Supporting Teenagers with ADHD

BEFORE UNDERSTANDING YOUR TEENAGER, IT IS IMPORTANT TO UNDERSTAND SOME BASICS ABOUT ATTENTION DEFICIT HYPERACTIVITY DISORDER. LET US SHARE WITH YOU AND OTHERS BASICS ABOUT ADHD, THEN OFFER SOME SUGGESTIONS TO SUPPORT YOUR TEENAGER.

ANSWERS TO PARENTAL QUESTIONS ABOUT ADHD
Today there are concerns that children have been overly diagnosed and treated with Attention Deficit Hyperactivity Disorder. While these concerns are significant, there are many factors to weigh in today's society to appropriately evaluate the question of over-diagnosing. Some frequently askedquestions by parents are:

1. Why are ADD and ADHD being diagnosed now when it wasn't before?
   ADD was not diagnosed as accurately years ago due to less research and knowledge of the effects. Today adults are being diagnosed who previously spent a lifetime of compensating to overcome ADD. Many adults have devised techniques to remember and organize while they struggle to complete tasks that often require two to three times the effort others have to put forth. Most of these adults have average to above average intelligence.
   
   
2. Is ADD genetic?
   Often one or the other parent has a history of being ADD as a child. Often parents feel if they were able to cope with their ADD so can their children. Mothers at times will be more cognizant of the child's ADD behavior than the father due to varying work schedules and time spent with the child. It is important in any evaluation to include both parents so each parent may share their concerns and learn equally prior to any decision of treatment for their child.
   
   
3. Why can't my child have special attention and help? Schools should adapt to my child!
   In this fast paced society with advanced technology, children are often asked to fit in but usually not at the expense of a child's special needs. Children do need to adapt to the classroom and peer relationships within reason. Schools do provide special behavior modification programs, resource room help and testing for learning disabilities. However, there is a point when a child is seriously unable to pay attention enough to learn that an evaluation for ADHD may be helpful.
   
   
4. I don't want my child on medications!
   As a parent this is your right. No parent should give a child medication unless they are comfortable with the decision. On the other hand, don't totally rule out medications at all cost if it might help your child. Options to try before considering the possible need for medication would be reward plans, behavior modification, reducing external stimuli, structuring the environment and resource room help. FOR MANY, MEDICATION HAS CHANGED THE LIVES OF THE CHILD AND FAMILY IN A POSITIVE MANNER. When medicating, the least amount of medication should be used to bring out the best of the child. Only a child/adolescent psychiatrist, pediatrician or family physician that is comfortable and knowledgeable about regulating ADD medications for children should prescribe any ADD medication. Consider the effects that ADD may be having on your child before you rule out medication.
   
   
5. What medications are available? I have heard bad things about Ritalin and it scares me.
   Ritalin is a safe medication that has been prescribed successfully for years. The regulation of this medication is adjusted with the doctor based on feedback from the child, family and teacher about the changes noted.
   
   The adjustment for each child is individuaulized according to their specific needs. Some children may only take medication on school days but not weekends, holidays or the summer. Others may require more consistent dosing. It is important to remember that learning does not only occur at school but in fun relationships with peers and family.
   
   Some children on Ritalin may experience a decrease in appetite. Most parents adjust medication after the meals, provide nutritious snacks and observe food intake. For some children on high doses at a young age, there have been concerns it may slow growth. Research has found the child's growth returns to normal over time.
   
   For many parents, Ritalin has been a miracle that allowed them to discover their talented child. Adderall is a new, safe medication that originally was very effective for ADD and is now found to have a positive response for ADHD with minimal side effects. Other medications used may be Cylert, Dexedrine, Wellbutrin, Effexor, Depakote. New long acting, once a day medications Concerta ER and Adderall XR are now available. *****The key when medicating a child is to bring out the best of the child's capabilities with the least amount of medication.
   
   
6. Why can my child pay attention to video games or computers but not at school?
   ADD children seem able to focus on fast moving action such as video games or the computer. There is some belief that the rapid action matches their rapid thinking which helps to retain the
   focus.
   
   
7. My child seems to have low self-esteem and I am worried. What should I do?
   Most children want to do well. ADD children try hard to please and are often puzzled when, try as they might, they still get in trouble. Often the child is blamed, scolded or given time-outs for his behavior or lack of homework completion. They may be held in from recess then become teased by peers, labeled and begin to isolate from normal peer fun relationships. Eventually the child blames himself, feels he or she is stupid, becomes discouraged and gives up.
   
   
8. I am frustrated as a parent and I don't know what else I can do. There is usually a family cycle of frustration. The parent wants their child to succeed and when the child doesn't, parents feel they need to do a better job of parenting. "I know he has the ability to do this, he is just lazy or unmotivated". Parents feel they have failed and need to try harder, so they stress more intensely the expectations to concentrate, listen, do the work that is not within their ability to do. They usually have the intellectual ability but not the concentrating ability. The child feels more pressure, is unable to meet the expectations, often becomes frustrated then anger escalates out of control and the whole family becomes discouraged. The child again feels bad because they have not pleased mom or dad. Often the child is brighter than the average student but is unable to produce evidence of their abilities without medication.
   
   
9. What is going on in my child's mind?
   Often their thoughts are racing, many different thoughts are occurring at one time which prevents the ability to listen and learn. Some children daydream, are easily distracted, unable to sit still enough to absorb information. If you don't absorb information how can you use it? The child needs help to absorb and retain information so they can productively use it.
   
