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Treating Distracted & Impulsive ADHD Children
10 CEUs Treating Distracted & Impulsive ADHD Children

Section 23
Treating Adolescents with ADHD

Question 23 | Test | Table of Contents | ADHD CEU Courses
Psychologist CEs, Counselor CEUs, Social Worker CEUs, MFT CEUs

Barkley noted that the academic outcome of adolescents with hyperactivity is significantly poorer than that of adolescents without ADHD. According to Barkley, when compared with their classmates without ADHD, adolescents affected by the disorder are more likely to fail a grade, be suspended or expelled from school, or score at significantly lower levels of academic achievement on standard tests of math, reading, and spelling. In addition to continued symptomatology, adolescents with ADHD display significant adjustment problems in various venues, such as frequent defiance and noncompliance with authority figures and rules; significant antisocial behaviors to include physical fighting, stealing, and vandalism; and difficulty establishing peer relationships (Barkley; Sealander, Eigenberger, Schwiebert, Wycoff, & Ross).

In another study, Barkley observed that teenagers with ADHD participated in more substance use and abuse of cigarettes and alcohol than did teenagers without hyperactivity. In addition, the adolescents who were formally diagnosed with both conduct disorder and ADHD used cigarettes, alcohol, and marijuana at a rate of 2 to 5 times that of teenagers with only hyperactivity symptoms or without any diagnosis of a disorder (Barkley).

As numerous helping professionals have indicated, the adolescent years of someone dealing with ADHD may be even more intense than those of other teens because of the increasing demands for individuals to conduct themselves in a responsible and socially acceptable manner. Issues of sexual identity, peer acceptance, emerging physical changes, courtship, and dating only add to the distress with which the adolescent with ADHD must now cope. Overwhelming sadness, depression, anxiety, and diminished hopes of future success may develop and exacerbate the symptoms of ADHD (Barkley). Researchers and other professionals agree that early intervention is crucial to prevent academic underachievement and other negative effects on the lives of children, adolescents, and adults affected by ADHD (DuPaul& Stoner; Mannuzza, Klein, & Bessler; Sealanderetal). If counselors, particularly high school counselors, address the needs of students with ADHD, these students may attain their potential and enter into the workplace or postsecondary education (Schwiebert, Sealander, & Bradshaw). Therefore, the purpose of this article is to provide counselors, and particularly secondary school counselors, with strategies for identifying interpersonal, academic, vocational, and life issues that may affect students with ADHD and to help teachers and parents prepare students with ADHD for the transition from high school to postsecondary education or the work environment.

Helping Clients Overcome Relationship Barriers
Even if an adolescent or young adult with ADHD has not had difficulties with educational or occupational issues, social relationships can remain a cloudy frontier, filled with insecurities. At the center of the relationship problem lies ADHD, itself, in its many dimensions: neurological, physiological, psychological, and behavioral. Poor self-esteem, chronic feelings of failure, and demoralization only exacerbate relationship difficulties, yet the interplay between ADHD and interpersonal problems continues to be overlooked. The reasons for "under diagnosis" are as multifaceted as the attention deficit disorder itself: adherence to the pervasive myth that children outgrow ADHD, a tendency toward diagnosing individuals with anxiety or depressive disorders that may mask an underlying attention deficit, and so on (Ratey, Hallowell, & Miller). Ratey et al. explained how helping professionals who have treated many adolescents and adults with ADHD have begun to understand and process how the phenomenology of ADHD undermines social relationships, emotional functioning, and personal intimacy. Behavioral, neurological, psychological, and physiological traits—typified by difficulties with impulsivity, distractibility, immaturity, and erratic mood shifts—sabotage the sincere efforts of those with ADHD to establish and maintain intimacy. For some individuals with ADHD, dose relationships can resemble class assignments, jobs, or life challenges. Once the thrill and excitement passes, they become bored and move on. The guilt of these broken relationships further adds to their sense of failure, poor self-esteem, and lacking self-confidence. Counselors can help students with attention deficit disorders overcome interpersonal barriers by empowering them to create structure and organization in their lives. Through individual coaching and organizational tools, students with ADHD can begin to structure their environment and manage daily living. Once they internalize the structure and organization as their internal map, students with ADHD can gain a sense of control and increase their self-confidence. Counselors can also create psychoeducational-counseling groups for students with ADHD, where such issues as social skills, problem-solving techniques, anger management, and peer relationships can be discussed. By using feedback games that focus on feelings, thoughts, and moral reasoning dilemmas, students with ADHD can process and reflect on positive ways to handle social interactions. Anger control techniques such as breathing exercises, positive self-talk, stress reduction strategies, verbal and nonverbal cues, and self-evaluation are instrumental in preventing a student with ADHD from exploding with frustration. By identifying self-defeating patterns, creating structured environments, and finding ways to cope with anger and stress, students with ADHD can form positive interpersonal relationships in educational, vocational, and social settings.

