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AD/HD (Inattentive Type) and High School Challenges
Also...The college application process is in full swing: some things to think about.
And listen to Michael's interview on "Understanding Teens"
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What's it like for high school students with AD/HD?




FEATURE STORY: High School and AD/HD

High School Students and AD/HD, Inattentive Type

by

Michael Y. Simon, LMFT


We know a lot about AD/HD. It is a heavily studied neurobiological disorder with wide-ranging consequences and unfortunately, with a well-documented, growing body of research showing impairment associated with AD/HD, well into adulthood. There is a tremendous amount of research on the neurological bases of AD/HD, on medication treatment and efficacy, and on psychosocial treatments (and problems with these approaches) for AD/HD. There is exciting work going on with longitudinal, prospective studies of ADHD, allowing us to understand how AD/HD looks over time in the same individuals, from childhood into middle adulthood. And yet, AD/HD remains one of the most misunderstood, misdiagnosed, argued about, stigmatized, and mistreated conditions. What information can be considered to support parents, youth, educators and clinicians dealing with (or possibly dealing with) AD/HD?

Students with ADHD-PI are not often diagnosed as such until later in the game, when parents and teachers become frustrated with the student “not living up to potential.” In my experience this is often in the sophomore year. If the specific diagnosis is not made until this year, it increases panic in the system; only two more years left for college! This isn't going to be enough time to right the ship.

Students with ADHD-PI are often extremely bright, caring and charismatic, but not in every situation and not all the time. “Consistently inconsistent,” is a phrase that could apply to most, if not all, students with ADHD. These students have trouble generalizing from the specific, so while they might complete an assignment and do a stellar job it, this doesn't mean they'll repeat that experience or even understand how or why they did such a good job on it that time. Parents and educators, looking for progressive learning and the accumulation of learned behaviors will become frustrated, thinking their bright child is lazy, simply picking and choosing those times to shine. The inconsistency is not understood as part and parcel of the disorder. This is, in part, because students with ADHD-PI often deny the diagnosis or have a thoroughly inadequate understanding of how the disorder impacts learning, memory, attention and motivation. Students with ADHD-PI do not have a deficit of attention. They have a surfeit of attention for things their brains deem salient and have trouble withdrawing their attention from those salient things to tasks others find salient. This feature of ADHD-PI makes the student look willful or vindictive, and frustrates educators (and parents) who are unaware of just how ADHD-PI works.

ADHD-PI presents itself in ways that change as the child ages. A child may start out in life with more hyperactive features and slowly lose the hyperactive presentation and present with great difficult staying on tasks in middle school, with that problematic behavior increasing into high school. Adults with ADHD-PI look different than teens with the “same” disorder, because as the brain develops, the presentation of the disorder changes. Some areas improve and some areas decline. Parents, educators and clinicians alike are used to an even or linear course to disorders and ADHD-PI does not work that way. It is easy—exceedingly easy—for educators to take personally the inconsistent behavior of the teen with ADHD-PI. When the school attempts to provide standard accommodations—extra time for assignments, extended deadlines, quiet study and test-taking spaces—the student will often refuse the accommodation or make use of these accommodations inconsistently. The student does not want to be “different” and already feels “out of step” in some ways with their peers and the process of education in the school. Anything that calls attention to the sense of failure that lurks quietly underneath is to be avoided. Teens with ADHD-PI in particular need to feel good about themselves to function well socially and academically, and that remains a primary motivation—to feel better than you feel right now.

To put a fine point on the accommodation issue, sometimes these accommodations do little or nothing to help the student with their main symptom: trouble with sustained motivation around tasks that are not immediately salient or do not make the student feel efficacious or happy. This is a feature of normal adolescents, in any case, but the need and desire for salient, positive stimulation in order to get innervated is exacerbated and exaggerated with the ADHD-PI teen. Therefore, educators and parents alike end up trailing their ADHD-PI kids like cops/investigators in order to guard against failure. Kids can easily experience adults around them as nags, constantly reminding them of their responsibilities, of how much they are doing for the inconsistent teen, “helpfully” pointing out the dire consequences of not pulling it together. It's important to say that this kind of close tracking is sometimes necessary, not always, but frequently helpful, usually resulting in acrimony, frustration and avoidance of the “helpful” individuals.

Sometimes medication helps, but sometimes it doesn't. Parents and educators get hopeful and excited when the student tries medication, but they often overestimate what medication will do. It won't cure the student of ADHD. It may allow the student to consider things they might not have considered, or to become less overwhelmed, less quickly. Therapy can help, but often it doesn't help, as it can further increase the sense of shame and pathologizing that can go with attending regular psychotherapy. In any case, it is just as difficult to follow through on suggestions made by the therapist, as it is to follow through on suggestions made by mom, dad or his favorite teacher. Teachers can participate in trainings on ADHD, but still end up complaining that the student doesn't make out-of-class appointments, doesn't make use of an accommodation or doesn't “appreciate” how they are bending over backwards for the student—all symptoms of ADHD-PI. So, there is often a disconnect that reinforces the message to the student that evidently, ADHD isn't “real,” since while people know about it, they still expect the student to do things as if they didn't have the disorder.

