Introduction to ADHD Resources

10/11/2017 The Most Common Misdiagnoses in Children | Child Mind Institute

what is noticed rst, but it may be secondary to another condition such as OCD.

Due to the shameful thoughts that many children with OCD have, they may not feel

comfortable sharing many of them, and may get misdiagnosed with depression.

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“ ere are many cases where children who have fears or worrisome thoughts
become depressed because they are scared and feel like things won’t get better,”
explains Dr. Rachel Busman, a clinical psychologist in the Anxiety and Mood
Disorders Center at the Child Mind Institute. “ at’s why it’s so important to
accurately assess the symptoms and obtain a history that explains when they
started. ere are excellent treatments for anxiety disorders and depression-once
a diagnosis is made, treatment can target these symptoms.”

5. Disruptive behavior
e common diagnosis: ODD

Most children have occasional temper tantrums or outbursts, but when kids
repeatedly lash out, are de ant, or can’t control their tempers, it can seriously
impair their functioning in school and cause signi cant family turmoil. O en,

https://childmind.org/article/the-most-common-misdiagnoses-in-children/ 8/1848

10/11/2017 The Most Common Misdiagnoses in Children | Child Mind Institute

these children are thought to have oppositional de ant disorder (ODD), which is

characterized by a pattern of negative, hostile, or de ant behavior. Symptoms of

ODD include a child losing his temper, arguing with adults, becoming easily

annoyed, or actively disobeying requests or rules. In order to be diagnosed with

ODD, the child’s disruptive behavior must be occurring for at least six months and

be negatively a ecting his life at school or at home.

Other possibilities:
Anxiety Disorders:

Children with anxiety disorders have signi cant di culty coping with situations
that cause them distress. When a child with an untreated anxiety disorder is put
into an anxiety-inducing situation, he may become oppositional in an e ort to
escape that situation or avoid the source of his acute fear. For example, a child with
acute social anxiety may lash out at another child if he nds himself in a di cult
situation. A child with OCD may become extremely upset and scream at his
parents when they do not provide him with the constant repetitive reassurance
that he uses to manage his obsessive fears. “It probably occurs more than we think,
either anxiety that looks disruptive or anxiety coexisting with disruptive
behaviors,” said Dr. Busman. “And this goes right back to why we have to have a
comprehensive and good diagnostic assessment.”

ADHD:

Many children with ADHD, especially those who experience impulsivity and
hyperactivity, may exhibit many symptoms that make them appear oppositional.

ese children may have di culty sitting still, they may touch and play with
anything they can get their hands on, blurt out inappropriate remarks, have
di culty waiting their turn, interrupt others, and act without thinking through
the consequences. ese symptoms are more a result of their impaired executive

https://childmind.org/article/the-most-common-misdiagnoses-in-children/ 9/1849

10/11/2017 The Most Common Misdiagnoses in Children | Child Mind Institute

functioning skills—their ability to think ahead and assess the impact of their

behavior—than purposeful oppositional behavior.

Learning Disorder

When a child acts out repeatedly in school, it’s possible that the behavior stems
from an undiagnosed learning disorder. Say he has extreme di culty mastering
math skills, and laboring unsuccessfully over a set of problems makes him very
frustrated and irritible. Or he knows next period is math class.

“Kids with learning problems can be masters at being deceptive—they don’t want
to expose their vulnerability. ey want to distract you from recognizing their
struggle,” explains Dr. Rappaport. “If a child has problems with writing or math or
reading, rather than ask for help or admit that he’s stuck, he may rip up an
assignment, or start something with another child to create a diversion.”

Paying attention to when the problematic behavior happens can lead to exposing a
learning issue, she adds. “When parents and teachers are looking for the causes of
dysregulation, it helps to note when it happens—to ag weaknesses and get kids
support.”

Read More:
How Anxiety Leads to Disruptive Behavior
What’s ADHD (and What’s Not) in the Classroom
What Should an Evaluation for Autism Look Like?

ATTENTION, BEHAVIOR PROBLEMS, DIAGNOSIS 10/1850

https://childmind.org/article/the-most-common-misdiagnoses-in-children/

10/11/2017 ADHD: Other Conditions With Similar Symptoms-Topic Overview

ADHD: Other Conditions With Similar 1/251
Symptoms - Topic Overview

Finding out exactly what is causing behavioral problems can be difficult, since symptoms
of attention deficit hyperactivity disorder (ADHD) may also be caused by other problems.
The main symptoms of ADHD-inattention, hyperactivity, and impulsiveness-may also
result from:

Giftedness. Some gifted children will show signs of inattention in class. Often they
are not challenged and are bored. So they lose interest in normal class activities. (It
is also possible for a child to be both gifted and have ADHD .)

Undernutrition. Without proper nutrients, especially in the first year of life, a child is
at risk of not developing normally. This includes compromised brain development
and function.

Abuse or neglect. Emotional problems that often result from abusive conditions can
cause a child to have behavior difficulties.

Stressful home environment. Temporary or permanent family or household
situations, such as divorce or a death of a loved one, may cause a child to act
differently than normal. Children can become confused and frightened when there
are major changes in their lives.

Parenting skills. Sometimes parents do not know how to effectively handle
challenging-but normal-behavior in a child. If parents are inconsistent or unsure of
themselves, their child may develop behavior problems.

Alcohol or drug abuse (most common in teens and adults). It is important to
screen for alcohol or drug problems, especially in adults, when evaluating behavior
problems.

Other medical conditions. Some other medical conditions have symptoms similar
to ADHD. These conditions can be the primary cause of symptoms, but can also
occur along with ADHD (coexist). Children with ADHD often have at least one other
condition along with ADHD, such as:

Learning disabilities. Symptoms like those of ADHD, especially inattention, are
common when children are in learning environments that are too difficult for
them.

Conduct disorder.

Oppositional defiant disorder.

https://www.webmd.com/add-adhd/childhood-adhd/tc/adhd-other-conditions-with-similar-symptoms-topic-overview?print=true

10/11/2017 ADHD: Other Conditions With Similar Symptoms-Topic Overview

Depression.

Anxiety disorders.

Tourette's disorder.

Developmental disorders, such as intellectual disability.

A lifelong childhood medical condition with bothersome symptoms, such as
asthma.

Long-term sleep problems, such as sleep apnea.

CONTINUE READING BELOW

In order to best treat symptoms of ADHD , a doctor must carefully investigate these
other possibilities as a contributor to or cause of behavior problems.

When symptoms are primarily a result of ADHD, they develop early in life (before the age
of 7) and get worse when school demands are placed on the child. Symptoms of ADHD
can be expected to continue into adulthood.

WebMD Medical Reference from Healthwise

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this
information.

© 1995-2015 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise,
Incorporated.

NEXT IN ADHD: OTHER CONDITIONS WITH SIMILAR SYMPTOMS 

Health Tools

https://www.webmd.com/add-adhd/childhood-adhd/tc/adhd-other-conditions-with-similar-symptoms-topic-overview?print=true 2/252

ADHD Symptoms

Six of the following nine symptoms: Five for late adolescents and adults:

ADHD predominantly inattentive presentation

□ Fails to give close attention to details or makes careless mistakes
□ Has difficulty sustaining attention
□ Does not appear to listen
□ Struggles to follow through with instructions
□ Has difficulty with organization
□ Avoids or dislikes tasks requiring sustained mental effort
□ Loses things
□ Is easily distracted
□ Is forgetful in daily activities

ADHD predominantly hyperactive-impulsive presentation

□ Fidgets with hands or feet or squirms in chair
□ Has difficulty remaining seated
□ Runs about or climbs excessively in children; extreme restlessness in adults
□ Difficulty engaging in activities quietly
□ Acts as if driven by a motor; adults will often feel inside as if they are driven by a motor
□ Talks excessively
□ Blurts out answers before questions have been completed
□ Difficulty waiting or taking turns
□ Interrupts or intrudes upon others

ADHD combined presentation

□ The individual meets the criteria for both inattention and hyperactive-impulsive ADHD presentations.

These symptoms can change over time, so children may fit different presentations as they get older.

Parent to Parent: Family Training on ADHD® Updated: 12/16/2016
© 2016 by Children and Adults with AƩenƟon-Deficit/HyperacƟvity Disorder (CHADD). All Rights Reserved

53

ADHD and Coexisting Disorders

Just as untreated More than two-thirds of individuals with ADHD have at least one other
ADHD can present coexisting condition. The symptoms of ADHD—constant motion and
challenges in everyday fidgetiness, interrupting and blurting out, difficulty sitting still and need for
life, other disorders constant reminders, etc.—may overshadow these other disorders. But just as
can also cause unnec- untreated ADHD can present challenges in everyday life, other disorders can
essary suffering in also cause unnecessary suffering in individuals with ADHD and their families if
individuals with ADHD left untreated. Any disorder can coexist with ADHD, but certain disorders tend
and their families if to occur more commonly with ADHD. ADHD may coexist with one or more
left untreated. Any disorders.
disorder can coexist
with ADHD, but certain Disruptive behavior disorders
disorders tend to occur
more commonly with About 40 percent of individuals with ADHD have oppositional defiant disorder
ADHD. ADHD may co- (ODD). ODD involves a pattern of arguing; losing one’s temper; refusing to
exist with one or more follow rules; blaming others; deliberately annoying others; and being angry,
disorders. resentful, spiteful and vindictive.

Among individuals with ADHD, conduct disorder (CD) may also be present,
occurring in 27 percent of children, 45–50 percent of adolescents and 20–25
percent of adults with ADHD. Children with conduct disorder may be aggressive
to people or animals, destroy property, lie or steal things from others, run away,
skip school or break curfews. Adults with CD often exhibit behaviors that get
them into trouble with the law.

Mood disorders

In adults, approximately 38 percent of ADHD
patients have a co-occurring mood disorder.
Mood disorders are characterized by extreme
changes in mood. Children with mood
disorders may seem to be in a bad mood
often. They may cry daily or be frequently
irritable with others for no apparent reason.
Mood disorders include depression, mania
and bipolar disorder.

