Your teen’s grades are tanking, their bedroom is impassible thanks to junk strewn on the floor, and when you try to talk to them, they just seem to zone out. You might be wondering, is this just normal teen behavior or does my child have ADD/ADHD?
It’s a good question to ask, because ADD and ADHD are conditions that can be substantially improved by treatment, including medication. But how can you know if your child actually has one of these conditions?
Recognizing ADD/ADHD Symptoms
The signs of ADD/ADHD can vary from person to person, so the diagnosis isn’t always obvious. There’s also a difference between the two conditions, although they do overlap.
ADHD stands for attention deficit hyperactivity disorder. ADD (attention deficit disorder) is a subtype of ADHD where the symptom of hyperactivity (the H) is absent.
Symptoms of ADHD/ADD vary from person to person. The main features are:
- inattention – trouble paying attention and focusing, especially to uninteresting topics, easily bored. An inattentive teen may still be able to focus extremely well when doing something they enjoy.
- hyperactivity – abnormally high activity level or excessive restlessness. A teen who is hyperactive is constantly “on the go” and in motion. For them, sitting still is virtually impossible. They may fidget and squirm or tap their feet.
- impulsivity – a tendency to act on a whim, with little or no forethought or consideration of consequences. An impulsive teen may have a tendency to blurt out inappropriate comments and find it hard to wait for things they want.
For one child, inattention may be most prominent, while for another, hyperactivity is the most problematic.
The presence of these symptoms alone isn’t enough to make a diagnosis. Several other factors must be considered:
- young age of onset – symptoms must have been present prior to 12 years of age
- presence in multiple settings – inattentive, hyperactive-impulsive behavior must occur in more than one settings, for example at home and at school
- duration – symptoms must be present for at least 6 months
- negative impact – there must be clear evidence that the symptoms interfere with social, academic, or occupational functioning
- not part of another disorder – the symptoms must not occur exclusively during the course of another disorder such as schizophrenia and are not better explained by another mental disorder such as anxiety or personality disorder.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-V), published by the American Psychiatric Association lays out the criteria doctors use to diagnose ADHD. It recognizes the different ways symptoms can manifest in different people by identifying three subtypes of ADHD (technically called presentations):
Predominantly Hyperactive-Impulsive Presentation – This subtype is diagnosed if at least 6 symptoms of hyperactivity/impulsivity are present but not 6 or more symptoms of inattention.
Predominantly Inattentive Presentation – Diagnosed if at least 6 symptoms of inattention are present but not 6 or more symptoms of hyperactivity/impulsivity. This subtype is the one that’s often referred to as ADD.
Combined Presentation – Diagnosed if at least 6 symptoms of inattention and at least 6 symptoms of hyperactivity/impulsivity are present.
All teens (and adults too) are inattentive at times, so you might be wondering, when does it rise to the level of ADD/ADHD? The diagnostic criteria are actually very specific.
The DSM-V lists nine symptoms considered to be signs of inattention. Children up to age 16 must have at least 6 of these to be diagnosed with ADHD. Adolescents 17 and older only require 5 of these:
- Often fails to give close attention to details or makes careless mistakes in schoolwork, at work, or with other activities.
- Often has trouble holding attention on tasks or play activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (e.g., loses focus, side-tracked).
- Often has trouble organizing tasks and activities.
- Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of time (such as schoolwork or homework).
- Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, mobile telephones).
- Is often easily distracted
- Is often forgetful in daily activities.
Remember, the symptoms must have been present for at least 6 months and interfere with normal functioning.
Diagnosing Hyperactivity and Impulsivity
The DSM-V also lists nine symptoms indicative of hyperactivity/impulsivity. Children up to age 16 must have at least 6 of these to be diagnosed with ADHD. Adolescents 17 and older only require 5 of these:
- Often fidgets with or taps hands or feet, or squirms in seat.
- Often leaves seat in situations when remaining seated is expected.
- Often runs about or climbs in situations where it is not appropriate (adolescents or adults may be limited to feeling restless).
- Often unable to play or take part in leisure activities quietly.
- Is often “on the go” acting as if “driven by a motor”.
- Often talks excessively.
- Often blurts out an answer before a question has been completed.
- Often has trouble waiting his/her turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games)
These symptoms must be present for at least 6 months and interfere with daily functioning.
Getting an Official Diagnosis
If you think your teen might have ADD/ADHD, it’s important to have them assessed by a medical professional who has experience diagnosing teens with this condition.
There are no specific tests for ADHD/ADD, but rating scales can give a good indication of the presence and severity of the condition. A rating scale gives individuals (the patient, teachers, parents) a way to rate the presence and impact of potential ADHD symptoms. Many types of rating scales are available.
A typical rating scale contains 18-90 questions. The questions are based on the DSM-V criteria for ADHD. Rating scales are used in combination with a full, clinical assessment to make a diagnosis.
What Happens if My Child is Diagnosed with ADD/ADHD?
ADD/ADHD can be successfully managed through treatment and self-care. According to the Center for Disease Control (CDC), a combination of behavior therapy and an oral medicine often works best.
The goals of behavior therapy are to strengthen positive behaviors (or learn new ones) and eliminate problem behaviors. Sometimes parents undergo behavior therapy along with their teens.
Medication can be an effective way to manage the effects ADD/ADHD has on daily life. Several different types of medications are approved by the FDA to treat ADHD in children:
- Stimulants – These are the best-known and most widely used. They work for 70%-80% of people. Examples include Adderall, Concerta, and Vyvanse.
- Nonstimulants – If stimulants don’t work or cause unpleasant side effects, nonstimulants may help. They can improve concentration and impulse control. Examples include Strattera and Kapvay.
The Positive Side of ADD/ADHD
Living with ADD/ADHD can be a challenge, but there are upsides that come along with it. ADHD is often associated with numerous positive character traits.
Increased creativity and the ability to hyper-focus on something of interest are commonly reported in people who have ADD/ADHD. Hyperactivity can also be described as “high energy,” and who among us wouldn’t like to have some of that?
Problem-solving skills in combination with a willingness to take risks, (which is often related to impulsivity) have built many a successful entrepreneur. Having ADD/ADHD doesn’t have to be all negative for your teen; it can also bring strengths that open new possibilities.