More on Comorbidity in ADD/ADHD: Learning Disabilities, Tourette’s, and more…
ByThis article comes from a subscriber’s question: “are you looking at comorbid conditions such as learning disabilities and Tourette’s that often accompany ADHD?”
To start with, I have reviewed comorbidity and what it means in this article: comorbidity in ADHD.
As a quick review, a comorbid condition is defined as another disorder which is also present when ADHD is there. It causes further morbidity, meaning more difficulties or suffering related to the second disorder.
When someone has ADHD it is very common that they would have a second disorder that affects their functioning. (Or maybe even a third disorder as well…)
Here are some of the common comorbid conditions, and how often they come:
Oppositional defiant disorder occurs in up to 60 percent of kids with ADD or ADHD. This is a behavior disorder characterized by testing limits and disobeying and defying which can be mild or quite severe and interfere with school, home etc. For more information, read this article on Oppositional Defiant Disorder.
Conduct disorder can be up to 25 percent of individuals with ADHD. This is a much more serious behavior disorder where individuals actually test limits to the point that they are crossing the line. These behaviors are severe enough that they would actually be considered criminal behavior. The symptoms include: stealing, setting fires, hurting animals, starting physical fights, bullying others etc.
Mood disorders occur in 20 to 30 percent of individuals with ADD or ADHD; depression much more common. Bipolar disorder is less common but causes a lot of difficulty. A child with bipolar disorder and ADHD can be one of the most difficult children to treat in all of child psychiatry.
Anxiety disorders can be up to 30 percent; that can be Generalized Anxiety Disorder, Separation Anxiety Disorder, Obsessive Compulsive Disorder, Social Anxiety Disorder, etc.
Learning disabilities can occur in 40 percent of people with ADHD or higher. It’s very important to realize that these are separate disorders. The ADHD does not cause the learning disability and the learning disability does not cause the ADHD. So if somebody receives good treatment for their learning disability but still has ADHD there is still interference going on or vice versa if somebody receives good treatment for their ADHD but is not receiving educational help for the learning disability there are still difficulties going on.
A small percentage of kids with ADHD also have Tourette’s (chronic vocal and motor tics) and a small percentage of kids with ADHD would have an autistic spectrum disorder or PDD (pervasive developmental disorder). We’ll cover that in more detail in another article.
So the answer to the question is ‘yes I do look for comorbid conditions such as learning disability and Tourette’s that often accompany ADHD and in fact it’s very important to look for the comorbidity’.
I will say that comorbidity can literally dictate the treatment and outcome for ADHD. By that I mean that simple inattentive ADHD is much easier to treat than ADHD with bipolar disorder for example and the comorbidity can really dictate how things go in the long run.
My son is eight and has inattentive type ADHD and a non-verbal learning disability (math, spatial relations, sequencing etc). He also happens to be quite gifted in the verbal arena according to his WISC-IV results.
I can certainly vouch for your statement Dr.Handelman that comorbidity contributes to further morbidity. Each condition exacerbates the other. This is definitely the case for my son. It is confusing and stressful to find the right solution to address his challenges and nurture his gifts to give him the very best chance for success in life.
Hi Dr. Kenny Handelman,
Your write up on cormobidity is very useful. My neighbour has a son who has ADHD but like some people, she lives in denial and refused to believe there is such a thing as ADHD. With your article, I hope I can persuade her to see the truth that this order exists and that her son may have other disorders as well.
Good day Dr. Kenny,
My son was diagnosed with ADHD and Dyslexia at age 5 and went on Adderall XR and received daily tutoring in school all the way up through 3rd grade. It was a dual approach that worked wonderfully for him. By the end of 3rd grade he was skeletal and Straterra had just recently come out, so the Dr. switched him to Straterra at our request. He reacted horrifically – he became rageful and violent. We pulled him off and left him off meds for the summer to clear out his system.
Back in 4th grade his father refused to allow him to go back on meds. He kept begging and begging and his father wouldn’t allow it. I watched my son slowly degrade and crumble until he was suicidal and the school had to call the Mobile Crisis Unit for him at the end of 6th grade. Last summer, just before his 7th grade year I was able to get him tested (psycho-emotional-educational) and it showed ADHD, a learning disability, and potentially a mood disorder. I needed this information to go against his father and get him treatment.
We began by putting him back on Adderall and while it was as effective as always, he had ticks and agitation. We switched him to Vyvanse, then to Concerta, now to Focalin. HELP! Everything we put him on works great while he’s on it, but as it wears off he starts getting agitated, anxious, and rageful. It’s horrible. It is worth mentioning his father has been diagnosed by 3 different doctors as being bipolar, but he’s in denial and won’t hear of his kids being bipolar – even though heredity from father’s to sons is high. My son has no bipolar symptoms other than when his ADHD meds are wearing off daily. I know that this doesn’t mean it’s not present. But he NEEDS the ADHD meds or he can not function at all in school.
What do you do with parents in this situation? What course of treatment have you found overall has a better success rate in treating the bipolar and ADHD. I’m going to get one chance to push this and get him treated and if it fails, I’m not going to get another one. That’s why I want to know what has been most effective amongst the general population being treated for both.
Your insightful experience would be gratefully appreciated.
Fondly, Melinda
Melinda,
Talk to the doctor about Risperidone. It can be very helpful if there is childhood bipolar.
Also consider getting a second opinion for diagnosis and treatment options.
Best,
Dr. Kenny
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Hi.
Comorbidity what an excelant expression marvelesly defining what is almost alvays found in ADD, ADHD and Autistic Spectrum Disorder. The comorbid condition is apraxia (dyspraxia).
For some basic info see http://www.jayseducation.com/apraxia.html. There is help and DIY help available at http://www.jayseducation.com, we offer (some free) literacy and numeracy worksheet programs designed to help children with learning difficulties. They are approved and used in many Australian schools as well as by parents.
Tom
Insomnia can also be a comorbid issue associated with ADHD. I found a website for children with ADHD who experience trouble sleeping. Parents can check the website out at http://www.StudyforADHDSleep.org
I’m 20 years old I know that learning disorder rarely occur with adult but I find some similar symptoms in that. I have less concentrate on studying although I tried and spend my time so much to study. I scare of strange people, I prefer staying at home to go to a party. I usually talk to myself and cannot remember what I just have already learnt. I come from Viet Nam and there are hardly have any doctor or expert who can help my situation. I do not know wheter I am a person with learning disability or not. Can you help me to diagnose my problem? Please…
Hi Anna.
Your problem is very familiar to me. I am a “foreigner” myself, my mother in law (Anna) had symptoms like you have. I cannot help you personally, however my granddaughter is a psychologist who is helping people as you.
If interested ask here or use http://www.learningdifficultieshelp.info.
Tom