Adding to ADHD

Adhd coexisting disorders and treatment options

/ Author:  / Reviewed by: Robert Carlson, M.D

ADHD, or attention-deficit/hyperactivity disorder, can include problems with focusing, paying attention and controlling behaviors. Obviously, this disorder alone comes with its own challenges and difficulties.

However, ADHD may not be the only disorder that patients have to cope with.

According to the National Alliance on Mental Illness (NAMI), “Over one-half of children living with ADHD live with at least one other major mental health condition.”

What are the most common of these coexisting conditions for ADHD? And how do patients and families cope?

Depression

Because ADHD can lead to issues with low self-esteem, trouble in school and problems with friends, sadness, frustration and depression can sometimes occur.

A 2008 study funded by the National Institute for Mental Health (NIMH) and published in the journal Child and Adolescent Psychiatry and Mental Health looked at 342 young ADHD patients and estimated that 21 percent of children and teens with ADHD also suffer from depression.

Symptoms can include a resistance to activities they once enjoyed, negative self-view, lethargy, irritability, hopelessness, aggressiveness and withdrawal from friends and family.

According to NAMI, a depressed child may “put on a good face” in public situations, but “display the worst of symptoms at home.”

Depression can be treated through various forms of psychotherapy (like cognitive behavioral therapy or interpersonal therapy), and through antidepressant medication.

“Antidepressants may be used in conjunction with stimulants with close supervision to treat major depression and ADHD,” reports NAMI.

Anxiety

The same NIMH study estimated that 30 percent of children with ADHD also cope with anxiety issues. In these cases, their ADHD may express itself in a different way.

“In the classroom, students living with both disorders are less likely to appear hyperactive and disruptive and more likely to appear slowed-down or inefficient,” reports the organization.

Symptoms can include feeling uncomfortable in non-threatening situations, panic attacks, missing school and avoiding attention or “the spotlight.”

However, it is important to note that many children and teens with anxiety issues may not display outward symptoms, but may be dealing with internal anxiety issues.

NAMI reports that parents of anxious children, “often struggle with accommodating their child’s anxious behaviors versus having their child continuously fall apart if they insist he or she do what is causing the anxiety.”

Anxiety disorders can be treated through therapies like cognitive behavioral therapy or exposure therapy, and through some antidepressant medications.

According to NAMI, “Youth living with ADHD and anxiety may show greater benefit from psychosocial interventions (like therapy) than those with ADHD alone.”

Learning Disorders

For some children with ADHD, learning disorders can also be present. The CDC estimates that this is the case for around one-half of ADHD patients between ages 6 and 11.

Depending on the age of the patient, this type of co-existing disorder can express itself differently.

For younger preschool-aged children, their learning disability may show up as trouble expressing themselves. For their older school-aged counterparts, problems with math, spelling or reading may be present.

NAMI suggests that a personalized route be taken to treat learning disorders, saying, “Working with health care professionals to determine a treatment plan that takes into account ADHD, learning disorders and the child’s strengths is the best way to treat a child living with both conditions.”

Oppositional Defiant Disorder and Conduct Disorder

According to NAMI, around 40 percent of children with ADHD also are coping with oppositional defiant disorder (ODD), which is characterized by persistent arguing, refusal to follow direction or instruction, inflexibility and hostile or resentful behavior.

“Parents of children living with ODD often express anger or exasperation over their child’s refusal to obey or cooperate,” reports NAMI. These issues often lead to problems at school and with friends.

Conduct Disorder (CD) is another behavioral disorder that may coexist with ADHD. CD is less common than ODD but is often severe and very disruptive.

Symptoms include destructiveness, lying, bullying, lack of remorse, violent behaviors and cruelty directed toward people or animals.

According to NAMI, “Parents of children living with ADHD and CD often feel frightened and intimidated by their child’s behaviors and worry about danger or injury to other family members.”

Issues with CD or ODD can lead to major behavioral and disciplinary problems at school, and NAMI reports that “The school dropout rate for this group is 12 times greater than the rate among adolescents who are not affected by ADHD.”

There are a variety of different therapy options for treating ODD and CD, many of which involve not only the patient themselves, but parents as well.

For example, functional family therapy can help strengthen communication and conflict management skills among the family unit as they try to handle with these disruptive disorders. Multisystemic therapy can help some families identify their own strengths and use them to create strategies to cope with behavioral problems.

For some patients, mentoring programs can help reduce some ODD or CD symptoms by increasing community involvement and activity levels.

NAMI also reports that for some of these young patients, stimulants or antipsychotic medications can help ease aggressive behavior problems.

Individual Journeys

For children with ADHD, the nature of any coexisting conditions and individual treatment plans must be determined carefully. 

Robert Pressman, PhD and pediatric psychologist, told dailyRx News that these plans and diagnoses must be done with extreme care. 

"Because children present with a narrow range of symptoms, the diagnostic categories share overlapping symptoms," said Dr. Pressman.

These overlapping symptoms can especially occur among attention, mood, anxiety and behavioral disorders.

According to Dr. Pressman, "On a given day, the same youngster might be taken to three doctors and receive a different primary diagnoses from each one of the doctors."

With care and time, doctors, patients and their families can come to understand the nature of childhood ADHD and the range of coexisting disorders that may occur, and determine how to best treat each individual case.

It is through this time, care and support that children with ADHD will move forward and learn to cope effectively with this disorder.

Reviewed by: 
Review Date: 
December 16, 2012