When Your Adult Child Breaks Your Heart

Coping with mental illness, substance abuse, and the problems that tear families apart

Teenagers With ADHD: the Growing Need For Transitional Care

The importance of maintaining treatment from high school to college

Nearly nine percent of children have attention deficit disorder or attention deficit hyperactivity disorder (AD/HD), and the CDC reports that the rate at which children are diagnosed with the disorder has increased at a rate of three percent every year. Many children are able to get the medication and therapy they need to live with this disorder, which means that by adulthood their symptoms can be minimal or even nonexistent. This doesn't, however, mean that the disorder goes away or is only limited to children. Nearly five percent of adults have the disorder, and millions more may have symptoms without ever getting a diagnosis. Far from being a children's disorder, the symptoms of AD/HD can persist into adulthood, particularly if children diagnosed with the disorder don't receive proper treatment as they become adults.

Why Transitional Care is Important

The transitions from high school to college and from living with parents to living independently are among the most important changes teenagers undergo. Challenges during this time can lead to serious long-term consequences. A college freshman who is unable to do her work, for example, may fail out of school, and a young adult overwhelmed by the process of paying bills may give up on trying to achieve financial independence.

AD/HD can make transitions challenging, and undermines young adults' ability to manage their time, study, remain on task, and avoid frustration when basic tasks aren't easy. Some teens discontinue treatment as they near their 18th birthday. This may be because their treatment works so well that they no longer have AD/HD. It can also be due to inaccessibility of treatment at college or the fact that mom and dad no longer schedule sessions with a psychiatrist. Without this transitional care, though, a teen with well-managed AD/HD can take a sudden and dramatic turn for the worse.

What is Transitional Care?

Transitional care, as the name implies, helps teens move from childhood treatment while living at home to the treatment they will need for their adult lives. Transitional planning should begin in the late teenage years, and the best treatment providers will bring up the issue with you or your teen. Among teens who are nearing adulthood and who have not yet developed a transitional plan, though, a parent's help can be invaluable in preventing AD/HD from escalating out of control. Elements of a good transitional plan include:

• A discussion of the differences between life as an adult and life as a child. For example, children with AD/HD may need constant reminders to complete their homework, while adults can't rely on another person nagging them to complete a task.

• A list of the current strategies being used to combat AD/HD, such as medication, time management, and therapy

• A treatment provider or team of providers who is accessible to the teen in her new location and who specializes in helping teens transition to adulthood. The treatment team should also be affordableideally covered by insurance or part of the free psychological treatment available to students at your child's school

• Assistance from parents, an academic counselor, or a school's disability office in maintaining a schedule and transitioning to life as an independent adult

• Re-evaluation of a teen's treatment needs. The landscape of AD/HD can change with age, so teens transitioning to adulthood may need different medications or alternative time management strategies

How AD/HD Affects Adults

Adults face different challenges than children do, so it's unsurprising that AD/HD would affect them differently. In many adults, the hyperactivity of the disorder tends to diminish. In its place may be left struggles to maintain romantic relationships and ongoing challenges with living fully and wellparticularly among adults who have untreated AD/HD. Common symptoms of the disorder in adults include:

Depression, particularly depression that is the product of problematic relationships, low self-esteem, or the inability to complete tasks

• Instability in relationships, particularly regarding your ability to follow through on tasks and keep promises

• Restlessness and difficulty focusing

• The need for constant stimulation

Impulsive behavior, including anger

• Sudden mood swings

• The inability to tolerate frustration

• Chronic disorganization

• Frequently missing deadlines and appointments or struggling to turn in homework or remember to study for tests

• The inability to complete tasks

• Hyper focusParadoxically, some adults with AD/HD have a remarkable ability to focus on enjoyable tasks. This focus is so strong that it may interfere with their ability to complete other tasks, so hyper focus can actually serve as a sort of distraction.

Treatment Options

Adults, just like children, do well with a combination of medication, therapy, and lifestyle changes. Stimulant medications such as Adderall can be particularly helpful, and adults can sometimes take a lower dose than children. The rate of Adderall abuse is at an all-time high on college campuses, so it is critically important that new college students avoid giving or selling their pills to others.

Cognitive-behavioral therapy that emphasizes changing thought patterns to alter behavior can be particularly effective. However, any type of therapy may be of benefit. The key is that adults with AD/HD need to learn about their disorder, master coping skills, and receive input from a therapist on how best to manage the disorder.

Transitioning to adulthood in our high-stakes, high-stress society is hard enough as it is. No teen deserves the stress of living with untreated AD/HD while trying to manage college life or a first job. If you're concerned about yourself or a loved one, make an appointment with a mental healthcare professional who specializes in AD/HD and begin developing a transitional plan now.

References:

Adult ADHD (attention-deficit/hyperactivity disorder). (n.d.). Retrieved from http://www.mayoclinic.org/diseases-conditions/adult-adhd/basics/s...

Attention deficit hyperactivity disorder (ADHD). (2014, February 28). Retrieved from http://www.cdc.gov/nchs/fastats/adhd.htm

Data & statistics. (2013, November 13). Retrieved from http://www.cdc.gov/ncbddd/adhd/data.html

Montano, C., & Young, J. (2012). Discontinuity in the transition from pediatric to adult health care for patients with attention-deficit/hyperactivity disorder. Postgraduate Medicine, 124(5), 23-32. doi: 10.3810/pgm.2012.09.2591

 

Joel Young, M.D., who teaches psychiatry at Wayne State University, is the Medical Director of the Rochester Center for Behavioral Medicine, near Detroit.

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