Navigating Puberty and ADHD: Understanding the Changes

Hands holding a small green plant in dark soil, set against a light gray, textured background, conveying growth and care.

The hormonal changes during puberty, including estrogen, progesterone, and testosterone, can intensify ADHD symptoms. As a parent of three children, including a 14-year-old son, I've witnessed these changes firsthand. It feels like he entered puberty overnight. He has some acne, has had girlfriends, and his voice has changed significantly. He has grown so tall that he can rest his chin on top of my head, which he loves to do.

I also have 11-year-old twins—a boy and a girl. My son shows small signs of puberty, like hair under his arms and on his legs. He seems to grow taller every day. Despite this, he still enjoys playing with toys and having sleepovers with us. His twin sister, however, just started her cycle. She has thrown away all her dolls and kiddie toys but still loves arts and crafts. She is heavily into makeup but not yet interested in boys. Interestingly, she also has ADHD, and I sometimes feel that her ADHD and puberty clash.

The Impact of Hormonal Changes

The hormonal changes of puberty lead pre-teens and teens with ADHD to experience more intense mood swings, irritability, and emotional outbursts. The executive function challenges associated with ADHD become even more difficult to manage during adolescence. I sensed something was off before my daughter started her cycle. We were butting heads. My daughter would never talk back, yell, or roll her eyes, but one day, we found ourselves in a heated argument. The very next week, "Aunt Flo" paid us a visit.

Hormonal changes can also affect how well ADHD medications work, especially for female patients. The effectiveness of these medications can vary throughout the menstrual cycle. The combination of social and academic stress during puberty creates overwhelming challenges for pre-teens and teens with ADHD. My daughter has only had her cycle twice, but each time, her signs were clear precursors. She was still taking her ADHD meds during both instances, prompting me to explore the correlation between ADHD and puberty.

Boys vs. Girls: Different Journeys

• Boys tend to display externalized behaviors through impulsive actions and risk-taking due to increasing testosterone levels.

• Girls often internalize their problems, leading to underdiagnosis. The hormonal changes in estrogen and progesterone can influence both mood and medication response.

  
  

A Deeper Link: Early Puberty?

Some research indicates that children with ADHD face an elevated risk of developing central precocious puberty (early onset puberty), although scientists have not identified the complete causes. I've been advised that putting either of my ADHD children on medication could lead to early puberty. While I don't believe that to be true, many do.

A glowing light bulb is surrounded by unlit bulbs on a dark background, highlighting contrast and focus on the illuminated bulb.

The differences in ADHD presentation between boys and girls become more pronounced during puberty due to both biological factors and social reactions. My husband and mother-in-law both have ADHD, and I suspect there are others in my family who may have it as well. Sometimes, I think I might have it too!

Boys: Loud, Risky, and Often Noticed

• Hyperactivity & Impulsivity: Boys are more likely to exhibit external behaviors—fidgeting, blurting out, interrupting, or acting without thinking.

• Risk-taking: Rising testosterone levels during puberty can increase thrill-seeking and impulsive behavior.

• Behavioral issues: Boys with ADHD may be more prone to oppositional defiant disorder or conduct issues, especially if they feel misunderstood or rejected.

• Earlier diagnosis: Because their symptoms are more disruptive, boys are often diagnosed earlier—sometimes as young as 6 or 7.

  
  

I've seen all these behaviors in my 14-year-old son—from an early age and continuing into now. He constantly blurts out random things at unexpected times and often repeats the same phrase. Before he started medication, he was getting into trouble at school.

In elementary school, he was known as the good kid—the smart one, the helper. But once he entered middle school, everything changed with the addition of puberty and ADHD. Our inbox was flooded with emails from his teachers, and our voicemail was always full. Sixth grade was particularly rough.

Some of those symptoms may have presented themselves when he was 6 or 7, but at that age, kids were just being kids.

Girls: Subtle, Emotional, and Often Overlooked

• Inattentiveness: Girls tend to daydream, lose focus, or appear “spacey,” which can be mistaken for shyness or laziness.

• Emotional sensitivity: Hormonal shifts, especially rising progesterone, can intensify mood swings, anxiety, and low self-esteem.

• Medication fluctuations: Estrogen can enhance the effects of ADHD meds, while progesterone can dull them, leading to a “rollercoaster” of symptom control across the menstrual cycle.