Approximately 14 percent of children with ADHD also have depression,
whereas only 1 percent of children without ADHD have depression. In adults
with ADHD, approximately 47 percent also have depression. Typically, ADHD
occurs first and depression occurs later. Both environmental and genetic factors
may contribute.

Up to 20 percent of individuals with ADHD may show symptoms of bipolar
disorder, a severe condition involving periods of mania, abnormally elevated
mood and energy, contrasted by episodes of clinical depression. If left untreated,
bipolar disorder can damage relationships and lead to job loss, school problems
and even suicide.

Anxiety

Up to 30 percent of children and up to 53 percent of adults with ADHD may also
have an anxiety disorder. Patients with anxiety disorders often worry excessively
about a number of things (school, work, etc.) and may feel edgy, stressed out,
tired and tense and have trouble getting restful sleep.

Tics and Tourette Syndrome

54

Less than 10 percent of those with ADHD have tics or The challenge for the health care professional is to figure
Tourette Syndrome, but 60 to 80 percent of those with out whether a symptom belongs to ADHD, to a different
Tourette Syndrome have ADHD. Tics involve sudden, disorder or to both disorders at the same time. For some
rapid, recurrent, involuntary movements or vocalizations. patients, the overlap of symptoms among the various
Tourette Syndrome is a much rarer, but more severe tic disorders makes multiple diagnoses necessary. Interviews
disorder, where patients may make noises, such as barking and questionnaires are often used to obtain information
a word or sound, and movements, such as repetitive about symptoms from the patient, the family and teachers—
flinching or eye blinking, on an almost daily basis for years. in the case of children—to screen for these other disorders.

Learning disorders

Up to 50 percent of children with ADHD have a coexisting
learning disorder, whereas 5 percent of children without
ADHD have learning disorders. Learning disorders can
cause problems with how individuals acquire or use new
information such as reading or calculating. The most
common learning disorders are dyslexia and dyscalculia. In
addition, 12 percent of children with ADHD have speech
problems, compared with 3 percent without ADHD.

Sleep disorders

One-quarter to one-half of parents of children with ADHD Treatment of co-occurring conditions
report that their children suffer from a sleep problem,
especially difficulties with falling asleep and staying asleep. Decisions about what disorder to treat first depends on
Sleep problems can be a symptom of ADHD, may be made the impairment that those symptoms are producing in
worse by ADHD or may make the symptoms of ADHD the individual’s life. Clinicians work with the patient and
worse. family members, especially with children, to establish an
individually tailored comprehensive treatment plan. These
Substance abuse plans are ongoing and should be reviewed at least annually
to make sure that the treatment options are working and
Research adjust them if necessary.
suggests that
youth with In many cases when an individual has both ADHD and a
ADHD are at co-occurring condition, the health care professional may
increased risk elect to treat the ADHD first because primary treatment
for very early of ADHD may reduce stress, improve attentional
cigarette use, resources and may enhance the individual’s ability to
followed by deal with the symptoms of the other condition. Treatment
alcohol and options for ADHD include behavior therapy, medication,
then drug abuse. skills training, counseling, and school supports and
Cigarette smoking is more common in adolescents with accommodations. These interventions can be tailored
ADHD, and adults with ADHD have elevated rates of to the patient’s and family needs and help the patient
smoking and report particular difficulty in quitting. Youth control symptoms, cope with the disorder, improve overall
with ADHD are twice as likely to become addicted to psychological well-being and manage social relationships.
nicotine as individuals without ADHD.
References
However, research has shown that individuals with
ADHD who are treated with stimulants are not more Adler, L. A., Spencer, T. J., Stein, M. A., & Newcorn,
prone to cocaine and stimulant abuse than others. Indeed, J. H. (2008). Best practices in adult ADHD: Epidemi-
adolescents who are prescribed stimulant medication for ology, impairments, and differential diagnosis. CNS
their ADHD are less likely to subsequently use illegal Spectrums, 13, 1–19.
drugs than are kids with ADHD who are not prescribed
medication. Kooij JJ, Huss M, Asherson P, et al. (2012 July). Dis-
tinguishing comorbidity and successful management
Diagnosis of adult ADHD. Journal of Attention Disorders. 16(5
Suppl):3S-19S. doi: 10.1177/1087054711435361.
As part of the diagnostic process for ADHD, the clinician Epub 2012 Apr 12. Review.
or mental health professional must also determine whether
there are any other conditions affecting the individual that
could be responsible for presenting symptoms. Often, the
symptoms of ADHD may overlap with other disorders.

help4adhd.org 2 55

Larson K, et al. (2011 March). Patterns of comorbid- 3
ity, functioning, and service use for US children with
ADHD, 2007. Pediatrics 127(3):462-70. 56
MTA Cooperative Group. (1999). A 14-month ran-
domized clinical trial of treatment strategies for atten-
tion deficit hyperactivity disorder. Archives of General
Psychiatry, 56, 12.
Pliszka, Steven R. (2015). Comorbid psychiatric dis-
orders in children with ADHD. In Russell A. Bark-
ley (Ed). Attention-deficit Hyperactivity Disorder: A
Handbook for Diagnosis and Treatment (4th ed.), (pp.
140–168). New York, NY, US: Guilford Press, xiii,
898 pp.

This factsheet is supported by Cooperative Agreement
Number NU38DD005376 from the Centers for Disease
Control and Prevention (CDC). The contents are solely the
responsibility of the authors and do not necessarily rep-
resent the official views of CDC. Permission is granted to
photocopy and freely distribute this factsheet for non-com-
mercial, educational purposes only, provided that it is
reproduced in its entirety, including the CHADD and NRC
names, logos and contact information.

© 2015 CHADD.

All Rights Reserved.
For further information about ADHD or CHADD, please
contact:
National Resource Center on ADHD: A Program of
CHADD
4601 Presidents Drive, Suite 300
Lanham, MD 20706-4832
1-800-233-4050
www.help4adhd.org

Please also visit CHADD at www.chadd.org.

help4adhd.org

When ADHD

by Roberto Olivardia, PhD SHUTTERSTOCK / NOMAD SOUL The Fundamental
Assessing for Co-O
A DHD IS RARELY SEEN ALONE. It is the exception rather
than the rule that ADHD is not accompanied by another 57
disorder or condition. Research shows that fifty to sixty per-
cent of those with ADHD have a learning disability, thirty
percent have an anxiety disorder, and twenty percent have bipolar disor-
der. Studies looking at patients with obsessive-compulsive disorder found
that approximately thirty percent of them also have ADHD. The same is
true for patients diagnosed with binge eating disorder. It was no surprise
that Vyvanse, an ADHD stimulant medication, became the first FDA-
approved medication for patients with binge eating disorder.

As a clinician, it is imperative that anyone who has ADHD be assessed
and screened for various other disorders and conditions. Likewise, when
patients are treated for any other problem, like anxiety, depression, or a
substance abuse problem, ADHD should be assessed. Not doing so re-
sults in missing an essential aspect of a person’s experience and therefore
lends itself to inadequate care and treatment. You cannot treat something
you have not identified.

The common scenario is that patients are diagnosed with either
ADHD or the comorbid disorder and that becomes the lens through
which all of their symptoms are seen. For example, someone with ADHD
may manifest their impulsivity in their eating, resulting in eating more
than they intend to. Careful assessment, however, may determine that it
goes beyond that and actually satisfies criteria for a binge eating disorder,
which requires treatment beyond what is indicated for ADHD.

Many times, ADHD can be missed. Too often in clinical settings
little attention is paid to how having ADHD can affect the presenta-
tion, course, and treatment of someone with a psychological disorder or
mental illness. The presence of ADHD absolutely will have an impact on
some aspect of a comorbid disorder.

When treating someone with depression, for example, a therapist may
find that some of the “homework” assigned to a patient does not get com-
pleted, but not because the patient is treatment resistant, ambivalent about
getting better, or simply lazy. It is because having ADHD can make it dif-
ficult to complete tasks that require a certain level of executive functioning
skills. Even attending therapy sessions can be impacted by ADHD symp-
toms. Since time management is an issue for many people with ADHD,
therapists may find these patients showing up late, forgetting about ap-
pointments, having trouble paying bills on time, or not fully paying atten-
tion throughout the 45-50 minute session. Thus, the proper identification
of ADHD is essential when treating a patient with any other disorder.
28 Attention

Is Not Alone

Importance of The first diagnosis “sticks”
Occurring Disorders
In my experience, whatever diagnosis a patient gets first becomes the
one that “sticks,” and all symptoms are fed through that portal. If you are
diagnosed with OCD, then any ADHD symptoms may incorrectly get la-
beled through the OCD lens. For example, a patient with both OCD and
ADHD may have significant time management issues. Unless a therapist
asks carefully about this problem, he/she may assume that the patient is
late due to compulsive rituals the patient may be doing at home, rather
than entertaining that another diagnosis, ADHD, may be the culprit.

The most serious result of not seeing the lens of the comorbid disorder
is when it comes to treating it. For example, having both bipolar disorder
and ADHD is associated with earlier onset of the bipolar disorder, more
completed suicides, higher likelihood to be on disability, increased risk
of any other psychiatric disorder, increased substance abuse risk and
poorer overall functioning as compared to having bipolar disorder alone.
Medications that work for ADHD may trigger a manic episode in bipolar
patients; thus doctors have to be very careful in monitoring medication
effects in ADHD patients with any comorbid disorder.

It is not just clinical mental disorders that are affected by this myopic
view. Parents of dyslexic children will often be told that their child’s reading
problems are a result of ADHD symptoms of inattention, lack of focus, and
motivation deficits. These ADHD traits may all affect one’s reading perfor-
mance. However, a large percentage of ADHD students also have dyslexia, a
language-based learning disability that affects the accuracy, rate, fluency, and
comprehension of reading. Often, all the traits of dyslexia are fed through the
ADHD lens. Parents are told that their undiagnosed dyslexic children need
to just “focus more” or led to believe that stimulant medication will improve
their reading. Then years go by and their seventh-grade child is reading at a
second-grade reading level, with his self-esteem pummeled.

