ADHD and Co-occurring Disorders
Attention Deficit Hyperactivity Disorder (ADHD) is a common neurological disorder characterized by difficulties in attention, impulsivity, and hyperactivity. To learn more about ADHD symptoms, as well as evidence-based treatments for this disorder, please see the previous blog posts on these topics. In continuation of our ADHD blog series, we sat down with Drs. Cara Lusby and Kirk Mochrie to understand more about the common co-occuring concerns for individuals with ADHD, as well as treatment implications.
1. What does it mean when treatment providers use the term “comorbidities”? What are the common comorbidities associated with ADHD?
Comorbidities are other psychological disorders that co-occur with the disorder being discussed (e.g., ADHD) at high rates. With some comorbidities, it is believed that one disorder may be responsible for or significantly contribute to the additional disorder(s). This might be the case if unmanaged depression were a primary concern and an alcohol use disorder is largely due to an individual’s attempt to cope with their depression. For other comorbidities, it is believed that a similar underlying cause may be an underlying mechanism for multiple disorders. This might be the case if an underlying concern with intolerance of negative emotion contributes to dual problems of both anxiety and depression.
Regardless of the type of comorbidity, it is important to consider all comorbid disorders when providing clinical care. Proper assessment can be important to determine whether treatment for one disorder needs to incorporate or be modified to account for any other relevant disorders. ADHD is a disorder that has a substantial number of comorbid conditions that are relevant both to the assessment and treatment of ADHD. Current estimates are that two-thirds of children with ADHD have at least one other co-occurring disorder and many adolescents and adults with ADHD also experience other psychological issues/disorders. Some of the most common mental health disorders that co-occur with ADHD include oppositional defiant and conduct disorders (in children and adolescents), anxiety, depression, tic disorders or Tourette’s, substance abuse, sleep disorders, and learning disabilities.
2. How do comorbidities with ADHD develop?
As mentioned above, comorbidities can have various developmental pathways. Many adolescents and adults with ADHD also have a mood disorder (primarily depression and/or anxiety). These symptoms of anxiety and depression most often present after the ADHD symptoms and this may suggest the anxiety and depression occur as a response to coping with ADHD. For example, individuals with ADHD who struggle with academic success often experience feelings of sadness, hopelessness, and disappointment with themselves, all of which are also consistent with symptoms of depression. In addition, when children struggle with school work due to their symptoms of ADHD, they commonly experience anxiety symptoms such as feeling overwhelmed, restless, or worrying related to their difficulties. Moreover, adolescents who have been diagnosed with ADHD are at an increased risk for developing Substance Use Disorders (SUDs). It seems that some adolescents begin using substances due to the impulsivity symptoms associated with ADHD, as well as to self-medicate in response to the ADHD symptoms they are experiencing. If the adolescent has depression and anxiety that are comorbid with their ADHD, their risk of substance misuse is further increased. Adults with ADHD may also use or misuse substances to self-medicate ADHD symptoms, as well as to cope with symptoms of co-occurring depression and/or anxiety.
3. How do you know what to treat if someone has ADHD and co-occurring disorders?
Due to the large number of individuals who experience difficulties related to both ADHD and co-occurring disorders, it is highly recommended that an individual first complete diagnostic testing to determine exactly what is contributing to their difficulties. Without the entire picture and an understanding of what underlying concern is driving which symptoms or diagnoses, treatment may improperly target (or miss altogether!) these comorbid symptoms. Luckily, there are evidence-based treatments for both ADHD and comorbid conditions such as anxiety or depression. If you believe that you have both ADHD and other symptoms of a comorbid condition (e.g., depression, anxiety, conduct, or substance misuse), or if you are experiencing symptoms and aren’t sure what is causing them, we encourage you to find a specialist to help you assess what is going on. An ADHD specialist will have the knowledge of the disorder itself, as well as an understanding of common comorbidities and how to treat them.
At the TAP clinic, Dr. Cara Lusby conducts both psychodiagnostic and psychoeducational assessments to help diagnose ADHD and other comorbid disorders. The results of these evaluations can be used to provide clinical recommendations/referrals, as well as help develop 504 plans to obtain accommodations at school.
Dr. Lusby also provides evidence-based treatments for ADHD for children and adolescents (Lusby). Dr. Lusby also has additional specialty training in comorbidities associated with ADHD. Dr. Lusby has extensive training and experience with children and adolescents presenting with behavioral concerns, such as Oppositional Defiant Disorder, as a result of or in addition to their ADHD. Additionally, Dr. Lusby has expertise in co-occurring mood and anxiety disorders in children and adolescents.
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