ADHD in adolescence: its effects and characteristic symptoms

Attention Deficit Hyperactivity Disorder shows typical symptoms in adolescents.

Attention deficit hyperactivity disorder (or ADHD) is a neurodevelopmental disorder that is diagnosed especially during childhood, with most of the scientific literature on the subject focusing on this age period.

Despite this, 85% of children with adhd continue to maintain symptoms into adolescence, and 60% persist into adulthood (when certified cases increase in the female population, with the ratio between the sexes becoming equal).

Because childhood and adolescence are periods with specific evolutionary particularities, due to the maturational milestones that are inherent to them, it is of great interest to know the expression of the syndrome in the female population, it is of great interest to know the expression of ADHD in adolescence..

In this article we will discuss what ADHD is and how it manifests itself clinically, showing its evolution in the process leading from childhood to adolescence (as well as the implications that may arise).

What is ADHD

ADHD is a neurodevelopmental disorder that expresses itself in the form of inattention and/or hyperactivity.. Individuals with ADHD may have only one of the two symptoms, or they may meet the diagnostic criteria for both. We will now proceed to describe how both symptoms manifest themselves in childhood, followed by a description of what they usually look like when they cross the threshold of adolescence.

Inattention

Inattention is usually easily detected when the child enters school. Teachers, as well as parents themselves, may notice that the child is not concentrating long enough to successfully complete school activities. enough time to successfully complete his school activities, skipping necessary details or expressing boredom during their completion. Likewise, when his attention is demanded, he responds in such a way that he does not seem to be listening to what is being said, as if what he is thinking about absorbs all his cognitive resources.

There is also a peculiar difficulty in following instructions and maintaining interest. difficulty to follow instructions and to maintain interest in those activities that require sustained attentional focus.. Attention is easily dispersed in front of external stimuli that are not related to the task in progress, entailing frequent interruptions that lengthen obligations and reduce leisure time. It can also behave in a forgetful or absent-minded way, neglecting its properties or losing them.

Hyperactivity

Hyperactivity is shown as excessive behavioral activation in contrast to what would be expected in the objective situation in which the child is involved. For example, he may fidget during the time he should remain seated, moving his arms or feet restlessly. He may also get up from his seat at inappropriate times or resort to annoying activities such as scampering, humming or even climbing; to satisfy an apparent need for movement.

In addition to motor activity, the ADHD child may talk in a loquacious manner, interrupting the turn of others and uttering words at such a rapid pace that it affects their ability to communicate.. Play behavior is also substantially affected, such that it is difficult for the child to engage in shared activities while remaining calm. This circumstance may be one of the first experiences of interpersonal rejection in childhood.

Other particularities

Diagnostic manuals (such as the DSM itself in its fifth edition) suggest that, in order to make the diagnosis of ADHD, the symptomatology must be present before the age of 12. Likewise, it must extend to at least two contexts (home, school, etc.) and ostensibly interfere with the normal development of family or academic activities. It is also key to rule out the diagnosis of another possible mental health problem (such as childhood schizophrenia).

ADHD in adolescence

Despite the relevance of the issue, relatively few studies have focused on the clinical expression of ADHD in adolescence.. This stage of development is extremely important for strengthening social ties outside the family, making decisions about the future, shaping identity, discovering sexuality and ultimately building the foundation on which the person will be built for years to come.

It is therefore essential to know how ADHD could limit, or perhaps hinder, the successful acquisition of such important developmental milestones. Especially since there is ample empirical evidence on the possible permanence of symptoms in this transition between the two vital periods, although subject to "transformation" as a result of the interaction between life experience, the demands of the environment and the effervescent maturation of the central nervous system.

Access to information and communication technologies, managing the (sometimes contradictory) expectations of family and friends, and even the initiation of the first intimate relationships can be compromised by the challenges that ADHD imposes on the sufferer. Additional difficulties in the area of mental health, such as mood and emotional disorders, are not uncommon.such as mood and anxiety disorders, which require specialized and independent attention.

In the following lines we will delve into the specific way in which ADHD expresses itself in adolescence. We will focus only on the most important complications that may arise, although it is necessary to emphasize that not all of them are necessarily present, and that we currently have effective therapeutic strategies available to us for the treatment of ADHD in adolescence. effective therapeutic strategies aimed at mitigating their effects are currently available.. This text is intended to guide in the detection and stimulate the search for effective solutions.

