ADD seldom rides alone


ADD Cormorbidities

by Madelyn Griffith-Haynie, CTP, CMC, MCC, SCAC

ABOUT ADD Comorbidities, the introductory article in this series, explained that a comorbid disorder refers to additional conditions, syndromes or disorders frequently found in a specific diagnostic population more often than the condition is found in the neurotypical population — to a statistically significant degree.

In other words, we’re talking about accompanying conditions that are not automatically included in the diagnostic criteria for the “main” condition, but are frequently seen in that particular population of individuals.

Regardless of the Reason Why

The overlap may reflect a causal relationship between the two diagnoses, and they may reflect an underlying vulnerability in common. The important concept is that two or more conditions co-occur more frequently in our “target population” than in population norms otherwise, and to a statistically significant degree.

From a behavioral standpoint, these additional conditions sometimes occur with similar or overlapping symptoms, and sometimes they show up with additional symptoms – those not necessarily seen in other individuals with the original or “base” diagnosis.

The Importance of an Excellent Differential Diagnosis

Sometimes the symptoms of the comorbid diagnosis are dramatic enough that only an excellent diagnostician with a depth of experience with ADD is able to “see” the ADD clearly enough to diagnose it as the primary condition.

There are also times when the comorbid conditions are missed because the diagnostician doesn’t know enough about ADD to look for them, or errantly believes that the ADD diagnosis is the source of the symptoms that are actually the result of something else in addition to ADD.

Since treatment protocols differ with diagnostic profile, if they aren’t aware of your total picture, how in the world can they believe they know how to treat it effectively?

How likely is it that YOU have more than “vanilla” ADD?

Depending of where you look and whose statistics you prefer to believe, the existence of comorbidity between ADD and other disorders or psychiatric conditions is between 60% and 88% SIX times the rate of the general population.

Looked at from the other end of the telescope,
individuals with “pure” ADD make up only 12% to 40%
of the ADD diagnostic population.

WHY?

Despite the overwhelming evidence of a great many studies that these statistics are credible, scientists and ADD Professionals continue to be perplexed by the high degree of overlap between ADD and additional psychiatric conditions.

At one end of the theoretical continuum, some experts attribute the incidence of high comorbidity to genetics, content to conclude that some people simply inherit a particular form of psychiatric problems due to some sort of underlying genetic vulnerability.

At the other end, some researchers propose that Attention Deficit Disorder is not, in fact, a single disorder, but a complex syndrome made up of a cluster of impairments that affects many different parts of the brain, causing (or contributing to the development of) many different types of psychiatric illnesses.

Primary or Secondary Comorbid Disorders

Although it is practically impossible to determine reliably on diagnosis, I believe it is helpful to understand and accept comorbidity statistics in light of the distinction between the concepts of Primary and Secondary Comorbid Disorders (a term heard most often when speaking of depression).

Primary Comorbids are those that appear to be inherited along with the primary diagnosis (ADD for the purposes of this article and this topic).

Although treatment is complicated by the presence of ADD, primary disorders do tend to respond similarly to intervention, as long as the treatment for the primary comorbids is effective.

Secondary Comorbids present as a response to the challenges of attempting to live with ADD (our primary diagnosis, in this article) — the ongoing experience of chronic failures, disappointments, and frustrations that most individuals with ADD have been forced to deal with since childhood, and routinely experience at work, in their marriage and friendships, and in social situations as ADDults.

ADDing to the Struggles

Further complicating the picture, unfortunately, are two realities that every single person with ADD or its look-alikes, formally diagnosed or not, must find a way to accept and push through.

1. The consequences of ADD challenges are routinely exacerbated by the lack of adequate ADD awareness on the part of many-to-most individuals in the sufferer’s families and communities-at-large.

This sorry state of affairs results in, at best, self-doubt and/or defended natures that must be worked through with a therapist or coach, and/or chronic underfunctioning and low self esteem.

2. Due to the dearth of ADD-knowledgeable practitioners (a great many of them who believe that the comparatively little they believe they understand about ADD is all there IS to understand), along with the difficulty locating (or the expense of working with) well-informed practitioners with a comprehensive information base  . . .

the ADD is not being treated effectively — in many-to-most cases.