Helping Clients Manage Dally Living Activities
Because attention deficit disorder is manifested in all aspects of life, it is essential for counselors to help students with ADHD cope with the challenges of daily living such as following schedules, remembering assignments, or completing tasks. Many researchers feel improving attention, concentration, and memory functioning is essential to helping individuals with ADHD participate successfully in vocational, educational, and social settings. Parente and Anderson-Parente proposed strategies that adolescents with ADHD can use to enhance attention: 1. Frequent self-monitoring: "What should I be doing now? 2. Assigning time: setting scheduled time to think about thoughts that repetitively intrudes into thoughts regarding the task at hand 3. Allowing activity: participating in physical movement while listening 4. Distributing practice sessions: taking frequent breaks 5. Active learning: repeating material that is heard or reading and restating it in your own words 6. Building incentives for concentration: scheduling small rewards earned by periods of concentrated studies

In addition to these suggestions, researchers have discovered that environmental structuring plays an essential role in enhancing concentration. Through interactions with clients, Nadeau  found that individuals with attention deficit disorders are both drawn to and overwhelmed by a highly stimulated environment. If the individual is "under stimulated," he or she may become sleepy, tired, lethargic, or mildly depressed. If the individual feels "over stimulated," he or she may become overwhelmed and "shut down." Therefore, secondary school counselors, teachers, and parents can create improved attentional abilities by teaching the student with ADHD to recognize and possibly avoid under-or-overstimulated environments. Nadeau provided individuals with ADHD with the following suggestions to reduce stimulation overload: (a) live alone; (b) have a living space large enough to allow periodic isolation; (c) work in a private office; (d) avoid overstimulating circumstances such as traffic jams, shopping malls, crowds, and noisy locations. Nadeau suggested the following strategies to avoid understimulation: (a) take frequent breaks from necessary but boring activity, (b) mix lower interest activities with higher interest activities, (c) interact with other people, (d) engage in physical exercise, (e) create challenges to increase interest, and finally, (f) choose a career path of high intrinsic motivation.

Although memory difficulties have received less attention than much impairment associated with ADHD, it is thought that some adults with attention deficit disorders experience problems with their memory. Therefore, these individuals may frequently lose items, forget homework assignments, or overlook class or appointment times. To help remedy memory problems, secondary school counselors can assist the student with ADHD in developing compensatory strategies to reduce the level of forgetfulness. A few strategies found useful by Nadeau are briefly highlighted as follows: • Daily Calendar: Use a daily calendar or "daytimer" to write all appointments, commitments, phone calls to make, or tasks to accomplish that day. • Electronic Reminders: List the types of things that are repeatedly forgotten in order to help strategize electronic reminders, such as a watch that is programmed to beep at certain intervals to remind the adult with ADHD to complete routine tasks. • Visual Prompts: Place items that should be taken to school or work in visible spots. • Backups for Essential Items: Keep backups for essential items such as reading glasses, house keys, or car keys. • Routines: Develop daily rituals and murines such as a morning routine (preparing for work or school) and evening routine (preparing for the next day and for bed).

The previous suggestions of enhancing attention and concentration focus on the more practical aspects of the treatment of attention deficit disorder. High school counselors can use these pragmatic techniques to assist the student with time management, stress reduction, memory function, and attentional ability. By learning to cope with the challenges of daily living, adolescents and adults with ADHD can survive and thrive in both the vocational and the postsecondary educational setting. In addition to these more pragmatic suggestions, counselors in all settings may be called on to advocate for their clients with ADHD. To advocate for these clients, counselors must be knowledgeable regarding the diagnosis of ADHD, symptoms of ADHD, assessment of individuals with ADHD, interventions for individuals with ADHD, and legislative mandates that prevent discrimination against individuals with ADHD. As the effects of ADHD are increasingly recognized in the adult population, counselors will be asked to assist these individuals in successful negotiation of the workplace and postsecondary education. To effectively advocate for adults with ADHD in these arenas, counselors must also be familiar with the Americans with Disabilities Act and its ramifications regarding accommodation of individuals diagnosed with ADHD.
- Schwiebert, Valerie L, Karen A Sealander, and Jean L Dennison; Strategies for Counselors Working with High School Students with Attention Deficit/Hyperactivity Disorder; Journal of Counseling & Development; Winter2002, Vol. 80 Issue 1, p3

Personal Reflection Exercise #9
The preceding section contained information about treating teens with ADHD.  Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Courrégé, S. C., Skeel, R. L., Feder, A. H., & Boress, K. S. (2019). The ADHD Symptom Infrequency Scale (ASIS): A novel measure designed to detect adult ADHD simulators. Psychological Assessment, 31(7), 851–860.

Karalunas, S. L., Gustafsson, H. C., Fair, D., Musser, E. D., & Nigg, J. T. (2019). Do we need an irritable subtype of ADHD? Replication and extension of a promising temperament profile approach to ADHD subtyping. Psychological Assessment, 31(2), 236–247.

Pelham, W. E. III, Page, T. F., Altszuler, A. R., Gnagy, E. M., Molina, B. S. G., & Pelham, W. E., Jr. (2020). The long-term financial outcome of children diagnosed with ADHD. Journal of Consulting and Clinical Psychology, 88(2), 160–171.

According to Parente, what are 6 strategies adolescents with ADHD can use to enhance attention? Record the letter of the correct answer the Test.


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