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Published in: ADHD Attention Deficit and Hyperactivity Disorders 1/2015

01-03-2015 | Original Article

Comorbid mental disorders in children and adolescents with attention-deficit/hyperactivity disorder in a large nationwide study

Authors: Christina Mohr Jensen, Hans-Christoph Steinhausen

Published in: ADHD Attention Deficit and Hyperactivity Disorders | Issue 1/2015

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Abstract

The present study aimed at identifying the full range of mental disorders comorbid to attention-deficit/hyperactivity disorder (ADHD) in children and adolescents (age 4–17) diagnosed in Danish psychiatric hospitals between 1995 and 2010. A total of 14,825 patients were included in the study and comorbid disorders diagnosed concurrent with ADHD were identified. Associations of comorbid disorders with sex, age, and other mental disorders were investigated by logistic regression analysis. In the total sample, 52.0 % of the patients had at least one psychiatric disorder comorbid to ADHD and 26.2 % had two or more comorbid disorders. The most frequent comorbid disorders were disorders of conduct (16.5 %), specific developmental disorders of language, learning and motor development (15.4 %), autism spectrum disorders (12.4 %), and intellectual disability (7.9 %). Male sex was generally associated with an increased risk for neuropsychiatric disorders while female sex was associated more frequently with internalizing disorders. The analysis of associations between the various comorbid disorders identified several clusters highlighting the differential developmental trajectories seen in patients with ADHD. The study provides evidence that comorbidity with mental disorders is developmentally sensitive. Furthermore, the study shows that particular attention should be given to patients with neurodevelopmental disorders such as autism and intellectual disability in future longitudinal analyses. These disorders are very frequent in patients with ADHD, and the affected patients might follow a different course than patients without these disorders.
Literature
go back to reference A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal treatment study of children with ADHD (1999). Arch Gen Psychiatry 56:1073–1086 A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal treatment study of children with ADHD (1999). Arch Gen Psychiatry 56:1073–1086
go back to reference Abikoff HB, Jensen PS, Arnold LL, Hoza B, Hechtman L, Pollack S et al (2002) Observed classroom behaviour of children with ADHD: relationship to gender and comorbidity. J Abnorm Child Psychol 30:349–359CrossRefPubMed Abikoff HB, Jensen PS, Arnold LL, Hoza B, Hechtman L, Pollack S et al (2002) Observed classroom behaviour of children with ADHD: relationship to gender and comorbidity. J Abnorm Child Psychol 30:349–359CrossRefPubMed
go back to reference August GJ, Garfinkel BD (1990) Comorbidity of ADHD and reading disability among clinic-referred children. J Abnorm Child Psychol 18:29–45CrossRefPubMed August GJ, Garfinkel BD (1990) Comorbidity of ADHD and reading disability among clinic-referred children. J Abnorm Child Psychol 18:29–45CrossRefPubMed
go back to reference Barkley RA, Fischer M, Smallish L, Fletcher K (2004) Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry 45:195–211CrossRefPubMed Barkley RA, Fischer M, Smallish L, Fletcher K (2004) Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry 45:195–211CrossRefPubMed
go back to reference Bauermeister JJ, Shrout PE, Ramirez R, Bravo M, Alegria M, Martinez-Taboas A et al (2007) ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. J Abnorm Child Psychol 35:883–898CrossRefPubMedCentralPubMed Bauermeister JJ, Shrout PE, Ramirez R, Bravo M, Alegria M, Martinez-Taboas A et al (2007) ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. J Abnorm Child Psychol 35:883–898CrossRefPubMedCentralPubMed
go back to reference Bellani M, Moretti A, Perlini C, Brambilla P (2011) Language disturbances in ADHD. Epidemiol Psychiatr Sci 20:311–315CrossRefPubMed Bellani M, Moretti A, Perlini C, Brambilla P (2011) Language disturbances in ADHD. Epidemiol Psychiatr Sci 20:311–315CrossRefPubMed
