ADHD and Adolescence
Megan, of Iowa, was diagnosed with the inattentive form of ADD when she was 10 years old. She was put on a low dose of Adderall and did well in school. Things changed when Megan turned 12, and entered seventh grade. Surging hormones produced by the onset of puberty, along with the demands of middle school, were too much to handle.
"She was late to class, forgot to bring her textbooks home, and worked three hours on homework assignments, only to forget to turn them in," recalls her mom, Susan. "We didn’t know if her problems were due to worsening ADD, hormonal changes, having to switch classes and deal with six different teachers, or a combination of all these things."
Megan’s doctor told her mom that, when girls hit puberty, they metabolize their ADD medication more quickly. So he increased Megan’s dosage. "During the next three years, we tried 10 different drugs at varying dosages," says Susan. "The higher concentrations of medication caused Megan to lose weight — and didn’t even seem to help her — so we stopped the meds."
While increasing medication dosages sometimes helps teen boys when their ADHD symptoms worsen, "clinical experience suggests that this approach often fails with adolescent girls," says Quinn.
Through trial and error, Megan, now 15, found a way to manage symptoms: a small daily dose of Metadate and fish oil supplements. "She hasn’t missed a school assignment in a year," says Susan. "She has enrolled in more challenging courses in high school, and she’s much happier. And now that she’s a little older, she’s not embarrassed to talk about what’s happening to her body. When she gets irritable, moody, or forgetful during those one or two days of the month, I can ask her, ‘Are you getting your period?’ If she says yes, I know I need to cut her a little slack."
Hormonal Effects on ADHD
The “raging hormones” that lead to rebellion and risky behavior in teenagers have profound effects on girls with ADHD, who typically start puberty between ages nine and 11 and get their periods between 11 and 14.
“We found that ADHD girls in their early teens have more academic problems, more aggressive behavior, earlier signs of substance-related problems, and higher rates of depression than girls who don’t have the condition,” says Stephen Hinshaw, Ph.D., professor and chair of the department of psychology at the University of California/Berkeley, who has been studying girls with ADD for more than 10 years. “Unlike teenage boys with ADHD, who tend to act out, girls with ADHD often internalize their problems. This makes their struggles easier to overlook."
Hormonal changes at puberty — especially the higher levels of estrogen and progesterone — can cause ADHD medications to be less effective. "Studies have shown that estrogen may enhance a woman’s response to amphetamine medications, but this effect may be diminished in the presence of progesterone,” says Quinn.
Solutions: Discuss different medications — or different dosages of current medications — with your daughter’s doctor. It may take time to figure out what works best, so be patient. Behavioral strategies for time management and improving organizational skills can help.
"Identify your daughter’s strengths and emphasize them during the worst times of her cycle," says Kathleen Nadeau, Ph.D., director of the Chesapeake ADHD Center of Maryland. "Too often, teachers and other adults in a girl’s life focus only on her weaknesses."
If your daughter notices that her ADHD symptoms worsen at certain times of the month, encourage her to complete schoolwork before they hit. Have her prepare for a big test or finish writing a paper a week before it’s due.
"Be patient with your daughter if she becomes argumentative or snippy," says Nadeau. "Instead of yelling, suggest that she rest for a while. You’ll be teaching her self-management skills."