present. You can refer to What We Know #6: Complementary and Alternative Treatments for more information.

The most common and effective treatment for teens with AD/HD combines medication and psychosocial treatment approaches. This is sometimes referred to as multi-modal treatment.

PARENTINGTHE TEEN WITH AD/HD

Teens with AD/HD are facing the same issues that prove challenging for their peers: development of identity, establishment of independent functioning, understanding emerging sexuality, making choices regarding drugs and alcohol, and setting goals for their futures. However, teens with AD/HD may also face some unique difficulties in successfully accomplishing these developmental tasks. Given their difficulties with executive functioning, teens with AD/HD may require more support and monitoring from parents than teens without AD/HD. If your teen has been diagnosed since childhood, you have already likely learned ways to maximize his or her success. However, the challenges teens with AD/HD present to parents are different than those presented by younger children. Below are some areas that may be unique to adolescents.

Behavior management:• All children seek additional freedom as they enter adolescence. Be clear with your expectations for responsible behavior, reward appropriate behavior with additional privileges, and enforce consequences for inappropriate behaviors to help your teen learn from his or her mistakes and successes. If you are experiencing difficulty with managing your teen’s behaviors, consider seeking additional help from a qualified mental health professional.

Driving:• Inattention and impulsivity can lead to difficulties with driving. Drivers with AD/HD have more tickets, are involved in more accidents, make more impulsive errors, and have slower and more variable reaction times.24 The use of stimulant medications has been found to have positive effects on driving performance.25 Talk to your teen about safe driving habits, such as using a seat belt, observing the speed limit and other “rules of the road,” and

“Use of medication to treat AD/HD is not associated with increased substance use.”What We Know20B ad/hd and teens: information for parents 6

eliminating distractions such as use of mobile phones and eating while driving. Consider restricting the number of individuals that can be in the car while your teen is driving.

Adherence to medication regimen:• Nearly half of children do not take AD/HD medications as directed, for a multitude of reasons,26 and the use of AD/HD medications decreases over the teenage years.27 Parent and teens often disagree on the degree of impairment that results from adolescent’s AD/HD symptoms.28 In addition, adolescents may have negative attitudes toward medication use. If your teen expresses a desire to discontinue his or her use of medications, it may be helpful to discuss this with his or her physician and consider a trial period without medication under the physician’s supervision. During this period, you can work with your teen to specify goals and develop a plan that includes tutors or behavioral interventions to achieve those goals. Also, specify with your teen what indicators might illustrate the need for resumption of medication. These could include declining grades or increases in conflict at home and with peers. Set a date and time to evaluate progress and re-evaluate the decision to discontinue medication.

Medication diversion:• Studies show the diversion of medications, or use or abuse of AD/HD medicines among peers for whom these medications are not prescribed, is an increasing problem.29 Teens may divert their medications either as a favor to friends or for financial gain. Reasons for non-prescription use of psychostimulants may either be academic or recreational.30 It is recommended that you talk to your child openly and honestly about AD/HD and its treatment. Inform teens that selling prescription medications in this way and the use of such medications by individuals for whom they were not prescribed is illegal and could have serious legal consequences. In addition, AD/HD medications are safe and effective when taken as directed, but can be dangerous if used without medical supervision. It is important to talk to your child about peer pressure so that he or she will be prepared to respond appropriately if asked to divert medications.

Boosting your teen’s confidence:• Living with AD/HD can be challenging for you and for your teen. Don’t forget to emphasize your love and support for your teen. Communicate that you are there to help him or her work through difficulties and that you believe that he or she can be successful. Try to help your teen identify his or her strengths and find opportunities for him or her to experience success.

Disclosing the diagnosis of AD/HD:• When your child was younger, it is likely that you made decisions regarding when and with whom your child’s diagnosis of AD/HD would be shared. As your child matures, you may find that your feelings regarding disclosure differ from those of your teen. A frank conversation with your teen on the potential risks and benefits of disclosure may help clarify this issue for both of you.

