Attention deficit hyperactivity disorder (ADHD) is a fairly common mental health concern among children and teenagers today. It is readily treated by medications, psychotherapy, or a combination of the two. Here are some commonly asked questions teens have about ADHD, and their answers.

Q: What is ADD?

A: ADD stands for “attention deficit disorder.” It is a neurological syndrome characterized by distractibility, impulsivity, and restlessness. “Neurological” means having to do with the brain and nervous system. ADD is a label for how the brain and nervous system of people with ADD works. People with ADD tend to think quickly and creatively. They are usually smart, intuitive, and full of new ideas and plans. They like to try out new things and they like to have fun. Sometimes they procrastinate, have trouble staying on task, completing projects, or following through on ideas. Sometimes they are hot-tempered, tactless, or loud. Sometimes they underachieve in school or unintentionally disrupt social occasions. All these problems relate to their brain having trouble focusing attention and regulating impulses. The problems do not relate to their being lazy, stubborn, stupid, or subversive. In other words, ADD is not their fault; it is just how their brains are wired. Furthermore, there is nothing wrong with having ADD. A lot of great people in history have had ADD, like Benjamin Franklin and Thomas Edison, and many highly successful adults have ADD.

For a young person to have the best chances of success in dealing with ADD, the trick is to get the diagnosis and treatment as soon as possible. It is never too late to treat ADD, however. And with treatment the negative aspects of ADD can usually be contained. This allows the many positive aspects to really flourish. There is no limit to the amount of success an individual with ADD can achieve.

Q: How can I believe this diagnosis is real and not just another way to try to get me to do what my parents want?

A: Look at the scientific evidence. Satisfy yourself. Question your doctor as to how you were diagnosed. Pin him or her down aggressively. Say that you are worried this is all a put-up job. The only way the treatment will ever work is for you to get behind it, and you will never get behind it if you think you are being duped.

Q: I don’t like having to rely on a drug to do my homework. It just doesn’t seem right. Either I can do the work, or I can’t. But to take a pill for it? It almost seems like cheating.

A: Does wearing eyeglasses seem like cheating? There’s really no difference except that in one case you swallow a pill and in the other you wear eyeglasses. Does taking a vitamin seem like cheating? All a vitamin does is replace a chemical that is missing or deficient; that’s exactly what the medication for ADD does.

Q: Some days I take the medicine and feel fine about it. Other days I just want to do it on my own. Problem is, that’s when I screw up. Any advice?

A: Keep taking the medicine as long as it works. Talk with your doctor and your parents about these feelings you have of wanting to do it on your own, but don’t stop the medicine because of them. Don’t feel alone. Most young people feel as you do, especially young men. It becomes an issue of self-reliance. What you have to understand is that you are still doing the work, not the medicine. The medicine won’t read the book for you or write the paper, anymore than another person’s eyeglasses will. The medicine simply makes it possible for you to read the book or write the paper as well as you can. It evens the playing field.

Q: How do you know the medicine isn’t dangerous?

A: Because medical research has given us much information about it, if you’re referring to Ritalin, which is the most common medicine used to treat ADD. But don’t just take my word for it. Ritalin has been studied by hundreds of scientists over decades. It is one of the most thoroughly studied medications we use. What side effects there are&emdash;agitation, appetite suppression, sleep loss&emdash;are easily controlled most of the time. The most annoying side effect is that Ritalin wears off in a few hours, and so you have to remember to take another. Of ominous side effects, growth suppression is probably the worst, and this is reversible by stopping the medicine. It is also very rare. On the whole, Ritalin is an extremely safe, well-investigated medication. Of course, it, like all prescription drugs, should be used only under a doctor’s supervision.

Q: Does the medicine interfere with sex?

A: Stimulant medication can make getting an erection moreƝdifficult. For females, there is no interference. If you plan to have sex, you may plan not to take your medication that evening. The other medications used may, but usually do not, interfere with sexual function. If you have any problem in this sensitive domain, be sure to talk it over with your doctor. If you feel too embarrassed to bring it up, perhaps one of your parents could broach the subject with your doctor for you. Above all, do not rely on rumor and hearsay. There is a lot of damaging misinformation out there about what these medications can do to you. The misinformation I have heard would almost be funny if it weren’t that some kids believe it. So, get professional, informed advice, then make up your own mind.

Q: Should I tell my friends I have ADD or keep it a secret?

