Top

Child and Adolescent Psychiatry and Mental Health

Published in:

01-12-2020 | Attention Deficit Hyperactivity Disorder | Research article

Symptoms and level of functioning related to comorbidity in children and adolescents with ADHD: a cross-sectional registry study

Authors: Marie Elwin, Tove Elvin, Jan-Olov Larsson

Published in: Child and Adolescent Psychiatry and Mental Health | Issue 1/2020

Abstract

Background

It is well known that a wide range of psychiatric disorders co-occur with attention deficit hyperactivity disorder. In this study we aimed to examine the associations of psychiatric comorbidity in ADHD with symptom severity and level of functioning.

Methods

We used data from the Swedish National Quality Registry for ADHD Treatment Follow-up and identified comorbid diagnoses in a sample of 3246 Swedish children and adolescents with ADHD. We investigated the association of comorbidity with symptom severity and level of function by multiple linear regressions.

Results

Autism spectrum disorder, anxiety and affective disorders, oppositional defiant disorder or conduct disorder, learning disorders, and multiple comorbid disorders associate to lower levels of functioning compared to ADHD only. Multiple comorbidity, autism spectrum disorder, oppositional defiant or conduct disorders and tic disorders relate to ADHD symptom severity.

Conclusions

Comorbidity subgroups with ADHD differ in functional impairment and ADHD symptoms severity. Information on comorbidity profiles could be used for treatment planning more adapted to the individual. Especially those who have autism spectrum disorders and multiple comorbid disorders are at risk of severe ADHD symptoms and low level of functioning.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington: American Psychiatric Association; 2013.

Barkley RA. Recent longitudinal studies of childhood attention-deficit/hyperactivity disorder: important themes and questions for further research. J Abnorm Psychol. 2016;125(2):248–55.PubMed

Friedrichs B, Igl W, Larsson H, Larsson JO. Coexisting psychiatric problems and stressful life events in adults with symptoms of ADHD–a large Swedish population-based study of twins. J Atten Disord. 2012;16(1):13–22.PubMed

Reale L, Bartoli B, Cartabia M, Zanetti M, Costantino MA, Canevini MP, et al. Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. Eur Child Adolesc Psychiatry. 2017;26(12):1443–57.PubMed

Larson K, Russ SA, Kahn RS, Halfon N. Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics. 2011;127(3):462–70.PubMedPubMedCentral

Bahmanyar S, Sundstrom A, Kaijser M, von Knorring AL, Kieler H. Pharmacological treatment and demographic characteristics of pediatric patients with Attention Deficit Hyperactivity Disorder, Sweden. Eur Neuropsychopharmacol. 2013;23(12):1732–8.PubMed

Giacobini M, Medin E, Ahnemark E, Russo LJ, Carlqvist P. Prevalence, patient characteristics, and pharmacological treatment of children, adolescents, and adults diagnosed With ADHD in Sweden. J Atten Disord. 2018;22(1):3–13.PubMed

Bendiksen B, Svensson E, Aase H, Reichborn-Kjennerud T, Friis S, Myhre AM, et al. Co-occurrence of ODD and CD in preschool children with symptoms of ADHD. J Atten Disord. 2017;21(9):741–52.PubMed

DuPaul GJ, Gormley MJ, Laracy SD. Comorbidity of LD and ADHD: implications of DSM-5 for assessment and treatment. J Learn Disabil. 2013;46(1):43–51.PubMed

10.

Antshel KM, Zhang-James Y, Wagner KE, Ledesma A, Faraone SV. An update on the comorbidity of ADHD and ASD: a focus on clinical management. Expert Rev Neurother. 2016;16(3):279–93.PubMed

11.

Meinzer MC, Pettit JW, Viswesvaran C. The co-occurrence of attention-deficit/hyperactivity disorder and unipolar depression in children and adolescents: a meta-analytic review. Clin Psychol Rev. 2014;34(8):595–607.PubMed

12.

Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716–23.PubMedPubMedCentral

13.

Gillberg C, Gillberg IC, Rasmussen P, Kadesjo B, Soderstrom H, Rastam M, et al. Co-existing disorders in ADHD—implications for diagnosis and intervention. Eur Child Adolesc Psychiatry. 2004;13(Suppl 1):I80–92.PubMed

14.

Capusan AJ, Bendtsen P, Marteinsdottir I, Larsson H. Comorbidity of adult ADHD and its subtypes with substance use disorder in a large population-based epidemiological study. J Atten Disord. 2019;23(12):1416–26.PubMed

15.

Matthies S, Philipsen A. Comorbidity of personality disorders and adult attention deficit hyperactivity disorder (ADHD)–review of recent findings. Curr Psychiatry Rep. 2016;18(4):33.PubMed

16.

Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27.PubMedPubMedCentral

17.

Arnold LE, Roy A, Taylor E, Hechtman L, Sibley M, Swanson JM, et al. Predictive utility of childhood diagnosis of ICD-10 hyperkinetic disorder: adult outcomes in the MTA and effect of comorbidity. Eur Child Adolesc Psychiatry. 2018;28:557–70.PubMed

18.

Roy A, Hechtman L, Arnold LE, Sibley MH, Molina BS, Swanson JM, et al. Childhood factors affecting persistence and desistence of attention-deficit/hyperactivity disorder symptoms in adulthood: results from the MTA. J Am Acad Child Adolesc Psychiatry. 2016;55(11):937–944.e4.PubMedPubMedCentral

19.

Caye A, Swanson J, Thapar A, Sibley M, Arseneault L, Hechtman L, et al. Life span studies of ADHD-conceptual challenges and predictors of persistence and outcome. Curr Psychiatry Rep. 2016;18(12):111.PubMedPubMedCentral

20.

