ADHD and Co-Occurring Disorders
Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.When two or more disorders occur at the same time, they are called co-occurring disorders (or co-morbidity). In general, individuals affected by ADHD often have other behavioral disorders that impact their ability to function successfully. About 60-80% of the time, someone with ADHD will also have another disorder (CHADD, n.d.). Likewise, about 25% of all children with ADHD also have a mood, depressive, or anxiety disorder (CHADD, n.d.).
The high comorbidity rate between ADHD and other disorders has created confusion regarding the definition of a "true" ADHD diagnosis. Since most children or adults with ADHD also have a second diagnosis, and both sets of symptoms frequently overlap, critics suggest that the nuances of ADHD have not been adequately described. Some even suggest that making an early ADHD diagnosis is inappropriate (i.e., when a child is very young). For instance, with very young children, it may not be possible to determine whether their symptoms will become ADHD, early onset Bipolar Disorder, or some other disorder. Each situation requires careful observation and evaluation to distinguish between various explanations for problematic behaviors. Obviously, establishing an accurate ADHD diagnosis is very challenging for even the most experienced clinicians!
When someone has two or more disorders, the treatment process can become very complex. For instance, medication treatment might be managed differently if a person has another diagnosis in addition to ADHD. People with ADHD also develop problems regulating their emotions in response to their disorder. This may lead to the development of additional problems and another diagnosis. Lastly, research indicates that individuals with ADHD, (both children and adults) are often impacted by the consequences of their own actions. For instance, increased risk-taking, substance abuse, and criminal behavior often have lasting consequences.
When other disorders are present, it can make the diagnosis of ADHD much more difficult to pinpoint and the symptoms harder to treat. Some comorbid disorders that commonly occur alongside ADHD are:
- Oppositional Defiant Disorder
- Conduct Disorder
- Depression
- Anxiety
- Bipolar Disorder
- Learning Disorder
- Autism
- Sensory Integration Disorder
- Early Speech/Communication problems
ADHD and Oppositional Defiant Disorder
Oppositional Defiant Disorder (ODD) symptoms occur in as many as 21% to 60% of children with ADHD. ODD symptoms tend to occur more often around people familiar to the child, such as family or caregivers. Some of the behaviors associated with Oppositional Defiant Disorder include:
- Arguing with adults or refusing to comply with rules;
- Frequently periods of anger, resentfulness, or vindictiveness;
- Deliberately annoying others, and/or becoming easily annoyed with others; and,
- Blaming others for mistakes.
Oppositional defiance to authority generally begins to appear well before adolescence and can indicate a true case of ODD. It could also be a side effect of a child's frustration with the world around him. Tensions flare in response to what the child with ADHD sees as "unreasonable" demands. This frustration can then trigger angry refusals. However, it is encouraging to note that children with ODD do improve.
ADHD and Conduct Disorder
Conduct Disorder involves some serious behaviors that usually get people into trouble. The behavioral symptoms include:
- Repeated aggression towards people (including fighting) or animals;
- destruction of property;
- deceitfulness or theft; and,
- serious violations of rules (e.g., running away from home, or skipping school).
There are some similarities between ADHD and Conduct Disorder. However, they can be distinguished from each other. Those with a single diagnosis of ADHD may get into trouble for lying or skipping school, but generally they are not aggressive. Likewise, the degree of problem behavior is not as intense and blatant as is the behavior of those with conduct disorder. However, some individuals may meet the diagnostic criteria for both diagnoses. Research indicates that as many as 25% to 40% of children with hyperactive-impulsive type ADHD also meet the criteria for a Conduct Disorder. The rate of conduct disorder in those ADHD children without hyperactivity is significantly lower.
Resources
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Articles
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Childhood ADHD Overview
- Introduction to Attention Deficit Hyperactivity Disorder (ADHD)
- Signs & Symptoms of ADHD
- ADHD Signs and Symptoms: Attention Difficulties
- ADHD Signs and Symptoms: Hyperactivity
- ADHD Signs and Symptoms: Impulsivity
- Are There Different Types of ADHD?
- The Social, Educational, Financial & Occupational Impact of ADHD
- What are the Legal Rights of Caregivers and Their Children with ADHD (USA)?
