Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder diagnosed especially in childhood, with most of the scientific literature on the issue focusing on this age period.
Despite this, 85% of children with ADHD continue to maintain symptoms into adolescence, and 60% persist into adulthood (periods when certified cases increase in the female population, which is equivalent to the sex ratio). .
Because childhood and adolescence are periods with concrete evolutionary peculiarities, due to the milestones of maturation which 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 discuss how it manifests at the clinical level, showing how it progresses in the process leading from childhood to adolescence (as well as the implications that can arise from it).
What is ADHD
ADHD is a neurodevelopmental disorder that expresses itself as inattention and / or hyperactivity. People who have it may experience only one of the two symptoms or meet diagnostic criteria for both. We then describe how they both manifest in childhood and then exhibit the faces they usually adopt when they cross the threshold of adolescence.
Inattention is usually easily detected when the child enters school. Teachers, as well as parents themselves, may notice that it is not focused sufficient time to complete their school activities successfully, ignoring necessary details or expressing boredom during their performance. Likewise, when his attention is called upon, he responds in such a way that he does not seem to listen to what is being said to him, as if what he is thinking is consuming all of his cognitive resources.
A particular is also appreciated difficulty following instructions and maintaining interest in activities that require sustained attention. Attention is easily dispersed in the face of external stimuli unrelated to the task at hand, leading to frequent interruptions that lengthen obligations and reduce leisure time. It can also behave in a forgetful or helpless manner, neglecting its properties or losing them.
Hyperactivity manifests itself by excessive behavioral activation contrary to what would be expected in the objective situation in which the child participates. For example, you can play during the time you should be seated, moving your arms or feet agitatedly. You may also get up from your seat at inappropriate times or resort to boring activities such as running, singing or even climbing; to satisfy an apparent need for movement.
In addition to motor activity, a child with ADHD may speak in a chatty manner, interrupting others’ turns and speaking words at such a rapid rate that it affects their ability to communicate. Gaming behavior is also significantly affected, making it difficult for him to engage in shared activities while remaining calm. This circumstance may be one of the first experiences of interpersonal rejection in childhood.
Diagnostic manuals (like the DSM itself in its fifth edition) suggest that in order to diagnose ADHD, symptoms must be presented 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 school activities. It is also essential to rule out the diagnosis of another possible mental health problem (such as childhood schizophrenia).
ADHD in adolescence
Despite the relevance of the problem, There are relatively few studies that have focused their attention on the clinical expression of ADHD in adolescence.. This stage of development is extremely important for strengthening extra-family social bonds, making decisions about the future, shaping identity, discovering sexuality and ultimately building the foundations on which the person will be built in the years to come.
This is why it is essential to know how ADHD might limit, or perhaps hinder, the successful acquisition of such important developmental milestones. Particularly because there is a great deal of empirical evidence for the possible permanence of symptoms in this transition between the two periods of life, although subject to “transformation” due to the interplay between the experience of life, demands of the environment and the effervescent maturation of life. central nervous system.
Access to information and communication technologies, managing (sometimes conflicting) expectations of family and friendships, and even the onset of first intimate relationships, can be compromised by the challenges that ADHD places on those who are suffer from it. It is also not uncommon for additional difficulties to arise in the field of mental health., Such as mental and anxiety disorders, which require specialized and independent care.
In the following lines, we will dig deeper into the specific way ADHD is expressed in adolescence. We will only focus on the most important complications that can arise, although it should be noted that they should not occur at all, and that we currently have effective therapeutic strategies aimed at mitigating their effects. Use this text to guide detection and stimulate the search for effective solutions.
One of the most important barriers to confirming a diagnosis of ADHD in adolescence is the fact that hyperactivity, the symptom that most easily infers the presence of the disorder in childhood, tends to subside. the entry of this period. Thus, it can be replaced by impulsive behaviors, which merge or camouflage themselves in the accumulation of expectations that society places on adolescents.
The prefrontal cortex it is a relatively recent anatomical region of the brain in evolutionary and phylogenetic terms. One of its most important functions is associated with inhibiting impulses as well as tolerance to frustration. This area of the nervous system completes its maturation in the second decade of life, so many adolescents have deficits in these executive functions. The effect, however, may be even more pronounced in people diagnosed with ADHD.
Adolescent ADHD has been proven to it can be expressed by a particular difficulty in making decisions weighing the possible future consequences, Which ends up resulting in a greater erraticism in the choice of curricular routes or employment options. It is also very important to focus on other impulsive behaviors, because of the physical risk they present, such as using substances or participating in risky sexual activities.
2. Planning difficulties
Adolescent ADHD can manifest itself at the cognitive level, in addition to referred impulsivity, by specific difficulties in planning for the future and developing action plans that orient propositional behavior toward a goal. In this sense, it is common that one’s own responsibilities are assumed within the time limit available for its realization, or that a sequence of steps is followed without sufficient logic for the optimal development of the intention.
3. Unstable social relations
Adolescents with ADHD may exhibit unstable interpersonal behavior, In such a way that they manage to leave their relations with great ease. They are also often very impatient, which can lead to constant interruptions for classmates, parents and teachers. All this, together with a possible tendency to “lose the stirrups”, contributes decisively to the emergence of conflicts in the family and academic context.
The rejection of social groups can also occur with some frequency in adolescence, prolonging a social problem that the germ may have germinated in childhood itself, and in turn attacking the way the person sees himself. The ostracism from the comparison group, as an additional consequence of ignoring key mental health issues, facilitates the onset of mood and anxiety problems in people with ADHD.
4. Difficulty in maintaining attention
As school demands increase, teens with ADHD may perceive their attentional skills as overwhelmed and show difficulty in their performance. This fact is accentuated in the face of repetitive tasks, Which require too much detail or which are considered cumbersome or uninteresting. This is why they can make various mistakes during their preparation, reaching a point where there is an explicit preference to leave them unfinished.
This difficulty in maintaining the center of attention also becomes extendable to social relationships. During the communication process, the person with ADHD may feel distracted by thoughts outside of the current conversation, so that they perceive gaps in capturing the content of messages and responding to them in a manner consistent with them. Sometimes there are difficulties in maintaining interest in a film, book or other audiovisual work; especially when you have no options to interact.
5. Labor problems
Professional life, like university life, can also be compromised by a diagnosis of ADHD., Especially in cases where this is maintained in adulthood. There are studies that suggest a preference for jobs in which the physical dimensions predominate, as opposed to those that require cognitive cutting skills. In addition, they may need help managing their time and organizing the agendas of their work responsibilities.
As in social relations, you may also notice a certain tendency to quit jobs when they exceed the resources for adaptation, or when faced with being seen as unrewarding.
6. Mental health comorbidities
Adolescents with ADHD may have other mental health problems with summative effects of their neurodevelopmental disorder; and that they are the consequence both of his nuclear symptoms and of the consequences of these on social relations, academic development, family life and self-image. The most common are anxiety disorders, major depression, and substance abuse or dependence..
It’s important to assume that ADHD can last into adolescence, in a way that often goes unnoticed, but can seriously undermine options for building a meaningful life. This is why it is 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 in adolescence in primary care: assessment and future indications. Journal of Adolescence Health, 59 (2), 135-142.
- Katzman, M., Bilkey, T., Chokka, P. and Fallu, A. (2017). ADHD in adults and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry, 17 (1), 302.