Two-thirds of U.S. children with ADHD have comorbid learning disorders or other mental health or neurodevelopmental conditions.
A systematic study in prevalence, disease awareness and treatment guidelines led by Ramos-Quiroga and Antoni, published in journal “Current Medical Research and Opinion”, concluded that: “Appropriate resources for the diagnosis and treatment of adult ADHD in Europe are scarce, and many cases go untreated, particularly because of the frequent presence of psychiatric co-morbidities.” The authors stress the need for broader access and improvement in treatments for ADHD patients.
This is a very serious problem as the presence of other conditions that often go along with adult ADHD further complicate diagnostic procedure. The result is that a condition, which affects 5% of population worldwide and causes psychosocial impairment, problems in schooling and subsequently in careers and personal life, still isn’t appropriately diagnosed and treated.
A Range Of Comorbidities
A study authored by Marks, Newcorn and Halpering published in the “Annals of New York Academy of Sciences” looked at range of co-morbidities associated with ADHD and the possible outcomes for the patients. The first one the authors list is association of ADHD and antisocial behavior. The authors base their conclusions on studies previously done by Wiley and Mannuzza, who report that specifically among hyperkinetic children there is a tendency for early and subsequent antisocial behavior which can, if left unaddressed, eventually result even in criminal activity.
The abuse of psychoactive substances is a second problem the authors address. Here, they rely on longitudinal studies that have reported two or three times greater incidence of alcohol abuse among patients with attention problems compared to general population. The studies found 40% prevalence of lifetime tobacco use among the ADHD sufferers vs. 19% for general population.
The authors also question whether the treatments that address ADHD pharmacologically may also neurochemically sensitize patients to stimulant abuse particularly of cocaine. The studies published so far are contradictory and further research is needed.
When it comes to mood disorders, studies reveal that they co-exist with ADHD in 10% to 75% of cases. A study done by Alpert and his colleagues found that mood disorders can persist into adulthood and that 12% of adults with major depressive disorder reported ADHD symptoms in childhood that persisted into adulthood. Researchers also looked at the link between hyperactivity/impulsivity and bipolar disorder. Wozniak and his group of researchers reported that 98% percent of children with manic features also met criteria for ADHD. Co-morbidity with adult ADHD may be even higher but further studies are needed.
Various anxiety disorders are also found to correlate with both children and adult ADHD. Among adults 53% met criteria for generalized anxiety disorder, 15% for panic disorder, 13% for obsessive-compulsive disorder and 8% for phobias. Here, again, studies produced somewhat contradictory results necessitating further investigation.
Not All Stories Are Grim
This grim list of possible problems and complications associated with ADHD needs an important qualifier. Diagnosing and treating psychotic disorders may present a formidable challenge to medical staff, however appropriate interventions hold great promise and produce significant gains in patients’ overall life success and satisfaction.
ADHD presents a difference in brain functioning and this difference harbors both problems and unique capacities. There are strong indications that multimodal therapy can be effective in treating patients with dual diagnosis. Multimodal approach is a necessity. ADHD and various co-morbidities are all influenced by genetic, neurochemical and psychosocial interactions. Nevertheless, ADHD and co-morbidities are relatively independent according to the study done by Milberger, S., J. Biederman, S.V. Faraone, et al. That means that different treatments are needed to address different symptoms.
Psychotherapeutic techniques may address coping mechanism that are destructive for patients’ wellbeing as well as address some residual effects of ADHD. Cognitive-behavioral therapy may be well worth the effort in cases of co-morbid mood disorders and anxiety. The vocational matching and other psychosocial interventions may prove to be indispensible tools since some patients cannot or prefer not to take medication.
The good news is that there is panoply of behavioral approaches that show great potential. Cognitive-behavioral interventions geared towards increasing participants knowledge and understanding of the their specific neural processing, increasing their skills in addressing the problems as well as getting the chance to discuss these issues and solutions with their peers showed promising results. A Finnish study that measured the effectiveness of this approach found that 30% of participants clearly benefitted from the program, while 97% considered the program to be at least moderately beneficial.
Environmental and psychosocial factors can not only greatly contribute to early amelioration of attention problems and various co-morbidities but also provide children with tools and education they can use throughout their lives. This type of intervention that involves families can be very effective in preventing grim scenarios, which occur when children’s’ problems are neglected or not adequately addressed. Regular routine and stable environment can provide great benefits: Family members should educate themselves and know as much as possible about the condition affecting their child. They should insist on proper diagnosis and regularly check in with pediatricians as well as teachers and other educators.
As a team they could provide optimal conditions for learning such as placing the child in the front of the class or allowing more time during tests as well as establishing appropriate structure at home. Parents can also model habits and behavior that can rub off on their kids. Above all they should stay positive. Presence of co-morbidities may complicate diagnostic process and require more complex treatment modalities. However, ADHD with or without dual diagnosis in children and in adults can be managed. When properly addressed, the specific patterns of thinking found among ADHD patients can also be a source of great creative achievement.
Milberger, S., J. Biederman, S.V. Faraone, et al. 1995. Attention deficit hyperactivity disorder and comorbid disorders: issues of overlapping symptoms. Am. J. Psychiatry 152: 1793–1799.
Marks, David J.Newcorn, Jeffrey H.Halperin, Jeffrey, 2001. Comorbidity in Adults with Attention-Deficit/Hyperactivity Disordrs, Annals of the New York Academy of Sciences Volume 931 ADULT ATTENTION DEFICIT DISORDER: BRAIN MECHANISMS AND LIFE OUTCOMES 216–238