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Comorbidity in ADHD

Comorbidity in ADHD

1.1. What is comorbidity

Comorbidity refers to mental disorders that coexist (conditionally independently) and typically often occur together.

Comorbid disorders are characterized by the fact that their joint occurrence is supercoincidental. It follows that the respective disorders must have at least partial common causes or must be mutually (co-)caused. This opens a view on the possible causes of ADHD.

Mental disorders are very common. Experts estimate a lifetime prevalence of up to 66% for mental disorders. This means that 2/3 of all people suffer from a mental disorder at some point in their lives, with many merely going undetected because those affected do not seek treatment.1

Many of the disorders listed as comorbidities under 2. for children and under 3. for adults arise in the same way as ADHD

  • Purely genetic (frequent)
  • By environmental stress alone (quite rare)
  • Due to an interaction of genes + environment (frequent)

ADHD is often accompanied by comorbid disorders. Which disorder should be treated first is likely to be determined by the degree of distress.

See ⇒ for more information Treatment prioritization for comorbidities In the article ADHD treatment guide in the chapter Treatment and therapy.

1.2. Comorbidity in ADHD

Children with ADHD are 60-100% likely to suffer from at least one psychopathological comorbidity (e.g., tic disorder, depression, social behavior disorder, and others).23
An average of 1.4 comorbidities were found in n = 174 ADHD-affected adults studied 4
Among 575 adults with ADHD, one study found 52.4% had at least one comorbidity (32.9% had one, 12.7% had two, 3.8% had three, and 3% had four comorbidities).5
One study found mental health comorbidities in 53.9% of 5,840 ADHD sufferers.6

1.3. Literature

A particularly good book on comorbidities in ADHD recommended by Müller et al:7

Brown (2009): ADHD comorbidities, Handbook for ADHD complications in children and adults. American Psychiatric Press, Washington DC

  1. Jules Angst (2001), persönlicher Brief an H. Hinterhuber, aus P. Hofmann (Hrsg.) (2002): Dysthymie. Anmerkung: Prof. Dr. Jules Angst von der Psychiatrischen Universitätsklinik Zürich gehörte während seiner aktiven Zeit als Arzt und Wissenschaftler zu den international bekanntesten und renommiertesten epidemiologisch tätigen Psychiatern. Seine oben dargestellte Überzeugung wird von vielen Fachkollegen geteilt.“ Zitiert aus Faust, DYSTHYMIE: CHRONISCHE DEPRESSIVE VERSTIMMUNG

  2. Gillberg, Gillberg, Rasmussen, Niklasson (2004): Co-existing disorders in ADHD—Implications for diagnosis and intervention; Article in European Child & Adolescent Psychiatry 13 Suppl 1(S1):I80-92 · February 2004; DOI: 10.1007/s00787-004-1008-4

  3. Schmitt (2014): Veränderungen des QEEG bei Kindern mit einer ADHS nach Neurofeedback-Training der langsamen kortikalen Potentiale; Dissertation, S. 9

  4. Müller, Candrian, Kropotov (2011): ADHS – Neurodiagnostik in der Praxis, S. 17

  5. Ohnishi, Kobayashi, Yajima, Koyama, Noguchi (2020): Psychiatric Comorbidities in Adult Attention-deficit/Hyperactivity Disorder: Prevalence and Patterns in the Routine Clinical Setting. Innov Clin Neurosci. 2019 Sep 1;16(9-10):11-16. PMID: 32082943; PMCID: PMC7009330.

  6. Slaby, Hain, Abrams, Mentch, Glessner, Sleiman, Hakonarson (2022): An electronic health record (EHR) phenotype algorithm to identify patients with attention deficit hyperactivity disorders (ADHD) and psychiatric comorbidities. J Neurodev Disord. 2022 Jun 11;14(1):37. doi: 10.1186/s11689-022-09447-9. PMID: 35690720; PMCID: PMC9188139.

  7. Müller, Candrian, Kropotov (2011): ADHS – Neurodiagnostik in der Praxis, Seite 16