It's important to know if your son has been brought up and educated in environments that have taught and demanded personal accountability for his actions. Sometimes kids with ADHD get "let off" because parents and teachers have the attitude that "he just can't help it -- it's that darned ADHD." Some children hear this so often that they get to believe it. ADHD might be a factor that contributes to inappropriate behavior, but it should never be invoked as an excuse for it. Unless an environment demands accountability and does it for all children, consistently and fairly, then children with ADHD may not develop this trait naturally. So it needs to be taught. Social skills groups, led by a counselor or psychologist who helps children move toward this goal in controlled situations, can be very helpful. Doing role-plays, role reversals, analyzing the behavior of other children, interpreting the behavior or the consequences of certain behaviors portrayed in movies, and reading stories of children who take responsibility for their actions can help develop this trait. Working on community service projects, especially in the lower grades when children are impressionable, can also help to instill a sense of accountability and responsibility. "Survival" simulations or group problem-solving activities can help children consider the impact of their actions on other people. Having to care for plants or animals can also teach valuable lessons. Involvement in sports activities that focus on cooperative rather than competitive efforts will help. Religious education and scouting programs offer fertile ground for growing moral and ethical character.

Some children with ADHD feign aloofness or shirk responsibility as a way to avoid having to face up to the rather chronic impulsive acts they commit. Saying "I don't care" may be an attempt to devalue the negative act after it has been completed. To care about what you do carries with it the implication that you will do something about it if you make a mistake. And if you make a lot of mistakes, doing something about it is hard work. This is a cycle that can be broken by responding: "You say (or act like) you don't care; but that's unacceptable in this classroom (or family). You must do something to make amends for what you have done" (and saying a hollow "I'm sorry" doesn't cut it -- the key is action).

We worry a lot about kids who do things to other people or who don't do things for other people without caring about it. The longer this behavior persists, the less likely it is that it will improve. Taking the steps outlined above will help most children become more caring and thoughtful individuals. Unfortunately, there are some children who have flawed personalities; they lack the capacity to care. This is a fairly rare, but serious condition that should be addressed in therapy.