ADHD: A TEENAGER'S GUIDE
by James J. Crist, Ph.D.

Introduction. This article is written primarily for teenagers with ADHD. Many ADHD teens get tired of hearing, "you're just lazy," "I know you can do better," or "if you would only pay attention in class and do your homework, your grades would be much better." While many books and articles have been written for children and adults, very little has been written specifically for teens. This article, which contains excerpts from my book, ADHD--A Teenagers Guide, is intended to give teens with ADHD some answers about the disorder and how to cope with it.

What exactly is ADHD? ADHD (or 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. ADHD has been studied for over 60 years, but has become more well-known only in the last 20 years or so. Estimates vary, but between five and ten percent of children are thought to have ADHD, and perhaps between one and two percent of teenagers and adults. Three types of symptoms generally occur in ADHD. You may have only one, or all three. The first is hyperactivity. This means that you may always be in motion, tapping your foot or your pencil. Or you may talk too much--people may call you "motor mouth!" You hate having to sit still, which causes problems at school. In teenagers and adults, hyperactivity often takes the form of a subjective feeling of restlessness. The second symptom is inattentiveness. This means you have trouble paying attention for long periods of time. You are easily distracted and daydream a lot, which causes problems at school. You make careless mistakes. Forgetting assignments is common. Reading may be very difficult. You may get bored easily. Getting yourself organized is likely to be a problem--you may always be losing or misplacing assignments, notes, your keys, etc. For girls, daydreaming a lot and not being able to focus are often the only symptoms present. Impulsivity is the third symptom. People who are impulsive often do not think before they act. You may skip classes, put off doing homework, or even break the law without thinking about the consequences. You may interrupt others or blurt things out and then wish that you had not said them, because they get you in trouble or hurt someone's feelings. You may also be accident- prone. In many ways, ADHD is not so much a deficit in attention as it is an inability to pay attention consistently over a period of time. Some people with ADHD overfocus, meaning that they become so engrossed in what they are doing (e.g. playing video games) that they completely tune out everything else.

How can you tell if you have ADHD? ADHD must be diagnosed by a qualified mental health professional who is knowledgeable about the disorder. Such professionals may include a physician, psychiatrist, psychologist, clinical social worker, or licensed professional counselor. The therapist will most likely ask you, your parents, and your teachers to complete a number of questionnaires that contain items that are associated with ADHD. A thorough personal, family, and medical history will be taken. You may also be asked to take a computer test to measure your ability to pay attention. These tests require you to press a button or computer key when you see a certain letter or shape on the screen. One of the problems in diagnosing ADHD is that many of its symptoms can also be symptoms of other disorders. For instance, people who are depressed often have trouble concentrating. People who are anxious may appear to be restless or have trouble sitting still. In addition, many teenagers are disorganized and do not focus consistently on their schoolwork. Another problem in diagnosis is the inconsistency of the symptoms. You may be able to focus on some days and on some activities, especially if they really interest you. Yet with other activities and at other times, you find it much harder to focus. In larger groups, your ability to focus is generally less than it is one-on-one. For these reasons, it is important to have a complete evaluation. What causes ADHD? No one really knows for sure what causes ADHD. It does seem to run in families, which suggests that it may be inherited. About three times as many boys have ADHD as compared to girls. Some research suggests that ADHD is a brain disorder in which the areas of the brain responsible for maintaining attention and controlling impulses do not function properly. Studies also suggest that the use of alcohol or drugs during pregnancy can interefere with the development of brain cells, and thus may be a cause of ADHD. Others believe that allergies may cause ADHD, though this belief is generally not accepted by the majority of practitioners.

What are the effects of having ADHD? People with ADHD are at greater risk for school failure, for having other learning disabilities, and for abusing drugs or alcohol. You may have more trouble maintaining friendships and getting along with your family. You might also be more irritable and have a quick temper. Left untreated, ADHD can also cause problems in college or even on the job. And when you have had these problems for a number of years, it is hard to feel good about yourself. If you suffer from low self-esteem, you may also become depressed and give up trying to succeed. Common symptoms of depression include long-standing feelings of sadness or irritability, no longer getting pleasure from activities you used to enjoy, changes in your eating or sleeping habits, avoiding being around people, being tired a lot, or thinking about death/suicide.

How is ADHD treated? ADHD is usually treated by a combination of medication and psychotherapy or counseling. Sometimes, only one or the other is needed. Counseling can help you deal with problems related to ADHD, such as improving your study skills, getting more organized, coping with depression, and boosting your self-esteem. It can also help you and your parents learn to get along better. Medications can help make you less fidgety and more focused. By slowing you down, the medications can make it easier to think before you act. The most commonly used medications are the stimulant medications. These include Ritalin (methylphenidate), Dexedrine (d-amphetamine), and Cylert (pemoline). These medications are helpful for about 75% of children and adults with ADHD. If these do not work, or if depression or anxiety is present, an antidepressant medication may be tried. Examples include Elavil (amitriptyline), Pamelor (nortriptyline), Tofranil (imipramine), Prozac (fluoxetine), or Wellbutrin (bupropion). Additional medications which are sometimes used, if neither the stimulants nor the antidepressants seem to work, include Catapres (clonidine) and Tegretol (carbamazepine). In some cases, a combination of two or more medications may be needed. These medications work by altering the levels of different brain chemical messengers, called neurotransmitters. It is thought that by doing so, medications correct a chemical imbalance that may be causing the symptoms of ADHD. Since we cannot know for sure which medication will be most helpful for a given individual, you may have to try a few different ones until your doctor finds one that works for you. Many teens dislike the idea of taking medication. You may worry that this makes you different from everyone else, that you may become addicted to it, or that it is a way that your parents are using to control you. None of these worries is true! If anything, medication can make it easier for you to control yourself. If you do not want people at school to know you take medication, there are medicines that only need to be taken once a day, which eliminates the need for a dose at school.

