Information on ADHD for Adolescents, Questions and Answers – long version

What is ADHD?

People with ADHD may need some help to succeed at some of the things they want to do or need to do, but it does not mean that they cannot be successful and accomplish what they set out to do. Just like someone who has trouble seeing may need to wear glasses, people with ADHD may need some strategies to help organize them, accommodations to help them at school and maybe some treatment to help them with their attention.

As an adolescent in school you probably have problems with paying attention and focusing in class. If you are working, getting things accomplished on time may also be a problem. Subjects and assignments that you find boring or tasks that are repetitive are usually the worst to deal with. Although most people think that ADHD is only a problem with paying attention, you might find that in some situations you over-focus. This may cause it to be difficult for you to stop doing the things that you find stimulating or interesting, like watching TV and playing computer games. Because of this you may not be able to break your focus and pay attention when people are talking to you. You might be missing out on vital instructions. You see, ADHD is really a problem with regulating your attention and not just a problem with paying attention. It can be a problem with under or over focusing, switching focus and prioritizing your focus on what is really important.

The Three Presentations of ADHD

Inattentive Presentation

If someone only has a problem with regulating their attention, they are diagnosed with the Primarily Inattentive presentation. You may have heard this called, Attention Deficit Disorder or ADD without hyperactivity, but we medically don’t use that term anymore. Adolescents with this presentation would not have a significant problem with hyperactivity or impulsivity.

Hyperactive-Impulsive Presentation

The Primarily Hyperactive-Impulsive presentation is very rare and is exactly what it sounds like. People with this type of ADHD would not have a problem regulating their attention.

Combined Presentation

The most common sub-type of ADHD is called the Combined Presentation. If you have this subtype, you would have problems with regulating your attention, have a high level of activity and have problems with impulsivity. Impulsivity in adolescents can exhibit as problems with stopping themselves from acting without thinking of the consequences. During adolescents this can cause more serious consequences than in childhood.

Hyperactivity is most apparent during childhood. Since adolescents seem to outgrow their outward hyperactivity, or at least learn to channel it into more product activities, it was thought that children outgrew their ADHD in adolescence. We now know that this is not true and that ADHD simply presents or looks different in adults than children. Eighty percent of adolescents who were diagnosed as children still qualify for the diagnosis as an adolescent. Teenagers and grown-ups often describe their ADHD as feeling, like they have a constant internal restlessness, or that their mind is racing or constantly switching channels.

What causes ADHD?

ADHD is highly hereditary. It is almost on the same level of hereditary as height. Chances are that if your parents are tall, you will be as well. It works the same way with ADHD. Other family members like your brothers or sisters, or your cousins, aunts, uncles or grandparents may also have ADHD. There is also a slim chance that ADHD may be caused by some sort of trauma before birth, during birth or early in childhood, but most of the time there is a hereditary component. Often parents are diagnosed with ADHD after their children are. When your parents were children we did not have a great deal of information about ADHD and were not very good at assessing and diagnosing ADHD. That is why many adults are just now getting diagnosed.

Through looking at MRIs or Magnetic Resonance Imaging we know that certain parts of the brain are smaller in children with ADHD and the brain develops more slowly. There is also a decrease in activity, especially in the frontal lobes of the brain. When MRIs are done on people who are taking medication for their ADHD, the activity in the brain appears more similar to someone without ADHD.

How Many People Have ADHD?

ADHD is the most common childhood neurodevelopmental disorder. Studies throughout the world have reported that at least 5% of children and 4% of adults throughout the word have ADHD. More boys than girls are diagnosed with ADHD, however we think this may be because we are not as good at diagnosing girls. In adulthood the percentages are closer to 50/50. Eighty percent of adolescents who were diagnosed as children continue to have enough symptoms to meet the criteria for an official diagnosis as an adolescent and at least sixty percent of adults who were diagnosed as children report suffering from ADHD symptoms to a level that causes impairment.
Are Rates of ADHD Increasing?

This question is often debated in the media, especially in the US. We do not have rates of ADHD diagnosis as high here in Canada. However, rates have increased somewhat here as well, at least partially due to better awareness, and better assessment and diagnostic procedures for ADHD.   We now know that you don’t need to be hyperactive to have ADHD, so many people with the Predominantly Inattentive Presentation are now being diagnosed. In fact, many women who may not have been diagnosed with ADHD as girls are now being diagnosed. Females often do not have the hyperactive component that makes ADHD easier to recognize. In children, three times as many boys as girls are still being diagnosed, but as adults the numbers are more equal. This leads us to think that we may still be missing many of the girls who have ADHD.