AD/HD doesn't “go away” in adulthood; it's a lifelong disorder. The way that AD/HD looks (the “presentation of symptoms” of AD/HD”) changes from childhood to adulthood, and this is exactly what we would expect with a syndrome made up of a “confluence of neurobiological, genetic and environmental factors.”

AD/HD is best worked with by establishing a thorough but flexible taxonomy of the ways in which the individual is being effected—for good and for bad. We need to know the current strengths and weaknesses possessed and in possession of the individual. Early weaknesses can become later strengths and vice-versa. But there are always both in play, and better outcomes are associated with an emphasis on building strengths and a positive, but realistic assessment of strengths and struggles. The collection of this knowledge is one step in the building of the healing community for the individual and family that are dealing with AD/HD. “Success” is not the immediate goal; the immediate goal is practice. Practice on tasks/behaviors should be combined with non-judgmental feedback, at the point of performance. That is to say, the student, the teacher, the parent must all learn about ADHD and try to become more expert in the disorder, so that they can support the development of management strategies once the impact of the disorder is more closely and clearly understood. This process will go on well into adulthood and cannot be rushed or finished by the time the student leaves high school. The student with ADHD-PI often has accompanying (co-morbid) disorders, usually anxiety or depression. A thorough approach to supporting students with ADHD-PI incorporates a treatment team that shares knowledge about the student, and with the student, and doesn't take too personally the student's inconsistency. Since these other mood-related disorders often show up with ADHD-PI, we have to develop compassion for the student who will always have a lot on their “plate,” managing his or her mood, worry/rumination, task completion and trying to please the caring adults in their lives. And as parents or educators, we cannot do this alone. We need education, resources, support, time off and an understanding ear around how difficult it can be to successfully deal with these challenges during your child's adolescence. "Putting your own oxygen mask on first" is the first rule of thumb in being a support to the teens in your life. That's not selfish: it's about surviving and thriving.


Michael Y. Simon, Practical Help for Parents.

Ask Michael....

My son and I have started arguing more since he started applying for college in earnest this fall. It seems he's letting certain opportunities go by in terms of application deadlines or researching schools in which he's expressed great interest. I don't want to do it for him but it's really difficult watching him mess this up or lose chances as he either procrastinates or doesn't do what he needs to do. I don't really understand what he's thinking or what's guiding his decisions (or lack of decisions). He seems so worried about getting in to the right school and yet he isn't even doing what he'd need to do to keep all his options open. Can you give me some idea of what is going on with him? I just want him to be happy.

We need to remember our kids are still adolescents as they go through this process of deciding what to do after high school.

What I know about teens is that they often make decisions based upon the heavy weighting of unconscious factors or the overestimation of positive benefits they attribute to the factors they are conscious about. So while a teen might say he's thinking a lot about the academic reputation of the school in making a decision, he's feeling pretty sure that this “academic reputation” (whatever that means) is going to bestow upon him some pretty sweet benefits. He doesn’t necessarily picture the overcrowded, cavernous 500-seat lecture halls, difficulty reaching his professor rather than a teaching assistant, a large, difficult-to-navigate bureaucracy, intense competition among peers and stress of excelling academically and possibly holding down a job. He cares about the academic reputation and the promise of future cash, but he is picturing other, positive, more current benefits to getting to the right school that may or may not pan out when he actually arrives.

In my experience, seniors might appear to go through a rigorous selection process, but they are often overwhelmed by all the factors that go into the decision and make the choice based on other criteria such as:

  • What are the status implications about going to my chosen school?

  • Did I feel comfortable on campus and in the surrounding city/town? Do I feel intrigued and excited by what is offered there?

  • How much of a hassle is it going to this school? (i.e., how convenient is it, how easy to pay for and negotiate the bureaucracy)

  • Are my friends going to the school and do they like it?  Are they having fun?

  • Are none of the people I know going there—so that I can have the chance to get away from this pressure and start fresh?

  • If I visited the school, did I get to go to a party or hang out with friends there? Did I have a great time?

  • Does the school have a program of study in the area I’m roughly interested in?

  • Can my parents afford the school and/or how guilty do I feel taking the money?

In other words, teens going off to college are mostly still being teens. That is to say, for teens that actually have a choice about college, their choices are often highly motivated by having fun, avoiding embarrassment and minimizing perceived hassle. Adolescents tend to prefer low-effort, high-reward activities. I’m not criticizing teens for this. It’s part of normal development. But its important to understand that these are overriding factors in their choices, despite what they tell us in surveys and what we want to hear as parents.

