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Advances in Clinical Child Psychology pp 109–155Cite as

Comorbidity of Disorders in Children and Adolescents

Developmental Perspectives

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Part of the Advances in Clinical Child Psychology book series (ACCP,volume 17)

Abstract

Since the advent of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition and Third Edition, Revised (DSM-III and DSM-III-R), clinicians and investigators have shown increasing interest in the significance of comorbid disorders in children and adolescents. Coincident with a sharpened focus on comorbidity, some investigators have developed detailed data on child and adolescent comorbid diagnoses in clinical and epidemiological studies (e.g., Bird, Gould, & Staghezza, 1993; Cohen, 1993; Pfeffer & Plutchik, 1989); and comorbidity has been the subject of recent reviews of child and adolescent disorders research (e.g., Biederman, New-corn, & Sprich, 1991; Zoccolillo, 1992). Accumulating evidence suggests that comorbidity is pervasive. Concerns about weaknesses of the nosological system are being advanced to account for the high rates of comorbidity in general (Achenbach, 1990/1991; Caron & Rutter, 1991; Pfeffer & Plutchik, 1989; Rutter, 1989), as well as for the co-occurrence of specific disorders (e.g., Biederman et al., 1991; Carlson, 1990). With respect to children and adolescents, these concerns intersect with developmental and methodological issues. For the advancement of knowledge about child and adolescent disorders, it is essential that comorbidity patterns be identified and examined, not only for their implications for prognosis and treatment, but also for evaluation of the classification system on which they are based.

Keywords

  • Conduct Disorder
  • Oppositional Defiant Disorder
  • Conduct Disorder
  • Separation Anxiety
  • Comorbid Disorder

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  • Achenbach, T. M. (1990/1991). “Comorbidity” in child and adolescent psychiatry: Categorical and quantitative perspectives. Journal of Child and Adolescent Psychopharmacology, 1, 1–8.

    Google Scholar 

  • Achenbach, T. M., Howell, C. T., Quay, H. C., & Conners, K. (1991). National survey of problems and competencies among four- to sixteen-year-olds. Monographs of the Society for Research in Child Development, 56 (Serial No. 225).

    Google Scholar 

  • Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101, 213–232.

    CrossRef  PubMed  Google Scholar 

  • Anderson, J. C., Williams, S., McGee, R., & Silva, A. (1987). DSM-III disorders in préadolescent children: Prevalence in a large sample from the general population. Archives of General Psychiatry, 44, 69–76.

    CrossRef  PubMed  Google Scholar 

  • Anderson, J., Williams, S., McGee, R., & Silva, P. (1989). Cognitive and social correlates of DSM-III disorders in préadolescent children. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 842–846.

    CrossRef  PubMed  Google Scholar 

  • Biederman, J., Baldessarini, R. J., Wright, V., Keenan, K., & Faraone, S. (1993). A double-blind placebo controlled study of desipramine in the treatment of ADD: III. Lack of impact of comorbidity and family history factors on clinical response. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 199–204.

    CrossRef  PubMed  Google Scholar 

  • Biederman, J., Newcorn, J., & Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry, 148, 564–577.

    PubMed  Google Scholar 

  • Bird, H. R., Canino, G., Rubio-Stipec, M., Gould, M. S., Ribera, J., Sesman, M., Woodbury, M., Huertas-Goldman, S., Pagan, A., Sanchez-Lacay, A., & Moscoso, M. (1988). Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. Archives of General Psychiatry, 45, 1120–1126.

    CrossRef  PubMed  Google Scholar 

  • Bird, H. R., Gould, M. S., & Staghezza, B. (1992). Aggregating data from multiple informants in child psychiatry epidemiological research. Journal of the American Academy of Child andAdolescent Psychiatry, 31, 78–85.

    CrossRef  Google Scholar 

  • Bird, H. R., Gould, M. S., & Staghezza, B. M. (1993). Patterns of diagnostic comorbidity in a community sample of children aged 9 through 16 years. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 361–368.

    CrossRef  PubMed  Google Scholar 

  • Block, J., & Gjerde, P. F. (1990). Depressive symptoms in late adolescence: A longitudinal perspective on personality antecedents. In A. S. Masten, D. Cicchetti, K. H. Nuechterlein, & S. Weintraub (Eds.), Risk and protective factors in the development of psychopathology (pp. 334–360). New York: Cambridge University Press.

