Parenting Teens with ADHD

Our first family makeover addresses many of the familiar challenges that come with parenting our teenagers. Through this particular family we will look at issues such as: parenting effectively through divorce and remarriage, how to determine whether your child has an issue requiring medication, such as ADHD or whether your child simply has behavior issues requiring a shift in parenting- like setting up critical boundaries that pre- teens need to be healthy and confident.

In my first meeting with Jackie and Joe, we began to discuss the challenges these two divorced parents were facing with their daughter…

THE FIRST VISIT

Jackie: Dr. Meeker, we’re here because we have concerns about our daughter, Sophie. She is 11 years old and is difficult to handle. She never listens to me, but she will listen to her dad. We are divorced, but live close to one another so we share custody pretty equally. I (Jackie) have a boyfriend who lives with us and her Dad (Joe) is remarried and has three stepsons who live with him and his new wife. So, when Sophie is at my house, she is with only my boyfriend and I, but when she is with Joe, she lives life in a busy houseful of people.

Dr. Meeker: What, specifically, are your concerns about Sophie?

Joe (Dad): Well, her family doctor told us a few weeks ago that he feels that she has ADHD and gave us prescription medication for her to take. We don’t know if we should use it or not and would like a second opinion.

Dr. Meeker: What lead your doctor to give her the prescription?

Jackie: Sophie’s teacher told us that she was leaving the classroom frequently, that she is distracted and talks too much in class. Another teacher said the same thing, so we brought her to see the doctor.

Dr. Meeker: Did he suggest any testing or have you fill out any forms?

Joe: No, the doctor talked with Sophie and told us to try this medication.

Dr. Meeker: So have you tried it?

Jackie: No, that’s why we’re here, we want a second opinion, first.

Over the course of the first hour I spoke with Sophie about her life. I learned that her grades were very good and that she only wanted to leave class because, according to her, she” just got bored.” She also went often to the school counselor and cried. She didn’t really know what she was crying about.

I asked Sophie what she did at home. She explained to me that she watched television at her mom’s and spent time hanging out with her mom’s boyfriend. She said she liked him “OK.” She liked being at her father’s because there was more to do. She said that her dad was a lot stricter than mom, but that was “okay” too. She told me that sometimes she would talk back to her mother, but never with her father because she knew that he would ground her.

Sophie was cheerful, bubbly and a little bit scattered. She spoke equally to her mother and her father. She liked school, but liked lunch, recess and her friends the most. She had trouble with math, but reading and other subjects were fairly easy.

At the end of the visit, I gave Sophie’s mother and father five forms called “Vanderbilt forms” that I wanted them to complete. Three were to be filled out by her teachers and the other two completed by each parent. I wanted them to send these evaluations back to me before their next visit. I asked them to hold off giving Sophie the medication and to return to my office in two weeks.

THE SECOND VISIT

Before Sophie and her parents returned, I scored the forms that they had completed and sent in to me. The teacher evaluations were highly suspicious of ADHD, primarily attention issues and the parents’ forms showed something different. They showed less attention issues and more behavioral issues such as defiance.

Dr. Meeker: I scored the tests that you gave me and Sophie does appear to have some attention issues according to the teacher forms. At home, however, there seems to be a different story. Tell me, Jackie, what is Sophie like when you are together?

Jackie- Well, I think that for an 11 year old, she gets pretty mouthy.

Dr. Meeker: What does she say to you?

Jackie: She’s very disrespectful, makes faces at me like I’m stupid and sometimes she says that I’m a bad mother and tells me to shut-up.

Dr. Meeker: What do you do when she does that?

Jackie: I take her phone away.

Joe: You mean you take it away for an hour and then give it back to her. She doesn’t listen to you because she knows she doesn’t have to.

Jackie: That’s not true! I’m very strict.

Dr. Meeker: Sophie, do you get mouthy with your mother?

Sophie: Yeah, sometimes.

Dr. Meeker: What happens when to you when you aren’t nice?

Sophie: Mom’s right. She takes my phone away. But Dad’s right too. He’s much stricter. I can kinda do whatever I want at Mom’s.

Dr. Meeker: Joe, let me ask you, do you see behavior problems at your house?

Joe: No, not really. But she does something that drives me crazy. She follows me around wherever I go. I have a short fuse and I have ADHD and I don’t have any patience for this.

Dr. Meeker: So, let me ask you both, does Sophie follow through with her chores at home?

Joe: Oh yeah, She’s good about chores at my house.

Jackie: No! I have to tell her over and over to do something. She never listens to me. I can’t get her to get to school on time. She can’t wake herself up. All I do is yell at her in the morning to get ready. If I didn’t, she’d miss school.

Joe: Hmm. She wakes herself up at my house. Maybe that’s because the boys get up.

