Of the 11% of American children ages 4-17 diagnosed with attention deficit hyperactivity disorder (ADHD), almost 70% of them are taking medication to manage their symptoms. Many people think of ADHD as a childhood condition, but nearly 60% of children with the condition continue to experience symptoms and difficulties into their teens and adulthood.
We were sure of our decision to put our young son on ADHD medication. But, when he entered adolescence, and his symptoms and the possible dangers were different, we re-evaluated whether to keep him on medication. In the process, here’s what we found.
What do ADHD symptoms in teens look like?
The visible hyperactivity commonly associated with ADHD tends to diminish as kids grow older, which can make it seem like the condition is becoming less severe. But, in adolescence, academic pressures and social expectations increase. This can be especially difficult to manage for adolescents with ADHD who grapple with invisible symptoms, like executive function and working memory deficits. The Child Mind Institute outlines the main areas where teens with ADHD often struggle.
Teens with ADHD often have difficulties with getting organized and staying focused in class or on homework. This can take a toll on their work and their academic success.
Making and keeping friends can be difficult for teens with ADHD. They may miss social cues, act impulsively, or struggle with appropriate communication. They are more likely to be bullied or to bully others.
Poor emotion-regulation can make the typical mood swings of adolescence more pronounced in teens with ADHD. They are often easily frustrated and find it difficult to control their emotions.
Teens with ADHD are more likely to engage in risky behavior like smoking, drinking, and other substance experimentation or abuse, and having sex (particularly unsafe sex). They often start this behavior earlier than their neurotypical peers.
Impulsivity and inattention tendencies put teens with ADHD at a higher risk of traffic tickets and accidents, particularly serious accidents.
How is ADHD in teens treated?
Appropriate treatment can help ameliorate these risks, and make an already challenging period a little easier for tweens and teens with ADHD. The decision to put my then-7-year-old son on medication after his ADHD diagnosis was not difficult. We had done the research, we knew the benefits of ADHD medication—and the potential risks.
We had a lengthy discussion with his pediatrician, and we knew it was the right choice, without hesitation. Within days, we saw positive changes, and within months we had found the optimal dosage of Concerta. He was having a much easier time in school, and most importantly, he felt better. His story is far from unique.
Medication is the most effective and reliable way to manage ADHD in adolescence. “There are several (medications),” says Dr. Joseph Shrand, Lecturer in Psychology at Harvard Medical School and founder of Drug Story Theater, “but basically two main categories of stimulants: methylphenidates (Ritalin, Concerta, Focalin, etc.) and amphetamine derivatives (Adderall, Vyvanse, etc.).” These medications calm teens with ADHD, but have a “revving up” effect on people who do not have ADHD. Dr. Shrand mentions that there are other medications that may help, such as the stimulant Dexedrine and the non-stimulant Strattera.
“Regular exercise is the most effective non-medicinal treatment for ADHD,” says Tia Cantrell, therapist and ADHD specialist in North Carolina. “Most people will still need medication intervention but exercise can drastically improve the ‘gaps’ in medication effectiveness,” for example, in between doses or when your teen first wakes up.
Cantrell stresses the importance of a good night’s sleep for managing symptoms in teens with ADHD. “While a good night’s rest won’t cure your ADHD symptoms, it will help your other ADHD strategies be more effective.”
Screening for dietary intolerances
Un-managed gluten intolerance and celiac disease can mimic ADHD symptoms. Cantrell emphasizes that current research doesn’t support a link between a gluten-free diet and ADHD management, but that, “…children and teens whose ADHD symptoms did improve on a gluten-free diet were found to have undiagnosed celiac disease or non-celiac gluten sensitivity.” It’s not a treatment per se, but it’s worth bringing up with your child’s doctor.
What are the benefits of ADHD medication for teens?
“Kids who are appropriately treated will face no more or less challenges than any teen faces,” says Dr. Shrand. “But kids who are not treated appropriately are at higher risk for substance use, dropping out of school, and feeling constantly inadequate.”
Cantrell agrees: “Many of the risks are reduced when teens are properly medicated for ADHD. They are less likely to get into a serious accident; less likely to become addicted to substances of any kind; less likely to self-harm, commit suicide, or end up in jail later on.”
Both Cantrell and Dr. Shrand recommend keeping teens on medication if they are struggling with ADHD symptoms. Dr. Shrand does not consider staying on ADHD medication to carry any significant risks. But if teens want to see if they can get by without medication, he suggests taking medication breaks occasionally, especially during school vacations. Stimulants leave the body quickly, so it doesn’t take long to assess how teens feel when off of medication versus how they feel on it.
Dr. Shrand recommends continuing medication into adulthood if it is helping. “I have had adult patients who should have been treated as kids, but never were, start on medication and change their lives around.” Cantrell experienced this personally.
For our family, the benefits of ADHD medication far outweigh the risks. We decided to keep our son on his medication for as long as he needs it, or until he is old enough to make a different choice. We are happy to challenge the medication stigma.
“Medicating (children with ADHD) gives them the level playing field they need to live up to their potential,” says Cantrell, who likens ADHD medication to giving a child a bag in which to hold his over-spilling marbles.
Dr. Shrand compares ADHD medication to mountain-climbing equipment. “I will ask a kid this: If you have a mountain to climb are you going to do it in your bare feet? What would happen if you tried? To climb your mountain you need the right equipment. And I don’t care how much equipment they need.”
We explained to our son that, for him, taking ADHD medication is like wearing glasses—something some people need in order to make the world clearer and easier to navigate. We are thankful that the help is out there.