Transcript ADHD and Comorbidities

ADHD&
CO-morbidities
Dr. Fatima Al-Haidar
Professor & Consultant
Child and Adolescent Psychiatrist
Introduction
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High rates of co-morbidity are found in referred
sample than in epidemiological sample.
About 2/3 of elementary school age children
with ADHD who were referred for clinical
evaluation have at least one other psychiatric
diagnosis.
Children with ADHD report higher percentage of
co-morbidity than parents.
Co-morbidity complicates course, prognosis,
assessment and response to treatment.
1. Conduct Disorder
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So great association
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There are many risk factors for such
association.
2. Speech Problems
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ADHD is strongly associated with a range of
abnormality in speech.
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What is the nature of that association?
3. Learning Disabilities
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ADHD is specifically linked to reading
underachievement in early and middle
childhood.
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How to explain this linkage?
4. Anxiety Disorders
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Internalizing disorders (both anxiety and
depression can occur with ADHD.
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Children with ADHD and anxiety show greater
improvement on combination of
Methylphenidate and behavioral modification.
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Family loading for anxiety and depression and
adversity influence child ADHD-Internalizing
co-morbidity.
5. Bipolar Affective Disorder (BAD)
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To date, no longitudinal study has established a
clear link between manic symptoms seen in
association with ADHD in childhood and adult
BAD.
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Mania with ADHD in childhood is associated
with severe irritability, mixed state, multiple
episodes, severe ADHD, frequent
hospitalization, marked impairment and rapid
cycling.
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Diagnosing mania in children with ADHD is
difficult ….why??
6. Cigarette Smoking (C.S.)
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ADHD had both quantitative and qualitative
impact on C.S.
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There is significant association between C.S. in
mothers during pregnancy and ADHD in their
children.
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Why children with ADHD smoke?
Can we prevent?
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6. Drug Abuse
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No meaningful association between ADHD and
alcohol or drug abuse.
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The association is mediated primarily by other
co-morbidities especially conduct disorder,
mood and anxiety disorders.
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Drug abuse by peers is a risk factor.
No evidence that stimulant treatment of ADHD
increases the risk for drug abuse.
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How an we prevent??
7. Sleep Disorders
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A range of abnormality in sleep has been
noticed in children with ADHD.
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Why such association has been noticed??
8. Mental Retardation
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ADHD is associated with reduced verbal and
performance intelligence.
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Clinically, such association is very important.
9. Enuresis and Encopresis
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Both co-exist with ADHD
* Direct Effect
* Indirect Effect
10. Tic Disorders
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ADHD is common in chronic tic disorder.
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Such association will increase referral of
children to psychiatric care.
11. Autistic Disorders
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Autistic children frequently show hyperactivity.
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Hyperactive children may have features of
autism.
12. Obsessive Compulsive Disorder
(OCD)
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High rate of ADHD in juvenile OCD subjects.
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Such presentation will complicate the course,
assessment and management.
13. Code V Diagnoses
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Poor relational problems
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Physical abuse of children
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Academic problems
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Occupational problems
14. Co-morbid Subgroups
1.
Pure ADHD
2.
ADHD + internalizing disorders
3.
ADHD + externalizing disorders
4.
Combined