- A Positive Spin: Is There Anything Good about ADHD?
- Signs of ADHD in Children at Home
- Signs of ADHD in Children at School
- Signs of ADHD in Children in Peer Relationships
- How Do I know if My Child Needs an ADHD Evaluation?
- What Should I Do If I Think My Child Might Have ADHD?
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ADHD Discoveries and Controversies
- ADHD: New and Exciting Brain Research
- ADHD: New and Exciting Brain Research - Part II
- Neurotransmitter Changes with ADHD
- Executive Functions
- Neurodiversity: Is ADHD a True Mental Disorder?
- ADHD Statistics
- Cultural and Gender Differences in Prevalence Rates
- Should Children with ADHD Be Medicated?
- New and Promising Areas of Research
- Causes of ADHD in Children
- ADHD or Another Condition?
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Diagnosis of ADHD in Children
- Who Can Diagnose ADHD?
- How Does ADHD Multi-Source Assessment Work?
- Assessment Instruments: Behavioral Checklists
- Assessment Instruments: Intelligence Tests
- Assessment Instruments: Achievement Tests (or Academic Tests)
- Assessment Instruments: Tests of Attention
- Assessment Instruments: Memory and Other Common Tests
- Step 2: Clinical Interviews
- Step 3: Physical Exam and Medical History
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ADHD Treatment in Children
- Multimodal ADHD Treatment Approach
- ADHD Medications
- Treating ADHD with Stimulant Drugs
- Commonly Prescribed ADHD Stimulant Medications
- Treating ADHD with Non-Stimulant Drugs
- Risks of ADHD Medication
- Risks of ADHD Medications - Part II
- Benefits of ADHD Medication
- Side Effects of ADHD Medications
- Medication Decisions and Medication Management
- How Long Should ADHD Medication Treatment Last
- Psycho-Education about ADHD and Its Management
- Family Therapy
- Individual and Cognitive Behavioral Psychotherapy for the Child with ADHD
- Skills Training
- Social Skills Training and Coaching
- Supports
- Alternative ADHD treatment: What Does NOT Work?
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Family and Personal Supports
- Effective Disciplinary Techniques
- Learn about Resources and Be Proactive
- Manage Stress, Self-Regulation & Provide Order
- Develop Routines, Organization and Expectations
- Communicate and Collaborate with Schools
- Express Confidence in Your Child's Abilities
- Help Children Improve Social Skills and Peer Relationships
- Avoid Homework Battles and Monitor Medication
- I Think I have ADHD. What should I do?
- I Think I Have ADHD - Part II
- Famous People with ADHD
- Adult ADHD Overview
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Diagnosis of Adult ADHD
- How is Adult ADHD Diagnosed?
- Diagnostic Challenge 1: Looking into the Past
- Diagnostic Challenge 2: ADHD versus Similar Disorders
- Diagnostic Challenge 2 - Part II
- Diagnostic Challenge 3: ADHD Symptoms
- Diagnostic Challenge 3 - Part II
- Diagnostic Challenge 4: A Concealed Disorder
- Specialized Tests and Tools
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Adult ADHD Treatment
- ADHD Medication Treatment
- Stimulant and Non-Stimulant Drugs for Adult ADHD
- Medication Timing, Dosage, Monitoring, and Duration of Treatment
- Weighing the Risks and Benefits of Adult ADHD Medications
- Psychotherapy for ADHD
- Coaching/Supported Employment for Adult ADHD
- Social Skills Training for Adult ADHD
- Psycho-Education and Cognitive Behavioral Therapy (CBT)
- ADHD Resources and References
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Childhood ADHD Overview
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Questions and Answers
- Does This Sound Like Bipolar?
- Do I Have Adult ADD?
- Why do I See Words and Numbers in my Mind...
- ADD Maybe?
- How do I Get Medical Treatment for my Medicine Refill Without Insurance?
- Is There Something Wrong With Me?
- I Can't function Normally Anymore, Can More Diagnoses issues Risk Survival?
- Bipolar Teen Son, ........
- Is My Daughter ADD?
- ODD and Risperdal
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- If There's Nothing New, There's Nothing Good.