There is a risk to be blind to any comorbid disorder when one has al-
ready been diagnosed with another condition. Sometimes, this blindness
is due to the competence and experience of the therapist that is treating
you. Many times therapists trained in treating Axis I and Axis II disorders,
such as the mood and anxiety and personality disorders, are not exten-
sively trained in ADHD. Therefore their view of ADHD is often limited.
Likewise, therapists who specialize in ADHD also need to understand and
be able to assess other disorders that commonly are seen with ADHD.

When pieces of a puzzle are missing, the complete picture cannot be
seen. Likewise, when pieces of a person’s diagnostic profile are missing or
neglected and therefore not adequately treated, it disables them from be-
ing the whole person that they truly are. ●A

Roberto Olivardia, PhD, is a clinical instructor in the department of psychiatry at Harvard
Medical School. He maintains a private practice in Lexington, Massachusetts.

August 2016 29 58

Understanding
ADHD and

16 Attention 59SHUTTERSTOCK

DYSLEXIA
by Elsa Cárdenas-Hagan, EdD, and Eric Tridas, MD

DID YOU KNOW that some people who have attention disorders can also exhibit a reading disorder such
as dyslexia? It is reported that approximately thirty percent of people with dyslexia also have one type of
attention disorder. Dyslexia is a reading disorder that is language based. at is, the same centers in the brain
that are responsible for language abilities are the ones a ected for reading problems such as dyslexia.

Characteristics of dyslexia eir eye movements are normal. However,
when they read they may appear to have ab-
Processing and manipulating sounds within normal eye movement, which is more a result
words, which is a basic skill needed for of their reading di culties and not the cause
successful reading, can be challenging for of their reading problem.
dyslexics. For example, they have trouble
knowing that the word trip has four sounds: Characteristics of attention disorders
/t/ /r/ /i/ /p/. ey may also have di culty
changing sounds within words. One example Individuals with an attention disorder have
might be: Say the word mat. Change the di culties with some or all of the following
sound /m/ to /b/. e word is bat. is skill is skills or symptoms.
referred to as phonological awareness.
Sustaining attention and concentration are
Reading words accurately is another chal- common de cits in people with ADHD. ey
lenge for dyslexics. is is related to their experience problems with the regulation of
di culty understanding the letter-to-sound attention rather than an inability to pay atten-
correspondences in an alphabetic language. tion. at is, individuals with ADHD struggle
to pay attention to the right thing, at the right
is decreases their ability to read uently. time, for as long as is needed and as in-depth
In turn, if someone cannot read accurately or as required. e problem is not that they can’t
pay attention; they have di culty regulating it.
uently, this can a ect their reading compre-
hension, which is their ability to understand A person that is inattentive may not be an
what they have read. e cient worker because they o en get dis-
tracted. ey make careless mistakes as they
Spelling words correctly, which is related to may not read all the instructions or pay atten-
processing sounds, understanding the letter- tion to details, such as the function symbol in
to-sound correspondences, and spelling rules a math problem.
is another characteristic of dyslexia. Spelling
is important, as it lays the foundation for good Due to their distractibility, inattentive
writing. Some dyslexics may also have dif- persons may not always do as they were told,
may not complete their work, or leave many
culty with handwriting, which inhibits their projects un nished as they start new ones.
written language.
ey may also be less attuned to subtle details.
erefore, dyslexia is a language-based is may impact their reading. For example,
disorder and is not a visual problem. Persons
with dyslexia do not see letters backwards.

June 2015 17 60

reading comprehension may be a ected when they are distracted hensive evaluation should also include tests of written language.
or their mind wanders, because the focus shi s from what they is would include the ability to spell sounds and spell words.
are reading to daydreaming. e ability to construct grammatically correct sentences and

Attention is also critical when a person is rst learning to read paragraphs is an essential component of written language. Spe-
or when trying to decode (sound out) an unfamiliar word. Dys- cial consideration for handwriting can be reviewed as well, since
lexics have trouble sounding out words, but it is not due to inat- many dyslexics exhibit di culty with writing legibly.
tention. It is more related to di culty understanding the letter-
to-sound correspondences. Given how o en ADHD and dyslexia coexist, it is impor-
tant that screening for ADHD is included in a comprehensive
Controlling impulsive behaviors is another symptom that af- evaluation of a person with reading problems. If an individual
fects many people with ADHD. Impulsivity is de ned as the exhibits dyslexia, then it is important that they receive a Struc-
inability to sustain inhibition; that is, the ability to stop and wait. tured Literacy approach for intervention; that is, an evidence-
based approach which will address phonological awareness in
is is o en referred to as re ection, which we de ne as the space addition to learning the sounds and the symbols that represent
between thought and action. Individuals who have the combined those sounds for reading, as well as for spelling and writing. In
or predominantly hyperactive/impulsive types of ADHD have addition, work on semantics or word meanings and word parts is
problems stopping to think about the consequences of their ac- necessary for understanding the text and should be included dur-
tions or to formulate a plan. ey o en don’t stop to consider the ing literacy instruction.
rules that may apply to a particular situation or to re ect on past
experiences. Writing a report can take a long time for them, due e Structured Literacy approach should be delivered in an
to poor planning. People with dyslexia have trouble writing, but it explicit, systematic, sequential and cumulative manner using a
is more related to their di culty with spelling, handwriting, and variety of learning styles. Students with dyslexia need routines
sequencing of words rather than primarily planning abilities. and need to learn the rules for reading, spelling, and writing. e
intervention should be delivered by an educator who has special-
Individuals with ADHD may also interrupt conversations or ized training for dyslexia intervention.
struggle to wait for their turn. Providing the rst response that
comes to mind without considering the details of the questions e International Dyslexia Association is in the process of
can lead to careless mistakes. Sitting still and controlling hyperac- accrediting universities that include Structured Literacy as an
tivity are also frequently seen in individuals with ADHD. instructional reading approach for their teacher training pro-
grams. In the future, parents and school administrators will be
ese symptoms present in three typical forms: overactivity, dg- able to nd teachers who are certi ed in Structured Literacy and
etiness, and excessive talking. When someone frequently gets up can provide high quality reading instruction for students with
from his seat or talks, he is engaging in activities that prevent him dyslexia.
from doing the assigned task. Once again, work productivity su ers.
Students with dyslexia can improve their reading, spelling, and
ese are also disruptive behaviors that can interfere with the work writing skills when provided the right kind of intervention at an
of others. early age. As students improve their reading skills, their willingness
to read may also improve. Because attention problems can have an
ADHD and dyslexia can coexist impact on reading accuracy and comprehension, it is important
that appropriate management of ADHD is provided. Medical man-
Dyslexia and ADHD are two distinct disorders; however, they can agement in conjunction with educational interventions for ADHD
co-exist. It is important to determine if a child’s reading problem can have a positive impact on reading remediation. ●A
is more than inattention or unwillingness to read.
To learn more about dyslexia read the fact sheets on the website
A comprehensive evaluation should be recommended if a stu- of the International Dyslexia Association (www.interdys.org).
dent is exhibiting di culties with reading. For more information on ADHD and dyslexia, see eida.org/
attention-deficithyperactivity-disorder-adhd-and-dyslexia/.
e evaluation should include a test of phonological aware-
ness; that is, a test which measures if the student can process Elsa Cárdenas-Hagan, EdD, is a bilingual speech-language pathologist and a
and manipulate sounds within words. e reading test should certified academic language therapist. She is vice president of the International
be standardized and include reading real and nonsense words. Dyslexia Association.
Many dyslexics memorize words, so a test of nonsense words will
determine if they can actually use their knowledge of letters and Eric Tridas, MD, is a developmental and behavioral pediatrician who specializes
sounds to read new and unfamiliar words. e evaluation should in the management of ADHD, dyslexia, and other neurodevelopmental disorders.
also include a test that measures their ability to read uently and He is the past president of the International Dyslexia Association.
one that measures their ability to understand what they have
read, which is known as reading comprehension.

It is important that the reading tests not only measure the abil-
ity to read words but also sentences and paragraphs. e compre-

18 Attention 61

10/12/2017 Disruptive Behavior Disorders | CHADD

Understanding ADHD | About ADHD | Coexisting Conditions | Disruptive Behavior Disorders

Disruptive Behavior Disorders

Having ADHD along with a coexisting disruptive behavior disorder (ODD/CD) can complicate diagnosis and treatment and also
worsen the prognosis. Even though many children with ADHD ultimately adjust, some (especially those with an associated conduct
or oppositional defiant disorder) are more likely to drop out of school, have fewer years of overall education, have less job
satisfaction and fare less well as adults. Early diagnosis and treatment of these conditions is by far the best defense against these
poorer outcomes.

What are the types of disruptive behavior disorders?

Disruptive behavior disorders include two similar disorders: oppositional defiant disorder (ODD) and conduct disorder (CD).
Common symptoms occurring in children with these disorders include: defiance of authority figures, angry outbursts, and other
antisocial behaviors such as lying and stealing. It is felt that the difference between oppositional defiant disorder and conduct
disorder is in the severity of symptoms and that they may lie on a continuum often with a developmental progression from ODD to
CD with increasing age.

Oppositional defiant disorder (ODD) refers to a recurrent pattern of negative, defiant, disobedient and hostile behavior toward
authority figures lasting at least six months. To be diagnosed with ODD four (or more) of the following symptoms must be present:

often loses temper
often argues with adults
often actively defies or refuses to comply with adults' requests or rules
often deliberately annoys people
often blames others for his or her mistakes or misbehavior
is often touchy or easily annoyed by others
is often angry and resentful
is often spiteful or vindictive.

These behaviors must be exhibited more frequently than in other children of the same age and must cause significant impairment in
social, academic or occupational functioning to warrant the diagnosis.

Conduct disorder (CD) involves more serious behaviors including aggression toward people or animals, destruction of property,
lying, stealing and skipping school. The behaviors associated with CD are often described as delinquency. Children exhibiting these
behaviors should receive a comprehensive evaluation.

Children and adolescents with ADHD and CD often have more difficult lives and poorer outcomes than children with ADHD alone.