Dr. Meeker: I want the two of you to sit down and talk about consequences for very specific behaviors. You must agree on a few ground rules here, because if one of you allows her to have her phone whenever she wants and the other won’t, she’ll learn to play one of you against the other. You have to get on the same page. Try implementing a few of the same rules and sticking with them. Don’t let her tell you that she will go to Mom’s because she gets her phone there. Jackie, you need to honor what Joe’s trying to do too. If not, it’s very confusing for Sophie.

Joe: But, we each have things that we want her to do and they aren’t the same.

Dr. Meeker: Here’s what I want you to do. Each of you needs to write down four things that are very important to you to have Sophie learn or follow. For instance, Joe, you want her to go to youth group on Wednesday nights and Jackie, you don’t care about that. Then, I want you to exchange the list. In the meantime, when you are at home, never criticize one another to Sophie, because this will make her not want to listen to either of you.

THE THIRD VISIT

Joe and Jackie returned one week later, this time, without Sophie. Each had a list of the top four important things that they wanted Sophie to follow. They were as far from one another as possible.

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Joe said that it was important for Sophie to:

Go to youth group Weds nights and to church on Sundays

Never speak badly to him or his wife

Wear clothes that were modest

Get good grades in school

Jackie said that it was important for Sophie to:

Act respectfully to Jackie’s boyfriend

Have a close relationship with her mother as she got older

Be allowed to wear what her mother thought was appropriate for a girl her age (this included make-up, nail polish and padded bras)

Be given freedom to make some of her own decisions about dating, going to friends homes for sleepovers

Clearly, there were two dramatically different parenting styles happening. No wonder Sophie was confused and having behavioral issues. She literally acted like one child at her father’s and another at her mother’s home. She would go to school with no makeup and modest clothes when she left her father’s and then when she left her mother’s home, she appeared like a different child. She wore padded bras, short skirts and makeup. Sophie was very confused and acting out in school.

Did she have ADHD or did she simply have behavior issues?

Dr. Meeker: It is very important that you honor one another’s requests when it comes to the things that are most important to you in parenting Sophie. I would like you each to discuss your top two priorities and then agree to honor those when your daughter is at each of your homes. Right now, I think she feels like two different people. Your rules are so different and this is extremely confusing to her. Neither of you is helping her reconcile who she is.

Jackie: We just disagree on so much. Dr. Meeker, can I ask you, what you would allow her to do if she were yours?

Dr. Meeker: Personally, I would never allow her to have a cell phone. If she has attention issues, this will make life much harder for her because it is a terrible distraction. So the phone would go. Furthermore, a child in Sophie’s situation is a high risk for getting into trouble because she likes attention. As she gets older, she will try and attract boys to get attention… and the wrong kind. I would start helping her learn to live differently from her friends right now so that she doesn’t always feel like she needs to “fit in.”

Second, I would insist that she speak respectfully to each parent. Period. If she didn’t, then both of you must let her know that under no circumstances will she get what she wants if she violates that rule.

Finally, Jackie, your boyfriend should move out. Statistically you are putting her at a higher risk of being abused because research shows that girls who live with their mother’s boyfriend are physically and sexually abused at much higher rates. I know you don’t want to hear this, but I have a responsibility to tell you.

Jackie: Dr. Meeker, you don’t understand, Mike is a great guy.

Dr. Meeker: I didn’t say he wasn’t. But for many reasons, it’s not healthy to have Sophie living with your boyfriend, whether you are there or not.

Jackie: Dr. Meeker. I gave Sophie three days’ worth of those pills. I thought that I was supposed to.

Dr. Meeker: Well, did you notice a change in her?

Jackie: Yes. She was like a different kid. She didn’t sass me, she did her chores and she was delightful to be around.

Dr. Meeker: Joe, did you notice any real change?

Joe: I had no idea she was on them! I thought that we were supposed to wait. I didn’t notice a difference in her at all. Jackie, did she take them at my house?

Jackie: Yes, I sent her with some and told her to take them.

Joe: Well, it’s no wonder you noticed a difference. She just likes attention and she likes the idea that she’s taking a pill!

Dr. Meeker: So here’s the deal. We have a child that may have some attention issues, but she’s doing well enough in school to get good grades. So, whatever way her ADHD is affecting her, she is able to compensate for it well enough to be academically successful… We know that she has behavior issues related to inconsistencies in the way you parent her. That is going to improve as the two of you begin to parent more on the same page. You don’t have to be the same people, but if you want Sophie to behave well, you must be consistent regarding some things.

Here’s our problem: Jackie, you say that Sophie behaves better on the medication. Joe, you say that she’s no different. So, we have two issues to resolve. First, do you medicate her for behavior? And second, is she behaving better because of the medication or it because she likes the attention she gets by taking the meds? Is there a placebo effect?

I want you to try an experiment. Give her the prescription medication for five days. Don’t tell her teachers. Each of you needs to watch her very closely during this time. Then, for five days, give her a vitamin instead of the prescription and see if you notice a difference in the way she behaves. Don’t let her know there is any difference.

THE FINAL VISIT

Joe and Jackie returned to my office (again without Sophie) a few weeks later and reported what they saw and to wrap up our work with their daughter.

