Adolescence

Adolescence is a key transition period in an individual’s life. An estimated 2.93 million adolescents aged 15 to 19 lived in Australia in June 2021. This consisted of 761,029 thousand male, 720,644 female and 1,481,673 peoples. Together, young people aged 15 to19 made up 13% of the total population (Australian Bureau of Statistics [ABS], 2022b). While most people experience good health and wellbeing, approximately 26.4% of persons aged 16 to 24 reported having long-term mental disorders that have lasted for more than 12 months (ABS, 2008, 2022a). It is most commonly reported that mental and behavioural problems were mood and anxiety related with the onset occurring during childhood or adolescence. For example, the adolescent may experience frequent risk-taking behaviour, conflict with adults and mood disruption. All these stressors can impact self-identity, physical changes and maladaptive coping strategies into adulthood and as a result require long term intervention.

Attention Deficit Hyperactivity Disorder

Attention Deficity Hyperactivity Disorder (ADHD) is a disorder that is characterised by difficulty maintaining attention and impulsive and excessive activity (Geldard et al., 2020) which can persist throughout adolescence. ADHD is recognised as lacking persistence and moving frequently between activities and interferes on daily life. It is a chronic debilitating disorder which may impact upon academic outcomes, social skills problems and strained parent child relationships. Therefore, individuals continue to show significant symptoms of the disorder into adulthood. Children are at greater risk of longer-term negative effects such as lower educational outcomes and employment attainment. The core difficulties in executive function seen in ADHD may result in inappropriate functioning in adulthood, depending on the demands made on the individual by their environment. Research suggests that there is a propensity associated with ADHD that key stages occur during the development lifespan, which get increasingly more complex and manifest in severe disruptions if left untreated or undiagnosed (Kewley, 1999). Adolescents with ADHD can experience either/or both inattention, hyperactivity and impulsivity. When compared to their peers this often creates issues in motor skills, intelligence, executive function, adaptive, behaviours, social and family relationships.

Evidence of Symptoms

Diagnosis of ADHD prescribes that several symptoms must be present before the age of 12 and be ongoing for at least 6 months. This neurodevelopmental disturbance has lifelong implications therefore being listed in the The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013) as impacting cognitive, behavioural and social domains (Wicks-Nelson & Israel, 2015).

Adolescents experiencing ADHD have difficulties in executive function. Whereby, “planning, organisation, working memory, verbal regulation, inhibition of behaviour and motor control are impacted compared to their peers” (APA, 2013). During adolescence this may be observed by parents and teachers as laziness, disobedience and decreased academic results.

ADHD tends to typically appear during childhood into adolescence, whereby adolescents engage in behaviour more immature than their peers. Everyday skills may not be achievable, due to the general intelligence level of not being able to regulate goal directed behaviour. Ten to forty percent of teens with ADHD experience some form of anxiety characterised by excessive worry including panic attacks without the ability to control such. Sleep disturbance is also characterised as common in adolescents with ADHD, whereby normal sleep cycles may change, further impacting on daily functions (Children and Adults with Attention-Deficit/Hyperactivity Disorder [CHADD], 2022a).

Social difficulties occur when adolescents with ADHD show excessive activity, inappropriate talkativeness and interrupting others. The other is an aggressive negative style of social interaction displayed by physical and verbal aggression, rule breaking and hostile controlling behaviour. Also, inattention can be exhibited as being distracted, not listening with a tendency towards anxiety, shyness and withdrawal. During adolescence, ADHD may see the onset of risk-taking behaviour, substance abuse, mood changes and changes in peer groups.

Impact on the Individual and Interactions

Due to the characteristics of ADHD namely: Inattention, Hyperactivity and Impulsivity they have significant impacts on an adolescent. Adolescence is already a stage of considerable change and transition from childhood to adulthood. Therefore, a person experiencing the symptoms of ADHD may by more likely to have extreme presentations in already heightened behaviours and emotions. Individually it may present as emotional dysregulation such as unusual crying, extreme sadness and trouble sleeping. With peers’ adolescents may seek out dangerous behaviours with the essence of impulsivity appearing as not holding back or being able to control behaviours that are dangerous. It is noted that during adolescence those with ADHD can experience conduct disorders in which careless and irresponsible getting in trouble with the law may start occurring. This then will have considerable impact on the family dynamic whereby altercations around expectations and responsibilities are not being met. Within the school setting it would be possible that teacher student relationships are strained due to the disruptive nature and expectation to deliver content while a student is constantly moving or losing their equipment while disturbing others. Redirection might work during childhood but during adolescent it is known that students respect peer thoughts more than adults. Therefore, truancy and no attendance may start occurring for those repeatedly getting in trouble for what might be undiagnosed ADHD.

