ADHD & Comorbidities

Many times ADHD doesn’t just present with inappropriate behaviours or issues at school, and it can commonly occur with other mental health problems, such as learning disorders, sleep disorders, anxiety, mood disorder, and autism spectrum disorders, to name the most frequent.

Students with severe ADHD can also have low self-esteem, underachieve at school, develop emotional and social problems, and be at risk of bullying/exclusion at school. This is why having a diagnosis is so important, many times we misinterpret the child’s behaviour instead of understanding where it is coming from and providing them with the tools to improve any of these problems mentioned above.

As this blog mentioned, many children and adolescents can have ADHD which commonly overlaps with other learning/behavioural conditions. Here is a list of the conditions that can occur along with ADHD:

  • Sleep disorders
  • Tourette’s Syndrome
  • Depression
  • Anxiety
  • Autism Spectrum disorder
  • Learning disorders
  • Developmental Co-ordination disorder
  • Conduct/Mood disorder
  • Oppositional Defiant Disorder

A study published in 2017 showed the prevalence of ADHD with psychiatric comorbidity. From the 2861 subjects included in this study, 1919 met the criteria for ADHD, and 1269 had a comorbid psychiatric disorder. The 4 most common comorbidities of ADHD were learning disorders, in almost 60% of the cases, followed by sleep disorders and oppositional defiant disorder, with around 20% of prevalence, and anxiety disorders, with around 10% of prevalence. Other comorbid psychiatric disorders, such as intellectual disability, language disorders, mood disorders, conduct disorders, tic disorders, and ASD accounted for less than 10% of prevalence each.[1]

As learning disorders’ prevalence is very high among children and adolescents with ADHD, it is important to understand more about them. Dyslexia and Dysgraphia are very common. Young people with dyslexia struggle to read fluently and to spell words correctly. This has nothing to do with their intellectual capacity. Dyslexia can affect their reading speed capacity. On the other hand, Dysgraphia is a neurological disorder that impacts writing skills; specifically, it causes the young person to write in a distorted or incorrect manner.

Sleep disorders are the second most common psychiatric comorbidity, according to a study published in 2017.[1] As we all know, sleep is really important for the healthy development of all children. Sleep problems are common, not only in children with ADHD but also in children with typical development. Behavioural insomnia is the most common type of sleep disorder among children with a neurodevelopmental disorder and may cause children to resist sleep, wake up frequently, or need more help from caregivers to fall asleep.

How to help them?

-No sugar, avoiding all sources of caffeine (e.g. coke, tea) within a few hours of bedtime

-avoid screen time at least 1 hour before bed

-avoid stimulating activities in the evening

-make a healthy sleep environment

-teach them relaxation techniques

-encourage children to get active earlier in the day

-develop a bedtime routine

There are no recommended medication treatments currently for behavioural insomnia, but there is lots of evidence around melatonin and its effectiveness when treating sleep-onset issues among children with ADHD.[2]

Regarding oppositional defiant disorder, children may frequently have a persistent pattern of anger, irritability, and arguing with their family members or other authority figures. Generally, these symptoms start to show at preschool and can greatly impact families, school, and social activities. It is important to mention that there are different degrees of ODD, being mild when the symptoms only occur in one setting (home, school, etc.), moderate when they occur in two different settings, and severe when they occur in three or more settings.

Unfortunately, ODD has no apparent cause, but it might be a combination of genetic and environmental factors. It is suggested that you look for help and see a doctor when your child doesn’t see that their behaviour isn’t an issue and if you are concerned as a parent/carer about your ability at the moment to parent them and give them your best support.

Finally, but not the least important, anxiety is one of the four more common comorbidities according to the study mentioned before. [1] Even though these are different conditions, they can come together many times. Sometimes, when having anxiety apart from ADHD, symptoms of ADHD can worsen if the anxiety is not treated correctly. Anxiety disorders can make children restless, have difficulties concentrating, constantly worrying about many things, and have sleep issues. Having a proper assessment with a doctor will help them decide which is the best approach for your child; being possible that treating the ADHD may ease the anxiety or if treating the anxiety first might be necessary, which can be done with a variety of tools, such as cognitive behavioural therapy, relaxation techniques, or medication when required.

1            Reale L, Bartoli · Beatrice, Cartabia M, et al. Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. Eur Child Adolesc Psychiatry 2017;26:1443–57. doi:10.1007/s00787-017-1005-z

2            Corkum P, Davidson FD, Tan-MacNeill K, et al. Sleep in Children with Neurodevelopmental disorders. A Focus on Insomnia in Children with ADHD and ASD. Sleep Med Clin 2014;9:149–68. doi:10.1016/j.jsmc.2014.02.006