» Families and ADD/ADHD

ADHD – A Profile

Families and ADD/ADHD - by admin - November 4, 2009 - 18:59 UTC - Be first to Comment!

Attention-deficit/hyperactivity disorder (ADHD) is a chronic, lifelong disorder with childhood onset, which seriously impairs the affected adults in a variety of daily living functions including:

• educational
• occupational functioning
• partnership
• parenting

ADHD is associated with a high percentage of other psychiatric disorders.

As an adult between 65–89% of all patients with ADHD suffer from one or more additional psychiatric disorders including:

• mood and anxiety disorders
• substance use disorders
• personality disorders mainly anti-social

Attention-deficit/hyperactivity disorder (ADHD) is characterised by chronic problems in attention and impulse control, age-inappropriate hyperactive behavior as well as emotional dysregulation like temper outbursts or mood swings.

A significant proportion of patients with the disorder also present with one or more additional psychological conditions.

The high percentage of comorbid psychiatric disorders in adults with ADHD is similar to the findings for children in which ADHD is associated in about 60–100% of all cases.

These include oppositional defiant disorders in 50–60%,
depressive syndromes in 16–26 % and
anxiety disorders in about 15% of all children with ADHD as

Also present are tic disorders and developmental disorders like reading and spelling disorders

The presence of comorbid disorders in adults with ADHD can create a stronger overall impairment with a poorer outcome and greater resistance to treatment as well as higher costs of illness.

All retrospective studies evaluating the lifetime prevalence of major depression consistently show that 35–50% of all adult individuals with ADHD suffer from one or more depressive episodes during the assessed lifespan a percentage which is higher than the risk in the general population of about
15%.

Dr. Harvey G. Davisson, Ph.D., LMFT, C.HT. has been serving the Dallas-Fort Worth area as a Licensed Psychologist, Licensed Marriage and Family Therapist, Certified Clinical Hypnotherapist for the past 35 years and includes over 100,000 clients. His practice is composed primarily of referrals from other professionals and successful clients.

Families

Families and ADD/ADHD - by admin - November 1, 2009 - 16:56 UTC - Be first to Comment!

Anxiety Disorders in the Family

Families and ADD/ADHD - by admin - September 4, 2009 - 19:29 UTC - Be first to Comment!

Anxiety disorders often accompany ADD and/or ADHD and represent the most common form of psychopathology in children and adolescents. In community studies including adolescents, approximately 4–19% of young people were found to be suffering from anxiety disorders There is a slightly higher occurrence of anxiety disorders in adolescent girls than boys.

Anxiety disorders can significantly interfere with a young person’s ability to function in interpersonal relationships and at school yet they often go unrecognized by parents and teachers.

Anxiety disorders frequently co-occur with other mood disorders, depression, and disruptive behavior disorders. Anxiety disorders early in life place young people at heightened risk for subsequent anxiety disorders, major depressive disorder, schizophrenia, substance abuse, suicide, and psychiatric hospitalization in adolescence and young adulthood.

major presence in the treatment and prevention area, the cognitive-behavioral theoretical model and treatment approach is described in detail. The chapter concludes with a set of recommendations for best practices in the treatment and prevention of anxiety disorders in children and adolescents.

The Diagnostic and Statistical Manual of Mental Disorders IV-TR (DSM-IV-TR American Psychiatric Association, 2000) provides a comprehensive categorical system for classifying anxiety disorders. Each of these disorders has distinct features, yet they all share a common foundation of excessive, irrational fear and dread. A brief synopsis of each major anxiety disorder follows.

Children and adolescents with Separation Anxiety Disorder (SAD) experience developmentally excessive fear and distress concerning separation from home or significant attachment figures. Frequently these young people worry excessively about their parents’ health and safety, have difficulty sleeping without their parents, complain of stomachaches and headaches, and may manifest school refusal.

Generalized Anxiety Disorder (GAD) is characterized by chronic, excessive, and uncontrollable worry. Worries may relate to friends, family, health, safety, and/or the future. A diagnosis of GAD also requires that at least one somatic symptom be present, such as motor tension or sleep difficulty.

Adolescents with Social Phobia (SocP) experience excessive fear or discomfort in social or performance situations. These young people fear negative evaluations from others and worry about doing something embarrassing, stupid, or awkward in social settings such as classrooms and restaurants or during sports activities.

