Coexisting Conditions of ADHD

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Often, an individual who is negotiating with ADHD in their life will also experience other coexisting conditions, or comorbidity. The rate of occurence for various other conditions can be surprisingly high and can make diagnosis and treatment more difficult. It is believed that as many as two thirds of children with ADHD have at least one other coexisting condition.

In an effort to inform parents, educators and others involved in maintaining the well-being of children in their care, we will give a very brief overview of some common coexisting conditions of ADHD.

Oppositional Defiant Disorder:
It is estimated that up to 40% of individuals who have ADHD also present symptoms of Oppositional Defiant Disorder. This can take form in resisting/resenting authority figures, being argumentative and deliberately annoying others, as some examples.

Conduct Disorder:
Conduct Disorder is found to coexist in 25% of children, 45-50% of adolescents and 20-25% of adults. Some presentations of Conduct Disorder are aggression towards people or animals, property destruction, stealing from others and running away from home. If ignored, this can often result in legal difficulties down the road.

Anxiety Disorders:
As much as 30% of children who are dealing with ADHD are also experiencing Anxiety Disorders. Frequency in adults is less clear with estimates ranging from 25% to 40%. Children with Anxiety Disorders have extreme feelings of fear, worry or panic that make it extremely difficult to function. These disorders can produce very real physical symptoms such as racing heart/pulse, sweating, diarrhea and nausea.

Mood Disorders:
This effects about 18% of children with ADHD. Often, there is evidence of a family history of these conditions. Frequently crying, with no apparent reason, or becoming easily irritated with others are some likely clues.

Depression:
Varying estimates, between 10 and 30%, have been made as to the number of children with ADHD who also are showing signs of depression. In adults with ADHD, it seems to worsen, with estimates of about 47% presenting. Repeated negative social experiences can significantly damage self-esteem, leaving the child, or adult, discouraged and in despair.

Tics or Tourette Syndrome:
Less than 10% of those with ADHD also present signs of Tics or Tourette Syndrome. Conversely, approximately 60% of those with Tourette Syndrome also have ADHD.

Learning Disabilities:
Learning disabilities are conditions that make it difficult for a child to master skills such as math or reading. Although ADHD is not a learning disability, it can make it hard for a child to thrive in school. Up to 50% of children with ADHD also have some form of learning disorder.

As I am not even remotely close to being a doctor, I will leave the reccomended treatments and therapies to brighter minds. Instead, the intention here is to raise awareness that these coexisting conditions not only exist, but occur quite frequently. If we are watchful, maybe someone we are close to or working with might benefit by our ability to see the signs as a need for additional help.

The Power of Choice

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We have changed direction a little lately. As mentioned in earlier posts, our son was having increasing difficulties with school. His ADHD was getting the best of him. PJ was reaching his limits with how many reprimands he could face each week. His spirit was at an all-time low.

Strict discipline was not working. It only seemed to shut down communication and showed itself as anger from all involved. After one particularly horrible night, I decided that the circus was over. We tried being more supportive, loving and encouraging. No more tug-of-wars over going to school each morning. We explained why it was important, offered rewards for going and explained restrictions if he didn’t.

In recent meetings with his school’s principal, vice-principal, psychologist and several of PJ’s teachers, I challenged them all to reach beyond their understanding of ADHD. We asked that they help PJ, through encouragement and support, rather than constant reprimands for his impulsivity. The principal made it clear that they were being understanding and that PJ had gotten off easy for his behaviors. For the second time, we suggested that maybe dealing with this was beyond reasonable expectations for the school and its staff. They insisted that they wanted PJ in the school and felt they could be of help.

In the following weeks, things got worse. PJ’s breaking point came when he told us through tears, that he just wants to be normal and that normal kids don’t get “written up” 5 times in one week. We assured PJ that he didn’t have to worry about Dawn and me getting upset over the school issues. We told him that he deserves to be happy and that he doesn’t have to worry about breaking the bad news of the day to us on top of everything else. We stopped pressuring him to go to school if he was having an anxiety moment getting ready in the morning. The school was clearly not helping.

Dawn was concerned. “He has to get to school! He’ll get left back!” I assured Dawn that right now, school was the least of our worries. PJ’s self-esteem and confidence were gone. He was in a depression-like state. There was more at risk for his mental health than was at risk for his academics.

