Navigating Puberty and ADHD

Adolescence is always a profound period of change. For teens living with Attention-Deficit/Hyperactivity Disorder (ADHD), however, the journey through puberty can feel especially turbulent. As a psychologist working with adolescents, I’ve seen how the biological, psychological, and social changes of puberty combine with ADHD in ways that are often misunderstood.

The biology of puberty

Puberty is not just about growing taller or getting a deeper voice; it’s re-wiring of brain and body. Hormones such as estrogen, progesterone in girls, and testosterone in boys drive significant changes in neural circuits.

The adolescent brain is still under construction, only about 80 % mature in the prefrontal cortex region. That cortex is hugely important for impulse control, emotional regulation, judgment, and planning. Because of this, teens with ADHD are more prone to novelty seeking, risk-taking, and emotional intensity.

Dopamine, the neurotransmitter tied to reward, motivation, and novelty-seeking, also plays a role here. In adolescents, baseline dopamine levels may be relatively low and this is even more true for those with ADHD. However, responses to reward and stimulation are heightened. For a teen with ADHD, who already struggles with impulsivity and regulation, this can translate into more extreme highs and lows.

How puberty alters ADHD symptoms

Females:

• The menstrual cycle introduces fluctuations in estrogen and progesterone that affect dopamine and brain regulation. High-estrogen states tend to enhance cognitive control and activation of the prefrontal cortex, while low-estrogen or high-progesterone states reduce it. This means attention, impulse control, and mood may shift in tandem with hormonal cycles.

• The rise of progesterone after ovulation may blunt the beneficial effects of estrogen on attention and hyperactivity.

Males:

• Testosterone influences dopamine turnover and release in response to rewarding stimuli. That means risk-taking behaviours, impulsivity, and novelty seeking may intensify during puberty.

• Boys with ADHD might therefore face heightened vulnerability to behaviours such as unsafe driving, substance use, or other impulsive acts.

It is also important to note that because the prefrontal cortex, which governs judgment, planning, and impulse control, lags behind other brain systems, the gap between impulse and control is even larger in adolescents with ADHD.

Considerations for treatment and support

Given these shifts, several clinical and practical considerations emerge for adolescents with ADHD and their caregivers:

• Medication may need adjustment: Growth, hormonal fluctuation, and changing school or social demands mean that previously adequate doses or formulations might no longer suffice.
  

• Non-medication supports are important: Given the heightened emotional reactivity, novelty seeking, and risk behaviours, supports that focus on emotion regulation, self-control, and executive function skills are important to consider.
  

• Open communication and psychoeducation: Teens need to understand that many of their challenges are not simply “bad habits” but biological and developmental in nature. This understanding can reduce shame and increase self-compassion.

Supporting your teen: Practical steps

1. Normalize the experience.  Help teens understand that puberty combined with ADHD involves neurological and developmental factors, not just “hormones acting up.”
   

2. Create structure and boundaries.  Because impulse control is more fragile now, clearly defined expectations, boundaries, and routines help reduce opportunities for reactive decisions.
   

3. Foster self-regulation and delay of gratification.  Helping a teen build the skill to pause, reflect, and choose rather than react is particularly important during this stage.
   

4. Validate emotional experience.  Saying “I can see this feels overwhelming right now and you’re doing your best” goes further than “calm down.” The heightened emotionality is understandable.
   

5. Collaborate with healthcare providers.  Given how hormonal cycles in girls or growth in boys may impact treatment response, regular review of the medication plan is wise.
   

6. Focus on strengths and identity.  Adolescence is a period of identity formation. Teens with ADHD benefit when their unique attributes such as creativity, spontaneity, and energy are affirmed.
   

7. Monitor risk behaviours.  Because the combination of ADHD and puberty increases susceptibility to substance use, unsafe driving, and extreme novelty-seeking, guardians and teens should proactively discuss risk and safety.

In summary, puberty is not just a developmental milestone. It is a period of amplification for ADHD. The biological changes of adolescence can surface vulnerabilities, alter symptom patterns, and challenge established treatment plans. But importantly, they also offer an opportunity for growth.

This blog post is for educational purposes only and does not replace individualised clinical advice.