All parents are aware of the risks associated with children using drugs and alcohol. We know that these substances are potentially damaging to human health and that they are all, to a greater or lesser degree, addictive. We also understand that some people are physiologically and psychologically more vulnerable to becoming addicted and that family (genetic) history is highly predictive of addiction in our children. Also, and of growing concern, is the prevalence of other addiction risks, including internet/electronic based activities such as texting, social media, gaming and pornography. Other addictions include gambling, shopping and sex/love/relationship addictions. It is very clear that there have never before been so many powerful, potentially addictive substances and activities available, and readily accessible, to our children.
Without going into a detailed discussion of addiction, it should be understood that it is a pattern of behaviour which occurs in an obsessive/compulsive fashion and that has a negative impact on important areas of our lives such as relationship, school, work, mental and/or physical health. Current theory is that it is a medical/physiological condition with significant behavioural components, and that different addictions may involve specific neurochemical systems within the brain. Several addictive substances and a number of behavioural addictions are primarily involved with the dopamine system, which, as we know, is associated with reward and with high-risk, extreme activities.
But we know, as well, that ADHD is a disorder whose neurological function is also rooted in the dopamine system, and therein lies a formidable danger for those having this disorder. It is well known that the likelihood of those with ADHD engaging in addictive, high risk behaviours is significantly higher than for those not having ADHD. Young people with ADHD may be marginalized socially, struggling academically and/or have a variety of psycho-social challenges that make these addictive behaviours and activities extremely attractive. There is also a restlessness and sense of not fitting or being like others that is reported by most people with ADHD and, again, this increases the perceived value of “medicating” with substances and activities that provide a surge of dopamine. It is interesting to note that the rate of substance abuse for individuals with ADHD who are taking prescribed stimulants is virtually the same as for the non-ADHD population.
What is to be done? ADHD children (like all children) need to develop the ability to self-manage and take responsibility for their own behaviour. This is accomplished through consistent, effective behaviour management that promotes self-discipline and a sense of agency. In combination with healthy attachment, this produces robust self-esteem, the ability to regulate emotions and to create/maintain meaningful connected relationships with others. Children (and adults) with ADHD have poor executive function, which means that they will require considerable guidance in organizing themselves and in making decisions. This is critical during childhood and adolescence, and parents should expect to have to monitor and manage potentially risky behaviours and to set reasonable limits around computer and phone use. Remember that children with ADHD are characteristically emotionally and socially 1/3 less mature than their peers, so a 15 year old may be require supervision more like a 10 year old would need.
Higher level, value based decision-making does not develop on its own. It must be taught and parents must be prepared to take a more directive role, as required. This is the basis for the development of safe, moral ethical behaviours. The ADHD child is vulnerable, but absolutely capable of achieving this level of functioning if parents commit to providing necessary information, building healthy attachment and implementing the appropriate behavioural limits that they require.