Possible Co-Existing Conditions with ADHD

Living and working with teenage children is often difficult. Teenagers are living in a precarious world today. In addition to going through the changes which bring them into young adulthood, they are faced with challenges very different from those of their parents. Alcohol and drug abuse, depression, anxiety and interpersonal/parental conflicts brought on by familial, peer or school pressures are the more common issues facing young people today regardless of economic status or cultural environment.

Parents of ADHD teenagers should be aware that it is common for ADHD teens to exhibit other difficulties. By comparing your adolescent's feelings and behavior with those outlined in each section, you can gain a better perspective of potential problems.

The greater the number of observable symptoms exhibited, the greater the likelihood that teens/parents need professional intervention.

BEHAVIOR DISORDERS
_repetitive physical violence against peers or adults. Behaviors include frequent fights during or after school with other students and/or aggressive confrontations with teachers.
_repetitive physical violence against property such as vandalism at school.
_a pre_occupation or fascination with, or possession of, violent weapons including knives or guns.
_theft of any kind.
_chronic violations of important rules such as truancy, substance abuse or inappropriate classroom behavior.
_frequent lying about almost any issue.
_blaming others and rarely taking responsibility for actions, even when caught in obvious wrongdoing. This type of individual often complains about how unfair everything is.
_low self_esteem is usually compensated for with a projected image of "toughness."
_association with peers who value acting out behaviors.

ALCOHOL/DRUG ABUSE
_abrupt drop in grades_usually a 1 to 2_letter grade drop over 2 grading periods.
_decreased school attendance, increased school tardiness, late for class.
_personality changes_increased withdrawal, moodiness, apathy, rapid loud talking or bursts of laughter.
_increase in behaviors requiring disciplinary action.
_a significant change in friends or association with drug or alcohol users.
_pre_occupation with drug/alcohol culture, writing drug/alcohol graffiti on notebooks, wearing drug/alcohol jewelry and clothing.
_dishonesty characterized by a pattern of unnecessary lies and deceits
_excessive argumentativeness regarding disagreements of little interest or significance.
_reduction of involvement in extracurricular school activities.
_stealing money at home or at school.

DEPRESSION
_frequent or continuously sad moods, sometimes verbalized in adolescents as "I'm bored"; expressions of hopelessness/helplessness.
_impaired concentration as evidenced by an increase in classroom day dreaming and general decrease in attentive behavior.
_loss of interest in school or extracurricular activities.
_general difficulty with self_motivation. This may result in reduced school attendance, general apathy and specific problems like failure to complete assignments.
_frequent expressions of personal failure "I'm so stupid," "I can do anything right."
_verbalizing of suicidal thoughts: "I'd be better off dead," "I wish I could go to sleep and never wake up," "I should just 'off myself'."
_crying spells of unusual frequency.
_decreased energy or appetite.
_sleeping all the time or inability to sleep.

Each of these problem areas, as well as the ones presented in the next months newsletter will be discussed in more detail at a later time. If a significant number of the symptoms are evident, seek professional help from a therapist specializing in adolescents. 

Surviving the tumultuous period of adolescence is easier for parents if they have some gauge to better distinguish normal teenage behavior of from ADHD behavior. By comparing your adolescent's feelings and behavior with those outlined in this article and in my article in last months newsletter, you will be able to gain a better perception of potential problems in the lives of your teenagers. The greater the number of observable symptoms in each category, the greater the likelihood professional intervention is needed.

SUICIDE RISK
1. Depressive behavior such as sleep problems, loss of appetite, withdrawal, feelings of hopelessness and helplessness, sad appearance, and neglecting personal appearance.
2. Evidence of alcohol and/or drug abuse.
3. Behaviors which indicate agitation and/or anxiety such as pacing, rapid speech, hand ringing and reactive hostility.
4. Alienation from family and/or friends. A rejecting family or lack of support from family and friends.
5. Family stress in the form of chronic illness, death of a loved one, divorce, significant financial loss, embarrassment, serious personal conflicts.
6. Previous suicidal threats or attempts.
7. A lethal plan of action and availability of lethal source, such as pills or a weapon.
8. Preoccupation with pain, death or the subject of suicide.
9. Giving away of prized possessions.
10. Loss of interest in schoolwork or favorite activities.
11. Feelings expressive of tremendous personal stress resulting from demands for better grades, behavior, or other performance.

SEXUAL ABUSE
1. In many cases, the teen will tell a trusted friend or teacher about the sexual abuse.
2. Withdrawn and/or isolated behavior.
3. Sexual acting out, precocious sexual knowledge or seductive behavior.
4. Unusual modesty.
5. Self destructive or suicidal behavior.
6. Depressive symptoms (e.g. expressions of hopelessness, decreased energy, frequent expressions of personal failure.)
7. Chronic running away from home, and/or school truancy. Reluctance to go home from school.

Information you need to know about sexual abuse:
· The vast majority of sexually abused adolescents are female.
· Most perpetrators are known and trusted by the victim.
· Current statistics suggest that one in five females are sexually abused by age 18.
· Physical and sexual abuse often occur simultaneously.

With guidelines for identifying significant problems in hand, the next step is to find appropriate help if a problem exists. If you're teenager exhibits some or many of the symptoms outlined in these two articles, you may want to seek help of someone who is experienced in treating these problems. Your choice of a therapist may be the key to successful treatment. Therefore, it is important to consider the following:
1. College degree: Consider someone who has at least a master's degree in counseling, psychology, or social work.
2. State licensure: Licensure laws established education and experience standards as criteria for practice.
3. Specialist in adolescent problems: Adolescent problems are often unique. The mental_health professional should specialize in the treatment of adolescent problems.
4. Professionalism and rapport: It is important to find a therapist who is able to relate to both you and your teenager. This rapport will enhance the likelihood of success.

Most teenagers resist counseling in the beginning. Therefore, the parent or guardian must decide if counseling is appropriate and make the initial appointment. This resistance generally decreases after one or two visits.

Finally, keep an optimistic attitude. Most teenage problems can be resolved. With the effort and support of parents, persistence, an expert therapist, the help of community support systems and the maturation process, most struggling teens are able to find their way through the maze. For those with more severe and chronic problems, like ADHD, treatment will be longer. Expert treatment and persistence on the part of the parents are often the key ingredients. For teens with milder or more acute problems, expert treatment and parental support are usually most helpful. Believing in your child, keeping your sense of humor and emphasizing their strengths is always important.