    CrossRef  Google Scholar 

  • Brady, E. U., & Kendall, P. C. (1992). Comorbidity of anxiety and depression in children and adolescents. Psychological Bulletin, 111, 244–255.

    CrossRef  PubMed  Google Scholar 

  • Brandenburg, N. A., Friedman, R. M., & Silver, S. E. (1990). The epidemiology of childhood psychiatric disorders: Prevalence findings from recent studies. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 76–83.

    CrossRef  PubMed  Google Scholar 

  • Brown, T. A., & Barlow, D. H. (1992). Comorbidity among anxiety disorders: Implications for treatment and DSM-IV. Journal of Clinical and Consulting Psychology, 60, 835–844.

    CrossRef  Google Scholar 

  • Capaldi, D. M. (1992). Co-occurrence of conduct problems and depressive symptoms in early adolescent boys: II. A 2-year follow-up at Grade 8. Development and Psychopathology, 4, 125–144.

    CrossRef  Google Scholar 

  • Carlson, G. A. (1990). Annotation: Child and adolescent mania—diagnostic considerations. Journal of Child Psychology and Psychiatry, 31, 331–341.

    CrossRef  PubMed  Google Scholar 

  • Caron, C., & Rutter, M. (1991). Comorbidity in child psychopathology: Concepts, issues and research strategies. Journal of Child Psychology & Psychiatry, 32, 1063–1080.

    CrossRef  Google Scholar 

  • Clarkin, J. F., & Kendall, P. C. (1992). Comorbidity and treatment planning: Summary and future directions. Journal of Consulting and Clinical Psychology, 60, 904–908.

    CrossRef  PubMed  Google Scholar 

  • Cohen, P. (1993). [Children in the Community Study: Comorbidity in 9- to 18-year-old children.] Unpublished data.

    Google Scholar 

  • Cohen, P., Cohen, J., Kasen, S., Velez, C. N., Hartmark, C., Johnsen, J., Rojas, M., Brook, J., & Streuning, E. L. (1993). An epidemiological study of disorders in late childhood and adolescence: I. Age and gender-specific prevalence. Journal of Child Psychology and Psychiatry, 34, 851–867.

    CrossRef  PubMed  Google Scholar 

  • Cohen, P., Velez, C. N., Brook, J., & Smith, J. (1989). Mechanisms of the relation between perinatal problems, early childhood illness, and psychopathology in late childhood and adolescence. Child Development, 60, 701–709.

    CrossRef  PubMed  Google Scholar 

  • Costello, E. J. (1990). Child psychiatric epidemiology: Implications for clinical research and practice. In B. B. Lahey & A. E. Kazdin (Eds.), Advances in clinical child psychology (Vol. 13, pp. 53–90). New York: Plenum Press.

    CrossRef  Google Scholar 

  • Costello, E. J., Costello, A. J., Edelbrock, C., Burns, B. J., Dulcan, M. K., Brent, D., & Janiszewski, S. (1988). Psychiatric disorders in pediatric primary care. Archives of General Psychiatry, 45, 1107–1116.

    CrossRef  PubMed  Google Scholar 

  • Edelbrock, C., & Costello, A. J. (1988). Convergence between statistically derived behavior problem syndromes and child psychiatric disorders. Journal of Abnormal Child Psychology, 16, 219–231.

    CrossRef  PubMed  Google Scholar 

  • Esser, G., Schmidt, M. H., & Woerner, W. (1990). Epidemiology and course of psychiatric disorders in school-age children—Results of a longitudinal study. Journal of Child Psychology & Psychiatry, 31, 243–263.

    CrossRef  Google Scholar 

  • Feehan, M., McGee, R., & Williams, S. M. (1993). Mental health disorders from age 15 to age 18 years. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1118–1126.

    CrossRef  PubMed  Google Scholar 

  • Fergusson, D. M., & Horwood, L. J. (1993). The structure, stability and correlations of the trait components of conduct disorder, attention deficit and anxiety/withdrawal reports. Journal of Child Psychology and Psychiatry, 34, 749–766.