We are also becoming better at recognizing ADHD when it presents less characteristically, that is, not as hyperactive little boys running around a classroom, or someone who is failing in school. Males can also present only with attentive regulation issues and those with ADHD who are bright may not necessarily be failing at school.

How Does ADHD Affect Adolescents?

Attention

When adolescents with ADHD try to pay attention in class they often find themselves more easily distracted by noises and other things around them than most other people. Even when they are really trying to stay focused on what the teacher is saying they may end up daydreaming or falling asleep. As student’s progress into the higher grades and classes become longer and are most often in the format of a lecture, this can become even more of a problem.

Note about Driving

Research has shown us that teens with ADHD have far more car accidents than teens without ADHD and their accidents are far more serious. Therefore not having others in the car with you or engaging in things that are distracting while driving is very important. Research also tells us that treating ADHD with medication while driving can help to reduce these risks.
Impulsivity

Adolescents may also have problems with impulsivity, or stopping themselves from acting on their thoughts long enough to consider the consequences of their actions. This can become more of a problem in adolescence than childhood as actions take on bigger consequences. When adolescents begin to drive, date, and experiment with drugs and alcohol these consequences can affect the rest of their lives. As an adolescent with ADHD, you may get confused about why you seem to be getting into trouble all the time if you do not understand how ADHD affects you.

Frustration and Emotional Regulation

Teenagers with ADHD can become frustrated more easily than others and find it more difficult to control their reactions to these feelings. When you are easily frustrated and impulsive when expressing those frustrations, it is understandable that you may lash out at the people who are often the closest to you. After these blow-ups people with ADHD react in a variety of ways; after they calm down they may regret their actions, but be unable to express their feeling; they may ruminate on their actions and become distraught or depressed; or they may be unaware of how much their behaviour affects others and go on with their activities as if nothing happened. Others (possibly medical professionals) may be able to help you recognize your inappropriate expression of your frustration and emotions and help you find more productive ways to do so.
Feeling That You Are Picked On

Since people with ADHD do not often have a great deal of insight into their behaviour or how they affect others, and have difficulty reading social cues, some people with ADHD can end up feeling that they are being unfairly treated. They feel that others do not understand what they are feeling or why they are having difficulty doing some things. This can be due to a misinterpretation of other’s intentions on the part of the person with ADHD and if so will need to be sorted out, but can also be due to others around them not understanding ADHD. This is why learning about ADHD can be an effective tool for the adolescent and for those around them.

ADHD as an Excuse for Behaviour

As an informed person with ADHD, you can teach others about ADHD and how it affects you. But, be careful not to use ADHD as an excuse to do whatever you want. ADHD is not an excuse for inappropriate, unlawful or hurtful behaviour. It explains why you have more difficulty regulating your attention and behaviour, but you can learn strategies to slow yourself down in order to make better decisions and implement treatments that will allow you to better deal with situations.

Forgetfulness and Losing things

You may find that you have trouble keeping track of things and may even lose them. This is often due to being distracted and therefore not remembering where you put them. Having a specific place where everything goes and a routine so everything gets to its place can be most helpful.

Problem Solving

You may have a hard time thinking through a problem and coming up with solutions, especially when your emotions are in high gear. You may only be able to come up with one solution to a problem and when that does not work or is not possible, you may become very frustrated or simply lose interest in doing anything else to solve the problem. Ask others for help in practicing problem solving skills. Engaging in Collaborative Problem Solving, or Collaborative and Proactive Solutions, as introduced by Dr. Ross Greene, with your parents and teachers can be helpful in developing this skill.

Social Skills

People may complain that you are too silly or not social enough. People with ADHD and people with learning disabilities can have trouble reading social cues and therefore have problems with social skills. These are not what we refer to as manners, they are expressions and subtle actions that people use to express their feelings without actually saying anything. They may frown or cross their arms or step back to indicate they are annoyed or no longer interested in talking. If you miss these signals you will not understand why others become angry with you, or possibly even when they are happy with something you just did.

People with ADHD may miss these signals because they are spending so much of their energy trying to stay focused on what other people are saying or, formulating what they are about to say themselves. As a society we do not actively teach social skills to children. They are skills that most children just pick up intuitively or from watching others. These skills can be very important and may need to be actively learned and practiced by someone with ADHD.

Procrastination and Time Management

This can be a very big problem for adolescents and adults with ADHD. The older you get, the more things you will have to accomplish in a shorter time, so learning how to deal with this early can be beneficial.

