c.ADHD: A River Wild

For aught that I could ever read, could ever hear by tale or history, the course of true love never did run smooth. William Shakespeare

The entire life with its different stages, psychologically and biologically as it’s been said by Shakespeare , is like a river but not smooth. While this river of life has its natural path genetically, depending what comes in its path, environmentally through years, its direction can greatly change.  But ADHD is a “River Wild” from the start! This river is powerful, rough with many ups, downs and turns, more than usual rivers. Managing this river is like wild water rafting and needs expertise, patience, knowledge and right tools. While this river is wild and different than the others, it is still a river and goes through the same paths (stages of life), though with more turbulence.

In fact, ADHD is a very good example of a primary psychiatric condition that if undiagnosed and untreated, it could have many other secondary emotional and behavioral conditions as comorbidities or complications that are better to be termed “post-morbidities”.  Examples of these  “post-morbidities” are : depression, anxiety, impulsivity & aggression, suicidality, substance use disorders, conduct & oppositional defiant disorders, risk taking behaviors, procrastination, poor cognitive, academic, vocational and other functional disorders, learning disorders, eating disorders, sleep disorders, accidents and injuries, low self-esteem and confidence, social/ interpersonal disorders, gambling, games, and internet addiction, antisocial and narcissistic personality disorders among others.  

A review of literature of  shows that under-diagnosed ADHD  is more than 5 times more likely to be diagnosed with major depression and three times more likely to be treated for depression before their ADHD diagnosis. Untreated ADHD also appears to increase the risk of suicide by increasing severity of comorbid conditions, such as  conduct disorder, anxiety , depression and substance abuse. Therefore it is prudent and common sense to think as depression, anxiety , suicidality and substance abuse as complications or “post-morbidities” in the course of ADHD.

Impulsivity, aggression and hostility have also been reported as comorbidities of ADHD. The Cambridge Study in Delinquent Development , in a survey of 411 London males from ages 8 years old to 32 years old showed the association between ADHD and adolescent aggression, violence and adult violence and convictions for violence.  Also in genetic studies ADHD subjects have shown significant association with comorbid conduct disorder symptoms, particularly the aggression. Therefore it is very common that untreated ADHD kids would be diagnosed or labeled with conduct disorders, oppositional defiant disorder, anti-social & other personality disorders due to their impulsive and disinhibited behaviours such as risk taking behaviours, risky driving, addiction gambling, etc.      

 Read more in the book “ADHD:Revisited” at Amazon, Kindle books.

  
Dr.Mostafa Showraki, MD, FRCPC Lecturer, University of Toronto,Head, Community Psychiatrists Association of Toronto (CPAT),Author: “ADHD:Revisited” Book “adhdrevisited.com”/”medicinerevisited.com”   

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