Parents of ADHD Teens: School Issues, Social and Peer Relationships

Alan R. Graham, and Bill Benninger, are our guest speakers. They have been working with with ADD, ADHD teens and their parents for over 20 years.

David is the HealthyPlace.com moderator.

The people in blue are audience members.

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Conference Transcript

David: Good evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is for Parents of ADD, ADHD Teens.

We'll be covering school issues, social and peer relationships, what to do during the summer, driving issues, how you, as a parent, can help your child, and some good coping mechanisms for yourselves.

Our guests, psychologists Alan Graham and Bill Benninger have been working with children, adolescents and adults with Attention Deficit Disorder and their parents for over 20 years. Besides doing direct therapy, they work with individuals and groups over the phone on a conference call line and they publish the newsletter, ADDvisor.

Good Evening, Dr. Graham and Dr. Benninger and welcome to HealthyPlace.com. We appreciate you being here tonight. People in the audience may have different levels of understanding Dr. Graham, I'd like you to define ADD (Attention Deficit Disorder), ADHD (Attention Deficit Hyperactivity Disorder) and then we'll get into deeper issues.

Dr. Graham: ADHD is a disorder of the inability to inhibit behavior and impulses. It is marked by hyperactivity, impulsiveness and inattention. ADHD kids are fidgety, interrupt others, break into lines, always have to be first, daydream and are unfocused. ADD (attention deficit disorder) is all the above without the hyperactivity.)

David: For those in the audience, I'm assuming that most of you have, at least, a basic understanding of ADD, ADHD. However, if you have any question on this subject tonight, please feel free to send it in.

It's almost summertime now, Dr. Benninger, and I know parents are sitting around and wondering what they can do with their ADD teen. What are the issues that parents face during this time of year and what are the solutions?

Dr. Benninger: Supervision is a major summertime issue. It is very important that ADHD teens be closely supervised. Even though it can be difficult, even paying a "sitter" for older kids may be important. There are many camps that may also be a good resource.

David: What kinds of things should parents be concentrating on during the summer, in terms of working with their kids?

Dr. Graham: Structuring their kids time so that their environment predictability is a priority.

Dr. Benninger: I think behavior issues and responsibility are very important. These can be worked on by keeping them accountable. Daily reward systems, even for older kids, can be of significant help.

David: I think that's one of the issues that parents deal with all the time -- accountability. How would you suggest they help their teenager with that?

Dr. Graham: If you want, for example, to encourage your child to maintain a job during the summer, make attendance at the job, the criteria for using the car. Develop a set of incentives that the teenager is well aware of that encourages the responsible behavior you want to see in your child.

Dr. Benninger: Structured behavior modification systems work very well.

David: Can you explain that?

Dr. Benninger: Picking out 2 or 3 behaviors that you want your teen to work on, using the rewards that Alan is talking about on a daily basis. This is important because ADHD teens need much more structure and accountability than non-ADHD teens.

Dr. Graham: Financial incentives can work too. Your teen can earn money for desired behavior.

Dr. Benninger: It is important to let the teen help select a list or menu of rewards that help keep them interested. Money, movies, driving screen time, time with friends can all be incentives.

David: Here are some audience questions:

teresat: How can a parent help an add child retain what he or she has learned at school in the summer.

Dr. Benninger: Good question - They aren't going to have much more trouble than the average teen unless they have a learning disability. Adhd is a disorder of doing - not knowing. It is important to strike a balance as you don't want to burn out a teen that already dislikes school.

Dr. Graham: It also depends on your child's attitude toward school. Would they be interested in summer school? Would it have to be a fun course? Is a tutor a possibility?

Sunshine777: Dr Benninger you say there are many camps, but where would one go to find out where or who these camps are? I have looked in the ACA and there are maybe 1 or 2 and they are back east.

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Dr. Benninger: I would contact CHADD, the national organization for ADHD. They can probably help. Be prepared. ADHD specialty camps can be expensive.

Dr. Graham: In the Chicago area, the Sunday newspapers often advertise camps for ADD kids. Also, some camp specialists are around who can help. School counselors too. I would also look in the yellow pages under "camps" and see if any work with ADD (Attention Deficit Disorder) or learning disabled or special needs kids. Also, special education districts or programs may know as well.

David: Also Sunshine, how about contacting your local school district for some suggestions.

Noele: So, would you say that it is more important to focus on the more serious issues and let some of the small stuff slide? To work on a piece of the problem at a time, rather than to tackle this head-on? And if so, how do we get schools and teachers to see this?

Dr. Benninger: I would say yes to that Noele as well. Getting teachers to see this is sometimes difficult. First you must try to maintain a good relationship with the teacher despite differences that come up.

