The Syndrome Mix
When kids experience a combination of special needs issues.
by Martin L. Kutscher, M.D.

PARENTGUIDE News September 2007

Start with a real, live child— a kid with feelings, needs and hopes. Mix in a double helping of ADHD, a touch of Tourette’s and a dash of dysgraphia. Stir gently. That is one possible “syndrome mix” that a child may be dealt. The child in question then must deal with symptoms from all three disorders.

Special needs issues often cluster together in various combinations. Common contributors to the syndrome mix include:

•ADHD
•Learning Disabilities
•Autistic Spectrum Disorders, such as Asperger’s Syndrome
•Sensory Integration Dysfunction
•Anxiety
•Obsessive Compulsive Disorder (OCD)
•Tics and Tourette’s Syndrome
•Depression
•Bipolar Disorder
•Oppositional Defiant Disorder
•Central Auditory Processing Disorder

If a child has any issue in this syndrome mix, there exists a significant chance of occurrence for each other problem listed.

Problems may exacerbate and imitate each other.
Not only does a special needs child tend to be born with multiple issues, the problems may exacerbate each other. For example, a child may innately have ADHD and learning disabilities. The child’s poor attention span can then make it harder for the child to learn, while the difficulty learning makes it harder to concentrate. As the mix of syndromes keeps exacerbating, learning becomes increasingly difficult.

Similarly, the problems can imitate each other. For example, a child constantly mulling over his anxieties can look distracted, as well as become confused because of his ADHD.

Stressed caregivers can cause other problems.
Often a stressed child will find himself in a stressed home or school environment. True, the stressful environment may have been caused by the youngster with special needs, but the end result is that the child now finds himself having to deal with stressed out adults— the last ingredient the child needs!

Also, many of the neuro-psychiatric conditions run in families. Thus, the child with special needs may find himself coping with parents (or teachers, therapists and caregivers) with personal special needs issues.

Parents and teachers are typically the first to detect an issue.
How does an evaluation start to identify special needs issues? With you! When you think about it, psychologists, therapists, neurologists and psychiatrists do not stand on the street corner and randomly pick children to evaluate. Rather, kids are all sent to doctors because other people have noticed a problem. Those people, namely parents and teachers, are the ones on the frontline. Parents, caregivers and teachers may not know exactly what the problem is, however, they are generally the first to diagnose that a problem exists. The whole system depends on you and other first-responders.

Redefine ADHD to include “executive dysfunction.”
Consider the “star” of the syndrome mix as attention-deficit/hyperactivity disorder (ADHD). ADHD occurs in roughly six percent of children, no matter where in the world we look.

ADHD needs to be redefined to include a wide range of “executive dysfunctions.” Executive functions are what allow us to think about where we came from, where we want to go and how we can control ourselves in order to actually get there. In ADHD, there is poor executive function because the brain’s frontal lobe brakes are “asleep on the job.” Without brakes, problematic behaviors are free to disrupt executive functions. Therefore, people with ADHD are better understood as brakeless than inattentive.

Will it all be OK?
We doctors and parents miss the point when we address only the ADHD triad of inattention, impulsivity and hyperactivity. These symptoms are only the tip of the iceberg. Much greater problems have usually been plaguing a child with special needs for his entire life. Yet, often no one has understood that the associated symptoms described earlier are part and parcel of the same neurologically-based condition— or relate to another issue in the syndrome mix.

Without this recognition, parents and caregivers tend to think that their ADHD child has been incidentally uncooperative and apparently self-absorbed. Unless we recognize that these extended symptoms are part of the same spectrum, teachers and parents will not address them, and doctors will never deal with them.

Finally, we must also keep in mind that some symptoms that special needs children experience are fantastic and enviable. While the rest of us obsess about the future or feel morose about the past, people with ADHD honor the present. People with ADHD can be a lot of fun— dullness is never a problem. Their carefree attitude may encourage people with ADHD to take chances that the rest of us may be afraid to take. Their flux of ideas may lead to creative innovations. Their extreme passion can be a source of inspiration and accomplishment that benefits us all.

It’s going to be quite a ride. Make sure that you and your doctors address all of the problems that are likely occurring simultaneously in your special needs child.

ADHD is more than a short attention span.
Kids with ADHD often exhibit the following personality traits or personality dysfunctions.

•They act like moths by being attracted to brightness. Kids with ADHD are like moths in the sense that they are always drawn to the brightest light. Sometimes, the brightest light is a fascinating paperclip on the desk; rarely is it homework. Unfortunately, sometimes the brightest light is a bug zapper.
•They have trouble executing a task. Johnny has ADHD. Johnny often finds himself saying, “I’m gonna do it, I’m gonna do it… Holy cow, I didn’t do it.”
•They lack organizational skills. Kids with ADHD who appear organized must work extremely hard to keep things in order.
•They show a lack of foresight. Mothers are usually endowed with great foresight— that verges on obsession— concerning their child’s future happiness. They are often crushed as they watch their child with special needs repeatedly head down counter-productive paths.
•They live at the mercy of the moment. It’s not that Johnny doesn’t care about the future. It’s not that Johnny doesn’t cares about all of the nice things that you have done for him in the past. However, right now, the future and the past don’t exist in Johnny’s mind. Such is the nature of ADHD.
•They frequently feel overwhelmed and angry. If you’re the parent of a child with ADHD, you’ve probably heard this: “Mommy, just stop! I can’t stand it! Just stop! Go away!”
•They lie, curse and blame others. Negative expressions become frequent symptoms of ADHD, especially as children age.

Martin L. Kutscher, M.D., is a pediatric neurologist specializing in children with neuro-behavioral disorders. He is author of several books, including Kids in the Syndrome Mix of ADHD, LD, Asperger’s, Tourette’s, Bipolar and More!: The One Stop Guide for Parents, Teachers, and other Professionals (Jessica Kingsley Publishers). His offices are in Rye Brook and West Nyack, NY. See his Web site at www.syndromemix.com for more information.