If your child has Attention-Deficit/Hyperactivity Disorder (AD/HD), some attention and behavior problems occur at home as well as at school. Even in the best circumstances, managing AD/HD can be an overwhelming – and exhausting – task for you and your child. And for many kids who have AD/HD, their struggle is complicated by a having a secondary psychiatric disorder or a learning disability.
More than AD/HD
When a child has another psychiatric problem in addition to AD/HD, his behavior and moods can be especially difficult to manage. If you’re a parent, the thought of your child having more than one disorder can be frightening. If you’re in this situation, be aware you have plenty of company. An estimated 40% to 60% of kids who have AD/HD also have at least one other psychiatric disorder. But be assured that help is available for you and your child. Professionals who are trained in childhood disorders can help you determine whether your child has a problem in addition to AD/HD.
Psychiatric Conditions that May Co-exist
The following conditions often affect kids who have AD/HD. The symptoms listed are intended only as a guide; diagnosis requires professional assessment.
A child or adolescent who is depressed may:
- Seem sad or irritable most of the time.
- Lose interest and pleasure in many activities he used to enjoy.
- Over-eat or lose his appetite.
- Feel inappropriate guilt.
- Have trouble thinking, concentrating, and making decisions.
- Feel worthless or hopeless.
A child who suffers from generalized anxiety may:
- Feel anxious and worried most of the time.
- Act nervous in certain settings – in crowds of people, at school, or when expected to perform – and try to avoid such situations.
- Fear being separated from her home or from parents and other adults she’s attached to.
A child who suffers from Obsessive-Compulsive Disorder (OCD), a specific type of anxiety disorder, may:
- Have obsessions, which are recurrent, persistent, and involuntary thoughts or impulses that appear to have no purpose. Common obsessions include fear of dirt or contamination; constant thoughts about certain sounds, images, words, or numbers; and fear of harming a family member or friend.
- Have compulsions, which are repetitive behaviors he is driven to perform regularly, even if they seem irrational. These behaviors stem from the obsessions described above and commonly include: excessive hand-washing and touching certain objects a certain number of times.
Oppositional Defiant Disorder (ODD)
A child who has Oppositional Defiant Disorder often may:
- Behave in a manner that is negative, hostile, and defiant.
- Seem angry and resentful.
- Lose his temper.
- Argue with adults and refuse to comply with adults’ requests and rules.
- Annoy people on purpose.
- Blame other people for his mistakes and misbehavior.
Conduct Disorder (CD)
A child who has Conduct Disorder may consistently:
- Try to “break the rules” without getting caught.
- Run away, skip school, and break curfews.
- Lie or steal.
- Be physically aggressive toward people or animals.
- Destroy property.
- Be considered a “juvenile delinquent” by authorities.
Tourette’s Disorder and other tic disorders
A child who has this condition may:
- Display motor tics – involuntary muscle twitches and spasms.
- Exhibit vocal tics – involuntary speech or voice sounds.
Tics may be a chronic problem or occur only occasionally. They vary in how severe they are.
Diagnosing Psychiatric Disorders
While many pediatricians and family physicians can diagnose and prescribe medication for AD/HD, a psychiatrist is usually required when a secondary condition exists. To make a proper diagnosis, the doctor will gather information from you and your child. Here are some questions you can expect:
- What specific feelings and behaviors does your child have that concern you?
- How long has your child felt and acted this way?
- Does the problem prevent your child from functioning normally? If so, where – at home, school, social events, etc.?
- Where are the feelings and behaviors most apparent – at home, school, social events, or in public places?
- Do any other family members show the same symptoms, or have they been diagnosed with a specific condition?
The doctor will also determine if your child’s problems are unusual for his age. The guide most physicians refer to when making a diagnosis is the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV). Diagnosing such problems can be tricky, because:
- At this time, there are no simple medical procedures or lab tests to help diagnose these disorders.
- The challenges of having AD/HD can lead kids to feel anxious, depressed, and angry.
- There is some “symptom overlap” between AD/HD and the other conditions listed above.
It can take a period of time for the doctor to make the diagnosis, so be prepared to be patient and cooperative during the process. You may be asked to bring additional reports from your child’s school or pediatrician.
The Diagnostic Debate about Bipolar Disorder
The diagnosis of bipolar disorder (also called manic-depressive illness) in children and adolescents remains controversial. According to the National Institute of Mental Health (NIMH), this is because “bipolar disorder is difficult to recognize and diagnose in youth…because it does not fit precisely the symptom criteria established for adults, and because its symptoms can resemble or co-occur with those of other common childhood-onset mental disorders. Better understanding of the diagnosis and treatment of bipolar disorder in youth is urgently needed.” The National Institute of Mental Health and other institutions are conducting research on child and adolescent bipolar disorder. Meanwhile, the NIMH goes on to say, “A child or adolescent who appears to be depressed and exhibits AD/HD-like symptoms that are very severe, with excessive temper outbursts and mood changes, should be evaluated by a psychiatrist or psychologist with experience in bipolar disorder, particularly if there is a family history of the disorder.”
Common Co-morbid Condition: Learning Disability (LD)
A child who has a learning disability (LD) along with AD/HD may experience academic struggles and behavior problems. The Centers for Disease Control and Prevention (CDC) stated that about one-half of children diagnosed with AD/HD have also been identified as having a learning disability. (Centers for Disease Control and Prevention, 2002.)
If a child struggles with learning, his public school may assess him for special education services. Public schools offer this type of assessment, as do some private professionals. Once a child’s disabilities are identified, appropriate learning strategies, accommodations, and treatment can be put in place.
How Counseling Can Help
Having AD/HD is a challenge in itself. Add a secondary disorder, and life becomes much more complicated for the child and his family. A psychologist or other counselor may be able to help you, your child, and other relatives manage any relationship problems through therapy or behavior management programs.
Hope on the Horizon
Researchers are working hard to better understand how to diagnose and treat AD/HD and other psychiatric conditions that affect children. Behind the scenes, pieces of the puzzle are coming together, and exciting discoveries are being made.
For more information about AD/HD and co-existing conditions, check the resources listed with this article.
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