Associated Conditions
This list includes the most commonly associated conditions, known as co-morbidities, that may co-exist with ADHD. This list is not exhaustive and many with ADHD can also be affected by other conditions or illnesses. Below is a list of conditions that may be of interest.
Oppositional Defiance Disorder and Conduct Disorder
Specific Learning Difficulties
Speech, Language and Communication Difficulties
ANXIETY
All children experience anxiety at certain periods of their life. This is normal and expected but how do you recognise severe signs of anxiety that may require intervention. Symptoms of anxiety can take many forms such as: stomach-aches, clinginess, sleep problems and/or nightmares, and tantrums. It may be in the form of a fear or phobia (e.g. spiders, a particular lesson or activity, or social situation). It could be the result of low self-esteem or lack of confidence or worries about friends or family. Children with conditions such as Autistic Spectrum Disorder and ADHD may experience anxiety as part of their symptoms, possibly because of the way their brain functions. If you are concerned that your child’s anxiety is affecting their daily life, having an effect on their education or friendships it is important to seek professional help. Download factsheet for more information.
DEPRESSION
The Royal College of Psychiatrists states that recognising depression in children is not easy. A depressed child can be sad and miserable for several weeks at a time that may be put down to their personality. Around 5% of children and young people are affected by depression at some point. Children who are stressed, have ADHD, learning difficulties, and/or behavioural issues amongst other things are more likely to become depressed. It is well documented that worrying and depression tends to run in families though the symptoms in children vary from those in adults. Children and young people can often still function and it is therefore not always easy to recognise the symptoms of depression. Some of the major signs in children include: feeling sad and tearful, no interest in activities they normally enjoy, less energy, isolation, low-self-esteem, hyper-sensitivity, complaining of headaches or other physical symptoms, changes in their normal patterns of behaviour, suicidal thoughts, and self-harming. This is not an exhaustive list. The obvious thing to do is try and find out what is troubling them but it may be they will need professional help and some form of treatment therapy. It is important that this is pursued as soon as possible. Download factsheet for more information.
BIPOLAR DISORDER
Bipolar Affective Disorder, previously known as Manic-Depressive Disorder, is a psychiatric condition that causes extreme changes of mood ranging from high or ‘manic’ to low ‘depression’. These mood swings are far more severe than would be considered normal. Previously thought to only affect adults it is now accepted that it can and does occur in children and young people. There is no definitive reason why some people experience bipolar but it is believed to be a combination of: biological (e.g. genetic predisposition, brain chemistry), psychological (e.g. the reaction to life events and stress), and physical factors (e.g. medical disorders, poor social relationships). There are five Bipolar sub-groups, one of which is known as Rapid Cycling. Children and young people seem to be more prone to this type than adults whereby they experience rapidly changing moods lasting a few hours to a few days. Symptoms include: irritability, depression, anxiety, defiance, explosive rages, hyperactivity, cravings, dangerous activities, inappropriate sexual behaviour, and delusions. Whilst the depressive phase is unsettling, the ‘manic’ phase can present a more serious situation. If you have concerns about your child’s extreme mood swings it is useful to keep a diary with details of what impact these are having. This can then be discussed with your doctor who, whilst having awareness of the condition in adults, may not have experience of bipolar disorder in children and young people. Download factsheet for more information and follow the links below to useful websites.
