ImageTreatment and the Teen Years

a chat with Ari Tuckman, PsyD, MBA

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 of his.

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 ongoing treatment?

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 responsibility.
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 the alternative.

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 a shot.

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 in.
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 kids do.

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 change him.
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 wants.
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 working.


CHADD’s National Resource Center on ADHD produces a series of What We 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 Parents (WWK#20B). 

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.
Posted in: 2011, October