Attention Deficit Hyperactivity Disorder in Teenagers

                                                                                               by James J. Crist, Ph.D.

Licensed Clinical Psychologist

TEENS AND ADHD

Introduction

Hello! Are you tired of hearing "you're just lazy" and "I know you can do better if you wanted to?" If so, read on! This article is written for teenagers with Attention Deficit Hyperactivity Disorder (ADHD or ADD). It describes what ADHD is, how it is diagnosed, how it is treated, and what you can do to cope with it.  Links to useful information are included as well.  This page is updated periodically, so check back for new information!

For those of you interested in more information, I have written a book especially for teenagers with ADHD. The book is called ADHD--A Teenagers Guide. It is written in an easy to read question and answer format.  The book is also informative for parents.  This article includes excerpts from the book.  Information on how to order the book is included at the end.  You can also ask your local library to order it for you if they do not yet carry it. 

News Flash! ADHD-A Teenager's Guide was just re-released in February 2007 in an updated format!  New information on the latest medications, including the Daytrana patch, research on causes and alternative treatments, school accommodations, executive functioning, and ADHD resources are included.  

What is ADHD?

ADHD (also called ADD) stands for Attention Deficit Hyperactivity Disorder. It is thought to be a brain disorder that makes it difficult to sit still and pay attention. Between 3 and 5 percent of children are thought to have ADHD. It is more common in males, though many girls also have it.

ADHD is characterized by hyperactivity (e.g. being too active, being fidgety, talking too much, being restless, or having your mind be always racing with thoughts); inattentiveness (e.g. difficulty paying attention, mind wandering, forgetting or losing things); and impulsivity (e.g. acting first without thinking, interrupting others, not thinking about the consequences of your words or actions).

You may not have all three types of symptoms.  If you only have problems with paying attention, this is called ADHD--Inattentive Type.  This type of ADHD used to be called ADD, though some people still use this term. If you mostly have problems with hyperactivity/impulsivity, this is called ADHD-- Hyperactive/Impulsive Type.  If you have both sets of symptoms, this is called ADHD--Combined Type.  Many teens mostly have trouble with inattentiveness, which creates lots of problems with paying attention in class, getting homework done, and finishing chores at home. You may have good intentions to finish things, but somehow you often end up being distracted by something else.

ADHD can also cause trouble in relationships. For instance, you may be more likely to interrupt others, to lose your temper and overreact to things, to forget what you promised to do, and to not pay attention when someone is talking to you. It can be harder to maintain friendships and relationships as a result.

Many teens with ADHD also have learning disabilities (LD). This means that you have trouble learning certain subjects, such as reading, math, writing, and spelling. It does not mean that you are not smart! Some teens with ADHD and LD are placed in LD classes to help them learn more effectively. For more information about learning disabilities, contact the Learning Disabilities Association.   Many ADHD teens have trouble with what is called executive functioning. This makes it hard to start things, stay focused while working on them, avoid distractions, and complete them. 

What causes ADHD?

While we do not know for sure, research suggests that people with ADHD may not have enough of certain brain chemicals (called neurotransmitters) that are needed for paying attention and controlling behavior. Two of these neurotransmitters are norepinephrine and dopamine. Recent studies are also demonstrating difference between brain activity of people with ADHD, as compared to people without ADHD. People with ADHD have less activity in certain areas of the brain that help you to pay attention. The medications that are used to treat ADHD work by increasing the levels of these neurotransmitters in the brain.  Dr. Daniel Amen's research has identified 6 types of ADD that he believes are caused by different types of neurotransmitter difficulties in different areas of the brain.  For more information on his work, check out his web site: www.amenclinic.com.  He also has an Online ADD test on his web site.  

How can I tell if I have ADHD?

ADHD must be diagnosed by a qualified mental health professional. Such professionals may include a psychologist, psychiatrist, social worker, or a pediatrician. The therapist or doctor will ask you, your parents, and your teachers to complete some questionnaires. Sometimes, computer tests are used to see how well you can pay attention. One commonly used computer test is the Test of Variables of Attention (TOVA).  

ADHD can be difficult to diagnose because the symptoms are often inconsistent. In addition, some of the symptoms are also common in other disorders. For instance, depression and anxiety can also cause difficulties in concentration and activity level.  If you are taking medications for other conditions, or if you have certain physical problems, these can cause symptoms similar to those of ADHD.  