The choice of a college is something like the choice of having a child/becoming a parent. There is a ton of information out there about the process and it’s not hard to get information on what to expect, when you’re expecting. You’ve got your parents (and plenty of other parents) to tell you about being a parent and the entire culture reflecting back to you the various meanings of parenthood, childhood and the like. There are statistics on complications of childbirth and delivery. There are statistics on numbers of kids with learning disabilities and attentional difficulties. There is plenty of stuff out in the world about how great it is to have sex. But until you actually become a parent, you don’t know what it is going to mean for you or how it is all going to unfold. And if you told someone all about parenthood and told them to delay, because it might make it easier for them, would they listen to you? Most people I know would just smile, say thanks and offer something that says, “Well, that was your experience” and then they’d go off to have their experiences. That is true for college and the college choice, too. How can your child possibly know what college is going to be like for them until they get there and figure out things like what I call the...

10 Little (Big) Truths About College

  1. This might be the wrong school for me.

  2. This might not be the right time to be in school.

  3. I might have chosen the wrong major.

  4. I might have chosen this school for the wrong reasons and don’t know yet what the right way of choosing a school might be.

  5. I might have done this all for you, instead of for me, even though you didn’t overtly pressure me to do anything at all.

  6. I’m prepared academically but not emotionally for college

  7. I want to belong and do what my peers are doing, but now that I’m doing that, I hate it or I feel lost or lonely.

  8. College isn’t the answer to my questions and I don’t know what the questions are.

  9. Where I go to college doesn’t really matter, in the end. It’s about where I graduate from…and the best place to graduate from, isn’t necessarily going to be known to me until I’ve had some significant experience in a college or outside of a college.

  10. I thought I was making a choice about college and everything hinged on that. I realize I was anxious about entering a different life, on my own…and all that got wrapped into “choosing the right college.”
     

Even if parents or guardians raise some of these possibilities in advance of the college decision, it still doesn’t prevent the student from “failing” or at least having to go through an experience that turns out quite differently than advertised.

Public and private conversations alike, as well as unquestioned efforts geared towards “getting in to the best college or university” are often really about status and anxiety over status. That is a subject we don’t talk enough about in the United States and when we do try to talk about it, it is quickly shut down as being about “class” or “class war.”  Another way of avoiding the issue of status is to boil it all down to “consumer choice” and question anyone who thinks it isn’t a normal, positive thing to have more information about the colleges and universities we’re going to be sending our money to this coming fall. And of course, we want our kids to be happy (and academically and financially successful), three things that are often conflated in our minds and in the minds of our kids. You can read more about how concerns about status impact teens and parents alike in The Approximate Parent.

The college experience and the experience of choosing a college is not the same for everyone in America. Barriers to entry and barriers to completion are drawn heavily along lines of affluence and preparation for the real challenges that happen between when the student arrives on campus and when they graduate.  Does your child really have to go to college after high school? Is she really ready? What constitutes readiness? Are there ways to try out a college experience without feeling that it all comes down to “going this year” or “getting into THAT particular school?”

There are many ways of being successful and happy in this world. It’s way past time to take “making the perfect choice about college” off the list of strategies for finding happiness.




Some Great Books & Articles for parents....

Suggested Readings

The Approximate Parent: Discovering the Strategies That Work with Your TeenagerMichael Y. Simon, Fine Optics Press, 2012.

Living and Learning with New Media: Summary of Findings from the Digital Youth Project. M. Ito et al., The MIT Press, 2009.

Mediated: How the Media Shapes Your World and the Way You Live in It. Thomas De Zengotita, Bloomsbury, 2005.

Over the Influence: The Harm Reduction Guide for Managing Drugs and Alcohol. Pat Denning, Jeannie Little and Adina Glickman, The Guilford Press, 2003.

Social Privacy in Networked Publics: Teens' Attitudes, Practices, and Strategies. danah Boyd & Alice E. Marwick, Paper presented at Oxford Internet Institute's "A Decade in Internet Time: Symposium on the Dynamics of the Internet and Society" on 9/22/11.


Talk to Me First: Everything You Need to Know About Becoming Your Kid's "Go-To" Person About Sex. Deborah Roffman, De Capo Lifelong Books, 2012.

Teens, Social Media and Privacy; A Joint Report of the Pew Research Center and the Berkman Center for Internet & Society, May 2013 (Numerous authors). Available online at http://www.pewinternet.org/Reports/2013/Teens-Social-Media-And-Privacy.aspx

The Triple Bind: Saving Our Teenage Girls from Today’s Pressures. Stephen Hinshaw (with Rachel Kranz), Ballantine Books, 2009.

Uppers, Downers, All Arounders: Physical and Mental Effects of Psychoactive Drugs. Darryl Inaba & W.E. Cohen, CNS Productions, 2007.

About Practical Help for Parents...and our Newsletter

Founded in 1998 by adolescent specialist Michael Y. Simon, MFT, Practical Help for Parents was developed to support the people who work daily with teens. PHFP provides: informative, entertaining, research-based workshops & presentations to high school & middle school parents, faculty, staff and administrators; parent consultation and support groups; program development and consultation to mental health professionals, policymakers, and schools/school districts and; access to online resources like the PHFP Newsletter, Practical Help Tip Sheets, PHFP Parenting Blog and other web-based resources all organized by 10 Key Parenting areas. You can find more information online at http://www.PracticalHelpforParents.com.

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