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Tuesday, September 12, 2017

A Child With ADHD Likely to Have Additional Behavioral Issues, Anxiety

From U.S. News & World Report

By Jennifer Lea Reynolds
June 30, 2017

Experts discuss the most common ones and suggest ways parents can help.

Anxiety is quite common, if not the most common coexisting ADHD condition.

The Centers for Disease Control and Prevention notes that "attention deficit hyperactivity disorder often occurs with other disorders," which may present "extra challenges" for children, parents, educators and health care providers.

To have ADHD and nothing else is the exception, not the rule,” says E. Mark Mahone, a child neuropsychologist, research scientist and the director of the Department of Neuropsychology at the Kennedy Krieger Institute in Baltimore. “If you have a child with ADHD, that child will likely also have something else."

Learning disabilities, anxiety and depression are just some of the other common coexisting issues.

However, he explains that without early intervention, coexisting – also referred to as “comorbid” – conditions may not be easily detected and therefore not properly treated. “An ADHD diagnosis typically occurs at age 7,” Mahone says, noting that symptoms may have been present for several years prior. He says those are “critical years” in terms of a child’s brain and social development.

“If there’s a delay between ADHD symptom onset and treatment, there’s a missed opportunity to reduce comorbid assessments with this condition.”

Dr. Francisco X. Castellanos, a professor in the Department of Child and Adolescent Psychiatry and director of the Center for Neurodevelopmental Disorders at NYU Langone Medical Center, agrees that it’s unusual for a person to have strictly an ADHD diagnosis. “It’s rare that a person only has ADHD,” he says. “Usually there’s something coexisting.”

Learning Disabilities

For young children, Castellanos says that “statistically, about 2 out of 5 with ADHD will also have learning disabilities.” The extent of these learning disabilities, which he says typically involve reading and math skills – although speech and language can be affected – may fall into mild, moderate or severe categories.

Learning disabilities among school-age children with ADHD are “very common” Mahone says, especially pertaining to reading and dyslexia. He states that about one-third of school-age children with ADHD will have dyslexia and that about one-third of school-age children with dyslexia will have ADHD.

This is why Mahone feels early screening – as soon as pre-K or kindergarten – is “critical.” He’s also an advocate of Universal Design for Learning, an educational framework that takes different learning needs into account at the onset in an effort to avoid inconvenient and potentially costly changes later.

For example, there could be flexibilities in classroom presentation styles such as using changeable font sizes or making adjustments to volume and speed controls. Topics like math skills could be altered to better engage the child by using topics they can relate to such as sports or animals. All of this strives to help kids with special needs learn at a pace that differs from traditional practices.

Mahone says that this approach is becoming more common, adding that Maryland state law requires UDL be part of all public school settings.

[See: 8 Things You Didn't Know About Counseling.]

Oppositional Defiance Behaviors

Although learning disorders are common, Mahone says that oppositional behavior also often coexists among young children with ADHD. He explains that these behaviors are usually picked up more rapidly than coexisting learning issues, likely because of their more obvious nature which transcends hyperactivity and impulsivity. Not following rules or having a difficult time getting along with others is common.

“A 5-year-old with ADHD and oppositional behaviors is more likely to see a healthcare provider,” he says, because the behaviors are identified more easily. Mahone adds that oppositional defiance behaviors are more prevalent in boys than girls.


What’s important for parents to know about oppositional behavior, Castellanos says, is that it may create a detrimental cycle that eventually affects a child’s future. “These behaviors can become so impairing that it becomes oppositional defiant disorder,” he says, explaining that these children might not do well with authority, are often resentful and may even be vengeful. This could ultimately impact a child’s relationship with the adults in their lives, who may provide frequent negative feedback.

All of this, Castellanos says, may put a child at a risk for “later life social isolation” and possibly lead to depression and demoralization.

Conduct Disorder

Not only can an oppositional child’s behaviors turn into a full disorder, but Castellanos says it may even segue into something more serious – a conduct disorder.

The Mayo Clinic lists conduct disorder as one of several coexisting ADHD conditions, noting that it’s “marked by antisocial behavior such as stealing, fighting, destroying property and harming people or animals.”

Although this can occur in childhood, Castellanos says it’s more common in adolescents. “Some grow out of it,” he says, but unfortunately, some may face serious problems. He explains a downward spiral in which people with ADHD may experience a string of struggles: academic challenges, persistent negative comments and engagement in problematic behaviors, which may be of a criminal nature.

These escalating series of challenges and events can compound behavioral and mood issues, ultimately causing these people to become intermittently depressed.

To avoid this, he feels parents need to take stock of what constitutes minor and major setbacks or surprises in their child’s actions. “Part of what I preach to parents during the adolescent years is that the only thing they need to care about is preventing irreversible mistakes,” he explains. It’s one thing if a teen has piercings, four hair colors or flunked a class, he says, because the child can always take the course over again and things like tattoos can be dealt with.

On the other hand, getting in a car accident, being arrested or engaging in risky situations are life-changing events that can be prevented with proper parental and professional intervention. “Prevent irreversible mistakes so brain maturation can continue and these kids can find their way without feeling pushed,” he says.

Anxiety, Depression

Other common coexisting ADHD conditions that usually develop during adolescence and early adulthood are anxiety and depression. Mahone explains that this age usually represents a time when those with ADHD may engage in substance abuse and develop these mood disorders.

“Hormones and the changes of a developing adolescent can increase coexisting conditions,” he says. “Being a young person and living with ADHD, a developmental disability, is hard. It requires more mental effort and can take its toll emotionally.”

Castellanos adds that anxiety is quite common, if not the most common coexisting ADHD condition. “Roughly a quarter of ADHD individuals have some level of anxiety,” he says. He notes that some children are faced with an extreme case of anxiety in which they’re “incoherently terrified parents will vanish.” But if parents scale back their empathetic tendencies, he says a child’s anxiety can be eased.

Instead of tending to the child’s every anxiety-riddled whim, he suggests letting the child experience a potentially anxiety-provoking circumstance on their own and discover that they survived it. Reassuring statements made in advance such as “you’ll be fine” or “the bus will be there to pick you up” may help calm an ADHD child with a great deal of anxiety, he says.

Parental Takeaways

Castellanos says it’s “crucial for parents to think about the ways they can support their ADHD child’s needs.” Realizing that ADHD kids take longer to mature is essential, as is making an extra effort and practicing patience. “Don’t say, ‘I already told you five times,’” he stresses. “It’s also important to not take these behaviors personally. The child isn’t doing this to aggravate intentionally. This is about an inability to apply internal brakes and it takes more time to develop their maturity.”

It’s also helpful for parents to do their best to provide their ADHD child with good nutrition, health and sleep routines and to ensure that they’re obtaining appropriate support from family and the school system, Mahone notes.

“Make sure other people are also meeting your child’s needs and not giving him or her undue challenges,” he says, adding that it’s also essential to create an environment that’s as free from chronic stress as possible.

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