Are the other conditions that frequently accompany ADHD evident in childhood, or do they develop later due to environmental influences?

By | March 21, 2015

Coexisting conditions appear early on in the picture of attention deficit hyperactivity disorder, but how early is the critical question. In one study comparing 165 four- to six-year-olds to 381 seven- to nine-year-olds, similar rates of impairment were found in school, social, and overall functioning. We can also look at a more recent study designed to assess the effectiveness and safety of the stimulant, methylphenidate, for the treatment of ADHD in preschoolers to determine what coexisting conditions can be found at this early age. In this study, 8% of the preschoolers were reported to have an anxiety disorder, 52% had oppositional defiant disorder, and 2% had conduct disorder. Seventy-six percent of this sample were male and all had combined or hyperactive/impulsive subtype attention deficit hyperactivity disorder, which probably accounts for the high percentage of externalizing behavior disorders ().

Oppositional defiant disorder is seen about half as frequently in girls with ADHD as boys with attention-deficit/hyperactivity disorder.

Oppositional defiant disorder (ODD) is seen about half as frequently in girls with ADHD as boys with attention-deficit/hyperactivity disorder. In studies of elementary school-aged populations, girls were noted to have more anxiety and mood disorders than behavior disorders. Low self-esteem and shame developed over time in these girls with attention deficit hyperactivity disorder, but many women tell me that they had experienced embarrassment from their symptoms early on (some as early as 8 years of age). Elementary school-aged girls with ADHD who do well academically have often already paid a high price in terms of their self-worth. Their need to work hard and put in more time to perform simple tasks is often translated (by themselves and others) into not being as smart as other children in whom learning goes more smoothly. In one study by Joseph Biederman and his coinvestigators, published in Biological Psychiatry in 2006, girls diagnosed with ADHD in childhood were seen to have a greater incidence of psychotic mood or anxiety disorders as they entered their 20s. Rates of these disorders increased over time, with up to about 60% exhibiting one of these problems compared to control subjects (25%) in young adulthood, but the roots can be found in early childhood.

 

Selections from the book: “100 Questions & Answers About Attention-Deficit Hyperactivity Disorder (ADHD) in Women and Girls”, Patricia O. Quinn, MD, Director National Center for Girls and Women with AD/HD, Washington, DC, 2011