Comorbidity prevalence and treatment outcome in children and adolescents with ADHD
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Although ADHD comorbidity has been widely studied, some issues remain unsolved. This multicenter observational study aims to examine comorbid psychiatric disorders in a clinical sample of newly diagnosed, treatment naïve children and adolescents with and without ADHD and, to compare treatment efficacy based on the type of comorbidity. We performed an analysis of the medical records of patients identified from the Regional ADHD Registry database, enrolled in 18 ADHD centers in the 2011–2016 period. 1919 of 2861 subjects evaluated (67%) met the diagnostic criteria for ADHD: 650 (34%) had only ADHD, while 1269 (66%) had at least one comorbid psychiatric disorder (learning disorders, 56%; sleep disorders, 23%; oppositional defiant disorder, 20%; anxiety disorders, 12%). Patients with ADHD of combined type and with severe impairment (CGI-S ≥5) were more likely to present comorbidity. 382 of 724 (53%) followed up patients improved after 1 year of treatment. ADHD with comorbidity showed greater improvement when treated with combined interventions or methylphenidate alone. Specifically, combined treatment showed significant superiority for ADHD with learning disorders (ES 0.66) and ODD (ES 0.98), lower for ADHD with sleep or anxiety disorders. Training intervention alone showed only medium efficacy (ES 0.50) for ADHD and learning disorders. This study was the first describing comorbidity patterns of ADHD in Italy, confirming, in a multicenter clinical setting, that ADHD is more often a complex disorder. Findings highlight important diagnostic, therapeutic, and service organization aspects that should be broadly extended to ensure an appropriate and homogenous ADHD management.
KeywordsComorbidity Attention deficit hyperactivity disorder Treatment outcome Children Adolescents
Grateful acknowledgement is made to Chiara Pandolfini for manuscript language editing. Lombardy ADHD Group: Stefano Conte, Valeria Renzetti, Laura Salvoni (Bergamo); Massimo Molteni, Antonio Salandi, Sara Trabattoni (Bosisio Parini, LC); Paola Effedri, Elena Filippini, Elisabetta Pedercini, Edda Zanetti (Brescia); Nadia Fteita (Como); Daniele Arisi, Roberta Mapelli (Cremona); Simona Frassica, Simonetta Oriani, Christian Trevisan (Garbagnate Milanese, MI); Susanna Acquistapace, Ottaviano Martinelli, Davide Villani (Lecco); Emanuela Binaghi, Andrea Deriu, Ernesta Ricotta (Legnano, MI); Arianna Borchia, Paola Morosini (Lodi); Maddalena Breviglieri, Giuseppe Capovilla, Roberto Segala (Mantova); Claudio Bissoli, Maurizio Bonati, Maria Paola Canevini, Massimo Cartabia, Maria Antonella Costantino, Isabella Cropanese, Emiddio Fornaro, Silvia Merati, Alberto Ottolini, Laura Reale, Monica Saccani, Roberto Vaccari, Vera Valenti, Alessandra Valentino, Michele Zanetti (Milano); Umberto Balottin, Matteo Chiappedi, Elena Vlacos (Pavia); Corrado Meraviglia, Maria Grazia Palmieri, Gianpaolo Ruffoni (Sondrio); Francesco Rinaldi, Federica Soardi (Vallecamonica–Sebino, BS); Chiara Luoni, Francesca Pavone, Giorgio Rossi, Cristiano Termine (Varese).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The study is part of the “Sharing diagnostic-therapeutic approaches for ADHD in Lombardy” project partially funded by the Healtcare Directorate of the Lombardy Region (D.G. sanità n.3798, 8/05/2014). The views expressed are those of the authors and not necessarily those of Regional Healthcare Directorate. The funder had no input in the conduct of the study; the collection, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript.
