OccupationalTherapy.com Phone: 866-782-9924


ADHD In Adolescence: Enhancing Success For Middle And High School Students

ADHD In Adolescence: Enhancing Success For Middle And High School Students
Elisabeth Bahr, OTD, MS, OT/L
August 28, 2023

To earn CEUs for this article, become a member.

unlimited ceu access $99/year

Join Now
Share:

Editor's note: This text-based course is a transcript of the webinar, ADHD In Adolescence: Enhancing Success For Middle And High School Students, presented by Elisabeth Bahr, OTD, MS, OT/L.

Learning Outcomes

  • After this course, participants will be able to:
    • identify the unique challenges faced by middle and high school adolescents with ADHD in school settings and their impact on occupational performance, school function, and quality of life.
    • recognize evidence-based strategies for supporting adolescents with ADHD in schools.
    • list intervention ideas tailored to enhance engagement, organization, and self-regulation.

Introduction

Hello everyone, and a warm welcome to this workshop. Your presence here is greatly appreciated. This session serves as a natural progression from our first workshop. In case you missed it, I highly recommend starting there as it sets a solid foundation.

My experience spans the entire spectrum of pediatrics, encompassing school-based settings, sensory clinics, and early intervention programs. I've had the privilege of working with children aged 2 to 21. Presently, I'm engaged as a contract-based school-based evaluator, contributing to supervisory responsibilities for fellow OTPs within the New York City Department of Education.

Overview of ADHD in Adolescence

  • ADHD - a neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity
  • Adolescence - a challenging time for students: increased academic demands, complex social interactions, and a greater need for independence
  • OT Goal: Provide targeted support balanced with teaching self-advocacy 
  • Middle school, high school, and post-secondary goals begin to remove parental, OT, and teacher scaffolding - think groups and consultation in school models

Let's begin with an overview of ADHD during adolescence. As a recap, there are three primary types of ADHD: inattentive type, hyperactive type, and combination type.

Recalling our discussion from the first workshop, envision a young bird in the process of learning to fly. Adolescence poses a distinctive challenge when it comes to ADHD. During this phase, students confront heightened academic expectations, intricate social dynamics, and an amplified need for autonomy. It's akin to them stretching their wings and preparing for takeoff. This stage unveils their authentic personalities and their evolving belief systems and places a spotlight on their friendships.

As OTPs, our mission is twofold: to offer targeted interventions during this pivotal period while simultaneously nurturing their capacity to self-advocate. We serve as mentors, providing guidance and strategies yet also fostering their self-development and independent navigation of the world.

During the middle school, high school, and post-secondary phases, our support strategy evolves. Think of it as a flock of birds flying in formation. We transition from direct scaffolding to more indirect interventions, including group settings and consultations in middle and high school. This transition enables students to learn from their peers, foster a sense of belonging, and cultivate the invaluable skills you are all imparting to them. It's crucial to bear in mind that our objective is to aid students in unfurling their wings and taking flight toward autonomy. We progressively dismantle external support systems, empowering them to confidently surmount the challenges of adolescence and transition into young adulthood.

Introduction to ADHD

  • There are 3.3 million individuals with ADHD aged 12 to 17, according to a 2016 survey (1).
  • The symptoms of childhood ADHD are found to persist in adulthood in up to 65% of cases, leading to a prevalence of the condition in that population to be approximately 2.5% (2).
  • The average age of diagnosis is 7, with symptoms often persisting into adolescence and adulthood.

A significant portion of individuals continue to experience ADHD symptoms well into adulthood. This proportion is notably elevated in young adulthood. Recent anecdotes have suggested that the prevalence of ADHD in adults has surged to approximately 5%, signifying a substantial increase. 

The average age at which ADHD is diagnosed hovers around seven years old. However, this isn't a steadfast rule. It's imperative to acknowledge that ADHD is a nuanced condition. Its manifestations vary across individuals, and intelligence remains unaffected. It's important to note that historical research and comprehension of ADHD primarily revolved around hyperactive boys, potentially leading to an underrepresentation of other groups such as girls and individuals of color.

ADHD defies a one-size-fits-all diagnosis. The range of symptoms encompasses both inattention and hyperactivity, occasionally either one in isolation. Furthermore, there are instances where symptoms might seem to diminish or become less conspicuous over time.

Symptomatology can also evolve with maturation. For instance, someone who exhibited hyperactivity during their earlier years might gradually shift toward more inattentive symptoms in the later stages of life.

ADHD Prevalence

  • ADHD is one of the most common neurodevelopmental disorders among children in the US.
  • The lifetime prevalence of ADHD among children is 11% (1).
  • The worldwide prevalence of adult ADHD is estimated at 2.5% (2).
  • The lifetime prevalence of ADHD in adults aged 18 to 44 years is 8.1% (1).

ADHD stands as a markedly prevalent neurodevelopmental disorder, exerting substantial influence on individuals across both childhood and adulthood on a global scale. In the United States, it is among the most common childhood disorders, impacting roughly 11% of children over their lifetime. Broadly, adult ADHD prevalence is estimated to hover around 2.5%. However, it's pertinent to note that this figure has shown a recent increase.

This statistical landscape underscores that ADHD transcends specific regions or geographical boundaries, extending its impact to individuals worldwide. Moreover, this influence persists as individuals transition into adulthood.

Specifically, among young adults aged 18 to approximately 44, the lifetime prevalence of ADHD stands at around 8.1%. This statistic underscores the enduring developmental consequences and the sustained presence of ADHD well beyond childhood, extending into the realm of young adulthood.

ADHD Diagnosis

  • Many adults with ADHD have a limited awareness of how ADHD adversely affects their lives. Some report higher symptoms but lower impairments or vice versa, and this may affect diagnostic accuracy (2).
  • Adult diagnoses may be missed in clinical practice due to a lack of knowledge about ADHD in adulthood among practitioners and due to the high frequency of comorbid psychiatric conditions (2).

For numerous adults and young adults grappling with ADHD, limited awareness exists regarding the substantial impact their condition wields on their occupational lives. Often, the full scope of how ADHD affects daily functioning remains elusive to them. This lack of insight can render addressing their ADHD a formidable task. In the sphere of occupational therapy practice, it's crucial to recognize that the diagnosis of adult ADHD might either be overlooked or delayed. Moreover, our comprehension of ADHD in young adulthood might be constrained, contributing to an underestimation of the condition's influence on occupational performance.

As we discussed in the earlier talk, comorbid conditions frequently intersect with ADHD. Approximately two-thirds of individuals diagnosed with ADHD exhibit some form of comorbidity. This dynamic can further convolute the diagnostic process, potentially resulting in misdiagnoses or overlooked diagnoses.

By acknowledging and illuminating these challenges, we can actively contribute to refining diagnostic accuracy. In our supportive role within the multidisciplinary team, we can pinpoint how various symptoms impede occupational performance and convey these insights to the individuals we work with. This endeavor aids in fostering a more comprehensive understanding of their condition and its ramifications.

ADHD in Adolescence

  • The estimated percentage of adolescents with ADHD ranges from 8.6% to 9% depending on age (1).
  • 4.2% of adolescent ADHD cases show severe impairment (1).

Imagine a classroom replete with middle school students, among whom a considerable percentage of adolescents grapple with the challenges of ADHD. Extensive research underscores that the prevalence of ADHD within this specific age cohort may fluctuate between 8.6% and approximately 9%, thereby underscoring its pervasiveness within both the classroom and broader society. In a hypothetical classroom comprising, for instance, 30 students, it becomes evident that multiple children within the class are likely contending with ADHD-related difficulties.

It is equally crucial to acknowledge, as previously mentioned, that not all instances of ADHD manifest identically. Beyond the existence of ADHD subtypes, it is noteworthy that roughly 4.2% of these adolescents, or about half, encounter significant impairments. Consequently, these symptoms wield a profound influence on their functioning, occupational performance, and participation in various activities. 

