Comorbidities common in children with ADHD

Two-thirds of children with attention-deficit/hyperactivity disorder (ADHD) have comorbid mental health or neurodevelopment disorders, according to a large survey reported online in Pediatrics.

The survey also showed a stepwise decline in social and educational functioning with increasing numbers of comorbidities and greater use of health and educational services and need for coordination of care.

The investigators analyzed data on 61,779 children from the 2007 National Survey of Children’s Health and identified 5,028 (8.2%) as having ADHD on the basis of interviews with parents and guardians.

Of children with ADHD, 67% had at least 1 other mental health or neurodevelopment disorder compared with 11% of children without ADHD: 33% had 1 comorbid disorder; 16% had 2; and 18% had 3 or more. Children with ADHD were more likely than other children to have learning disabilities (46% vs 5%), a conduct disorder (27% vs 2%), anxiety (18% vs 2%), depression (14% vs 1%), or speech problems (12% vs 3%).

Children with ADHD scored more poorly on measures of child and family functioning, including activity restriction, school problems, grade repetition, and parent-child communication. ADHD also was associated with lower social competence scores and higher parent aggravation scores. Children with 3 or more comorbidities had the greatest deficits in functioning. In addition, children with ADHD used more health, mental health, and education services than other children.

Most pediatricians report screening children with ADHD for common comorbidities such as depression and learning disorders, but only about 20% agree that they are adequately trained to treat children with ADHD and comorbidity, said researchers. They added that “these findings reinforce a need for greater integration of primary care with mental health, education, and social services” in order to determine the best clinical management approach that meets the needs of children with ADHD, especially those who are at greatest risk for poorer function.

Larson K, Russ SA, Kahn RS, Halfon N. Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics. 2011. doi:10.1542/peds.2010-0165.