Over one-half of children living with ADHD live with at least one other major mental health condition. Any condition can coexist with ADHD, but certain conditions are seen more often, including:
The combination of ADHD with other mental health conditions often presents extra challenges for youth and their families. The key to positive treatment outcomes for children living with ADHD is the early identification of any coexisting conditions with ADHD, followed by a treatment plan that uses the most effective interventions, including home and school-based interventions. Coexisting conditions must be considered simultaneously to broaden understanding of the child’s symptoms and to maximize treatment outcomes. Sometimes it may be necessary to identify the symptoms that are having the biggest impact on the child’s life and to treat them in order of priority.
I read up on it a lot and took courses. Once my husband began taking medicine, he was able to focus better both at work and home. The medication for my husband made a night and day difference. ADHD has ultimately brought our family closer together. Because typical vacations like taking a cruise didn’t really work for an ADHD child, we experienced a lot of bonding from more interactive activities like camping. It’s been a fun way of life. My husband’s disorder could have led to a divorce, but instead it made our marriage stronger.
Oppositional defiant disorder (ODD) is one of the most common conditions coexisting with ADHD. NIMH’s (Multimodal Treatment Study of Children with ADHD (MTA) ) reveals that 40 percent of children living with ADHD also live with ODD. ODD usually starts before age 8, but no later than early adolescence. Symptoms of ODD include:
Parents of children living with ODD often express anger or exasperation over their child’s refusal to obey or cooperate. The behaviors of ODD often result in significant difficulties for children in school, at home and with peers.
Conduct disorder (CD) is less common than ODD, but it is severe and highly disruptive to youth and their families. Treatment for CD should be implemented as early as possible. According to the latest data from the American Academy of Child and Adolescent Psychiatry (AACAP), almost half of those diagnosed with ADHD are also diagnosed with ODD or CD. Symptoms of CD include:
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. Parents are also shocked or embarrassed by their child’s sadistic behaviors.
Adolescents living with ADHD and coexisting conduct disorder and/or oppositional defiant disorder are at higher risk for antisocial behavior and suspension from school. The school dropout rate for this group is 12 times greater than the rate among adolescents who are not affected by ADHD. These outcomes underline the importance of early identification and treatment of ADHD, ODD and CD.
There are several effective psychosocial interventions for the treatment of ODD and CD:
Additionally, behavioral interventions that address negative behaviors and promote positive behaviors should be implemented within the school setting for children living with ADHD, ODD and/or CD.
Stimulants are often effective treatment for aggressive or antisocial behavior in youth living with ADHD.
Sometimes, the outcomes associated with living with ADHD—including low self-esteem, difficulty making friends and poor school performance—can lead to persistent feelings of irritability, sadness and frustration. According to data from a 2008 NIMH-supported study, approximately 21 percent of children and adolescents living with ADHD also have depression. Symptoms of depression in children include:
Symptoms of depression in adolescents include:
Parents of children living with depression may observe that nothing seems to please their child and that their child “puts on a good face” in public but displays the worst of symptoms at home. Parents often express that their child seems to be completely different and unfamiliar to them.
Children and adolescents living with depression are at an increased risk for suicide. However, depression—when identified—is highly treatable.
There are several effective psychosocial interventions for the treatment of depression, including:
The combination of CBT and antidepressant medication (SSRIs) is often the most effective in treating major depression in children and adolescents. Antidepressants may be used in conjunction with stimulants with close supervision to treat major depression and ADHD.
According to a 2008 NIMH-supported study, over 30 percent of children living with ADHD also live with anxiety. 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. The symptoms of anxiety include:
Parents of children living with anxiety often report worry or concern over their child’s repeated absences from school. They 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 is an internalizing condition—meaning children and adolescents living with anxiety may not show any outward signs of distress or discomfort. It is important that parents and school personnel are extra vigilant in their observations if they are concerned a child may have anxiety.
There are several effective psychosocial interventions for the treatment of anxiety.
Youth living with ADHD and anxiety may show greater benefit from psychosocial interventions than those with ADHD alone.
Antidepressant medications (SSRIs) and Benzodiazepines have been shown to be effective in treating anxiety. A child’s response to stimulant medication for the treatment of ADHD is not affected by coexisting anxiety.
The CDC reports that roughly one-half of children living with ADHD also have a learning disorder. The combination of attention problems caused by ADHD and a learning disorder can make it especially hard for a child to learn in school. A child in preschool with a learning disability may have difficulty understanding certain sounds or words or have problems expressing him or herself in words. A school-aged child may struggle with reading, spelling, writing and math.
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. Different types of health care providers may need to be involved with the treatment plan to achieve the best outcomes.
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