Co-morbid Conditions or Conditions Associated with ADHD

The term co-morbid is often used when talking about conditions associated with ADHD.  Co-morbid just means the tendency of one condition to co-exist with another – in this case ADHD.
There are several conditions more commonly found in people diagnosed with ADHD than for the general population.
Whilst some people with ADHD may have multiple co-morbid conditions others may not have any at all.
Around 50% of people with ADHD also suffer from one or more additional conditions requiring separate treatment.
Sometimes these problems are ‘secondary’ to ADHD meaning they are caused by the frustration of coping with the ADHD symptoms. This would include problems such as anxiety or depression.
If ADHD treatment is effective, these secondary problems should resolve but if they don’t, they can be classed as symptoms of a co-morbid condition.
ADHD presentations, and most of its common co-morbid disorders, can vary over time and developmental stages. For example, in early childhood co-morbid conditions such as Oppositional Defiant Disorder (ODD), Enuresis and Language Disorder are common whereas later on there may be more symptoms of anxiety or tics observed.  With the onset of adolescence mood disorders, personality issues and substance use disorders may begin to emerge.
Below is a comprehensive, alphabetical list of most of the co-morbid conditions that can come along with ADHD. 
As you can see the list is quite long, but it’s important to remember that some people may have no co-morbid conditions whereas others may have several.  
Each person is unique.

As you can see the list is quite long, but it’s important to remember that some people may have no co-morbid conditions whereas others may have several. Each person is unique.

  • Addictive Personality Disorder (APD)
  • Antisocial Personality Disorder (ASPD)
  • Anxiety
  • Asperger’s Syndrome
  • Attachment Disorders/Reactive Attachment Disorder (RAD)
  • Auditory Processing Disorder (APD)
  • Autism Spectrum Disorder (ASD)
  • Bi-Polar Disorder (PD)
  • Borderline Personality Disorder (BPD)
  • Conduct Disorder (CD)
  • Depression
  • Developmental Coordination Disorder (DCD)
  • Disruptive Mood Dysregulation Disorder (DMDD)
  • Dysgraphia
  • Dyslexia
  • Eating Disorders (ED)
  • Enuresis
  • Executive Function Difficulties
  • Fine & Gross Motor Difficulties
  • Gut Issues
  • Non-Verbal Learning Disabilities (NVLD)
  • Obsessive Compulsive Disorder (OCD)
  • Oppositional Defiant Disorder (ODD)
  • Post-Traumatic Stress Disorder (PTSD)
  • Rejection Sensitive Dysphoria (RSD)
  • Schizophrenia
  • Seizure Disorders
  • Sensory Processing Disorder (SPD)
  • Sleep Problems
  • Slow Processing Speed
  • Specific Learning Difficulties (SLD)
  • Speech & Language Disabilities
  • Socialisation Issues
  • Substance Use Disorder (SUD)
  • Tic Disorder/Tourette Syndrome
  • Written Language Disorder
People with ADHD have a greater propensity of developing Addictive Personality Disorder.

This not only relates to addiction to substances, but may include addictive behaviours such as gambling, video games and internet.

A study compared the behaviour of ADHD and non-ADHD children playing video games. The ADHD children were more vulnerable to developing addictive tendencies, particularly for a specific category of games called massively multiplayer online role-playing games (MMORPG).

This propensity to addictive behaviour in ADHD is closely related to impulsivity, a need for immediate feedback and stimulating the dopamine receptors.
Children with both ADHD and Conduct Disorder are at an increased risk of developing an Antisocial Personality Disorder (ASPD) as early as 15 years of age.

Identifying childhood predictors of adult ASPD as soon as possible is essential to providing early intervention.
Kids with ADHD are 3x more likely to have an anxiety disorder than kids who don’t have ADHD.

Some studies put the rate of anxiety amongst children with ADHD at 18% or even higher.

Because anxiety is a such a common co-morbidity of ADHD, and indeed increasingly common in the general population, it deserves it's own page here.
For a short period of time (1994-2013) Asperger’s Syndrome was listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It was one of five Pervasive Developmental Disorders and part of the Autism Spectrum. It was commonly used as another term for mild or high functioning autism.

Officially, practitioners can no longer diagnose an individual with Asperger’s Syndrome. Since 2013 the official diagnosis is Autism Spectrum Disorder, which has a severity level between one and three based on their need for support, with 1 being the lowest support needs.

Many people already diagnosed with Asperger’s wish to maintain that diagnosis and label as there is an existing community and supports for that diagnosis and many support groups and clinicians will still use the term, even if the American Psychiatric Association does not.

People previously diagnosed with Asperger’s are very different from those diagnosed with the more severe forms of autism but are now grouped together under the single category of autism spectrum disorder. This means people with very severe challenges, who are non-verbal, intellectually challenged and who require significant support to perform everyday tasks on a daily basis are now included in the same category as those who may be graduating university but have social and sensory difficulties.

ADHD and Asperger’s share many similarities, and professionals may find it tricky to distinguish the two. Both conditions involve difficulties with executive functioning and information processing. Sometimes children and adults are misdiagnosed with one or other condition, but it is also possible to have both diagnoses at once.

The similarities between Asperger’s and ADHD include:

  • Impulsivity
  • Distractibility
  • Inattentiveness
  • Delayed social skills
  • Sensitivity to sound, light and texture
  • Problems following directions
  • Tantrums
  • Learning problems
  • Problems with coordination
  • Difficulty making and keeping friends
  • High intelligence
  • May be anxious
Not forming proper attachments or having an insecure attachment with a primary caregiver is a well-known risk for externalised behaviours during childhood.

