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ATTENTION-DEFICIT HYPERACTIVITY DISORDER ADHD & CO-EXISTING DISORDERS

Ernest J. Bordini, Ph.D., Licensed Psychologist
Presented to Chadd of Alachua County 3/21/02                                                      Gainesville - Ocala  Florida

All rights reserved - Clinical Psychology Associates of North Central Florida    CPANCF.COM    352 336-2888

Attention-deficit Hyperactivity Disorder (ADHD) is the single most prevalent psychiatric disorder among elementary school children. ADHD is a childhood disorder previously labeled hyperactivity, hyperkinesis, minimal brain dysfunction, minimal brain damage, minimal or minor cerebral dysfunction.

Prevalence rates from 3% to 5% of school age children.  Males are over representing from 5 to 10 : 1. Depending on criteria uses some researchers estimate as many as 10-20% prevalence rates. Longitudinal studies of children with ADHD into adolescence found continued symptoms in 20% to 80% of probands studied.

CO-EXISTING CONDITIONS

About half of ADHD children have a coexisting oppositional or conduct disorder. These children show temper outbursts, argumentativeness, defiance, and aggressiveness.  A study by Taylor et al suggested the presence of oppositional (ODD) or conduct (CD) problems does not affect the probability of a positive response to stimulants. Children with ADD and CD respond to stimulant therapy just as well as those without a conduct disorder. The same study also showed that measures of family function had no relationship to stimulant response.

A study of 1300 children by Davidson et al., 1992, found no relationship between symptoms of hyperactivity and injury. But the coexistence of conduct disorder seemed to be a major risk factor in ADHD children. However, 16 to 22 year old ADHD individuals when matched with controls have almost four times the number of motor vehicle accidents and four time the rate of traffic citations (1993).  Thus, monitoring teen ADHD driving and modeling safe driving practices are even more important in families who have ADHD children.

Nine to 10% (or more) of ADD children have learning disabilities (Halperin 1984). Up to 30 to 40 % of learning disabled children may also have ADHD (Levine, 1982, Hobrow, 1986). ADHD children in general tend to be behind in reading and arithmetic (Holborow and Berfrry 1986). The frequent co-existence of these disorders suggest that a thorough assessment be completed for these children.

The frequency of speech and language problems is inconsistent across studies, but are more likely to involve expressive rather than receptive language. This might involve dysfluent speech and problems of articulation. This more likely in those children with ADD and LD. A finding of reduced verbal fluency in ADHD children, was reported by Kozill, et. al., 1992.

Steven Henshaw, in a 1992 article in the JCCP, Number 60, 890 - 903 found treatment of behavior problems in ADHD children with learning problems is often not adequate if assistance for academic deficiencies is not provided.

Social skill problems are not uncommon in ADHD children.  Poor social skills often leads to being teased or rejected by peers and contributes to low self-esteem.  Social skill problems can also be seen in children with nonverbal learning disabilities or Asperger's disorder, but it is important not to mistake the common social skill problems of ADHD children with the more severe disturbance in social awareness and reciprocity seen in Autism Spectrum Disorder.

Encorporesis and Enuresis are not unusual. Enuresis 43% vs 38% of matched normal children. 56% may have sleep difficulties.

ADD children may display nonlocalized "soft" pediatric neurological signs, poor eye hand coordination, and perceptual motor dysfunction. Slightly more than 50% ADD children have motor problems relative to a 35% base rate in normals. They may show motor overflow, motor impersistence, and poor handwriting. Many perform poorly on Pegboard tasks.

Up to 25% of ADHD meet the criteria for anxiety or phobic disorder and 1/3 preadolescent children with anxiety showed 1/3 had ADHD. Higher levels of anxiety and depressive symptoms in children with attention-deficit hyperactivity disorder may predict a nonresponse to stimulant medication. However mild anxiety is not a contraindication to stimulant treatment.

A study published in the Journal of Abnormal Child Psychology, in 1993, followed over a thousand children for fifteen years and found there is no greater than expected association between allergic disorders and ADHD.

The presence and severity of ADHD was evaluated in eighteen families with history of "generalized resistance to thyroid hormone". About 50% of the adults and 70% of the children met the criteria for ADHD. However, few people with ADHD have thyroid disorders. It is suggested if ADHD difficulties are present and there is a family history of thyroid difficulties, further evaluation may be indicated.

Over 50% of Tourette's syndrome individuals have attention deficit disorder but only 5% of ADHD children have Tourette's syndrome. Tourettes children with ADD exhibited significant differences from non ADD children on SSPT, TMT, and DS (Yates, 1994).  Some Tourette's children show patterns of deteriorating neuropsychological test performance with time.

Assessment of possible co-existing conditions is often relevant for treatment planning, accomodations and medication approaches.

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