What if it’s not ADHD?
A comprehensive psychiatric evaluation ensures accurate diagnosis by considering the presence of other conditions that can exist with ADHD. Having one or more conditions at the same time is called having co-occurring or comorbid disorders.
Diagnosing and treating ADHD with comorbid disorders is more difficult and requires a specialist with the experience necessary to identify and treat these other conditions. Some frequent co-occurring conditions with ADHD present as defiance, lying, stealing, learning difficulties, anxiety, hopelessness, low self-esteem, depression, mood dysregulation, and excessive/extreme temper tantrums.
Frequent co-occurring conditions with ADHD
oppositional defiant disorder
anxiety & depression
Language or Learning Disorder
Of the children with ADHD, 20-25% have a comorbid language or learning disorder. These children benefit from accommodations at school and occupational therapy targeting speech and language. An Individual Education Plan (IEP) at school is a needed component in the treatment of children with co-occurring language or learning disorder and ADHD.
oppositional defiant disorder
Research indicates nearly half of children with ADHD also have Oppositional defiant disorder (ODD) or Conduct disorder (CD). Children with ODD are often defiant towards authority figures (parents or teachers), irritable, angry, often losing temper, blame others for personal mistakes, compulsively lie, and deliberately annoy other children or family members.
Conduct disorder is a serious psychiatric disorder affecting some children with ADHD. These children regularly violate the rights of others by stealing, exhibiting physical aggression, or destroying property. Children with ADHD and comorbid conduct disorder are at a significantly higher risk for violating the law, substance abuse, depression, and becoming suicidal than children with only an ADHD diagnosis. The prognosis for CD co-occurring with ADHD is poor but improved with proper treatment.
Anxiety or Depressive Disorders
Anxiety and depression affect 33% of children with ADHD. The symptoms can be so overwhelming that these children self-harm or consider suicide. Treatment of the underlying ADHD often quickly resolves the depression, anxiety, sense of failure, and hopelessness.
The most serious comorbid conditions occurring with ADHD are mood disorders. These symptoms include frequent and extreme “meltdowns” in younger children, quickly shifting mood from irritable or anger to “too happy” in teens, agitation, limited ability to tolerate people or situations, things not happening fast enough or to one’s liking, preference to play alone, and difficulty falling or staying asleep. These children may also be overly sensitive and reactive to situations. Many parents describe their child as “I never know what I’m going to get with him/her.” Treatment of children with mood disorders starts with treating the mood. It is difficult for these children to focus and complete what is required of them when they have a disrupted mood, irritability, and daytime sedation due to difficulty sleeping. Once the mood is stable, the remaining ADHD symptoms are assessed and treated accordingly.
How are these other disorders diagnosed?
Your child’s behavior may be caused by ADHD, another condition, or a co-occurring disorder. A thorough psychiatric evaluation by a specialist considers all potential co-existing disorders to achieve an accurate diagnosis or diagnoses. This is essential to choosing the right treatments, including the choice of medication that will benefit your child the most.
What about sleep?
Difficulty falling asleep, staying asleep, or waking up too early commonly co-occur with ADHD and affect nearly 3 out of 4 children and teens and up to 4 out of 5 adults with ADHD. Children with ADHD who are deficient in sleep have increased hyperactivity and impulsivity, decreased attention span, irritability, and even aggression. For children currently taking ADHD medication, several factors may be involved. It could be the formulation (long-acting v. short-acting), dose amount, or the time of day the medicine is taken. Other factors involved include bedtime routine, use of electronics near bedtime, naps, caffeine, other medications, or the presence of another psychiatric or medical disorder.
The goal is to improve the sleep, which will improve the ADHD, which will improve the sleep. Sleep is assessed by your provider at the initial evaluation and at all follow up visits. Each individual is different, so your specific circumstances are considered in treatment.
How are these other disorders treated?
Treating ADHD and co-occurring disorders depends on the child’s age and comorbid condition. Treatment may include medication, parent training, behavioral therapy, coaching, and educational supports (IEP or 504 plan). Every additional disorder with ADHD adds to the complexity of the treatment. For instance, Oppositional defiant disorder has no FDA approved medication for treating it, but a mood stabilizer may be indicated if the anger and aggression are at a level where the safety of the child or others is a concern. While stimulant medication is first line treatment for ADHD, for a child with a co-occurring mood disorder, it may make the temper tantrums and irritability worse. When treating multiple disorders, the order in which they are treated and the choice of medication used requires the expertise of a specialist.
The providers at KEGE Center for ADHD will advise you when medication is indicated and the symptoms it intends to target. The decision to start medication will be thoroughly discussed and agreed upon by the provider, the parents, and the child. It’s important to weigh the risk and benefits of any medication.
Medications are not a cure, but they may be able to help control your child’s symptoms. Children are better able to learn and participate in therapy when their symptoms are stable.
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Most people can be inattentive, impulsive, or hyperactive at times. When is it ADHD and how is it treated?