ADHD’s Hidden Conditions

By Gene Carroccia, Psy.D.

Attention-deficit/hyperactivity-disorder (ADHD) is a complicated neurobiological condition that exists all over the world. There are two main types of ADHD.  The most common is Combined ADHD, where individuals suffer from significant inattention, hyperactivity, and impulsivity difficulties. Inattentive ADHD is the other type that causes chronic problems with attention and concentration. In the United States, the Centers for Disease Control and Prevention found that just under 10% of all children and adolescents ages 2 to 17 have been diagnosed with ADHD. About 5% of adults have this condition as well.  ADHD is a brain-functioning condition, and not an emotional disorder. It exists on a continuum, and depending on its severity, can cause a range of difficulties with school, work, relationships and social functioning, organizational abilities, time and financial management, self-control, and overall personal effectiveness in life. When ADHD is not sufficiently diagnosed and treated, children and adults typically experience unreached potentials and frustrating, stressful lives. Fortunately, societal awareness of the condition is improving.

 

However, when someone has ADHD, this is often not the full story. Many do not know that ADHD is a foundational disorder that frequently has one or more coexisting conditions. There are a number of medical, sleep, psychological, substance use, trauma, neurodevelopmental, sensory processing, and fetal substance exposure conditions which can occur with and worsen true ADHD. Between 67 to 80% of clinic-referred children and 80% or more of adults with ADHD have at least one additional disorder, up to 50% have two or more other conditions, and 20% have three or more coexisting disorders. Consequently, in addition to the life problems it causes, families should expect other conditions to occur along with ADHD.

 

When other disorders exist along with ADHD, these combinations can magnify the ADHD and create more complex difficulties that are collectively more intense than if someone just had depression or ADHD alone. The sum is greater than the parts.

 

Some of the most common coexisting conditions with ADHD for children and adults include:

  • A range of sleep problems (including insomnia and inadequate hours of sleep)
  • Sleep-disordered breathing (chronic mouth breathing and sleep apnea)
  • Depressive disorders
  • Anxiety conditions
  • Dysgraphia (significantly impaired and messy handwriting)
  • Oppositional defiant disorder
  • Learning disorders
  • Gaming disorder (video game addiction)
  • Fetal substance exposure conditions
  • Substance abuse for adolescents and adults

 

Additionally, children and adolescents with ADHD often have higher rates of:

  • Speech deficits
  • Expressive and receptive language delays and disorders
  • Fine and/or gross motor deficiencies
  • Nighttime bedwetting
  • Conduct disorder
  • A number of sensory processing disorders, including auditory, visual, tactile, olfactory, vestibular, and proprioceptive sensory processing disorders, as well as the sensory-based motor disorders of dyspraxia and postural disorder

 

Many children, adults, and clinicians may not identify other conditions because the ADHD can mask and hide these conditions, and they are commonly not recognized as separate disorders. The additional symptoms and conditions may be incorrectly assumed to be part of the ADHD. Additionally, clinicians might not screen for and identify the numerous additional conditions as part of their diagnostic process because they do not know about them, or have not been trained to do so. Sometimes true ADHD does not exist, but because many other conditions can cause ADHD-like presentations, a misdiagnosis of ADHD may occur. If other conditions were identified, they could be treated. Sadly, these are barriers to individuals living better lives.

 

So what can be done to improve this? Accurately diagnosing ADHD involves identifying all possible existing conditions, and then addressing them in treatment plans. Therefore, an effective diagnostic provider is very important. In the United States, if children or adults were told they have ADHD but did not get a thorough evaluation, it may be time to obtain a new comprehensive ADHD evaluation from a clinical psychologist or experienced masters’ level behavioral health therapist. Other clinicians may be able to provide thorough evaluations as well. A neuropsychological or neurobehavioral psychological testing assessment from a neuropsychologist (not a neurologist physician), would probably provide the most definitive answers, but is costlier and there are fewer of these providers. The 10-step ADHDology Evaluation Model should assist provides with providing comprehensive diagnostic approaches to evaluating ADHD. The goal would be to get a second opinion on the ADHD and to explore if there are other coexisting conditions. If there is only a partial response to ADHD medication (assuming it is the right medication at an adequate dose), this could be a sign that other conditions are present as well.

 

Finally, the six phase ADHDology Treatment Model can help provide a comprehensive approach to maximize results:

 

1). Obtaining an accurate ADHD evaluation or assessment (which would include exploring the many possible conditions that may be causing ADHD-like symptoms or coexist along with true ADHD)

2). Acquiring information about ADHD to assist families to better understand and accept this and other conditions

3). Becoming more effective in managing difficult behaviors at home, including sleep problems

4). Better addressing work and school challenges (as well as obtaining appropriate official school plans and services for children and teens)

5). Partnering with physicians to get the most from ADHD medication

6). Learning about potent additional and alternative ADHD treatment approaches