Comorbid Conditions, Part 3
A child or adolescent who appears to be depressed and exhibits severe ADHD-like symptoms, with outbursts and mood changes, should be evaluated by a psychiatrist or psychologist with experience in bipolar disorder, particularly if there is a family history of the illness.
Getting help for your child
Are your child's symptoms secondary to ADHD (and therefore likely to go away on their own, once treated)? Or are they evidence of a comorbid disorder (which requires additional treatment)? It's not always easy to tell.
Consider where and when your child's problems arise. Secondary problems typically start at a certain time or occur only under certain circumstances. Did your daughter start experiencing anxiety only in the third grade? Is she anxious only in school or at home when doing homework? Odds are, her anxiety is secondary to ADHD and not a true comorbid disorder. Ditto if your son became aggressive only upon starting middle school.
In contrast, comorbid disorders are both chronic and pervasive. They are generally apparent from early childhood and occur in every life situation. Rather than occurring just during the school day, for instance, they persist over weekends and holidays and during the summer; they are evident in school, at home, at work, and in social situations. As with ADHD, there is often a family history of similar problems.
Perhaps you feel that your daughter's ADHD medication is working, but her teacher continues to describe her as inattentive and suggests increasing the dose. Maybe the inattention is because she has an unrecognized learning disability, or she is anxious in class, depressed, or tied up with obsessions.
If you suspect that your child has a comorbid condition, consult a child and adolescent psychiatrist. (If there is not one in your community, it's almost certainly worth the trouble to go to the nearest medical center that has one.) Specific studies may be needed to identify learning, language, motor, or organization/executive function problems. A clinical evaluation will be needed to see if there is anxiety, depression, anger control, OCD, or a tic disorder.
Regulatory problems — anxiety, depression, anger control, and OCD — often respond to a specific group of medications known as selective serotonin reuptake inhibitors, or SSRIs. These meds, which include Prozac, Paxil, Zoloft, Luvox, and Celexa, can generally be used in conjunction with ADHD meds.
Tic disorders are treated with medications such as Catapres, Haldol, Tenex, and Orap — which can generally be given along with ADHD stimulant medication.
Bipolar disorder is an exceedingly complex condition with many possible treatments. With this disorder especially, it's important to work with a psychiatrist who understands how to use these medications and, when necessary, use them along with the medications for ADHD.
Ultimately, trust your intuition. If you feel that your child might have one or more of these related neurologically based disorders, take action. Early recognition of the problem and prompt intervention are critical, before the problems become greater or more ingrained.
This article comes from the April/May 2006 issue of ADDitude.