Is it ADHD or a Behavior Problem?

Or can ADHD be used as an excuse for bad behavior?

This is an edited transcript of my ADHD Audio Newsletter #4. To sign up for the newsletter, visit here: The ADHD Doctor.

Hi – it’s Dr. Kenny Handelman here with the next ADHD Audio Newsletter. The question this time is:
“How does one differentiate between true ADHD and behavior problems?”

In this edition of the newsletter, we will address this question, and put this issue to rest once and for all.

There are two ways to address this question:

1) Before the diagnosis of ADHD is made: The question could be reworded,
“How do you know if it is just a behavior problem and not ADHD?”

2) After the diagnosis of ADHD is made: The question could be reworded,
“Was that misbehavior due to ADHD of was it just bad behavior?”

Before addressing this question, we need to realize that all people have ‘behaviors’. We all use our behavior to function in this world. Sometimes our behavior moves us toward our goals (and is therefore adaptive, or appropriate behavior), and sometimes our behavior is a problem and interferes with our functioning (and is therefore maladaptive, or problematic behavior).

Now, let’s review this in the context of ADHD:

Behavior before the diagnosis of ADHD:

There are certain behaviors which are part of the actual diagnosis of ADHD.

For example, running and climbing excessively is one of the diagnostic criteria for ADHD, and this information is used to help to diagnose ADHD.

Some people may wonder – ‘maybe that child is just misbehaving, and it is not really ADHD’.

In the post which reviewed the diagnosis of ADHD, I explained that one has to have six of the nine criteria to make a diagnosis, plus many other criteria. In other words, a little misbehavior does not lead to the diagnosis. Please review the previous article for the full explanation.

Behavior after the diagnosis of ADHD:

I think a really important issue here is once a person has the diagnosis of ADHD, if they misbehave – is it because of the ADHD, or is it just ‘plain old bad behavior’?

This question leads to a real concern for many people – and that is: “If I explain the misbehavior because of ADHD, it will be making it into an excuse.”

We are going to put this issue to rest right here.

The answer is: “it’s both”.

That’s right – it is both ADHD and behavior – and I want you to consider that in every situation.

Let’s take an example: People with ADHD have trouble ‘shifting sets’, so stopping one task and moving on to a second one can be a challenge.

Imagine there is an eight year old boy who is involved in playing and his mom says: “it’s time to stop playing and come to supper”. The boy has trouble stopping his play and coming to the meal. Hopefully the parents will use techniques like warnings – such as 10 minute warning, 7 minute warning, five minute etc. These ‘warnings’ allow the boy to gradually get ready to stop playing and have a chance to prepare himself.

Let’s say the boy doesn’t come to the meal, the parent gets frustrated, and the child has a ‘freak out’ (or a ‘behavioral issue’).

So here is the ultimate question: Is the bad behavior because of ADHD or just bad behavior?

When a child is misbehaving, a parent often asks: “Why didn’t you come when I called?”

I have yet to meet a child who says: “Well mom, I’ve got this deficit of dopamine in my prefrontal cortex and it’s very hard for me to use my executive function of shifting sets and disengage from this activity because of the ADHD that I have…”

Usually a child says: “… because I didn’t want to”.

That sounds very behavioral, doesn’t it?

But the reality is there is a significant component of ADHD in there. In other words, it is both ADHD and misbehavior.

Now let’s look at it from another angle.

Let’s say somebody has ADHD and they work hard to control it. They have supports, they have strategies, etc. They manage and function very well.

But they are having a bad day… And they are grumpy, not completing tasks, and displaying ‘behavior’.

Now when that sort of behavior is going on is there ADHD in there as well?

Of course there is. This situation may be more related to behavior than to ADHD, but one cannot ignore the ADHD, because it is still there.

So the short answer is whenever there is a question ‘is this behaviour? Or is this ADHD? The answer is it’s both.

Can ADHD be used as an excuse for bad behavior?

I don’t want people with ADHD to use it as an excuse, and it is my experience that if they do, it is very negative for them in many ways.

Rather, they can use it as an explanation.

What’s the difference between an excuse and an explanation?

Excuse: after negative behavior – a parent, or the individual with ADHD, says that it was beyond their control because of the ADHD, and people should just accept that.

Result of an excuse: no lessons learned, no responsibility taken for control of the behavior, because it was from the ADHD.

Explanation: after a negative behavior – a parent, or the individual with ADHD, reviews the situation for problems which occurred and opportunities to learn and adapt. The fact that ADHD is there is used as part of the explanation for the behaviour – and also helps to create the ‘search for solutions’ – to learn from the situation and create plans for the next time that situation is encountered. The person with ADHD is still assumed to have responsibility for their behavior – but they are seen to need new skills to manage that type of situation.

Result of an explanation: lessons are learned, and responsibility is assumed for the behavior. The individual is better prepared to deal with that type of situation again in the future, and learning occurs.

In summary, misbehavior in ADHD is a combination of behavior, and the diagnosis itself.
It is important to use ADHD as part of an explanation of the behavior, and not as an excuse.

This will contribute to better learning for the individual with ADHD, and also better education to all of the other people around who will be learning about ADHD from this interaction.

To learn more about ADD/ADHD, visit: Everyday Health on ADHD

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Comments

  1. I find that after diagnosis and treatment it is much easier to understand and accept my husband’s occasional ‘bad behavior’. Meds are wonderful but understanding is crucial!

  2. I think that was a great question and I have heard it asked before from other parents I know whose chidren have adhd. I also think that it answers any questions I might have as well about behavior. I like hearing these questions as it gets me thinking of other problems, such as my son who is in grade 10 now has trouble with P.E and I now realize that it is alot of instructions to take in and if he wasn’t focused he wouldn’t have a clue as to what to do! I try to remind his new teacher at the begining of each year.

  3. Hi Dr. Handelman,

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