• Delayed diagnosis: Girls are often diagnosed later—sometimes not until middle or high school—because their symptoms are less disruptive.

  
  

My daughter, who is 11, is beginning to show some of the same signs my 14-year-old son displayed around the same age—except for the blurting out. She definitely spaces out, especially when she’s had enough of whatever is going on. We call it “her social battery has run low.”

There have been times when this behavior has been misread as disinterest or laziness. But that’s far from the truth. Her energy level drops significantly—especially during that time of the month. If you're a woman reading this, you know exactly what I mean.

She’s still new to puberty and has only had her cycle three times, but I’ve already noticed a pattern. As her cycle approaches, her moods shift. Sometimes she becomes quiet, sometimes overly affectionate, and other times she can be a little mean. The mood swings are real.

Why It Matters

The failure to diagnose girls properly results in extended periods of mental distress, academic failure, and anxiety. The incorrect identification of high energy as ADHD in boys leads to overdiagnosis without proper assessment. The period of puberty marks a crucial moment for both genders because symptoms either become more pronounced, change direction, or fade away, thus requiring essential support and understanding.

I was apprehensive about putting either of my kids on ADHD medication because I wasn’t sure it was the right decision. I didn’t want them to become “dependent” on the meds or feel like they couldn’t function without them. But my son’s grades were slipping because he couldn’t focus, and homework had become a nightmare—he was crying regularly.

Once we started the medication, he returned to being the straight-A student he had always been. No more emails or phone calls from the school. He still has moments of blurting out, but that usually happens when he’s off the medication—on weekends or during the summer—since we don’t require him to take it then. During those times, he takes a much lower dosage because he doesn’t need to focus as intensely.

As for my daughter, when she was first diagnosed in fourth grade, we chose not to start medication because her diagnosis wasn’t affecting her schoolwork or behavior. We had her tested because she was showing signs, and we wanted to understand what was going on—for ourselves and so her teachers would be aware. She’s also autistic, and she likes to wear headphones, so having documentation helped her teachers understand and support her needs.

It wasn’t until fifth grade that she told her psychiatrist she wanted something to help her concentrate. She said she was having a hard time staying focused in class and at dance. Once she started medication, her teachers noticed a slight difference. Since she’s in elementary school, the most noticeable change was that she wasn’t as fidgety at her desk and didn’t space out as much. Her academic performance remained at an honor roll level.

The social challenges of puberty become even more complicated when ADHD enters the picture because friendships become like trying to navigate with a constantly spinning compass.

Executive Function Meets Social Function

ADHD affects executive functioning, which includes skills like impulse control, emotional regulation, and attention—all crucial for building and maintaining friendships. During puberty, these challenges often become more pronounced. They can present in ways such as interrupting or dominating conversations. Pre-teens and teens with ADHD may blurt things out or talk excessively, which can frustrate peers. Missing social cues is another issue. They might not notice when someone’s bored, annoyed, or trying to change the subject. Forgetting plans, birthdays, or inside jokes can make friends feel unimportant. Mood swings and overreactions can lead to misunderstandings or conflict.

The Friendship Struggle Is Real

Pre-teens and teens with ADHD may be “all in” one day and distant the next, which can confuse or hurt friends. Social anxiety or rejection sensitivity might lead them to fear being judged or rejected, causing withdrawal or clinginess. Trouble with conflict resolution is a true struggle for many, especially those with ADHD. They may have difficulty seeing others’ perspectives, making it hard to repair rifts after disagreements.

Three children in school uniforms playfully hang on a black railing against a red brick wall. Blue bags are on the ground.

Gender Nuances

• Girls with ADHD may internalize struggles—feeling left out, anxious, or overly self-critical when friendships falter.

• Boys may externalize—acting out, becoming bossy, or gravitating toward riskier peer groups.

  
  

What Helps?

Social structures provide excellent support networks for children. Pre-teens and teens can find secure environments to connect through clubs, sports teams, and interest-based groups with adult supervision. Developing confidence requires practicing perspective-taking, also known as social coaching, along with turn-taking and learning to read the room.

Open discussions enable pre-teens and teens to grasp how ADHD impacts their relationships with friends. The ability to self-advocate develops through this experience. ADHD exists throughout every aspect of life beyond school and work environments because it infiltrates all areas of existence in unexpected ways.