Lundberg L. BUSA. Årsrapport 2017; 2018.

21.

Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, et al. A Children’s Global Assessment Scale (CGAS). Arch Gen Psychiatry. 1983;40(11):1228–31.PubMed

22.

Swanson JM, Schuck S, Porter MM, Carlson C, Hartman CA, Sergeant JA, et al. Categorical and Dimensional Definitions and Evaluations of Symptoms of ADHD: history of the SNAP and the SWAN Rating Scales. Int J Educ Psychol Assess. 2012;10(1):51–70.PubMedPubMedCentral

23.

Lundh A, Kowalski J, Sundberg CJ, Gumpert C, Landen M. Children’s Global Assessment Scale (CGAS) in a naturalistic clinical setting: inter-rater reliability and comparison with expert ratings. Psychiatry Res. 2010;177(1–2):206–10.PubMed

24.

Lundh A, Forsman M, Serlachius E, Lichtenstein P, Landen M. Outcomes of child psychiatric treatment. Acta Psychiatr Scand. 2013;128(1):34–44.PubMed

25.

Bussing R, Fernandez M, Harwood M, Wei H, Garvan CW, Eyberg SM, et al. Parent and teacher SNAP-IV ratings of attention deficit hyperactivity disorder symptoms: psychometric properties and normative ratings from a school district sample. Assessment. 2008;15(3):317–28.PubMedPubMedCentral

26.

Ullebo AK, Breivik K, Gillberg C, Lundervold AJ, Posserud MB. The factor structure of ADHD in a general population of primary school children. J Child Psychol Psychiatry. 2012;53(9):927–36.PubMed

27.

Jensen PS, Hinshaw SP, Kraemer HC, Lenora N, Newcorn JH, Abikoff HB, et al. ADHD comorbidity findings from the MTA study: comparing comorbid subgroups. J Am Acad Child Adolesc Psychiatry. 2001;40(2):147–58.PubMed

28.

Mazefsky C, White S. Adults With Autism. In: Volkmar F, Paul R, Rogers S, Pelphrey K, editors. Handbook of autism and pervasive developmental disorders, vol. 1. Hoboken: Wiley; 2014. p. 191–211.

29.

Ghirardi L, Pettersson E, Taylor MJ, Freitag CM, Franke B, Asherson P, et al. Genetic and environmental contribution to the overlap between ADHD and ASD trait dimensions in young adults: a twin study. Psychol Med. 2018;49(10):1713–21.PubMedPubMedCentral

30.

Polderman TJ, Hoekstra RA, Posthuma D, Larsson H. The co-occurrence of autistic and ADHD dimensions in adults: an etiological study in 17,770 twins. Transl Psychiatry. 2014;4:e435.PubMedPubMedCentral

31.

Mansour R, Dovi AT, Lane DM, Loveland KA, Pearson DA. ADHD severity as it relates to comorbid psychiatric symptomatology in children with Autism Spectrum Disorders (ASD). Res Dev Disabil. 2017;60:52–64.PubMed

32.

Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015;56(3):345–65.PubMed

33.

Idring S, Lundberg M, Sturm H, Dalman C, Gumpert C, Rai D, et al. Changes in prevalence of autism spectrum disorders in 2001–2011: findings from the Stockholm youth cohort. J Autism Dev Disord. 2015;45(6):1766–73.PubMed

34.

Rommelse NN, Franke B, Geurts HM, Hartman CA, Buitelaar JK. Shared heritability of attention-deficit/hyperactivity disorder and autism spectrum disorder. Eur Child Adolesc Psychiatry. 2010;19(3):281–95.PubMedPubMedCentral

35.

Gargaro BA, Rinehart NJ, Bradshaw JL, Tonge BJ, Sheppard DM. Autism and ADHD: how far have we come in the comorbidity debate? Neurosci Biobehav Rev. 2011;35(5):1081–8.PubMed

36.

Lai MC, Kassee C, Besney R, Bonato S, Hull L, Mandy W, et al. Prevalence of co-occurring mental health diagnoses in the autism population: a systematic review and meta-analysis. Lancet Psychiatry. 2019;6(10):819–29.PubMed

37.

Ghirardi L, Brikell I, Kuja-Halkola R, Freitag CM, Franke B, Asherson P, et al. The familial co-aggregation of ASD and ADHD: a register-based cohort study. Mol Psychiatry. 2018;23(2):257–62.PubMed

38.

NICE guideline. Attention deficit hyperactivity disorder: diagnosis and management; 2018.

Title: Symptoms and level of functioning related to comorbidity in children and adolescents with ADHD: a cross-sectional registry study
Authors: Marie Elwin
Tove Elvin
Jan-Olov Larsson
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Attention Deficit Hyperactivity Disorder
Autism Spectrum Disorder
Tic Disorder
Tic Disorder
Disturbance of the Social Behaviour
Attention Deficit Hyperactivity Disorder
Published in: Child and Adolescent Psychiatry and Mental Health / Issue 1/2020
Electronic ISSN: 1753-2000
DOI: https://doi.org/10.1186/s13034-020-00336-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Symptoms and level of functioning related to comorbidity in children and adolescents with ADHD: a cross-sectional registry study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2020

Bottom-up and top-down approaches to understanding oppositional defiant disorder symptoms during early childhood: a mixed method study

Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample: treatment interventions and patient satisfaction

Family violence against children in the wake of COVID-19 pandemic: a review of current perspectives and risk factors

Positive intervention for depression and teacher–student relationship in Iranian high school girl students with moderate/mild depression: a pilot randomized controlled trial

The relationship between acculturation and mental health of 1st generation immigrant youth in a representative school survey: does gender matter?

Depression and suicidality among adolescents living with human immunodeficiency virus in Lagos, Nigeria