YOUR TEEN’S FUTURE

Teens with AD/HD are at risk for potentially serious problems as they transition into adulthood. First, as many as two-thirds of teens with AD/HD continue to experience significant symptoms of AD/HD in adulthood. In addition, as they become adults, adolescents with AD/HD are at higher risk for lower educational attainment, greater job difficulties, and greater social problems; have a higher likelihood of acquiring sexually transmitted diseases; and are more likely to become parents at earlier ages compared to their counterparts without the disorder.31 However, these are only risks, they are not guarantees. Many teens with AD/HD go on to become successful, productive adults. Continued awareness and treatment is crucial in helping your teen avoid these risks and fulfill his or her potential.

References

1. Ingram, S., Hechtman, L., & Morgenstern, G (1995). Outcomes issues in ADHD: Adolescent and adult long-term outcome. Mental Retardation and Developmental Disabilities Research Reviews, 30, 243-250.

2. Ibid.

3. Brown, T.E. (2000). Attention-deficit Disorders and Comorbidities in Children, Adolescents, and Adults. Washington, D.C.: American Psychiatric Press, Inc.

4. Wolraich, M.L., Wibbelsman, C.J., Brown, T.E., Evans, S.W., Gotlieb, E.M., Knight, J.R., et al. (2005). Attention-deficit/hyperactivity disorder among adolescents: A review of the diagnosis, treatment, and clinical implications. Pediatrics, 115, 1734-1746.

5. Ingram, S., Hechtman, L., & Morgenstern, G (1995). Outcomes issues in ADHD: Adolescent and adult long-term outcome. Mental Retardation and Developmental Disabilities Research Reviews, 30, 243-250.What We Know20B ad/hd and teens: information for parents 7



6. Wolraich, M.L., Wibbelsman, C.J., Brown, T.E., Evans, S.W., Gotlieb, E.M., Knight, J.R., et al. (2005). Attention-deficit/hyperactivity disorder among adolescents: A review of the diagnosis, treatment, and clinical implications. Pediatrics, 115, 1734-1746.

7. Barkley, R.A., Fischer, M., Smallish, L., & Fletcher, K. (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology, 111, 279-289.

8. Wolraich, M.L., Wibbelsman, C.J., Brown, T.E., Evans, S.W., Gotlieb, E.M., Knight, J.R., et al. (2005). Attention-deficit/hyperactivity disorder among adolescents: A review of the diagnosis, treatment, and clinical implications. Pediatrics, 115, 1734-1746.

9. Barkley, R.A. (2004). Adolescents with attention-deficit/hyperactivity disorder: An overview of empirically based treatments. Journal of Psychiatric Practice, 10, 39-56.

10. Biederman, J., Faraone, S.V., & Lapey, K. (1992). Comorbidity of diagnosis in attention-deficit hyperactivity disorder. In G. Weiss (Ed.), Attention-deficit hyperactivity disorder, child & adolescent clinics of North America. Philadelphia: PA.

11. Sanders; Bartholemew, K and J. Owens, M.D., MPH (2006). Sleep and AD/HD: A review. Medicine and Health Rhode Island, 89: 91-93.

12. Angold, A., Costello, E.J., & Erkanli, A. (1999) Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57-88

13. Geller, B., & Luby, J. (1997). Child and adolescent bipolar disorder: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1168-1176.

14. Spencer, T., Wilens, T., Biederman, J., et al. (2000). Attention-deficit/hyperactivity disorder with mood disorders. In: Brown, T.E., ed. Attention deficit disorders and comorbidities in children, adolescents, and adults. Washington, DC: American Psychiatric Press: 79-124.

15. Wolraich, M.L., Wibbelsman, C.J., Brown, T.E., Evans, S.W., Gotlieb, E.M., Knight, J.R., et al. (2005). Attention-deficit/hyperactivity disorder among adolescents: A review of the diagnosis, treatment, and clinical implications. Pediatrics, 115, 1734-1746.

16. Wilens, T.E., Biederman, J. & Spencer, T.J. (2002). Attention deficit/hyperactivity disorder across the lifespan. Annual Review of Medicine, 53, 113-131.

17. Wolraich, M.L., Wibbelsman, C.J., Brown, T.E., Evans, S.W., Gotlieb, E.M., Knight, J.R., et al. (2005). Attention-deficit/hyperactivity disorder among adolescents: A review of the diagnosis, treatment, and clinical implications. Pediatrics, 115, 1734-1746.

