Anxiety: an often-overlooked condition that may be present with ADHD

Trying to understand the impact of one condition can be a challenge, but some conditions tend to have a lot of other problems that “go with them.” ADHD is a disorder that has a tremendous amount of comorbidity. To help teachers understand that they need to be aware of “what else” the student with ADHD may have, I often use the following overhead:

Overwhelming, isn’t it?

With so much going on, it is somewhat understandable that teachers – and even parents – often overlook the presence of an anxiety disorder.  And yet anxiety may contribute to some of the worrisome behavior that they have been attributing to ADHD.   If a student becomes disruptive due to heightened levels of anxiety but their behavior is misunderstood as ADHD-related impulsivity or disinhibition, parents may think their child needs (more) medication for ADHD, when what they might really need is treatment for anxiety.  And increasing a stimulant medication to treat ADHD may make anxiety worse.

I came across an article online that may open some parents’ and teachers’ eyes about the relationship between ADHD and anxiety:

It’s not uncommon for individuals with attention deficit hyperactivity disorder (ADHD) to struggle with anxiety, whether it’s several symptoms or a full-blown disorder.

In fact, about 30 to 40 percent of people with ADHD have an anxiety disorder, which includes “obsessive-compulsive disorder, generalized anxiety disorder, phobias, social anxiety and panic disorder,” according to Roberto Olivardia, Ph.D, a clinical psychologist and clinical instructor at Harvard Medical School. The Anxiety Disorders Association of America even estimates the figure to be almost 50 percent.

Read more of this article on PsychCentral.

5-year-old with ADHD handcuffed, charged with battery on officer

All too often, I read something in the news that upsets me with all of my hats on – as a psychologist, a mother, and a disability rights advocate – like the item I posted earlier about using vinegar-soaked cotton balls in the mouths of autistic children or my coverage on this blog of the use of aversives and the  controversial Judge Rotenberg Center.  Other stories that are particularly upsetting to me are those involving the arrest of young children. I’ve posted some of those incidents in the past on this blog, and  in August, I read of another case where Toronto police handcuffed an autistic 9-year-old.  Then this week, I saw a news report from California by Dave Manoucheri of KCRA News involving a 5-year-old with ADHD that was very disturbing:

Earlier this year, a Stockton student was handcuffed with zip ties on his hands and feet, forced to go to the hospital for a psychiatric evaluation and was charged with battery on a police officer. That student was 5 years old.

Michael Davis is diagnosed with Attention Deficit Hyperactivity Disorder or ADHD. His mother says it has led to fights at school. But when the school district said it had a plan to change Michael’s behavior, his mother says things went wrong.

“Michael is energetic,” Thelma Gray said. “He is one big ball of energy.”

Gray calls Michael a comedian. She says his biggest problem is his ADHD stops him from thinking before he acts or speaks.

“He’s very loving,” Gray said. “He’s a good kid and he’s not the discipline problem that he was made out to be.”

Those discipline problems include fights with other students, even throwing a chair.

Gray says the school, Rio Calaveras Elementary of Stockton, wanted to change that behavior by having Michael meet with a school police officer.

“He could come out and talk to Michael and the kids are normally scared straight,” said Gray, describing how she says the school district proposed the meeting.

But the meeting didn’t go as planned.

You can read more of the news story on KCRA. In this case, the U.S. Department of Education reportedly did investigate and the news station obtained the report under Freedom of Information. I’m not sure why the department released the report and didn’t invoke FERPA like the district did, but the news station summarizes the report:

The report states that the Stockton Unified School District “delayed an evaluation of the student {Michael} which denied the student a fair and public education.”

They added that the school didn’t offer behavioral services to Michael or his mother, because “it would cost the district money.”

The report goes on to say that, whether or not funds are available through state or federal grants, the school district had an obligation to have Michael evaluated, which it failed to do.

The comments under the news story are also upsetting as the lack of understanding expressed by some people reminds me of how much ignorance still exists about ADHD.

But commenters aside, this case represents a total failure on the part of the school district, the building administration, and the state.

What the heck were the school personnel thinking if they thought a 5 year-old with ADHD could be “scared straight?” That they would even consider this approach demonstrates to me that they do not understand ADHD at all.

Would you want these people educating your child? I wouldn’t. This child might have (or may have?) been seriously psychologically harmed by their inappropriate handling.

I have often noted that schools fail to use research-validated or best practices in handling students with neurological challenges.  This is a case in point.  Have the school personnel received adequate training in how to educate students with ADHD (or other neurological disorders, for that matter)?  Are budgetary concerns an excuse for mishandling a student?

I am not a lawyer, but I hope that the family sues the district.  And I hope that as part of any settlement, the district is required to undergo training in best practices for educating students with neurological disorders – and is audited for compliance with I.D.E.A.

In various places around this country, parents have banded together to call for a halt to handcuffing young children. If you have not been involved in such advocacy efforts, you might want to look into what goes on in your area or state lest this happen to your child.

My kids are safe because they are out of school.  Are your children safe?

Carousel image credit: © Richard Nelson | Dreamstime.com

UK study finds low rate of Bipolar Disorder in ADHD youth

One of the “hot” topics in recent years has been the comorbidity between ADHD and Bipolar Disorder – and how difficult some people find it to be clear about whether a child or adult has one, the other, or both.

