|
Information
Section: Conditions
Condition:
ADHD
Article: ADHD: Safety
Source: Leslie E. Packer,
PhD
This File Last
Updated: December
27, 2004
|
Article
Page 1
2
|
|
ADHD:
SAFETY
|
|
Ever
wonder how your child could be such a
total klutz? Ever suddenly panic and have
visions of hospital emergency room
personnel calling Child Protective
Services to report you after what seems
like the umpteenth visit because of some
fall or accident your ADHD child has
experienced? You're not alone.
|
|
|
|
WAIT --
IS MY INSURANCE PAID UP?
|
|
A few months ago --
as I got ready to jump in the car and pick up my
son to transport him to an emergency room to find
out why he had reportedly lost his hearing after
getting hit in the head with a ball in gym -- my
daughter asked me, "Mom, how many times have you
had to take Justin to the emergency room?" Well,
that was not exactly the time to discuss it, but as
I drove to my son's school, I tried to think
back.....
There was
the time when he fell off the school bus getting
off, but hey, he was only 6, and any kid can
fall, right? His school picture taken the next
day showed this gorgeous kid with a beautiful
Mickey Mouse sweater and a fat
lip.....
Then there was the
time when he was playing with a neighbor's child
and amazingly ran head on into a tree that had
only been there for about 50
years....
And the time that
he stood up on the school bus because he thought
that they had arrived, only to fall backwards
when the bus started moving again, requiring
stitches to the back of his
head....
And the time he
stepped on a fish hook in his summer camp cabin,
and had to get the hook removed in the
E.R....
And the time a kid
in his gym bumped or pushed him, and he fell
down, breaking his wrist....
And now this --
his failure to duck when a large round object
was coming at his head in gym, where one might
reasonably expect people to be aware of airborne
balls during sports....
As a former medic, I
tend to stay pretty calm in emergencies. After all,
I'd handled plenty of car crashes at the race
tracks. And I was the one all the neighbors came to
when their children fell or got hurt. But was I
under-reacting to my son's safety needs now? Was
his school? This would be his 5th emergency room
visit compared to 0 for his younger sister. Now I
know boys are supposed to be active, but was my son
just a klutz, was this a gender thing, or are kids
with ADHD more likely to have accidents, and if so,
why?
|
|
IS ADHD LINKED TO INCREASED RISK OF ACCIDENTS OR INJURIES?
|
|
While it might seem
almost intuitively obvious that children who are
inattentive or impulsive are more likely to get
into accidents, the actual published literature on
the question has been somewhat equivocal at
times.
Gayton et al. (1986)
rated 189 patients at a child psychiatric clinic on
a scale which included measures of hyperactivity
and accident proneness. They reported that
hyperactivity was correlated with reports of being
"accident prone," and that the relationship applied
to girls as well as to boys. Farmer and Peterson
(1995) expanded on earlier research by looking at
specific processes that might account for the
increased risk. In their study, two groups of
7-11-year-old boys (14 ADHD and 16 controls) were
asked to watch a videotape which simulated play
activities. The children were asked to identify
risky behaviors and then answer questions about
risky scenes. Both the ADHD and control groups were
able to identify the hazards, but the children with
ADHD underestimated or anticipated less severe
consequences following risky behavior than the
non-ADHD controls. The ADHD children also generated
fewer active methods for preventing injury than did
the controls. Their data suggest, then, that the
ADHD child's reduced expectation of personal risk
or injury and their reduced ability to generate
preventive strategies may contribute to increased
risk of accident and injury.
Wazana (1997)
reviewed 11 general child injury studies and 6
child pedestrian injury studies to determine if
there really is a pattern of accident proneness
that is specific to any disorder or behavioral
factors. When design limitations and other factors
are considered, it appeared that: (1) aggression or
aggressive behavior is a consistent risk factor for
general injuries but not for pedestrian injuries,
(2) hyperactivity is inconsistently associated with
all types of injuries, and (3) both a general
measure of behavior problems and a measure of
unsafe behavior were found to be significantly
related to pedestrian injuries.
It is important to
note that in Wazana's data, while child risk
factors contributed significantly to pedestrian
injuries, their overall effect or contribution was
small compared to environmental and social risk
factors. Indeed, other investigators have noted
that risk of injury is correlated with social class
differences and parental education in terms of
addressing home stressors (such as parental
behaviors that contribute to increased risk),
developing safety rules and strategies for their
children, and supervising the children. Rivara
(1995, 1998) notes that the most important risk
factors for injury are gender, age, socioeconomic
status, developmental status, behavior problems,
substance abuse by parent and adolescent, and
parents' perceptions of injury risk. Rather than
looking to tag or label the child as "accident
prone," Rivara's approach emphasizes the need for
parents and society to alter our behavior to keep
all children safe by considering whether there is a
match (or mismatch) between a child's skill and
their development age so that anticipatory guidance
can be provided. While most parents do try to
anticipate situations and help the child rehearse
safe responses, there are so many situations that
we don't anticipate. And we are not there in the
classroom, on the playground, or in gym, so school
personnel also need to be alert to the potential
for accidents and injury and take appropriate
steps.
|
|
IS
ADHD LINKED TO INCREASED RISK OF ACCIDENT OR
INJURY?
|
|
While it might seem
almost intuitively obvious that children who are
inattentive or impulsive are more likely to get
into accidents, the actual published literature on
the question has been somewhat equivocal at
times.
