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ADHD in Teens

The disorder, known for making patients restless and limiting their concentration, can be a catalyst for more severe problems as it progresses. If your child has ADHD, they could develop a co-occurring substance use disorder. Call us today for more information.

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20 min read

What Is ADHD?

Attention deficit hyperactivity disorder, known widely as ADHD, is a behavioral disorder seen in millions of kids. The prevalence of this disorder varies based on the community sample, but as of 2011, 6.4 million American kids aged 4–17 have been diagnosed with ADHD — 11% of this age group. That number is up from 7.8% in 2003, and the disease has trended upward every year since 1997. The average age of ADHD diagnoses is 7 years old.

In short, ADHD makes it difficult to concentrate and stay put. It’s a chronic, debilitating disorder that’s notorious for making the educational experience extremely troublesome. ADHD can lead to impulsiveness (i.e. making decisions without thinking them through) and hyperactivity in children (i.e. having excessive amounts of energy). In the United States, it affects 13.2% of boys and 5.6% of girls.

What’s the Difference Between ADD and ADHD?

Teenage girl with ADHD

ADHD, and hyperactivity in particular, has been written about since 1798. ADHD was first defined in 1902 by George Still — considered the father of pediatrics — despite the disorder not being given a definitive name. The medical terminology changed several times over the 1900s (“minimal brain dysfunction” and “hyperkinection reaction of childhood” among the terms given). The disorder was labeled attention-deficit disorder with or without hyperactivity, or ADD, in 1980 by the American Psychiatric Association.

In 1987, the medical community scratched the term ADD in favor of ADHD, underlining the significance of hyperactivity in diagnosing the disorder. While people may still refer it as ADD, doctors only refer to the disorder now as ADHD.

What Causes ADHD?

Genetics plays the most significant role in developing ADHD. It’s a disease that runs in families, with a heritability of 76%. The specific genes that cause ADHD are still being discovered — experts believe there are many, and we may never know all of them.

“We’re still at the level of trying to find genes that might play a role in ADHD,”

says Dr. Susan Smalley, director of the Mindful Awareness Research Center at the University of California, Los Angeles.

“It’s kind of like looking for a needle in a haystack.”

Other factors that may contribute to ADHD include:

  • Drinking or smoking during pregnancy
  • Low birth weight or other birth complications
  • Exposure to lead or other toxic substances
  • Extreme abuse, neglect or social deprivation
  • Food additives (e.g. artificial coloring)

ADHD in Children

One primary condition of diagnosing ADHD is that several inattentive or hyperactive-impulsive symptoms need to be present before age 12. ADHD is known for developing very early and impacting children and teens more than anyone — in fact, it’s the most common chronic mental health problem for kids in the U.S..

From age 11 onward, patients with ADHD exhibit the highest number of side effects. As a teen diagnosed with the disorder enters middle school and high school, it can damage their productivity and potential in a big way. A severe case of ADHD nearly doubles the probability of failing a grade level and having to repeat it, and average math and reading test scores for these students are 8–10% lower than the national average.

ADHD in Adults

Studies show that 30–60% of young children with ADHD will carry significant symptoms with them into adulthood. Symptoms of hyperactivity tend to decrease with age, but inattentive symptoms can hang around for years or even decades. It can be an uncomfortable thing to discuss the older an individual gets, and the world may be less forgiving to their struggles. ADHD in adults can lead to difficulty holding down a job, and bouncing from employer to employer for years. Lateness, excessive errors and the inability to accomplish expected workloads are contributing factors, along with interpersonal difficulties and a short attention span (i.e. losing interest in their work).

The problems don’t stop there. Among adults with ADHD, troubled relationships and breakups are more common. The risk of developing an unhealthy drug or alcohol habit is higher, especially if their ADHD symptoms go unmedicated. On top of this, patients are more likely to have children with ADHD.

ADHD can be a subtle, sneaky illness when it develops, causing many cases to go overlooked. But if it flies under the radar, it can snowball into a lifelong burden. Approximately 4.1% of adults live with ADHD, and 41.3% of these cases are considered severe. The best bet for preventing flare-ups through adulthood is to take care of ADHD in adolescence.

Types of ADHD

Stressful teenage girl with messy thought

With the continued research of ADHD, the medical community has determined that patients can exhibit three different subtypes of the disorder. If your child is diagnosed with ADHD, they’ll likely be diagnosed with one of these.

The different subtypes of ADHD are:

  • Predominantly Hyperactive-Impulsive – in which 6 or more of the symptoms that fall into the hyperactive or impulsive categories are on display, and while inattention may be present to some degree, its presence is limited
  • Predominantly Inattentive – displaying a heavy majority or inattention symptoms, with some — but not many — symptoms of hyperactivity or impulsivity
  • Combined Hyperactive-Impulsive and Inattentive (or Combined ADHD)- an equal representation of hyperactive, impulsive and inattentive symptoms — typically 6 or more of each

Combined ADHD is the most common subtype for a teen with ADHD.

