Attention Deficit Hyperactivity Disorder (ADHD) (cont.)
John Mersch, MD, FAAP
John Mersch, MD, FAAP
Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
William C. Shiel Jr., MD, FACP, FACR
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
What is the relationship between ADHD and other disorders, such as learning disabilities, anxiety disorders, bipolar disorder, or depression?
While the recognition and understanding of ADHD has advanced greatly, it is still frequently under-recognized by most laypeople and many physicians that coexisting conditions affect as many as 50%-60% of all children with ADHD. Many of these coexisting conditions have many of the same symptoms of ADHD, and these symptoms are often the first signs of problems in youngsters under 5 years of age. At the time of the initial evaluation and diagnosis of ADHD, as well as throughout the lifetime of the ADHD patient, these other conditions must be looked for. They include the following.
Disruptive behavior disorders (in up to 35% of children with ADHD) include oppositional defiant disorder (ODD) and conduct disorder (CD). The behaviors in these areas go well beyond the usual "limit testing" of childhood and adolescence. Patients with ODD repeatedly demonstrate major defiance and hostility toward authority figures, refusal to follow rules, frequent loss of temper, deliberate annoyance of others, and generally angry, vindictive, and resentful behavior. Conduct disorder is more extreme and is defined as "a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate social rules are violated." CD extends into serious acts of violence against people and/or animals, school truancy, running away, vandalism, stealing, and so on. The person with CD is often labeled as "a delinquent" and has the potential for serious legal problems. It has been shown that early introduction of stimulant medication improves not only the basic ADHD symptoms but also the ODD or CD symptoms as well. Frequently, additional measures are also needed, especially in the CD category. These may include therapy from professional behavior-therapist intervention to special classrooms set up for more intensive behavior management to residential school placement with psychiatric involvement.
Mood disorders (in up to 15%-20% of children with ADHD) such as depression and bipolar disorder are often more difficult to recognize than the disruptive behavior disorders. Many children with ADHD alone are noted to be irritable, moody, easily frustrated, or immature emotionally. When these symptoms become severe enough to dominate the child's life, mood disorders must be considered. Children with combined ADHD/mood disorders (especially the more severe bipolar disorder) are at greater risk for drug abuse and suicide. Children in this category often require referral to a developmental/behavioral specialist or a psychiatrist, as there are a variety of behavioral/psychotherapeutic methods along with additional medications that can be very helpful.
Anxiety disorders (in up to 25% of children with ADHD) often involve symptoms that are largely internal and, again, more difficult to immediately recognize. These symptoms may be extreme fear, worry, and feelings of panic associated with physical findings like racing heart rates, muscle tension, nausea, vomiting, or extreme sweating. These bouts of anxiety are severe, ongoing, and frequent (at least three to five times per week and lasting for more than one hour). The use of stimulant medication alone may help both the ADHD symptoms and anxiety symptoms as well. If not, behavioral therapy and/or additional medication in the tricyclic antidepressant family or the selective serotonin reuptake inhibitor (SSRI) family (Celexa, Zoloft, Lexapro, and Prozac, etc.) can be very helpful.
Learning disorders are conditions that can interfere with the child's mastery of specific skills like mathematics or reading. They can include auditory perceptual problems, visual perceptual problems, and so on. The school should be approached to carry out testing for these specific learning disorders. Depending on the type of learning disorder detected, altering teaching techniques can help the student bypass areas of weakness and utilize other pathways of learning that may actually be quite strong.
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 7/2/2012
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