go back to reference Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Silva JM et al (2006) Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med 36:167–179CrossRefPubMed Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Silva JM et al (2006) Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med 36:167–179CrossRefPubMed
go back to reference Biederman J, Petty CR, Dolan C, Hughes S, Mick E, Monuteaux MC et al (2008) The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study. Psychol Med 38:1027–1036PubMed Biederman J, Petty CR, Dolan C, Hughes S, Mick E, Monuteaux MC et al (2008) The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study. Psychol Med 38:1027–1036PubMed
go back to reference Boden JM, Fergusson DM, Horwood LJ (2010) Risk factors for conduct disorder and oppositional/defiant disorder: evidence from a New Zealand birth cohort. J Am Acad Child Adolesc Psychiatry 49:1125–1133PubMed Boden JM, Fergusson DM, Horwood LJ (2010) Risk factors for conduct disorder and oppositional/defiant disorder: evidence from a New Zealand birth cohort. J Am Acad Child Adolesc Psychiatry 49:1125–1133PubMed
go back to reference Campbell M, Malone RP (1991) Mental retardation and psychiatric disorders. Hosp Community Psychiatry 42:374–379PubMed Campbell M, Malone RP (1991) Mental retardation and psychiatric disorders. Hosp Community Psychiatry 42:374–379PubMed
go back to reference Costello EJ, Erkanli A, Federman E, Angold A (1999) Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex. J Clin Child Psychol 28:298–311CrossRefPubMed Costello EJ, Erkanli A, Federman E, Angold A (1999) Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex. J Clin Child Psychol 28:298–311CrossRefPubMed
go back to reference Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60:837–844CrossRefPubMed Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60:837–844CrossRefPubMed
go back to reference Elia J, Arcos-Burgos M, Bolton KL, Ambrosini PJ, Berrettini W, Muenke M (2009) ADHD latent class clusters: DSM-IV subtypes and comorbidity. Psychiatry Res 170:192–198CrossRefPubMedCentralPubMed Elia J, Arcos-Burgos M, Bolton KL, Ambrosini PJ, Berrettini W, Muenke M (2009) ADHD latent class clusters: DSM-IV subtypes and comorbidity. Psychiatry Res 170:192–198CrossRefPubMedCentralPubMed
go back to reference Elkins IJ, McGue M, Iacono WG (2007) Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry 64:1145–1152CrossRefPubMed Elkins IJ, McGue M, Iacono WG (2007) Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry 64:1145–1152CrossRefPubMed
go back to reference Ellington EE, McGuinness TM (2012) Mental health considerations in pediatric enuresis. J Psychosoc Nurs Ment Health Serv 50:40–45CrossRefPubMed Ellington EE, McGuinness TM (2012) Mental health considerations in pediatric enuresis. J Psychosoc Nurs Ment Health Serv 50:40–45CrossRefPubMed
go back to reference Faber A, Kalverdijk LJ, de Jong-van den Berg LT, Hugtenburg JG, Minderaa RB, Tobi H (2010) Co-morbidity and patterns of care in stimulant-treated children with ADHD in the Netherlands. Eur Child Adolesc Psychiatry 19:159–166 Faber A, Kalverdijk LJ, de Jong-van den Berg LT, Hugtenburg JG, Minderaa RB, Tobi H (2010) Co-morbidity and patterns of care in stimulant-treated children with ADHD in the Netherlands. Eur Child Adolesc Psychiatry 19:159–166
go back to reference Freeman RD (2007) Tic disorders and ADHD: answers from a world-wide clinical dataset on Tourette syndrome. Eur Child Adolesc Psychiatry 16(Suppl 1):15–23CrossRefPubMed Freeman RD (2007) Tic disorders and ADHD: answers from a world-wide clinical dataset on Tourette syndrome. Eur Child Adolesc Psychiatry 16(Suppl 1):15–23CrossRefPubMed
go back to reference Freitag CM, Hanig S, Schneider A, Seitz C, Palmason H, Retz W et al (2012) Biological and psychosocial environmental risk factors influence symptom severity and psychiatric comorbidity in children with ADHD. J Neural Transm 119:81–94CrossRefPubMed Freitag CM, Hanig S, Schneider A, Seitz C, Palmason H, Retz W et al (2012) Biological and psychosocial environmental risk factors influence symptom severity and psychiatric comorbidity in children with ADHD. J Neural Transm 119:81–94CrossRefPubMed