Bipolar Disorder, which can include symptoms of mood swings, depression, intense anger/rage, and irritability in addition to many of the typical ADHD symptoms, can be very difficult to distinguish from plain ADHD.  You can also have both disorders.  Unfortunately, medicines often used to treat ADHD can make symptoms of Bipolar Disorder worse.  For more information about Bipolar Disorder, check out this website: Juvenile Bipolar Research Foundation or a recent article from Time magazine (8-19-02).

If you are smart or gifted, chances are you got by pretty well in the earlier grades, when homework wasn't such a big issue. Often, gifted students are not identified as having ADHD until middle school or high school, when the work load increases and you are penalized a lot more for not completing homework.   You are also expected to work more independently, and that can be a big problem if you have trouble concentrating and staying organized.

Finally, the use of marijuana also tends to decrease your ability to concentrate and remember things. For these reasons, it is very important to be evaluated properly. If you are using drugs, try to stop for at least a month before being evaluated.

What are the effects of having ADHD?

People with ADHD are at greater risk for school failure, having other learning disabilities, and abusing alcohol or other drugs. You may have more difficulty maintaining friendships and getting along with your family. You may be more irritable and have a quick temper. People with ADHD are at higher risk for developing depression because of the frustrations that go along with having ADHD.  For information on alcohol and other drugs of abuse, check out this page from the National Institute on Drug Abuse.

Some people go on to develop Oppositional Defiant Disorder (ODD). People with this disorder often defy and are hostile toward anyone in authority.  They are argumentative and blame others. This makes things more difficult because of the negative way in which people with ODD treat those who could help them.  For more information on ODD, click here.

You may have trouble maintaining your responsibilities at work. For instance, you may show up late because you are disorganized or plan poorly, or may blurt out something to your boss or coworkers that you later regret.

We are also finding that there may be subtypes of ADHD.  For example, you can be anxious and have ADHD.  Gifted students can also have ADHD.   Some people with ADHD can be hyperfocused, which means when they do focus on something that interests them, they get so absorbed that they tune out everything else.

For all of these reasons, proper treatment is essential. Failure to get the appropriate help now can lead to more problems later on.

How is ADHD treated?

A combination of counseling and medication is often used. The most commonly used medication s are the stimulant medications.  They appear to work by stimulating certain centers in the brain which are responsible for behavior control, motivation, and attention.  Ritalin (also called methylphenidate, its generic form) is the most well-known and well-studied. Sometimes, Dexedrine (d-amphetamine) or Adderall is used.  These medicines usually last about four hours, but this can vary.  A new medicine, Concerta, has just been released. It is a time-release brand of methylphenidate that can last all day--about 10-12 hours.  It comes in 18, 27, 36, or 54 milligram capsules. The 18 mg. size is roughly equivalent to 5 mg. of methylphenidate three times a day, while the 36 mg. is equivalent to 10 mg. three times a day and the 54 mg. size is about 15 mg. three times a day. It should be noted that some people respond better to the brand-name medicines than they do to the generics.  

Adderall XR is also available, with three dose sizes (10, 20, and 30 mg.) available which last all day as well. This eliminates the need to take medicine at school.   Some people may still need a small dose of the shorter-acting medicines after school to help with homework.  

Two newer stimulant medications have recently been made available.  Metadate is a formulation of methylphenidate (generic Ritalin) that lasts about 6-8 hours, is available in a small capsule, and comes in a 30-capsule dose pack.  Ritalin-LA works similarly.  Focalin is also a new form of methylphenidate that contains only the part of methylphenidate that is primarily responsible for its effectiveness.  It is more potent, which means that it takes less of the medicine to achieve the same effect.  

The Daytrana patch is also now available.  It is a small patch placed on the skin to deliver a dose of methylphenidate.  

Cylert (pemoline) has also been used, but is used much less often now because of some evidence that it may damage your liver.  It takes a few weeks to build up in your system before it starts working.

