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Adolescence (13-18 years)


ADHD may be harder to diagnose in adolescence because teens with ADHD have often learned some compensatory strategies, making them more likely to ‘fly under the radar’. Additionally, impulsive, risk-taking behavior is considered more normative in adolescence than it is in middle childhood.

Anxiety Disorder

Adolescents who struggle with anxiety often begin to recognize the irrational nature of their anxieties, but still cannot control them. Anxiety related symptoms more common to adolescence than other age groups include substance abuse, truancy, and increased risk taking behaviors or acting out. In adolescence, attempts to avoid or mask feelings of anxiety take on an increasingly oppositional appearance.

Autism Spectrum Disorder

The adolescent years are difficult for children with ASD. They have difficulties relating to peers and reading the complex social rules and cues that are associated with this age group. They are often misunderstood, making them targets for teasing and bullying. They may have some behavior challenges including withdrawal, noncompliance, and outbursts and are apt to struggle with less structured settings (cafeteria, PE) and organizational and study skills.

Attachment Disorder

  • Aggressive, anti-social, impulsive, risk-taking, or delinquent behavior
  • Substance abuse
  • Higher levels of disengagement
  • Related depression and/or anxiety

Bipolar Disorder

Bipolar Disorder becomes easier to diagnose in adolescence as its presentation becomes more consistent and similar to adult Bipolar Disorder. Puberty is a time of heightened symptoms and risk for adolescents with Bipolar Disorder. Adolescents with this disorder may increasingly engage in high risk behaviors such as substance abuse, self-injury (i.e. cutting), and reckless sexuality.


In addition to other symptoms of depression characteristic of all age groups, adolescents with depression may have an increase in school failure, truancy, alcohol or other substance abuse and other self-harming behaviors. In the 2008 New York State Youth Development Survey, 29% of local middle school students reported feeling depressed or sad most days. Twenty-eight percent of area high school students surveyed reported feeling depressed or sad most days.

Eating Disorders

Symptoms of eating disorders in pre-adolescents and adolescents are similar. However, adolescent eating disorders may be accompanied by loss of menstruation in girls, co-occurrence of alcohol and other substance abuse, fear of intimacy, social withdrawal, and maintenance of superficial relationships. Additionally, as young people mature, their ability to hide their eating disorder may become more sophisticated, making detection increasingly difficult.

Oppositional Defiant Disorder

While boys are more frequently diagnosed with O.D.D. in early and middle childhood, this gender gap disappears in adolescence; girls and boys are diagnosed at equal rates during this developmental period. Adolescents may experience the same symptoms as their middle childhood counterparts, but also have an increased tendency to exhibit more sophisticated disruptive behaviors that are covert and done without adult awareness. Adolescents with O.D.D. also have a higher incidence of alcohol and other drug use than their typical peers and may exhibit more aggressive behaviors. While most adolescents begin to develop a higher level of self-awareness, adolescents with O.D.D. tend to have limited personal insight and have a difficult time accepting responsibility for their choices and actions.

Substance Abuse

Pre-adolescent and adolescent youth are most likely to seek drugs and alcohol on their own and as a result have access to a wider range of substances. This age group is also the most likely to engage in high risk behavior when under the influence of substances (i.e. driving, unprotected sex) and are often more sophisticated at hiding substance use than their younger peers. In the 2008 New York State Development Survey for Tompkins County, the most commonly used drugs by middle and high school students were alcohol and marijuana. Of the middle school students who responded to the survey, 9% reported the use of alcohol within the past 30 days, and 2% reported use of marijuana. Of the high students who responded to the survey, 32% reported use of alcohol within the past 30 days, and 16% reported use of marijuana within the past 30 days.


Adolescents experiencing post trauma stress are at higher risk for engaging in the use of alcohol, tobacco or other drugs, sex, and other dangerous thrill seeking behaviors as a form of self-medication. They are also at increased risk for the development of depression, cutting, and other self-injurious behaviors. Adolescents with post trauma stress may compensate for their unmanageable feelings by forming an age inappropriate dependence on their caregivers or alternately may separate or detach prematurely. It is common for these same adolescents to develop conflicts with authority figures which may play out at home, school and/or in the community.