ADHD

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ADHD
CO-morbidities

• Dr. Fatima Al-Haidar
• Associate Professor Consultant
• Child and Adolescent Psychiatrist

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Introduction

• 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.

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1. Conduct Disorder

• So great association
• There are many risk factors for such association.

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2. Speech Problems

• ADHD is strongly associated with a range of
  abnormality in speech.
• What is the nature of that association?

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3. Learning Disabilities

• ADHD is specifically linked to reading
  underachievement in early and middle childhood.
• How to explain this linkage?

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4. Anxiety Disorders

• Internalizing disorders (both anxiety and
  depression can occur with ADHD.
• Children with ADHD and anxiety show greater
  improvement on combination of Methylphenidate and
  behavioral modification.
• Family loading for anxiety and depression and
  adversity influence child ADHD-Internalizing
  co-morbidity.

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5. Bipolar Affective Disorder (BAD)

• To date, no longitudinal study has established a
  clear link between manic symptoms seen in
  association with ADHD in childhood and adult BAD.
• Mania with ADHD in childhood is associated with
  severe irritability, mixed state, multiple
  episodes, severe ADHD, frequent hospitalization,
  marked impairment and rapid cycling.
• Diagnosing mania in children with ADHD is
  difficult .why??

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6. Cigarette Smoking (C.S.)

• ADHD had both quantitative and qualitative impact
  on C.S.
• There is significant association between C.S. in
  mothers during pregnancy and ADHD in their
  children.
• Why children with ADHD smoke?
• Can we prevent?

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6. Drug Abuse

• No meaningful association between ADHD and
  alcohol or drug abuse.
• The association is mediated primarily by other
  co-morbidities especially conduct disorder, mood
  and anxiety disorders.
• Drug abuse by peers is a risk factor.
• No evidence that stimulant treatment of ADHD
  increases the risk for drug abuse.
• How an we prevent??

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7. Sleep Disorders

• A range of abnormality in sleep has been noticed
  in children with ADHD.
• Why such association has been noticed??

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8. Mental Retardation

• ADHD is associated with reduced verbal and
  performance intelligence.
• Clinically, such association is very important.

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9. Enuresis and Encopresis

• Both co-exist with ADHD
• Direct Effect
• Indirect Effect

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10. Tic Disorders

• ADHD is common in chronic tic disorder.
• Such association will increase referral of
  children to psychiatric care.

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11. Autistic Disorders

• Autistic children frequently show hyperactivity.
• Hyperactive children may have features of autism.

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12. Obsessive Compulsive Disorder (OCD)

• High rate of ADHD in juvenile OCD subjects.
• Such presentation will complicate the course,
  assessment and management.

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13. Code V Diagnoses

• Poor relational problems
• Physical abuse of children
• Academic problems
• Occupational problems

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14. Co-morbid Subgroups

• Pure ADHD
• ADHD internalizing disorders
• ADHD externalizing disorders
• Combined

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THANK YOU