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Adult ADHD in Psychiatric Conditions

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The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders

Abstract

Comorbid psychiatric disorders are present in the vast majority of adults with ADHD, and ADHD is frequently undiagnosed in people who are in treatment for other disorders. In fact, 50–75% of adults with ADHD suffer from at least another neurodevelopmental or psychiatric condition, and have six times the likelihood to suffer from another disorder throughout the lifespan. People with ADHD are four times more likely to suffer from a mood disorder, three times more likely to develop major depressive disorder, six times more likely to develop dysthymia, and twice as likely to develop a substance dependence. Interestingly, up to 43% of gamblers have a history of childhood ADHD.

Some medical and psychiatric conditions can co-occur with ADHD differently, depending on the developmental stage. For example, autistic traits, sleep disorders, and atopic eczema are frequently found in children who later receive a diagnosis of ADHD. Encopresis and enuresis as well as specific learning disorders can emerge in the same period of ADHD symptoms presentation, while the vast majority of psychiatric disorders occur after the ADHD onset, including depression, anxiety, bipolar disorder, and substance use disorder.

Comorbidities seem to differ according to the ADHD subtype presentation, with the combined presentation of ADHD more frequently associated with externalized disorders and the inattentive ADHD presentation with comorbid internalizing disorders. Interestingly, the use of medication in childhood resulted associated with a different comorbidity pattern, with evidence indicating that those who were treated with ADHD medication in childhood had a reduced risk for oppositional defiant disorder, substance abuse, major depressive disorder, and social phobia. Instead, drug-naive adults ADHD showed to have a higher risk for major depressive disorder, sleep disorders, and alcohol use disorder.

Finally, there is evidence showing that women with ADHD are afflicted by several comorbidities in comparison to men, who are generally affected by another co-occurrent disorder. This leads to consider that the differential diagnosis in female patients could be more challenging.

Clinicians should know that people with ADHD and comorbidities have a worse prognosis, but that early and appropriate ADHD treatment has the potentiality of altering the trajectory of psychiatric morbidity, by reducing the risk of the emergence of other psychiatric conditions, and particularly of mood, anxiety, and substance use disorders.

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    Stefano Pallanti & Luana Salerno

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Pallanti, S., Salerno, L. (2020). Adult ADHD in Psychiatric Conditions. In: The Burden of Adult ADHD in Comorbid Psychiatric and Neurological Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-39051-8_6

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  • DOI: https://doi.org/10.1007/978-3-030-39051-8_6

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