Contributed by: Terry Matlen, MSW, ACSW
Summary
Attention deficit/hyperactivity disorder (AD/HD) is a lifelong,
genetic disorder. (Barkley 2002) Parents of children who have been
diagnosed should be screened for AD/HD. Adults with this disorder
often experience difficulties in relationships, on the job and in
other life areas. The problems of raising a child with special
needs are exacerbated by undiagnosed AD/HD in one or both of the
parents. Fortunately, the majority of adults respond well to
treatment.
Introduction
It is estimated that between 1% and 6% of the adult population has
AD/HD. (Wender) Forty percent of children who have AD/HD have at
least one parent who also meets the criteria for diagnosis.
(Zeigler) AD/HD affects up to 7.5% of school-aged children, or
between one to three students in every classroom. (Barbaresi, et
al) For various reasons, AD/HD in adults often goes undiagnosed.
Thus, these parents are trying to carry out adult responsibilities
without the benefit of appropriate treatment for their own AD/HD.
Undiagnosed AD/HD in parents affects the entire family. These
adults typically exhibit emotional labiality and tend to have
higher rates of depression, substance abuse disorders, and other
co-morbidities.
Adults with AD/HD are less likely to graduate from college and even
less likely to obtain advanced educational degrees. Like most
adults with AD/HD, these parents face uncertain career prospects.
Although they may be intelligent and enthusiastic workers, they
often have difficulties keeping a job. (Pary) Social skills
deficits are common among this population. AD/HD can interfere with
the ability to establish and maintain close relationships and may
contribute to an unstable home environment.
Parents of a child who has AD/HD are three times as likely to
separate or divorce as parents of non-AD/HD children. (Barkley
1995) Simply put, the parent may not have the emotional tools
needed to effectively support the special needs of the AD/HD child.
Parents who do not have AD/HD report that these children are often
far more challenging to parent than their non-AD/HD siblings. The
adult with AD/HD faces the already formidable task of raising a
difficult child while at the same time trying to cope as best they
can with their own AD/HD. If the parents' own AD/HD issues are not
addressed, these adults can have tremendous difficulties fulfilling
their roles as parents.
Evaluating the Parent
Parents may be unaware that they exhibit behaviors that would
indicate the presence of AD/HD. Furthermore, AD/HD has been long
considered a childhood disorder. It was not until the mid-1980's
that researchers began to acknowledge that AD/HD indeed lasted into
adulthood. Parents may be under that mistaken belief that they
outgrew their AD/HD while in fact it continues to affect their
life. When treating a child who has AD/HD, the physician should
discuss with the parent the genetics of AD/HD and inquire if a
parent might be struggling with symptoms too. Physicians (i.e.
pediatricians) who are uncomfortable or unable to evaluate the
adult should then refer parents to another health care provider for
an AD/HD evaluation. Should the parent show resistance to the idea,
the physician might discuss the difficulties of raising an AD/HD
child if ones own AD/HD is not addressed and treated. One or both
of the parents may indicate that they faced many of the same
problems when they were a child. The parent may recall that school
was difficult, although he or she had the intellectual capabilities
to do well. There may be family stories of hyperactivity or
behavioral problems during the parent's childhood.
Mothers or fathers may see in the opposite sex parent many of the
same behaviors now being exhibited by their child. Often is the
case when one parent will turn to the other and say, "I know where
it comes from. You're the exact same way!" Physicians may want to
ask about the behaviors of other family members as well, to better
ascertain the possibility of undiagnosed AD/HD in the family. These
kinds of questions can bring up a plethora of information pointing
to the possibility that the parent, too, might have the
disorder.
Research on AD/HD and behavioral disorders is fairly recent and may
not have been attributed to AD/HD when the parent was a child. The
astute physician will take a patient history by posing questions in
terms of behavior and not necessarily in terms of any specific
diagnosis. How does this affect the physician's role in evaluating
and treating their young patients? Treating the parent is an
important part of improving the quality of life for the child. One
can see that an impulsive, distracted parent might have problems
remembering to give a youngster his/her medication. Adults with
AD/HD tend to be disorganized and often have difficulty maintaining
a home. These adults have trouble keeping appointments, getting the
child ready and off to school in time, and performing other basic
parenting duties.
How AD/HD Symptoms Compare in Adults and
Children
The same symptoms that apply to children with AD/HD also apply to
adults; however, the symptoms may be manifested in a number of
ways. Diagnosis is further complicated by the overlap between the
symptoms of adult ADHD and the symptoms of other common psychiatric
conditions such as depression and substance abuse. (Searight)
The primary symptoms of AD/HD are inattention, impulsivity and
hyperactivity. The adult versions of these symptoms often have
severe consequences. Inattentive children are reprimanded for
daydreaming in class. Inattentive adults neglect their spouses,
forget directions, and crash their automobiles. Impulsive children
often make bad choices. Impulsive parents also make bad decisions.
Consequently, they may face huge credit card bills, marital strain
and other negative consequences. Hyperactive children are always
moving. Hyperactive adults may feel restless and are drawn to
high-risk behaviors. Other behaviors that are common to children
who have AD/HD are also seen in adults with the disorder. Children
with AD/HD will procrastinate, turning in homework late, if at all.
Their work is often sloppy. Procrastination in adults results in
paperwork and work-related projects being completed late or not at
all. Bills go unpaid not because there is no money, but because the
adult simply never gets around to mailing in the payment.
Other common symptoms include not living up to one's potential,
hypersensitivity to stimuli, emotional reactivity, and poor short
term memory. Any one of these behaviors presents a problem for an
adult. Taken as a group, they represent a potentially disabling
condition.
Consider the following challenges:
Treatment for Adults
Adults with AD/HD respond well to treatment. Appropriate management
of adult patients with AD/HD is multimodal and should include
psychoeducation, counseling, supportive problem-directed therapy,
behavioral intervention, coaching, and cognitive remediation.
Couples or family therapy may be indicated to help the parent learn
better parenting strategies for raising the AD/HD child.
(Wender)
Stimulant medications are the first line of treatment for adults
with AD/HD. Stimulant use among patients with a history of
substance abuse should be closely monitored to ensure that no abuse
occurs. Approximately 70% of adults who have been treated with
stimulant medication show a reduction of symptoms. The
antidepressant medication Bupropion has also been shown to be
effective in treating adults with AD/HD. (Kuperman) Atomoxetine, a
non-stimulant medication which is a highly selective inhibitor of
the norepinephrine transporter, appears to be an efficacious
treatment for adult AD/HD. Its lack of abuse potential may be an
advantage for many patients. (Michelson)
Once effective treatment is in place, adults with AD/HD usually do
quite well. Paired with the other interventions, medication can
provide the parent with the tools he or she needs to improve the
quality of life for the family.
Conclusion
Because AD/HD is a genetic disorder, screening the parent of the
AD/HD patient is imperative as part of the overall
medical/psychological management of the child. Appropriate and
effective treatments are available to both child and parent and
should be considered for both in order for families to live
successful, healthy lives.
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Attention-Deficit/Hyperactivity Disorder? Incidence in a
Population-Based Birth Cohort in Rochester, Minnesota" Archives of
Pediatrics and Adolescent Medicine, Vol. 156 No. 3, March 2002
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© 2013 Created by Terry Matlen.
