Case Study:

Juan is a 6 year old male who presents in clinic with his mother. She says, “I just don’t know what to do with him, I’m at the end of my rope. His grades are terrible, he tunes me out and I can’t get him to do his chores, he doesn’t think through things- he just does them, and he’s constantly in trouble. He can’t get along with his sisters- I can’t take it anymore, I just don’t know how to help him.”

Parents, caregivers, loved ones, or patients themselves, typically report several of the following symptoms:

  • Makes careless mistakes or fails to pay attention to details
  • Easily distracted
  • Difficulty starting tasks and concentrating long enough to complete them
  • Over-focused/ hyper-focused – “gets lost” in favorite activities such as video games, drawing, reading, etc.
  • Difficulty following instructions and organizing tasks
  • Poor impulse control
  • Hyperactivity
  • Feelings of restlessness
  • Difficulty with social relationships
  • Low frustration tolerance

Berkowitz, C. (2014). Berkowitz’s Pediatrics, A Primary Care Approach. (5th Edition)

The physical and social consequences of severe symptoms can also be a clue to the presence of undiagnosed/untreated ADHD.

  • For children, this can manifest as getting in trouble at school, poor academic performance, frequent injuries, and difficulty making friends.
  • For adolescents and adults this can manifest as frequent speeding tickets, license suspension, difficulty keeping a job, failed interpersonal relationships or marriages, frequent injuries, and criminal arrest.

Attention Deficit Hyperactivity Disorder and Increased Risk of Injury

Social Impact of ADHD

Parents and Caregivers:

Parents of children with ADHD experience significantly more parenting stress than other parents, and the level of stress they experience often directly correlates with the type and severity of the child’s symptoms. This is particularly true when children display hyperactivity and impulsivity, and have co-morbid conduct problems such as oppositionality and externalizing behaviors. The stress and frustration for parents can be overwhelming.

When a parent expresses feelings of exhaustion, isolation, anxiety, irritation, desperation, frustration, anger, powerlessness or helplessness, it may be a clue to the severity of symptoms in their child. Without appropriate diagnosis and management, these feelings can damage the parent-child relationship and cause significant long-term sequela.

Managing children with challenging behaviours. Parents’ meaning-making processes in relation to their children’s ADHD diagnosis

Spouses

Adults with untreated ADHD may suffer from guilt or shame as a result of chronic underachievement, and these feelings can lead to insecurity, depression, and tumultuous relationships. Untreated adults with ADHD have a higher number of marriages on average, and report lower levels of marriage satisfaction.

Spouses of patients with ADHD often report feeling an increased burden to “manage everything in the household,” and may describe their marriage as “difficult.” They typically report that their spouse is easily distracted, has difficulty following-through with projects, and may forget to complete household chores or pay bills. Couples often seek help from marriage counselors and/or therapists to no avail. This pattern of marital conflict should cue a primary care provider to consider the possibility of undiagnosed ADHD in the adult patient.

American Psychological Association. “Pay Attention to Me.” Undiagnosed ADHD affects millions of adults — and their romantic relationships.