Half of All Kids with ADHD Have a Learning Disability or Related Condition
The stereotypical hallmarks of ADHD — inattention, poor executive functions, behavioral problems, and more — could actually be symptoms of learning disability like dyslexia or another related comorbid condition. Learn how to distinguish the signs between ADHD and coexisting conditions.
A mother takes her daughter to the family doctor because she’s always tired and lacks energy. The doctor notes that the linings of her eyelids are pale and concludes that she has iron deficiency anemia. The doctor prescribes iron.
Another mother hears from her daughter’s teacher that she isn’t sitting still and paying attention in class. The teacher does some rating scales that confirm this observation. The mother takes these comments and forms to the family doctor, who says, “Why don’t we put her on Ritalin (or Adderall or Dexedrine or Strattera….)?”
In each case, the doctor has observed symptoms that suggest a problem. However, before treatment is started, it’s critical to clarify the specific cause of it. Clearly, in the first case, the doctor would do several diagnostic tests before concluding the cause of anemia and starting a treatment plan. This approach is just as critical in making a diagnosis of attention deficit disorder (ADHD or ADD).
Yes, your child or adolescent might be overactive, inattentive, and/or impulsive. But these behaviors could be caused by anxiety, a mood disorder, a learning disability, family problems, or even pinworms (which can cause itchiness around a child’s rear end). It’s essential that the physician explore and find the cause of the behavior (see Diagnosing ADHD, below).
More Than ADHD
While it’s essential for a physician to make a definitive diagnosis of ADHD, it’s equally important for him or her to look for other problems that often coexist with it. These are called comorbidities. Once a diagnosis is made, starting treatment with the appropriate medication is critical. But medication isn’t the sole answer. In fact, kids with ADHD who are only on medication have less successful outcomes than those who receive help for other problems they might have.
Your family doctor may not know this. So you must be informed to shape the evaluation process and treatment plan. Toward that end, here is what you should know about the most common conditions associated with ADHD and a basic treatment plan for each:
Fifty percent of children and adolescents with ADHD also have some type of learning disability (LD), such as dyslexia or auditory processing disorder. An LD may explain why a child with ADHD on medication can sit still and stay focused and yet do poorly academically. There could also be another reason for academic failure. If the ADHD diagnosis isn’t made until the fourth or fifth grade, it’s possible that a child will have gaps in basic skills, especially math and language arts, prior to receiving treatment for ADHD. While this student may not have a learning disability, he will need academic interventions to help him or her catch up.
Course of action: Speak with your school professionals about assessing your child to see if he or she has a learning disability. If they refuse, you might try getting a private assessment. If your student has an LD, he/she will need special education services, along with appropriate accommodations in the classroom.
Fifty percent of those diagnosed with ADHD will have so-called regulatory problems — difficulty regulating their emotions. Some might struggle with anxiety, possibly having panic attacks, while others may experience a mood disorder. Other children may have trouble controlling their anger, while still others might have difficulty regulating their thoughts and behaviors, which can result in obsessive-compulsive disorder. Some kids have trouble controlling their motor behavior (tics are a common symptom).
Such problems are caused by faulty wiring in an area of the brain other than that involved in ADHD. If your child has any of these problems, and if they have been chronic and pervasive, it’s essential that they be diagnosed.
Course of action: Speak to your family doctor and request a referral to a mental health professional. (Since medication may be needed, it would be efficient to see a child and adolescent psychiatrist, who, unlike a psychologist, can prescribe medication.) If your child has a regulatory problem, a selective serotonin reuptake inhibitor (SSRI) may help significantly.
Unlike regulatory problems, these behaviors aren’t pervasive or chronic. They usually begin at a certain age — third grade or middle school — and seem to occur in certain settings, such as the classroom or when doing homework. They’re often caused by frustrations and failures a child has experienced before his or her ADHD was diagnosed. Some kids deal with emotional pain by externalizing their problems. They blame others and take no responsibility for their behaviors. This syndrome is called oppositional defiant disorder or, when it’s more severe, conduct disorder. Some children keep the pain inside and have a poor self-image. They might show clinical evidence of anxiety or a mood disorder.
Course of action: Seek a consultation with a mental health professional, preferably one who is familiar with ADHD. Treatment often requires that the child work with a therapist, along with his parents and siblings.
Social Skills Problems
If the child acted oddly or inappropriately with friends or schoolmates before he received treatment for ADHD, it’s often hard for his peers to shake that image of him. The child might need help relearning social skills. For others, difficulty in relating to peers may have other causes, which should be both explored and diagnosed.
Course of action: Once again, seek a consultation with a mental health professional familiar with ADHD. Interventions might include counseling, group therapy, or participation in a group that focuses on teaching social skills. The school counselor can often play a significant role in these interventions.
Parents of a child with ADHD symptoms may be overwhelmed by managing their child’s behavior or conflicted about a course of action. The stress often causes marital problems that may adversely affect a child.
Course of action: Seek a mental health professional who specializes in marital or family counseling.
Make sure that your physician takes a thorough history of your child before making a diagnosis. This will be crucial when distinguishing between ADHD and an ADHD comorbidity. Here are some guidelines to keep in mind when talking with the doctor and before starting a course of ADHD medication:
- Symptoms and behaviors due to anxiety or a mood disorder — not ADHD — start at a specific time or occur only in certain circumstances.
- Symptoms caused by ADHD are chronic and pervasive. You probably would have noted his or her behavior since preschool.
- A diagnosis of ADHD requires three steps: 1) showing that the behaviors exist; 2) showing that they have existed since at least age six ; and 3) showing that they occur in two or more life situations (home, school, work, relationships).