Adolescents Play a Key Role in Their Own ADHD Diagnosis and Treatment
Sep 18, 2014
By: Susanna Visser, Dr.P.H, M.S., Acting Associate Director of Science, Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention; Jackie Oberst, Ph.D., Office of Science Policy, Planning, and Communications, NIMH; Ruth Perou, Ph.D, Program Performance and Evaluation Office, Centers for Disease Control and Prevention; and Mark Wolraich, M.D., University of Oklahoma Health Sciences Center
The face of attention-deficit/hyperactivity disorder (ADHD) has changed dramatically over the past two decades. Once diagnosed mostly in elementary school-aged children, ADHD is now diagnosed more frequently among children of every age now than it was 10 years ago, raising concern of over-diagnosis. In 2007–2008, adolescents, 12–17 years of age, had the largest increase in the percentage of diagnosed ADHD compared to younger children.
To meet ADHD diagnostic criteria, a child must have some ADHD symptoms before age 12 (adolescence). A diagnosis should only be made when the symptoms are severe enough that they are getting in the way of normal functioning.
So, why have we seen such an increase in ADHD diagnoses among adolescents? Some experts question if many of these diagnoses are valid. However, some adolescents may have had ADHD symptoms that were missed in earlier childhood. Others may have had symptoms but were able to cope with them in earlier childhood; with the greater academic and social demands of middle and high school the symptoms may now cause problems that require additional support.
The good news is that a group of doctors, scientists, and parents recently reviewed and updated the diagnostic and treatment guidelines for ADHD . These guidelines include special recommendations for adolescents.
Best practices for evaluating an adolescent for ADHD include:
- Asking about ADHD symptoms and other problems in a structured way, such as through the use of criteria-based checklists;
- Collecting information about symptoms, their impact, and related problems from the adolescents themselves, one or both parents, at least two teachers, and other adults who know the adolescent well (for example, a coach or school guidance counselor);
- Looking for earlier signs of ADHD symptoms that may have been missed; and
- Considering other conditions that might better explain the symptoms or might co-occur with ADHD symptoms, such as trauma and exposure to violence, depression, anxiety, or substance use.
Best practices for treating ADHD among adolescents include:
- Making sure treatment is necessary and understand what is happening in the adolescent's life that might lead to anxious and hyper behavior;
- Receiving permission from the adolescent for treatment;
- Considering family and adolescent preferences and circumstances when creating the ADHD treatment plan and goals;
- Prescribing medications approved by the U.S. Food and Drug Administration (FDA), and behavioral therapy, if possible, depending on the preferences of the family and adolescent;
- Considering the adolescent's risk of misusing or sharing ADHD medications, which is more common among older youth, and choosing a medication formulation that is appropriate for the adolescent; some formulations, such as extended-release and transdermal (patch) formulations, are less likely to be abused;
- If applicable, considering needs and risks around driving (teens with ADHD are involved in nearly four times as many car accidents than teens without ADHD) when developing a treatment plan.
Parents, adolescents, and healthcare providers need to know about the best practices for ADHD diagnosis and treatment among adolescents. It is especially important that adolescents play an active role in the process to diagnose and treat their ADHD. This way, adolescents are empowered to take care of their own wellbeing and can control their ADHD treatment in a way that best fits their needs and supports their health and development.