Comorbidity prevalence and treatment outcome in children and adolescents with ADHD

Abstract

Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011-2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.

School‐based interventions for attention‐deficit/hyperactivity disorder: A systematic review with multiple synthesis methods

“…Combined interventions were assessed in eight studies (McGraw et al., ; Molina et al., ; Seeley et al., ; Evans et al., , , ; Looyeh et al., ; Pfiffner et al., ) . Four of these interventions were versions of the Challenging Horizons Programme (Molina et al., ; Evans et al., , , ).…”

“…Diagnostically, ADHD has three subtypes: primarily inattentive (approximately 30% of diagnosed individuals), primarily hyperactive/impulsive (<10%) and combined (approx. 60%) where the individual has both inattentive and hyperactive/impulsive symptoms (Reale et al, 2017).…”

“…Children with ADHD have symptoms that persist throughout adolescence and into adulthood in between 30% and 70% of cases (Caye et al, 2016). Individuals who have ADHD are more likely to have cognitive impairments (Kuntsi et al, 2014), socio-emotional difficulties (Wehmeier et al, 2010), problems regulating their behaviour (Barkley, 1997) and high levels of co-occurring disorders and mental health difficulties including emotional disorders such as depression and anxiety (Reale et al, 2017). Children with ADHD are also more likely than their peers to have low educational attainment, substance use, vehicle accidents, involvement in crime, antisocial behaviour and experience socioeconomic disadvantage (Able et al, 2007;Shaw et al, 2012;Tarver et al, 2014;Faraone et al, 2015).…”

Prevalence of Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) in Methamphetamine Dependence: A Descriptive Study

“…The studies that are conducted in various countries showed that the Wender -Utah test had a good validity and reliability and was suitable tool for examining attention deficit hyperactivity disorder in childhood. This test has been translated to different languages up to now (21). In Iran, this test is translated by Sarami Foroushani and its validity and reliability is examined by him (2000).…”

ECAP Editorial

“…Diagnoses properly used can aid communication and shared understanding about a problem, but in the context of the changes inherent in children's development they can be problematic. This is seen in part in the high levels of comorbidity seen alongside ADHD explored in the paper by Reale and colleagues [7]. Comorbidity is so common in child and adolescent mental health, and it does illustrate some of the problems with our categorisation of mental distress and difficulties that young people experience.…”