Boys 2 Men: When ADHD and Puberty Collide
What parents of boys with ADHD should watch for as their sons pass through adolescence.
Until he was 10 or 11, Robert was cheerful and lively, if sometimes distractible and hyper. Then came 12 and 13. “He alternates between couch potato and monster,” says his mother, Anne. “What happened to my sweet little boy?”
What happened were puberty (physical changes) and adolescence (psychological and social changes), which occur when children begin maturing into adults. Some kids begin to “act” like adolescents before puberty; others may not accept the role of adolescent until long after puberty. Whenever they happen, you’re in for a bumpy ride.
Fortunately, boys with attention deficit disorder (ADHD or ADD) don’t seem to have more difficulty coping with puberty than others. However, their particular problems and stresses may differ somewhat. Here are some issues to consider.
“Raging hormones” can cause intense physical and psychological changes. Teens often find body changes distressing and desperately want to fit in. That’s why many kids who cooperatively took medication in elementary school begin to protest and rebel in their teens; they don’t want to be singled out by going to the school office or health room.
Try to understand and help. If you can find an appropriate medication in a long-acting formulation, your child won’t have to take medicine in school. You can even allow a short trial off medication which may help your teen understand the need to continue taking it. Before discontinuing medication, consult with your family doctor or a mental health professional.
All children need to feel accepted by their peer group. If the years of having ADHD (and possibly a learning disability) have resulted in poor social skills and limited success with friends, early adolescence may be painful.
The danger for some kids is that they may seek out any peer group that accepts them. Socially rejected boys with ADHD frequently latch on to other “misfits” who do not do well in school or sports. The combination of a misfit peer group, the need to be accepted, and low self-esteem places teens with ADHD at great risk of alcohol and drug use. Get educated and if you suspect these problems, get help.
Lack of Supervision
Experimentation with alcohol, drugs, and sex doesn’t take place on weekend nights. The riskiest hours are between 3 and 6 P.M. on school days. Kids are often unsupervised because both parents work. They frequently visit friends’ houses with no adult present.
Be proactive. If you can’t supervise your teens after school, make sure they’re involved in sports, arts, community service or other activities that are supervised by adults. Keep tabs on where they are and what they’re doing at all times.
People with ADHD are at increased risk of comorbid disorders (two or more conditions that occur at the same time). Depression and anxiety disorders often first show up between the ages of 8 and 12, and again in early adolescence. Watch your child for symptoms, and seek help if you think there’s a problem.
Also watch for signs of Conduct Disorder and Oppositional Defiant Disorder, which are marked by antisocial, hostile, and unusually oppositional behavior. These disorders frequently place impulsive boys in dangerous, even criminal situations. Intervention is imperative.
Most boys on medication for ADHD do not need to change medication as they enter puberty. Even significant weight increases may not warrant an increased dose. If the dose used earlier in life still works, don’t change it.
The good news is that about half of kids with ADHD improve significantly after puberty. Many no longer need medication. The rest will probably need medication through adolescence and possibly into adulthood.
On balance, most boys with ADHD pass through adolescence with no more difficulty than others. Becoming a couch potato is not a disorder. However, seek professional advise if your son seems unusually sad, withdrawn, angry, or anxious. Don’t wait for a problem to escalate into a crisis. Even if your concerns are unfounded, it’s better to discuss them with a mental health professional than to wish you had acted sooner.