We know that the frontal lobe is in charge of things like time management, i.e. making sure that you have enough time to get things done. Do people complain that you do not get things done on time or that you are always late? This may be caused by a problem managing your time and being unable to accurately estimate how long something will take you to do. Students with ADHD can benefit from working with someone who can keep them on track and teach them skills on how to manage their time. There are also strategies that you can learn to assist you with this.

When you are given a large assignment at school you may feel overwhelmed with the amount of work even if you are given a long time to do it. This might cause you to procrastinate or put off starting your work and then find yourself in trouble later because you don’t have enough time to get it done. You may need someone to help you break down large projects into smaller pieces that you find manageable. You may also need help to assign due dates to each of those smaller pieces of the larger assignment in order for you to stay on track. You may also need strategies to help to get started with your work.

Many people with ADHD have a difficult time completing projects, tasks and assignments that they find boring. When a project or hobby is new, it is often exciting and challenging, but often becomes old very quickly. Staying on schedule when completing schoolwork is a very big challenge for students with ADHD and a mentor or coach can be very helpful.

Executive Functioning Skills

We know that one area of the brain that is affected by ADHD is called the ‘frontal lobe’. As well as regulating attention, this part of the brain is used for other things like: organizing, managing time, reviewing the past (hindsight), planning ahead (foresight), finding a variety of solutions to a problem, and where we store and manipulate information for brief periods of time (active working memory).

Active Working Memory

One way to describe active working memory is to compare it to a computer. When working on a computer, we may have numerous files open at the same time. We may move from one file to another, look up stored information, cut and paste it or alter it. We can add information to a spreadsheet and ask the computer to do calculations and store this information to another file. Like this computer, our brains need to do similar tasks all at the same time without us being consciously aware of it.

As an example, let’s look at the process of writing. Not only do we need to think about what we want to say, how we want to say it and how we will organize it, we also need to access files in our brains that store vocabulary, spelling, sentence structure, paragraph structure, punctuation, letter formation and the actual hand movements on how to form them. Not only do we need to open the stored files, but we need to add and alter things in them at the same time that we use the information to produce new files. This is a lot to think about at one time and most of the time we do it unconsciously. But what happens when there is a delay in the brain when sorting the file, opening the file, retrieving the file, editing the file or storing the file? You can imagine how this would delay the processing of information and greatly slow down the completion of work, causing great frustration.

Hand Writing
People with ADHD often have problems with hand writing. They can find it difficult to remember how to form and link the letters in cursive writing and get the signals from their brain down to their hands quickly enough to produce fast, neat writing all at the same time. Writing and copying off the board can be very painful for students with this problem. Handwriting is slower which may result in the person not having sufficient time to get everything down; more mistakes are made in copying; and it may even be painful because of the strain on their hands, due to gripping the pen too tightly or in the wrong way. Students with this problem often complain of their hands aching after writing for any length of time.

This is why keyboarding skills can be so important to learn early. When keyboarding, students can produce work faster, make it more legible and with less effort. Students who can use a computer often say they can get down two to three times the information in the same period of time. Being able to use spell check is also a great benefit for students who have problems with short-term memory or problems with those active working memory skills that were mentioned earlier. Being able to use a computer for written tests and exams are a must for students with ADHD.

Hindsight and Forethought

Being able to look back at your actions and those of others is a very important skill that can be helpful when making decisions. By analyzing how you reacted to a similar situation in the past and reviewing the consequences of that action you can better decide on the best plan of action in the present situation.
Similarly, foresight can help you review alternative actions to a situation and assess possible outcomes of those different actions. When these two skills are weak and decisions are made impulsively, bad decisions are often made. Again, there are skills that are often weaker in people with ADHD, however with recognition of this weakness, assistance from others and practice, you can learn to slow yourself down, and use your hindsight and forethought more often to make better decisions.

Are Executive Functioning Skills Important?

Executive functioning skills are very important. We use them hundreds of times a day without even realizing it. The older you become, the more these skills will be needed. When you are a young child, much of the organization and planning in your life is handled by your parents and teachers. When you become an adolescent you will be expected to master these skills; these are the very skills that prove you are mature enough to handle your own life. You can clearly see how they can affect you at school and work, but these skills are just as important when you are planning activities with friends after school.

How is ADHD Treated?

Treatment for ADHD should always be “Multimodal” or use a variety of treatments.