   
10. Are there screening tests for ADD?
    Yes, most schools have access to the Conners Inventory for Parent, Teacher and Youth Self Report. Most child/adolescent psychiatrists and pediatricians have access to these screens. CHADD is an online web site for ADHD with helpful information.
    
    
11. What should I look for in a good assessment for ADHD?
    It is important that numerous areas are evaluated to rule out the possibility of other concerns that may be affecting the child, with or without ADD. Areas to evaluate are: family history and issues, developmental history, medical history, school performance, stresses current and past, drug and alcohol use, past treatment, and characteristics of ADHD. It is important to receive information from numerous sources as parents, teachers, and others in the child's life. When numerous sources provide input, patterns and themes of behavior , the information may confirm the characteristics to diagnose ADHD.
    
    
12. How is ADD diagnosed? What does ADD, ADHD mean? Is it all the same?
    ADHD means Attention -Deficit Hyperactivity Disorder. To diagnose this, there are specific criteria established in the DSM IV (Diagnostic and Statistical Manual of Mental Disorders).
    There are three diagnostic categories:
    • ADHD-Inattentive Type - A child has difficulty concentrating, paying attention, is easily distracted, daydreams, forgets a lot, something is always missing , has difficulty organizing and completing the whole expectation as compared to peers.
    • ADHD- Hyperactive/Impulsive Type - A child has difficulty sitting still, talks excessively, is disruptive, fidgety, impulsive, has non-stop energy, is difficult to manage.
    • ADHD- Combined Type - These children experience both Inattentive and the Hyper characteristics.
      
      
13. If you believe your child needs an evaluation, here are some resources.
    • Check with your school for teacher concerns.
    • Discuss your concerns with your pediatrician.
    • ADHD assessments are available at St. John's Mercy Behavioral Health. Some insurance plans cover the assessment and they are also available as self-pay.
    • FOR AN APPOINTMENT CALL #314- 251-6898.

SUPPORTING TEENAGERS WITH ADHD

Assuming the teenager has been diagnosed and treated now or in the past, these are some issues that have been shared as specific teenage struggles.

1. Organizational Help
   First of all, teenagers like to be independent, solve for themselves but can use some suggestions they may wish to pursue to assist themselves. Numerous stores offer very innovative structures
   to help provide assists to organization. Locker shelving, home components to organize their room and drug stores offer organizational containers for remembering their pills. Middle school
   is often a difficult transition due to the increase in teachers, assignments, class changes and numerous expectations. Check early in the year with your teenager and the school to make sure they are adapting to these increased expectations.
   
   
2. Rebellion
   Part of the teenager normal growth is the struggle to want help and not want help. Parenting used to be easier when you could just do it for them. Now parenting requires supportive listening. Often your adolescent just wants you to listen not do for them and offer support without telling them what to do. This is difficult when you love them and don't want to see them hurt in any way. Part of parenting a teen is to help them solve on their own with loving support.
   
   The struggles to work through a problem, help them to believe in themselves and know they can solve other struggles when parents are not there.
   
   
3. Refusing to Take Medications
   There are times when a teenager decides they don't like their medication and refuses to take it anymore. This is part of their normal growth where they wish to control their own body and decide what is best for them. As difficult as this is, it may also provide an opportunity for the adolescent to assess himself and his real needs. When a child is older, it is nearly impossible to force them to comply. What can be considered is the opportunity for them to assess themselves responsibly and honestly whether off medications they are functioning to the fullest of their capabilities. If they are refusing but still have significant characteristics that are intruding on their abilities, parents may consider setting some boundaries to seek help, re-assess if their current medication is sufficient, if an adjustment is needed or perhaps another medication could be more supportive.
   
   
4. Boundaries
   Freedom is earned! The more accountable a teenager is in making good decisions that support their capabilities the more parents are able to trust. When a teen makes a mistake it can be viewed as a learning opportunity. For mistakes there are consequences, privileges may be decreased or rescinded for a brief period of time to help the teen learn to accept responsibility for their choices. This is part of learning how to be accountable for your actions and does help an adolescent believe in themselves that when things do not go right they can re-right it. If the mistakes or choices continue that are not supportive of good decision making, parents can set stronger boundaries stating that at this time you are demonstrating that it is still difficult for you to make healthy choices and you need intervention until trust can be earned again. Believe it or not, teens like that parents care, that they are willing to stand up and set boundaries when their behavior is out of control, that you love them enough to take the flak of being able to say NO when required.
   
   
5. Listen, Listen, Love
   Any teen and especially those with any kind of extra struggles needs unending support and love. This can be very hard during adolescence where there are times they do not wish to tell you anything and other brief times where they will unloaded the world in 5 minutes or less. Unless you feel your adolescent is in some kind of danger, a parent needs to be more flowing, shift with the teen needs, accept when they don't want to tell and stop all when they wish to share. This is very difficult for parents because it is the beginning of seeing their child grow up, they don't need them like before. But in truth, they need parents just as much but in a different, more beginning grown up way where they begin to decide what they can handle and seek you out when they wish. Parents can learn to support teens in a more subtle, behind the scenes way unless they see the teen is out of control or making non-healthy choices then boundaries are appropriate.
   
   
6. Resources
   If you are concerned that with all your interventions your teenager is still out of control, or not doing well with or without medications, consider re-assessment. St John's Mercy Child Psychiatry is available to assess if you wish. For an appointment call 314-251-6898.