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ADHD & ODD

Attention Deficit Hyperactivity Disorder & Oppositional Defiant Disorder

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ADHD (Attention Deficit Hyperactivity Disorder)     AADD (Adult Attention Deficit Disorder)    ODD (Oppositional Defiant Disorder)    Conduct Disorder 

ADHD


 

This section is relevant to Rugby League and more particularly to the area of ‘Junior League’. Due to the very nature of the symptoms associated with both ADHD & ODD, the game has many advantages and opportunities for the individual suffering these types of disorders. They may be drawn toward League themselves, feeling it answers many of their troubles, or their parents/guardians may feel it an appropriate sport to in which become involved.  

 

Rugby League has structure & discipline; it requires physical effort & energy; it offers teamwork & a sense of purpose, of belonging, of self, of worth. Parents may feel that their ADHD child could benefit from these qualities & attributes of the code. They may feel their child’s hyperactivity is best suited to a highly energetic, physically demanding & exhaustive sport. They may also believe that their child’s scholastically poor achievements are compensated by a sport that offers a future. 

 

The reasons are many and varied, though the likelihood of children & adolescents being involved & playing the game is quite distinct. It is therefore necessary to understand the disorder and the associated symptoms and how best to manage them should they become a problem. Further to this, the resultant behaviours & personality development could determine how the player presents as an adult, particularly if league becomes their career.

 

 

ADHD

Attention Deficit Hyperactivity Disorder

 

Attention Deficit Hyperactivity Disorder is a ‘neurodevelopmental disorder’ affecting 3 – 5% of the world’s population under the age of 19. It is currently considered to be a chronic & persistent disorder for which there is no medical cure. It presents primarily during childhood & is characterized by forgetfulness, hyperactivity, inattentiveness, poor impulse control & distractibility. 

 

 

In the last ten (10) years it has become increasingly diagnosed in adults, though a degree of skepticism & conjecture has occurred as a result. It appears that about 60% of all those diagnosed with ADHD as children carry it through to adulthood. 

 

Symptoms (most common) 

 

  • Distractibility 
  • Difficulty with attention & focus 
  • Short term memory slippage 
  • Procrastination 
  • Tardiness 
  • Organisational problems – belongings & ideas 
  • Impulsivity 
  • Weak planning & execution 

 

Whilst classified as simply ADHD, there are three (3) types present under the one heading. They are ADHD (predominantly hyperactive – impulsive type), ADHD (predominantly inattentive type) and ADHD (combined type). It appears that hyperactivity & inattention are the defining differences or key components. 

 

For a diagnosis of ADHD (inattentive type), the following symptoms need to have been present for at least six (6) months and considered functionally disruptive & inappropriate for the developmental stage:  

 

1.       Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.  

2.       Often has trouble keeping attention on tasks or play activities.  

3.       Often does not seem to listen when spoken to directly.  

4.       Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to

              oppositional behavior or failure to understand instructions).

5.       Often has trouble organizing activities.  

6.       Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such

               as  schoolwork or homework).

7.       Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).  

8.       Is often easily distracted.  

9.       Often forgetful in daily activities. 

 

For a diagnosis of ADHD (hyperactivity – impulsivity type) the following symptoms have had to be present for six (6) months; functionally disruptive & inappropriate for the stage of development. 

 

1.       Often fidgets with hands or feet or squirms in seat.  

2.       Often gets up from seat when remaining in seat is expected.  

3.       Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).  

4.       Often has trouble playing or enjoying leisure activities quietly.  

5.       Is often "on the go" or often acts as if "driven by a motor".  

6.       Often talks excessively.  

Impulsiveness  

1.       Often blurts out answers before questions have been finished.  

2.       Often has trouble waiting one's turn.  

3.       Often interrupts or intrudes on others (e.g., butts into conversations or games).  

 

In addition to these symptoms, there are also specific criteria for an accurate diagnosis:  

 

A.                  Six (6) or more of the symptoms of each need to be present 

B.                  Some symptoms causing impairment need to have been exhibited before the age of seven (7) years 

C.                  Some impairment from the symptoms needs to be present in at least two (2) different settings (eg. at school,

                             work or home) 

D.                  There must be clear evidence of significant impairment in social, school or work functioning 

E.                  The symptoms should not occur in the presence of another concurrent disorder, particularly a pervasive one such

                             as a psychotic illness or schizophrenia. This also applies to Depression, Anxiety Disorders, Bipolar or

                             Personality Disorders.   

