Problems with aggression are one of the most common presenting complaints by parents of children with ADHD.
In the 2nd week of January the parents of a sister and brother duo brought their children to the Dyslexia Association of India™. The boy was 12 years old and his elder sister was 18 years old and studying in Lady Shiriam College in South Delhi.
At the slightest provocation, the sister would slap her brother – and quite violently. The psychological trauma was such that this young boy has begun to feel unwanted in his own house.
Within a developmental psychopathological perspective this form of aggressive behaviour by the young lady is not a normal normative developmental issue. The reason is that by the age of 18, any individual develops the capacity to understand – to a large extent what is considered appropriate behaviour and when we cross the line of propriety.
Growing up as a child with AD/HD this young ladies normative pattern of aggression is still exceeded by the sheer intensity and pattern of agitated reaction to an ordinary situation.
Ideally, we would view this pattern separate from ADHD because of the unique set of issues and diagnostic consideration relating to ADHD specifically. However, it would be well worth examining her conduct in view of the hyperactive and impulsive behaviour displayed by her – as it is not normal to slap a younger brother of 12 years repeatedly when he does not shut the door to a room.
As a child growing up with ADHD and impulsivity this young lady consistently displayed reactive, defensive as well as impulsive tendencies. This hot aggression on her part which is effectively unplanned, impulsive and marked by a unthought-of lightning fast response to perceived slight is followed by defensive behaviour and is marked by a sense of guilt and remorse – but the damage is already done.
When asked why, she reacts so impulsively; the response is that ‘I am not able to control my anger’. In this particular case reactions have become automatic and as the parents felt that these hyperactive and impulsive behaviours would go away as she grew older they did not have her tested or assessed and took no remedial action. The result – however is that this young lady's response to stimuli which were not often for her liking – have become routine and by default automatic.
Growing up as a young lady from a dignified family, and constantly being told to control herself and behave, the internalizing behaviour have resulted in a personality which has developed which shows unreasoned aggression which is now uncontrollable.
The situation now is such that even a slight non-compliance to her request or other social and environmental circumstances causes an outburst, which is far in excess of the ground reality of the trigger.
Besides environmental factors, it is our equivocal belief that genetic factors also contribute to the development of a neurochemical network responsible for ADHD. And if left unmanaged in childhood, the symptomatic observation of ADHD behaviours lead to idiosyncratic acting out behaviour when the child or adult is exposed to a particular environmental stressors which is unbearable to the ADHD child, whereas in normally developing individual the child would tend to overlook it.
As in this case the biological basis of the young ladies reaction to the slightest provocation is rooted in the neurophysiology of a fear - frustration system that has developed over time. The result is a reactive aggression pathology that has become a part of her mental make-up, where she has to prove her point -whatever the cost may be.
As her regression is out of context and disproportionate to the stimuli, it is in our opinion maladaptive and now - pathological. If only the parents had not ignored the early symptoms of attention deficit hyperactivity and impulsivity disorder, the situation would have never arisen.
Ignoring a problem or symptom during adolescence whether it is related to academics or behaviour may not be the best course for parents. The reason is that our brains rewire themselves over time and maladaptation eventually results in expressive behaviours even if the situation is not sufficiently irritating or adverse.
The severity and persistence with which this young lady responded to a ‘demand’ from her end - off shutting the door was uncalled for and indicates dysregulated emotional functioning.
In a similar but not identical case, screened at the Dyslexia Association of India™, a 15-year-old boy in class IX developed a history of aggressive patterns in the context of a history of learning disabilities and lack of academic success. This boy acts out so aggressively in response to arguments or perceived limit setting and threats by his parents and teachers that he threw his schoolbooks out of the 10th floor flat.
He directs his frustrations and aggressions towards inanimate objects and then regrets his actions after he has cooled down. He has no insight into his actions and behaviours. His pattern of ADHD has a evolved into aggression that is being uncovered by academic stressors of poor marks and social stressors of his parents constantly after him to ‘behave’ correctly and study.
The Dyslexia Association of India™ has actually recommended an intervention and diversion program for his impulsivity and hyperactivity along with a combination of therapy to reduce his reactivity.
It is this reactivity and a lack of coping strategies that should worry parents if they observe signs of attention deficit disorder or if the school repeatedly indicates that the child is in a state of constant deficit of Attention, Impulsivity and Hyperactivity.
Children with ADHD/I are prime targets for depression and anxiety disorders. The environment, which is not so kind to an ADHD child, can also change and modify the resiliency – Lowering the threshold for aggression.
We also believe that hyper vigilance is a part of ADHD that is not well understood by parents in India and emotions and experiences of frustration by an ADHD child activate anger and irritability, which result in some form of aggression.
To conclude we would like parents to appreciate that dysregulation in certain brain areas is responsible for disruption of pathways involved in modulating behaviour and attention deficit related symptoms and activating what we call reactive aggression.
The Dyslexia Association of India™ works with ADHD children without involving medications and by altering and changing behaviour through Neuroplasticity to effect understanding of social cues and contingency changes.
Modifying behaviour at the neural level to prevent frustration occurring when behaviour, which is initiated to achieve a reward - does not prove fruitful can help your child overcome his limitations before they become his greatest shortcomings.
The DAI™ uses Cognitive Neuroplasticity under its patented T.R.A.I.N™ programme to help children gain control of their lives, their reactivity and impulsivity. The brain is a remarkable organ and if we know what to target there is a substantial lot that we can achieve.
To know more how we can help your child who may be displaying symptoms of ADHD, please call us at +91 8826022886 or email us at firstname.lastname@example.org.
(Views and observations expressed in our articles are equivocal and personal based on our observations and experience of contributing authors. Being equivocal and personal they are non contestable under any circumstances and conditions and Individuals are under no pressure to confirm to our views, thoughts and observations. The accuracy ratio for screening and remedial processes of the DAI™ is extremely high.)