Lack of attachment may result for a number of reasons including post-natal depression, substance abuse and general neglect.

If a child suffers emotional, physical trauma or maltreatment this creates psychoneurophysiological effects, which may take the form of central nervous system hyper-arousal, hyper-vigilance, elevated cortisol levels and so on.

In many respects there is an overlap between the symptoms of ADHD and attachment disorder where difficulties regulating emotions and difficult temperament are common to both.

Attachment issues in children cause symptoms such as:

  • Mood lability
  • Depression
  • Anxiety
  • Distractibility
  • Aggression
  • Poor cause-and-effect thinking
  • Anxiety
  • Distrust of oneself and others
  • Feeling helpless and hopeless
  • Feeling unloved, worthless, rejected, and abandoned
  • Perceiving the world as unsafe

Reactive Attachment Disorder (RAD)

RAD is a Post-Traumatic Stress Disorder (PTSD) of infancy and toddlerhood. Children with RAD have persistent symptoms of fear, which may lead to increased arousal, heart rate, startle responses, and sleep disturbance. When they encounter a fearful situation, defiance, opposition and overt resistance may occur. Avoidance of further pain becomes a primary motive and they may become calculating and devious. They will often have low self-esteem and poor relationships with their peers.
Auditory processing disorder (APD) and ADHD are two very different issues that look extremely similar and may be mistaken for each other and misdiagnosed.

APD is a brain-based condition that makes it hard to process what the ear hears, such as recognising subtle differences in the sounds that make up words.

APD impacts language-related skills, such as receptive and expressive language.

Symptoms of APD include:

  • Seems “tuned out” due to not understanding what’s being said
  • Seems forgetful
  • Struggles to follow conversations/respond to spoken questions
  • Frequently asks people to repeat what they’ve said
  • Often responds with “huh?” or “what?”
  • Has trouble following directions and spoken instructions
  • May not speak clearly
  • Confuses similar sounds, such as “three” instead of “free”
  • Has trouble with rhyming
  • Easily distracted by background noise/loud and sudden noises
  • Struggles with activities that involve listening comprehension
  • May prefer to read stories rather than listen to them read aloud
  • May miss social cues due to having to focus so hard on understanding the actual words being said
  • May not pick up on sarcasm/non-verbal forms of conversation
  • May avoid socialising/want to be alone during gatherings because keeping up with conversation can be exhausting and stressful
The DSM V officially recognises Autistic Spectrum Disorder (ASD) as a co-morbidity of ADHD and is also classified under ‘Neurodevelopmental Disorders’.

Up to 58% of children with ASD also have an ADHD diagnosis.

Having both diagnoses generates additional challenges and it is therefore vital to assess for both conditions.

The symptoms of ASD can range widely in severity and can include:

  • Avoids eye contact and/or physical contact
  • Difficulties with social skills
  • May be verbally advanced, but finds non-verbal cues challenging
  • Difficulty understanding his own and other people’s feelings
  • Has delayed speech (or no speech) or repeats phrases over and over
  • Dislikes changes in routine
  • Is constantly moving, fidgeting, picking up and fiddling with everything
  • Has sensory processing issues
  • Is prone to meltdowns anxiety, frustration or communication difficulties
  • Self-soothes using excessive body movements (stimming)
  • Has obsessive interests
ADHD and Bipolar Disorder (BD) commonly occur together, making it difficult to tease them apart. Up to 20% of BD cases co-occur with ADHD.

The main point of difference between the two is that the symptoms of ADHD are continuous whereas BD is more cyclical in nature.

BD results in dramatic mood swings ranging from extreme highs in energy levels and a sense of euphoria to extreme lows of depression, hopelessness and low energy levels. The mood swings are irregular and alternate with periods of normal mood and function and can occur relatively independent of outside influences within the environment.

There are some similarities and overlap in symptoms - both may include:

  • Hyperactive or restless behaviours
  • Distractibility
  • Poor concentration
  • Impulsivity
  • Racing thoughts
  • Sleep disturbances
  • Poor social relationships
  • Feelings of anxiety, depression, frustration, and self-doubt
  • Can impact daily functioning

It is important to pay close attention to the fact that BD can manifest with less clearly defined cycles pre-puberty.
Borderline Personality Disorder (BPD) and ADHD symptoms overlap to a degree, as both disorders share deficits in attention, impulsivity and emotional dysregulation.

People with BPD have persistent difficulties in regulating their emotions and relating to other people and typically experience some, but not necessarily all of these symptoms:

  • Intense mood swings including anxiety, anger or depression
  • Tumultuous interpersonal relationships
  • Fluctuate between idealising/devaluing others
  • Fear of being alone
  • Unstable and distorted self-image or sense of self
  • Feeling neglected, alone, misunderstood, chronically empty or bored
  • Feelings of self-loathing and self-hate
  • Self-harm, such as cutting as a coping mechanism
  • Suicidal thoughts or suicide attempts
  • Impulsive and risky behaviour
  • Difficulty compromising
  • Paranoid thoughts in response to stress

Since ADHD presents earlier than BPD, ADHD might be either a risk factor or an initial stage in the development of BPD or in the reinforcement of its symptoms.
The co-morbid condition of Conduct Disorder (CD) occurs in some children with ADHD. CD has a prevalence of 2-9% in the general population and ADHD is comorbid in around one third of cases.

A child or teenager who repetitively and persistently displays patterns of behavior, whereby the basic rights of others or major societal norms are violated, may be at risk of having CD.

The typical behaviors fall into four main areas:

  1. Aggressive conduct causing/threatening physical harm to others
  2. Aggressive conduct causing/threatening physical harm to animals
  3. Non-aggressive conduct - property loss/damage, deceitfulness or theft;
  4. Repetitive serious violations of rules.