Misconceptions of ADHD

There are several close similarities between ADHD and certain other common mood disorders. If your teen displays certain behaviors, it may be difficult for you — and even doctors — to identify the exact underlying problem. Many kids are misdiagnosed — or incorrectly labeled with the wrong problem — in cases where ADHD symptoms are present. Similarly, it’s estimated that nearly 1 million kids in the U.S. are potentially misdiagnosed with ADHD, when in fact they likely suffer from something else.

ADHD vs. Depression

Consistent feelings of sadness, lethargy and lack of motivation are common during sporadic major episodes of depression in teens. These individual incidents can cause difficulty concentrating in the classroom or in other environments, along with other symptoms of inattentiveness— not very much unlike the symptoms of ADHD in teenagers.

In a 2002 national survey, girls reported being commonly misdiagnosed with depression prior to being properly diagnosed with ADHD. A major contributing factor is that girls with ADHD tend to internalize symptoms and become socially withdrawn — typical indicators of depression. Teens with ADHD do regularly suffer from high rates of co-occurring or simultaneous clinical depression, and in adults with ADHD, 18.6% also have major depressive disorder.

ADHD vs. Bipolar Disorder

Extreme highs (i.e. manic episodes) and extreme lows (i.e. depressive episodes) are indicators of bipolar disorder in teens. During manic episodes, a person can be restless and disorganized, which can resemble “hyperactive” ADHD symptoms. On the flip side, depressive episodes of bipolar disorder can appear as “inattentive” symptoms of ADHD. Because ADHD is far more common, children who are actually bipolar will typically be misdiagnosed at first as having ADHD. In fact, in one study, 29% of kids with bipolar disorder were misdiagnosed as having ADHD.

ADHD vs. Anxiety

Teen anxiety is marked by proneness to frequent worrying and uneasiness, which can interfere with day-to-day wellness and productivity. It will leave them consistently feeling “on edge.” An anxiety disorder can easily be confused with certain hyperactive, inattentive or impulsive traits of somebody with ADHD.

Anxiety disorders are the most common mental illness among adults in the U.S., but 25% of cases occur by age 14. If your teen has ADHD, the doctor may first diagnose them with an anxiety disorder. Anxiety could also develop on top of their ADHD, as a result of the daily struggle it creates for a young person. Up to 30% of children and 40% of adults with ADHD have a co-existing anxiety disorder.

What Are the Effects of ADHD?

At a very young age, the effects of ADHD may be limited. Parents report ADHD symptoms in kids as young as age 2, but besides low self-esteem, this disorder doesn’t necessarily interfere much with the life of a toddler.

Each year that passes, though, ADHD can start to interrupt a child’s life in drastic ways.

ADHD and the Brain

Attention deficit hyperactive disorder begins in the brain, and this is where the most noticeable effects take place. From an early age, the brains of adolescents with ADHD look different than the brains of peers. The common symptoms of the disorder (e.g. trouble focusing and learning, impulsive behavior, etc.) are triggered by abnormalities in the teenage brain.

The frontal lobe, the region of the brain that’s responsible for executive functioning, shows significant differences in ADHD patients and is often noticeably smaller. It is involved with prioritizing and ordering tasks as well as a host of other important daily functions. The cerebellum, where coordination occurs, is also different in children with this disorder. Issues in the cerebellum are responsible for the hyperactive symptoms of ADHD in teens.

As these teens grow older, the cerebellum often restores itself to a more healthy, average shape. The frontal lobe, however, can remain underdeveloped. This explains why hyperactive symptoms tend to diminish as patients grow older, but inattentive symptoms often linger.

ADHD also leads to a burn through brain chemicals faster, specifically neurotransmitters (messenger chemicals) like dopamine and norepinephrine. A depletion in neurotransmitters contributes to the appearance of all ADHD symptoms.

Effects on the Body

ADHD does minimal direct damage to the body compared to other disorders. Still, problems can come about in several ways.

Children with ADHD are more susceptible to injuries (both minor and major), emergency room visits and general hospital stays than kids without the disorder. As they get older and earn their driver’s licenses, these teens are at a greater risk for car crashes and traffic violations. They’re also more likely to drink and drive.

Self-harm, a disturbing trend of cutting, burning or otherwise hurting one’s self, is a serious issue among teens with ADHD — especially girls. More than 50% of girls with combined ADHD symptoms engage in self-harming activities. Approximately 22% of these girls will attempt suicide at some point. These risks are greatly increased in cases where a teen experiences childhood trauma, such as sexual abuse or neglect. A study of women with ADHD revealed that 1 in 4 reported some form of trauma by adolescence — compared to 11% in women without ADHD. Girls who both have ADHD and suffered childhood trauma had a higher rate of depression, anxiety or self-destructive behaviors.