go back to reference Germano E, Gagliano A, Curatolo P (2010) Comorbidity of ADHD and dyslexia. Dev Neuropsychol 35:475–493CrossRefPubMed Germano E, Gagliano A, Curatolo P (2010) Comorbidity of ADHD and dyslexia. Dev Neuropsychol 35:475–493CrossRefPubMed
go back to reference Ghanizadeh A (2009) Psychiatric comorbidity differences in clinic-referred children and adolescents with ADHD according to the subtypes and gender. J Child Neurol 24:679–684CrossRefPubMed Ghanizadeh A (2009) Psychiatric comorbidity differences in clinic-referred children and adolescents with ADHD according to the subtypes and gender. J Child Neurol 24:679–684CrossRefPubMed
go back to reference Ghanizadeh A (2010) Comorbidity of enuresis in children with attention-deficit/hyperactivity disorder. J Atten Disord 13:464–467CrossRefPubMed Ghanizadeh A (2010) Comorbidity of enuresis in children with attention-deficit/hyperactivity disorder. J Atten Disord 13:464–467CrossRefPubMed
go back to reference Gillberg C, Wahlstrom J, Forsman A, Hellgren L, Gillberg IC (1986) Teenage psychoses–epidemiology, classification and reduced optimality in the pre-, peri- and neonatal periods. J Child Psychol Psychiatr 27:87–98CrossRef Gillberg C, Wahlstrom J, Forsman A, Hellgren L, Gillberg IC (1986) Teenage psychoses–epidemiology, classification and reduced optimality in the pre-, peri- and neonatal periods. J Child Psychol Psychiatr 27:87–98CrossRef
go back to reference Hinshaw SP (2002) Preadolescent girls with attention-deficit/hyperactivity disorder: I. Background characteristics, comorbidity, cognitive and social functioning, and parenting practices. J Consult Clin Psychol 70:1086–1098CrossRefPubMed Hinshaw SP (2002) Preadolescent girls with attention-deficit/hyperactivity disorder: I. Background characteristics, comorbidity, cognitive and social functioning, and parenting practices. J Consult Clin Psychol 70:1086–1098CrossRefPubMed
go back to reference Hoek HW, van Hoeken D (2003) Review of the prevalence and incidence of eating disorders. Int J Eat Disord 34:383–396CrossRefPubMed Hoek HW, van Hoeken D (2003) Review of the prevalence and incidence of eating disorders. Int J Eat Disord 34:383–396CrossRefPubMed
go back to reference IBM Corp (2010) IBM SPSS statistics for windows. (Version 19.0) [Computer software]. Armonk, NY IBM Corp (2010) IBM SPSS statistics for windows. (Version 19.0) [Computer software]. Armonk, NY
go back to reference Jensen PS, Martin D, Cantwell DP (1997) Comorbidity in ADHD: implications for research, practice, and DSM-V. J Am Acad Child Adolesc Psychiatry 36:1065–1079CrossRefPubMed Jensen PS, Martin D, Cantwell DP (1997) Comorbidity in ADHD: implications for research, practice, and DSM-V. J Am Acad Child Adolesc Psychiatry 36:1065–1079CrossRefPubMed
go back to reference Kadesjo B, Gillberg C (2001) The comorbidity of ADHD in the general population of Swedish school-age children. J Child Psychol Psychiatr 42:487–492CrossRef Kadesjo B, Gillberg C (2001) The comorbidity of ADHD in the general population of Swedish school-age children. J Child Psychol Psychiatr 42:487–492CrossRef
go back to reference Kessing L (1998) Validity of diagnoses and other clinical register data in patients with affective disorder. Eur Psychiatry 13:392–398CrossRefPubMed Kessing L (1998) Validity of diagnoses and other clinical register data in patients with affective disorder. Eur Psychiatry 13:392–398CrossRefPubMed
go back to reference Kraut AA, Langner I, Lindemann C, Banaschewski T, Petermann U, Petermann F et al (2013) Comorbidities in ADHD children treated with methylphenidate: a database study. BMC Psychiatry 13:11CrossRefPubMedCentralPubMed Kraut AA, Langner I, Lindemann C, Banaschewski T, Petermann U, Petermann F et al (2013) Comorbidities in ADHD children treated with methylphenidate: a database study. BMC Psychiatry 13:11CrossRefPubMedCentralPubMed
go back to reference Larson K, Russ SA, Kahn RS, Halfon N (2011) Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics 127:462–470CrossRefPubMedCentralPubMed Larson K, Russ SA, Kahn RS, Halfon N (2011) Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics 127:462–470CrossRefPubMedCentralPubMed
