When an adolescent with Attention - Deficit Disorder (ADD) graduates from school, the teachers who grew frazzled trying to educate the youngster might be relieved.
However, while the condition may be only a passing inconvenience for the instructors, the teen could be stuck with ADD forever.
ADD: Not just for kids
Michael Layne, Ph.D., KidsPeace staff psychologist, made this point in his recent Continuing Medical Education luncheon talk, "Transitioning the ADD Teen into Adulthood," this past April. The talk was part of the free National Hospital for Kids in Crisis educational seminars series.
"Instead of being a problem to their teachers, these young adults may now become a problem to employers, spouses - maybe even law enforcement personnel," said Dr. Layne of the challenges ADD kids have in what most people consider simple social interactions.
Dr. Layne, who is also a clinical psychologist at the Growth Opportunity Center in Huntington Valley, Pennsylvania, described the characteristics of one of his clients who had been diagnosed with ADD:
- Poor school and work performance.
- Deficient ability to read and to do paperwork.
- Easily bored.
- Poor organizational skills.
- Procrastinates until deadline.
- Often late.
- Restless and impulsive.
- Can't work independently.
- Frequent job switches.
- Fails to see others' needs as important.
- Quick to anger and frustration.
- Verbally abusive.
- Trouble sustaining relationships.
- Self-centered and immature.
"These qualities sound like they belong to a classic ADD child," said Dr. Layne. "But they were actually observed in an adult male. ADD is a chronic disability that requires long-term treatment."
The statistics Dr. Layne shared with the group indicated that 79 percent of ADD adults complain of anxiety and sadness, 75 percent have interpersonal problems, 30 percent drop out of school, 25 percent have antisocial problems and only five percent go to college. That doesn't mean these adults are doomed to failure. But they must learn to manage their disability, just as people with diabetes learn to manage their blood sugar levels.
Dr. Layne also clarified a few additonal facts about ADD: "The DSM-IV identifies two types of ADD - with hyperactivity (ADD/+H) and without hyperactivity (ADD/-H)."
ADD kids without hyperactivity "often daydream and are easily distracted," Dr. Layne continued. "They may not get as much negative attention from the teacher because they're quiet." In some cases, hyperactivity will lessen over time, he noted; but the individual is still considered to have ADD.
For both ADD/+H and ADD/-H clients, behavior varies with each situation. "Some professionals have observed that people with ADD can focus. While this is true, the consistency with which they are able to focus varies. Sometimes I'll do an ADD test on a child, and he seems okay. But the school report lists all the symptoms of ADD. Maybe he responded to the tests because they provided structure and novelty. The one-on-one attention and feedback I gave him may also have helped him focus."
Dr. Layne stressed that just having the symptoms does not necessarily mean one has a case of ADD. "The real question is, how pervasive are the symptoms?" he said.
Paving the way to a "manageable" adulthood
"To prepare an ADD teen for adulthood, you first need to diagnose the condition," said Dr. Layne. "Educate the person about what ADD is. Often it's a relief for the client to learn because it explains his or her difficulties.''
The most important step in treatment is to teach self-management, Dr. Layne added. "ADD teens need to learn to set up their environment and manage themselves for their own benefit."
Dr. Layne suggested the following tips for professionals, their ADD clients and their clients' families:
What the professional can do
- Hire an ADD coach to go to work with a client to help set up an organized and stimulating work environment.
- Set up signaling systems. A device in a person's ear, or another type of signal can go off every five minutes or so to remind a client to keep focused on the task.
- Teach memory skills. Teach kids mnemonic devices, such as associating names with unusual images.
- Administer medication. "Medication does help, but we must remember that ADD requires more than just medication," Dr. Layne said. "Medication doesn't teach you cognitive skills and organizational skills."
What parents can do
- Leave reminders. If a kid always forgets her homework, she might have a bell ring when she leaves the house. When that bell rings, it rings a bell in her mind to make sure she has her homework. The bell substitutes for her parents' nagging.
- Break up tasks. Don't let him try to do everything at once. It just sets him up for failure.
- Get a word processor. "There's nothing more boring than rewriting the same paper three or four times," said Dr. Layne. "The word processor has done wonders for ADD kids."
- Get a tutor. The individualized attention and personal feedback may help.
- Don't reinforce impulsivity. If your ADD child interrupts you while you're talking, tell her she must wait until you're done before you respond.
What kids can do to help themselves
- Color coding. If a kid has five different classes, for example, she can put blue dots on all papers that have to do with social studies, green on geography papers, red for math...
- Ask teachers to help. An ADD person may ask a teacher if she could take a test in a room by herself to take advantage of fewer distractions. Maybe a teacher could grant extended time on tests.
- Get help taking notes. Someone who has trouble paying attention to a lecture will have trouble taking notes. An ADD student might consider borrowing notes from a fellow student or the teacher. Or he may tape the lecture to give himself another opportunity to catch what his wandering attention missed.
- Arrange for reinforcements. Teens and adults should not depend on others for reinforcement. They may have to bribe themselves for task completion: "If I read five pages, I can buy myself something."
- Find a job that matches your symptoms. "I had a client who could talk his head off," said Dr. Layne, "so he became a sportscaster. He found an environment in which he could use his natural tendency in a positive manner."
- Learn self-talk to diminish impulsivity. "Some ADD people put signs on their desks: 'STOP BEFORE YOU SPEAK,'" said Dr. Layne. "Or they may learn to count to 10 before they speak."
Join CHADD. Children and Adults with Attention - Deficit Disorder (CHADD) is a support group you can turn to when you need information and a friend. CHADD is now on the Internet. You can visit them at http://www.chadd.org/.
"In Hallowell's book, 'Driven to Distraction,' the author says the most common mistake in dealing with ADD kids is forgetting that the youngster has a disorder," said Dr. Layne. "We must keep reminding ourselves that ADD behaviors are not malicious attempts to cause problems. These teens are suffering from a chronic disorder."
To find out more about the free National Hospital for Kids in Crisis Continuing Medical Education Seminars, please call (610) 799-8851.