ADHD and School

Difficulties in school tend to plague teens with ADHD. Grades can suffer, often impacting their chances at graduating on time or being accepted into a good college. Due to trouble in class, frequent absences or problems with school administrators, a teen suffering from the disorder may be expelled or suspended from school. Being caught with drugs or alcohol — the odds of which are higher in teens with ADHD — can also mean immediate suspension or expulsion, and potential trouble with the law.

Teenagers with ADHD are 4–5 times more likely to require special educational services, tutoring or remedial classes than their peers. Those with predominantly inattentive ADHD have the highest risk of below average or failing grades and are more likely to be placed in classrooms alongside students with learning disabilities. Although 25% of kids eventually function at a normal level, the majority show continued functional impairment, limitations in learning and applying knowledge, and poor progress through school.

ADHD and Relationships

In addition to a troubled classroom experience, kids with ADHD have far more difficulty making or maintaining friendships. Problems with peers are 3 times more likely among children with ADHD, occurring in 21.1% of these kids compared to 7.3% of their classmates. Parents also report that these kids are 10 times as likely to have difficulties that interfere with friendships.

According to one study, a majority of ADHD sufferers show restricted social participation. Less than 25% will develop antisocial disturbance or a similar psychiatric problem. In romantic relationships where one partner has untreated ADHD, a parent-child dynamic often develops, in which the non-ADHD partner takes on additional responsibilities. This can drive a wedge between them and their significant others, decreasing the chances that the relationships last.

Other Effects

The problems can rapidly expand to criminal behavior if the disorder isn’t addressed and treated. In a study of incarcerated juvenile offenders, 55% had some form of ADHD. Teens with ADHD are more likely to commit crimes later in adulthood — a study of adult inmates revealed that 25% of them had ADHD symptoms as children and still have them as an adult. Research also shows a higher rate of risky behaviors in young people with the disorder, such as earlier experiences with sex and lower rates of contraceptive use.

Co-Occurring Disorders

Bored students during lesson

Attention deficit hyperactivity disorder can exist alongside an additional, equally problematic disease as a co-occurring mental disorder in teens. These are also referred to as dual disorders or comorbidities. At least 65% of kids with ADHD have one or more co-occurring disorders. Neurodevelopmental issues, like dyslexia and developmental coordination disorder, are especially common.

Co-occurring disorders observed in ADHD patients range from mild to severe, but some are considered more as complications of ADHD itself. If teens face adversity in their daily environment — at school or at home — they can develop antisocial conduct. Some studies show that conduct disorder and obsessive-compulsive disorder in teens (OCD) can coexist in 30–90% of ADHD cases. In many of these cases, oppositional defiant disorder can also develop. Many victims develop tic disorders, displaying random, sudden and rapid movements (e.g. frequent blinking, twitching). Approximately 60% of young people with Tourette’s syndrome meet the criteria for ADHD.

ADHD and Substance Abuse

Overwhelming evidence shows that ADHD can also be a co-occurring disorder of substance use disorder in teens. The symptoms of ADHD create a combustible mental state for teens, where they’re far more likely to experiment with drugs or alcohol and develop an addiction — an uncontrollable urge to keep using these substances — than their healthy peers. In one study of teens with ADHD, at an average age of 15, 35% said they actively use at least one substance (compared with 20% of teens without the disorder).

Teens with ADHD are:

  • Almost twice as likely to have alcohol problems
  • Nearly 3 times as likely to have nicotine problems
  • Approximately twice as likely to develop marijuana addiction
  • About twice as likely to develop a cocaine problem
  • More than 2.5 times as likely to develop a substance addiction in general

As the symptoms of ADHD roll over into adulthood, the patient’s likelihood of at least experimenting with substances remains dangerously high. These symptoms (e.g. impulsive and reckless behavior), along with the need to self-medicate, may cause these people to give less thought to the dangers of heavy drinking or illicit drugs. A one-time experience with smoking, drinking or doing drugs can be enough to spawn addiction, a disorder very much all its own.

As these simultaneous issues compound — either developmental problems or substance abuse habits — the chances of your teen responding successfully to treatment start to dwindle. Co-occurring disorders have a history of intensifying the symptoms of each other, causing a complex puzzle for doctors to address and setting patients up for a turbulent future. If you are able to attack symptoms of ADHD or similar illnesses early on, your son or daughter’s odds of recovery are improved dramatically.

What Are the Symptoms of ADHD?

The defining traits of ADHD are things all children might display at a certain point: inattention, hyperactivity and impulsivity. This conundrum can cause actual cases of ADHD to go overlooked or cause healthy kids to be diagnosed as having the disorder.

