The symptoms of adolescents with Attention Deficit Hyperactivity Disorder can present more like they do in adults at times, depending on an adolescent’s age. It is not uncommon for adolescents who were diagnosed with ADHD as younger children to become less active as they grow older, appearing to loose the hyperactive/impulsive component. However, many still have them, but the hyperactive/impulsive behavior may have been internalized. For example, they may sit still more often instead of moving around too much, yet they still want to desperately leave, stand about, or walk around the room. Sometimes these are the adolescents who go to the restroom often during classes, ask many questions in class on subjects they seem to already know well, or are constantly fidgeting and/or talking when they should be quietly sitting still and listening.
There can also be a constant stream of thoughts, which is often exhibited by speech that has a continuous flow and change of ideas or subjects. Adolescents who suffer from ADHD can perform poorly in school, despite an average or above average intelligence. I have often heard parents say how smart their children are or how inconsistent their behavior is from their ability to produce or behave in an expected manner, “She should know better.” At times parents and other adults, such as school staff, choose to believe that adolescents diagnosed with ADHD have willfully decided to disobey and can do tasks if they only “choose” to do them. This is further complicated by the fact that many who are diagnosed with ADHD have inconsistent output; when they sometimes do a task well, exceptionally, or timely, yet at other times perform below the expected standard or average. Although it is important to be firm and provide structure, a hard-line stance can lead to other complications, such as low-self-esteem and other behavioral problems, including Oppositional Defiant Disorder (ODD). Moreover, a rigid and punitive strategy is often times exhaustive to all parties involved and less productive than more supportive approaches. Many parents who have tried rigid and punitive methods of discipline have reported that their adolescents “don’t care anymore.”
Adolescents diagnosed with ADHD need to be held accountable, but negative labels should be avoided. I have met with adolescents who were labeled as problem children by school staff and more often than not by their own parents. These adolescents were constantly being admonished for “bad behavior” when instead these adolescents may have done better if they had been provided with the proper support so that they could function at their optimal level. As incredible as it may sound, some of the adolescents that I encountered had not even been identified as having a special need or learning disability, despite their poor grades, hyperactivity, impulsivity, social deviance, and other symptomatic behaviors typical of ADHD and/or other disorders; this can be more common in those with a higher than average IQ.
Parents that have Adolescents who are struggling in school due ADHD symptoms can request a special arrangement with the school to help their teens succeed, such as a 504 or an Individual Educational Program (IEP). Often, these plans can be implemented in a regular school setting. The plans may include allotting extra time for projects and tests, seating where they are more likely to listen, access to counseling services, and other strategies. Depending on the level of impairment, schools may be legally obligated to provide their students with the services needed to help them succeed. Therapists working with this population should be skilled in helping parents understand and successfully attain educational services from their teenagers’ schools, including the ability to help parents enhance their adolescents existing services or adjust their existing programs when they are not effective.
With rare exception, it is important that parents and other key family members are engaged when treating adolescents with ADHD, as this can greatly improve the outcome. The family is always part of the equation and solution. It common to find that one or both parents of adolescents who have been diagnosed with ADHD have the disorder as well, as studies show a strong genetic association. In those cases, it is important that any problems that the parents are experiencing due ADHD symptoms, or any other mental health issue or disorder, also be addressed.