What other disorders can co-occur with ADHD?

Diagnosing and treating ADHD can be complicated when there are co-occurring or comorbid disorders. Comorbid disorders are other conditions that exist alongside ADHD, which can make the diagnosis and treatment more difficult. Common comorbid disorders with ADHD include insomnia, Oppositional Defiant Disorder (ODD), Disruptive Mood Dysregulation Disorder (DMDD), Conduct Disorder (CD), language and learning disorders, anxiety disorders, and depressive disorders.

What if it’s not ADHD?

It's important to note that ADHD is often misdiagnosed, and a comprehensive psychiatric evaluation is necessary to ensure an accurate diagnosis. The evaluation should consider the presence of other conditions that may exist with ADHD, such as anxiety, mood disorders, or learning difficulties. Diagnosing and treating ADHD with comorbid disorders requires a specialist with experience in identifying and treating these conditions.

ANXIETY OR DEPRESSIVE DISORDERS

Anxiety and depression in children with ADHD can be so severe that they may consider self-harm or suicide. Treatment of underlying ADHD symptoms can quickly improve these conditions. Children with comorbid language or learning disorders often benefit from accommodations at school and occupational therapy targeting speech and language. An Individual Education Plan (IEP) at school is often necessary for these children.

MOOD DISORDERS

Children with ODD are often defiant towards authority figures, irritable, and angry. Conduct disorder is a serious psychiatric disorder that can cause children to regularly violate the rights of others. Children with ADHD and comorbid conduct disorder are at a higher risk for violating the law, substance abuse, depression, and suicidal ideation. Treatment for these disorders is complex and may include medication, parent training, behavioral therapy, coaching, and educational support (IEP or 504 plan).

LANGUAGE OR LEARNING DISORDER

Of the children with ADHD, 20-25% have a comorbid language or learning disorder. These children benefit from accommodations at school and occupational therapy targeting speech and language. An Individual Education Plan (IEP) at school is a needed component in the treatment of children with co-occurring language or learning disorder and ADHD.

OPPOSITIONAL DEFIANT DISORDER

Research indicates nearly half of children with ADHD also have Oppositional defiant disorder (ODD) or Conduct disorder (CD). Children with ODD are often defiant towards authority figures (parents or teachers), irritable, angry, often losing temper, blame others for personal mistakes, compulsively lie, and deliberately annoy other children or family members.

CONDUCT DISORDER

Conduct disorder is a serious psychiatric disorder affecting some children with ADHD. These children regularly violate the rights of others by stealing, exhibiting physical aggression, or destroying property. Children with ADHD and comorbid conduct disorder are at a significantly higher risk for violating the law, substance abuse, depression, and becoming suicidal than children with only an ADHD diagnosis. The prognosis for CD co-occurring with ADHD is poor but improved with proper treatment.

Treating ADHD and co-occurring disorders depends on the child’s age and comorbid condition. Treatment may include medication, parent training, behavioral therapy, coaching, and educational supports (IEP or 504 plan). Every additional disorder with ADHD adds to the complexity of the treatment. For instance, Oppositional defiant disorder has no FDA approved medication for treating it, but a mood stabilizer may be indicated if the anger and aggression are at a level where the safety of the child or others is a concern. While stimulant medication is first line treatment for ADHD, for a child with a co-occurring mood disorder, it may make the temper tantrums and irritability worse. When treating multiple disorders, the order in which they are treated, and the choice of medication used requires the expertise of a specialist.

Medications are often used to treat ADHD and comorbidities, but they are not a cure. Stimulant medication is a first-line treatment for ADHD, but it may not be appropriate for children with certain comorbidities. Children with comorbid mood disorders may experience increased irritability and temper tantrums with stimulant medication. Some children with ODD or conduct disorder may benefit from mood stabilizers or atypical antipsychotics. The decision to start medication will be thoroughly discussed and agreed upon by the provider, the parents, and the child. It’s important to weigh the risks and benefits of any medication.

Non-medication treatments, such as behavioral therapy and parent training, can also be effective for managing ADHD and comorbidities. Every additional disorder with ADHD adds to the complexity of the treatment. The order in which comorbidities are treated, and the choice of medication used, requires the expertise of a specialist.