ADD seldom rides alone
Thursday, July 19, 2012 9 Comments
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.
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
- Major depression
- Dysthymia (Dysthymic Disorder)
- Manic depression [bipolar disorder]
- Seasonal affective disorder [SAD]
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)
- Social phobia (or social anxiety disorder)
- Specific phobias (fear of flying, spiders, claustrophobia, etc.)
• 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
- Myofascial pain syndrome [MPS]
— also known as myofascitis & chronic myofascial pain [CMP]
• ADD Plus Tics
- Motor tics and twitches
- Vocal tics and twitches
- Tourette’s Syndrome [TS]
- Recreational drug use, abuse & addictions (including marijuana)
- Prescription drug addictions
- Problem drinking and alcoholism
- Sugar cravings
- Anorexia nervosa (AN]
- Bulimia nervosa [BN]
- Binge eating disorder [BED] & Night eating syndrome
- Compulsive overeating [COE]
- Purging disorder
- Eating disorders not otherwise specified [EDNOS]
• Sleep Difficulties and Disorders
- sleep transition struggles: falling asleep and/or waking up
- remaining asleep
- staying awake and regulating the level of alertness
- Sleep Apnea
- Sleep Terrors
- Teeth Grinding (Bruxism)
- Restless Leg Syndrome [RLS]
- Chronorhythm disorders
• Sensory Processing Disorders [SPD]
- Sensory Modulation Disorders
- Sensory Based Motor Disorders
- Sensory Discrimination Disorders
- Sensory Defensiveness (hypersensitive; can affect any or all sensory modalities)
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.
As always, if you want notification of new articles in the What Kind of World series – or any new posts on this blog – give your email address to the nice form on the top of the skinny column to the right. (You only have to do this once, so if you’ve already asked for notification about a prior series, you’re covered for this one too). STRICT No Spam Policy
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!)
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)
- ABOUT ADD Comorbidities
- ADD and Its Look-alikes
- Differential Diagnosis
- The Top Ten Stupid Comments from [supposed] ADD Professionals
- ODD & Oppositional Rising
- Chronorhythm disorders
- Sensory Defensiveness
- Shifting your Come-From
Other Related Content on ADDandSoMuchMore.com
Articles in the Executive Functioning/Differential Dx series:
- ABOUT Executive Functions
- What ARE Executive Functions?
- Zebras, hoof-beats and Dr. House: Differential Diagnosis
Articles in the Comorbidities series:
- Variations on ADD/ADHD
- Oppositional Rising
- Overfocusing: Cognitive Inflexibility and the Cingulate Gyru
- Recognizing the Types of ADHD (everydayhealth.com)
- Comorbidity of Personality Disorders and Substance Abuse Disorders (try-therapy.com)
- Anxiety Disorders Respond Well To Cognitive-Behavioral Therapy With A Transdiagnostic Approach (medicalnewstoday.com)
- the symptoms lists, the charting system, and my prayer life (madsensundercover.wordpress.com)
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.