Repost: ADHD, ODD, & Mania, pt 1

• I need help on a paper, is anyone able to give me suggestion about linking ADHD, conduct disorder and antisocial personality? jholsinf@mato.com by (No author), 3/17/97
  
  

There's too much accumulated data in the past 5 years, data that challenge any fixed sequence of ADHD to APD; earlier findings, however, did raise exactly that possibility. I currently tend to look more for parents, especially fathers, with antisocial behavior when assessing CD or antisocial personality disorder. (Impulsive girls marry antisocial boys?) In addition, lots of things can happen to one person that are separable when you examine a larger group. ADHD is probably no worse than other childhood disorders although it is known for having 40% overlaps with many other emotional problems; ADHD, however, is the best researched. Mania is one such overlapping problem. The relation between ADHD and mania should be one of the prime discovery areas for the next decade.

Recent models suggest that ADHD or bipolar disorder or both can occur in the same child (Wozniak & Biederman, 1994; Glasser, 1995). Given that milder forms of mania and bipolar disorder exist, then it's also likely that they occur more often than full bipolar disorder but may not be recognized. The clinical distinction between mania and ADHD may be subtle because both groups appear to be hyperactive, talkative, and distractible (3 of the DSM 4 criteria for ADHD) (Wozniak & Biederman, 1994). Manic children can also seem oppositional, yet, mania may not be considered in the diagnosis if its intensity does not include extreme aggression and cruelty.

Possible features of mania:

Some children have mania traits of such intensity to be a significant management problem for parents and teachers. There may be unusual degrees of persistence especially in areas related to dominance. Relative standing within the family, control of property, access to family resources, and manipulation of friends are common themes. The child does his math or English erratically because he's more interested in phone privileges, social freedom, or winning conflicts with teachers who are characterized as "mean" or "unfair" for imposing their will on him. Aggression, lying, and manipulation are common and there may be hypersexuality after puberty (Cantwell, 1995). There may be some evolutionary significance to domineering humans, like domineering males in other species, being more sexually active and attractive.

It is important to detect mania early because there may be a heightened, future risk for legal difficulties, drug abuse (Beiderman, et al., 1996), and aggression against adults or peers. While some authorities argue for impairment in planning and strategic thinking in ADHD (Barkley, 1993, 1996), the manic child appears to plan but in a distorted fashion in areas related to power or social dominance. At times, he may appear "obsessed" with winning at any cost and resist coming to therapy because he objects to any notions of personal impairment.

Cont. in part 2

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