ADD Comorbidities Seen Most Often

Link Dense – subtle dark gray links turn red on mouseover
(ALL links in this section open in a new window/tab)

Oppositional Defiant Disorder/Conduct Disorder

Mood Disorders

Depression

Other types of depression can include:

  • Postpartum depression
  • Premenstrual dysphoric disorder [PMDD]
  • Adjustment disorder with depressed mood
  • Cyclothymic disorder – chronic illness characterized by mood swings that can occur as often as every day and last for several days, weeks, months, or as long as two years.

• Anxiety & Phobias

  • Generalized anxiety disorder [GAD]
  • Panic Disorder
  • Obsessive-compulsive disorder
  • PTSD – Post-traumatic stress disorder (Dr Edward Hallowell believes most ADDers have a mild form of PTSD because, unless properly managed early in life, ADD generally results in chronic failure leading to repeated trauma as the result of humiliation, rejection and “tough love” approaches that are shaming in nature)

Phobias

• Autistic Spectrum Disorders

• Cognitive Performance & Learning Disabilities/Disorders

Expressive or receptive language difficulties and disorders (speech and communication problems)

Non-Verbal Learning Disorders [NVLD or NLD]

A constellation of brain-based difficulties characterized by difficulty recognizing and processing nonverbal cues (body language, facial expression, conversational nuances, etc.  Also included are poor visual, spatial, and organizational skills, poor motor performance.

Dyslexia – affects reading, writing, spelling and MUCH more

Dysgraphia – writing and more

Dyscalculia – numbers, arithmetic, calculation and more

Dyspraxia – Processing disorders affecting brain/body coordination & movement signals potentially affecting any area of development (physical, emotional, language, social development, etc.), causing potential problems with basic or customary tasks and life skills (grooming, driving, cooking and other household chores, etc.

• Somatic dysfunctions

• ADD Plus Tics

  • Motor tics and twitches
  • Vocal tics and twitches
  • Tourette’s Syndrome [TS]

• Substance Use Disorders

• Eating Disorders

• Sleep Difficulties and Disorders

Sleep Difficulties

  • sleep transition struggles: falling asleep and/or waking up
  • remaining asleep
  • staying awake and regulating the level of alertness

Sleep Disorders

• Sensory Processing Disorders [SPD]

Can’t understand what sensory processing disorder feels like?
Click here for an instant empathy lesson

MORE TO COME

In additional articles in this series, I will expand on many of the conditions listed above – what they are, how they show up in behaviors that complicate or confound ADD treatment, and more links to great information where you can find out still more.

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IN ANY CASE, stay tuned.
There’s a lot to know, a lot here already, and a lot more to come
Get it here while it’s still free for the taking.

Want to work directly with me? If you’d like some one-on-one (couples or group) coaching help with anything that came up while you were reading this Series, click HERE for Brain-based Coaching with mgh, with a contact form at its end, or click the E-me link on the menubar at the top of every page. Fill out the form, submit, and an email SOS is on its way to me; we’ll schedule a call to talk about what you need. I’ll get back to you ASAP (accent on the “P”ossible!)
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You might also be interested in some of the following articles
available right now – on this site and elsewhere.

For links in context: run your cursor over the article above and the dark grey links will turn dark red;
(subtle, so they don’t pull focus while you read, but you can find them to click when you’re ready for them)
– and check out the links to other Related Content in each of the articles themselves –

Related articles right here on ADDandSoMuchMore.com
(in case you missed them above or below)

Other Related Content on ADDandSoMuchMore.com

Articles in the Executive Functioning/Differential Dx series:

Articles in the Comorbidities series:

BY THE WAY: Since ADDandSoMuchMore.com is an Evergreen site, I revisit all my content periodically to update links — when you link back, like, follow or comment, you STAY on the page. When you do not, you run a high risk of getting replaced by a site with a more generous come-from.

About Madelyn Griffith-Haynie, MCC, SCAC
Award-winning ADD Coach Training Field founder; ADD Coaching field co-founder; [life] Coaching pioneer -- Neurodiversity Advocate, Coach, Mentor & Poster Girl -- Multi-Certified -- 25 years working with Executive Functioning struggles in hundreds of people from all walks of life. I developed and delivered the world's first ADD-specific coach training curriculum: multi-year, brain-based, and ICF Certification tracked. In addition to my expertise in ADD/EF Systems Development Coaching, I am known for training and mentoring globally well-informed ADD Coach LEADERS with the vision to innovate, many of the most visible, knowledgeable and successful ADD Coaches in the field today (several of whom now deliver highly visible ADD coach trainings themselves). For almost a decade, I personally sponsored and facilitated seven monthly, virtual and global, no-charge support and information groups The ADD Hours™ - including The ADD Expert Speakers Series, hosting well-known ADD Professionals who were generous with their information and expertise, joining me in my belief that "It takes a village to educate a world." I am committed to being a thorn in the side of ADD-ignorance in service of changing the way neurodiversity is thought about and treated - seeing "a world that works for everyone" in my lifetime. Get in touch when you're ready to have a life that works BECAUSE of who you are, building on strengths to step off that frustrating treadmill "when 'wanting to' just doesn't get it DONE!"