Specific Symptoms of CD:

  • Aggression to people and animals
  • Frequent bullying, threatening or intimidating others
  • Frequent initiation of physical fights
  • Use of a weapon able to cause serious physical harm to others
  • Physical cruelty to people and/or animals
  • Stealing while confronting a victim
  • Forcing someone into sexual activity

Destruction of property

  • Deliberate fire setting with the intention of causing serious damage
  • Deliberately destroying others’ property (other than by fire setting)

Deceitfulness or theft

  • Breaking into someone else’s house, building or car
  • Frequently lying to obtain goods or favours or to avoid obligations
  • Stealing items of non-trivial value without confronting a victim

Serious violations of rules

  • Frequently stays out at night despite parental prohibitions, before age 13
  • Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for lengthy period)
  • Frequent truanting from school, beginning before age 13

If 3, or more, of the following criteria have occurred in the past 12 months, with at least one present in the past 6 months, CD could be a possibility and professional help should be sought.

The disturbance in behaviour causes clinically significant impairment in social, academic, or occupational functioning.

There are 2 sub-types of CD:

Childhood-Onset Type

This sub-type is characterised by the onset of at least one criterion characteristic of CD prior to age 10 years.

Adolescent-Onset Type

This sub-type is defined by the absence of any criteria characteristic of Conduct Disorder prior to age 10 years.

If the individual is age 18 years or older, criteria are met for Antisocial Personality Disorder.

CD is one of a group of behavioural disorders known collectively as Disruptive Behaviour Disorders, which include Oppositional Defiant Disorder (ODD), and ADHD.

Early intervention and treatment are important, since children with untreated CD are at increased risk of developing a range of problems during their adult years including substance use, personality disorders and mental illnesses.

It is vitally important for the adults/authority figures to handle children with CD appropriately. There are great ideas in the Dr Ross Greene book - The Explosive Child or Lost at School. Dr Greene believes that disruptive and challenging behaviours are a result of a child being unable to meet expectations due to lagging skills and these lagging skills must be investigated and accommodated. He suggests a child may be developmentally delayed with regard to flexibility, adaptability and frustration tolerance or lack crucial cognitive and emotional skills. If they have ADHD they will have problems with executive functioning skills relating to planning, initiating and carrying out actions, which can lead to the development of CD.

On the other hand Dr William Walsh believes that disruptive behaviour can be caused by certain nutrient deficiencies or overloads, such as excess copper, and can be treated with nutrient therapy.
Children with ADHD are 5 x as likely to have depression as children who don’t have ADHD.

Around 14% of children with ADHD also have depression.

Children diagnosed with depression are at a higher risk for also having ADHD.

Because depression is a serious and common co-morbidity it deserves it's own page here.
The comorbidity of Developmental Coordination Disorder (DCD) and ADHD is as high as 50%.

DCD is a neurodevelopmental and chronic physical health condition with persisting motor problems, which restrict the ability of a child to perform daily activities such as tying shoelaces and writing but also in physical activities with peers. Dyslexia and poor handwriting are often associated with DCD.

Lower confidence in their physical ability to participate in peer activities leads to children with DCD reporting fewer friendships and more bullying.

Practitioners should incorporate screening for DCD when evaluating students with a suspected ADHD diagnosis.
Disruptive Mood Dysregulation Disorder (DMDD) was a new diagnosis in the DSMV in 2013.

DMDD is highly co-morbid with ADHD with one study finding 87% of DMDD children also had ADHD.

DMDD is characterised by a chronic dysphoria associated with a minimum of three severe anger episodes per week over a period of a year. Anger episodes are associated with severe and persistent irritability.
Up to 50% of children with ADHD may also have dysgraphia - a condition that affects their ability to organise numbers and letters and causes difficulties in keeping words on a straight line.
Roughly 40% of children with ADHD also have Dyslexia.

Symptoms can seem to overlap as children with Dyslexia may fidget or act out in class because of frustrations over reading/writing and ADHD can make it difficult to focus during reading or other activities.

Dyslexia is the most common learning issue and although it’s not clear what percentage of kids have it, some experts believe the number is between 5-10%.

Dyslexia is a neurobiological specific learning disability characterized by difficulties with accuracy and fluency in word recognition and poor spelling and decoding abilities.

Secondary problems may include problems in reading comprehension and reduced reading experience, which can affect growth in vocabulary and background knowledge.

Dyslexia impacts learning but it is not an indicator of intelligence.

Children with dyslexia may have trouble answering questions about something they’ve read. But when it’s read to them, may have no difficulty at all.

Dyslexia can create difficulty with other skills such as writing and maths.

Dyslexia is a lifelong condition but there are supports, teaching approaches and strategies to help overcome the challenges.

Dyslexia can also impact other areas too, such as social interaction, memory and emotional regulation.

Here are some common signs of dyslexia:


  • Trouble recognising whether two words rhyme
  • Struggles with taking away the beginning sound from a word
  • Struggles with learning new words
  • Has trouble recognising letters and matching them to sounds

Primary School

  • Trouble taking away middle sounds from words/blending several sounds
  • Often doesn’t recognise common sight words
  • Studies how to spell words but quickly forgets
  • Difficulties with word problems in maths
  • Makes frequent spelling errors
  • Frequently has to re-read sentences and passages
  • Reads at a lower academic level than how she speaks

High School

  • Frequently misses small words when reading aloud
  • Reading at below expected grade level
  • Strong preference for multiple-choice questions over written answers.
ADHD has been found to be a predictive factor of eating disorders (ED), especially in girls.