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Incidence of ADHD and ODD or CD

Approximately one-third to one-half of all children with ADHD may have coexisting oppositional defiant disorder (ODD). These
children are often disobedient and have outbursts of temper. The rate of children meeting full diagnostic criteria for ODD is similar
across all ages. Males have a greater incidence of ADHD and ODD, as do children of divorced parents and mothers with low
socioeconomic status. Children with the ADHD combined subtype seem to be more likely to have ODD.

In some cases, children with ADHD may eventually develop conduct disorder (CD), a more serious pattern of antisocial
behaviors. Conduct disorder may occur in 25 percent of children and 45 percent of adolescents with ADHD. CD is more commonly
seen in boys than girls, and increases in prevalence with age. Children with ADHD who also meet diagnostic criteria for CD are twice
as likely to have difficulty reading, and are at greater risk for social and emotional problems. Non-aggressive conduct problems
increase with age, while aggressive symptoms become less common.

Given the high co-occurrence of ADHD with disruptive behavior disorders, all children with ADHD symptoms and disruptive
behaviors need to be assessed for the possibility that ODD or CD may be present in addition to ADHD.

Risks of having ADHD and a disruptive behavior disorder

Children with ADHD and CD are often at higher risk for contact with the police and the court system than children with ADHD alone.
These children frequently lie or steal and tend to disregard the welfare of others. In addition, they risk getting into serious trouble at
school or with the police. The risk for legal troubles may be mostly attributable to the symptoms of CD rather than ADHD.

Disruptive behavior disorders and untreated ADHD have been found to lead to an increased risk of substance use disorders. In
addition, adolescents with disruptive behaviors disorders and ADHD are more likely to be aggressive and hostile in their interactions
with others, and to be arrested. It has also been suggested that the greater impulsivity associated with the ADHD may cause greater
antisocial behavior and its consequences. Thus, early recognition and treatment of both the ADHD and disruptive behaviors in
children is essential.

Treatment of ADHD and Disruptive Behavior Disorders

All children with symptoms of ADHD and ODD/CD need to be assessed so that both types of problem behaviors can be treated.
These children are difficult to live with and parents need to understand that they do not need to deal with their ADHD and ODD/CD
child alone. Interventions such as parent training at home and behavioral support in the school can make a difference and parents
should not hesitate to ask for assistance.

Home Interventions

Parent Training (PT): Parent training has been shown to be effective for treating oppositional and defiant behaviors. Standardized
parent training programs are short-term interventions that teach parents specialized strategies including positive attending, ignoring,
the effective use of rewards and punishments, token economies, and time out to address clinically significant behavior
problems. Such training programs may include periodic booster sessions.

Severe cases of CD may require multisystemic therapy, an intensive family- and community-based treatment that addresses the
multiple causes of serious antisocial behavior in youth. This approach is very comprehensive and demanding. The therapist using
such an approach must possess access to developmental and clinical expertise. These intervention services are delivered in a
variety of settings, such as home, school and peer groups. Academic and school-based problems are included and some therapists
work directly with an entire peer group to influence change.

Parent-child interaction therapy is a treatment that teaches parents to strengthen the relationship with their child and to learn
behavior management techniques. It has been found to be effective in the long term for young children with ODD and ADHD. Three
to six years after treatment, the mothers of children with these disorders reported that the changes in their children's behavior and

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their own feelings of control had lasted. Mothers' reports of disruptive behavior decreased with time after treatment.

Collaborative Problem Solving (CPS): Another technique that seems to be promising for children with ADHD and ODD is
collaborative problem-solving (CPS). CPS is a treatment that teaches difficult children and adolescents how to handle frustration and
learn to be more flexible and adaptable. Parents and children learn to brainstorm for possible solutions, negotiate, make decisions,
and implement solutions that are acceptable to both. They learn to resolve disagreements with less conflict.

Family Therapy: Often a child's behavior can have an effect on the whole family. Parents of children with ADHD often report marital
difficulties. Mothers may be more depressed and siblings may also develop behavior problems. Family therapy is critical to helping a
family address these issues and cope with the realities of having a child with ADHD and disruptive behaviors. Seeking out a
counselor or family therapist in your neighborhood can help the entire family address these issues.

School Interventions

School-wide Positive Behavioral Supports: In addition to the environment at home, the school can have a significant impact on a
child's behavior patterns. Many school systems now have programs in place to provide school-wide positive behavioral supports. The
aim of these programs is to foster both successful social behavior and academic gains for all students. These programs consist of:
(1) clear, consistent consequences for inappropriate behaviors; (2) positive contingencies for appropriate behaviors; and (3) team-
based services for those students with the more extreme behavioral needs.

Tutoring: Children's ADHD symptoms, as well as oppositional symptoms, have been found to be significantly lower in one-on-one
tutoring sessions than in the classroom.

Classroom Management: Providing appropriate instructional supports in the classroom can also lessen disruptive behavior. These
include: creating an accepting and supportive classroom climate, promoting social and emotional skills, establishing clear rules and
procedures, monitoring child behavior, utilizing rewards effectively, responding to mild problem behaviors consistently and effectively
managing anger or aggressive behavior.

Medication

Overall results from several clinical studies indicate that medications used for the treatment of ADHD (stimulants as well as non-
stimulants) remain an important component in the treatment of ADHD and coexisting ODD/CD. Children with these disorders treated
with these medications were not only more attentive, but less antisocial and aggressive. ADHD medications are often effective
treatments for aggressive or antisocial behavior in patients with ADHD and certainly play a role in any treatment program. See
Managing Medication for Children with ADHD for more information.

In addition to using stimulant medications alone, medication combinations to reduce behavioral and conduct symptoms associated
with attention-deficit/hyperactivity disorder appear to be very effective. In several studies, this treatment combination was reported to
be well tolerated and unwanted effects were transient.

What can a parent do?

To increase the chance for a successful future and to discourage delinquent behaviors in children with ADHD, diagnosis and
intervention is extremely important. It is essential for parents to provide structure and reinforce appropriate behavior. In addition, a
positive behavior management plan to lessen anti-social behavior is important. Parents should discuss their child's behavioral
symptoms with the pediatrician or family practitioner and seek a referral to a mental health professional who can suggest effective
parenting strategies.

In addition, parents should contact their child's school counselor or school psychologist to discuss possible interventions to improve
behaviors at school. Having the counselor or psychologist support the teacher in handling classroom behaviors often results in
significant behavioral changes and decreases the incidence of expulsion. Consistent behavior management at home, school and
elsewhere needs to be enforced.

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For more information and further reading

Barkley, Russell. (1998). Your defiant child: 8 steps to better behavior . New York, NY: Guilford Press. This book is divided into two
parts, "Getting to Know Your Defiant Child" and "Getting Along with Your Defiant Child." Part two contains an eight-step parenting
program built on consistency.

Clark, Lynn. (1996) SOS! Help for parents . Berkeley, CA: Parents Press. This book helps parents learn methods for helping children
to improve their behavior and techniques for aiding a variety of child personalities, from the stubborn and willful child to time-out
basics. It focuses on the basic skills of time-out and how parents can use these techniques to further a child's behavior modification.

Forgatch, Marion S. and Gerald R. Patterson. (2005) Parents and adolescents living together: Family problem solving. Champaign,
IL: Research Press. This book shows parents how to improve their communication and problem-solving skills, hold family meetings
and get the whole family involved in solving problems. It explains how parents can teach their teenaged children to be responsible
about schoolwork, sexual behavior and drugs and alcohol.

Goldstein, Sam; Robert Brooks and Sharon K. Weiss. (2004) Angry children, worried parents: Seven steps to help families manage
anger . Plantation, FL: Specialty Press. This book helps parents cope with anger in their children. It presents the following seven
steps to help children learn to manage anger: (1) understand why children become angry; (2) determine when your child needs help;
(3) help the child become an active participant in the process; (4) use strategies to manage and express anger; (5) develop and
implement a daily management plan; (6) assess and solve problems; and (7) instill a resilient mindset in the child.

Follow

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Join CHADD
Attention Magazine

http://www.chadd.org/Understanding-ADHD/About-ADHD/Coexisting-Conditions/Disruptive-Behavior-Disorders.aspx

Autism, SHUTTERSTOCK
Asperger’s
24 Attention Syndrome,

and ADHD

by Edward B. Aull, MD

Our thinking about Asperger’s syndrome and ADHD has
changed significantly since I last wrote on this topic for
Attention magazine (April 2003). Today, people are much
more likely to have heard of Asperger’s syndrome and
know that it is a mild form of autism. Not only is the
public more aware but so are the schools, and there-
fore autism spectrum disorders are much more
likely to be suspected and diagnosed today,
compared to ten years ago.

The incidence of ADHD in the general population is
about eight to ten percent. The incidence of any autism
spectrum disorder is currently thought to be about one in
eighty-eight children, or a bit more than one percent. In
1990, the incidence of an autism spectrum disorder was
thought to be four per ten thousand. A careful study by the
National Institute of Health revealed an incidence of 12.3
per ten thousand. In that study, seventy percent of patients
who met criteria for an autism spectrum disorder also met
criteria for intellectual disability. We now know that there
are individuals with an autism spectrum disorder who are
not only of normal intelligence, but are actually gifted. Most
of the large increase in incidence of the diagnosis of autism
spectrum disorders is related to better recognition and di-
agnosis of the more common milder types, which in the
DSM-IV included Asperger’s syndrome.