The newest medication available is Strattera (generic name: atomoxetine), which was recently approved by the Food and Drug Administration.  It is the first non-stimulant medicine specifically developed for treating ADHD.  It works by increasing the amount of the neurotransmitter norepinephrine.  It may be useful for people who do not do well with stimulant medicines,  such as those people diagnosed with Bipolar Disorder or who have problems with tics.  The medicine comes in capsule form and is taken once or twice a day.  Strattera takes about two to four weeks to take effect and initial reports have been very positive.  It has fewer side effects than many of the stimulants. However, it can give you a nasty stomach ache if you take it on an empty stomach!  It's best to take it with food containing protein and fat (e.g. peanut butter). Refills are also easier since it is not a Schedule II drug (meaning it does not have the potential to be abused). For more information, click on Strattera.com.  

In some cases, antidepressant medications are used. Examples include Tofranil (imipramine), Prozac (fluoxetine), Effexor (venlafaxine), and Wellbutrin (buproprion). Wellbutrin is probably the most commonly prescribed antidepressant medication for teenagers with ADHD, as it appears to be more effective than other antidepressants.  Sometimes, Catapres (clonidine) or Tenex (guanfacine) are used. Both are originially blood pressure medications but can be helpful in treating the hyperactivity, impulsivity, and aggressiveness that is often associated with ADHD.   They can also help with tics, which can be made worse with stimulant medications.

When needed, combinations of the three types of medications noted are used. This is often done in more difficult to treat cases. Be sure to ask your doctor if you have any questions about medications.

Some side effects may occur with these medications. The most common side effects of stimulants such as Ritalin include upset stomach, difficulty sleeping, loss of appetite, and irritability. Some people also have a rebound effect, which means that the ADHD symptoms come back pretty quickly and intensely when the medicine is wearing off.  Common side effects of antidepressant medications include headaches, dry mouth, blurry vision, and drowsiness. These side effects will often decrease after awhile. Make sure you tell your doctor if you experience these or any other side effects. If the side effects bother you, your doctor may change the dose, switch medications, or possibly add another medication.

These medicines are not addictive when used at the prescribed doses. They make it easier for you for control your own behavior and make better choices. Some evidence suggests that teens who are properly treated for ADHD are less likely to abuse alcohol and other drugs.  Make sure you take the medicine as prescribed. Do not skip doses or take more than you are supposed to unless advised to do so by your doctor.

If you are thinking about stopping, talk to your doctor or therapist first. Do not stop taking your medicine suddenly! If you are taking a stimulant such as Ritalin or Adderall, you may not need to take it on weekends and holidays--again, ask your doctor about this.   Remember also that while you may not think the medicine is helpful, others around you may see an improvement even when you cannot.   

Counseling is also often recommended to help you develop better organizational strategies for home and school. If you also suffer from depression, low self-esteem, family conflict, or other problems, counseling can help you work these problems out. It could also prevent problems from occurring later in life.

Alternative treatments are also being studied.  While sugar has not been shown to cause ADHD, it can make your symptoms worse.  Try limiting your intake of sugar (a can of soda has about 11 teaspoons of sugar!) and see if it helps.  Some people may have reactions to certain kinds of foods or food additives.   Neurofeedback involves teaching people how to control their brain waves. Some people believe herbs or other "natural" products can help with ADHD.  Be sure to check with your family doctor or therapist before trying one of these alternative approaches. Most have not been validated by scientists yet.  If the advertisement sounds too good to be true, chances are that it is!  Questions to ask  include how safe is the product?  Are the ingredients listed?  What research has been done on its effectiveness?  Scientists are studying alternative treatments--if you are interested in the lastest research, check out the National Center for Complementary and Alternative Medicine. Or you can also check out CHADD's fact sheet #6 on assessing alternative treatments for ADHD.

Will I always have ADHD?

While some people may outgrow it, most people have at least some ADHD symptoms well into adulthood.  Frequently, teenagers are less hyperactive than are children with ADHD--they tend to be fidgety and impatient--but they still have problems paying attention, getting organized, and acting impulsively.  Some adults may still need to take medicine, though not all do.  

If you are an older teenager or adult and are still experiencing ADHD symptoms, you may want to consider being evaluated by a psychologist or psychiatrist with expertise in adult ADHD.  The same medicines that work with children and teens can also help adults.

Even if your ADHD symptoms continue, there is much you can do to overcome them.  Scott Eyre, baseball player with the San Francisco Giants, recently spoke with Attention magazine (December, 2003, pp. 14-19) about his own experiences with ADHD.  His coaches have noticed improvement in his performance on the field since he sought treatment for his ADHD.  Scott added that "having ADHD is nothing to be ashamed about."  He is talking about his ADHD to help others who are struggling with it.

