ADHD in Adolescence - Early Diagnosis Matters
ADHD is a treatable and prevalent neurodevelopmental disorder which can impact on the academic, home and social functioning of children and young people. We now understand a lot more about the areas of the brain affected in ADHD presentation and the fact that modifying the process through behaviour and/ or medication management results in improvement.
Early diagnosis in childhood helps improve the prognosis in children with ADHD. The diagnostic label ‘ADHD’ has been given different interpretations within our society and sometimes bad press within the media. This has resulted in Parents and some professionals being hesitant to consider ADHD as an explanation for a child’s behavioural difficulties and poor academic progress. Children and young people with the disorder have most times gone through a long period of being labelled ‘naughty’ by peers, family members and schools. Children with the disorder usually have onset of these behaviours in the early childhood years with parents sometimes seeing various professionals in the attempt to understand the child’s behaviour. Young children with ADHD present with more externalizing behaviours such as hyperactivity and impulsivity hence their behaviours can be visibly disruptive in school, home and leisure activities. Children with more significant symptoms are more likely to present to the health professional following concerns raised by school and parents.
Teenagers with ADHD tend to present differently hence the secondary schools sometimes refute the idea that the young person may have ADHD. It is not uncommon for schools to comment that the Teenager is not hyperactive and hence cannot have ADHD. Girls with ADHD may pose more diagnostic challenges as they are less likely to have been hyperactive in their earlier years. The teenager in secondary school will have many more classes with different teachers who have a snapshot view of the child. The teachers may feel that the child does not display ADHD symptoms during their class and therefore cannot have ADHD. Parents also have less involvement and direct contacts with the teenager hence are unable to provide a comprehensive account of the young person’s behaviour through the day.
Teenagers with ADHD may first present in services with complications of undiagnosed ADHD such as conduct disorder where the young person has been involved in negative and challenging behaviours, or sometimes behaviours that result from impulsivity such as substance misuse. Teenagers with longstanding ADHD symptoms may become depressed from long standing underachievement and low self-esteem.
Poor academic progress is a common feature in young people with ADHD. Poor motivation, difficulty completing tasks and projects, difficulty sustaining attention and poor organisational skills are some of the features that can be seen in young people with ADHD
It is important that Parents, Professionals within Education and Other services are aware of the varying ways in which children with ADHD can present. Primary care clinicians seeing young people for other mental health or behavioural concerns should scope further information from the young person’s history to determine if the teenager / young adult could have underlying ADHD. There is a need to educate the public that ADHD is a ‘Real disorder’ which can be very impairing to the young person.
ADHD can coexist in other conditions and should be screened for when young people present with the difficulties below.
Anxiety disorder- This can coexist with ADHD and is said to be present in 10-40% of young people with ADHD
Sleep difficulties- Many young people with ADHD struggle to sleep at night and this may be the main presenting feature. Sleep concerns occur as a result of the young person’s mental restlessness and hyperarousal. Sleep medications are not effective without treatment of the underlying ADHD symptoms. Clinicians should screen the young person for ADHD
Mood disorders are fairly common in young people with ADHD. Girls may present with more mood problems as part of their presentation. Many young people diagnosed with depression have not had good response to treatment due to undiagnosed ADHD. It is important that proper screening for ADHD is done in young people with mood disorders.
Substance use and abuse is fairly common in untreated ADHD. This results from the impulsive behaviours seen in ADHD. It is important to consider screening for ADHD in this population.
What should I do if I suspect a Young person has ADHD?
It is important to refer the young person for further assessment either to the Neurodevelopmental (Child Development) Paediatrician or Child Psychiatrist.
Parents should provide supporting information from school and if possible, get information from the different subject teachers. Parents should also collate primary school reports and other relevant reports from tutors and professionals who know the child.
Writing down a summary of the child’s behaviour from early childhood days and noting when the concerns started as well as the impact of the behaviours on the child’s learning, home life and social life. This information will be reviewed by the clinician seeing the child.