In the DSM-V, Asperger’s syndrome has been subsumed
into a broad category of autism spectrum disorder. However,
I believe the term will continue to be utilized, at least with
the public, if not in research studies. The incidence of the
more severe forms of autism has not significantly increased.
Individuals with milder forms of autism spectrum disor-
ders, such as Asperger’s syndrome or PDD-NOS (pervasive

66

developmental disorder—not otherwise specified), are much Individuals with Asperger’s syndrome have more trouble
more likely to be diagnosed with only ADHD or anxiety plus with ADHD treatment, mostly because of their innate co-
ADHD, than those with more severe forms of autism where morbid anxiety issues. Many of the medications used in
the social issues, anxiety issues, and repetitive or ritualistic ADHD can “pressure” anxiety and cause patients with As-
movements, such as hand flapping, are more obvious. perger’s syndrome to be less comfortable or even fearful.
Thirty-one percent of people with ADHD have a comorbid
When the DSM-IV was published in 1994, it brought As- anxiety disorder, and may have similar outcomes, but peo-
perger’s syndrome to the forefront through its inclusion as ple with Asperger’s syndrome are almost uniformly affected.
a separate clinical diagnosis under Pervasive Developmental It often requires a doctor with experience in treating autism
Disorders. According to the DSM-IV, a diagnosis of ADHD spectrum disorders to achieve the best outcome in someone
or Asperger’s syndrome excluded one another. Therefore, if with ADHD and autism, although it is not required.
you made a diagnosis of ADHD in a patient, the individual
could not have a diagnosis of Asperger’s syndrome and vice Although the diagnoses are not always
versa. Since then, studies in the USA and abroad have shown
that ADHD may be a significant issue in autism spectrum easily di erentiated, Asperger’s syndrome
disorders (most studies cite an incidence of thirty-five to
eighty percent) and is going to require treatment for good is important to consider when someone
patient outcome. It has also been shown that individuals with
autism spectrum disorders are much more likely to have side thought to have ADHD is not doing well.
effects from stimulant therapy for their ADHD.
Changes in the DSM-V
When diagnosis is incomplete According to the DSM-V, ADHD may be included as a part
I have long defined autism spectrum disorders as a mix of of the diagnosis of individuals with autism spectrum disor-
ADHD, anxiety, and a language-based learning disability, ders that may require treatment. Many of the medications
where language is taken too literally and body language is for ADHD work, at least in part, by improving the effects of
poorly understood. I see that many individuals with mild dopamine in the brain. This is very effective for ADHD but
Asperger’s syndrome are often diagnosed by their family it can worsen anxiety in someone with ADHD and anxiety
and by their doctors as having only ADHD, because the disorders. Individuals with Asperger’s syndrome are indi-
anxiety and the language difficulties may be overlooked or viduals with ADHD and anxiety.
poorly understood. In someone with a mild condition, it
often requires prolonged symptom review by the evaluator It is important to discern whether Asperger’s syndrome
to “discover” the correct diagnosis. It is not that the diag- might be a diagnosis for multiple reasons. People with As-
nosis of ADHD is incorrect, it’s incomplete. perger’s syndrome have more social difficulties than people
with ADHD alone. In fact, although frequently mentioned,
I recently saw a patient, a college junior who was referred social difficulties are not part of the DSM-IV or DSM-V
by his school for an evaluation for ADHD. His history was diagnostic criteria for ADHD but are a major component
significant for symptoms of ADHD, but it was also signifi- for an autism spectrum disorder diagnosis. Individuals with
cant that he has a brother with high-functioning autism. Asperger’s syndrome have difficulty joining into groups
One has to be at least suspicious that this student may have and are often bullied by others. Certainly individuals with
ADHD, but he may also have a milder form of Asperger’s ADHD may have trouble with bullies, but those with As-
syndrome. I could not make a conclusive diagnosis of As- perger’s syndrome are quite gullible and can be easily set
perger’s syndrome and I could for ADHD. When I selected up to get in trouble.
a medication, however, I picked one that was less likely to
aggravate anxiety and social quietness in case he has more Studies show that in ADHD, thirty-one percent of chil-
than “simple ADHD.” One significant fact in his history dren and about fifty percent of adults suffer with anxiety,
(that might suggest Asperger’s syndrome) was that while but anxiety should always be present to some degree in in-
he had dated girls, it seemed to always be “one date and dividuals with an autism spectrum disorder. Many of the
gone,” and he did not know why. medications used to treat ADHD affect dopamine. Dopa-
mine is good for ADHD symptoms but it aggravates anxi-
Typically, if someone begins taking stimulant medication ety. If the doctor understands that the patient has Asperger’s
for ADHD and he or she actually has Asperger’s syndrome,
there will be less than ideal results. A common result is that
the medication may work for three or four months and
then cease to be effective. Perhaps the dose is raised or the
medication is changed to another stimulant, and it works
for a while and then again ceases to be effective. Another
common effect is to increase attention, but the person fo-
cuses mostly on anxiety and becomes worse.

February 2014 25 67

syndrome, therapy can be adjusted to protect the anxiety, anxiety and return to school when the new semester starts.
typically with the addition of an SSRI (selective serotonin This student has a particular academic interest and wants
reuptake inhibitor). In a patient with an autism spectrum
disorder, anti-anxiety therapy with an SSRI is frequently go- to become a professor. This could work well for him as a
ing to be required so that the patient can tolerate the use of profession. But if he had been in business management, ho-
an ADHD medication, especially a stimulant medication. It tel management, or personnel management, his education
is not rare to see a patient who has tolerated a low dose of a would not have fit well with his Asperger’s syndrome diag-
stimulant medication, but who requires treatment of anxiety nosis in the “real world.” Knowing a patient has Asperger’s
with an SSRI in order to tolerate an adequate dose. syndrome may be helpful, even while in school, in selecting
certain occupations or at least avoiding some.
Individuals with Asperger’s syndrome are much more
likely to say the wrong thing, at the wrong time. This trait is Scientific study suggests that ADHD is a part of autism
sometimes attributed to ADHD, but it is much more typical spectrum disorders and the treatment of ADHD and anxiety
of someone with Asperger’s syndrome. is helpful in achieving good outcome in school and employ-
ment. Recognition that a person doesn’t simply have ADHD,
I recently saw a senior in college who’d had to drop out of but also has Asperger’s syndrome or another autism spec-
school due to extreme anxiety. Diagnosed with ADHD many trum disorder, may lead to better school and occupational
years before, he was thought to have been adequately treated results. Although the diagnoses are not always easily differ-
and made very good grades. It is quite possible that he never entiated, Asperger’s syndrome is important to consider when
told the doctor about his anxiety or his mild social issues—or someone thought to have ADHD is not doing well. ●A
maybe the doctor never asked. His situation came to a major
head in the fall of his senior year, when he had to drop out of With a specialization in developmental behavioral pediatrics
school due to high anxiety and inability to sleep. This poor and psychiatry, Edward Aull, MD, practices in Indiana. He is
result might have been avoided with the correct diagnosis the author of The Parent’s Guide to the Medical World of
and appropriate treatment of anxiety and autism at an ear- Autism: A Physician Explains Diagnosis, Medications and
lier time. He should respond to appropriate treatment for Treatments (Future Horizons, 2014).

SAVE THE DATE!

26 Attention 2014 CHADD
Annual International
Conference on ADHD

Chicago, IL
Nov. 13–15, 2014

CHADD does not endorse products, services, publications, medications or treatments, including those advertised in this magazine.

68

ADHD, Sleep and Sleep Disorders

Growing evidence has Although sleep problems can affect anyone in the general population, people
shown sleep disorders with ADHD are more likely to have sleep disorders. How ADHD and sleep are
are more common in related can be complex. Sleep problems can be a symptom of ADHD, may be
individuals with ADHD. made worse by ADHD or may make the symptoms of ADHD worse. Not all
However, whether people with ADHD suffer from sleep problems, but because such difficulties
people with ADHD can cause distress in people with ADHD and their families, it is important to
have more difficulties understand the nature of these problems and how they relate to ADHD.
settling down at
bedtime that are not Despite much research, how sleep, ADHD, medication and other disorders are
related to outside related remains uncertain. Scientists are working to develop a clearer idea how
factors, co-existing the different regions of the brain interact and overlap for attention, sleep and
conditions or sleep
disorders remains a functioning.
question.
Children with ADHD and
sleep problems

One-quarter to one-half of
parents of children with
ADHD report that their
children suffer from a
sleep problem, especially
difficulties with falling asleep
and staying asleep. Based
on parent reports, kids with
ADHD are two to three times
more likely to have sleep problems when compared to kids without.

Inadequate sleep in children can negatively affect the way kids think, function
and behave. In addition, children who have problems sleeping may show
symptoms, behaviors or impairments that are remarkably similar to those
of ADHD. Sleeping problems have been shown to induce hyperactivity,
impulsivity or behavioral problems in children. The hyperactivity may be
paradoxically a response to daytime sleepiness. In studies, parents have
reported ADHD-like symptoms in typically developing children when the
kids don’t sleep long enough. To make diagnosing more difficult, the use of
psychostimulant medications to treat ADHD can cause sleep problems in some
patients but can improve sleep in others.

Causes of sleep problems in individuals with ADHD

Growing evidence has shown sleep
disorders are more common in
individuals with ADHD. However,
whether people with ADHD have
more difficulties settling down at
bedtime that are not related to outside
factors, co-existing conditions or
sleep disorders remains a question. In
other words, does ADHD itself lead to
difficulty sleeping or are people with
ADHD more susceptible to external environmental aspects that affect normal
sleep patterns?

69

Here are some specific causes of sleep problems that can population is around 2 percent. In individuals with

impede sleep in children or adults with ADHD. ADHD, RLS is one of the most frequent sleep

• Bedtime resistance: Children with ADHD may have disorders. Up to 44 percent of people with ADHD

may have RLS symptoms, and up to 26 percent of

a great deal of difficulty settling down in the evening. people suffering RLS may have ADHD or symptoms

Interruptions during bedtime routines can be more of ADHD. Daytime symptoms of RLS can mimic

challenging when the child has ADHD, and parents ADHD symptoms, such as restlessness and inattention.

often describe [For more information, see the National Institute of

increased bedtime Neurological Disorders and Stroke (NINDS) fact sheet

resistance and on RLS (http://www.ninds.nih.gov/disorders/restless_

struggles. legs/detail_restless_legs.htm) or the Restless Legs

• Stimulants: The Foundation at www.rls.org.]

caffeine found • Sleep Disordered Breathing (SDB): The term

in coffee, tea, sleep-disordered breathing (SDB) describes a spectrum

chocolate and of conditions ranging from obstructive sleep apnea

many carbonated (OSA) to primary snoring. SDB has been consistently

beverages have long been known to increase problems associated with neurobehavioral and neurocognitive

with sleep. Also, the stimulant medications used to treat deficits, including inattentive or ADHD-like symptoms.

