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Psychiatric comorbidities in ADHD

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Psychiatric comorbidities in ADHD

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Author: Ulrich Brennecke
Review 10/2024: Dipl.-Psych. Waldemar Zdero

In persons with ADHD, the following psychiatric disorders often occur in addition (comorbid), sorted in descending order of frequency with ADHD (in % of people with ADHD) compared to the frequency in non-affected persons.

Adults with the highest 10% of ADHD symptom severity according to ADHD-E were 6.99 times more likely to experience psychological distress than non-affected adults.1

The percentages in the headings indicate the frequency of comorbidity in ADHD. Example: 70 to 80 % of children with ADHD suffer from sleep disorders, compared to 35 to 40 % of children without ADHD.

One study found one or more comorbid mental illnesses in 51.8% of people with ADHD.2

1. Sleep disorders

1.1. Sleep disorders in children with ADHD - 70 to 80 % (compared to 35 to 40 % = + 100 %)

70 - 80 %3; 73.3 % (28.5 % mild plus 44.8 % moderate and severe),45 twice as common as in children not affected by the disease67
For the treatment of sleep disorders ⇒ Sleep problems with ADHD.

A meta-analysis found that around 33% of people with narcolepsy also have ADHD.8
Narcolepsy is associated with a reduced level of dopamine in the cerebrospinal fluid. This is consistent with the dopamine deficiency found in ADHD. In dogs with narcolepsy, on the other hand, increased dopamine levels were found in the amygdala and increased noradrenaline levels in the oral pontine reticular nucleus. Nevertheless, the dogs respond to stimulants that increase dopamine and noradrenaline.9
Kooij sees sleep disorders (difficulty falling asleep or sleeping through the night) in 43% of people with ADHD.10

1.2. Sleep disorders in adults with ADHD

Sleep problems that last longer than a month are called sleep disorders.

  • In adult people with ADHD: 11.3%11 to 29%12
  • For non-affected persons: 2.3 %11
    = 5 to 12 times the risk

Of the 670 adult persons with ADHD (with a medical diagnosis) who took the ADxS.org online symptom test, 69% reported sleep disorders, compared to 39% of the 159 people with ADHD who said they were certainly not affected (as of March 1, 2022).

A meta-analysis found that around 33% of people with narcolepsy also had ADHD.8

2. Motor clumsiness

Source5

2.1. Developmental motor coordination disorder - 47 %

Developmental coordination disorder (DCD) occurs in 47% of people with ADHD.1314

A combination of ADHD and DCD usually represents a more severe phenotype. Despite some shared neuronal features, ADHD and DCD appear to have a separate etiology.14

Diagnostic criteria according to DSM 5:

  1. The learning and execution of coordinated motor skills (if the opportunity to learn the skills is given) is below the level expected for the age.
  2. The motor difficulties significantly impair the activities of daily life and have an impact on school performance, pre-professional and professional activities as well as leisure and play.
  3. The beginning is in the early development phase.
  4. A doctor cannot better explain motor difficulties by intellectual delay, visual impairment or other neurological conditions that affect movement.

The delay is usually in the acquisition of motor skills. Motor milestones are often not delayed.

2.2. Gross motorist

Frequent accidents, bumping into things, bruises. See also under Symptoms of ADHD.

2.3. Impaired fine motor skills, poor handwriting - 60 %

Up to 60% of people with ADHD suffer from impaired fine motor skills, such as poor handwriting.15

3. Affective disorders (depression / dysphoria / dysthymia / mania) - 30 to 61 % (compared to 4.7 to 8.9 % = + 550 %)

Dysphoria with inactivity is an original ADHD symptom and not a symptom of depression. Antidepressant treatment of dysphoria with inactivity would be malpractice.
⇒ Depression and dysphoria in ADHD
Of 70 adults with ADHD, 60.7% had had an affective disorder in their lifetime, compared to 25.7% of those not affected 16

3.1. Depression

Depression found

  • according to a large Swedish cohort study in 42.28% (men: 35.60%; women: 40.27%) of adult people with ADHD compared to 4.69% (men: 3.55%; women: 5.87%) of those without.17
  • according to another cohort study at 29.9 % (over the entire age range) and 55.7 % compared to 24.3 % in a small study of adults16
    18
  • a Norwegian cohort study found major depression in 24.5 % (men: 20.3 % women: 28.8 %) of adult people with ADHD compared to 5.8 % (men: 4 %; women: 7.6 %) of those not affected.19
  • In children with people with ADHD: 37 %2021
  • For children not affected: 8.9 %21 to 14 % 20
    = 4 times the risk
  • Mood swings (15 - 75 %)22
  • Depressive disorders5
  • A simple survey by www.adhs-chaoten.net, in which 73 people with ADHD took part, revealed that a majority suffer from seasonal fall-winter depression.23 This is quite regularly the result of a vitamin D3 deficiency.
    ⇒ Vitamin D3
  • In adult people with ADHD: 61.8 %11;
    Depression (40 to 60 %)24; 25 %12
  • Severe depression (MDD
    • 32 %25
    • At least once in the lifetime of 26.4% of adult persons with ADHD compared to 16.2% of people without ADHD26
    • Major depression (6 %)25
      = 4 to 5 times the risk
  • Depression (adults with ADHD overall: 21.4 %; women 32.1 %, men 19.8 %; ADHD-I 22.3 %, ADHD-C 17.6 %, ADHD-HI 32.5 %)27
  • The population prevalence of major depression is 7.8%. People with ADHD have a prevalence of 18.6%, which is 2.4 times higher.28
  • Adults with the highest 10% of ADHD symptom severity according to ADHD-E are 6.68 times more likely to experience depression than non-affected adults.1
  • A meta-analysis found depression in people with ADHD and those without:29
    • in the total population at
      • 8.6 % to 55 % of persons with ADHD compared to 1.2 % to 12.5 % of people without ADHD
    • in clinical cases with
      • 15.4 % to 39.7 % of persons with ADHD compared to 5.8 % to 39.6 % of people without ADHD
  • Women with ADHD had a 3.69-fold risk of depression. Women with ADHD who used hormonal contraception (“pill”) had a 5.19-fold risk of depression.30
  • Cyclothymic affective temperament and low positive coping strategies are predictors of comorbid depressive symptoms in adults with ADHD31

3.2. Dysthymia

Dysthymia was found in:

  • Adults with ADHD overall: 7.3 %; women 9.4 %, men 5.4 %; ADHD-I 6.3 %, ADHD-C 7.6 %, ADHD-HI 15 %)27
  • In 6.1% of adult persons with ADHD compared to 3.4% of people without ADHD at least once in their lives26
  • The population prevalence of dysthymia is 1.9%. People with ADHD have a prevalence of 12.8%, which is 6.7 times higher.28
  • Dysthymia 5.7 % compared to 1.4 %16

3.3. Bipolar Disorders

Bipolar Disorders (“manic/depressive”):

  • at 6 %12; (adults with ADHD overall: 6.4 %; women 8.3 %, men 4.7 %; ADHD-I 5.1 %, ADHD-C 8.0 %, ADHD-HI 10.0 %)27 to 4.7 % (over the entire age range)18
  • In 33.5% of adult persons with ADHD compared to 6.2% of people without ADHD at least once in their lives26
  • The population prevalence of Bipolar Disorder is 3.1 %. People with ADHD have a prevalence of 19.4 %, which is 6.3 times higher.28

