Forty percent of children who have ADHD have at least one parent who also meets the criteria for diagnosis. (Zeigler) ADHD affects up to 7.5% of school-aged children, or between one to three students in every classroom. (Barbaresi, et al) For various reasons, ADHD in adults often goes undiagnosed. Thus, these parents are trying to carry out adult responsibilities without the benefit of appropriate treatment for their own ADHD. Undiagnosed ADHD 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 ADHD are less likely to graduate from college and even less likely to obtain advanced educational degrees. Like most adults with ADHD, 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. ADHD 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 ADHD are three times as likely to separate or divorce as parents of non-ADHD children. (Barkley 1995) Simply place, the parent may not have the emotional tools needed to effectively support the special needs of the ADHD child. Parents who do not have ADHD report that these children are often far more challenging to parent than their non-ADHD siblings. The adult with ADHD faces the already formidable task of raising a hard child while at the same time trying to cope as best they can with their own ADHD. If the parents’ own ADHD 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 ADHD. Furthermore, ADHD has been long considered a childhood disorder. It was not until the mid-1980′s that researchers started to acknowledge that ADHD indeed lasted into adulthood. Parents may be under that mistaken belief that they outgrew their ADHD while in fact it continues to affect their life.
When treating a child who has ADHD, the physician should discuss with the parent the genetics of ADHD 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 ADHD evaluation. Should the parent show resistance to the thought, the physician might discuss the difficulties of raising an ADHD child if ones own ADHD 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 hard, although he or she had the intellectual capabilities to do well. There may be family tales 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 question about the behaviors of other family members as well, to better ascertain the possibility of undiagnosed ADHD 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 ADHD and behavioral disorders is honestly recent and may not have been attributed to ADHD 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 vital 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 ADHD tend to be disorganized and often have difficulty maintaining a home. These adults have distress keeping appointments, getting the child ready and off to school in time, and performing other basic parenting duties.
How ADHD Symptoms Compare in Adults and Children
The same symptoms that apply to children with ADHD also apply to adults; but, 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 ADHD 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 terrible choices. Impulsive parents also make terrible 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 ADHD are also seen in adults with the disorder. Children with ADHD 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 small 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:
1. How can the parent who procrastinates, help his ADHD child learn strategies for getting homework and other school projects finished in a timely fashion?
2. How can the disorganized parent help his child learn organizing skills to keep materials and possessions tidy and at hand?
3. How can the hyperactive, restless parent find a way to emotionally connect with a child who may prefer silent activities?
4. How can the daydreaming parent listen and be attentive to her child’s needs?
5. How can the overly emotional, small-fused parent stay cool when his child needs a steady, cool parent to help her self-regulate her own volatile unpredictable moods?
6. How does the hypersensitive parent handle the onslaught of activity and noise of a busy household? Untreated, the parent facing such challenges could easily become depressed, nervous, mad, or an explosive combination of all three, setting up a vicious cycle wrought with guilt and poor self-esteem. These parents often question why they can’t do a better job raising their child. Invariably, the child loses out too, because his or her emotional and sometimes physical needs are not being met.
Treatment for Adults
Adults with ADHD respond well to treatment. Appropriate management of adult patients with ADHD 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 ADHD child.
Stimulant medications are the first line of treatment for adults with ADHD. 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 ADHD. (Kuperman) Atomoxetine, a non-stimulant medication which is a highly selective inhibitor of the norepinephrine transporter, appears to be an efficacious treatment for adult ADHD. Its lack of abuse potential may be an advantage for many patients.
Once effective treatment is in place, adults with AHD 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 ADHD is a genetic disorder, screening the parent of the ADHD 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.