- Mystery Symptoms
- Bipolar Disorder and ADHD
- How To Help My Son
- Anger
- Depression in College Seniors
- Odd Eating Behavior
- 5 Year Old Behavior-Is it ADHD or Bipolar or Both?
- odd (ADHD)
- Attention Deficit and Depression
- What Should I do? Noah
- 16 year old girl with Attention Deficit Disorder
- Thoughts
- Diagnosed ADHD at 13, now being told I have bipolar disorder
- ADHD in Twins
- Inherited ADHD
- How to get off Focalin
- new diagnosis
- am i off my head i feel i have no feelings and want to harm ppl
- 17 yr old refuses help with bi-polar disorder
- Is Depression a Factor in Children With ADD?
- IS ADHD CAUSING HIM TO FAIL?
- heightened sexual behavior in my 8 yr. old with adhd
- seperation anxiety disorder or environment?
- my 7 year old nephew
- my daughter
- Do I have adult ADD?
- Fantasy land for attention
- 13 Yearl Old
- ADD
- Misdiagnosed and Lied To
- Funding Treatment (Without Insurance)
- Can ADHD Turn Into Bipolar?
- How Long To Diagnose ADHD?
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Tests
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Book & Media Reviews
- 10 Simple Solutions to Adult ADD
- A Walk in the Rain With a Brain
- ADD-Friendly Ways to Organize Your Life
- ADHD & Me
- ADHD Grown Up
- ADHD in Adults
- ADHD Nation
- Attention Deficit Disorder
- Attention-Deficit/Hyperactivity Disorder
- Buzz
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- Driven to Distraction
- Facts About ADHD Children
- Healing ADD
- Helping Hyperactive Kids
- I Am Not Joey Pigza
- Joey Pigza Loses Control
- Joey Pigza Swallowed the Key
- Learning Outside the Lines
- Making ADD Work
- Medicating Children
- Mind Fields
- New Look at ADHD: Inhibition, Time, and Self-Control
- Non-Drug Treatments for ADHD
- Overcoming ADHD
- Parenting Children With ADHD
- Reclaiming Our Children
- Rethinking ADHD
- Ritalin is Not the Answer Action Guide
- Ritalin Nation
- Running on Ritalin
- Should I Medicate My Child?
- Taking Charge of ADHD, Revised Edition
- The Explosive Child
- The Gift of Adult ADD
- The Little Monster
- The Science of ADHD
- Thumbsucker
- Treating ADHD and Comorbid Disorders
- What Would Joey Do?
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Links
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- How to Select the Best School Accommodations for Your Child with ADHD
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- What You Need to Know about Students with ADHD and Anxiety
- ADHD and Eating Right
- Tourette Syndrome and ADHD
- Homework, Organization, and Time Management Strategies to Help Kids with ADHD
- Nutrition in Support of ADHD Treatment
- Behavioral Therapy: What it is and finding a therapist
- Project-Based Learning and ADHD
- Conditions May Mimic ADHD
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- Department of Education Guidance Broadens Understanding of 504 Rights for Kids with ADHD Part I
- Treating ADHD in the African American Community
- How to Build Self-Motivation in Teens with ADHD
- Goal Setting and Keeping for the ADHD Brain
- Neurofeedback Treatment for ADHD
- ADHD in Preschoolers: What to Look For and How to Help
- FYI on ADHD Evaluations
- Teaching Grit, Perseverance and Frustration Tolerance to Students with ADHD
- Does my Child Have ADHD?
- How to Start Eating Well When You Have ADHD
- 5 Solutions for Common ADHD Social Struggles
- Is My High School Student Ready for College? (And Is My College Student Ready to Go Back?)