http://www.mentalhealth.org.uk/
http://www.nhs.uk/conditions/stress-anxiety-depression/
https://www.anxietyuk.org.uk/
http://www.youngminds.org.uk/for_parents
http://www.bipolaruk.org.uk
ATTACHMENT DISORDER
The term attachment disorder refers to specific moods or behaviour and the inability to form social relationships and attachments at a young age. Attachment disorder tends to affect young children, but without recognition and help it can continue even into adulthood. Attachment issues can develop into what is known as Reactive Attachment Disorder, a condition that is likely to require professional help and occurs when children have been unable to consistently connect with a parent or primary caregiver. This results in a lack of trust and poor self-worth, a fear of getting close to anyone, and a tendency to be controlling. Children with an attachment disorder often feel unsafe and alone because they have been unable to establish these early relationships. This disorder is often considered a controversial condition though most psychologists are convinced of its validity. More information from:
http://www.counselling-directory.org.uk/attachment-disorder.html
https://learning.nspcc.org.uk/
Autistic Spectrum Disorders (ASDs) are a group of lifelong conditions that affect how a person communicates with and relates to other people. The word ‘spectrum’ is used because the symptoms of ASDs vary widely and in their degree of severity. Generally, children who have an ASD don’t develop the social and language skills that other children of the same age do. As a result, they find relating to other people difficult. Children with an ASD may also display unusual behaviours and learning disabilities. There are specific areas that affect people with ASD: communication, social skills, interests, and behaviour and these characteristics can vary widely. Communication difficulties become apparent when the child fails to develop the normal speech and non-verbal skills as children of the same age and may also have trouble understanding spoken or written language. Children with ASD have a very poor sense of language and take things you say literally. They seem unable to understand metaphors, jokes, or sarcasm and have difficulties recognising facial expressions or body language. Older children and adults may have difficulty starting or keeping up conversations. Children with severe autism may not speak at all, but can be helped to communicate in other ways, such as through signing or using pictures. Social skills are usually acquired naturally but those affected by ASD have difficulty engaging with other people and making friends. They may be unable to cope with new situations, understand and accept social rules, manage their emotions, resist shows of affection, and prefer to spend time on their own. Efforts by parents and teachers to overcome these characteristics may trigger anger outbursts. Behaviour and interests in children with ASDs are likely to be at odds with other children of their age. They tend to have little or no interest in activities that require pretending, imagination, or have an abstract concept and prefer tangible interests, collecting facts and figures, and familiar routines. Any changes can cause distress. They can be very sensitive to tastes, smells and sounds and have odd body movements such as hand-flapping, finger-twiddling or rocking movements. Within the ASD spectrum is Asperger Syndrome (AS). Children affected by AS are less severely affected, have better communication abilities, average or above average intelligence, and unlikely to have the learning disabilities that children with autism have. Download a factsheet for more information and follow the links below to useful websites.
Diagnosis of Adults with Autism number around 1 in every 100: Download leaflet for further information and check website links below.
http://www.autism.org.uk/
http://www.nhs.uk/conditions/autistic-spectrum-disorder/
https://www.pdasociety.org.uk/
PATHOLOGICAL DEMAND AVOIDANCE (PDA)
As the name suggests PDA is the term used for a person who finds it difficult to respond to the demands of life. In the case of children compliance with parents’ requests, even those considered insignificant, can be a challenge and has an impact on the whole family. It is now considered to be part of the autism spectrum. Individuals with PDA share difficulties with others on the autism spectrum in social aspects of interaction, communication and imagination. However, the central difficulty for people with PDA is the way they are driven to avoid demands and expectations. This is because they have an anxiety based need to be in control. People with PDA seem to have better social understanding and communication skills than others on the spectrum and able to use this to their advantage.
Download Pathological Demand Avoidance leaflet here for more information.
OBSESSIVE COMPULSIVE DISORDER
Obsessive-compulsive disorder (OCD) is a mental illness that causes repeated unwanted thoughts or sensations (obsessions) or the urge to do something over and over again (compulsions). Some people can have both obsessions and compulsions. Research studies have estimated that between 1.9% and 3% of children suffer from OCD. People with OCD become preoccupied with whether something could be harmful, dangerous, wrong, or dirty or with thoughts that bad things could happen. Obsessions are unwanted upsetting or scary thoughts or images that repeatedly pop into a person’s mind and are hard to shake. Some children and teens have unwanted thoughts about deliberately harming other people that cause great anxiety. A compulsion is a pattern of repetitive behaviour or mental act that someone feels they need to carry out to try to prevent an obsession coming true. For example, someone who is obsessively afraid of catching a disease may constantly wash their hands or take a shower. Another person may feel the need to check that windows and doors are locked several times before leaving the house. Compulsions can involve counting, touching, or tapping objects in a particular way. Some children and teens have lucky and unlucky numbers involved in their rituals (for example, needing to touch a door four times before leaving a room). Others feel the need to keep things in order or arrange items in a specific way. This compulsive behaviour provides temporary relief from the anxiety of the obsession(s) until the cycle begins again. Download a factsheet for more information and follow the links below to useful websites.
