Since He Won’t Outgrow ADHD can I prevent the worst outcomes?

Yes, you can have an influence and potentially prevent the worst outcomes for children with ADHD.  Ironically it is not directly with ADHD symptoms but those often associated with it. Those are called co-morbid problems. This simply means problems which are associated with ADHD. They co-occur or are co-morbid with ADHD. Go to this link to read a very useful post on another blog of mine titled: “ADHD Statistics Ease Fears about the Trajectory of your child with ADHD”

Now that you have read that post you have a better handle on many of the co-morbid problems associated with ADHD.

Before we dig into the details here let’s first broaden the scope to consider a big question.

What is a good life?

Let’s go with Freud:  Success in Work and Love.

We all need something to do and someone to love and love us.

How does ADHD in childhood relate to success in love and work as an adult?

To have a successful and rewarding life one would need to carve out meaningful work and healthy relationships.  Before you go to work and get a fulfilling job you have to achieve in school.  Your ability to achieve in school relates to your ability to succeed in work.  Similarly, before you can have a loving relationship with a spouse you have friends in school.  Those friendships in school set up some of the dynamics for how you have relationships generally and specifically with your spouse in the future.

Yet, as we saw in my last post, most kids don’t grow out of ADHD so what can you do?

This was in my mind when I did my research for a talk in November of 2004 titled:

“ADHD Treatment Outcome, Deaconess Family Practice”

I was thinking about these two questions:

What can I do to help children with ADHD?

When do I need to do it?

My thinking was influenced by my doctoral program at DePaul University that included a community psychology program in which there was significant focus upon prevention.  I realized my goal was to prevent certain problems from developing for my son and my clients who had ADHD.  Interestingly these problems were factors which were associated with ADHD, but were not ADHD itself.

Prevention is defined this way:

Reducing vulnerability and protecting against cumulative risk in the developmental period must take into account the particular factors that are most relevant for the outcomes of interest.

What were the factors most relevant to a successful outcome for a child with ADHD?

Or, conversely, what were the factors most associated with a poor outcome for a child with ADHD?

Study shows that most and worst co-morbid problems associated with ADHD were related to social disability.  Aggression would be considered possibly the most prominent characteristic of social disability.

What is interesting is that it is not the problems specific to ADHD which created the worst outcomes for children with ADHD.  It is the co-morbid problems which are associated with ADHD that create the worst outcomes for children with ADHD.  So determining what factors are associated with the worst co-morbid problems and preventing them is a key to facilitating better outcomes for children with ADHD.

What was unclear to me when I began to dig into the literature in 2004 was just how early these preventive factors came into play. I found they came into play in Preschool. I will get to even more detail on that in my next blog post but today I will consider the first study which caught my attention on this topic.

I realize that the rest of this post is somewhat technical and has some jargon, but understanding these ideas is very important for you to understand your role in facilitating better outcomes with your child.

Here is a brief synopsis of the first critical study that caught my attention:

Results showed that, at follow-up, boys with ADHD who also had social disability evidenced significantly higher rates of mood, anxiety, disruptive, and substance use disorders, compared with nonsocially disabled boys with ADHD and comparison boys without ADHD. Findings also showed that social disability at baseline in boys with ADHD was a significant predictor of later conduct disorder and most substance use disorders after baseline mood and conduct disorders and behavior checklist ratings of aggressive behavior and attention problems were controlled.  Greene, Biederman, Faraone, Sienna & Garcia-Jetton (1997).

This study opened my eyes.  An important factor was that it was a 4 year follow up study. So, it studied these children over time which is not easy to do but is critically important.

Secondly, there are a number of problems that co-occur with ADHD which are called “co-morbid” disorders.  This study showed that most of the co-morbid problems associated with ADHD were related to social disability.  This list of problems associated with social disability is legion and includes the following: anxiety problems, problems with substance abuse, problems with mood and disruptive problems (includes violating other’s rights, fighting, breaking rules and the law, etc.).  Additionally social disability was associated with the most problematic of psychiatric diagnoses in childhood:  conduct disorder (often bullies, threatens, or intimidates others, initiates physical fights, has used a weapon, been cruel to people and/or animals, has stolen while confronting a victim, destroyed property and stolen).  In other words, conduct disorder encompasses many of the problems parents want to avoid, was associated with social disability.

This finding is critical in that it points the direction to prevent many problems associated with ADHD.  Preventing social disability has the potential to prevent many of the worst problems associated with ADHD, the slew of co-morbid problems commonly cited as a concern for children with ADHD.

Also, in a coming post I will consider aggression.  The data is very interesting and instructive.

Dr. Charles Shinaver

Located in Carmel, Indiana near Indianapolis, Noblesville, Fishers, Zionsville, and Westfield.

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