  • In adult psychiatric clinical patients with ADHD: 92.2 %32

  • For those not affected: 14.3 %11

  • Mania 0.15 % (for ADHD over the entire age range)2

  • 57 to 86% of children and adolescents with Bipolar Disorder also have ADHD33

4. Aggressive behavior - over 50%

Slightly more than 50 %34

Aggressive behavior is not an original symptom of ADHD-HI. Aggressiveness can be an expression of stress, but not everyone reacts to stress with aggression, nor does everyone externalize stress.
One of the arguments in favor of pure comorbidity is that non-ADHD-specific drugs such as risperidone only reduce aggressiveness but not ADHD symptoms, while MPH (methylphenidate) can alleviate the symptoms of ADHD and ODD in equal measure.35

See also ⇒ Neurophysiological correlates of aggression

5. Severe behavioral disorder (disruptive behavior disorders) - 30 to 50 %

Frequency of comorbidity in children with ADHD:

  • 50 %36
  • 31% in Iran for children between the ages of 6 and 1837
  • Among people with ADHD, 30 to 50 % have comorbid ODD or CD.38

Newer definition models of externalizing aggressive disorders are

  • Disruptive Mood Dysregulation Disorder (DMDD)39 and
  • Intermittent Explosive Disorder (IED)38

5.1. Deficient emotional self-regulation (DESR) - 44 to 55 %

DESR is described as

  1. Self-regulation deficits of physiological arousal caused by strong emotions
  2. Difficulty inhibiting inappropriate behavior in response to positive or negative emotions
  3. Problems with refocusing attention when emotions are strong
  4. Disorganization of behavioral coordination in response to emotional activation
  • DESR is distinct from the persistent and severe aggressive irritability that is common in pediatric bipolar Disorder (which is rare).40 The abnormal moods of bipolar Disorder are not due to poor self-control and include other DSM-IV mood criteria.
    DESR is not associated with an increased risk of bipolar Disorder.41
    In studies, DESR was found in 44%41 to 55%42 of persons with ADHD, compared to only 2% of people without ADHD.41
    DESR is diagnosed if the person with ADHD scores between 180 and 210 points on the 3 scales of anxiety/depression (intense emotions), aggression and attention (impulsivity) of the Child Behavioral Check List (CBCL) (on average between 60 and 70 per scale). Scores above 210 points are no longer referred to as DESR, but as more severe forms of affective disorders (mood and behavioral dysregulation disorders). Due to the defined diagnostic criteria of DESR, which cannot be achieved without a high score on the aggression scale, the diagnosis of DESR is likely to be limited to the ADHD-HI subtype, which is phenotypically more likely to react to perceived stress with aggression
    The CBCL scale for aggressive behavior:43
    1. Argues or disagrees a lot
    2. Specifies, cuts to
    3. Is crude or mean to others, intimidates them
    4. Requires a lot of attention
    5. Breaks his own things
    6. Breaks things that belong to parents, siblings or others
    7. Does not obey at home
    8. Does not obey at school
    9. Is easily jealous
    10. Easily gets into fights, arguments
    11. Physically attacks others
    12. Screams a lot
    13. Likes to produce or clown around
    14. Is stubborn, grumpy or irritable, is easily annoyed by others
    15. Shows sudden changes in mood and emotion
    16. Talks too much
    17. Likes to tease others
    18. Has outbursts of anger or a hot temper
    19. Threatens, bullies or intimidates others
    20. Is unusually loud

According to our assessment, all question topics are primarily aimed at the ADHD-HI subtype (with hyperactivity), while only question topics 7, 8, 9, 14 and 15 also fit the ADHD-I subtype, but do not specifically ask about possible symptoms of inwardly directed emotional intensity. In the predominantly inattentive subtype (ADHD-I), barely any externalizing symptoms such as aggression or oppositional defiant behaviour occur.44 According to our understanding, the ADHD-I subtype internalizes perceived stress and does not primarily react aggressively.

DESR can therefore only occur in people with ADHD-HI and ADHD-C, not ADHD-I.
We assume that people with ADHD-I also suffer from emotional dysregulation, which just does not or rarely manifests itself as aggression. This perception was confirmed by an ADHD therapist in a personal interview.

Consequently, significantly more than 44 to 55% of all people with ADHD are likely to suffer from emotional dysregulation, although the forms of expression can vary greatly
Here, too, studies would be desirable that take into account the subtypes and the phenotypic expression of intense emotions (ADHD-HI: externalization / ADHD-I: internalization).

5.2. Oppositional Defiant Disorder (ODD) - 26 to 53 % (compared to 3.9 % = + 560 % to + 1,260 %)

  • In children and adolescents with ADHD-C: 53 %45

    • For ADHD-C and ASD: 63 %45, with 80 % of people with ADHD-C also showing ASD
    • For ADHD-I and ASD: 28 %45
    • For ASA: 24 %45
    • For ADHD-I: 14 %45

  • In children with ADHD: 39.3%42; explicitly for ODD: (35%)22

  • Among people with ADHD, 30 to 50 % have comorbid ODD or CD.38

  • Biedermann quotes an ODD prevalence of 60% in children with ADHD.46 We consider this to be a translation. In our opinion, this could at best apply when considering only boys with severe ADHD-HI. In addition, the ODD prevalence of boys is given as 55 % and of girls as 30 %, which does not match the overall prevalence. For adults, Biederman cites a prevalence of 30% for the entirety of social behavior disorders in ADHD46

  • ODD 26.1% in Iran among children between 6 and 18 years of age.37

  • For those not affected: 3.9%11
    = 10 times the risk

  • ODD refers primarily to people with ADHD-HI (with hyperactivity) rather than ADHD-I (without hyperactivity), as hyperactivity is an outgrowth of an externalizing stress response pattern, whereas ADHD-I is an outgrowth of an inwardly directed stress (playing dead, escaping). ⇒ The subtypes of ADHD: ADHD-HI, ADHD-I, SCT and others

  • We understand ODD (Oppositonal Defiant Disorder) as a pure comorbidity to ADHD, i.e. not as ADHD symptoms.

    • Steinhausen describes disorders of social behavior on the one hand as the most common comorbidity of ADHD,47 describes the comorbidity on the other hand on page 174 as a subtype of ADHD.
    • Apart from the fact that sleep disorders are likely to be significantly more common, we do not consider ODD to be a subtype due to the delimitability of the genetic basis.
      • A specific polymorphism of the MAO-A gene is cited as a genetic contributory cause of both social behavior disorders and ADHD (in each case as one of several interacting specific genes). However, this gene polymorphism seems to play a much greater role with regard to social behavior disorders, as it is mentioned much more frequently there and ADHD can also manifest itself without the involvement of this gene (through the interaction of other genes). In the case of ADHD, the MAO-A gene is always mentioned in a subset of people with ADHD who also suffer from behavioral disorders.
      • A further argument in favor of pure comorbidity is that non-specific ADHD medications such as risperidone only reduce aggressiveness but not ADHD symptoms, while MPH (methylphenidate) can alleviate the symptoms of ADHD and ODD equally.35

  • ODD does not correlate with any of the symptom circuits of the dual / triple pathway model, so at least in this respect it has a different neurological basis.48

Symptoms Oppositional defiant disorder (ODD):

  • Frequent and persistent defiance or disobedience towards authority figures
  • Quarrelsome and easily irritated or annoyed
  • Deliberate attempts to annoy others or behave vindictively
  • Difficulty following rules and displaying a pattern of negative, hostile and defiant behavior

5.3. Disorders of social behavior / Conduct Disorder (CD)

Source5

  • Persons with Disorder of Social Behavior have 21 times the risk (compared to people with ADHD) of also suffering from ADHD.49
  • Disorders of social behavior and aggression disorders have their own genetic disposition in a specific polymorphism of the MAO-A gene. ⇒ How ADHD develops: genes or genes + environment
  • Biedermann cites a CD prevalence of 16% in children with ADHD (boys 18%, girls 8%)46

The prevalence of conduct disorder was determined by an Iranian study:50

  • 0.58 % for children aged 6 to 9 years
  • 0.57 % for adolescents aged 10 to 14 years
  • 1.22 % for young people aged 15 to 18

32% also met the criteria for ADHD, 55% the criteria for ODD.