go back to reference Lauritsen MB, Jorgensen M, Madsen KM, Lemcke S, Toft S, Grove J et al (2010) Validity of childhood autism in the Danish Psychiatric Central Register: findings from a cohort sample born 1990–1999. J Autism Dev Disord 40:139–148CrossRefPubMed Lauritsen MB, Jorgensen M, Madsen KM, Lemcke S, Toft S, Grove J et al (2010) Validity of childhood autism in the Danish Psychiatric Central Register: findings from a cohort sample born 1990–1999. J Autism Dev Disord 40:139–148CrossRefPubMed
go back to reference Levy F, Hay DA, Bennett KS, McStephen M (2005) Gender differences in ADHD subtype comorbidity. J Am Acad Child Adolesc Psychiatry 44:368–376CrossRefPubMed Levy F, Hay DA, Bennett KS, McStephen M (2005) Gender differences in ADHD subtype comorbidity. J Am Acad Child Adolesc Psychiatry 44:368–376CrossRefPubMed
go back to reference Loffler W, Hafner H, Fatkenheuer B, Maurer K, Riecher-Rossler A, Lutzhoft J et al (1994) Validation of Danish case register diagnosis for schizophrenia. Acta Psychiatr Scand 90:196–203CrossRefPubMed Loffler W, Hafner H, Fatkenheuer B, Maurer K, Riecher-Rossler A, Lutzhoft J et al (1994) Validation of Danish case register diagnosis for schizophrenia. Acta Psychiatr Scand 90:196–203CrossRefPubMed
go back to reference Mezzich JE (2002) International surveys on the use of ICD-10 and related diagnostic systems. Psychopathology 35:72–75CrossRefPubMed Mezzich JE (2002) International surveys on the use of ICD-10 and related diagnostic systems. Psychopathology 35:72–75CrossRefPubMed
go back to reference Miller CJ, Flory JD, Miller SR, Harty SC, Newcorn JH, Halperin JM (2008) Childhood attention-deficit/hyperactivity disorder and the emergence of personality disorders in adolescence: a prospective follow-up study. J Clin Psychiatry 69:1477–1484CrossRefPubMedCentralPubMed Miller CJ, Flory JD, Miller SR, Harty SC, Newcorn JH, Halperin JM (2008) Childhood attention-deficit/hyperactivity disorder and the emergence of personality disorders in adolescence: a prospective follow-up study. J Clin Psychiatry 69:1477–1484CrossRefPubMedCentralPubMed
go back to reference Mors O, Perto GP, Mortensen PB (2011) The Danish Psychiatric Central Research Register. Scand J Public Health 39:54–57CrossRefPubMed Mors O, Perto GP, Mortensen PB (2011) The Danish Psychiatric Central Research Register. Scand J Public Health 39:54–57CrossRefPubMed
go back to reference Munk-Jorgensen P, Ostergaard SD (2011) Register-based studies of mental disorders. Scand J Public Health 39:170–174CrossRefPubMed Munk-Jorgensen P, Ostergaard SD (2011) Register-based studies of mental disorders. Scand J Public Health 39:170–174CrossRefPubMed
go back to reference Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE et al (2007) The epidemiology of autism spectrum disorders. Annu Rev Public Health 28:235–258CrossRefPubMed Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE et al (2007) The epidemiology of autism spectrum disorders. Annu Rev Public Health 28:235–258CrossRefPubMed
go back to reference Pliszka SR (2000) Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 9:525–540, vii Pliszka SR (2000) Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 9:525–540, vii
go back to reference Roeleveld N, Zielhuis GA, Gabreels F (1997) The prevalence of mental retardation: a critical review of recent literature. Dev Med Child Neurol 39:125–132CrossRefPubMed Roeleveld N, Zielhuis GA, Gabreels F (1997) The prevalence of mental retardation: a critical review of recent literature. Dev Med Child Neurol 39:125–132CrossRefPubMed
go back to reference Rutgers AH, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Swinkels SH et al (2007) Autism, attachment and parenting: a comparison of children with autism spectrum disorder, mental retardation, language disorder, and non-clinical children. J Abnorm Child Psychol 35:859–870CrossRefPubMed Rutgers AH, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Swinkels SH et al (2007) Autism, attachment and parenting: a comparison of children with autism spectrum disorder, mental retardation, language disorder, and non-clinical children. J Abnorm Child Psychol 35:859–870CrossRefPubMed