How can I deal with having ADHD?

There are many strategies you can use to help you. In terms of school, use an assignment notebook! Write down all assignments, due dates, test dates, appointments, etc. Make sure you check the book on a daily basis.  "Palm Pilots" and other electronic organizers may be helpful in keeping track of schedules and things to do.  Tell your teachers you have ADHD and ask them if they would be willing to help you do your best. Ask to be seated near the teacher, away from distractions such as the door or windows. Ask for written instructions whenever possible. Check with friends to make sure you did not miss what was assigned in class. When studying, use a multisensory approach. This means you use all of your senses--read chapters, write down notes, tape record the highlights, lay them back, and quiz yourself. The more ways you try to get the information in, the better you will remember it.   Some people find that having fidget tools, things they can fidget with in their hands, helps them to stay focused.  For more information, check out Southpaw Enterprises or The Therapy Shoppe.  

At home, use "to do" lists as much as possible. Prioritize your tasks (highlight or put a star next to them), so that you do the most important ones first. Cross tasks off when you complete them. Make time to let off steam. Being physically active is very important when you have ADHD, especially if you have the hyperactivity symptoms. Keep your room as simple as possible--otherwise, the clutter can cause you a lot of aggravation! Learn to express your feelings appropriately. People with ADHD sometimes blurt out things without thinking about the consequences, and end up hurting family members (and other). Use "I" statements. Example: "I feel upset when you nag at me, because it makes me feel stupid. Please tell me only once, or leave me a note."

With friends,  you may want to tell them you have ADHD. They may be willing to give you feedback if you are talking too much, interrupting, or forgetting things (a common problem with ADHD)! They may also be able to support you when you get frustrated because of your problems.

If you have problems with organization, you may want to consider getting the WatchMinder.  It is a vibrating watch with 16 alarms and 70 pre-programmed messages, such as reminders to pay attention and do homework.  For more information, check out www.watchminder.com.   PDA's such as a Palm Pilot can also help you keep track of lists, things to do, addresses, schedules, and more.  You can also set alarms to remind you of things that are due or even dates to remember such as birthdays.  You can also download games to put on your PDA! 

Remember that ADHD also has its advantages!  ADHD can give you lots of energy, which can help with sports.  The high need for stimulation can be helpful in entertaining others and doing emergency work.  Talkativeness can help in sales positions. Many people with ADHD are very creative, since ADHD may allow you to think of many different possibilities at once.  

Is help available from my school?

Yes. You may qualify for extra services if it can be demonstrated that your ADHD is interfering with your ability to learn.  Accommodations are strategies that your teachers can use to make sure you are able to be successful in school.  (Click on the "accommodations" link for some suggested strategies.

If a learning disability is suspected, a child study team will be organized. This involves getting information from your teachers and doing some psychological testing, such as IQ and achievement testing. If evidence of a learning disability in a certain area such as math, reading, or writing is found, you may qualify for special services, ranging from in-class help to being put in a special class for certain periods. If your problems are severe, especially with your behavior, you may be placed in a smaller class which is more structured.    The site ADDInSchool.com has suggestions for teachers--you can share them with your teacher.  Other sites include Dr. Kutscher's list of common sense suggestions and Dr. Hallowell and Dr. Ratey's 50 Tips on the Classroom Management of Attention Deficit Disorder.   

If you do not qualify based on testing alone, you may qualify for help based on Section 504 of the Rehabilitation Act. This means that the school may be required to make accommodations to help you learn. Examples could include being given shorter assignments, having a tutor, having tests be given orally, being placed in front of the class, and being allowed to tape record classes. You may even qualify for accommodations for standardized testing, such as the SAT's. 

It is important for you to participate in this process.  Sometimes you have to make a strong case to get the services you need. By giving your input, and knowing your rights, you may be happier with the final decision.   If your school is not willing to provide help, see if there is a special advocate who can help you and your parents get the services your need.  In some cases, legal advice may be needed.   For more information about ADHD and your legal rights, check out WrightsLaw.  