Impulsivity

One of the most important obstacles to confirming the diagnosis of ADHD in adolescence is the fact that hyperactivity, the symptom that most easily allows us to infer the presence of the disorder during childhood, tends to soften as we enter this period. Thus, it can be replaced by impulsive behaviors, which are confused or camouflaged in the accumulation of expectations that society places on adolescents.

The prefrontal cortex is a relatively recent anatomical region of the brain in evolutionary and phylogenetic terms. One of its most relevant functions is associated with impulse inhibition and frustration tolerance. This area of the nervous system completes its maturation in the second decade of life, so many adolescents have deficits in these executive functions. The effect, however, may be even more pronounced in those diagnosed with ADHD.

There is some evidence that ADHD in adolescence may be expressed by a particular difficulty in making decisions weighing up possible future consequencesThis results in a greater erraticism when choosing curricular itineraries or job options. It is also very important to pay attention to other impulsive behaviors, due to the physical risk they entail, such as substance abuse or participation in risky sexual activities.

2. Difficulties in planning

ADHD in adolescence can manifest itself at the cognitive level, in addition to the impulsivity referred to, through specific difficulties in planning for the future and devising action plans that direct behavior purposefully toward a goal. In this sense, it is common that one's own responsibilities are assumed beyond the time limit available for their realization, or that a sequence of steps is followed without sufficient logic for the optimal development of the intention.

3. Unstable social relationships

Adolescents with ADHD may show an interpersonal behavior battered by instability, so much so that they may abandon their social relationships.They are also often very impatient, and may be very impatient in their relationships. They are also often very impatient, which may translate into constant interruptions to peers, parents and teachers. All this, together with a possible tendency to "lose their temper", contributes in a decisive way to the appearance of conflicts in the family and academic context.

Rejection by social groups can occur with some frequency also in adolescence, prolonging a social problem whose germ may have sprouted in childhood itself, and consequently threatening the way in which the person perceives him/herself. The ostracism of the reference group, as another consequence of the lack of knowledge about essential mental health issues, facilitates the appearance of mood and anxiety problems in people with ADHD.

4. Difficulty maintaining attention

As academic demands increase, adolescents with ADHD may perceive that their attentional capacities are exceeded and show difficulties in their performance. This fact is accentuated in the face of repetitive taskstasks that require excessive detail or are perceived as tedious or uninteresting. For this reason, they may make several mistakes during their preparation, reaching a point where an explicit preference for leaving them unfinished is evident.

This difficulty in maintaining attentional focus also extends to social relationships. During the communicative process, the person with ADHD may feel distracted by thoughts unrelated to the conversation in progress, so that he/she perceives a lack of ability to grasp the content of the messages and respond congruently with them. Sometimes there are difficulties in maintaining interest in a movie, book or other audiovisual work, especially when there are no options for interaction.

5. Problems at work

Work life, as well as academic life, can also be compromised as a result of the diagnosis of ADHDespecially in cases where ADHD continues into adulthood. Studies suggest a preference for jobs where physical dimensions predominate, as opposed to those requiring cognitive skills. In addition, they may need help in managing time and organizing the schedule of their work responsibilities.

As in social relationships, there may also be a tendency to abandon jobs when they exceed coping resources, or when they are considered unrewarding.

6. Mental health comorbidities

Adolescents with ADHD may present other mental health problems with additive effects to those of their neurodevelopmental disorder, which are a consequence of both their core symptoms and the consequences of ADHD on social relationships, academic development, family life and self-image. The most common are anxiety disorders, major depression, and substance abuse or dependence..

It is important to realize that ADHD can extend into adolescence, in a way that often goes unnoticed, but can seriously undermine the options for building a meaningful life. It is therefore always advisable to consult a mental health professional if in doubt about the presence of this condition and/or the comorbidities that may accompany it.

Bibliographical references:

• Brahmabat, K., Hilty, D., Hah, M., Han, J., Angkustsiri, K., & Schweizer, J. (2016). Diagnosis and Treatment of ADHD during Adolescence in the Primary Care Setting: Review and Future Directions. Journal of Adolescence Health, 59(2), 135-142.
• Katzman, M., Bilkey, T., Chokka, P., & Fallu, A. (2017). Adult ADHD and Comorbid Disorders: Clinical Implications of a Dimensional Approach. BMC Psychiatry, 17(1), 302.