Jackie: Dr. Meeker, honestly, I think I noticed a little difference between the pills. I will tell you that every morning, Sophie asked me for her pill. She said that school was going better and that she was going to the counselor’s office less.

Joe: I didn’t see any difference at all between the pills and, in fact, when she took the prescription medicine, I thought she acted sleepier. But, she did ask for the pills every morning. So, what do we do? Her mother wants to keep giving her the pills, but I don’t want to because I don’t think they help at all.

Dr. Meeker: Here’s what I think is going on. Does Sophie have some attention issues? Yes, probably. The question is: what do you do about them? Her grades are good and Jackie thinks the medication makes her nicer to be around. Maybe it does? But she could be having a placebo effect too.

We know that Sophie’s biggest issues stem from getting very mixed messages from the two of you. She knows what she can get away with at her mother’s and what she can get away with at her Dad’s. She’s smart and wants attention, so she does whatever she can to get it. She is confused and I do believe she is craving healthier attention and some serious boundaries. We know that she craves attention because she likes the fact that you are giving her pills. This tells her that you recognize that she needs help and you’re giving it to her.

Here’s what I recommend: Joe, you need to spend more one on one time with her. She may be getting lost at your house. You say that the stepbrothers act “perfectly” and she is jealous of this. So, you need to take her away from the house periodically and spend time with just her. Also, you need to be more respectful in the way you talk about her mother in Sophie’s presence. She hears you criticize her mother and she uses this against her mother.

Jackie, I recommend that you let her dress and act more like an 11 year old than a 15 year old. You want her to be close to you, but treating her like a teenager when she isn’t completely confuses her and it causes her to disrespect you. If you treat her like a girlfriend, she will treat you very inappropriately in return.

Finally, both of you need to honor one another’s top two priorities that you put on the list. You need to implement a schedule at home that has a consistent rhythm. She should have the same bedtime, same expectations for after-school activities, and similar chores. She needs to know what to expect each day. This will give her greater security and help her attention issues. The worst thing you can do for a child with attention issues is to have their routine change constantly.

As far as what to do about the medication? I wouldn’t give it to her. With some parenting changes, I believe that you can help her focus more and you can really help get her behavior under control.

FAMILY MAKEOVER CONCLUSION

Let’s review some of the issues that Joe and Jackie faced, how they resolved them, and what we can learn from them:

Co-parenting when neither parent liked one another. Clearly, Jackie and Joe didn’t particularly like one another, but the fact that they set their feelings aside and came in together to discuss issues with their daughter was enormously helpful to Sophie. It communicated to her that they were a team and this deflected any further manipulation Sophie tried (such as playing one parent against the other). Sophie also knew that eventually, the rules at each home would be the same because they were working together.

ADHD vs. Behavior issues. Both parents brought Sophie in because she was not paying attention at school and she was distracted at home. Was she impulsive and tearful at school and distracted and defiant at home because she had attention issues or because she simply wanted more attention? After much discussion and review of tests, we determined that Sophie did have attention issues, but these were not as severe as her behavioral issues. She wanted her mother to set boundaries at home and her mother learned to do this. She wanted more attention from her father and he began to provide this. Most important, she needed consistent rules between the two homes. Once her parents decided to cooperate and honor one another’s rules, Sophie settled down. She behaved much better at her mother’s home and at school.

To medicate or not medicate? While Sophie’s attitude improved when her mother gave her medicine, this was not a significant enough indication to validate the use of medication. Both parents decided to parent more cooperatively to curb these behaviors instead of giving her the medication. I agreed with them.

Different parenting styles. Both parents gave their daughter completely different messages regarding their expectations of her. This lead Sophie to become confused about who she thought she was. At her mother’s home, she was allowed to act more provocative and “grown-up,” wearing make up and clothes that many 17-year-old girls wore. At her father’s home, she went to church youth group and wore modest clothes. Getting mixed messages about parental expectations was confusing for her. This is common among parents, particularly divorced parents. By having each parent state their top priorities for their daughter then asking each parent to honor the other’s priorities, they not only parented better, but Sophie became less confused. Her father felt strongly that Sophie needed to act more age appropriate with her speech and dress and so her mother honored this. In return, her mother really wanted Sophie to have a cell phone so she could interact with her friends and her father honored this.

Ultimately, Sophie was the one who benefited from their cooperation. Finally, as we watched these parents work through their disagreements, I saw a clear difference in Sophie’s demeanor when she spoke to her parents in my office after they both set up firm, consistent and clear boundaries at their homes. Jackie confided after several months that she felt that she treated Sophie more like a sister than a daughter because she was lonely. She was afraid that if she enforced rules about how Sophie spoke to her or what Sophie could or couldn’t wear to school, that Sophie would want to leave and go live with her father. So, Jackie said, she just let Sophie have her way. Once she realized that her relationship with Sophie got better when she enforced rules, both of them became much happier.