How ADHD Changes in Teens

What is ADHD?

Attention deficit hyperactivity disorder (ADHD) is a health condition that makes it harder for people to:

• pay attention for long periods of time
• organize and follow through on complex tasks
• focus in the presence of distraction
• control impulses
• remain still and quiet

These symptoms may interfere with your ability to function at home, in social settings, and at school or work.

It’s important to note that in childhood, the teen years, and adulthood, ADHD can look different from person to person. Cultural factors, sex and gender, and individual personalities can all shape how ADHD presents. This can make it harder to recognize, diagnose, and treat.

What is ADHD like for teens? 

ADHD is not only a childhood condition. Researchers say roughly 60 percent of people diagnosed with ADHD in childhood will continue experiencing symptoms into adulthood.

That means along with all the other changes adolescence brings, you might also notice some changes in how your ADHD presents. Here are some examples of how ADHD may affect you during your teen years:

Changes in hyperactivity

Many people’s symptoms improve during adolescence. Which symptoms continue and which ones abate can vary from person to person.

One of the hallmarks of childhood ADHD is high energy and an inability to sit still. The amount of physical movement might change for some teens with ADHD. For example, hyperactivity may morph into general restlessness, but inattention and impulsivity may persist.

Academic ups and downs

In late middle school and high school, academic demands increase at the same time as parents and teachers begin expecting students to show more self-discipline and independence. A variety of circumstances can lead to academic challenges:

• The practicalities of high school — changing classrooms, having different teachers, and using lockers — can make it harder to stay organized.
• An increasing number of complex or long-term academic projects can tax your time management skills.
• Collaborating with other students can be a challenge if socializing is difficult for you.
• Fewer parental and educational supports coupled with more independence and autonomy could lead to a drop in academic performance.

Relationship conflicts

For some people with ADHD, social conflicts can intensify or increase during this period. Social conflict isn’t uncommon among teens, but ADHD may present added challenges.

Studies show that some people with ADHD may have a harder time socializing than others. Engaging in extracurricular activities and having parents who are involved, attentive, and positive can help make socializing easier for people with ADHD.

Research also shows that conflicts between children and parents or guardians, along with conflicts in romantic relationships, might arise. There may be a tendency among some parents of adolescents with ADHD to become overly protective — possibly even controlling. Attentive and caring parenting styles usually feel more supportive.

While social conflicts in friendships, families, and dating relationships aren’t uncommon in teen years, they may be more of an issue if you have ADHD.

Mood and self-esteem differences

ADHD symptoms may make normal fluctuations in mood and self-esteem more extreme. Some people with ADHD feel particularly irritable during their teen years. Studies show that more authoritarian and less egalitarian parenting styles may make irritability worse.

If you are having trouble in school or in important relationships, you might also be feeling more stress or anxiety than you are used to feeling.

Research shows that, for some teens with ADHD, anger can trigger substance use. Stress, poor sleep habits, emerging mood disorders, and substance use can make it harder to pinpoint what’s causing changes to mood and self-esteem.

Sleep pattern changes

During adolescence, lots of physiological changes can affect sleep patterns:

• Hormones can change your circadian rhythms (the internal “clock” that sets your sleep/wake cycle).
• Sleep spindles and other brain structures that regulate sleep are maturing.
• School demands and social activities may also disrupt your usual sleep schedule.

While these changes are normal, they may complicate matters for people with ADHD, since 25–55 percent of young people with ADHD already have trouble getting good sleep. People who take stimulant medications to treat ADHD may take longer to fall asleep, wake up more often at night, or not sleep as well overall.

Escalation in risk-taking

When teens with ADHD get behind the wheel, impulsivity may cause accidents. Studies show that ADHD is associated with a higher number of car accidents — an average of one accident every 2 years.

Sexual maturity can also involve some potentially dangerous risk-taking. Risky sexual behaviors tend to be more common if you use cannabis or have a conduct disorder at the same time.

Substance use could become problematic. A small 2018 study found that adolescents who had more severe ADHD symptoms in childhood had a greater risk of substance use. The study also found that people whose dominant symptom was inattention gravitated toward cannabis use, while those with impulsivity and hyperactivity symptoms used both cannabis and alcohol, often in binge patterns.

The bright side

Though adolescence presents new challenges for people with ADHD, it also affords new opportunities.

As academic studies become more difficult, problems with organization and attention may become more obvious, which means some teens are able to get a more accurate diagnosis and receive an effective treatment plan for the first time.

Along with the struggles faced by teens with ADHD, there may also be traits that are considered positive, like creativity, high energy levels, and for some, the ability to hyperfocus on specific tasks.

Read this for more information about the potential benefits some people find from their ADHD.

