ADHD seldom comes alone

4. December 2012

Oppositional behaviour problems are a known side effect of ADHD. Other mental disorders such as tics, anxiety and personality disorders in children with ADHD are more common than in children without it, researchers have now shown.

Teachers often make the parents of children with ADHD aware of it: In addition to the lack of concentration, impulsivity and constant restlessness, the children do not want to follow rules, are “defiant” and disrupt the peace of the class. The disruption of social conduct with oppositional, defiant behaviour (ICD-10: F 91.3) is commonly associated with ADHD. These and other mental disorders are considered comorbidities of ADHD, whereby scientists still disagree about what is the “chicken” and what the “egg”: From a psychodynamic perspective, ADHD symptoms are the result of trauma and relationship disorders.

More aware of mental disorders

Biologically oriented behavioural scientists describe ADHD as an independent disease that may lead to further mental disorders. Kouichi Yoshimasu et al. of the Mayo Clinic Rochester, Minnesota, USA, were also not able to clarify this question. What they nevertheless were able to show: mental disorders are such frequent companions of ADHD that paediatricians and psychologists should be especially careful to ensure that children receive adequate help. The data of 5,718 children (2,956 boys and 2,762 girls) born in Rochester, Minnesota (USA) between1976 and 1982, and who at the age of 5 years still lived there, was made available to Kouichi Yoshimasu and colleagues. The authors obtained medical data from the Mayo Clinic, from Olmsted Medical Center and three affiliated hospitals – this were combined with the database of the Rochester Epidemiology Projects (REP). Furthermore, the schools made their data available. According to this project, school psychologists, physicians, social workers, teachers, or parents identified symptoms of ADHD in 1,961 children.

Large amount of data

With 379 of these children a diagnosis of ADHD, which doctors and psychologists made on the basis of DSM-IV criteria, ADHD questionnaires and a clinical picture, existed with certainty. These 379 children were followed passively until the age of 19 years as far as their high school diploma. For every ADHD child there were two matching non-ADHD children who served as a control for comparison. The authors searched the REP database for further diagnoses of the ADHD and the control children. They found 299 documented diagnoses, which they pooled into groups from among the ten diagnostic categories of DSM-IV. In the end, the researchers had before them the data of 343 children with ADHD and 712 children without ADHD. Children with ADHD were predominantly white (p = 0.02), often had mothers with a low level of education (p = 0.01) and relatively young mothers (P <0.01) compared to the controls. There were no significant differences established in terms of perinatal factors.

At least one other mental disorder

Of 343 children with ADHD, until age nineteen 213 (62%) of the children had at least one other mental disorder. In contrast, only 19% of control children were diagnosed as having mental disorders. The number of cases of psychiatric disorders in ADHD children was significantly higher than in non-ADHD children (p < 0.001) – while there was no difference between girls and boys. Nevertheless, those boys affected by ADHD significantly more frequently showed exclusively externalising comorbidities than girls (20.2% vs. 7.0%, p <0.01).

ADHD children suffered when compared to non-ADHD children significantly more often from oppositional problem behaviour (Hazard Ratio [HR] = 9.54), tics (HR = 6.53), personality disorders (HR = 5.80), eating disorders (HR = 5.68), substance use disorders (HR = 4.03), adjustment disorders (HR = 3.88), affective disorders (HR = 3.67) and anxiety disorders (HR = 2.94). Children affected with ADHD with comorbidities suffered more often from social, emotional and psychological difficulties than children with ADHD who had no other disorder. The study results illustrated once again that “pure attention deficit hyperactivity disorder” is rarely encountered, according to the authors.

Further studies

Interesting in this context are also psychoanalytic approaches to ADHD. Marianne Leuzinger-Bohleber and her colleagues at the Sigmund Freud Institute in Frankfurt were able to demonstrate in the ADHD Prevention Study that the factors of anxiety, aggression and hyperactivity in girls could be significantly reduced by psychoanalytic support services in kindergarten. The study was conducted from 2003-2006 in 14 day care centres with 500 children and an equally large control group with 14 other control kindergartens. In a follow-up project the Frankfurt scientists are now comparing the efficacy of psychoanalytic therapy and behavior therapy for ADHD.

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