    CrossRef  PubMed  Google Scholar 

  • Fergusson, D. M., Horwood, L. J., & Lynskey, M. T. (1993). The effects of conduct disorder and attention deficit in middle childhood on offending and scholastic ability at age 13. Journal of Child Psychology and Psychiatry, 34, 899–916.

    CrossRef  PubMed  Google Scholar 

  • Fleming, J. E., Boyle, M. H., & Offord, D. (1993). The outcome of adolescent depression in the Ontario Child Health Study follow-up. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 28–33.

    CrossRef  Google Scholar 

  • Fleming, J. E., Offord, D. R., & Boyle, M. H. (1989). Prevalence of childhood and adolescent depression in the community. British Journal of Psychiatry, 155, 647–654.

    PubMed  Google Scholar 

  • Frick, P. J., Lahey, B. B., Loeber, R., Tannenbaum, L., Van Horn, Y., Christ, M. A. G., Hart, E. A., & Hanson, K. (1993). Oppositional defiant disorder and conduct disorder: A meta-analytic review of factor analyses and cross-validation in a clinic sample. Clinical Psychology Review, 13, 319–340.

    CrossRef  Google Scholar 

  • Frost, L. A., Moffitt, T. E., & McGee, R. (1989). Neuropsychological correlates of psychopathology in an unselected cohort of young adolescents. Journal of Abnormal Psychology, 98, 307–313.

    CrossRef  PubMed  Google Scholar 

  • Gould, M. S., Bird, H., & Jaramillo, B. S. (1993). Correspondence between statistically derived behavior problem syndromes and child psychiatric diagnoses in a community sample. Journal of Abnormal Child Psychology, 21, 287–313.

    CrossRef  PubMed  Google Scholar 

  • Gould, M. S., Wunsch-Hitzig, R., & Dohrenwend, B. (1981). Estimating the prevalence of childhood psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 20, 462–476.

    CrossRef  Google Scholar 

  • Graham, P., & Rutter, M. (1968). The reliability and validity of the psychiatric assessment of the child II: Interview with the parent. British Journal of Psychiatry, 114, 581–592.

    CrossRef  PubMed  Google Scholar 

  • Harrington, R., Fudge, H., Rutter, M., Pickles, A., & Hill, J. (1991). Adult outcomes of childhood and adolescent depression: II. Links with antisocial disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 434–439.

    CrossRef  PubMed  Google Scholar 

  • Hughes, C W., Preskorn, S. H., Weiler, E., Weiler, R., Hassanein, R., & Tucker, S. (1990). The effect of concomitant disorders in childhood depression on predicting treatment response. Psychopharmacology Bulletin, 26, 235–238.

    PubMed  Google Scholar 

  • Jensen, P. S., Shervette, R. E., Xenakis, S. N., & Richters, J. (1993). Anxiety and depressive disorders in attention deficit disorder with hyperactivity: New findings. American Journal of Psychiatry, 150, 1203–1209.

    PubMed  Google Scholar 

  • Kashani, J. H., Beck, N. C., Hoeper, E. W., Fallahi, C., Corcoran, C. M., McAllister, J. A., Rosenberg, T. K., & Reid, J. C. (1987). Psychiatric disorders in a community sample of adolescents. American Journal of Psychiatry, 144, 584–589.

    PubMed  Google Scholar 

  • Kashani, J. H., Orvaschel, H., Rosenberg, T. K., & Reid, J. C. (1989). Psychopathology in a community sample of children and adolescents: A developmental perspective. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 701–706.

    CrossRef  PubMed  Google Scholar 

  • Kendall, P. C., & Clarkin, J. F. (1992). Introduction to Special Section: Comorbidity and treatment implications. Journal of Clinical and Consulting Psychology, 60, 833–834.

    CrossRef  Google Scholar 

  • King, N. J., Ollendick, T. H., & Gullone, E. (1991). Negative affectivity in children and adolescents: Relations between anxiety and depression. Clinical Psychology Review, 11, 441–459.