https://www.gosh.nhs.uk/conditions-and-treatments/conditions-we-treat/obsessive-compulsive-disorder/
http://www.nhs.uk/conditions/obsessive-compulsive-disorder/
OPPOSITIONAL DEFIANCE DISORDER
Oppositional Defiant Disorder (ODD) is summed up in its title and is a condition that adults find very hard to deal with. Children with ODD are oppositional, disruptive, and non-compliant, and this behaviour is particularly directed towards authority figures, such as parents or teachers. Children with ODD are constantly defiant, hostile and disobedient. They don’t like responding to instructions or taking orders from others and purposefully refuse simple requests – “I won’t do it and you can’t make me.” Sometimes they blame others for their own mistakes, lose their temper easily, and act in an angry, resentful or touchy manner. To receive a diagnosis of ODD these behaviours have to be causing a significant impact on home, education, and social life.
Conduct Disorder(CD)is the most common reason for referral of children to mental health services. The exact cause of CD is unknown but certain characteristics make them more likely to develop including a difficult temperament, specific learning difficulties, depression, poor parenting, poor supervision, harsh discipline, and rejection. Children with CD display aggressive behaviour towards people and animals, destroy property, steal, tell lies, truant from school, and indulge in anti-social behaviour that may lead to police involvement. Approximately 40–50% of children with CD may develop antisocial personality disorder.
Download factsheet for more information and follow the links below to useful websites.
Conduct Disorder (CD) is the most common reason for referral of children to mental health services. The exact cause of CD is unknown but certain characteristics make them more likely to develop including a difficult temperament, specific learning difficulties, depression, poor parenting, poor supervision, harsh discipline, and rejection. Children with CD display aggressive behaviour towards people and animals, destroy property, steal, tell lies, truant from school, and indulge in anti-social behaviour that may lead to police involvement. Approximately 40–50% of children with CD may develop antisocial personality disorder. Download factsheet for more information and follow the links below to useful websites.
http://psychcentral.com/disorders/conduct-disorder-symptoms/
http://www.gosh.nhs.uk/
https://www.rcpsych.ac.uk/mental-health/parents-and-young-people/
SENSORY PROCESSING
Sensory processing (or sensory integration) refers to the way the nervous system responds to messages from the senses. Whatever activity you are doing, eating, walking, reading etc. the successful completion of that activity needs sensory integration. Sensory Processing Disorder (SPD) exists when the sensory signals fail to get an appropriate response. Co-ordination, behavioural problems, anxiety, depression, academic achievement, and other issues may emerge if these sensory difficulties are not recognised and treated effectively. Research suggest that at least 5% of children are affected by SPD which has a significant effect on everyday life. The degree of severity varies with some people having occasional difficulties processing sensory information and others whose difficulties are chronic. People affected by sensory processing are either hypersensitive (over-responsive) or hyposensitive (under-responsive) to sensory stimuli. Some symptoms of hypersensitivity include extreme reaction to noise that other people do not find a problem, to close or physical contact such as hugging, and to fear of games with movement such as tag or climbing. They may also have balance problems which has caused occasional falls. People with hyposensitivity have a tendency to touch – people, furniture, clothing, and seem oblivious to respecting personal space. Some have poor co-ordination, a high pain threshold, and a tendency to inadvertently hurt others due to their poor sensory processing. They are often fidgety and prefer movement sports, in some cases pursuing high adrenaline and dangerous activities.
Further information can be found at:
spdfoundation.net
https://thesensoryseeker.com/sensory-processing-disorder-in-the-uk/
Sensory tick list:
ENURESIS and ENCOPRESIS
Encopresis (soiling) occurs when a child does not reliably use the toilet for a bowel motion after the age when it would be expected for them to do so. They may dirty their pants or poo in inappropriate places. There are several reasons why encopresis can occur, the most common of which is not having developed a regular routine. Sometimes a child links pain with passing a motion. They can become reluctant to go making it even harder and difficult. If the child suffers from chronic constipation the bowel is likely to become blocked and it will be painful to pass the hard stools. If this happens there may be involuntary liquid leakage from around the blockage staining clothes and causing distress. Children who are constipated may become irritable, lack energy, and lose their appetite. Prescribed medication may help clear your child’s bowel and lots of fruit, vegetables and foods high in fibre as well as drinking lots of water will make the poo softer and easier to pass. If your child is not constipated, the cause of the soiling may be emotional or psychological. In any event it would be wise to discuss the situation with your GP who may suggest seeking help from a specialist.
