The 6 Most Important Comorbidities of ADHD

Those who live with a diagnosis of attention deficit hyperactivity disorder (ADHD) face, every day of their lives, notable obstacles in achieving their most relevant personal goals.

And not only because of the impact of alterations in executive functions, such as attention and/or behavioral inhibition, but also because of the “social frictions” in which its particular clinical expression is involved. And from a very young age they can be labeled as agitated or even violent, which conditions the way they live this age period.

The literature on ADHD suggests that, beyond the limitations that this neurodevelopmental disorder imposes, the affective consequences related to difficulties in achieving school goals or satisfying all the demands of a job also contribute.

In this article We will address some of the comorbidities of ADHD All of them are important, since they are linked to a worsening of symptoms and/or their prognosis and evolution. Let us delve, without further ado, into such a relevant issue.

Attention deficit disorder and hyperactivity

ADHD is a neurodevelopmental disorder with three different symptoms associated with it, namely: impulsivity (problems inhibiting impulses or delaying incentives), inattention (difficulty maintaining “focus” for the necessary time on a task being performed) and motor hyperactivity (feeling of pressure and inability to stay on task). a state of stillness in contexts in which it should be done). There are diverse profiles of ADHD, since each of the people who suffer from it reports very different symptoms (emphasis on inattention or hyperactivity, or even a mixture of both).

It is estimated that a percentage between 3% and 10% of the child population presents symptoms compatible with this diagnosis following the DSM-5 manual, with an expression that very often begins before the age of five and exceptionally debuts after the seven. Resonances on cognition, especially in executive function (planning or inhibitory control), imply notable consequences on several areas of daily functioning. Therefore, a multitude of those have been used to explain the comorbidities that the literature has detected for this same group of patients.

Comorbidity is understood as the presence of two or more clinical entities (including ADHD) simultaneously in a single individual (child or adult), in such a way that a synergistic relationship is established between them. The result cannot be calculated through a simple sum of the diagnoses, but rather an interaction occurs between them, resulting in a unique manifestation for each of the people who may present it. And this is so because these comorbid disorders mix with the dimensions of personality and character, resulting in a profound psychopathological idiosyncrasy from this process.

In patients with ADHD, comorbidity is the rule, and not an exception, so the presence of all the disorders must be taken into account, which will be detailed from the very beginning of the therapeutic relationship (initial interview with the parents and the patient). infant, definition of evaluation strategies, etc.). It is known that, in addition, comorbidity can obscure the prognosis and accentuate the obstacles that the family will have to deal with as time passes, given that up to 50% of cases extend beyond adolescence.

Comorbidities of Attention Deficit Hyperactivity Disorder

We proceed to detail the six disorders that most frequently coexist with ADHD. Although at first a very special emphasis was placed on externalizing disorders (disruptive behaviors), currently the importance of internalizing disorders (major depression, eg) is also beginning to be considered for the balanced development of the person with this clinical condition.

1. Major depression

depression is a disorder characterized by deep sadness and great difficulty experiencing pleasure In the case of boys or girls, as well as adolescents, it is sometimes expressed as irritability (and is confused with behavioral alterations). The scientific community is increasingly aware of the possibility that such a mood problem may occur in those diagnosed with ADHD, very frequently as the emotional result of existing limitations in adapting to school or in forging relationships with peers.

In any case, it is estimated that between 6% and 9% of children and adolescents with ADHD have a comorbid diagnosis of depression, which increases their subjective level of stress and exacerbates the underlying cognitive problem. These are conditions that debut much earlier than what is observed in the general population, and that require the design of interventions of greater intensity and duration. The high attendance of both was the definitive incentive for the research community to set out to define the common aspects that could explain and predict it.

After multiple studies on this issue, it was concluded that the common axis was emotional dysregulation; understood as the presence of excessive affective reactions in contrast to the triggering event, the great lability of internal states and excessive emphasis on past negative experiences or ominous expectations for the future. Among all the characteristics associated with such a relevant shared factor, frustration intolerance emerges as that with greater explanatory and predictive power

It has been described that up to 72% of boys and girls with ADHD present this trait, which is expressed as a significant difficulty in delaying the reward or tolerating the existence of obstacles that prevent its immediate and unconditional achievement. This circumstance would precipitate the emergence of a recurring feeling of failure, the dissolution of all motivation to achieve goals and the solid belief that one is different and/or inappropriate. All of this can be accentuated when, in addition, we live with constant criticism every day.

2. Anxiety disorders

Anxiety disorders are also very common in ADHD. Studies on this issue conclude that Between 28% and 33% of people with this diagnosis meet the criteria for an anxiety problem, and especially when they reach adolescence. It is also at this point that differences begin to be noticed between boys and girls in terms of the risk of suffering from them, being much more common in girls than in men. When comparing subjects with ADHD and without it, it is noted that in the first case these disorders emerge at earlier ages and last longer.

Boys and girls with ADHD show higher levels of social anxiety than those who do not suffer from it, and are more likely to report acute panic attacks and specific phobias. The latter may be formed by evolutionarily normal fears that persist despite the passage of time, which accentuates them and accumulates them with those that arise during later periods. There are also studies that describe a higher prevalence of generalized anxiety disorder in this population, characterized by constant/inevitable worries about a wide constellation of daily issues.

