Pens clicking. Chairs shifting. A neighbor twirling hair.
These distractions dominated Grace Friedman's mind every time she sat down to take a test. Even on her attention deficit hyperactivity disorder medication, the Alameda High School senior had trouble concentrating and keeping up.
"When my peers turned in their work, I was still struggling to finish," says Friedman, 17. "Right away, I would get a rush of anxiety, start to panic and not be able to control my emotions."
Being a teenager is hard enough. But for those diagnosed with ADHD -- a chronic medical, neurodevelopmental and psychosocial condition -- managing the academic and social rigors of high school can be extra challenging. Pills help with focus and impulsivity, but many teens still need to learn the social, organizational and time management strategies to be successful. Particularly challenging for adolescents are the kinds of issues any teenager faces with drives, boundaries and risk-taking behavior, explains Brad Berman, a developmental and behavioral pediatrician in Oakland and Walnut Creek.
"For youth with ADHD who are also impulsive," Berman says, "this may mean greater and potentially more unhealthy risk-taking behavior."
According to Ronald Mah, a San Leandro marriage and family therapist who works with ADHD teens, the medications help take his clients "off the edge," but they still have to start the process of figuring out who they are and what they need to make the long-term lifestyle change.
"That's why teens need to learn how to problem-solve, how to think before they speak or act and develop an internal sense of routine," he says.
Berman says the best treatment needs to be individualized for each adolescent and in addition to medication often includes academic and time-management skills coaching. Many youths also benefit from individual or group therapy. While some schools offer academic assistance and some insurance companies cover limited therapy, all experts interviewed for this story say teens and parents must be vigilant in seeking out the support needed to thrive.
"Most of these kids get 10 minutes in the pediatrician's office to get treated," says national ADHD expert Stephen Hinshaw, who co-authored "The ADHD Explosion: Myths, Medication, Money, and Today's Push for Performance" and is a psychologist in the UC San Francisco psychiatry department. "It's a quick and dirty diagnosis, and most pediatricians aren't well-trained in behavioral disorders. So, you've got to find out what's going on at school. You've got to pound the pavement. Find out who the experts are in your community."
Friedman did that -- and more. She took psychology classes, attended scientific lectures and over a period of two years interviewed more than a dozen other teenagers about their experiences with ADHD. Her research culminated in "Embracing Your ADHD," a free, no-nonsense guide for teens available at www.addyteen.com.
"I realized that the medication wasn't going to help me learn about my condition," she explains. "So I didn't know how I was supposed to help myself. I had to learn what ADHD was and then learn time-management skills. I had to learn how to manage relationships with teachers and how to avoid emotional breakdowns and giving up."
Her tips include everything from advocating for a quiet environment and extra time to take tests to bridging the emotional gap between frustrated "addy" teens and their concerned parents.
In one chapter, Friedman talks about how teens with ADHD have a hard time voicing their emotions and offers anxiety-reducing tips. "They're just so frustrated, they don't know how to tell parents what they need when they ask," she says. "But, when I walk around the block and take some deep breaths, I am able to think about the fact that I am having trouble (and need help) with my science homework."
It's important for parents to understand what's going on with their child as well. For A. Thompson, whose 16-year-old takes medication for anxiety and depression in addition to ADHD, managing her daughter's emotional health has been critical to managing the ADHD.
To get that support, Thompson, who asked to omit her first name to protect her privacy, intentionally enrolled her daughter in small, private schools where she could benefit from small group instruction.
"When she started on the Ritalin, it was as if she could learn with all of her brain power," Thompson says. "But she was also taught the coping and self-management skills to deal with her own inner geography, to keep a datebook with assignments and due dates, to ask for help."
With help from a learning specialist, Thompson's daughter received these accommodations: twice normal time on tests, "scaffolded" information, where she is told on Friday what to expect on Monday and approval for an auditory learning program that allows her to download required books for free on her iPad.
"We have had to work with virtually every teacher she has had to tell them what she needs to be successful," Thompson says. "This is the first year that we didn't do that. In some classes, it was OK, and in others, we had to go back and pick up the pieces."
The Learning Center at Campolindo High School kept Tessa Cummings from giving up. Cummings, 19, of Moraga, was placed in the special education program immediately after diagnosis and medical treatment.
She was designated one instructor who worked with all of Cummings' other teachers to develop an Individualized Education Program (IEP) with appropriate accommodations, like preferential seating in large classrooms. She often had tests and assignments read to her to avoid distraction.
"The high school and my parents did everything under the sun to help me get through high school," says Cummings, who is now an agricultural business major at Chico State University. "I really don't think I would've been able to do it just on the medication."
Despite the challenges, having ADHD has had its rewards, Cummings says.
"It's given me a strong work ethic," she says. "I know I have to work harder than some other kids do. I know how to put my mind to something and get it done, no matter how long it takes. Sometimes I push myself a lot harder than I should. But it's good, because I always thought I wasn't smart enough or good enough."
Grace Friedman, 17, of Alameda wrote "Embracing Your ADHD" to offer teen-friendly, practical advice about thriving in high school and beyond, free guide available at www.addyteen.com. Some of her tips:
-- Jessica Yadegaran