18. Brook, U., & Boaz, M. (2005). Attention deficit and hyperactivity disorder (ADHD) and learning disabilities (LD): Adolescents’ perspective. Patient Education and Counseling, 58, 187-191

19. Edwards, G., Barkley, R.A., Laneri, M., Fletcher, K., & Metevia, L. (2001). Parent-adolescent conflict in teenagers with ADHD and ODD. Journal of Abnormal Child Psychology, 29, 557-572.

20. Hazell, P. (2007). Pharmacological management of attention-deficit hyperactivity disorder in adolescents: Special considerations. CNS Drugs, 21, 37-46

21. Hazell, P. (2007). Pharmacological management of attention-deficit hyperactivity disorder in adolescents: Special considerations. CNS Drugs, 21, 37-46

22. Wolraich, M.L., Wibbelsman, C.J., Brown, T.E., Evans, S.W., Gotlieb, E.M., Knight, J.R., et al. (2005). Attention-deficit/hyperactivity disorder among adolescents: A review of the diagnosis, treatment, and clinical implications. Pediatrics, 115, 1734-1746.

23. Barkley, R.A. (2004). Adolescents with attention-deficit/hyperactivity disorder: An overview of empirically based treatments. Journal of Psychiatric Practice, 10, 39-56.

24. Barkley, R.A., & Cox, D. (2007). A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance. Journal of Safety Research, 38, 113-128.

25. Barkley, R.A., & Cox, D. (2007). A review of driving risks and impairments associated with attention-deficit/hyperactivity disorder and the effects of stimulant medication on driving performance. Journal of Safety Research, 38, 113-128.

26. Thiruchelvam, D., Charach, A., & Schachar, R.J. (2001). Moderators and mediators of long-term adherence to stimulant treatment in children with ADHD. Journal of the American Academy of Child & Adolescent Psychiatry, 40, 922-928.

27. Charach, A., Ickowicz, A., & Schachar, R. (2004). Stimulant treatment over five years: adherence, effectiveness, and adverse effects. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 559-567.

28. Kramer, T.L., Phillips, S.D., Hargis, M.B., Miller, T.L., Burns, B.J., & Robbins, J.M. (2004). Disagreement between parent and adolescent reports of functional impairment. Journal of Child Psychology and Psychiatry, 45, 248-259.

29. Wolraich, M.L., Wibbelsman, C.J., Brown, T.E., Evans, S.W., Gotlieb, E.M., Knight, J.R., et al. (2005). Attention-deficit/hyperactivity disorder among adolescents: A review of the diagnosis, treatment, and clinical implications. Pediatrics, 115, 1734-1746.

30. Low, K., & Gendaszek, A.E. (2002). Illicit use of psychostimulants among college students: A preliminary study. Psychology, Health, & Medicine, 7, 283-287.

31. Barkley, R.A., Fischer, M., Smallish, L., & Fletcher, K. (2006). Young adult outcome of hyperactive children: Adaptive functioning in major life activities. Journal of the American Academy of Child & Adolescent Psychiatry, 45, 192-202.What We Know20B ad/hd and teens: information for

Do your Words Interfere with your Effort to Teach your Child/Teenager to be Independent?

Clearly, every parent of a child/teenager with ADHD knows how important it is to build independence in their child. One of the most important, and arguably, the most important goal when raising a child with ADHD is to build self-reliance, self-regulation and independence.

The tasks that you teach your child so that he will reach those goals may be making his own lunch; initiating a play date; calling his grandparents himself to wish them a happy birthday; problem-solving his homework so that he is able to do most of it himself, with just a bit of help, etc.


However, sometimes, a parent’s language may obstruct that goal. For example, one of the parents of a child with whom I work told me the other day that “We have a Science Fair project to do this weekend.” This language, which certainly may not be detrimental to the child, may give the child the impression that the Science Fair project may not be his responsibility alone. Another comment from a parent was “Let’s go. We have a lot of homework to do.”

Even though certainly those comments from parents are not meant to be harmful, they may give the child/teenager the idea that his work is not his alone. Additionally, and more importantly, those comments may encourage the child to be more dependent on his parents, rather than behaving in an independent manner.

What do you think?