Adolescents with ADHD tackle daily lives well but struggle at school
A small Swedish study shows that school is where students experience their ADHD as a problem.
Swedish researchers interviewed 12 youths aged 15 to 17 years about what it’s like to live with ADHD.
The teens said that they manage pretty well when they’re with their friends, sweethearts or families.
According to the study participants, it’s at school that ADHD poses a problem, because people lack an understanding of the condition.
The study has been published in the latest issue of Tidsskrift for psykisk helsearbeid, a Nordic journal on mental health work.
Teens rarely asked
The purpose of this study was to describe how young people with ADHD think and how they feel in everyday life and at school.
“The ADHD diagnosis has been heavily researched. But young people themselves are rarely asked how they perceive having ADHD,” says Rikard Olof Eriksson.
He is a researcher at Østfold University College and carried out the new study with researcher Maria Carlsson at the University of Gothenburg. They interviewed teens in Sweden.
“Clinical medical research on drugs— figuring out what helps and what doesn’t help —dominates ADHD research. Sociological and ethnographic studies of those who are diagnosed are almost completely absent in the research literature,” Eriksson said.
Have faith in the future
An important question for the researchers was whether these young people have the opportunity to realize their hopes for the future.
“It turns out that these young people have the same optimism and the same future dreams as other teenagers. This is encouraging, despite the fact that they believe they haven’t received the help they need in school,” says Eriksson.
Medication makes life easier
Three quarters of the teens in the study were diagnosed with ADHD when they were between 14 and 16 years old. All were medicated. None of them had a contact person in the child and adolescent psychiatry field.
Concentration, sitting still and scheduling schoolwork count among the main challenges for these young people. They grapple with mental chaos, fatigue, difficulty remembering and finding motivation.
Most interviewees said that medication has allowed them to concentrate better in school. They have become less impulsive and less hyperactive.
Not getting help in school
A key result of the study is that young people believe that schools have not offered them much support. Both the students and their parents have asked for help when they needed it, and often they haven’t received assistance.
Some young people also faced scepticism on their ADHD diagnosis in school, which has resulted a negative attitude towards school. They are afraid that they won’t succeed there.
"School is the only place I hate ADHD," one teen says.
Medication for better or worse
The study reveals that young people have many different ideas about medication.
On the one hand, they say that they experience positive personality changes. They feel more normal and get more rest when they take medication.
But they also experience feeling like they become a duller version of themselves. The greater calmness makes them feel down.
“Some kids describe how their friends don’t recognize them because they become a different person. The drug affects them positively in everyday life but it’s seen as more negative in their private life,” says Eriksson.
Struggling in school
Nikolai Kaas, now 24, is the youth representative for the Norwegian ADHD association, ADHD Norge. He lives with ADHD, too.
He says that many of the requests he gets from adolescents with ADHD are about how to make their way through secondary education.
“Many kids don’t know what rights they have and what they can do to get help. Young people also seem to struggle with getting teachers to understand what the diagnosis is all about. They don’t feel understood,” says Kaas.
The people who turn to ADHD Norge are often experiencing problems, says Kaas. So how many students actually experience school as unproblematic is difficult to say, he believes.
“It’s also important to remember that no ADHD diagnoses are the same. How much extra help a person need is very individual,” he adds.
Kaas says that what is quite clear is that much less facilitation of students with ADHD happens in secondary school than in primary school. And there isn’t much information about where they should go to get extra help. “I think that if a family can arrange a dialogue with the school, it can be really helpful. But this obviously varies from school to school,” he says.
Lower doses on weekends
Kaas can relate to the Swedish youths’ description of the medication’s advantages and disadvantages.
“You don’t get it both ways. The hyperactivity and creativity that come with having an ADHD diagnosis has to be suppressed to concentrate. Then you experience yourself as more boring and less spontaneous. But you have to weigh the positives against the negatives. I know several individuals whose general practitioner helped them adjust their medication so they’re less medicated on weekends than in everyday life. Then they can live more freely and have more energy when they don’t require the same concentration,” he says.
Kaas agrees that living with this diagnosis in everyday life is generally okay.
“But a lot of people find secondary and university studies considerably more challenging,” he says.
Early assessment can pave the way
Lisbeth Iglum Rønhovde is a special education teacher and has extensive professional experience as a teacher and in educational-psychological counselling (PPT). She has published the textbook Kan de ikke bare ta seg sammen [Can’t they just pull it together] about ADHD and Tourette's syndrome.
She said the study from Sweden is too small to draw conclusions. She also points out that she has a weak basis for comparing Norway and Sweden.
“In general, I would say that it isn’t typical for such a large number of children to be evaluated with ADHD as late as age 14. Depending which symptoms are most prominent, the diagnosis is usually made about halfway through primary school,” Rønhovde says.
The longer a person goes undiagnosed and untreated, the harder the symptom picture becomes. Late treatment can lead to psychological problems or failure in school, and for some students, drugs and dropout in adolescence.
If medications work well for children, and treatment is established before they lose courage and feel they’re unsuccessful, adolescence often goes well, she says.
ADHD alone not a basis for extra help
ADHD is not in itself a reason to get additional support in school; it is the pupil’s level of functioning that determines whether additional measures are needed, says Rønhovde.
“Many children with ADHD also have specific learning disabilities. If the difficulties are so great that students can’t satisfactorily benefit from the general instruction, they may be entitled to special education. Others may manage the academics relatively well but need an aide or some teacher support to get an overview of and bring structure to their school day. Others will need support due to immature social skills,” she says.
Much of this occurs at an excellent level in Norwegian schools, says Rønhovde.
“Of course, one can find students who are struggling and haven’t been seen. Or students whose performance isn’t so weak that they’re entitled to special education. But it’s never just the ADHD diagnosis that determines this,” she says.
Rønhovde thinks that there are also certainly some teachers in Norway who are wary of letters and diagnoses. “But I believe that the vast majority of Norwegian teachers don’t perceive ADHD as a new and mysterious unknown,” she says.
Att leva med ADHD. En intervjustudie av ungdomar med koncentrationssvårigheter med fokus på deras vardagsliv och sociala relationer [Living with ADHD. An interview study of youth with concentration difficulties with a focus on their daily life and social relationships], Tidsskrift for psykisk helsearbeid 01-02/2016.