At it’s simplest level, ADHD represents a delay in the development of self-control. How does this fact explain the dramatic prevalence of other learning, emotional and behavioral problems children with ADHD appear to suffer? Will the treatment of ADHD reduce the occurrence of these problems? In this month’s article I will explore the catalytic role ADHD appears to play in increasing risk for affected individuals to develop other developmental, emotional and behavioral problems.
Let’s consider four common problems that often present in children with ADHD: Anxiety, depression, oppositionality and learning disability. Consider the role self-control may play in each of these conditions. I cannot think of a manner in which delayed development of self-control would be a buffer or protective factor in reducing the risk of any of these conditions. In fact, just the opposite appears to be the case. When a child has to deal with stress causing worry, fear or helplessness, a key component in the child’s outcome is his or her ability to process and think about emotions, consider alternatives and take some action, whether it be thinking or acting differently to cope with oncoming stress. Children with ADHD are cueless. They tend to miss important cues in their environment. This leads them to be “repeat offenders.” They know what to do but often don’t do what they know because they miss the cues to act. They have trouble developing habits. Possessing a habit is insufficient if you don’t cue yourself when it is time to put the habit into play. For example, a street corner is a cue. It reminds you to look both ways. If you forget to remember the cue, even though you understand that traffic is dangerous you may find yourself in the middle of the street as you thoughtlessly chase after your ball. Thus, many children with ADHD over-estimate how they are doing in life. They seem carefree and apparently unbothered by their struggles. For the most part this is because they are unaware of exactly how poorly they may be doing. This awareness often hits them like a freight train when they finally realize that they are about to fail a grade or lose out on participating in an enjoyable activity. The primary means by which human beings cope with problems of depression and anxiety relates powerfully to self-control, self-reflection and thinking differently. When most children engage in problematic behavior we usually ask them what they were thinking. However, for children with ADHD the better question is “what weren’t you thinking?” It is the absence of thinking that often leads to problems.
Many children with ADHD are oppositional, simply because it is difficult for them to stop and think through what is being requested and consider alternative responses. Their oppositionality occurs either when they are doing something they like and perceive that what you want them to do they will like less (e.g., playing when called to dinner) or are attempting to access something they view as desirous (e.g., wanting to play Nintendo instead of doing homework). It is rare that a child with ADHD is oppositional in other types of situations (e.g., there is no reported case of a child with ADHD in the midst of cleaning his room refusing to stop when parents indicate that it is time to leave for the amusement park).
Finally, consider that if learning to read, write, spell or complete mathematics is harder to accomplish for a particular child, that child is likely to become frustrated. If in fact your self-control is limited, you will frustrate even quicker. Thus, if you struggle with delayed development of self-control and also are struggling to develop phonemic awareness, exactly the activities required to master reading – more time on task and more repetitions of reading activities – are exactly the activities you are least likely to choose to engage in.
Thus, it is not surprising that among a group of children clinically diagnosed with ADHD the rate of learning disability is 20% to 30% with as high as 80% falling behind by high school, the rate of anxiety 20% to 30%, the rate of depression at any given time as high as 25% and finally the rate of oppositional behavior as high as 50% to 70%.
Can the treatment of ADHD reduce the occurrence of these problems. Given the view that ADHD is a catalyst, the absence of the catalyst decreases the chances of a reaction. Thus, although there are no guarantees that a child at risk to develop depression, anxiety, learning disability or oppositional behavior will not develop these problems if their symptoms of ADHD are treated, there is a reduced probability that these problems will develop. Further, should they develop, the ongoing treatment of ADHD will likely reduce the severity of these problems. Co-authored with Dr. Nancy Mather, our new book, Learning Disabilities and Challenging Behaviors: A Guide to Intervention and Classroom Management (Brookes, 2001) provides an indepth overview of these conditions as well as strategies for effective classroom intervention.