Suggested Interventions

Approximately 3 to 7% of school age children are likely to experience ADHD. Boys are more likely to be diagnosed displaying hyperactivity/impulsivity. Research suggests for some children the primary features of ADHD continue into adolescence, but to a lesser degree into adulthood (CHADD, 2022a). Therefore, high school Guidance Officers have a unique opportunity to deliver strategies and commence referrals for intervention to lessen the effects of this disorder in adulthood.

Due to the unique behavioural or outward presentation of ADHD, Guidance Officers could recommend observations of the student in and out of the classroom environment. Combined with the collation of current school behaviour reports, past academic achievement records, previous school reports and any medical reports or professional referrals and recommendations could assist in the case management of a student with suspected ADHD. Guidance Officers would work with school staff including various teachers, Deputy Principal and use feedback obtained from previous schools to benefit the student. This would be with the view to assess the frequency, severity and types of behaviours / incidents occurring for the student, in a way that it is impacting on their ability to maintain appropriate social emotional and cognitive levels. Therefore, suggested use of two psychometric testing could assist in developing a hypothesis and validation of indicators for a specific disorder.

Firstly, according to DSM-5 intelligence and achievement testing and consideration of medical and social factors should be used when looking into ADHD. The Department of Education (2021a) provides approved Restricted Psychoeducational Tests that may be administered by Guidance Officers. Therefore, the use of Wechsler Intelligence Scale for Children – Fifth Edition (Pearson, 2022) would determine the impacts and ability of Intelligence and cognition for the student. This test would be preferred over the Preschool Primary age Wechsler due to the age range it considers. Also, the examples of subtests are based more on cognitive models such as vocabulary, block design, digit span and coding. The full IQ scale score is determined through four index scores namely: Verbal Comprehension, Perceptual Reasoning, Working Memory and Processing Speed.

Secondly, the Guidance Officer could implement the National Institute for Children’s Health Quality Vanderbilt Assessment Scale (VAS) (NICHQ, 2022) used for diagnosing ADHD. Both parent and teacher complete initial assessment scales consisting of 2 components: symptom assessment and impairment in performance. On both the parent and teacher initial scales, the symptom assessment screens, for symptoms that meet criteria for both inattentive and hyperactive ADHD. According to the DSM-5 criteria a certain ratio of results must be recorded within the symptoms scale. The second scale has a set of performance measures that provide a scale weighting the problematic impairment and not just symptoms. Although the name of the test is diagnosis, in the role of guidance counsellor they are not diagnosing, rather gathering sufficient evidence to provide a referral for paediatric and/or psychological assessment of possible ADHD in this case. Collett et al. (2003) and Kratochvil et al. (2009) suggest the VAS is easy to complete and score, is psychometrically sound, useful for collecting data from multiple sources and assessing academic and behaviour performance.

Inventory screeners assists educators to refer on for further evaluation. It is suggested that gathering what has happened over time, whether it be a gradual drop or sudden drop in behaviour and/or cognition, a case conceptualisation provides the groundwork for further investigation. Gathering assessment administered by previous Guidance Officers, or making a phone call to fill in any gaps or questions the file may have with previous Guidance Officer could be prudent. Having a transitionary meeting, if for example the student was coming from primary to high school could be an opportunity to discuss OneSchool or relevant school support records, regarding the student. Using the specialists’ tabs that have more information about students will also provide further information regarding referrals that have been completed to external agencies, for example Headspace or Child Youth Mental Health Service in the past. Having this knowledge means Guidance Officers can support the student where they are rather than starting the process over, possibly wasting time or bringing further and unnecessary distress to the family. Furthermore, meeting with the parent to discuss their next steps, noting what are the current medications that paediatricians prescribe could be beneficial to ongoing support. This will enable the Guidance Officer to work with staff to prepare and make adjustments to workload, assessment and environment, all of which contribute to daily provisions allowable to support adolescent with ADHD.