When it comes to the rate of comorbidity (co-occurrence of the two disorders), results from studies have been all over the place, with one study suggesting that 94% of youth with Bipolar Disorder also have ADHD. Studies demonstrating high comorbidity rates of 80% or higher are not unusual, although there have been some studies – usually from non-U.S. samples – that find significantly lower rates. Hence, the range of estimates has been from 4% to 94%.

If you pose the question the other way, though, i.e., what percent of youth with ADHD also have Bipolar Disorder, studies report that 11-22% of ADHD youth also have Bipolar. In 2010, I visually summarized the results in a presentation this way:

If you have only been hearing about the high estimates, here’s more food for thought:

A study conducted in the U.K. of 200 youth with ADHD aged 6-18 years found that only one child, a 9-year-old boy, met diagnostic criteria for both ICD-10 hypomania and DSM-IV bipolar disorder not otherwise specified.

The study was published in the March 2011 issue of the British Journal of Psychiatry.

So… are we overdiagnosing Bipolar youth in the U.S. or is there some other explanation?

 

For kids with ADHD, regular ‘green time’ is linked to milder symptoms

Diana Yates at University of Illinois describes some research going on there:

A study of more than 400 children diagnosed with Attention Deficit Hyperactivity Disorder has found a link between the children’s routine play settings and the severity of their symptoms, researchers report. Those who regularly play in outdoor settings with lots of green (grass and trees, for example) have milder ADHD symptoms than those who play indoors or in built outdoor environments, the researchers found. The association holds even when the researchers controlled for income and other variables.

The study appears in the journal Applied Psychology: Health and Well-Being.

Read more on University of Illinois.   It’s important to note that the findings are correlational and do not prove anything, but they certainly are suggestive.  Unfortunately, they do not seem to address what happens to children who have grass, trees, and pollen allergies, as so many of the children I see seem to have. Do those children also benefit, or are their symptoms made worse?  Hopefully, more controlled research will clarify these questions.

So how much time in open green spaces does your child spend?

ADHD doubles the risk of injury in grade-school kids

Back in 1998 when I first wrote an article for parents about ADHD and safety, my blog was one of the only resources on the internet for information on what I saw as a serious but often overlooked aspect of parenting children with ADHD.

Since that time, there has been more research on this issue. The following is a news release by Kevin Storr from the University of Alabama that I encourage parents and educators to read:

Injury kills more 11-year-olds in the United States than all other causes combined, and a new study from University of Alabama at Birmingham reveals ADHD almost doubles the risk of serious injury among this age group.

“We found that children with more ADHD symptoms, those in the 90th percentile, are nearly twice as likely to get hurt as those with symptoms in the 10th percentile,” says David Schwebel, Ph.D., director of the UAB Youth Safety Laboratory and lead author. Boys, he said, are nearly twice as likely to be injured as girls.

The research, published in the September/October Academic Pediatrics, studied 4,745 fifth-graders from Houston, Los Angeles and Birmingham. Serious injury is defined as one that requires medical attention; more than half of the injuries included broken bones.

“These are children that no longer have adults or parents or teachers watching over them all the time, which means they have to make decisions on their own,” Schwebel said. “Children with ADHD are impulsive, inattentive; they may not notice things because their mind is wandering, and they’re hyperactive so they’re always moving and getting into things.”

The Center for Disease Control and Prevention says 9.4 percent, or 5.4 million, kids ages 4-17 in the United States have been diagnosed with ADHD. Schwebel, professor in the UAB Department of Psychology, says this study will improve injury-prevention strategies for millions of mental health practitioners, pediatricians, parents and children.

“Medication, seeing a psychologist and getting treatment for ADHD will reduce the risk and the symptoms,” Schwebel said. “In some cases you can make the child aware and get them to think about what they’re doing so they will slow down and be more careful. It won’t work for everyone, but it certainly can’t hurt to try.”

This study is part of UAB’s Healthy Passages research, a decade-long program funded by the CDC, designed to help families, health-care providers, schools and communities develop effective policies and programs to keep children and adolescents healthy. The participants’ gender was 52 percent male. The mean age was 11.12 years. The racial/ethnic breakdown for the youth was: 30 percent African-American, 42 percent Hispanic, 23 percent white non-Hispanic, 5 percent multiracial or of other ethnicities.

Schwebel also analyzed the affect of Conduct Disorder. CD is a disorder marked by chronic behavioral problems like breaking rules without reason, physically or psychologically abusing people or animals and destruction of property, symptoms that go beyond simple mischievousness. Researchers wanted to know if the combination of CD and ADHD had a multiplier effect on a child’s chances of injury.

“What we found in the past, with younger children, is that ADHD and oppositional behaviors mattered equally. But in this study with fifth-graders, we found that ADHD is more relevant,” says Schwebel. “When you put ADHD and CD together statistically, we did not see multiplication at all. ADHD is the primary issue.”

The study was originally published online in June, 2011.

If you have a school plan for your child, does it include added supervision on the playground? Does the physical education teacher know to be extra vigilant in gym? How about extra supervision in close proximity when your child is in a novel situation or on a field trip?

As parents, you probably are already aware of the need to keep your child close lest they get into trouble or risk injury. But don’t assume that educators know this. If you haven’t had a conversation with them about your child’s safety, why not arrange for one?

« Previous Page — Next Page »