In a study, patients with ADHD had a 1.82 times greater risk of developing an easting disorder compared to those without ADHD.

Bulimia nervosa and binge eating disorder, which are associated with impulsive behaviours, are the most frequently found in those with ADHD.

Eating can become a way of managing anxiety, fatigue or inner restlessness when under-stimulated, and so on.

Different studies have hypothesized about the link between obesity and ADHD.

One hypothesis is that dopamine comes into play in both conditions, thus linking them together.

Dopamine levels in the brain increase when food is present. Dopamine is linked to the reward system, causing a person to feel happy when there is an increase in levels. By activating the dopaminergic pathways, eating becomes a pleasurable task.

As those with ADHD have lower dopamine levels, any action that increases the dopamine levels, such as eating, will be appealing for those with ADHD. Because of the satisfaction that comes from eating, those with ADHD may use food to self-medicate and increase dopamine levels. This overeating can lead to obesity if not monitored.
Enuresis is defined as the failure of voluntary control of the urethral sphincter.

Bedwetting affects 15–20% in the child population but children with ADHD had a 2.7 times higher incidence of enuresis and a 4.5 times higher incidence of daytime enuresis. It is not currently known why children with ADHD are more prone to this issue. Some researchers believe it may be because both conditions are linked to a delay in the development of the central nervous system or that children with ADHD find it more difficult to pay attention to their bodily cues.

If this is happening to your child seek advice from your GP in the first instance.
Executive Function Difficulties refers to a weakness in key mental skills responsible for memory, organisation, attention, time management and flexible thinking.

Children with ADHD also struggle with these skills but the difference is that ADHD is an official diagnosis whereas Executive Functioning Difficulties is not.

Many children with Learning Difficulties also have Executive Functioning Difficulties or struggle with one or more of these key skills but may not be diagnosed with ADHD.

Symptoms include:

  • Has a hard time paying attention
  • Has difficulty with self-control
  • Has trouble managing emotions
  • Has difficulty holding information in working memory
  • Has trouble switching easily from one activity to another
  • Has trouble getting started on tasks
  • Has problems organizing his time and materials
  • Has difficulty keeping track of what he’s doing
  • Has difficulty completing long-term projects
  • Has trouble with thinking before acting
  • Is easily distracted and often forgetful
  • Has trouble waiting his turn
  • Has problems remembering what he’s been asked to do
Gross motor skills are large movements, such as running.

Fine motor skills are small movements, such as writing.

Researchers report more than 50% of children with ADHD also have problems with gross and fine motor skills.

As a result many studies have linked ADHD with poor handwriting, which can make it hard for them to write quickly and clearly. Their work may be labelled as messy and may lead to feelings of frustration, avoidance of schoolwork and low self-esteem.

Poor handwriting can also be a sign of other developmental disorders such as:

  • Development Coordination Disorder
  • Written language disorder
  • Dysgraphia

A good Occupational Therapist will help to pinpoint exactly what the problem is and special motor skills training might help your child develop better fine and gross motor coordination.
Children with ADHD are significantly more likely to suffer from digestive complaints such as chronic constipation and faecal incontinence than those without ADHD.

A study of more than 700,000 children found that among children with ADHD the incidence of constipation was nearly tripled and faecal incontinence increased six-fold compared to children without ADHD.

Faecal incontinence is a severe form of constipation where the constipation worsens over time causing faecal matter to overflow and leak out.

Some suggest children with ADHD have lost the normal cue to empty their bowels or become distracted because of their ADHD and this leakage occurs as a result, but faecal incontinence occurs in those suffering chronic constipation that don’t have ADHD.

Many children, especially teenagers, won’t discuss their toilet habits or what their stool looks like with you. But you need to know! Often children become used to the way things are and accept them as normal when they are not!

If you notice your child is suffering from constipation first steps are to:

  • Increase fibre (if constipation not too severe)
  • Drink more water
  • Get plenty of exercise
  • Allow a regular, un-rushed time for children to go to the toilet
  • Use a toilet step such as as the Aussie Squatter, which is critical for providing the correct posture for elimination, particularly for children who are smaller and therefore sit on the toilet with their feet swinging in mid air!
  • Increase intake of Vitamin C or Magnesium
  • Avoid the prolonged use of laxatives – find the root cause of the problem

If these initial steps don’t improve the situation you should see an integrative GP or naturopath who is experienced in treating the root cause of constipation, which may be caused by gut dysbiosis, SIBO or a food intolerance.

Identifying and rectifying any gut issues is a vital step in creating strong foundations for brain health and mental wellbeing.

Never simply accept that poor digestive function is normal or ‘just the way you are’ or a diagnosis of IBS. There is always a cause which should never be overlooked.

We are increasingly recognising the microorganisms in our intestines – the gut micro biome - and their impact on human health, including brain functioning.

For example, ADHD is a neurodevelopmental disorder associated with abnormalities in dopamine neurotransmission and deficits in reward processing so a study that showed there was a lesser amount of the bacteria associated with dopamine precursor synthesis in those with ADHD than in those without ADHD should be noted.
Non-verbal Learning Disabilities (NVLD) often co-occur with ADHD. Both can impact on learning and social skills, but although some of their symptoms are similar, there are some important differences between them.

NVLD is a brain-based learning issue affecting social and spatial skills, which can then impact on maths skills too.

Signs include some but not all:

  • Talks a lot
  • May interrupt people due to misread social clues such as body language
  • Seems oblivious to people’s reactions
  • Doesn’t get sarcasm and jokes
  • Acts in socially inappropriate ways
  • Stands too close to people
  • May have poor balance/coordination and appear physically awkward
  • Easily memorises information but may not know why it’s important
  • Has trouble adjusting to change; can be inflexible
  • May avoid or be fearful in new situations.

