Tuesday, August 10, 2010

Reunion (2 of 3) or My ADHD Story 2 - Revisited.

I intended for my second installment on my high school reunion to be a retrospective on my post
My ADHD Story Part 2 – Early years through high school.

However, I delayed because I could not find adequate parallels between my reunion and my post.

I read and re-read my original post, and I finally exclaimed,
"My reunion issues were not about ADHD! They were about self-esteem, self-confidence, and feeling socially isolated although I was not really isolated!"


Ladies and gentleman, allow me to introduce the concept of "Secondary Symptoms of ADHD".

Secondary symptoms represent those symptoms that are not really listed as the primary symptoms of ADHD (inattentiveness, hyperactivity, etc.).
However, these symptoms are closely associated with people that have ADHD.
Low Self-Esteem.
Before I continue, a lot of times, miscommunication arises when people use the same term different ways.
So I wish to clarify.

Most of the literature uses the term "Comorbid."
However, comorbidity only truly means that another disorder exists at the same time.
Sometimes, there may an inference of the two comorbid diagnoses being independent of each other.
"Comorbid" does not quite work well enough.

Even the term "secondary" has different meanings in clinical circles.
To some, the term means "not as important as the Primary."
In this case, I am using the term as "Secondary to ADHD."

For example, the direct signs and symptoms (unstable blood-sugar, insulin insensitivity, etc.) of Diabetes can cause problems of their own.
These problems can be referred as "Secondary to Diabetes."

It works like this:

A student with ADHD misses social cues, interrupts others, and misses/ignores what others say.
This leads to other students avoiding social interaction with the student with ADHD, or worse, teasing and/or bullying.
Social isolation ensues, which then denies the student more opportunities to improve and learn from positive social interactions.

This same student also conceptualizes school-work at a level far-higher than classwork and grades suggest.
Underachievement of one's potential ensues.
Teachers and parents see this.
Bring on the numerous lectures that start,

You are a smart kid, but you just do not do your work. You could be successful if just applied yourself more... Be more serious... Tried harder... blah... blah...

"What? Yes, I am listening, I am smart, but lazy. Got it!"

The result?

I am friendless and lazy.
I am a failure.

It does not take a psychologist to figure out that low self-esteem and depression are imminent.

This is not the type of depression that occurs when a child genetically inherits the same chemical-imbalance from a parent.
That would truly and accurately be considered comorbid.

In this case, the secondary depression is a logical response to the situation - social isolation, the frustration of achieving below potential, etc.
Furthermore, the situation is a direct result of the ADHD.

Why is this important?

For one thing, many students may not get referred for assessment or treatment for ADHD.

The Secondary Symptoms may get the adults' attention - depression, oppositional behavior, withdrawal, even self-harm.

This is my argument for comprehensive assessments that deeply seek differential diagnosis, not the just the easy or superficial diagnosis.

A poor practitioner can use faulty circular-logic to attain a diagnosis of Oppositional Defiance Disorder, but have we worked hard enough to ensure that it is just ODD?

Or, was there something that triggered the symptoms that we are using the label ODD?

This goes beyond the semantics of labelling, "You say 'Poe-TAY-to.' I say, 'Po-TAH-to'."

There are treatment implications.
Yes, you can give a pill to limit the symptoms for, say, depression or anxiety.

What is the long-term prognosis if you do not address the triggers and/or reinforcers that caused those symptoms?

I still have no friends and fail in social situations, but I take a pill that makes me not feel so bad about it.


I am still a genius with below-average achievement.

(Aside, Malcolm Gladwell gives a great case-study on an under-achieving genius in his book "Outliers.")

Don't get me wrong, you still need to address these secondary symptoms/diagnoses.
However, success will be severely limited without addressing their cause.

This makes intuitive sense with medical disorders.

Most people can address a head-ache with some Tylenol and a glass of water.

However, there is a point when the head-aches' severity, frequency, duration and functional impairment prompt you to ask a professional, "What is the cause and cure?"

If those head-aches were caused by a malignant brain tumor, you may still need pain-killers, but will you just stop there?

Why would ADHD be any different?

Note: For my readers that do advocacy work, Secondary Symptoms do not meet the "Direct or substantial relationship" test required to argue that a behavior is a manifestation of a disability.
There are too many degrees of separation.
 I have seen this argument only work when districts do not know what they are doing or when they have other legal exposure that they do not want to risk.


1 comment:

  1. wow...you just described my 17-year old son's situation...We are now working hard to help him recover his self esteem and deal with this depression. We knew he was unhappy, but had no idea how bad it was until he made a serious suicide threat. Wish I had read this 2 years ago when he was diagnosed