Moving from Adolescent into Adult ADHD: What Parents and Adolescents Need to Know

Those with ADHD:

  • Are less likely to attend post-secondary
  • Have lower grade point average
  • Are less likely to graduate a 4 year program
  • End up with a lower personal income despite a similar IQ and background to others
  • Are more likely to be fired or laid off
  • Are more likely to have quit a job
  • By age 32, are more likely to be unemployed and not in school, or working and in school
  • Who have academic problems are predicted to have more job loss
  • Have a two fold increase of premature death due to accidents – untreated ADHD is contributing to these statistics

Coexisting Disorders seen in Adult ADHD

  • 85% of adults with ADHD have a coexisting mental health disorder
  • Mood and anxiety disorders continue to increase in adulthood
  • Chronic dysthymia (a mild form of chronic depression) can become an issue
  • Additional adult conditions begin, Bipolar, Personality Disorder
  • Hard drug use, most often cocaine which is a stimulant, is associated with Conduct Disorder

Increased Challenges Moving into Adulthood

  • Challenges increase with additional responsibilities, just as the parental support system decreases
  • There is more pressure to become independent
  • They now become solely responsible for their choices, decisions, and actions – consequences are larger
  • Post-secondary and career path decisions are required
  • The move out of the family home and may need to cohabitate with strangers
  • Life skills are now required to manage finances, food purchase and preparation, care of living environment, clothes etc.
  • A job search with applications and interviews becomes a requirement
  • Responsibilities at work generally increase
  • Time management skills become more essential – they become solely responsible for being on time
  • Their relationships with peers are less monitored and they are exposed to a wider group
  • Intimate romantic relationships take on more importance

Challenges with Accessing Ongoing Treatment after the Age of 18

  • Although eighteen year olds with ADHD do not often function at an adult level of maturity the medical system recognizes and treats them as such
  • Many physicians and medical professionals still think of ADHD as a childhood disorder
  • Children who have been followed by pediatricians and child and adolescent psychiatrists lose their follow-up care
  • Family physicians are not sufficiently educated about adult ADHD
  • Treatment away from home is challenging because:
    • Post-secondary healthcare facilities have few resources and are often uninformed
    • They are reluctance to prescribe medication due to misuse and abuse at this age and in post-secondary setting
    • Adults with ADHD forget appointments, forget to renew medication
  • Many multimodal ADHD treatments, CBT, coaching, mindfulness and other therapies are difficult to access and are not covered by provincial health care – this results in two tier medical care

Tips on How to Improve Medical Care

  • It is essential that care continues, if not expands
  • Teach and practice medical self-care
    • Begin to involve them in their medical care before they leave home
    • Start to include them in the responsibly of tracking their medical appointments – electronic reminders
    • Include them in the practice of booking appointments, observe, role play, execute
    • Increase their responsibility for keeping track of their medication pill count – when would they need to call for a renewal and pick-up medication (back-up will be required)
    • Have them and not you report to the doctor on symptom control and side effects
  • Make sure that medical follow-up procedures are set up for when they leave home
    • Can they access their physician in times of crisis?
    • What services does the post-secondary health care provide?
  • A year prior to their turning 18 start looking for an adult psychiatrist or confirm that family doctor will do the long term follow-up prescribing – wait lists are lengthy and the new physician may require a new assessment for adult ADHD even if they were diagnosed as a child

Preparation for Post-Secondary

  • Become involved with their search for a career path – set up experiences within those environments
  • Assist in the search for a school and program
  • Questions to ask and things to consider when choosing a school and program
    • How does the school recognize and accommodate students with ADHD?
    • Can they take fewer courses at one time?
    • Might a smaller school be less overwhelming?
    • Is commuting from home a possibility and allow for more supervision?
    • Always visit the school and their “Access Center” to help answer these questions
  • Always, always put school accommodations in place before starting post-secondary school
  • Meet with your medical professional to have the required documentation prepared well before school begins – access the CADDAC Post-Secondary Toolkit designed to help physicians and other medical professionals write comprehensive reports required by post-secondary institutions for students to access accommodations

Post-Secondary Impairments to Expect

Access the above CADDAC Toolkit for a comprehensive chart of impairments and appropriate accommodations

  • Procrastination will remain an issue
  • Difficulty remaining focused – distractibility will continue and affect concentration at lectures and completion of assignments
  • Missed instructions, assignments, due dates will occur
  • Note taking will be an issue – it will be difficult to listen and take notes at the same time
  • Following a list of instructions will be a problem
  • Misinterpretation of instructions and questions on tests will occur
  • Sequencing steps to a task and formulas will be impaired
  • Inability to chunk large assignments will continue often resulting in students becoming easily overwhelmed
  • Difficulty starting or initiating assignments or tasks will continue
  • Becoming motivated and maintaining motivation remains impaired
  • An inability to manage time will continue, over or under estimation of the time required and prioritize of time will continue
  • Time spent on unimportant but stimulating activities will further impede time management
  • Unable to sit still for long periods

Possible Post-secondary Accommodations  

Work with Access Center staff, coach or supervisor to review assignment understanding, chunking work, time management and due dates

  • Assignments given in written format
  • Access to professor’s notes or PPTs, or another student’s notes
  • Ability to tape lectures
  • Access to reminder sheet for steps and formulas
  • Ability to use headphones when working in class
  • Use of electronic organizers
  • Additional copies of course material
  • Allow for more frequent breaks, controlled movement, stress ball
  • Preferred seating, allowed to leave for movement breaks and return on their terms
    • Use of a computer for tests
    • Allowed to write tests in a quiet room
    • Extended time for tests and exams, usually time and a half
    • Testing over several sessions
    • Tests and assignments spaced out – due date flexibility if overwhelmed
    • Allow for independent rather than group work
    • Priority registration for classes with a professional in the Access Center
    • Substitution for non-compulsory subjects

ADHD in the Workplace

  • Workers with ADHD are more likely to enter the workforce as unskilled or semiskilled (due to high school or post-secondary drop out)
  • More periods of unemployment and are more likely to be dismissed, change job frequently (impulsivity)
  • Career or job needs to be stimulating and of individual interest for attentional issues to be minimalized
  • ADHD and Executive Functioning impairments will continue to be an issue if strategies and accommodations are not put in place
  • ADHD is recognized as a disability so employers are required to recognize impairments and put accommodations in place, but this does not always happen
  • Although disclosure is a personal decision if accommodations are requested disclosure and medical documentation will be required

Questions to Ask When Searching for or Deciding on a Job/Career

  • What sparks their interest and engages them
  • Best environment? – quiet, stimulating
  • Is there a need to move?
  • What are the strengths? Best when interacting with others, when working with their hands, when analyzing data?
  • What are the skills that have allowed for success in the past?
  • Are their specific skills that set them apart from others?
  • Energy levels throughout the day?
  • What parts of a current or past job do they enjoy doing and what parts do they dread?

For more information access Understanding Adult ADHD and ADHD in the workplace on the CADDAC web site

Resources

Growing Up With ADHD: Clinical Care Issues, Thomas E. Brown

Published on Psychiatric Times (http://www.psychiatrictimes.com)