A: That is entirely up to you. It is your business. However, my advice is to be open about it if you can. There is nothing to be ashamed of. I myself have announced on national television that I have ADD, and no one has given me a hard time about it.Believe it or not, the biggest barrier is your own feelings, not other people’s. Once you feel OK about having ADD (or any sort of learning disorder), you will find it much easier to tell others. So what’s the big deal? So you have ADD? So what? So did Thomas Edison and Benjamin Franklin. So does Dustin Hoffman. John Irving has various severe learning disabilities. Not bad company. There is nothing to be ashamed of. Keeping it secret only perpetuates a feeling of shame within yourself.

Q: Any advice on how to deal with the fact that I feel like a reject because I have ADD?

A: Remember the good side of ADD. Keep in mind the pluses. High energy, creativity, warmth, openness, spontaneity, intuitiveness, resilience, persistence, and a good sense of humor are some of the positive qualities often associated with ADD. Keep those in mind, because you need them.The biggest negative that goes with ADD is not the ADD itself but the negative thoughts that churn up in the wake of it. The ADD symptoms themselves&emdash;distractibility, impulsivity, restlessness, and so on&emdash;can be dealt with. But negative thinking defeats you. Sometimes you probably get into a mood when you think one bad thought after another about yourself. You sit there hammering away at yourself, for minutes and hours, until you practically have to be pulled up off the floor, you feel so bad.

Don’t do this. The moment you feel one of those moods coming on, take action. Go for a run. Call a friend. Do something to get you out of the negative cycle before it gets you into its clutches and you can’t escape.

It’s good if you have a coach, too. Someone you can talk to. Someone who can help pull you out of the bad thoughts and get you back on track. It is hard to do this alone. A coach or a therapist or a friend can really help.

Q: How long am I going to have ADD? (I’m sixteen now, and I’ve had ADD since I was in the first grade.)

A: You’ll probably have it for the rest of your life, if you have it now. Kids who are going to grow out of it do so before they reach your age, usually. But that is not such a bad thing. Sure, you may need to take medication indefinitely, but once you get used to that, it’s OK. And many kids learn certain techniques or tricks while on the medication that carry over to when they’re not taking it. If this is the case for you, then you’ll be able to stop taking the medication.The nonmedication approaches to treatment last longer than medication anyway. Practice these (they’re outlined in chapter 7, “Making Up Your Mind”). In the course of a lifetime, ADD need not be disabling; indeed, it can be a definite benefit.

Q: Can I take the medicine just once in a while?

A: In general, it is best to take the medication regularly. On the other hand, it may be that your target symptoms appear irregularly. If that is the case, you may need the medicine only intermittently. This is OK. There is no danger or harm in taking the medication on an intermittent basis. The reason I say it is better to take it regularly is that, for most people, the symptoms are present most of the time. Therefore, by taking the medication on a regular schedule they get maximum benefit, and they also get into a dosing routine that decreases the likelihood of their forgetting a dose.

Q: I just read Brave New World. In that book there’s this drug everyone takes to keep them happy called soma. The government basically uses it to keep the people quiet. That made me nervous because I just started on Ritalin for ADD. How do I know Ritalin isn’t like soma?

A: Just ask yourself. Does your Ritalin make you serene and happy, as soma does in Brave New World, oblivious to the problems around you? If it does, you should stop taking it right away. I doubt, however, that you find Ritalin does that, because Ritalin is not a medicine that induces oblivious or “happy” feelings. All Ritalin should do is help you focus better. That means you can focus on problems better, as well as on pleasant topics.

Q: What is the best way to deal with my mom, who is constantly reminding me about everything, as if I had brain damage instead of ADD?

A: Ask her to back off. Explain to her that you think you can handle the details of everyday life on your own. Tell her you want to set it up as an experiment. If the experiment works, and you handle things successfully, then she will stay backed off. However, if you start dropping the ball, then she will have your permission to reinvolve herself. If you would like someone’s help with daily details, just not your mom’s, then talk over with her the possibility of another person’s getting involved. Tell her, “No offense, Mom. I love you, but you push my buttons when you remind me to do things, and it makes me not want to do them.” I think she’ll understand; she probably felt that way once about her mom as well.

Q: Ever since I got the diagnosis of ADD, I have this feeling in my gut I’ll never be successful. My mom and dad tell me it doesn’t matter, but they used to tell my brother it didn’t matter he had zits, and I knew it did. Tell me the truth. Just how bad is ADD?