If you believe your child might qualify, it’s important that you trust their doctor and have legitimate cause for concern. In order to be diagnosed with ADHD, symptoms need to be present for 6 months or longer and be more severe than healthy children of the same age.

Signs of ADHD are observable across the three main traits. Inattentiveness symptoms include:

  • Having trouble focusing on one thing
  • Being easily distracted, forgetting things and missing details
  • Constantly bouncing from one activity to the next
  • Becoming easily bored with and having difficulty completing tasks
  • Seeming not to listen when spoken to
  • Difficulty learning new things
  • Moving slowly, being easily confused and often daydreaming
  • Struggling to follow instructions

Hyperactivity symptoms include:

  • Talking nonstop
  • Fidgeting and squirming in one’s seat
  • Difficulty sitting still during dinner, school or story time
  • Constant motion, and touching or playing with everything in sight
  • Trouble engaging in quiet tasks or activities

Impulsivity symptoms include:

  • Frequent impatience
  • Blurting out inappropriate comments
  • Acting without regard for consequences
  • Often interrupting conversations or others’ activities
  • Showing their emotions without restraint

If your teen has ADHD, they may not exhibit all of these symptoms, Similarly, even healthy children will show these behaviors from time to time. But if you notice a number of these signs for a prolonged period of time, and your teenager shows no signs of improvement, it may be time to consider a doctor’s appointment.

How to Treat ADHD

A combination of behavioral therapy and medication is the preferred treatment for ADHD in teens. Unfortunately, less than 1 in 3 kids diagnosed with the disorder receive this combined approach.

In 2011, 6.1% of all kids aged 4–17 were prescribed ADHD medication. Nearly 18% of kids with ADHD in the U.S. were not receiving any sort of treatment — either medication or mental health counseling.

The medications prescribed for ADHD are typically stimulants, which can manage the primary symptoms of this disorder. The most commonly prescribed drugs for ADHD include:

  • Methylphenidate (e.g. Ritalin, Concerta, Methylin, Metadate, Daytrana)
  • Dextroamphetamine and amphetamine (e.g. Adderall)
  • Dextroamphetamine (e.g. Dexedrine)

Depending on the severity of your teen’s symptoms, along with their body chemistry, their doctor may prescribe them a less common medication for their ADHD. Other medications prescribed for ADHD include:

  • Vyvanse
  • Focalin
  • Strattera
  • Aplenzin
  • Wellbutrin
  • Zyban
  • Intuniv
  • Tenex
  • Catapres

Each medication is designed differently, with its own list of possible side effects. Do your research on these drugs and discuss options with your child’s doctor before your teen begins taking medication.

Abuse of ADHD Medication

In the event your teen is prescribed drugs like Adderall or Ritalin, it’s important to know the dangers of these drugs. These are potent medications with a potential for addiction or abuse, or being used inappropriately. In the last two decades, teens and college students have reported excessive abuse of these prescription pills, and many kids who have prescriptions are now reselling them to classmates and peers. Kids will abuse these ADHD pills —lso known as “study drugs” — to help focus during important tests or stay up late writing papers. This “study drug” abuse now occurs at the same rate as some of the abuse of other illicit drugs popular among teens. Among high school students, around 8% report nonmedical use of prescription stimulants like Adderall in the last year. It’s an even bigger issue in colleges, where the numbers leap to 35% in some universities. At one university surveyed, more than 26% of students diagnosed with ADHD report using higher medication dosages than what they were prescribed.

Adderall is currently the most abused drug by 12th grade students, lagging behind alcohol and marijuana abuse. According to the research, most teens get these pills from friends or relatives. This presents a complex problem for doctors trying to meet the demand of increasing ADHD patients. As more of these drugs hit the street, the chances of your teen using them improperly increases. When you speak with your teen about drugs and alcohol abuse, be sure to also mention prescription drug abuse — prescribed pills can be just as dangerous as the “harder” drugs out there. And if your son or daughter is prescribed one of these medications, keep a close eye on their prescribed dosages and make sure they aren’t taking too much or sharing them with friends.

Does My Teen Need Rehab?

If you begin to notice signs of substance abuse in your teen, talk to a treatment professional right away. They can help you figure out what is going on. If in fact addiction is present, your child may need rehab.

Especially when a co-occurring disorder like ADHD is at play, addiction can be tough to manage. That’s why teens with ADHD tend to require a well-structured treatment program with personalized therapy sessions, behavior management courses and medication, if necessary. That said, it’s crucial that you choose the right program for your child. The resources here at TeenRehabCenter.org exist to help you do exactly that. We offer free, confidential assistance to parents like you, whose children are dealing with substance abuse problems. Whether you need help perusing different treatment facilities, sorting through the confusion of the insurance process, or you just need to talk, we are here for you.

Treatment can help your child recover from their addiction, minimize their ADHD symptoms, and live a more enriching life. Don’t wait to get your child the help they deserve.

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