These social issues means making and keeping friends is challenging and the feelings of social rejection can impact self-esteem.
Children with Obsessive Compulsive Disorder (OCD) have ADHD in 33% of the cases.

Obsessive Compulsive Disorder (OCD) is a serious anxiety-related condition where a person experiences frequent intrusive and unwelcome obsessional thoughts, often followed by repetitive compulsions, impulses or urges.

OCD presents itself in many guises, and extends beyond the common perception that OCD is merely hand washing or checking light switches.

In general, OCD sufferers experience obsessions, which take the form of persistent and uncontrollable thoughts, images, impulses, worries, fears or doubts.

These obsessions are often intrusive, unwanted and disturbing, significantly interfering with the ability to function on a daily basis, as they are incredibly difficult to ignore.

People with OCD usually understand their obsessional thoughts are irrational, but believe the only way to relieve the anxiety caused by them is to perform compulsive behaviours, often to prevent perceived harm happening to themselves or, more often than not, to a loved one.

Compulsions are repetitive, physical behaviours and actions or mental thought rituals that are performed over and over again in an attempt to relieve the anxiety caused by the obsessional thoughts.

Avoidance of places or situations to prevent triggering these obsessive thoughts is also considered to be a compulsion.

Typically OCD falls into one of four main categories:

  • Checking
  • Contamination/Mental Contamination
  • Hoarding
  • Ruminations/Intrusive Thoughts

To some degree most OCD-type people probably experience symptoms, at one time or another. However, OCD itself can have a totally devastating impact on a person’s entire life, from education, work and career to social life and personal relationships.

The key difference distinguishing little quirks from a clinical diagnosis of OCD is when the distressing and unwanted experience of obsessions and compulsions impacts significantly on a person’s daily life.

OCD is diagnosed when the obsessions and compulsions:

  • Consume excessive amounts of time (approx. 1 hour +)
  • Cause significant distress and anguish
  • Interfere with daily functioning at home, school or work, including social activities and family life and relationships.

OCD is indeed a chronic, but also a very treatable medical condition. Most people can learn to stop performing their compulsive rituals and to decrease the intensity of their obsessional thoughts through Cognitive Behavioural Therapy (CBT).

Although treatment differs for ADHD and OCD, they should take place simultaneously.

Current research suggests that symptoms of OCD have been associated with PANDAS - at least in some cases.

PANDAS results from the effect of the body's own immune system's antibodies attacking parts of the brain.

PANDAS is a little known illness resulting in the sudden onset of mental health issues.

PANDAS is an acronym for a condition called Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS).

The onset of PANDAS usually occurs following an ear, nose or throat (ENT) infection from Group A Beta Haemolytic Streptococcus (GABHS).

GABHS antibodies in some cases can damage parts of the brain resulting in a range of behavioural disorders such as OCD, Oppositional Defiant Disorder, Tourette’s, ADHD and even psychosis.
The co-morbid condition of Oppositional Defiant Disorder (ODD) occurs in around a third to a half of children with ADHD.

ODD behavioural problems at a young age may predispose children to bullying involvement in early primary school.

Most children can be difficult and challenging at times and the difference between an emotional or strong-willed child and one with ODD might be hard to distinguish sometimes. Indeed, oppositional behaviour can be perfectly normal at certain developmental stages such as with toddler tantrums or teenagers. However, if your child or teen displays tantrums, argumentative and angry or disruptive behaviour toward you and other authority figures persistently, he or she may have Oppositional Defiant Disorder (ODD).

ODD almost always develops before the early teen years with signs of ODD generally beginning before a child is 8 years old, although sometimes it may develop later.

The signs of ODD behaviour generally tend to begin gradually and worsen over months or years.

What behaviours are associated with ODD?

  • Negativity
  • Defiance
  • Disobedience
  • Hostility directed toward authority figures

What do ODD symptoms look like?

  • Having temper tantrums
  • Being argumentative with adults
  • Refusing to comply with adult requests or rules
  • Deliberately annoying other people
  • Blaming others for mistakes/misbehaviour
  • Becoming annoyed easily
  • Feeling angry and resentful
  • Acting spitefully or vindictively
  • Act aggressively toward peers
  • Finding maintaining friendships difficult
  • Having academic problems
  • Lacking self-esteem
  • Not seeing his/her behaviour as defiant
  • Believing unreasonable demands are being made of him/her

For a diagnosis to be made the symptoms and behaviours must:

  • Be persistent
  • Have lasted at least 6 months
  • Be disruptive to the family and home or school environment

Up to 30% of children diagnosed with ODD may go on to develop Conduct Disorder.

It is vitally important for the adults/authority figures to handle children with ODD appropriately. There are great ideas in the Dr Ross Greene book - The Explosive Child or Lost at School. Dr Greene believes that disruptive and challenging behaviours are a result of a child being unable to meet expectations due to lagging skills and these lagging skills must be investigated and accommodated. He suggests a child may be developmentally delayed with regard to flexibility, adaptability and frustration tolerance or lack crucial cognitive and emotional skills. If they have ADHD they will have problems with executive functioning skills relating to planning, initiating and carrying out actions, which can lead to the development of ODD.

On the other hand Dr William Walsh believes that disruptive behaviour can be caused by certain nutrient deficiencies or overloads, such as excess copper, and can be treated with nutrient therapy.

Current research suggests that symptoms of ODD have been associated with PANDAS - at least in some cases.

PANDAS results from the effect of the body's own immune system's antibodies attacking parts of the brain.

