ADHD in Adolescence

Family Therapy vs. Non-Family Treatment for Adolescent Behavior Problems in Usual Care

ADHD in Adolescence: Psychoeducation Modules

Chris A. Zeigler DendyConsulting LLC

Cedar Bluff, Alabama

© CASAColumbia 2014

Aaron Hogue and Molly BobekNational Center on Addiction and Substance

Abuse at Columbia University

ADHD Basic Facts


ADHD is All Around You

Approximately 10% of all children and teens have ADHD

Both boys and girls have ADHD • About 3 boys for every

1 girl

ADHD runs in families• 50% of teens with

ADHD have at least one parent with ADHD

• 30% have at least one sibling with ADHD


What Causes ADHD?

People with ADHD are born with a certain kind of brain chemistry (genetics), and they cope with their surroundings as well as they can (environment)

ADHD is NOT caused by• Eating habits• A difficult childhood• A specific childhood

event

• A specific style of parenting

• A character problem (such as lack of empathy)


Inattentive• Fails to give close attention to details,

makes careless mistakes• Difficulty maintaining attention in work

or fun activities

• Does not seem to listen when spoken to directly

• Does not follow through on instructions, fails to finish schoolwork or chores

• Difficulty organizing tasks & activities

• Avoids, dislikes, or is reluctant to engage in tasks that require continual mental effort (school work, homework)

• Loses things necessary for activities at school or home

• Easily distracted• Forgetful in daily activities

How do Doctors Diagnose ADHD?


Hyperactive/ImpulsiveHyperactivity Symptoms• Fidgets with hands or feet, squirms in

seat• Often feels restless, moves about at

inappropriate times

• Talks excessively; Difficulty being quiet in recreation activities

• Often “on the go” or acts as if “driven by a motor”

Impulsivity Symptoms• Blurts out answers, Difficulty awaiting

turn

• Interrupts or intrudes (e.g., butts into conversations or games)

• Easily becomes angry, tearful, or emotional

How do Doctors Diagnose ADHD?


IMPORTANT: Many teens with ADHD also experience volatility: Inconsistent or rapidly changing moods, often accompanied by outbursts

Am I an ADHD Teen?

The daydreamer• Inattentive • Disorganized • Reading, written

expression and math problems

The whirlwind• Impulsive• Hyper/restless• Emotional control

problems


Am I the Caregiver of an ADHD Teen?

Extra support needed!• Inattentive • Disorganized • Learning and school

problems

Extra stress!• Impulsive• Hyper/restless• Emotional control

problems


I Need a Black Belt in Parenting!

Emotional maturity

• Grows at different rates for different teens

• ADHD teens take longer!


Academic learning

• Progresses in different stages for different subjects

• ADHD teens hit more bumps in the road!

What ADHD Teens Need from Caregivers

Acceptance and adjusted expectations

Extra directions and support


Patience and a sense of humor

ADHD teens are definitely more challenging

For teens with ADHD, being in a high school classroom can feel like being a fish out of water. Their unique strengths and abilities are often not a good fit for the expectations and environment around them.

“I don’t feel like I belong here”



HOWEVER: The unique strengths and abilities of people with ADHD allow for great success in different environments: Artists (musicians, actors, comedians), Athletes, Visionaries, Leaders.

Neurotransmitters: Dopamine and norepinephrine• Maintain attention on boring and

routine tasks• ADHD brains: neurotransmitters are

less available, because they are cleared more quickly from synapses, resulting in less attention and impulse control

What is the core issue? Interest Deficit


School work: Not so much


Teens with ADHD lose attention unless something is constantly interesting

Videogames& Internet:

YES!

ADHD and Treatment: Four Key Ideas

ADHD is not a choiceIt is related to brain chemistry

ADHD can be a lifetime condition that affects both behavior (due to symptoms) and learning (due to problems with attention and self-direction)

ADHD causes or is related toother mental health problems for which families seek counseling

Medication is very effective in helping many(but not all ) ADHD challenges


1 432

ADHD and Executive Skills


Executive Skills

Executive skills are the management functions of the brain that dictate self-direction:• Organization• Planning• Self talk• Getting started

Executive skills are like the film director in the brain• Film directors control

the actors, lighting, and music

• Executive skills control how we think and work in specific ways


Organizing and analyzing

Executive Skills Deficits

Processing speed

Planning


Working memory

Getting started

Self talk

Auditory processing

Visual processing

Attention

Attention and self-direction center

Teens with ADHD are likely to experience executive skills deficits

Executive Skills Deficits Lead to Learning Challenges in School

Reading comprehension, written expression and complicated math

Handwriting and shapes/figures


Organizing and analyzing work

Remembering, getting started and planning ahead

3 Separate Influences on School Performance

Every teen’s potential• Intelligence• Motivation• Effort

ADHD executive challenges• Attention• Self-direction• Remembering


ADHD behavioral challenges• Inattention/

disorganization• Impulsivity/

hyperactivity

Understand and analyze new information

Plan ahead for the future


Manage stressful situations

Start and complete tasks that are complex and require multiple steps

Executive Skill Deficits Also Lead to Coping Challenges in Everyday Life

ADHD Style & Scorecards


ADHD Style Index

Daily Life□ Independent/pushes limits□ Stubborn/willful□ Easily frustrated or

discouraged□ Willing to try new things□ Energetic□ Daring/sensation seeking□ Creative□ Night owl/morning zombie□ Enthusiastic□ Bouncing off the walls□ Leaps before looks