ADHD can contribute to sleep disorders in people with

ADHD. The frequency of SDB in children with ADHD is

• Co-existing conditions: In addition to primary sleep approximately 25–30 percent compared with 3 percent

in the general population. In addition, obesity has been

disorders, sleep problems in people with ADHD can associated with ADHD in up to 40 percent of

also be the result of common co-existing conditions. individuals, and obesity is associated with higher

Anxiety and depression disorders can lead to frequency of SDB. Together, these data suggest a

difficulties with sleeping and are two conditions often complex interplay between ADHD, obesity and sleep

found to exist with ADHD. Drug and alcohol abuse problems. It is not clear if difficulties arising from SDB

problems also have a negative impact on a person’s make existing ADHD symptoms worse in general, or

ability to sleep properly. only in a subset of people with ADHD.

Common sleep disorders among people with • Circadian-rhythm sleep disordersThe human
ADHD
body undergoes physical, mental and behavioral

changes throughout a 24-hour cycle, responding to

Since sleep disorders can be related to ADHD or may result light and darkness throughout the day. The patterns of

in ADHD-like symptoms, screening for sleep problems and these changes are known as circadian rhythms. The

disorders is recommended during initial assessment and main feature of circadian-rhythm sleep disorders is the

ongoing management of patients with ADHD. The most mismatch of sleep pattern timing with the day-night

common sleep problems that children with ADHD have earth cycle leading to disrupted sleep and impaired

are unwillingness to go bed, difficulties waking up in the functioning.

morning, trouble falling asleep at night, breathing issues

during sleep, night waking and daytime sleepiness. One of the

most common

Other sleep problems reportedly associated with ADHD in problems in this

children and adults include trouble falling asleep, trouble category is a

staying asleep, waking up in the middle of the night, sleep delayed sleep-

walking, snoring, breathing difficulties, restless sleep, phase disorder,

nightmares, daytime sleepiness, delayed sleep phase, short where sleeping

sleep time and anxiety around bedtime. and waking

occur later

The following are some of the most common sleep than normal.

disorders in children and adults with ADHD: This disorder

• Restless Legs Syndrome (RLS) and Periodic may show up

Limb Movement Disorder (PLMD): RLS is a as difficulty

getting to

neurological disorder characterized by an irresistible sleep, staying

urge to move the legs to relieve uncomfortable up too late

sensations while the person is at rest. PLMS is a and difficulty

characterized by periodic limb movement during waking.

the sleep. The frequency of RLS in the general 2

help4adhd.org/ 70

Such sleep problems are common during adolescence frequent daytime sleepiness than children who do not have 71
in general, resulting in decreased total sleep time ADHD.
and daytime sleepiness. However, there is evidence
to suggest that those problems are more common in Sleep questionnaires provide a wider view of the problem
individuals with ADHD. over time. However, they rely on the interpretations of the
parents and other caregivers to provide information.
Diagnosis
Depending on the severity of the sleep problems, th
Screening for possible sleep problems should be part clinician will decide which assessment measurements to
ofthe evaluation of every person with behavioral and/or use.
academic problems, especially ADHD. Identifying any
sleep problems before prescribing medication will help the Management of sleep problems in individuals
clinician to decide the best treatment and monitor the side with ADHD
effects more efficiently.
If a sleep problem is suspected, the evaluating clinician As part of a multimodal treatment plan for patients
should take a thorough sleep history. The history should with ADHD, special attention needs to be given to
include questions about the usual bedtime, time required interventions that focus on improving sleep and bedtime
to fall asleep, night awakenings, snoring, difficulty waking behavior. The National Sleep Foundation (NSF) offers
up, naps and daytime drowsiness. Patients may be asked tips to help adults and children sleep better. The following
to fill out a sleep diary that records daily sleep behaviors suggestions may help to accomplish a smoother transition
for a number of weeks. from wakefulness to restful sleep.

When clinicians diagnose ADHD, they must rule out • Practice good sleep habits. Maintain a regular bed
other conditions as the source of the symptoms as well and wake schedule, even on weekends; avoid caffeine
as determine whether there are any other psychiatric or after late afternoon; avoid nicotine and alcohol close
neurological disorders present. Often, the same symptoms to bedtime; use the bed for sleeping only and avoid
overlap in different disorders. The problem for the clinician having children watch television or videos before
is to discern whether a symptom belongs to ADHD, to a bedtime.
different disorder or to both disorders at the same time.
For some individuals, the overlapping of symptoms can • Set up a realistic time for bed, and stick to that
indicate the presence of multiple disorders. In addition, schedule. Behavioral techniques may be necessary to
some conditions that can co-occur with ADHD may be help children with ADHD stay in bed. Children with
affected by or associated with sleep problems. The clinician ADHD do better with structure and knowing what to
will use interviews and questionnaires as part of the expect ahead of time.
diagnostic process to obtain information from the patient,
the patient’s family, and his or her teachers to screen for • Pay attention to the room environment. Keep the
these other disorders. bedroom dark, quiet, cool and comfortable for the
best sleep. Using a fan or humidifier to create white
If a sleep disorder is suspected, the clinician can noise can help. Minimize potential interruptions, such
recommend further evaluation. Full assessment of sleep as outside noise; keeping televisions, computers,
may be done using a combination of measurements, some videogames and other electronic equipment out of the
using devices to monitor waking and sleeping patterns bedroom helps create a sleep-friendly environment.
and others relying on reporting (parent or self-rated The light emitted from electronics can delay the
questionnaires or diaries). release of the sleep-inducing hormone melatonin. In
addition, these devices can overstimulate the brain,
One of the most common assessments is the use of a sleep making it harder to go to sleep.
study or polysomnography, which is usually conducted
in a sleep laboratory. Machines monitor brain waves; • Get plenty of exercise during the day. Exercise
cardiac, muscle and eye activity; breathing patterns and helps dissipate hyperactivity and feelings of
the oxygen level in the blood. Sometimes these sessions restlessness in those with ADHD. However, exercising
use audiovisual recording as well. Although this type of close to bedtime can make it more difficult to fall
sleep study is considered the best objective measurement of asleep, so exercise should be completed at least three
sleep, it has many limitations. The fact that the study occurs hours before bedtime.
in a laboratory and unfamiliar environment with the person
hooked up to machines can affect the traditional and natural • Monitor eating times. Eating heavily too close to
sleep patterns, especially in children. bedtime can inhibit a good night’s sleep. However,
because some children with ADHD don’t get enough
Nevertheless, sleep studies show that children with ADHD calories throughout the day to maintain proper
tend to move their limbs more, sleep less, are more likely nutrition, a small snack close to bedtime can ease
to experience symptoms of sleep apnea, take longer to fall bedtime hunger pains and help maintain a healthy
asleep, experience shorter true sleep time and have more weight.

help4adhd.org/ • Establish a routine. People benefit from a relaxing
routine at the end of the day. This helps ease the
transition from the activities of the day to the calm

3

• Consult your doctor if necessary. Using prescribed
or over-the-counter medications to improve sleep is a
decision that needs to be made with a physician. Type
of medication, duration and side effect are some of
the considerations that need to be taken into account
before starting any medication for sleep problems.
Medications can affect people differently. Discuss
any medication taken with a physician to determine if
there are any side effects that could affect the quantity
or quality of sleep.

This factsheet is supported by Cooperative Agreement
Number NU38DD005376 from the Centers for Disease
Control and Prevention (CDC). The contents are solely
the responsibility of the authors and do not necessarily
represent the official views of CDC. Permission is granted
to photocopy and freely distribute this factsheet for non-
commercial, educational purposes only, provided that it is
reproduced in its entirety, including the CHADD and NRC
names, logos and contact information.

©2015 Children and Adults with Attention-Deficit/
Hyperactivity Disorder (CHADD)

For further information please contact:
National Resource Center on ADHD
CHADD
4601 Presidents Drive, Suite 300
Lanham, MD 20706

www.help4adhd.org
Please also visit CHADD at www.chadd.org.

help4adhd.org/ 4

72

Some children with ADHD and Tics or Tourette Syndrome
ADHD may develop
a simple motor tic ADHD frequently co-occurs in children with Tourette Syndrome. Less than 10
disorder that first percent of those with ADHD have Tourette’s, but 60 to 80 percent of children
appears during with Tourette Syndrome have ADHD. The ADHD diagnosis usually precedes
the course of their the onset of the motor or vocal tics of Tourette’s, although sometimes the two
treatment for ADHD. occur together. Some children with ADHD may develop a simple motor tic
disorder that first appears during the course of their treatment for ADHD. While
these two conditions appear linked in time, most experts believe that the co-
occurrence in most cases is purely coincidental and not caused by ADHD or its
treatment.

What is a tic?

Tics are defined as sudden, rapid, non-rhythmic movements or sounds that
people do repeatedly. They may commonly include such behaviors as eye
blinking, mouth opening, sniffing or throat clearing. Tics are common in
childhood but do not continue into adulthood in most cases. Males are more
affected than females in a ratio of 4.4 to 1. The occurrence of tics can be
temporary, lasting less than 12 months, or chronic.

Tics can be either simple or complex. Simple tics are short in duration and
involve a single muscle group. Complex tics are longer in duration and often
include a series of simple tics. Motor tics may range from simple movements
such as eye blinking, lip licking, or mouth opening to more complex movements
like facial grimacing, head movements, shoulder shrugging or combinations of
these. Vocal tics many include throat clearing; coughing; barking; unnecessary
belching; or more complex vocalizations such as repeating parts of words or
phrases or, in rare cases, saying obscene words.

Tic Disorders and Tourette Syndrome

The Diagnostic and Statistical
Manual, Fifth Edition (DSM
5), outlines the symptoms of
three tic disorders: provisional
tic disorder, persistent
(chronic) motor or vocal
tic disorder, and Tourette’s
disorder. Each of these
disorders is characterized by
the presence of motor or vocal
tics, and which disorder is
diagnosed is determined by
the severity of the symptoms.
The most severe of these is
Tourette’s disorder or Tourette’s Syndrome.