 

In excess of 50% of children with ADHD will carry these behaviours & symptoms through to adulthood. The impact on their families, social relationships & occupations is severe.

 

 



Ruby Wax - ADHD

 

 


 

AADD

Adult Attention Deficit Disorder

 

The diagnosis for AADD (Adult Attention Deficit Disorder) is the same for those younger people with ADHD. The difference being that they must have been diagnosed or have suffered from ADHD as a child in order for that diagnosis to apply as an adult. 

Symptoms are sometimes difficult to diagnose or are misdiagnosed in adults. Often, when a child with ADHD has received treatment, they develop ‘coping mechanisms’ that somewhat deal with their ongoing symptoms. Also the manifestation of symptoms can be different in the adult setting. Hyperactivity is also not as observable as with children, being exhibited in different ways. 

 

ADHD in adults can cause moderate to extreme malfunctioning at home, in social settings, work or school. It is usually characterised by inattentiveness, impulsiveness & restlessness. Adults have problems structuring their lives and planning simple daily tasks.  It can result in relationship breakups, job loss, and trouble with people or work due to the person’s forgetfulness, inattentiveness & disorganisation rather than ‘direct aberrant behaviour’. 

 

The most prominent neurological characteristic of AADD is that of impaired or impoverished ‘executive functioning’. This is the area of the brain that oversees & controls the ability to monitor a person’s own behaviour by planning & organising. There are frequent behavioural problems & learning deficiencies and all these can create significant emotional disturbances. 

 

The person with AADD often ‘self medicates’ with alcohol or drugs. They are more likely to suffer from depression & anxiety disorders due to their relationship difficulties & breakdowns and similar occupational losses. 

 

The following is a list of the common symptoms and behaviours associated with Adult ADHD. 

 

 

1.       A sense of underachievement, of not meeting one's goals (regardless of how much one has actually accomplished).  

2.       Difficulty getting organized.  

3.       Chronic procrastination or trouble getting started.  

4.       Many projects going simultaneously; trouble with follow through.  

5.       A tendency to say what comes to mind without necessarily considering the timing or appropriateness of the remark.  

6.       A frequent search for high stimulation.  

7.       An intolerance of boredom.  

8.       Easy distractibility; trouble focusing attention, tendency to tune out or drift away in the middle of a page or conversation,

                often coupled with an inability to focus at times.  

9.      Trouble in going through established channels and following "proper" procedure.  

10.    Impatient; low tolerance of frustration.  

11.    Impulsive, either verbally or in action, as an impulsive spending of money.  

12.    Changing plans, enacting new schemes or career plans and the like; hot-tempered  

13.    Physical or cognitive restlessness.  

14.    A tendency toward addictive behaviour.  

15.    Chronic problems with self-esteem.  

16.    Inaccurate self-observation.  

 

It is suggested that individuals who exhibit at lease twelve (12) of these behaviours and who have done so since childhood, in the absence of any psychiatric or medical condition, should be considered for a provisional diagnosis of AADD. 

 

The multiple symptoms & behaviours need to be exhibited in multiple settings for the preceding six (6) months.  

 

Anyone involved in the game of Rugby League can probably relate to having played with or against, or had dealings with, someone who has exhibited many of these characteristics. Some are similar to Bipolar Disorder, some similar to a Personality Disorder. Some of those who use & abuse Alcohol & Drugs and constantly frequent clubs & bars may also display similar symptoms. 

 

Those with AADD are often in trouble with the establishment for many and varied reasons, not least of which is their impulsiveness and distorted perception and their overarching debilitated executive functioning. These are those individuals for whom league clubs and the respective administration constantly have to explain behaviour. 

