15. How Serious Is Attention-Deficit Hyperactivity Disorder?
Accompanying Emotional and Learning
More than half of children with attention deficit disorder
also have accompanying disorders, including anxiety, depression,
and conduct disorders. One study found that 25% of children
with ADHD have or develop bipolar disorder (commonly called
manic depression). Speech and learning disorders are also
common in children with ADHD. About 20% have reading difficulties
and 60% have serious handwriting problems. Adults with ADHD
are also at very high risk for these conditions.
Long
Term Outlook
Little is known about the long-term effects of ADHD, although
studies are now underway to determine them. One study reported
that only 4% of boys with ADHD still had the disorder when
they grew up, although recent studies indicate that the
symptoms of ADHD in adults may differ from those in children.
In one analysis, investigators reported that almost all
ADHD patients improve over time, with the rate of the disorder
declining by 50% over every 5-year period. In other studies,
half of ADHD children functioned normally when they grew
up, even if symptoms remained. The other half had difficulties;
a small percentage of these problems were severe. Attention-deficit
disorder does not affect intelligence; people with the problem
span the same IQ range as the general population. One study
suggested, however, that 90% of ADHD children were underachievers
and that half were held back at least once. ADHD has been
associated with a higher risk for alcoholism, drug abuse,
and criminal activity. Studies indicate however that, in
general, only ADHD children who also have conduct disorders
or accompanying emotional or mental disorders are at significantly
higher risk for anti-social activities. Those with a simple
diagnosis of ADHD are at no higher risk, although they still
may have educational and therefore greater social and work
problems later on than those without ADHD.
Lifelong
psychologic or social damage may certainly stem from an
on-going cycle of punishment and ostracism for behaviors
that the child cannot control without help. It is becoming
evident that an accurate early diagnosis, education, support,
and medication, if necessary, can overcome many of the early
problems in most people and help prevent long-term negative
behavior.
Effect
on Family
The time and attention needed to deal with the ADHD child
can change internal family relationships and have devastating
effects on parents and siblings. Mothers generally get the
brunt of the emotional and physical abuse that an ADHD child
can cause, which is ironic because the child tends to love
the mother intensely and feel safe with her. She must protect
herself and her child by establishing tough but kind rules
about where her space ends and the child's begins. She may
have to give up on the idea of an immaculate house and a
hot meal every night. (One advantage of an ADHD child in
the family is that the parents learn that they are not perfect,
nor do they have to be. In fact, striving for perfection
is among the most counterproductive goals to pursue in raising
an ADHD, or any, child.) The ADHD child is wonderful one
day and terrible the next and can hurt the parent's feelings
as drastically as an adult can. Parents must face the dislike
and anger of other parents and see their own child rejected.
It is very easy to fall into an emotional black hole, and
feel alone, inadequate, and helpless. Marriages are often
stressed to the breaking point. Siblings of ADHD children
have particular difficulties, and studies are showing that
they are also at risk for psychologic impairment, including
depression, drug abuse, and language disorders. They are
often victimized by an ADHD brother or sister who is intense,
demanding, often bullying, and who may be receiving positive
attention from the parent for behavior for which they would
be punished or ignored. The non-ADHD sibling also does not
have the control a parent does in the management of the
ADHD child's behavior and is likely to feel alienated. A
sibling who is not given attention in his or her own right
may begin to imitate undesirable behaviors or act out negatively
in other ways. It is very important to make the siblings
equally vital to the family's functioning, although their
value in the family should never be as fellow-caregivers
of the ADHD sibling.
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© 2003 The Kids Clinic
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