Psychoeducation

This is a medical term that simply means that everyone needs to learn about ADHD. This includes you and your parents as well as other family members. The more everyone understands about ADHD, the better chance you and your family have of solving any problems that may be occurring at home or at school. When others around you become educated about ADHD, they will better understand why you may forget things or lose things and why you have difficulty paying attention in class and getting your work done.

Hopefully, this increased understanding will stop the mislabelling and unfair blame those with ADHD are often subjected to. ADHD is not due to laziness, lack of motivation or moral fibre, or lack of intelligence. It is due to a medical disorder. However, the point of learning about ADHD is not to use it as a convenient excuse. It is to learn about your strengths and weaknesses and how you can use one to help with the other so that you can succeed at your goals. There are also many strategies and accommodations that you can learn and can be put in place to assist you.

School Accommodations

You may need to be identified as a special needs student to qualify for these accommodations. There is nothing wrong with this and at CADDAC we strongly recommend it. Everyone has strengths and weaknesses and everyone is good at some things and not at others. Because you need some things altered so that you can succeed at school is not something to be ashamed of. Not accomplishing your goals and dreams for the future would be the real shame.

tudents with ADHD often complain of feeling different when they receive these accommodations and sometimes others will accuse them of taking advantage or receiving special treatment. Actually, they are receiving what they need to be able to be successful at school. People who need glasses to see better, are not accused of gaming the system, and school accommodations for students with ADHD are no different.

Possible School Accommodations

Extra Time

Since we know that students with ADHD often have a slower processing speed and lose time through distraction, things can take longer to accomplish, one of the accommodations that can be very important is extended time for tests and assignments. This has absolutely nothing to do with the amount of knowledge a student has, it just means that it takes him or her longer to get it down on paper. People with ADHD can be very bright or even gifted. If they are given enough time to complete their work, they can actually show people how much they do know.

Computers

Getting to use a computer or laptop to take notes can be a huge help to many students with ADHD. As discussed earlier, hand writing can be very difficult and slow for some students. With the use of a computer a student would be able to write more on a test and find it easier to produce written work for an assignment.

Class Notes

Since many ADHD students find it hard to listen and pay attention while taking notes they should be allowed to photocopy other students’ or the teacher’s notes. This will allow them to pay attention while the teacher is giving the lesson. Often students with ADHD can produce wonderful notes, come out of a class and not have a clue what they mean. Since regulating their attention while listening to the lecturer takes so much effort, as does writing notes, it is understandable why splitting their attention between both may be impossible. Having a laptop to take class notes may be helpful for some students if they are skilled at keyboarding.

Instructions

Following a list of verbal instructions is very difficult for people with ADHD, young or old. This may be due to many issues, difficulty remaining attentive, distractions, difficulty with sequencing, or executive functions. This can be a problem at home and at school, but at school it can cause assignments to be written down wrong, remembered incorrectly, not remembered, or misinterpreted. It can be very frustrating when a great deal of work is done on the wrong question or for the wrong due date.

Having assignments written down as well as giving verbal instructions is better for all students, but a necessity for students with ADHD. This allows them to read over the instructions whenever they are not sure about specific details, like the due date or the details of the assignment. This will also help a tutor or parent figure out what you need to get done.

Students with ADHD can often misinterpret a question on a test or exam and lose marks not because they do not know the answer, but because they have not understood the question. Allowing students to clarify the question during a test or exam can be a very helpful accommodation.

Sequencing

Issues with sequencing as mentioned earlier, not only impacts the ability to get instruction correct, it can impact several areas of study. Allowing a written list of sequences for tests and exams helps the student display their understanding of the area of study rather than being penalized for their memory. This, as well as problems with detailed work, can be one of the reasons that math can be a challenge even if the student readily understands the concepts.

Distractions

One thing that may help with distractions in class is listening to a CD player while doing desk work. This will shut out distracting noises around you and help you to stay focused. Being able to work in an alternate quiet spot, if you choose, can also be helpful. Writing tests and exams in a quiet place is a must for students who are easily distracted.

Help with Organization

As mentioned earlier, organization and time management can be a paralyzing problem. Having a mentor or special education teacher to help you organize your assignments and keep you on time can be helpful. Tutors or coaches can also be useful.

Medication

How Can Medication Help?

Medication has been shown to help with regulating attention. If you are having a difficult time staying focused in class, you are probably missing out on a great deal of important information. Unfortunately, these periods of inattention can result in gaps in your learning and missed instructions. Many students with ADHD complain of feeling exhausted at the end of a school day. We think this is because they expend so much of their energy during the day trying to stay focused that they are drained by the end of the day and are often too tired and miserable to join in on after school activities and sports. Medication can help with attention regulation making it easier to stay focused, be less distracted, switch your focus and prioritize your focus on what is most important.

