Childhood ADHD is strongly associated with a broad range of psychiatric disorders during adolescence: a population‐based birth cohort study

Abstract

Background To evaluate associations between ADHD and comorbid psychiatric disorders using research-identified incident cases of ADHD and population-based controls. Methods Subjects included a birth cohort of all children born 1976–1982 remaining in Rochester, MN after age five (n = 5718). Among them we identified 379 ADHD incident cases and 758 age-sex matched non-ADHD controls, passively followed to age 19 years. All psychiatric diagnoses were identified and abstracted, but only those confirmed by qualified medical professionals were included in the analysis. For each psychiatric disorder, cumulative incidence rates for subjects with and without ADHD were estimated using the Kaplan-Meier method. Corresponding hazard ratios (HR) were estimated using Cox models adjusted for gender and mother’s age and education at the subject’s birth. The association between ADHD and the likelihood of having an internalizing or externalizing disorder was summarized by estimating odds ratios (OR). Results ADHD was associated with a significantly increased risk of adjustment disorders (HR=3.88), conduct/oppositional defiant disorder (HR=9.54), mood disorders (HR=3.67), anxiety disorders (HR=2.94), tic disorders (HR=6.53), eating disorders (HR=5.68), personality disorders (HR=5.80), and substance-related disorders (HR=4.03). When psychiatric comorbidities were classified on the internalization-externalization dimension, ADHD was strongly associated with coexisting internalizing/externalizing (OR=10.6), or externalizing-only (OR=10.0) disorders. Conclusion This population-based study confirms that children with ADHD are at significantly increased risk for a wide range of psychiatric disorders. Besides treating the ADHD, clinicians should identify and provide appropriate treatment for psychiatric comorbidities.

Attention-Deficit/Hyperactivity Disorder in Young Children: Predictors of Diagnostic Stability

“…This finding is consistent with previous literature on older children with ADHD, [52][53][54] and it points to the importance of screening for internalizing symptoms at initial diagnostic visits, even when parental concerns are about disruptions due to externalizing symptoms.…”

Subthreshold and threshold attention deficit hyperactivity disorder symptoms in childhood: psychosocial outcomes in adolescence in boys and girls

“…With higher base‐rate levels of emotional problems among girls in the general Swedish population 74, the associations between ADHD and internalizing/emotional problems reported here could to some extent be explained by covariation. However, higher rates of internalizing and/or emotional problems among girls with ADHD have been commonly reported in both clinical and population‐ or community‐based studies 8, 16, 19, 29, 46, 75, 76, 77, 78, 79, 80, 81. Thus, ADHD symptoms seem to contribute to the total internalizing problem load in a gender‐specific manner 61.…”

“…ADHD affects both boys and girls in all areas of functioning, for example, academically, cognitively, psychosocially, and psychiatrically 14, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30. Even though ADHD is associated with coexisting externalizing and internalizing disorders in both genders, girls with ADHD are significantly more likely to display internalizing disorders than boys with ADHD 25, 31, 32, 33.…”

Children With Conduct Problems and Co-occurring ADHD: Behavioral Improvements Following Parent Management Training

“…In a recent population-based birth cohort study, 22.5% of the children diagnosed with ADHD also met diagnostic criteria for Conduct Disorder=Oppositional Defiant Disorder (CD=ODD; Yoshimasu et al, 2012). Moreover, many children referred to treatment because of conduct problems also have co-occurring ADHD (Scott, Knapp, Henderson, & Maughan, 2001).…”