Enuresis (wetting) is a term used for wetting or passing of urine without control at an age when it would be expected. This can occur either during the day or night. Bedwetting (nocturnal enuresis) is when a child passes urine when asleep at night. It is an ‘involuntary’ loss of urine whilst the child is sleeping; an accident and not their fault. There are several reasons why children still wet the bed after the age of five such as the inability to wake up when their bladder is full particularly if they are deep sleepers, if they’re unwell, or if they drink a lot prior to bedtime. Bedwetting may also be caused by constipation, an infection, or a sign of anxiety or stress. Children are more likely to experience bedwetting if one or both of their parents had the difficulty as children too. Download a Factsheet-1 and Factsheet-2 for more information and follow the link below to a useful website.
SPECIFIC LEARNING DIFFICULTIES
Learning Difficulties, unlike Learning Disablement, is the term used to describe particular areas of learning that some people struggle with despite having a normal IQ. These include:
Dyscalculia – a condition that affects the ability to grasp arithmetic (numeracy). People with this problem have difficulty understanding number concepts and problems learning the facts and procedures of mathematics. Unlike dyslexia little is known about dyscalculia but it is thought between 3% and 6% of the population are affected and it is likely caused by dysfunction in a specific area of the brain. Some children who have difficulties with mathematics may also have dyslexia but no problems with other areas of their learning. Adults with dyscalculia can often work out betting odds with no difficulty. Further information can be obtained from:
http://www.dyscalculia.org/
childsplay.scientopia.org/
http://www.learningdisabilities.org.uk/
DYSLEXIA
People with dyslexia have difficulties in making sense of reading, writing and spelling. There is much that can be done to help with these difficulties, but it is a life-long condition and cannot be ‘cured’. It is estimated that around 10% of the population have dyslexia with varying degrees of severity. Dyslexia causes problems in processing and remembering information which restricts their ability to acquire literacy skills. Dyslexia appears to run in families and it is likely that there is a genetic link though this has not been confirmed. Despite the difficulties people with dyslexia face they are often creative and good at problem-solving with many becoming entrepreneurs, artists, or actors. Further information can be obtained from:
SPEECH, LANGUAGE & COMMUNICATION
Speech, language and communication – making our needs known, expressing ourselves, interacting with other people, and fostering relationships – is important in everything we do. Developing these skills tend to be taken for granted, but many children struggle to communicate and conquering these difficulties is crucial for learning. They may have speech that is difficult to understand (expressive language difficulty) and find it difficult to remember words and their meanings, or hear words, phrases, or instructions they don’t fully understand (receptive language difficulty). Children with pragmatic language impairment have difficulty in using language appropriately and may say things that are inappropriate or unrelated to the conversation. There are many reasons why children have difficulties with communication such as delayed development or possibly glue ear (a hearing impairment). Whatever the reason it is important that it is investigated thoroughly to try and determine the cause so that treatment can be provided to improve situation. For more information: http://www.ican.org.uk
TOURETTE’S SYNDROME
If your child has tics, it does not necessarily mean that they have Tourette’s
Syndrome. Children often develop tics or twitches, known as transient tics, that disappear after several months. Simple vocal tics include grunting, coughing, sniffing, and clearing throat whilst simple physical tics are things like blinking, jerking the head, and twitching the nose. Complex vocal tics include repeating other people’s phrases (echolalia), repeating the same phrase over and over again (palilalia), swearing loudly or shouting inappropriate words and phrases (coprolalia). Complex physical tics include shaking the head, hitting or kicking objects, touching themselves or others, copying the movements of others (echopraxia), or making obscene gestures (copropraxia). A chronic tic condition is one in which several motor or vocal tics have been experienced on and off for more than a year. Tourette’s Syndrome is a neurological condition in which those affected have a combination of repetitive involuntary physical and vocal tics, which can be both simple and complex. For more information:
http://www.cdc.gov/ncbddd/tourette/diagnosis.html
http://www.tourettes-action.org.uk/