- Understanding and Applying the Science of Time Management
- ADHD Medication and College Students: Prevent Misuse, Abuse, and Diversion
- Improve Homework Time with Strategies That Work For ADHD
- Student Voices: What Really Matters to Young Adults With Learning and Attention Issues
- 5 Ways Nutrition can Impact ADHD Symptoms
- 3 Tips for Adjusting to a New Diagnosis of ADHD
- Creating the Best Learning Environment for Students with ADHD
- ADHD & Executive Functioning
- Department of Education Guidance Broadens Understanding of 504 Rights for Kids with ADHD Part II
- Ask The Expert: Neurofeedback Treatment for ADHD
- ADHD and Suicide Risk Factors
- The Choice is in the Details: Medication Options for ADHD
- Understanding and Supporting Young Adults with ADHD
- Helping Your Young Adult Become Independent
- Creating Structure and Routines for Children with ADHD
- When You and Your Child Have ADHD - Communication Skills to Resolve Conflict
- Guidance for Uncertain Times: Navigating Relationship Challenges
- Guidance for Uncertain Times: Mindful Parenting
- Couples with ADHD: Creating Caring Connection amid the Chaos
- Disclosure and Workplace Accommodations for Individuals With ADHD
- A Summer At Camp
- Self-Advocacy Tips For Teens With ADHD
- ADHD and Curbing Impulsive Spending to Help Your Relationship
- ADHD: Signs, Symptoms, Research
- ADHD & Risk of Adult Drug Use
- Health and Life Expectancy in ADHD
- Focus on ADHD
- Pediatrics: ADHD and Food Allergies
- ADHD: It's a Family Affair
- Does Your Child Have ADHD?
- ADHD in Children
- Living with ADHD
- Rise in ADHD Cases in Children
- Why is Dating Difficult When You Have ADHD
- Video Games, Screens, and ADHD A Potent Mix
- Ask the Expert Helping Children with ADHD LD Conquer Chronic Stress
- Ask the Expert: Mindfulness, Stress, & Emotion
- Attention Deficit Hyperactivity Disorder
- Ask the Expert Educator Edition: ADHD & Executive Functioning
- Ask the Expert - Academic Evaluations - What Parents Need to Know
- ADHD and Sibling Relationships
- Medication Treatment for ADHD
- Using Time Out
- Treating Childhood ADHD
- ADHD-friendly Summer Family FUNdamentals
- Preparing Older Teens for the Road Ahead
- Tips for Teachers: Tailoring homework to make a difference
- Your Active Preschooler: Could it be ADHD?
- Tips for Teachers: Creating a positive dialogue with parents of students with ADHD
- Helping Parents & Kids Understand the Social & Emotional Aspects of ADHD
- Social and Emotional Concerns of Children with ADHD: Strategies to Help
- Holiday Gifts for Children with ADHD
- Behavior Management and Combined Treatment for Children with ADHD
- Setting Realistic School Expectations for Students with ADHD
- On Their Own: Helping College Students with ADHD
- Children's Communication Challenges: Is it Attention, Language or Both?
- Out-of-School: Parenting During the Summer
- ADHD in the Workplace: Finding Success
- Emotions and Motivation in ADHD
- The Role of Medication in Managing Children's ADHD Symptoms
- Top Tips for Combating Stigma and Addressing Myths about ADHD
- Facts and Myths about ADHD
- What To Do If Your Child Has ADHD?
- How Common is ADHD?
- Children, Meds, and Heart Safety: A Tale of ADHD and Public Health
- ADHD & Your Child’s Transition to College
- Your Teen with ADHD: Challenges and Strategies for Success
- Ask the Expert - No more homework battles
- A Frontline to ADHD
- Understanding Girls with ADHD
- What is ADHD?
- What To Do When Your Child With ADHD is Bullied
- Stop the Chaos! Tips for Creating a Peaceful Household When Mom has ADHD
- Is It ADHD?
- Ask the Expert - What else can I do? Complementary approaches to ADHD treatment
- All in a row: Getting your kids with ADHD organized
- Your Student With ADHD Was Admitted to College, Now what?
- Evidence-based treatment for ADHD in young children
- Home life when Mom or Dad has ADHD: Succeeding with your family
- How does technology affect ADHD?
- Diagnosing ADHD
- Helping Your Child Successfully Handle Change
- Recognizing challenging behaviors in young children: Could it be ADHD?
- Classroom Managment Supports for ADHD Behaviors in Preschool Settings
- Getting through to your teenager with ADHD
- What Everyone Should Know about ADHD
- Make Learning Exciting: Apps for Executive Functioning
- Teenagers, ADHD, and Substance Abuse
- Past Procrastination -- Get Your Kids Organized, Focused and Motivated
- Ask the Expert: Late, Lost, and Unprepared: How to Help Your Child with Executive Functioning
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