Symptoms of conduct disorder (CD):

  • Aggressive or violent behavior
    • Frequent physical altercations
    • Harm to humans or animals
    • Bullying or cruelty
  • Antisocial behavior
    • Frequent disregard for the rights of others
  • Recurring and persistent patterns of difficulties in accepting norms
    • Destruction of property
    • Participation in thefts
    • Fraudulent behavior
    • Lies
  • Lack of remorse or feelings of guilt for one’s own actions
    • Lack of empathy

9. Anxiety disorders - up to 47 % (compared to 19.5 %)

The population prevalence of anxiety disorders is 19.5%. People with ADHD have a prevalence of 47.1 %, which is around 2.4 times higher.28
There was no genetic overlap between ADHD and anxiety disorders. Genes that correlated with high intelligence showed a protective factor against ADHD, but not against anxiety disorders.51

9.1. Anxiety disorders in children - 25 to 38 % (vs. 10 %)

  • 37 % over the entire age range18
  • 37.9% in Iran for children between 6 and 18 years of age.37
  • 25 %5222 , 34 %53, without % specification54
  • Around 10 % for those not affected55
    = 3 times the risk
  • Anxiety disorders and ADHD seem to reinforce each other. Treating anxiety or AD(HS also reduces the symptoms of the other Disorder.56
  • Generalized anxiety disorder tripled and a half the risk of ADHD, while ADHD quadrupled the risk of generalized anxiety disorder.57
  • 40 to 85% of children with an anxiety disorder also had ADHD58

9.2. Anxiety disorders in adults - 44 % (compared to 4.9 %)

An anxiety disorder was found in 44.65% (men: 37.02%; women: 55.74%) of adults with ADHD compared to 4.89% (men: 3.64%; women: 6.19%) of people without ADHD, according to a large Swedish cohort study.17 A Norwegian register study found a prevalence of 22.2 % (men: 18.2 %; women: 26.3 %) of adult people with ADHD compared to 5 % (men: 3.3 %; women: 6.7 %) of those not affected.19
Other sources cite a prevalence of 42 % or 20 to 60 % in adults with ADHD24; 19 % anxiety disorders and 15.5 % phobic disorders12

In adult psychiatric clinical patients with ADHD: 25%52 to 28.6%32

  • Of 70 adults with ADHD, 34.3% had an anxiety disorder in their lifetime, compared to 25.7% of the 70 unaffected16

Anxiety disorders and ADHD seem to reinforce each other. Treating anxiety or AD(HS also reduces the symptoms of the other Disorder.56

A meta-analysis found an anxiety disorder:29

  • in the total population at
    • 4.3 % to 47.1 % of persons with ADHD compared to 0.5 % to 9.5 % of people without ADHD
  • in clinical cases with
    • 3.9 % to 84 % of persons with ADHD compared to 5.4 % to 40 % of people without ADHD

9.2.1. Generalized anxiety disorder - 5.9 to 25 % (vs. 2 %)

  • The population prevalence of generalized anxiety disorder is 2.6%. People with ADHD have a prevalence of 8%, which is around 3 times higher.28
  • Total adults 2.6 %; women 2.9 %, men 3.7 %; ADHD-I 1.2 %, ADHD-C 5.0 %, ADHD-HI 12.5 %27
  • In adult people with ADHD:
    • Adults with ADHD overall: 5.9 %; women 7.6 %, men 4.4 %; ADHD-I 7.1 %, ADHD-C 3.5 %, ADHD-HI 7.5 %27
    • 25 %25
  • For non-affected persons: 2 %25
    = 3 to 12 times the risk
    Of 70 adults with ADHD, 2.9% had a generalized anxiety disorder in their lifetime, compared to 1.4% of the 70 unaffected16

9.2.2. Social phobia - 5 to 29.3 % (compared to 3.5 to 10 %)

Adults with ADHD overall: 3.5 %; women 2.5 %, men 4.4 %; ADHD-I 3.3 %, ADHD-C 3.0 %, ADHD-HI 7.5 %27
Of 70 adults with ADHD, 18.6% had social phobia in their lifetime, compared to 10% of the 70 unaffected16
Social anxiety disorder was found in 22.8% of adult persons with ADHD compared to 6.6% of non-affected people at least once in their lifetime.26
The population prevalence of social phobia is 7.8%. People with ADHD have a prevalence of 29.3%, which is almost 3.8 times higher.28

9.2.3. Panic disorder - 1.9 to 4.3 % (compared to 2.9 %)

Adults with ADHD overall: 1.9 %; women 2.9 %, men 2.4 %; ADHD-I 2.1 %, ADHD-C 2.5 %, ADHD-HI 7.5 %27
Of 70 adults with ADHD, 4.3% had a panic disorder in their lifetime, compared to 2.9% of the 70 unaffected16

  • At least once in the lifetime of 22% of adult persons with ADHD compared to 7% of people without ADHD26
  • The population prevalence of panic disorder is 3.1%. People with ADHD have a prevalence of 8.9%, which is almost 3 times higher.28

9.2.4. Specific phobias

  • Specific phobias were found in 35.8% of adult persons with ADHD compared to 14.6% of people without ADHD at least once in their lives26
  • The population prevalence of specific phobias is 9.5%. People with ADHD have a prevalence of 22.7%, which is almost 2.4 times higher.28
  • The population prevalence of agoraphobia is 0.7%. People with ADHD have a prevalence of 4.0 %, which is around 5.7 times higher.28

6. Substance abuse and addiction - up to 45

A meta-analysis found addictive disorders:59

  • in the total population at
    • 2.3 % to 41.2 % of persons with ADHD compared to 0 % to 16.6 % of people without ADHD
  • in clinical cases with
    • 10 % to 82.9 % of persons with ADHD compared to 2 % to 72.2 % of people without ADHD

6.1. Substance-related addictions / substance abuse

Of n = 873 patients in a psychiatric emergency department in an emerging urban county in North Carolina (USA) with ICD10 diagnoses of anxiety, depression, schizophrenia, ADHD, bipolar disorder, alcohol abuse, or schizoaffective disorder showed:60