If you are planning on attending college, it helps to plan ahead of time.  You may qualify for accomodations on testing.  Also, some colleges offer specific programs for students with ADHD or learning disabilities.  For more information, check this site: Getting Ready For College. You will also find more information and resources about learning problems.  Another good site is the Heath Resource Center.  This is a national clearinghouse on college education for students with disabilities, including ADHD.  Information on financial aid is also listed! If the above link doesn't work, try this one:  HEATH.  Check out this site to learn more about College Students and Disability Law.   Finally, I recently found out about a book written by two students about their experiences and how to take charge of your education.  The title is Learning Outside the Lines: Two Ivy League Students with Learning Disabilities and AD/HD Give You the Tools for Academic Success and Educational Revolution, by Jonathan Mooney and David Cole.  It is available at Amazon.com.    

One book you may want to check out is Peterson's Colleges With Programs for Students With Learning Disabilities or Attention Deficit Disorders.  Eds. C.T. Mangrum II, Ed.D. and S. S. Strichart, Ph.D.   While it is out of print, Amazon.com may have used copies.   You can get some of the same information by visiting the Peterson's Educational Portal.  

Are there any online support groups for teens with ADHD?

Yes, there are some online support groups. This can be a great way to talk with other teens who actually understand what it is like to have ADHD. Check these out:

Young People Matter           ADDYouth          ADHD Teens Find Friends

If your parents are interested in finding an online club or chat for parents with ADHD kids, tell them to try these sites:   Our ADHD Club and JOEY's Support Group.     The JOEY site also contains many links to other information.   Check it out!  

Conclusions

ADHD can cause significant problems in your life. However, with proper treatment, it can become much more manageable. Learning as much as you can about the disorder will help you to cope. Don't forget that having ADHD is not all bad.  People with ADHD often have lots of energy, can be entertaining, and are very creative too.  Many famous people have been diagnosed as having ADHD yet have been successful.  

Ordering the book, ADHD--A Teenagers Guide

ADHD--A Teenager's Guide is now available in a revised and updated edition.  The book is available at some bookstores.   If your local bookstore doesn't carry it, they may be able to get it through an inter-library loan if you ask. You could also ask your local library to order it for their own collection.

The best way to get the book is to order it directly from the publisher, Childswork/Childsplay, by calling 1-800-962-1141. They can send you a catalog as well. The price is $24.95.  For a direct link, click here:  ADHD A Teenager's Guide

It is also sometimes available through Amazon.com, an online bookstore, as well as Barnes and Noble.  Please note that these sites may not have the current prices listed.  

Resources for Teens with ADHD

Catalogs

These catalogs contain many books and resources for people with ADHD. You can call and be placed on their mailing list.

Childswork/Childsplay: 800-962-1141

ADD Warehouse: 800-ADD-WARE

Additional books and videotapes

Bell, Michael T.  (2002).  You, Your Relationship, and Your ADD.  Oakland, CA: New Harbinger Publications, Inc.  This workbook is directed at adults, but contains useful information on issues that arise in relationships with people with ADHD.

Dendy, Chris A. Ziegler (1995). Teenagers with ADD: A Parents' Guide. Bethesda, MD: Woodbine House.  woodbinehouse.com  This is an excellent book for parents!

Dendy, Chris A. Ziegler (2000).  Teaching Teens with ADD and ADHD.  Bethesda, MD: Woodbine House.  Another excellent book for teachers and parents.  Includes information on Federal laws governing ADHD, classroom management, helping teens with organizational skills, as well as useful forms to copy.

Dendy, Chris A. Ziegler.  Teen to Teen: The ADD Experience.  In this powerful video, six teenagers and young adults talk about their experiences living with ADD.  For more information, including how to order this tape and other products, visit Chris Dendy's website: http://www.chrisdendy.com/

Gordon, Michael. (1993). I Would If I Could. DeWitt, NY: GSI Publications.

Nadeau, Kathleen G. (1993). School Strategies for ADD Teens. Annandale, VA: Chesapeake Psychological Publications.

Quinn, Patricia O. (1995). Adolescents and ADD--Gaining The Advantage. New York: Magination Press.

Ziegler, Alex and Ziegler Dendy, Chris.  A Bird's-Eye View of Life with ADD and ADHD.  This book is written by a teenager with ADHD and his mother.  It gives a lot of information and is written from a teenager's perspective.  For more information, check out the Cherish the Children Website.