go back to reference Rutter M (2011) Response: growing consensus on classification needs. J Child Psychol Psychiatry 52(6):673–675CrossRef Rutter M (2011) Response: growing consensus on classification needs. J Child Psychol Psychiatry 52(6):673–675CrossRef
go back to reference Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry 47:921–929CrossRefPubMed Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry 47:921–929CrossRefPubMed
go back to reference Smalley SL, McGough JJ, Moilanen IK, Loo SK, Taanila A, Ebeling H et al (2007) Prevalence and psychiatric comorbidity of attention-deficit/hyperactivity disorder in an adolescent Finnish population. J Am Acad Child Adolesc Psychiatry 46:1575–1583CrossRefPubMed Smalley SL, McGough JJ, Moilanen IK, Loo SK, Taanila A, Ebeling H et al (2007) Prevalence and psychiatric comorbidity of attention-deficit/hyperactivity disorder in an adolescent Finnish population. J Am Acad Child Adolesc Psychiatry 46:1575–1583CrossRefPubMed
go back to reference Spencer TJ (2006) ADHD and comorbidity in childhood. J Clin Psychiatry 67(Suppl 8):27–31PubMed Spencer TJ (2006) ADHD and comorbidity in childhood. J Clin Psychiatry 67(Suppl 8):27–31PubMed
go back to reference StataCorp (2009) Stata statistical software: release 11. StataCorp LP, College Station, TX StataCorp (2009) Stata statistical software: release 11. StataCorp LP, College Station, TX
go back to reference Taurines R, Schmitt J, Renner T, Conner AC, Warnke A, Romanos M (2010) Developmental comorbidity in attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord 2:267–289CrossRefPubMed Taurines R, Schmitt J, Renner T, Conner AC, Warnke A, Romanos M (2010) Developmental comorbidity in attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord 2:267–289CrossRefPubMed
go back to reference van Ijzendoorn MH, Rutgers AH, Bakermans-Kranenburg MJ, Swinkels SH et al (2007) Parental sensitivity and attachment in children with autism spectrum disorder: comparison with children with mental retardation, with language delays, and with typical development. Child Dev 78:597–608CrossRefPubMed van Ijzendoorn MH, Rutgers AH, Bakermans-Kranenburg MJ, Swinkels SH et al (2007) Parental sensitivity and attachment in children with autism spectrum disorder: comparison with children with mental retardation, with language delays, and with typical development. Child Dev 78:597–608CrossRefPubMed
go back to reference Wichstrom L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH (2012) Prevalence of psychiatric disorders in preschoolers. J Child Psychol Psychiatry 53:695–705CrossRefPubMed Wichstrom L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH (2012) Prevalence of psychiatric disorders in preschoolers. J Child Psychol Psychiatry 53:695–705CrossRefPubMed
go back to reference Willcutt EG, Pennington BF, DeFries JC (2000) Twin study of the etiology of comorbidity between reading disability and attention-deficit/hyperactivity disorder. Am J Med Genet 96:293–301CrossRefPubMed Willcutt EG, Pennington BF, DeFries JC (2000) Twin study of the etiology of comorbidity between reading disability and attention-deficit/hyperactivity disorder. Am J Med Genet 96:293–301CrossRefPubMed
go back to reference Zeanah CH, Smyke AT (2009) Attachment Disorders. In: Zeanah CH (ed) Handbook of infant mental health, 3rd edn. Guilford Press, New York, pp 421–434 Zeanah CH, Smyke AT (2009) Attachment Disorders. In: Zeanah CH (ed) Handbook of infant mental health, 3rd edn. Guilford Press, New York, pp 421–434
Metadata
Title
Comorbid mental disorders in children and adolescents with attention-deficit/hyperactivity disorder in a large nationwide study
Authors
Christina Mohr Jensen
Hans-Christoph Steinhausen
Publication date
01-03-2015
Publisher
Springer Vienna
Published in
ADHD Attention Deficit and Hyperactivity Disorders / Issue 1/2015
Print ISSN: 1866-6116
Electronic ISSN: 1866-6647
DOI
https://doi.org/10.1007/s12402-014-0142-1

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