him, hovering around him to tell him a thousand things in one breath. When Dad phones home from London he can scarcely talk to Mom because Rafiq takes over the phone. At the end of the call, Rafiq is unable to tell Mom what Dad said, and Dad has no idea what Rafiq was trying to tell him. Dad is angry with himself for getting irritable with his child. Rafiq is unhappy and tearful. Mom must heal the wounds.
The adult sufferer will burst into your personal space and be completely unaware that he has crossed a line. I have never met anyone with ADHD who knocked quietly or coughed discreetly and asked whether he could come in.
A while back, four of us – me, a childhood friend, her mother and another friend – went away for the weekend. Elaine’s mom is in her eighties and still a classic ADHD sufferer. It is a privilege to experience her enthusiasm and zest for life, and we often chuckle at her direct way of saying things. On the day I was taking Elaine and her mom back to the airport after the weekend, she was trying her best to listen to a story I was telling, but my voice was soft and the story long. A hair hanging down in front of my eyes kept distracting her attention. Unable to stand it any longer, a determined expression came over her face, she reached over, grabbed the hair firmly and yanked it out. “That’s better,” she said.
Talkativeness
Talkativeness is related to an inability to respect boundaries, impulsivity and high energy levels. People with ADHD will go on and on and on even after numerous hints from those around them that they cannot follow the movie. And saying directly “You’re talking too much,” is also not always the solution, or can embarrass and hurt the person. The focus then shifts to the insensitive remark, and the person who made it gets the blame for the unpleasantness.
Blaming behaviour
As in the example above, people with ADHD often blame those around them for the discomfort they experience. The person will often not have the insight to realise that it is his own behaviour that drives others to such an extreme response. For example, a mother will rebuke her husband because his teasing has reduced their child to tears. He will then reply, offended, that he is always criticised and that nothing he does is ever right or good enough. This gives rise to a whole new drama in which the offender becomes the victim.
In summary
The typical characteristics of ADHD sufferers we have examined in this section (besides the symptoms listed in the DSM-5) are:
•impulsivity (this is a symptom according to the DSM-5)
•disorganisation
•literal or concrete mindedness
•rigidity
•poor linguistic skills
•overhastiness due to poor auditory processing skills
•carelessness
•underachievement
•physical characteristics (e.g. poor handwriting)
•poor planning skills
•irresponsibility
•poor perseverance
•impatience
•temper tantrums
•aggressive behaviour
•self-centredness (selfishness)
•problems with boundaries
•talkativeness
•blaming behaviour
What should I know about stimulant medication?
ADHD has become virtually synonymous with the use of stimulant medication such as Ritalin or Concerta for treatment. There are, however, other forms of medication available these days, and because of growing fears about the side effects of stimulant medication, many parents have also started looking at natural forms of treatment such as dietary supplements. To help you decide on a treatment best suited to your convictions and needs, the different types of treatment are discussed in chapter 8.
Part 2: Conditions sometimes associated with ADHD
There is a growing tendency to diagnose so-called co-morbid or associated conditions in ADHD sufferers. Some of the most common include:
Oppositional defiant disorder (ODD)
According to Professor André Venter of the University of the Free State, ODD is one of the conditions most frequently associated with ADHD. About half of the children in the combined ADHD group suffer from ODD, while a quarter of those in the inattentive group can be diagnosed with ODD. This condition leads to behavioural problems that should not be treated with medication alone.
Children diagnosed with ODD manifest oppositional or defiant behaviour. They lose their temper, are argumentative and refuse to obey rules or respond to requests. These children usually blame others for their mistakes. (Even ADHD sufferers who do not display oppositional behaviour, have this tendency.) They are often vengeful and spiteful. These symptoms often manifest when the ADHD child experiences himself as a failure and carries a lot of frustration and anger.
Conduct disorder (CD)
Conduct disorder is a much more serious behavioural problem than ODD. A quarter of children, adolescents and adults with combined ADHD, show clear symptoms of CD.
Children diagnosed with CD do not show respect for the basic rights of others. They threaten or intimidate other children, often initiate fights and generally exhibit aggression and even cruelty towards people and/or animals. Children with CD often run away from home or stay out the whole night. Serious transgressions, such as damage to property and theft, are sometimes committed. A multidisciplinary team should be involved in the treatment of such a child.
CD is diagnosed in adult ADHD sufferers if the person does not meet the criteria for a diagnosis of antisocial behaviour disorder.
Disruptive mood dysregulation disorder (DMDD)
Disruptive mood dysregulation disorder, a new diagnosis in the DSM-5, may also be diagnosed in addition to ADHD. This disorder is not diagnosed for the first time before the age of six years or after the age of eighteen, and must have started before the age of ten years. Children suffering from DMDD have regular temper tantrums (an average of three or four a week). The rage is expressed either verbally or through aggressive behaviour. When aggression is not expressed verbally or in actions, the children generally appear to be irritable. The anger and irritation are obvious to teachers, parents and friends.
Gilles de la Tourette syndrome
With this syndrome, commonly known as Tourette’s syndrome, ADHD symptoms may manifest in combination with obsessive compulsive behaviour and nerve and/or muscular spasms. A diagnosis is made only when uncontrolled sounds, as well as muscle tics are present for longer than six months.
Previously it was believed that sufferers of Tourette’s syndrome could not use Ritalin. However, nowadays the medication is regularly prescribed for sufferers.
The effectiveness of neurotherapy as a treatment for Tourette’s syndrome looks promising. Neurotherapy is discussed in chapter 10.
Mood disorders
Depression and bipolar disorder sometimes occur in ADHD sufferers. Depression occurs in a minority of ADHD sufferers, but more often than in the general population.
Anxiety disorders
Anxiety disorders are also diagnosed fairly often in hyperactive-impulsive ADHD sufferers in particular. Among children,