Dr. Graham: Certainly, you want to pick your battles with your child. You have to make an assessment if the power struggle is worth it. Remember that you do not have control over your child's actions. You only have control over your own actions. Make sure that any response you make is something you feel comfortable doing.

Gailstorm: My 15 year old son has frequent explosive, angry tantrums that can last for an hour or so. Then he settles down to a slow burn. What do you suggest outside of medication and therapy that I can do to help curb this type of behavior?

Dr. Benninger: In general, angry tantrums are not necessarily only ADHD (Attention Deficit Hyperactivity Disorder), especially as you describe. I would be sure your psychologist knows these details and completes a thorough evaluation.

Dr. Graham: When your child experiences a meltdown as you describe, rational thought is gone and trying to reason with him at that time is useless. Let your child know that you will wait until he is calm before you will talk to him and that you will walk away when he is in a meltdown. Tell him this at a calm moment, not when he is in a meltdown.

A good resource, Gailstorm is a book by Ross Greene, The Explosive Child.

Dr. Benninger: Excellent recommendation Alan.

David: I'm sure, Dr. Graham, that for parents dealing with explosive children, it must be emotionally and physically exhausting? How can a parent live with that day in and day out?

Dr. Graham: Again, pick your battles. Also, give yourself a break. I always tell parents that you could be "parents of the year" and still feel frustrated and angry much of the time, even if you are doing everything right.

Go to ADD support groups, stay in touch with other parents of ADHD teens. Go out with your spouse. Keep yourself replenished.

Dr. Benninger: It is important for the parent to take care of themselves to avoid becoming depressed. Try to get a regular night out by trading services with other parents of ADHD teens.

LisaHe: I have learned that ADD (Attention Deficit Disorder) can precipitate ODD, Oppositional Defiance Disorder in teens. What is your view on that?

Dr. Benninger: Oppositional Defiance Disorder (ODD) occurs in about 30% of ADHD teens, but it's a logical problem. You'd be frustrated too if you struggled like an ADHD child does. This may be due to the constant negative feedback they get throughout their life that they are "lazy", "underachieving", that they could "do it if they try". So they see themselves as losers and celebrate their "outcastness".

Dr. Graham: By being oppositional.

Dr. Benninger: How to handle this? Structure, rewards, consequences, consistency, persistence.

David: Another issue I want to touch on here, because like every teenager, an ADD teen wants to drive when he/she comes of age. But as we all know, impulsivity isn't one of the best traits for good driving skills. What should parents be aware of here and what are your suggestions for handling the issues that come up?

Dr. Benninger: Small steps, a lot of practice with an adult, a limited driving range, incentives for responsible behavior are all important. It could be that they will have to wait an extra year or so before they can drive independently.

Dr. Graham: First of all, ADHD is a developmental disorder of impaired behavioral inhibition. These kids are up to 30% delayed in their ability to control their impulses. Your 16-year-old who wants his/her license may have the control of an 11-year-old. In our last newsletter, we listed some guidelines for letting add kids drive.

Don't let them drive until you feel comfortable as a passenger in the car. Use the car as an incentive for responsible behavior.

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teresat: Are most ADHD teens immature for their ages?

Dr. Benninger: Yes they are, teresat. You can see it in behaviors, interests, socialization.

Dr. Graham: Yes, Teresat, but it is in the area of behavioral inhibition. They may be more mature in other areas.

David: On the average, emotionally speaking, how many years behind is an ADD child from a child without Attention Deficit Disorder?

Dr. Benninger: 30% so, get out your calculators!

David: So that's important to keep in mind when you are dealing with your ADD teen. He/she will be 3 or more years emotionally behind their age.

And here's an audience comment regarding letting your teen drive:

Sunshine777: Because we feel that driving or having your license is a privilege our son doesn't have his yet, but he sure manages to find the car keys and take the car out for a joy ride. Thank goodness there have been no accidents, but he couldn't understand why we were so upset to find out. "But Mom I'm a good driver, don't you trust me?" Then he goes into his negative feelings about himself. But someone suggested allowing them to take the lessons because of the liability issues.

Dr. Benninger: Sunshine - it's not that you don't trust him (that's a manipulation), you need to be sure he's safe and that he can follow the rules! I don't have any problems with lessons - that's supervised practice.

joan3: Nothing seems to work on my son in regards to him taking responsibility for things he does and it is "never his fault". What can I do to reach him?

Dr. Graham: Joan, whether you son takes responsibility for his actions or not, you remain consistent in your administration of appropriate consequences. Repetition is key. Eventually, hopefully, he'll get it. Many ADHD kids were very problematic as teens but grew up to be productive, happy adults.