9 Responses to ADD seldom rides alone

  1. Pingback: Overfocusing: Cognitive Inflexibility and the Cingulate Gyrus | ADD . . . and-so-much-more

  2. Pingback: A thorn in the side of ADD/EFD-ignorance | ADD . . . and-so-much-more

  3. andy wolmer says:

    extraordinary

    Like

  4. What a comprehensive list! I think 95% of the population should fall into several of these categories. Is ADD/ADHD undiagnosed, but the other symptoms clearly fall into a diagnosis. The other diagnosis are usually treated if the client seeks help. How would the practitioner identify ADD/ADHD, or is it frequently overlooked?

    Like

    • Your “95%” comment zeroes in on the problem with the “invisible” diagnoses – primaily of the mood and cognition kind. (It wasn’t all that long ago that major depression was cruelly discounted because the world collapsed it with “depressed MOOD?”)

      Diagnosis is a matter of degree of impairment, NOT whether or not some symptom is primarily absent in the so-called “neuro-typical” population!! Humans ALL exhibit ALL the symptoms of MOST of the diagnoses at SOME times and in SOME situations. (This deserves an entire post, so I’ll save additional comments for later).

      Re: “overlooked”: you ask a good question, Edie. The sad answer is that, not only is it NOT “over-diagnosed” (DAMN the popular press and all the clue-free bloggers for publishing that misinformation EVER, much less as often as they do), it is FREQUENTLY overlooked, primarily because far too many “professionals” who CLAIM to work with ADD have a woefully inadequate level of what I call “ADD-literacy” — AND a bunch of them are pretty much clueless (see Top Ten Stupid Comments from supposed . . . )

      #1 – to say that you work with ADD MEANS (or should, in any case) that you have a high level of “ADD literacy” and that your information-base stays CURRENT.

      #2 – to provide a decent ADD differential, the diagnostician must ALSO be literate in the “look-alikes” and “tag-alongs.” Even the BEST can only make a “best guess” dx and tweak from there, but it is absolutely true that we can only find what we know to look for.

      #3 – FINALLY, as you can see from this article, *most* ADDers have at least one comorbid dx. That make dx harder, of course, but it ALSO changes treatment options in many, many cases. So the practitioner must be (or work with) an excellent psychopharm to stand a prayer of helping to balance neurochemistry.

      I strongly believe that claiming an ADD speciality without having #1 and at least diagnostic knowledge of #2 is MALPRACTICE. It would be in any of the other specialties – why not ours?

      Heart doctors are supposed to know ALL about the heart, with referral relationships for areas outside their expertise, right? Dentists are expected to be able to recognize mouth cancers, alignment problems, evidence of teeth grinding – even if all they do personally is clean and fill teeth. They STAY CURRENT because they darn well know that a lawsuit is coming if they don’t!!

      Maybe it’s time for us to start bringing some lawsuits and going after some licenses! If you think I’m over-reacting, take time to read Top Ten Stupid Comments from supposed . . . ) I’m not talking about a little bit of misinformation here.

      AS ALWAYS – love your visits, and love you for taking the time to post comments and questions.

      xx,
      mgh

      Like

  5. Kent Brooks says:

    I appreciated you taking the time to differentiate between primary and secondary comorbidities. ADD + Tics, for example… in many cases I suspect that tics are caused by the pharmaceuticals used to treat ADD… (i.e. stimulants) Have you seen the new DIsruptive Behavior Disorder diagnosis in the proposed DSM-V? It’s a whole new ballgame when the new DSM comes out.

    Like

    • Oh baby are YOU saying something important. I’m personally NOT a fan of what this particular DSM caucus has decided to do with Executive Functioning Disorders (including the “spectrums”) – BAD ideas, IMHO (as short-sighted at the DSM2 listing of “HRC” in the childhood section.) But we must all [attempt to] live with it until the NEXT caucus does whatever IT does!

