Question: My son has ADHD and he has a lot of trouble with impulse control and with dealing with frustration. When he was little we taught him to hit a pillow when he was angry because this was better than having him smash things or hit people. Now he is 15 and he is 6 foot 2 and he is getting to a size that when he starts hitting pillows and yelling and cursing he is starting to scare people around that do not know him. He needs to learn a new way to handle frustration but he does not learn new things easily and he has a lot of trouble handling his impulses. I do not want to make him stop with something that works unless he can learn something better first. What should we do and is there someone that can help us with this?

Cynthia Klatte Says...:

Dear anonymous,

Impulse control problems are common struggles for adolescent boys with ADHD. ADHD is an inherited disorder that has been associated with lower activity in the front part of the brain, called the prefrontal cortex or PFC. Low activity in the PFC is associated with reduced impulse control (Rheba Estante, Attention Deficit Disorders Association). And the coping skill you taught him served him well as a child, but now that he is older and larger, he will be needing to learn additional skills to cope with feelings of anger and frustration. And yes, there is help out there for you and your son.

There are many types of treatment for ADHD and treatment is usually multimodal, or consisting of a combination of types of assistance. Treatment can include stimulant medication, specialized educational programs or supports, coaching for parents in the use of behavior modification and management techniques, and education and counseling for the adolescent in ways to manage the symptoms. There are also many other types of treatment that have been used that are alternatives to traditional treatment.

A good resource for families is the National Resource Center on ADHD at http://www.help4adhd.org. Here you can find helpful information regarding ADHD diagnosis, treatment, issues for parents, educational issues, and more. You can consult with the center online or by phone at 800-233-4050 to get connected with help for your son.

In terms of your concern about him stopping using his coping skill before learning a new one, he will likely need to use the tools he has until he can be taught others, but perhaps he can use that skill in a more private way to not frighten others who don't understand. By pairing it with the skill of walking away, he can go somewhere private to hit a pillow or other safe target. In addition, getting him involved with sports or some form of physical activity can help give him a healthy outlet for feelings of anger and frustration.

You and your son don't need to go through this alone. There are a lot of resources out there to help your family and thank you for your question.

Best,

Cynthia Klatte, LCSW, ACSW

Question: I am sure I have ADD but I do not remember and my parents have confirmed this, that my restlessness and inattention did not begin until I was in my mid teens. According to my doctor this means that I could not have ADHD now. She did not suggest what else I could have. I have read a lot on the symptoms of adult ADHD and it is like every article is writing about me personally. Is it at all possible to have ADHD that doesn’t start until adolescence?

Cynthia Klatte Says...:

Dear Anonymous,

ADHD, by definition, is a disorder that begins in childhood. Per Kevin R Krull, PhD, in his article Attention deficit hyperactivity disorder in children and adolescents: Clinical features and evaluation, hyperactivity in ADHD typically begins by age 4. It tends to peak by age 7 or 8 and declines steadily, being barely noticeable by adolescence. Therefore, whatever you are experiencing is not likely to be ADHD.

There are many conditions that can mimic symptoms of ADHD. The bipolar spectrum disorders can sometimes be mistaken for ADHD and have their onset either in childhood, adolescence or early adulthood. Per recent studies, another condition commonly misdiagnosed as ADHD is sleep apnea. Other similar conditions are anxiety, depression, traumatic brain injury and learning disabilities.

Typically, when someone is experiencing difficulties with attention, concentration, and restlessness or excessive energy, they consult with their primary care physician, a psychiatrist or a mental health clinician. If the situation is complex, it may be recommended that the individual undergo neuropsychological testing, which is conducted by a psychologist or neuropsychologist. Testing will help with the process of accurate diagnosis and with the development of a treatment plan.

Cynthia Klatte, LCSW, ACSW