The Key to Reducing Teens’ Risky Behavior? It Might Be Medication Coverage

Puberty is not for the faint of heart, and raising teenagers with ADHD requires an extra sturdy constitution. Hallmark symptoms of ADHD such as impulsivity and emotional dysregulation, combined with common comorbidities like depression and anxiety, put teens with ADHD at a higher risk for the following:

• Car accidents and moving violations
• Unwanted teen pregnancy and STIs
• Substance and alcohol use disorder
• Self-harm

A slew of recent research, however, has revealed that treating diagnosed ADHD may dramatically reduce the incidence of these negative outcomes in teens. In response to this data, many clinicians are urging teens and their parents to see the benefits of medication, not just for school, but for the life that presents itself through the day (and night).

The Developing Teenage Brain

Adolescents navigate thrilling new freedoms and significant new responsibilities at a time when their prefrontal cortex, responsible for decision making and risk analysis, is still developing (a process not completed until the late 20s). Brain-imaging studies show that this maturation process takes, on average, two years longer for teens with ADHD than it does for their neurotypical peers.

“In the teenage years, the prefrontal cortex matures later than the limbic system, putting teens at risk of having emotional decision-making, addictive decision-making, and impulsive decision-making that isn’t modulated by the prefrontal cortex. This affects the ability to pause and think through a thought before it becomes an emotion or an action,” explained Greg Mattingly, M.D., in the APSARD webinar “ADHD Treatment in the Primary Care Setting: The Teenage Years.” “Individuals with ADHD have an even further maturation gap, so concentration, impulse control, working memory — they get there, but it takes about two more years. We want to be mindful of this as we talk to our teenagers. How does this impact things like substance use, and sexual behavior?”

[Read: ADHD Symptoms in Teens – Your Guide to Warning Signs & Treatments]

Understanding that your teen has an increased likelihood of engaging in risky behaviors may provoke anxiety, but Mattingly suggested that awareness helps parents make more informed and collaborative decisions about their teens’ treatment plans. While ADHD medication is often considered a tool for improving school performance, studies show its benefits extend to protecting against everything from car accidents to substance abuse. Said Mattingly: “This data demonstrates the importance of holistic treatment, treatment that lasts as long as possible, into the evening.”

ADHD Medication Lowers Serious Risks

1. Car Accidents and Moving Violations

Getting a driver’s license is a rite of passage for teens, and with it comes the exhilarating promise of freedom. But new drivers with ADHD face special risks that need to be taken into consideration. “From traffic citations to serious crashes, drivers with ADHD are more likely than drivers without ADHD to experience adverse driving outcomes,”¹ explained Joseph Biederman, M.D., in his 2022 ADDitude article “Driving with ADHD: Pumping the Brakes on Vehicle Safety Risks.”

“Driving is a multidimensional activity involving many cognitive abilities and executive functions,” Biederman said. “The underlying impairments inherent to ADHD are thought to interfere with driving.” Impulsivity can lead to speeding, passing, weaving through traffic, as well as driving under the influence of alcohol and other substances. Inattention can make sustained focus difficult, especially in low-stimulus, monotonous environments. The result?  Moving violations, license suspensions, and car crashes.

The incidence of risky driving and car accidents is especially high among teenage drivers with ADHD. According to a study published in Pediatrics,² over the first four years of having a license, drivers with ADHD are:

• Twice as likely as their non-ADHD peers to drive while intoxicated
• 37% more likely to get into a crash
• 150% more likely to receive an alcohol, drug, or moving violation

While these are sobering statistics, new research offers hope about the potential of ADHD medication to significantly reduce driving risks.

[Free Driving Contract Template: Safety Rules for Teen Drivers with ADHD]

In a study conducted by Biederman with other researchers at Massachusetts General Hospital (MGH) and Massachusetts Institute of Technology (MIT), teens with ADHD were separated into two groups, then tasked with driving through a virtual roadway featuring surprise events, including oncoming traffic.³ The teens in the first group received stimulant medication (lisdexamfetamine: brand name Vyvanse) while the teens in the second group did not. Compared with the group of non-medicated ADHD teens, the medicated group:

• Were 67% less likely to have a collision during these events
• Reacted 9.1% faster to these events

While a 9% faster reaction time may not seem like much, Biederman explained that for drivers moving at 65 mph, that translates to a car traveling an additional eleven feet before reacting to a sudden obstacle. Eleven feet can have serious — even deadly — consequences.

“For families that stop ADHD treatment on weekends and during ‘downtime,’ I emphasize the importance of driving only while medication is active,” Biederman said. “A short-acting medication taken about half an hour before hitting the road may just be life-saving.”