    CrossRef  Google Scholar 

  • Kovacs, M., Gatsonis, C., Paulauskas, S. L., & Richards, C. (1989). Depressive disorders in childhood: IV. A longitudinal study of comorbidity with and risk for anxiety disorders. Archives of General Psychiatry, 46, 776–782.

    CrossRef  PubMed  Google Scholar 

  • Kovacs, M., Paulauskas, S., Gatsonis, C., & Richards, C. (1988). Depressive disorders in childhood: III. A longitudinal study of comorbidity with and [without] risk for conduct disorder. Journal of Affective Disorders, 15, 205–217.

    CrossRef  PubMed  Google Scholar 

  • Lahey, B. B., Loeber, R., Quay, H. C., Frick, P. J., & Grimm, J. (1992). Oppositional defiant and conduct disorders: Issues to be resolved for DSM-IV. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 539–546.

    CrossRef  PubMed  Google Scholar 

  • Ledingham, J. E., & Schwartzman, A. E. (1984). A 3-year follow-up of aggressive and withdrawn behavior in childhood: Preliminary findings. Journal of Abnormal Child Psychology, 11, 157–168.

    CrossRef  Google Scholar 

  • Lewinsohn, P. M., Rohde, P., Seeley, J. R., & Hops, H. (1991). Comorbidity of unipolar depression: I. Major depression with dysthymia. Journal of Abnormal Psychology, 100, 205–213.

    CrossRef  PubMed  Google Scholar 

  • Livingston, R. L., Dykman, R. A., & Ackerman, P. T. (1990). The frequency and significance of additional self-reported psychiatric diagnoses in children with attention deficit disorder. Journal of Abnormal Child Psychology, 18, 465–478.

    CrossRef  PubMed  Google Scholar 

  • Loeber, R., Keenan, K., Lahey, B. B., Green, S. M., & Thomas, C. (1993). Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder. Journal of Abnormal Child Psychology, 21, 377–410.

    CrossRef  PubMed  Google Scholar 

  • McBurnett, K., Lahey, B. B., Frick, P. J., Risch, C., Loeber, R., Hart, E. L., Christ, A. G., & Hanson, K. S. (1991). Journal of the American Academy of Child and Adolescent Psychiatry, 30, 192–196.

    CrossRef  PubMed  Google Scholar 

  • McGee, R., Feehan, M., Williams, S., & Anderson, J. (1992). DSM-III disorders from age 11 to age 15 years. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 50–59.

    CrossRef  PubMed  Google Scholar 

  • McGee, R., Williams, S., & Feehan, M. (1992). Attention deficit disorder and age of onset of problem behaviors. Journal of Abnormal Child Psychology, 20, 487–502.

    CrossRef  PubMed  Google Scholar 

  • Moffitt, T. E. (1990). Juvenile delinquency and attention deficit disorder: Boys’ developmental trajectories from age 3 to age 15. Child Development, 61, 893–910.

    CrossRef  PubMed  Google Scholar 

  • Moskowitz, D. S., Schwartzman, A. E., & Ledingham, J. E. (1985). Stability and change in aggression and withdrawal in middle childhood and early adolescence. Journal of Abnormal Psychology, 94, 30–41.

    CrossRef  PubMed  Google Scholar 

  • Offord, D. R., Boyle, M. H., Fleming, J. E., Blum, H. M., & Grant, N. I. R. (1989). Ontario Child Health Study: Summary of selected results. Canadian Journal of Psychiatry, 34, 483–491.

    Google Scholar 

  • Offord, D. R., Boyle, M. H., & Racine, Y. (1989). Ontario Child Health Study: Correlates of disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 856–860.

    CrossRef  PubMed  Google Scholar 

  • Offord, D. R., Boyle, M. H., Szatmari, P., Rae-Grant, N. I., Links, P. S., Cadman, D. T., Byles, J. A., Crawford, J. W., Blum, H. M., Byrne, C., Thomas, H., & Woodward, C. A. (1987). Ontario Child Health Study: II. Six-month prevalence of disorder and rates of service utilization. Archives of General Psychiatry, 44, 832–836.

    CrossRef  PubMed  Google Scholar 

  • Pfeffer, C. E., & Plutchik, R. (1989). Co-occurrence of psychiatric disorders in child psychiatric patients and nonpatents: A circumplex model. Contemporary Psychiatry, 30, 275–282.