Are there any side effects of medication? Yes. In most cases, the side effects are mild and may eventually go away. The most common side effects of stimulant medications are difficulty sleeping, loss of appetite, irritability, and upset stomach. Common side effects of antidepressant medications include headaches, dry mouth, blurry vision, drowsiness, and constipation. Make sure you tell your doctor if you experience these or other side effects. Your doctor may change the dose or switch you to a different medication.

How long do I have to keep taking medicine? Taking medication does not mean you need to stay on it forever. Give it a try for at least four to six weeks, to give the medication a fair chance to work. Take it exactly as prescribed, without skipping any doses. Give your doctor a chance to adjust the dose or try different medications. If you honestly think that nothing has helped, then at least you can say you tried. If you decide that you do not want to keep taking the medication, it is very important that you tell your doctor first. With certain medications, it can be dangerous to stop taking them suddenly. You may need to slowly decrease your dose over a period of days.

What kind of special help is available through my school? Attention Deficit Hyperactivity Disorder is considered to be a disability under federal law if it significantly interferes with your ability to learn. As a result, you may be eligible for special services to help you to do your best. In order to qualify for this help, you will most likely need to undergo specialized testing. This will usually include an IQ test, which measures your ability to learn. The WISC-III is a commonly used example of this test. You will also be given achievement tests, which measure your level of achievement (what you have actually learned) in different subject areas, such as mathematics, spelling, and reading. Once the testing has been completed, school officials will meet with your parents to review the results and decide whether or not you qualify to receive special services. An IEP (Individualized Education Program) will be developed for you which describes your problem areas and specific strategies the school will use to help you. I recommend that you attend school meetings if at all possible. This will help you to understand decisions that are being made about your life. It will also give you the opportunity to voice your opinion. After all, it is your life!

How can I improve my school performance? You cannot afford to just "wing it" in school if you have ADHD. Many teens with ADHD were able to get by in earlier grades, but find that high school is different. You have more assignments, more deadlines, and are expected to work more independently. Some suggestions for coping with school are listed below. Try different ones and see which work best for you.

* Tell your teachers you have ADHD. If you explain that you have a problem and ask for their help, teachers will be much more likely to work with you. Do so at the beginning of the year, not after problems start.

* Use an assignment notebook. This is essential. You cannot rely on your memory to keep track of all of your assignments. Put all homework assignments in it, as well as upcoming tests or quizzes. Check the book daily and check off your assignments as you complete them.

* Use a homework folder. Label one side "Work to Be Done" and put all assignment sheets there. Label the other side "Completed Work to Be Turned In" and put all finished assignments there as soon as you finish them. Check this folder every day.

* Use your backpack as an organizer. Keep pens and pencils in outside pockets, your assignment notebook in another pocket, and your homework folder and books inside. When you finish assignments, put them immediately into your bag to avoid losing them or forgetting them the next morning.

* Sit at the front of the class, near the teacher. It will make it much easier for you to pay attention and not get distracted. Don't worry what others will think. Just explain to them that it makes it easier for you to pay attention.

* Take notes, even if you think you know the material. This makes it easier to keep focused. Do not write everything down word for word, because this will slow you down too much. Use an outline and indent as needed.

* Use a tape recorder for lectures and studying. If you have a hard time paying attention to the teacher, ask if you can tape record the lectures. You can listen to the tapes later, not only to help you fill in the gaps of what you missed in class, but also to help you study for tests and quizzes.

What can I do to cope better with my day to day life? Having ADHD may seem like a burden, and in some ways it is. You may wish that it would just go away. This is understandable. By following some simple strategies, you can make your life much easier. Again, try different ones and see what works for you.

* Tell friends you have ADHD. While it may seem embarrassing, having ADHD is nothing to be ashamed about. Telling close friends can be very helpful. They can be more supportive of you. Perhaps they can give you reminders if they know you tend to be forgetful.

* Make time to let off steam. Being physically active is very important to work off some of the excess energy and stress you may have. * Make lists of things to do. This is extremely important! Make lists of things you have to do on a regular basis and post them on the wall or some other place (e.g. your assignment notebook). Possible lists include: checklists for taking trips; materials you need to bring home from school; and things to do before going to bed.

* Learn to express your feelings more appropriately. Blurting things out can often hurt the feelings of those close to you. Try to use "I" statements. For example, instead of saying "you make me so angry," say "I really feel upset when you nag me all the time." You can also try writing letters to people if that would be easier. This gives you time to think about what you really want to say.

Will I ever outgrow ADHD? Most people do not outgrow ADHD. However, people do learn to adapt and lead successful lives. Remember also that having ADHD is not all bad. Many people with ADHD tend to be energetic, outgoing and creative. They become successful in business, sales, sports, and other careers.

Conclusions: ADHD is a treatable disorder. Counseling, education, and sometimes medication can all be very helpful. Dealing with ADHD can be a struggle. However, if you work at it and develop good coping strategies, you will be much more likely to minimize the negative effects of ADHD. This article contains a number of suggestions for making your life easier. If you want more information, there are books that can give you additional suggestions for coping with ADHD.

Click here for a list of ADHD books for teens.

About the author:
James J. Crist, Ph.D., is a clinical psychologist with the Family Counseling Center in Woodbridge, Virginia. He specializes in working with children, adolescents, and adults with ADHD. You can reach Dr. Crist via e-mail at DrJCrist@aol.com   Dr. Crist is the author of ADHD--A Teenagers Guide.