- 2.Centers for Disease Control and Prevention (2013) Mental health surveillance among children—United States, 2005–2011. MMWR 62:1–35Google Scholar
- 3.Barkley RA, Russell A (2014) Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Publications, New YorkGoogle Scholar
- 9.Brown T (2000) Attention-Deficit Disorders and Comorbidities in children, adolescent and adults. American Psychiatric Press, WashingtonGoogle Scholar
- 20.Yoshimasu K, Barbaresi WJ, Colligan RC, Voigt RG, Killian JM, Weaver AL, Katusic SK (2012) Childhood ADHD is strongly associated with a broad range of psychiatric disorders during adolescence: a population-based birth cohort study. J Child Psychol Psychiatry 53(10):1036–1043CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Healy JM (2010) Different learners: identifying, preventing, and treating your child’s learning problems. Simon and Schuster, New YorkGoogle Scholar
- 29.Gagliano A, Germanò E, Calamoneri F (2007) Specific learning diabilities and ADHD: characteristic of association. Giornale Neuropsichiatr Evolutiva 27:216–228Google Scholar
- 39.Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA) (2011) Canadian ADHD practice guidelines, 3rd edn. CADDRA, TorontoGoogle Scholar
- 45.Gazzetta Ufficiale Della Repubblica Italiana, No. 230; 3 ottobre 2003. http://www.gazzettaufficiale.it/atto/serie_generale/caricaDettaglioAtto/originario?atto.dataPubblicazioneGazzetta=2003-10-03&atto.codiceRedazionale=03A10942&elenco30giorni=false. Accessed March 27, 2017
- 49.Wechsler D (1991) Wechsler intelligence scale for children, WISC-III, 3rd edn. Psychological Corporation, New YorkGoogle Scholar
- 50.Wechsler D (2002) WPPSI-III administration and scoring manual. Psychological Corporation, San AntonioGoogle Scholar
- 51.Wechsler D (2003) Wechsler Intelligence Scale for Children, 4th edn. Psychological Corporation, San AntonioGoogle Scholar
- 52.Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36(7):980–988CrossRefPubMedGoogle Scholar
- 53.Achenbach TM, Eofbrock C (1983) Manual for the child behaviour checklist. University of Vermont, BurlingtonGoogle Scholar
- 56.Guy W (1996) ECDEU assessment manual for psychopharmacology: publication ADM 76-338. US Department of Health, Education and Welfare, Washington, pp 218–222Google Scholar
- 57.National Institute for Health and Care Excellence (2008) Attention deficit hyperactivity disorder. CG72; 2008. http://guidance.nice.org.uk/CG72. Accessed March 27, 2017
- 58.SINPIA (2002) Linee-guida per la diagnosi e la terapia farmacologica del Disturbo da Deficit Attentivo con Iperattività (ADHD) in età evolutiva. http://www.iss.it/binary/wpop/cont/SINPIA_L.g.ADHD.1116940207.pdf. Accessed March 27, 2017
- 59.Sharpe D (2015) Your Chi-Square test is statistically significant: Now What? Practical assessment. Res Eval 20:1–10Google Scholar
- 60.Cohen J (1969) Statistical power analysis for the behavioral sciences. Academic Press, CambridgeGoogle Scholar
- 62.Bakare MO (2012) Attention deficit hyperactivity symptoms and disorder (ADHD) among African children: a review of epidemiology and co-morbidities. Afr J Psychiatry (Johannesbg) 15(5):358–361Google Scholar
- 80.Lee MJ, Yang KC, Shyu YC, Yuan SS, Yang CJ, Lee SY, Lee TL, Wang LJ (2016) Attention-deficit hyperactivity disorder, its treatment with medication and the probability of developing a depressive disorder: a nationwide population-based study in Taiwan. J Affect Disord 189:110–117CrossRefPubMedGoogle Scholar
- 84.SINPIA (2015) L’assistenza ai minori con disturbi neuropsichici in lombardia. Prevenzione, diagnosi, cura e riabilitazione nella rete dei servizi di Neuropsichiatria dell’Infanzia e dell’Adolescenza. http://goo.gl/egJ0EN. Accessed March 27, 2017
- 89.Busner J, Targum SD (2007) The clinical global impressions scale: applying a research tool in clinical practice. Psychiatry (Edgmont) 4:28–37Google Scholar