ADHD and learning disorders
The majority of kids with ADHD have some co-morbid disorder at some point. Many of them have other subtle or not so subtle learning disorders. During the school age years they’re prone to mild or modest problems with behavior and from time to time depression and anxiety. Once they hit adolescence they’re also prone to problems with substance abuse and more serious behavioral or mood disorders. By the time kids hit their mid teen years the combination of learning, behavioral, and anxiety and depressive disorders are pretty common. It is really important for children and their families to be fully aware of the problems. In that way they can identify them early and intervene effectively. We know a lot about ways of helping minimize the long term impact.

Stuart Goldman, MD, Senior Associate in Psychiatry, Child and Adolescent Psychiatrist


ADHD and Learning Disabilities
If the child’s achievement in reading or math is lower than what you would expect based on their intelligence, and it isn’t just explained by their ADHD, then they should be tested for a specific learning disability. If ADHD is present, too, it would be best to do that testing when the child’s ADHD is well treated so the child can give their best effort during the testing, and so the psychologist can then determine if there is a learning disability present. One thing to keep in mind is that if the problems with attention are only present when the child is trying to work on a single subject area that they are struggling with, it’s worth considering that the learning disability is what is driving the ADHD instead of having two independent things going on.

Joseph Gonzalez Heydrich, MD, Senior Associate in Psychiatry, Child and Adolescent Psychiatrist


ADHD and Depression
Most of the kids I’ve seen who have ADHD have really low self esteem. I feel they are at higher risk for depression, if they don’t already have depression, because children’s lives revolve around school and social lives, and these are the two areas where kids with ADHD really suffer.

Ariel Botta, LICSW, Group Therapy Team, Outpatient Psychiatry Service


The stats on ADHD and other disorders
Kids with ADHD are at higher risk for other problems. Oppositional Defiant Disorder, where kids have a lot of trouble with authority and tend to argue a lot with adults, is one such problem. About half the kids with ADHD have oppositional issues as well. A quarter of kids with ADHD will have more a more serious problem called Conduct Disorder which includes behaviors that violate the rights of others. Kids with ADHD are three times as likely to have delinquent behavior later on in life than kids without ADHD. Kids with ADHD are at higher risk for taking up smoking and for drinking at a young age. They are at higher risk for substance abuse. There is evidence that with treatment you can reduce their risk of substance abuse. Kids with ADHD tend to have a higher risk for depression and anxiety– maybe a third of kids with ADHD will have problems with depression or anxiety. Finally, for kids with ADHD who also have severe temper tantrums or irritability that’s really outrageously high, a diagnosis called Bipolar Disorder should be considered. Almost all kids who have Bipolar Disorder also have ADHD.

Joseph Gonzalez Heydrich, MD, Senior Associate in Psychiatry, Child and Adolescent Psychiatrist


Risk factors for ADHD
I don’t believe that all the kids who we diagnosis and treat for ADHD have just one thing– they probably have more than one thing. There are multiple conditions we know of that the prevalence of ADHD is much higher in. For example, even though extreme prematurity doesn’t cause ADHD– certainly not all kids who were born prematurely have ADHD–looking at that group, one sees that there is a higher incidence of ADHD than in kids who had a normal gestation period. It’s helpful to know as a pediatrician that someone is premature so that you know they are at higher risk for ADHD, but it certainly doesn’t make a diagnosis and you don’t think about it as the cause per se.

Leonard Rappaport, MD, MS, Director, Developmental Medicine Center


Co-existing disorders
I’d like to begin with an example. If you are to have what appears to be a straightforward surgery, the surgeon can feel that everything is going to be fine until he or she learns that you have high blood pressure, or another medical complication. It then becomes a very different surgery all together–what seemed basic and routine now becomes much more complicated. Similarly, a clinician treating ADHD needs to be able to plan for problems that might complicate the treatment plan. First, s/he should assess whether the circumstances surrounding the presenting problems are clearly understood and all possible contributors are recognized. Second, the clinician should try to move forward carefully addressing the various symptoms that are present. I’ll give you an example: sometimes I see children whose ADHD coexists with anxiety disorders. Anxiety disorders can moderate the full positive effect of stimulate medication for children because they are so anxious. When you are anxious you get distracted, and if you have this distracting disorder called ADHD, anxiety exacerbates that distractibility. Therefore, the medication doesn’t necessarily improve the attention deficit to the extent we would like if anxiety is a prominent part of the clinical picture. What I do is try to, somewhat artificially, separate out the two disorders recognizing that they actually co-exist and intermingle. I create a plan to treat the attentional part and at the same time create a plan to treat the anxiety part, and make sure I’ve covered all my clinical bases. I then monitor both symptom presentations and responses to the different treatment strategies accordingly.

Eugene D’Angelo, PhD, Chief, Division of Psychology