Treatment

  • The most effective ADHD treatment is a combination of medication and behavioral therapy (1).
  • As of 2016, 77% of children with ADHD were receiving some form of treatment, with approximately one-third receiving both medication and behavioral treatment (1).
  • Treatment for ADHD typically includes medication (stimulants or non-stimulants) and lifestyle changes, such as building a supportive network, improving sleep habits, exercising, maintaining a healthy diet, and creating an ADHD-friendly environment (3).
  • ADHD cannot be cured, but appropriate treatment can effectively manage symptoms and improve daily functioning (3).

First and foremost, it is imperative to recognize that the most efficacious approach to treating ADHD involves a combination of medication and behavioral therapy. While approximately 77% of children grappling with ADHD avail some form of treatment, it is worth noting that about one-third of these children exclusively receive medication, devoid of the synergistic benefits derived from the amalgamation of medication and behavioral intervention. This underscores the necessity for further advancements in the realm of comprehensive treatment, with a view to optimizing therapeutic strategies for these children.

The realm of ADHD treatment is inherently multifaceted. When addressing medication, there are two primary categories: stimulants and non-stimulants. These medications play a pivotal role in symptom management. Their mechanism involves regulating neurotransmitter activity in the brain, thereby enhancing focus, mitigating impulsivity, and reducing hyperactivity. It's important, however, to recognize that medication alone does not constitute a comprehensive solution.

Consequently, attention must also be directed toward lifestyle modifications. These encompass establishing a robust support network, refining sleep patterns, participating in regular exercise, adopting a nutritious diet, and cultivating an environment conducive to managing ADHD-related challenges. These facets collectively embody the ways in which occupational therapy practitioners (OTPs) can contribute to the treatment of adolescents with ADHD. Notably, the significance of sleep patterns cannot be understated, as sleep deprivation can amplify ADHD symptoms.

Prioritizing adequate sleep and fostering healthy sleep routines can effectively optimize cognitive function and bolster overall well-being, a particularly critical consideration for effective engagement during the school day. Additionally, adhering to a consistent exercise regimen yields favorable outcomes for individuals with ADHD. This proactive measure stimulates the release of neurotransmitters and endorphins, fostering improved focus, potential reduction in hyperactivity, and, perhaps most significantly, an enhanced mood. A balanced diet, albeit unique to each individual, constitutes another crucial component.

Equally pertinent is the concept of cultivating an ADHD-friendly environment. This involves orchestrating efficient workspaces, minimizing potential distractions, and implementing strategic approaches. Subsequent sections of this presentation will delve into more specific strategies pertaining to optimizing the environment.

Structural and Functional Differences in the ADHD Brain

  • Structural differences include smaller volumes in subcortical areas and differences in the prefrontal cortex, frontal cortex, limbic system, basal ganglia, and reticular activating system (3).
  • Brain activity and functional connectivity are also altered in individuals with ADHD, with increased activity associated with more severe hyperactivity symptoms (4).
  • ADHD is associated with reduced function and functional connectivity in several brain networks (4).
  • These networks are involved in executive functions such as working memory, inhibition, attention, and timing (4).

While we initially explored this subject in the preceding segment of this lecture, it's prudent to revisit these concepts for reinforcement. Envision the brain as an intricate network of interconnected thoroughfares. Within individuals with ADHD, discernible differences emerge in terms of both structure and function, setting them apart from their neurotypical counterparts. These distinctions manifest as divergences in pivotal brain regions that govern the regulation of attention, behavior, and emotional processing.

Remarkably, researchers have discovered that individuals showcasing heightened hyperactivity symptoms tend to exhibit augmented activity in highly specific cerebral regions. This observation potentially underscores a correlation between brain activity and the intensity of hyperactive manifestations, a nuanced point worth exploring.

Furthermore, the impairments associated with ADHD extend to the interconnectivity among different brain networks. These networks are responsible for executing essential cognitive functions encompassing working memory, inhibition, and attention. In individuals with ADHD, these networks display reduced functional connectivity.

It's noteworthy that there exists a certain degree of developmental lag in the frontal cortex, encompassing the prefrontal cortex accountable for a spectrum of cognitive aptitudes. This developmental lag contributes to the difficulties encountered in regulating attention, behavior, and cognitive processes within individuals affected by ADHD.

Neurotransmitter Activity in ADHD

  • Neurotransmitter activity, particularly dopamine and norepinephrine, is implicated in ADHD, affecting reward, motivation, mood regulation, energy levels, and focus (3).
  • Dopamine = pursuit and goal-directed 
  • Not a “dopamine deficiency” 

Think of neurotransmitters as messengers in the brain. They carry important signals that help control how things work. But in people with ADHD, things get a bit mixed up when it comes to neurotransmitters like dopamine and norepinephrine.

This mix-up changes how some important brain functions work. It affects stuff like feeling rewarded, staying motivated, controlling moods, having enough energy, and staying focused. Dopamine is critical because it helps us chase after goals and keeps us paying attention.

Executive Functioning Skills

  • Emerging evidence suggests abnormal function and interregional functional connectivity in networks involved in executive functions, which are cognitive processes influenced by emotion (4).
  • ADHD is associated with abnormally reduced deactivation in the default mode network (DMN), a network of brain regions that is active when the individual is not focused on the outside world and the brain is at wakeful rest (4).
  • Individuals with ADHD suffer from deficits affecting different networks that connect the frontal, striatal, parietal, and cerebellar regions (4).

ADHD brings about challenges in relation to dopamine, resulting in difficulties with maintaining attention, managing impulses, and staying motivated. However, it's essential to avoid oversimplifying the matter. This oversimplification is often seen while scrolling through social media, where some people mistakenly label ADHD as merely a shortage of dopamine. In reality, ADHD involves a complex interplay of various neurotransmitters and neural circuits. It signifies a disruption in the overall balance of neurotransmitter systems rather than a solitary deficiency of dopamine.

Moreover, ADHD is sometimes described as a disorder of self-regulation. Within individuals affected by ADHD, we observe anomalies in the functioning and connectivity of executive functions. As mentioned previously, there is a reduced deactivation within the default mode network. But what does this mean exactly? The default mode network and the task network are meant to work in tandem, inhibiting each other. Yet, in ADHD cases, we sometimes witness simultaneous activation of both these networks. The default mode network is responsible for processes like narrative thinking, daydreaming, and making sense of things. On the other hand, the task network comes into play when we need to concentrate on a specific job, such as schoolwork or paying attention in class.

In individuals with ADHD, these systems may fail to effectively inhibit each other. This is linked to the role of dopamine, which helps regulate the on-and-off switches for these networks.

Symptoms in Adolescents and Teens

  • ADHD symptoms vary, and having some symptoms doesn't automatically mean a diagnosis of ADHD.
  • Key symptoms include lack of focus, disorganization, self-focused behavior, fidgeting, heightened emotionality, fear of rejection, daydreaming, impulsivity, difficulty in following a conversation, procrastination, trouble working quietly, and always being "on the go" (5).
  • Additional symptoms encompass trouble reading social cues, difficulty in compromising, personal hygiene issues, and difficulty in following directions.
  • ADHD symptoms may manifest differently in boys and girls, with girls often showing less noticeable inattentive symptoms (5).
  • Comorbid conditions such as anxiety and depression are common (5).

Neurological differences manifest as symptoms, particularly in adolescents and teenagers. While we've extensively discussed this in the context of children, let's consider how these differences interact with the complexities of the developmental process. These manifestations aren't uniform, as they vary from person to person. Symptoms can encompass challenges related to focus, organization, self-regulation, and social interactions. Additionally, they might include difficulty concentrating, being disorganized, fidgeting, exhibiting heightened emotional responses, harboring fears of rejection, daydreaming, or struggling to pay attention. Challenges in following conversations due to deficits in working memory and difficulties with working quietly are also common, especially among middle school-aged individuals grappling with ADHD.

