AD-HKD is associated with serious social, academic, and psychological difficulties at each stage of development. The quality of the social relationships of children with AD-HKD with their siblings, peers, parents, and other adults is poor as a result of their verbal and physical aggressiveness, inattention to social cues, and bias toward attributing hostile motives to others. (31 As a result, children with AD-HKD are rejected by others and treated in a controlling and negative fashion by their peers, teachers, and parents.(3233> Their families experience considerable stress, feelings of incompetence, and marital discord because of these behavioural problems. These children's parents tend to use coercive parenting strategies. Children with AD-HKD are more likely than their unaffected peers to live in families whose lives are disrupted by poverty, marital separation, and parental psychopathology. (3 35 and 36

AD-HKD is associated with deficits in various cognitive skills: planning, sustaining attention, maintaining performance, identifying and adjusting to errors, judging the passage of time, and inhibiting inappropriate responses (see Table.. .2). Their sleep is poor; for example, they tend to have sleep-related breathing disorders, periodic limb movements, and habitual snoring/37) Frequently, these children feel demoralized and incompetent. Compared with their normally developing peers, children with AD-HKD get lower marks, fail more grades at school, are more poorly organized, and more often have a diagnosis of a mental retardation. (3,39>

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Table 2 Common impairments associated with AD-HKD

Adolescents and adults with AD-HKD show many of the same features as their younger counterparts, although they are less restless. They are more likely to drop out of school with lower marks and to have lower paid and lower status occupations than their non-AD-HKD peers and siblings. Their self-esteem is low. Persons with AD-HKD are more likely to exhibit poor driving practices and to have a substance abuse disorder. There is evidence that they may be more likely to attempt suicide or die accidentally. (More information about the effects of AD-HKD on the lives of adolescents and adults is given elsewhere. (3840)

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