There are also indications that, during adolescence, the cerebral cortex in the brain may develop new connections, helping some teens learn new ways to compensate for their ADHD symptoms.

As teens mature, they may be able to articulate their symptoms more clearly, helping parents, educators, and healthcare providers better meet their needs and making them more effective self-advocates.

Why do people get ADHD?

Researchers aren’t sure exactly what causes ADHD. There appears to be a genetic connection: If you have a sibling with ADHD, for example, you’re roughly twice as likely to have the disorder yourself.

There also seem to be some structural differences in parts of the brain that control impulses, researchers say. While impulse control can be a challenge for any teen, differences in the way the brain develops may make the problem more likely in teens with ADHD.

What are common risk factors for developing ADHD?

Research shows that people whose ADHD symptoms are severe are more likely to have ADHD that persists into the teen years. ADHD also tends to continue into the teen years for people who also have conduct and depression disorders.

Some common risk factors for ADHD include:

• having a parent who smoked cigarettes or used alcohol during pregnancy
• having a parent who was exposed to lead or other environmental toxins while pregnant
• having a low birth weight
• experiencing a brain injury

How is ADHD treated?

Just as is true during childhood, adolescents benefit from a multimodal treatment plan created by a team that includes the teen and their parents, educators, and healthcare providers.

Here are some current, evidence-based recommendations:

Medication

Because height, weight, and other physical factors change dramatically during teen years, it’s a good idea to review medications and dosages with your doctor every year. Some researchers recommend occasional “medication breaks,” supervised by your physician, to be sure that prescribed medications are still necessary and are still effective in treating symptoms.

Medication, combined with behavioral therapy, is still considered the most effective way to treat the core symptoms of ADHD.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT), which focuses on identifying unproductive thinking patterns and replacing them with healthier ones, is highly effective in helping you manage your thoughts and actions.

As you age and mature, CBT may help you learn new social skills and develop the ability to organize, plan, and follow through on tasks in school, on teams and organizations, and at work.

Family therapy

Managing ADHD — especially if both parents and children have the condition — can stress the family. It may be helpful to spend some time together in therapy, building healthy patterns of interaction and problem-solving skills. Family counseling might be a good place to make sure parenting styles are still effective as young people mature.

Physical activity

Physical exercise sharpens your brain’s executive functioning abilities. It also helps you use self-control when you need to pay close attention to something.

Research has found that exercise improves anxiety, depression, and self-esteem in young people with ADHD. It can benefit you in the future, too. Intense exercise during adolescence has been associated with not carrying ADHD symptoms into early adulthood.

Educational reevaluation

The start of high school is a good time to take a look at any IEPs or 504 plans in place. If you’ve just received a new diagnosis, it’s important to put educational supports in place, even if you’re not sure you’ll need them regularly.

You may want to ask:

• How do accommodations work in high school? Does the student have to request them or are they automatically offered?
• Are the accommodations appropriate at this point? Are they meeting your current needs?
• What are your most important goals?
• Are there schedule changes, locker assignments, or other practical changes you can make to facilitate a smoother day?

If the language in an education plan doesn’t make sense to you, or it isn’t tailored to your specific needs, you can meet with the educational team to make changes. Meeting early in the school year, before activities get underway and before grades are in jeopardy, is the best strategy.

Other tips

• Consider delaying the driver’s license process. Some experts recommend a delay in independent driving because ADHD often slows the development of brain structures that are important to safe driving: executive functions, impulse control, and risk assessment. With that in mind, experts also recommend obtaining a learner’s permit so you have ample time to practice before driving alone. Arguments for and against an independent driving delay can be found here.
• Think about a manual transmission. Driving experts say the step-by-step driving process can make it easier for people with ADHD to stay attentive and engaged. Also, avoid using cruise control, which is associated with dangerous drifting.
• Discuss the risks of substance use with your doctor. A recent study found that teens who used alcohol or cannabis didn’t understand the risks involved and had never talked about them with a healthcare provider.

What’s the outlook for teens with ADHD?

Early intervention is really important for teens and young adults with ADHD. Studies show that when people experience ADHD that persists through childhood into the late teens, or when ADHD is diagnosed later in the teen years, it can have a negative effect on substance use patterns, socioeconomic status, and overall mental health. Getting help early can improve those outcomes.

The bottom line

Adolescence introduces several new challenges to teens with ADHD and their families. While some symptoms, like hyperactivity, may recede, others continue.

Early adolescence — or any time you’re noticing a shift in symptoms — is a good time to talk to your doctor, therapists, family members, and teachers to be sure that your medications are working, educational supports are sufficient, and your relationship with your family is positive and supportive.

Yes, there are new challenges with ADHD in the teen years. As you mature, it’s important to ask for what you need so you can stay healthy and start building the life you want.