Furthermore, it's crucial to acknowledge the impact of gender differences on symptom presentation. Societal conditioning and masking behaviors can significantly influence how ADHD manifests externally. Girls, for instance, might predominantly exhibit inattentive or internalized symptoms. This, in turn, can lead to underdiagnosis or delayed recognition of ADHD in girls. Frequently, comorbid conditions like anxiety and depression co-occur with ADHD, underscoring the necessity for a comprehensive multimodal approach to treatment.

Diagnosis in Teens

  • Adolescents with ADHD face heightened risks, including "risky" sexual behaviors, suicidal thoughts, incarcerations, car crashes, job problems, illegal drug use, smoking, and obesity.
  • Around 15% of children with ADHD still have symptoms at 25. 
  • Treatment plans typically involve medication, behavior therapy, and addressing any co-existing conditions such as anxiety or depression.

(5)

Teenagers with ADHD are more prone to engaging in risky behaviors, such as risky sexual behaviors, perhaps increased suicidal thoughts, incarceration, car crashes, job problems, illegal drug use, smoking, and challenges with obesity. Approximately 15% of children with ADHD are going to experience these symptoms into adulthood. The symptoms are going to significantly interfere with daily functioning if they're pretty significant. As I had mentioned before, children who have more hyperactivity when they're children tend to fare better as adults, and they tend to see more of a reduction in their symptomatology. Whereas children who are diagnosed with inattentive ADHD tend to see that inattention remains the same throughout their lifetime.

Impact on Academic Performance and Social Interactions

  • Students with ADHD may struggle with:
    • Time management and organization
    • Maintaining focus and completing tasks
    • Managing emotions and impulsivity
    • Navigating complex social situations

The challenges that adolescents with ADHD face in terms of time management, organization, prioritization, and emotional regulation can be quite significant. These challenges can impact various aspects of their academic and social lives, as you mentioned.

Adolescents with ADHD might struggle to effectively manage their time and organize their tasks. They could have difficulty breaking down larger assignments into smaller, manageable steps, which can lead to last-minute rushes to complete assignments. Keeping track of assignments, projects, and deadlines may also prove challenging. As a result, they might benefit from strategies that help them create routines, use visual cues or planners, and learn time management skills.

Maintaining focus and completing tasks in a classroom environment can be challenging for adolescents with ADHD. They may struggle to sustain attention on lessons, assignments, or projects. Frequent distractions, both internal (e.g., daydreaming) and external (e.g., noise), can interrupt their concentration. Implementing strategies like using timers, creating a structured work environment, and breaking tasks into smaller chunks can help improve their focus and task completion.

The heightened social demands of the middle and high school environment can place adolescents with ADHD in situations where emotional regulation and impulsivity are tested. They might find it challenging to control impulsive behaviors or emotional outbursts. Strategies such as mindfulness, self-regulation techniques, and social skills training can be instrumental in helping them navigate social interactions and manage their emotions more effectively.

Recognizing these unique challenges and addressing them through a combination of supportive strategies and interventions can make a significant difference in the academic and social experiences of adolescents with ADHD. By equipping them with the tools they need to manage their time, stay organized, focus on tasks, and navigate social situations, OTs and educators can help set them up for success in school and beyond.

ADHD Myth Busting: True or False

  • Adolescents with ADHD aren’t perfectionists. Many are forgetful, impulsive, and make rash decisions. 
  • False!
    • At this age - overcompensation can occur
    • ADHD and OCD co-occurrence can occur
    • Fundamental attribution error 
  • The “second wave” of ADHD - how does this diagnosis impact the rest of their life?

Adolescents with ADHD often exhibit traits of forgetfulness, impulsiveness, and making hasty decisions. These characteristics are more prevalent than perfectionism within this population.

More Issues with ADHD in Adolescence

  • Rejection sensitivity 
  • Time blindness
  • Perfectionism/overcompensation 
  • Other diagnoses (see ADHD and elementary school) 
  • Learned helplessness and negative self-talk
  • Masking
  • Trauma - especially in communities of color
  • ADHD tax 
  • Addiction and substance use

Individuals with ADHD experience a range of challenges that extend beyond the core symptoms of the disorder. Rejection sensitivity is a heightened sensitivity to perceived criticism or rejection, which can lead to emotional distress within relationships.

Time blindness involves struggling to estimate and manage time accurately, resulting in difficulties with time management and planning.

Perfectionism and overcompensation can emerge as teenagers with ADHD strive to compensate for perceived shortcomings.

Co-occurring diagnoses are common, with about two-thirds of those with ADHD having another diagnosis such as learning disabilities, Oppositional Defiant Disorder (ODD), or mood disorders. Learned helplessness and negative self-talk can develop due to the challenges posed by ADHD, leading to cycles of low self-esteem and reduced motivation. Masking, akin to the concept in the autistic community, involves concealing ADHD symptoms, which can be mentally taxing.

The impact of trauma, particularly within marginalized communities, must be considered, highlighting the importance of culturally sensitive support. The "ADHD tax" refers to the extra effort and energy required for tasks like meeting deadlines or paying bills, leading to mental fatigue. Individuals with ADHD are at a higher risk of addiction and substance use, potentially as a coping mechanism.

The second wave of ADHD diagnosis occurs when new challenges related to ADHD emerge in different life phases. The fundamental attribution error leads to misunderstandings and stigma, as behaviors are wrongly attributed to internal characteristics. These insights provide a comprehensive understanding of the intricate aspects and challenges associated with ADHD, revealing the complex nature of the condition.

Occupational Therapy and ADHD

  • Occupational therapy interventions for adolescent young adults with ADHD are not well-established, but they are often requested by service users (schools, parents, administrators) and have a clinical basis.
  • ADHD affects all aspects of occupational functioning, including educational functioning, relationships, employment, ADLs, and IADLS.
  • Interventions should focus on organizing and adapting the physical and social environment, promoting social interaction and awareness, developing stress management techniques, optimizing time management, and monitoring and regulating sensory stimulation (9).

What role do occupational therapy practitioners (OTPs) play in addressing ADHD, especially within the context of adolescents? While ADHD isn't a primary practice area for OTs, it's a frequent referral or request that prompts us to consider how to assist this significant population of ADHD-affected teens.

In my own experience, during evaluations conducted for the Department of Education, I've encountered numerous middle and high school teenagers seeking occupational therapy assessments shortly after receiving an ADHD diagnosis. They are keen to understand how occupational therapy can provide assistance.

ADHD impacts various aspects of occupational functioning, spanning education, relationships, employment, activities of daily living, instrumental activities of daily living (IADLs), and health management. Effective interventions revolve around organizing and adapting physical and social environments to bolster attention and executive functioning skills. A significant aspect involves fostering social interaction and self-awareness within relationships.

Further strategies encompass stress management techniques and time management strategies. While we touched on sensory stimulation in our previous lecture, we'll only briefly mention it here. If you're seeking more comprehensive insights on this, I recommend revisiting the details provided in the initial lecture.

Models for Intervention

  • Canadian Model of Occupational Performance (CMOP)
  • Person-Environment-Occupation-Performance Model (PEOP)
  • Model of Human Occupation (MOHO) (7)

Given the limited literature surrounding Occupational Therapy practices with this population within educational settings, it becomes imperative to rely on theoretical frameworks to shape our approach. Let's explore a few models that can guide the development of client-centered plans for students already on your caseload:

CMOP (Canadian Model of Occupational Performance)

This model centers around the interconnectedness of the individual, their environment, activities, and the resulting participation and performance. By considering how these elements interact, occupational therapists can formulate interventions that address the intricate relationship between students, their surroundings, and their engagement in meaningful occupations.

PEOP (Person-Environment-Occupation-Performance Model)

The PEOP model emphasizes the interplay between the individual, their environment, the activities they undertake, and their overall participation and performance. By assessing and addressing these factors holistically, OTs can design interventions that foster improved functioning and participation for students.

MOHO (Model of Human Occupation)

The MOHO incorporates not only performance but also factors like volition (motivation) and habituation. This model enables occupational therapists to delve into the underlying motivations, routines, and habits that impact a student's engagement in daily activities. By considering these aspects alongside performance, comprehensive interventions can be crafted.