  • 58% of patients with a psychiatric history have a positive urine drug test
  • ADHD (n = 135)
    • 34.7 % alcohol
    • 20.2 % THC
    • 15.3 % Cocaine
    • 14.9 % Paracetamol
    • 12.9 % Benzodiazepines
    • 12.1 % Opiates
    • 8.1 % Amphetamine drugs
    • 1.6 % barbiturates
  • Depression (n = 225)
    • 40.8 % Paracetamol
    • 25.6 % THC
    • 20.9 % alcohol
    • 15.0 % Opiates
    • 13.7 % Benzodiazepines
    • 12.6 % Cocaine
    • 7.4 % Amphetamine drugs
    • 2.1 % barbiturates
  • States of anxiety
    • 30.8 % THC
    • 10.3 % alcohol
    • 5.1 % Opiates
    • 5.1 % Cocaine
    • 4.7 % paracetamol
  • bipolar disorders
    • 29.4 % THC
    • 27.3 % alcohol
    • 16.9 % Opiates
    • 13.0 % Cocaine
    • 10.4 % Benzodiazepines
    • 9.2 % Paracetamol
    • 8.2 % Amphetamine drugs
  • Schizoaffective Disorder (n = 245)
    • 26.1 % THC
    • 25.6 % alcohol
    • 24.4 % Paracetamol
    • 20.8 % Cocaine
    • 12.1 % Benzodiazepines
    • 8.7 % Opiates
    • 5.1 % amphetamine drugs
    • 2.5 % barbiturates
  • Schizophrenia (n = 45)
    • 32.6 % THC
    • 14.4 % alcohol
    • 10.9 % Cocaine
    • 5.5 % paracetamol
    • 8.7 % Benzodiazepines
    • 2.2 % opiates

Overall, there was no significant correlation between the psychiatric diagnosis and positive drug screening.60

6.1.1. Substance abuse - 21.9% to 35% (compared to 2.9% to 3.6%)

According to a large Swedish cohort study, substance misuse (SUD) was found in 35.12% (men: 39.44%; women: 30.88%) of adult people with ADHD compared to 3.61% (men: 4.40%; women: 2.79%) of non-affected people.17
A Norwegian cohort study found substance abuse in 21.9% (men: 27.5% women: 16.2%) of adult people with ADHD compared to 2.9% (men: 3.6%; women: 2.1%) of those without.19

Another Norwegian cohort study found no association between ADHD and alcohol or drug abuse,61 as well as an earlier study,62 which found increased alcohol and drug abuse in people with ADHD only in the presence of additional externalizing disorders.
However, these studies clearly contradict the vast majority of specialist literature, which reports a significant risk increase in ADHD.

Substance abuse is a common comorbidity of ADHD.5 One possible connection could be that dopamine deficiency leads to increased expression of CB1 cannabinoid receptors.636465 THC binds to CB1 receptors.

Of 70 adults with ADHD, 17.1% had experienced substance misuse in their lifetime, compared to 2.9% of those without16
People with ADHD showed an ADHD prevalence of 21%.66
Among 153 addicts (98.7% males) at a clinic in India, 33% were found to have ADHD. The prevalence of ADHD was different for certain addictions:67

  • 47.6 % of people with cannabis addiction
  • 38.8 % of people who use tobacco/smoke
  • 33% of people with cocaine addiction and
  • 21.5 % of people with alcohol dependence.
  • The prevalence of ADHD among opioid addicts was around 50%. ADHD symptoms, especially impulsivity, increase the risk of opioid addiction. 68
  • For people with ADHD, substance abuse begins on average 3 years earlier69
  • Appropriate medication (especially methylphenidate) reduces the likelihood of addiction or substance abuse in ADHD.
  • People with ADHD with comorbid cocaine addiction showed a significant reduction in addictive behavior when treated with stimulants, corresponding to a decrease in ADHD symptoms.70

6.1.2. Smoking - 40 to 45 % (compared to 22 to 25 %)

  • In adult persons with ADHD: 40%71 to 42%7273 to 44.8%26
  • Compared to 22.6%26 to 26% of those not affected (2005),74 therefore a 61% increased risk (regardless of medication).
  • In adult psychiatric clinical patients with ADHD are dependent on nicotine
  • For those not affected:
    • 27% of women and 32% of men in the total population aged 18 and over75
      = 1.6 times the risk
      Adult persons with ADHD-HI: plus 100 % compared to non-affected people76
  • ADHD medication, nicotine (smoking) and zinc block the dopamine transporters (DAT) (which are elevated in ADHD) and thus reduce their overactivity77

6.1.3. Alcohol dependence (30 to 39 % compared to 5 to 15 %) / alcohol abuse

  • In adult persons with ADHD between 30 %25, 25 to 44 %76 and 38.9 %26
    although we suspect that these data refer to psychiatric inpatients with ADHD.
  • A large Norwegian cohort study found no association between ADHD and alcohol or drug abuse,61 as well as an earlier study,62 which found increased alcohol and drug abuse in people with ADHD only in the presence of additional externalizing disorders.
  • In adult psychiatric clinical patients with ADHD, one study found alcohol dependence in 4.1%.32
  • For those not affected: 5%25 to 14.6%26
    = 6 to 8 times the risk
    Conversely, among n = 153 alcoholics, 43% were found to have childhood ADHD and 22% were found to have persistent ADHD.78 Another study found an ADHD diagnosis in 19% of 100 adult alcoholics in India.79
  • Alcohol / substance abuse: Adults with ADHD overall: 1.6 %; women 1.1 %, men 2.0 %; ADHD-I 0.9 %, ADHD-C 2.5 %, ADHD-HI 2.5 %27 to 18.1 %22.6 %26 compared to19.3 % for those not affected26
  • Of 70 adults with ADHD, 8.6% had an alcohol dependency in their lifetime, compared to 2.9% of those without16

6.1.4. Substance-related addictions in general - 7.8 %

  • In adult persons with ADHD: 7.8 %11, 20 %25 to 50 to 60 %8081
  • For those not affected: 1.9 %11 to 5 %2581
    = 4 to 12 times the risk
  • According to another source, the lifetime prevalence of psychoactive substance use in people with ADHD is 52%, compared with 24% in people without the disorder.82
  • Of 70 adults with ADHD, 11.4% had a substance dependence in their lifetime, compared to 0% of the 70 unaffected16

6.1.5. Drug addiction

  • The population prevalence of drug addiction is 0.6%. People with ADHD have a prevalence of 4.4%, which is around 7.3 times higher.28
  • Among adult psychiatric clinical patients with ADHD, 7.1% have comorbid drug dependence.32
  • Drug addicts are 4 to 5 times more likely to have ADHD83
  • 15.5%84 to 25% of all addicts have ADHD85
  • ADHD was found in 11.2% of all adult addiction patients who used intravenous opiods or intravenous/intranasal benzodiazepines. The ADHD rate was higher among women (15.3 %) than among men (10.3 %).86
  • With ADHD, the risk of substance dependence (addiction) is 2 to 3 times higher than for those not affected.87
  • The risk of nicotine dependence is up to 9 times higher in those with ADHD than in those without.87
  • Persons with ADHD are about as likely to be addicted as relatives who are not affected by ADHD.
    • Cannabis: 67 vs. 72 %81
    • Cocaine: 23 vs. 21 %81
    • Stimulants: 18 vs. 10 %81
    • Hallucinogens: 18 vs. 7 %81
    • Opioids: 16 vs. 3 %81
    • Sedatives: 14 vs. 10 %81
  • According to one study, 12% of cocaine users had ADHD in childhood and 10% still had it as adults.88

