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WAIT --
IS MY INSURANCE PAID UP?
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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?
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IS ADHD
LINKED TO INCREASED RISK OF ACCIDENT OR
INJURY?
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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.
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WHEN THE
CHILD HAS
ADHD + OTHER CONDITIONS
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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 student 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....
Article
continues on next
page.
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