A: It all depends. How bad is it to be nearsighted? If you never get treatment for your nearsightedness, it can be really bad to be nearsighted. You could flunk out of school because of it. Same thing with ADD. If you don’t know you have it, it can cripple you. But if you do know, as you do, it can actually prove to be an asset. First of all, you have to get treatment to take care of the bad aspects of ADD&emdash;the distractibility, the impulsivity, the restlessness, the forgetfulness, the procrastination, the disorganization, and the mood problems. Once you get a handle on these, you can start benefiting from the positive&emdash;the high energy, the creativity, the openheartedness, the resilience, the willingness to work hard, and the ingenuity. Not only can you be a success, you can be a great success. Many highly successful people have ADD. I have treated multimillionaire businesspeople, professional athletes, actors and actresses, doctors, lawyers, university professors, authors, real estate developers, racecar drivers, airline pilots, and many others.

Q: I’m really burned out from school, and I feel I need time off to recharge my batteries. I feel guilty, though, that I’m taking the easy way out. What do you think?

A: There is a difference between taking the easy way out and finding the right way in. If you are going nowhere in school, it may make a great deal of sense for you to take time off.I have treated a large number of high-school and college students who came to me feeling the same way you do. Some of them wanted to leave school. I did not think it was a good idea for all of them to do so. Some of them needed a little encouragement and some redirection to get more out of school.

However, some of them really needed a break. They were lost where they were. They were not keeping up, they were getting more and more depressed, their self-esteem was plummeting, and I was worried they were at risk for more intense depression, or substance abuse, or simply a miserable educational experience.

By leaving school these young people were able to step back and regroup. I was able to set up a thorough neuropsychological evaluation for them, so that we knew exactly what we were dealing with from that standpoint. They were able to sit and talk with me for a while without the pressure of school impinging upon them, so we could begin to sort out what was going on in their emotional lives. I urged them all to get jobs, which they did. This gave them a regular daily activity that brought them both income and the satisfaction of doing work. Some of them found interesting jobs, and some of them found menial jobs, but they all reported they were happier having a job than not. I also required that they pay for a fraction of my bill, rather than letting their parents carry it all. I required they pay a sizable enough fraction that they approached our sessions seriously, wanting to get their money’s worth.

Some also worked on an academic program set up through their school or college in preparation for returning. This was not pressured&emdash;just a short reading list or one session a week with a tutor&emdash;but it was enough to keep their scholastic hand in, so to speak.

Others took trips. Some were vacations, some were unstructured roaming, some were adventures, some were work-related, but all were liberating. These kids needed to stretch their wings and fly. They needed to be free for a while.

For most, the time away from school was about one academic year. Typically, they left school in October or November and returned the following September. Some planned the year off in advance, so they left from June of one year to September of the next. But most had not planned to take a year off. When they arrived in my office exhausted and burned out, as you describe, we decided then that a leave of absence made sense.

These young people returned to school in much better shape than they had left. Some had ADD; some did not. Of those that had ADD, we were able to get treatment stabilized during the year away and set up a good coaching relationship with a person at their school so the next year could be more productive.

A year away from school that is wasted makes no sense. But if the time is wisely spent, under some guidance, it makes all the sense in the world. In fact, it takes courage to leave your friends and leave the mainstream and go off on a program of your own design. It takes courage and creativity. In a subtle way you increase your visibility in your family and your community because you are doing things differently, and this always causes people to look twice. With increased visibility comes increased accountability. So this is no easy way out.

Instead, it can be the right way in. You may need a year to learn about yourself, your learning style, your emotional life, and your long-term goals. You may need some perspective on school. By leaving for a while, you may return in much better shape to make the best use of your time in school.

Q: The shrink I see makes me pay for part of my sessions even though my parents would be willing to pay the whole bill. Why does he do that?

A: I alluded to your question in my previous answer. It makes sense for you to pay as much as you can because you are the one using the services. If you pay, there is a natural human tendency to take the services more seriously, no matter what they are. If your parents pay, you can just show up and pass the time. But if you pay, you’ll be more likely to go into your therapist’s office with an attitude of “I want my money’s worth.” That’s good. It makes for better therapy.Sometimes young people don’t know that there is a fee associated with therapy. I remember a twelve-year-old I was seeing eight or nine years ago. Let’s call him Tommy. One day Tommy said to me, “Does it cost money for me to come here?”

“Yes, it does,” I replied.

“How much?” he asked.

“Seventy-five dollars,” I replied. I’ll never forget his response to that.

“Wow!” Tommy said, wide-eyed. “I could buy two skateboards for that much money.”

