Attention Deficit Hyperactivity Disorder (or ADHD) is a neurodevelopmental disorder that is diagnosed especially during childhood, and it is during this period that most of the scientific literature on the subject focuses.
Despite this, 85% of children with ADHD continue to have symptoms in adolescence, and 60% persist into adulthood (when the number of certified cases in the female population increases, equaling the ratio between the sexes).
Because childhood and adolescence are periods with specific developmental characteristics, due to the maturity milestones that are inherent to them, it is of great interest to know the expression of ADHD in adolescence .
In this article we will discuss what ADHD is and how it manifests itself at the clinical level, showing its evolution in the process leading from childhood to adolescence (as well as the implications that may arise).
What is ADHD
ADHD is a neurodevelopmental disorder expressed in the form of inattention and/or hyperactivity . People who suffer from it may meet only one of the two symptoms, or satisfy the diagnostic criteria for both. We shall now proceed to describe the way in which one or the other is manifested in childhood, going on to expose the face that they usually adopt when they cross the threshold of adolescence.
Inattention is often easily detected when the child enters school. The teachers, and also the parents themselves, may notice that the child does not concentrate long enough to finish his school activities successfully, ignoring necessary details or expressing tediousness during the course of the activities. Likewise, when his attention is called upon, he responds in such a way that it seems that he is not listening to what is being said, 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 sustained attention . Attention is easily dispersed when faced with external stimuli that are not related to the task in hand, 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 is involved. For example, he may play during the time he should be sitting, moving his arms or feet restlessly. He may also get out of his seat at inappropriate times or resort to annoying activities such as running, humming or even climbing; to satisfy an apparent need for movement.
In addition to motor activity, the child with ADHD may speak in a loquacious manner, interrupting the turn of others and uttering words at such a fast pace that it affects his or her ability to communicate . Playing behaviour is also substantially affected, so that it is difficult for him to engage in shared activities while maintaining peace of mind. This may 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 make the diagnosis of ADHD, the symptoms must be presented before the age of 12. Likewise, it should be extended to at least two contexts (home, school, etc.) and should 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, relatively few studies have focused on the clinical expression of ADHD in adolescents . This stage of development is extremely important for strengthening social bonds outside the family, making decisions about the future, shaping identity, discovering sexuality and ultimately building the foundations on which the person will be constructed during the coming years.
It is therefore essential to know how ADHD could limit, or perhaps hinder, the successful acquisition of such important 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 conflicting) expectations of family and friends, and even the beginning of the first intimate relationships, can be compromised by the challenges that ADHD imposes on the sufferer. It is also not uncommon for additional difficulties to occur in the area of mental health , such as mood and anxiety disorders, which require specialised and independent attention.
In the following lines we will delve into the specific 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 there is no reason why all of them should occur, and that we currently have effective therapeutic strategies aimed at mitigating their effects . The present text serves as a guide for detection and to stimulate the search for effective solutions.
One of the most important obstacles to confirming the diagnosis of ADHD in adolescence is the fact that hyperactivity, the symptom that most easily allows us 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 finishes its maturation in the second decade of life, so many adolescents present deficits in these executive functions. The effect, however, may be even more pronounced in those with a diagnosis of ADHD.
There is evidence that ADHD in adolescence can be expressed through a special difficulty in making decisions weighing up possible future consequences , which ends up translating into greater erraticity when choosing curricular itineraries or employment options. It is also very important to focus attention on other impulsive behaviours because of the physical risk they entail, such as substance use or participation in risky sexual activities.
2. Difficulties in planning
ADHD in adolescence may be manifested 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 one’s responsibilities to be assumed bordering on the time limit available for their realization, or for a sequence of steps to be followed without sufficient logic for the optimal development of the intention.
3. Unstable social relationships
Adolescents with ADHD may show interpersonal behaviour that is affected by instability , so that they may abandon their relationships very easily. They are also often very impatient, which may result in constant interruptions to peers, parents and teachers. All of this, together with a possible tendency to “lose their temper”, contributes decisively to the emergence of conflicts in the family and academic context.
Rejection by social groups can also occur with some frequency in adolescence, prolonging a social problem whose germ could have sprouted in childhood itself, and consecutively attacking the way in which the person perceives himself. The ostracism of the reference group, as another 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 in maintaining attention
As academic demands increase, adolescents with ADHD may perceive their attentional capacities to be exceeded and show difficulties in their performance. This fact is accentuated in the face of repetitive tasks , which require an excess of detail or which are valued as tedious or uninteresting. For this reason, they can make various errors during their preparation, reaching a point where an explicit preference is shown for leaving them unfinished.
This difficulty in maintaining focus also extends to social relationships. During the communicative process, the person with ADHD may feel distracted by thoughts that are alien to the conversation in progress, so that he or she perceives a lack of grasping the content of the messages and responding to them in a congruent manner. Sometimes it is difficult to maintain interest in a film, book or other audiovisual work, especially when there are no options for interaction.
5. Work problems
Working life, just like academic life, can also be compromised as a result of the diagnosis of ADHD , especially in cases where this is maintained when reaching 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 in managing time and organising the agenda of their work responsibilities.
As in social relations, there may also be a tendency to abandon jobs when they exceed coping resources, or when they are considered unrewarding.
6. Mental Health Comorbidities
Adolescents with ADHD may have other mental health problems that add to those of their neurodevelopmental disorder, and that arise as a consequence of both their core symptoms and the consequences of the disorder 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 continue into adolescence, in a way that often goes unnoticed, but can seriously undermine the options for building a meaningful life. It is therefore always advisable to consult a mental health professional if you have any 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.