6.2. Behavioral addiction / gambling 5.3 % (vs. 2.4 %)

People with ADHD have more than double the risk of developing a gambling addiction (5.3% compared to 2.4%). Problem gambling behavior is 4 times more common among persons with ADHD (2.4%) than among people without ADHD (0.6%).89
Another study found gambling addiction in 1.54% of adult persons with ADHD compared to 0.39% of non-affected people at least once in their lifetime.26

A study of n = 97 gambling addicts found an ADHD rate of 26.0 % and an ASD rate of 29.8 %.90
One study found that gene variants that correlate with substance use can causally increase the risk of ADHD.91

7. Restless legs (RLS, akathisia) - 11 to 44 % (vs. 2.6 to 15.3 %)

A meta-analysis found RLS in 11 to 42.9 % of children with ADHD and in 20 - 33.0 % of adults with ADHD. In the general population, RLS was found in 2.6 to 15.3%.92
A study of children with ADHD (aged 6 to 16) found RLS in 33.3%.93 Other sources speak of 44%.94 A smaller study of adults with ADHD found RLS in 20%, with comorbid RLS aggravating ADHD symptoms.95
Kooij sees RLS in 30 % to 40 % of people with ADHD.10
One study found 10% of people with ADHD had a disorder of periodic limb movements (PLMS) (more than 5/hour).96 Another study found 66% of children with ADHD had a PLM index greater than 5/hour, which is a marker for RLS, while no ADHD non-affected individuals had an elevated PLM index.97 A meta-analysis found no evidence of more frequent PLMS in ADHD.98
In adult psychiatric clinical patients with ADHD, 25.5% showed RLS32
A large cohort study found a strong correlation between restless legs and ADHD.99

ADHD is found in up to 26% of people with ADHD.94

Irrespective of ADHD, RLS occurs in around 2% of all children and adolescents, and in 0.5 to 1% in moderate to severe form. In adults, it affects 5 to 10 %. In 25% of people with ADHD, the disorder begins between the ages of 10 and 20.100 Other sources cite a prevalence of RLS of up to 8%.101
In 70% of people with ADHD, one parent is also affected.

A genetic link between RLS and ADHD has not yet been established. It is conceivable that the BTBD9 gene, which is associated with iron stores, could be involved.
69.4 % of children and adolescents with RLS have sleep disorders (compared to 39.6 % of those not affected), 80.6 % have a history of “growing pains” (compared to 63.2 % of those not affected).101

Common causes of RLS and ADHD

7.1. iron deficiency in RLS and ADHD

There is increasing evidence that iron deficiency (S-ferritin level < 12 ng/ml) underlies common pathophysiological mechanisms in patients with RLS and patients with ADHD-HI101
Iron is a cofactor for tyrosine hydroxylase, an enzyme that is essential for dopamine synthesis. ADHD and RLS both often show decreased iron levels. Lower S-ferritin levels in people with ADHD correlate with more severe ADHD-HI symptoms. Children with ADHD and RLS showed lower ferritin levels than children with ADHD without RLS.102103104 However, other studies did not find decreased S-ferritin levels in ADHD 105106
In RLS, the severity correlates more clearly with a reduced S-ferritin level.107108 particularly in children.109 It is possible that impaired transport of iron from the serum into the cerebrospinal fluid and of iron into the dopaminergic cells leads to a reduced iron concentration in the cerebrum.110 Adults with RLS show a low iron status in the cerebrum.111
Children with ADHD and a predisposition to RLS appear to represent a subgroup at particular risk for severe ADHD-HI symptoms, and iron deficiency may contribute to the severity of ADHD symptoms.102
An RC study found improved ADHD symptoms in children with ADHD and low ferritin levels when given iron (80 mg/day).112

7.2. adenosine for RLS and ADHD

Restless legs could be caused by downregulation of adenosine A1 receptors as a result of iron deficiency.113
Adenosine is closely linked to dopamine. Adenosine receptors are found throughout the brain in the vicinity of dopamine receptors and sometimes form receptor heteromers with them. Adenosine could also be involved in ADHD, although more likely via an excessive adenosine effect on adenosine A2A receptors. Adenosine inhibits dopamine, adenosine antagonists such as caffeine (coffee, cola, black tea) and theobromine (cocoa) therefore increase dopamine.
More on this in the article =&gt Adenosine

7.3. treatment of RLS in ADHD

The problem with the comorbidity of restless legs and ADHD is that ADHD medications (although also dopaminergic) do not work against RLS and RLS medications such as L-dopa (although also dopaminergic) do not work against ADHD.114101115
Prolonged treatment with L-dopa often leads to a worsening of RLS symptoms.
Simultaneous administration of L-dopa and stimulants may cause increased side effects.

A single case report documented a good response of a 6-year-old boy with ADHD and RLS, who was also an MPH nonresponder, to the dopamine agonist ropinirole, in terms of ADHD as well as RLS.116

8. Developmental disorder - 24.7 %

Developmental disability (adults with ADHD overall: 24.7 %; women 25.6 %, men 23.8 %; ADHD-I 22.6 %, ADHD-C 25.6 %, ADHD-HI 37.5 %)27

8.1. Specific developmental disorders - 37.4 % (compared to 13.4 %)

  • In children with people with ADHD: 37.4%11
  • For those not affected: 13.4 %11
    = 3 times the risk

8.2. Specific developmental disorders of school skills - 23% (vs. 2.8%)

  • In children with people with ADHD: 23.0%11
  • For those not affected: 2.8%11
    = 8 times the risk

10. Autism Spectrum Disorders (ASD) - 3.6 to 21% (vs. 0.40 to 1.85%)

A meta-analysis reported that autism spectrum disorders were found in 15% to 21% of children and adolescents with ADHD, and that ADHD-affected children with ASD showed more severe ADHD symptoms than children without ASD.117118
Similarly, 21.6% of persons with ADHD were found to have comorbid ADHD.119 Another source mentions 85 % comorbid ADHD in persons with ADHD.118
A recent study found previously undiagnosed ASD in 27 cases of 103 children (85% boys) with ADHD without intellectual impairment.120
Girls with autism who also had ADHD showed significantly stronger symptoms of ADHD, learning disabilities and ODD than boys with ASD and ADHD in a large study.121
A cohort study mentions 3.6% (over the entire age range).18
Other sources do not provide % figures.5122
Source123
DSM-IV still stipulated that ADHD and autism spectrum disorders should not be diagnosed as comorbid. This was changed in DSM 5.

In the overall population, ASD occurs in 1 in 54 boys (1.85%) and 1 in 252 girls (0.40%).124

ADHD and ASD share two genes that are known as risk genes.122 There are considerations that ADHD and autism could have further common genetic roots.125 Disorders of dopaminergic neurotransmission are suspected in ASD, among other things,126 while there is evidence of such disorders in ADHD.

Around 28%127 to 50% of people with ADHD have ADHD as a comorbidity.
The fact that ADHD could not be diagnosed in autism according to DSM IV speaks against empirical experience and is therefore omitted in DSM 5.123
There are indications that ADHD and autism have common genetic roots.125 Disorders of dopaminergic neurotransmission are suspected in ASD, among other things,128 while there is evidence of such disorders in ADHD.