Incorporating these models into your practice can assist in navigating the complex relationships that form during adolescence between individuals, their environments, and their occupations. This theoretical foundation enables OTs to develop client-centered plans tailored to the unique needs of students grappling with ADHD within educational settings.

Transition to High School

  • Addressing lifestyle habits is the major point of intervention.
  • Foster understanding: Many teens resist interventions because they don’t see how ADHD is impacting them.
  • Encourage self-knowledge and focus on specific examples and patterns.
  • Identifying the causes of problems gives them more control over future outcomes.
  • Encourage parents to give students as much freedom as they can handle with homework but with more oversight than they want.
  • Encourage parents to engage with teachers about their homework and test patterns and expectations.

(14)

Transitioning to high school is a pivotal developmental phase for middle schoolers. Understanding how ADHD specifically impacts the lives of teenagers is essential, as they might not fully grasp the extent of its effects and could potentially resist interventions. It's common for students with ADHD to be hesitant about standing out or being pulled out of the classroom for specialized support, which can lead to challenges in receiving the help they need.

Empowering teenagers with ADHD involves recognizing the patterns and evidence that illustrate their challenges and strengths. By addressing terms like rejection sensitivity or other underlying factors, teenagers can develop insight into their difficulties and take proactive steps to make necessary adjustments. This approach helps prevent the fundamental attribution error, where personal traits are mistaken for symptoms. Instead, it encourages the recognition that certain challenges are rooted in ADHD and can be addressed with targeted strategies.

When it comes to parents, finding a balance between providing freedom and oversight is crucial. Instead of focusing solely on biological age, parents should consider their child's age-equivalent self-regulation skills. Striking the right balance between accountability and support is essential. Encouraging parents to stay engaged with teachers and utilizing virtual classroom management systems can also be tremendously helpful in supporting the development of executive functioning skills for middle schoolers and young teenagers with ADHD.

Transition to Post-Secondary Goals

  • Teens need to convince parents about their readiness for college, starting before senior year.
  • Discuss specific requirements for greater freedom and connect their motivation for college to what it will take to get there.
  • Parents often worry more than the student about his/her readiness for college - It’s the student’s job to prove they are ready.
  • Seniors can apply and then defer once accepted.
  • Some students can strengthen their application with a productive gap, especially when their high school transcript doesn’t capture their abilities.
  • Determine alternatives to college - trade school, community college, gap year, etc. 

(14)

Transitioning to post-secondary roles, especially in the context of college, requires proactive conversations between high school students and their parents well before senior year. It's crucial to emphasize that with the increased requirements and responsibilities of college, greater freedom accompanies the need for students to demonstrate their readiness. Recognizing that readiness varies from person to person is key.

Beginning these discussions before senior year allows for thoughtful planning. Some students may choose to apply to colleges and defer enrollment to provide more time for preparation or exploration of alternative opportunities. A productive gap year might be beneficial for some, offering a chance to gain experience, maturity, or clarity about their future direction. Additionally, students might explore different paths like trade schools or community colleges, especially if their high school transcript doesn't adequately reflect their capabilities or interests.

These conversations and considerations are vital for ensuring that students are well-prepared to succeed in their post-secondary endeavors and make informed decisions aligned with their strengths and aspirations.

Evidence-Based Strategies

  • Environmental modifications to reduce distractions
  • Collaboration with teachers, parents, and other professionals
  • Physical environmental modification
  • Creating structures and routines
  • Social interaction and awareness
  • Promoting self-efficacy and personal capacity
  • Stress management techniques
  • Time management
  • Sensory stimulation regulation (7)

Creating an optimal learning environment by minimizing distractions and fostering a supportive setting is essential. Educating teachers, parents, and other professionals about the unique needs of students with ADHD is vital. Strategies like organized workspaces, quiet areas, and minimizing distractions can significantly enhance the learning experience.

Given the distinct social dynamics of middle and high school, additional support is essential for both learning and socialization. Collaborating with teachers and parents to establish effective structures and routines can greatly assist students with managing their time and tasks. Utilizing worksheets, checklists, and interactive exercises can be valuable tools in this process.

Supporting social skills development and enhancing self-efficacy are critical. Addressing self-efficacy, especially in relation to the fundamental attribution error, empowers students to overcome challenges. Stress and time management techniques, along with fostering sensory regulation awareness, can contribute to improved self-awareness and self-management.

Employing sensory strategies, such as weighted vests and managing noise levels, can help students maintain focus and prevent sensory overload. Promoting self-awareness of when to take breaks and providing tools for self-regulation play a significant role.

These strategies offer practical ways for occupational therapists to collaboratively support students with ADHD in middle and high school settings. By tailoring interventions to meet the unique challenges and needs of each student, OTs contribute to enhancing their overall well-being and success.

Cog-Fun

  • The Cognitive Functional model, also called Teen Cognitive-Functional intervention, adapted for adolescents with ADHD shows promising results.
  • Significant improvements were reported in occupational performance, executive functioning, and strategy behavior of the adolescents post-intervention (6).

Certainly, the Cognitive Functional Model (Cog-Fun) is an intervention strategy tailored for adolescents with ADHD. This model, outlined in Resource 6, offers valuable insights for those interested in exploring it further. The Cog-Fun model centers around enhancing occupational performance and executive functioning skills among adolescents with ADHD.

By honing in on specific cognitive processes in conjunction with functional tasks, this model aims to promote improved overall performance and executive functioning capabilities. This intervention strategy offers a systematic approach to address the challenges that adolescents with ADHD may face in their daily lives, particularly within a school context.

For more in-depth information, Resource 6 provides an excellent reference point to delve into the intricacies of the Cognitive Functional model and its potential application in educational settings.

Driving

  • A computerized skills-training program aimed at reducing long glances away from the roadway for drivers aged 16 to 19 with ADHD showed promising results.
  • The specialized computerized simulated-driving program effectively reduced the frequency of long glances and lessened variation in lane position compared to a control program. The rate of collisions and near-collisions in real-world driving was lower in the intervention group in the year after training (8).

Driving is a significant activity for many adolescents, especially those in suburban or rural areas who may commute to school. A study involving a computerized skill training program for drivers aged 16 to 19 with ADHD showcased promising outcomes. This intervention focused on reducing extended glances away from the road and improving lane position during simulated driving scenarios, resulting in noteworthy benefits.

Compared to a control program, the intervention group demonstrated a considerable reduction in prolonged glances away from the road and showed enhancements in lane positioning. Additionally, in real-world driving situations, those who underwent the training had fewer instances of collisions and near collisions. The effectiveness of this computerized skills training was evident through its capacity to improve specific skills that are often impacted by adolescents with ADHD.

This study underscores the potential of targeted interventions to enhance driving skills and safety for adolescents with ADHD, thus contributing to their overall well-being and competence in this important occupation.

Social Skills

  • Interventions that incorporate typically developing peers can help improve the social skills of children with ADHD (10).
  • Social skills interventions combining multiple modalities—for example, parent involvement, video feedback, and play—in addition to incorporating peers have the potential to result in greater improvements in social behaviors for children with ADHD than one intervention method alone.
  • Targeting behaviors in natural environments and involving parents during the intervention process can promote the generalizability of skills and improve outcomes (10).

A notable study focused on social skills interventions for children with ADHD has highlighted the effectiveness of involving neurotypical peers in the process. This intervention amalgamated various approaches, including parental engagement, video feedback, and play-based strategies, resulting in substantial improvements in the social behaviors of children with ADHD.

Significantly, the integration of neurotypical peers played a pivotal role in the intervention's success. This aspect has noteworthy implications for school-based interventions. For instance, establishing after-school clubs based on shared interests could bring together children with ADHD and neurotypical peers in a cohesive environment. This setting not only allows them to collaborate on projects or activities but also facilitates the acquisition of crucial social interaction skills.

By drawing on the outcomes of this study, educators and Occupational Therapists can tailor interventions that harness the potential of involving neurotypical peers to foster enhanced social skills development among children with ADHD.

