ABOUT ADD Comorbidities
Thursday, March 8, 2012 3 Comments
Cormorbid or Co-occuring?
by Madelyn Griffith-Haynie, CTP, CMC, ACT, MCC, SCAC
Wait! Doesn’t comorbid mean
Not exactly. Comorbidity refers to a specific KIND of “co-occurance.”
A comorbid disorder refers to additional conditions or syndromes or disorders frequently found in a specific diagnostic population.
In other words, we’re talking about accompanying conditions that are not part of the diagnostic criteria for the “main” condition, but are frequently seen in that particular population of individuals.
From a behavioral standpoint, these additional conditions occur sometimes with similar or overlapping symptoms, and sometimes they show up with additional symptoms – those not necessarily seen in those with the original or “base” diagnosis.
The overlap may reflect a causal relationship between the two diagnoses, and they may relect an underlying vulnerability in common, but the important concept is that they co-occur more frequently in our “target population” than in population norms otherwise, and to a statistically significant degree.
So, even if an entire hotel full of ADDers happens to be diabetic as well, we still would not say their diagnosis was ADD with comorbid diabetes, because the two conditions haven’t been proven to occur in tandem any more frequently than the incidence of diabetes in the general (non-ADD or “vanilla”) population.
So, in this example, the two conditions are co-occuring, NOT comorbid, even though it may not look that way to anyone staying in this particular hotel!
Muddying the waters further, the statistics change depending on which end of the diagnostic telescope you look through. For example, up to 60% percent of children with tic disorders also have ADD, but nowhere near 60% of ADDers have tic disorders.
The high possibility of comorbidities is yet another good reason to make sure you get an excellent differential diagnosis – but the articles in the Comorbidities Series are going to look at some of the diagnoses that frequenly hitch-hike along with ADD through another lens: SUCCESS!
Developing person-specific work-arounds and interventions to help you achieve that blessed state of Optimal Functioning that I believe is our birthright comes through the identifying, understanding, and learning to work with and work around ALL of the “mix-ins” in your particular flavor of ADD:
“Learning to drive the very brain you were born with
- even if it’s taken a few hits in the meantime!”™
Pieces of the Puzzle
In ADDITION to ADDers with bona fide comorbid diagnoses, in my 25 years of working with what I refer to as “Attentional Spectrum Dysregulations,” I have found it helpful to think of certain symptom profiles as having “a high Aspergers piece” or “a high oppositional piece” in their puzzle box — even if those “pieces” would never be sufficiently troublesome or definitive to warrent an official diagnosis of, in this example, either Aspergers or Oppositional Defiant Disorder.
But before I expand on that perspective, let’s take a look at some of the disorders that are considered “ADD Comorbids,” BEGINNING with why it might be helpful for us to do so.
Understanding the Benefits of Understanding
There are a number of benefits to researching and understanding comorbids:
- It reminds doctors to look for more than a single cause for a cluster of symptoms, and gives them a better idea of which disorders to consider.
- It helps researchers determine where to look — and what to look for – as possible causes of disorders with similar or overlapping symptoms.
- It helps the doctors who write your prescriptions (psychopharmacologists, or “psychopharms”) to develop a list of which medications to prescribe, especially useful if the first medication is contraindicted for any reason, has side-effects that are intolerable, or is ineffective across a broad enough range of symptoms.
- It reminds YOU to make sure you gather all the elements of your symptom profile,
and to make sure your doctor is aware of them.
In many cases, reading about the symptoms of a comorbid disorder will highlight a few symptoms that you formerly believed were something that was your own private shame, or something that “everybody” has to deal with somehow (even though you’ve never been able to figure out how they did it!)
- MOST important, understanding the combined effect of several comorbid conditions can alter the treatment of one or all diagnoses, sometimes substantially.
• Depending on the mix, stimulants, the first-line medication for ADD, might exacerbate the symptoms of the comorbid disorder.
• With ADD/Depression comorbid, often the depression refuses to respond until the ADD is under control.
(Don’t take this information to the bank, and don’t entrust your life and health to what you read on ANY blog or website. Every case is individual, so take the time to find a doctor you can trust, then carefully consider his or her opinion and advice!)
Rounding up The Usual Suspects
ADDandSoMuchMore, OFI and ADDCoach.com™ will use the terms “comorbid” and “comorbidity” regardless of whether the additional symptoms co-exist (overlap) with ADD as independent diagnosable states, or appear as a result of, or in reaction to ADD symptoms (as with depression, in many cases).
ADD comorbidities include:
- autistic spectrum & Pervasive Developmental Disorders
- developmental coordination disorders.
- language disorders – 30-35%.
- learning disabilities and disorders — 15-25%
- mood disorders – 15-20%
The National Comorbidity Survey showed that ADD can be diagnosed in 21.2 percent of adult patients with Bipolar Disorder (2006 by psychologist Ronald C. Kessler, Ph.D.), and that anxiety disorders present in 20-25% of those with an ADD diagnosis.
- obsessive-compulsive disorder
- oppositional defiant disorder – up to 40%
- conduct disorder – 15-20%
- sleep disorders – up to 75%
- substance abuse and substance use disorders
- tic disorders – up to 60% percent of children with tic disorders also have ADD
Frequently noted in individuals clinically treated for ADD, but not currently part of the
DSM diagnosic criteria (Diagnostic And Statistical Manual Of Mental Disorders),
include impairments in:
- all phases of memory
- cognitive processing
- prioritization and sequencing
- motor skills
- social skills
- mood swings and modulation of emotional response
- lack of response to discipline (or effective learning from mistakes)
WOW — that’s a lot of overlap!