Tourette Syndrome is a complex, genetically inherited disorder whose primary
symptoms include tics (both motor and vocal) lasting for more than one year,
beginning before age 18. Tourette Syndrome is usually mild, and a large number
of patients tend to improve as they get older. Tourette Syndrome is often
accompanied by other conditions including ADHD and obsessive-compulsive
disorder in more than half of the patients as well as learning disabilities
and mood disorders. More than half (57.1 percent) of patients with Tourette
Syndrome have a family history of the disorder.

73

Diagnosis individual’s needs, and the most troublesome symptoms
should be targeted first.
As part of the diagnostic process for ADHD, the health care
professional must determine whether there are any other Behavioral Intervention
conditions affecting the individual. Often, the symptoms of
ADHD may overlap with other disorders. The challenge for For many children with ADHD and Tourette Syndrome,
the professional is to figure out whether a symptom belongs medicating the tics may not be necessary. Growing
to ADHD, to a different disorder or to both disorders at the evidence shows that behavioral interventions can cause
same time. a substantial reduction of tics. Practice on how to control
tics in everyday situations can be part of therapy sessions,
and self-monitoring (counting tics) has been shown to
have temporary but significant benefit. Habit reversal
therapy is an intervention consisting of awareness training
and competing response training. A competing movement
is done for three minutes after each tic and after each
sensation that a tic is about to occur.

In the case of tics, the intermittent nature of the condition Comprehensive behavioral intervention for tics (CBIT) 74
may make it difficult to identify in its early stages. includes guidance for parents on what makes tics better or
However, over time, a pattern of motor tics and other worse, relaxation techniques and strategies to reduce tic
behaviors will emerge. During the assessment process, it severity. CBIT is based on the fact that tics are preceded
is important to determine the frequency of the symptoms by a warning sensation that signals that a tic is on its way.
and the degree to which the tics and other behaviors The Tourette Syndrome Association also recommends
impair functioning. Patterns associated with the tics (for counseling for individuals and their families on dealing
example, are they brought on or made worse by stress or with tic symptoms, rejection by peers, school problems and
tiredness) may also be key in recommending appropriate a host of other issues.
modifications or strategies to deal with them.
Medication
Treatment
After a proper assessment and trying behavior therapy,
In many cases when a child has both ADHD and tics, the medication may still be necessary in children with ADHD
health care professional may elect to treat the ADHD first and Tourette Syndrome. Mild symptoms can usually be
because primary treatment of ADHD may reduce stress, treated with clonidine or guanfacine. Clonidine can be
improve attention and sometimes reduce tics by enhancing given by skin patch or in pill form. Clonidine or guanfacine
the individual’s ability to suppress tics. Treatment have the advantage of treating all the symptoms of TS―
options for ADHD include medication, skills training, the tics, the ADHD, obsessive-compulsive behaviors, and
counseling, behavior therapy, and school supports and oppositional and other behaviors. The major side effect of
accommodations. These interventions can help the patient these two medications is falling asleep or tiredness if the
control symptoms, cope with the disorder, improve overall dose is too high or
psychological well-being and manage social relationships. raised too rapidly.

Tics may only need to be treated if they are causing Any treatment
significant problems. In mild cases of tics or Tourette with stimulant
Syndrome, education and reassurance for the patient and medications should
family may be sufficient. Psychological interventions, be closely monitored
including counseling, behavior modification and skills for side effects,
training, should be guided by an individual treatment plan especially the
that includes family and school needs. presence or increase
of tics. In the past,
The use of medications, however, may be considered the use of stimulants
when symptoms interfere with peer relationships, social had not been recommended when tics or Tourette
interactions, academic or job performance or with activities Syndrome was present; however, recent studies report
of daily living. Therapy should always be geared to the that short-term use of stimulant medications, especially
methylphenidate (Ritalin, Concerta), seem to be safe and
help4adhd.org well tolerated in children with chronic tics or Tourette
Syndrome with co-occurring ADHD. Children who were
given methylphenidate did not develop more frequent
tics when compared with those who were not given the
medication. However, frequency of tics seems to be higher
with dextroamphetamines (Dexedrine, ProCentra) than
compared with methylphenidate.

2

If a child has already been diagnosed and treated with 3
stimulants and significant tics develop, the physician may
elect to stop treatment with stimulants, decrease the dose 75
or change to other stimulant medication until the tics are
treated and under control. In some cases, the benefits of the
stimulant medication outweigh the mild impact of the tics.
Other medications may also benefit the ADHD symptoms
and have some impact over the tics.

For more information on Tourette Syndrome:

National Tourette Syndrome Association
http://www.tsa-usa.org/

National Institute of Neurological Disorders and Stroke
Tourette Syndrome factsheet

The information provided in this sheet is supported by
Cooperative Agreement Number 1U84DD001049 from the
Centers for Disease Control and Prevention (CDC). The

contents are solely the responsibility of the authors and
do not necessarily represent the official views of CDC.
Permission is granted to photocopy and freely distribute
this factsheet for non-commercial, educational purposes
only, provided that this document is reproduced in its
entirety, including the CHADD and NRC names, logos
and all contact information. Permission to distribute this
material electronically without express written permission

is denied.
©2015 Children and Adults with Attention-Deficit/

Hyperactivity Disorder (CHADD).
For further information please contact:
National Resource Center on ADHD
Children and Adults with Attention-Deficit/Hyperactivity

Disorder
4601 Presidents Drive, Suite 300

Lanham, MD 20706

www.help4adhd.org

Please also visit CHADD at www.chadd.org.

help4adhd.org

My Child’s Strengths Parent to Parent:
Family Training on ADHD
My Child’s Strengths

1. _______________________________________________________________
2. ______________________________________________________________
3._______________________________________________________________
4._______________________________________________________________
5._______________________________________________________________

Issues that need to be addressed:

1. _______________________________________________________________
2. ______________________________________________________________
3._______________________________________________________________
4._______________________________________________________________
5._______________________________________________________________

Parent to Parent: Family Training on ADHD® Updated: 12/16/2016
© 2016 by Children and Adults with AƩenƟon-Deficit/HyperacƟvity Disorder (CHADD). All Rights Reserved

76

In partnership with Primary Children’s Hospital

ADHD: Talking with Your Child

If your child has been diagnosed with ADHD, you may If your child has been diagnosed with ADHD, it’s
be wondering, “Should I talk to my child about the important to talk with your child about what this means.
diagnosis, and what should I say?” This fact sheet explains
why it’s important to talk to your child about his ADHD, •• Gear the conversation to your child’s perspective.
how to shape the conversation, and how to help your child Stick with language that is familiar to your child
adjust to the diagnosis and treatment. and use metaphors to help create mental pictures (see
the example conversation on page 2 for ideas). Avoid
Should I talk to my child technical terms — just say “ADHD.”
about the diagnosis?
•• Discuss your child’s fears. Your child may wonder if
Most child experts say that yes, you should talk to your ADHD is dangerous. It can help to explain that lots of
child about ADHD. Knowing what’s causing symptoms people have ADHD — and they have great lives.
can be a relief for your child, who may have been labeling
himself as “stupid” or “lazy” as a result of not knowing •• Emphasize positive goals. Talk about the benefits
why he’s different from his peers. of treatment — like free time because homework is
finished more quickly, getting along better with friends,
Talking about ADHD gives your child a chance to ask keeping up in class, or enjoying more privileges.
questions. It also helps your child see why treatment is
helpful, which increases the chance that your child will •• Describe treatment as a way to help your child be
take an active part in it. in control, rather than the ADHD being in control.
See page 3 for ideas on how to help your child adjust
What approach should I take? to treatment.

There’s no one right way to talk about this topic, and of
course as a parent you know what will work with your child.
Here are some general suggestions that may be helpful:

•• Work with your child at his own pace, looking for
“teachable moments.” A child may not be ready for a
full conversation about this topic all at once.

•• Affirm your child’s unique strengths. Explain that
everyone has unique strengths and weaknesses. Use
yourself and other family members as examples.

•• Acknowledge the difficulties your child has been
having. To introduce the topic, focus on what your
child has said he’s concerned or frustrated about, such
as waiting his turn or having trouble sitting still.

1

77

An example conversation Treatment and outlook:

The example conversation below is geared for an “You’ll start taking medicine every day for ADHD. Just like
elementary school child — you can adjust it for your glasses help someone’s eyes to focus, the medicine helps
child’s age and needs. Don’t worry about covering your brain to focus. We’ll also work together on ways
everything at once. You’ll probably find many chances to you can practice “putting on the brakes” and paying
talk about this topic. attention. We’ll set some goals and you’ll get better and
better. I won’t have to put you in time out so much, and
The reasons for the ADHD evaluation: things will probably go more smoothly at school, too.

“This year has been kind of tough, and school hasn’t been I think things will start feeling a lot better for you. You’ll
fun for you. And you know how I’m always getting on always have ADHD, but you’ll learn to manage it. Lots of
you about fighting with your sister and not staying at the successful people have ADHD — and they do great things
table during dinner? We wanted to find out if there’s a in life.” (See page 4 for examples.)
reason some of these things are happening. That’s why
we met with your teachers and went to the doctor.” Adjusting to the ADHD diagnosis

The diagnosis and how ADHD works: Your child may wonder what the diagnosis might mean at
school and with friends. Siblings also need to understand
“Guess what? We found an answer that helps explain why what this means for the family.
you’ve been having these problems. You have something
called ADHD. You know how you’ve said it’s hard to stop •• Give your child words to use for talking with their
yourself sometimes, and it’s too boring to sit and read? friends about ADHD and medication. Your child
That’s because of ADHD. might simply say, “I have ADHD, so it’s harder for my
mind and body to keep still and focus on things. I take
ADHD means your brain is like a race car with a powerful medicine to make it easier.”
engine, but with brakes that don’t work perfectly. The
sights out the window go by really fast, and sometimes it’s •• Give your child words to use if ADHD‑related
hard to slow down to look at them or read the road signs. behavior causes problems. For example, your
child could say, “I’m sorry about that — my ADHD
Another way to think about ADHD is that it’s like watching sometimes makes things harder for me. I’m working on
TV when the channels change every few seconds, or a ways to do better.”
bunch of channels all play at once! That can make it hard to
pay attention.” •• Explain how teachers will be involved. For example,
“Your teacher knows you have ADHD — that’s great,
Putting ADHD in perspective: because she can help you with it. She might make
changes in where you sit to make things easier. She
“I’m glad we know about your ADHD — now we know why might give you extra chances to practice focusing on
things have been tough for you lately, and we can do assignments. And the two of you might work out a
something to help. Lots of kids have ADHD, and learn to private signal she can use to remind you when you’re
manage it just fine. having trouble focusing.”