Executive Functioning Skills

  • Executive functioning skills are mental processes that help us connect past experiences with present actions. They are crucial for planning, organizing, strategizing, and paying attention to details.
  • Inhibition: The ability to stop one's behavior at the right time, controlling impulses. For example, a student might need to stop and think before answering a question in class.
  • Shift: The ability to move from one situation to another and think flexibly to respond appropriately. For instance, a student might need to shift from working on a math problem to answering a question about a reading assignment.
  • Emotional Control: The ability to manage emotional responses by bringing rational thought to feelings. For example, a student might need to control their frustration when struggling with a difficult task.
  • Initiation: The ability to begin a task or activity and independently generate ideas, responses, or problem-solving strategies. For example, a student might need to start a research project for a class.
  • Working Memory: The capacity to hold information in mind for the purpose of completing a task. For instance, a student might need to remember the steps of a science experiment while carrying it out.

(11)

Developing and mastering executive functioning (EF) skills holds immense significance for adolescents with ADHD, especially within this age group. What's worth noting is that fostering these skills requires a joint effort from both occupational therapists and teachers. While teachers have a pivotal role in supporting EF skills, incorporating these skills into the treatment plan can yield substantial advantages for adolescents.

Consider EF skills as the integral gears within a smoothly operating machine that seamlessly drive our actions and thoughts. Several crucial EF skills come into play. Initiation involves directing behavior to determine when to proceed or pause, curbing impulsive urges, and making deliberate choices while sidestepping distractions. Shift entails smoothly transitioning between tasks, adapting one's thinking to novel situations, and demonstrating adaptability when confronting challenges. Emotional Control encompasses managing emotions, ensuring a logical thought process before reacting emotionally, and addressing aspects like rejection sensitivity. Working Memory functions as a temporary storage system for information, aiding in retaining and manipulating details and facilitating the conversion of information into both short-term and long-term memory.

A firm grasp of these EF skills empowers adolescents with ADHD to proficiently navigate their academic and personal spheres. The collaborative integration of EF skill development into treatment plans serves as a catalyst for their overall growth and triumph.

  • Planning/Organization: The ability to manage current and future-oriented task demands. For example, a student might need to plan out the steps of a project and organize their time to complete it.
  • Organization of Materials: The ability to impose order on work, play, and storage spaces. For instance, a student might need to keep their school materials organized to be able to find what they need for homework.
  • Self-Monitoring: The ability to monitor one's own performance and measure it against some standard of what is needed or expected. For example, a student might need to check their work for errors and make sure they've met all the requirements of an assignment.

(11)

In the realm of executive functioning skills, a few more key aspects require attention. The first involves planning and organization, a skill that holds immense importance for delineating the steps of complex tasks like projects or essays. It also aids in effectively allocating time to ensure their completion, fostering a strategic approach to work and goal achievement.

Another crucial skill pertains to the organization of materials, particularly in the context of readily accessible school materials for homework. This entails maintaining functional spaces like backpacks or lockers, facilitating easy retrieval of items. While pristine order is not obligatory, the aim is to enable efficient use.

Additionally, the skill of self-monitoring proves valuable. It empowers students to evaluate their performance autonomously, enabling them to compare their work against predetermined expectations. This process helps identify areas for improvement and prompts adjustments in strategies.

Mastering these executive functioning skills equips adolescents with ADHD to adeptly navigate the complexities of their academic and personal pursuits. Collaborative efforts involving occupational therapists, educators, and parents contribute significantly to the development and overall success of these skills.

Strategies for Executive Functioning Skills

  • Use step-by-step approaches to work and visual organizational aids.
  • Use tools like time organizers, computers, or watches with alarms.
  • Prepare visual schedules and review them several times a day.
  • Ask for written directions with oral instructions whenever possible.
  • Plan and structure transition times and shifts in activities.
  • Create checklists and "to do" lists, estimating how long tasks will take.
  • Break long assignments into chunks and assign time frames for completing each chunk.
  • Use visual calendars to keep track of long-term assignments, due dates, chores, and activities. 
  • Use project management and/or scheduling software such as Notion, Trello, OneNote, etc. 
  • Organize the workspace and minimize clutter.

(11)


There are a range of strategies designed to support the development of executive functioning skills. These resources are available to you and cover a comprehensive spectrum of over 50 pages. They are adaptable for middle school, high school, and elementary school students. It's vital to customize these resources to suit the individual student's needs, ensuring that they find the content meaningful and relevant.

By utilizing these resources, we aim to make school-related tasks more manageable and impactful for students. This effort is centered around externalizing executive functioning skills, effectively relieving some of the cognitive load on the prefrontal cortex. Among the resources provided are checklists, organizers, and planners. These tools have the potential to positively influence students' self-esteem and enhance their overall organizational capabilities.

Feel free to employ these strategies and resources to empower your students to navigate their academic responsibilities with increased confidence and competence.

Mindfulness and Self-Compassion in ADHD Management for Preteens and Teens

  • Mindful awareness of emotions and emotional regulation are key components of this approach.
    • Tools like R.A.I.N (Recognize, Allow, Investigate, Non-identification) help manage difficult emotions.
    • Techniques such as imagery and journaling, along with physical posture adjustments, can help process and express emotions.
    • Cultivating positive emotions is also crucial. Techniques include:
      • "Taking in the Good": consciously recognizing and appreciating positive experiences
      • Finding mastery: engaging in activities that boost self-esteem and provide a sense of accomplishment
      • Gratitude: acknowledging and appreciating the positive aspects of one's life
      • Joy/Humor: seeking out and appreciating moments of joy and humor
      • Appreciation: valuing the positive aspects of experiences and relationships
      • Loving-kindness reminders: using images, quotes, gestures, positive connections, and elements of spirituality to promote feelings of love and kindness towards oneself and others.
    • Self-compassion, treating oneself with kindness and understanding, especially during difficult times, is a vital part of this approach.
    • These strategies can help preteens and teens with ADHD to better understand their experiences, manage their emotions, and cultivate positive self-perception and coping skills.

Mindfulness and self-compassion play integral roles in managing emotional regulation for individuals with ADHD.

A powerful tool called RAIN—Recognize, Allow, Investigate, Non-identification—can assist in managing challenging emotions. This technique aids in perceiving emotions accurately, allowing their presence, exploring their nature, and ultimately detaching from identification with them. As perceptions often differ for individuals with ADHD, RAIN can be particularly helpful.

Additional techniques, such as guided imagery, journaling, and posture adjustments, facilitate the effective processing and expression of emotions. Encouraging students to observe and adjust their posture during emotional discussions can heighten self-awareness.

Cultivating positive emotions is equally vital. Practices such as "taking in the good," fostering gratitude, finding moments of mastery, and engaging in loving-kindness reminders (Metta meditation) can contribute to a more positive emotional landscape. These techniques empower adolescents with ADHD to understand their experiences, manage their emotions, and foster self-compassion.

Introducing these strategies to pre-teens and teens equips them with tools to navigate their emotional journey with greater mindfulness and self-awareness.

Time-Assisted Devices and ADHD

  • Active participation from the children in goal setting is crucial to achieve their occupational performance goals.
    • Both children and parents reported higher satisfaction and occupational performance at follow-up with the use of a device to help with time-tracking. 
    • Main areas of occupational performance goals included carrying out daily routines, understanding the duration of an activity, and knowing future plans.
    • TADs were used to establish and maintain habits regarding sleeping routines, addressing common sleep problems among children with ADHD.
    • Highlights importance of assistive technology + environmental and task adaptations 

(15)

Utilizing time-assisted devices is a powerful approach to aiding individuals with ADHD to effectively manage their daily routines and activities. The integration of such devices allows individuals to better understand the duration of tasks, make informed decisions about future plans, and establish consistent sleep routines.

Research highlights the significance of active participation from children in setting their own goals. Studies show that incorporating time-tracking devices results in increased satisfaction and improved occupational performance, as reported by both parents and children during follow-up assessments.

