Abstract
The present study aimed at identifying the full range of mental disorders comorbid to attention-deficit/hyperactivity disorder (ADHD) in children and adolescents (age 4–17) diagnosed in Danish psychiatric hospitals between 1995 and 2010. A total of 14,825 patients were included in the study and comorbid disorders diagnosed concurrent with ADHD were identified. Associations of comorbid disorders with sex, age, and other mental disorders were investigated by logistic regression analysis. In the total sample, 52.0 % of the patients had at least one psychiatric disorder comorbid to ADHD and 26.2 % had two or more comorbid disorders. The most frequent comorbid disorders were disorders of conduct (16.5 %), specific developmental disorders of language, learning and motor development (15.4 %), autism spectrum disorders (12.4 %), and intellectual disability (7.9 %). Male sex was generally associated with an increased risk for neuropsychiatric disorders while female sex was associated more frequently with internalizing disorders. The analysis of associations between the various comorbid disorders identified several clusters highlighting the differential developmental trajectories seen in patients with ADHD. The study provides evidence that comorbidity with mental disorders is developmentally sensitive. Furthermore, the study shows that particular attention should be given to patients with neurodevelopmental disorders such as autism and intellectual disability in future longitudinal analyses. These disorders are very frequent in patients with ADHD, and the affected patients might follow a different course than patients without these disorders.
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A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal treatment study of children with ADHD (1999). Arch Gen Psychiatry 56:1073–1086
Abikoff HB, Jensen PS, Arnold LL, Hoza B, Hechtman L, Pollack S et al (2002) Observed classroom behaviour of children with ADHD: relationship to gender and comorbidity. J Abnorm Child Psychol 30:349–359
Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40:57–87
August GJ, Garfinkel BD (1990) Comorbidity of ADHD and reading disability among clinic-referred children. J Abnorm Child Psychol 18:29–45
Barkley RA, Fischer M, Smallish L, Fletcher K (2004) Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry 45:195–211
Bauermeister JJ, Shrout PE, Ramirez R, Bravo M, Alegria M, Martinez-Taboas A et al (2007) ADHD correlates, comorbidity, and impairment in community and treated samples of children and adolescents. J Abnorm Child Psychol 35:883–898
Bellani M, Moretti A, Perlini C, Brambilla P (2011) Language disturbances in ADHD. Epidemiol Psychiatr Sci 20:311–315
Biederman J, Monuteaux MC, Mick E, Spencer T, Wilens TE, Silva JM et al (2006) Young adult outcome of attention deficit hyperactivity disorder: a controlled 10-year follow-up study. Psychol Med 36:167–179
Biederman J, Petty CR, Dolan C, Hughes S, Mick E, Monuteaux MC et al (2008) The long-term longitudinal course of oppositional defiant disorder and conduct disorder in ADHD boys: findings from a controlled 10-year prospective longitudinal follow-up study. Psychol Med 38:1027–1036
Boden JM, Fergusson DM, Horwood LJ (2010) Risk factors for conduct disorder and oppositional/defiant disorder: evidence from a New Zealand birth cohort. J Am Acad Child Adolesc Psychiatry 49:1125–1133
Campbell M, Malone RP (1991) Mental retardation and psychiatric disorders. Hosp Community Psychiatry 42:374–379
Costello EJ, Erkanli A, Federman E, Angold A (1999) Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex. J Clin Child Psychol 28:298–311
Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60:837–844
Elia J, Arcos-Burgos M, Bolton KL, Ambrosini PJ, Berrettini W, Muenke M (2009) ADHD latent class clusters: DSM-IV subtypes and comorbidity. Psychiatry Res 170:192–198
Elkins IJ, McGue M, Iacono WG (2007) Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry 64:1145–1152
Ellington EE, McGuinness TM (2012) Mental health considerations in pediatric enuresis. J Psychosoc Nurs Ment Health Serv 50:40–45
Faber A, Kalverdijk LJ, de Jong-van den Berg LT, Hugtenburg JG, Minderaa RB, Tobi H (2010) Co-morbidity and patterns of care in stimulant-treated children with ADHD in the Netherlands. Eur Child Adolesc Psychiatry 19:159–166
Freeman RD (2007) Tic disorders and ADHD: answers from a world-wide clinical dataset on Tourette syndrome. Eur Child Adolesc Psychiatry 16(Suppl 1):15–23
Freitag CM, Hanig S, Schneider A, Seitz C, Palmason H, Retz W et al (2012) Biological and psychosocial environmental risk factors influence symptom severity and psychiatric comorbidity in children with ADHD. J Neural Transm 119:81–94
Germano E, Gagliano A, Curatolo P (2010) Comorbidity of ADHD and dyslexia. Dev Neuropsychol 35:475–493
Ghanizadeh A (2009) Psychiatric comorbidity differences in clinic-referred children and adolescents with ADHD according to the subtypes and gender. J Child Neurol 24:679–684
Ghanizadeh A (2010) Comorbidity of enuresis in children with attention-deficit/hyperactivity disorder. J Atten Disord 13:464–467
