ADHD& CO-morbidities

Dr. Fatima Al-Haidar

Professor & Consultant

Child and Adolescent Psychiatrist

Introduction

High rates of co-morbidity are found in referred sample than in epidemiological sample.

About 2/3 of elementary school age children with ADHD who were referred for clinical evaluation have at least one other psychiatric diagnosis.

Children with ADHD report higher percentage of co-morbidity than parents.

Co-morbidity complicates course, prognosis, assessment and response to treatment.

1. Conduct Disorder

So great association

There are many risk factors for such association.

2. Speech Problems

ADHD is strongly associated with a range of abnormality in speech.

What is the nature of that association?

3. Learning Disabilities

ADHD is specifically linked to reading underachievement in early and middle childhood.

How to explain this linkage?

4. Anxiety Disorders

Internalizing disorders (both anxiety and depression can occur with ADHD.

Children with ADHD and anxiety show greater improvement on combination of Methylphenidate and behavioral modification.

Family loading for anxiety and depression and adversity influence child ADHD-Internalizing co-morbidity.

5. Bipolar Affective Disorder (BAD)

To date, no longitudinal study has established a clear link between manic symptoms seen in association with ADHD in childhood and adult BAD.

Mania with ADHD in childhood is associated with severe irritability, mixed state, multiple episodes, severe ADHD, frequent hospitalization, marked impairment and rapid cycling.

Diagnosing mania in children with ADHD is difficult ….why??

6. Cigarette Smoking (C.S.)

ADHD had both quantitative and qualitative impact on C.S.

There is significant association between C.S. in mothers during pregnancy and ADHD in their children.

Why children with ADHD smoke? Can we prevent?

6. Drug Abuse

No meaningful association between ADHD and alcohol or drug abuse.

The association is mediated primarily by other co-morbidities especially conduct disorder, mood and anxiety disorders.

Drug abuse by peers is a risk factor. No evidence that stimulant treatment of ADHD

increases the risk for drug abuse.

How an we prevent??

7. Sleep Disorders

A range of abnormality in sleep has been noticed in children with ADHD.

Why such association has been noticed??

8. Mental Retardation

ADHD is associated with reduced verbal and performance intelligence.

Clinically, such association is very important.

9. Enuresis and Encopresis

Both co-exist with ADHD

*Direct Effect

*Indirect Effect

10. Tic Disorders

ADHD is common in chronic tic disorder.

Such association will increase referral of children to psychiatric care.

11. Autistic Disorders

Autistic children frequently show hyperactivity.

Hyperactive children may have features of autism.

12. Obsessive Compulsive Disorder (OCD)

High rate of ADHD in juvenile OCD subjects.

Such presentation will complicate the course, assessment and management.

13. Code V Diagnoses

Poor relational problems

Physical abuse of children

Academic problems

Occupational problems

14. Co-morbid Subgroups

1. Pure ADHD

2. ADHD + internalizing disorders

3. ADHD + externalizing disorders

4. Combined