Dr. Benninger: Alan is right - be consistent - try not to get worn down -continue to see the positive too.

David: Here are a few audience responses on successful parenting of teens:

antmont: I found that my son who takes taekwondo has learned to be more responsible for his actions. He has become a leader among his friends. I and my son worked on getting a car to work and he earned his money to pay for his insurance and car repairs, and then I let him get his driving license. He is a good and responsible driver.

Dr. Graham: I love to hear success stories. ADD kids are creative, bright, exciting and fun.

Dr. Benninger: I have found tae kwon do to be excellent for ADHD teens especially with a good instructor, even if I can't spell it!

Nadine: My son is 5 and his teacher thinks he has Attention Deficit Disorder. I was told a year ago that he was bright, gifted. Now he fidgets in class, interrupts, daydreams, he is totally unfocused, shifts from one uncompleted task to another, appears not to be listening to what is being said, has difficulty playing quietly. However, he is not hyperactive. What is your opinion?

Dr. Benninger: He could be ADHD, the inattentive type.

Dr. Graham: Yes Nadine, it may be that your son has ADHD primarily inattentive type. It may be worthwhile to get an evaluation to help determine if what you are seeing is ADD or something else.

Dr. Benninger: but you need to find a psychologist that specializes in ADHD for a evaluation. If medication is in the picture, this could be affecting things as well.

sms: A 15-year-old 9th grader wants to stay up late on school nights (11, 12, 1am+), and doesn't get up in the morning without big conflict. Then he gets to school just in time or late. Organization is an issue anyway, and it is being stressed further by this pattern. "Experts" suggest that we allow him the freedom of running more of his own life in this regard, and letting external sanctions shape his behavior (like feeling tired, and school detention for being late). We tested for 5 weeks, while this makes Mom nuts.

Dr. Graham: Dear sms, by letting your child have freedom that he is not capable of managing, you are setting up a disaster. True, only he controls his actions, but you can set up a series of incentives that can reward earlier bedtimes and more cooperative mornings.

Dr. Benninger: Natural consequences are not always the best if they create long term problems of their own.

teresat: What type of rewards would you suggest?

Dr. Benninger: Ask your teenager - they can help you set up a menu. And since ADHD teens shift their desires it will have to be flexible and fluid.

Dr. Graham: Rewards? $$$$, use of the car, anything that you truly have control over and your child wants.

David: I want to ask about that. Is money really an appropriate incentive for good behavior?

Dr. Benninger: Absolutely - if it is motivating.

Dr. Graham: I think so. Some people fear we are bribing our kids. But we work for pay. We get paid for what we do. Why not use it for kids if it is motivating.

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David: Here's an audience comment on that subject:

sms: Our fear is that he will never develop his own healthy self-control if we manage his life for him. For these issues, rewards didn't help for long (2 or 3 days).

Noele: If it works don't fix it with money, bribes are bribes, but not with the ADHD child.

Dr. Benninger: Bribing is incentives for illegal - undesirable behavior.

Dr. Graham: An ADHD child is externally motivated. If you wait for your child to develop internal motivation, you may be asking something that they are not capable of.

Dr. Benninger: Alan is exactly right. The nature of ADHD limits the amount of self-control that will be developed. You have to strike a balance.

Sunshine777: Dr. Benninger, I have a 16, soon to be 17 yr old who is having a very rough year in high school. Now he says he can't take the stress of being on campus and doesn't want to go to school anymore and doesn't care about not finishing school or graduating. Right now we just want him to finish the year with the credits and there are no incentives that he sees that are worth him going back to school. In fact, I have an IEP (Individualized Education Plan) meeting tomorrow to see if we will be allowed to do homeschooling. He is ADHD/ODDOCD.

Dr. Benninger: It really sounds like you have your hands full Sunshine - he may feel differently after a summer break and some adjustments in his schedule. But what about next year?

But this is a difficult problem for many parents with this complicated set of diagnoses. Homeschooling is okay but he misses the important socialization.

Dr. Graham: On the other hand, homeschooling may get him through the year as there are only a few weeks or days left.

David: Meanwhile, what would you suggest for Sunshine since she has an IEP meeting in the morning? What should she say at the meeting or ask for?

Dr. Benninger: At the IEP meeting - ask the school what they see as most enjoyable/motivating for him. Come up with as many positive programs/ideas as you can - a shortened school day may also be an option.

Dr. Graham: Ask for homeschooling for the remainder of the year and explore a smaller teacher-student ratio and less stressful atmosphere for next year.