Specific Phobia (SP) represents an intense fear of a particular object or situation and frequently is accompanied by avoidance of the focal object or situation. To distinguish between a developmentally normal fear and a specific phobia, one must consider age, severity of symptomatology, and impairment. Compared to normal fears, phobias are excessive, persistent, or maladaptive.

Panic Disorder (PD) involves recurrent and spontaneous attacks or episodes of intense fear. These episodes are accompanied by at least four somatic symptoms such as pounding or racing heart, sweating, shaking, difficulty breathing, chest pain, or fear of dying or going crazy. For many individuals, the onset of PD occurs at some point during adolescence.

Adolescents with Agoraphobia (Ag) avoid or are extremely uncomfortable in places they fear they will be unable to get help or escape. Agoraphobia may present independently or accompany panic disorder. Common stressful situations for agoraphobics include crowds, standing in line, shopping malls, traveling (especially via public transportation), enclosed places such as elevators, open spaces such as large parks, and trips or camps away from home.

NEGATIVE LIFE EVENTS. Multiple studies have shown that children and adolescents with mental health needs experience more negative, stressful, or traumatic life events than their healthy counterparts (Boer, Markus, Maingay, Linkhout, Borst & Hoogendijk, 2002), and these events represent risk factors for anxiety disorders as well. Elevated rates of anxiety disorders have been found following natural disasters (Yule & Williams, 1990) and negative life events such as the death of a family member, divorce, or changes in school (Donovan & Spence, 2000). Several studies suggest that youth with anxiety disorders experience a higher incident of negative life events compared to non-anxious children (Benjamin, Costello, & Warren, 1990; Boer et al., 2002; Goodyer & Altham, 1991), even when compared with siblings in the same household (Boer et al., 2002).

Dr. Harvey G. Davisson, Ph.D., LMFT, C.HT. has been serving the Dallas-Fort Worth area as a Licensed Psychologist, Licensed Marriage and Family Therapist, Certified Clinical Hypnotherapist for the past 35 years and includes over 100,000 clients. His practice is composed primarily of referrals from other professionals and successful clients.

ADD and Relationships

Families and ADD/ADHD - by admin - May 29, 2009 - 19:57 UTC - Be first to Comment!

ADD and Relationships

Individuals who have attention deficit hyperactivity disorder (ADHD) both impact their relational environment and are impacted by it. Of course, many factors influence relationships, such as family background, financial or legal stressors, and health conditions. However, there are a number of problems that individuals who have ADHD commonly experience in relationships that are caused by the neurological effects of the disorder.

Adolescents and adults who have ADHD often experience social skills deficits and have poorly developed communication skills. Accurately reading and interpreting social cues (body language, facial expression), a crucial component of developing good social skills, are often challenging to individuals who have ADHD. Their distractibility, impulsivity, sensitivity, tendency to over react, self-focus, and poor self-regulation can interfere with learning these important skills. Children who have ADHD often miss the important details involved in mastering social skills through observing, copying, practicing, and receiving feedback. Adults may have learned some of these skills but have often missed important pieces and may not even know they are missing them.

As children, many tend to be socially neglected, living on the periphery of the peer group (those who are primarily inattentive) or actively teased and rejected (those who are hyperactive). Females tend to be more negatively impacted by poor social interactions, as they typically have a greater need for peer affiliation than do males.

The roles of spouse and parent add new dimensions of complexity to the daily life of an adult with AD/HD. Because in our society, women often bear more of the responsibility for maintaining the household and raising the children, women with ADD might struggle with these roles. We expect the homemaker to provide organization and structure for the rest of the family members. Office jobs often have specific schedules and clear job descriptions. The home is much less structured. Tasks may not have a clear beginning or end.

Some women with AD/HD may feel overwhelmed at the sheer number of tasks in the home. It may be difficult to break down and prioritize tasks. A woman with difficulty maintaining divided attention may blow up when her children make demands while focused on another task.  She may have difficulty providing the structure her children need to help contain their own AD/HD. A woman prone to impulsive temper outbursts may have difficulty disciplining her children.

Many individuals who have ADHD have suffered from social isolation or rejection because their ADHD behaviors were misattributed to selfishness, lack of caring, thoughtlessness, laziness or stupidity. For example, when an individual who has ADHD is late, others tend to attribute this to a lack of caring or selfishness, rather than understanding that time management is a chronic problem for many who have attention deficit disorder.