2. Unwanted Teen Pregnancy and STIs

When you combine impulsivity with surging hormones and burgeoning sexuality, the result is often risky sexual behavior. Of the many studies that have explored the ramifications of this behavior in teenagers with ADHD, one of the most comprehensive is the Milwaukee Longitudinal Study by Russell Barkley, Ph.D.

Barkley and his fellow researchers followed a large group of children with combined type ADHD, as well as a control group of neurotypical children, through childhood into young adulthood, assessing them at four points in development.⁴ They found that, compared with non-ADHD peers, teens with ADHD had the following:

• More sexual partners (19 vs. 7)
• More teen pregnancies (38% vs. 4%)
• More sexually transmitted diseases (17% vs. 4%)

It’s a data set, Mattingly said, that builds a compelling case for making sure teens are medicated for ADHD beyond school hours. “It’s important to consider as you’re thinking about what days of the week you’d like your child to take their medicine,” Mattingly explained.

ADHD medication can prove indispensable at protecting against these unwelcome outcomes by decreasing levels of impulsivity — both physical and mental. In “How Does ADHD Medication Work?” Laurie Dupar, PMHNP, RN, PCC, explained that, when ADHD medication is working effectively, “You’ll notice that your thoughts are less impulsive. Instead of jumping from one thought to the next, you’ll follow a train of thought more effectively.” Medication can help teens create a space between the urge to do something and actually doing it. This space gives their good judgment more of a fighting chance.

3. Substance Use Disorder

Stimulants are classified as controlled substances because of their risk for abuse, leading many parents to worry that taking these medications may lead to addiction. So it may come as a surprise to learn that the risk of developing a substance use disorder drops dramatically when a person with ADHD receives treatment.

While people with childhood ADHD are almost twice as likely to develop a substance use disorder as people without childhood ADHD, those who receive treatment are 60% less likely to have a substance use disorder, compared with people whose ADHD is left untreated.

The research is clear: receiving ADHD treatment protects teens against substance abuse.

“Considerable evidence suggests that children taking ADHD medication commonly experience improvements to academic and social functioning, which translates to improved self-esteem, and lower rates of self-medication with drugs or alcohol,” said Timothy Wilens, M.D., in the ADDitude article “ADHD Medication Diminishes Risk of Substance Abuse.”

The protective effect of ADHD medication against drug and alcohol use is evidenced in the research that shows medication can help those who abuse substances maintain sobriety. “Treating ADHD with medication tripled people’s rates of staying in substance use treatment,” Mattingly said. “When we treat ADHD. we find dramatic improvement, not just in ADHD symptoms, but in staying in substance use treatment and maintaining sobriety.”⁵

4. Self-Harm

One of the most frightening behaviors associated with ADHD in adolescence is the increased likelihood of self-harm. This correlation was a focus of investigation for UCSF psychologist Stephen Hinshaw, Ph.D., who wrote about his research in the ADDitude article “ADHD and Self-Harm: How to Help the Girls Who Suffer Most.” “Our findings of extremely high rates of cutting and other forms of self-injury, along with suicide attempts, show us that the long-term consequences of ADHD in females can be profound,” Hinshaw said.

Specifically, Hinshaw’s study uncovered the following:

• More than 50% of teen girls with a history of inattention and impulsivity engaged in moderate to severe self-harm vs. 19% of neurotypical peers
• More than 20% of teen girls with ADHD attempted suicide vs. 6% of teen girls without ADHD⁶

A new study published in Child and Adolescent Mental Health confirmed that ADHD increased likelihood for self-harm and recommend screening all self-injuring teens for ADHD.⁷ The connection between ADHD and self-harm is not fully known, but it is thought to be related to both impulsivity and emotional dysregulation, as well as the high incidence of comorbid conditions such as depression and anxiety.

“Impulsivity, a key trait of ADHD, is frequently implicated as a possible risk factor for self-harm (in conjunction with other risk factors such as affective disorders),” wrote the authors of the study. “It has been shown that young people who self-harm struggle to express emotions verbally: it is plausible that emotional dysregulation would lead to expression of strong feelings through impulsive acts of self-harm.”

Medication can play an important role in reducing emotional dysregulation and impulsivity in people with ADHD,⁸ leading the authors of the study to conclude that “this may suggest a potential pharmacological therapy for self-harm.”

Teens, Drunk Driving & Unplanned Pregnancies: Next Steps

• Read: ADHD and Addiction – The Truth About Substance Abuse
• Watch: The Teen Years with ADHD – a Practical, Proactive Parent’s Guide
• Read: How Can I Help a Teen Patient with ADHD Who Needs But Resists Medication?
• Watch: ADHD and Substance Use Disorders – How to Recognize and Manage Addiction

Joseph Biederman, M.D., co-founder of APSARD, groundbreaking ADHD researcher, psychiatrist, and mentor to many in the field, passed away in January of 2023.

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