Gayton et al. (1986)
rated 189 patients at a child psychiatric clinic on
a scale which included measures of hyperactivity
and accident proneness. They reported that
hyperactivity was correlated with reports of being
"accident prone," and that the relationship applied
to girls as well as to boys. Farmer and Peterson
(1995) expanded on earlier research by looking at
specific processes that might account for the
increased risk. In their study, two groups of
7-11-year-old boys (14 ADHD and 16 controls) were
asked to watch a videotape which simulated play
activities. The children were asked to identify
risky behaviors and then answer questions about
risky scenes. Both the ADHD and control groups were
able to identify the hazards, but the children with
ADHD underestimated or anticipated less severe
consequences following risky behavior than the
non-ADHD controls. The ADHD children also generated
fewer active methods for preventing injury than did
the controls. Their data suggest, then, that the
ADHD child's reduced expectation of personal risk
or injury and their reduced ability to generate
preventive strategies may contribute to increased
risk of accident and injury.
Wazana (1997)
reviewed 11 general child injury studies and 6
child pedestrian injury studies to determine if
there really is a pattern of accident proneness
that is specific to any disorder or behavioral
factors. When design limitations and other factors
are considered, it appeared that: (1) aggression or
aggressive behavior is a consistent risk factor for
general injuries but not for pedestrian injuries,
(2) hyperactivity is inconsistently associated with
all types of injuries, and (3) both a general
measure of behavior problems and a measure of
unsafe behavior were found to be significantly
related to pedestrian injuries.
It is important to
note that in Wazana's data, while child risk
factors contributed significantly to pedestrian
injuries, their overall effect or contribution was
small compared to environmental and social risk
factors. Indeed, other investigators have noted
that risk of injury is correlated with social class
differences and parental education in terms of
addressing home stressors (such as parental
behaviors that contribute to increased risk),
developing safety rules and strategies for their
children, and supervising the children. Rivara
(1995, 1998) notes that the most important risk
factors for injury are gender, age, socioeconomic
status, developmental status, behavior problems,
substance abuse by parent and adolescent, and
parents' perceptions of injury risk. Rather than
looking to tag or label the child as "accident
prone," Rivara's approach emphasizes the need for
parents and society to alter our behavior to keep
all children safe by considering whether there is a
match (or mismatch) between a child's skill and
their development age so that anticipatory guidance
can be provided. While most parents do try to
anticipate situations and help the child rehearse
safe responses, there are so many situations that
we don't anticipate. And we are not there in the
classroom, on the playground, or in gym, so school
personnel also need to be alert to the potential
for accidents and injury and take appropriate
steps.
|
|
WHEN THE
CHILD HAS ADHD
PLUS OTHER CONDITIONS
|
|
The preceding
discussion only considered the potential
relationship between ADHD and accidents. What if
the child also has Tourette's Syndrome, or
Obsessive-Compulsive Disorder, or Bipolar Disorder?
Are these children at even more risk if they feel
they "have to" touch something in response to an
obsessive worry? What about the Bipolar
child who is manicky and impulsive? Will
she be more likely to engage in behaviors that can
lead to injury? What about the depressed
child who is angry?
In my experience,
children with ADHD plus comorbid conditions do seem
to be at more risk for accidents and/or injury than
the child who has ADHD without any comorbid
conditions.
In the absence of
research on this population, it is impossible to
know whether the children are underestimating the
risk or danger to themselves (as is the case with
ADHD children) or if they estimate it properly but
still can't stop themselves.
Whenever possible,
planning for the child with ADHD or ADHD+ should
incorporate reducing the environmental triggers or
risks. And added adult supervision should be
incorporated for those settings that are reasonably
likely to increase safety risks -- such as gym, the
playground, and field trips.
But even with
vigilance, there may be times when your student or
child will do something that you didn't anticipate.
If you're lucky, you and the child will escape with
just a "near miss" story. But when things calm
down, talk with the child and help them figure out
how they will manage that kind of situation if it
occurs again.
Safety first. Yes, I
know it may sound odd to have The Mother of the
Child With Five ER Visits tell you this, but so far
(and knock wood!), my son has never had an accident
when he's been with me or under my supervision.
Indeed, it was that last accident that made me
realize how much we may need to educate educators
so that they don't assume and don't take things for
granted on the premise that the child "should know"
by that age....
|
|
Information
Section: Conditions
Condition:
ADHD
Article: ADHD: Safety
Source: Leslie E. Packer,
PhD
This File Last
Updated: December
27, 2004
|
Article
Page 1
2
|
|
Tourette
Syndrome "Plus" © Copyright 1998 - 2005 Leslie
E. Packer, PhD. except as noted.
All rights reserved
This page last updated January 7, 2005.
Reprint
Policy.
Privacy
Policy.
Contact.
|
|
