After receiving appropriate treatment, most children with attention deficit disorder (ADHD) experience a dramatic turnaround. Once-distractible kids are suddenly able to focus, and kids who used to be hyperactive or impulsive are able to sit still and attend to their lessons.
As they feel less frustrated by their ADHD symptoms and become more confident in their ability to succeed at home and at school, most of these children gradually overcome sadness, anxiety, or other emotional problems they may have been experiencing.
But not always. Some kids experience significant emotional problems long after their ADHD symptoms are brought under control. Maybe your daughter seems more focused since she went on medication — yet she remains anxious or depressed. Perhaps your son's hyperactivity has eased — yet he remains defiant and aggressive. Maybe a child continues to have trouble keeping up with school despite his increased ability to focus.
A Common Problem
Doctors used to view ADHD as a stand-alone disorder. But recent evidence suggests that about half of all individuals who have ADHD also suffer from depression, anxiety, obsessive-compulsive disorder (OCD), a learning disorder, or some other emotional or neurological problem.
In some cases, these problems are "secondary" to ADHD — that is, they are triggered by the frustration of coping with symptoms of ADHD. For example, a girl's chronic lack of focus may cause her to experience anxiety in school. Years of disapproval and negative feedback from friends, family members, and teachers may cause a boy to become depressed. Most of the time, secondary problems resolve on their own, once the child's ADHD symptoms are brought under control.
There is another possibility. Some problems are not secondary to ADHD, but distinct entities known as "comorbid" conditions. Like ADHD, comorbid conditions occur along what doctors call a "continuum of neurologically based disorders."
Comorbid disorders may be caused by the same factors that trigger ADHD (heredity, exposure to environmental toxins, prenatal injury, and so on). But unlike secondary problems, comorbid conditions do not go away on their own once ADHD has been treated. They require their own specific treatment in addition to any treatment given for ADHD itself.
In other words, a child who has one or more comorbid conditions might need to get tutoring or school accommodations, undergo psychotherapy, or take medication beyond that which he takes for ADHD.
Three Kinds of Trouble
There are three categories of comorbid conditions commonly found with ADHD.
1. Cortical "wiring" problems. These are conditions caused by structural abnormalities in the cerebral cortex, the brain region responsible for high-level brain functions. Cortical wiring problems include learning disabilities, language disabilities, problems with motor coordination, and/or severe problems with organization and time planning (executive functions).
2. Tic disorders. These include motor and oral tics. These tics may come and go and change form. Children with both motor and vocal tics are often referred to as having Tourette's disorder.