As many as four out of every five adults with ADHD may have at least one other co-existing psychiatric condition to live with at some point. How does this affect and influence their experience of neurodiversity?
Adult ADHD is a complex and individual mixture of symptoms selected from impulsivity, inattention and hyperactivity, that starts during childhood. Left untreated, ADHD can lead to psychosocial challenges such as unemployment, criminal behaviour and educational underachievement. ADHD itself can also lead to mental health problems such as depression and anxiety.
For many people dealing with all ADHD has to throw at them, they have other “comorbid” condition(s) to think about at the same time. These can vary from a range of psychiatric conditions such as depressive episodes, substance-related disorders and eating disorders. There are so many of these, it is almost impossible to list them all. To make matters worse, this can also include childhood-onset comorbidities such as autistic traits, tics and learning differences or other disorders developed later in life.
How many of these are there and how likely is it?
The ADHD foundation have developed a helpful summary poster of many main comorbid or coexisting conditions and the fantastic CHADD organisation have summarised the likelihood of these conditions coexisting in adults with and without ADHD.
Why do we call them comorbid conditions?
A comorbid disorder is generally agreed to be one NOT caused by the original condition that wouldn’t go away if the ADHD was treated; a clear separation between the two disorders is of course, very hard to prove.
That’s not all folks.
Many adults with ADHD also face non-psychiatric comorbid conditions. It is very difficult to say whether these are due to behaviours more likely to be seen in adults with ADHD or due to the cause of ADHD itself. Examples of these include alcohol-related liver disease, sleep disorders, chronic obstructive pulmonary disease (COPD), epilepsy, fatty liver disease and obesity. ADHD was also linked to a slightly (and probably environmental) increased risk of dementia, cardiovascular disease and Parkinson’s disease.
How should we take all of these extra challenges into account for adults with ADHD?
The perhaps unsatisfying answer is that we have to start thinking more individually. Even with ADHD on its own, the manifestation of ADHD symptoms can be strikingly different for the same behaviours. For example, people-pleasing or shutting off social contact in response to rejection sensitivity. Add in any one of a number of comorbid conditions and defining a one-size-fits-all treatment and management regime is unhelpful at best. At worst, damaging.
The treatment and management of ADHD is difficult enough. The inclusion of a huge swathe of other psychiatric AND physical conditions creates an incredibly complex matrix of possibilities. On top of that, the similarity in some of the symptoms of ADHD and many of these comorbid conditions represent challenges for diagnosis and treatment.
New approaches to individual treatments are needed based on screening more people and evidence-based research.
Author: Alex Conner PhD.
Editor: James Brown PhD.