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Comorbidity prevalence and treatment outcome in children and adolescents with ADHD

European Child & Adolescent Psychiatry volume 26, pages 1443–1457 (2017)Cite this article

Abstract

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.

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Acknowledgements

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).

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Authors and Affiliations

  1. Laboratory for Mother and Child Health, Department of Public Health, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy

    Laura Reale, Massimo Cartabia, Michele Zanetti & Maurizio Bonati

  2. Child Neuropsychiatry Unit, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy

    Beatrice Bartoli & Cristiano Termine

  3. Child Neuropsychiatry Unit, ASST dei Sette Laghi, Varese, Italy

    Beatrice Bartoli & Cristiano Termine

  4. Child and Adolescent Neuropsychiatric Service, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy

    Maria Antonella Costantino

  5. Child Neuropsychiatry Unit, Department of Health Sciences, University of Milan, Milan, Italy

    Maria Paola Canevini

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  1. Laura Reale
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  2. Beatrice Bartoli
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  8. Maurizio Bonati
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Consortia

on behalf of Lombardy ADHD Group

  • Stefano Conte
  • , Valeria Renzetti
  • , Laura Salvoni
  • , Massimo Molteni
  • , Antonio Salandi
  • , Sara Trabattoni
  • , Paola Effedri
  • , Elena Filippini
  • , Elisabetta Pedercini
  • , Edda Zanetti
  • , Nadia Fteita
  • , Daniele Arisi
  • , Roberta Mapelli
  • , Simona Frassica
  • , Simonetta Oriani
  • , Christian Trevisan
  • , Susanna Acquistapace
  • , Ottaviano Martinelli
  • , Davide Villani
  • , Emanuela Binaghi
  • , Andrea Deriu
  • , Ernesta Ricotta
  • , Arianna Borchia
  • , Paola Morosini
  • , Maddalena Breviglieri
  • , Giuseppe Capovilla
  • , Roberto Segala
  • , 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
  • , Umberto Balottin
  • , Matteo Chiappedi
  • , Elena Vlacos
  • , Corrado Meraviglia
  • , Maria Grazia Palmieri
  • , Gianpaolo Ruffoni
  • , Francesco Rinaldi
  • , Federica Soardi
  • , Chiara Luoni
  • , Francesca Pavone
  • , Giorgio Rossi
  •  & Cristiano Termine

Corresponding author

Correspondence to Laura Reale.

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Conflict of interest

The authors declare that they have no conflict of interest.

Funding

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.

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Reale, L., Bartoli, B., Cartabia, M. et al. Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. Eur Child Adolesc Psychiatry 26, 1443–1457 (2017). https://doi.org/10.1007/s00787-017-1005-z

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  • DOI: https://doi.org/10.1007/s00787-017-1005-z

Keywords

  • Comorbidity
  • Attention deficit hyperactivity disorder
  • Treatment outcome
  • Children
  • Adolescents