ADHD increases risk for comorbid psychiatric disorders

By Mark Cowen

Attention deficit/hyperactivity disorder (ADHD) in childhood is associated with an increased risk for a broad range of comorbid psychiatric disorders in adolescence, study results show.

The risk for comorbid conduct/oppositional defiant disorder was particularly elevated among children with ADHD, note Slavica Katusic (Mayo Clinic, Rochester, Minnesota, USA) and team.

"Screening for evaluating and managing such comorbid conditions will reduce the likelihood of the adverse social and emotional outcomes reported in the research literature," they comment. "Furthermore, the burden on the families and on society as a whole will be lessened."

The findings come from a retrospective study of 5718 children born between 1976 and 1982 who were followed up until the age of 19 years as part of the Rochester Epidemiology Project.

In total, 343 children who were diagnosed with ADHD during the study period were compared with 712 age- and gender-matched children without ADHD (controls) for the development of psychiatric disorders.

The researchers found that 62% children with ADHD had developed one or more comorbid psychiatric disorders by the age of 19 years. By contrast, just 19% of controls developed a psychiatric condition by this age.

Compared with controls, children with ADHD were significantly more likely to develop conduct/oppositional defiant disorder (hazard ratio [HR]=9.54), tic disorders (HR=6.53), personality disorders (HR=5.80), eating disorders (HR=5.68), substance-related disorders (HR=4.03), adjustment disorders (HR=3.88), mood disorders (HR=3.67), and anxiety disorders (HR=2.94).

Overall, children with ADHD were 10.6 times more likely to develop coexisting internalizing and externalizing disorders, 10.0 times more likely to develop externalizing-only disorders, and 4.1 times more likely to develop internalizing-only disorders compared with controls.

Writing in the Journal of Child Psychology and Psychiatry, Katusic et al conclude: "Clinicians should be aware that children and adolescents with ADHD are at significant risk for a wide range of psychiatric disorders."

They add that "our results emphasize the importance of remaining alert to the potential occurrence of internalizing and externalizing psychiatric disorders for both girls and boys as an essential element of comprehensive clinical care for children and adolescents with ADHD."

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