1. ADHD& CO-morbidities Dr. Fatima Al-Haidar Professor & Consultant Child and Adolescent Psychiatrist

2. Introduction  High rates of co-morbidity are found in referred sample than in epidemiological sample.  About 2/3 of elementary school age children with ADHD who were referred for clinical evaluation have at least one other psychiatric diagnosis.  Children with ADHD report higher percentage of co-morbidity than parents.  Co-morbidity complicates course, prognosis, assessment and response to treatment.

3. 1. Conduct Disorder  So great association  There are many risk factors for such association.

4. 2. Speech Problems  ADHD is strongly associated with a range of abnormality in speech.  What is the nature of that association?

5. 3. Learning Disabilities  ADHD is specifically linked to reading underachievement in early and middle childhood.  How to explain this linkage?

6. 4. Anxiety Disorders  Internalizing disorders (both anxiety and depression can occur with ADHD.  Children with ADHD and anxiety show greater improvement on combination of Methylphenidate and behavioral modification.  Family loading for anxiety and depression and adversity influence child ADHD-Internalizing co-morbidity.

7. 5. Bipolar Affective Disorder (BAD)  To date, no longitudinal study has established a clear link between manic symptoms seen in association with ADHD in childhood and adult BAD.  Mania with ADHD in childhood is associated with severe irritability, mixed state, multiple episodes, severe ADHD, frequent hospitalization, marked impairment and rapid cycling.  Diagnosing mania in children with ADHD is difficult ….why??

8. 6. Cigarette Smoking (C.S.)  ADHD had both quantitative and qualitative impact on C.S.  There is significant association between C.S. in mothers during pregnancy and ADHD in their children.  Why children with ADHD smoke?  Can we prevent?

9. 6. Drug Abuse  No meaningful association between ADHD and alcohol or drug abuse.  The association is mediated primarily by other co-morbidities especially conduct disorder, mood and anxiety disorders.  Drug abuse by peers is a risk factor.  No evidence that stimulant treatment of ADHD increases the risk for drug abuse.  How an we prevent??

10. 7. Sleep Disorders  A range of abnormality in sleep has been noticed in children with ADHD.  Why such association has been noticed??

11. 8. Mental Retardation  ADHD is associated with reduced verbal and performance intelligence.  Clinically, such association is very important.

12. 9. Enuresis and Encopresis  Both co-exist with ADHD *Direct Effect *Indirect Effect

13. 10. Tic Disorders  ADHD is common in chronic tic disorder.  Such association will increase referral of children to psychiatric care.

14. 11. Autistic Disorders  Autistic children frequently show hyperactivity.  Hyperactive children may have features of autism.

15. 12. Obsessive Compulsive Disorder (OCD)  High rate of ADHD in juvenile OCD subjects.  Such presentation will complicate the course, assessment and management.

16. 13. Code V Diagnoses  Poor relational problems  Physical abuse of children  Academic problems  Occupational problems

17. 14. Co-morbid Subgroups 1. Pure ADHD 2. ADHD + internalizing disorders 3. ADHD + externalizing disorders 4. Combined