Common Co-existing Conditions and Complications of Attention Deficit Hyperactivity Disorder

• Oppositional defiant disorder (ODD)
• Conduct Disorder o Depression
• Anxiety and obsessions
• Specific learning difficulties
• Speech and language disorder
• Bipolar disorder
• Co-ordination difficulties
• Substance abuse
• Dyspraxia
• Asperger's syndrome
• Tics and/or Tourette's Syndrome
• Sleep difficulties

Common Additional Problems of ADHD

People with ADHD commonly exhibit a number of additional problems, which are largely secondary and may get worse if the ADHD is not treated.

• Poor self-esteem
• Poor social skills
• Insatiability
• Variation in symptoms from day to day
• Excessive dogmatism
• Poor organization and management of time
• Relationship difficulties Lack of motivation
• Problems with rule-governed behaviour
• Over-sensitivity
• Vulnerability to stress
• Auditory short-term memory problems
• Physical symptoms relationships. Yet again, others have under-achieved academically, have low self-esteem and poor social skills, and may be anxious, depressed or obsessive.

Assessment of ADHD

An experienced, comprehensive specialist assessment is required as the symptoms can vary so much between individuals and because ADHD is so easily confused with many other conditions, which must be excluded.

Management of ADHD

Medication is the option considered to have most benefit in treating the core symptoms of ADHD, ie, inattentiveness, impulsivity and/or hyperactivity as part of the comprehensive management. It frequently has a flaw-on effect to many of the other problems. Individuals with significant ADHD should be seriously considered for medical treatment. Medication should be seen as providing a "window of opportunity" that normalizes brain function and stabilizes the situation and allows other strategies to be more effective, making the sufferer less vulnerable to the stresses of the environment. The two medications that are available in the UK to treat ADHD core symptoms are meth- ylphenidate (Ritalin) lO mg and dexamphetamine (Dexedrine) 5mg. Studies show that approximately 90 per cent of children with ADHD will show a very significant improvement on medication. However, there will still be on-going difficulties in about 40 per cent, usually because of the co-existing conditions. Once the core ADHD symptoms are managed, the other problems can often be dealt with more effectively.

The management of a teenager with ADHD is a particular challenge to the professional. Often more than one medication is necessary, to treat some of the difficult complications. It must be appreciated that there are likely to be setbacks and difficulties in management that require fine tuning, patience and understanding.

One of the myths of ADHD is that it is outgrown by puberty and/or is not present by late teens. In reality, by teenage years, as ADHD is progressive, it is often much worse and compounded and masked by the other difficulties. Hyperactivity has often diminished, but there are often other problems. It is often essential to treat teenagers and also adults.

Possible Masked Presentations of ADHD

• School underachievement and/or behavioural difficulty
• Special schooling, especially EBD (emotional and behavioural difficulties) or dyslexic school
• Gifted children with self-esteem problems
• Children involved with Portage who also have poor concentration
• Early onset Oppositional Defiant Disorder/Conduct Disorder
• Those with predominantly inattentive problems Teenage suicide/attempted suicide
• Those with Asperger's Syndrome
• Early onset substance abuse
• Infants with persistent crying/sleeping difficulties.