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Comorbid mental disorders in children and adolescents with attention-deficit/hyperactivity disorder in a large nationwide study

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ADHD Attention Deficit and Hyperactivity Disorders

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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References

  • 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

    Article  PubMed  Google Scholar 

  • Angold A, Costello EJ, Erkanli A (1999) Comorbidity. J Child Psychol Psychiatry 40:57–87

    Article  CAS  PubMed  Google Scholar 

  • August GJ, Garfinkel BD (1990) Comorbidity of ADHD and reading disability among clinic-referred children. J Abnorm Child Psychol 18:29–45

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed Central  PubMed  Google Scholar 

  • Bellani M, Moretti A, Perlini C, Brambilla P (2011) Language disturbances in ADHD. Epidemiol Psychiatr Sci 20:311–315

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    CAS  PubMed  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • Campbell M, Malone RP (1991) Mental retardation and psychiatric disorders. Hosp Community Psychiatry 42:374–379

    CAS  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed Central  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Ellington EE, McGuinness TM (2012) Mental health considerations in pediatric enuresis. J Psychosoc Nurs Ment Health Serv 50:40–45

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Germano E, Gagliano A, Curatolo P (2010) Comorbidity of ADHD and dyslexia. Dev Neuropsychol 35:475–493

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Ghanizadeh A (2010) Comorbidity of enuresis in children with attention-deficit/hyperactivity disorder. J Atten Disord 13:464–467

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Hoek HW, van Hoeken D (2003) Review of the prevalence and incidence of eating disorders. Int J Eat Disord 34:383–396

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  CAS  Google Scholar 

  • Kessing L (1998) Validity of diagnoses and other clinical register data in patients with affective disorder. Eur Psychiatry 13:392–398

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed Central  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Levy F, Hay DA, Bennett KS, McStephen M (2005) Gender differences in ADHD subtype comorbidity. J Am Acad Child Adolesc Psychiatry 44:368–376

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • Mezzich JE (2002) International surveys on the use of ICD-10 and related diagnostic systems. Psychopathology 35:72–75

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed Central  PubMed  Google Scholar 

  • Mors O, Perto GP, Mortensen PB (2011) The Danish Psychiatric Central Research Register. Scand J Public Health 39:54–57

    Article  PubMed  Google Scholar 

  • Munk-Jorgensen P, Ostergaard SD (2011) Register-based studies of mental disorders. Scand J Public Health 39:170–174

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Rutter M (2011) Response: growing consensus on classification needs. J Child Psychol Psychiatry 52(6):673–675

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Spencer TJ (2006) ADHD and comorbidity in childhood. J Clin Psychiatry 67(Suppl 8):27–31

    PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Google Scholar 

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Correspondence to Christina Mohr Jensen.

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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

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