Learning Disabilities and other Comorbidities Common with ADHD/ADD

Medical News: Comorbidities Common with ADHD - in Pediatrics, ADHD/ADD from MedPage Today

For information on ADHD Assessment and Treatment services in Vancouver and Burnaby please visit my website at either: www.relatedmindsbc.com/adhd or www.relatedminds.com

This week I saw three adults for ADHD assessment. Two were fairly quick assessments for a diagnosis that was requested by their medical doctors. The third was more complicated and involved more extensive testing. Two children were also see, and both of those cases involved extensive testing, including cognitive and academic assessments. Clients often ask: "Why such differences from case to case?" And at our initial session we spend a good deal of time deciding how externes (and honestly expensive) an assessment is necessary.

This short article reviewing a recent research program explains this pretty well. In this study two-thirds of U.S. children with attention deficit/hyperactivity disorder were found to have comorbid learning disorders or other mental health or neurodevelopment conditions. Two-thirds of all children with ADHD or ADD have a comorbid - secondary -disorder. So if you are diagnosed with ADHD you are more likely than not to also have a learning disorder, anxiety, depression or similar problem.

Now I know many people make the choice to simply see their family medical doctor, who asks a few questions, looks at your history, maybe asks you to complete a form of 20 questions and makes a diagnostic decision: "Yes, you meet the diagnostic criteria for ADHD or ADD, now lets put you on meds." They write a script and much of the time you feel better, able to concentrate, focus a bit better and there is improvement. Much of the time. But it's the likelihood that you have a comorbid disorder -more likely than not - that is troublesome. Recently two adults came in who told me about temper outbursts, crying, frustration and intrusive thoughts. They had ADHD, but may also have had depression, anxiety, bipolar disorder and we hadn't even addressed learning disabilities. All of these possibilities should have an effect on a medical doctor's decision of which, if any, medications would be appropriate for these adults with ADHD. Should someone with manic episodes really be trying to address ADHD with stimulant medication? And if your depressed and having a difficult time at work, does the stimulant medication address your difficulty with learning new tasks, spelling mistakes or math errors? Most likely not. I'd guess that 50% of the time additional testing isn't necessary, maybe a little higher, with adults. But at a minimum a thorough look at possible comorbid mental disorders such as anxiety, depression, mood disorders and learning disabilities needs to be looked at.

With children this is even more important, as a child with ADHD is far more likely to have a learning or speech disorder that is causing academic difficulty if not failure. Only addressing the ADHD often masks these other issues for months if not years. Schools and parents think, "Well things are getting better...that good enough." only to discover three years later that a specific math learning disability or anxiety disorder has continued and now become the primary issue.

Lets look at what this survey found: It included more than 5,000 children with ADHD, found that 33% had one comorbid disorder, 16% had two, and 18% had three or more. This is not new information. These finding have been found again and again. "School and social problems, along with poor communication with parents, were significantly associated with ADHD as well,: the researchers stated. "Comprehensive screening for other problems that occur with ADHD is necessary, and treatment profiles should be tailored by comorbidity status and levels of functional impairment in home and school settings."

Comprehensive screening for other problems that occur with ADHD is necessary. Comprehensive screening takes time, and regretfully costs, but I have to agree, it is necessary. Most physicians do not have the tests or expertise to do this type of assessment. Yes, they are able to diagnose ADHD, but how to they diagnose a learning disability in a 15 minute session? This study concludes that, " many physicians already screen (screening is not testing or diagnosing) for common comorbidities among children with ADHD, few are adequately trained to treat such co-occurrence."

The study linked to above analyzed the 2007 National Survey of Children's Health, which included 5,028 children with ADHD among the 61,779 children ages 6 to 17, who participated in the nationally-representative telephone survey of parents and guardians. According to parental report of physician diagnosis ADHD prevalence was 8.2 %. Prevalence was higher among children in lower income families and those headed by single mothers, or more specifically, a diagnosis was given more frequently when parents were of a higher economic status. Overall, 67% of ADHD children had at least one other mental health or neurodevelopmental disorder compared with 11% in other children.

ADHD was associated with the following:
Learning disabilities (46% versus 5% in other children, adjusted relative risk 7.79)
Conduct disorder (27% versus 2%, adjusted RR 12.58)
Anxiety (18% versus 2%, adjusted RR 7.45)
Depression (14% versus 1%, adjusted RR 8.04)
Speech problems (12% versus 3%, adjusted RR 4.42)
Comorbidities didn't vary by age or gender, but poor children with ADHD were 3.8 times more likely to have three or more comorbidities than the most affluent (30% versus 8%). For various reasons the researchers state that over-diagnosis was unlikely to be the cause of this socioeconomic factor. Rather, there may be common etiologic factors, like maternal stress or prenatal smoke exposure or genetic susceptibility, that are more prevalent in lower income families, they suggested. Every measure of functioning showed a disadvantage with ADHD, including higher odds of the following:
Activity restriction (adjusted odds ratio 4.14)
School problems (69% versus 27%, adjusted OR 5.18)
Grade repetition (29% versus 9%, adjusted OR 3.71)
High parent aggravation scores (53% versus 19%, adjusted OR 4.30)
Low social competence scores (43% versus 18%, adjusted OR 2.86)
Poor parent-child communication (8% versus 3%, adjusted OR 2.55)
Poorer functioning increased with each step-wise increase in the number of comorbidities, as did use of mental health and education services.

Researchers also found that the high rate of grade repetition and school problems "indicates that existing management strategies are falling short of meeting the needs of these children." Yes, medication is helpful, but not enough. While this study was limited because it relied on parent self reports it is similar to what we have found in research over and over again. If you or your child have ADHD you are more likely than not also going to have a second issue, a comorbid disorder. Specific learning disabilities are the most likely. Because of this research I don't offer just simple quick diagnostic procedures for ADHD or ADD. Instead I provide a wide range of testing, assessment and treatment for those who suspect they have ADHD or ADD. This includes testing for learning disabilities, personality assessments (especially for adults) to rule out any significant mood disorders such as anxiety or depression, and followup services such as behaviour planning for school, parent education, cognitive therapy (for anxiety, depression), anger management training and specific skill training for deficits in organization, planning and procrastination.

If you have ADHD and need treatment, get the assessment you need. It might be a short, easy and quick assessment done by your medical do cot in his or her office and covered my MSP. Or you might need something more complex and detailed. Talk this over with a psychologist or psychiatrist who is an expert in ADHD.