ADHD in Teens: Learn everything

ADHD in Teens. Sitting in class, eyes wandering, a student’s bounces up-and-down in their desk as the teacher drones on about the day’s science lecture. The desire to listen is there, but they are suddenly distracted by a noise near the back of the room. Focusing is difficult. If this situation describes you or your teenager, it might be attention deficit hyperactivity disorder (ADHD)—a medical condition characterized by inattention, impulsivity, and hyperactivity. Learn the symptoms, types, and treatments for teenagers with ADHD.

ADHD in teens
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What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. Inattention causes those with ADHD to struggle with tasks that require focus and concentration. Hyperactivity means they are unusually active, demonstrating excessive movement unfitting to the situation, whereas impulsivity is frequent behavior without weighing the consequences.

ADHD is most often associated with school-aged children, as the signs are evident in a classroom setting. However, the disorder does not end in childhood. Symptoms can remain throughout the teenage years and into adulthood. Its presentation manifests differently with age. Between childhood and adulthood, teenagers are especially unique in their ADHD presentation.

Types of ADHD In Teens

The subtypes of ADHD are predominately inattentive, predominately impulsive/hyperactive, and combined inattentive and impulsive/hyperactive. The type is determined by which symptoms the teen exhibits. Regardless of subtype, ADHD can greatly interfere with the teen’s daily life.

Inattentive

The predominately inattentive type greatly impacts listening, focus, task completion, and organization. More so than behavior, these teens have difficulty concentrating on tasks such as schoolwork, chores, and work responsibilities. They do not have severe problems with hyperactivity or controlling their impulses.

Impulsive/Hyperactive

The predominately impulsive/hyperactive type still includes symptoms of inattention, but milder. Managing impulses is the primary challenge for these teens. Impulse control, or lack thereof, exacerbates hyperactivity. Difficulty sitting still without fidgeting, interrupting others who are speaking, and acting without thinking of the repercussions are hallmark signs of the impulsive/hyperactive type.

Combined Type

Teenagers with the combined type of ADHD have aspects of both inattention and impulsive/hyperactive types. They do not lean more towards one type or the other. Instead, they have symptoms of varying degrees that affect their ability to focus on tasks, organize themselves, control their activity level, and manage emotions.

Symptoms of ADHD in Teens

While those with ADHD share a set of similar symptoms marked by inattention, hyperactivity, and impulsivity, the symptoms the teen primarily displays depends on the type of ADHD. Having an ADHD diagnosis does not guarantee they will have all of the symptoms. They can range from mild, moderate, to severe.

Inattention

Symptoms of inattention can include:

  • Easily distracted and bored
  • Finds it hard to concentrate on tasks
  • Difficulty organizing tasks
  • Forgetful
  • Does not follow directions
  • Avoids tasks that require sustained attention
  • Makes careless mistakes
  • Often misplaces things
  • Daydreaming
  • Slower at processing information

Hyperactivity

Symptoms of hyperactivity can include:

  • Restlessness
  • Tends to fidget (constantly moving)
  • Excessive talking
  • Trouble remaining seated
  • Does not complete tasks quietly
  • Sleep problems

Impulsivity

Symptoms of impulsivity can include:

  • Inpatient
  • Frequently blurts out answers or disrupts others during conversation
  • Acting or speaking without thinking of the consequences
  • Making inappropriate comments
  • Difficulty controlling emotions

Causes of ADHD In Teens

The exact cause of ADHD in teens is unknown. Based on the largest imaging study of ADHD published in The Lancet Psychiatry, researchers have hypothesized that the brain volumes are decreased in people with ADHD (Radboud University Nijmegen Medical Centre, 2017). This is especially evident in the caudate nucleus, putamen, nucleus accumbens, amygdala, and hippocampus. The amygdala is the part of the brain responsible for emotional regulation and the nucleus accumbens is related to motivation—both of which are processes affected in ADHD. There is also thought to be a genetic component. Having a family member with ADHD increases the chance of developing the disorder.

