ADHD and Coexisting Conditions, There’s often more to ADHD…

If you observe symptoms of the following mood conditions, it may be time to talk to your doctor about whether there is more to your child’s ADHD.

• Anxiety Disorder

  Research shows that up to 50% of children with ADHD have an anxiety disorder. In addition, children with anxiety may have more severe ADHD symptoms.

  Even for kids, a certain level of anxiety in everyday life is normal. However, children with anxiety disorder may express:

  • Specific or general fears beyond what is expected for their age
  • Worry or panic in the face of everyday stressors, such as school exams or social events
  • Irritability and feeling “keyed up”
  • Sleep disturbances
  • Physical symptoms, such as stomach upset, muscle tension, or headache
• Depression

  Up to 50% of children with ADHD also suffer from depression. You may think depression is mostly sadness, but it may be more than that. Depression may also look different in kids and teens than in adults. Be aware if you notice that your child is:

  • More angry or irritable
  • Less interested in activities he/she used to enjoy
  • Experiencing sleep disturbances
  • Expressing feelings of guilt or low self-worth
• Bipolar Disorder

  Nearly one-quarter (22%) of children with ADHD are also diagnosed with bipolar disorder. As mentioned, some moodiness is common as children develop—particularly during adolescence. However, children with bipolar disorder have more apparent symptoms.

  • Mood swings that come and go, seemingly without explanation
  • Negative moods that are sustained for long periods of time
  • Shifts in mood that are more extreme (eg, from calm to raging to an overly happy/enthusiastic state)

In addition to the specific mood conditions described above, many children with ADHD have difficulties tied to the regulation of behavior.

• Obsessive Compulsive Disorder (OCD)

  Difficulty managing thoughts and emotions in ADHD is associated with risk for developing OCD. Children with this disorder may have:

  • Obsessions: repetitive words, images, or fears
  • Compulsions: handwashing, checking, counting, or feeling the need to arrange items in a particular order
• Oppositional Defiant Disorder (ODD)

  Approximately 40% of children with ADHD also have ODD. Children with ADHD may deal with their emotional pain by “externalizing”— blaming others for their problems and taking no personal responsibility.

  ADHD may overlap ODD with behaviors marked by:

  • Openly defying rules at home or at school
  • Arguing excessively with adults or authority figures
  • Acts of physical aggression (eg, shoving or hitting peers)
  • Frequent behavioral outbursts (extreme temper tantrums or “meltdowns”)
• Conduct Disorder (CD)

  When ODD becomes more serious or ingrained as a child ages, it results in conduct disorder (CD). This may lead to more troubling behavior patterns such as:

  • Frequent lying (for the sake of lying)
  • Stealing items of no apparent worth
  • Physical bullying
  • Skipping school
  • Substance use (eg, cigarettes, alcohol, marijuana)
• Tic Disorders

  Anxiety and other factors associated with ADHD may also lead to issues controlling motor behavior.

  Tics (involuntary movements) and tic disorders, like Tourette syndrome are common, occurring in up to 30% of kids with ADHD.

A developmental delay is more than being “a little behind”. It represents a substantial delay in areas such as:

• Cognition (Thinking or Reasoning Skills)

  This includes the ability to think, learn, and solve problems. Children with ADHD often have issues with:

  • Cognitive inhibition (resisting distraction)
  • Cognitive flexibility (switching between tasks)
  • Working memory (ability to use new and learned information in the middle of a task)
• Learning and Language Skills

  This includes understanding what is said (receptive language), as well as using words to express thoughts or emotions (expressive language).

  • Kids with ADHD often start talking later than their peers
  • Attention issues may also make it hard for kids with ADHD to slow down their thoughts, organize their speech, and not interrupt others
  • Involuntary vocal tics sometimes accompany ADHD and may make speech difficult
• Social and Emotional Skills

  These skills allow children to relate to others and express and regulate emotions. Lack of emotional regulation is frequently seen and defined by symptoms such as reduced tolerance for frustration , irritability, aggression, and marked mood swings.

  • Kids with ADHD often feel frustrated by minor things and may have trouble calming down when angry
  • Difficulties with emotional regulation may lead kids with ADHD to struggle in social settings (eg, making friends, appropriately reading social cues, and fitting in with their peers)
• Fine and Gross Motor Skills

  It’s important to understand what fine and gross motor skills are, and how these skills may develop differently in kids with ADHD. Fine motor skills are related to smaller muscle groups (eg, picking up objects, drawing, and writing). Gross motor skills are skills related to larger muscle groups (eg, running, jumping, and climbing).

  • Kids with ADHD may have less developed fine motor skills, leading to problems with handwriting. Teachers may label their work “messy” or “careless”
  • Kids with ADHD also exhibit less developed gross motor control (climbing too high, running too fast); this, along with the behavioral impulsiveness often seen in ADHD, puts them at greater risk for accident or injury

Developmental issues that go hand-in-hand with ADHD may be a source of significant worry for parents. However, it’s important to remember that the long-term developmental outcome for children with ADHD varies—and often depends on what help or interventions they receive. As always, you should talk with your child’s doctor to decide on the best support and treatment for your child. You can also see links to some helpful resources here.