My daughter is on a dance team, her twin brother is on a soccer team, and my oldest son is on a weight team—all social clubs. I believe these activities have helped them develop the social cues needed, especially the two who have ADHD.

Daily Routines & Organization

The natural process of puberty creates a challenging experience, but children with ADHD face a much more intense period marked by changing emotions, disrupted sleep patterns, impulsive choices, and unclear time perception. During such times of turmoil, a daily routine transforms into a vital source of support. The routine provides children with stability when every other aspect of life appears unpredictable, even though it does not resolve all problems.

A daily routine helps bring order to confusing situations. ADHD makes it challenging for people to plan their future or keep track of upcoming events, and puberty exacerbates this issue. The daily schedule functions as both a mental and visual guide, showing the sequence from waking up to breakfast, school, homework, play, dinner, and bedtime. It's not rigid—it’s reassuring. The routine provides children with clear expectations about what needs to be done and when, thus reducing their anxiety regarding unknown events.

During puberty, executive function suffers from degradation. The brain undergoes rewiring during this time, intensifying the natural difficulties that children with ADHD face in task transitions and time management. A daily routine gives external cues and scaffolding. Children depend on structured routines as their anchor during times of emotional struggles or intense focus because internal motivation can be unpredictable.

Sleep regulation proves to be extremely difficult for children with ADHD, but puberty complicates this challenge. Children benefit from a consistent bedtime protocol that includes dim lighting, quiet activities, and calming dialogues to restore their body rhythms. Improved sleep quality enables children to better regulate their emotions, enhance their thinking abilities, and reduce explosive outbursts.

A daily routine serves as the foundation to build confidence in children. Those who understand what will happen next develop confidence through small achievements, such as brushing their teeth correctly, completing homework, and remembering dance shoes. Children in this stage of development need to feel capable because worthiness becomes a central concern.

Daily routines work through steady consistency rather than perfect execution. It’s not just for managing behavior. Through this practice, children gain emotional security because they receive reassurance that they are not alone in their experiences. Is there a way you would like assistance creating a sample routine that meets your child's needs and suits their personality? We can create a routine that provides a comfortable framework while maintaining flexibility and giving your child power over their daily activities.

Without a routine, my children are all over the place, and I am too. I plan out my next day the day before, mostly because I don’t want to forget what I need to do. We always have so much going on. Sometimes having a routine can be challenging.

For my daughter, if she has a routine that she is used to and something interrupts it, she has a meltdown. If she is used to having waffles in the morning and we run out, even though there are plenty of options she likes, that throws her off for the morning.

I try to ensure the routine is structured enough so that if something like waffles is missing one day, we are okay. For example, I tell her that on Mondays, she can have waffles or toast. On Tuesdays, she can have pancakes or waffles. On Wednesdays, she can have waffles or a fruit bowl, and so on. You can see that waffles are something she loves, but she has a second option every day that she can pick from, which is on the routine schedule.

If I run out of waffles on Tuesday, she knows she can have pancakes, giving me time to pick up more waffles for Wednesday. However, if I run out of pancakes and waffles on Tuesday, it won't be a good morning for anyone, but we avoid that as best as we can.

Advocating for Your Child

People with ADHD experience large emotional responses that can sometimes become overwhelming because they occur too quickly or last too long. Emotional challenges serve as primary issues for many individuals who experience them. The following section presents an analysis of this experience.

Advocating for your child with ADHD represents a strong expression of love, protection, and empowerment. Your role as an advocate means you will defend your child from misunderstandings while protecting them from system failures and teaching them to assert their needs independently. The following guidance will help you take on this role with clarity and confidence.

The process of advocacy unfolds gradually; you do not need to accomplish everything simultaneously. Every action you take during advocacy work leads your child toward better visibility, stronger support, and increased confidence. I am ready to assist you in writing a teacher letter, preparing for school meetings, and developing methods for your child to express themselves effectively.

The correct support system enables people with ADHD to overcome their full-body and full-life condition so it does not become a limiting factor.

The world has different ways for people to navigate through it, and this alternative method holds equal worth and value. Finding out what works best for you and your child is what is most important. There really isn't a book that will teach you that. Some say meds, some say diet, and some say nothing—just let it work itself out. Ultimately, the most important factor is to listen to your child and be there for them and yourself.