study, just published in the Journal Pediatrics, confirms what psychiatrists have seen in their practices for quite some time. The Pediatrics study reports that sixty seven percent of kids with ADHD have at least one other mental health or learning disability diagnoses. This study found that 8% of the 62,000 children, aged 6-17, had been diagnosed with ADHD and for the vast majority of these kids; this was not their only mental health condition.
The most common co-occurring mental health diagnosis was conduct disorder; of the kids studied 27% vs. 2% of the non-ADHD kids had a conduct disorder such as Oppositional Defiance Disorder. Eighteen percent of the kids had anxiety and 14% had been diagnosed with depression while 2% or less of the non-ADHD kids had anxiety or depression. As concerning as these finding were, even more alarming was the fact that a third of these kids had three or more co-occurring conditions.
The results of these finding confirm what we have suspected for a while. ADHD Inattentive type kids are dealing with many issues. Families dealing with ADHD Predominantly Inattentive children are not only try to manage the monumental task of improving their child's attention but are also trying to manage a child who is anxious, depressed and perhaps even, in the case of teenagers, abusing drugs or alcohol.
These coexisting conditions must be considered when physicians and parents consider medication treatment for their kids with ADHD Predominantly Inattentive type or the other types of ADHD. All the medications used for the treatment of ADHD have an effect on the conditions that accompany ADHD. Some improve the co-occurring conditions but many can worsen other mental health problems.
The stimulants, methylphenidate (Ritalin) and the amphetamines (Adderall), may help depression but they worsen anxiety and the tics of Tourette's and must be used with extreme care in teenagers who are prone to substance abuse.. Atomoxetine (Stattera) can help anxiety but it should never be used if there is co-existing depression or Bipolar disorder. Guanfacine improves sleep issues and may improve Oppositional Defiance Disorder but may worsen the sluggishness seen in Sluggish Cognitive Tempo.
When you take into account the fact that when treating ADHD you are rarely treating one problem, and the fact that when you improve on problem, you may worsen another, you can better understand why over 50% of Inattentive ADD children do not gain any clinical benefits from medication. Sometimes the treatment of the coexisting condition is of a higher priority than the ADHD problem and this problem must be stabilized before attempting to improve inattention or hyperactivity. If a child is suicidal, for example, the fact that he is not paying attention is far from the main concern.
Dr. Charles Parker, in his book, Medication Rules, does a fantastic job of explaining the complexity of medicating ADHD. If you have not read this book, I would highly recommend it. Dr. Parker also addresses the issues of how you determine what to treat first when it comes to medicating or treating someone with ADHD who has other coexisting mental health problems.
Inattentive ADHD rarely occurs without a coexisting mental health condition such as anxiety and/or depression. Both anxiety and depression can cause ADHD like symptoms and it is frequently difficult to determine if the symptoms of Inattentive ADHD are worsened by these co-existing conditions or caused by them. It is important to take these issues into consideration when trying to manage the inattention and other symptoms of ADHD Predominantly Inattentive.