Risk Factors for ADHD In Teens

Although the underlying cause of ADHD in teens is unknown, certain risk factors make ADHD likely to occur. Males are more prone to ADHD than females. Teens born prematurely or to a mother who smoked tobacco products, consumed alcohol, or suffered significant depression during pregnancy are also at a higher risk. Incidents of traumatic brain injury have been found to result in ADHD.

ADHD and the Teenage Brain

Teenagers are infamous for their impulsive, risky behaviors. Since ADHD is already correlated with diminished brain volume, symptoms of ADHD may appear to be worse in childhood. However, the human brain does not reach structural maturity, strengthening its connections, until around age 25. 

Myelin is a fatty sheath that insulates connections between the nerve cells (neurons) in the brain. Brain connections are myelinated from the back structures of the brain to the front, leaving the frontal lobe containing the pre-frontal cortex for last. The pre-frontal cortex, responsible for planning, personality, and executive functions. A non-developed pre-frontal cortex predisposes teens to risky behavior because they struggle to control their impulses. Along with this, dopamine levels rise which attracts even non-ADHD teens to pleasure-seeking experiences as they establish their identity as a soon-to-be adult. These two mechanisms in the brain make teens with ADHD even more susceptible to risky behavior like motor vehicle accidents, sex, and experimenting with uncontrolled substances.

ADHD in Teens Vs. Children

Symptoms of ADHD tend to improve with age, but that is not to discount the impact the disorder has on a teen’s life. Most cases of ADHD are diagnosed during childhood. Teachers, school staff, parents, and other authority figures in a child’s life notice the signs of inattention, hyperactivity, and impulsivity. As a teen matures, they are granted independence. They are not in the presence of an adult as often. When the symptoms surface in the teenage years, the hyperactivity characteristic of ADHD is not as extreme. The teen is less likely to receive a diagnosis.

Teens do face different stressors than children. Poor academic performance is more distressing for a teen with ADHD, as the demands of their teachers increase. They are also remarkably concerned with the way their peers perceive them. A teen with ADHD is likely to encounter low self-esteem over the embarrassment of having the condition. They must share these concerns to avoid anxiety and depression.

ADHD in Teens: Gender Differences

Teenage females are not as likely to receive an ADHD diagnosis compared to their male counterparts. They often go undiagnosed because their combination of symptoms differs. Inattention is more prevalent in girls with ADHD. The lack of hyperactive and impulsive symptoms prominent in males makes their ADHD less evident. Studies confirm teen girls with untreated ADHD have a higher incidence of secondary mental health issues such as anxiety, depression, disordered eating, and suicidal behaviors (Crawford, 2003). They should also be monitored to avoid the risk of substance abuse and teenage pregnancy.

ADHD in teens
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How To Diagnose ADHD In Teens

Teachers, community figures, and parents are typically the first to observe the symptoms of the teen’s ADHD. Once reported, a psychologist, pediatrician, counselor, social worker, neurologist, or a nurse practitioner all have the credentials to begin the diagnostic process.

ADHD in teens presents diagnostic obstacles. The diagnostic criteria featured in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are geared toward children. Signs of ADHD may be subtle in the teen years, so evaluating a teenager with criteria intended for children is not optimal.

Teens with suspected ADHD will have a thorough evaluation of their social and emotional functioning, a medical and family history, a clinical assessment of academic performance, and a physical exam to rule out physical causes of the teen’s symptoms. Input from parents, teachers, and other adults are helpful; however, these reports are tricky to obtain because teens do not remain with one adult throughout their day.

Treatment for Teens with ADHD

There is no cure for ADHD, yet many cases can be well managed through medications, behavioral therapy, and patient and family education. The teenage years do pose some limitations in treatment as remembering to take medications and attend therapy decreases during adolescence when experimenting with their independence. Treatment often goes neglected in favor of school and social interests.

