Young ADHD children at Risk for Nonsuicidal Self-Injury

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Young ADHD children at Risk for Nonsuicidal Self-Injury

Young children with ADHD are probably more likely to engage in nonsuicidal self-injury than children who are not ADHD.

Children with ADHD as a group are of course much more impulsive than children without ADHD. As most parents and teachers know, it’s that increased impulsivity that forms one of the core symptoms of ADHD and makes an accurate diagnosis of ADHD more likely.

Increased impulsive behavior in ADHD is felt to be caused by inefficient executive brain processing of sensory input and the subsequent lack of an ADHD child’s or adult’s ability to delay gratification. It’s often this tendency to act before thinking through the consequences of doing something that gets the ADHD child, teen or adult in trouble.

As I’ve previously pointed out, excessive and off-the-spur of the moment tattoos and body piercings tend to be good examples of impulsive ADHD nonsuicidal self-injury behavior (NSSI). However, quite a few parents would argue even one body piercing or tattoo was excessive and impulsive, but we won’t debate that opinion here.

ADHD experts have realized over the past few years that adolescents with ADHD suffered higher rates of self-injury not related to suicidal gestures or thoughts. In some cases, these ADHD teens were looking for attention. In other cases, they may have been trying to improve their self-image or fit in with a particular group. Whatever the reason, it’s been my experience that teenagers with ADHD are much more prone to self-harm than teens who are not ADHD.

Imagine my surprise when a community-based study of children as young as 7 years from central New Jersey and Denver showed that 8% of kids interviewed from grades 3, 6, and 9 reported at least one episode of self-harm behavior. Of those, about one-third admitted self-harm multiple times. Most of us just never suspected such a high rate of this behavior problem existed in kids as young as 7 years.

In this study, Benjamin L. Hankin, PhD states “girls in the 9th grade appeared to be at greatest risk of engaging in NSSI, hurting themselves 3 times more often than their male peers.”

Reported self-injury behaviors in both boys and girls included:

  • hitting themselves (55% in boys),
  • cutting or carving skin (63% in girls),
  • biting themselves,
  • pulling their hair to cause pain,
  • throwing themselves into walls or sharp objects.

These self-harm behaviors were much worse in 9th graders where skin carving was reported at the unbelievable rate of 70%. It appears the closer a child is to becoming a teenager, the more likely self-harm occurs.

Obviously, as advocates for our children, we must be diligent in spotting these behaviors and seeking help for affected children as soon as possible. While children with nonsuicidal self-injury behavior don’t really intend to seriously and permanently injure themselves, they often don’t think about the consequences of their behavior before acting.

As a result, many times, they will be ashamed what they’ve done or scared they will be punished and will hide all traces of their behavior in hopes to avoid further pain and suffering. So, it’s rare that they will tell you when they’ve done something painful or disfiguring that they didn’t mean to do.

Here are a few things I’ve noticed in similar kids that caused suspicion of self-harm behavior and things that parents of children who self-harm have shared with me:

Kids who prone to self-injury tend:

  • to suddenly wear long sleeves to hide scars, fresh wounds and sores or self-applied tattoos
  • put their long hair up so as to hide areas where hair has been pulled from their scalp or areas of redness or sores
  • to want to eat in their room and spend more time away from parents and close family
  • keep unusual objects (knives, rope, rocks) in their room or backpack
  • lose their “good friends” and attract more “bad friends”
  • to become more irritable and moody for no reason (this always makes me suspicious of ADHD misdiagnosis).

As parents, teachers and healthcare providers, we need to keep our eyes open for signs of self-harm in our children. The earlier we detect and treat this type of impulsive and dangerous behavior, the more likely the child will avoid similar risk in the future.

A word of caution: not only are young children with ADHD more likely to engage in nonsuicidal self-injury, but adults with ADHD are probably at increased risk of self-harm as well. If your spouse has ADHD, you might want to discuss this topic.

Frank Barnhill, MD

Here’s a previous article dealing with self-harm you might find interesting:

Children with ADHD at Risk for Bullying and Self Harm
http://www.mistakenforadhd.com/2012/05/children-with-adhd-at-risk-for-bullying-and-self-harm/#more-1595

ADHD Impulsive Behavior and Risk of the Choking Game
http://www.mistakenforadhd.com/2012/04/adhd-impulsive-behavior-and-risk-of-the-choking-game/

Why ADHD Kids Get Tattoos and Piercings
http://www.mistakenforadhd.com/2010/10/hey-adhd-kids-get-tatoos-and-piercings/

Reference:
Young Children Engaging in Nonsuicidal Self-Injury
http://www.medscape.com/viewarticle/766097

P.S. Please share this article with friends and family who might have the same concerns.

www.adhdbehavior.com 

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