Externalizing time through digital clocks in every room can address time blindness, a common challenge for those with ADHD. These devices aid in establishing regular sleeping patterns and assist individuals in overcoming difficulties with staying asleep, falling asleep, and adhering to morning routines.

This emphasis on assistive technology, along with environmental and task adaptations, underscores the essential role these tools play in accommodating the unique neurological differences of individuals with ADHD. Recognizing ADHD as a neurological difference rather than a personality trait is a fundamental takeaway from these interventions.

Supporting Learning Differences

  • Supported Education Intervention 
    • Brief didactic lessons on time management, studying, reading, and stress management
    • Use of a weekly planner and breaking assignments into smaller parts
    • Adoption of active reading strategies such as creating outlines and writing notes in margins
    • Identification of stress triggers and symptoms and implementation of positive coping strategies
    • Teaching and practicing individualized problem-solving strategies (13)
  • Psychoeducation Intervention:
    • Role-playing activities to practice discussing diagnoses, symptoms, and learning needs
    • Mastering self-advocacy strategies to navigate conversations (13)
  • Relaxation Intervention :
    • Scheduling times during the week to take mindfulness breaks and setting daily alerts
    • Improvement of academic performance through improved symptom management and engagement in meaningful, restorative activities
    • Independent engagement in self-guided mindfulness activities
    • Improvement of concentration, management of depressive symptoms, and reduction of anxiety during times of academic stress (13)
  • Exercise Intervention 
    • Provision of health-promotion exercise education and development of cardiovascular exercise routines
    • Reduction of anxiety and depressive symptoms and improvement of sleep quality through exercise interventions
    • Incorporation of daily 30-min brisk walks and participation in sports previously enjoyed (13)

A study emphasizes a comprehensive approach to supporting college students with learning differences, offering insights for occupational therapists working with individuals with ADHD. It also highlights the importance of multiple interventions to enhance occupational engagement and overall quality of life for these students.

The occupational therapy intervention addressed various areas. The education intervention involved teaching essential skills such as time management, effective studying, and reading strategies. Providing tools like a weekly planner helps students organize their tasks and responsibilities. Identifying stress triggers and practicing problem-solving techniques further equip students with adaptive strategies for managing challenges. The psychoeducational intervention focused on enhancing relaxation techniques. As discussed earlier, mindfulness and self-compassion practices contribute to emotional regulation and stress management, promoting a better quality of life for individuals with ADHD. The exercise intervention incorporated into the plan acknowledges the positive impact of physical activity on cognitive functioning, mood regulation, and overall well-being. Encouraging healthy lifestyle behaviors like regular exercise is vital, as it contributes to better outcomes for individuals with ADHD.

By integrating these interventions, occupational therapists can create personalized plans that address academic, emotional, and physical well-being, ultimately supporting the overall quality of life for individuals with ADHD, particularly as they transition to college and beyond.

Case Studies Discussion

  • Now, let's take a look at two case studies involving middle and high school students with ADHD.
    • Case Study 1: A 14-year-old student who struggles with organization, time management, and maintaining focus during class
    • Case Study 2: A 16-year-old student who faces difficulties with social interactions, emotional regulation, and impulsivity

I've included two insightful case studies that shed light on the intricacies of dealing with ADHD in adolescents. The first case study is the focal point of our discussion today, offering an opportunity to delve into its details and extract valuable insights.

The second case study is added as a reference. This inclusion stems from a growing realization that more girls are being diagnosed with ADHD. Notably, the presentation acknowledges that the manifestation of symptoms can differ among individuals, especially when considering the unique perspectives of girls with ADHD. The second case study is provided as a valuable resource for those eager to explore this distinct facet of ADHD symptomology in girls, encouraging a comprehensive understanding of the condition.

Case Study 1:

Jason, a 14-year-old middle school student with ADHD, has been struggling with organization, time management, and maintaining focus during class. His teachers report that he often loses track of assignments and has difficulty completing tasks within the allotted time. Jason's difficulties also affect his ability to manage his locker and belongings, leading to frequent frustration. He finds it challenging to pay attention in class, which impacts his academic performance and participation in group activities.

Support Strategies for Jason:

  • Implement personalized planners or digital organization tools to help Jason manage assignments and deadlines.
  • Break down tasks into smaller steps and use a timer to help him stay focused and complete assignments.
  • Provide visual aids or checklists to help Jason stay organized and manage his locker and belongings.
  • Collaborate with teachers to provide preferential seating near the front of the classroom to minimize distractions.
  • Offer study skills training, including note-taking and time management strategies, to improve academic performance.
  • Use sensory tools (e.g., stress balls or noise-canceling headphones) to help Jason maintain focus during class.
  • Foster communication and collaboration among teachers, staff, and parents to ensure consistency in strategies and expectations.

The first case study focuses on Jason, a 14-year-old middle school student grappling with ADHD. His challenges revolve around organizational struggles, time management issues, and maintaining concentration during class sessions. Jason's story might resonate with educators and practitioners familiar with students like him in school settings. 

Reports from his teachers highlight a common narrative: Jason often loses track of assignments, finds it difficult to complete tasks within designated timeframes, and encounters particular difficulties in managing his belongings and locker. The culmination of these difficulties leads to frequent frustration. Moreover, his struggle to pay attention in class has tangible repercussions on both his academic performance and his active involvement in group activities within the classroom.

To help Jason navigate these challenges, a range of support strategies have been suggested. Personalized planners could provide structure and aid in managing his tasks. Recognizing that digital tools might resonate better with Jason, the presentation offers various digital organization tools as alternatives, such as Notion, Trello, and Evernote. Breaking assignments into smaller, manageable steps is proposed to prevent overwhelming feelings. Utilizing a timer, possibly the digital clock concept previously discussed, might help him stay focused while systematically completing his assignments. Visual aids and checklists, reminiscent of an activity analysis, are suggested to provide a clear roadmap for task completion. By breaking tasks into actionable items and allowing him to check them off, Jason could experience the satisfaction of progress.

Addressing the classroom environment and collaborating with teachers for preferential seating is advised to minimize distractions and maximize his engagement. This strategic move aims to optimize his learning experience. Additionally, offering study skills training could be an empowering intervention. Drawing from the previous case study's example of a college student, the occupational therapy practitioner could work alongside Jason to develop effective study strategies. By doing so, the practitioner helps him not only with immediate academic needs but also equips him with skills that can be honed over time.

Sensory tools are also proposed as part of the support plan, acknowledging the potential impact of sensory regulation on Jason's attention and overall functioning. However, a noteworthy emphasis is placed on fostering collaboration among teachers, staff, and parents. This unity ensures a consistent approach to managing Jason's challenges both at school and home, ultimately enhancing the efficacy of interventions and creating a more supportive environment for his growth and development.

Case Study 2:

Sophia, a 16-year-old high school student with ADHD, has been facing difficulties with social interactions, emotional regulation, and impulsivity. She often gets into conflicts with her peers and has trouble maintaining friendships. In class, Sophia finds it difficult to manage her emotions and impulsivity, which sometimes results in outbursts or other disruptive behavior. These challenges also impact her participation in group activities and projects.

Support Strategies for Sophia:

  • Implement social skills training through role-playing, group activities, and peer mentoring to help her build friendships and navigate conflicts.
  • Offer mindfulness and relaxation techniques tailored for adolescents to help Sophia manage her emotions and impulsivity.
  • Collaborate with teachers to provide clear expectations and routines, which can help minimize disruptive behavior in class.
  • Encourage the use of a "cool-down" area or break space where Sophia can go when she feels overwhelmed or needs to regain emotional control.
  • Assign a designated staff member or mentor to check in regularly with Sophia to discuss her progress and address any concerns.
  • Facilitate support groups or clubs for students with ADHD to foster a sense of community and belonging, which can improve Sophia's social connections.
  • Foster communication and collaboration among teachers, staff, and parents to ensure a consistent approach in supporting Sophia across settings.

