Mental Health & ADHD Comorbidities

When It’s Not Just ADHD: Symptoms of Comorbid Conditions

At least half of all people with ADHD also have a second condition — like learning disabilities, depression, or anxiety — that requires separate treatment. Learn about the most common conditions that come along with ADHD and how to distinguish symptoms.

Could this brain have ADHD and other layered comorbid conditions?
illustration of brain with multiple layers and question mark against solid colored backgrounds

Is It ADHD? Or a Related Condition with Similar Symptoms?

When an individual has only attention deficit disorder (ADHD or ADD), treatment is often a life changer. Stimulants or nonstimulants — particularly when paired with behavior therapy, dietary changes, and exercise — can spark a dramatic improvement in distractibility, hyperactivity, and impulsivity symptoms for most patients once treatment is fine-tuned.

Some individuals, however, continue to experience significant symptoms — deep sadness, anxiety, defiance, learning and organization problems — long after their most pressing ADHD symptoms are brought under control.

For example: A child is diagnosed with ADHD and his doctor starts him on a stimulant. His parents notice that the symptoms that led to the ADHD diagnosis improve, but other challenges persist. His teacher remarks on his improved attention, yet he continues to struggle with classwork. Or perhaps his hyperactivity decreases, yet he remains defiant. When challenges remain after ADHD is diagnosed and treated, this is often a clue that another undiagnosed condition may accompany the ADHD.

Half of All People with ADHD / ADD Also Have Another Condition

Doctors once considered ADHD a standalone disorder. They were wrong. We now know that at least half of people with ADHD also suffer from one or more additional condition, referred to as a comorbidity. Most commonly, ADHD comorbidities include:

[Free Resource: Is It More Than Just ADHD?]

In some cases, these problems are “secondary” to ADHD — that is, they are triggered by the frustration of coping with symptoms of ADHD.

For example, a boy’s chronic lack of focus may trigger anxiety in school. Years of disapproval and negative feedback from family members may likewise cause a woman with undiagnosed ADHD to become depressed. Most of the time, secondary problems fade once the ADHD symptoms are brought under control.

When secondary problems don’t resolve with effective ADHD treatment, they are likely symptoms of a “comorbid” condition.

What Is a Comorbid Condition?

Comorbid conditions are distinct diagnoses that exist simultaneously with ADHD or ADD. They do not go away once the primary condition – in this case, ADHD – is treated. Comorbid conditions exist in parallel with ADHD and require their own specific treatment plan.

[Read: ADHD Comorbidity: An Overview of Dual Diagnoses]

A child with comorbid conditions may need school accommodations, psychotherapy, and/or a second medication in addition to his ADHD treatment.

Three Common ADHD Comorbidity Categories

The three categories of comorbid conditions most commonly diagnosed with ADHD all occur along a spectrum of severity — from mild to serious. Their symptoms are as varied as their causes, which range from genes to exposure to environmental toxins to prenatal trauma, and beyond.

ADHD Comorbidity #1: Cortical wiring problems

Cortical writing problems are caused by structural abnormalities in the cerebral cortex, the brain region responsible for high-level brain functions. Cortical wiring problems include:

  • Learning disabilities
  • Language disabilities
  • Fine and gross motor difficulties
  • Executive function difficulties

Cortical wiring problems are treated with academic accommodations and lifestyle changes. They do not respond to medication.

ADHD Comorbidity #2: Problems regulating emotions

Problems regulating emotions often include:

Note that depression can cause a range of symptoms beyond sadness and thoughts of suicide; these include irritability, reduced interest in activities that used to be pleasurable, sleep disturbances, decreased ability to concentrate, indecisiveness, agitation or slowness of thinking, fatigue or loss of energy, and feelings of worthlessness or inappropriate anger.

Regulatory problems often respond to a group of medications known as selective serotonin reuptake inhibitors, or SSRIs, which generally can be used in conjunction with ADHD medications.

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 administer medications alongside treatment for ADHD.

