Attention Deficit Hyperactivity Disorder shows typical symptoms in adolescents.
Attention deficit hyperactivity disorder (or ADHD) is a neurodevelopmental disorder that is diagnosed especially during childhood, focusing on this age period most of the scientific literature on the issue.
Despite this, 85% of children with ADHD continue to maintain symptoms in adolescence, and 60% persist into adult life (times when certified cases increase in the female population, equating the ratio between the sexes).
Because childhood and adolescence are periods with specific evolutionary characteristics, due to the maturational milestones that are inherent to them, it is of enormous interest to know the expression of ADHD in adolescence.
In this article we will talk about what ADHD is and we will address how it manifests itself at a clinical level, showing its evolution in the process that leads from childhood to adolescence (as well as the implications that may arise).
What is ADHD
ADHD is a neurodevelopmental disorder that is expressed in the form of inattention and / or hyperactivity. People who suffer from it can meet only one of the two symptoms, or meet the diagnostic criteria for both. We then proceed to describe the way in which one and the other manifest in childhood, going on to expose the face that they usually adopt when crossing the threshold of adolescence.
Inattention is often easily detected when the child enters school. Teachers, and also parents themselves, may notice that they do not concentrate long enough to complete their school activities successfully, ignoring necessary details or expressing boredom during their completion. Likewise, when his attention is called for, he responds in such a way that he seems not to be listening to what he is being told, as if what he is thinking about absorbs all his cognitive resources.
There is also a peculiar difficulty in following instructions and maintaining interest in those activities that require projecting the attentional focus in a sustained way. Attention is easily dispersed before external stimuli that are not related to the task in progress, assuming frequent interruptions that lengthen obligations and reduce leisure time. It can also behave in a forgetful or absent-minded way, neglecting its properties or losing them.
Hyperactivity is shown as excessive behavioral activation in contrast to what would be expected in the objective situation in which the child participates. For example, she may fiddle for as long as she should be sitting, fidgeting with her arms or feet. You may also get out of your seat at inappropriate times or engage in annoying activities like running around, humming, or even climbing; to satisfy an apparent need for movement.
In addition to motor activity, the child with ADHD can speak in a loquacious way, interrupting the turn of others and speaking words at such a rapid rate that it affects their ability to communicate. Gambling behavior is also substantially affected, such that it is difficult for him to engage in shared activities while remaining calm. This circumstance can be one of the first experiences of interpersonal rejection in childhood.
Diagnostic manuals (such as the DSM itself in its fifth edition) suggest that, in order to diagnose ADHD, the symptoms must appear before the age of 12. Likewise, it must be extended to at least two contexts (home, school, etc.) and ostensibly interfere with the normal development of family or academic activities. It is also key to rule out the diagnosis of another possible mental health problem (such as childhood schizophrenia).
ADHD in adolescence
Despite the relevance of the question, there are relatively few studies that have directed their focus of interest towards the clinical expression of ADHD in adolescence. This stage of development is extremely important for strengthening extra-family social ties, making decisions about the future, shaping identity, discovering sexuality, and ultimately building the foundations on which the person will build for years to come.
Therefore, it is essential to know how ADHD could limit, or perhaps hinder, the successful acquisition of such relevant evolutionary milestones. Especially due to the fact that there is ample empirical evidence on the possible permanence of symptoms in this transition between both life periods, although subject to “transformation” as a result of the interaction between life experience, the demands of the environment and the effervescent maturation of the central nervous system.
Access to information and communication technologies, managing the (sometimes contradictory) expectations of family and friends, and even the beginning of the first intimate relationships, can be compromised by the challenges that ADHD imposes on those who suffers from it. It is also not uncommon for additional difficulties in the area of mental health, such as mood and anxiety disorders, which require specialized and independent care.
In the following lines we will delve into the concrete way in which ADHD is expressed in adolescence. We will focus only on the most important complications that may arise, although it is necessary to emphasize that they do not have to occur at all, and that we currently have effective therapeutic strategies aimed at alleviating their effects. This text can be used to guide the detection and stimulate the search for effective solutions.
