Diagnosing ADHD and Comorbid Conditions
We receive many emails from parents of children with ADHD who are frustrated. Although their child is receiving treatment for ADHD and may receive accommodations at school, things just don’t seem to be getting better. They are still faced with behavioral issues and underperforming at school. Their child’s moods may go up and down, with other family members never knowing what to expect.
Research has shown that the most effective treatment for ADHD is a combination of medication and behavioral strategies. But when ADHD is accompanied by one of many common comorbid conditions, treatment needs to be individualized so that both ADHD and any other condition are both (or all) adequately treated.
According to the National Survey of Children’s Health, approximately two-thirds of all children with ADHD had at least one other condition. Almost 20 percent had three or more conditions on top of ADHD. The survey found there were a number of psychiatric, neuro-developmental and physical problems to be common in children with ADHD:
Psychiatric and Neuro-developmental disorders that commonly exist alongside ADHD:
- Bipolar Disorder
- Conduct Disorder
- Obsessive Compulsive Disorder
- Substance Abuse
- Tics/Tourette’s Disorder
- Autism Spectrum Disorders
- Learning Disabilities
Physical conditions that commonly exist alongside ADHD:
- Enuresis (bedwetting)
- Sleep Disorders
- Developmental Coordination Disorder
- Perthes Disease
- Height and Weight Problems
Difficulties in Diagnosis
Because symptoms can overlap, or be caused by other disorders, it is sometimes difficult to sort out exactly what disorders are present. For example, inattention can be a symptom of ADHD, depression, anxiety and sleep disorders; height and weight problems may be a side effect of ADHD medications or caused by a different problem. Medical professionals must determine if there is one condition causing the child’s difficulties or if a combination exists. Parents and teachers may be asked to fill out questionnaires about different disorders.
In the book, Current Directions in ADHD and It’s Treatment , it states “Other conditions must be ruled out before a diagnosis of ADHD is made because there are many other possibilities or explanations for hyperactive impulsive behavior. A few of the conditions are learning disability (that leads to poor school performance), frustrations and a behavior pattern where the child stops paying attention or gives up. Attention lapses can be caused by partial complex seizure, obsessive thoughts or silent impulsive rituals. A middle ear infection, causing an intermittent hearing problem, interferes with a child’s ability to respond to an orally presented request. Disruptive unresponsive behavior can be due to anxiety, depression or bipolar disorders. Environmental factors or stresses, such as divorce in the family, can lead to restlessness or inattention.” 
If there is possible physical illness, a complete physical and laboratory tests can help determine what may be causing the symptoms. Once this illness has been treated, if symptoms still exist, then ADHD can be diagnosed.
Primary, Secondary or Simultaneous?
Generally, symptoms causing the most impairment would be considered to be primary and that disorder should be treated first. For example, if a child is diagnosed with both depression and ADHD, symptoms of depression may be causing the most difficulty and should be treated before ADHD. However, this approach may not take into account that frustration over the symptoms of ADHD may be worsening depression. There is the possibility that one condition is not causing the other, but that both exist and should both be treated, simultaneously.
Because children with ADHD and cormorbid conditions usually have more impairment and can continue symptoms throughout their lives, it is important to have an accurate diagnosis. Treatment should focus on the individual rather than the disorder.
 Current Directions in ADHD and It’s Treatment, 2012,, February, Edited by Dr. Jill M. Norvilitis, InTech
“Other Concerns & Conditions,” Updated 2011, Dec. 12, Staff Writer, Division of Human Development, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
“Patterns of Comorbidity, Functioning, and Service Use for US Children with ADHD,” 2007, Kandayce Larson, Shirley A. Russ, Robert S. Kahn, Neal Halfon, Pediatrics