ADHD in Adolescence

Family Therapy vs. Non-Family Treatment
for Adolescent Behavior Problems
in Usual Care
ADHD in Adolescence:
Psychoeducation Modules
Chris A. Zeigler Dendy
Consulting LLC
Cedar Bluff, Alabama
© CASAColumbia 2014
Aaron Hogue and Molly Bobek
National 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/Impulsive
Hyperactivity 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
choice
It 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 to
other mental health
problems for which
families seek
counseling
Medication is
very effective in
helping many
(but not all ) ADHD
challenges

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 seizuresDiabetes
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

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