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One of the most important obstacles to confirming the diagnosis of ADHD in adolescence is the fact that hyperactivity, the symptom that makes it easier to infer the presence of the disorder during childhood, tends to soften as we enter this period. Thus, it can be replaced by impulsive behaviors, which are confused or camouflaged in the accumulation of expectations that society places on adolescents.
The prefrontal cortex is a relatively recent anatomical region of the brain in evolutionary and phylogenetic terms. One of its most relevant functions is associated with the inhibition of impulses, as well as the tolerance of frustration. This area of the nervous system completes its maturation in the second decade of life, which is why many adolescents present deficits in these executive functions. The effect, however, can be even more pronounced in those diagnosed with ADHD.
There is evidence that ADHD in adolescence can be expressed through a special difficulty in making decisions weighing the possible future consequences, which ends up translating into greater erratism when choosing curricular itineraries or work options. It is also very important to sharpen attention on other impulsive behaviors, due to the physical risk they entail, such as substance use or participation in risky sexual activities.
2. Difficulties in planning
ADHD in adolescence can manifest itself at a cognitive level, in addition to the aforementioned impulsivity, through specific difficulties in planning the future and drawing up action plans that purposefully direct behavior towards a goal. In this sense, it is common for their own responsibilities to be assumed bordering the time limit that was available for their realization, or that a sequence of steps is followed without sufficient logic for the optimal development of the intention.
3. Unstable social relationships
Adolescents with ADHD can show interpersonal behavior battered by instability, so that they can leave their relationships with great ease. They are also often very impatient, which can lead to constant interruptions to peers, parents, and teachers. All this, together with a possible tendency to “lose one’s temper”, contributes in a decisive way to the appearance of conflicts in the family and academic context.
The rejection of social groups can occur with some frequency also in adolescence, prolonging a social problem whose germ could sprout in childhood, and consecutively attacking the way in which the person perceives himself. The ostracism of the reference group, as one more consequence of the lack of knowledge about essential mental health issues, facilitates the appearance of mood and anxiety problems in people with ADHD.
4. Difficulty maintaining attention
As academic demands increase, adolescents with ADHD may perceive their attentional capacities as being overwhelmed and show difficulties in their performance. This fact is accentuated by repetitive tasks that require an excess of detail or that are valued as tedious or uninteresting. For this reason, they can make various errors during their preparation, reaching a point where an explicit preference for leaving them unfinished is evident.
This difficulty in maintaining the attentional focus also extends to social relationships. During the communicative process, the person with ADHD may feel distracted by thoughts unrelated to the ongoing conversation, in such a way that they perceive lacks to grasp the content of the messages and respond in a congruent way. Sometimes difficulties are observed in maintaining interest in a film, book or other audiovisual work; especially when you don’t have options to interact.
5. Labor problems
Work life, like academic life, can also be compromised as a result of the diagnosis of ADHD, especially in cases where it is maintained into adulthood. There are studies that suggest a preference for jobs in which physical dimensions predominate, as opposed to those that require cognitive skills. In addition, they may need help managing time and organizing their work responsibilities schedule.
As in social relationships, a certain tendency to abandon jobs can also be noticed when they exceed the coping resources, or when they are considered as unrewarding.
6. Mental health comorbidities
Adolescents with ADHD may have other mental health problems with effects in addition to those of their neurodevelopmental disorder; and that they stand as a consequence of both its core symptoms and its consequences on social relationships, academic development, family life and self-image. The most common are anxiety disorders, major depression, and substance abuse or dependence.
It is important to assume that ADHD can last into adolescence, in a way that often goes unnoticed, but can seriously undermine the options for building a meaningful life. Therefore, it is always advisable to consult a mental health professional in case of doubts about the presence of this condition and / or the comorbidities that may accompany it.
- Brahmabat, K., Hilty, D., Hah, M., Han, J., Angkustsiri, K. and Schweizer, J. (2016). Diagnosis and Treatment of ADHD during Adolescence in the Primary Care Setting: Review and Future Directions. Journal of Adolescence Health, 59 (2), 135-142.
- Katzman, M., Bilkey, T., Chokka, P. and Fallu, A. (2017). Adult ADHD and Comorbid Disorders: Clinical Implications of a Dimensional Approach. BMC Psychiatry, 17 (1), 302.