21. Impulse control disorder, impulse control disorder - 19.6 % (vs. 6.1 %)

  • The population prevalence of impulse control disorder is 6.1%. People with ADHD have a prevalence of 19.6%, which is around 3.2 times higher.28
  • Total adults 2.6 %; women 2.9 %, men 3.7 %; ADHD-I 1.2 %, ADHD-C 5.0 %, ADHD-HI 12.5 %27

11. Adjustment disorders - 18.9 % (compared to 3 %)

Adjustment disorders are described as reactions to a one-off or ongoing stressful life event.
Types of adjustment disorders are:

  • Short depressive reaction
  • Prolonged depressive reaction (up to 2 years)
  • Mixed anxiety and depressive reaction
  • With predominant impairment of other feelings
  • With predominant Disorder of social behavior
  • With mixed disorders of emotions and social behavior
  • With other predominantly mentioned symptoms

Prevalence in the presence of ADHD:

  • In adult people with ADHD: 18.9%11
  • For non-affected persons: 3.0 %11
    = 6 times the risk

12. Learning disorders - up to 92

12.1. Learning disorders in children - 10 to 92 %

10 - 92 %22/ general learning disability (approx. 20 %)1295

12.2. Learning disorder in adults - 2 % (compared to 1.6 %)

Total adults 1.6 %; women 1.4 %, men 2.4 %; ADHD-I 1.5 %, ADHD-C 2.5 %, ADHD-HI 2.5 %27

13. Partial performance disorders - up to 40

Source5

One study found that 6.6% of children between the ages of 7 and 11 had learning-specific partial performance disorders. Reading difficulties were found in 4%, dyscalculia in 3.6% and a weakness in written expression in 1.8%. Approximately 63% of children with learning-specific partial performance disorders had one or more comorbid diagnoses, with ADHD being the most common comorbidity at 54.9%. Boys were more frequently affected.130

13.1. Reading difficulties, dyslexia, dyslexia - 8 to 40 % (compared to 5.6 %)

A distinction must be made:

  • Reading and spelling difficulties (LRS): acquired temporary weakness, usually caused by external circumstances
  • Dyslexia: genetically caused disorder in the area of reading and writing that cannot be overcome through normal practice
  • Dyslexia (reading difficulty): Limited ability to read and understand words or texts, despite normal vision and hearing. Tool disorder.
  • Alexia: complete loss of reading ability

8 - 39 %131132 , 25 - 40 %40, 40 %53

Dyslexia and ADHD have a relevant genetic match.133
One study found only weak evidence of concordant neurophysiological changes in ADHD and dyslexia.134

6-year-old children with reading difficulties are around 4 times more likely to have ADHD in the teacher assessment (21.0% instead of 5.6%) and around twice as likely to have ADHD in the parent assessment (30.5% instead of 17.8%) than children without reading difficulties.135
There is evidence that reading impairment with ADHD shows different connectivity in the brain than reading impairment without ADHD.136

65 to 70 % of all children with dyslexia are said to have functional binocular disorders:137

  • Oculomotor dysfunctions (OMD) (9 %)
    • Fixation impaired
    • Subsequent movements impaired
    • Horizontal eye saccades impaired
  • Dysfunctional binocular vision (DBS) (16%)
    • Heterophoria
    • Suppression
    • Convergence insufficiency
    • Accommodative dysfunction
    • Fusion insufficiency
    • Stereopsis insufficient
  • DBS and OMD (51 %)
  • Neither DMS nor OMD (24 %)

13.2. Spelling difficulties (agraphia, dysgraphia) - 12 to 40 %

12 - 27 %129, 25 - 40 %40, 40 %53
Also for adults with ADHD.138

13.3. Dyscalculia 12 - 27 %

12 - 27 %129
A meta-analysis found that reading problems correlate more strongly with math problems than with ADHD.139
Also for adults with ADHD.138
Mathematical performance is said to correlate less with ADHD than with executive function problems in ADHD.140

13.4. Weakness in facial recognition (prosopagnosia)

It is unclear whether facial recognition deficits are more common in ADHD. There are sources for this141 and against it142.

13.5. Name recall weakness

A weakness in remembering names is said to occur more frequently with ADHD.141

13.6. Speech disorders

Speech disorders are said to occur more frequently with ADHD.5

13.7. Right-left weakness

Right-left weakness correlates with ADHD.143
The overall prevalence of right-left weakness among medical students was 14.7%.

14. Mental disability - 13 %

13 %53

15. Bipolar Disorders - 4.5 to 35.5 % (compared to 0.2 to 3.6 %)

Bipolar Disorder was found in

  • 14.29% (men: 9.95%; women: 18.95%) of adult persons with ADHD compared to 0.72% (men: 0.53%; women 0.91%) of people without ADHD (large Swedish cohort study)17
  • 10.9 % (men: 8.9 % women: 12.9 %) of adult people with ADHD compared to 1.3 % (men: 1.1 %; women: 1.6 %) of those not affected.19
  • 6 %12; (adults with ADHD overall: 6.4 %; women 8.3 %, men 4.7 %; ADHD-I 5.1 %, ADHD-C 8.0 %, ADHD-HI 10.0 %)27
  • 5.1% of adult psychiatric clinical patients with ADHD32
  • 4.7 % (over the entire age range)18

In 2.4 million people examined, 9250 bipolar disorders were observed. If an ADHD disorder was already present, the risk of bipolar disorder increased 12-fold over a lifetime; if ADHD and an anxiety disorder were previously present, the risk increased 30-fold compared to people without ADHD and without an anxiety disorder.144

People with ADHD have an ADHD prevalence of:

  • 60 % (meta-analysis of twenty studies with n = 2,722 PBD patients (average age = 12.2 years)145
  • 27 % in euthymic people with ADHD146
  • 25% (n = 703 adult people with ADHD), with males and BP type I more likely to have ADHD comorbidity147
  • 3.06-fold increase148

A meta-analysis found Bipolar Disorder in people with ADHD and non-affected people:29

  • in the total population at
    • 4.48 % to 35.5 % of persons with ADHD compared to 0.2 % to 3.6 % of people without ADHD
  • in clinical cases with
    • 7.4 % to 80 % of persons with ADHD compared to 2 % to 19.5 % of people without ADHD

One study found evidence of overlap between the genetic causes of bipolar and ADHD, particularly in early-onset bipolar (under the age of 21),149 another study also found genetic overlap between bipolar and ADHD.150

16. Eating disorders - Loss of Control Eating Syndrome (LOC-ES) - 7.5 to 11.4 % (vs. 1.4 %)

12-fold increased risk in people with ADHD-HI.151152

A cohort study of Iranian children and adolescents found an increased prevalence of ADHD of 7.5% among people with ADHD.153

A very large study found the risk of bulimia or anorexia increased 18.3-fold with ADHD.154

Appetite disorders in adults with ADHD: 21 %

Disordered eating was 40% more common in adolescents with ADHD.155

17. Personality disorders (in adults) - 11.5 % to 33.2 % (compared to 0.9 % to 1.4 %)

Personality disorders are generally not yet diagnosed in children.