ADHD is just one part of who you are, like the way you like •• Discuss ADHD with other family members. Help
strawberries and soccer, but can’t do a cartwheel. We’re all siblings understand what ADHD is. Be sure to explain
different — your dad can go up on the roof, but I’m scared that ADHD is just part of who their brother or sister is,
to stand on a ladder. I’m a good singer, but your dad can’t and that it isn’t “catching.” Explain that treatment will
carry a tune.” help their brother or sister focus better — and that the
family might set up some routines that will help things
go more smoothly at home.

2

78

Adjusting to medication Adolescents and teens (12–18 years)

Children have special challenges in taking daily medication. •• Explain medication and its benefits fully. Don’t
Below are some age‑specific tips to help you and your child assume that a teen knows the whys and hows of taking
develop a routine. medication. Explain why medication is more effective
if taken routinely. Explain side effects to watch for, and
School-age children (6–11 years) the importance of telling you about them. Involve your
child’s doctor in this discussion.
•• Prepare your child. Explain why medication is
needed, along with how often and when your child will •• Agree on a plan. Work together to create a plan to
take it. You may want to help her practice (see the panel help your teen remember to take medication. If your
below). Explain that the medication might make her teen resists taking medication or forgets it routinely,
feel different, that she should tell you how it makes her tackle the problem together.
feel. Let your child know that you can try a different
medication if this one causes problems. Your child’s •• Offer rewards if necessary. Teens don’t usually need
doctor can help you with this conversation. rewards or treats to take medication, but you might try
them if your teen has trouble staying motivated.
•• Involve your child. Let your child have as much
control as possible over the process of taking Solving medication problems
medication. Talk with your child about how to make it
more fun or easier to remember. If your child isn’t taking medication properly, you need to
talk about why. Keep the tone positive and encouraging,
•• Offer rewards. Award an age‑appropriate token and explore the problem together. Below are some tips on
(such as a sticker or ticket) each time your child takes handling problems that may occur:
medication easily. Once your child has earned a certain
number of tokens, trade them for an item on a “reward •• “I don’t WANT to take it!” If your child
menu” you’ve worked out ahead of time. actively resists medication, find out why. Does it taste
bad? Are side effects bothering her? Work with your
Swallowing practice child’s healthcare providers to find ways to minimize
these problems.
If your child has trouble swallowing medication,
try this: •• “I don’t need it.” There are lots of reasons why
children might think they don’t need medication. They
•• Roll a tiny piece of bread could be practicing “wishful thinking,” deciding that
in a ball and have your their ADHD has gone away. Or they may not be able
child swallow it. to see a difference from being on medication. You may
want to explain that even if they don’t see a difference,
•• Slowly work up to larger their teachers, friends, and family members can tell it’s
balls until they are the helping. (If you don’t feel your child is getting much
same size as your benefit from the medication, talk to your healthcare
child’s medication. provider about an adjustment.)

Because bread tastes good and won’t scratch the •• “Aunt Jill says I shouldn’t be taking medicine.”
throat, this is a great way to teach children how to Other people might share their opinions with your
swallow medication. child about whether medication is appropriate. Help
your child understand that these are just opinions, and
may not be based on understanding the situation fully.
Reassure your child that many people — including
kids — take daily medication for various reasons.

3

79

Resources Famous people with ADHD

The books listed below can help as you talk with your It may help your child to know that many famous and
child about ADHD: successful people have ADHD. Here are a few examples:

•• A Bird’s-eye View of Life with ADD and ADHD. •• Albert Einstein (scientist)
Chris Dendy and Alex Zeigler. Cherish the Children •• Ansel Adams (photographer)
2007. (Ages 13 and up) •• Bill Gates (founder of Microsoft)
•• David Neeleman (founder of JetBlue airlines)
•• A Walk in the Rain with a Brain. Edward Hallowell and •• Howie Mandel (comedian and TV host)
Bill Mayer. HarperCollins 2004. (Ages 4 to 8) •• John Lennon (singer)
•• Justin Timberlake (singer)
•• All Dogs Have ADHD. Kathy Hoopmann. Jessica •• Jamie Oliver (chef)
Kingsley Pub 2008. (Ages 4 to 8) •• Jim Carrey (actor and comedian)
•• “Magic” Johnson (NBA basketball star)
•• Help 4 ADD @ High School. Kathleen Nadeau. •• Richard Branson (founder of Virgin Airlines)
Advantage 1998. (Ages 13 and up) •• Terry Bradshaw (NFL quarterback and

•• Learning to Slow Down and Pay Attention: A Book sports announcer)
for Kids about ADHD. Kathleen Nadeau, Ellen Dixon,
and Charles Beyl. Magination 2004. (Ages 6 to 14) •• Ty Pennington (designer, Extreme Makeover:
Home Edition)
•• Putting on the Brakes. Patricia Quinn and Judith
Stern. Magination 2008. (Ages 8 to 13) •• Whoopie Goldberg (actress, TV host)
•• Will Smith (actor)
•• Putting on the Brakes Activity Book for Kids. (Note: The people listed above have either been diagnosed
Patricia Quinn and Judith Stern. Magination 2009. with ADHD, or are believed by many to have ADHD based
(Ages 8 to 13) on its trademark signs.)

•• Real Life ADHD: A DVD Survival Guide for Children
& Teens. Chris A Zeigler.

© 2012–2015 Intermountain Healthcare, Primary Children’s Hospital. All rights reserved. The content presented here is for 4
your information only. It is not a substitute for professional medical advice, and it should not be used to diagnose or treat a health
problem or disease. Please consult your healthcare provider if you have any questions or concerns. More health information is available 80
at intermountainhealthcare.org. Patient and Provider Publications 801-442-2963 LTA014 - 03/12 Also available in Spanish.

22 Attention 81

How to Talk to

YourYCohuildr OAbwount
ADHD

by Jonathan D. Carroll, MA

BEING AN ADULT WITH ADHD
has its moments. Trying
to manage the day-to-day
happenings of life presents some
interesting moments. If you have
children, you can add another di-
mension to this already challenging
experience. So how do you explain
ADHD to your children—the ups/
downs, twists/turns of daily life?
Based on my personal and profes-
sional experiences as an adult with
ADHD, here are some suggestions.

Spring 2017 23 82

HOW TO TALK TOUR CHILD ABOUT YOUR OWN ADHD

LET’S FACE IT: The term ADHD isn’t a se- able to live successfully. Your children need to hear and
understand this!
cret anymore. The cat is out of the bag, so to speak.  The
mainstream media is well aware of it; we see it referred to It is difficult for parents to show that we have
in movies, on television, and in music. However, just be- challenges. We want our children to see us as
cause it is out there, it isn’t always a good thing. There is a invincible. It can also be difficult for children to see our
lot of misinformation floating around, which can lead to struggles. Being selectively vulnerable, however, teaches
some frustrating misconceptions and stereotypes.  our children that it is okay to have areas of struggle. I
would not recommend opening the floodgates on infor-
Because of this, I believe in being as transparent as mation, but I would suggest sharing some truths. You’d
possible. If you’re honest and open about ADHD, be surprised!
your children will begin to learn more about it.
I cannot tell you how many times I’ve heard things about I would also recommend the in-the-moment learning
ADHD that just aren’t true (and frankly hurtful). But opportunities. I caution you against using ADHD as an
when you’re given the opportunity to talk about ADHD excuse, but as an explanation for what potentially hinders
openly, many misconceptions will be clarified and the you. For example, let’s say you forget something at the
disorder better understood. store. You can tell your child that sometimes you
struggle to remember things if you do not write
As I like to tell folks new to ADHD, this is a disorder them down. Then, when you go shopping together,
not a disease. While there is no cure, there are ways to show your child why making a list is important. Explain
compensate for it. That statement alone opens the door to why lists are an important tool for you to use. Having
effective dialogue. Instead of a burden, ADHD requires ADHD doesn’t mean you cannot remember things; it just
success strategies. When you’re able to apply them, you’re

24 Attention 83

makes it a little more challenging. By developing compen-
satory strategies, you’re able to function like everyone else.

Encouraging your children to ask questions is essen-
tial. Creating open and constructive dialogue helps this
process. Children will ask questions, so allow them to do
so. This method of discovery is key to improving under-
standing. Once children start asking questions, they’re
showing us they actually care and are engaged. Perhaps
you and your child can create a shared journal
where you can answer their questions. This will
act as a good resource moving forward. 

We learn as much from ourselves as we do from oth-
ers. I would recommend connecting with other adults
with ADHD and learning more about their conversa-
tions. Other parents who have been successful at hav-
ing these conversations with children are an excellent
resource. Do not be afraid to ask them questions.
Local ADHD support groups are always a good resource.

Talk with the professionals assisting you with your
ADHD as well. The more information you gather from
others, the better equipped you’ll be for any difficult con-
versations. If possible, invite your children to a meeting so
they can also ask questions. I find that this is helpful and
comforting for children as well as parents. It shows our
children that we don’t always have the answers, but we can
always ask others for help.

These are but a few suggestions about telling your chil-
dren about ADHD. I cannot stress enough the importance
for open and clear communication as well as transparency.
Because your relationship with your children is so impor-
tant, open and effective dialogue is a great way of keeping
things strong. You might learn something from this pro-
cess as well. ●A

Jonathan D. Carroll, MA, is an ADHD and executive function coach as
well as a special education advocate and educational advisor. He is based
in the Chicago area, but also works remotely with both US-based and
international clients. Visit his website, adhdefcoach.com, to learn more.

Spring 2017 25 84