PANDAS is a little known illness resulting in the sudden onset of mental health issues.

PANDAS is an acronym for a condition called Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS).

The onset of PANDAS usually occurs following an ear, nose or throat (ENT) infection from Group A Beta Haemolytic Streptococcus (GABHS).

GABHS antibodies in some cases can damage parts of the brain resulting in a range of behavioural disorders such as OCD, Oppositional Defiant Disorder, Tourette’s, ADHD and even psychosis.
The prevalence of PTSD with ADHD is around 5% and this increases to just over 20% in sexually abused children.

Similarities in the symptoms of ADHD and PTSD make the differential diagnosis confusing and can lead to misdiagnosis.

Symptoms include:

  • Hyper arousal
  • Hyper vigilance
  • Irritability
  • Sleep disorders
  • Inattention
  • Executive dysfunctions

Consequently, during the diagnostic interview, the patient’s history should be thoroughly reviewed to ensure no traumatic events are missed. The consequences of a misdiagnosis may include inadequate treatment, such as potentially harmful interventions that focus on ADHD rather than PTSD.
Rejection sensitivity is part of ADHD and almost 100% of people with ADHD experience rejection sensitivity.

It is comforting for parents to know there is a name for this feeling!

Rejection Sensitive Dysphoria (RSD) is an extreme emotional sensitivity and emotional pain triggered by the perception of being been rejected, teased, or criticized by someone important in your life. The emotional response seems to hurt more than it does for people without the condition.

Failing to meet your own, or others’ high standards and expectations can also trigger RSD.

An external response to this emotion can be instantaneous rage towards the person responsible for causing the pain.

An internal response to this emotion can look like a mood disorder and a person can go from feeling perfectly find to intensely sad very quickly, which can be mistaken for Borderline Personality Disorder (BPD).

Because RSD can make people with ADHD anticipate any possible rejection they become hyper-vigilant which can often be mistaken for social anxiety - an intense fear that you may humiliate or embarrass yourself in public and be harshly judged because of it.

This can play out in two ways – becoming afraid to try for fear of failing and underachieving in life or becoming perfectionistic – constantly driven to achieve more, be above criticism/reproach and striving for an unattainable perfection
There is a greater presence of ADHD symptomatology in Schizophrenia compared to that reported for ADHD in the general population.

Schizophrenia is a mental health disorder that can interfere with your ability to:

  • Make decisions
  • Think clearly
  • Control your emotions
  • Relate to others socially

While some of the defining characteristics can seem similar to ADHD, they’re two very different disorders.

The symptoms of schizophrenia must occur for over six months. They may include the following:

  • Having hallucinations in which you hear voices, or see or smell things that aren’t real, but seem real to you.
  • Having delusions - false beliefs about everyday situations .
  • Have negative symptoms, such as feeling emotionally dull or disconnected from others and wanting to withdraw from social opportunities. It may appear as if you’re depressed.
  • Have disorganized thinking, which can include having trouble with your memory or having difficulty being able to put your thoughts into words.

The possible causes of schizophrenia include:

  • Genetics
  • The environment
  • Brain chemistry
  • Substance use

10% of people who have a first-degree relative with schizophrenia have this disorder or a 50% chance if you have an identical twin who has it.
Children with ADHD have an increased risk of seizures, with approximately 14% of children with ADHD developing seizures.

ADHD is the most common co-occurring disorder in children with epilepsy. Studies suggest that 30-40 out of 100 children with epilepsy have ADHD in contrast to 7-9 out of 100 children without ADHD while nearly 20 in 100 adults with epilepsy also have ADHD compared to 2-4 out of 100 adults without ADHD.

Symptoms of ADHD may complicate a diagnosis of epilepsy, as they may be mistaken for seizures.

ADHD and Childhood Absence Epilepsy (CAE) have similarities in symptom presentation. Inattentiveness is one of the core symptoms of ADHD and it is also a common symptom in children with CAE who suffer frequent seizures. CAE symptoms frequently include periods of staring into space which could be mistaken for inattentive ADHD.

Differentiating between ADHD and CAE is of vital importance, as the misdiagnosis may cause a delay for proper treatment or lead to inappropriate medication regimens for each condition.

If a person is having seizures, treating these first should be the priority. If seizures can be controlled, some symptoms thought to be due to ADHD may improve.
Most people develop normal sensory functioning but around 10% of children develop Sensory Processing Disorder (SPD).

In children who are also ADHD, ASD, Gifted or have Fragile X Syndrome the prevalence of SPD is much higher.

Studies suggest that the sympathetic and parasympathetic nervous systems are not functioning as they should in children with SPD.

Primitive reflexes are evolutionary reflexes important in the early days, months or years of life – their purpose being to support a baby’s survival. However, if for some reason these reflexes are retained beyond 12 months of life, they may suggest evidence of a structural weakness or immaturity of the central nervous system (CNS) and may cause some of the symptoms of sensory processing disorder.

SPD can affect all areas of life such as feeling anxious in/avoiding crowded and noisy places or having peers avoid children because they play too roughly or don’t respect their personal space.

The causes can be unclear but risk factors (apart from those mentioned above) include:

  • Maternal deprivation
  • Premature birth
  • Prenatal malnutrition
  • Early institutional care
  • Repeated ear infections before age 2
  • Retained Primitive Reflexes

Symptoms of SPD


  • Trouble focusing – can’t filter out distractions
  • Dislikes being touched
  • Notices sound/smells others don’t
  • Has meltdowns, flees or becomes upset in noisy crowded places
  • Fears for his safety even when there’s no real danger
  • Has difficulty with new routines, new places and other change
  • Shifts and moves around because he can’t get comfortable
  • Is very sensitive to the way clothing feels


  • Constantly needs to touch people or things
  • Has trouble gauging others’ personal space
  • Seems clumsy or uncoordinated
  • Shows a high tolerance to pain
  • Plays roughly and takes physical risks
Research suggests children with ADHD have extensive sleep disturbances and that they not only co-occur, but are intrinsic to ADHD.

