Comorbid ADHD Complicates Most Diagnoses and Treatment Plans
About 60 percent of people with ADHD have a co-existing psychiatric condition. Learn about the most common co-existing disorders here, and don’t leave the doctor’s office until you receive a complete diagnosis.
An accurate ADHD evaluation must screen for far more than ADHD. Though 60 percent of people with ADHD have some co-existing psychiatric condition1, comorbidities rarely factor into the evaluation — leading to an incomplete diagnosis. You have ADHD, but what else might you have? Or, no, you do not have ADHD but rather some other condition that explains the symptoms that led you to seek help.
This is why checklist evaluations, while helpful screening tools, are inadequate by themselves. You need to sit down and talk to a human being and tell your story. In medical parlance, this is called sharing your history, and your history is the most revealing and useful test in all of medicine. While most mental health professionals do not perform a physical exam, the “history and physical” remains the cornerstone of a medical evaluation.
Whether you’ve yet to undergo an ADHD evaluation, or you’ve already been diagnosed with ADHD, be sure to ask your doctor if you might have any of the following comorbid conditions often seen with ADHD:
ADHD and Common Coexisting Disorders
1. Learning differences
- Dyslexia. The most common learning disability, dyslexia makes you slow to learn to read and spell your native language. I have both ADHD and dyslexia, which can manifest quite differently and change over time. For example, I majored in English in college and now make my living with words, even though to this day I am a painfully slow reader.
- Dyscalculia is sometimes called “math dyslexia.” A person with dyscalculia has trouble with math facts, with counting, with computation, and with word problems. But, just as the dyslexic individual may turn out to be gifted with words, the child with dyscalculia may mature into a gifted mathematician.
- Dysgraphia includes trouble with handwriting, an awkward way of gripping a pen or pencil, trouble spacing written words or letters, frequent need to erase, and an awkward body position while writing.
- Dyspraxia, or Developmental Coordination Disorder (DCD), denotes clumsiness, lack of coordination, a tendency to drop or spill things, awkwardness in movement. DCD often leads to tremendous problems with confidence and self-esteem in childhood and adolescence, when athletic prowess and physical fluidity are so highly valued among peers.
Treatment for all of these LDs includes specialized tutoring (like Orton-Gillingham, Wilson, or Lindamood-Bell for dyslexia) or coaching; occupational therapy; and counseling to help with the attendant emotional problems.
2. Behavioral or conduct problems
The diagnostic terms for these include oppositional defiant disorder (ODD); conduct disorder (CD); and anti-social personality disorder (ASPD). Without intervention, a child may move from ODD to CD to ASPD as they age (though these conditions are more common in males). It’s critical to get help early on, and treatment is best undertaken by a team of providers.
3. Anxiety disorders
However, sometimes an individual has a freestanding anxiety disorder, which needs to be treated with a combination of education, counseling, cognitive behavioral therapy (CBT), physical exercise, positive human connection, and, perhaps, medication, such as an SSRI or an anxiolytic.
4. Mood problems
- Depression. Once again, what looks like depression may occur in the wake of untreated ADHD. If the person responds well to ADHD medication, performance improves and the “depression” disappears. However, sometimes an individual has primary (not secondary) depression as well, which requires its own treatment.
- Dysthymia. The sadness and low mood of dysthymia is less severe than with depression, but it lasts longer.
- Lifelong low mood. Historically, there have been many terms for this, but a common clinical observation is that some people who have ADHD struggle with low mood and emotional dysregulation.
- Bipolar disorder (BD). Up to 1 in 13 patients with ADHD has comorbid BD, and up to 1 in 6 patients with BD has comorbid ADHD4 .
5. Substance use disorder
SUD is common with ADHD, as are behavioral addictions or compulsions. Do not let shame hold you back from talking with your doctor about them. There are treatments other than willpower and white knuckling.
If you or your child is given an ADHD diagnosis, be sure to ask your doctor about the conditions listed here as well as any other issues that may not have come up during the evaluation. To get the best results — to experience the total life re-make this diagnosis can trigger — you need to treat the entire self.
Don’t worry about bothering your doctor with questions about comorbid disorders. The only stupid question is the one you don’t ask. Good doctors welcome and respect these questions and are glad to provide more information and knowledgeable reassurance. Don’t leave the office until you’ve gotten all the answers. That way you can maximize the benefit of the diagnosis, the complete diagnosis.
ADHD Comorbidities: Next Steps
- Free Download: Overcoming Common Learning Challenges
- Self-Test: The ADDitude Symptom Checker
- Read: ADHD Comorbidity: An Overview of Dual Diagnoses
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1Gnanavel, S., Sharma, P., Kaushal, P., & Hussain, S. (2019). Attention deficit hyperactivity disorder and comorbidity: A review of literature. World journal of clinical cases, 7(17), 2420–2426. https://doi.org/10.12998/wjcc.v7.i17.2420
4Schiweck, C., Arteaga-Henriquez, G. et.al. (May 2021). Comorbidity of ADHD and bipolar disorder: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 124: 100-123. https://doi.org/10.1016/j.neubiorev.2021.01.017