Tommy would be shocked to know that my fee has risen to $125 per session today. But so has the price of skateboards, so it is still probably about a two-skateboard transaction.

I urge all my patients to share Tommy’s reaction. For an adult, one session amounts maybe to their monthly telephone bill or the cost of an evening out. For an adolescent, it’s a dozen CD’s or four rock concert tickets. For Tommy, as I’ll always remember, it’s two skateboards. Whatever your age, if you consider the money that is going to your therapist and then imagine where else you could spend it, that will help induce you to make as much of the sessions as you can. Particularly if you have to work to earn the money, and you then have to part with the money for something as apparently trivial as talking to a therapist, you will try very hard to make that therapist work to earn his money. That is good.

Q: I want to join the Navy Seals, but I can’t continue to take Ritalin in the military. Do you think I would still have a chance of success without medication?

A: Absolutely, yes. It may be more difficult without medication, especially at first, but would you have a chance? Yes, indeed. There are many tips on the nonmedication treatment of ADD outlined in this book. See which ones seem relevant to you, then try to follow them. Work closely with someone who understands ADD before you join the Navy, so when you go in, you will be ready.

Q: Why do teachers sometimes think you’re not paying attention if you ask a question about something they just finished explaining and you don’t understand it?

A: Because they cannot imagine that their explanation wasn’t clear. If you were paying attention, say so, then add, “I just don’t understand. Would you explain it again, please?” It is important that you let the teacher know that you want to understand. Otherwise the teacher may assume that you don’t care. This is a big trap lots of students with ADD fall into. Stay out of that trap by telling your teacher you do want to understand. Don’t assume that is obvious, because sometimes it isn’t.

Q: I am a high-school sophomore with ADD without hyperactivity. My history teacher doesn’t believe in ADD and tells the whole class that I am fat and lazy. How can I convince him that ADD exists and that it affects my performance?

Answers to DistractionA: Maybe you can’t. If this teacher is so backward that he openly insults his students, as you describe, then he may be one of those teachers you simply have to work around.

But before you do anything else, talk to him one-on-one. Give yourselves the chance to solve the problem simply and directly. You’d be amazed how many year-long struggles with a teacher could have been avoided with a direct conversation early in the year. So ask your teacher for an appointment. Don’t talk to him on the fly, between classes. Get an appointment, just the two of you. Tell him you want to work with him, not against him. Tell him you feel hurt when he calls you fat and lazy. Tell him you’ve been diagnosed with ADD and you’d be happy to have your parents and/or a professional meet with him to explain the diagnosis. Be open, honest, and straightforward.

If he does not respond favorably to that, then I would suggest the following. First of all, make sure someone in authority knows what this teacher is saying to you. I’m sure you do not want to “tell on” your teacher; on the other hand, the people in charge can’t control this person’s behavior unless they know it is going on. Perhaps your parents could intervene.

Second, try to change teachers. Again, your parents will need to help. Unless there is no other teacher available, I think you have clear grounds to change teachers.

Third, get together with your parents and a school consultant or other professional to put together a plan for dealing with this person if you are stuck with him. Your parents may need to be quite aggressive in dealing with the school. You are protected under various statutes and laws. The school knows this. Your parents need to make sure the school knows that you and your parents know this. If your teacher wants to play hardball, you and your parents need to put together a team that is ready to take on the teacher&emdash;and the school.

I learned a valuable lesson about this kind of situation when I was working with psychotically violent patients at the Massachusetts Mental Health Center in Boston. When a patient got really crazy and violent, the best way for us to intervene was to surround him with a team of large young men. If we did that, rarely did we have to rush the patient and tackle him. Rarely did anyone get hurt. The patient quieted down at the sight of a force he knew could contain him. The key was in preparation, in quickly gathering the needed resources, in this case at least four large young men.

In your case, you need to put together a team that can bring this teacher under control. For him to be denying your diagnosis and calling you fat and lazy is the teacher’s equivalent of psychosis. This teacher needs to be brought under control. The school should help you and your parents do this. If the school refuses, put together a team that can contain the teacher and the school.

You cannot do this by yourself. Don’t try. It is good for you&emdash;and other students with ADD&emdash;to be able to act as your own advocate, but you must know your limits. In an extreme situation like this, you need the help of people in authority.

Before the confrontations begin, though, try to work it out one-on-one, if you can.



Reprinted with permission from the book, Answers to Distraction by Edward M. Hallowell, M.D. and John J. Ratey, M.D.