Clinical Psychology, School Counseling

ADHD Turns Onto …

Cantwell (1988) discusses the relationship of ADHD to conduct, affective disorders and later substance abuse disorders.  Dykman (1993) found that children with ADHD who were also hyperactive and aggressive were at increased risk to have oppositional and conduct disorders.  Lilienfeld, (1990) reviewed the literature on ADHD and antisocial behavior. 

The ADHD and Oppositional defiant disorder (ODD) Link

ODD is related to a child’s conduct and how they interact with their family, friends, and teachers. ADHD is a neurodevelopmental disorder.These conditions are different, but can occur together. Some seemingly defiant symptoms may be related to impulsivity in ADHD. In fact, it’s believed that about 40 percent of children with a diagnosis of ADHD also have ODD. Though, just like ADHD, not all children diagnosed with ODD have ADHD.

A child who only has ADHD may be full of energy or get overly excited when playing with classmates. This can sometimes lead to roughhousing and causing unintended harm to others.Children with ADHD may also throw tantrums. But this isn’t a typical symptom of the disorder. Instead, the tantrum can be an impulse outburst due to frustration or boredom.If the same child has ODD, not only do they have issues with impulse control, but also with an angry or irritable mood which can lead to physical aggression.

These children may have tantrums due to an inability to control their temper. They may be spiteful, upset others on purpose, and blame others for their own mistakes. In addition to getting overly excited and hurting a classmate while playing, they might lash out and blame the classmate and then refuse to apologize.It’s important to note that traits of ODD and ADHD can also occur with learning disabilities and other conduct disorders. Care should be taken by a provider to get a clear picture of the overall symptoms before making a diagnosis.

The ADHD and Conduct disorder (CD) Link

Among individuals with ADHD, conduct disorder (CD) may also be present, occurring in 27 percent of children, 45–50 percent of adolescents and 20–25 percent of adults with ADHD. Children with conduct disorder may be aggressive to people or animals, destroy property, lie or steal things from others, run away, skip school or break curfews. Adults with CD often exhibit behaviors that get them into trouble with the law.

Children with coexisting conduct disorder are at much higher risk for getting into trouble with the law or having substance abuse problems than children who have only ADHD. Studies show that this type of coexisting condition is more common among children with the primarily hyperactive/impulsive and combination types of ADHD.

The ADHD and Antisocial Personality Disorder Link

Antisocial Personality Disorder is one of the most researched disorders in connection with ADHD and is the adult version of Conduct disorder. Lilienfeld, (1990) reviewed the literature on ADHD and antisocial behavior.  Findings from longitudinal, family and adoption, neuropsychological, psychophysiological, and other laboratory studies reviewed indicate that childhood ADHD is associated with adult disorders characterized by antisocial behavior

 Antisocial Personality Disorder most closely resembles the hyperactive-impulsive type of ADHD.  Both ADHD and Antisocial personality have difficulties with impulse control.  There is a risk taking, thrillseeker component to both, but the individual with Antisocial Personality disorder will typically have less regard for their own safety and the safety of others than the person with ADHD.  In contrast, the adult with ADHD is often times overly sensitive to the reactions and feelings of others and may feel remorseful to the point of becoming depressed over his/her impulsive actions. 

Unlike some of the other disorders we have been discussing in the differential diagnosis section, Antisocial Personality disorder is not easily and quickly treated.  The personality disorders in general are long standing patterns of behavior and personality that have developed over a life time.  Individuals with personality disorders are so familiar with the symptoms and behaviors that they are not distressed by them.  Many times it is a significant other who will request that the personality disordered individual seek treatment, or in the case of Antisocial Personality, it is often times due to legal difficulties.  Relatively long term therapy can alter the patterns of behavior, and if the individual has ADHD and Antisocial Personality disorder, medications may help control the level of impulsive behavior. 

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