Inattention and hyperactive behavior are not necessarily the only problems in children with ADHD. ADHD exists on its own in only about 1/3 of the children diagnosed with it. The combination of ADHD with other conditions can greatly complicate diagnosis and treatment. Many co-existing conditions (co-morbidities) require other courses of treatment and should be diagnosed separately instead of being grouped in the ADHD diagnosis.
Some of the associated conditions are:
- Oppositional Defiance Disorder and Conduct Disorder which occur with ADHD at a rate of 50 percent and 20 percent respectively, and are characterized by anti-social behaviors such as stubbornness, aggression, frequent temper tantrums, deceitfulness, lying, or stealing, inevitably linking these co-morbid disorders with Antisocial Personality Disorder (ASPD); about half of those with hyperactivity and ODD or CD develop ASPD in adulthood. However, modern brain imaging technology indicates that Conduct Disorder and ADHD are two distinct disorders.
- Borderline Personality Disorder which was (according to a study on 120 female psychiatric patients) diagnosed and treated for BPD associated with ADHD in 70 percent of those cases.
- Primary disorder of vigilance which is characterized by poor attention and concentration, as well as difficulties staying awake. These children tend to fidget, yawn and stretch and appear to be hyperactive in order to remain alert and active.
- Mood disorders (especially Bipolar Disorder and Major Depressive Disorder. Boys diagnosed with the combined ADHD subtype have been shown to be more likely to suffer from a mood disorder.
- Bipolar Disorder – Adults with ADHD sometimes have co-morbid bipolar disorder, which requires careful assessment in order to accurately diagnose and treat both conditions.
- Anxiety Disorders have been found to occur more commonly in the ADHD population.
- Obsessive Compulsive Disorder (OCD) can co-occur with ADHD and shares many of its characteristics.
- Substance Use Disorders – Adolescents and adults with ADHD are at a significantly increased risk of developing a substance abuse problem which can interfere with the evaluation and treatment of ADHD. The most commonly misused substances by the ADHD population are alcohol and cannabis; serious substance misuse problems should be treated first due to the serious risks and impairments that occur,with long-term alcohol misuse and long-term cannabis misuse and other drug misuse.
- Restless legs syndrome, is associated with ADHD and is often due to iron deficiency anaemia. However, restless legs can simply be a part of ADHD and requires careful assessment to differentiate between the two disorders.
- Sleep disorders such as obstructive sleep apnea syndrome, can cause neurocognitive and behavioural symptoms in children that fulfil the ADHD diagnostic criteria. Sleep disorders also commonly co-exist with ADHD or can be caused by side effects of medications used to treat ADHD; insomnia is the most common sleep disorder found in ADHD children. Behavioural therapy is preferred as a first line treatment of insomnia rather than medication in these children. Melatonin is sometimes used in children who have sleep onset insomnia.
There is a strong association between persistent bed wetting and ADHD as well as dyspraxia with up to 50 percent of dyspraxics having ADHD. Multiple research studies have also found a significant association between ADHD and language delay.
Anxiety and depression are some of the disorders that can also accompany ADHD.
Academic studies, and research in private practice suggest that depression in ADHD appears to be increasingly prevalent in children as they get older, with a higher rate of increase in girls than in boys, and to vary in prevalence with the subtype of ADHD. Where a mood disorder complicates ADHD, it is usually best to treat the mood disorder first, but parents of children with ADHD often wish to have the ADHD treated first, because the response to treatment is quicker.
Daily Shoot Anxiety photo courtesy by Kedral at www.flickr.com