Low self-esteem is a contributing factor to the development of relationship deficits in individuals who have ADHD. Many have experienced a life replete with broken relationships. They have often felt disliked by parents, teachers, and peers. Many of their problematic behaviors, such as tantrums, arguments, and poor anger management, are indicators of relationship problems that continue into adulthood in the form of loud, angry arguments with family, friends, and even bosses.

When growing up, children who have ADHD were frequently bombarded with countless criticisms of behaviors that bother adults, with little or no focus on what the child needs. Others typically do not understand how an individual who has ADHD experiences the world, and thus they often do not feel heard or understood. A parent’s understanding of the difficulty adolescents have in doing their chores, starting their homework, turning off the television or video game, going to bed, and getting out of bed in the morning may make it more likely that parents and their children will engage in problem solving, rather than blaming, criticizing, and arguing.

Parents who have ADHD typically compound the problem through their own difficulties: tuning in to social cues, being distracted, and generally being busy, hurried, and disorganized. This cycle of frustration, blame, criticism, and lack of understanding forms the core experience of many individuals who have ADD in relationships with others, beginning in childhood and continuing though adulthood.

Other environmental and family impacts can contribute to the relationship problems an individual has. One example is that some individuals who have ADHD must maintain an orderly and clutter-free home environment in order to function effectively. Without it, they experience significant anxiety about losing control—not seeing important bills and papers among the piles of clutter, forgetting critical events, or losing key items. A boisterous family’s typical noise and chaos can be over-stimulating for many who have ADHD. Likewise, stressful home environments in which there are high levels of conflict, tension, or depression can exacerbate already challenged executive functioning and overload highly sensitized receptors. Another common family stressor is the tendency to take on too many activities, with resulting stressful over-scheduling. These over-commitments can intensify ADHD difficulties with time management, lateness, and forgetfulness, as well as leave no down time to recuperate from life’s daily stresses.

The development of poor communication skills probably results from a combination of social skills deficits and other typical ADHD-related behaviors, which interfere with healthy communication in relationships. Many individuals who have ADHD feel under-stimulated and may attempt to self-stimulate by seeking conflict and provoking others. Some seem always to need to have the last word, to create arguments, and to be unable to refrain from arguing once they have begun. Their inattentiveness can result in divided attention while listening to significant others, hearing only parts of what is being communicated. The tendency to have difficulty holding onto thoughts, combined with impulsivity, may result in interruptions, speaking over others, and failing to communicate.

Other common challenges of ADHD are emotional sensitivity and the tendency to over react and be prone to outbursts and moodiness. They are easily irritated, offended, and hurt because they instinctively respond to the smallest changes in the environment, both physical and emotional. This hypersensitivity and subsequent hyper-reactivity can be off-putting to spouses, family members, and others in the community. Others may respond by downplaying or negating what appear to be excessive reactions; by criticizing the individual as too thin-skinned, defensive, or sensitive; or by retreating from the intensity of the emotional response. This intense reactivity prevents people who have ADHD from being fully emotionally available to hear others, a trait that often leads to further exacerbation of the conflict or power struggle.

Impulsive behavior can also significantly impact relationships. Behaviors can take many forms, such as crossing the street or changing lanes without looking, taking on too many activities, making plans or purchases without consulting spouse or family, and making poor decisions. Impulsive spending can be a huge problem in many families affected by ADD, potentially leading to bankruptcy and/or divorce. The combination of poor self-control, stimulation seeking, and self-medication can lead to compulsive or addictive behaviors as well.

Executive dysfunction creates yet another set of interpersonal behavior difficulties. Organizational and memory problems contribute to relationship conflicts, both within couples and between adolescents and parents. Disorganization and forgetfulness lead to piles of unfinished laundry, clutter, chronic lateness, lost keys, missed events, and unpaid bills. These behaviors decay trust over time; the individual who has ADHD cannot be depended on to “execute.” Disappointment sets in and often causes the spouse to feel unimportant.

ADD and Parents

Families and ADD/ADHD - by admin - May 29, 2009 - 19:55 UTC - Be first to Comment!

ADD AND PARENTS

While 12.6 percent of the parents of children without ADHD were divorced by the time the children were 8-years-old, the figure was 22.7 percent for parents of kids with ADHD. Couples with ADHD kids also tended to reach the point of divorce or separation faster.

For many years, scientists have explored how parental conflicts and other marital problems can affect the well-being of children. Far less attention has been paid to the opposite question: How do children, especially difficult children, influence the quality of married life?