Medication

Two categories of drugs are prescribed as ADHD treatment—stimulants and non-stimulants. Stimulant medications include methylphenidate (i.e. Ritalin) and amphetamines (i.e. Adderall). They are available in short-acting and long-acting formulas, the latter in which is ideal for school days when focusing for long periods is crucial to their success.

Stimulants

Stimulants work by increasing the levels of the neurotransmitters dopamine and norepinephrine. Dopamine is released by nerve cells and associated with movement, motivation, reward, pleasure, attention, and learning, while norepinephrine affects mood, energy, and alertness. 70 to 80 percent of ADHD patients have positive responses with improved concentration and a reduction in hyperactive and impulsive behaviors.

Potential side effects are feeling restless or jittery, mood swings, headaches, fast heart rate, loss of appetite, and difficulty sleeping. By influencing the perception of reward, stimulants can be addictive. The addictive nature has received much concern from parents and medical professionals. Teens with substance abuse issues are advised to avoid stimulants if possible.

Non-stimulants

If the teen does not respond to stimulant medications or if they are contraindicated, non-stimulant medications can be effective at decreasing ADHD symptoms without the side effect profile and risk of addiction. Non-stimulants are not as fast-acting as stimulants. They begin working over a few weeks rather than hours.

Medication Limitations for ADHD In Teens

ADHD medications are safe when taken as directed. However, teenagers may become inconsistent in their medication regimen. With increased responsibility and independence, remembering to take their medication is a challenge. Additionally, the recreational use of ADHD stimulants (i.e. Adderall or Ritalin) is growing popular among adolescents. Whether for financial gain or concern over social status, teenagers with prescribed stimulants for their ADHD treatment are susceptible to illegally selling their medication to their peers.  

Cognitive Behavioral Therapy

Cognitive-behavioral therapy is a form of psychotherapy that aims to alter the negative thinking patterns contributing to unwanted behavior. Teenagers with ADHD experience additional stressors stemming from their condition: low self-esteem, self-blame, poor academic performance, difficulty maintaining relationships, anxiety, and depression. These struggles lead to cognitive distortions. The goal of cognitive behavioral therapy is not to treat the underlying cause of inattention, hyperactivity, and impulsivity, but to change distorted thinking that further prevents teens with ADHD from staying on task and organizing their lives.

The therapist helps the teen to identify areas of struggle and then implement coping strategies to manage the disorder. Techniques applied through cognitive behavioral therapy entail creating a notebook and calendar planner to enhance time management, dividing tasks to improve concentration and successful completion, cognitive restructuring, as well as role-play to enact challenging situations Cognitive behavioral therapy is useful for encouraging compliance for medications and other treatments.

Psychosocial Education

Psychosocial education involves the teen, their parents, and teachers. The first step is locating a mental health professional to provide education. That professional evaluates the teen’s struggles at home, at school, and in social settings. They educate by the acronym ABC: antecedents (things that trigger or precipitate behavior), behavior (actions parents and teachers seek to change), and consequences (what happens after said behaviors). Parents and teachers change their response to the teen’s behavior in order to foster productive behaviors.

Support from family members and teachers is a significant component of psychosocial education. The best results occur when psychosocial education behavioral therapies are implemented at home and at school simultaneously. It is important to:

  • Begin with small attainable goals
  • Ensure consequences immediately follow the behavior
  • Execute psychosocial education approaches long term
  • Be consistent even as the environment changes
  • Understand that progress will be gradual—shifts in behavior and mindset take time

References

Crawford, N. (2003). ADHD: a women’s issue. Monitor on Psychology, 34(2).

Radboud University Nijmegen Medical Centre. (2017, February 16). Brain differences in ADHD. ScienceDaily. Retrieved November 16, 2019 from www.sciencedaily.com/releases/2017/02/170216105919.htm