Gillberg C, Wahlstrom J, Forsman A, Hellgren L, Gillberg IC (1986) Teenage psychoses–epidemiology, classification and reduced optimality in the pre-, peri- and neonatal periods. J Child Psychol Psychiatr 27:87–98
Hinshaw SP (2002) Preadolescent girls with attention-deficit/hyperactivity disorder: I. Background characteristics, comorbidity, cognitive and social functioning, and parenting practices. J Consult Clin Psychol 70:1086–1098
Hoek HW, van Hoeken D (2003) Review of the prevalence and incidence of eating disorders. Int J Eat Disord 34:383–396
IBM Corp (2010) IBM SPSS statistics for windows. (Version 19.0) [Computer software]. Armonk, NY
Jensen PS, Martin D, Cantwell DP (1997) Comorbidity in ADHD: implications for research, practice, and DSM-V. J Am Acad Child Adolesc Psychiatry 36:1065–1079
Kadesjo B, Gillberg C (2001) The comorbidity of ADHD in the general population of Swedish school-age children. J Child Psychol Psychiatr 42:487–492
Kessing L (1998) Validity of diagnoses and other clinical register data in patients with affective disorder. Eur Psychiatry 13:392–398
Kraut AA, Langner I, Lindemann C, Banaschewski T, Petermann U, Petermann F et al (2013) Comorbidities in ADHD children treated with methylphenidate: a database study. BMC Psychiatry 13:11
Larson K, Russ SA, Kahn RS, Halfon N (2011) Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics 127:462–470
Lauritsen MB, Jorgensen M, Madsen KM, Lemcke S, Toft S, Grove J et al (2010) Validity of childhood autism in the Danish Psychiatric Central Register: findings from a cohort sample born 1990–1999. J Autism Dev Disord 40:139–148
Levy F, Hay DA, Bennett KS, McStephen M (2005) Gender differences in ADHD subtype comorbidity. J Am Acad Child Adolesc Psychiatry 44:368–376
Loffler W, Hafner H, Fatkenheuer B, Maurer K, Riecher-Rossler A, Lutzhoft J et al (1994) Validation of Danish case register diagnosis for schizophrenia. Acta Psychiatr Scand 90:196–203
Mezzich JE (2002) International surveys on the use of ICD-10 and related diagnostic systems. Psychopathology 35:72–75
Miller CJ, Flory JD, Miller SR, Harty SC, Newcorn JH, Halperin JM (2008) Childhood attention-deficit/hyperactivity disorder and the emergence of personality disorders in adolescence: a prospective follow-up study. J Clin Psychiatry 69:1477–1484
Mors O, Perto GP, Mortensen PB (2011) The Danish Psychiatric Central Research Register. Scand J Public Health 39:54–57
Munk-Jorgensen P, Ostergaard SD (2011) Register-based studies of mental disorders. Scand J Public Health 39:170–174
Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, Levy SE et al (2007) The epidemiology of autism spectrum disorders. Annu Rev Public Health 28:235–258
Pliszka SR (2000) Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 9:525–540, vii
Roeleveld N, Zielhuis GA, Gabreels F (1997) The prevalence of mental retardation: a critical review of recent literature. Dev Med Child Neurol 39:125–132
Rutgers AH, van Ijzendoorn MH, Bakermans-Kranenburg MJ, Swinkels SH et al (2007) Autism, attachment and parenting: a comparison of children with autism spectrum disorder, mental retardation, language disorder, and non-clinical children. J Abnorm Child Psychol 35:859–870
Rutter M (2011) Response: growing consensus on classification needs. J Child Psychol Psychiatry 52(6):673–675
Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry 47:921–929
Smalley SL, McGough JJ, Moilanen IK, Loo SK, Taanila A, Ebeling H et al (2007) Prevalence and psychiatric comorbidity of attention-deficit/hyperactivity disorder in an adolescent Finnish population. J Am Acad Child Adolesc Psychiatry 46:1575–1583
Spencer TJ (2006) ADHD and comorbidity in childhood. J Clin Psychiatry 67(Suppl 8):27–31
StataCorp (2009) Stata statistical software: release 11. StataCorp LP, College Station, TX
Taurines R, Schmitt J, Renner T, Conner AC, Warnke A, Romanos M (2010) Developmental comorbidity in attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord 2:267–289
van Ijzendoorn MH, Rutgers AH, Bakermans-Kranenburg MJ, Swinkels SH et al (2007) Parental sensitivity and attachment in children with autism spectrum disorder: comparison with children with mental retardation, with language delays, and with typical development. Child Dev 78:597–608
Wichstrom L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH (2012) Prevalence of psychiatric disorders in preschoolers. J Child Psychol Psychiatry 53:695–705
Willcutt EG, Pennington BF, DeFries JC (2000) Twin study of the etiology of comorbidity between reading disability and attention-deficit/hyperactivity disorder. Am J Med Genet 96:293–301
Zeanah CH, Smyke AT (2009) Attachment Disorders. In: Zeanah CH (ed) Handbook of infant mental health, 3rd edn. Guilford Press, New York, pp 421–434
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Jensen, C.M., Steinhausen, HC. Comorbid mental disorders in children and adolescents with attention-deficit/hyperactivity disorder in a large nationwide study. ADHD Atten Def Hyp Disord 7, 27–38 (2015). https://doi.org/10.1007/s12402-014-0142-1
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DOI: https://doi.org/10.1007/s12402-014-0142-1