Treatment and the Teen Years
a chat with Ari Tuckman, PsyD,
A PSYCHOLOGIST IN PRIVATE
PRACTICE, Ari Tuckman, PsyD, MBA, specializes in the
diagnosis and treatment of children, teens, and adults with ADHD,
anxiety, and depression. He has appeared on CNN, National Public Radio,
and SiriusXM Radio, and has been quoted in the Washington
Post. He is the author of Integrative Treatment for Adult
ADHD: A Practical, Easy-to-Use Guide for Clinicans (New Harbinger,
2007), and More Attention, Less Deficit: Success Strategies for
Adults with ADHD (Specialty Press, 2009).
Before moving to West Chester, Pennsylvania, Tuckman facilitated a
monthly adult ADHD support group for the Northern Virginia chapter of
CHADD for five years. He has facilitated a monthly teen ADHD support
group for the Chester County chapter of CHADD since 2005.
My teenage son was diagnosed with ADHD last summer, and he is still
resistant to help in dealing with the challenges he is facing. Even
though I have tried to educate myself and have tried to pass on some of
that education to him, he still feels that admitting he has ADHD means
there is something wrong with him. Do you have any suggestions for how
we can help him to accept his ADHD so he can move forward by focusing on
his strengths rather than his weaknesses or challenges in life?
Talk to him about how ADHD is a part of who he is, but not all
of who he is. He has other strengths and good qualities, just as
everyone does. We all have strengths and weaknesses. Also, remind him
that he was distracted and forgetful before your family had a name for
it. So the label doesn't change the facts—it just changes your
understanding of the situation and what to do about it.
By understanding that this is ADHD, you and he are in a better position
to know what to do about it. This will help him be more successful in
life and be better able to meet his goals.
For everyone, accurate self-knowledge is a key to success—what
we're good at, what we're not as good at, how we best get things done,
and so forth. Knowing that he has ADHD is part of this self-knowledge.
Understanding how his brain works will help make the most of his
abilities and potential.
I wouldn't tell him that ADHD is a gift or that it gives him other good
qualities (like creativity), because it doesn't. But everyone has some
things that they wished they did better. These ADHD symptoms may be some
Remind him of his other strengths and how he does better with them than
some other people do. Talk about how seeing his treatment providers will
help him do better in life. Also, point out that even the best
professional athletes still have coaches who help them do even
better—asking for help is a sign of strength and wisdom.
At what point should teenagers be
responsible for taking medication on their own? When is it appropriate
to transition from a pediatric specialist to an adult physician for
I would base this decision on the extent to which the teenager
can be reliable. If he or she is able to remember to take the meds
consistently, then give him or her that responsibility. If not, then you
need to be involved or at least monitor it. The same goes for any other
I like for kids and teens to have as much responsibility as they can
handle—but not too much more. A little failure is a good thing
because that's how we learn, but too much failure is a set-up for
disappointment and giving up.
Lots of teens and young adults take themselves off medication because
they either don't see the benefit (but others sure do!) or because they
don't like the idea of being different and having to take meds.
As for when to switch doctors, I would talk to your current doctor. Some
will want to transition at a younger age, some at an older age.
What’s most important is that the doctor gets the medications
right, and that your teen or young adult feels comfortable talking to
the doctor and is able to be honest with him or her.
What do you suggest parents do if they
suspect their teen is not taking his or her medication?
I would ask directly and express your concerns, for example,
that the teen's behaviors suggest that he or she isn't taking them,
there are too many pills left in the bottle, and so forth.
You can also count the pills to see if the expected number is there. Of
course, a sneaky kid will take the daily pill out and throw it away! If
you really doubt that the teen is taking the meds, then you may need to
watch him or her take it. This isn't ideal but it’s better than
Talk about why the meds are important and how they can help. Then ask if
the teen has any hesitations about taking them. It may help to talk
about this together with the prescriber or therapist.
How can a parent deal with a teen who is
insistent about stopping medication, despite school problems?
I would suggest taking a brief break. Of course, you first need
to make sure with your prescribing professional that it's okay to take a
break. For some medications it is, but for others it isn't.