ADHD Comorbidity #3: Tic disorders

Tic disorders refer to sudden twitches of whole muscle groups. They vary in severity and typically include:

  • Motor tics (ranging from involuntary eye blinking to head jerking to repeated gestures)
  • Oral tics (ranging from grunting to random blurting to, in very rare cases, obscene words or phrases)
  • Tourette’s syndrome (multiple motor and vocal tics that have been present for more than a year)

How to Differentiate Symptoms of an ADHD Comorbidity from ADHD

If you or your child continue to struggle after you’ve begun treatment for ADHD, your next step is to determine whether the symptoms are secondary to ADHD (and likely to dissipate if you fine-tune your treatment plan), or evidence of a fully fledged comorbid disorder that requires additional treatment. signs of a fully fledged comorbid condition. There is no litmus test that can determine this. The best differential diagnosis begins with careful observation of where and when symptoms arise.

  1. 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? If so, her anxiety is likely secondary to ADHD and not a true comorbid disorder. Ditto if your son became aggressive only upon starting middle school.
  2. 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, holidays, and summer vacation; they are evident in school, at home, at work, and in social situations. For example, ADHD-related mood shifts are usually triggered by life events. Bipolar mood shifts, on the other hand, may appear to come and go without any connection to the outside world, and may be sustained over longer periods of time. As with ADHD, they are often hereditary.

Consult a child and adolescent psychiatrist or psychologist.

If you suspect that your child has more than just ADHD, it’s time to request an assessment designed to identify learning, language, motor, or organization/executive function problems. You may also need to pursue a clinical evaluation to determine if your child is living with anxiety, depression, anger control, OCD, or a tic disorder.

Common ADHD Comorbidity Symptoms

Review the list of symptoms associated with each comorbid condition below. If you see similarities to your or your child’s behavior, take action. Early recognition of symptoms and prompt intervention are critical. Start with the recommended resources, and seek professional evaluation if it seems warranted.

[The Full Library of ADHD Tests and Assessments for Related Conditions]

Suggestive Symptoms Recommended Resources
Learning disabilities
  • Difficulty mastering reading, writing, and/or math skills
  • Difficulty with memory, mastering new academic concepts, and/or reasoning
Language disabilities
  • Difficulty understanding what is said
  • Difficulty organizing thoughts and finding the right words when speaking
Executive function difficulties
  • Difficulty organizing thoughts when writing
  • Difficulty planning and executing projects
  • Difficulty remembering and recalling details
  • Difficulty with regulating emotions and managing frustration
  • Specific or generalized fears beyond what would be expected given a child’s age
  • Excessive worry
  • Headaches or stomach aches
  • Panic attacks
  • Persistent moodiness, fatigue, or loss of appetite
  • Unexplained feelings of guilt
  • Unexplained agitation or irritability
  • Reduced interest in activities that used to be pleasurable
  • Decreased ability to concentrate
  • Feelings of worthlessness
  • Sleep disturbances
  • Inappropriate anger
Anger-control problems (oppositional defiant disorder, intermittent explosive disorder)
  • Uncontrollable anger or rage lasting 5-30 minutes or longer
  • Irrational during “meltdown”
  • Often remorseful afterward
Bipolar disorder
  • Mood swings from calm to rage and/or from depression to manic (super-happy) state
  • Excessive talking
  • Difficulty relaxing
  • Mood shifts come and go without any connection to the outside world, and are sustained for a long period of time
Sensory processing disorder
  • Feeling overwhelmed by sensory stimuli, such as bright lights, loud noises, strong odors, tags or seams on clothing
  • Alternately, an individual with SPD may experience muted sights, sounds, and touch, and crave extra stimulation, as from swinging or spinning
Tic disorders (motor, oral, Tourette’s)
  • Patterns of simple and complex motor or vocal tics that come and go and may change form
Obsessive-compulsive disorder (OCD)
  • Ritualistic, goal-directed behavior, such as counting or repeating, or picking at sores or scabs or pulling out hair
  • Need for extreme order or cleanliness
  • Need to collect or hoard objects
  • Hypervigilance or extreme anxiety

[Read This Now: The Complete ADHD Guide]