Social□ Late for everything□ Likes to argue his/her point□ Good leader□ Has difficulty tuning in□ Charming/good at persuading

others□ Intrusive/nosy□ Has a short fuse□ Interesting/unpredictable□ Fidgety/restless□ Funny/charismatic□ Sensitive to needs of others


Academic□ Puts off work to last minute□ Has difficulty planning ahead□ Imaginative□ Restless/easily bored□ Daydreams□ Good at presenting an

argument□ Can’t get good ideas on paper□ Curious□ Has difficulty with facts and

figures□ Good communication skills□ Has poor handwriting□ Is a slow reader

Family Problems Scorecard

Inattentive

Impulsive

Easily Frustrated

Independent


Hard to discipline

Always fighting with siblings/sets poor example

Angers or frustrates one or more caregivers

Doesn’t contribute to household upkeep

Doesn't listen or communicate

Ignores or forgets responsibilities

Always challenging/pushing limits

Disrupts/ruins family activities

School Problems Scorecard

Inattentive

Disorganized

Easily Frustrated


Completed work is rushed, messy or incomplete

Loses track of time

Constantly talking or blurting out

Can’t get started

Slow reader

Impatient or never proofreads

Daydreams in class/Slow to respond

Loses homework or forgets responsibilities

Can’t sit still or wait turn

Can’t plan or finish complicated projects

Gives up too soon on new or hard work

Peer Problems Scorecard

Inattentive

Impulsive

Hyper/Silly


Not tuned in/Spacey

Doesn’t think about perspective of others

Interrupts or dominates conversations

Doesn’t get the joke or vibe

Seems insensitive or insulting

Seems self-centered

Invades others’ personal space

Always changing or can’t maintain friends

Always late or unprepared

ADHD Medication


Worries about the Diagnosis• I will feel damaged or

limited• I will feel weird, hard to

like, or separate

• Others will believe I am damaged

• Others will blame me for having ADHD

Don’t Label Me With ADHD!

Worries about Taking Medication• People will avoid me or

treat me differently• People will overlook my

good qualities

• I will experience bad side effects

• I will develop substance use problems


ADHD symptoms are creating chaos at home• Rules and routine are

constantly disrupted or non-existent

• Emotional outbursts and sibling fights

• Caregiver always under stress and ineffective

Why Consider Medication?

ADHD symptoms are creating struggles with school• Teachers constantly

complain about poor attention, organization and self-control

• Teen cannot maintain focus or get organized about homework

• Teen constantly struggles or refuses to start/finish homework


Medication + Behavior Therapy

treats:

How Can Combined Treatment Help with ADHD?

Inattention and Impulsivity


Organization and Self-Direction

Medication is Corrective!


What I got Not My Fault! What to Do What’s the Benefit

Poor vision

Not the right amount of blood sugar

Insulin Avoid blackouts and seizures Diabetes

ADHD

Not the right curve of the retina

Glasses/Contacts See objects from far away and in greater detail

Not the right amount of neurotransmitters

Medication Improve attention, impulse control, and information processing


Just as when a person with poor vision is immediately able to see individual blades of grass when wearing glasses for the first time, a person with ADHD on medication is likely to immediately pay attention in a better and more meaningful way.

What Does Medication Correct?

Increased• Attention• Concentration• Responding to

requests• Amount and accuracy

of school work• Speed of learning• Ability to organize

thinking

Decreased• Activity levels• Impulsivity• Negative behaviors• Physical and verbal

hostility• Outbursts and

meltdowns


Medication helps 80%-90% of all ADHD teens

What Are the Medication Options?

Type• Which

neurotransmitters are affected?

Dose• How strong is the

medicine?


Length of Action• How long does one pill

last (half day, school day, all day)?

Medication Fit is Trial-and-Error

Every person’s brain chemistry is unique!

Your type, dose and length of medication may be adjusted several times


Peaks and valleys may occur throughout the day—at school, at home

Medication is Not Perfect…

Changes you experience may be surprising or disappointing• You are likely to

notice them immediately

You may not be as fun and spontaneous


You may experience an increase in mood problems

Most Teens Experience Some Side Effects

Physical symptoms• Sleep problems• Appetite decreased• Nervous and restless

OR low energy and tired• Headaches or stomach

aches• Increase in tics


Most Teens Experience Some Side Effects

Rebound effect• When medication

wears off, ADHD symptoms can return, sometimes in a more severe way



ADHD in Adolescence

Health & Medicine