A Ferrari Brain with Bicycle Brakes

“Jeremy, age 12, sits in my office flanked by his mother and father…Jeremy and his parents seem tense. Jeremy, his baseball cap on backward, stares at a spot on the floor as if he wants to be somewhere else. Mom and Dad lean forward, looking at me with anticipation and fear written on their faces.

I get to the point. “I have great news for you. We’ve learned a lot about you, Jeremy, and guess what? You have an amazing brain. Your brain is incredible.”

Jeremy looks up, and Mom and Dad lean back a bit. “Your brain is like a Ferrari. Do you know what a Ferrari is?” Jeremy nods, smiling. “Well, your brain is like a Ferrari race-car engine. It is very powerful. With the right care, you will win many races in your life.”
I pause. “But there is one problem.” Parents and son shoot looks at me. “You have bicycle brakes. Your brakes are not strong enough to control the powerful brain you’ve got. So, sometimes, you race past places where you mean to stop, or you ignore instructions you mean to hear. But don’t worry. I am a brake specialist. I will help you strengthen your brakes, so you can become the champion you are.” For the next 15 minutes, we discuss the race-car brain outfitted with bicycle brakes.” - Edward Hallowell, M.D., ADDitude Magazine (16)

As we come to a close, I want to leave you with a metaphor that has always resonated with me: the "Ferrari brain with bicycle brakes." This metaphor, shared by a psychiatrist in a story, beautifully encapsulates the essence of working with individuals who have ADHD.

Imagine a young boy named Jeremy, age 12, sitting in the psychiatrist's office with his parents. Their expressions betray tension and disinterest. But then, the psychiatrist delivers a revelation – he talks about Jeremy's remarkable brain and its incredible capabilities. He paints a picture of Jeremy's brain as a powerful Ferrari race car engine, invoking excitement and understanding in Jeremy's eyes.

The metaphor continues to unfold. The psychiatrist acknowledges Jeremy's potential – the possibility of winning many races in life with the right support and guidance. But he doesn't shy away from the challenge. He introduces the concept of "bicycle brakes" – a representation of Jeremy's difficulty in controlling his formidable brain's power. He tactfully reassures Jeremy and his parents that he specializes in strengthening these brakes, tackling the very challenges that might hold Jeremy back.

The psychiatrist's approach is goal-oriented. He pledges to help Jeremy enhance his brakes, giving him the tools to overcome his challenges and tap into his full potential. This intervention isn't just about addressing difficulties; it's about empowering Jeremy to fully engage in his roles and activities, particularly in his role as a student.

This metaphor is both amusing and profound, and it perfectly captures the heart of our work with individuals facing ADHD. It encapsulates the idea that we're working with individuals who possess incredible potential, akin to a high-performance engine, but they require support to manage their executive functioning challenges – their "bicycle brakes."

Before we conclude, I encourage you to explore the full article linked here from ADDitude Magazine. It's a valuable resource that delves deeper into this concept and offers insights into our roles in supporting individuals with ADHD.

Summary

As we come to the end of our discussion on ADHD and its impact on adolescents, let's take a moment to reflect on some key takeaways from our time together. Our journey has been focused on understanding ADHD through a strengths-based lens, recognizing that there's a rich diversity in the ways individuals think, learn, and behave.

We've explored the intricate characteristics and symptoms of ADHD, peering into its influence on various occupations and how it shapes occupational performance. Our exploration led us to an array of interventions, equipping us with practical tools and resources that you can readily incorporate into your practice.

Delving deeper into executive functioning skills, we recognized the value of not only enhancing these skills but also externalizing them to create a more supportive environment. Additionally, we dove into the developmental nuances that come into play when working with middle school and high school students, understanding their unique challenges and crafting appropriate strategies.

Our journey culminated in the exploration of specific techniques that can be harnessed to empower and uplift adolescents with ADHD. As we conclude, I want to extend my heartfelt gratitude for your engagement and participation. It is our collective dedication as occupational therapy practitioners that paves the way for a more inclusive and enriching environment where ADHD adolescents can flourish.

Should you have any further questions or seek more insights, my email is readily available for you. I encourage you to explore the comprehensive resources provided to further augment your knowledge and practice. Thank you once again, and I extend my best wishes for your success in working with this remarkable and diverse population.

Questions and Answers

Can you expand on the dual diagnosis of ADHD with OCD? What do you mean by parents having something to contribute to this? And please include the role of OT with regard to this combination diagnosis.

When we discuss the dual diagnosis of ADHD and OCD, we're referring to individuals who are diagnosed with both Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive-Compulsive Disorder (OCD). It's important to note that around two-thirds of individuals with ADHD also have an additional diagnosis alongside it. Regarding the reference to parents contributing to this, there's a phenomenon where individuals with opposing characteristics, such as those with ADHD and OCD, might be more likely to form relationships. When they have children, there's a higher chance of their children inheriting both ADHD and OCD due to the genetic component.

The role of occupational therapy (OT) in this combination diagnosis involves supporting individuals to manage the challenges presented by both ADHD and OCD. OT practitioners can focus on helping individuals develop effective coping strategies for managing impulsivity, attention, organization, and sensory sensitivities, which are common features of ADHD. Additionally, they can assist in developing strategies to address the obsessions and compulsions associated with OCD and promote adaptive daily routines and habits.

What is the name of the computerized driving program?

The specific computerized driving program wasn't mentioned in the presentation. However, you can find the information about it by checking the reference numbers provided in the presentation. Clicking on the link associated with the relevant reference number should lead you to the details of the computerized driving program discussed.

In school settings, OTs do not typically address executive functioning. What can be done to address this gap?

It's unfortunate that executive functioning skills may not always be addressed proactively in school settings. While counselors may play a role in addressing executive functioning, OTs can contribute their expertise as well. One way to bridge this gap is by proactively collaborating with teachers and educators to introduce strategies that support executive functioning skills in the classroom. Offering resources, checklists, and tools that teachers can integrate into their teaching methods can be helpful. By providing practical, ready-to-use resources, OTs can enhance their role in promoting executive functioning skills in educational settings.

What are your recommendations regarding screen time use and gaming with ADHD teens?

Managing screen time and gaming for ADHD teens requires a balanced approach. It's important to consider guidelines from organizations like the American Academy of Pediatrics (AAP), which provide recommendations based on age groups. These guidelines help ensure that screen time is not excessive and doesn't interfere with other important activities.

For ADHD teens, it's beneficial to establish clear routines and boundaries around screen time. Encouraging breaks, physical activity, and engaging in other activities can help maintain a balanced lifestyle. Collaborating with parents to set screen time limits and incorporating activities that promote focus and self-regulation can be valuable. While screen time can be a source of entertainment, it's essential to strike a balance to ensure that it doesn't adversely affect other areas of life.

Do you have any recommendations for continuing education in ADHD, particularly for OTs?

Continuing education in ADHD is crucial for OTs to stay current and effective in their practice. The presentation includes resources from Continued, which offers several courses related to ADHD. Additionally, the PESI certification mentioned provides an in-depth exploration of ADHD topics and can be a valuable investment for OTs seeking to expand their knowledge in this area. Exploring courses and certifications related to ADHD from reputable sources can enhance your expertise and effectiveness in working with individuals with ADHD.

With the shortage of ADHD meds and restrictions on their use in school, do you see a greater need for 504 plans or OT in school or outpatient settings? Any suggestions for goals for 504 plans?

The shortage of ADHD medications and the evolving perspectives on their use may indeed lead to a greater need for alternative interventions in school and outpatient settings. OTs can play a significant role in supporting individuals with ADHD by offering strategies to enhance executive functioning, self-regulation, and sensory processing. This could translate to a heightened need for OT involvement in schools and outpatient settings to help individuals manage ADHD-related challenges effectively.

When it comes to goals for 504 plans, consider focusing on promoting school function, organization, self-regulation, and sensory support. For instance, goals could include developing strategies for managing transitions, completing assignments, and maintaining attention in class. Goals that foster self-advocacy skills and encourage independence could also be valuable. Tailoring the goals to each individual's needs and collaborating closely with educators and parents can lead to effective 504 plans that support the individual's success in the school environment.

