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THE CATALYTIC ROLE OF ADHD
Sam Goldstein,
Ph.D.
At its 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
behavioural 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 behavioural 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 cue-less. 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 behaviour 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 behaviour 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 behaviour 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 Behaviours: A Guide to Intervention and Classroom
Management (Brookes, 2001) provides an in-depth overview of these conditions as
well as strategies for effective classroom intervention.
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