The following prevalence rates were found in adults:

  • 11.5 % (men: 9.1 % women: 13.6 %) of adult people with ADHD compared to 1.4 % (men: 1.1 %; women: 1.7 %) of those not affected.19
  • 33.2 % in adult persons with ADHD11 to 80.3 % in adult outpatients with ADHD156
  • For non-affected persons: 0.6 %11
    = 50 times the risk

A meta-analysis found personality disorders:59

  • in the total population at
    • 0.31 % to 33.8 % of persons with ADHD compared to 0 % to 3.9 % of people without ADHD
  • in clinical cases with
    • 21.9 % to 65.95 % of persons with ADHD compared to 6.6 % to 34.4 % of people without ADHD

17.1. Antisocial PS - 18 % (compared to 2 to 3.5 %)

One study found antisocial personality disorder in 18% of people with ADHD-HI with hyperactivity compared to 2% of those without.157.
Other sources cite 37.1 %15843 .
One study found Antisocial PS in 18.9% of adult persons with ADHD compared to 3.5% of non-affected people at least once in their lifetime.26

Of 30 prison inmates with ADHD-HI, 96% also had antisocial personality disorder.
In contrast, 20 non-prison ADHD-HI affected people and 18 non-affected people (without ADHD) were not found to have Antisocial Personality Disorder.Interestingly, amphetamines are the drugs most commonly used by prison inmates affected by ADHD-HI.75 Amphetamines are known to be a highly effective medication for ADHD.

For domestic violence offenders who had ADHD, ADHD treatment reduced domestic violence far more significantly than domestic violence interventions.159

17.2. Borderline PS / Emotionally unstable PS - 18 to 33 % (vs. 1 to 5 %)

Adults with ADHD are said to have BPD in 18.3% of cases160
A population study found that 33.7% of people with ADHD also had borderline personality disorder (BPD) (compared to 5.2% in the general population).26
A Swedish cohort study found a 19.4-fold risk of comorbid borderline personality disorder in people with ADHD.161 3.9% of the more than 2 million people studied had an ADHD diagnosis (women 3.0%, men 4.8%), 0.5% had BPD (women 0.8%, men 0.1%). People who had relatives with an ADHD diagnosis also had an increased risk of BPD:

  • Identical twins: n = 9,130, OR = 11.2 (Among 9,130 twins, the risk of BPD was 11.2 times higher if the other twin had ADHD)
  • Fraternal twins: N = 17,350, OR = 1.0
  • Full siblings: n = 2,211,396, OR = 2.4
  • Maternal half-siblings: n = 332,486, OR = 1.4
  • Paternal half-siblings: n = 331,080; OR = 1.5
  • Cousins Parents Full siblings:n = 6,456,848; OR = 1.5
  • Cousins Maternal parents Half-siblings: n = 472,212; OR = 1.3
  • Cousins Paternal parents Half-siblings: n = 466,836; OR = 1.2

The risk of a BPD diagnosis if the person with ADHD had ADHD themselves or a full sibling was:161

  • 19.1 times higher in women (OR = 19.1)
  • 21.8 times higher in men (OR = 21.8)

People with ADHD in childhood were 14% more likely to be diagnosed with BPD later in life.162

BPD in people with ADHD: 35.7%15843

In adult psychiatric clinical patients with ADHD: 30.6 %32

People with ADHD have an ADHD prevalence of 30 to 60 %.163164165166

For the differential diagnosis of ADHD / Borderline, see ⇒ Emotionally unstable personality / Borderline In the article ⇒ Differential diagnostics for ADHD in the chapter ⇒ Diagnostics.

17.3. Anxious PS - 10.6 % (vs. 2.1 %)

One study found avoidant PS in 10.6% of adult persons with ADHD compared to 2.1% of non-affected people at least once in their lifetime.26
In adult psychiatric clinical patients with ADHD: 31.6 %32

17.4. Self-insecure PS

27,1 %15843

17.5. Compulsive PS - 19.3 (vs. 7.8 %)

One study found compulsive PS in 19.3% of adult persons with ADHD compared to 7.8% of non-affected people at least once in their lifetime.26
40,7 %15843

In adult psychiatric clinical patients with ADHD: 10.2 %32

17.6. Combined PS

In adult psychiatric clinical patients with ADHD: 25.5 %32

17.7. Paranoid PS - 14.8 % (compared to 4.1 %)

20,0 %15843
One study found Paranoid PS in 14.8% of adult persons with ADHD compared to 4.1% of non-affected people at least once in their lifetime.26

17.8. Dependent PS - 3.1 % (vs. 0.4 %)

15,7 %15843
One study found Dependency PS in 3.1% of adult persons with ADHD compared to 0.4% of non-affected people at least once in their lifetime.26

In adult psychiatric clinical patients with ADHD: 18.4 %32

17.9. Narcissistic PS

15.7 %15843
One study found Narcissistic PS in 25.2% of adult persons with ADHD compared to 5.7% of non-affected people at least once in their lifetime.26

17.10. Histrionic PS (10.7 % compared to 1.6 %)

14,3 %15843
One study found Histrionic PS in 10.7% of adult persons with ADHD compared to 1.6% of non-affected people at least once in their lifetime.26

17.11. Schizotypal PS - 22.4 % (compared to 3.5 %)

8,6 %43
One study found Schizotypal PS in 22.4% of adult persons with ADHD compared to 3.5% of non-affected people at least once in their lifetime.26

Former names: Borderline schizophrenia, latent schizophrenic reaction, pseudoneurotic schizophrenia

17.12. Schizoid PS - 9.2 % (compared to 2.9 %)

6.4 %43
One study found schizoid PS in 9.2% of adult persons with ADHD compared to 2.9% of non-affected people at least once in their lifetime.26

18. Behavioral disorders / social disorders (aggression, antisocial behavior, oppositional defiant behavior) - 1.5 to 20.2 % (compared to 4.3 %)

Conduct disorder (CD): Adults with ADHD total: 1.2%; females 0.7%, males 1.7%; ADHD-I 0.3%, ADHD-C 1.0%, ADHD-HI 10.0%27
Another study found Conduct Disorder in 20.2% of adult persons with ADHD compared to 4.3% of non-affected people at least once in their lifetime.26

Oppositional defiant behavior (ODD): Adults with ADHD overall: 0.7 %; women 0.0 %, men 1.7 %; ADHD-I 0.0 %, ADHD-C 1.5 %, ADHD-HI 5.0 %27

Reduced cortisol levels have been reported in ADHD in conjunction with aggression disorders.167
Externalizing stress reactions are associated with lower basal cortisol levels and a reduced cortisol response to acute stress.
Disorders of stress hormone levels, especially cortisol, are extremely common in ADHD.
⇒ Cortisol in ADHD

19. Epilepsy - 3.4 % (compared to 0.5 to 1 %)

A meta-analysis of 63 studies with N = 1,073,188 people from 17 countries found:168
People with ADHD have an ADHD prevalence of 22.3% (12.7% for the ADHD-I subtype).
People with ADHD have an epilepsy prevalence of 3.4%.

