smiling girl in school uniform
smiling girl in school uniform

ADHD co-occurring conditions – some mask it, others are hidden by

Research shows that between 50% and 67% of kids with ADHD also have another co-occurring condition.

Need to know

Research shows that between 50% and 67% of kids with ADHD also have another co-occurring condition. Children with multiple diagnoses may be diagnosed at a different age to children with a single diagnosis. For many children, each individual diagnosis can take months or years to be identified.

Co-occurring conditions with ADHD can include a range of neurodevelopmental differences, mental health challenges and learning disabilities. Some of the most commonly associated conditions in children with ADHD include:

  • Oppositional Defiant Disorder (ODD): ODD is a condition characterised by persistent patterns of negative, defiant, disobedient, and hostile behaviours toward authority figures. 
  • Conduct Disorder (CD): CD is a condition characterised by persistent patterns of behaviour that violate the rights of others and societal norms.
  • Anxiety Disorders: Anxiety disorders, including Generalised Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Obsessive Compulsive Disorder (OCD), and Specific Phobias, are prevalent in children with ADHD.
  • Mood Disorders: Mood disorders, including Depression and Bipolar Disorder, are common co-occurring conditions in children with ADHD.
  • Learning Disabilities: Learning disabilities such as Dyslexia and Dyscalculia frequently co-occur with ADHD.
  • Tic disorders: Tic disorders are a group of neurological conditions that involve repetitive, involuntary movements or sounds that are sudden, rapid, and unpredictable. Tics can be simple or complex, and can involve various body parts, including the face, neck, arms, and legs.
  • Autism: a neurodevelopmental difference, which can impact sensory experiences, language and communication styles, and generally changes how an individual processes the world around them. 

Why it’s important

ADHD symptoms may sometimes mask or obscure the presence of co-occurring conditions, making it more challenging to identify them. Parents think that they finally found the help a child needs with stimulant medication, only to watch their child continue to struggle.

ODD/CD

40% to 50% of children diagnosed with ADHD also have ODD. Identifying co-occurring conditions with ADHD in children can be challenging because the symptoms of each condition can overlap. For example, symptoms of ODD and CD can be similar to symptoms of ADHD, making it difficult to differentiate between the conditions. 

Anxiety

20% to 32% of children with ADHD are also diagnosed with an anxiety disorder. Although anxiety is often a symptom of untreated ADHD, it is also possible for a child to have a separate diagnosis of an anxiety disorder, which will need to be treated separately. In some cases ADHD medication can make symptoms of anxiety worse, which is why it is crucial to have your child assessed and treated by the right medical professionals.

Learning disabilities 

Approximately 45% of children with ADHD also have a learning disability. ADHD symptoms can be more pronounced in a classroom, where organisation, focus, sustained attention and emotion regulation are needed to succeed. These executive functioning related issues are often blamed for reading difficulties, struggles with maths, illegible handwriting, etc, because they have a direct impact on a child’s ability to learn. Once a child starts on a stimulant medication, these other underlying conditions become more evident, the child can now focus and pay attention but they still have significant struggles with learning.

Tic disorders

20% of children with ADHD have a tic disorder and approximately 50% of children with Tourettes have also been diagnosed with ADHD. The co-occurence percentages vary depending on the specific type of tic disorder, such as chronic tic disorder or provisional tic disorder (less than a year). In a small percentage of children, ADHD stimulant medication may trigger tics, in this case talk to your doctor about non-stimulant medications.

Autism

59% to 83% of children who have been identified as autistic also have an ADHD diagnosis. Both ADHD and autism have overlapping challenges making it challenging to clearly identify each one. In many cases, it is only when ADHD is treated that parents find that  their children are still struggling, but in a different way. Stimulant medication usually quietens down some of the more intense ADHD symptoms, which makes it easier to identify autism.

To diagnose co-occurring conditions with ADHD in children, healthcare professionals typically take a comprehensive approach that involves gathering information from multiple sources. This approach may include interviews with the child and their parents, medical history, and the use of standardised and specialised assessment tools.

Tips and strategies

Identifying co-occurring conditions to ADHD in children can be challenging, but there are several strategies that you can use to help identify other underlying conditions. 

Observe your child’s behaviour: Pay close attention to your child’s behaviour and note any patterns or changes over time. Look for symptoms such as anxiety, depression, aggression, oppositional behaviour, tics, or sleep disturbances.

Use the Keywell app to track your concerns: Keep note of your child’s behaviour and symptoms, including their frequency and intensity. This can be helpful in identifying patterns and changes over time and can provide valuable information to healthcare professionals.

Consult with your child’s healthcare provider: Talk to your child’s healthcare provider about any concerns you have about their behaviour or symptoms. They can help identify any potential co-occurring conditions and provide appropriate referrals for further evaluation.

Get a comprehensive evaluation: Consider getting a comprehensive evaluation for your child, which can include a thorough medical and psychological evaluation. This can help identify any underlying medical conditions that may contribute to your child’s symptoms.

Seek input from teachers or other caregivers: Talk to your child’s teachers or other caregivers about any concerns they may have about your child’s condition. They can provide valuable information and observations into your child’s behaviour and academic performance. Ask your child’s teacher about any concerns they have noticed and work with them to develop strategies to support your child.

Educate yourself: If you know there is a history of certain mental health or neurodevelopmental conditions in your family, it might be worth learning about how it presents in children. This can help you recognise potential signs in your child and advocate for appropriate care.

References

  1. Comorbidity in Children and Adolescents with ADHD
  2. ADHD characteristics: I. Concurrent co-morbidity patterns in children & adolescents
  3. About Autism
  4. Age of Diagnosis for Co-occurring Autism and Attention Deficit Hyperactivity Disorder During Childhood and Adolescence: a Systematic Review
  5. ADHD and co-occurring conditions by the numbers
  6. ADHD & Anxiety in Children
  7. Tourette syndrome associated with attention deficit hyperactivity disorder: The impact of tics and psychopharmacological treatment options
  8. Attention-Deficit/Hyperactivity Disorder and Co-Occurring Tics

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