Make Your Teen the CEO of His Treatment Plan
Working with your teen on her ADHD treatment plan — instead of against her — makes it more likely she’ll respond to treatment and build the skills she needs to manage symptoms on her own. Learn how to collaborate on medication, therapy, and symptom management.
How Can I Get My Teen to Take His ADHD Medication?
One major recommendation I make in my book, I Always Want to Be Where I’m Not: Successful Living with ADD and ADHD, is not to drop in on your teen’s physician and grab an ADHD diagnosis and a prescription for medication. That works for the flu or a sprained ankle — conditions that resolve after short-term treatment. Treating mental health conditions, including ADHD, does not work that way. Every professional organization that oversees the practice of psychiatry, psychology, or pediatrics recommends integrative treatment plans — ones that include medication, psychotherapy, and frequent checkups.
Too often, however, parents head down one treatment path and ignore the other — or worse, ignore their teenager’s input, feelings, and reservations about the ADHD treatment process along the way. This is a recipe for medication refusal, wasted money, and built-up resentment between you and your teen. Instead, here’s how to devise an effective treatment plan with your teen, not for her — building life skills, trust, and symptom control along the way.
Medication vs. Therapy: Which Treatment Is Best for Teens with ADHD?
Trying therapy without medication is like telling yourself, “I can work my way out of a bona fide neurological condition. I just need to try harder. Focus, focus.” I know that’s a popular idea, but it punishes and shames teens with ADHD who can’t figure out why they aren’t making it, when what they need is more dopamine in their synapses. Likewise, meds may seem to improve your teen’s life, but without the daily management skills a therapist can teach your teen, they won’t change his long-term trajectory.
It’s not easy to get teenagers, particularly boys, to accept either of these treatments. The sad fact is that lots of teens buy stimulants on the street and self-medicate when faced with finals they didn’t study for, while others wouldn’t touch a stimulant with a 10-foot pole. The secret to teen medication success isn’t much of a secret, but it’s hard to pull off. It requires an actual relationship with the prescriber, one in which the teen feels like he or she isn’t just a member of the team, but its leader. Teens must see their challenges with ADHD clearly, like and trust the provider interested in solving the challenges, and feel they will have full consent. In the parlance of the day, teens say, “my body, my choice.”
We agree. In our clinic, we won’t see a teenager who is refusing treatment. If they’re over the age of 14, we legally can’t. To do otherwise is to waste everyone’s time and money. But guess what? By stating that up front, by saying, “We’re only here for you if you want to be here,” we increase compliance dramatically. It’s actually the rare teen who refuses treatment, at least with medication. Give a teen nothing to push against, and he or she will start making decisions to get better.
Therapy is another matter. The policy of our clinic is that we won’t see clients for medication only, until they’ve completed whatever therapy we recommend they have. If families or teens don’t agree to that, we let them go elsewhere. However, few clients actually do. Teens and young adults understand the value of integrative treatment as long as it is their choice.
Does CBT Benefit Teens with ADHD?
To take meds without a directive therapy process is like filling your gas tank and driving around the parking lot a thousand times. You’ve got the juice, but you’re not going anywhere.
Successful psychotherapy for teens with ADHD starts with a strong relationship. This is not, in my experience, a good place for reserved, non-directive approaches. ADHD clients struggle day-to-day making decisions, setting short- and long-term goals, following through, engaging socially, and managing their affairs. A therapist who offers only a kind ear isn’t going to effect the change clients need. This can be a tough process. I recently sat behind a one-way mirror and (with permission) watched one of my ADHD clients describe our work together to a new therapist at our clinic.
“Wow,” I thought as I listened to this teen client share her perspective. “I sound like a tyrant. This therapist will think I’m terrible.” But at the end, the teen added, “It’s like Wes is my best friend, and he’s also an adult, so he’s an authority. It’s the best of both [worlds].” I interpreted this to mean that I was a kindly tyrant. Despite significant impairment, this hard-working client is graduating on time and going away to college this fall.
Finally, it’s important to consider which brand of therapy best fits your teen. Cognitive Behavioral Therapy (CBT) has a loyal, maybe even “cult-like” following among providers, but many teens do not find the sessions exciting. Instead, in the last two years, I’ve begun studying Acceptance and Commitment Therapy (ACT) as a better alternative. ACT adds mindfulness and existentialism in a complex but smart approach that is greater than the sum of its parts. There’s a branch of ACT designed for adolescents, called DNAv (see sidebar below), and it’s one of the few approaches that doesn’t talk down to kids.
Another factor critical to success is parents joining the sessions with their teen. ADHD affects and is affected by the family, school, work, and peer groups. A good intervention, one that will engage young people, should draw on the resources of the community helping to accommodate the teen and helping the teen work well within it. We require parents to be involved in treatment, and we require ADHD teens, and not infrequently young adults, to allow them to be. We have strict rules about what can and can’t be shared, and everyone is clear that the teen is captain of the ship. Rarely does anyone complain about this stance, since everyone is aiming for the same goal — a teen who successfully transitions to adulthood.
DNAv: A New Therapy for Teens that Works
- The Discoverer learns, builds skills, gains resources, and develops social networks. It drives us to acquire new behaviors, test how useful they are, repeat them when they’re helpful, and grow. As seekers of novelty and sensation, kids with ADHD may over- or misuse The Discoverer, acting too often on trial and error without taking in sufficient information or reflecting enough on what they observe.
- The Noticer is the part of the self that pauses and absorbs experience, without necessarily reacting to it. It allow us to gather information from both the environment and our bodies as it unfolds in the present moment. The Noticer enables us to observe our experience more fully, to respond appropriately to the demands of any given situation, and to appreciate the good things all around us.
- The Advisor is the inner voice of evaluation, judgment, prediction, and, most important, advice about life. It’s so well integrated into our lives that we usually take it for granted. The Advisor has positive and negative sides. It protects us from danger, speeds our evolution as a species, promotes fast and efficient functioning, and provides helpful rules and social conventions.
Teens with ADHD usually have an inaccurate Advisor, one that offers internal criticism rather than useful guidance. DNAv helps the teen notice which messages are helpful and energizing and which are hurtful and debilitating.
V is for Values
DNAv holds that teens seek meaning and vitality in their lives. The Advisor, Noticer, and Discoverer are used to connect a teen’s behavior and decision-making to values that are life-enhancing, rather than those that are valueless or life-draining. Though values vary from person to person, they are expressed through any one of six activities: connecting with others; giving; being active; embracing the moment; taking on challenges; caring for oneself.
For teens with ADHD, life sometimes seems to have no goal, and no amount of nagging will create one. DNAv starts with questions about what’s important to the teen to establish engaging, high-order goals.