Most teenagers have
concerns about being accepted by their peers, but many teens with ADHD have
come to expect some social rejection due to their difficulties with controlling
their behavior and understanding others’ social signals. Social issues
encountered in childhood can become worse in adolescence, with the intensity of
any rejection or bullying increasing during the teenage years. This rejection
can negatively affect both academic performance and emotional health—and can
be, in fact, much more troubling to him than making poor grades in school. He
also may appear emotionally immature compared with classmates, and sometimes
he’ll be more comfortable interacting with younger peers or when spending time
with adults who may show greater acceptance of his immature actions.
As with academic
challenges, however, difficulties with social interaction can often be helped
by having adolescents learn specific skills. You learned a number of ways
to teach younger children how to interact positively with others, including
role modeling, role-playing, analyzing interaction, and practicing new
techniques. Now, in adolescence, your child is likely to experience new
motivation to improve his social life, and advice about social issues is now
more often sought from peers than from parents.
Friendships
Teenagers with ADHD
can certainly have the close friendships that are important for their happiness
and self-esteem. A teenager’s targeted efforts to increase the accuracy of his
social perceptions and monitor his social interactions may make this easier for
him. As he develops friendships, support this by allowing his friends to hang
out in your home and help to provide the kind of supportive environment that
facilitates all friendships. Observe how the friends relate to one another, and
provide tactful feedback later if you feel that it will be received in a
positive and constructive manner. Teenagers with ADHD need to be increasingly
aware that friendships take organizational skills too—returning phone calls,
arriving at meeting places on time, and following through on plans.
Conflict
Resolution
It is important for
your teenager to learn how to resolve conflict without resorting to physical
fights, and how to avoid becoming the target of others’ aggression. Again,
resolving conflict can be a difficult teenage task if his impulsiveness causes
him to strike out when he gets upset. An important step in avoiding this problem
is to identify his own anger cues and to brainstorm in advance about the kinds
of positive solutions he can apply to future conflicts.
If this is an issue
with your teenager, through discussions with you and peers; post-conflict
analysis; and sessions with a counselor, therapist, or social-skills
instructor, he can learn to “talk himself down” when he finds himself in a
frustrating clash of wills (“I’m going to take three deep breaths and think
about my best choice in this situation before lashing out.”). He can also
practice conflict-prevention techniques, such as providing an alternative (“How
about if we go bowling first and then see a movie?”), adding provisions (“OK,
you can drive, but then I get to decide on the restaurant.”), or changing the
subject (“I’m starving. You want to get some pizza?”).
Once your child has
learned a few of these specific techniques, he may be surprised at how
effective they are in helping him avoid the crises that used to disrupt his
social life. If you are seeking counseling in this area, the most proven
approach is through cognitive-behavioral therapy—this is a type of talk therapy
that views behavioral issues as related to the interaction of thoughts,
behaviors, and emotions. In cognitive-behavioral therapy, the therapist and
adolescent will work on identifying and directly changing behaviors that are
problematic.
Working
on Social Skills
As with other
learning processes, your teenager can hone his social skills and interaction by
- Developing a list of specific target behaviors to work on
- Outlining a step-by-step plan to address each one
- Receiving consistent, tactful feedback from you, his peers, and his teachers
- Learning such techniques as identifying cues that set off his anger, analysis of others’ social interaction, social role-playing, etc
- Getting training in anger management or social skills, or treatment in individual or group therapy, when appropriate
- Receiving treatment for any coexisting conditions that may affect his social interaction
- Getting positive feedback for improvement in targeted social skills
- Staying involved in rewarding prosocial activities
That said, it is also
true that many people with ADHD continue to have trouble with certain social
interactions throughout adolescence and into adulthood. Whether or not this is
the case with your teenager, make it clear that you support him no matter what.
Nothing will be more difficult for him than overcoming social rejection. It
will mean a lot to your teenager to know that you will always be in his corner.
Keep in mind that even teenagers who are socially unhappy in high school go on
to find rewarding friendships in college or work situations.
Your
Teenager’s Emotional Development
It is easy to see how
academic, social, and family strains can create a heavy emotional burden for
adolescents with ADHD. Low self-esteem caused by academic failure and social
rejection can lead to depression, defensiveness, pessimism about the future,
hostility, and physical aggression. Combined with ADHD-related impulsiveness,
it can pave the way for unsafe sexual activity; alcohol, tobacco, or drug
abuse; and other high-risk behavior.
Take a moment to
consider your teenager’s emotional state. Does he spend nearly all of his time
alone in his room? Does he seem sad nearly all the time, or irritable? Is his
anger starting to get out of hand? Has he been suspended from school more than
once this year, or are you receiving reports of inappropriate behavior? If so,
discuss these issues with your adolescent and bring them up at follow-up
sessions with his pediatrician. Anxiety and depressive disorders should be
thought of any time an adolescent’s social, academic, or behavioral functioning
starts to deteriorate without an obvious explanation.
In teenage years
depression and anxiety increase significantly in individuals with ADHD. Whereas
in childhood the number of boys and girls who experience depression are about
equal, in adolescence the number of girls outnumber boys by 2 to 1. The sooner
an adolescent’s depression, anxiety, anger, substance use, etc, is recognized,
the greater the chances that the situation can be resolved before worse
problems develop.
Risk
Taking
Adolescence is a time
when all teenagers are prone to testing limits and engaging in risk taking.
Adolescents with ADHD and an impulsive style are especially prone to taking
risks. Surveys have shown that teenagers with ADHD can have an earlier age of
first intercourse, more partners, less use of birth control, and more sexually
transmitted infections and teenage pregnancy than their peers. Education about
these issues in the preteen years and continuing guidance now can really pay
off.
Driving can be a
particular area of concern as well. Teenage drivers with ADHD have been reported
to be 8 times more likely to lose their license, 4 times more likely to be
involved in a collision, 3 times more likely to sustain a serious injury, and 2
to 4 times more likely to receive a moving violation. As a parent, you may want
to consider this area carefully, make sure that your adolescent is at a
maturity level appropriate for driving, and set appropriate limits if
necessary. Some parents restrict the time of day when their adolescent with
ADHD can drive and make driving contingent on responsible driving behavior.
It is a known fact
that teenage driving accidents go up progressively with the number of people in
the car. Parents may put limits on how many teenagers can travel in the car
when your teenager is behind the wheel, particularly in the first year or two
of driving. Discuss safe driving at home. Where medication is found helpful in
cutting down on impulsivity, it makes sense to have a rule that teenagers who
respond well to medication make sure that their medication schedule includes driving
times.
Finally, as with any
teenager it makes ultimate sense to have a “parent taxi” understanding. Even if
use of alcohol or drugs is never condoned by parents, develop an understanding
that it is always safe for your teenager to call you and ask you to pick them
up if they are even minimally impaired from these substances.