 


 

 

ODD

Oppositional Defiant Disorder

 

Oppositional Defiant Disorder is a controversial diagnosis which is described as an ‘ongoing pattern of disobedient, hostile & defiant behaviour toward authority figures which supposedly goes beyond the bounds of normal childhood behaviour’. 

 

 

 

Diagnostic Criteria: 

 

1.     A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following

          are present:

 

1.       often loses temper  

2.       often argues with adults  

3.       often actively defies or refuses to comply with adults' requests or rules  

4.       often deliberately annoys people  

5.       often blames others for his or her mistakes or misbehavior  

6.       is often touchy or easily annoyed by others  

7.       is often angry and resentful  

8.       is often spiteful or vindictive  

 

2.       The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.  

3.       The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.  

4.       Criteria are not met for Conduct Disorder (see below), and, if the individual is age 18 years or older, criteria are not

                 met for Antisocial Personality Disorder (refer to ‘Personality Disorders’).

 

 

 Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level. 

 


 

 Conduct Disorder

Yet another ‘controversial’ disorder, though its symptoms & the behaviours exhibited are extremely serious, irrespective of where it originates or whether it should be classified as a mental illness or disorder. It is similar to ‘Oppositional Defiant Disorder’, though more extreme. 

 

It pertains to children & adolescents under the age of 18. After this it would be most likely considered ‘anti-social personality disorder’. It describes ‘repetitive behaviour where the rights of others and societal norms are violated’. Some of the symptoms exhibited are bullying, over-aggressive behaviour, cruelty to people & pets, truancy, physical aggression, destructive behaviour, lying, stealing and vandalism. 

 

The diagnostic criteria used to define ‘Conduct Disorder’ are set out below: 

 

 

1.         A repetitive & persistent pattern of  behaviour  in which the basic rights of others or major age-related societal norms or rules are violated, as manifested by the presence of three (or more) of the following criteria in the past twelve (12) months, with at least one (1) criterion present in the past six (6) months.

 

1.       Aggression to people or animals 

·         Often bullies, threatens or intimidates others 

·         Often initiates physical fights 

·         Has used a weapon that can cause serious physical harm to others (eg. bat, knife, brick or stone, broken bottle,

                  gun etc..) 

·         Has been physically cruel to people 

·         Has been physically cruel to animals 

·         Has stolen while confronting a victim (eg. mugging, puse snatching, extortion, armed robbery) 

·         Has forced someone into sexual activity 

 

2.          Destruction of Property 

·         Has deliberately engaged in fire setting with the intention of causing serious damage 

·         Has deliberately destroyed other’s property (other than by fire) 

 

 

3.          Deceitfulness or Theft 

·         Has broken into someone else’s house or car 

·         Often lies to obtain goods or favours or to avoid obligations (ie. ‘con job’) 

·         Has stolen items of nontrivial value without confronting the victim (eg. forgery, shoplifting)

 

 

4.          Serious Violation of Rules 

·         Often stays out at night despite parental prohibitions, beginning before the age of 13 

·         Has run away from home overnight at least twice while living in parental or parental surrogate home (or once

                 without returning for a lengthy period) 

·         Is often truant from school, beginning before the age of 13

 

 

2.       The disturbance in behaviour causes clinically significant impairment in social, academic or social functioning.

 

3.       If the individual is 18 years or older, the criteria is not met for ‘Anti-social Personality Disorder’. 

 

 

Many believe these disorders are the result of ‘poor parenting and/or ‘role modelling’ or the absence of discipline and/or appropriate & necessary ‘boundaries’. Certainly there is evidence to suggest this indeed may be somewhat true. Others attribute children’s behaviour, particularly hyperactivity, as being the result of poor or inappropriate dietary intake. 

 

Irrespective of your opinions regarding the cause, the symptoms and the condition it persists and requires intervention and treatment. The overhauling of society’s behaviour & thinking and the re-education and proactive, pre-emptive, preventative primary health care needed may ultimately improve the problems associated in the longer term, though in the interim it is essential we address the issue with our current means of treatment. 

 

 

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Michael J. Salamon, Ph.D., FICPP
Senior Psychologist/Director
ADC Psychological Services, PLLC
1728 Broadway, Suite 1
Hewlett, NY 11557

 



 

 

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