Yesterday morning, PJ announced that he wasn’t going back to school. Considering what he had been going through, I could not blame him. I told him that it’s his choice and that was fine. (I know what you’re thinking – “who in their right mind would allow their 11 year old decide he wasn’t going to school?”. It needed to be done – read on!)

I continued to explain that it might be best for him to tough it out for the remaining three months of school. Then, PJ would be in a new school, entering 7th grade. I told him although it was OK that he did not want to go back, we would have to work out some other school or program, as he was legally required to stay in some form of education. I also warned him that, due to his numerous absences and time that would be lost transitioning into another school, he would likely have to repeat the 6th grade. I left the decision up to him. His choice. No tug-of-war. You can’t have a tug-of-war if no one is pulling on the other end.

PJ decided that he did not want to have to repeat the year. He chose to go back to school. This morning, I asked again what he decided and if he was sure. He confirmed that he wanted to go to school. Dawn called a little while ago – he went right in with no problems.

The power of choice can be an amazing thing. No one likes to have things forced upon them. We all like to feel that we are having some control over where we are going and what we do. I realize that this is not the end – just a great day.

- Peace

A Breakthrough!

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As PJ has been having difficulties with anxiety leaving for school in the morning and has expressed more of a reluctance to socialize with kids his age, we decided that a new approach was needed. My wife Dawn had arranged an interview for PJ with the director of a summer camp that specializes in helping kids with social difficulties related to ADHD, Asperger's and LD's. That was the easy step. Now, how do we get PJ to go? It meant a couple of anxiety nurturing hours of travel to meet the director. Additionally, PJ had been stubbornly resistant to working with a counselor or therapist, other than his psychiatrist who he sees regularly for his meds. I was sure he would not get in the car with Dawn, or worse yet, he would take off from her once outside the director's apartment in Manhattan.

I had spoken with PJ in the days before. We discussed how he wasn't exactly happy and that this was a chance to meet someone who might be able to help him in dealing with ADHD and the other resulting conditions. I appealed to him that the only challenge was meeting someone, putting his hand out and saying "Hello, I'm PJ- nice to meet you." There was no discussion yet that this was about a possible 6 weeks away from home.

I was surprised! He was receptive and said that he would do it. Promises of a stop at Nintendo World didn't hurt. But I knew he wasn't in the car yet. Sure enough, the night before he said he changed his mind - he did not want to go.

I explained to PJ that he had agreed and we had committed to meeting this person, tying up the director's weekend. After much back and forth, PJ relented. Again, I knew this was not a done deal yet.

The next day, I was at work and expecting the phone call to come. I called Dawn many times that day. "Is he getting ready?" "Is he still on board?" "You're on the train?" So far so good. To my surprise, the appointed time came. It was 10 minutes past the appointment time and no phone call! Could this be it or has she been chasing him around NYC for the past 15 minutes?

An hour later I checked in. He did it! The appointment went well. PJ was polite and spoke openly with the director. He had finally made a concerted effort to reach out and be receptive to some possible help. This was big!

As it turned out, the director felt that the camp was not as well suited to PJ's needs as we had hoped. He recommended another camp that he felt would be helpful.

That's OK. This was a very successful day!

Lesson Learned

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I am currently traveling in the Midwest for a little more than a week. I checked in at home this morning to find that my son would not go to school today. He was "tired".

To bring you up to speed quickly, my son is a gifted 6th grader, with ADHD. He has been struggling with mornings of anxiety, which in turn becomes "not feeling well" enough to go to school. This has occurred on and off for about 3 years. So far this school year he has missed 8 days.

Before anyone jumps to the conclusion that this is a matter of a "lack of discipline" or poor parenting by enabling parents, I can assure you it is neither. It is so real to him that he has gone as far as jumping out of a moving car on the way to school.

Threats of punishment have no impact at the time of the event. He is in another world when it is happening. Positive reinforcements and rewards can be of limited help.

My wife was at the end of her rope. We talked about how he should spend his day. He has been lagging in Math. I suggested that my wife have my son spend his day working on Math exercises and work around the house, particularly cleaning bathrooms. I spoke with him and told him that it was fine that he was home, but that he was going to either learn to study or learn to work.

A call to my wife later brought good news. After cleaning the two bathrooms on his hands and knees and vacuuming the second floor of the house, he told my wife that he wanted to lay down. She reminded him that there was still a great deal of work to do. She also suggested that going to school was probably a bit easier then the work she had lined up for the day.

He made it to school in time for his Math class. Another day survived.