If the prescriber approves taking a break, talk with your teen and write
up an agreement. For example, come to an agreement that your son or
daughter will stop taking the meds for a week or two, but everything
else will be exactly the same. Write down who will do what.
Then write down the requirements for staying off the meds—for
example, if the teen has all Bs or better, then he or she can stay off
the meds another two weeks. If the grades drop below a B, then he or she
has to go back on the meds. It's really important to make sure that
everyone agrees and to write it all down.
Then get your teenager to agree that he or she won't fight you on it or
try to justify why he or she got lower grades, blame the teacher, and so
forth. Talk about your concerns, but say that you will agree to give it
You also need to pick the time for the break well. The week before
finals is probably not a good time, but somewhere in the beginning or
middle of a marking period might be. You need to be willing to let the
teen struggle without your getting overwhelmed by anxiety and jumping
It may also be helpful to put an escape clause in the agreement. For
example, if the teen is missing more than five homework assignments,
then the deal is off and he or she is going back on the meds.
Explain to your teen that the meds aren't just for school, but for other
things as well—for example, interacting with friends, less yelling
at home, and so forth. Explain the importance of taking them. You might
use the analogy of glasses, saying that the meds help your child focus
better and bring more of his innate intelligence to his work.
This is especially hard when teens go off to college—you aren't
there to see them take the meds. Unfortunately, they often go off their
meds at the worst time, when the demands on them are the highest and the
other supports are the lowest. So you will probably have lots of
conversations about this topic!
I have a seventeen-year-old
son who does not utilize the tools his
therapist/organizational tutor/psychiatrist have supplied him with to
help him succeed in school. He consistently hands in his homework late
(if at all) and misses classes. He is very resistant and seems to lack
the motivation to perform up to his potential. I feel like he needs some
kind of breakthrough to break this cycle.
I hear this a lot. All the strategies in the world mean nothing if
someone doesn't apply them.
Some kids just don't realize how what they're doing is setting them up
for trouble, or how it is their actions, not other people, that are
making their lives difficult.
Some kids with ADHD feel like they have been told what to do too much
and now don't want to hear any of it. They probably have been told what
to do more than other kids—because being off-task, distracted, and
impulsive tends to cause parents and teachers to tell that kid what to
do. So these kids are right that they get a lot more commands than other
Try to talk to your son about what HE wants out of life—now and in
the future. If his goals are unrealistic or incompatible (for example, I
don't want to go to college or learn a trade but I want a BMW) then talk
about how that probably won't work. So he needs to either change his
goals or find another way to get there.
It may also help to talk about why he doesn't want to try these
strategies—does he not think they will work? Does he think that he
will stand out if he uses these strategies and other kids will make fun
of him? Does he think that no one else uses any strategies so therefore
he must be defective if he has to use them?
Try to identify why he is resisting. To do this, you have to have an
open conversation, where you're just trying to understand him, not
You may need to try this several times before he believes you. Also, at
seventeen, you can talk to him more as an adult and to tell him that he
soon will be an adult, so he needs to be able to make good choices for
himself. These conversations are intended to help him figure out what he
Your goal is to raise a young adult who has a good process of figuring
things out and knows when to ask for help. Give examples from your life
when you've asked for help. Maybe also some examples where you didn't
ask for help and now see that you should have.
Although I feel that meds and coaching can be helpful, sometimes some
therapy is needed to get the person to buy into it and make the most of
these other interventions.
Ultimately, you can't make your son do anything he doesn't want to do.
So present the problem to him—how does he want to solve it? He has
certain goals—what is he going to do to accomplish them? He may
need to struggle and suffer a bit before realizing that his way isn't
FOR MORE INFO
CHADD’s National Resource Center on ADHD produces a series of
Know information sheets. To learn more, see Managing
Medication for Children and Adolescents with ADHD (WWK #3), ADHD and Teens: Information for
Teens (WWK #20A), and ADHD and Teens: Information for
This article originally appeared in the October 2011 issue of
Attention magazine. Copyright © 2011 by Children and
Adults with Attention Deficit Hyperactivity Disorder (CHADD). All rights
reserved. No portion of this article may be reproduced without written
permission from CHADD.