References

  1. SingleCare Team. (2023). ADHD statistics 2023. The Checkup. https://www.singlecare.com/blog/news/adhd-statistics/
  2. Jacob, C. P., Romanos, J., Dempfle, A., Heine, M., Windemuth-Kieselbach, C., Kruse, A., et al. (2007). Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center. Eur Arch Psychiatry Clin Neurosci, 257(6), 309–317. doi: 10.1007/s00406-007-0722-6.
  3. Pugle, M. (2021). The ADHD brain vs. the non-ADHD brain. Verywell Health. https://www.verywellhealth.com/adhd-brain-vs-normal-brain-5210534
  4. Rubia, K. (2018). Cognitive neuroscience of attention deficit hyperactivity disorder (ADHD) and its clinical translation. Frontiers in Human Neuroscience. doi: 10.3389/fnhum.2018.00100 
  5. Pietrangelo, A. (2021, May 1). What are the symptoms of ADHD in teenagers? Healthline. https://www.healthline.com/health/adhd/adhd-symptoms-in-teens
  6. Levanon-Erez N, Kampf-Sherf O, Maeir A. (2019). Occupational therapy metacognitive intervention for adolescents with ADHD: Teen Cognitive-Functional (Cog-Fun) feasibility study. British Journal of Occupational Therapy, 82(10):618-629. doi:10.1177/0308022619860978
  7. The OT Dude (2021, May 22). ADHD interventions & models for occupational therapists – Evidence-based practice. https://www.otdude.com/ot-practice/adhd-interventions-models-for-occupational-therapists-evidence-based-practice/
  8. Epstein, J. N., Garner, A. A., Kiefer, A. W., Peugh, J., Tamm, L., MacPherson, R. P., Simon, J. D., & Fisher, D. L. (2022b). Trial of training to reduce driver inattention in teens with ADHD. The New England Journal of Medicine, 387(22), 2056–2066. https://doi.org/10.1056/nejmoa2204783
  9. Adamou, M., Asherson, P., Arif, M., Buckenham, L., Cubbin, S., Dancza, K., Gorman, K., Gudjonsson, G., Gutman, S., Kustow, J., Mabbott, K., May-Benson, T., Muller-Sedgwick, U., Pell, E., Pitts, M., Rastrick, S., Sedgwick, J., Smith, K., Taylor, C., Thompson, L., … Young, S. (2021). Recommendations for occupational therapy interventions for adults with ADHD: A consensus statement from the UK adult ADHD network. BMC psychiatry, 21(1), 72. https://doi.org/10.1186/s12888-021-03070-z
  10. Fox, A., Dishman, S., Valicek, M., Ratcliff, K., & Hilton, C. (2020). Effectiveness of social skills interventions incorporating peer interactions for children with attention deficit hyperactivity disorder: A systematic review. The American Journal of Occupational Therapy, 74(2), 7402180070p1-7402180070p19.
  11. National Center for Learning Disabilities (NCLD) (2005). Executive functioning fact sheet. From http://www.nsadhd.org/uploads/3/5/4/1/3541269/executive_functioning.pdf. 
  12. Mindfulness Strategies for ADHD in Therapy. (2022) https://catalog.pesi.com/item/mindfulness-strategies-adhd-integrate-neuroscience-awareness-practices-selfcompassion-treatment-110018
  13. Nagata R, Forry S, Lannigan EG. (2022). Occupational therapy interventions for college students with learning differences. Am J Occup Ther, 76(6):7606390010. doi: 10.5014/ajot.2022.050057. PMID: 36622933.
  14. ADHD in the family: Strategies for parents at home & school. (2022). https://catalog.pesi.com/item/adhd-family-interventions-parents-home-classroom-109894
  15. Wennberg, B., Janeslätt, G., Kjellberg, A., & Gustafsson, P. A. (2018). Effectiveness of time-related interventions in children with ADHD aged 9-15 years: A randomized controlled study. European child & adolescent psychiatry, 27(3), 329–342.
  16. Hallowell, E., MD. (2021, September 28). Your brain is a Ferrari. ADDitude. https://www.additudemag.com/how-to-explain-adhd-to-a-child-and-build-confidence/?platform=hootsuite

Citation:

Bahr, E. (2023). ADHD in adolescence: Enhancing success for middle and high school students. OccupationalTherapy.com, Article 5634. Available at www.OccupationalTherapy.com

To earn CEUs for this article, become a member.

unlimited ceu access $99/year

Join Now

elisabeth bahr

Elisabeth Bahr, OTD, MS, OT/L

Liz Bahr is an occupational therapist, writer, professor, and yoga therapist. She is a neurodiverse-affirming, neurodivergent OTP committed to creating a more inclusive and equitable world for all. She graduated from Boston University's Occupational Therapy Post-Professional Doctorate and New York University, Master of Science programs. She is currently a Master of Creative Writing student at Harvard Extension.

In her clinical practice, she focuses on merging creativity and occupation to improve the quality of life for adolescents and young adults. She has undergone additional training in ADHD and uses this knowledge to help her clients develop strategies and reach their goals. She is also a certified yoga therapist and uses yoga to help her clients improve their physical and mental health.

Liz is a sought-after speaker and writer on occupational therapy, ADHD, and creativity. She has presented at conferences and workshops nationwide, and her work has been featured in national publications. She is passionate about sharing her knowledge and experiences with others to help them live their best lives.

You can find her on LinkedIn or at her wellness practice, pegasuswellness.co. She also writes for Continued.com.



Related Courses

ADHD In Action: Empowering Occupational Therapy Practitioners In Elementary Schools
Presented by Elisabeth Bahr, OTD, MS, OT/L
Video
Course: #5988Level: Introductory1 Hour
Rehabilitation professionals working with children with ADHD in school settings will be educated on evidence-based strategies and creative interventions in this workshop. Participants will explore practical approaches to support these children in achieving academic success, enhancing social skills, and optimizing their school function.

ADHD In Adolescence: Enhancing Success For Middle And High School Students
Presented by Elisabeth Bahr, OTD, MS, OT/L
Video
Course: #5991Level: Introductory1 Hour
Occupational therapists working with middle and high school adolescents with ADHD are provided with evidence-based strategies and interventions in this 1-hour workshop. Participants will explore practical approaches to support these students in achieving academic success, enhancing social skills, and managing their symptoms effectively in a more complex school environment.

Assessment And Treatment Strategies To Boost Brain Skills In Partnership With The Pocket Occupational Therapist
Presented by Cara Koscinski, OTD, MOT, OTR/L, CAS
Video
Course: #5453Level: Intermediate1.5 Hours
Children often struggle with fidgeting, attention deficits, and immature motor patterns which manifest themselves through frustration, sensory, and behavior issues. The optimal function of our bodies occurs when our sensory and motor systems are strong and able to adapt to the demands of the environment. Lack of movement opportunities and the use of electronic devices at a young age both affect the development of patterns used in the occupation of children. Occupational therapists can easily build-in assessment of body and segmental movement and posture. This session provides strategies for assessment and introduces treatment ideas for using movement to improve performance in occupation.

Learning Disorders And ADHD, Building Your OT Toolbox In Partnership With The Pocket Occupational Therapist
Presented by Cara Koscinski, OTD, MOT, OTR/L, CAS
Video
Course: #5471Level: Introductory1.5 Hours
Children with learning disabilities often struggle in multiple areas of occupational performance. This course helps with understanding the characteristics and treatment of learning disabilities and ADD/ADHD in the pediatric population. Throughout this course, we will focus on practical treatment ideas to improve outcomes. Goal writing while considering the utilization of a strengths-based approach is discussed.

Executive Function in Children with Autism Spectrum Disorder
Presented by Cara Koscinski, OTD, OTR/L
Video
Course: #4491Level: Introductory1 Hour
Smooth executive function includes the ability to regulate emotions and think creatively about situations by forming multiple solutions. This course describes the effects of EF on participation in play, social skills, and discusses interventions based on the Occupational Therapy Practice Framework, 3rd Edition.

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.