ADHD and coexisting conditions

04 January 2024

Around two thirds of children with Attention deficit hyperactivity disorder (ADHD) will have at least one other condition, either mental, behavioural or emotional. Clinicians/doctors refer to these as ‘comorbid conditions’. ‘Comorbid’ means that the condition exists alongside another one or more at the same time and is not caused by the original condition. Equally, there are feelings that are caused by having ADHD (such as frustration, low self-esteem).

The most common other comorbid conditions are:

Autism spectrum disorder
Anxiety (up to 30% of children and young people with ADHD can experience high levels of anxiety)
Depression (ranges from 12% to 50% which is more than five times higher than in young people without ADHD)
Learning difficulties (eg dyslexia – difficulty reading and writing; dysgraphia – difficulty writing by hand, between 20%- 60% of children and young people with ADHD can be affected by dysgraphia; dyscalculia – difficulty understanding numbers)
OCD (obsessive-compulsive disorder – where a person has obsessive thoughts and compulsive behaviours; 40-50% of children often have both ADHD and OCD)
ODD (oppositional defiant disorder – negative and disruptive behaviour, particularly towards authority figures such as parents or teachers; 30%-50% children with ADHD also fulfill the criteria for ODD)
Tic disorders (Tourette’s Syndrome; motor and/or vocal tics); between 60- 80% of children and young people with Tourette’s Syndrome have ADHD while tics can occur in up to 10% of those who have ADHD
Sleep disorders (difficulty falling asleep; waking up during the night; difficulty waking up; insomnia; between 25%- 50% of children and young people with ADHD will experience difficulties with sleep)

Neurodevelopmental conditions

Medical studies have shown that there are important developmental, structural and functional differences between the brains of people with and without ADHD. The development of the brain cortex (the surface area of the brain that plays a key role in memory, attention, thought and language) develops differently in children with ADHD. These areas are important for memory and controlling behaviour. The brain cortex is also responsible for high-level brain functions so comorbid conditions in children with ADHD

can be:

Learning disabilities
Language disabilities
Motor difficulties (movement of the body eg dyspraxia)
Executive function difficulties* (see below)

*Executive functions: processes that help us to plan and organise; control our attention, impulses and emotions: retrieve information from our memory; self-monitor ourselves; manage time effectively.

ADHD and ASD

ADHD and autism spectrum disorder (ASD) are both neurodevelopmental conditions affecting the parts of the brain responsible for language, memory and social skills. Children and young people with ADHD or ASD can have problems focusing, can be impulsive, have difficulty communicating and may have difficulty with social relationships. ADHD and ASD can occur in an individual at the same time and it is important that consideration of both conditions is given.

Emotional/mental health disorders

Children and young people with ADHD are more susceptible to symptoms such as anxiety and depression. Life can be challenging for them – school, homework, making and keeping friends are difficult. Their self-esteem can take a battering every day and this can lead to anxiety and depression.

Did you know? Up to 30% of children and young people with ADHD can experience high levels of anxiety which can continue into adulthood and may require treatment in its own right.

Sleep disorders

ADHD has been linked to a range of sleep disorders. Children and young people with ADHD can experience problems such as:

Difficulty falling asleep
Waking in the night
Feeling tired despite having slept
Being unable to ‘shut off’ busy thoughts in order to fall asleep

Sleep issues can have a considerable impact on a child and young adult’s physical health, their mood and ability to concentrate. For those with ADHD, sleep problems can make the ADHD symptoms worse. Read our ‘Why teenagers need their sleep’ leaflet for some useful information on helping your child get a good night’s sleep.

Treatment

If a child ‘only’ has ADHD, treatment can be life-changing. ADHD in children and teenagers can be managed with appropriate educational support, advice and support for parents and affected children, as well as medicine (if appropriate).

However, if a child continues to struggle despite getting treatment for their ADHD, there are two steps to take. One, to work out whether the treatment plan for ADHD needs adjusting slightly so that the symptoms disappear. Or whether there is a specific comorbid condition that needs its own specific treatment. As with ADHD, these comorbid conditions can range from mild to severe.

If you believe that your child has more than just ADHD, contact us. Your child will need to be assessed to identify any learning, language, motor or executive function problems. A clinical evaluation will also determine if your child is experiencing anxiety, OCD, depression or is on the autism spectrum as well.

We are here to help

We are here to support and care for you as a family. We work with children and teenagers, along with their families, diagnosing and treating those who have developmental disorders like ADHD. As child psychiatrists, we have medical degrees which allow us to prescribe medication (if appropriate) as well as delivering therapy. If you have concerns, do get in touch. We can chat over the phone and establish what the issues are.

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