Children with sleep disturbances often display behavioural patterns that resemble some features of ADHD so it is often difficult to pinpoint which of the disorders is the primary and which a by-product of the other.

Therefore, it is critical for health providers to correctly identify the exact abnormality in sleep disturbance as successful treatment depends on an accurate diagnosis.

Evidence showed that in ADHD children, despite no difference in actual sleep time, there was a consistent trend for poorer sleep quality resulting in a worsening of their ADHD symptoms.

Research shows successful management of sleep disturbances results in considerable improvement in the level of daytime impairment, which is crucial. One study showed sleep disorders lasting for one week or longer may cause significant emotional disorder or compromise cognitive function. Another showed that sleep problems were associated with greater student-teacher conflict and that daytime sleepiness was associated with less student-teacher closeness.

Clinicians should consider sleep disordered breathing, as there is evidence that treatment of Obstructive Sleep Apnea Hypopnea Syndrome (OSAHS) may cause relief from symptoms of ADHD in 81% of OSAHS children with ADHD. Research also found that effective treatment of snoring can relieve ADHD symptoms in 25% of children with both presentations, suggesting that hypoxia may play an important role in producing symptoms of ADHD.

The incidence of ADHD is higher than 30% in OSAHS children and increases over age in OSAHS children. Therefore, OSAHS should be treated as early as possible to reduce the incidence of ADHD symptoms.

Unfortunately, stimulant medications used in the treatment of ADHD can sometimes adversely affect sleep quality such as sleep-onset delay, shorter sleep duration and night awakenings. Stimulant medication has been found to lead to longer sleep latency, worse sleep efficiency, and shorter sleep duration. It is recommended that paediatricians carefully monitor sleep problems and adjust any medications to promote optimal sleep.

Good sleep hygiene should be observed by everyone for optimal health, but is particularly important for those with ADHD since, as we saw above, sleep problems are common and lack of sleep exacerbates symptoms.

Research shows that using media devices at night may contribute to sleep problems and co-morbid internalising symptoms in adolescents with ADHD. Nighttime media use was associated with shorter sleep duration and increased sleep problems, greater adolescent reported anxiety and depression and greater daytime sleepiness as well as greater adolescent-reported panic symptoms and parent-reported anxiety disorder symptoms.

Apart from minimising the use of screens and blue light in the evening environment, one suggestion is to wear blue light blocking glasses (red/amber lenses) at night to block the blue light from the surrounding environment.

In addition, getting plenty of natural light during the day was also found to be effective for re-setting circadian rhythms, reducing sleep disturbances and bringing overall improvement in ADHD symptoms.

Other tips for improved sleep quality are:

  • Taking a warm Epsom Salts bath
  • Massage
  • Essential Oils
  • Magnesium
  • Breathing Techniques
  • Meditation
  • Completely dark sleep environment
  • Remove electronics/devices from the bedroom
  • Dim red-lit environment in the evenings
  • Binaural beats
  • Weighted blankets
Slow processing speed isn’t a learning or attention issue on its own but it can contribute to learning and attention issues.

It can also impact executive functioning skills.

Processing speed is the pace at which you take in information, make sense of it and begin to respond. This information can be visual, such as letters and numbers. It can also be auditory, such as spoken language.

It may take kids who struggle with processing speed a lot longer than other kids to perform tasks, both school-related and in daily life for example, they may have trouble getting started on assignments, staying focused and monitoring how well they’re doing.

Slow processing speed impacts learning at all stages. It can make it harder for young children to master the basics of reading, writing and counting. And it impacts older kids’ ability to perform tasks quickly and accurately.

Slow processing speed can affect kids in the classroom, at home and during activities like sports.

Children might have trouble with:

  • Finishing tests in the allotted time
  • Finishing homework in the expected time frame
  • Listening or taking notes when a teacher is speaking
  • Reading and taking notes
  • Solving simple math problems in their head
  • Completing multi-step math problems in the allotted time
  • Doing written projects that require details and complex thoughts
  • Keeping up with conversations
  • Becoming overwhelmed by too much information at once
  • Missing nuances in a conversation
  • Executing multiple instructions
  • Needing to read information more than once for comprehension
  • Needing more time to make decisions or give answers

Having slow processing speed has nothing to do with how smart kids are—just how fast they can take in and use information.
ADHD itself is not a specific learning disability but because ADHD affects concentration and focus, this obviously makes learning more difficult.

If a specific learning difficulty is present alongside ADHD this compounds a child’s problems further.

Children with ADHD are 40% more likely to have a specific learning disability than children without ADHD.

The specific learning disabilities common in children with ADHD are difficulties with language, reading, writing and maths.

It is vital these be diagnosed in addition to ADHD in order for these problems to be supported appropriately.

A child whose achievements are falling below what would be expected for their age, intelligence level and prior schooling needs specific, individually administered, standardised testing to diagnose potential learning problems.

Professionals assessing patients for ADHD should also enquire about SLD and vice versa.

Children with SLD should be screened for other disorders such as auditory processing, motor disorders and speech & language difficulties.

It is important to distinguish difficulties linked to ADHD from difficulties due to SLD.
Children with speech & language disorders often have difficulties processing information and/or getting their words out.

Children with ADHD often have similar problems.

