Q: “Will ADHD Medication Worsen My Child’s Other Condition(s)?”
Stimulant medications effectively treat the symptoms of ADHD, but they may worsen comorbid behaviors. Similarly, some of the medications commonly used to treat comorbid conditions are known to exacerbate ADHD.
Q: “When a child has ADHD and another diagnosis such as anxiety, obsessive compulsive disorder (OCD), or depression, will ADHD medication treat the other diagnoses as well? What effect will ADHD medication have, if any, on symptoms of co-occurring conditions? Will medications used to treat other conditions impact ADHD symptoms?”
About 60% of children with attention deficit hyperactivity disorder (ADHD) will have a comorbid condition.1 Comorbid means that one disorder often co-exists with a separate disorder. The most common comorbid conditions with ADHD include anxiety disorders, OCD, oppositional defiant disorder (ODD) and autism spectrum disorder. ADHD symptoms and symptoms of comorbid conditions may overlap, but they each require their own treatment.
Stimulant medications effectively treat the symptoms of ADHD, but they may worsen comorbid behaviors. For example, temper tantrums — common in ADHD and in other conditions — may worsen after taking medication, even if the same medication improves other ADHD symptoms.
[The ADDitude Symptom Checker: Use It to Scan for 17 Comorbid Conditions]
On the other hand, some of the medications commonly used to treat comorbid conditions like depression and anxiety — medications like Zoloft, Prozac, and Celexa, for example — are known to worsen ADHD symptoms.
As a result, the following scenario is common: Clinicians will start a child on a stimulant medication to control core ADHD symptoms. While the child’s ADHD symptoms improve, the same medication may cause them to experience more irritability and temper tantrums. So, the clinician adds a non-stimulant medication to address these worsening behaviors. But that second medication, in turn, worsens ADHD symptoms. In response, the clinician increases the dose of the stimulant — which helps improve the ADHD symptoms but worsens the tantrums and irritability.
At this point (and to stop the cycle), most clinicians will consider changing course and treating ADHD with a non-stimulant medication alone. Though not as effective as a stimulant, a non-stimulant will reduce the ADHD symptoms and at the same time, many symptoms of comorbid conditions as well.
Finally, it is important to note that many comorbid symptoms can be effectively treated with counseling as well. If the comorbid symptoms are mild to moderate, counseling may be the first treatment option before trying non-stimulant medication. But if the comorbid behaviors interfere with learning and social interaction, then a non-stimulant would be indicated.
In all, the presence of comorbid conditions certainly complexifies ADHD. It can be difficult alone to determine whether a symptom like difficulty focusing stems from ADHD or anxiety – or both. Making the distinction between ADHD and other co-occurring conditions takes time, and comes from getting to know an individual patient.
How to Treat ADHD in Children: Next Questions
- What ADHD medications are used to treat children?
- Is ADHD medication right for my child?
- What are common side effects associated with ADHD medication?
- How can I address appetite suppression caused by ADHD medication use?
- How can I solve sleep problems associated with ADHD medication use?
- What can I do if ADHD medication use causes tics?
- How can I prevent the afternoon ‘medication crash?’
- What if my child becomes a ‘zombie’ while taking meds?
- Should my child take an ADHD medication vacation?
- What natural treatments help kids with ADHD?
- What if the medication stops working?
- How can I find an ADHD specialist near me?
The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023. Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?
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1 Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(2), 199–212. https://doi.org/10.1080/15374416.2017.1417860