One study found that 35% of adult people with ADHD also had ADHD.169
Epilepsy and ADHD have a genetic correlation (rg=0.18), which was even stronger for focal epilepsy (rg=0.23).170

In adults with psychogenic non-epileptic seizures (PNES), ADHD was found in 63.6%, while in adults with epileptic seizures (ES), ADHD was found in 27.8%.171

Some anti-seizure medications can cause or worsen ADHD symptoms as a side effect, while some ADHD medications can increase the risk of seizures.172

The prevalence of epilepsy in the general population is 0.5 to 1 %.
44.1% of people with ADHD have at least one other mental health diagnosis in their lifetime.170

20. Schizophrenia - 3.4 % (compared to 0.8 %)

A Norwegian cohort study found schizophrenia in 3.4 % (men: 4.2 % women: 2.5 %) of adult people with ADHD compared to 0.8 % (men: 0.9 %; women: 0.6 %) of those not affected.19
Another study found a prevalence of ADHD of 0.9% across the entire age range18

22. Obsessive-compulsive disorder - 1.9 to 2.4 %

Obsessive-compulsive disorders are more common in adults with ADHD.5

  • Adults with ADHD overall: 1.9 %; women 1.4 %, men 2.4 %; ADHD-I 0.9 %, ADHD-C 1.5 %, ADHD-HI 12.5 %27
  • 2.4 % over the entire age range18
  • In a large study, the prevalence of ADHD was found to be 2.19 times higher in family members of people with ADHD.173
  • Of 70 adults with ADHD, 8.7% had OCD in their lifetime, compared to 5.7% of the 70 unaffected16

23. Intellectual disability - 1.4 %

Total adults 1.4 %; women 1.8 %, men 1.0 %; ADHD-I 1.2 %, ADHD-C 1.0 %, ADHD-HI 5.0 %27

24. Post-traumatic stress disorder (PTSD) - 0.7 % to 22 % (compared to 6 % to 11.9 %)

  • The population prevalence of PTSD is 3.3%. People with ADHD have a prevalence of 11.9%, which is around 3.6 times higher.28
  • Adults with ADHD overall: 0.7 %; women 0.7 %, men 0.7 %; ADHD-I 0.9 %, ADHD-C 0.0 %, ADHD-HI 2.5 %27
  • In adult psychiatric clinical patients with ADHD: 26.5 %32
  • In 22% of adult persons with ADHD compared to 6% of non-affected people at least once in their lifetime.26

25. Tic disorders 30 % (compared to 5 %)

Source5123

About 30% of all patients with ADHD have tics or Tourette syndrome, while about half of all patients with a tic disorder or TS also have ADHD.174
The population prevalence of tic disorders is around 5%175

26. Migraine

Source123

27. Obesity

2.1-fold risk for people with ADHD.176

ne study found that gene variants that correlate with obesity can causally increase the risk of ADHD.91
For treatment options, see below under 4.5.

28. Socialization disorder

Source5

29. Disorder of sexual development

Source5

  • Earlier onset of sexual activity
    • For children with people with ADHD: 15 years177
    • For non-affected persons: 16 years177
  • More sexual partners
    • For people with ADHD: 18.6177
    • For non-affected persons: 6.5177
  • Less time with a partner177
  • Higher rate of contraception177
  • High rate of unwanted pregnancies
    • In children with ADHD: 38 %177
    • For non-affected persons: 4 %177
      = 19.5 times the risk
  • Teenage pregnancies 5.5 times178
    • Teenage pregnancies of mothers with ADHD: 15.3%
    • Teenage pregnancies of mothers without ADHD: 2.8%
  • Birth rate increased (42:1)177
    = 42 times the risk
  • Higher risk of sexually transmitted diseases
    • For people with ADHD: 16 %177
    • For non-affected persons: 4 %177
      = 4 times the risk

30. Narcolepsy

A meta-analysis found that around 33% of people with narcolepsy also have ADHD.8

31. Messi syndrome / Hoarding

Messi syndrome is characterized by a strong urge to collect useless objects with a tendency to litter the living environment. A strong coincidence with ADHD is discussed. For an overview of the literature, see Kuwano et al.179 They found a comorbidity of ADHD in 26.7% of people with ADHD.

32. Attachment disorders

Source5

One study found that gene variants that correlate with increased social interaction are a protective factor against ADHD.91

33. Enuresis (enuresis)

Source5
Enuresis in children increased the risk of comorbid ADHD by 2.15-fold (OR 3.15).180

34. Encopresis (defecation)

Source5

35. Suicidal tendencies - 2.4 to 6.7-fold

A meta-analysis of 57 studies found a correlation between ADHD and181

  • Suicide attempts (OR 2.37)
  • Suicidal thoughts (OR 3.53)
  • Suicide plans (OR 4.54)
  • Suicide (OR 6.69).

According to the study, suicide is between 2.37 and 6.69 times more common in people with ADHD than in those without the disorder.

Another study found increased suicidality in children and adolescents with ADHD (OR 1.1), but this was mediated by comorbid depression, irritability and anxiety, not ADHD itself.182

36. Fibromyalgia - 4-fold

One study found a fourfold frequency of ADHD in people with fibromyalgia, without quantifying the frequency of fibromyalgia in people with ADHD.183

37. Chew nails

A study examined 450 children. 14% of them bit their nails. Among these were found:184

  • ADHD at 74.6 %
  • Oppositional defiant behavior at 36
  • Separation anxiety at 20.6 %
  • Enuresis at 15.6 %
  • Tic disorders at 12.7 %
  • Obsessive-compulsive disorder at 11.1
  • mental retardation at 9.5 %
  • major depressive disorders at 6.7 %
    profound developmental disorders at 3.2 %.

38. Mental disorders in relatives of people with ADHD - 6.8-fold

An analysis of the entire Taiwanese population in 2010 examined 220,966 parents of children with ADHD-HI (according to ICD-9, which did not recognize ADHD-I), 174,460 siblings of children with ADHD-HI, and 5,875 children of parents with ADHD-HI. Among these relatives of people with ADHD-HI, the risk of severe psychiatric disorders was significantly increased compared to matched control subjects without relatives with ADHD-HI:185

  • ADHD-HI: 6.87-fold risk
  • Autism spectrum disorder: 4.14 times the risk
  • Bipolar disorders: 2.21 times the risk
  • Major depressive disorders: 2.08 times the risk
  • Schizophrenia: 1.69 times the risk

This can be understood as an indication of common genetic causes. However, it is also theoretically conceivable that this could be explained by the immunological consequences of (primarily viral) infections (which are more frequently transmitted between close relatives). See the chapter ⇒ Immune system and behavior.
Similarly, similar external life circumstances and similar dysfunctional behavior patterns and stressful experiences are likely to be shared more frequently among close people. These mechanisms can complement each other.

39. Psychoses - 8.8 % (compared to 3 %)

One study found psychosis in 8.8% of adult persons with ADHD compared to 3% of non-affected people at least once in their lifetime.26

  1. Schmidt, Waldmann, Petermann, Brähler (2010): Wie stark sind Erwachsene mit ADHS und komorbiden Störungen in ihrer gesundheitsbezogenen Lebensqualität beeinträchtigt? Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 58, 9–21, zitiert nach Schmidt, Petermann: ADHS über die Lebensspanne – Symptome und neue diagnostische Ansätze, Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 59 (3), 2011, 227–238, Seite 229 ↥ ↥

  2. Merrill RM, Merrill AW, Madsen M (2022): Attention-Deficit Hyperactivity Disorder and Comorbid Mental Health Conditions Associated with Increased Risk of Injury. Psychiatry J. 2022 Oct 14;2022:2470973. doi: 10.1155/2022/2470973. PMID: 36277995; PMCID: PMC9586798. ↥ ↥

  3. ADHS, iPads, Schlaf und Konzentrationsprobleme: Im Licht neuer Erkenntnisse ↥

  4. Sung, Hiscock, Sciberras, Efron (2008): Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family; Arch Pediatr Adolesc Med. 2008 Apr;162(4):336-42. doi: 10.1001/archpedi.162.4.336. n = 239 ↥

  5. Edel, Vollmoeller: Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen, 2006, Seite 53, ohne %-Angabe ↥ ↥ ↥ ↥ ↥ ↥ ↥ ↥ ↥ ↥ ↥ ↥ ↥ ↥ ↥ ↥

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