The symptoms can be so similar it can be hard to tell whether the main issue is an attention issue or a language disorder. Because children with ADHD can have difficulty with hyperactivity, distractibility, impulsivity and inattention their language and communication can be affected, for example, by interrupting others, having trouble finding words, speaking too loudly or out of turn, filtering out background noise, losing track of the conversation or taking things out of context.

Speech and language are two separate entities.

Speech is how we form the words we say and there are four elements of speech:

  • Articulation - making sounds.
  • Phonology - how the sounds of language are put together to make words.
  • Voice - the pitch, volume and quality of speech
  • Fluency - the flow of speech.

Language is how we put words together to communicate.

It’s also how we understand the words other people put together.

Language involves vocabulary—being able to find the right words and know what they mean—and knowing the rules for using words in sentences.

Language also includes pragmatics – a social understanding of using language i.e. the ability to have conversations, “read” other people’s facial expressions, body language and tone of voice.

There are three kinds of language disorders.

  • Receptive language issues - difficulty understanding what others are saying.
  • Expressive language issues - difficulty expressing thoughts and ideas.
  • Mixed receptive-expressive language issues - difficulty understanding and using spoken language.

    If your child has ADHD, it’s likely he also struggles with some aspect of speech or language. To find strategies to help him succeed, it’s a good idea to speak with their teacher or find a good speech pathologist.
  • ADHD can often impact social skills. Children who have ADHD typically have fewer friends, are less likely to be accepted by their peers and are more likely to experience social rejection during their teenage years, regardless of whether or not their symptoms of ADHD continue.

    This happens for several reasons as children with ADHD:

    • Miss social cues
    • Don’t notice how their behaviour is affecting others
    • May interrupt others
    • May misinterpret what others are saying
    • May be distracted by unrelated thoughts
    • May have difficulty filtering what others are saying
    • Easily lose the thread of a conversation
    • May have difficulty taking turns and waiting for things
    • Struggle with self-control
    • May be more intense or demanding
    • Have trouble planning and following through
    • May be more aggressive & lash out physically
    • May have meltdowns and behaviour not appropriate to their age group

    This is not true for all children with ADHD but it is common. Many ADHD children have plenty of friends, have no language difficulties and are extremely charismatic.

    They often find slightly older or younger people easier to get along with as their emotional age can be a couple of years behind their chronological age.
    50% of adolescents with SUD also have ADHD.

    Cannabis, alcohol, cocaine and nicotine are the substances consumed the most, but stimulants are also frequently misused.

    It is thought this is due to impulsivity, self-medication and addictive tendencies, which are also common in ADHD due to the dopamine-boosting properties of many of the substances. Other psychosocial factors are academic failure, social problems or permissive parenting styles.
    Statistics show that as many as 50% of children with ADHD may also have Tourette Syndrome or a tic disorder.

    Tourette Syndrome (TS) is a neurological disorder characterised by involuntary, irresistible, rapid, repetitive and involuntary muscle movements and vocalisations called “tics”, and can also often involve behavioural difficulties.

    Although the term “involuntary” is used to describe tics, most people with TS do have some control over their symptoms. However, this control can only be exerted for seconds or hours at a time and this merely delays a later more severe outburst of symptoms.

    Tics can be described as a build up of tension that are irresistible and must eventually be performed. With greater stress/tension tics generally increase and decrease with greater relaxation or concentration on an absorbing task.

    TS symptoms are often thought to be a sign of behavioural abnormality or “nervous habits”, which they are not.

    The two categories of the tics of TS and some common examples are:



    • Eye blinking
    • Head jerking
    • Shoulder shrugging
    • Facial grimacing
    • Nose twitching


    • Throat clearing
    • Barking noises
    • Squealing
    • Grunting
    • Gulping
    • Sniffing
    • Tongue clicking



    • Jumping
    • Touching other people and things
    • Twirling about
    • Repetitive movements of the torso or limbs
    • Pulling at clothing; and
    • Self-injurious actions including hitting or biting oneself


    • Uttering words or phrases
    • Coprolalia (the involuntary utterance of inappropriate or obscene words)
    • Echoalia (repeating a sound, word or phrase just heard); or
    • Palilalia (repeating one’s own words)

    There is an enormous variety and complexity of tics or tic-like symptoms seen in TS. People with TS rarely have all of these symptoms but will show some of the symptoms to varying degrees over a long period of time. The symptoms can vary in degree each day.

    In mild cases a person will have a few tics or twitches perhaps confined to the face, eye and shoulder areas, whereas in more severe cases, multiple areas of the body may be affected.

    If a child has tics and ADHD, taking ADHD medications will make it worse more than 50% of the time. In addition, tics can be a side effect of taking ADHD medications such as methylphenidate (Ritalin). In many instances, these tics go away after the medication is discontinued or changed.

    PANDAS is an acronym for a condition called Paediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcus (PANDAS).

    Current research suggests that symptoms of Tourette’s and OCD have been associated with PANDAS at least in some cases.

    PANDAS results from the effect of the body's own immune system's antibodies attacking parts of the brain.

    The onset usually occurs following an ear, nose or throat (ENT) infection from Group A Beta Haemolytic Streptococcus (GABHS). GABHS antibodies in some cases can damage parts of the brain resulting in a range of behavioural disorders. OCD, Oppositional Defiant Disorder, Tourette’s, ADHD and even psychosis.
    Research has found a link between ADHD and Written Language Disorder (WLD). It was found that girls with ADHD are at higher risk of WLD and reading disabilities than boys.

    It is a condition that can cause poor handwriting and for children to become developmentally behind their peers in reading, spelling or writing skills but does not affect overall intelligence.

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