Web sites for more information

Children and Adults with Attention Deficit Disorder (CHADD) and Attention Deficit Disorder Association  (ADDA) are both excellent organizations which have websites for more information about all aspects of ADHD.  ADHD News is another good site.  ADDResource.com is a new search engine and web directory for ADHD and other learning disabilities.  It includes links to research articles and support groups.  Another good site is ADDResources.org--it has information on Adult ADHD as well.    Dr. Sam Goldstein, author of Raising Resilient Children, has an excellent ADHD website with many relevant articles.  Check out the Shire ADHD-Support website.   On the Clinical Tools website, you can download ADHD guides for families, teens, and kids.    The National Resource Center on ADHD is helpful, and includes information in Spanish.

 The LD OnLine site contains numerous articles about ADHD and LD, including strategies for dealing with schools and the legal rights of students with ADHD.   Check them out!

If you are on AOL, go to keyword Online Psych.  Information about ADHD and other mental health issues is included on this site.

For a lengthy list of links on ADHD, including experiences with ADHD, parenting, relationships, managing money and time, and even ADHD humor, check out the ADD Home Page.  While this page is mostly geared toward parents, you may find some useful information here as well.

NEW!   Check out the new magazine ADDitude, liasted as "The Happy, Healthy Lifestyle Magazine for People with ADD.  Their premiere issue, Summer 2000, featured Texas Rangers outfielder Gabe Kapler and how he copes with his own ADHD.  Click here to access their website, complete with resource links.  You can also call toll free to order: (888) 762-8475.

You may want to visit www.harborhouselaw.com for their books on Special Education Law.  This may be useful if you are having trouble getting your school to provide services that could help you do your best at school.  

For help with math, check out mymathman.com.  It includes instruction for algebra and geometry among other math topics. A section for teachers is also included.  Other good sites include AAAMath.com and MathLeague.com.

I can also send you information on therapeutic schools and summer camps for kids and teenagers with ADHD.  Many of them have websites.  E-mail me if you are interested or click here.  The information is contained in a text file.  

If you are interested in more information about other mental health disorders, check out Mental Health Net.  Youth Health contains links for various items of interest to kids and teens, including physical and mental disorders.  Their ADHD section is also good and includes information written by teens.  

Finally, some people with ADHD can qualify for Social Security Disability payments if their symptoms are severe enough.  This extra money can be helpful to pay for tutors, special camps, and other services.  For more information, check out Tim Moore's SSI and ADHD website.  

About the author, James J. Crist, Ph.D, CSAC.

I am a licensed clinical psychologist in practice at the Child and Family Counseling Center in Woodbridge, Virginia. I am also an adjunct faculty member in the Counseling graduate program at Argosy University in Arlington, Virginia. I am originally from Rochester, NY.  I am a graduate of Williams College and of the University of North Carolina at Chapel Hill.  I work with a wide variety of people, including children, teenagers, adults, couples, and families.  I am also a Certified Substance Abuse Counselor. 

I have also written a number of other self-help books for kids and teens, including What to Do When You're Scared & Worried, What to Do When You're Sad & Lonely, and MAD--How to Deal with Your Anger and Get Respect.  For more information, check out my webpage http://jamesjcrist.com.  

Questions or comments

Feel free to send me e-mail if you have questions or comments about my web page. My e-mail address is DrJCrist@aol.com.   You can also visit my home page by clicking HERE--my home page contains information about my practice. I generally respond quickly to questions, but if you do not hear back, feel free to e-mail me again.  Also, let me know if any of these links are not working.  Thanks!

If you are looking for a referral for a therapist:

If you are looking for a referral for yourself or your child, I would suggest that you ask your pediatrician or guidance counselor for a recommendation.  Click on the following links for more information on finding a good therapist:  Find a Therapist  Choosing a Therapist. The American Psychological Association can also refer you to a therapist.  Some insurance companies also know who among their list of providers are experts in working with ADHD.  You may also want to contact your local chapter of CHADD, as they would most likely know the best clinicians in your area.  Click HERE to be linked to the CHADD chapter search page.    

Last updated: 11-4-08

(Copyright 2000, 2008 by James J. Crist, Ph.D.)  

You may print and copy this webpage for personal or educational purposes.  If you would like to include any part of this page in a publication, please let me know first.  Thank you!