Functional Impairments of Adolescents




  • The following article was published in ADDvisor newsletter earlier this year. We are publishing this article in our newsletter with kind permission from Alan Graham and Bill Benninger of ADDvisor.

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    FUNCTIONAL IMPAIRMENTS OF ADOLESCENTS WITH ADHD

    In the following article I will quote extensively from an excellent article written by Margaret Weiss, M.D. and Umesh Jain, M.D. This article was published in The ADHD Report, edited by Russell A. Barkley, Ph.D., Guilford Publications, Inc., Vol. 8, No. 6, Dec. 2000.

    This month we will look at the functional impairments of adolescents with friends, in activities of daily living and at home. Since it is often difficult to distinguish “normal” adolescent behavior from behavior in adolescents with ADHD parents must continually educate themselves as to the differences.

    Friends

    “Children who have always had difficulties getting along with their peers are likely to have particular difficulty in adolescence, when socializing with peers becomes a central focus of development (Green et al., 1997). ADHD adolescents may exhibit the following various patterns of social adjustment: social isolation (i.e., the loner), identification with a fringe group (i.e., the “geeks” or “druggies”), or acting out behavior (i.e., class clown, joker, daredevil).

    Parents are particularly concerned when they see their child team up with delinquent peers who lead them into trouble. The ADHD adolescent may become a willing accomplice, who is unfortunately also the one most likely to get caught.

    Activities of Daily Living

    Functional impairment comes in many forms that are reflective of ADHD adolescents developmental immaturity. Driving is a typical example. Teens take great pride in their learners permit or driver’s license and having access to a car. However, this interest in learning to drive is not associated with equal interest and learning how to drive safely (Nada-Raja et al., 1997). We have been surprised by how many ADHD adolescents impulsively take their parents car without permission.

    Substance use is a common comorbid factor in the ADHD adolescent…. Use of marijuana may be a form of self-medication… ADHD teens describe marijuana as ‘taking the edge off.’ Adolescents with ADHD may also suffer from other impulse based addictions such as gambling, alcohol use, sexual promiscuity, bingeing, video games, compulsive TV habits, or Internet addiction to chat groups and surfing. The result of these various addictions may include academic failure, poor self-care, lack of exercise, financial debt, social isolation, and family conflict.

    Home

    The adolescents capacity to separate and individuate is predicated upon the development of self-control. Adolescents in a 16-year-old body with the inhibitory control of an eight-year old presents a parenting dilemma. The parents become more and more controlling as they assess the child’s risk to be increasing. The teen may demand more freedom, feeling that it is “only fair” for them to have the same privileges as siblings or peers. They want this freedom unconditionally.

    Parents complain that the adolescent “does not deserve” to be given privileges when they have not shown that they can take responsibility for themselves. Since the adolescent does not see the relationship between privileges and responsibility, the parents concerns seem arbitrary and unreasonable. The result is an impasse…

    Management of ADHD in adolescence requires specific accommodations. These include providing the adolescent with as much control over treatment as possible, so they perceive treatment as widening their autonomy rather than limiting it. Ongoing psychoeducation may help to minimize blame. Restructuring the adolescents school, family, and peer environment to be “ADHD friendly” may enable him or her to be able to successfully attain reasonable expectations. These interventions may help smooth the transition through this critical period, and establish a commitment to treatment that lays the foundation for adult growth.”

    This information leads us to make a number of practical suggestions. These suggestions are based on information provided in the newsletter articles from 3/1/01 and from this one.

    1. Work with the school to maintain as much structure and support as your child needs. This is not necessarily the same as what the school says they can provide. It is not uncommon for schools to have the expectation of providing fewer services than your child needs. You will have to educate the school as to what your child needs and how to give it. You may have to be very persistent in getting your child’s needs met. It is usually in everyone’s best interest to work hard at maintaining good relationships during this ongoing process.
    2. Help your children identify their “islands of competence”. Help them to focus on these two help them increase achievement and self-esteem.
    3. Closely monitor the “comings and goings” of your adolescent with their friends and activities. Although this is necessary with all teenagers it is particularly important with teenagers diagnosed with ADHD. They will often protest, sometimes strongly, but do not let that deter you from this very important task. You need to know where they are, who there with, when they’ll be home, what time they’ll be home, every time they go out. They will hate you for it now and love you for it later.
    4. You will need to provide structure for your adolescents daily tasks and activities. Have a chore chart, closely monitor their driving limiting them to familiar roads, short distances and a few passengers. Expanded these privileges only when it is clear that they have mastered their current level of responsibility. Provide daily structure in the form of daily routines including; waking up at the same time daily, having a similar afternoon and evening routine throughout the week, and involvement in structured activities.
    5. Look for ways to give them “structured independence”. Give them choices but make sure all of the choices are acceptable to you.