    CrossRef  Google Scholar 

  • Prior, M., Smart, D., Sanson, A., & Oberklaid, F. (1993). Sex differences in psychological adjustment from infancy to 8 years. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 291–304.

    CrossRef  PubMed  Google Scholar 

  • Rohde, P., Lewinsohn, P. M., & Seeley, J. R. (1991). Comorbidity of unipolar depression: II. Comorbidity with other mental health disorders in adolescents and adults. Journal of Abnormal Psychology, 100, 214–222.

    CrossRef  PubMed  Google Scholar 

  • Russo, M. F., Loeber, R., Lahey, B. B., & Keenan, K. (1994). Oppositional defiant and conduct disorders: Validation of the DSM-III-R and an alternative option. Journal of Clinical Child Psychology, 23, 56–68.

    CrossRef  Google Scholar 

  • Rutter, M. (1989). Isle of Wight revisited: Twenty-five years of child psychiatric epidemiology. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 633–653.

    CrossRef  PubMed  Google Scholar 

  • Sanford, M. N., Offord, D. R., Boyle, M. H., Peace, A., & Racine, Y. A. (1992). Ontario Child Health Study: Social and school impairments in children ages 6 to 16 years. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 60–67.

    CrossRef  PubMed  Google Scholar 

  • Schachar, R., & Wachsmuth, R. (1990). Oppositional disorder in children: A validation study comparing conduct disorder, oppositional disorder and normal control children. Journal of Child Psychology & Psychiatry, 31, 1089–1102.

    CrossRef  Google Scholar 

  • Szatmari, P., Boyle, M., & Offord, D. (1989). ADDH and conduct disorder: Degree of diagnostic overlap and differences among correlates. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 865–872.

    CrossRef  PubMed  Google Scholar 

  • Velez, C. N., Johnson, J., & Cohen, P. (1989). A longitudinal analysis of selected risk factors for childhood psychopathology. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 861–864.

    CrossRef  PubMed  Google Scholar 

  • Verhulst, F. C., & Althaus, M. (1988). Persistence and change in behavioral/emotional problems reported by parents of children aged 4–14: An epidemiological study. Acta Psychiatric Scandinavica, 77(Suppl. 339), 1–28.

    CrossRef  Google Scholar 

  • Verhulst, F. C., & van der Ende, J. (1993). “Comorbidity” in an epidemiological sample: A longitudinal perspective. Journal of Child Psychology and Psychiatry, 34, 767–783

    CrossRef  PubMed  Google Scholar 

  • Walker, J. L., Lahey, B. B., Russo, M. F., Frick, P. J., Christ, M. A. G., McBurnett, K., Loeber, R., Stouthamer-Loeber, M., & Green, S. M. (1991). Anxiety, inhibition, and conduct disorder in children: I. Relations to social impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 187–191.

    CrossRef  PubMed  Google Scholar 

  • Zahn-Waxler, C. (1993). Warriors and worriers: Gender and psychopathology. Development and Psychopathology, 5, 79–89.

    CrossRef  Google Scholar 

  • Zoccolillo, M. (1992). Co-occurrence of conduct disorder and its adult outcomes with depressive and anxiety disorders: A review. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 547–556.

    CrossRef  PubMed  Google Scholar 

  • Zoccolillo, M. (1993). Gender and the development of conduct disorder. Development and Psychopathology, 5, 65–78.

    CrossRef  Google Scholar 

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Authors and Affiliations

  1. National Institute of Mental Health, Rockville, Maryland, 20857, USA

    Editha D. Nottelmann & Peter S. Jensen

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  1. Editha D. Nottelmann
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  1. Virginia Polytechnic Institute and State University, Blacksburg, Virginia, USA

    Thomas H. Ollendick

  2. University of South Carolina, Columbia, South Carolina, USA

    Ronald J. Prinz

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Nottelmann, E.D., Jensen, P.S. (1995). Comorbidity of Disorders in Children and Adolescents. In: Ollendick, T.H., Prinz, R.J. (eds) Advances in Clinical Child Psychology. Advances in Clinical Child Psychology, vol 17. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-9044-3_3

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