Having a child who is inattentive or hyperactive can be extremely stressful for caregivers and can exacerbate conflicts, tensions and arguments between parents leading to the high divorce rate exhibited in parents of ADD children. This is not to suggest that children are solely to blame for the parent’s marital problems but that they can strain a marriage.

The study, led by psychologists Brian Wymbs and William Pelham and published last year in the Journal of Consulting and Clinical Psychology, longitudinally tracked a large number of families with and without children diagnosed with ADHD, a disorder characterized by inattention and hyperactivity and often accompanied by conduct problems and oppositional behavior.

While 12.6 percent of the parents of children without ADHD were divorced by the time the children were 8-years-old, the figure was 22.7 percent for parents of kids with ADHD. Couples with ADHD kids also tended to reach the point of divorce or separation faster.

Pelham also conducted a study that looked into how children’s behavior influenced the propensity of their parents to consume alcohol. Pelham had a large number of parents interact with children who were not their own. Some of the kids were trained to act cooperatively, while others were trained to act as though they had ADHD.

The parents were given a break midway through the session, when they could consume alcohol, and then sent back in for a second period with the same child. The parents thought the experiment was measuring how parent-child interactions changed depending on alcohol use; in reality, Pelham wanted to know how dealing with easy and difficult children influenced the propensity of caregivers to drink.

The psychologist found that parents randomly assigned to interact with the difficult children drank 40 percent more alcohol during the break than parents who were assigned manageable kids.

“Parents of children with ADHD report less marital satisfaction, fight more often, and use fewer positive and more negative verbalizations during child-rearing discussions than do parents of children without ADHD especially if the child also has conduct or oppositional problems,” Pelham and Wymbs noted in their paper.

Many other factors influence whether couples stay together. Communication problems, substance abuse, financial difficulties and mental health problems among partners all play a role in the health of intimate relationships. The difference between those other factors and the role that children play is that the other factors have been widely documented and discussed.

Wymbs said that in a separate study, he brought parents with and without ADHD kids into a laboratory. As before, he assigned them to interact with children who were not their own; some had been trained to act cooperatively, and others had been trained to act difficult.(The “difficult” kids in the study were nowhere as difficult as many kids with ADHD in real life; ethical guidelines forbade researchers from training child actors to hit or scream.)

Wymbs had the parents and kids perform four exercises: The first involved playing the game Jenga, which requires strategic thinking and planning. Kids trained to be helpful worked cooperatively with the parents; the kids trained to act difficult undermined the parents at every turn.

A second exercise called for parents to monitor the kids solving math problems while they themselves had to fill out a checkbook, the kind of parallel processing that induces stress. The easy kids attended to their homework; the difficult kids refused to do their homework, scribbling on their papers or erasing their answers and blowing the shavings on the parents.

In the third task, the kids directed play. The child actors always chose to play mini-bowling and mini-basketball. The cooperative children took turns and helped set up the games, and the difficult children played out of turn and were disruptive.

The fourth task involved cleanup where, as you might imagine, the children were trained to be either helpful or unhelpful.

Wymbs videotaped the interactions. What he was on the lookout for was not how the parents interacted with the children, but how the children’s behavior affected the way the parents worked with each other.

Regardless of whether they had children with ADHD, Wymbs found, the parents asked to work with difficult children were four times as likely to exchange negative criticism and questions, or to ignore each other and trade nonverbal barbs, than the parents in the other group.

And regardless of whether they were dealing with easy or difficult children, parents who had ADHD children at home were three times as likely to be negative toward each other as parents who did not. Put another way, the parents of children with ADHD simply had less ability to respond to challenges with equanimity, they appeared to be psychologically worn thin.

Several researchers said parents need to develop behavioral techniques to improve coping skills. Johnston teaches parents to get on the same page and follow three rules: The first is to pare down their expectations and to focus on only one or two problem behaviors in their ADHD child.

The second rule is the familiar parental technique of rewarding all positive behavior and discouraging negative behavior, often by ignoring it. The third rule is to consistently stick with the technique long enough to see it work.

Just as it is important to enforce order, routine, organization, and positive communication skills  in a child with ADD, it is vital that the parents foster these practices in themselves. This means keeping an organized and clean home and working on open communication with a spouse or other family members. Other experts said it is also important to teach parents to take time to pamper themselves.