It’s known that This comorbidity is more common in those who have mixed ADHD, that is, with symptoms of hyperactivity/inattention. However, it is believed that attention deficits are related to anxiety in a more intimate way than any other of its forms of expression. Despite this, anxiety accentuates impulsivity and alterations in executive function to the same extent, aggravating any difficulty (academic, work, etc.) that one may be going through.

3. Bipolar disorder

Bipolar disorder in childhood and ADHD overlap significantly on a clinical level, such that they are often confused and mixed in an indistinguishable way. Thus, both present with low tolerance for frustration, high irritability and even outbursts that do not fit with the objective characteristics of the event that triggers them. It is also possible that in both cases there is difficulty delaying rewards and “fluctuations” (more or less pronounced) in mood. Because the treatment is different in each case, the particular disorder suffered must be identified or if there is an underlying comorbidity.

There are some differences between bipolar disorder and ADHD that should be considered when evaluating. To distinguish one from the other, it is key to take into consideration the following: in bipolar disorder there is a long family history of this same clinical picture, there are periods of great expansiveness of mood, irritable affectivity stands out compared to depressive affectivity, emotional changes are more frequent/severe and there is a tendency towards grandiosity in the way one thinks about oneself.

Finally, it has also been described that more or less half of infants with bipolarity present inappropriate sexual behaviors, or in other words, that do not correspond to their age and that are displayed in contexts in which they are disruptive (masturbation in public places, eg). All this without there having been a history of abuse (a context in which these habits can arise in a common way).

Furthermore, also they express with some frequency that they do not require sleep something that must be distinguished from the reluctance to go to bed typical of ADHD.

4. Addictions

Addictions are also a very important problem in ADHD, especially when reaching adolescence, where the danger of substance abuse increases fivefold. The research carried out on such an essential issue shows figures of between 10 and 24% of comorbid dependence, reaching maximum prevalences of 52% in some of the works. Although there is a belief that there is a kind of preference for stimulant drugs, the truth is that there is no clear pattern, describing all types of consumption (most of the time being an addiction to several substances at the same time).

A very relevant percentage of adolescents who show ADHD/addiction showed problematic behavior prior to this stage, which may include discrete thefts or other activities that violate the rights of others. Likewise, there is evidence of an early debut in recreational consumption (frequently before the age of fifteen) along with a substantially greater presence of antisocial personality traits (50% in adolescents with ADHD and addiction and 25% in those who only have ADHD).

It is known that The presence of ADHD symptoms negatively affects the prognosis of addiction, and that on the other hand the use of substances alters the effectiveness of the drugs that are usually administered in order to regulate their symptoms (especially stimulants of the central nervous system). It should not be forgotten, on the other hand, that the therapeutic approach with such medications requires the closest possible monitoring in cases of addiction, to avoid inappropriate use of them.

Finally, working with family is always essential, aimed at promoting tools that minimize the risk of relapse and preserve relational balance. All drug consumption is a difficult situation at the level of the social group, and requires adjusting the different roles that have been played until now. On the other hand, at a systemic level there is what appears to be an indissoluble functional and bidirectional connection: ADHD is more common in families where there is addiction and addiction is more common in families where there is ADHD.

5. Behavioral disorders

Behavioral disorders are common in children with ADHD. These are acts that cause harm to other people or to the child himself, and are related to a high level of conflict in the family and school environment. Some examples of this may be bullying, arguments with parents that include scenes of physical/verbal violence, petty theft, and tantrums whose purpose is to extract a secondary benefit. All of this would definitely translate into aggressive, defiant and impulsive behaviors.

When ADHD presents these difficulties, it is understood as a specific variant in which family stress levels reach a threshold higher than that of conventional ADHD. And in general the symptoms of inattention, impulsivity and hyperactivity are much more intense; and end up torpedoing the child’s efforts to overcome the historical milestones that are associated with each stage of development (which isolates him from peer groups with prosocial tendencies and segregates him into marginal groups where dissocial behaviors acquire a normative value and power. reinforcing).

The family history of such a case of comorbidity is characterized by poor parenting, poor supervision of the child’s habits outside the home and even abuse of all kinds and harshness These are, therefore, environments with an exorbitant level of social conflict, and even families at extreme risk of exclusion. It is not uncommon for one or both of these parents to suffer from serious mental illnesses (including antisocial disorder or chemical and non-chemical addictions). This situation also increases the risk of the minor engaging in drug use, aggravating the entire problem, as seen in a previous section.

6. Suicide

Suicide is not a disorder in itself, but rather a dramatic and painful consequence, often involving a long history of psychological pain. In fact, Up to 50% of adolescents who try or succeed suffer from a mental health problem, with an average evolution of two years taking the moment of the suicidal act as a reference. It is known that patients diagnosed with ADHD are more likely to engage in suicidal behavior, to present self-harming ideation, and even to cause injuries of varying degrees to themselves.

The literature on this matter is consistent in pointing out adolescence and adulthood as the periods of greatest vulnerability, to the point that 10% of adults with ADHD have attempted suicide at least once and that 5% die precisely from this cause. The risk increases when living with major depression, a behavioral problem, or substance dependence; and also in the event that the patient is male. That is why, during the treatment that is articulated for subjects with ADHD and some comorbidity, this possibility must be kept in mind.

The cognitive alterations that these patients present, especially in areas such as attention and behavioral inhibition, are associated with a greater risk of suicidal behavior. This is so much the case that many studies on the epidemiology of suicide highlight ADHD as a risk factor for this important health and social problem.