Blog Post

The Four Major Types of Problems in ADHD

  • difficulties investing, organizing, and maintaining attention and effort
  • difficulties inhibiting impulsive behavior
  • difficulties regulating their level of excitement (modulating arousal levels) to deal with the current situation
  • an unusually strong inclination to seek immediate reinforcement (reward)

The child with ADHD will likely perform worse…

 

  • later in the day than earlier
  • when restraint is demanded (e.g. public settings)
  • with tasks of greater complexity that require organizational strategies
  • when persistence in work-related tasks is required (i.e., chores, homework, etc.)
  • under low levels of stimulation:
    • absence of supervision
    • absence of reward (reinforcement)

Consequences for the ADHD children and adolescents

 

Academic problems

  • Disruptive classroom behavior
  • Underperforming in school relative to ability
  • Expressing ideas is disorganized and or inefficient
  • Require academic tutoring (up to 56 percent)
  • Learning disabilities are more common – Reading (8-39%), Spelling (12-26%), Math (12-33%)
  • May repeat a grade (30 percent or more)
  • May be placed in special education programs (30-40 percent)
  • May have school suspensions (up to 46 percent)
  • May have school expulsions (up to 20 percent)
  • May fail to graduate high school (up to 35 percent)
  • Only 5% of ADHD finish college comparing with 35% in general population

Task Performance

  • Impaired sense of time, inaccurate time estimation
  • Impaired planning and problem-solving
  • Impaired self control and judgment (30% behind – a 9 year old acts like is 6, 14 like is 9, 18 like is 12)
  • Reduced sensitivity to errors (mistakes are not that motivating to improve)
  • Poor persistenceof effort/motivation
  • Greater variability in responding (some time is better than other times)
  • Performance/productivity decreases if the rewards are not immediate
  • Performance decreases if the rewards change from being continuous (all the time) to intermittent (some of the times)

Social problems

  • Poor self-regulation of emotion – has a hard time keeping the emotions balanced
  • Greater problems with frustration tolerance
  • Social skill deficit, peer rejection

Various problems

  • Prone to accidental injuries (up to 57 %)
  • Start sexual intercourse earlier as teens
  • Greater risk of teen pregnancy (38%)
  • Greater risk of sexually transmitted disease (16%)
  • Greater risk for cigarette smoking and substance abuse
  • Greater driving risks: vehicular crashes and speeding tickets
  • Greater risk for delinquency

ADHD disrupts the sense of time

 

  • It is not about perceiving the time but about using time,
  • ADHD is a time management disorder
  • Children, adolescents and even adults with ADHD have a really hard time holding the time concept in mind as they go about their things (organize their behavior around time);
  • Time is perceived to go very slowly they get very impatient

Patients with ADHD discount the value of future rewards

 

  • The further away in the future a reward is, the least valuable it seems
  • This is true for everybody but it is much more significant in ADHD
  • 20-30% more discounting than “normal”
  • As a result the child will choose an immediate reward
  • While the child may really want that PS3 console, the promise will get that for Christmas if he behaves well will likely not be effective.

Conditions co-occurring with ADHD

  • Up to 89% of the children with ADHD will also have another psychiatric diagnosis and up to 67% will have two additional diagnoses.

 

Oppositional Defiant Disorder (ODD) and Conduct Disorder

54-67% of the children referred for treatment of ADHD have ODD by age 7 or later. A subgroup of these children will further develop a more severe pattern of behavioral disturbance like Conduct Disorder (CD).

 

The risk for ODD/CD is increased if:

  • ADHD is severe
  • There is family history of conduct problems
  • The family environment is adversarial (high levels of family conflict)

The risk for progression towards Conduct Disorder (CD) is increased if:

  • One of the parents has Antisocial Personality Disorder
  • Divorce – especially the case of a single parent with depression, adult ADHD or substance abuse problems
  • Affiliation with deviant peers – belonging to a deviant peer group
  • Parental monitoring – do you know where your child is? This may be the single best predictor if an ADHD child with ODD will get to have CD

Anxiety

  • If ADHD is present – 30% of the children with ADHD have Anxiety
  • Children with anxiety and ADHD tend to have less impulsiveness

Depression

  • 20-30% of those with ADHD may have a mood disorder
  • If ADHD is present, the risk of developing depression is 5.5 times higher than in youngsters without ADHD.

Bipolar Disorder

  • There is no evidence that ADHD may increase the risk to develop Bipolar Disorder.
  • Still, ADHD can be diagnosed in most children and adolescents with Bipolar Disorder.
  • Bipolar Disorder may be diagnosed in just around 10% of the children with ADHD.

Tics & Tourette Disorder

  • About 18 % of children will present at some point a motor tic, but the number declines to about 2% by mid-adolescence and less than 1% by adulthood.
  • ADHD does not elevate risk for Tourette’s but the treatment of ADHD (especially stimulants) may increase the risk of tics.
  • Looking at the children with Obsessive Compulsive Disorder (OCD) or Tourette’s Disorder (TD) 48% (range 35–71%) will have ADHD. In this group, ADHD often seems to precede TD.

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