Comorbidity, or the co-occurrence of two or more disorders, is surprisingly common among those with ADHD (Attention Deficit Hyperactivity Disorder). In fact, as many as 60-90% of children with ADHD have at least one comorbid disorder.
Comorbid conditions can further complicate the path to clinical diagnosis and accurate treatment. Let’s have a look at some of the most common comorbidities and their symptoms.
The 10 Most Common Comorbidities For ADHD
ADHD’s most common comorbid conditions can go from mild to severe. In some cases, the symptoms associated with these comorbid conditions aren’t due to a separate disorder, but rather “triggered” by ADHD symptoms and the struggles that come with them.
For example, children struggling with focus in school may develop strong feelings of anxiety, low self-esteem, and even depression. It’s important to recognise the signs of ADHD as early as possible, so you or your child can receive the treatment you need and prevent additional struggles.
Many things can factor into the development of ADHD comorbidities, including:
- Genetics
- Epigenetics
- Chronic infections
- Inflammation
- Life stressors
- Trauma
- Childhood abuse
The 10 conditions with the highest co-occurrence with ADHD are:
Autism Spectrum Disorder
Just like ADHD, autism spectrum disorder (ASD) is a neurodevelopmental condition that can present in many ways: sensory processing issues, struggles with social communication, emotional disregulation, etc.
According to studies, 50-70% of individuals with ASD also fit the criteria for ADHD. Still, autism and ADHD don’t just co-occur – they share many overlapping symptoms (e.g. challenges with social skills, attention, and focus). Because of that, it can be challenging to reach an accurate diagnosis, once again highlighting the importance of clinical assessments done by experienced professionals.
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Depression
People with ADHD often report struggles with depression, which can manifest as:
- Persistent moodiness
- Fatigue
- Loss of appetite
- Unexplained feelings of guilt
- Unexplained agitation or anger
- Reduced interest in activities that used to be enjoyable
- Decreased focus
- Feelings of worthlessness
- Sleep irregularities
Depression can often be managed through medication (SSRIs or selective serotonin reuptake inhibitors), which you can use alongside ADHD medication.
Anxiety Disorders
Anxiety disorders, including panic attacks, are also fairly common in those diagnosed with ADHD. Symptoms include:
- Specific or generalised fears
- Excessive worry
- Headaches or stomach aches
- Panic attacks
Individuals with ADHD and anxiety may develop avoidance behaviours, and may completely avoid situations that trigger anxiety or situations where they fear they might fail – which can make it hard to realise the anxiety is present in the first place.
Obsessive-Compulsive Disorder (OCD)
Another common comorbid condition is Obsessive-compulsive disorder (OCD), characterised by ritualistic, goal-directed behaviour, such as counting or repeating, or picking at sores or scabs or pulling out hair. Other symptoms include:
- Need for extreme order or cleanliness
- Need to collect or hoard objects
- Hypervigilance or extreme anxiety
Learning Disabilities
Studies show a complex relationship between learning disabilities and ADHD, potentially due to common underlying neural mechanisms. The co-occurrence can range from 20% of people with ADHD all the way to 60%.
Common types of learning disorders people with ADHD often report are:
Some common types of learning disorders include:
- Dyslexia – difficulty with reading, spelling, and writing
- Dyscalculia – difficulty with math concepts and calculations
- Dysgraphia – difficulty with handwriting and fine motor skills
- Auditory processing disorder – difficulty processing and understanding auditory information
- Visual processing disorder – difficulty processing and understanding visual information
Language Disabilities
Children with ADHD may also struggle with language disabilities, often reporting difficulty understanding what is said, or difficulty organising their thoughts and finding the right words when speaking.
Executive Function Difficulties
Executive function difficulties are also very common in ADHD, including challenges such as:
- Difficulty organising thoughts when writing
- Difficulty planning and executing projects
- Difficulty remembering and recalling details
- Difficulty with regulating emotions and managing frustration
Tic Disorders
Tic disorders refer to sudden twitches of whole muscle groups, resulting in uncontrollable movements or sounds.
- Motor tics (e.g involuntary eye blinking, head jerking to repeated gestures)
- Oral tics (e.g. grunting, random blurting of obscene words or phrases, though rarely)
- Tourette’s syndrome (multiple motor and vocal tics that have been present for more than a year)
These disorders can affect both children and adults, but studies show that children with ADHD are more likely to have tics than unaffected children.
Anger-Control Problems
Intermittent explosive disorder, also called oppositional defiant disorder, is characterised by uncontrollable anger or rage lasting 5-30 minutes or longer. Someone struggling with this might experience becoming:
- Irrational during a “meltdown”
- Often remorseful afterwards
Bipolar Disorder
Bipolar disorder is another extremely complex condition that appears in about 1 in 5 people with ADHD. It can manifest as:
- Mood swings from calm to rage and/or from depression to manic (super-happy) state – these moods come and go without any outside influence
- Excessive talking
- Difficulty relaxing
With this disorder, it’s important to get help from specialists who understand how these two conditions coexist and can administer the appropriate medication alongside ADHD treatment.
Our GMC-registered consultant psychiatrists can help you get started on your path to an easier life.
Assessing Comorbidities - Essential In The Management Of ADHD Symptoms
Assessing comorbidities is an essential and often transformative step in the comprehensive management of ADHD symptoms.
While standard treatments, like stimulant or nonstimulant medications combined with behaviour therapy, diet modifications, and exercise, frequently lead to dramatic improvements in core symptoms like hyperactivity and impulsivity, many individuals continue to struggle.
Persistent, non-responsive issues, such as deep sadness, anxiety, defiance, or profound learning/organisation problems, strongly suggest the presence of a co-occurring disorder.
Given how many symptoms overlap between ADHD and other conditions, accurately identifying these comorbidities is challenging but essential for effective treatment. Clinicians must use various diagnostic aids and strategies, including clinical interviews, detailed history-taking, behavioural observation, and scientifically validated scales, to differentiate symptoms and arrive at an accurate diagnosis.
Only with a comprehensive diagnosis process can we ensure that all underlying conditions are addressed and that every patient’s specific difficulties are effectively managed.
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