Why teens with ADHD care more than they appear to—and how to help them stay on track
By Elliott Field
Note: Jack is a fictional composite character created to illustrate common ADHD-related challenges I frequently encounter in practice.
It’s a typical Monday morning in June with only a few weeks left of the school year. After dropping my children off at daycare, checking my emails, and making a cup of coffee, I sit down with my first client of the day. Let’s call this client Jack. Jack is 18-years-old and in grade 12. He is what I call “parent-mandated.” Meaning his parents have given him an ultimatum. Something like either you go to therapy, or I will take your keys away and you’ll be without a car. This may be obvious, but Jack isn’t thrilled to be sitting in my office at 8:00 am on a Monday. He would rather be anywhere else than in my office, where some guy he doesn’t know is going to tell him to get it together.
Jack has his hood up and is sitting on my couch with his arms crossed. He’s wearing a hoodie with strings tied in a bow, the way all the cool kids do, and Birkenstocks with white socks (I wish I could pull that off). Less than 60 seconds into the session, he’s already looked up to his right at my green clock on the wall. I ask him why he’s here. He says something like, “Because my parents are making me.” When I ask him to elaborate, he explains that he is behind on his schoolwork, and his parents say he’s not putting in any effort.
As soon as he explains that his parents don’t think he is putting in any effort, I realize I have a short window to connect with Jack. This is because Jack does care, or at least he would like to. Jack is neurodivergent. He was diagnosed with ADHD several years ago and has attempted to treat it with varying degrees of success.
Jack is in grade 12 and has already decided he wants to take a gap year after he graduates. He doesn’t particularly like school and already has enough credits to graduate. Moreover, he has determined that his average is sufficient to gain admission to the University of Saskatchewan. His goal is to take a few classes after a year off to experiment and figure out what he wants to do.
Because Jack already has a vision of his future, it’s very difficult for him to complete his homework and attend class. His brain looks at the schoolwork and sees no immediate purpose, which is challenging because the ADHD brain craves immediate reward/purpose.
What does this have to do with ADHD?
Now, it is important to explain some of what is at play in Jack’s brain. Jack’s peers without ADHD have brains that have an easier time staying engaged with tasks that are repetitive, uninteresting, and that do not offer an immediate reward. As a result, important skills such as attention, motivation, impulse control, time management, working memory, organization, and emotion regulation can operate more automatically. This is often more challenging for people with ADHD, like Jack. As a result, Jack struggles to manage impulses to skip class, regulate his attention, stay motivated and organized, and connect his actions to future goals. In other words, Jack’s brain is having a hard time sticking with school because it struggles to keep up with the demands. This is exhausting, as Jack must work much harder than his peers to complete his schoolwork. It’s like trying to find the motivation to clean a car immediately after it’s been professionally detailed.
What do I do in this initial session?
In a situation like this, I have a few objectives. First, as with any clinician, I need to quickly establish rapport with Jack. After all, because he is “parent-mandated,” Jack may skip his next session if he does not connect with me.
My second objective is to explain to Jack that what he is experiencing is common within the context of an ADHD brain. Jack needs to be validated. He needs to know that even though his parents disagree with his behaviour, his thought process, albeit maybe not the most helpful, is reasonable. Based on how his brain functions and his lived experience, Jack’s thinking makes complete sense to him. If that is directly challenged, he will likely become defensive, and my ability to connect with him will be over.
My third objective is to provide Jack with Psychoeducation to explain to him how his brain works. More specifically, I want to help him understand why he may be unmotivated. He needs to know, and so do his parents, that his behaviour isn’t due to laziness or a lack of effort. Instead, it often relates to how the brain responds to motivation, reward, and stimulation.
When I explain this to Jack, he feels heard and understood. He realizes that his behaviours (i.e., not completing schoolwork and skipping classes) aren’t due to a lack of caring or laziness. Rather, it often relates to how the brain responds to motivation, reward, and stimulation, which can compromise executive functioning. At this point, I can end the initial session with the commitment to provide his parents with psychoeducation, if he consents, as well as to provide him with concrete strategies in our next session to attend classes and complete his schoolwork in these final weeks of school.
How do we help Jack cross the finish line?
There are a few ways that I help Jack, and I encourage his parents to do the same.
The first strategy is to work with Jack to find his own “why”. His parents’ version of why (attend school and complete your homework) doesn’t suit the ADHD brain. That is more effective for neurotypical, or non-ADHD, brains. Remember, Jack has already decided he got what he needs from high school. If his parents reinforce their own rationale for completing school, he will keep hitting a wall. Instead, his parents could help Jack cultivate a “why.” For example, if Jack is into chess and wants to pursue it at a higher level, His parents could help him identify a link between putting up with school for a few weeks, which can build resilience, and going through a challenging period as a chess player. This shift in thinking can help Jack see his current struggle with school as training for something he finds meaningful.
Another common strategy is to utilize positive reinforcement. People with ADHD brains, such as Jack, tend to do better with positive reinforcement. This is because the possibility of receiving a meaningful reward can be a huge motivator. Encouraging Jack to work toward a specific milestone (e.g., completing a math unit) and giving him an immediate reward after he completes it can help.
Finally, medication is another tool many people find helpful. In my practice, I often say that a combination of skills and pills is highly effective in treating ADHD. If Jack isn’t taking medication, or if he is and it isn’t effective, it may help to see his primary care physician or Nurse Practitioner for medication management. A tweak in ADHD medication, especially first-line stimulant medication, can improve ADHD symptoms quite rapidly in many cases.
It’s all about the relationship and understanding Jack
The relationship is the most important part of therapy. The same goes for parenting and teaching. To foster this relationship, Jack’s parents need to understand that he does, in fact, care. There’s just a disconnect between what the world expects of Jack and how his brain operates. If we understand that and work toward solutions, we can stop spinning our tires and start rolling again.
The kids will be alright. They just need help crossing the finish line.