Carole Jacobs and Isadore Wendel, Ph.D., MSCP say that 88% of ADDults — six times the rate of the general population — suffer from some type of psychiatric condition at some point in their lives, althought scientists aren’t sure why that is so.
Some experts attribute it to genetics: that certain people inherit a particular form of psychiatric struggle.
Others theorize that ADD is not a single disorder, but a complicated syndrome made up of a cluster of impairments that affects many different parts of the brain, which causes or contributes to a vulnerability to many different types of psychiatric illnesses.
In future articles in The Comorbities Series, I’ll expand on how some of these additional and overlapping syndromes affect particular ADD symptom profiles, along with suggesting some ideas about what you can DO to help you manage the effect they have on your lives.
But before I conclude this one, let’s take a closer look at how often comorbities effect the ADD population.
According to Dr. Kenny Handleman:
The most common comorbid conditions with ADD or ADHD in kids and teens are: Learning Disabilities, Behavior Disorders (including Oppsitional Defiant Disorder and Conduct Disorder), Anxiety Disorders, Mood Disorders (commonly Depression, rarely Bipolar Disorder), tic disorders (like tourette’s), etc.
In adults, he says, comorbidity in ADHD is very common. Research has shown that only about 14% of adult ADHD is simple ADHD, meaning that 86% of adults with ADD or ADHD actually have a second or third disorder.
In addition to comorbidities found in children, ADDults also present with substance abuse and dependences, personality disorders, and high rates of Learning Disabilities, Behavior Disorders, Anxiety Disorders, Depression and even Bipolar disorder.
According to Yales’ Thomas E. Brown, Ph.D.
in his comprehensive book on the topic, Attention-Deficit Disorders and Comorbidities
in Children, Adolescents, and Adults:
. . . comparisons of individuals with ADD and persons without ADD in the general population have yielded markedly higher incidence rates for a wide variety of psychiatric disorders in the ADD samples.
- For example, the generally reported rate of anxiety disorders in the general population of children is about 5%; among children with ADD the observed rate of anxiety disorders is approximately 25%.
- Similarly elevated incidences of major depressive disorder, oppositional defiant disorder, conduct disorder, learning disorders, bipolar disorder, Tourette syndrome, substance abuse, and other psychiatric diagnoses have been reported for children and/or adults with ADD (Biederman et al. 1991b, 1993).
- . . . Biederman et al. (1992) reported that among the children with ADDs in their sample, 51% met the criteria for at least one other psychiatric diagnosis;
- among adults with ADDs in [the above] sample, the authors found 77% with at least one comorbid psychiatric diagnosis.
Carole Jacobs and Isadore Wendel, Ph.D., MSCP note the following, on their site:
- 45% of ADDults have mood disorders, including depression — three times the instance of depression in the general population
- 59% suffered from anxiety disorders (3.2 times higher than the general population)
- 35% had issues with substance or alcohol abuse or dependency (2.8 times the general population), and
- 69% suffered from impulse disorders (5.9 times the general population).
They go on to say that research shows that ADDults had an even higher rate of comorbidity than ADD children, and that, at some point in their lives:
- 63% had been treated for depression
- 35% for anxiety
- 30% for conduct disorders
- over 33% also suffered from oppositional disorder at some point, and
- almost 25% suffer from social phobia, and that
- with ADDults with the combined type, 69% had some history of substance abuse and/or dependence.
Stay tuned – there’s A LOT more to explore about ADD Comorbidities. AS ALWAYS, if you’d like notification about additional posts in this series (or any other), give your name and email to the nice form at the top of the skinny column to your right. (If you’ve done this for another series, you’re good to go! You only need to do this once.) Stringent NO SPAM policy.
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Related Articles on ADDandSoMuchMore.com
- Overfocusing: Cognitive Inflexibility and the Cingulate Gyrus
- ABOUT ADD and Sleep Struggles
- JetLagged for Life
- Differential Diagnosis
- Identifying ADD Comorbidities
Related articles around the ‘net
- Drugs That Treat Adult ADHD & Bipolar Together
- AD/HD Co-Morbidity: What’s Under the Tip of the Iceberg?
- PDD Hereditary From Mother or Father: Is There a Genetic Link? (brighthub.com)
- Sleep, Hyperactivity, and Behavior in Children (psychologytoday.com)
- Meet Debra Rae (executivefunctiondisorder.wordpress.com)
- Comorbidity in Bipolar Disorder (manicmusingsmagazine.org)
- Obsessive compulsive disorder commonly coupled with depression and bipolar disorder (skwillms.wordpress.com)
- Treatment of Insomnia in Anxiety Disorders (mariadorfner.wordpress.com)
- PTSD Energy Therapies (my.psychologytoday.com)
- Anxiety: Boon and Bane? (jajsamos.wordpress.com)
- Obsessive-Compulsive Disorder and the “Root of the Problem” (psychologytoday.com)
- Sensitive Kids May Grow Into OCD Adults [Mental Health] (jezebel.com)
- Childhood disorder bolsters research on infection link (vancouversun.com)
- Tic Disorders In Our School (ekcarmel.wordpress.com)
- the symptoms lists, the charting system, and my prayer life (madsensundercover.wordpress.com)