      Sounds like you are making sure YOU have the information to understand at deeper levels. Bottom line: your body, your decision!

      Re: meds – yes, knowledgeable pros have known for some time that tics are frequently exacerbated by stims (sometimes present for the very first time). AS ALWAYS, you have to look closely at the *individual* being treated and the “degree of disruption” of a RANGE of symptoms when you make person-specific treatment decisions. What’s great for one may be lousy for another.

      And VERY few docs are looking at biology (especially the gut) as part of the picture. Check out Charlie Parker’s Core Psych blog – he keeps his finger on that particular pulse. The Integrative Medicine docs are pretty good there too – as long as they don’t adopt a black-and-white “no pharmaceuticals EVER” stance, I like the way they approach the so-called “mental” disorders.

      ALL substances have “side” effects – and finding the right balance can be tricky indeed. POSSIBLE, however. That gives me hope. AND – very important – “treatment” means MORE than “substances,” as I know YOU know. If a child NEEDS glasses, she probably struggles with reading. She’s not suddenly going to be ABLE to read when you get the right “prescriptive lenses” in place. With ADD (or *any* dx), skills remediation is to be expected – meds or no meds. Various types of therapy and/or coaching step in to fill THAT bill – with or without whatever “prescriptive treatments” are in place.

      Thanks for stopping by and taking the time to comment.
      xx,
      mgh

      PS. ANYONE ELSE reading – take the time to check out this commenter’s site – there is a link to one article in the bottom “Related” section – good stuff over there.

      Like

  6. jeg700 says:

    I did not know that sugar cravings was part of the substance abuse category…yet it makes total sense. My caffeine, nicotine and sugar cravings have always been present for as far back as I can remember. I have also been very fortunate to have a metabolism that prevents me from carrying any extra weight. Sugar has always been the magic ingredient to alleviate the “mind shut-down”, which happens when boredom sets in. When I finally get that sugar crash, I sleep, deeply, but for a short period of time. Still, it’s a better sleep than any other sleep I get 🙂 And sleep is always welcome when insomnia is a way of life!

    Anorexia has always been an issue with me as well, not intentionally but only because I forget to eat, get too distracted on my way to get some food or just too hyper-focused on something I love to realize I haven’t gone to the bathroom in hours nor eaten. I’ve even gone days without eating when younger and living alone.

    Insomnia is part and parcel of my life for many, many years now. Teeth grinding, restless legs, night terrors etc. all come and go, never persistent enough to be medically treated because they take turns interrupting my sleep 🙂 Not to mention the medical professions’ ignorance on treating or diagnosing ADD/ADHD in adults.

    Oh well, I cope with what I can and the rest I just live with it 🙂

    After all, my crankiness bothers others more than it does me. I embrace that crankiness and wallow in it for as long as it lasts LOL

    Like

    • Thanks for commenting!

      Since this list represents a GREAT deal of time in development (checking recent sources as well as everything I have collected in the past 20 years – not to mention adding all the live links), I’m thrilled to know that somebody is reading who might find this resource useful — and particularly thrilled that YOU were the somebody.

      I LOVE your attitude and your sense of humor — sometimes the only link to my own I can count on 😐

      I, too “forget to eat” – but I have a hearty appetite when I DO eat. (people have said, “How can you eat like that and stay so thin?” – long before I knew about ADD and stims, btw) My sleep struggles do NOT “come and go” – mores the pity – although it looks that way to the chronorhythm disorder clueless (more about that in an upcoming article).

      Re: Sugar cravings and ADD: – blog article coming “soon” – meanwhile . . .

      Friend and colleague Wendy Richardson writes:

      “What if we have been looking at the question backward? What if ADD hyperactivity actually causes people to crave sweets? If the ADD brain is slower to absorb glucose, it would make sense the body would find a way to increase the supply of glucose to the brain as quickly as possible.

      I have worked with many ADD adults who are addicted to sugar, especially chocolate which also contains caffeine. They find that eating sugar helps them stay alert, calm, and focused. Prior to ADD treatment many report drinking 6-12 sugar sodas, several cups of coffee with sugar, and constantly nibbling on candy and sweets throughout the day. It is impossible to sort out what is pure sugar craving when it is mixed with the stimulating effects of caffeine on the ADD brain.”

      xx,
      mgh

      Like

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