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AD/HD and Common Coexisting Conditions

Ideally, a diagnosis of AD/HD should consider a child's symptoms as well as the degree to which they impair his functioning at home and school.

By Sam Goldstein, Ph.D.

If AD/HD 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 AD/HD appear to experience? Will the treatment of AD/HD reduce the occurrence of these problems? In this article, Sam Goldstein, Ph.D., answers those complex questions.

Let's consider four common problems that often present in children with AD/HD: anxiety, depression, oppositional behavior, 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 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.

Kids with AD/HD 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 it 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's time to put the habit into play. A street corner, for example, is a cue. It reminds you to look both ways. If you forget to remember the cue, even though you understand traffic is dangerous, you may find yourself in the middle of the street as you thoughtlessly chased after your ball.

Thus, many children with AD/HD 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 they're 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 AD/HD the better question is, "What weren't you thinking?" It is the absence of thinking that often leads to problems.

Consider oppositional behavior, for children with AD/HD, as Rick Lavoie has pointed out, it's "On the Mind - Out the Mouth." Many children with AD/HD are oppositional simply because it's difficult for them to stop, think through what's being requested, and consider alternative responses. Their oppositionality occurs either when they're doing something they like and perceive that they'll like what you want them to do 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's rare a child with AD/HD is oppositional in other types of situations. There is no reported case of a child with AD/HD who's in the midst of cleaning her room and refuses to stop when parents say it's 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 struggle to develop phonemic awareness, the activities required to master reading - more time on task and more repetitions of reading activities - are exactly the activities you're least likely to choose to engage in.

Thus, it's not surprising that, among a group of kids with AD/HD, the rate of learning disability is 20 to 30 percent, with as high as 80 percent falling behind by high school. The rate of kids with anxiety may be 20 to 30 percent; depression, as high as 25 percent; and oppositional behavior, 50 to 70 percent.

The second part of this question addressed whether treatment of AD/HD can reduce the occurrence of these problems. Given the view that AD/HD is a catalyst, the absence of the catalyst decreases the chances of a reaction. Thus, although there are no guarantees a child at risk to develop depression, anxiety, learning disability, or oppositional behavior will not develop these problems if their symptoms of AD/HD are treated, there is a reduced probability these problems will develop. Further, should they develop, the ongoing treatment of AD/HD will likely reduce the severity of these problems.

AD/HD by Other Names and Acronyms

While Attention-Deficit/Hyperactivity Disorder (AD/HD) is the official term and acronym used by today's mental health care professionals, it is sometimes referred to by other names and abbreviations. For example, it is sometimes called:

  • ADHD (without the "slash" in the middle)
  • Attention Deficit Disorder (ADD)
  • Attention Disorder

Sam Goldstein, Ph.D. is a Clinical Professor of Psychiatry at the University of Utah, a Research Professor of Psychology at George Mason University and Director of the Neurology, Learning and Behavior Center in Salt Lake City, Utah. He is Editor-in-Chief of the Journal of Attention Disorders, author, co-author or editor of 26 books and dozens of book chapters and peer reviewed research articles.


Comments from GreatSchools.org readers

07/25/2011:
"Thank you for this helpful information. My 2 kids have ADHD and everyday it is a struggle, especially with my son (age 7). He was diagnosed 2 years ago... ADHD with aggression and ODD. This article describes him to a "T". Any suggestions, tips, or advice is always welcoming!! "
03/2/2010:
"I am so greatful to have had this so I can further support my son with his ADHD, and bring light to his principle/vice principle at his school about his disability. He has been labeled 'a problem child' and it is outragous the ignorance our teachers and ppl heading the schools have when it comes to these childrens faults and or needs!"
06/15/2009:
"This was very helpful to me. I will attemt to show this to my childs Psychiatrist and hope he does not get offened because of it. The child psychiatrist have a problem with offerd out side information. I wish I could find a child nerologist in my area."
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