Since medication can increase your attention span it will increase what we call your ‘window of opportunity’ to learn. If your brain is not paying attention, the window to your mind is closed and learning cannot enter. When this window is open your mind is also open to learning new skills and strategies that will make it easier for you to cope with your ADHD and be successful.

Medication is not a Magic Pill

Medication is not magic and it won’t cure your ADHD. It is just one of the things that you can do to assist you in dealing with your symptoms. We do know that medication will often help you to pay attention when you need to and also help to decrease your hyperactivity and impulsivity, but medication alone is never the answer. However, “Pills don’t teach skills”. You, your parents and teachers will still need to do all the things that were discussed earlier, but medication, if you choose to take it, can help a great deal. No one wants to take medication, but medication can really help, especially with your attention and hyperactivity.

Types of Medication

Stimulant Medication

There are two types of medication that are most commonly used for ADHD. The type used most often is known as stimulant medication. There are stimulant medications that last a short time, usually about 3 to 4 hours, called Ritalin and Dexedrine, and there are newer stimulant medications available that last 8 to 12 hours called Concerta, Adderall XR, Biphentin and Vyvanse. Occasionally if approved by Health Canada new medications can be added to this list.

Non-Stimulant Medication

There are two medications that are non-stimulants that are also used for ADHD, Strattera and Intuniv. These medications are not considered to be as effective as stimulant medications, however sometimes people are unable to tolerate stimulant medications, or require these medications as well as stimulant medications. These medications can also be used if the person is experiencing anxiety or difficulty regulating their emotions.

Side Effects

All medications can have side effects. Some of the medications used for ADHD may have short-term side effects that go away after taking them for a while, like stomach aches and headaches. Some of the medication can affect your appetite. For some individuals, one medication may have side effects and another may not. Many of these medications have been around for decades and have been researched extensively. However, as with any medication, even over-the-counter medications, we need to be aware of possible side effects. Talk to your doctor about which side effects are considered short term and unimportant and which side effects are very important to let him/her know about. There are more choices in medication today and your doctor will work with you to find the right medication and the correct dose that works best for you. The goal is to find the most effective medication with the least amount of side effects.

Anxiety

Some adolescent use their anxiety to try to control their attention, hyperactivity and impulsivity. This causes them to be very tense and nervous all the time. Since medication can make it easier to control the symptoms of ADHD, it may help you relax and not feel that you have to stand on guard all the time.

How Can I Help With My Treatment?

ADHD is something that causes weaknesses in specific areas, but everyone has weaknesses in one area or another. Everyone also has strengths and it is important to use your strengths and assets to learn strategies and coping skills to deal with problems that arise due to your ADHD.

Also remember, many of your strengths may be a result of your ADHD and not all your problems are caused by your ADHD. There are many successful adults with ADHD who attribute their success directly to their high energy level and their innovative way of thinking. Some people find the skill of being able to over-focus very valuable in their job. Many people with ADHD are very creative and good at thinking outside of the box. Everyone is suited to a different type of career and this is especially true for people with ADHD.

There are many successful people who have ADHD. When we asked these people what helped them to succeed, many report that getting into a field or a job that they found interesting and stimulating made all the difference. People with ADHD find spending time doing things they find boring very difficult, but time seems to fly for them when they are interested in what they are doing. Unfortunately, you may need to spend some time doing those boring things to get to the exciting stuff at the end.

You can also help with your treatment by trying to keep an open mind. Some of the things that people may be suggesting to you may sound strange and may seem like they will never work, but sometimes trying different things is the only way you can really find out what works for you.

The most important thing that you can do is to learn about ADHD and how it impacts you. Only when you understand your strengths and needs will you be able to work at implementing what you need to reach your potential.

What about School, My Job, Friends?

Your school definitely needs to know about your ADHD or else they will not be able to help by providing accommodations for you. They will also be more likely to understand why you might be having problems with, getting your work in on time, forgetting your work and belongings at home or at school, acting or speaking impulsively, not being able to focus in class and needing extra time to do tests and assignments.

Your friends already like you for being you. ADHD is a part of you. They probably like you for some of the things that go along with your ADHD, like your high energy level, your spontaneity, your creativeness, and your sense of humour. They won’t stop liking you if they are your friends. In fact, if you can help them to understand you better, your relationship may even improve.