Dr. Robert Needlman
Specialist in pediatric behavior and development.
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 Ask Dr. Needlman
Daughter with ADHD, Tourette's, and Impulsive Behavior | | | QUESTION | | | Dear Dr. Needlman,
My seven-year-old daughter has Tourette Syndrome and ADHD. She does very well in school. But at home, she really pushes my buttons. She calls me names, and accuses me of not caring for or not loving her. After we have finished arguing, she realizes what she has done, and puts herself down. She says she is stupid and an idiot and that she wishes she were never born. That really hurts my feelings. I feel so responsible. I don't want her to get away with things, but it is so hard for me to tell whether this behavioral problem is coming from her Tourette's or is she doing it on purpose. We only see her "Tourettes" doctor every six months. The last time we saw him, this had only happened a few times, so I didn't bring it up! I feel like I am failing her!— Deon2 in Springfield, OH | | | ANSWER |
February 26, 2002 | | | Dear Deon2,
It's fairly common for children who have Tourette Syndrome to also have Attention Deficit Hyperactivity Disorder (ADHD). The converse also is true: many children with ADHD also have Tourette's. Most people know that Tourette Syndrome is a serious condition that involves multiple involuntary movements, or tics, usually including vocal tics such as sudden uncontrollable swearing, barking, or other noise making.
The behaviors you describe--name calling, accusing you of not loving or caring for her--don't sound on the surface like sudden, uncontrolled vocal tics. Instead, they sound similar to problems with impulsive behavior that are common in children with ADHD. In anger or frustration, a child with poor impulse control may yell all sorts of things he or she later regrets, while a child with better impulse control will be able to keep quiet long enough for the negative impulses to pass.
Your daughter's harsh self criticism--saying she wished she was never born--raises the possibility that she also is experiencing some symptoms of depression. Many children with ADHD, Tourette's, or both do have depression. It may be that the neurological problems that result in ADHD or Tourette's also make them more prone to depression. But certainly it is true that ADHD and Tourette's are terribly stressful for anyone to live with, so that just having those serious, long-term problems often contributes to depression in children. Remember, depression in children more often appears as irritability (getting angry for little reason) than as sadness (which is more common in adults).
Not knowing your child, it's hard for me to have answers for you, and I won't pretend to be able to tell you what is actually going on. But I do have some questions that might help you to move forward:
- Is she having symptoms of depression, and does she perhaps have a diagnosis of depression that needs to be treated?
- Is it possible that your daughter's problems in the afternoon are related to undertreatment of her ADHD. If she takes medicine that helps her control her behavior during school hours, but that wears off after school, perhaps she would benefit from medication that lasts throughout the day.
- Have you received any coaching, either one-to-one or in a group, on how to best respond to and manage your daughter's behavior? All parents of children with ADHD probably need this. Being a part of a parents support group also can be terrifically helpful.
I think you should probably take up these, and any other questions that come to mind, with the doctor who is treating your daughter's ADHD, and/or Tourette's, as soon as you can. The longer depression goes untreated, for example, the worse it can get. Doctors treating children with chronic behavior problems really do appreciate hearing if there is any change in the child's behavior. The every six months follow-up visit may make sense when things are going well. But if there has been a change for the worse, your daughter's doctors deserve to know sooner, rather than later. Good luck!— by Robert Needlman, M.D., F.A.A.P. |
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