David: Here are a couple of audience suggestions too, Sunshine:

antmont: Sunshine777, IEP may not be addressing all needs. Look for new evaluations and then seek out programs outside of school program. Another school may work. You have a right to look for other placements and the school district pays.

LisaHe: My son goes to a technical school and he is doing very well, I don't think college is for all children, it can just lower their self esteem and create chaos as to their goals in life.

Dr. Benninger: Good suggestions.

Noele: I think that she should ask the IEP team to ask for a summer evaluation to see if maybe they miss something in the diagnoses, as well as set up a proper set of so-called rules, realistic to her child's needs for the upcoming year. Ask that it be reviewed as early as 2 months into the school year and so on, or maybe extended school year. Just my thoughts.

jujubon: Could perhaps a mentorship in an area of his interests motivate him?

Noele: Dr. Graham, have you found that a lot of teens find that they have been treated for ADHD or ODD and then discover that they, in fact, had bipolar in addition, or instead of?

Dr. Graham: Noele, that occasionally occurs. Bipolar disorder is an inability to self regulate emotions which leads to a gyrating emotional roller coaster. It is very difficult to diagnose in children and teens.

Dr. Benninger: This is an emerging area, and one worth careful evaluation with someone who knows how to diagnose both disorders.

David: For the audience, here are the links to the HealthyPlace.com ADD-ADHD Community, and Bipolar Community. You can click on these links and sign up for the mailing lists at the top of the pages so you can keep up with events like this.

One of the sites in the ADD Community, for those of you concerned about school issues, is "The Parent Advocate". Judy Bonnell is the site master, who has a lot of experience in dealing with school-related issues, and she shares a lot of her knowledge on her site.

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LisaHe: Why has no one mentioned their self-esteem? When a child is proud of what he can do, and not focus on what he can't do, can make all the difference, can't it? And shouldn't you use those strengths that they have to build up their self-esteem, and concentrate on them?

teresat: LisaHe, exactly what I was thinking.

Dr. Graham: LisaHe, you are exactly right. We want to catch our kids being good. Work at finding the good and build on them.

Dr. Benninger: Self-esteem is very critical in the big picture - on our web site under newsletters - there is an old newsletter with the content called "The Game" read it, it can help.

David: Here are a few audience comments:

Noele:The Bipolar Child: The Definitive and Reassuring Guide to Childhood's Most Misunderstood Disorder, by Dimitri and Janice Papolos is a fascinating book!

jujubon: That is how community-based mentorships can help children with ADD and low self-esteem. They can even get credit for it.

LisaHe: Mood stabilizers have helped my child a great deal.

Gailstorm: I also have a son who is failing out of school but is very smart. He's being evaluated next week again.

LisaHe: I think waiting an extra year to drive sounds more like a punishment, why not be prepared for this a year ahead of time.

Dr. Benninger: LisaHe, sometimes you can't rush the maturation process - or the ADHD problem symptoms. Remember the 30% age rule? Disappointing to ADHD teens, yes, but safety is very important.

teresat: Can you explain more on the difference between attention deficit disorder and a learning disability? What is the specific difference?

Dr. Graham: Teresa, a learning disability is a discrepancy between a child's intellectual capability and achievement. This is caused by significant variability in processing either auditory or visual information. ADD is an impairment of behavioral inhibition. These kids may score high on achievement tests because they are learning but they fail in school because they are not producing.

David: Here again is Drs. Benninger and Graham's website address: www.ADDvisor.com.

Dr. Benninger: You can see our pictures - we are both very handsome.

Dr. Graham: Oh Bill, you are so modest.

Dr. Benninger: And for what it's worth, we are both parents of teenagers.

David: Also, for those of you interested in Bipolar in children, we had an excellent conference with Trudy Carlson.

Here's verification from one of our audience members:

Gailstorm: Went to the website, yep they're right: 2 very handsome gents ;-)

Dr. Graham: Aw shucks, Gail.

Noele: I want to thank you both, Dr. Benninger and Dr. Graham for all of your wisdom. I'm a parent with 3 kids. As mentioned above, want to beg the medical community to see if there is more children with Bipolar than meets the eye. I have two of the 3 with ADHD and Bipolar, and one just Attention Deficit Hyperactivity Disorder. It's imperative that we diagnose these kids earlier for their sake and ours, as parents. These kids often have both disorders. Please help me in my mission of knowledge on this!

Dr. Benninger: I agree Noele - but it's an emerging field with still lots to learn.

David: It's getting late. We'll call it a night. I appreciate our guests coming tonight and sharing their expertise with us. And for those of you in the audience, thank you for participating. I hope you found it helpful.

Dr. Benninger: Thanks for having us!!!!

Dr. Graham: Goodnight.

David: Good night everyone.

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