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Using Behavioral Modification Therapy With ADHD Teens
Impulsivity. Inattention. Hyperactivity.
Under the right conditions, these three symptoms combine to form the core of the neurobiological disorder known as Attention Deficit/Hyperactivity Disorder (ADHD).
Once thought to occur only in young children, we now know this disorder is likely to extend into adolescence. In fact, researchers estimate that 80 percent of elementary school children with ADHD continue to exhibit symptoms during their teen years.
Once thought to occur only in young children, we now know this disorder is likely to extend into adolescence. In fact, researchers estimate that 80 percent of elementary school children with ADHD continue to exhibit symptoms during their teen years. But adolescents with ADHD are different from their younger counterparts. They don't necessarily present the same symptoms, and treatment plans once successful may have to be modified.
Most important, the physical, emotional, and social changes of adolescence produce important challenges for both parent and child.
Not Just Bigger Kids
Young children with ADHD are easily identifiable. Many are in constant motion, have short concentration spans, forget instructions, and have low frustration thresholds. Some chatter endlessly, interrupt constantly, and cannot tolerate delay. All have difficulty with basic tasks involving organization.
During adolescence this picture changes.
On the plus side, attention span and impulse control are likely to show a natural increase as the immature brain continues to grow. Raw physical hyperactivity is often channeled into sports and peer feedback may teach conversational manners.
What does not change is the difficulty that an individual with ADHD has in organizing tasks into sequences that will insure successful outcomes.
For a teen with this disorder, it does not matter if the goal is being popular, getting good grades, losing weight, or building a fine looking body. It is the very ability to create a path to achieving these goals that remains compromised.
It is this frustration combined with a normal self doubt fed by hormonal, social and emotional changes which produces a special kind of angst for the ADHD teen.
And it is this pain that is often self medicated with alcohol, tobacco, and other drugs as well as risky activities such as unprotected sex and driving while impaired.
How can we help teens with ADHD learn to help themselves? One answer is to provide behavioral modification tools in areas that are identified as problematic by both youth and adult.
The Treatment of Choice
Behavioral modification therapy, with or without the addition of psychostimulant medication, is currently considered to be the treatment of choice for ADHD. The goal of this technique is to increase the frequency of "positive" behaviors and to decrease the frequency of undesirable ones.
In the case of parent and child, this aim is accomplished by clearly identifying a behavior to be changed, establishing reasonable and mutually agreed upon expectations, developing a fair system of consequences for success and/or failure, and applying these standards consistently.
The following guidelines are helpful for parents using behavioral modification techniques with an ADHD teen:
- Involve your adolescent in the goal formation and treatment planning aspects. Not only does active participation of your teen insure greater success in goal achievement but it also empowers and serves to increase self esteem. Remember that the long-term goal of behavioral modification is to teach skills necessary to identify and modify any unwanted behavior throughout a person's life.
- Help your child with compliance to medical protocols. Teens do not want to be "different" and having to take medication is often seen as embarrassing. Your doctor can help you work out a more private medication schedule. Even so, it is important to make sure medication levels are maintained.
- Keep channels of communication open between you and your teen. Remember, the burden of maintaining the possibility of open discussion falls disproportionally on the adult during these growing up years. That does not mean asking your child daily if they "want to talk." It just means not closing your part of the door because your teen does not appear ready to walk through it.
- Identify and treat any co occurring emotional disorders through short term therapy. The major psychological cost of growing up with ADHD is diminished self esteem. This can manifest as chronic depression or bipolar disorder. In addition, estimates are that 25 to 45 percent of teens with ADHD also suffer from conduct disorders.
- Be willing to let your child learn by experiencing natural consequences. Adolescence is a time of self-discovery. There will be times that your teen chooses negative over positive behavior. As long as results are not harmful to self or others, much gain can occur from this process. If you have faith in your child's ability to learn from mistakes, he or she will develop a corresponding faith in his or her own resilience.
- Find your own support through professional or self help groups. Being the loving, guiding, limit setting, consequence providing cheerleader for your child can be emotionally and physically exhausting. It is critical that you keep your reservoir of positive energy full by eating well, exercising often, and maintaining your own social contacts.
Challenges of Adolescence
Adolescence is a time of intensive growth and development. The simple world of childhood becomes very complex as the body alters, academic demands change, and a healthy process of separating from family of origin begins. For the teen with ADHD, there is often a conflict between needing help from adults and wanting to be independent.
It is a challenging time for parents also. Their ADHD child, who was once willing to participate in a simple rewards and consequences behavioral modification program, now may laugh at the idea of earning stars or quarters for good behavior. It is sometimes difficult to remember how much you love this rebellious being.
But you do not have to go through this process alone.
Help is available for both parties. Arranging a consultation with a behavioral modification therapist is a good way to begin this process. With appropriate interventions, a healthy and productive life is possible for all.
Copyright 2002 Judy Shepps Battle